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Putting knowledge to work in creative discovery

By Carole Bartoo
August 2012

Conrad Myler, M.D., co-chaired the curriculum committee with fourth-year student Billy Sullivan for the 2011 school year. Now a first-year anesthesiology resident at VUMC, Myler recalls he entered the School of Medicine as the first components of the re-design were launching. Many departmental lectures previously taught in traditional, department-led, lecture style had already become team-taught block courses.

“I knew about it when I was being recruited and was excited about it. For me it fit the way my brain works,” Myler said. “I would say it was overdue.”

During the next phase of changes to the curriculum the Medical School administration invited faculty to design a new type of elective course that had never been offered before which would be piloted by fourth-year students. The fourth year of medical school had traditionally focused on preparing for the intensity of internship by maximizing exposure to clinical care while tying up loose ends and travelling to interview with potential residency sites. Now, a series of electives will be offered to give students a much closer look at applying basic science and current evidence into clinical practice in their areas of interest. Myler says the experience showed him the potential power of these courses.

“It really hit me fourth year, when I took our immersion course in perioperative care,” Myler said.

He explains that immersion means taking students at a higher level of knowledge and putting them with top experts in a single area, like cancer hematology or perioperative care. Critical thinking, creative thinking, applying basic science and transitioning to independent lifelong learning were the goals of this course.

“In this immersion course, we were able to really put to use what we had learned before. Early in medical school, even in the new curriculum, there is still a lot of rote learning for the basic biology of complex concepts, for example the clotting cascade (the chain reaction of chemicals that interact to form a blood clot).

“First year we were memorizing vitamin K dependant clotting factors labeled with numbers like 2,7,9, 10, not to be confused with 3,7,9, and 10, which are the cranial nerves with parasympathetic innervations. At times it felt like memorizing phone numbers,” Myler recalled.

In a traditional curriculum, by graduation, students would have memorized clotting factors, as well as medications and diseases that impact clotting, and would have seen interesting examples of how those facts apply. But essentially, the learning would stop there. Instead, the new fourth-year immersion courses allowed students to glimpse the next step.

“I was sitting down with an expert in hematology and the clotting cascade. She was showing us the new drugs and research information that had come out even in the last year. I realized I was able to listen, and understand fully and ask the right questions. She could show me how to assess the new information and apply it to my practice, and to look for the next question,” Myler said.

By talking with those on the cutting edge, studying current evidence and protocols, Myler was able to experience the essence of discovery and evidence based medicine through the application of scientific rigor during medical school, at a time when he was ready for it.

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