Establishing Nine Abilities Expected of All Brown University Medical Grads
Beginning in 1990, Brown University School of Medicine redesigned its curriculum. The school delineated specific basic science and clinical medicine competencies expected of its graduates.
The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Preparing Physicians for the Future.
The curriculum redesign included the following:
- Defined nine abilities expected of all Brown graduates: effective communication; basic clinical skills; using basic science to guide therapy; diagnosis, management, and prevention; life-long learning; self-awareness, self-care, and personal growth; problem solving; moral reasoning and ethical judgment; and context of medical practice.
- Established six six-month-long ambulatory clerkships in medicine, surgery, pediatrics, obstetrics/gynecology, family medicine and psychiatry.
- Reconfigured and consolidated the leadership of the Division of Biology and Medicine.
RWJF provided $148,664 in funding from September 1990 to February 1992.
Beginning in 1985, Brown University admitted 60 college freshmen into a new program that led to both a bachelor's degree and a medical degree over an eight-year period. This initiative, the Program in Liberal Medical Education (PLME), was created to provide students an opportunity to become fully educated citizens as well as competently trained physicians. It abolished traditional premedical course requirements, replacing them with competency requirements that use performance-based assessment methodologies to measure student achievement. Half of the PLME students chose to major in areas other than science, unique among premedical students in the United States.
Under Brown's program, the M.D. Curriculum Committee was responsible for recommending curriculum policies to the Dean of Medicine, and the Dean of Medicine was responsible for implementing those policies. Under this grant, the M.D. Curriculum was given greatly expanded functions, including developing conceptual models for the educational blueprint, delineating competency requirements, devising measures of student assessment, supervising the process of competence assessment, and continuously reviewing the teaching program. The Teacher-Scholar Committee, which ran faculty development programs, was also given a much-expanded role, including conducting faculty workshops in performance-based assessment and problem-based learning, and teaching communication skills.
- A task force on curriculum competencies consisting of basic science and clinical faculty and students defined nine abilities expected of all Brown graduates. These were: effective communication; basic clinical skills; using basic science to guide therapy; diagnosis, management, and prevention; life-long learning; self-awareness, self-care, and personal growth; problem solving; moral reasoning and ethical judgment; and context of medical practice. Two models to define the knowledge base were designed and refined, one relating to the basic sciences and the other to the clinical training of medical students. Eighteen working groups, each composed of about six faculty members and one or two students, were established to further define abilities and knowledge bases.
- For the clinical years, the M.D. Curriculum Committee approved a new competency requirement for six-month longitudinal ambulatory clerkships. Staff for all six required clerkships in medicine, surgery, pediatrics, obstetrics/gynecology, family medicine, and psychiatry agreed to systematically and uniformly assess student competence in two of the abilities (effective communication and basic clinical skills) and to further assess students on at least two more abilities in each of the six clerkships.
- A major review of the organization of the Division of Biology and Medicine was conducted, resulting in a reconfiguration and consolidation of its leadership.
The project director reported the following principal problem to RWJF:
- Defining the knowledge base proved to be more difficult than originally anticipated. The challenge was to avoid the extremes of either being too general and broad or too specific and exhaustive. Participants solved this problem by defining the knowledge base in overarching principles rather than specific factual entities. Project staff were also challenged in their efforts to determine what would be expected of students for each ability at the beginning, intermediate, and advanced levels.
Project staff made two presentations on curriculum reform. See the site's Bibliography for details.
AFTER THE GRANT
After the ending of RWJF support, a faculty retreat was held to discuss plans for implementing the competency-based curriculum. While the process was expected to take longer without RWJF support, faculty reaffirmed its intention to proceed.
GRANT DETAILS & CONTACT INFORMATION
Preparing Physicians for the Future, Brown University
Brown University School of Medicine (Providence, RI)
Dates: September 1990 to February 1992
David S. Greer, M.D.
Note: (Planning) ID# 017236
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Greer DS. "Altering the Mission of the Academic Health Center: Can Medical Schools Really Change?" in Education of Physicians to Improve Access to Care for the Underserved: Proceedings of the Second HRSA Primary Care Conference. Health Resources and Service Administration, Rockville, Md., March 1990.
Report prepared by: Paul Mantell
Reviewed by: Susan Parker
Reviewed by: Robert Crum
Program Officer: Leighton Cluff
Program Officer: Lewis Sandy
Program Officer: Richard Reynolds
Program Officer: Annie Lea Shuster
Evaluation Officer: Beth Stevens