The doctor calls you in. Despite the framed certificates and degrees on the walls, they seem out of their depth. They brusquely deliver upsetting news before ushering you out the door. This is an intolerable patient experience – but it’s not an uncommon one. It stems from an old-fashioned approach to curriculum delivery, and it makes for unhappy doctors and disempowered patients.
So, how can medical schools avoid producing these kinds of graduates? And what is the optimal way to train excellent doctors?
In reviewing our medical curriculum, we began by considering the evolving world in which future medical graduates will practice.
- It’s a digital world – patient records and databases are online
- Technologies such as artificial intelligence and robotics are playing greater roles in diagnosis and treatment
- It is highly influenced by climate change and environmental factors, with emerging diseases, environmental pollution and heat and cold stressors having a growing impact on public health
So, what do doctors need in this rapidly changing world?
They have to think on their feet, learn fast and be able to embrace change. It is a demanding profession, sometimes stressful, so resilience and self-awareness are key for any medical graduate to flourish.
- ‘This is going to hurt’: taking the pain out of group assessment
- How to build competency-based assessment into a clinical supervision course
- How can we help students manage frustration and build resilience?
Most of all, perhaps, they need a “growth mindset” – the belief that they can improve and grow – and this is something good teaching can provide in spades.
How to build a growth mindset
This is why we ditched traditional medical exams and moved towards programmatic assessment.
What is this? Instead of big exams stretched across their education – and a big, high-stakes final at the end of it all – medical schools should consider introducing low-stakes assessments throughout the year, as well as progress testing across the years.
With constant feedback, it shifts the focus from grades to growth, and with progress testing it means a first-year medical student could consider a case or scenario and apply the learned concepts to a final-year question.
There’s less of a focus on passing or failing. Instead, students can focus on improvement and understanding. They get constant feedback throughout their course, leading to more self-reflection, which, in turn, builds confidence for the lifetime of continuous professional development that comes with being a doctor.
How to integrate foundational and clinical sciences
Good teaching and good learning are not just intertwined; they’re two parts of the same body. With programmatic assessment, teachers look to encourage engagement by finding new growth and learning opportunities for our students.
Consider introducing content in a spiral manner. This means that, as students progress through the years of the programme, they will revisit topics or themes.
In the earlier years of their medical education, the focus is on a case-based learning approach, which deeply enhances student understanding, focusing on the integration of foundational and clinical sciences. This takes place in small groups of 12.
For example, we introduce our first years to “Kate”, an 18-year-old university student experiencing persistent fatigue.
In this scenario, Kate is tired all the time and not sure why. She is experiencing heavy periods, which allows the introduction of the concepts of menorrhagia (heavy menstrual bleeding) and anaemia; in turn, this allows us to teach about the anatomy and physiology of a red blood cell, and weave in pharmacology, psychiatry and treatment options.
This patient-centred approach allows first-year medical students to explore clinical conditions from the outset. It also makes learning more manageable and real than an education where students learn foundational sciences in the abstract.
It requires students to make connections between different concepts in real time, which is how doctors work in reality.
With case-based learning, students can:
- Be assessed, through low-stakes tests and assignments, on what they have learned about these real-life medical scenarios, teamwork, collaboration and their communication with colleagues in small groups
- Put their learning into practice
- Learn and grow from any mistakes or errors
With a spiralled curriculum, it will not be the last time these students consider menstruation, anaemia, blood cells, anatomy or physiology throughout their medical education. Because these are concepts they will repeatedly encounter throughout their career, repetition can help consolidate learning.
Later in their education, during their placement periods, Entrustable Professional Activities focus on practical competence and individualised learning through supporting them to perform tasks and operations without direct supervision.
How students respond
The feedback from our students has been overwhelmingly positive, and both learners and faculty are seeing meaningful improvements. However, implementing such a change is not without its challenges. The shift to real-time progress tracking through live dashboards requires new technologies, and the transition demands careful attention to governance and staff workload.
But it is worth it. By supporting students in developing both personal and professional identities, the curriculum fosters deeper self-awareness and resilience, making for better, more resilient and happier patients and doctors alike.
Gozie Offiah is associate professor and director of curriculum at RCSI University of Medicine and Health Sciences.
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