The curriculum for training Alabama’s future physicians is evolving, shaped by a global pandemic, a deeper understanding of our communities, and important changes in the ways medical students are assessed in the U.S.
At UAB, it all starts with Patient, Doctor, and Society (PDS)—medical students’ first course, taken prior to the White Coat Ceremony. Course co-directors Caroline Harada, M.D., assistant dean for Community-Engaged Scholarship in the Heersink School of Medicine and a professor in the Division of Gerontology, Geriatrics, and Palliative Care, and Stephanie Berger, M.D., associate professor in the Department of Pediatrics, are shining a light on the societal issues that affect health and the ways physicians can impact communities.
Naturally, COVID-19 has become part of the conversation, with leaders from the Jefferson County Department of Health sharing pandemic insights and experiences. Berger and Harada also have added sessions examining implicit bias, racism, and strategies to help physicians address health disparities. Other highlights include a panel discussion with African-American physicians and an exploration of the history of racism in medicine.
Students also interview a patient and research the patient’s neighborhood “with a goal of understanding not only their medical history but also the social context in which they live, and understanding how that impacts their health,” Harada says. “We show the complex web physicians and patients live and work in every day, because if you don’t understand how social factors determine health outcomes, you can’t help your patients effectively.”
Following the PDS course, students proceed through a curriculum that reflects major changes in the United States Medical Licensing Examination (USMLE) testing structure, namely the switch to a pass/fail grade for the Step 1 exam (taking effect in January 2022) and the discontinuation of the Step 2 Clinical Skills (CS) exam.
The USMLE made these decisions to address unintended impacts of the exams on medical students. For example, Step 1 “initially was developed to serve as a benchmark, to show the student has mastered the foundational sciences and can proceed to the clinical curriculum,” says Craig Hoesley, M.D., senior associate dean for Medical Education and chair of the Department of Medical Education. Yet the exam had become a “stratification tool for graduate medical education programs,” pressuring students to focus on achieving specific scores to compete for specific residencies at the expense of learning, he explains. As for Step 2 CS, Hoesley says the financial burden associated with the test had risen to approximately $2,000 per student. Many students also struggled to prepare for the exam, while others had concerns that the assessment was subjective.
Hoesley, a member of the USMLE Management Committee, anticipates that the National Board of Medical Examiners eventually will develop a new clinical skills exam.
In the meantime, the Heersink School of Medicine has strengthened its clinical skills curriculum by enhancing the Introduction to Clinical Medicine course for MS1 and MS2 students, and by requiring MS3 students to take three OSCEs (objective structure clinical exams) with standardized patients.
Hoesley predicts that residency program directors nationwide are likely to put a greater emphasis on Step 2 Clinical Knowledge exam scores in the wake of the USMLE’s decisions. Heersink School of Medicine faculty are encouraging students to take that exam early—as soon as they complete their MS3 year—and are modifying the curriculum calendar so that students have time to prepare for it. Research and service activities, along with letters of recommendation, also will be key for students looking to distinguish themselves as they compete for residency positions, Hoesley says. – Charles Buchanan, Kendra Carter