Training medical students for the twenty-first century: Rationale and development of the Utrecht curriculum "CRU+".

Aim: The aim of this report, written for the 40th anniversary issue of Medical Teacher, is to document 20 years of development of the Utrecht undergraduate medical curriculum, as both to exhibit accountability and to inform the community of the process and choices that can be made in long-term curriculum development.

Methods: We used the SPICES model, created by Medical Teacher's Editor Ronald Harden and colleagues in 1984.

Results: The Utrecht six-year program, now called "CRU+", has many distinct features that were introduced, most of which are well documented. A limited selection includes  • A new 3+3 years Bachelor-Master structure following the EU Bologna rules leading to MD registration for cohorts of about 300.  • Horizontally integrated classroom teaching of basic sciences with clinical disciplines predominantly in groups of 12 and limited lectures.  • Mandatory knowledge retention tests, retesting the clinically relevant core knowledge from block tests of semesters one through four.  • Vertical integration not only linking clinical experience with background knowledge, but also exemplified by a stepwise increase in health care responsibilities throughout the curriculum.  • A final year focussing on growth towards the level of a primary responsible physician in a 12-week sub-internship for a limited number of patients and beds, in a chosen specialty. The student is called a semi-physician in the clerkship of this transitional year to residency.  • Teaching skills training for all medical graduates, an elective teaching rotation and various peer-teaching arrangements throughout the curriculum.  • Integrated semi-longitudinal clerkships with an assessment focus on entrustment decisions for Entrustable Professional Activities.

Conclusion: UMC Utrecht has made a continuous attempt to both develop its medical curriculum and to study and report on its development in the literature, regarding new methods found and insights derived. UMC Utrecht will remain committed to developing training to meet twenty-first century demands of medical graduates.