Tradition and Change: Cornell's Curriculum Overhaul

Cornell's curriculum needed to be updated to reflect the current needs of medical students. It wasn't easy and the change involved much resistance from faculty. The school is now two years in to this overhaul. What were the lessons learned and how is Cornell measuring success? J. David Warren, Ph.D., associate research professor explains. 


Host: We're broadcasting live at the AAMC in Baltimore 2015, and this year's conversation is about change. What needs to change in health care? I know there's a ton of things, but we're asking each person what specific thing is on their mind right now?

Announcer: Asking questions, seeking solutions, Algorithms for Innovation. Live from Baltimore at the AAMC 2015.

Warren: Hi, my name is David Warren from Weill Cornell Medicine in New York City. I am an associate research professor in the Department of Biochemistry.

Host: What was something at your institution that had to change?

Warren: We'd, over the past several years, looked very closely at our curriculum, and realized that it needed to change to update to be in line with what the current needs of medicine are, primarily due to the Flexner II report. It played a big role in what we wanted to approach and get our curriculum in line with.

Host: So you redid your whole medical school curriculum just a couple of years ago.

Warren: Right. We're in year two of the new curriculum right now.

Host: That sounds completely over whelming. Were there some barriers to changing that?

Warren: I think one of the biggest ones we had to overcome was the faculty's resistance to change. A lot of people were perhaps complacent with the old curriculum. One of the things that we did was move from the classic Flexner I curriculum of two years of basic science, two years of clinic to a more integrated approach. We now have roughly a year and a half of the basic sciences and then the remainder of the year into the clinical sciences.

When you do that, there are a lot of people who feel very protective about what they're doing in those classes and don't want their areas cut. It took a long time to get people to understand that their areas were not being cut, they were being reworked so that redundancies were reduced, things were being taught just in a different way. We were able finally to realize our dream of integrating in the first two years, the basic sciences and the doctoring courses.

Host: So you're two years into it. You still haven't graduated your first class with this new curriculum. What outcomes do you hope to achieve, and how do you know if the curriculum change was successful?

Warren: That's a very good question, and a question that we are constantly worried about. How will we know if we're successful?

Host: Do you have some benchmarks right now that you're kind of hoping to look at in a couple more years?

Warren: I think the first benchmark that we're looking for is Step I board scores. Is this experiment, and that's what it is really at this point is an experiment, is this going to give us better board scores? Our students have always done very well in the boards, but are they going to do better, and are they going to feel better prepared? Are they better prepared for their residencies? Do they get better residencies? And once our students go into their residencies, do they feel better prepared?

Host: At this point is there anything that you wish you would have done differently had you done it differently this process would have been a little bit easier or more successful at this point? We're looking for that advice for somebody else that's going to go down this same path so they can avoid something.

Warren: It's very challenging to do, and I think you've got to get faculty champions on board early who can recognize and understand that change has to take place, who can recognize and understand that you're not destroying what they've built over the course of perhaps their career.

You have people who have been teaching in the same course for 15 years, 20 years. They've got all of their PowerPoints. They've got all of their lectures down, and you're not necessarily destroying that. And you're not taking that away from them, but you're giving them an opportunity to do something which makes a lot more sense.

Host: Are your faculty buying into that argument?

Warren: Some of them, yeah. Many of them, we still have people who complain there's a lot of work, especially in the initial years with faculty who do have to redo their lectures.

Host: Did you build in some time for them to redo some of that stuff because that could be a lot of work? I could see why they would have that issue.

Warren: There was some time. This was not something that was taken lightly. There were a number of years of planning. Towards the end it did feel a little bit rushed, especially for that first course that first year of the change. Although a lot of that first course which we did, which is the basic science course that we teach including cell biology, biochemistry, physiology and the like, there was a lot of overlap between the new and the old. And so a lot of stuff could be reused and redone, but we did give some time, and our administration did give people a little bit of extra time to do that.

It's a constantly evolving thing, so we look at student feedback. One of the things that we've been very active about is being in constant communication with the students. So if there's something that we're doing that isn't working and it's something we can change immediately, we change it immediately. If it's something that was only for a certain subsection of the course and it didn't work, then next year we'll do it differently. And so we're in constant flux, and I think that's important in doing anything that you not be rigid about the change, that you always see and look at how can we make it better.

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