In response to major shifts in the practice of medicine and the unprecedented upheaval caused by the COVID-19 pandemic, Albert Einstein College of Medicine is transforming its medical education curriculum. New and enhanced elements include: compressing the pre-clerkship “basic science years” to 18 months; an expanded course in healthcare delivery and health equity; a mandatory service-learning component; and more focused training to prepare students for their rotations and residencies.
“Einstein is well known for its scientific and research excellence and dedication to social justice,” said Joshua Nosanchuk, M.D., senior associate dean for medical education and professor of medicine and of microbiology & immunology at Einstein, and an infectious disease specialist at Montefiore Health System. “Along with our commitment to our local community, these tenets were our guideposts when we started this curriculum renewal. With the help of an extraordinary team, we were able to make substantial changes very quickly and now have a truly novel and revitalized curriculum that will help us better prepare the next generation of physicians.”
Innovating Through COVID-19
Although Einstein continuously adjusts and improves its curriculum in response to changes in medical practice, technology, and student needs, the pandemic jump-started this curriculum overhaul.
“This pandemic has brought almost unimaginable loss and devastation to our community,” said Todd Cassese, M.D., associate dean for medical education, associate professor of medicine, and a hospitalist at Montefiore. “But it also forced us to innovate and develop new approaches to educating our students while keeping them safe. This opened up opportunities for us and our students to consider implementing appropriate changes to the curriculum and to accelerate our plans for renewal.”
Earlier this year, several internal committees and Gordon Tomaselli, M.D., the Marilyn and Stanley M. Katz Dean at Einstein, approved and accepted the changes. The curriculum renewal also was approved by Einstein’s accreditation body, the Liaison Commission on Medical Education.
Integrating Across the Years
One of the most significant changes to the curriculum is the integration of basic, clinical, and health system science across all four years of medical education. The standard medical school approach is to deliver basic science instruction during the first two years, shifting to clinical training in hospital-based rotations for the last two. Now, Einstein students will be exposed to patient care within the first two months of their first year, and have ongoing clinical opportunities while focusing on their basic science coursework. Students will also continue learning basic science as it relates to the clinical care of patients through the end of their final year at Einstein.
“Our goal is to ensure that our students’ clinical work is grounded in and informed by science, and vice versa. By entering the clinic earlier, they will immediately start learning—both first-hand and in class—how the healthcare system works, and how to integrate their academic knowledge to provide better care to their patients,” said Dr. Cassese.
Addressing Health Equity
As part of the integration, Einstein has introduced a new 50-hour course in health systems science and health equity that students will take over all four years. Health systems science is the field of understanding how health care is delivered, how health and medical professionals work together, and how the health system can be improved to advance patient care.
“Health systems science is where the rubber hits the road, where training becomes practice,” Dr. Cassese said. “It builds on the students’ scientific and clinical knowledge to develop higher-order skills, such as critical reasoning and clinical decision-making.” These skills are necessary to effectively manage more complex cases, such as patients who have multiple diseases, and they lay the groundwork for the future doctors to successfully advocate for their patients.
“Through this course, our students will gain an understanding about how our healthcare system works—or doesn’t work—and how they can improve their own clinical ability while also learning their role in changing the system so it becomes more efficient, equitable, and just,” said Oladimeji Oki, M.D., assistant professor and assistant clerkship director of family and social medicine at Einstein who is directing the new course. “Addressing equity here and beyond Einstein’s walls will require an exploration, not only of individual factors contributing to disparities, but the larger institutional and systemic factors.” Dr. Oki is also a family practitioner at Montefiore.
The course’s coverage of health equity and health disparities will include lectures and case studies on social and structural determinants of health, the specific challenges patients face, and solutions to achieving better access to quality care. “It’s not only learning that, for example, many of our Bronx residents are diagnosed at a later stage of disease compared to the national average,” said Dr. Cassese. “It’s also asking, ‘Why is that?’ Is it their lack of insurance? Citizen status? Distrust? Something else? And how can we, as individuals, as a health system, start to dismantle these obstacles?”
Early Start in the Clinic
Beginning with members of the Class of 2025, who come to campus this August, medical students will complete the first part of the curriculum, often referred to as the basic science curriculum, in 18 months rather than two years. The total number of hours of basic science instruction will actually increase, as topics will be integrated on continually advanced levels throughout all four years.
Students will also gain an earlier opportunity to interact with patients.
“We’re going to ensure that our students—even though they can’t do physical exams yet—have clinical experiences during their first month at Einstein,” Dr. Nosanchuk said. “One of the first skills they will learn is how to take a medical history. Immediately, they can join in on patient visits and ask about their medical issues or prior health conditions, under the appropriate supervision.”
Ready for Rotations
While students will begin to engage with patients in their first semester, there is still a significant shift in responsibility once their clerkships begin. To better prepare students for their rotations, Einstein has already launched a nine-week “transition to clerkship” course, with case studies, small-group activities, and clinical skills and reasoning exercises. The course covers a wide range of topics, including implicit bias awareness and mitigation, interprofessional education, telehealth, patient safety, and phlebotomy skills.
"We performed a needs assessment and listened closely to the advice from medical students, faculty, and clerkship directors. As a result, we were creative in designing content that includes the information and skills our students need to navigate through and thrive during the clinical years and beyond,'' said Claudene George, M.D., M.S., associate professor of medicine. Dr. George and Sandra Oza, M.D., associate professor of medicine, were instrumental in building the course and are overseeing its implementation. "We have also included a number of self-directed learning activities, which will help them in their future careers and help to build a path towards life-long learning,” added Dr. George.
After the course, students begin six-week rotations in six areas: general surgery, internal medicine, family medicine and ambulatory care, pediatrics, obstetrics and gynecology, and psychiatry and neurology. The new schedule will provide time for an elective rotation during their third year, allowing students to explore other specialties prior to applying to residency programs.
The fourth-year curriculum also will expand to include independent professional development experiences, such as opportunities for mentored research projects and “acting” internships, in which fourth-years can assume a level of responsibility similar to first-year residents.
Starting in 2023, graduating students will be required to attend a “residency boot camp,” which will provide general guidance on common medical scenarios, note writing and presentation skills, as well as education tailored to their residency specialty. Students can attend the new boot camp this year and next on a volunteer basis.
“The goal of the boot camp is to provide rising interns with the knowledge and skills to be successful from day one,” said Maxwell Bressman, M.D., an instructor in the department of medicine at Einstein and an internist at Montefiore. “As the course develops, we will expand the curriculum to provide education on a range of subjects outside of the scope of many medical school curriculums, such as more in-depth discussions around palliative care and self-care/personal wellness.”
Learning From and Giving Back to Our Community
Faced with the COVID-19 pandemic, Einstein students rose to the challenge and created numerous programs to help the Einstein-Montefiore and Bronx communities. Nearly 400 students logged more than 10,000 volunteer hours in the spring of 2020, as cases surged in New York. And more recently, almost 100 volunteered to deliver the vaccine or act as vaccine coordinators.
This was part of a long tradition among Einstein students. From the establishment of the student-run ECHO free clinic in 1999, to the dozens of student clubs that partner with our Bronx community, service learning has long been an integral, although informal, part of the Einstein experience.
“Students learn critical lessons through these programs, most notably about the social determinants of health and the importance of advocacy,” Dr. Nosanchuk said. Now, this component will become a required part of the formal curriculum. The newly reorganized class schedules will ensure regular days off for each academic year, allowing students to make larger commitments—to a volunteer project, an outside organization, or in a research lab.
“We want students to be working over their four years toward something that truly impacts science research, social justice, or the community,” said Dr. Nosanchuck, “whether it’s through our health system, our medical school, or our research labs. We expect this new curriculum will provide them with the skills, experiences, and opportunities to do that.”
Posted on: Tuesday, May 04, 2021