Firm Foundation for Medical Education

First-Year Curriculum Offers Students Firm Educational Foundation

During the first year of medical school, in addition to learning critically important clinical skills such as communication, Einstein students take courses steeped in the basic sciences. The goal of this first-year curriculum is to shape the overall educational experience, while laying the foundation from which the rest of the medical school education emanates. Still, as they memorize bits of histology, the Class of 2014 may not yet fully grasp just how important their first-year curriculum courses – covering subjects such as histology, anatomy and biochemistry – are to their future as the life-saving physicians and innovative scientists of tomorrow.

(from left): Drs. Todd Olson, Howard Steinman and Michael Risley in Riklis Auditorium, where first-year students attend lectures on the basic sciences
(from left): Drs. Todd Olson, Howard Steinman and Michael Risley in Riklis Auditorium, where first-year students attend lectures on the basic sciences
“When you’re in your first year, it’s really hard to see the forest for the trees,” said Reid Thompson, an Einstein M.D.-Ph.D. student recalling his first year at Einstein, in 2003. “You are really packing in an encyclopedia of knowledge, so it’s hard to see how the basic sciences will come into play until you start doing clinical work.”

Over time, though, as he has read journal articles and case reports and undertaken scientific research projects, Mr. Thompson also has realized the integral role of the first-year curriculum, especially histology.

“Our course leaders are truly dedicated to the students, ensuring that they gain important knowledge of the sciences that inform medical practice”, said Dr. Howard Steinman, professor of biochemistry, assistant dean for biomedical science education and course director for the Molecular and Cellular Foundations of Medicine (MCFM) course.

Among the first course leaders students see is Dr. Michael Risley, associate professor of anatomy and structural biology, who Dr. Steinman calls a “consummate educator.” Dr. Risley teaches the histology course that affords students with a keen understanding of the microscopic anatomy of cells, tissues and organs.

“The first-year curriculum is a time of transition and the histology course offers an opportunity to ease students into medical school,” he noted. “I feel it is my obligation to make their transition from college to medical school as smooth as possible. Helping them to overcome their anxieties as fast as possible contributes to their success and helps them better understand what it means to be a doctor.”

As part of this transition process, Dr. Risley makes guest appearances during other lectures to show students how histology is pertinent to the basic sciences of genetics, immunology, cancer, and several units of the biochemistry they will learn during MCFM. He explained, “We structure the histology course so that it is taught with clinical relationships to every topic in order to give students the fullest sense of basic science-clinical integration.”

At medical examination rooms in the Ruth L. Gottesman Clinical Skills Center, first-year students conduct interviews with patients to hone their communication skills
At medical examination rooms in the Ruth L. Gottesman Clinical Skills Center, first-year students conduct interviews with patients to hone their communication skills
This initiative comes as a result of Dr. Steinman’s own ability to embrace change as he continually seeks to strengthen the educational experience for students. After each MCFM course, Dr. Steinman surveys his class to come up with ideas for the next crop of first-year students. Ideas have included bringing in educators and fourth-year students to offer some context to what students learn in the first-year course. Another addition has been including more clinical material.

“Perhaps we’ll bring in someone that deals with high-risk pregnancies and she will talk about a case involving a woman in her third trimester that was found to have cancer,” explained Dr. Steinman. “You can’t offer the patient chemo, so that will give rise to a conversation about when to take the baby out. It allows students to relate the material to real life cases.”

The need for students to be exposed to the practice of medicine and start learning fundamental clinical skills from the beginning of their medical education is the basis for the Introduction to Clinical Medicine (ICM) course led by Dr. Felise Milan, professor of clinical medicine. “At Einstein, we get the students out in the clinical setting early and often during their first year,” she said.

She recalled how she spent her own first year of medical school memorizing various facts without being able to immediately relate them to being a doctor. “One of the big changes from when I was a student is the attempt now to relate information to the actual practice of medicine” she said. “Through the ICM, students are assigned to a clinical site where they initially observe their faculty preceptors but then weekly have the opportunity to interview patients and participate in their care.”

In addition, through the Ruth L. Gottesman Clinical Skills Center students are immediately thrust into an educational setting where they have the opportunity to learn and practice core clinical skills. Students have the opportunity to interview both real and standardized patients (professional actors who reliably portray patients) who present a variety of communication challenges including language barriers, differing cultural health beliefs, sexual dysfunction and substance abuse. In this way students learn the fundamental communication skills essential to the practice of medicine . Over time, students’ interactions with patients expand, allowing them to take what they have learned in their basic science courses and apply it in a medical setting.

This concept of integration found in the ICM course is something Dr. Martha Grayson, senior associate dean for medical education, would like to see expand further.

“It’s important to get students to start thinking like doctors,” she said. “That’s what they are here for and they should be able to directly relate what they are learning to caring for patients. My goal is to increase the alignment of the foundational courses in the basic medical sciences with those that stress fundamental principles of caring for patients, such as ICM and ethics, during the first two years of medical school.”

Dr. Todd R. Olson, course director for clinical and developmental anatomy, introduces Einstein students to their first human patient, albeit an inert one. Through his anatomy course, students learn about individualized medicine, dissecting a full cadaver and learning almost immediately that no two bodies are alike and that no two people will react to a treatment in the same way.

To help students put the pieces together, Dr. Olson has invited various guests, including the head of cardiovascular surgery, to visit the class and provide additional learning opportunities that pertain to particular parts of the body being dissected.

“We focus on what is clinically relevant,” he said. “It's the knowledge they need to know in order to be successful doctors.”

Because Einstein’s educators strive to make sure that the curriculum keeps pace with evolving trends in medical practice, students can take the knowledge they gain during first year and find its relevance still resonates years later when they are professionals.

“You may forget about the basic science you learned in your first year and you might still get through 95 percent of your cases, but what we teach you in your first year helps solve the hard cases,” said Dr. Steinman. “And that’s the real goal. It’s not to make you good doctors; it’s to make you the very best doctors.”

Posted on: Tuesday, October 26, 2010