Medical school curriculum types (What’s The Best?)

Medical schools operate differently both at a national and international level. Their curriculum’s, mostly decided by the institutions themselves, are broadly based on (or a mixture of) four main types; block scheduling, non-block scheduling, problem-based learning (PBL) and clinical. Most schools also operate on a systems-based or non-systems approach to the first and second years of education too.

This article aims to discuss each of these systems, explain their differences and talk about the possible pros and cons of each too. Readers of this blog who follow my story, may notice that European medical schools, for the most part, take a non-systems approach with non-block scheduling. But this isn’t always the case.

Here’s more on each curriculum type.

Block Scheduling (Integrated)

Block scheduling is a type of academic scheduling (not just medical) used globally. It will be very familiar to most American students who’ve gone through the schooling system from kindergarten to 12th grade. Wikipedia describes it as “taking one class at a time, all day, every day, until all of the material is covered.”

Usually this means classes run over the typical 50 minutes class time and can go anything up to 90 minutes.

Commonly medical schools employ this type of scheduling when preparing students for integrated exams. The U.S.’s USMLE board examinations, for example, fit well with this style. Ensuring students cover all the potential topics covered on STEP exams ahead of time.

John Hopkins medical school, for example is a famous proponent of this system. Their timetabling is also visible publicly here. But it’s also common at a range of US-based med schools including Kentucky, Chicago as well as Caribbean med schools too (just to name a few).

The Pros of Block Scheduling:

• Centralised focus on one core system at a time (eliminating possible distraction)
• Variety of disciplines discussed in regards to a system (different professors, labs etc)
• Potentially easier for Universities to organise
• Spaced exams (occur at the end of every block period (every 6 weeks etc))

The Cons of Block Scheduling:

• Information overload (different disciplines discussed at one time could cause confusion)
• Students more dependent on independent self-study (without the pressure of regular tests and examinations)
• Makes exam cramming (learning everything covered during an entire block for one week of exams) incredibly stressful

One thing to bear in mind when considering block scheduled programs is another sub-division. That of whether the curriculum is systems-based or not. Discussing this will also help you better understand what is meant when med students refer to “blocks”.

Systems-Based Vs Non Systems

Systems-based is the most common way blocks are organised. This means students focus on one organ system, say cardiology, and learn the anatomy, physiology, pharmacology, pathology etc pertaining to that system in a single block. Once that block finishes they do the same for the respiratory system, the renal system etc.

This is the direct opposite to studying each of these courses independently (non systems-based). Meaning students will take exams at the end of each block that cover each discipline.

So cardiology block examinations could have questions pertaining to embryological development of the heart, flow and resistance, endocarditis and other related pathology. Not just anatomy, physiology etc, as broad subjects. This is often why the blocked curriculum is also referred to as “integrated“.

Blocks can also be non-systems based too. Meaning some schools might cover physiology as a block (covering all systems) over the course of some weeks. Before moving on to something like microbiology next. Without any overlap of individual disciplines.

Non-Block Scheduling (Traditional)

As mentioned before, my school works on a traditional non-block format. This is where individual disciplines (courses) run simultaneously. So you’ll might be expected to take pathology, physiology and biochemistry classes all in one day for example. Followed by labs or lectures in each interspersed throughout the week.

My third year at med school, which I reviewed here, shows how this traditional scheduling works. Consistently throughout a semester students take colloquiums (mini-tests) and mid-terms and then finals at the end. With each course covering all organ systems over a period of semesters (some taking up multiple semesters).

The easiest way to understand ‘traditional’ med school curriculum’s, as the terminology can get confusing, is that their courses are run by individual departments. Meaning the microbiology department, for example, is responsible for running all lectures, seminars and examinations for the course.

Sometimes schools will state their curriculum being “traditional” or “integrated” while being a combination of the two. Hence separating them into these classifications is problematic.

The Pros of Non-Block Scheduling:

• Continual testing (meaning students are more dependent on departments for hand-held studying)
• Varied approach (overlap of subjects can provide more novelty for students who get bored by prolonged focus on a single topic)

The Cons of Non-Block Scheduling:

• Continual testing (the stress of always having something to study for)
• Drip-fed information for each organ system over time (takes longer to form the complete clinical picture)
• Juggle multiple subjects at once (can lead to overwhelm if you don’t dedicate enough time to each)

Problem-based Learning (PBL)

According to Feinberg School of Medicine, part of Northwestern University, problem-based learning uses “clinical cases to stimulate inquiry, critical thinking and knowledge application” to learn medical sciences. The idea behind the model is that it better prepares students for their roles as future physicians. Collecting and synthesising information much in the same way they’d be expected to do in clinic.

Typically PBL based schools divide their student cohorts into small groups of between 5 and 10 people. Putting them under the supervision of a course facilitator. It works by students receiving a medical case, which they are then tasked with discussing, analysing and diagnosing. It’s rare for schools to strictly employ PBL-style learning across all medical courses. Instead it’s used as an integrated approach to taking apart some of the broader topics.

Biochemistry, for example, may suddenly become more relevant to students when the concepts are directly applied to a patient’s case. That’s PBL in a nut-shell. It takes the learning outside the books and frames it on real-world cases.

The Pros of PBL:

• Provides direct relevance to course material and the day-to-day roles and responsibilities involved with being a physician
• Better contextualizes difficult to grasp concepts
• Not passive; no rote memorization of facts required

The Cons of PBL:

• Expensive system for medical schools to employ (small class management, facilitators etc)
• Requires a lot of commitment, self-study and self-discipline to ensure you apply the material correctly to the cases
• Less structured than other curriculum types

Non-PBL

Non-PBL simply refers to courses that may divide student’s up into small groups and teach them in a more traditional format. An example of this could be internal medicine where students join a teacher on a specific ward or clinic who then guides them through the sequential order of patient examination.

Or anatomy class where a group of eight students gathers around a cadaver and observes a professor’s guided dissection.

Usually this is mixed into other curriculum types.

The Pros of Non-PBL:

• More teacher-student time; better able to observe details
• Potential to form/improve relationships with colleagues (working in a closer environment)

The Cons of Non-PBL:

• Expensive for medical schools to deliver
• Ineffective for studying broader, less visual subjects

Clinical

Clinical curriculum classes generally fall between the traditional or block scheduled types. They refer to sessions held before clinical rotations (usually third year hospital ward-based teaching), where students might have to go in and work in a hospital a few times per week or month.

These courses might cover topics that could deviate from standard medical curricula like public health. This is also what some med schools refer to as “early clinical exposure”, given their typical timings in either first or second year schedules.

Again such sessions are usually mixed into other curriculum types.

The Pros of Clinical:

• Early exposure to patients and hospital work
• Contextualized learning in a real-setting

The Cons of Clinical:

• Expensive and difficult to schedule
• Limited skills/experience restrict student effectiveness

Pass/Fail

Another important thing to consider when it comes to the organization of med school programs is whether classes work on a pass/fail or grades based system.

European medical schools, as explained in my article a rough guide to European medical school exams, work on a grade basis. Meaning students score on a spectrum of 1-6 with 3 being the minimal pass grade and 6 being the highest possible score. Other schools may have different rubrics.

Pass/fail systems can work well. They equalise the playing field. Meaning the advantages open to some students to score higher (more time, better budget etc) no longer count so long as they pass. But this can also be an annoyance for the hard-working student too.

What’s The Best Medical School Curriculum?

The best med school curriculum is probably a systems-based one. Covering each organ system in depth, taking time to learn the anatomy and physiology, pathology and then pharmacology, makes more intuitive sense. It also helps contextualize each piece of information more broadly as a whole.

Clinical or problem-based curriculums seem pretty useful also. Especially as this is what doctors are doing on a day-to-day basis.

Deciding what’s best is objective. As a student going through the non-block scheduling approach, my experience of the other systems is limited (this will be the same for other students). I can’t say with any confidence what’s best for you or not.

As med schools are also continually updating their curriculum’s and changing the way they do things, the question is more complex. Following different schools on the web or on YouTube can give you an idea of what could be good or bad. Check out this example from Harvard for instance…

Who knows if this new curriculum is the best or not? It’s almost an impossible thing to measure.

Summary

Many medical students take different routes to become doctors thanks to the protocols or schedules of the universities they attend. Although the course material is largely the same, curriculum’s may differ. Meaning there’s no such thing as a typical med student experience!

Hopefully the article above, however, has helped explain better how different schools can work.