Personalized Learning in MedEd: Multiple Learning Pathways

Personalized learning, or the ability to customize the learning experience for the purpose of student satisfaction, effective learning, and better (more + more relevant) outcomes is a trend emerging across every aspect of higher education. In the context of medical education, the concept of personalized learning as a mandate can be linked to its mention in 2010 Carnegie Report, which called for the transformation of the medical education system to include (1) standardized outcomes, (2) better integration between classroom and workplace learning, and (3) more emphasis on the development of professional identity WITH (3a) personalization and/or acceleration of learning once professional identify was established.

I’ve written on (1) the standardized outcomes and (2) clinical-classroom integration before (best done so far in this post).  I’ve also written on how many schools are working on enhancing their formal and informal curriculum around professional identity through learning communities and targeted, proactive – dare I say aggressive? – coaching (see this post, among others).

So let’s talk about 3a:  the personalization and/or acceleration of learning. Between the figure and the text, you’ll see a conflation of two terms: personalized learning and precision education.  As I’ve mentioned before, “precision” medical education may be taking over for “personalized” learning as an official buzzword…or maybe it is going to be one approach or type of personalized learning (most likely, in my opinion). The jury is still out, so feel free to read this post with whatever phrase you prefer.  But regardless of what name you want to use, let’s walk through the components mentioned in the graphic above in more detail. This post will focus on multiple learning pathways.

One of the most common ways to promote personalized learning is the presence of multiple, personal learning pathways. Personal learning pathways can mean a lot of things across – or even within – programs.  This section explores three approaches medical schools take to providing students with the ability to customize their learning pathways

WWW.NORTHBOUND.CO (1)Express Lanes: Accelerated and Dual Degree Programs

Accelerated or dual-degree programs are designed for students who know what they want and how they want it.  Once a student enters the pathway, their experience will be very different from students on the traditional track, but similar to others who share their lane. Yes, best practice dictates that these programs have multiple entry and exit points, but for the most part, they are about fast-tracking.

Acceleration (3-year programs).

Three-year accelerated undergraduate medical education programs were commonplace in the 1970s, but they languished in the US due to legal and logistical challenges.  While accelerated programs continued to grow in Canada (See McMaster University & University of Calgary), the US only recently began to reexamine the idea as a means to support individualized learning,  fast-tracking for much needed primary care physicians, and reduction of student debt.

As of 2018, there are eight U.S.-based undergraduate medical education programs that support three-year accelerated programs.  All are members of the Consortium of Accelerated Medical Pathway Programs (CAMPP).  According to recent CAMPP publications (this and this), lessons learned from the currently participating programs include the following:

  • Multiple entry points. More students have a latent desire to opt-in to accelerated programs, so offering opportunities to opt-in during or after the first year of schooling (rather than offering it only at the beginning of the first year) is helpful.
  • Multiple exit points. Students must have a flexible opt-out option if they change their minds.
  • Mentoring. Early and active mentoring related to professional identity (including opportunities to meet, shadow, work, and research with residents and attending physicians within the same role) is important.
  • Partnerships with residency programs. Students must be assured of opportunity for placement after graduating with an accelerated degree. In most cases, these programs offer contingency acceptance at the school in which they completed undergraduate training.

Who does acceleration well?

The University of Calgary and McMaster University Michael G. DeGroote School of Medicine, both of Canada, have been graduating medical students after three years (131 and 130 weeks, respectively) of study for the last forty years with equal or better student satisfaction and outcomes.  However, since my work focuses on U.S. based medical programs (for better or worse), let’s look at the accelerated program at NYU School of Medicine.  Started in 2013, here is how NYU hits all the best practices listed above – and then goes above and beyond the call of duty.

  • Multiple entry points. At NYU students  offers  entry points: options (reasons) for entering a three-year MD pathway:
    • As part of the medical school application process.
    • Between the first and second years of school (halfway through the first year until halfway through the second year).
    • After completing a PhD (for those interested in research-focused residency programs and careers).
  • Mentoring and identity development. Students have three mentors: a traditional mentor, an accelerated program mentor, and a departmental mentor. The traditional mentor focuses on academic achievement. The accelerated program mentor focuses on professional development and student wellness.  The Departmental advisor helps students identify appropriate departmental activities (such as grand rounds, shadowing opportunities, social events, research experiences) for the student to attend.  Students also spend the summers between year 1 and 2 completing a project in the department of the intended residency.
  • Partnerships with residency programs. While many three-year programs focus on primary care, NYU provides accelerated track students with a conditional match with one of 20 specialties.
  • Multiple exit points. Students may exit the program at any time.  If they decide to pursue a different specialty, they may transfer their conditional placement to a different NYU residency program (pending availability and space) or return to the 4-year curriculum.

Dual degree programs

Dual degree programs used to the be only way to customize undergraduate medical education (beyond the universal ability to select fourth-year clinical electives). Typically, students who pursue dual degrees are those whose interests lie outside basic clinical practice in fields that draw heavily from multiple disciplines (e.g. medical law, public health, or medical education).   Because dual degree programs are so common, I’m not going to spend a lot of time on them here, other than to say that many programs are opening the doors to degree combination that far exceed the traditional MD-JD, MD-MPH, MD-PhD combinations.   However, I have one shout-out…

Who does dual degree programs well?

I chose Stanford University Medical School for the shout-out, not because their dual degree options are too different than other schools of the same caliber.  Rather, it’s the flexibility with which they interpret “dual degree” that caught my eye. According to their website, Standford University’s Discovery Curriculum offers all students the opportunity to take two or three years to complete their pre-clerkship (typically an 18-month to two-year block) coursework.  If students follow a three-year plan, they may use the extra time for independent research, dual degree options (which includes any of the substantial degree offerings Stanford has to offer),  or any other longitudinal scholarship or leadership activities.

31 flavors

31 Flavors: Electives and Scholarship

Medical schools are serving up new and interesting (read “interesting” as interdisciplinary, interprofessional, global, digital, and humanities-focused) opportunities for elective, co-curricular, or self-directed study.  I won’t focus too much on these as the concept of electives are not new; the trend in electives speaks to how the next generation of physicians value diverse types of knowledge and experience  – and this is beyond the scope of the blog post.

But let’s talk about required research – rebranded as scholarship in many schools – as an area for personalized learning.

Who does student-driven scholarship well?

I’ve written previously on Oregon Health & Science University, where students are encouraged to choose to engage in “scholarship” (not necessarily a “research project”) that makes sense.  This means that some students will use this time to take a business class, shadow practice managers, and write a business plan for their private practice while other students might teach or develop health education materials.  If students want to add a little time to their program to engage in clinical or translational research, they will be assigned a special mentor and potentially earn an additional degree.

Success in student-driven projects emerges from a simultaneous increase and decrease in structure over that found in traditional projects.  Structure around instructional design and assessment need to increase; structure around specific details of content (“You must have five sections, starting with a 180-word abstract and typed in 12-point font) must be relaxed. Johns Hopkins does an excellent job of this with their Scholarly Concentrations.  Students are individually mentored in an inquiry project related to one of five areas of study:

  • Basic Science
  • Clinical Research
  • Ethics and the Art of Medicine
  • History of Medicine
  • Public Health and Community Service

Students choose an area of concentration by December of Year One. There are seven core assignments beginning with the project proposal and ending with the final project presentation in March of Year Two. Most students devote the summer after Year One to the scholarly project.

choose your own adventure

Choose Your Own Adventure: Modular Learning

While ‘Express Lane’ approaches put students in several pre-designated tracks and ’31 Flavors’ limits personalization to small chunks of the curriculum, a modular curriculum opens the door for free-range degree programs designed (almost) in real-time by a student and their coach. By modular curriculum, I mean a time-variable, competency-based (or micro-competencies for even more pinpoint personalization) curriculum assessed through badging. We don’t have a medical degree program like this yet.

However, this is where “precision education” comes into the mix.  I’m not going to rewrite the blog post I wrote last week here.  However…look for innovative programs at Stanford, Oregon Health & Science, Johns Hopkins, and National Universities to be writing more about this in the next few years.

Featured Image by Alexander Ramsey on Unsplash

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