A More Perfect Union

The new curriculum reflects the school’s overall efforts to better intertwine the basic and clinical sciences

By Susan Ipaktchian
Illustrations by Stan Fellows


Medical science has changed a lot in the past 90 years. Medical education, until relatively recently, has not. Despite the explosive growth of scientific knowledge in recent decades, American physicians are still largely being trained under the model developed in 1910 by Abraham Flexner that calls for two years of basic science courses followed by two years of clinical training with very little overlap between the two.

Today’s medical students face a fast-paced world of discovery in which some elements of their basic science training may be outdated by the time they complete their residencies while, simultaneously, the connection between bench and bedside is growing tighter. Many U.S. medical schools are in various stages of revamping their educational programs to reflect those realities.

The Stanford School of Medicine stepped into the education reform spotlight this fall with the launch of a new curriculum aimed at instilling in students a lifelong passion for learning while equipping them with the tools to translate laboratory discoveries into life-enhancing therapies throughout their careers. The new curriculum introduces stronger clinical training earlier in the education process, adds basic science “refreshers” during the clinical years and requires students to participate in a scholarly concentration, or medical major, in which they can hone their research skills while developing early expertise in a topic that excites them.

And while the new curriculum is the most visible change at the medical school these days, it’s far from the only one. [See “Strategic Steps,” below.]

For the past two years, the school has begun implementing a broad-based strategic plan to focus education, patient-care and research activities on translational medicine in a quest to speed the time in which scientific discoveries become mechanisms for improving human health. In short, the school wants to foster a greater partnership between its research and clinical components.“We are at a point in time in medicine where we have the greatest opportunity to make a difference from a research perspective than has ever existed and that may ever exist,” says Dean Philip Pizzo, MD, the Carl and Elizabeth Naumann professor of pediatrics and of microbiology and immunology. “We are also at a point when there are significant factors that could interrupt the success of those programs. To me, this is the moment at which Stanford should – as an elite, small, focused, research-intensive school of medicine – emerge as a model and leader.”


Pizzo:”This is the moment at which Stanford should — as an elite, small, focused, research-intensive school of medicine — emerge as a model and leader."

To reach this goal, it was vital, says Pizzo, to reassess the medical curriculum and make changes in concert with an overhaul of the school’s financial structure – so that educational activities would be properly supported. “It was also imperative to shape the educational program so that we could really understand the kinds of facilities we would need to deliver it.”

There was also a feeling among some faculty and school leaders that, as strong as it was, the school’s curriculum needed updating so that students emerged with the skills they would need for 21st-century medicine. “Stanford is not simply about training physicians or clinicians,” Pizzo says. “That’s a really important thing to do and we will continue to do that, but we want to do something more. We want to equip our students with skill sets that will enable them to become leaders who will help to shape the medicine of the future.”

The team of faculty and students involved in developing the new educational plan had three main objectives: to reflect the evolving nature of medicine; to make the learning process more dynamic; and to enable students to capitalize on the opportunities for interdisciplinary study available, not only at the medical school but throughout the Stanford campus.

What emerged is the New Stanford Curriculum, which differs dramatically from the traditional model. Many of the basic science courses — including histology, physiology and pathology – are being restructured and will be team-taught around organ systems rather than as separate disciplines. The restructuring will make the classroom portion of the curriculum more efficient and effective, freeing up time for students to participate in a scholarly concentration by selecting an area of study and then completing an in-depth research project on a topic that interests them.


Parsonnet: “Our students will have the opportunity to do something unique and interesting that they’re passionate about.”

“Our students will have the opportunity to do something unique and interesting that they’re passionate about,” says Julie Parsonnet, MD, senior associate dean for medical education and associate professor of medicine (infectious diseases). “Through the scholarly concentrations, students will choose how to intertwine the basic and clinical sciences for their projects.

“As our students choose their in-depth projects, we want them to look at the role of physicians in the community and learn how to become advocates for individuals and for biomedical science. We want their scholarly concentration work to be something that’s sustainable throughout their careers,” Parsonnet adds.

Key aspects of the first two years of the new curriculum are:

• During the first two quarters of the first year, students will take foundation courses such as anatomy, genetics, developmental biology, neurobiology and immunology.

• During spring quarter of year one, students will begin their interdisciplinary organ-based systems instruction, which will focus on the heart and lung. Autumn quarter of the second year will focus on the kidney, gastrointestinal system and the blood, while the winter quarter focus will be the brain, endocrine/reproductive system and multi-organ systems.

• All 8 a.m. classes have been eliminated and Wednesdays are open, giving students time for research and academic exploration. Beginning in the spring quarter of the first year, students will also have two additional free afternoons. To accommodate this time, the first quarter was lengthened and now begins three weeks earlier in September.

• Throughout the first two years of the curriculum, students will participate in eight hours of instruction in clinical sciences, with at least one hour spent in clinical correlates tied to a condition the students are studying. Students will develop their clinical skills (interviewing patients, conducting a physical exam, cultural sensitivities and ethics) in simulated environments that will prepare them to begin interviewing patients sometime in the winter quarter of the first year.

• Toward the end of first year’s spring quarter, students will begin identifying the scholarly concentration that interests them. The initial eight concentration areas are biomedical ethics and humanities; bioengineering; biomedical informatics; immunology; public service and community medicine; women’s health; health services and policy research; and molecular and genetic medicine. Five other areas – international health, imaging, infectious disease, cardiovascular medicine and clinical investigation – are being developed and could be available later this year. If students find none of the concentrations appealing, they can create their own under a faculty member’s supervision.

• In each concentration, students will take a group of core courses in addition to participating in journal clubs and small-group activities. For their individual projects, students can choose whether to spend a year on original research or use available information to investigate an original question they develop. School officials believe most students will complete at least two-thirds of their work in the concentrations before heading into their clinical clerkships.

While the curriculum for the first year has been finalized, details for the remaining years are still being solidified. The new curriculum applies only to this fall’s entering class, although interested second-year students can participate in the scholarly concentrations. “Current students are saying that they wish they had the opportunities that will be available through the new curriculum,” says Al Taira, who is entering his fourth year of medical school and helped develop the new curriculum.

So do some faculty members, adds Oscar Salvatierra, MD, professor of surgery (transplantation) and of pediatrics who also chairs the school’s Faculty Senate. “I’ve had several faculty members say that they wish they were back in medical school,” he recounts, pointing out that all of the curriculum changes were approved unanimously by the senate. “The medicine in the early part of this new century really involves basic science as an integral part of the practice. Translational medicine is the future; we just have to make it applicable to everybody.”

Pizzo, Parsonnet and Salvatierra have high praise for the faculty, students and staff involved in the difficult and complex effort to develop the new curriculum. Among the key groups are the school’s Committee on Courses and Curriculum (chaired by Ted Sectish, MD), the Office of Medical Education (directed by Elizabeth Porter), the dean’s office and the course directors. “Our timeline in making these changes would not have been even remotely possible had there not been very strong collaboration between various members of this community,” Pizzo says.

He acknowledges that the aggressive timeline concerned some faculty members who felt the school should delay implementation for a year to work out more of the details. “It’s my view that education and curriculum change are lifetime works in progress. You never quite get it right; you just have to keep working at it. I felt very strongly that it was more important for us to move forward than it was for us to wait and ‘get it perfect.’ ”

In addition to concerns about the speed and magnitude of the curriculum changes, some faculty members also worry that the emphasis on the scholarly concentrations might weaken the role of basic science courses. Neil Gesundheit, MD, associate dean for medical education and associate professor of medicine (endocrinology), says the school will closely monitor students’ progress to ensure that the hoped-for success of the scholarly concentrations doesn’t come at the expense of the basic sciences.

School officials are prepared for bumps and glitches to emerge in this inaugural year and are asking students and faculty members for the feedback needed to fine-tune the curriculum. “We anticipated that it wouldn’t be perfect and we’re aiming for something like a 70 to 80 percent success rate in the first year,” Gesundheit says. “We’re going to have a lot of brainstorming and critiquing and revision, but if we get that 70 percent mark – if seven out of 10 hours are good and seven out of 10 students are satisfied and seven out of 10 faculty are energized by the change in curriculum – that will be a fabulous success. And next year we will do even better.”

The medical school commissioned Stanford’s School of Education to gather baseline data from students and faculty last year against which officials will benchmark the performance of the new curriculum. In addition, Gesundheit says, the school will continue to use data from class surveys to gauge reactions to individual courses.

David Korn, MD, senior vice president for biomedical and health sciences research at the Association of American
Medical Colleges and a former dean of the Stanford School of Medicine, is encouraged by what he’s heard about the new Stanford curriculum and its potential impact on the medical world.

“American medical education has not devoted sufficient attention and creativity to the question of how best to produce, nurture and provide career opportunities for translational physician-scientists,” Korn says. “If Stanford can really focus on that and develop cadres of talented people with passion to devote their lives to that professional activity, I think they’d be making an incredibly important contribution.”

Good things come in small packages

Why growth isn’t always the answer

When it comes to medical schools, Dean Philip Pizzo, MD, believes that bigger isn’t always better.

In launching the school’s strategic planning effort, Pizzo and other school leaders needed to deal with the size question early on. At roughly 730, Stanford’s faculty is considerably smaller than that of other elite medical schools – for instance, Harvard’s faculty numbers 8,000 — so an obvious question was whether the school should expand. While the rocky economy as well as university limits on building and faculty hires would have made expansion difficult, Pizzo says ultimately the leadership chose smallness simply because it is more conducive to translational research.

“Our size becomes both an advantage and a disadvantage,”says Pizzo. While the school lacks the luxury of a large faculty to call on, it has the benefit of intracampus connections, a feature that larger medical schools, especially those on campuses separate from the main university, tend to lack.

Dave O’Brien, director of institutional planning, says those connections will be valuable as faculty members collaborate more with their colleagues in other departments and schools. “It’s the casual interaction, the informality of a small community that allows investigators an opportunity to know what others are doing.”

Staying small also ensures that Stanford sustains its reputation for excellence. “We can make the case that if you’re good enough to come to Stanford, you’re the best,” O’Brien says. “We can promote the quality of our faculty and the quality of our science as the gold standard for biomedicine.”

There is also a rigor that requires smaller schools to carefully weigh growth opportunities, O’Brien adds. “You have to decide – is this something that plays to our strengths? Is this something that’s going to deliver the types of successes to which we aspire? Staying small allows us to focus.” – S.I.

Pest-o change-o!

If only he could make institutional change happen so easily

Dave O’Brien is a pleasant, affable man, but he fully understands why some faculty and administrators may not always look forward to chatting with him. As the school’s institutional planning director, O’Brien has the day-to-day responsibility of working with the senior associate deans and other faculty and staff leaders to ensure that the goals set forth in the strategic plan are being accomplished on time. “Part of my job is to be a pest,” he says with a grin.


O'Brien: "We don't have a stock price or a profit margin or a market share we can point to. We have to look for more subtle cultural and attitudinal measures."

The development of the school’s strategic plan, titled “Translating Discoveries,” was a comprehensive effort during the 2000-01 academic year involving faculty, staff and students from a variety of departments and offices. The document sets forth the school’s plan to better integrate its basic science and clinical endeavors in order to become a leader in translational medicine.

Several high-profile changes have already occurred [see adjacent], including the introduction of the new medical curriculum; establishment of the Stanford Institute for Cancer/Stem Cell Biology and Medicine – the first of the school’s four planned interdisciplinary institutes; clarification of the advancement and promotion criteria for the professoriate; and pay increases for postdoctoral scholars. But much remains to be done, and school officials need to ensure that all changes are sequenced appropriately.

Implementing such wide-ranging changes means applying fresh perspectives to the processes and procedures that have been in use for decades. “The school’s view of the areas of science around which we should be planning, such as the institutes, is independent of specific departmental structures. However, our leadership, our faculty, our finances, our space and our dollars are all organized through a departmental structure. That’s a challenge,” O’Brien says.

And once the solutions have been identified and implemented, O’Brien still faces the task of measuring whether the effort has been successful. “We don’t have a stock price or a profit margin or a market share we can point to. We have to look, in part, for more subtle cultural and attitudinal measures,” he says. “One thing that underlies the strategic plan is the degree to which organizational barriers are being bridged.”

How can that be tracked? O’Brien says he may use “surrogate” measures that indicate whether faculty and students are more receptive to nontraditional collaborations. The surrogates might include such data as the number of faculty members with joint appointments, the number of research collaborations involving investigators from multiple disciplines and the number of MD/PhD candidates in both basic science and clinical areas.

“We aren’t saying that we should set a specific number we want to hit in these areas, but if we believe those are legitimate surrogates then we would like to see a direction of change occurring,” O’Brien says.

In addition to those types of changes, O’Brien says he hopes students and faculty feel that the school’s environment “is more supportive and conducive to the type of investigation that interests them. If you’ve got a vision that is inclusive and compelling, then you would expect the investigators to be saying, ‘I feel that my values and the institution’s values are more in sync and are better recognized.’ That’s not something that happens just because you publish a report.” – S.I.

Strategic steps

Key moves toward the goal: To be a premier research-intensive medical school that improves health through leadership and a collaborative approach to discovery and innovation in patient care, education and research

• Created “Translating Discoveries,” the strategic plan for the School of Medicine

• Created the Office of Institutional Planning
• Created the framework for the new medical curriculum
• Revised the Dean’s Letter to be recognized as the school’s official evaluation of each medical student
• Established the single designation of “postdoctoral scholars” and implemented tuition policy changes, benefits enhancements and an improved minimum compensation schedule for this group
• Established a policy on the maximum duration of postdoctoral training
• Developed guidelines for the planned Stanford institutes
• Established the Council of Clinical Chairs in conjunction with Stanford Hospital & Clinics
• Clarified and changed the appointment/promotion criteria for the professoriate and gained principal-investigator status for faculty in the Medical Center Line
• Created and filled the position of senior associate dean for information resources and technology
• Implemented the Staff Seminar Series
• Implemented the annual Dean’s SPIRIT Award to recognize the contributions of an exempt and a non-exempt staff member
• Implemented the “Respectful Workplace” program
• Created the school’s Office of Government Relations
• Established the Stanford Medicine Leadership Council, a panel
of key business and government leaders

• Created the scholarly concentrations and Year 1 of the new medical curriculum
• Initiated early orientation seminar programs for graduate students
• Opened a career center for graduate students and postdocs
• Developed an online, schoolwide calendar of seminars, lectures and events
• Established the Stanford Institute for Cancer/Stem Cell Biology and Medicine
• Approved the creation of the Stanford Neuroscience Institute
• Initiated the Beckman Center-Department of Medicine seminar series on translational research
• Established the governance structure and administrative team for the faculty practice organization at Packard Children’s Hospital
• Developed a joint planning committee and a joint leadership council with Stanford Hospital & Clinics
• Deployed phase I of the wireless computing network
• Established a new operating budget formula and funds-flow formula for FY04
• Created and filled a training and organizational development position at the school 2003-04
• Implemented Year 1 of the new medical curriculum
• Implemented a joint Masters of Public Health program with UC-Berkeley that is available to students enrolled in the Public Service and Community Medicine scholarly concentration

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