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By Catherine Duncan
For two years, multiple teams throughout the Joe R. and Teresa Lozano Long School of Medicine spent hundreds of hours completely modifying the school’s curriculum. Those who graduated prior to 2016 may not recognize this dynamic way of learning.
The new curriculum is called CIRCLE, an acronym for Curricular Integration: Researchers, Clinicians, Leaders, Educators. Led by Florence Eddins-Folensbee, M.D., vice dean for education, and Deborah Conway, M.D., associate dean for curriculum, planning began in 2010 with implementation occurring in 2012. The Class of 2016 was the first group to complete four years of the CIRCLE curriculum.
“Now that we have graduated our second class and are welcoming our sixth class, we can see the results of everyone’s efforts,” Dr. Conway said. “This curriculum was developed with the goal of creating well-rounded and highly qualified clinicians. Proof of our success is the results of Match Day 2017. This second class of CIRCLE graduates boasts the highest match percentage in the school’s history—98 percent.”
She attributes this success to the school’s faculty collaborating to create a curriculum that deeply integrates basic science, clinical knowledge and the art of doctoring so students from week one are learning important facts alongside core skills and the nuances of practicing medicine.
“Our students are now learning the patient-centered approach as soon as they start medical school,” Dr. Conway said. “CIRCLE emphasizes active learning in a setting based on experience and observation. Today’s students spend fewer hours in lectures, and they have assumed a more direct responsibility for their education.”
Jessica Hughes, M.D., who was in the first class to complete the four-year curriculum, said CIRCLE promotes clinical reasoning from day one. “First-year medical students work through weekly case-based scenarios from the beginning of medical school. I think this was one of the strongest aspects of the new curriculum,” she said.
The new curriculum is heavily reliant on technology. Dr. Conway explained, “Students now access all medical information on their laptops. Textbooks and syllabuses are all electronic. The students can discuss course content through blog posts and online chats. Even examinations are administered electronically which allows faculty members to provide custom feedback to students.”
Dr. Hughes, who is now completing her residency in obstetrics/gynecology at UT Health San Antonio, called the advances in technology an extremely beneficial aspect of CIRCLE. “Having the ability to re-watch lectures and access dozens of textbooks instantly really enhanced the learning process. Now that all board exams are done electronically, taking medical school tests online better prepares students for USMLE (United States Medical Licensing Examinations),” she said.
Omid Rahimi, Ph.D., director of the human anatomy program and associate professor of cell systems and anatomy, said the digital anatomy laboratory in the Academic Learning & Teaching Center is becoming an integral part of the new curriculum. While the digital anatomy lab will not replace the traditional gross anatomy instruction (which uses donated bodies), it enhances students’ educational experience, he said.
“Using 3-D technology, we are able to digitally dissect real patients’ data, which can include CT scans and MRI images of normal and diseased anatomy. Students digitally dissect this data using a PlayStation controller,” Dr. Rahimi. “This technology, for example, allows them to filter just for vessels. They can rotate them and cut them digitally. We can enhance the students’ understanding of spatial relations we are trying to teach in anatomy courses.”
The digital lab is allowing students to learn from real radiologic studies in their first semester; previously, students did not see this until their third year, he said. “From day one, they are combining basic science with patient care. They get to see why they are learning the basic science material. I am seeing a higher level of engagement now,” Dr. Rahimi added.
Many classes are taught as a “flipped classroom,” which means students first view lectures by faculty online and later attend class. Dr. Conway explains, “These virtual desktop lectures allow the students to start and stop the lecture at any time. They can stop and research questions with other students or the faculty member. Later in class, they discuss the material with the professor and other students. This has proven to give them a deeper understanding of the material.”
The new student-centered curriculum also features team-based activities. Dr. Conway said team work is not only important but mandatory for the medical students. There are many benefits of the team-based approach: learning professional navigational skills, providing learning support, and gaining exposure to new perspectives and ideas.
Clinicians facilitate the teams’ activities so that student teams practice real-world reasoning in a setting where they are not graded. They gain valuable experience and coaching in discussing cases or constructing diagnostic plans, she said. “Hopefully, we are creating an environment where skilled and innovative teachers can bring their best to the table while students develop their skills,” Dr. Conway said.
Dr. Hughes said by working each week in small groups led by an attending physician, students developed clinical reasoning and began to think like clinicians. “These groups also foster teamwork because each group of students must develop an action plan to work through case-based scenarios,” she added. “I think this was one of the most engaging and rewarding aspects of the new curriculum.”
The CIRCLE curriculum is created with a framework open to adjustment and adaptation with feedback encouraged from students and faculty. Dr. Conway said, “The structure also allows us to respond to emerging trends in medical education. There is an ongoing fine tuning of the courses.”
CIRCLE has contributed to fulfilling the school’s fundamental mission of teaching students how to be good learners. As students and later as clinicians, they must have developed habits of inquiry and innovation. “We are helping them learn how to ask questions, identify what they don’t know, and find answers for their patients,” she said.
Dr. Conway said the Long School of Medicine team is proudest of the product at the end of this process—graduating spectacular students.
Today’s medical students are “conducting research, starting up new clinics, developing new threads of curriculum, attaining dual degrees, and serving as advocates for their patients. They continue to amaze us in ways we can’t imagine,” she said.