Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

Page 19 text:

year. The real difficulty arose in trying to decide what to include and where. Each department had to justify the number of hours it was allo- cated. To appreciate The dimensions of this burden, a comparison of the number of hours assigned tothe departments in The respective curricula is helpful: DEPARTMENT OLD NEW CURRICULUM CURRICULUM Anatomy igross, micro. and neuroj 531 252 Biochemistry 208 117 Physiology 358 150 Microbiology and immunology 164 160 Pharmacology 110 121 Pathology 348 214 Introduction to Clinical Medicine 364 96 The most conspicuous cutbacks were in The time allotted to Gross Anatomy and to Physical Diagnosis. Despite The obvious shortcomings ot The system, however, iT has been The consensus of most students over The past 18 years that The sacrifices and constraints of years one and two are well-compensated by The immense free- dom of The elective curriculum of years Three and four. Although The new curriculum weathered almost 15 years without major revi- sions, The 1980s brought a few major changes. By original design, the second year was composed of five required clinical rotations each of Two months duration: lntemal Medi- cine, Surgery, Pediatrics, Ob-Gyn, and Psychi- atry. However, tothe surprise land constema- tion of somel of The class of 1984, a sixth re- quired rotation - Family Medicine - was added effective September of 1981. Although the rotation has generally been a popular one, the12-month duration ofthe second year has been a source of dissatisfaction to many stu- dents. The most recent chapter in the evolution of the curriculum was written in January of 1984 when MEDSAC lthe Medical School Advisory Committeej, after months of deliberation by various committees, announced major curric- ulum changes to take effect with the entering class of 1984. The changes included: 111 mov- ing Introduction to Clinical Medicine to the early part ofthe second year, 121 utilizing the six weeks thus vacated to decompress the first year - not by increasing the number of lec- tures, but by setting aside Tuesday and Thurs- day afternoons throughout the first year for study, and 131 allowing second year students the choice of five ofthe currently required six rotations, with the option of taking the omitted rotation as an elective during the fourth year. Thus, the second year was restored to its origi- nal 10 months in duration. There were no changes made in the elective curriculum. lf the unfolding of the new curriculum dominated the middle and late 1960s, the de- velopment of Duke North was foremost in the decade ofthe 1970s. The history of the development of Duke Hos- pital North TDHNJ began on November 22, 1970 with a decision made by the Medical Center Administration and supproted by its clin- ical departments to proceed with the plan- ning of new hospital facilities. The decision re- sulted in the authorization of a hospital plan- ning staff, the Hospital Planning Studies Office, To coordinate all planning activities associ- ated with new hospital facilities. The members ofthe HPSO were Dr. Jane Elchlepp, Associate Vice President of Health Affairs who, in The words ofthe Vice President of Health Affairs, Dr. William Anlyan, orchestrated the develop- ment of Duke North, Wallace E. Jarboe. Larry D. Nelson, and Robert G. Winfree. This office established liaison with planning agencies and area hospitals, collected patient statisti- cal data, and involved clinical faculty and staff and administration in developing other plan- ning data. Inpatient and outpatient data was gathered from as far back as 1964 and was analyzed with respect to patient loads, origins, etc., in order to obsenfe trends in the patient population. One of the more important observations, noted Dr. Elchlepp, was that pa- tients were coming from farther and farther away - Duke was becoming a tertiary care hospital. The data generated also showed that inpatient services were grossly overloaded. For example, occupancy studies showed that surgery frequently ran in excess of 100070 ca- pacity. a feat made possible bythe existency of a recovery room. When the inpatient func- tional unit analyses were compared with Unit- ed States Public Health data, Duke Hospital was found to be severely lacking in both pa- tient space and support space. The HPSO data documented the need for expansion. The HPSO went on to identify consultants necessary to develop programs for hospital modemization. On January 14, 1972, the Execu- tive Committee ofthe Board of Trustees autho- rized acceptance of a proposal submitted in November, 1971, by American Health Facilities TAHFJ, lnc., To Develop the Conceptual Mas- ter Plan, Project Budget and Economic Feasi- Dr. Roy T. Parker X 1 15

Page 18 text:

10415 Q2 8 1050 Q7 3 1955 Q9 0.3 1960 811 16 lt was against this background that a very important meeting occurred in November of 1961 in Dr. Handlers office. ln addition to Dr. Handler: Dr. Eugene Stead, Chairman of the Department of Medicine: Dr. Thomas Kinney, Chairman of the Department of Pathology: and of Pediatrics were present. Certain criti- cisms won unanimous agreement: ffl The curriculum was much too inflexible. Even though medicine offered a diversity of specialities, a student could not vary hisfher curricular content to coincide with hisfher in- terests. Similarly, a student was precluded from exploring one particular field of interest in depth. 121 instead of promoting creativity or original research, the curriculum inhibited it. The stu- dent leamed basic sciences during the first two years when hefshe could not appreciate their clinical pertinence. Rather than a sense of appreciation and interest, a feeling of frustra- tion and a sense of distaste for these subjects developed. Only after the clinical skills have been mastered does a physician realize the importance of a sound background in the basic sciences, but then the rigors of practice make it too late for the average physician to pursue these areas of importance. l3J Students were not exposed to clinical areas until late in the curriculum, thereby dis- couraging early career decisions. By delaying such decisions, a student could not construct a curricular program in accord with hisfher ca- reer plans. With this conceptual basis a unique curricu- tum slowly took shape. The first year would pro- vide a student with the core material needed to understand the clinical experiences hefshe would encounter on the wards during the sec- ond year. The third and fourth years would be entirely elective, with approximately one half of the student's time being devoted to basic science studies and one half in clinical rota- tions. Thus, students would be encouraged to design their own elective experiences. These aims were articulately stated in a grant proposal to the Commonwealth Foun- dation for financial assistance in instituting this curricular format: fit to provide a strong academic basis fora lifetime of growth within the profession of medicine, with the development of techni- cal competency, proficiency, and the proper attitudes perculiar to the practice of medicine as well as appreciation of the broader social and service responsibilities: T21 to establish for the first year a basic scien- ce program which will fulfill the purposes of the increasingly heterogeneous student body: l3J to offer both clinical and basic 111 4 science education simultaneously: lrll to permit the student to explore his personal intellectual preferences and capabilities: L51 to allow study in depth in selected areas, either basic science or clinical: lol to pro- vide greater freedom of course selection, and thus to encourage earlier career de- cision: l7J to achieve better integration of the medical school curriculum with residen- cy training and the practice of medicine. The Commonwealth Foundation unanimously approved the Duke request, and entering class of 1966 became the first class of the New Curriculum. Dr. Ewald Busse For the new curriculum to be successful, the general approach to each year had to be reassessed. Furthermore, each department had to review its own approach to the different years. This required an enormous amount of time, energy, and willingness to compromise. Departmental autonomy has a strong tradition at Duke and for the new curriculum to function effectively, it required support and commit- ment from all the departments. This was most obviously seen in the revision of the first year. The goal was simple: to trim down two years of basic science material to a core of information to be crammed into eight months of the first

Page 20 text:

bility Analysis of Duke Hospital. Seven altematives, ranging from staying in the existing hospital with minimal bed expan- sion, minimal new spaoe, and maximum ren- ovation, to total replacement of the existing hospital by a new hospital, were presented by AHF. Studies were done which indicated that it was functionally inappropriate and financially unfeasible to relocate the entire inpatient and ambulatory functions of Duke Hospital, includ- ing support facilities, in a new structure. No use for the vacated structure could be found and the price was not acceptable to the trustees. The altemative specifying renovation of the ex- isting hospital with minimal new construction was also rejected onthe basis that the renova- tion would be drawn out over 15 years. inflation would elevate the cost to that of a new hospi- tal. ln addition the final product would be less efficient than a new construction and would not allow for appropriate expansion. On January 19, 1973, the Hospital Advisory Committee approved as the target for fiscal evaluation the altemative called G-94 North. This altemative provided for 615 new beds and all support services, with Psychiatric and Ob! lo .VT gf li j.. ,.,- 3. i ' la' Luv- rf L3 1'-5 Ar'