Frequently Asked Questions about Training the Physicians of Tomorrow

What is the Training the Physicians of Tomorrow curriculum?

It is a 3-Phase medical curriculum that reflects the collaborative 21st Century medical environment.

• Foundations of Medicine (Phase I): Integrates basic, clinical and health systems sciences into blocks that are organized by the organ systems of the body.

• Clinical Applications (Phase II): Provides extensive clinical learning experiences in six of the core disciplines of medicine.

• Career Preparation (Phase III): Provides individualized training for each student in their career specialty choice with the goal of preparing students for success in residency training and beyond.

 Why did UNMC change its curriculum?

Our medical curriculum last underwent major changes in 1993, and since then, many small changes have occurred.  We have utilized innovative teaching methods that promote active learning and we have incorporated new teaching experiences, for example flipped classrooms, and learning modules). It was time to look at our curriculum as a whole, to incorporate new ways of teaching and technologies to more actively train students to become lifelong learners and competent practitioners using evidence-based medicine for the care of patients.

Was there something wrong with the curriculum that caused UNMC to change?

Not at all — as UNMC students graduate, they are well on their way to becoming compassionate, competent, socially conscious caregivers.  Our students do extremely well in USMLE testing and in the residency match.  We frequently receive positive feedback from residency program directors that our students are well prepared for residency. The Training the Physicians of Tomorrow curriculum reflects the evolving health care environment and changing needs of our students with an even greater emphasis placed on career preparation and fostering skills at lifelong learning.

 Why is the Training the Physicians of Tomorrow curriculum beneficial?

One major element of the curriculum is a highly integrated Phase I that is organ system-based.  Integration of disease processes will more directly interface with the underlying biochemistry, physiology, anatomy and cell biology with the intent of enhance understanding while being more time-efficient to meet the needs of the students.

The time saved in Phase I is applied to implement an expanded and focused Phase III, which allows students to explore a variety of disciplines for residency by completing more electives prior to choosing residency programs for application.  To help with career preparation, unique, specialty-specific career tracks have been established for Phase III.

The Training the Physicians of Tomorrow curriculum retains the most attractive features of the existing core UNMC College of Medicine curriculum, especially the early clinical exposure that is a UNMC hallmark.  Students will continue to have invaluable early clinical experiences including taking medical histories and performing physical exams within the first months of medical school.  We also continue the Longitudinal Clinical Experience, beginning the first semester of Phase I, as well as the summer Rural Care Block.  Students will have a 10-week summer break during Phase I, allowing time to perform research as well as to participate in global health experiences.

What other medical schools have made this change?

Curricula in approximately 140 medical schools around the country have been changing to organ systems-based formats for the past ten years.  Most new allopathic and osteopathic medical schools that have opened in that time, given the opportunity to design a curriculum from scratch, have implemented this format.  UNMC has consulted and is still working with the medical schools of Tufts University, the University of Iowa, the University of California San Francisco and the University of North Carolina to inform the implementation of our new curriculum.  Feedback from these schools is that the major reorganization of the M1/M2 curriculum has had minimal impact on USMLE Step 1 scores.

What will a “typical day” look like during Phase I, II, III?

Foundations of Medicine (Phase I): The typical day will be a mix of experiences; large-group lectures, small-group interactions such as team-based learning, problem-based learning, patient-oriented problem solving, and clinical skills, with morning and afternoon activities.  There will be more active learning experiences and small assessments and quizzes, in addition to labs.  Some days will have as much as 6-8 hours of scheduled activities, while others will have 4 or less.  The week will consist of up to 7 half-days per week, with an assurance of 2 half-days per week as “off” time and sometimes up to 4 hours of exams.

Clinical Applications (Phase II): This will consist of the clinical rotations, with similar hours and experiences as our current M3 year.  Students should expect to work as active team members in the care of patients in the hospital and outpatient settings.  Days typically consist of individual and team-focused direct patient care along with learning at the patient bedside and in small groups depending upon the clinical rotation.

Career Preparation (Phase III):  This will still consist of month-long clinical rotations consisting of specialty-specific electives chosen by the student with the goal of preparing for a career in a chosen specialty.  These experiences will start in April rather than July as in the core curriculum.  Phase III is intended to allow students to explore career opportunities by participating in specialty tracks and by taking as many key senior electives as possible prior to residency application.

When will tests occur?

In Phase 1, tests will generally occur at intervals of 2-3 weeks and will be administered on weekdays or on some occasions, on Saturdays.  A key change is that these exams will not be as “high-stakes” as before.  Instead of constituting a very high percentage of the final grade, the primary exams will constitute less of  the overall final grade for each organ system-block.  Percentages will differ from one block to the next, but the goal is that at least 30% of the final grade will be determined by smaller assessments that happen throughout the block.

How much time will there be for study and when should I prepare for USMLE Step I exams?

Preparation for USMLE Step 1 begins at the winter break after the third semester of medical school.  At that point, all major Phase I organ systems blocks will be completed and the main content will have been covered.  Students will still be enrolled in 5, two-week synthesis blocks, which are designed to purposefully review and apply previously learned material within a new context of medicine such as rheumatology, infectious disease, geriatrics, and pediatrics.  In the synthesis blocks, scheduled activities are limited relative to the organ systems blocks in order to allow for individual study time.  The final synthesis block ends early in February, leaving 2.5 weeks of unscheduled time for students to complete preparation and take USMLE Step 1prior to starting Clinical Applications (Phase II).  The overall time available for Step I preparation, including the coincident synthesis blocks, is nearly 11 weeks.