Teaching Tomorrow's Medicine Today: The Mount Sinai School of Medicine, 1963-2003

The Curriculum

2 The Curriculum OF ALL THE tasks facing the founders of the new School, none was more daunting than the development of the curriculum. Yet, as Hans Popper, M.D., the founding Dean, pointed out, it was “an optimal time [to develop curriculum] because the vested interests of the faculty are not yet established and the opportunity for change diminishes fast as the school is organized.”1 In 1965, Popper enunciated “The Mount Sinai Concept,” which would serve as the foundation for the new school.2 Referring to the traditional tripod of academic health centers—patient care, research, and teaching—Popper proposed creating another tripod out of the “teaching leg.” This leg would balance three objectives in the training of the future physician: it would introduce quantitative biology into medicine (which Popper noted would lead to area specialization); it would broaden the influence of social sciences and human studies to counteract the presumed depersonalization of the organ-specialized physician; and it would strengthen the role of community medicine, which strives to provide good care to every patient beginning in the presymptomatic stage. Also in 1965, Popper stated the principles that would underlie the new curriculum.3 These included subject integration in the clinical as well as the basic science areas, relatively early career choice, the provision of adequate free and elective time, early exposure of the students to patients and clinical medicine through the provision of the course “Introduction to Clinical Medicine” to be given throughout the first two years, provision for basic science recall during the clinical years, and recognition of the significance of community medicine as an integral part of the overall curriculum. George James, M.D., the School’s first President and Dean, noted that “the content of the current stan74 dard medical curriculum will be reduced . . . to allow the presentation of courses in behavioral science, social anthropology, philosophy, ethics and other fields of human science.”4 James went on to note that, because of the large clinical and laboratory staff of the Hospital, much of the teaching could be done on a tutorial basis. Popper’s tenets had been presented to and accepted by the Liaison Committee on Medical Education (LCME), the national body responsible for the accrediting of medical schools. Four curriculum coordinators were chosen in 1966 to lead the effort: Tibor Barka, M.D., Professor of Pathology and the Chair-designate of the Department of Anatomy; David Koffler, M.D., Associate Professor of Pathology and Assistant Dean for Academic Affairs; Howard Gadboys, M.D., Professor of Surgery (Cardiothoracic); and Fenton Schaffner, M.D., Professor of Medicine and Pathology. The group was chaired by George Christakis, M.D., Professor of Medicine and Associate Dean. The educational philosophy and the curricula of several existing and developing medical schools were studied, and, within a year, the group was able to present a four-year curriculum for discussion .5 Teaching time was distributed by semesters for each of the four years. In the summary, the coordinators noted, “the proposed curriculum will necessitate a larger teaching staff than that required by the classical curriculum and continuous re-organization and supervision of teaching.”6 In March 1967, the original group of curriculum coordinators was expanded into a curriculum committee. The committee included two nominees from each department represented on the Executive Faculty Committee and one nominee from all other departments of instruction. George James and Hans Popper cochaired the expanded committee. When it was fully constituted, the curriculum committee consisted of forty individuals. In April 1967, at the first meeting of the entire committee, it was “charged with the responsibility of proposing a curriculum for the Mount Sinai School of Medicine which takes into consideration the past excellence of The Mount Sinai Hospital’s inpatient care, clinical teaching and research, the recent trends in medical education and the future needs of society.”7 At the time, the Departments of Biochemistry, Microbiology, and Laboratory Education were without chairs. As chairs were recruited to these disciplines, they were added to the committee. The coordinators’ proposal was presented, and discussion over the contents was begun. THE CURRICULUM 75 Chairmanship of the Curriculum Committee was taken over by Horace Hodes, M.D., Chair of the Department of Pediatrics, in June 1967, and three subcommittees were formed to define the contents of the “Introduction to Clinical Medicine” course, to decide the degree of integration of the study of disease...