Honing a medical education that is “Patient First”

By Lindsay Key, senior science writer in the Duke University School of Medicine
Patient First curriculum
First year medical students practice patient exams as part of the new “Patient First” curriculum at Duke University // Credit: Duke

Instead of meeting in an on-campus lecture theatre, first-year medical students at Duke University, North Carolina, found themselves interacting with patients at a clinic on the first day of medical school.

Aptly named “Patient First,” Duke University’s revamped medical curriculum involves a revised first year experience, which includes a new Clinical Immersion course that allows students to spend time with patients almost immediately. The new curriculum kick-started with a pilot class in August 2020, to be rolled out over the next four years. 

Caring for patients a full year earlier than their medical school peers is a hallmark of Duke’s curriculum.

In this revised curriculum, students head out to the clinic a full year earlier, so they hit the ground running the moment they begin medical school, rather than starting on patient care during their second year.

It is a change that has been met with much enthusiasm from the students in the pilot class. “It was a great way to begin medical school before starting our more science-focused classes,” said Ivana Premasinghe.

“You feel like you're immersed in medicine right away,” added Meghan Sullivan.

Both Premasinghe and Sullivan started their first week of medical school in the clinic by conducting patient interviews and learning basic exam skills like blood pressure reading and heart rate monitoring.

A change four years in the making   

Duke started planning the new curriculum as early as 2017.

“We began looking at our current curriculum and trying to see how well it fit with what we expect the physician to know in 2030,” said Dr Edward Buckley, Vice-Dean for Education at Duke University School of Medicine who spearheaded this initiative, with other medical education leaders.

“We decided that we were missing some good things that we needed to include and some of the things that we were doing just weren't as applicable anymore going forward,” said Buckley, who also sits on the Governing Board of Duke-NUS. “So we brought a group of educators, clinicians, basic scientists, and students together, and said, ‘Okay, what is the skill set that physicians will need in ten years?’”

For the past four years, more than 70 faculty, staff, and students have served on the curriculum development committee, playing a pivotal role in shaping the new “Patient First” curriculum, which goes beyond having students see patients in the first year of medical school.

“Whether students choose to become physician-scientists, public health advocates or clinicians in clinics and hospitals, they should think about patients first,” said Dr Aditee Narayan, Associate Dean for Curricular Affairs.

The programme hopes to cultivate a patient first mentality in future clinicians, through new courses and by incorporating ‘knowledge threads’ into existing courses. These threads teach students about the social determinants of health, how to leverage data science to best care for a patient, and how to be an advocate for patient health through innovation and leadership.

Other than patient care, the program continues to place a strong emphasis on basic science and clinical research, a trait common to MD programs at Duke and Duke-NUS.

“We still have as a cornerstone of our curriculum a research heavy third year where the students can go and do a project over a longer period of time and do a deep dive into a particular subject,” said Buckley. “That subject could be in the basic science laboratories, or it can be in a clinical realm, or it could be a second degree, but it just adds to the clinical experience and the educational experience they get, so that we hopefully graduate individuals who are going to be very innovative and creative and will approach problems with a different view than someone who hasn't had that background.”

Adapted from Magnify, Duke University School of Medicine’s online storytelling magazine.