Education: Patient centered, discovery oriented

The medical school’s class of 2011—the first students to begin their education under a new curriculum inaugurated in 2007—are now well on the way to becoming the kind of doctors with which Emory wants to “seed” the medical profession.

They are learning real-world health care, involved with patients from their second week in medical school and spending an unprecedented amount of time in outpatient settings. They are completing full-scale research projects, often in the field of their anticipated residency, and publishing their results in leading journals. They also are learning compassion and professionalism—qualities they see modeled by faculty and advisers—in more deliberate and measurable ways than ever before.

  In this section

Real patient care, real research

Measuring the formerly intangible

Student satisfaction

Training the trainers

Trends for the future

Real patient care, real research 

Foundations and Applications phases—In the new curriculum, the traditional first two “basic science” years of medical school have been replaced by a 17-month Foundations Phase in which students learn basic science not in isolation but within the context of patient care. The Foundations Phase is followed by a 12-month Applications Phase, a full fourth of which takes place in outpatient settings, where, after all, 90% of doctor-patient encounters occur. Emory’s primary care colleagues in the community, many of them alumni, make it possible for every student to spend 12 weeks of half days with an internist and six weeks of half days with a primary care pediatrician. In these primary care settings, students have the opportunity to learn the importance of long-term relationships that shape both patient and doctor. They also learn how to manage the earaches, sprained backs, rashes, and other problems that make up much of real-world outpatient practice. The remaining six weeks of outpatient half days are spent with Emory specialists in dermatology, otolaryngology, ophthalmology, orthopaedics, palliative care, and urology.

Discovery Phase—In recent years, four out of five Emory medical students have participated in research, but the new curriculum provides for longer, more in-depth, more highly mentored research experiences. The minimum time students spend in the Discovery Phase, which follows the Applications Phase, is five months, but many students elect extra time to do research. Research projects are taking students to Africa, Bolivia, Haiti, and other distant points or immersing them in labs at the CDC, Emory, Georgia Tech, NIH, and elsewhere. One student drives regularly to McDonough, Georgia, to pick up material from a local slaughterhouse for his orthopaedics research project.

And Emory’s ongoing success in the research arena has attracted students who have published in Science, Nature, JAMA, and other mainline publications, based on work done prior to their time at Emory or while they are here as students.

Final year—Beginning with fall semester, the class of 2011 moved into the Translation Phase (clinical rotations in intensive care and emergency medicine and a subinternship in medicine, surgery, or pediatrics). This will be followed in the spring by the Capstone course (a final month of preparation for residency training).

Measuring the formerly intangible 

Teaching, enhancing, quantifying—In the past, many medical educators might have said that empathy, resilience, burnout, professionalism, and other such qualities were a little like pornography, as described by the U.S. Supreme Court: easily recognizable but devilishly difficult to define, much less quantify. However, as the new curriculum unfurled, Emory medical educators were determined to measure how well students were being infused with the personal qualities essential in truly great physicians. They developed new programs to teach and enhance these qualities and new methods to measure them. A major effort to measure professionalism is being coordinated with the Association of American Medical Colleges.

Student satisfaction 

Student surveys show increased student satisfaction with how and what they are being taught. More students show up to attend class every day than in the past—class is too exciting to miss, students say. One reason for this may be that the new curriculum brings more real patients into the classroom than ever before.

Students also give high marks to the system in which eight students are grouped into a “society” led by a carefully chosen faculty member who serves as adviser to the group throughout their entire medical school experience. Society mentors meet with students as often as twice a week during the Foundations Phase, every two weeks during the Applications Phase, and monthly during Discovery. These groups benefit greatly, students say, from the “cohort” effect of all learning the same thing together.

Training the trainers 

For their part, society mentors and other faculty are benefitting from new efforts to help them hone their teaching skills. This includes weekly sessions with society mentors to prepare them to lead small group sessions on specific case histories. It also includes workshops providing special training in “humanistic” techniques. Faculty who undergo humanistic training say they have become more reflective and that their students and residents rank them higher on listening carefully and being a caring person.

Where teaching compassion is concerned, faculty are aiming their efforts not only at students but also at residents, who themselves serve as role models for students. For example, residents learn “habitual reflection”: looking back on interactions with patients, imagining themselves in the patient’s place, and understanding how their own words and body language may have affected the situation.

Trends for the future 

The new curriculum beginning in 2007 was possible thanks to completion, also that year, of the James B. Williams Medical Education Building, widely considered one of the finest medical education facilities in the country and certainly one of the most environmentally green. The 162,000-sq-ft building was designed in part to address the worsening U.S. physician shortage. The entering class immediately expanded by 15%, and the class that will graduate in 2014 (76 women and 64 men) will be the largest in school history.

The class of 2014 as it exists today, however, is sure to differ somewhat in its membership by the time these students graduate—some will take time out for extracurricular pursuits, like the 75 students in the other classes at the moment who are “away” from the medical school working on an additional degree. The class of 2014 reflects other trends among Emory’s medical students as well, including growing proportions of women and foreign-born students and increasing numbers also of nontraditional students—more than half of this class have been out of college for one or more years.

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Emory School of Medicine Annual Report 2010