The New Word on the Street: “Bridges”

Saturday, October 29, 2016

This year, UCSF introduced Bridges, a new curriculum for first year medical students.

The new curriculum involves 1.5 preclinical years instead of two, and features three major components: Foundational Sciences (FS), Core Inquiry Curriculum (CIC), and Clinical Microsystems Clerkship (CMC).

With so many moving parts, trying to understand each piece is a challenge even for the first year medical students experiencing the new curriculum.

Synapse’s newest column, Crossing Bridges, provides an insider view from five first year medical students as they break down the new curriculum’s different components.

Why the need for reform?

By Lakshmi Subbaraj

In keeping with our natural human tendency, we love to question change. So when the new Bridges curriculum was introduced for medical students, the first thought was to ask why.

Why did the administration decide to completely overhaul the old curriculum that seemed to be doing well in producing top notch UCSF trained physicians in favor of a new, preliminarily tested curriculum?

The structure of the traditional curriculum — two years pre-clinical education followed by two clinical years — was launched way back in 1910 when the Flexner Report resulted in closure of one third of medical schools in the country and radical changes in the remaining institutions.

In 2002, the Health Professions Education Summit, called for by the Institute of Medicine in response to identifying the need for major reform in medical education, released a report, Health Professions Education: A Bridge to Quality, which offered a new idea: All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics

At UCSF, the Bridges Curriculum’s goal is to revamp medical education to provide students with the early perspective and awareness of prevalent problems of safety, quality, patient satisfaction and waste in health care delivery as noted by Catherine Lucey MD, vice dean for medical education.

Medical schools have tried to address these problems for many decades, but nothing permanent has been done, until now.

Today, with the dynamic nature of health care environments and the medical sciences, students need to be able to work within healthcare systems and teams and improve the health of large populations in addition to individual patients.

Medical Student Reflection

By Sarah Takimoto

There is excitement about being part of a redesigned curriculum like Bridges. For many of us, the elements of Bridges directly align with our reasons for pursuing a career in medicine.

Clinical Microsystems Clerkship (CMC) offers those who value patient interaction and experiential learning a chance to escape the classroom, whereas Inquiry caters to the physician-scientists who aim to gain familiarity with the medical literature and jumpstart prolific research careers.

With any transition, there are road bumps and unexpected challenges that arise.

What is evident is that we students and the many dedicated faculty and staff at UCSF are in this undertaking together.

As we continue on with the curriculum, we hope our column not only sheds light on the student perspective but also allows us to reflect on our experiences as we train to become doctors of the 21st century.

While we have just begun our four-year journey, we look forward to crossing Bridges.

Clinical Microsystems Clerkship (CMC)

By Alexander Haddad

One new aspect of the Bridges curriculum is the Clinical Microsystems Clerkship (CMC), which is replacing a preceptorship.

The CMC has groups of five or six students assigned to a physician coach visit a clinical site once a week for half a day. There, groups integrate with clinical teams to take on various projects, such as quality improvement.

The sites are diverse — from a family medicine clinic in a shopping center to the emergency room at UCSF Parnassus — so experiences vary.

The other half of the day involves practicing for patient encounters, with recent focus on physical exam and history taking skills for standardized patients.

CMC has become one of my favorite days of the week. It's nice to get into the clinic and actually interact with patients after a long week of classes.

Our CMC group has also become a little family so it's nice to see everyone and check in on how they are doing.

Core Inquiry Curriculum (CIC)

By Jason Parad

The Inquiry element of Bridges offers us increasing opportunities to explore the frontiers of science.

It begins with weekly clinical cases in our fall quarter, introduces mini-courses in our winter quarter, and prepares us for mentored research in subsequent years.

I'm especially excited about my mini-course, which focuses on the role of physicians in responding to climate change.

Some of the clinical cases we've discussed so far include gene editing, long QT syndrome, and medication reconciliation.

Case discussions take place across two sessions in groups of eight students. For each case, students meet in a first session to identify unfamiliar concepts — whether a biological pathway, clinical diagnosis, or treatment guideline.

After reviewing the medical literature, students reconvene in a second session to present their findings and clarify the concepts.

Sometimes it's eye-opening to see the incredible breadth of literature on such topics.

At other times, the ambiguity of a pathway or guideline can leave us uncertain about how to proceed.

Thankfully, Inquiry provides us tremendous faculty facilitators who are always willing to chime in with their clinical wisdom when needed.

Foundational Sciences (FS)

By Lillian Lai

In Foundational Sciences (FS) classes, we learn core scientific knowledge necessary for providing the most efficacious medical care to our future patients.

During our first block of FS, we studied a broad range of topics that served as primers for the subsequent blocks that are more specific organ systems.

We are currently on our second block where we focusing on the cardiopulmonary system.

Within each block, biomedical sciences are integrated with social and behavioral sciences. Systems sciences are accompanied by epidemiology and population sciences.

At the end of class, we always find ourselves wondering how clinicians and researchers are able to discover the intricate mechanisms behind our bodies’ functioning.

The reality is there is still a lot that the scientific community does not yet understand. For example, we learned that pacemaker cells fire less frequently in hypothermia but we don’t know the reason. So we have to become comfortable with memorizing observational phenomena that we can’t necessarily explain.

Our education begins with independent reading and online lessons, and follows with in-class lectures and various self-assessments. We then convene in small groups for about 8 hours a week to tie all the concepts together.

While the amount of material can be overwhelming, a broad range of tools allows us to learn based on our own style.