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Continuing to change and grow

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No longer "new," the medical curriculum that debuted at Emory in 2007 is now fully implemented and has hit its stride. But the preparation of young doctors continues to broaden, sometimes in ways that surprise the faculty and always with the promise of changing how the next generation views their patients and provides them care.  

When not graduating on time is a good thing

If the goal of a mandatory five-month "discovery" phase was to pique students' curiosity, it is succeeding. Almost a fourth (33) of the 138 students in the class of 2012 were delayed in receiving their MD degree. Many paused their medical studies to complete a master of public health (MPH) degree. Several completed a master's of science in clinical research. a highly competitive program in the multi-institutional Atlanta Clinical and Translational Science Institute. Two studied at the London School of Hygiene and Tropical Medicine. And two coordinated a clinical trial for flu vaccine and helped start an evidence-based medical course for physicians in Mali, West Africa.

Providing such opportunities requires commitment from faculty who carve out time and provide funds to train, supervise, and mentor young students in their labs.

The payoff is visible in the achievements of students like Ryan Summers, now an Emory pediatrics resident. As a medical student, Summers spent his discovery phase in the lab of hematologist Pete Lollar, a Hemophilia of Georgia Research Chair in Hemostatis. Two months before receiving his MD, Summers was already first author of a cover article in Blood describing a previously uncharacterized mutation related to hemophilia A. 

Outpatient, in the community

The sheer logistics of teaching students in hospitals are much simpler than teaching in outpatient settings, but hospitals are not where students best learn prevention, longitudinal care, and maintenance of long-term, sometimes intergenerational relationships with patients.

Early in their education, during their "foundations" phase, Emory students begin interspersing time in classrooms, labs, and dissecting rooms with what they fondly call OPEX (outpatient experience). For many, these half-day, every-other-week interactions are a reminder of why they chose medicine. For a growing number, it's the first step on a path toward a career in primary care, a track whose growth is sorely needed across the country. 

Experience in outpatient care continues after students complete foundations. The next phase, "applications," includes a three-month block of ambulatory care in which students see outpatients four days a week, both adult and pediatric, general and specialized, and return to campus on Fridays for classes that pull the experiences together. This unprecedented amount of time spent in outpatient care would be impossible without the support of dozens of community volunteer faculty physicians across Atlanta.

Learning how to handle genetic information

More than 1,600 genetic tests are now available commercially. By the time today's first-year medical students enter practice, reading an individual's entire genome will cost less than $1,000. But they'll be ready. In their first year, before students begin to confront the genetics integrated in almost every unit over the next four years, they take a two-week module that provides a firm grounding in ethics and principles of working with patients on genetic issues, such as how to approach testing and diagnosis and how to talk about difficult topics that affect not only patients but also family members. 

New training in genetic counseling—This year, Emory's Department of Human Genetics inaugurated a master's program in genetic counseling, the first in Georgia, to address a national shortage of board-certified genetics counselors to help clinicians and patients interpret genetic information related to risk.

Understanding patients' lives outside the medical encounter

Social medicine—A month-long elective includes weekly lectures on how economic, social, and cultural conditions affect health and health behaviors. But the meat of the course is in individualized firsthand exposures to challenges faced daily by many patients. Students visit low-income communities where jobs don't exist and the nearest grocery store is miles away. They visit homeless shelters and nursing homes. They accompany Meals on Wheels drivers to patients' homes. They tour the local jail. After spending hours in line in the Grady Hospital pharmacy for indigent patients, they better understand that cost is not the only barrier to taking medicines. The course also covers legislation affecting health care.

Compassion 101—It's not really a course, but the curriculum is consciously designed to make sure students develop and retain compassion and empathy to their fullest extent, no matter the exigencies of time and technology. For starters, small groups of eight or nine students spend all four years with the same faculty adviser, enabling students to model their own behaviors on someone they know well. The small groups also explicitly cover topics not usually found in textbooks, such as how to break bad news or the importance of body language. Communication lessons are repeated throughout medical school: talking to patients in a way that elicits important information; explaining procedures in detail, with no surprises; respecting privacy (exam tables should never face the door); allowing patients to process difficult news; really listening. Students also gain empathy from presentations by patients and from their own experiences, such as male students who are told to place a gown over their pants, put their feet in stirrups, and slide down the exam table as the professor explains how to communicate with a patient during a pelvic exam.