A Leap for Medical Learning

Cold sodas in the admissions office.

You wouldn't think that would stand out as a perk to being a medical student at Duke University, but a stop to the little white fridge in the corner of the admissions office waiting area is an integral part to many students' daily routine.

That refreshment brings students together and helps steel them against one of the most demanding medical school programs in the country. Duke's program is highly regarded for developing some of the most capable physicians and researchers in the nation -- the program ranks sixth in the most recent U.S. News & World Report rankings.

So, say faculty and student leaders, with the April announcement that the Duke Endowment will give the Duke University Medical Center its largest gift ever -- $35 million for a medical education center and $15 million for a pediatrics facility -- the school's already successful program is poised to reach a new level.

Currently, life as a Duke medical student involves a lot of running around, navigating the halls of Duke North and South like mice in a maze.

The prospect of a new medical student education center will have profound implications for the future of the School of Medicine, said third-year student Eleanor Vega one recent afternoon.

"The first year is like drinking from a fire hose," said Vega, president of the Davison Council, the student government body. "There is so much information and it just keeps coming. But we all get through it."

Four years ago, the School of Medicine further refined its curriculum, developing what is known as the Foundation for Excellence. This model is unusual among medical school curriculums in that all of the basic sciences, from physiology to gross anatomy, are taught in the first year.

Changes introduced in 2004 further refined the first year to bring more cohesiveness to the topics covered.

During the second year, Duke medical students do clinical rotations.

"Going onto the wards a year early is amazing and having that experience before you take your boards and having a whole year of core clerkships before deciding what field to go into is definitely an asset that other institutions don't get," said Vega.

A Year to Explore

However, the third year is what sets Duke apart.

During the third year, students are able to study a wide-variety of subjects related to biomedicine, here at Duke and elsewhere. During this year of self-motivated inquiry, many students have their work published in peer-review journals and up to 30 percent earn a graduate degree in addition to their medical degree.

"It's a huge drawing point," said Vega, echoing other current students and recent alumni.

During their fourth year, students do more clinical work and apply to residency programs.

Does Duke's dedication to producing physician-scientists detract from the traditional clinical portion of a med school education? Yes and no, said Dr. Edward Buckley, vice dean of education.

"Of course, if you take time out to focus on independent research, you'll have less time for other things," Buckley said.

"However, this may be the only time for many individuals in their post-graduate training to really take the time to step back and think about something as a particular entity and really delve into it."

That adds up to students who come out of the program as much more critical thinkers about science as it relates to medicine, Buckley said.

One unfortunate side effect of the unusually structured curriculum, however, is how it divides the student body.

Many of the criticisms of the medical school experience are not related to curriculum but to the social atmosphere. With classrooms dispersed throughout the medical campus and small, unwelcoming meeting areas, it's hard to interact with other medical students.

"Besides the Octagon, there aren't many large facilities where you can find students," said first-year student Teralyn Carter. The Octagon is the nickname students gave the amphitheatre near the Duke South cafeteria where first-years attend lectures.

"It would be nice to be able to interact with older students to get some guidance and support," said first-year student Wendy Zhang.

Vega agreed: "We don't have a place to go a study where you know you're going to run into other medical students. We don't have a place to go get coffee and sit down and relax and maybe run into our professors and have casual conversations with them."

A Valuable Gift

The Duke Endowment award has huge meaning for the students, Vega said.

Planning for a student-learning center will incorporate developing trends shaping the future of medical instruction, Buckley said.

"It is becoming increasingly important to have a facility that can house initiatives such as simulation labs and provide space for the team-based learning programs that are rapidly replacing traditional lecture-based learning," said Dr. Nancy Andrews, dean of the School of Medicine.

Much as a pilot is required each year to log a certain amount of time in a flight simulator, med students could be required to practice certain procedures before moving on to actual patients.

"Simulation will become even more important to developing skill sets as technologies become more life-like and less expensive to operate," said Buckley.

Medical school administrators have acknowledged the importance of these various areas in building a state-of-the-art medical education facility.

Until then, today's medical students will continue on the path to excellence armed with knowledge instilled in them by Duke's program and a dedication to patient-centered and evidence-based medicine.

And an ample supply of cold soda.