Integration of a “cardiovascular system” curriculum into an eight-year medical education program: exploration and the experience in China

Introduction

Harvard Medical School, one of the best medical colleges in the world, radically reformed the medical curriculum in 1985. The “new pathway” of medical education contains nine novel, integrated curriculum modules that effectively incorporate basic and clinical medicine [1]. The aim is to solve clinical problems. This approach has greatly influenced medical teaching worldwide. In the past decade, the School of Medicine at the University of California, Los Angeles (UCLA), has gradually reformed the original curriculum system. National Yang-Ming University built a complete and functional integrated curriculum over the course of 10 years. Compared to American students, those trained in National Yang-Ming University exhibited similar pass rates on the United States Medical Licensing Examination. Given such success, the traditional subject-based teaching mode has gradually transitioned to a system-based integration mode [2].

Commencing in 2004, the Chinese government directed several colleges and universities to strengthen science and engineering education. To this end, the initial five-year course of education gradually turned into an eight-year course in most medical colleges and universities [3]. The ultimate goal of medical education is to cultivate excellent qualified clinicians. An eight-year medical education program is by no means a simple “5 + 3.” Of note, the 2022 National Education Conference in Beijing stressed the importance of improving the quality of education, accelerating its modernization, building a strong system, and preparing students to become well-rounded individuals. These are to be morally integral, intellectually knowledgeable, physically healthy, esthetically sensible, hard-working, and industrious people. The conference established new requirements and higher goals for medical education. It was imperative to pursue educational reform. However, most medical colleges and universities in China still engage in spoon-fed medical education. This does not encourage systematic thinking or independent learning.

Xi’an Jiaotong University, one of the oldest universities in China, is a key university that is under the direct administration of the Ministry of Education of China. This is a comprehensive research university that focuses on 10 major disciplines, including medical education. In total, 4496 undergraduate students are enrolled in medicine-related majors including the eight-year program of clinical medicine, stomatology, pharmacy, basic medicine, nursing, and other majors. Our medical school still generally uses the traditional subject-based teaching mode. Based on the demand for educational reform, our school selected study of the cardiovascular system as a pilot program when integrating the curriculum of eight-year medical education. Our school has established cooperative and exchange relationships with the National Yang-Ming University of Taiwan, China, and the UCLA School of Medicine [4], 5]. These efforts are supported by the Kwang-Hua Education Foundation (Taiwan, China). Drawing on their successful experience [6], we engaged in preliminary exploration and practice, and then launched our problem-based learning (PBL)-driven curriculum integration project in China.

Methods

After preliminary theoretical evaluation and field testing, an integrated curriculum centered on the cardiovascular system was successfully established (Figure 1).

Figure 1:

Diagram of an integrated curriculum centered on the cardiovascular system. The “cardiovascular system” curriculum was divided into six functional parts, including cardiovascular morphological structure, cardiac electrophysiology and relevant drugs, coronary circulation and relevant drugs, cardiovascular function, diseases, and relevant drugs, heart failure and therapeutic drugs, and other cardiovascular diseases.

Results

Discussion

Given the developments in human healthcare and the changes in the spectrum of human diseases, modern medicine has evolved from a simple biomedical model to a biological–psychological–social discipline. When treating patients, it is necessary to understand the biological causes of the disease, the pathophysiological mechanisms in play, and the possible prognoses and outcomes. However, it is also important to understand the social and mental states of patients and to tailor treatment to their social circumstances and family environments. The “global minimum essential requirements” of the Institute for International Medical Education include clinical skills, population health, professional values, attitudes, scientific foundations, critical thinking, communication skills, and information management [8]. All doctors must acquire these competencies. Today, medical education features new requirements and higher goals than before. It is imperative to further foster educational reform.

Developments in medical science have been associated with the emergence of many interdisciplinary, intradisciplinary, and comprehensive fields of study. The old disciplinary boundaries are no longer clear. The traditional teaching mode is no longer adequate. There is an apparent general trend that disciplinary barriers are broken because knowledge is becoming fused. About half of the 178 winners of the Nobel Prize in Physiology or Medicine from 1901 to 2002 were from the United States. Most experts and scholars believe that the key to such success lies in the solid form of pre-medical education. Most students acquire a bachelor’s degree in science or engineering before entering medical school. In recent years, when building a brand-new model of medical education, medical schools in the United States successfully reformed the traditional education model of subject-based teaching. Today, teaching features system-based integration combined with PBL. Students learn by working in groups to solve an open-ended problem. The problem thus drives learning. Globally, medical education is being innovatively improved to include team-based learning (TBL), PBL, and case-based learning (CBL). To these, the recent case-based collaborative learning (CBCL) introduced by Harvard University should be added [9]. All feature organ-system-based integrated curricula.

It is thus clear that reform of the eight-year Chinese medical education program is urgent. Pilot studies aid the direction of program development. The “curriculum integration + PBL” model has become popular in many medical colleges and universities worldwide and more recently, in certain Chinese medical colleges and universities. The Peking University Health Science Center has been exploring curriculum integration for some time. By breaking the increasingly artificial boundaries between related disciplines such as basic and clinical medicine, medical knowledge acquisition is being reorganized with a focus on the various organ systems. Reform in Xi’an Jiaotong University commenced with the introduction of an integrated study of the cardiovascular system. This forms part of the eight-year study program. The aim is to produce doctors and physicians of high quality. Our school has established cooperation and exchange relationships with National Yang-Ming University of Taiwan, China and the UCLA School of Medicine. Drawing on their experience, we launched our PBL-driven curriculum integration project. We successfully integrated the “cardiovascular system” curriculum that is part of the eight-year medical education program. The class hours fell significantly from 64 to 42 h. The organ-system-based, integrated curriculum reduces knowledge redundancy, creating more opportunities for competency-oriented medical education and independent learning. Both students and teachers reported that the integrated “cardiovascular system” curriculum was successful. Real-world medical practice is interdisciplinary. The curriculum improved clinical thinking and allowed students to use comprehensive knowledge of the cardiovascular system when solving problems. The curriculum fostered student learning, improved knowledge retention, and cultivated a holistic clinical mindset.

Based on the success of the “cardiovascular system” curriculum, we plan to integrate all courses on other organ systems. We will build a fully organ-system-based curriculum similar to those of our peers worldwide. We seek to contribute to the development of medical education and ensure excellent physician training. The Chinese government has implemented the Healthy China 2023 Project that provides policy support for teaching reform. Only by “breaking through and then standing up” can we make great progress. Higher medical education in China must prosper with the goal of training excellent clinicians.