April 7, 2005
By Susan Green
Although the practice of medicine and the pursuit of medical education have undergone countless changes since the days of the ancient Greeks, fundamental elements have remained constant, for example, the need for doctors to communicate with their patients, to be sensitive to their needs, to minister to those needs and to develop life-long learning skills.
Like many other disciplines, medicine was traditionally taught in a strictly lecture-based setting with students as passive recipients of information. Faculty presented volumes of information on separate scientific disciplines, yet it was unclear how much of that information students were able to integrate and utilize, particularly in the clinical setting.
In response to changing needs in osteopathic medical education, the Ohio University College of Osteopathic Medicine (OU-COM) has initiated a number of curricular innovations in recent years. "We currently offer two excellent medical curricula at OU-COM that reflect differences in student learning styles," says Nancy Stevens, assistant professor and director of the Patient-Centered Continuum (PCC) curriculum.
About 25 percent of each entering class selects the PCC curriculum. The PCC program is a student-directed approach that emphasizes small group collaborative learning, problem solving, and critical thinking skills -medical students learn in the context of situations similar to those they'll be working in for the rest of their careers. The program is a good example of what students can achieve when they're actively involved in their education, an activity emphasized in Vision Ohio, the university's strategic visioning process.
The PCC curriculum offers students an opportunity to work with clinicians, basic scientists and social medicine faculty in a variety of active learning environments, including small group sessions, problem sets and resource hours, journal article discussions, debates, video conference sessions, grand rounds presentations and evidence-based medicine email dialogues. Student-faculty interaction also plays a strong role in gross anatomy and microanatomy laboratories.
"Resource hours and problem sets are often team-taught by basic scientists and clinical faculty to help students integrate different perspectives," Stevens says. "Question and answer sessions require students to be prepared in advance so they can engage in an active dialogue with faculty." Other strengths of the program include a clinical focus in laboratory sessions.
Medical students report that time spent engaging in these activities yields a high degree of integrative learning.
Small group sessions are the cornerstone of the PCC curriculum. The experience gives medical students an opportunity to further develop critical thinking and problem-solving skills, enhancing their ability to interpret complex concepts and promoting collaboration and the development of interpersonal skills. Such characteristics are essential in a field that requires professionals to care humanely and sensitively for individuals and their families.
In small group sessions using simulated patient cases, PCC students have an opportunity to assume roles of both the doctor and the patient. Based on real cases, the "patients" are armed with information about their complaint while the "doctors" elicit the patient's history, working together as a team to request results of laboratory tests and ultimately diagnose the problem and prescribe a treatment. The process is overseen by clinical and basic science experts, and designed to emulate and practice the interaction between doctor and patient in a real world setting.
New developments in the PCC include evidence-based medicine discussions. In these activities, clinicians pose common treatment dilemmas via email, asking students to research and present solutions that incorporate the latest findings available in the medical literature.
Stevens says that in a time with medical advances outpacing textbooks, it is particularly important for young doctors to understand how to evaluate information and make decisions on the best available findings, "Evidence-based approaches are having sweeping effects on the way that medicine is practiced and taught."
A recent article in Academic Medicine reports an increase in academic performance in students engaging in active, problem-based and community based learning. And problem-based learning approaches have been particularly effective for reducing attrition rates in students from traditionally underrepresented or economically disadvantaged backgrounds (Iputo and Kwizera, 2005). In addition, a recent study supports a higher degree of student satisfaction and confidence in key competency areas such as profession-specific methods, teamwork and communication skills along with a higher degree of connectedness between school and work in graduates of an active learning and problem-based curriculum (Prince et al., 2005).
"Students demonstrate a high degree of comfort with the information they learn in this setting," Stevens says. "They report enhanced communication skills perhaps due to their interactions with basic scientists, clinicians, hospital staff and patients on a regular basis. This comfort and ability to communicate in the clinical setting is pivotal to their long term success."
Last year, PCC students had a 95 percent pass rate on COMLEX board exams. "The interplay between an innovative faculty, hardworking students, and a challenging, fast-paced field results in a tremendously successful learning environment, and that's where I like to keep the focus."
The Patient-Centered Continuum was created by Drs. Jack Brose, Walter Costello and Peter Dane. The program took wing under the thoughtful guidance of Dr. Costello for four years, and has subsequently benefited from the leadership of Drs. Ronald Portanova, Malcolm Modrzakowski and now Nancy Stevens. Deborah Thomas has consistently provided her support and insight since the program's inception. The curriculum is in its eleventh year, and continues to flourish.
Nancy Stevens and her colleagues are presenting active learning best practices in the Patient-Centered Continuum during Spotlight on Learning, Friday, May 8, in Baker University Center.
Susan Green is a writer with University Communications and Marketing.