May 2002

Grant Results

National Program

Preparing Physicians for the Future: A Program in Medical Education

SUMMARY

During the 1990s, Johns Hopkins University School of Medicine revamped its entire curriculum, integrating basic science with the clinical experience.

The project was part of the Robert Wood Johnson Foundation (RWJF) national program Preparing Physicians for the Future: A Program in Medical Education.

Key Results

  • Implemented case-based, small-group sessions throughout all four years.
  • Offered a new required course that places first-year students in the offices of community-based generalist physicians.
  • Added required clerkships in emergency medicine and ambulatory internal medicine.
  • Initiated a new course, Rational Therapeutics, to reintroduce some of the basic sciences into the fourth year.
  • Developed and implemented a Physician and Society Course as a required course throughout all four years of the medical school curriculum.
  • Developed a Medical Informatics and Computers Program. Several hundred computers were purchased and connected to the Internet.
  • Revised policies and procedures for faculty advancement, specifically citing teaching as a criterion for promotion.

Funding
RWJF provided $2,642,818 in funding from September 1990 to June 1997 to support the work.

 See Grant Detail & Contact Information
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THE PROBLEM

Johns Hopkins had long been an eminent institution among American medical colleges and was rooted in tradition. Yet the impetus toward change had taken place before the RWJF initiative began. Governance of the medical education program had already been centralized in the office of the dean. An Educational Planning Committee was formed by the dean in 1990, and developed a mission statement and goals for reform. The Committee on Educational Policy and Curriculum was given responsibility for the ongoing functioning of the curriculum once in place.

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THE PROJECT

During its planning phase (ID# 017241), Johns Hopkins identified a curriculum coordinator to oversee detailed planning for curriculum revisions, prepared a procedure for evaluating the impact of curricular changes, decreased basic science hours, increased small group hours, and gave students three free afternoons a week to integrate what they were learning.

For its implementation phase (ID# 019642), the school had the following goals:

  • Integration of basic science and clinical experiences.
  • Expanded use of case-based, small group learning sessions.
  • Early experience with community-based practicing physicians.
  • Development of a four-year, longitudinal Physician and Society course focusing on the social, cultural, economic, and ethical factors influencing physician/patient relationship.
  • Computerization of learning/teaching to educate students to effectively use electronic networks and databases for patient care and research.
  • Expanded experiences in ambulatory settings in the required clinical courses.
  • Rewarding faculty for teaching.

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RESULTS

  • The school revised all four years of the curriculum to assure integration of basic science and clinical experiences. The first year of the new curriculum was instituted with the class that entered Johns Hopkins University School of Medicine in September 1992. No more than two one-hour lectures per day are given. Some afternoons are free for independent study and reflection.
  • The new curriculum features case-based, small-group sessions throughout all four years. Teaching methods include: group discussions of problem sets, labs, Journal Club (groups of 15 students discuss current medical literature relevant to their courses with faculty from both basic science and clinical departments), and Clinical Correlation (involving a patient presentation, an analysis of clinical features, and a strong basic science component designed to integrate the main concepts covered during the week).
  • Introduction to Clinical Medicine, a course that places first-year students in the offices of community-based generalist physicians, began in 1992 and continues to be a popular experience for first-year medical students. Students spend at least two half-day sessions per month, or 8 to10 sessions per semester, observing a generalist physician's work with his or her ambulatory patients.
  • In the clinical years, the school added required clerkships in emergency medicine and ambulatory internal medicine. At least 25 percent of the other required clerkships — which focus on medicine; surgery; pediatrics; ophthalmology, psychiatry, and neurology; and obstetrics and gynecology — are experienced in outpatient settings.
  • The school initiated a new course, Rational Therapeutics, to reintroduce some of the basic sciences into the fourth year. The course is organized around clinical topics to reinforce clinical problem-solving skills in the use of drugs. Pharmacologic principles are covered as they become pertinent to the clinical situation.
  • The school developed and implemented a Physician and Society Course as a required course throughout all four years of the medical school curriculum. Two-hour sessions are held weekly in the first two years, and twice monthly in the clinical years. More than 60 faculty are involved in teaching the course, which focuses on the importance of social, cultural, economic, and ethical factors in the physician/patient relationship.
  • The school began implementing a Medical Informatics and Computers Program. Several hundred computers were purchased and connected to the Internet. Computer use has expanded into many courses that formerly did not use them. The program received national recognition when its design was used to inform the medical informatics objectives established by a panel of the Association of American Medical Colleges (AAMC), which represents accredited US and Canadian medical schools.
  • The school instituted revised policies and procedures for faculty advancement in March 1992 and expanded them in 1996. They specifically cite teaching as a criterion for promotion, and faculty members who have played significant roles in teaching continue to be rewarded with recognition and promotions.

Principal Problems

The grantee reported no significant shortfalls or problems in implementing the planned initiatives.

(For lessons learned by the sites in PPF, see Lessons Learned.)

Communications

Faculty members published 12 articles about the curriculum changes at JHUSM, and made 12 presentations. An Associated Press article about the project was printed in the Chicago Herald and other papers. In addition, written information (primarily annual reports) has been sent, upon request, to 32 American and 8 foreign medical schools. Catherine DeAngelis, vice dean for academic affairs, published a monograph that describes the Hopkins experience in revising their curriculum. (For a listing of communications activities, see the site's Bibliography.)

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AFTER THE GRANT

The Dean's Office has provided a full budget to continue the curriculum, making up for the financial support no longer provided by RWJF.

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GRANT DETAILS & CONTACT INFORMATION

Project

Preparing Physicians for the Future, The Johns Hopkins University School of Medicine

Grantee

The Johns Hopkins University School of Medicine (Baltimore,  MD)

  • Amount: $ 149,914
    Dates: September 1990 to February 1992
    ID#:  017241

  • Amount: $ 2,492,904
    Dates: March 1992 to June 1997
    ID#:  019642

Contact

Michael M.E. Johns, M.D.
(404) 727-5715
mmejohns@emory.edu
Edward D. Miller, Jr., M.D.
(410) 955-3180
emiller@jhmi.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Brandt K and Lehmann H. "Teaching Literature Searching in the Context of the World Wide Web." Journal of the American Medical Informatics Assoc, 2(Suppl.): 888–892, 1995.

Centofani M. "Evolving Medical Education." Hopkins Medical News, 16: 18–31, 1992.

Centofani M. "Carving Out the Next Generation of Physicians." Johns Hopkins Magazine, 1: 56–59, 1992.

Chang PP, Sosa JA, and Shatzer JH. "Involving Students in Curriculum Reform (letter to the editor)." Academic Medicine, 70(4): 253, 1995.

DeAngelis C. "Hopkins Implements Innovative Medical School Curriculum." Maryland Medical Journal, 42(5): 461–466, 1993.

DeAngelis C (ed.). "The Johns Hopkins Medical Curriculum for the Twenty-First Century." Johns Hopkins University Press, 1998.

George E, Eliasson M, Freedman J, and Lehmann H. "Computerized Interactive Clinical Case Presentation: Teaching Students to Think Like Neurologists." Neurology, 46: A117, 1996.

Lehmann H and Wachter M. "Delivering Structured Educational Images Over a Network." Journal of the American Medical Informatics Association, 2(Suppl.): 989, 1995.

Miller ME. "Inventing Patients." Dome, Publication of The Johns Hopkins Medical Institutions, 45: 4, April 1994.

Pangaro LN, Worth-Dickstein H, Macmillan MK, Klass DJ, and Shatzer JH. "The Performance of 'Standardized Examinees' in a Standardized-Patient Examination of Clinical Skills." Academic Medicine, 72(11): 1008–1011, 1997. Abstract available online.

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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

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