Episode 9: The Pritzker Initiative and Upcoming Curriculum Changes

A discussion with Dr. Halina Brukner, Associate Dean for Medical School Education, and Sylvia Robertson, Assistant Dean of Admissions & Financial Aid, about upcoming changes to the curriculum and how they will affect current and future students.

If you have questions for us, please send them to pritzkerquestions@gmail.com.

Embedded Links:
Dr. Brukner’s Physician Profile

Episode 9 Transcript

Ben Ferguson: Hi folks. Welcome to another episode of the Pritzker Podcast. Thanks once again for joining us. We are joined by Sylvia Robertson, who is the Assistant Dean of Admissions and Financial Aid at the Pritzker School of Medicine, and Dr. Halina Brukner, who is the Associate Dean for Medical School Education at Pritzker School of Medicine. Hey Sylvia, hey Dr. Brukner.

Sylvia Robertson: Hello, Ben.

Halina Brukner: Hi. Nice to be here.

BF: Thanks so much for joining us, both of you.

HB: Pleasure.

SR: A pleasure.

§ “Why change the curriculum?”

BF: So, in this episode, we’ll be discussing the Pritzker Initiative, which is a new version of the Pritzker curriculum, and we’re happy to have the both of you join us because you happen to know something about that and have been instrumental in helping to implement the new curriculum. So, I have a list of questions here, and I think I’ll just start with the first one. So, Dr. Brukner, if I could ask you, the first one just very clearly is why do we need this? Was the old one sort of broken? Was is out of date? What’s the point of instituting a new curriculum?

HB: Well, I would certainly say that our old curriculum was not broken in any way. It’s a curriculum that has stood us well for years. Our students have done beautifully in their careers by going through this curriculum. But, I think medical schools ,and really all institutions of higher learning, owe it to themselves to periodically review how they’re teaching, what they’re teaching, to try to keep up with new knowledge that’s developed both in the scientific realm and in the medical education realm. And so I think it’s incumbent on all medical schools, as successful as they may be, to think about how they teach and make sure that their methods and content are appropriate for the new paradigms of science, medicine, and, really, education. So that’s the reason we undertook this comprehensive review of our curriculum. The last time this school did such a comprehensive review was actually in 1994. So we have thought that it’s about time to look again at what we’re doing, and I actually would say to whoever’s listening that I think it’s important for any student who’s looking at an institution of higher learning to ask whether the school does periodically rethink the way they teach because that’s the sign to me of a healthy institution and an institution with confidence in its ability to deliver really cutting edge education.

BF: So just keeping up with the times essentially.

HB: Yeah, to make sure that we incorporate new ways of teaching, to make sure we are covering the material that students need to make sure that we are meeting the learning styles of all our students. Again, it doesn’t mean in any way that the way we’ve been doing things all these years is wrong, but there’s always room for new ways of slicing the pie and making sure that we meet the needs of all our students both while they’re in medical school and in their future as physicians who are going to be learning for the next 30, 40 years in their careers.

BF: And certainly, as you alluded to, this is not uncommon for schools across the country.

HB: No. In fact, external institutions such as accrediting agencies mandate that medical schools do self-studies and look at their curriculum and point out areas of strength and areas that can be improved. And so, that’s an ongoing process no matter what. But a real comprehensive review is something that I think it’s incumbent on institutions to undertake periodically to really understand what’s being taught through a vast curriculum and to consider ways that it could be enhanced.

§ “What do the changes entail?”

BF: So I think one of the reputations that Pritzker had previously was that we had a very traditional lecture-based, traditional lab-based curriculum. Is that going to change in the new curriculum? Is there going to be any sort of this PBL fad, I guess, that’s going to be implemented or is it going to be minor changes?

HB: Well, I would agree that the Pritzker curriculum has been a fairly or significantly traditional curriculum in that it has been a two-plus-two setup. By that, I mean that by and large, the first two years of pre-clinical work are focused on the basic science and the basic clinical skills that are needed to move into the second two years, which are largely clinical. So in that sense, the structure has been traditional. And in addition, the instruction, especially in the first two years, has been quite traditional as you said, Ben, with large component of lecture, large component of in-class time, and a significant lab experience in some courses, although not all courses. We have not incorporated problem-based learning in its pure sense into our curriculum before. I would say clearly that our Pritzker Initiative curriculum will not be a problem-based learning curriculum, although I think we have come to appreciate some of the aspects of problem-based learning that can be successful even within a traditional curriculum. And some of our courses over the years and certainly in the last couple of years have learned from what I think are the strengths of problem-based learning and have incorporated those types of experiences into the traditional courses. So, for example, problem-based learning often deals with small-group learning facilitated by a faculty member. It uses clinical cases sometimes to point out the relevance of the basic science.

So I think the plan is that the Pritzker Initiative will take advantage of some of the aspects of problem-based learning that bring it more to a student level in terms of student participation in the learning process, as opposed to purely sitting there receiving information. It will incorporate a lot of active learning. But I would certainly say that it will not be a problem-based learning curriculum as some medical schools have adopted.

SR: Dr. Brukner, you shared with our leadership team last week a very exciting example of the way that way we’re going to use the strengths of problem-based learning. Could you share that with our listeners?

HB: Oh, I’d be happy to. For example, our first year course, which is ongoing as we speak, in fact literally at this hour, one of our courses is molecular and cell biology, and that in the past has been about as traditional as you can get, with really just lectures and minimal small-group learning. This year, a new course director has incorporated some of the aspects of problem-based learning into this traditional course by focusing each week’s learning objectives around a clinical case. So, a clinician comes in the first day of each unit and presents in quite a bit of detail a real clinical case, which turns out to illustrate some very important aspects of cell biology in its basis. And the students work with the course director and with each other in small groups to determine those aspects of cell biology that this case illustrates. There are lectures. The course director calls them a “safety net” in a way, so that the students can be certain that they are exposed to the important didactic material that they need to understand the case. But in addition, they work in these small groups and on the last day of each unit, a group presents an analysis of the hypotheses that the students came up with the first week, and an answer to some of the questions related to the cell biology.

So this is, I think, a very good example of melding the strengths of a traditional curriculum while using some of the successful principles of problem-based learning. One of the goals of this course’s structure actually is to try, in a basic science setting, in the first year of medical school, to reproduce the experience a clinician has when faced with a patient with a condition that is not clear or is unknown. And the physician in his or her practice needs to figure out where they’re going to find the information and how to use that information to take care of the patient. This is an experience I’m very familiar with myself as an internist when faced with new patient problems. And I think it’s a very interesting approach to teaching basic science to try to mimic that type of learning process because that’s the type of learning process that physicians will be engaging in through their entire lives, whether they’re mostly taking care of patients, mostly doing research, doing a little of both, doing some of both. And so, we want to show our students that whether it’s clinical science or basic science, the learning process is really one that is continuous and that they need to learn to access information in order to be successful.

BF: We’ve talked briefly a little bit before about how many schools are doing this and the basis for these changes. Is that something that’s part of a broader change in medical education across the country, or is this something that’s a little bit different from other schools?

HB: Well, I think many schools have adopted a completely problem-based curriculum. Most schools in our group of comparable schools have adopted some aspects of small group learning and some aspects of problem-based learning. I think here at Pritzker, we’re doing it in a way that is in concert with our mission statement, with our institutional strengths, which include a very tight link between our scientists and our clinicians, between our hospital, medical center, and our Division of Biological Sciences. And so, I would say, in answer to your question, that many schools have created their own mix of teaching methods. And I think what we’re working toward is one that really fits in with the culture of the University of Chicago: an interdisciplinary, rigorous, exciting, active learning culture.

§ “What can future Pritzker students expect?”

BF: Sylvia, what would you say to students who feel like they might be guinea pigs in this sort of experimental new curriculum? Is that a concern that people should be warranted to have, I guess?

SR: Well, you know, Ben, I was a Health Professions Advisor for a number of years before I took the role in admissions. And so, I clearly remember talking to students as they considered their choice of medical schools to be certain that they were entering a curriculum that would serve them well, and where they would not be treated as guinea pigs. So I think it’s a good question and I have a great deal of confidence in telling them that that would not be the case here because of the enormous respect that our faculty and staff have for our students. I think that they can begin to get a sense of that in the way that they experience us in the admissions process. And then I think they certainly will understand that in their White Coat Ceremony experience. And it might be good for them to talk with our current students to talk about what that experience is like where, at the beginning of medical school, they are welcomed as junior colleagues into the profession of medicine. And I just think that this shows an enormous respect that comes with a dedication to ensuring that the curriculum here is one that will serve them well and really allow them to achieve their goals in medicine.

BF: Going back to Dr. Brukner, is the change to the new curriculum a gradual process or is all going to be rolled out at one time? And have changes already been made?

HB: I guess I would answer yes and yes to your question. In order to make a structural accommodation for some of the changes that will happen with the Pritzker Initiative, we are making one significant change in the summer of 2008. And that is that Pritzker will be starting at the beginning of August. In the past, Pritzker started at the very end of September. And so, we will essentially be adding six or eight weeks to the beginning of medical school. The reason for that is the following: In response to feedback over many years from our medical students, we realized that the very, very intense autumn and winter quarter at Pritzker was a real challenge for our students. Just if you can imagine, and I know you can, Ben, because you went through it, you can imagine that having six or eight weeks less of medical schools than many other schools means that material really is compressed into a very short period of time. And as a result, although students successfully mastered all this course material, the feedback was that it was a relatively stressful experience. And in addition, students told us that they would be happy to start medical school a little bit earlier in order to decompress a little bit. And so, starting August of 2008, our students will begin medical school in August with a comprehensive course in human morphology (anatomy) that will be the major academic undertaking during the summer. And students will complete all of their anatomy course by mid-October.

Also, in addition in the summer, the students starting this coming summer will participate in a course in Health Care Disparities in America. This course has been part of our orientation period for the last two years, has been extremely successful and highly regarded, both by our own students and actually it’s been presented nationally at educational meetings. And so our students will also be participating in this Health Care Disparities experience, as well as an orientation to medical school and the medical profession over the summer. That will allow the autumn and winter quarters of instruction, which will structurally be quite similar to the past, that will allow them to focus on those courses in a way that in the past, when they focused also on anatomy, was really impossible. And so the students will have significant increased time to spend on their studies, on other educational activities in the University, and on learning the vast amount of material in a more small-group and personal way. So that will be the major change for this coming academic year.

And then, in summer of 2009, the Pritzker Initiative will be rolled out for year one. And then subsequently, year by year, we’ll follow from that. I will say, however, that it is not like in the summer of 2001, I will walk into a room or someone will walk into a room, turn off the light, change the light bulb, and then switch back on and poof–we have a new curriculum. Over the course of this time, changes and improvements are being made constantly so that as each year is rolled out, the students who are currently in the school will have the advantage of being part of those changes and having input into those changes.

I guess I want to really emphasize how important student input and feedback has been to the development of these plans. And as we talk to students about where things stand currently, the feedback has been extremely positive about the changes I had discussed, especially the opportunity to do the anatomy in the summer as I have described.

BF: How do you gauge that? Are there questionnaires that are sent out to current students or do you question potential future students? How exactly do you tell?

HB: Well, we have had student representation on these planning committees and we also have had and are planning to have more focus groups with students as we move forward to get their input in an ongoing way.

BF: Okay. So you have some idea of what the students like, what they don’t like, and what you guys need to do about it?

HB: Right. Well, we have a lot of data from our students. We have data that we collect when they graduate from medical school looking back on their experience. We have data that we collect related to their evaluations, of courses in clerkships, and how well-prepared they feel for the challenges that follow. And then we have the more informal, but in many ways richer, feedback that we get from actually just talking to our students and soliciting their input.

BF: Right. So, Sylvia, just to go back to something Dr. Brukner said about taking classes in the more general University setting, is that something that will possible with this new curriculum because I know a lot of people consider that to be a great strength at Pritzker.

SR: Oh, absolutely. I think the new curriculum with the decompressed first quarter will actually give our students even more flexibility to pursue the study and experiences that allow them to pursue their individual interest. I think that the capstone experience is a perfect example of that. So I think it will give them even more opportunities to become the leaders they want to be in science and medicine.

BF: Can you explain what you mean by the capstone experience?

SR: Dr. Brukner can do a better job of that than I can, I’m sure.

HB: Well, the capstone experience will take place in the fourth year. And it will be a time that all of our graduating medical students will come together at the end of the fourth year for several purposes. One is to just get together again as a class. Over the course of the previous two years, students have been doing their clinical rotations and not really interacting as a class in the way that they do in the first two years when they’re together physically for a large part of their time. So they’ll get together, there’ll be opportunities for discussion, reflection about medical school, about being a doctor, about becoming a doctor. In addition, the capstone course will have a large component of skill review in preparation for their residencies. So skills such as physical skills, like putting in IVs and lines, doing procedures, physical examination skills that they have acquired over the course of their four years of learning those skills will be reviewed, enhanced, and honed so that students go into their residency experiences even more confident that they are ready to move forward. In addition, the capstone course will occur at a time that students will be presenting their scholarly work at the Senior Scientific Session and having all of our students together during that period I think will certainly enhance that experience as well.

SR: Dr. Brukner, and Ben, I may have just confused us because those experiences are not required for the 2008 entering class, is that correct?

HB: Correct. The requirement for a scholarly product will begin with the entering Class of 2009.

SR: If a student in the Class of 2008 were interested in doing this scholarly culminating experience, would that be available to them?

HB: Oh, well, certainly. Not only is it available, it’s been available for years. You may know, Ben, that 70 or 80% of our students participate in a Summer Research Program here at the university between first and second years. And many of them, if not most, continue some aspect of their scholarly pursuit through medical school. So this requirement for scholarly work of some type is going to be very easy to fulfill for the vast majority of our students because they already do it in a formal way. And many of those students who don’t do it over the summer can do some type of scholarly work anyway subsequently. So, a student who is interested in doing research or scholarly investigation of some type entering in the Class of 2008 absolutely will have ample opportunity to pursue those projects throughout their time at Pritzker.

BF: Sure. So it’s sort of a new implementation, so to speak, in the curriculum but it’s certainly nothing new to the students.

HB: It’s nothing new to the students. In fact, what we’re anticipating is that we’re going to enhance the infrastructure to support our students’ scholarly work. Since the vast majority of our students are already doing it, what we want to do is firm up the infrastructure for mentorship, for support of research. We want to make sure that our students early on are exposed to the tools they need in order to be successful in scholarly pursuits. And so, that is the goal of the piece of the Pritzker Initiative that deals with scholarship and discovery. It’s really to enhance what’s being done and to give all students an opportunity, whether or not they participate in the Summer Research Project, to give them all the opportunity to see what it’s like to become an expert in an area and master an area of scholarly pursuit.

BF: Sure. So, Sylvia, since this is a very new thing for most people who are applying right now and they will be the new people that go through this, how will they really know if this is working ahead of time before getting here? What sorts of things should they be looking for from us in order to determine whether this is good for them?

SR: Well, I think it’s important for students considering us to identify the characteristics in a curriculum that are important for them to be successful and then to compare that to the curricular map that we provide for them in the admissions process. And it’s also on our website for them to review. And then, I think it would be a good idea to ask our current students about their experiences in their first-year curriculum, and maybe what they would have changed. And I think that they could give you some good feedback about the opportunities that this new decompressed quarter will provide. And they need to remember that students are on the curriculum committee, they’ve been very much a part of the planning for the decompressed first quarter and the early start date. This is all in response to input from faculty and students.

BF: Right. So, as someone who is rather intimately involve with admissions, does this change the types of students that you guys will look for or will that not be affected too much?

SR: No, I don’t see that. Our admissions process is very much driven by our mission statement and that certainly is not going to change. I just think that this new initiative gives the students coming here remarkable opportunities for learning in an energized and positive environment.

BF: Dr. Brukner, if this is starting after the summer of 2009 you said, right?

HB: Yes.

BF: Will that affect only the entering class or will that affect all classes at once?

HB: No. It will affect the entering class as each year then rolls out. But as I mentioned earlier, many of the changes that will ultimately be under the umbrella of the Pritzker Initiative will not wait to be implemented in year three, year four. Many of them can be implemented as they develop. So, while I would say the entering Class of 2009 will certainly be the ones to have the full benefit of each year’s rollout, classes who are ahead of them, who are in our current curriculum also will be able to take advantage of some of these modifications as they are incorporated.

SR: Ben, I think that the fact that we are talking with our respective students in this way demonstrates the partnership that we see with our students at Pritzker. And it would have been very easy for us to not share this information but we’re very excited about it and we’re confident that it is a wonderful moment to come to Pritzker. And I think that students can take heart in knowing that we want to have this conversation with them, we want to be open and transparent about our curriculum, and that people like Dr. Brukner are in leadership around this important initiative.

§ “Will Pritzker still be a true pass/fail school?”

BF: Dr. Brukner, one big question I still have is will the curriculum remain pass/fail? I know a lot of people see that as a major strength of Pritzker. Is that going to stick around?

HB: Oh, absolutely. I also agree that it’s a major strength of Pritzker. I think it fosters cooperation among the students. It de-emphasizes competitiveness. It emphasizes that we are a competency-based curriculum and we want all students to achieve 100% competency. And if that happens, that’s our goal. And so, whether you get an 85 or a 79 on a test, as long as you have achieved the competencies that the course directors and the directors of the curriculum have set out as necessary, then we’re satisfied that students will be successful. And so the pass/fail curriculum is, I think, integral to the character of Pritzker. It’s one of the things that our students feel, I believe, feel that gives Pritzker its unique atmosphere of cooperation and collaboration. And so I certainly expect that it will continue in the future.

BF: Great. That’s great to hear as a current student. I think all the benefits you mentioned are certainly felt very strongly here as a student.

§ “A Student’s Perspective”

SR: Ben, what do you think about the Pritzker Initiative?

BF: You know, I think it sounds great. I think most current students would tell you that their academic experience here has been nothing short of positive in the vast majority of areas. The one that really jumps out to me is just starting earlier. I think a lot of students have some trouble sometimes adjusting to medical school and just being thrown into anatomy and doing it so quickly along with a lot of other classes sometimes is a little bit tough to handle, especially since we have such a large cohort of non-traditional students here who haven’t necessarily been in lectures, in class, or anything like that for several years, potentially. It’s really nice for them especially to be able to take it a little bit more slowly and have some time to adjust to medical school. And a lot of students feel sort of thrown into a medical school, again. So I think it’s always a benefit to slow down and be able to focus on things as much as you can, I guess.

HB: Yeah, I think of anatomy as one of the seminal experiences of medical school. I think everybody remembers their anatomy course. They remember their anatomy partners. They remember their experience for the first time the privilege of learning from a real body. And I think it really lends itself to an intensive bonding experience for our students and for an intensive study experience, and will serve as a basis with that knowledge base for the other courses that they’ll have later. So I think there are really a lot of unspoken advantages to starting with that course in particular. And as you know, our anatomy course is about learning the structure and function of the human body but it also incorporates a lot of other aspects of medicine. For example, our Department of Surgery has become very involved in teaching aspects of the anatomy course. Our Department of Radiology works with the anatomy instructors to use the technology of CAT scans, MRIs, X-rays, et cetera, angiograms, to really bring the anatomy to life, so to speak. And so it’s a very, very robust introduction to medical school and also includes a very important part about ethics and dying and, again, the privilege that the students are given to work with a human body. And so, for all those reasons, I think the students who start with anatomy moving forward will really have an opportunity to begin medical school in a way that is really unique and meaningful.

BF: Anything else either of you would like to add before we close up?

HB: Well, I personally am looking forward to the next few years. I think it’s going to be very exciting, a lot of work, but it will really move our educational experience forward in a way that I hope will be a model for medical education around the country.

SR: And my thanks to you, Ben, for guiding us through these important questions. And I just want to tell our listeners that I’m very much looking forward to the honor of coming to know those who see Pritzker as a potential good match for their medical school education in the coming years. And best wishes to them.

BF: Yeah, good. It’s a very exciting time for sure.

HB: Well, thank you very much for including us.

BF: Thank you both for being here. It was really a pleasure talking to you.

SR: Bye-bye.

HB: Bye-bye.

BF: Take care.


BF: So that was Episode 9 of the Pritzker podcast. Thanks once again for joining us. We, as usual, encourage you to email us at pritzkerquestions@gmail.com if you have suggestions or questions for the show. And we also encourage you once again to add a comment of yours if you like the show or if you don’t like the show to those that are already there on iTunes. I should mention, too, that Mary hasn’t left the show or anything. She’s just in class right now so she wasn’t able to make it. It’s hard to schedule this many people all at the same time sometimes. Check back soon for Episode 10 where we interview a few more students and talk about their interview experiences here at Pritzker. Thanks very much. Take care.