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PubMed2006

Medical nutrition: a comprehensive, school-wide curriculum review.

BACKGROUND: A school-wide nutrition program was established in 1982 and a required medical nutrition course (MNC) was established in 1985 at the University of Nevada School of Medicine. Emphasis was placed on developing an integrated curriculum and on using innovative methods to incorporate nutrition into the existing curriculum. OBJECTIVE: The objective of this review was to establish a baseline and make positive curricular changes to comply with the recommendations of the Liaison Committee on Medical Education for accreditation. The MNC and the nutrition curriculum were evaluated as part of this 3-y comprehensive, school-wide evaluation process. DESIGN: The MNC was invited for review (December 2004) because of its position in the curriculum (first year), special content and methods, and relation to other courses. A review team, which consisted of the Assistant Dean for Medical Education (who chaired the team), a curriculum coordinator, faculty representatives, and a medical student, was appointed. The MNC coordinator prepared a review book that included the requested documentation. The initial 3-h review meeting culminated in a formal evaluation and recommendations. Follow-up meetings at 1 mo and 1 y were scheduled. RESULTS: The review was a positive process that reaffirmed the uniqueness of the nutrition program at the University. It supported the MNC as an important part of the required curriculum. Recommendations included use of the Web, encouragement to identify new opportunities with interested faculty, and a structure to further integrate and align nutrition into existing courses. CONCLUSIONS: A positive, proactive review process supports the importance of nutrition in the medical school curriculum and encourages further integration.

Curriculum↗

PubMed2001

Development of a genetics education workshop curriculum for Native American college and university students.

The long-term goal of Genetic Education for Native Americans (GENA), a project funded by the National Human Genome Research Institute (NHGRI), is to provide a balance of scientific and cultural information about genetics and genetic research to Native Americans and thereby to improve informed decision making. The project provides culturally sensitive education about genetic research to Native American medical students and college and university students. Curriculum development included focus groups, extensive review of available curricula, and collection of information about career opportunities in genetics. Special attention was focused on genetic research to identify key concepts, instructional methods, and issues that are potentially troublesome or sensitive for Native Americans. Content on genetic research and careers in genetics was adapted from a wide variety of sources for use in the curriculum. The resulting GENA curriculum is based on 24 objectives arranged into modules customized for selected science-related conference participants. The curriculum was pretested with Native American students, medical and general university, health care professionals, and basic scientists. Implementation of the curriculum is ongoing. This article describes the development and pretesting of the genetics curriculum for the project with the expectation that the curriculum will be useful for genetics educators working in diverse settings.

Curriculum↗

PubMed1978

Diseases of the curriculum.

During the past 20 years the author has visited almost half of all the American medical schools, usually as a consultant in matters of curriculum and instruction. Certain recurring curriculum problems have emerged and have been described as "diseases of the curriculum." To be exact, this article includes nine such entities. In addition to the naming of these nine curriculum conditions, there is ample illustrative material to ensure that each curriculum disease is fully explained--although the basic sciences supporting the study of education as a discipline are not advanced enough to allow fuller understanding of the disease processes. There is speculation, however, that even being able to name and describe these disturbances of normal curriculum development might be of help in solving some of our more serious curriculum problems.

Communication↗

PubMed1992

Conceptualizing curriculum for graduate medical education.

Several recent developments affecting graduate medical education (GME) have kindled an interest in curriculum. For the most part, however, GME curriculum is being conceived in terms of behavioral learning objectives. The authors find this approach to curriculum ill-suited for the reality and complexity of housestaff training. Several other approaches are considered but none, they conclude, fits well with the mission of GME. Instead, they propose a more comprehensive experiential conception of curriculum for GME. This approach stems from an experiential learning paradigm and a commitment to curriculum as an expression of valued activities rather than of predetermined objectives. Taking as an example a curriculum for an ambulatory care block rotation, the authors show how an experiential curriculum can be developed and how it can be used to frame the residents' rotation, including patient care and didactic program.

Curriculum↗

PubMed1994

The hidden curriculum, ethics teaching, and the structure of medical education.

The authors raise questions regarding the wide-spread calls emanating from lay and medical audiences alike to intensify the formal teaching of ethics within the medical school curriculum. In particular, they challenge a prevailing belief within the culture of medicine that while it may be possible to teach information about ethics (e.g., skills in recognizing the presence of common ethical problems, skills in ethical reasoning, or improved understanding of the language and concepts of ethics), course material or even an entire curriculum can in no way decisively influence a student's personality or ensure ethical conduct. To this end, several issues are explored, including whether medical ethics is best framed as a body of knowledge and skills or as part of one's professional identity. The authors argue that most of the critical determinants of physician identity operate not within the formal curriculum but in a more subtle, less officially recognized "hidden curriculum." The overall process of medical education is presented as a form of moral training of which formal instruction in ethics constitutes only one small piece. Finally, the authors maintain that any attempt to develop a comprehensive ethics curriculum must acknowledge the broader cultural milieu within which that curriculum must function. In conclusion, they offer recommendations on how an ethics curriculum might be more fruitfully structured to become a seamless part of the training process.

Bioethical Issues↗

PubMed2001

The Interdisciplinary Generalist Curriculum Project at Joan C. Edwards School of Medicine at Marshall University.

The Interdisciplinary Generalist Curriculum (IGC) Project was designed to enhance interest in and support of generalism during the first two years of medical education. The original goals at Joan C. Edwards School of Medicine at Marshall University included the design and implementation of a core curriculum, Introduction to Patient Care (IPC), and enhancement of teaching excellence through faculty development. The core curriculum facilitated integration with the basic sciences and early introduction of physical examination skills, which were further developed in longitudinal clinical experiences with mentors. Although it was not originally intended to include basic scientists in the preceptor groups, they became important additions and created additional opportunities for interdisciplinary teaching and reciprocal learning. The mentor program, another well-received and intended curriculum change, evolved from a structured experience to a more flexible component of the curriculum. The program met the requirements of the IGC Project but 53% of the originally intended mentor time was achievable, due to curriculum constraints. Faculty development, another success, was originally intended to target IPC faculty but ultimately became a university-wide effort. The changes implemented as a result of the IGC Project continue to flourish beyond the funding period and have become integral aspects of the curriculum and the medical school.

Curriculum↗

PubMed2002

Teaching medical residents about teenagers: an introductory curriculum in adolescent medicine.

OBJECTIVE: Adolescents in the United States have high morbidity rates, which are attributable to injuries, behavioral disorders, sexually transmitted diseases, and unplanned pregnancies. This has led to a call to action for health care educators to better prepare future practitioners to meet adolescent health care needs. Although pediatrics residency programs have required one-month curricula dedicated to adolescent medicine, many internal medicine (IM) residency programs do not have such requirements despite an American College of Physicians position paper recognizing the importance of internists' providing health care to adolescents. Thus, an introductory curriculum in adolescent medicine was developed for a community hospital IM residency program. The curriculum was designed to train IM residents to effectively interview, provide preventive care for, and evaluate common medical problems of older adolescents (ages 16-21) in an outpatient setting. DESCRIPTION: The curriculum was based on the results of an extensive needs assessment, which included surveys sent to practicing internists and current IM residents. It included three units, each a series of one-hour lessons delivered via morning report or grand rounds sessions. The first unit was interviewing, which covered specific interviewing questions, communication methods, and confidentiality issues. The second unit was preventive medicine care, which addressed immunizations, injury prevention, and adolescent drug and alcohol use. The third unit was diagnosis and management of common problems, which focused on topics frequently encountered during adolescent outpatient visits, including acne, sexually transmitted diseases, reproductive health care needs, and menstrual abnormalities. Other topics pertinent to the care of adolescents, notably depression, eating disorders, and sports medicine, were covered by previously established curricula, and thus omitted. This curriculum was created through the support of the Michigan State University Primary Care Faculty Development Fellowship Program, and was reviewed by curricular and adolescent medicine content experts. The residency program director supported its implementation over the course of two academic years. The pilot unit interviewing was conducted in February 2001, during two one-hour morning report sessions. In the first session, a short lecture outlining interviewing concepts and principles was given, followed by several case-based studies describing office presentations of adolescent patients. In the second session, an actual office visit was simulated; the residents observed adolescent volunteers being interviewed, and were then given an opportunity to ask the patients further questions. Residents completed a brief quiz and evaluation survey at the end of the pilot unit. DISCUSSION: Twenty-one of 40 residents participated in the pilot unit. Evaluations were overall very positive. Quiz scores confirmed that the residents achieved the desired learning objectives. Given these results from the pilot unit, the remaining two units of the curriculum have been integrated into the residency curriculum. Additional faculty members have been selected to deliver future sessions and support this important educational activity. The adolescent medicine curriculum can be used as an model by other IM residency programs for teaching adolescent health care, with an emphasis on both the knowledge base of adolescent issues and awareness of the unique skills necessary for the establishment of a physician-patient relationship between internists and older adolescents.

Adolescent↗

PubMed2002

An unfolding case with a linked OSCE: a curriculum in inpatient geriatric medicine.

OBJECTIVE: This study sought to design, implement, and evaluate a unique educational curriculum in inpatient geriatrics for internal medicine housestaff. DESCRIPTION: Traditionally the didactic curriculum on an inpatient geriatrics unit varies according to the attending faculty on service, the types of patients admitted, and preferences of the housestaff and students-in-training. However, a more structured educational curriculum would allow for comprehensive attention to, and a detailed exploration of, the principles of geriatric care necessary to effectively treat all hospitalized older adults. We have developed a unique curriculum using an unfolding case that is followed by an OSCE, which assesses the knowledge and skills gained by the learners. An unfolding case is one that evolves over time and is unpredictable to the learners when they begin participating in the curriculum. It is well suited to postgraduate training and assessment since the learner must develop a differential diagnosis, discuss possible work-ups, and use the work-ups' results to reassess the case as it unfolds. Our scripted case, administered by a geriatrics fellow rotating on the unit, follows an ambulatory geriatric patient from her admission throughout her treatment and until the end of her stay. It culminates in a decision-making session about her functional ability and hence her discharge plans. Moreover, several topics relevant to inpatient geriatrics, including dementia, delirium, falls, urinary incontinence, wound care, and depression, are covered in three one-hour sessions. Written examinations or pre- and post-testing after an intervention are better suited to the early years of medical training but provide poor measures of curriculum mastery and clinical competency. Alternatively, our OSCE approach uses "stations" and "interstations" that provide a structured and timed opportunity to test these skills and assess specific areas of knowledge. We have designed a five-station, five-interstation OSCE that is conducted one week after the unfolding case-based conferences have ended. Learners are evaluated by attending physicians and given immediate feedback after each station and interstation. DISCUSSION: This newly developed project has been implemented as a standardized curriculum on our inpatient geriatrics unit since September 2001. Thus far, it has been extremely well received by housestaff because of real-time assessment and review of the materials covered during the month. In addition, this progressive approach has provided an excellent forum for geriatrics fellows to develop teaching skills. Attending physicians have shown their support, finding the content to be appropriate and relevant to inpatient geriatrics. Finally, this didactic approach will be continued on our unit and a modified version is being developed and piloted for other unit staff.

Curriculum↗

PubMed2004

End-of-life care in the curriculum: a national study of medical education deans.

PURPOSE: To describe attitudes and practices of end-of-life care teaching in the undergraduate medical curriculum in the United States as reported by administrative leadership and identify opportunities for improvement. METHOD: A telephone survey of associate deans for medical education or curricular affairs at a random sample of 62 accredited U.S. medical schools was conducted in 2002. RESULTS: Fifty-one deans participated (82% response rate). Most (84%) described end-of-life care education as "very important" and supported incorporating more end-of-life care teaching into the undergraduate curriculum. Sixty-seven percent reported that insufficient time is currently given to palliative care in their curriculum. Although a majority opposed required courses (59%) or clerkships (70%) that focused on end-of-life care, they did unanimously endorse integrating teaching end-of-life care into existing courses or clerkships. Key barriers to incorporating more end-of-life care into the curriculum included lack of time in the curriculum, lack of faculty expertise, and absence of a faculty leader. CONCLUSION: Associate deans for medical education or curricular affairs in the United States support integrating end-of-life care content into existing courses and clerkships throughout the undergraduate medical curriculum. Successful integration will require institutional investment in faculty development, including both the development of faculty leaders to drive change efforts, and the education of all faculty who teach students and exert influence as role models and mentors. The strong support for end-of-life care education expressed by academic leaders in this study, combined with the high level of interest expressed in the authors' 2001 national survey of students, provide evidence of the potential for meaningful change in the undergraduate medical curriculum.

Adult↗

PubMed2006

Commentary: Health systems and health policy: a curriculum for all medical students.

A companion article in this issue of Academic Medicine provides an example of a method for electively integrating health systems and health policy issues into medical education. However, a curriculum in health systems and health policy is crucial to the education of all future physicians and other health professionals. The Clinical Prevention and Population Health Curriculum Framework of the Healthy People Curriculum Task Force has recently recommended a health systems and health policy curriculum that includes the domains of organization of clinical and public health systems; health services financing; health workforce; and health policy process. The curriculum should commence prior to year three and continue in years three and four so that students have a framework for integrating and subsequently sharing their experiences. Current Liaison Committee on Medical Education data indicate that on average less than 70% of medical schools require any curriculum in these four domains and only 40% of medical schools include all four of these domains in their required curriculum. Incorporation all of these domains into well-defined, required curricula that are broad in scope has the potential to change the attitudes of future clinicians toward efforts to control costs, collaborate with other health professions, and influence health policies.

Curriculum↗

PubMed1993

Experiences with a method for obtaining feedback on a medical curriculum undergoing change.

Successful innovation and change in the way medical students are prepared are notoriously difficult. The relationship between the administrative structures of the medical school and its teaching hospitals, other responsibilities of its teachers and administrators, and the intricacies of the curriculum as a system of interrelated components, mean that any real change has wide repercussions. An opportunity for evaluation of a curriculum undergoing change was presented at the University of New South Wales, when the Faculty of Medicine introduced a new 6-year medical curriculum in 1988. The change was made to address a number of problems experienced with the old 5-year curriculum. The Course Evaluation Committee was in a unique position to conduct an ongoing evaluation of the new curriculum, year by year, as it was being introduced. A method for obtaining feedback from both staff and students on a medical curriculum undergoing change, is described. While some sample results are presented, the paper concentrates on the advantages and disadvantages of, and our experiences with, this method. Advantages include the specificity and timing of the information collected, and the high response rate. One disadvantage was the repeated use of the same cohort of students. Some staff still perceived the evaluation process as a threat, or were sceptical about the value and validity of student feedback. Whether staff acknowledged ownership of the new curriculum also affected the use of feedback.

Attitude of Health Personnel↗

PubMed1997

The new Dundee medical curriculum: a whole that is greater than the sum of the parts.

The medical undergraduate curriculum at the University of Dundee has evolved in response to changing needs. The new curriculum, introduced in 1995, combines idealism and pragmatism. Underpinning it is the concept that the curriculum is an educational programme where the whole is greater than the sum of the parts. The concepts contributing to this are: the spiral nature of the curriculum, with its three interlocking phases; a body-system-based approach, with themes running through the curriculum, providing a focus for the students' learning; a core curriculum with special study modules or options; the educational strategies adopted, including elements of problem-based and community-based learning and approaches to teaching and learning that encourage the students to take more responsibility for their own learning; an approach to assessment which emphasizes the overall objectives of the course; an organization and management of the curriculum; and an allocation of resources designed to support the educational philosophy.

Community Medicine↗

PubMed2005

A comprehensive collaborative patient safety residency curriculum to address the ACGME core competencies.

CONTEXT: Patient safety currently receives only scant attention in most residency curricula. Safety is a subject that transcends the US Accreditation Council for Graduate Medical Education's 6 core competencies. OBJECTIVE: To design and implement a new patient safety curriculum in collaboration with the Schools of Nursing and Pharmacy, in such a way as to address all 6 competencies. SETTING AND PARTICIPANTS: The curriculum applies to a university-based family medicine residency programme with 45 residents at 5 sites, including urban, suburban and rural sites. CURRICULUM DESIGN: The curriculum includes introductory workshops for faculty and residents, a series of didactic courses, individual portfolios and a series of small group exercises including chart reviews, case presentations and a longitudinal quality improvement project. The activities are run by a multidisciplinary team. OUTCOME MEASURES: Main outcome measures include assessment of resident performance in curriculum activities and in an annual objective structured clinical examination (OSCE) that includes standardised patient interviews, simulations and a written examination. Programme evaluation will include comparison of OSCE performance with that at a neighbouring residency. RESULTS: Residents identified safety problems and system-based solutions using a safety journal. Cases of polypharmacy were identified using journals and chart reviews, and medication changes proposed and discussed. At resident practice sites, residents identified safety priorities based on a staff survey and proposed system-based solutions. Results of the OSCE will be presented elsewhere. CONCLUSIONS: A new patient safety curriculum was successfully introduced into a family medicine residency. The curriculum integrates patient safety into residents' daily activities and incorporates input from the disciplines of nursing and pharmacy so as to help build more effective clinical teams and inculcate a culture of safety.

Clinical Competence↗

PubMed1990

Student error patterns as a function of curriculum design: teaching fractions to remedial high school students and high school students with learning disabilities.

This study evaluated the relative effectiveness of a curriculum that incorporated three empirically derived principles of curriculum design with a basal approach in teaching basic fractions concepts to students with learning disabilities and other low performing students in high school remedial math classes. The components of effective mathematics instruction articulated by Good and Grouws (1979) were implemented in both conditions. Thus, the curriculum design variables were isolated by keeping all other aspects of instruction constant. Results indicated that, although both programs were reasonably successful in teaching the material, the curriculum program utilizing sophisticated principles of curriculum design was significantly more effective. Mean scores on a curriculum-referenced test were 96.5% for that group and 82.3% for the basal group. Secondary analyses of item clusters revealed that areas of weakness in the performance of the basal group could be directly linked to hypothesized flaws in its curriculum design.

Adolescent↗

PubMed1999

Impact of a sun awareness curriculum on medical students' knowledge, attitudes, and behaviour.

BACKGROUND: Physicians teach sun awareness to their patients, but frequently have no formal training in this area. A week-long dermatology curriculum during Sun Awareness Week that included skin cancer and sun awareness education to first-year medical students was introduced in May 1998 at the University of Western Ontario, London, Canada. OBJECTIVE: The purpose of this study was to determine the baseline knowledge, attitudes, and behaviour of the first-year medical students towards sun awareness before and after the new curriculum. METHOD: This study used a pre- and post-test design to determine the impact of the curriculum on the medical students' knowledge, attitudes, and intent to change behaviour. It also reports any influence of demographic variables on these parameters. RESULTS: The students demonstrated a substantial improvement in their knowledge of sun-related topics despite some baseline knowledge. Many students reported unhealthy behaviour prior to the curriculum, but demonstrated an intent to adopt more healthy behaviour after the curriculum. Minor differences in knowledge and behaviour due to demographic characteristics disappeared upon completion of the curriculum. CONCLUSIONS: An undergraduate medical curriculum with skin cancer and sun awareness education can improve the medical students' knowledge, attitudes, and behaviour towards sun awareness.

Adult↗

PubMed2003

The impact of a newly implemented PBL curriculum on the National Board of Chiropractic Examiners Part I Examinations at the National University of Health Sciences.

BACKGROUND: Performance differences between students of traditional lecture-based curricula and students of problem-based learning (PBL) curricula on standardized National Board Examinations have been studied. PURPOSE: To assess the impact and effectiveness of a change from a traditional lecture-based curriculum to a PBL curriculum. METHODS: Student performance in a traditional lecture-based curriculum (entering class of 1997) was compared to student performance in a PBL curriculum (entering class of 1998) on the standardized National Board of Chiropractic Examiners Part I Examination. RESULTS: There was a difference between the two curricula, with the PBL curriculum students outperforming the traditional lecture-based curriculum students on each individual part (d =.36-.95) of the National Board Examination and overall (d =.96). CONCLUSION: A comparison of student performance on a standardized National Board Examination has proved a useful tool at quantifying the impact of a newly implemented PBL curriculum.

Adult↗

PubMed1994

University-college collaboration: rethinking curriculum development in nursing education.

The behavioral approach to curriculum development is inadequate to educate nurses to practice in the future health care system. As a result of a government initiative, a Canadian university and four community colleges had an opportunity to collaborate on development of a nursing program and thereby consider alternative approaches to curriculum development. This paper describes the process used to develop this curriculum and provides an overview of the curriculum development model that emerged. A community development process characterized by a commitment to be futuristic and visionary about nursing while making curriculum decisions was established. The curriculum model that emerged used a phenomenological exploration of our common vision for nursing in the future. The resulting curriculum is based on a human science paradigm that encourages nurses to work from a health promotion perspective with an ethic of caring.

British Columbia↗

PubMed1999

Medical informatics in the medical curriculum--when?

Undergraduate teaching of medical informatics (MI) at the Medical School University of Zagreb has been changing its position in the medical curriculum. Nowadays, this subject is positioned in the second year of the medical curriculum. The aim of this paper is to find out what the students of the second year (S2Y) and of the sixth year (S6Y) think about the position of MI in the medical curriculum. The results of students' opinions have shown that MI should be positioned: in the last two years (63% of S2Y, 36% of S6Y), in the middle (11% of S2Y, 21% of S6Y), and at the beginning of the medical curriculum (26% of S2Y, 43% of S6Y). However, analysing this question according to previous experience of the students of both groups, it can be concluded that: the S6Y with more previous experience shift the subject towards the end of the medical curriculum, and the S2Y with more previous experience shift the subject towards the beginning of the medical curriculum. According to our long-term experience and students' opinion, the most relevant MI subjects, any kind of medical application, should necessarily come at the end of the medical curriculum.

Computer Literacy↗