"Systems-Based" Curriculum

[zoopeda]

I recently went out to a Pacific University info session where they touted an innovative "systems-based" curriculum--meaning the first year courses are all coordinated to follow one common curriculum (ie, when Gross Anatomy is studying the brain, Physiology, Pharmacology, Clinical Diagnosis, etc are all studying the brain too, and they all move, system-by-system, through the body over the course of the year).  Then I went to an interview at DeSales University, and they have a Systems Based model as well.  And Penn State does too.  And, apparently, even the OHSU MD program uses this model.  It seems like a brilliant way to integrate the material.  Yet, from what I gather, the OHSU PA Program does not have a systems-based curriculum.  How could this be?  So far this is the only real deterant I can see to their program.  Can anyone provide any insight into their curriculum design?  Please: prove me wrong!

Thank you!!

[gbrothers98]

There is nothing innovative about a systems based curriculum. When I was in PA school back in 96-98, our class intuitively felt that systems based progression was a better way to spend our academic year. After discussion with faculty, it was apparent that our appreciation of all the moving and conflicting parts to a PA program was not fully realized. There were and can be distinct obstacles such as the availability of labs, lecturers and classroom space that would inhibit this model. With more online teaching, simulation experiences and 'flipping the classroom' approaches, the system based curriculum may be more of a reality. I part time teach at a PA program that follows the systems based curriculum and the distinct downside is scheduling in classes that dont flow with learning the medicine and its foundations. There also seems to be distinct overlap when moving from system to system ie attending a final lecture on ENT disorders while starting the pulmonary anatomy dissection lab later that day and then sitting for the ENT exam 3 days later. Amidst this a paper or project due in Patient Communications or Medical Lit Interpretation. Can make things a bit confusing and unfocused.

The specific program that you mention above has a very respectful initial PANCE passage rate over more than a decade. Regardless of the organization of their curriculum, they seem to know what to do to get a student successfully through to the end goal, passing the PANCE and becoming a PA. Cant argue with repeated success.

Good luck.

G Brothers PA-C

[zoopeda]

The distinct downside is scheduling in classes that dont flow with learning the medicine and its foundations.

 

Thank you; that is very insightful.  It does seem like perhaps you're suggesting that smaller, free-standing programs like Pacific and DeSales can get away with scheduling the Systems Based curriculum because they're not sharing space and time with Medical Students.  I'm trying to see the advantage of a PA program associated with a medical school (i.e. OHSU), but in this case, I wonder if that's an obstacle to a more logical curriculum design.  I understand no program or course of study will be perfect, but even with little overlaps, it seems to make a lot more sense.  Again, even the OHSU MD program is scheduled that way, and the Penn State PA program is a Systems Based curriculum yet is also a free-standing program WITHIN the university school of medicine.  So it CAN be done at a medical school.  It just feels like blowing my mind out for an intense quarter of gross anatomy with medical students is a better way to crowd out other important coursework while setting oneself up to forget the material months later, but ultimately, PANCE is also a key marker.  I wonder if these results are purely due to the curriculum or if the admissions department has become impeccable at attracting a certain kind of driven, "type A" student while filtering out the types who are seeking (and might thrive better in) a systems based model.  Hard to know for sure.  

 

*by "innovative" I merely meant in comparison to the traditional model as pioneered a hundred or more years ago--the one where students approach medicine like a blunt instrument (shall the best man win) compared with newer models (1990s and later) such as systems based trainings that appeal to a wider range of learning styles and are perhaps better suited to the modern student of medicine.  Why would the OHSU medical school adopt a newer curriculum format around the same time (mid-90s, early 2000s) the OHSU PA program was being designed and implemented around the older model?  Intentional, or left hand not talking to the right?  Food for thought...

[primadonna22274]

I'm pretty proud of my alma mater (my class was the 2nd and the first to coin the phrase "PUPA", er, Pacific University PA" ????

When I went through in 98-00, we had a much more traditional science-based curriculum. Meaning first summer was Anatomy with lab, Physio, H&P, a couple ethics classes, intro pharm and I don't remember what else lol. Then fall was a whirlwind EKG in 2 wk (yuck!), then one system at a time through the spring. Only near midwinter-early spring did things start to click..."aha! It's all interconnected!!" But it was kinda nice to focus on one major course at a time.

I learned systems based in med school (2011-14). The interconnectedness of pathophys, Biochem, Physio, anatomy, microbio/genetics, histo, pharm and physical exam was pretty helpful. Our osteopathic department aligned OMT lectures and skills testing with the specific system being taught at the time. It did help but was still a mite overwhelming.

I do think PU benefits from being essentially a freestanding PA program. I actually had FAR better rotations in PA school than I did in med school, but it's hard to know how much of that is a 15-year difference (so much more restrictive now) and regional variations (east coast/west coast).

I don't know much about OHSU's curriculum. When I was a student their PA-Ss liked to brag they took "the same classes as the med students" (???) but in my mind we had dedicated faculty who were committed to our individual success and we enjoyed freedom to guide our learning toward the most beneficial for us.

Personal preference, I think.

You really can't go wrong at either program. There was oj PA school in Oregon until 1995, and both programs have demonstrated effectiveness at producing quality PAs to serve the state and beyond.

Good luck whatever you choose.

[rev ronin]

The PA school at Pacific is no longer free-standing.  It may be among the oldest of the programs in the College of Health Professions, but OT, PT, Pharm, Psych, and dental hygiene outnumber the PA students by a lot.  They're going to be moving the OD program from Forest Grove to Hillsboro as well... it's really got just about everything but a med school and a nursing program.

[primadonna22274]

Wrong term, maybe. PT/OT and psych were there long before the PA program. Optometry LONG before (not sure how old the program is--dating back to 50s I think?). But not connected to a med school, yes--that's what I meant.

[MarciKiser]

I fully agree with the "moving parts" issue. With our students, the challenges of the systems-based curriculum we use have always been:

 

1) While some systems (cardio, etc.) are complex enough that it's easy to spend a month teaching the clinical medicine, pharm, h&p, and diagnostics equally, others suffer a crucial imbalance. When we reach a subject like endo or hem/onc, the clinical medicine portions are very complex, but the pharm and h&p portions can often be handled in one or two lectures. So your option is to either not have them come to pharm or h&p for the next three weeks or let those professors move on.

 

2) When it's test time, it's a beast. The students are trying to memorize pharm, understand pathophys, practice diagnostics, and prep for their h&p practicals all within the space of a week or so. While there is usually some overlap in material that makes it a bit easier, more than one student has had a bad week for this reason or that and it has tanked their entire semester (and sometimes, their ability to continue in the program)

[zoopeda]

Re #1: why aren't instructors simply given the appropriate time they need per unit? It seems most classes happen in one room. If phys needs more time one week, that prof would stay longer each day while the pharm prof cuts back until the next unit (for example). I imagine this is easier to achieve at a school like Pacific than at a program trying to share classes with med and other students...

 

Re #2: Isn't the quantity of material equal at both schools? Amount of learning per test should be roughly the same since both programs have a one year didactic portion. Isn't it just the organization that would differ?

[whoRyou]

Lately I have been looking and doing some research for HCE. I have been talking with different PDs at my local Community College as well as in nearby towns. I have noticed most if not all have adopted the "systems-based" curriculum which I think is interesting. I just assumed since I was researching strictly at CCs it would have been a traditional approach, apparently I was wrong. Maybe this is the future for all CCs?

[primadonna22274]

It's basically a move toward systems-based curricula at all med schools (mostly) in the past decade or so. Don't know if outcomes are better at all. In some ways I think it's a fad like PBL was 10-15 years ago.

[MarciKiser]

zoopeda,

 

1) While that would be the ideal, in practice it's just not how professors or lectures work. Our pharmacology is taught by pharmacology professors, our anatomy by anatomy professors, etc. Each of these people have other responsibilities and classes they teach, and their schedules vary by the semester. Making it even more complicated, as with most professorial contracts, we must negotiate with them a set block of lectures (so they're not setting aside time for us only to not be utilized). They're not simply on-call experts. There has been discussion of utilizing PA faculty to teach the entire curriculum, but in the past this has been a complete debacle. Smart as any professor may be, it takes real expertise to properly teach something like pharmacology or pathophysiology or even psychiatry, not a passing familiarity.

 

And finally, all of the above has to meet our ARC-PA accreditation guidelines for proper instruction in those subject areas. These are the "moving parts" so many people aren't aware of. You have to try to maximize student's time, while working around professor's schedules and meeting the terms of their university contracts, while meeting the expectations of your accrediting body, and all the while trying to make sure your actual students are actually learning what they need to know. And that's not even broaching the subject of academic advising and extra tutoring and the inevitable drama of packing dozens of Type A neurotics into the same classroom for a year...

 

2) It's a matter of temporal and biological limitations. Trying to cram for testing on an entire system within the space of a week or so is hugely taxing (yes of course "blah blah when I was in PA school we..."), and for some students they simply don't have enough time or mental energy after their H&P test on Monday to shift gears and study for their Pharm test on Tuesday and their Physiology test on Wednesday (all of which are learned in very different ways). Compound this with the fact that any student can have a bad week (sick, bad break-up, family emergency, etc.), and we've found that it's perhaps best to not make such a short period of time so high-stakes.

[db_pavnp]

Compound this with the fact that any student can have a bad week (sick, bad break-up, family emergency, etc.), and we've found that it's perhaps best to not make such a short period of time so high-stakes.

 

Good.

[zoopeda]

Thanks for taking the time to explain yourself, MarciK!  I didn't realize there was only one test/testing week per unit in these systems based programs.  I can see there is a lot more challenge on the back end to actually coordinating these classes.  Part of me really wonders if programs like Penn State are doing it perfectly or if they're battling some of the same issues you're talking about.  Ultimately, I'd love to get an OHSU interview invitation to seize an opportunity to discuss some of these issues directly with the program staff.  Obviously OHSU has just about the best first-time PANCE pass rate going, so there's obviously more to the story than I realize.  Thanks again!

[gbrothers98]

I think this is a great discussion.

Several important points concerning ideals, accreditation, limitations.

This is my personal observation.

Students attending PA programs today are handing over a lot of money for their education. They expect the ideal education. They also expect the education to conform to what they believe is important, which is usually the medicine. I think education makes the best attempt possible to reach that ideal but conflicts with the accreditation needs and also internal program desires on what the education should consist of.

The limitations are time and experience. The 24 to 27 month program length is a holdover from decades ago when medicine was a simpler practice. There should be more time. The old expectation was plenty of solid HCE to make up for the time limitation. The HCE is not there in many cases and worsens the time limitation effect.

I also think PBL is far from dead or a fad. Done correctly, it can be a great learning and teaching tool but there needs to be solid heavy investment in the concept. PBL, self directed learning and online learning are all tools that will be utilized more. The days of butt in classroom seat are not effective and I see students struggle with this regularly. The program I part time teach at have made many lectures optional in an effort to address the various learning styles and time conflicts.

Just like medicine itself, medical education including PA education is changing. Students entertaining admission to a PA program should ask questions at interviews to ascertain if their chosen program is staying innovative or doing the same usual thing. It may determine their personal success.

G Brothers PA-C

[futurePA2016]

Thanks for taking the time to explain yourself, MarciK!  I didn't realize there was only one test/testing week per unit in these systems based programs.  I can see there is a lot more challenge on the back end to actually coordinating these classes.  Part of me really wonders if programs like Penn State are doing it perfectly or if they're battling some of the same issues you're talking about.  Ultimately, I'd love to get an OHSU interview invitation to seize an opportunity to discuss some of these issues directly with the program staff.  Obviously OHSU has just about the best first-time PANCE pass rate going, so there's obviously more to the story than I realize.  Thanks again!

So I'm actually a student at the Penn State PA program where we're using systems based learning. I really like it because what we learn in anatomy and history and physical all go along with what we're learning in clin med/pathophys/pharm. I feel like what we learn in one class complements and enhances the learning in the other classes and really helps me understand the process behind the disease. We also don't just have one testing week per unit but instead our material is split into multiple sections that we get tested on as we learn them. For instance, gastrointestinal was split into 3 separate exams throughout 1.5 months and renal was 2 exams. One giant test would be insanity for us, especially with all our other classes.

[zoopeda]

Anecdotely, upon interview, student feedback about this model has been 100% positive (n= 5 or 6).

[zoopeda]

Future PA, re: a concern above, do you notice this schedule to less forgiving of a "bad week?" Thanks all; great discussion!

[futurePA2016]

Future PA, re: a concern above, do you notice this schedule to less forgiving of a "bad week?" Thanks all; great discussion!

Actually probably the opposite! By splitting up the material into multiple sections, it makes it a million times more manageable to absorb and learn. The material from the beginning of the section is also fresher in your mind. Doing one entire system for one test would involve memorizing hundreds upon hundreds of slides, and it would be a lot easier for someone to fall behind. Studying and testing periodically throughout the system ensures that we're caught up and makes the rest of material more comprehensible. 

 

Yes, it's a beast when we're studying for these exams every week to every other week combined with all our other classes but I've been finding that a lot of our classes build on each other because we're mostly in the same system, so studying for one class helps shed some additional light on material in another class. 

 

I haven't had an awful week yet where I just wasn't able to study so I find this system great because we don't have too much information to study for one test but I can definitely see where if you had a family emergency and missed a week, it can be very hard to catch up simply because we average 2-3 tests per week. That can be very difficult to make up (and I actually do think about this from time to time, hoping that I don't get too sick come wintertime). However, our course director is really awesome and very understanding so I'm 100% positive that she'll be able to help any student through that rough time.

 

Sorry, I may have rambled on a bit (and hopefully I did manage to answer your question in the end) but if you have any questions, feel free to ask!

[zoopeda]

It's sounding like there are actually three models here: traditional model (OHSU) where courses are not arranged by "system," full-on systems-based model where students literally take one all-encompassing class that goes system-by-system through the material (i.e. Pacific U), and a sort of hybrid that still follows a systems organization but where there is still a separate class (some perhaps shared with MD students and some not) for each major subject (path, pharm, anatomy, etc).  I'll be really curious to see if the systems-based curricula result in longer retention and higher pass rates or if the appeal of having multiple models simply allows applicants to self-select schools based on what they know of their own learning style.  It would be great to sit in on a couple classes to get a feel for each method...