Sharon Long is professor of biological sciences at Stanford University and adjunct professor of biochemistry at Stanford University School of Medicine. Together with Robert J. Alpern, dean of the Yale University School of Medicine, Long co-chaired a committee of researchers, physicians, and science educators who developed the Scientific Foundations for Future Physicians (SFFP) report, aimed at preparing the next generation of physicians for 21st-century medicine.
How did your own experiences influence your interest in curriculum design?
I was one of those students who don’t do well in large lectures. I became very interested in active learning, and in other ways of helping students maximize their learning. Through this and through conversations with colleagues, especially in chemistry departments, I also became aware that many science faculty felt stymied by what they saw as rigid course content requirements that were tied to MCAT content [MCAT is the universally accepted medical school entry exam]. For example, chemists felt that the MCAT questions basically amounted to a nation-wide imposed curriculum for organic chemistry.
MCAT content was regularly revised and examined by the AAMC [Association of American Medical Colleges], and this effort always included surveys of medical and chemistry faculty, but the structure of the survey was oriented towards reporting the status quo. Thus, no one individual faculty member, or department, or university, was able to act in a really independent way for fear of not serving their students well. This convinced me that only some kind of action at the center could help facilitate change. Getting the offer to work on the SFFP committee was a great opportunity to make a difference on behalf of faculty and students alike.
The report encourages “creativity” in the design of new curriculum. How does that play out?
I think “freedom” is perhaps the more appropriate word. Creativity is there already, for example in chemistry departments where some faculty wish to design innovative classes that teach organic chemistry in a context combined with biochemistry, or in universities that offer combined calculus-statistics-computer science courses. As it stands now, such classes don’t necessarily count as satisfying the prerequisite requirements for application to medical school, because the requirements are stated in terms of course names instead of being described for the needed content to be learned. With the new system, a course could be given in many different contexts and still satisfy the medical school admission goals because the students succeed in learning what they need.
Why is a more scientific curriculum necessary to train physicians?
Medicine is a complex art, and needs to consider the whole human being, not just the mechanical body; thus a comprehensive medical education is likewise multidimensional. But science is the fundamental basis for understanding human health and human disease. Our human bodies obey the laws of nature, and science has given us the tools to understand those laws and to refine that understanding through further research. Furthermore, the scientific processes for testing hypotheses and defining significance are at the basis of rational decisions about the cause of disease and about efficacy of various therapeutic approaches.
What does the word “competency” mean to you?
Instead of mandating a curriculum, we should ask, what should students be able to do? That’s a competence. Imagine you’re on the ground floor of a building and you need to get to the next floor up. There are steps, and there’s a ramp. The MCAT, and many other tests, would assume that you had to take the steps and it would test every one of the steps. In competency-based curriculum approaches, the thing that matters most is that you can get to the top. We wanted the MCAT to stop testing the steps.
What is your ultimate goal?
My aim is to offer learning opportunities to undergraduates in a way that is effective in bringing in all the talented people who could make talented physicians, and giving them all the background they need to flourish in medical environments. The uniformity that was imposed on curricula was creating a rigidity that was not allowing innovation to help certain populations of students that might flourish in the kinds of conditions that exist now, but who would make terrific physicians and have great scientific ability. I’m an example of a student who started to do better when I got into small, interactive courses my junior year. That just saved me.