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DEAN’S MESSAGE
important, but mandatory; after all, nearly everything a physician The change is one of both mindset and culture. Many faculty
does is team-oriented. The relationships they build with each members report that the process forced them to think about their
other and with the assigned faculty members become an integral work as professors in a new and creative way. One described the
part of their learning experience. previous curriculum as being passive, with lectures consisting of
slide after slide while students sat silently. Now, faculty members
The benefits of this team-based approach are many. Because are actively engaging with students in an exchange of information.
students are required to work closely together, even conducting
peer evaluations, they learn professional navigation skills. Teams Many faculty members also report that, like students, the new
also provide learning support. Even for driven, gifted students curriculum requires them to work harder, yet they also cite a re-
who are accustomed to working independently, the team can ex- newed sense of excitement for their disciplines and interactions
pose them to new perspectives, ideas, even new questions. In a with colleagues. Team-based learning activities also require in-
group setting students learn how a broader perspective and col- depth collaboration among faculty members. Basic science and
laborative effort can benefit them as individuals, and clearly ben- clinical faculty have forged meaningful relationships with each
efit their future patients. Close access to a faculty member also other through this integration. Faculty members who had little
creates a setting in which students can more easily get answers to reason to interact in the past now collaborate to design and write
questions that are challenging to them. each learning module, from the syllabus to exam questions. The
collegiality and sharing of different perspectives has been very ben-
Clinicians also facilitate the teams’ activities, in which student eficial to both faculty members and students.
teams practice real-world reasoning in a formative setting where
they are not graded, gaining valuable experience and coaching in Another benefit of the new curriculum is that it is student-cen-
discussing cases or constructing diagnostic plans. This gives stu- tered. Contributing to this is a shift in the way content is chosen.
dents a “safe” way to comfortably try these activities with a dedi- To better serve students, we ensure that the information included
cated clinical teacher there to guide them. in each module is more objectively analyzed for its role before
being selected as part of a comprehensive program. Instead of in-
Our CIRCLE curriculum gives students the clinical skills and dividual departments or faculty members, the Curriculum Com-
knowledge to go in and identify a chief complaint in a systematic mittee now has the final determination over content. If
way. By the end of their first semester they know how to perform information has been included previously that is no longer critical,
a complete history and physical exam. They then learn to apply the curriculum committee has the authority to remove or replace
these skills to pathological conditions to generate a differential di- it. This is a key difference that has contributed to a more robust
agnosis and evaluation of common presenting complaints. learning experience.
Now there is more emphasis on clinical reasoning and devel- Once content is selected, faculty works with the team at the
oping a differential diagnosis using assessments called trans-mod- Office of Undergraduate Medical Education (UME) to determine
ule cases, with standardized patients. We train and then task the best way to design and deliver the information, whether it is
students with demonstrating their emerging ability to reason and a lecture, an interactive lab, or an online activity. UME involve-
apply the skills they’ve learned in patient examinations. For ex- ment also ensures more consistency in the way coursework and
ample, instead of instructing a student to interview a patient with requirements are structured among the specialties, making it easier
an asthma attack, the student instead talks to a patient who com- to identify gaps or unintentional redundancies in the material.
plains of shortness of breath, chest pain, or abdominal pain.
The CIRCLE framework also lends itself to adjustment and
This new student-centered curriculum demands more of both adaptation. It is more responsive to feedback from students and
students and faculty. While building this new curriculum required faculty, as well as to important emerging trends in medical edu-
a tremendous amount of time, skill and communication, faculty cation. Because it is an integrative process, there is an ongoing
relished the opportunity to create new materials, develop new fine-tuning and adjusting of courses.
courses and convert a passive learning, lecture-based course pres-
entation to a more active modality. Four years into the CIRCLE curriculum, the results are prom-
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