Implementing a Flexible, Preclinical, Medical School Curriculum to Increase Student Academic Productivity


The Mayo Medical School, a research institution and medical school that is part of Mayo Clinic in Rochester, Minnesota, is considered one of the leading medical schools in the United States. Since its beginning in 1972, Mayo Medical School has offered a variety of classes and studies to its students through its preclinical curriculum. In a student’s first year, the curriculum focuses on normal structure and function, such as anatomy, histology, and physiology, while the second year focuses on pathophysiology. Students also are engaged in clinical experiences with basic doctoring skills in year one and move toward more advanced discipline-specific skills, such as pediatric or surgical exams, in the second year.

While this curriculum provided students with an excellent background, there were a few recognized deficiencies in the program, including long lecture times (upward of eight hours per day), little to no flexibility in course schedules, and lack of time to integrate and consolidate information upon learning.

In 2006, small blocks of flexible curriculum time, termed “selectives,” were implemented in the Mayo Medical School preclinical curriculum. Selectives permitted students to pursue professional endeavors, such as research, service, and career exploration. To establish the value of selectives, current and former Mayo Medical School students were surveyed regarding the impact of selectives on their research interests. Approximately 154 students from the 2004 to 2014 graduating classes responded to the survey. The study was recently published in the Biochemistry and Molecular Biology Education Journal.

Joseph Grande, M.D., Ph.D.

According to Joseph Grande, M.D., Ph.D., who was the associate dean for Academic Affairs within Mayo Medical School in 2006 and first author on the paper, the top priority for the school was to transform a lecture-based curriculum into one that:

  • Focused on health care of the future.
  • Provided a greater patient focus.
  • Encouraged greater integration and coordination of material.
  • Employed more effective didactic methods.
  • Addressed student concerns regarding curricular density and stress.

To achieve these goals, selectives were implemented to provide students with the flexibility to explore their careers through “shadowing” other medical professionals; service learning; community-based work; other health care delivery models, such as international health or rural health; and research.

“The idea was to provide dedicated time, without distraction of ongoing coursework, to allow students to pursue these objectives,” said Dr. Grande.

Based on feedback from current and former students, selectives are now among the most popular courses that Mayo Medical School offers. Selectives have been instrumental in “decompressing” the curriculum, allowing students time for reflection and pursuit of their specific interests. Many medical students have expressed value and satisfaction in providing service and giving to others. Prior to the implementation of selectives, many students had little time to pursue these activities, and instead, spent this time preparing for exams.

However, many faculty members believe an effective use of students’ time is during lectures conducted by experts.

“Mayo Medical School faculty had concerns that adding selective time would further ‘dilute’ the curriculum, rendering students less well-prepared for medicine—academic medicine in particular,” said Dr. Grande. “It was for this reason that we wanted to ask one specific, objective question—Do selectives improve academic productivity of students?”

The study consisted of students who graduated before selectives were implemented (pre-selective) and students who had selectives as part of their curriculum (post-selective). Based on the study results, it was discovered that post-selective students published more papers and gave more presentations than pre-selective students. On average, students spent four of their selective weeks in research, publishing approximately 1.8 papers as a result of this work. This represented more than half of the total research productivity of the medical students.

Based on this study, selectives are an effective means to increase research productivity by Mayo Medical students.

“In my opinion, the students used the selective time to ‘hit the ground running’ and to get research projects set up. In many cases, they used their own discretionary time and designated research block to complete their work,” said Dr. Grande. “The flexibility provided by selectives permitted the students to identify research problems, find research mentors, and find available resources, allowing them to use their subsequent research time more effectively.”

Kelley Luedke (@kschrib)

Kelley Luedke

Kelley Luedke is a Marketing Channel Manager at Mayo Clinic Laboratories. She is the principle editor and writer of Insights and leads social media and direct marketing strategy. Kelley has worked at Mayo Clinic since 2013. Outside of work, you can find Kelley running, traveling, playing with her kitty, and exploring new foods.