Letters to the Editor
To the Editor:
Mejicano and Bumsted’s1 article describes the medical curriculum makeover the two authors engineered at Oregon Health & Science University School of Medicine (OHSU). As a former professor of biochemistry and molecular biology at OHSU, I witnessed the transformation involve a complete takeover of the curriculum in which all decision-making authority was transferred away from the faculty and into the dean’s office. Per the article, the “goal of the new curriculum was to effectively prepare graduates for residency training and professional practice,” implying that the previous curriculum had not properly done so. However, the article does not offer explicit justification for the curriculum transformation or provide metrics by which the authors’ goal can be evaluated. Indeed, rationale for the new curriculum is lacking throughout the article.
To execute their curriculum, the authors employed Kotter’s principles, an eight-step, top-down business template for executing organizational change, but one that does not address whether such change is for the good. Vital to Kotter’s model is the removal of obstacles, and to this end the authors marginalized the existing teaching faculty toward whom they expressed antipathy in the article. Other aspects of Kotter’s change model were also implemented, but the practicality—and, in my opinion, the wisdom—of implementing a business change paradigm to the academic enterprise, a fundamentally different organizational prototype, is problematic.
The curricular changes were extensive, often imaginative, and occasionally unrealistic. Basic science content was diminished dramatically; new pedagogical methods mandated; different assessment methodologies implemented. Students were situated in a new nontiered classroom located far away from faculty and physician centers; faculty experts were removed from the classroom in favor of other content providers (I was replaced by the medical librarian), and 43 competencies were added. Too many variables were dramatically altered to enable effective assessment of any of these changes, and the authors do not justify or analyze any of them.
Fundamentally, the transformation of OHSU’s medical curriculum has changed the medical education platform into an apprenticeship and the MD degree from a doctoral-level degree into a club membership card with no well-thought-out mechanism for appraisal. Have there been improvements over the previous curricular model? Undoubtedly. Have there been deteriorations? Of course. But the elephant in the room continues to be whether the new medical school curriculum is an upgrade over the one that was replaced. This fundamental issue was not addressed in the article, and the faculty, and I, have our reservations.
Buddy Ullman, PhD
Retired professor of biochemistry and molecular biology, Oregon Health & Science University, Portland, Oregon; firstname.lastname@example.org.
1. Mejicano GC, Bumsted TN. Describing the journey and lessons learned implementing a competency-based, time-variable undergraduate medical education curriculum. Acad Med. 2018;93(3 suppl):S42–S48.