Medical students branch out during final two years

At the U-M Medical School, students begin their journey by building a foundation in scientific and clinical education. When students reach their third and fourth years, however, a new phase of the transformed curriculum — the branches — offers them a more flexible educational experience.

M3 and M4 students have the choice of pursuing one of four branches: patients and populations, procedures-based care, diagnostic and therapeutic technologies, and systems-focused and hospital-based practice. By following a branch, students participate in advanced clinical experiences specific to their fields of professional interest and choose electives tailored to their career goals.

Now in its third of four years as a pilot program, the branches will be fully implemented in fall 2018.

“The branches give students the autonomy to craft their own journey and make it more meaningful,” said Michael J. Englesbe, M.D., the Cyrenus G. Darling Sr., M.D., and Cyrenus G. Darling Jr., M.D., Professor of Surgery and faculty lead on the branches. “Given the opportunity, students will absolutely exceed expectations as far as innovation and impact, and will demonstrate a passion that will really get faculty excited to be part of it.”

Through the branches program, students engage in individual pursuits like earning a dual degree, doing an international rotation, developing a research project, creating and managing a health plan or starting a company.

Carrie Braun, administrator for the branches in the Office of Medical Student Education, said the objective of the program is two-fold — to help students achieve clinical excellence and to help them take on impactful work that will change the health care industry.

“In the new curriculum, we’re keeping all of the things that we know make our students great doctors, plus we’re providing individualized opportunities so they can impact health care in a positive way,” Braun said.

The Patients and Populations — or PP — branch allows students to identify and follow a cohort of patients throughout the course of a year. Family medicine resident Julie Blaszczak, M.D., who participated in PP last year, took part in several primary care-based rotations and took electives in women’s health and sports medicine.

“Medical education is fragmented into rotations, making it difficult to truly experience what one’s future calling will be like,” Blaszczak said. “Through PP, I was able to see the same patients over time, allowing me to get a glimpse into my future as a family medicine physician and giving me incredibly valuable experience with outpatient primary care.”

Future surgeon Ryan Howard participated in one of the newest features of the branches curriculum, helping to pilot the IMPACT program, which gives students the opportunity to address a pressing health care issue. IMPACT is expected tocome a permanent feature of the branches curriculum in fall 2018.

As part of the program, Howard researched opioid prescriptions at U-M, looking at the issue of leftover pills.

“About 70 percent of people in America who abuse or misuse opioids aren’t getting them from a doctor, or even a drug dealer; they get them from family and friends who have leftover pills,” Howard said.

IMPACT allowed Howard to survey opioid prescriptions after gallbladder removal. Through his work, he found a large discrepancy between what physicians prescribed (30-60 pills) and what patients used (5-10 pills). His research informed guidelines that call for caregivers to prescribe smaller amounts of Oxycodone or Norco combined with over-the-counter Tylenol and Motrin.

“We found a way to adequately cover pain, but also prevent this excessive medication from getting into the community,” Howard said, noting the new guidelines have prevented approximately 5,100 pills from entering the community since last fall. “It has been phenomenal as a student to change the way we deliver care, in one small way.”

Michelle M. Daniel, M.D., assistant dean for the curriculum, said she is thrilled by the students’ diversity of interests. “The enthusiasm of the students to engage in projects has been infectious,” she said. “When our students are given the space and support to engage in these unique pursuits, they fly.”

This is one in a series of Headlines stories highlighting the medical school curriculum transformation.