We appreciate the opportunity to respond to our former colleague’s letter on our article “Describing the Journey and Lessons Learned Implementing a Competency-Based, Time-Variable Undergraduate Medical Education Curriculum.”1 Those who have led transformational initiatives have likely encountered significant supporters and fervent resisters. Indeed, differences of opinion are expected regarding the need for change, the optimal method to achieve desired outcomes, and the metrics used to evaluate success.
Our intent was to describe our journey and share lessons learned, not to justify our rationale for transforming the curriculum. Nevertheless, we did include a paragraph that describes the national imperative for change.
We also completely disagree with the author’s characterization of a “takeover” since we meticulously followed university governance procedures, including formal approval of curricular changes by the faculty-led Curriculum Committee, the school’s Faculty Council, the dean, and the provost. Further, over 30 faculty members actively participated on our Curriculum Transformation Development Teams. As we described in our article, some seasoned contributors expressed reservations and decided not to engage in or embrace the curriculum transformation. In contrast, hundreds of other faculty members are enthusiastically participating in teaching and leading new curricular components. We agree with the author that our curricular changes are extensive. This was by design as we modernized the curriculum to integrate all three sciences—basic, clinical, and health systems sciences—instead of perpetuating the siloed and compartmentalized approaches used in the past. Further, we recognize the value to our students’ education of incorporating both content and instructional expertise in modern curricula. And it’s important to clarify that the “medical librarian” the author references holds a PhD in biochemistry and is an outstanding, highly regarded teacher.
Metrics used to evaluate our success go well beyond learner satisfaction, national exam scores, and residency match rates by incorporating longer-term, meaningful outcomes related to the knowledge, skills, and attitudes in all six of the physician competency domains needed to care for patients in the modern era. Thus, we are now better able to entrust that our graduates are residency-ready to practice medicine. Results to date are encouraging and validate the approach, process, and outcomes we helped implement.
George C. Mejicano, MD, MS
Professor of medicine and senior associate dean for education, Oregon Health & Science University School of Medicine, Portland, Oregon; firstname.lastname@example.org.
Tracy N. Bumsted, MD, MPH
Associate professor of pediatrics and associate dean for undergraduate medical education, Oregon Health & Science University School of Medicine, Portland, Oregon.
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(3S Competency-Based, Time-Variable Education in the Health Professions):S42–S48.