What’s Next for NextGenMD?
Article Summary
- The Miller School of Medicine’s 2024 class was the first to graduate after studying the NextGenMD curriculum exclusively.
- NextGenMD emphasizes clinical experience, mentorship and diverse skill sets.
- The curriculum is under constant analysis and revision to make sure current topics in medicine, like AI, are featured.
In the summer of 2020, just months after declaration of the global pandemic, as the world huddled in apartments and combed the internet for the most effective face masks, the University of Miami Miller School of Medicine debuted NextGenMD.
The runway to the new medical school curriculum was long. Henri R. Ford, M.D., M.P.H., dean and chief academic officer at the Miller School, convened a task force to analyze the curriculum that preceded NextGenMD. Hundreds of Miller School faculty, residents and students poked at dozens of models used by other schools and poured over published data on the subject.
Extensive research led to group conversations, text threads and lengthy email chains. The task force got together for a visioning exercise that produced the curriculum’s desired end.
“We deconstructed the curriculum entirely to reconstruct our approach to shaping the ideal physician,” Dean Ford said.
Students in the Clinical Environment
The curriculum emphasizes case-based and small-group learning, early clinical skills, community involvement, mentorship and diverse skill sets. In short, NextGenMD creates accomplished, well-rounded physicians and scientists.
Perhaps the most tangible change for students was their early ability to work with patients in the clinical environment. Most medical school programs, including the prior legacy curriculum at the Miller School, devote the first two years to classroom work. NextGenMD introduced students to clinical settings after one year.
The shift in approach acknowledged not only what students need to learn while in medical school, but how they learn.
“When you’re seeing patients, you learn in a different way, because you can see how things are immediately relevant,” said Gauri Agarwal, M.D., associate dean of curriculum at the Miller School. “If you’re learning about anatomy in a classroom, it hits you in a different way than when you’re taking care of a patient in the operating room.”
That early interaction with patients invites students to refine the soft skills successful doctors need.
“In medicine, direct exposure to patients is critical to not only clinical reasoning and judgment, but also to communication and empathy for patients and for working in teams,” said Latha Chandran, M.D., M.P.H., M.B.A., executive dean for education at the Miller School. “That’s part of being a physician.”
Flipping the Classroom
NextGenMD employs a more contemporary teaching philosophy. The “flipped” classroom lets students absorb information at their own pace outside of class and put it to practical use inside.
“We use the classroom time for application of information, not for just delivering information,” Dr. Chandran said. “Instead of being the ‘sage on the stage,’ the teacher is the ‘guide on the side.’”
Class of 2024 graduate Dr. Krisna Maddy found the approach energizing.
“I love the idea of being in charge of my own learning, making sure that I was coming prepared for class and engaging with my classmates,” said Dr. Maddy, who was selected by her classmates as Class of 2024 commencement speaker.
The flipped classroom’s workload is substantial. Students manage their time independently. The Miller School provided an extra layer of support in the form of longitudinal clinical educators (LCEs) to make sure students stayed on track.
LCEs are faculty members that meet weekly with first-year students and every six weeks with second-year students. During years three and four, LCEs use one-on-one meetings to prepare students for residencies.
“We start the students on their journey into clinical reasoning,” said LCE Andrew Brown, M.D., assistant professor of clinical neurology and chief in the Division of General Neurology at the Miller School. “We couple clinical reasoning with listening skills and an exploration of empathy. This allows the LCE to place the students on a path to becoming excellent clinicians.”
Establishing a Physician-Scientist Identity
LCEs also help introduce the concept of professional identity in medicine, one that Dr. Chandran said requires a sound understanding of the individual practitioner’s core values.
“We focus not just on the development of the student’s professional skills, but also on the development of a professional identity,” Dr. Chandran said. “Who you are as a person —and a physician — is shaped by faculty role modeling and is a reflection of our learning process.”
In the NextGenMD framework, clerkships are completed by the end of a student’s second year, leaving time to explore specific areas of clinical interest. Medical students are notoriously achievement-oriented, and many decided to complement their M.D. with another degree entirely.
“Students have their third and fourth years to really individualize their education with opportunities they didn’t have before,” Dr. Agarwal said. “Our students now have the time and the space to do an entire second degree while they’re in medical school. This allowed us to have the largest four-year M.D./M.P.H. program in the country. We also now have the largest four-year M.D./M.B.A. program in the country.”
NextGenMD Curriculum Review, Revision
With the first NextGenMD class having just graduated, the time was right for evaluation. How’d the first cohort of NextGenMD students do?
The Step 1 and Step 2 exams evaluate medical students’ comprehension of principles and mechanisms underlying health and disease and their ability to apply medical knowledge, skills and understanding of clinical science. The Miller School Class of 2024 excelled in both.
“The pass rate for Step 1 nationally dropped from about 96% to 93%, but our first NextGenMD class had a 98% pass rate,” Dr. Agarwal said. “Step 2 is a scored exam. The national mean score is 245 and our students were at 250, above the national mean. We were very happy about their success.”
Residency match rate is another important barometer. The National Residency Matching Program reported a 2024 match rate of 93.5%. The Miller School’s 2024 final placement rate was 100%.
“By all the metrics and national benchmarks, our students did well,” Dr. Chandran said. “We’re very, very proud of that.”
The Miller School also compared the Class of 2024’s progress with that of the Class of 2023, which studied under the previous curriculum, with clinical exposure offered in the third, rather than second, year. Both sets of students were evaluated by Miller School faculty and residents and took objective structured clinical exams in the Miller School’s Gordon Center for Simulation and Innovation in Medical Education.
“These exams are not just about assessing medical knowledge. They assess multiple other competencies,” Dr. Agarwal said. “Students have to make eye contact, exhibit professional behaviors and examination skills, communicate effectively and connect with their patients.”
The structured clinical exams revealed that the performance of second-year students was at the level of third-year students.
“I was recently attending physician on a team at Jackson (Memorial Hospital) with two second-year medical students,” Dr. Agarwal said, “and that they were performing just as well with their patients as what I have conceptually thought of as third-year medical students.”
AI and NextGenMD
The Class of 2024’s sterling achievements validated the design of NextGenMD. Now Drs. Agarwal and Chandran are looking to improve it. In April. Dr. Agarwal led a session that focuses on the impact of artificial intelligence (AI) and virtual reality (VR) in medicine, a first for the Miller School.
“A healthy curriculum is constantly responsive to what’s happening in the world,” Dr. Agarwal said. “We’re recognizing that AI and VR may be used heavily in the training of residents in the future.”
On the instructor side, medical education leadership sees immense value in using AI to create valid and varied educational test cases.
“We have large language models that can generate cases quickly, as long as we provide a proper prompt,” Dr. Chandran said. “In our clinical skills center, we are looking at how we can we use AI tools to save faculty time and have a similar yield from the student perspective.”
Dr. Agarwal is also interested in tracking the performance of Miller School graduates after they leave Miami. Nationally, residency and internship program directors produce reports that account for the first few years after medical school. Dr. Agarwal would like to extend the correspondence further.
“We’re asking, ‘What are the pieces of data that we could track objectively?’” she said and mentioned tabulating Miller School graduates who obtained leadership positions in their fields and factoring in publicly accessible patient health and satisfaction scores as possible future metrics.
It’s all part of the regular curriculum review that keeps NextGenMD current, engaging and responsive to the needs of the modern medical student.
“It’s a continuous quality improvement process, which is critical for an excellent, current curriculum,” Dr. Chandran said.
Tags: curriculum renewal, Dr. Gauri Agarwal, Dr. Latha Chandran, medical education, medical students, NextGenMD