Education At The Interfaces

Changes are afoot in undergraduate premedical education. Rather than prescribing a set of courses that all premed students must take, four schools around the country are experimenting with a competency-based, rather than course-based, approach to the curriculum. Such an approach opens the way to a more interdisciplinary premed curriculum, because a competency can be taught in any class, as long as it’s taught in some class.

The movement has its roots in the 2009 report “Scientific Foundations for Future Physicians,” published jointly by Howard Hughes Medical Institute (HHMI) and the Association of American Medical Colleges.The report advocates a competency-based approach to premed and medical education. Not long after the report appeared, HHMI invited research universities to propose experiments in science education. With the report fresh in everybody’s mind, four of the responding universities focused on how they could respond to its recommendations. HHMI staff members noticed the common theme.

“The idea for collaborating came from us,” says Cynthia Bauerle, a senior program officer in HHMI’s precollege and undergraduate program. “The institutions responded by submitting—this is almost unheard of—a second, joint proposal.” That proposal outlined the collaborative program the universities had in mind.

And thus, NEXUS—the National Experiment in Undergraduate Science Education—was born. In this four-year, $1.8 million program, educators at the University of Maryland, College Park (UMCP); the University of Maryland, Baltimore County (UMBC); Purdue University; and the University of Miami are developing interdisciplinary modules that they can plug into existing premed courses.

NEXUS is focusing on the interfaces between biology and the other sciences, with each university concentrating on a different one. UMCP is focusing on physics; UMBC, on mathematics; and Purdue, on chemistry. Miami, with a slightly different emphasis, is developing clinical case studies that pull together at least two, sometimes more, of the sciences.

The modules are designed to fit into existing premed curricula. “Early on we decided it was better to have a modular approach and not change the curriculum so that it would be unrecognizable,” says Katerina V. (Kaci) Thompson, director of undergraduate research and internship programs at UMCP. “There’s a lot that we can do within the constraints of the traditional intro biology class, intro physics class, to make them better, more interdisciplinary.”

“The idea is to make something that’s transportable. We’d really like to make a portfolio of modules,” says William LaCourse, a chemistry professor and interim dean at UMBC. The modules could be validated, collected in a database, and made available to anyone who wants to use them.

At Purdue, Marc Loudon and his coworkers are revising the organic chemistry class for prepharmacy students. That class is one of four organic classes Purdue offers, each tailored to different students: premed students, engineers, and chemistry majors. The new version of the prepharmacy course will roll out next semester.

“I’ve been teaching pharmacy students a somewhat modified version of the standard organic course for years. My conscience hurts more every year,” Loudon says. “We really could be doing a better job of making this more relevant to them.”

But just because the course will be more relevant doesn’t mean it will be easier. “It’s more a question of emphasis than of rigor,” Loudon explains. “These students are intellectually very capable, and there’s no reason they shouldn’t have a rigorous course.”

For the class, Loudon and his colleagues are developing modules for areas not well covered by standard textbooks. The first organic chemistry module addresses noncovalent intermolecular interactions. “It starts with boiling points and goes all the way up to protein folding,” Loudon says.

Purdue is large enough that it can offer several organic and biochemistry classes. “Other schools don’t have this huge population of students and are going to have to kill two birds with one stone,” Loudon says. Smaller schools may face challenges meeting the needs of premed students without compromising those of traditional chemistry majors. A task force at the American Chemical Society is identifying ways the society can help chemistry departments address the recommendations in the 2009 report (C&EN, Oct. 17, page 65).

UMCP is handling the physics part of NEXUS. This semester, the university is piloting a revamped physics class tailored to premed students. When students heard about the new course, which includes more biological material than the standard physics class, they snatched up all 24 spots within a day, Thompson says. “There’s a huge demand for a course like this,” she notes.

UMBC’s portion is focused on developing modules to introduce quantitative modeling to introductory biology students. “People have been taking the math out of biology for years,” LaCourse says. “Now they recognize they need to put it back in for these students to be successful.” Professors from the biology and math departments are writing the modules, he says.

Whereas the other universities are focusing on the interface between biology and one other discipline, Miami is developing case studies that cut across multiple disciplines. It is the only one of the four universities with a medical school, and science and medical faculty are collaborating to develop the case studies.

Miami is in the unusual position that about 85% of its undergraduate science students are premed, says Richard S. Myers, a lecturer in the department of biochemistry and molecular biology. The university has a premedical honors program called PRISM, which integrates chemistry, biology, physics, math, and computer science. The PRISM students are Miami’s NEXUS test group; they are being matched with a control group from another Miami honors program in which students earn bothB.S. and M.D. degrees in seven or eight years.

The PRISM group is typically 50 to 70 students per year, Myers says. “We can get a cohort of students who experience more or less the same educational environment throughout their undergraduate experience,” he says. “They take special PRISM chemistry, math, and physics classes with biology mixed in.”

For its PRISM students, Miami will adopt the NEXUS structure as it’s rolled out, Myers says. “We’re grabbing modules as they’re developed, and we’re sticking them in the courses we already have.”

The case studies incorporate preclinical and clinical information to both teach and assess the competencies, Myers says. “We’re developing a set of capstone competency case studies that will evaluate students across the campus,” he says.

Even harder than developing the new modules and curricular materials is figuring out how to assess their effects on student learning. The NEXUS team is developing assessment tools that they can share. The team members met in August for a workshop led by David I. Hanauer, an assessment expert at Indiana University of Pennsylvania.

“We are all at various points on the learning curve of assessment, especially when it comes to how you assess a competency-based approach, which requires a different way of thinking about student learning and therefore a different way of assessing how students learn,” HHMI’s Bauerle says.

Much of the success of the program will depend on whether it adequately prepares students for the revamped, competency-based Medical College Admission Test, or MCAT, the exam taken by medical school applicants, which is due to be launched in 2015.

Even if the MCATs don’t change significantly, NEXUS can still improve undergraduate education, Loudon says, “but getting schools to be interested in it is going to be a lot harder.”