Is there a 'best' curriculum for medical school?

I've been in many meetings lately where we our medical school is grappling with the question of whether our recent/ ongoing curriculum transformation has accomplished what we set out to accomplish. Many people are asking if our new way of doing things is 'better' than the old way of doing things. What most people are expecting to see is a single (or at most two to three) metrics to say that we are better. These are primarily physicians who can clearly state the literature on risk reduction and NNT if I start aspirin in a patient with stroke compared with clopidegril and aspirin. We all like single data points as they are easy to put into practice.

However, our true measure of whether the curriculum is working well is actually pretty darned hard to measure. We want to know if we equipped physicians who are better prepared than the ones who went through the prior curriculum. The potential confounders are enormous, and the outcome data takes years to develop.These are the easy things to see. There is really no one 'best' number to see if we are accomplishing what we should do (yes, in my opinion, this includes the USMLE).

I think there is another inherent issue. Maybe there is no 'best' curriculum. Every system as complex as a medical curriculum will have strengths and weakness, shiny parts and rusty closets no one wants to clean, and areas of emphasis and areas that are not covered as well. Any endeavor has limits and boundries. In education it is often time and effort both on the part of students and teachers is not eternal. You have to make choices on what to include and what to exclude. Choices have to be made on how material is delivered. As a result, some curricula perform better in one area (say medical knowledge) and others perform better in another area (say reflective thinking). But to get better at one, you need to spend time that might be spent on another. Hence without unlimited time, there may be no perfect system.

There may be no 'best'.

And actually that's OK. You just need to decide what the main goals for your curriculum is. It doesn't matter if you are creating a new medical school curriculum or a curriculum for a single learner in your clinic with you for one week. You pick what you want to accomplish, and that will help you determine if you have the 'best' curriculum for you and your learners. And then go to measure whatever you can to see if it is working. We may not have a single best way to measure if our system is working, but if we know what we'd like to measure, it's far easier to get meaningful data.