How did we make the Interdisciplinary Generalist Curriculum Project work? School-level efforts to facilitate success.

This article examines how the schools funded by the Interdisciplinary Generalist Curriculum (IGC) Project handled the process of planning and implementing their proposals; incorporated the IGC requirements as templates for changes in educational programs and organizational infrastructures; and identified key educational and management issues that emerged over time. How collaboration flourished at each IGC school was the central functional ingredient for successful implementation. Shared power and support from the dean were essential for success. The need for excellent channels of communication among all constituencies in the process of curricular change cannot be overemphasized. The most common approach was the addition of the new interdisciplinary clinical curriculum to the existing, usually discipline-based, curriculum, with attempts to establish integrative horizontal connections among concurrent courses in years one and two. The integration, sequencing, and correlating of basic science and clinical material occupied much of the IGC course directors' time in the early stages. Several approaches were used to help ensure a beneficial initial clinical experience for medical students, while accepting that a uniform experience for all students was not attainable or necessary. Encouraging active learning on the part of students was a goal of IGC schools' planning in and of itself. The splash of establishing interdisciplinary communication structures and greater melding of disciplinary cultures that occurred at and among the IGC schools appeared to lead to ripple effects that were recognized within the first year of planning and early implementation.

What did we learn about early clinical experience?

This article explores the lessons learned by ten demonstration schools regarding the early clinical experience (ECE) component of the Interdisciplinary Generalist Curriculum (IGC) PROJECT: Students in ECE at these schools participated in longitudinal, one-to-one or two-on-one preceptorships with primary care physician preceptors in outpatient settings. Development of an ECE was a key component of curricular change at each of the IGC Project schools. Shattering the traditional barrier between preclinical and clinical years of the 2 + 2 medical curriculum model helped create a leading edge for innovation at each of the schools. In this article, the authors incorporated evaluation information from several sources, including the external evaluation reports of the IGC Project, final annual reports from demonstration schools, and curriculum evaluations from the coauthors' schools (the University of Colorado School of Medicine, Nova Southeastern University College of Osteopathic Medicine, and the University of California, San Francisco School of Medicine).

The Interdisciplinary Generalist Curriculum Project at Nova Southeastern University College of Osteopathic Medicine.

Nova Southeastern University College of Osteopathic Medicine (Nova Southeastern) proposed for its IGC Project to match students with community-based generalist physician role models through partnership with a managed care organization (MCO). An unanticipated corporate merger between the initial managed care partner and another health plan resulted in Nova Southeastern's negotiating training partnerships with multiple MCOS: Other program elements that differed from what was originally proposed include provision of an interactive utilization management session at a hospital or skilled nursing facility, rather than a headquarters-based utilization management rotation; combining multiple learning experiences for students within a single MCO session; having a portion of the training take place at field-based sites outside MCO headquarters or after normal business hours (i.e., MCO physician committee meetings); and recruitment of physician mentors through a variety of means and not just through MCOS: The current goals emphasize preparing students to have a working knowledge of managed care principles and practice that can be applied in any medical field and setting. This goal contrasts with the original goal of preparing students for jobs "within" managed care. The IGC Project is viewed at Nova Southeastern as the flagship of interdisciplinary curricular changes in the training of tomorrow's physicians.