Implementing the New Era of Systems-Based Medicine
(This is part 2 of 3 of a series of articles excerpted from "Georgetown Ushers in New Era of Systems-Based Medicine" in the Spring/Summer 2009 issue of Georgetown Medicine Magazine. Click here to read Part 1.)
Educating a New Class of Physicians
For Howard J. Federoff, MD, PhD, executive vice president for health sciences at Georgetown University Medical Center, the move towards a systems medicine approach for the Medical Center necessitates a fundamental shift in medical education.
“Medical education has to change if we are to successfully make the transition to systems medicine,” he said.
Georgetown had already begun to revamp its medical curriculum to better reflect the interdisciplinary underpinnings of systems medicine as part of a six-year curriculum review process. The evolving curriculum will impart an even deeper understanding of skills such as statistical analysis, computation and data mining, all of which are expected to help students prepare for a higher degree of quantitative rigor.
The curricular revision got underway some six years ago, well before the strategic planning began or before the words “systems medicine” were part of the Medical Center vernacular. Yet, according to Stephen Ray Mitchell, MD, dean for medical education, those tasked with the revision knew that “this was where education was going.”
“Educationally, we’ve always been aware of the need to give students the ability to understand evidence and data, and to quantitatively assess all those components and make them much more independent in how they seek answers,” Mitchell said.
To this end, the medical school has implemented a new, more integrated curriculum for the first, third and fourth years, and the new second-year curriculum is expected to debut in August. As a whole, the revamped curriculum groups teaching units by biological systems – think molecules and cells, metabolism and genetics – and no longer by disciplines such as biochemistry and anatomy.
“[Teaching medicine by] systems makes sense because that is how biology works. We realized pedagogically that we had to put the systems together. We were in pursuit of biological integration, which leads to systems understanding,” Mitchell said.
In addition to the changes in the existing curriculum, a new Master of Science in systems medicine is in the works, primarily geared for medical students who wish to add an additional year of study in topics ranging from systems biology and bioinformatics to computational biology and biostatistics. The proposed curriculum for the master’s program is under review by the Executive Committee of the Graduate School of Arts and Sciences, but has not yet been finalized. The first group of students could be matriculated into the new program as early as fall 2010.
While the program’s developers would eventually like to offer a standalone master’s program, for now it will be a combined MD/MS degree, with the master’s portion comprising 24 credits. The year of MS coursework will essentially be inserted between the second and third years of medical school, tacking one year onto the traditional four-year program. In the fifth year, students will take a systems medicine practicum instead of the research component they typically would do in their fourth year of medical school.
“This will keep them engaged in the systems medicine learning paradigm from the end of their second year to when they graduate at the end of the fifth year with an MD/MS degree,” said Robert Clarke, PhD, professor at the school of medicine and interim director of Georgetown’s Biomedical Graduate Research Organization.
The master’s program, which is expected to start with no more than 10 students in the first year, is designed to be easily adaptable and changeable – both to reflect rapidly developing technologies and to respond to feedback from students and teachers. It is an ideal launch pad from which to observe how students assimilate the principles of systems medicine and also what elements might be added to the medical school curriculum that would further this goal, according to Clarke.
“If we get this even half right, we think this will produce very attractive students when they start looking to match, because they’ll have a set of skills that very few medical school students will be graduating with,” he said. “This will help us maintain a curriculum that is current and modern, and continue to generate very high-quality students who are prepared to deal with the changing face of how medicine is practiced.”
While it is neither feasible nor advisable to make swift, reactionary changes to medical school coursework, the master’s program can be much more nimble.
“You can’t change a medical school’s curriculum on a dime. But the approach we’ve chosen [with the master’s program] allows us to work with the students to make sure we are providing them with the right material. As we follow them we can determine whether what they are learning is useful, and we can change the master’s curriculum [easily],” Clarke said. “We can’t do that – and it would be inappropriate to do that – in a medical school curriculum.”
Fostering Research Through Strategic Partnerships
As anticipated, the strategic planning process and the adoption of systems medicine has revealed areas where collaboration and outside expertise will be necessary to bring this vision to fruition.
“If you look at our location, our extraordinary assets on the policy, ethics and legal side … you’ll see a substantial probability that this small research university in the nation’s capital can actually help pioneer this,” Federoff said. “But we will not do it alone – we’ll do it in conjunction with other great institutions.”
To fill these gaps, the Medical Center has established strategic collaborations with several outside parties, including Oak Ridge National Laboratory and the Hamburg, Germany-based research and bio-banking company Indivumed GmbH. GUMC has also created an alliance with the Institute of Systems Biology, a Seattle-based organization that provides a key support network for advancing the various components of systems medicine.
The Collaboration Research and Development Agreement (CRADA) with Oak Ridge – the first of its kind between a national lab and a university – formalizes an existing research relationship to facilitate biomedical research.
Through the agreement with Indivumed, GUMC will be able to access and analyze an arsenal of samples from cancer patients – an essential step in the development of the Georgetown Database of Cancer (G-DOC).
By Lauren Wolkoff, excerpted from the 2009 Spring/Summer issue of Georgetown Medicine Magazine.
