EL PASO - The new Paul L. Foster School of Medicine is at the forefront of a shift in medical education.

While many medical schools teach students one subject at a time for their first two years, El Paso's medical school will bypass the standard anatomy and biochemistry classes in favor of a curriculum that teaches students through a series of clinical presentations while also learning medical skills.

So instead of taking a semester of microbiology and another of anatomy, students at the El Paso medical school will, for example, learn about stomach pain, how to determine its cause and the details of each cause and symptom. The relevant microbiology, anatomy, biochemistry and other traditional subjects will be woven into the instruction.

David Steele, senior associate dean of medical education and director curriculum at the Paul L. Foster School of Medicine, said students will find a system designed to link all the knowledge together from the very beginning of their studies.

They will learn through 120 clinical presentations, such as acute abdominal pain, fever or headache. With these the students will branch into the decision-making points of diagnosing the cause of each.

"We do it in the context of what we call schemes, and it illustrates for a student how an experienced clinician would chunk their information together in order to create a coherent pattern in their reasoning process," Steele said.

The medical school based much of its curriculum model on that used by the University of Calgary's Faculty of Medicine since about 1995.

"When you think about it, medical education is going to be a lot of the same content no matter where it's taught, but the idea of helping students understand why they need what's being taught is exciting," said Dr. Kathryn McMahon, a professor of pharmacology at the new medical school and a college master.

The new style of curriculum intrigued many of the incoming medical students.

"It's scary and exciting at the same time that they're doing something not too many places do," Eastwood graduate Thomas Tullius Jr. said.

Benjamin Ramos, 24, said he looked forward to a curriculum built with patients in mind. "Instead of just learning, say, about the GI (gastrointestinal) tract and reading about it, we'll also get a lot of different clinical applications to it as well."

The Foster School of Medicine received preliminary accreditation by the Liaison Committee on Medical Education in February 2007.

The committee will visit the campus twice more before the first class of students graduates to make sure the school is adhering to the group's standards as it implements the curriculum.

Administrators at the school are confident their model will work as intended.

"Presenting information in the context in which it is used has been shown to enhance learning, to enhance retention of the information and help the student gain access to those points when they need it," Steele said.

Dr. Jose Manuel de la Rosa, founding dean of the Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, said the school's opening allows it to take on a new curriculum more easily than other campuses.

"One of the advantages of having a new medical school like we have here at Paul L. Foster is that we can look at different approaches to medical education," Steele said. "We can look at new things that seem to work and work well. We can learn from approaches to medical education that have not been as effective."

De la Rosa said the fully integrated clinical presentation model was too big a departure from standard medical education for some faculty.

"We went through a phase where it was so radical some of our traditionalist faculty got really concerned because they were taught in a certain way, and to teach at a new school with a new curriculum was a little too much," he said.

To assuage their worries, the school brought in consultants from other schools that use a similar curriculum model to discuss problems they encountered and ways to avoid them.

What Foster School of Medicine professors and administrators decided was that students at the school will take four classes simultaneously during their first two years: scientific principles of medicine; society, community and individual; medical skills; and masters' colloquium.

Each of the 40 students in the school's inaugural class will receive a laptop loaded with their medical school curriculum.

The first class they will take on scientific principles of medicine will include the clinical presentations and schemes the students should use to arrive at medical decisions.

The second course, medical skills, will be taught in the school's clinical simulation center. Students will work with lifelike mannequins and with patient actors who present with a variety of problems.

"This is where they're going to learn how to take a history, how to conduct a physical examination, how to perform basic procedures in the office," Steele said.

The third course about society and community is designed to get students off campus and into El Paso.

"This course is intended to reinforce the idea that physicians take care of people, and in order to take optimal care of a person you need to have a good understanding of that person in the context of their family, in the context of their community, in the context of their culture," Steele said.

Among the activities medical students will undertake are working in community health centers and learning Spanish. As part of this, the students will be matched with mentor families for at least a year.

"People who have someone with a chronic disease in their family will host a student ... so the student has the ability to understand not only the physical impact of chronic disease but also the social determinants of health," de la Rosa said.

Steele said the students will learn about barriers to accessing health care, alternative remedies used by some families, complimentary community health care resources and the issues that might arise when people try to follow their doctor's orders.

The final course required of students during their first two years is the masters' colloquium. The medical school school divided its class of students into two colleges, each staffed with two masters.

"This is a very senior person either at the pinnacle of their career or just past the pinnacle of their career, someone who has been through the system and knows their way," de la Rosa said.

One master in each college will be a medical doctor and the other will be a PhD, Steele said. The masters' colloquium will focus on hot topics in medicine dealing with professionalism, ethics and other topics, de la Rosa said.

The third year of medical education in El Paso will be similar to what is offered at other institutions. It will include clerkships in internal medicine, family medicine, obstetrics and gynecology, pediatrics, surgery, and psychiatry.

The students will have weeklong sessions between each clerkship block. These will focus on advanced topics in ethics and include review of basic sciences, Steele said.

Fourth-year medical students will be required to undertake experience in critical care, emergency medicine and neurology. They also will take on elective experiences in which they're interested.

"(The curriculum) has some very traditional elements that are going to shore it up," de la Rosa said. "The medical skills curriculum is very traditional. You teach students how to make a diagnosis, and yet it has a different bend."

He said the difference is the local model teaches on simulated patients rather than live patients.

"The Scientific Principles of Medicine course has this unique organization but it's very traditional in terms of giving you the scientific background to be a physician," he said. "Ten years from now I think the El Paso curriculum is going to be the model for everyone else."

He and Steele said the clinical presentation model of education slowly is catching on in medical schools throughout the country.

"There's probably a lot of reasons why not everyone is doing this," Steele said.

"I think one of the biggest reasons is just the heavy weight of tradition. Medical education and medical schools have been around for a long time, and medical educators tend to be comfortable teaching the way they're taught."