Curriculum Innovation: Training the Physician Leaders of the Future

Duke University School of Medicine’s Doctor of Medicine (M.D.) program is launching a new Patient FIRST curriculum that provides a transformative learning experience for students which puts the patient at the center of their learning beginning Day 1 of medical school.

Patient FIRST (Foundations, Immersion, Research, Service, 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. 

In academic year 2020-21, first-year medical students participated in a pilot of the new MS1 curriculum, with a full launch of the new MS1 curriculum taking place in Fall 2021. Over the past few years, more than 70 faculty, staff, and students have served on the curriculum innovation committee, which has led development of this new curriculum and will continue to work to implement pilots for MS2, MS3, and MS4 years over the next few years.

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. 

    Innovations to the second year of medical school (MS2) center on three major domains: ambulatory experience, assessment, and coaching. These innovations work together in synergy to enhance the clinical and professional development of students through expanded relationships with faculty, strategic alignment between competency-based education and assessment practices, and better continuity of outpatient experiences. These planned changes will serve to strengthen the faculty-student connections that are pivotal to clinical training. 

    Dedicated Outpatient Training

    The MS2 year provides a rich blend of inpatient and outpatient experiences. Historically, outpatient experiences have been embedded within specialty blocks (e.g., family medicine and pediatrics). Toward promoting better integration of students into clinical teams and strengthening long-term student-faculty relationships, a model is being developed to organize outpatient clinics into unified blocks, in addition to inpatient blocks. In this planned structure, students would continue to rotate through all the different specialties, which include both primary and acute care settings. 

    Assessment

    The Curriculum Innovation committee is developing a strategic plan for formative and summative assessment across clinical education over the four years of medical school. The assessment strategic plan should enhance objective and transparent methods that mitigate bias, while allowing the committee to recognize the diversity of excellence among our students. The assessment strategic plan should also best support our students in successful applications for residency programs, allowing programs to efficiently and effectively recognize the unique strengths of each student.  

    Support for Growth

    The Doctor of Medicine has a longstanding tradition of providing individualized, student-centered support as learners acquire competencies and grow professionally throughout their education. Formal advising and mentorship provided by experienced medical educators will continue in the new curriculum. Additionally, the Curriculum Innovation committee is exploring ways to provide more support and guidance during in the MS2 curriculum as students acclimate to clinical learning environments.  

    • Expected MS2 Curriculum Innovation Implementation: Planning for Pilots in Fall 2022 

    The third year of medical school (MS3) represents a unique opportunity for the student to broaden his or her background in the biomedical and social sciences—the basis of clinical medicine. The primary goals of the third year are: 

    • to develop physician leaders through a rigorous scholarly experience in biomedical-related research;

    • to develop skills for scholarly investigation, pursuit of discovery, and transmission of knowledge to others; and

    • and to apply these skills in the pursuit of life-long learning. 

    The MS3 research program is dynamic and, along with all components of the M.D. curriculum, is periodically assessed to ensure it is optimally meeting its mission. An MS3 task force is exploring how best to achieve a vision of developing students as academic leaders and change agents. The task force consists of faculty, staff, and students representing a variety of perspectives. Recommendations will be focused on integrating enhancements in alignment with the of the Patient FIRST curriculum. 

    • Expected MS3 Curriculum Innovation Implementation: Beginning Fall 2022 

    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/Spring 2023 

    Patient FIRST Curriculum Implementation Timeline

    MS1: Full implementation Fall 2021

    MS2: Planning pilots in Fall 2022 with fuller implementation in Fall 2023 

    MS3: Beginning Fall 2022 

    MS4: Beginning Fall/Spring 2023 

    New Longitudinal Curricular Experiences

    As part of the new Patient FIRST curriculum, new longitudinal curricular experiences will be incorporated through all four years of the students’ medical education, in addition to existing longitudinal experiences.  

    New 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.