Academics

New MED Curriculum Will Drive Patient-Centered, Equitable Care

Team-based learning launches in new Learning Center

First-year medical students in the new $5.5 million Learning Center attending a class on gene expression August 22. One of the focal points of the new curriculum, the Learning Center has students problem-solving in teams guided by faculty and subject experts who assist at tables and use overhead monitors to aid students.

Five years ago, when Priya Garg became Boston University School of Medicine associate dean for medical education, the feedback she heard from student focus groups about how MED was doing was pretty clear: the students wanted greater flexibility in how they learn and they wanted designated time in the curriculum allowing them to explore the societal and health-care issues that brought them to the school in the first place. 

But that was just the students. Faculty concerns were different—they focused on why their lectures were sparsely attended, leading them to believe that most students were learning outside the classroom.

Garg had her work cut out for her. And the entering Class of 2026 is about to see the changes.

MED has launched a newly designed medical education curriculum, whose goal is to graduate “doctors who can provide patient-centered, equitable care, who have a solid knowledge base and a strong ability to clinically reason,” says Molly Cohen-Osher, MED assistant dean of medical education for curriculum and instructional design.

While the curriculum is what gets taught to students, it must also apply to what they are able to learn, understand, and retain, Cohen-Osher says.

The teaching model that has dominated medical education for over a century consists of two years of learning the science underpinning diagnosis and care, followed by two years of clinical rotations. Medical students typically spend their first year understanding how the systems in the body work. In the second year, they focus on what can go wrong. The new curriculum merges the two using multiple teaching methodologies and formats that focus on active rather than passive learning.

The hallmarks of the new approach include the expansion of clinical casework and cases that apply knowledge into all four years, an emphasis on team-based and self-directed learning, and the integration of content across foundational, clinical, and social science with a focus on health equity.

The bigger picture: the role of health equity

Before she came to MED from Tufts University School of Medicine, Garg often heard from her husband, Arvin Garg (MED’99, SPH’99), that students chose MED for its mission of training future leaders and advocates addressing health-care disparities. (Many of the physicians at neighboring Boston Medical Center, the region’s largest safety net hospital and MED’s primary teaching hospital, hold faculty positions at the school.) 

“Many students come to medical school focused on learning as much science as they can and believe that knowledge is what will make them a great physician. But all of us who take care of patients know that science is actually only one piece of what you need to provide exemplary care,” says Garg, who is leading the MED curriculum change initiative with Karen Antman, MED dean and provost of the Medical Campus.

Health equity will be fully integrated into the new curriculum in all the courses, with seven weeks of dedicated classroom instruction in the first two years. Cheryl McSweeney, a MED assistant professor of family medicine, directs the new health equity course. Known by the acronym LEADS (Learn, Experience, Advocate, Discover, Serve), the classes encompass subjects focused on the health impacts of societal factors like racism, the refugee population, immigrant and global health, homelessness, addiction, and LGBTQ+ communities. Additional skill development in areas such as advocacy and research, narrative medicine, and public health knowledge will be included.

“So little of what actually contributes to health for people happens in that one-on-one visit that we’re training everybody for. It’s much broader than that,” says McSweeney, director of the first-year course Essentials of Public Health. “We need students to understand the physiology and to know what’s the best evidence for the treatment of patients in terms of medication, but you also have to have an understanding that it’s not going to work if they don’t have the refrigerator to store that medication.”

Along with broadening student perspectives on health care, another goal of the curriculum is to improve understanding and retention of what is being taught. Garg recalls that when she first came to MED, faculty expressed concern that they weren’t interacting with students, that few were coming to their classes, but were instead viewing lecture recordings. This has been a trend in medical schools nationwide for years.

“Even the chairs began to notice and asked me why we didn’t require students to come to class,” she says. “My response has always been that we have to make the classroom experience meaningful if we want students to be required to attend.”

Sherry Ershadi (MED’25) chose MED because the program allows first-years access to Boston Medical Center to give them real-life experience.

“Integrating those cases into team-based-learning sessions or into Doctoring [another first-year course] definitely helps to keep classes interesting. You’re seeing how the information that you’re learning is going to relate to the real world and it prepares you” for clinical rotation, Ershadi says.

The curriculum redesign also is focused on improving communication skills, physical examination, and clinical reasoning. The Doctoring courses that focus on these skills were redesigned in 2019, the first phase of the curriculum changes.

A better way to study

The reality is that medical students face a torrent of information coming at them every day, making it difficult to absorb and retain this knowledge. Self-esteem, health, and knowledge can all suffer when the amount of content being delivered is not considered, Garg says.

“We’re giving them so much information in a way that makes it hard to retain, and it’s just not reasonable for anyone,” she says. “It’s disheartening as a student, and when you finally get through all of it you just never want to think about it again.” 

Ershadi says that most of the medical students she knows don’t go to lectures, They watch them on video instead. “For me, the in-person lecture does not work because at that speed I just can’t pay attention.”  

Educators point out that absorbing material at their own pace and reviewing what they don’t understand leads students to better comprehension. “No one told me how to study. They just said, ‘Use what you’ve always used. It got you this far,’” Garg says.

To increase understanding and retention, MED is employing new teaching methods, among them spaced learning, which portions out lessons and learning assessments over time and repeats them to improve retention. Interleaving is another novel method—it teaches closely related topics together, encouraging learning by distinguishing between multiple, but similar, concepts, like teaching math by mixing in multiplication, addition, and subtraction problems.

“Surface learning is memorizing it as you cram for a test; then you dump it. Deep learning is developing a deep and meaningful understanding of the material,” Cohen-Osher notes. “Right now, what we do is we give you all of cardiovascular, all at once in the first year, and you memorize it and pass the course, and then you go on. But what we really wanted was to bring back that learning again and again so that it stays in your memory for the long term.” 

Team-based learning and new learning center

Construction was completed this summer on a new $5.5 million learning center that can accommodate up to 200 students divided into teams of 8, seated at round tables. The new facility is central to the expanded use of the “flipped classroom,” a collaborative team-based approach that is more in line with how students, who have unprecedented access to information on the internet, study today.

Students are given example cases with questions and are provided with materials to learn about them outside of the classroom, self-testing to find their knowledge gaps. When they return to the classroom, they undergo both individual and team assessments. The teams then tackle an hours-long investigation, assisted by faculty and content experts working together from across disciplines who visit the various tables with technology that can link to screens around the room.

“We wanted to create an open classroom where everyone was on one level, the faculty were walking around, and students really felt like they were connecting with the faculty and learning from them, asking questions and having a dialogue rather than a lecture,” Garg says.

Her goal is that medical students will become great clinicians and agents of change in health care and equity, the latter in large part because of their experience working with the underserved and marginalized populations that come to BMC.

“I think those of us who work here are doing it because we want patients to feel safe when they walk into the hospital and not feel like it is a place where you will be judged,” Garg says.