1 THE ASK CURRICULUM The central challenge of the modern medical curriculum is to educate future physicians who will continue to learn throughout their careers. The curriculum of the Robert Wood Johnson Medical School seeks to cultivate a thirst for ongoing learning and the skills for self-directed lifelong learning. The faculty seeks to provide learning and teaching environments that help our students become graduates who not only possess essential basic and clinical science knowledge, including a broad understanding of the environmental, emotional and societal aspects of health and illness, but also to become physicians who are humanitarian, compassionate, and focused on disease prevention as well as diagnosis and cure. The curriculum has been designed to develop medical students and graduates who are competent to begin postgraduate training. Competence is traditionally defined as the knowledge, skills and attitudes necessary to perform capably in a field of endeavor. Basic and clinical medical knowledge is increasingly complex, and there is an escalating rate of change for new information. The four years of medical school cannot possibly impart all the knowledge necessary to practice medicine, let alone the knowledge needed over a professional career. Robert Wood Johnson Medical School seeks to broaden the concept of competence, with a strong emphasis on the attitudes that are inherent in the profession of medicine, while maintaining the development of the skills and knowledge traditionally emphasized in medical school. The ASK (Attitude, Skills, Knowledge) model is a central element in the ongoing process of reviewing and improving the curriculum. For each of the four overarching educational goals that define our educational enterprise, we have described the core competencies essential to each goal, as well as the attitudes, skills and knowledge that comprise those competencies. Goal 1. To develop enthusiastic, self-directed learners who possess the essential knowledge in the basic medical sciences and clinical medicine, and who have the ability to assimilate new knowledge in these disciplines. Competencies. The competent graduate demonstrates the essential knowledge in the basic medical sciences and clinical medicine. The graduate demonstrates the ability to assimilate new knowledge as a self-directed learner, and demonstrates the ability to determine how to incorporate it into practice. Attitudes comprising these competencies include enthusiasm about learning, commitment to applying the scientific method to problem-solving, commitment to self-directed, life-long learning, commitment to the academic community, with respect for student/faculty colleagues, and commitment to data-based decision-making. Goal 2. To produce humanitarian physicians with high moral and ethical standards. Competencies. The competent graduate applies the ethical dimensions of medical practice and health policy; identifies alternatives in difficult ethical choices; analyzes
2 systematically the considerations supporting different alternatives; and formulates, defends and effectively carries out a course of action that takes account of this ethical complexity. Attitudes comprising these competencies include demonstrating personal integrity and honesty in professional activities and interactions, showing compassion for patients and families, embodying service to others, and acting for the benefit of the patient over one s own benefit, with a commitment to ethical decision-making. Goal 3. To ensure that students acquire the fundamental knowledge, skills and attitudes necessary for the responsibilities of a physician beginning residency training. Competencies. The competent graduate demonstrates the fundamental attitudes, skills and knowledge necessary to provide quality care for an individual patient, as a physician beginning residency training. Attitudes comprising these competencies include developing a sense of professional identity and responsibility in one s actions, commitment to continuously improving one s skills and knowledge, enthusiasm for collaboration and teamwork, and a commitment to sound clinical decision-making. Goal 4. To prepare physicians who appreciate the environmental, emotional, and social aspects of health and illness, and who focus on disease prevention as well as on diagnosis and cure. Competencies. In caring for the individual patient, the competent graduate takes into account the emotional, environmental, cultural and societal aspects of health and illness. The graduate focuses on disease prevention as well as diagnosis and cure in addressing problems of individuals, families and communities. Attitudes comprising these competencies include valuing and respecting differences, appreciating individuals in all their complexity, showing interest in learning from all interpersonal contacts, dedication to the prevention of disease and disability, and commitment to contextuallyrelevant decision-making. We seek to develop physicians who value the scientific method, who are enthusiastic about learning, who are committed to self-directed, lifelong learning, who are compassionate toward and respectful of patients and their families, who demonstrate personal honesty and integrity, who embody professional identity and responsibility, who collaborate enthusiastically as members of teams, who value and respect differences, and who are dedicated to prevention, diagnosis and treatment of disease and disability. In short, we seek to train physicians who are committed to evidencebased, ethical, sound clinical and contextually-relevant decision-making. Within these overall goals, with attitudes, skills and knowledge as our guiding curricular principles, we have developed specific learning objectives for each pre-clinical course, clinical clerkship and elective. These objectives are delineated for each course, as is the means of assessing whether the objectives have been achieved. ASKing is fundamental to becoming a medical professional.
3 The Robert Wood Johnson Medical School curriculum incorporates the best elements of both the classic and more modern interdisciplinary approaches to medical education. Traditional basic science departments are preserved, but courses of study do not always follow departmental lines. Some contain material customarily covered in several different courses; others follow a more traditional pattern. For example, during the first two years, clinicians from the departments of Anesthesiology, Family Medicine, Medicine, Neurology, Obstetrics, Gynecology and Reproductive Sciences, Pediatrics, Psychiatry, Radiology and Surgery assist in the teaching of the basic sciences. First and second-year courses, e.g., Introduction to the Patient, Physical Diagnosis and Clinical Decision Making, Medical Ethics, and Case-Based Learning, involve students in the assessment of patients whose clinical problems reflect basic science concepts. The Clinical Pathophysiology course is a year-long course that is integrated with the Pharmacology and Pathology courses. Lecture hours are reduced, with a shift to small group teaching and discussion. Small group, integrated case-based learning is taught by faculty who also participate in other courses; e.g., Clinical Pathophysiology, Pharmacology, Pathology, Behavioral Science, and Environmental and Community Medicine. Several interdisciplinary courses cross traditional departmental boundaries. Interdisciplinary first year courses include Case-Based Learning, Introduction to the Patient, Medical Ethics, Cellular and Genetic Mechanisms, and Basic Life Support. Second year interdisciplinary courses include Human Sexuality, Medicine and the Law, Physical Diagnosis and Clinical Decision Making, Basic Life Support II, and Universal Precautions/Venipuncture. Interdisciplinary courses are designated MDC. There is an increased emphasis on interviewing and communication skills and the use of standardized patients for teaching in the first two years. Many optional electives are available during the first and second years of the curriculum, such as Alternative and Complementary Medicine, Medical Spanish, Deafness, Doctors and American Sign Language, and the award-winning HIPHOP: Homeless and Indigent Population Health Outreach Project (presented with the Outstanding Program of the Year Award by the Association of Teachers of Preventive Medicine). These offerings augment the required curriculum and enhance clinical experiences. The third year curriculum is taught in the clinical environment, devoting approximately half the scheduled time to learning in the ambulatory setting. There are five eight-week clerkships: Family Medicine, Medicine, Obstetrics-Gynecology, Pediatrics, and Surgery and one six-week clerkship in Psychiatry. There are also opportunities to take electives. There is a one-week course in Introduction to the Clinical Experience, which includes a formative Clinical Skills Assessment exercise. The school regularly measures the clinical skills of its students, using tools such as faculty-observed patient assessments and Objective Standardized Clinical Examinations. Successful completion of a summative clinical assessment exercise is a requirement for graduation.
4 By the end of the third year, students will have completed core material. The flexible fourth year curriculum allows students to increase their specialty awareness and clinical competencies. The fourth year is divided into eleven four-week periods, including four required rotations (Advanced Clerkship in Ambulatory Medicine, Advanced Clerkship in Surgery, Neurology Clerkship, and a Sub-internship), and a minimum of four electives, individually chosen by each student from a catalogue describing more than 300 electives offered at Robert Wood Johnson Medical School. Students have an opportunity to select their faculty advisor and may additionally consult any other member of the faculty. Students are encouraged to work out elective programs that fit their individual needs. Such programs may be a part of the fourth year curriculum of a medical institution in this country or abroad, but must be judged to be of educational value by the student s advisor, and by the chair of the appropriate department. Students from other medical schools are welcome to take Robert Wood Johnson Medical School electives to the extent that their doing so does not interfere with the education of Robert Wood Johnson Medical School students. FLEXIBLE CURRICULUM The flexible curriculum provides the opportunity for a limited number of students to personalize the sequence of courses. All courses continue to be taught on the existing schedule. Students who are accepted into the program are able to select courses based upon their ability to satisfy prerequisites. They are required to complete core instruction before enrolling in more advanced courses. Flexible curriculum students are required to pay eight semesters of tuition during their matriculation. Tuition payments are prorated over the duration of their educational program. The opportunity to personalize scheduling of courses accommodates students with special circumstances. The program is structured to permit the pursuit of other academic, research, employment or family interests. It also facilitates the scheduling of our combined degree programs: MD/JD, MD/MBA, MD/MPH, MD/MS in Biomedical Informatics, MD/MS in Jurisprudence, and MD/PhD. Students participating in the flexible clinical curriculum must complete the first year and second year preclinical curriculum before entering the third year. Clerkships must be taken as complete entities, but may be scheduled as independent courses over an extended period of time. Students may schedule other activities such as research or work experiences between clerkships. STUDENT SCHOLARS PROGRAM Students may apply to a student scholars program during the curriculum. Students may engage in meaningful scholarship in the laboratory, clinical milieu or community setting.
5 They gain beneficial educational advantage from such experiences. They may also cultivate interest in a career in academic medicine. ACADEMIC PROGRESS Students are considered to be making satisfactory academic progress provided they are currently enrolled in courses or in an approved Student Scholar Program or an approved program of special study. REQUIREMENTS FOR PROMOTION AND GRADUATIO N Candidates for the degree of Doctor of Medicine must exhibit the requisite knowledge and skill to complete the prescribed course of study, and must also possess personal qualifications and attributes deemed necessary to perform the duties of the medical profession. Specifically, all candidates are expected to exhibit unimpaired judgment and behavior consistent with the responsibilities of the medical profession. Thus, in addition to the usual academic evaluations for each course, the student will be evaluated with regard to: Professional demeanor Professional conduct Concern for the welfare and dignity of patients Concern for the rights of others Responsibility to duty Trustworthiness Honesty Ethical conduct Aberrant behavior General or specific conduct meriting concern Should problems be noted in these areas, further action will be initiated by the Associate Dean for Admissions and Student Affairs. Attendance at the school is a privilege and not a right. Accordingly, the school reserves the right to require withdrawal of any student whenever necessary to maintain standards of scholarship or personal character. After due process, the school has the final authority in the application of this right to individual cases. All students, in addition to the usual requirements, are required to pass the United States Medical Licensing Examination (USMLE) Step 1 before beginning the third clinical clerkship of the third year curriculum. All students, in addition to the usual requirements, are required to pass USMLE Step 2 (Clinical Knowledge) and are required to sit for USMLE Step 2 (Clinical Skills) for graduation.
6 Candidates who successfully complete all three steps of the examinations receive certificates from the National Board of Medical Examiners. These certificates are accepted as adequate qualification by medical licensing authorities of most states, the District of Columbia and the territories. USMLE Step 1, which is taken at the end of the second year, is a written examination covering anatomy (gross anatomy, histology, neuroanatomy and embryology), behavioral science (psychiatry, epidemiology, biostatistics), biochemistry, microbiology (immunology), pathology, pharmacology and physiology. Candidates for certification by the New Jersey State Board of Medical Examiners may apply for waiver of the State Board examination if they attain passing scores on USMLE Step 1. USMLE Step 2, taken in the fourth year, includes written examinations in clinical knowledge in psychiatry, medicine (including legal medicine), surgery, obstetrics/gynecology, public health and preventive medicine, and pediatrics, and a standardized clinical exercise to evaluate clinical skills. After receiving the MD degree and upon completion of at least six months of internship, those who have passed USMLE Steps 1 and 2 may take Step 3. GRADES AND PROMOTION In June 1986, the faculty of Robert Wood Johnson Medical School approved the adoption of a five-point grading system (Honors , High Pass , Pass , Low Pass , Fail ). In addition, departments routinely submit a brief written appraisal of each student at the end of each course. A notation of Incomplete may appear on a student s record. This is not a grade, but a notation that a grade for this student cannot be determined because the student has not completed all or part of the course because of absence due to extenuating circumstances (illness, death in the family, etc.).