The first three years of medical school traditionally offer students little schedule flexibility amid their pre-clinical and clerkship training. The fourth and final year grants some leeway, and medical students—for all their dedication and discipline—are not immune to the scourge of senioritis.
“After being told what to do for three years ... you are in charge of your own schedule—it can be a bit of shock,” said Katherine Klein, MD, associate professor of radiology at the University of Michigan Medical School (U. of M.). “What was happening in the traditional M4 year is that the students were not taking it as seriously as the rest of their curriculum.”
To Dr. Klein and her colleagues at U. of M., that traditional approach seemed to circumvent the goal of creating residents who are equipped to thrive on day one. So U. of M.—one of 32 member schools of the the AMA Accelerating Change in Medical Education Consortium—crafted a new calendar and gave students faculty advisers to make the final phases of undergraduate medical education more meaningful.
Flipping the script
In U. of M.’s reformed curriculum, the content traditionally covered in the fourth year extends to the final 18 months. To do that, U. of M. condensed its pre-clinical curriculum—typically spread over the first two years of training—to 15 months. Faculty did that by identifying redundancies in the clinical and basic science lessons, allowing the school to teach them concurrently. The bulk of the clinical-experience year then takes place during students’ second year of training, after the 15 months of preclinical work—a year earlier than at most medical schools.
The opening stages of Michigan’s revamped curriculum, which takes place over about two and half years, are referred to as “the trunks”—as in the trunk of a tree—because they give students the scientific and clinical foundation on which to build their medical knowledge.
The final 18 months of the medical school experience are referred to as “the branches” portion of the curriculum, aimed at giving students more advanced clinical experiences specific to their fields of interest and the ability to seek out electives tailored to their career goals.
Branching out
Prior to completion of the clinical trunk, students pick one of four branches to pursue in the next phase of their training: patients and populations; procedure-based care; diagnostic and therapeutic technologies; and systems-based and hospital-based practice.
When students pick a branch, they are assigned an adviser. The initial student-adviser meeting takes place prior to the student’s making a class schedule. Advisers will review students’ grades, clerkship performance, research and capstone projects to help them identify their passions and areas of interest.
“The adviser is a branch curriculum expert who understands the new graduation requirements,” said Dr. Klein, assistant director of the Professional Development Branches Program. “They are there to help them navigate the new curriculum. This fills that void that was present when [students] were making their final schedules in the past.”
U. of M. has about 150 faculty advisors, each of whom works with one to four students. The advisers help students create individual development plans, which may include longer-term goals and areas for improvement. The plans offer a tailor-made road map for success and, by following up on the plans, advisers hold students accountable.
Since its initial implementation in 2015, the branch curriculum and advising program has been operating as a pilot, with significant student interest. Its success—well over half of the eligible students elected to participate in the program this past year—has won notice. The approach will be implemented program-wide for all third-year, post-clerkship medical students in fall 2018.
Dr. Klein has noticed increased confidence and career focus among the students who have gone through the branch curriculum and worked with advisers. Those are assets that can be instrumental in success in residency, she said.
“We really want to elevate these students,” Dr. Klein said. “We want to push them.”
