Curriculum Innovation: Training the Physician Leaders of the Future

Duke University School of Medicine’s Doctor of Medicine (M.D.) program has launched the new Patient FIRST curriculum that provides a transformative learning experience for students.

The patient is at the center of learning Day 1.

Patient FIRST (Foundations, Immersion, Research, Social/Structural Drivers, Transformation) is designed to better prepare physicians of the future to address the evolving needs of patients and communities by teaching medical students how community health impacts individual health, and how to have effective conversations with patients from diverse backgrounds.



What Patient FIRST Focuses On

The M.D. Patient FIRST curriculum teaches biomedical sciences in the context of patient symptoms integrating differential diagnoses, clinical reasoning, and the social context of medicine into a holistic view of the patient's care. Barriers between the biomedical and clinical clerkship years are removed, with intentional vertical integration across the first two years.

The curriculum focuses on developing inquiry and life-long learning necessary for clinical practice. A dedicated research project during the third year—along with a longitudinal curriculum on leadership—equips students to continually advance change in patient care, biomedical science, medical education, health system transformation, and health-oriented public policy. M.D. graduates will become compassionate, highly competent physician leaders who put patients FIRST.

Guiding Principles

  • I​ntegration: within the biomedical sciences, between the biomedical sciences and the clinical sciences 

  • Iteration: providing multiple points of contact with the same content with increasing complexity to promote mastery learning 

  • Inclusion: promoting meaning, connection and community through addressing racism and health care disparities 

Curriculum Innovation Planning By Year

To be a physician, there are things you need to know (knowledge), things you will need to do (skills) and things you need to be (attitudes and character traits). The stage for the first year of medical school (MS1) year is set with a two-week clinical immersion course which introduces clinical skills and professional identity formation. Following that is Foundations of Patient Care, a single integrated course that blends biomedical and clinical sciences to prepare students for clinical practice. Woven throughout, students experience small group sessions with faculty focusing on clinical skills, cultural determinants of health, and leadership. 

The goals of Patient FIRST curriculum are advanced with PIONEER in second year. Approved by the Curriculum Committee in 2022 and implemented in 2023, the PIONEER curriculum was inspired by lessons learned from our excellent ​Longitudinal Integrated Clerkship (LIC).  We learned the value of longitudinal ambulatory clinical experiences for our LIC students, as well as the values of a cohesive learning community and experiences in health systems science.  We wanted to bring these experiences to all our traditional students to provide for a more equitable access to these amazing resources and opportunities.  We are thrilled that we were able to deliver the new PIONEER curriculum which allows us to meet these goals for all our students. 

During the 16-week PIONEER block, students care for patients in Family Medicine, Internal Medicine, Pediatrics, Obstetrics/Gynecology, Neurology, and Emergency Medicine. This clerkship brings students into the communities where our patients receive their outpatient care and increases training in preventative care and chronic disease management – areas of increasing importance for our patients and communities.

  • In Discovery, students have half days during which they can enhance their curriculum with individualized learning experiences. Students are encouraged to reflect on their own goals and interact with patients, seek out clinical experiences that align with their learning objectives, foster career exploration, or meet other academic or wellness needs.
  • Trailblazing sessions for PIONEER students are Wednesday mornings. During this time, students are involved with active skills-based clinical training sessions. In addition to this skills-based content, sessions on areas such as leadership, design thinking, ethics, and population health build on foundational skills learned in MS1 year.

The PCLT Program continues alongside PIONEER as a dedicated four-year program in developing primary care leaders. 

The dedicated scholarly experience of the Third Year has remained a cornerstone of the unique Duke School of Medicine curriculum for more than 60 years. Initially envisioned as a laboratory-based research experience, this component of the Duke curriculum has maintained its relevance by undergoing revisions in response to a rapidly changing medical landscape, and currently includes a broad array of internal and external scholarly experiences as well as integrated second and dual degrees. Despite the evolution of the scholarly research program, its fundamental mission has remained consistent: allowing students an immersive experience to gain the experiences and skills set necessary to become life-long learners in a rapidly changing medical environment; to give a head-start towards a successful academic career; and to train the next generation of physician leaders.

The Third Year Taskforce has completed their review and reaffirmed Duke’s commitment to a flexible, immersive scholarly experience. The Taskforce affirmed Duke’s investment in a variety of scholarship and discovery, including biomedical sciences, clinical research, educational research, humanities. In select circumstances, the scholarly experience may be integrated with an advanced degree.

  • MS3 Curriculum Innovation Implementation: Beginning Fall 2024 

The fourth year of medical school (MS4) prepares students for their transition to graduate medical education (GME) during residency. As part of a dedication to continuous improvement, the curriculum innovation committee will increase the opportunities in the fourth year to reflect updates to all previous years of medical school. In particular, growth will be directed by changes in the MS2 year as well as recommendations from the Patient FIRST Assessment Taskforce. The goal is to provide the most effective and valuable fourth year learning experiences for our students.

  • Expected MS4 Curriculum Innovation Implementation: Beginning Fall 2025

Longitudinal Curricular Experiences

The Patient FIRST curriculum will incorporate longitudinal curricular experiences throughout all four years of the students’ medical education.  

Longitudinal curriculum experiences will include a focus on: 

  • Innovation Sciences: This thread seeks to integrate topics that prepare medical students to lead transformations in health care. These concept areas will augment the biomedical and clinical sciences and introduce medical students to skills and ideas equipping them to become leaders in design health, evidence-based clinical medicine, clinical research, basic science research, population health, health systems science,data science as their careers progress. 

  • Interprofessional Education: The Duke Center for Interprofessional Education and Care is developing deliberate opportunities for health professions students in the School of Medicine (Doctor of Medicine, Physician Assistant, Doctor of Physical Therapy, Doctor of Occupational Therapy) and School of Nursing (bachelor, master, and doctoral programs) to engage in learning with, from, and about one another. Foundational coursework during the MS1 year will involve major co-located learning events and longitudinal small group engagement to prepare students for clinical learning on teams during MS2 and MS4. Duke graduates will be collaboration-ready physicians through participation in curricular, clinical, social, and service-learning activities. 

Patient FIRST Curriculum Implementation Timeline

MS1: Full implementation Fall 2021

MS2: Full implementation Fall 2023 

MS3: Fall 2024 

MS4: Beginning Fall 2025