Frequently Asked Questions about the Integrated Pathways Curriculum (IPC)

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

• 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

The clinical and basic science faculty members 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.

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.

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.

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.

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.

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.

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.

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.

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.

The Integrated Pathways curriculum emphasizes student-centered, active learning and incorporates multiple teaching modalities including lectures, case-based learning, team-based learning, Problem Oriented Patient Sessions (POPS), laboratories, and patient skill laboratories. 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.

Lectures are used to ensure conceptual understanding of difficult material, emphasize key concepts and principles and provide an organizational structure on which to build new learning. Lectures are meant to be interactive—that is, they will involve students in problem solving, demonstrations, or discussion.

Team based learning occurs throughout the curriculum, including both the Foundations and Clinical Years and is an example of a “flipped classroom” approach to education. Students are expected to familiarize themselves with topics assigned prior to the session. They are assigned to teams in class. The session begins with a pre-test, which is taken by the individual student, and then repeated by the team. The teams then address a problem or problems to solve regarding specific topics and asked to answer questions. All teams come together and discuss their rationale for answer choices and a subject matter expert is present to help facilitate the discussion of confusing concepts.

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.

Yes, our facility is in its first phase of development and consists of 2 patient rooms separated by a control room. We have an iStan and NOELLE, high fidelity robotic mannequins, that facilitate the identification of pathologic physical exam findings and foster the development of clinical reasoning and procedural skills.

Some examples of our task trainers include phantom torso's and arms permitting trainees to practice central and peripheral intravenous line placement, transvaginal ultrasound, airway mangement, breast exam, pelvic exam and rectal exam . A compact ultrasound system and additional tissue phantoms allow our trainees to learn bedside limited ultrasound and to practice ultrasound-guided techniques for invasive procedures.

An integrated computer based learning system tracks educational sessions and manages and serves real time clinical educational content on mounted monitors in the simulated patient rooms.

Undifferentiated Severe Illness

This simulation based course for 3^rd and 4^th year students teaches identification and initial management skills for the patient with undifferentiated severe illness.

Ultrasound Guided Procedures

Through didactic and hands on training, 4^th year students learn several clinically relevant bedside ultrasound guided procedures. Topics include peripheral and central line catheterization, nerve blocks, paracentesis, and thoracentesis.

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).

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.

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.

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.

Three phase structure of the four years of the new curriculum:

The curriculum is divided into three curricular phases with four promotion Gateway points. All six of Downstate College of Medicine competencies are taught and assessed during the entire curriculum.

Phase 1: Foundations of Medicine

Throughout this 18 month phase of the curriculum, students develop the foundational understanding and skills necessary to begin to care for patients on clerkships. Students begin to form their professional identity from day one as they learn clinical skills, foundational medical knowledge, and the skills needed to develop into life long learners.

Phase 2: Core Clinical Medicine

Paired clerkships during the 12 months of Core Clinical Medicine enhance interdisciplinary teaching across clerkships and support integration of relevant basic science knowledge.

Phase 3: Advanced Clinical Medicine

The 14 months of Advanced Clinical Medicine is designed to prepare students for post-graduate training and life long learning. Students are required to learn to care for complicated and/or unstable patients as well deepen their understanding of translational science.

Gateways 1, 2, 3, and 4

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, 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.

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.

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.

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.