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A Better Method for Medical Education?

Created May 16, 2010 by Juliet Farmer
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Do students like this new model of medical education being delivered at A.T. Still University School of Osteopathic Medicine in Arizona?  SDN interviews current students.

A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA) is changing the way medical students learn. Called a clinical presentation curricular model, their new teaching method is based on the ways patients present to physicians.

Approximately 120 presentations comprise the curriculum, which ATSU touts as a union of both basic and clinical science, with the clinical presentations organized based on the organ system to which they most logically fit (abdominal pain is covered in the gastrointestinal course). According to ATSU, this creates a complete set of organ-system based courses during the first two years of the curriculum.  The curriculum also contains courses in medical skills, osteopathic principles and practice.

Jenny Demos, OMS III, currently at OHIO Community Health Center (CHC), says she chose the model because she was excited about being in the clinics her second year of medical school. “[That] was a huge draw to the program. It’s hard to imagine becoming a doctor when all of the work is done in the classroom,” she observes.

Brandi Addison, OMS III, currently at Alabama CHC, says she was also attracted to the model because of the early exposure to clinicals in the second year of school.

“What attracted me to the model was beginning clinical experiences in the second year,” Danielle Barnett, OMS III, agrees, adding she was first introduced to the curriculum at ATSU SOMA when she attended an open house on campus. “I knew I was a hands-on learner, so the earlier I could get out and see patients with real problems the better,” she adds.

But is the reality living up to the advertising?

“I didn’t completely understand the impact of the model until I entered my third year of medical school,’ recalls Barnett. “When I began rotations, I realized that the way I reasoned through cases directly reflected the clinical presentation schemes I was taught. It allowed me to consider a broader range of differential diagnoses and not get boxed into one system.”

Besides the early exposure to clinicals, Addison says she appreciates the chance to not only study disease processes, but also to experience the symptoms and presentations in a clinic situation, which makes it easy to solidify the information.

Of course, being the first class through has its drawbacks.

“There have been bumps in the road, but they were to be expected, being such a new program,” notes Demos, adding, “I came out to southwestern Ohio with the community health center, Healthsource of Ohio, to complete years two through four, and it has been more than I could have imagined. My entire experience has been wonderful.”

Aside from that, consensus is that the pros far outweigh that particular con.

“I like how much clinical experience we have had,” Demos says. “It was a great feeling when I started third year rotations and my preceptors were shocked at how much I knew and how comfortable I was with patients. I feel like I am becoming a great physician because of all the exposure I have had.”

“The best part of the model is the way it affects your approach to patient encounters,” adds Barnett. “It affects not only your thought process, but also your confidence. After working with patients for a year prior to third year clerkships, taking a history and performing a physical exam become second nature. I also like how, in our second year, we were able to work with our learning facilitator in small groups. It is unique to find a program that has a 1:10 professor to student ratio.”

The three students also feel they are ahead of the game.

“I constantly hear that I am ahead,” explains Demos. “I have nothing to compare myself to, except for what my preceptors have shared with me. In a recent rotation, I had one preceptor say that I was ‘better than most interns’.”

Addison concurs. “I believe the model has in fact given me an edge when compared to my peers from traditional models. During my second year, I had to make an adjustment to the clinical setting. This same adjustment had to be made by third years in traditional programs this year. However, this year I was already accustomed to the hospital setting and entered with more confidence. I was able to take my clinical skills to another level and expand upon my knowledge,” she notes.

Barnett agrees. “From speaking with other students, I know that beginning third year clerkships can be a scary time for medical students from traditional models,” she says. “Most of the time, it is the first time they have experienced encounters with real patients. When I began my first third year clerkship, I had been working with patients for a year. I had no problem taking a history, performing a physical exam, or presenting patients to my preceptors. I felt that the preparation our school provided exceeded that of other students from traditional models. I also felt that when considering differentials on patients, I was able to come up with more possibilities based on their clinical presentation and what I was taught in our schemes.”

And what about boards?

“When it comes to boards for step I, I feel the model gives adequate preparation equal to that of the traditional model,” Barnett says. “I didn’t feel I had an advantage or a disadvantage. However, for step II, I feel the model gave me an advantage. For the PE, beginning clinical experiences in second year definitely gives you an advantage over those from traditional models. I have not completed the written portion of step II, however I feel I will have an advantage given our school’s clinically-geared curriculum.”

Which bring up another drawback. “Being such a clinical program, I did feel that the school didn’t focus on some of the science foundations as much, which is what Step 1 covers,” notes Demos. “I felt that I had to study harder for boards because of this.”

For Barnett, the challenge was the unexpected. “Being the first class, we were treading unexplored territory because we didn’t have upper class students to guide us. But because of those first-year experiences, there is a strong community that is leading the way for incoming students,” she says.

Endorsements mean a lot, and all three students say they would not hesitate to recommend the model.

“I would strongly recommend this model to others,” explains Barnett. “Everything about it sets you up for success…Physicians are problem solvers. A patient presents with bits and pieces of information, and it will be our job to see the big picture.  Not every patient fits in a box or presents with textbook symptoms. When you are able to step outside the box and approach the patient as a whole, considering all possible causes and a broad range of differentials, it gives you an advantage. The model we are taught provides that knowledge.”

“[The model] makes learning fun and interactive. It is not just sitting in a classroom or behind a desk studying a disease and its pathophysiology. You get the chance for real life experiences,” adds Addison.
There is one caveat, however.

“Our second year had a lot of independent studying, so I would not recommend the program to someone who has a hard time self motivating,” notes Demos. “All in all, our program has done a wonderful job at making us good soon to be physicians. Looking back, I really can’t imagine starting third year without seeing patients regularly second year. I would have been terrified. It’s not to say that I wasn’t nervous, but what an extra push we had.”

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  1. Dennis says:

    It’s about time the medical field caught up with the rest of us. This sounds like an apprenticeship. on the job training, learning from those who know rather than from those who wish they knew.

  2. Joe says:

    Right… 2 years rotating in hospitals while in Medical school then 3-7 years of Residency (post-graduate medical EDUCATION before board certification), not really on the job training is it?

    Sounds interesting. I go to a PBL based medical school where we have small groups 8-10 students per faculty member and work through actual cases from presentation and differential to ordering lab values and talking about treatment. We stress mechanisms and basic sciences while integrating all of the courses into a systems based approach and kick ass on STEP 1 while still getting a feel of the clinical aspects of medicine. All in all more diversity in education is important.

  3. Tayyaba says:

    What school do you go to?

  4. JP says:

    Dennis’ ignorance is displayed by his inane comment. I agree with Joe, PBL with strong basic research is the most needed curriculum in medicine. Nurse practitioners and physician assistants learn great on the job but they’ll never know the basic science as well as us – which is why they will never be able to run labs, be basic science researchers (all this public health research, etc is basically weenies trying to be big time), be full professors in any department other than nursing, or run major departments.

  5. Student says:

    As a current student, I’d like to say that our curriculum does emphasize problem based learning as well. We go through clinical cases weekly and apply our schemes to evaluate cases. We still didactic learning our first 2 years, we just supplement our 2nd year with early clinical exposure to emphasize reinforce our classwork.

  6. Dan says:

    The problem with PBL is that it does not adequately prepare students for the USMLE. Most MD and DO schools have dropped PBL-only tracks. I can think of 2 DO schools that maintain PBL only tracks. Personally, I like the integrated approach of lectures and PBL.

  7. Chris says:

    To the person who said PBL doesn’t work for USMLE, well, that’s just plain wrong. Go look at the stats of PBL-based schools, they’re all doing plenty well on boards. If not, then the problem isn’t with PBL, but the particular institution’s implementation of it.

    I don’t get what’s innovative about this program as compared to all the other PBL curricula out there. I attend a school that is PBL-based, we have two clinical cases every week to research and then we present them all to each other in small groups with a faculty facilitator. Everything is integrated into organ-based blocks. So I fail to see where ATSU-SOMA is “changing the way medical students learn.” Maybe they do more overall cases/presentations than we do, but that’s about it.

    Come on, SDN, you call this writing? You can do better than this. This is nothing but thinly-veiled advertising. How much did they pay you to write this?

  8. James says:

    I agree with the above posters. The traditional model of separate classes (anatomy, physiology, biochemistry…) has largely been replaced with systems based or problem based learning to allow for more integrated thinking. The curriculum described above is not innovative, but has already been implemented nationwide over the last decade.

    I really don’t think it matters. There is a just a lot of information to learn in medical school (traditional or PBL/systems based learning). In the end, students from either route will learn to integrate that massive amount of information and then decide what information is important for their particular patient.

  9. Siggy says:

    This sounds a lot like the system that WU/COMP is going to be introducing next year. While it’s being called “Large group/small group sessions,” it feels like an integrated lecture/PBL style system (even though it was emphasized that this isn’t PBL). Essentially a primer lecture is given, then the students break out into small groups to work on the case and answer a set of questions, followed by all of the groups coming back together to present the case. During the scheduled breakout times (we were told that the specific time that the group meets isn’t important), the professors would be walking around the study rooms in case we need to grab one of them to ask questions, clarify, etc.

  10. bruce says:

    I’m a student here at SOMA, and love it here. But I agree with you all – this isn’t journalism. It’s 95% quotes from students. While it is important that students be happy with their education, it would have been more valuable to explore the origins of the clinical presentation model, potential negatives, quotes from SOMA faculty as to why they chose to implement the model, etc. It doesn’t even do a great job, apparently, of explaining the clinical presentation model, which is definitely not PBL.

    Again, the article does a great job of highlighting that students are happy to be here, but is very incomplete.

  11. Student2011 says:

    Bruce- I am glad you are happy with the education you are receiving at SOMA. I believe the point of interviewing 3rd year medical students was to get an idea of how the 3rd year clerkships are perceived all over the country. There is a lot of apprehension regarding the transition from 1st year to 2nd year to 3rd year. I enjoyed hearing from current students on how they are enjoying their 3rd year out on their own. Kudos SDN!

  12. Dennis says:

    Why don’t you all face it, you are in it for the money anyway. So it doesn’t matter how you learn. There are now and always will be bad Doctors and good Doctors.

  13. Dave says:

    At the end of the day it all comes down to reading stuff, memorizing stuff, being able to apply what you learned and being smart.

    I’ve said for at least the last 2 years now that the ideal medical school for me would just get the heck out of my way completely for the first 2 years, give me all that hands-on stuff during 3rd year, and pretty much get the heck out of my way again for 4th year. At least they pretty much get the heck out of my way for most of 4th year.

    Should’ve gone to Yale…

  14. James says:

    “Dennis says:
    May 20, 2010 at 9:32 am

    Why don’t you all face it, you are in it for the money anyway. So it doesn’t matter how you learn. There are now and always will be bad Doctors and good Doctors.”

    Dennis, you obviously no nothing about the medical climate of today. That stereotype is from the 1980s. I think your education system failed you.

  15. bruce says:

    haha, I’m going to assume that you wrote “no” intentionally…but even if you didn’t – that sentence is pretty funny.

  16. fizzle says:

    You don’t know what opportunity cost (7-11 years of training AFTER college) and time value of money are, do you?

    What about those health care CEOs that be making 12 million+ annually? One cat exercised his stock options for 98.6 MILLION in 2009.

    I’m outtie.

    “Dennis says:
    May 20, 2010 at 9:32 am

    Why don’t you all face it, you are in it for the money anyway. So it doesn’t matter how you learn. There are now and always will be bad Doctors and good Doctors.”

  17. An interesting article. I interviewed at SOMA and was impressed with the emphasis an innovative way to learn. But will it pan out?

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