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Frequently Asked Questions about the Integrated Pathways Curriculum (IPC)

Foundation Phase – 18 month

Will a shortened pre-clerkship curriculum make the first 18 months more difficult?

No.  We are not taking 2 years of learning and squeezing into 18 months. The pre-clerkship curriculum, or Foundations of Clinical Medicine phase, can be shortened because of the following changes:

  • Reduction of unnecessary repetition of material because students no longer learn normal functioning the first year and abnormal functioning/disease the second year
  • Foundational science is moved into the Core and Advanced phases
  • Less time spent taking tests

How are basic science and clinical knowledge learning integrated in the Foundation Phase?

  • Basic science and clinical faculty are co-designing the curriculum to highlight linkages between foundational science and the competencies required of a physician.
  • Students use the same clinical cases to learn medical knowledge and patient care skills
  • Students learn anatomy, physical exam skills, and clinical reasoning in linked sessions

How do the classes connect? How is basic science integrated with clinical knowledge?

The clinical and basic science faculty who teach in the Foundations years have designed the Integrated Pathways Curriculum so that the classes and learning activities each week relate to each other and the material that is to be learned by the students. For example, the asynchronous biostatistics and epidemiology sessions use material related to the week to teach that material. Anatomy lab includes radiology and imaging and is directly tied to learning the physical exam. Because we teach normal structure and function in close relationship to disease and clinical skills it is easy to integrate basic science with clinical knowledge.

Is everything still systems based?

Yes. Our units are designed so that students learn within the context of systems. The first unit focuses on homeostasis and the musculoskeletal system, the second unit on biochemical, molecular, cellular, and genetic basis for disease, the third unit on the human response to infection and inflammation, the fourth unit on the gastrointestinal and endocrine systems, the fifth unit on the circulatory, urinary, and pulmonary systems, and the six unit on the central nervous system and the mind.

What do students think about overlapping learning normal function and abnormalities in this systems-based curriculum?

Most of our students think that it is easier to learn and remember when “normal functioning” is taught in close proximity to learning about illness and disease.

What are the clinical experiences the first year?

Students learn how to perform a physical examination in the first Unit when they are introduced to human structure and function. In the second Unit, students begin to spend an afternoon every other week in a physician’s office. In the office, students will begin to practice some patient care skills such as interviewing and performing parts of the physical exam. This experience continues throughout the year.

For the doctor’s office experience in the first year, can you select who you work with?

Although we attempt to match students with preceptors based on factors such as location, students do not select with whom they will work with in the doctor’s office.

How will the doctoring program integrate into the IPC?

SUNY Downstate groups the knowledge, attitudes and skills required of a physician into six physician competencies. In the past, we have taught some of these competency skills such as medical interviewing in a separate doctoring or Essentials of Clinical Medicine course. In the IPC, there is no longer a separate course for learning physician competencies.  The competencies are learned in an integrated fashion during Foundations and assessed at the end of each unit.

Daily Schedule

What does a sample week’s schedule look like?

Sample Week Schedule

Each of the six units has clinical cases that help to organize the material within the unit. These cases are Problem Based Learning cases and the first case is always held with a student’s small group clinical preceptor who uses the case to help the students learn clinical skills and develop the learning issues for the next Problem Based Learning sessions. In the PBL sessions that follow this initial session, students discuss learning issues and develop new issues for the next session.

Other activities in the week include interactive lectures, physical exam labs in which students learn and refine their skills in physical examination, problem solving sessions, and interdisciplinary laboratories in areas such as anatomy. Beginning early in the first year, students spend an afternoon in a physician’s office every other week. Hours of required activities are not more than 25 hours in each week.

What is the size of the small groups?

Small group size depends on the activity. Physical exam labs are in groups of 8 students, problem solving activities in group of 4 to 6, and problem based learning groups in groups of 12.

Are the faculty members who lead the small groups going to stay with the group for more than a week or do they change according to topic?

Students in each of the clinical small groups (including the first session Problem Based Learning session) will have a single faculty preceptor for the year to ensure continuity. For other sessions, we are planning to have the same faculty member facilitate as much of the unit’s Problem Based Learning sessions as possible.

How much time will be devoted to team-based learning vs. lecture?

The Integrated Pathways curriculum emphasizes student-centered, active learning. Lecture time, and total classroom time, is somewhat reduced, lectures feature more interaction, and active small-group modes such as Problem-Based Learning get somewhat more emphasis. Team-Based Learning, a newer activity, is still in development and will be a small curricular element at first, pending the opening of a new learning space in our new academic building that is better suited for that mode than our current facilities. The opening is expected for 2015.

Grading and Assessment

What are the Gateways?

The Gateways are evaluation points located at the following points of the curriculum; before the second year of the Foundations of Medicine curriculum, before entering the Core Clinical phase or clerkships, before the Advanced Clinical phase and in the last year of the curriculum. These are points in the curriculum at which students reflect on their mastery of the six competencies and the faculty certify that the students meet expectations in the competencies and are ready to proceed to the next portion of the curriculum, or in the case of Gateway 4, graduate.

Will there be a simulation center used during the first two years?

This current center is located in the library. Construction of a new building with a state of the art simulation center and standardized patient center is anticipated to be completed in 2015. Until completion of the building, there will be some focused use of simulation and task trainers for learning. 

What is the grading and ranking system?

The grading system in Foundations of Medicine is Pass/Fail.   Excellence in the attainment of six competencies will be recognized by “pass with distinction” designation.  The grading in core clinical rotations and beyond is tiered (Honors, High Pass, Pass, Conditional, Fail).

Is there an internal ranking in place within pass/fail?

There is no internal ranking for Foundations of Medicine.  Students will be provided with a supportive learning environment in which they will receive regular feedback on their strengths and areas to improve.  They will receive feedback according to benchmarks mapped to professional standards, not to other students.

What is Distinction in Foundations of Medicine?

Students who excel in IPC across all 6 competencies will be recognized at the end of Foundations of Medicine by being awarded a “pass with distinction” which implies meritorious performance across all six competencies and reflections that indicate self-awareness and the ability to identify his/her own strengths and areas of improvement.

How is feedback given for formative assessments?

After the deadline for completion of formative assessments, the correct answers are released for all weekly formative assessments.  Students may discuss their performance with their advisors and receive support for mastering areas that they identify as needing improvement.  Formative feedback is continuous and just-in-time.  The assessments are tied to the concepts of the week and students may monitor their progress as they proceed through the curriculum.

Students and the Integrated Pathways Curriculum

Was the curricular change as a result of the student feedback?

In the fall of 2008, Downstate began a scheduled review of our curriculum that took into account the changing landscape of medicine and medical education. Three faculty/student committees and one student committee produced reports that formed the basis of the recommendations for the IPC. The Steering Committee for Curriculum Renewal also had student members. Here is some of the feedback from the student report that contributed to our IPC.

  • Learn the physical exam and have more clinical “hands on learning” in the first year
  • Case-based Learning should include more active teaching by students
  • Lectures should be geared toward clinical medicine
  • More mentoring by faculty members

Will upper-class students help the students in the Integrated Pathways Curriculum considering that the upper-class students do not have experience with the IPC?

Our students are wonderful teachers and mentors to younger students. In many cases our upper-class students will be able to help our first year students. For example, our second year students from the current curriculum will be able to help with anatomy and our third and fourth year students will be able to help with other parts of the curriculum. The Office of Education will be keeping a close eye on our incoming students need for support and be able to make sure help is available to all.

Has the new curriculum been partially tested on other students?

We began piloting new features of the Integrated Pathways Curriculum a few years ago with activities such as integrating imaging and with anatomy, using simulation and portable ultrasound, and team-based learning sessions.

Will there be a way for students to provide feedback?

Student feedback is solicited formally at the end of each course of the curriculum and each segment.  Students are invited to complete an anonymous online self-administered survey.  In addition, informal feedback is also solicited and welcome.  Students provide comments to faculty as the curriculum unfolds.  We respond to feedback and welcome it!  It provides us information to improve.  Remarkable changes have been implemented by faculty on the basis of a single student’s thoughtful and perceptive comments.  Giving feedback as well as receiving feedback is an important area for professional growth and development.

Is the medical school administration receptive to making adjustment to the curriculum if students suggest areas of improvement?

Absolutely. We depend on dialogue with our students to make sure we are continuing to improve our curriculum. Our Student Liaison Committee will meet with the curriculum leadership after each unit to provide feedback and input into change. We will also survey our students for feedback on the curriculum.