Teaching Chest Disease Diseases of the Chest in a New Curriculum

Basic objectives of good medical education have changed little in the past 50 years. The tremendous advances in the preclinical sciences and in clinical medicine during this time have made it impossible for a faculty to impart this mass of knowledge or, indeed, to expect or require the student to know all of it. This became more apparent with the accelerated program required for undergraduate medical education during World War II. It was also felt that the social and economic changes that have occurred deserved more recognition. Therefore, in 1946, the faculty of the School of Medicine of Western Reserve University, under the leadership of its Dean, Dr. Joseph T. Wearn, began to plan a new curriculum approaching it as a scientific experiment. In 1952, the new curriculum was implemented, and in 1956, the first class under the new curriculum was graduated. I have drawn largely from the reports of Wearn,1 Ham,2 Patterson,3 and Caughey,4 and my own experience as a participating faculty member. The objectives of this curriculum are to graduate a physician with adequate knowledge and skills, who has proper professional ideals and scientific attitudes. Since knowledge is not static, a strong effort is made to develop habits of self-education which, it is hoped, will continue throughout life. It was realized that the example set by the faculty would play an important role. The idea of total coverage was abandoned from the outset. It was agreed to emphasize basic concepts and their -application to the mechanisms of disease. To do this better, the previously existing more or less sharp separation of teaching along purely departmental lines was altered so that from the first day of medical school, teaching would be on an interdepartmental basis. Therefore, the material has been organized into subject groupings. Each subject is taught by a subject committee made up of members from the departments concerned. It was also felt that the introduction of the student to the patient should be early in the first year rather than at the end of his second year. The course in clinical science, described below, is designed to do this. The usual four year curriculum has been divided into three phases. Phase 1, occupying the first year, is concerned with normal structure and function. Phase 2, in the second year and first half of the third year, studies disorders of structure and function. Phase 3, during the last year and one