META-CURRICULUM IN MEDICAL EDUCATION, THE

Medicine and Health Rhode Island, Aug 2004 by Smith, Stephen R

The Program in Liberal Medical Education (PLME), the 8-year combined baccalaureate-MD program, represents one of the most visible meta-curriculum decisions taken by Brown. By assuming a large degree of control over the premedical as well as medical years of training, the medical school sought to mitigate against the notorious dehumanizing features of the "premedical syndrome" as depicted in the highly publicized 1984 report from the Association of American Medical Colleges on the General Professional Education of the Physician and College Preparation for Medicine (the GPEP report).3 The PLME ameliorated the stress and competitiveness of premedical education, reduced the number of required premedical courses, encouraged students who wished to concentrate in the humanities and social sciences to do so, and allowed students to integrated liberal arts and medical science courses across the 8-year continuum.

Associated with the ability to take liberal arts courses during the traditional four years of medical school and, reciprocally, to take medical school courses during the first four years of college, the medical school schedule was deliberately organized along the same 50-minute Monday-Wednesday-Friday or 80-minute Tuesday-Thursday recitation session blocks. This enabled first-year medical students to finish their pharmacology lecture in the Biomedical Center and have enough time to walk across campus to Grant Hall for the course on the history of American jazz, as happened a number of years ago. For the same reason, the medical school calendar largely coincided with the university calendar, beginning and ending on the same dates as the college.

Since the inception of the PLME in 1985, fewer and fewer students took advantage of the opportunity to take liberal arts courses during their preclinical years. At the same time, students and faculty increasingly saw the advantage of horizontal integration across medical school courses. To make this horizontal integration feasible, the rigid adherence to the college recitation block schedule had to be relinquished. Meta-curriculum decisions are not carved in stone. Goals change. Tastes change. The curriculum picture has now been rematted in a new frame, one that emphasizes integration between courses, rather than integration of liberal arts and medical school courses.

SPECIFIC CONSIDERATIONS

Meta-curriculum decisions made by individual instructors shape the medical school's overall curriculum. Continuing the painting analogy, each decision is like a dab of paint in an impressionist painting-when seen individually, it means little, but when seen from afar in the context of the whole painting, it acquires meaning. I use the nine abilities in our competency-based curriculum as a framework within which to analyze these decisions.

ABILITY I-EFFECTIVE COMMUNICATION

Beyond the obvious example of the medical interviewing course, several other courses in the first two years of medical school emphasize oral communication skills. all students must participate in two oral recitation exercises in the human morphology course in which they receive feedback and evaluation on their presentations. Oral presentations are also part of the microbiology course. Faculty assess students on their oral communication skills in the context of problembased learning in small groups in the general pathology course in the first year and the pathophysiology course in the second year.