UND photo by Chuck Kimmerle

Training Tomorrow’s Doctors

with Patient-Centered Learning

Jon Allen, M.D. ‘84, associate professor of internal medicine, recalls the days when a medical student would enter a patient’s room and fumble through an awkward exchange, not exactly sure what to say or do.

“You could just tell they were insecure.  It was very easy to tell they were third-year medical students,” he said.  “And the patient would say, encouragingly, ‘You’ll be a good doctor someday.’”

Today, with the UND medical school’s curriculum focused on patient-centered learning (PCL), students are much more adept, comfortable and “ready to roll” when they get on the wards, says Allen, who played a major role in developing the clinical teaching components of PCL.  “Now you’d have a hard time telling if they’re a resident or a student.  Their skills are so advanced and they know how to interact with patients.”

Not too surprising.  By the time they complete their first two years at UND in Grand Forks, they have dealt with 64 patients, on paper, one each week.  Including the patients they have “seen and examined” as part of clinical skills testing and those they process during exam week at the end of each block, that number jumps to well over 100.

What’s different?

Since 1998, the UND School of Medicine and Health Sciences has offered a medical curriculum that places the patient at the center of learning.  This patient-centered learning approach was launched only after several years of work and study by the faculty and consultation with other schools that had initiated this method or a version of it.

“We’ve integrated clinical medicine basically from day one,” Allen said.  “Students have exposure to patients and clinical medicine early on, so it makes the transition to the clinical (third and fourth) years easier...  It’s not as scary for students to begin interacting with patients as it was under the former, more traditional curriculum.”

In the past, first- and second-year students typically had little or no contact with patients.  In a curriculum heavy with lectures, they were busy memorizing volumes of basic science information usually for the sake of exams, without a clear understanding of how this information would be used or how to apply it to a patient case.

“We weren’t allowed to touch a patient until the third year of medical school,” Dean H. David Wilson, M.D., recalls.

Now, with two years of studying patients under their belts, third-year med students “are far more advanced” than they were in the past, Allen said.  “They are more comfortable with doctor-patient interactions and further ahead in clinical skills, interviewing and clinical examination because they’ve had so much practice already.

“They are more advanced in clinical-reasoning skills,” he says.   “They’re taking medical knowledge and applying it to the clinical setting much more effectively than in the older curriculum.”

Why change?

What are the reasons for changing the curriculum offered in medical school?  Why did medical school leaders feel so strongly a need for curricular reform?

Jon Allen, M.D. (left), associate professor of internal medicine, and Richard Vari, Ph.D., associate dean for medical education, are instrumental in the development and implementation of UND’s curriculum, focused on patient-centered learning.  UND photo by Chuck Kimmerle.

Richard Vari, Ph.D., associate dean for medical education and an

early leader in the reform process at UND, says the faculty saw burnout in the faces of students and wanted to do something to change it.

Explaining the flaws in the traditional model of medical education, he says, “We took the finest young people, right out of college, full of altruism and enthusiasm, and we essentially beat them down.  In two years, we made them hate the basic sciences, because all they did was regurgitate it.  We never asked them to learn the basic sciences in context.  They sat in lectures and labs for eight hours every day.  It was like boot camp.Typically, by January of the first year, they were burned out.”

Now “we give them a fresh patient every week,” Vari says, “They are learning basic science in the

context they’ll use it every day.  Students are engaged in their learning, and they value it more.  They learn to think from the very beginning.”   

“We’ve integrated all the basic sciences (in the patient cases), and they process that information with every case,” he says. Students don’t just remember basic science information for tests, but learn how it applies to patients even from the very beginning.

They also learn where to find information, he adds.  “They become more vested in life-long learning,” a critically important trait in any health care provider.

After eight years in use, how has the PCL curriculum held up? “The major concept, the structure and design, has remained intact,” Vari says.  “We’ve changed some of our assessments (and) improved . . . clinical skills teaching in interviewing and psychological aspects . . . We’re holding to our standards.”

Evidence of excellence

What confirms that this curriculum is preparing students well for a career in medicine? Medical schools nationwide are recognizing the importance of patient-centered learning, yet just a few, including the UND medical school, are supporting a fully integrated PCL program.  While larger schools struggle with budgetary and staffing needs, the size of the UND school has worked to its advantage and the school has thus become a national role model for patient-centered learning and medical education in the 21st century.

Jon Allen, M.D. (left), associate professor of internal medicine, teaches Eric Fenstad, Fargo, and Michelle McCann, Grand Forks, second-year medical students, how to palpate the spleen. UND photo by Chuck Kimmerle.

Board scores for USMLE Steps I and II are as good or better than in the past, Vari says.  When students take shelf exams in various disciplines, during clerkships in surgery, pediatrics and internal medicine, for example, their scores are higher than the national average.

Vari points to the school’s selection as one of eight medical schools (and the only community-based school) to be studied for the Carnegie Foundation’s report on the status of and promising practices in

medical education in the United States - a rare honor shared with schools such as Harvard, the University of California-San Francisco and the University of Pennsylvania.

It is clear from the data the Office of Medical Education (OME) collects that “students perceive themselves as more confident in their abilities and more competent”... so “student satisfaction is very high,” he says, noting that OME seeks student feedback regularly.

“We know that most students come to this school because of the curriculum,” he says. “This is their first choice.”

return to top