Tufts School of Medicine is committed to curricular innovation and improvement as we continually strive towards the next level of educational excellence. Rapid changes in health care delivery, biomedical knowledge and technology require medical students to confront a wide range of new information, practices and issues as they progress through their education. To meet these challenges, more than 200 faculty, students and staff have worked to redesign the Tufts’ curriculum to continue to position Tufts’ graduates for success, no matter what field of medicine they choose to pursue. The new curriculum will roll out in August of 2019 with the class of 2023.
The New Curriculum @ Tufts, 2019
Tufts is committed to curricular innovation and improvement and we continually strive towards the next level of educational excellence. Rapid changes in health care delivery, biomedical knowledge and technology require medical students to confront a wide range of new information, practices and issues as they progress through their education. To meet these challenges, more than 200 faculty, students and staff have worked to redesign the Tufts’ curriculum to continue to position Tufts’ graduates for success, no matter what field of medicine they choose to pursue. The new curriculum will roll out in August of 2019 with the class of 2023.
The overall goal of the Tufts curriculum is to graduate compassionate and highly-skilled physicians who possess the knowledge, ability, and attitudes to promote the health of individuals and populations. Our students will develop advanced skills in clinical reasoning and communication, allowing them to improve the patient experience while delivering the highest quality care. We will also help students to cultivate skills in personal reflection, mindfulness, resilience, inquiry, and lifelong learning. These tools will ready them to skillfully navigate diagnostic and therapeutic uncertainty and successfully adapt to a constantly changing healthcare environment. Our students will understand the importance of patient-centered outcomes and the processes of patient care at a systems level, including the functioning of interprofessional teams. Tufts’ graduates will be positioned to provide outstanding care by applying a detailed understanding of: the scientific basis of health and disease, healthcare delivery systems (and how to navigate those systems), social determinants of health, and population health (the ability to address the needs of patients and communities).
The schematic below shows the organization of the Tufts curriculum which centers on the four-year integration of basic science, clinical science/medicine, healthcare delivery science, and personal and professional development. Four “threads” have been developed and designed to be woven throughout the four-year curriculum.
- Healthcare Systems: healthcare costs, healthcare delivery systems, quality and safety, quality improvement, interprofessional collaboration, advocacy, law and reporting obligations, clinical informatics, chronic illness care, team-based care
- Population Health: health determinants, health disparities, public health, prevention, culturally competent care, care of the underserved, active citizenship, global health, social justice
- The Patient Experience: advanced communication, shared decision making, impact of health on patient and family life, end-of-life care/palliative care, assessment and management of pain and of substance use disorders
- Personal and Professional Development: wellness, resilience, professionalism, ethical practice, evidence-based medicine, self-regulated lifelong learning, inquiry/discovery, navigating uncertainty, professional identity formation, leadership, teaching, clinical skills, clinical reasoning.
The pre-clerkship phase of the Tufts’ curriculum (August of year one to January of year two) uses interactive lectures and other forms of active learning (flipped classrooms, small groups, team-based learning) to fully engage students in the educational process. There is a focus on case-based problem solving. Early clinical work allows students to apply classroom learning at the beside. A state-of-the-art clinical simulation and standardized patient program provides abundant opportunity for our students to further refine their clinical skills.
The curriculum commences with an introduction to the healthcare system and the profession of medicine, providing essential context on which to scaffold all subsequent learning. A foundational medical science unit follows, integrating core principles of biochemistry, cell biology, genetics, molecular biology, pharmacology, immunology, microbiology, and infectious disease. Clinically-focused organ system units begin in November of year one and run until January of year two. These units integrate anatomy, histology, physiology, pharmacology/therapeutics, pathology, pathophysiology, clinical skills, imaging, and the threads (see above). This strong foundation in the pathophysiologic basis of disease is critical to the formation of the expert clinician.
Early in year one students begin two 15-month long sequences. The first, Foundations of Patient Care, builds skills in medical interviewing and physical diagnosis, and culminates in the Competency-based Apprenticeship in Primary Care (CAP). CAP begins during the last block of year one with students spending one day a week in a primary care office, working through a core set of competencies focusing on fundamental clinical and communication skills. Afternoon Selectives during year one afford students the opportunity for early career exploration. The second, Foundations of Evidence-Based Medicine and Clinical Reasoning, begins with Problem-Based Learning (PBL), a case-based small group experience designed to develop student’s ability to effectively engage in self-directed learning. The Introduction to Clinical Reasoning Course follows with expert clinicians facilitating small groups to build students’ non-analytic and analytic reasoning skills, refining their ability to diagnose disease while recognizing pitfalls in the diagnostic process. An additional small group case-based experience, Integrated Cases, brings together elements from different organ systems, biomedical science and the threads.
Core clerkships start during March of year two and consist of eight weeks each of medicine and surgery, and six weeks each of family medicine, obstetrics-gynecology, pediatrics, and psychiatry. An additional eight weeks of electives allow for career exploration, and based on the student’s interest, more advanced work in a variety of disciplines. Two one-week intersession periods have been created to return students to campus to allow for ongoing integration of the threads and advanced skill development. The clerkships allow students to develop clinical skills and to learn to take responsibility for patient care at a number of Tufts affiliate sites representing a wide variety of clinical settings.
During the last block of year three and continuing through year four, students take advanced clinical rotations, including acting internships, a clinical neuroscience rotation, and a wide variety of electives. These experiences expand clinical knowledge and strengthen clinical skills and reasoning, positioning students for success in their first year of postgraduate training. An end-of-year, one-week bootcamp, including extensive simulation experience, provides final preparation for internship.
A spirit of inquiry and commitment to scholarship is an essential component of the Tufts curriculum. Beginning with the class of 2024, all students will complete a scholarly project during the four-year curriculum. The project allows students to pursue an area of interest in detail by formulating a scholarly question, using appropriate methodology to address that question and presenting findings in a scholarly forum. In addition to more traditional basic science and clinical research projects, students’ scholarly work can focus on public health, civic engagement or clinical quality improvement. Two periods of time, one at the end of year three (between the end of the core clerkships and the start of advanced clinical rotations) and another during the middle portion of year four, are reserved for completing the scholarly project. The scholarly project will be optional for the class of 2023.
An important addition to the curriculum will be the implementation of a faculty coaching model designed to ensure that a faculty member has a four-year longitudinal picture of a student’s development of clinical skills and professional attributes. The coach will be the main faculty member responsible for the student’s professional identity development (including resilience, ethical practice, self-regulated lifelong learning, navigating uncertainty), and will also assist in teaching clinical skills, in facilitating self-reflection (meta-cognition) and helping students remediate areas of weakness. The coach will:
- Meet regularly with student
- Review all formative and summative assessments
- Directly observe clinical skills
- Monitor progress toward achievement of competencies.
This model will help to strengthen student connections to faculty members and improve students’ acquisition of skills required to practice medicine in the 21st century. In addition, the coach will be key in identifying students who, though not failing, may need more support/remediation to achieve competency.
|Med Foundations I||Med Foundations II||The Brain||SFSBM|
|Problem Based Learning|
|Ethics & Professionalism|
|Foundations of Patient Care|
|Foundations of Evidence-Based Medicine & Clinical Reasoning|
Med Foundations I: Biochemistry, Cell Biology, Genetics, Histology, Immunology, Intro to Microbiology
Med Foundations II: Anatomy, Core Pathology, Core Pharmacology, Core Physiology
The Brain: Addiction Medicine, Head & Neck Anatomy, Intro to Clinical Psychiatry, Neuroscience
MIDPR: Medical Interviewing and the Doctor Patient Relationship
CAP: Competency Based Apprenticeship in Primary Care
EBM: Introduction to Evidence Based Medicine
SFSBM: Scientific Foundations of Social & Behavioral Medicine
(See Year 3)
|Introduction to Clinical Reasoning|
|Ethics & Professionalism|
|Health to Disease: Integrates Physiology, Pathophysiology, Pathology, Pharmacology|
|Foundations of Patient Care|
|Foundations of Evidence-Based Medicine & Clinical Reasoning|
CORE CLERKSHIPS *
Family Medicine – 6 wks, Medicine – 8 wks
Obstetrics-Gynecology – 6 wks, Pediatrics – 6 wks
Psychiatry – 6 wks, Surgery – 8 wks
BASIC ELECTIVES* - 8 wks
*Includes time during Year 2
ACTING INTERNSHIPS – 8 wk (2, 4 wk blocks)
(selected from Family Medicine, General Surgery, Obstetrics-Gynecology, Medicine, Pediatrics, Psychiatry, Surgical Subspecialties, and multiple Critical Care offerings)
CLINICAL NEUROSCIENCE EXPERIENCE – 4 wks
(selected from Adult Neurology, Community Neurology, Neurologic Critical Care,
Neurosurgery, or Pediatric Neurology,)
OTHER ELECTIVES – 24 wks
*Includes time during Year 3
The first year consists of integrated units and longitudinal experiences:
- Scientific Foundations of Medicine I: This 11-week unit integrates six components: Immunology, Biochemistry, Genetics, Molecular Biology, Cell Biology, and Tissue and Organ Biology. During the first three weeks students will learn (and meet patients with) six diseases: diabetes mellitus, coronary artery disease, HIV/AIDS, breast cancer, cystic fibrosis, and rheumatoid arthritis. These patients will form part of the framework for learning basic science and understanding the clinical relevance of those foundational concepts. This unit is integrated with concurrent courses in the Foundations of Evidence-Based Medicine and Clinical Reasoning experience.
- Scientific Foundations of Medicine II: This 11-week unit integrates four components: Clinical Anatomy, Core Pathology, Core Physiology, and Core Pharmacology. This unit is integrated with concurrent units including Foundations of Patient Care.
- The Brain: This eight-week unit integrates four components: Neuroscience, Introduction to Clinical Psychiatry, Addiction Medicine, and Head and Neck Anatomy. This unit will build on the previous units and is integrated with concurrent courses in the Foundations of Patient Care and Foundations of Evidence-Based Medicine and Clinical Reasoning experiences.
- Scientific Foundations of Social and Behavioral Medicine: This five-week unit integrates Population Medicine, Healthcare Policy, Public Health, Healthcare Economics, Quality and Patient Safety, and Growth and Development. This unit is integrated with Foundations of Evidence-Based Medicine and Clinical Reasoning.
- The longitudinal Foundations of Patient Care Unit comprises three components and extends throughout the first two years: Medical Interviewing and the Doctor-Patient Relationship (MIDPR), Physical Diagnosis, and the Competency-Based Apprenticeship in Primary care (CAP I, first year; and CAP II, second year). CAP helps students develop tangible skills related to caring for patients and integrating information more effectively in a clinical setting. The course curriculum reinforces skills taught in Medical Interviewing and the Doctor‐Patient Relationship, and Physical Diagnosis. Over the course of this year-long experience (beginning last block of first year and continuing through March of second year) students, working in pairs, spend one full-day per week in a primary care office (family medicine, general internal medicine, pediatrics). Students work through a core set of competencies that focus on fundamental clinical skills, knowledge and attitudes (taking a focused history, conducting all elements of the problem based physical exam, taking a social history, counseling a patient on smoking cessation, etc.). In addition, students participate in a series of ten workshops throughout the course, where they learn specific office‐based skills (administering vaccinations, performing medication reconciliation, working with the electronic medical record, offering nutrition/exercise counseling, accessing the evidence-based medical literature in the clinical setting, etc.). This active learning approach allows students to contribute to the effective office‐based care of patients while receiving superb education from primary care faculty.
- The course in Ethics and Professionalism stretches across the first- and second-year and tackles challenging topics including end of life care, patient’s rights and conflict of interest.
- Foundations of Evidence-Based Medicine and Clinical Reasoning stretches across the first two years. The unit consists of Epidemiology and Biostatistics, Problem-Based Learning (PBL), Introduction to Evidence-Based Medicine (EBM) and the second-year Introduction to Clinical Reasoning. A strong emphasis on the use of problem-based learning, a teaching method based on case studies, is a highlight of the curriculum. The cases chosen are closely coordinated with the material from the on-going segments of the curriculum and provide opportunities for student learning in a wide range of areas. Students are not only responsible for their own education in PBL but are also expected to actively support the education of their fellow students as part of this program. PBL emphasizes self-directed learning and fosters a spirit of inquiry, essential for lifelong learning.
- Selectives are one half-day per week sessions (Tuesday afternoons, August through April) that allow students to explore a diverse range of clinical experiences or topics in medical humanities, the business of medicine, issues in public health, and many others.
The second year's From Health to Disease units integrate Physiology, Pathophysiology, Pharmacology, and Systemic Pathology using an organ-based approach. The first unit includes Pulmonary, Renal and Cardiovascular. The second unit includes Hematology/Oncology, Rheumatology, Microbiology/Infectious Diseases and a Dermatology curriculum. The final unit consists of Nutrition, Gastroenterology, Endocrine and Reproductive. All components of From Health to Disease are extensively integrated with the longitudinal Introduction to Clinical Reasoning course.
The Introduction to Clinical Reasoning (ICR) course builds on the Foundation of Evidence-Based Medicine and Clinical Reasoning courses from first year. This small group experience meets nine times (two-hour sessions) between mid-September and early March to work through a series of cases based on common chief complaints that emphasize key aspects and pitfalls of clinical reasoning. In the intervening weeks, students prepare for the sessions by working through on-line virtual cases.
During CAP II students spend either Monday or Tuesday at their primary care site. Students in the Maine Track travel to Maine every other week to spend Monday and Tuesday at their primary care site. A series of workshops emphasize advanced topics in physical diagnosis and office based procedures.
An optional USMLE Step 1 Board Review course is conducted beginning in early January through mid March.
Active citizenship is a core value of Tufts University. All medical students are required to complete a community service project during their tenure at Tufts University School of Medicine. This requirement stems from the belief that the role of physicians extends beyond the clinic and hospital walls, and that future physicians will benefit enormously from first-hand experience working in the community. Through the Community-Service Learning (CSL) program students serve a minimum of 50 hours in a community with the goal of improving their communication, organization, and teamwork skills. Students have the opportunity to examine issues such as healthcare disparities, community outreach, public health initiatives, humanitarian service, and global health programs.
Years 3 and 4
Core Clerkships and Basic Electives
During the Core Clerkships students focus on developing their clinical skills and learn to take responsibility for patient care under close preceptor supervision at a number of affiliated sites representing a wide variety of clinical settings. The Core Clerkships start during the last block of the second year and consist of eight weeks each of medicine and surgery and six weeks each of family medicine, obstetrics-gynecology, pediatrics, psychiatry. An additional eight weeks of Basic Electives allow for career exploration and, based on the student’s interest, more advanced work in a variety of disciplines.
The medical school believes that all students should have experiences in a variety of teaching settings. Students should expect to participate in rotations that are located outside of Boston, including some at the Baystate Medical Center in Springfield, Massachusetts (the western campus of Tufts School of Medicine), and Maine Medical Center in Portland, Maine. See below for a list of Third-Year core teaching sites.
Advanced Electives begin during the last block of third year and extend throughout fourth year. These experiences expand the basic clinical knowledge and skills acquired in the first three years, enabling the student to manage clinical problems with the degree of independence required of the first-year postgraduate level of medical training. The specific program is based on the individual student’s career plans and needs, and is chosen by the student with faculty advice and is subject to the approval of the Dean for Students. Each fourth-year student is required to take a minimum of nine 4-week rotations. Five of these nine rotations must be taken at Tufts-affiliated sites. Of these five rotations, the following requirements must be met: two must be Acting Internships; one must be a clinical neuroscience experience; and one must be in medicine. A large selection of electives, including many nationally and abroad, allows fourth-year students to explore areas of interest and to round out their personalized educational program.
Third Year Core Clinical Teaching Sites
Tufts School of Medicine has an outstanding and diverse group of affiliated clinical teaching sites. The third year clinical educational program is conducted at the following associated hospitals:
|Baystate Medical Center||X||X||X||X||X|
|Metro West Medical Center||X||X|
* Four weeks at Lemuel Shattuck and four weeks at Faulkner Hospital
Community Service Learning (CSL)
The Community Service Learning (CSL) initiative at Tufts University School of Medicine stems from the firm belief that the role of physicians extends beyond the clinic and hospital walls and that future physicians benefit enormously from firsthand experience working in the community.
The goal of the SAT program is to expose all students to basic principles of teaching and learning at different points in their four-year medical school training. Upon completion, students will have achieved twenty-eight learning objectives that are grouped in four competency domains: 1) Adult and Practice-Based Learning; 2) Learning Environment; 3) Instructional Design and Performance; and, 4) Learner’s Assessment and Evaluation.
Healthcare Systems: healthcare costs, healthcare delivery systems, quality and safety, quality improvement, interprofessional collaboration, advocacy, law and reporting obligations, clinical informatics, chronic illness care, team-based care
Population Health: health determinants, health disparities, public health, prevention, culturally competent care, care of the underserved, active citizenship, global health, social justice
The Patient Experience: advanced communication, shared decision making, impact of health on patient and family life, end-of-life care/palliative care, assessment and management of pain and of substance use disorders
Personal and Professional Development: wellness, resilience, professionalism, ethical practice, evidence-based medicine, self-regulated lifelong learning, inquiry/discovery, navigating uncertainty, professional identity formation, leadership, teaching, clinical skills, clinical reasoning.