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Raising the Bar: The School Updates Its Curriculum and Develops New Ways to Educate Tomorrow’s Doctors
photoWhen asked about changes at the Wake Forest School of Medicine, David Manthey, MD, sees an evolutionary, rather than revolutionary, process at work.

“The knowledge-based curriculum we want is already there,” said Manthey, who, as associate dean for medical education, directed the school’s first significant update of what and how it teaches in more than a decade. “We’re altering the way in which we deliver the material to enhance the students' learning.”

He admits more revolutionary change may be needed at some point, due to an ongoing in-depth evaluation of the program as well as seeing where the Association of American Medical Colleges (AAMC) is headed. While a wide ranging group of people involved in the curriculum work through that evaluation, more gradual changes are being implemented now.

While the academic material being presented isn’t changing significantly—medical students still have to know anatomy, after all—the way some of that material is provided is going to look different. It’s being repositioned for a new generation of students raised on mobile phones, video on demand and Internet connectivity.

Competency, especially building it and finding the best ways to assess it, is king.

“There has not been major surgery on the curriculum,” said Steve Block, MB, BCh, senior associate dean for academic affairs. “The changes are being made to make sure our students develop competencies so that they are thoroughly prepared when they start their residencies.”

The changes result from what Dean Edward Abraham, MD, called a “deep dive” to examine what was in the curriculum and how relevant it is to today’s medical education needs.

“We discovered we had a robust curriculum; all of the content was there,” said Block, who chaired the curriculum review steering committee.

“We needed to reform it and update our methods, to focus on student life and the atmosphere in which students are learning."

Expectations are high, even before the updates are fully implemented over the next two years.

“I want every Wake Forest medical student to be so sound and so competent,” said Manthey, “that residency directors ask specifically for a Wake Forest School of Medicine graduate.”

The First Step: Step 1
The first change involved raising student scores on the Step 1 test required for entering their third year of study. While at or above national standards, the scores weren’t what school leaders believed they should be. A year ago, seven students at the school failed Step 1.

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It was enough that the school wanted to make some changes in the test preparation process:

  • A question bank and assessments were added to the students’ study approach.
  • A consultant helped improve test-question writing skills.
  • A resident led a Step 1 study series.

The changes yielded a positive impact: Only one student failed this year.

“The students did well on Step 1 because they had a wonderful curriculum and studied hard,” Manthey said. “None of the changes in and of themselves caused this improvement, but together they should prove very valuable to future students.”

Block said the goal is to make the Step 1 test an issue of knowledge, not an issue of test-taking technique. He said helping students raise their scores is vital. “It’s important because the programs that are recruiting residents look at those scores,” Block said.

“It’s very competitive, and total residency slots, relative to the number of medical school graduates, will diminish in the next few years.”

Sharon Babcock, MD ’12, one of two students who served on the review committee, believes this new approach will pay dividends.

“It takes one Wake Forest student to get a foot into the door for that residency program to recognize, ‘That’s a Wake Forest graduate. We want other students from Wake Forest in our residency program because they produce the best students,’” said Babcock, who herself is now a resident in orthopaedics at Wake Forest Baptist.

A Strong Foundation
To assure competency, Wake Forest medical students will take a lot more tests.

“We found that students like to be assessed, to see where they stand,” said Robert Rowe, a fourth-year student who also served on the review committee. “We learned that we shouldn’t shy away from assessing students more often.”

photoHe said students actually worry less about exams when they take them more often. It helps students to know—every day, every week—what they are learning and what they need to work on. More assessments also help the faculty identify potential problem areas while there is still time to help.

“In the past, we didn’t identify students early on who were at risk of failing,” Block said. “By having more frequent assessments of skills and tests, we have greatly increased the likelihood of finding problems early in the process.”

The first-year course Human Structure and Development (HSD) provides a good example of how increased testing will work. Like other parts of the curriculum, HSD includes component classes in the overall course: there’s gross anatomy, embryology, radiographic anatomy, histology and neuroanatomy.

Theoretically, in the past, a student could post a grade of Less Than Satisfactory or even fail one of the component classes and still pass the overall HSD course. No more. Each component class is now independently graded, and low scores must be addressed.

Manthey compared it to building a foundation.

“If I have a crack in my base of knowledge in anatomy, that crack is only going to get worse when I get to hematology in the second year,” Manthey said.

“We want to get involved immediately, as soon as that crack becomes apparent in testing. We want to look at that test and provide additional resources for studying. You have to make up that test, but you only need to target the material you didn’t know. That will focus your studying on areas of weakness or need.”

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