Spiral Curriculum: Innovating Medical Education at Trinity

Imagine you are a new MD, fresh out of med school. You aced your classes, graduated with honors, and matched into your dream residency program. You walk into the treatment room and are ready to treat a patient with symptoms of a serious renal issue. But then you remember - your med school curriculum only included one class on the renal system and you took it in your first year. What if you can’t remember everything required to properly diagnose and treat your patient? Unless you are considering med schools with a spiral curriculum, this is a likely scenario.

You may have heard of an integrated curriculum (a learning style that combines concepts taught in separate classes), but the idea of a spiral curriculum builds on this approach to create a gold-standard in learning. In 1995, the University of Dundee in the UK developed what is now known as a spiral curriculum in order to help their medical students learn and retain information by repetition. This approach helped students build on their knowledge year by year, rather than having to memorize the complexities of systems through a single class, never to be revisited.

Now, almost 20 years later, the spiral curriculum has proven to be so successful in terms of retention that many US medical schools are migrating towards this approach. Dr. John Geisler and Dr. Kelly Manahan, Trinity’s Dean and Provost and Associate Dean of Clinical Sciences respectively, believe this repetition-based learning style offers a value to our students that they can’t find at any other Caribbean medical school in existence.

Unlike the traditional subject-based curriculum, which often segregates learning into siloed disciplines, or the standard integrated curriculum that blends these disciplines but lacks repetition, the spiral curriculum ensures that students not only see the connections between subjects but also appreciate the evolving nature of medical knowledge as they advance. Spiral curriculum means students no longer sit through 4 or 5 different classes a term -— each module is one singular class. This approach enables students to build a solid foundation, while simultaneously encouraging deeper understanding and critical thinking skills as they progress.

We asked Dr. Manahan to explain what students can expect to learn in each module. “The way this spiral curriculum works is that students first learn the way normal systems function. For example, in the first cardiovascular module, students learn things like the anatomy of the heart, how to listen to it, how to take blood pressure and pulse. Then when they revisit the cardiovascular system in term 4, students build on their existing knowledge and learn what happens when those systems do not function normally by focusing on the microbiology, pathology, and pharmacology aspects.”

“The first module is general principles, which are foundational concepts that you need to know for all of the core basic science subjects,” continued Dr. Manahan. “Students learn general principles of physiology, anatomy, histology, and biochemistry, and are quizzed every Friday. Then in the next module, they follow that same road map, learning about the physiology, anatomy, histology and biochemistry of the musculoskeletal system. The students work their way through each module and then as they revisit the topic, they will learn about those systems again through a clinical lens and learn about treatment.”

Spiral curriculum places importance on learning material in small bites instead of large chunks, so it makes sense that the testing style reflects that, said Dr. Geisler, Trinity’s Dean and Provost. “In a traditional linear curriculum, med students will learn all about one system in one class and have a midterm and a final. But what that does is teach students to prepare for tests, not for the application of knowledge in a clinical setting. Spiral curriculum eliminates that stress so students can focus on learning well, not just scoring well.”

Dr. Geisler was also able to fill us in on the testing methods in this newly-adopted curriculum style, saying “To measure the absorption and application of principles, we have weekly quizzes and practical evaluations, such as labs. This method has been shown to decrease stress and increase learning because students are able to delve into smaller amounts of digestible material.

”Weekly testing not only measures the absorption of material, but also prepares students for successful completion of the United States Medical Licensing Examination (USMLE). Through these frequent assessments, students gain valuable exposure to the exact type of questions they will be asked in the USMLE, written by the same people who write the questions (the National Board of Medical Examiners or NBME). “Our spiral curriculum is standardizing the questions they will be asked on the USMLE,” said Dr. Geisler. “By utilizing the NBME’s database of questions instead of having professors write their own, we are using questions that are standardized, transparent, clear, fair, and equitable.”

“It is the best curriculum for medical school, period,” said Dr. Manahan. “Our students, like many others, learn best by repetition. Spiral curriculum allows for all different learning styles and that repetition throughout students’ four years with us means that by the time they graduate and start their residency, they have reached a mastery level of each system.”

At Trinity School of Medicine, we are proud to offer a spiral curriculum that ensures our students are not just well-versed in medical knowledge but are also confident and competent in applying this knowledge in real-world scenarios. This revolutionary approach to medical education is just one of the many ways we prepare our students for successful and fulfilling careers in medicine during which they never stop learning and discovering new and better ways to care for their patients.