“What gets measured, Gets Improved.”

Peter Drucker

A Curriculum based on Metacognition

A medical school curriculum is an academic content that is taught in the undergraduate medical school program. The curriculum incorporates pedagogical approaches that foster active learning and critical thinking. It also includes clinical experiences, clerkship rotations including cores in (surgery, internal medicine, family medicine, pediatrics, obstetrics and gynecology, and Psychiatry) and In addition, there are 32 weeks of elective rotations, that allow AUIS medical students to seek out further training is specific fields based on both interest and possible consideration for postgraduate residency training.

In 2016, the administration of AUIS tasked me with the opportunity to revise and implement changes in the curriculum, in keeping with the demands set out by ACGME (American Council Graduate Medical Education.) This endeavor resulted in a paradigm shift in our undergraduate medical education program resulting in improved performance of the United States Licensing Exams (USMLE). Scores on USMLE exams are a major determinant in acquiring a residency position, necessary for postgraduate medical education in both Canada and the United States.
The opportunity to invoke change came as a result of a lifelong interest in metacognition. The science of learning has existed for hundreds of years, dating back to Herman Ebbinghaus, a German psychologist who pioneered the study of memory and published the forgetting curve. Unfortunately, these influential findings have lied dormant in academic journals and research papers rather than been executed in improving learning in our undergraduate medical students.

By drawing on the empirical research of cognitive scientists and practical strategies from educators, AUIS has been successful in executing these learning strategies. These teaching strategies have focused on four powerful teaching strategies: including retrieval practice, spaced practice, interleaving, and feedback-driven metacognition.

Retrieval practice boost learning by pulling information from a student’s memory rather than cramming information.  By instituting multiple diagnostic assessments in the curriculum, faculty assist students early in their course work to allow for improvement and spot deficiencies, long-before a final exam.

Spaced practice boosts learning by strategically placing interval redundancy in the curriculum.  Cognitive psychologists have demonstrated the importance of this learning technique.  Spaced repetition utilizes the spacing effect, in which learning is greater when studying is spread out over time as opposed to studying the same amount of content in a single session.  By having all assessments in the basic sciences including 30% of the previously studied material, we have been successful in improving outcomes and long-term retention. 

Interleaving improves learning by mixing tasks and topics, rather than studying one topic or “blocking”.  By mixing topics, students are forced to notice and process similarities and differences among the topics.  An example, instead of a student studying the chest x-ray findings of patients with tuberculosis for 3 hours, they would improve their retention and retrieval by studying the chest x-ray findings of multiple pulmonary diseases, interleaved with each other, such as pneumonia, pulmonary embolus, COPD, lung tumors, and TB.

AUIS has also utilized the value of the “testing effect” in our curriculum. The benefits of the “testing effect”, including identifying gaps in knowledge of the student, improved long-term retention, better organizational skills, improved transfer of knowledge to new concepts, and most importantly testing give feedback to instructors.

Ideally, the goal of our school of medicine is to produce a physician who is professional, empathetic compassionate, and confident.  A physician who is a self-directed learner equipped with training that is rooted in evidence-based medicine yet is introspective, analytical, and humble enough to realize that medicine is constantly changing field and to stay current, one needs to continue to learn and implement best-evidence treatments in their practice.    Real evidence-based practice is fluid, ever-changing, and continually revisable specific knowledge. 

Students who are considering a career in medicine, are encouraged to investigate the curriculums of the various allopathic and osteopathic schools.  Although, the final outcome is the same, that being a physician, the road to that goal is different.  Those students who through self-reflection of their own metacognitive style; students who succeed in smaller class size, where the ratio of professor to student is 12 to 1, those that need feedback from their educators on an on-going basis and those that can appreciate the metacognitive principles that have been integrated into our curriculum, would prosper at the American University of Integrative Sciences, School of Medicine.

AUIS | Caribbean Medical School