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PubMed2005

Using curriculum design principles to improve health education for adolescent girls.

Learning and teaching are main concepts within health contexts, but curriculum theory is generally overlooked in the design of health education. In this paper, we describe the curriculum development component of a health research study designed to develop and present educational interventions for adolescent girls. Through the use of these interventions, we encouraged the girls to recognize and address potential health compromises in their dating relationships. By blending our disciplinary approaches of nursing and education to address the challenges of this research, we developed a curriculum that would effectively meet the needs of the participants. To do this, we assessed humanistic, social reconstructionist, technological, and academic curriculum approaches to determine that our approach is one of social reconstruction. We then considered teacher-centered, learner-centered, and problem-centered curriculum designs, choosing both learner and problem centered, and analyzed six dimensions of these designs. We describe these approaches, designs, and dimensions of curriculum considering pedagogical issues, criteria for evaluation, and appropriateness to educational health intervention programs.

Adolescent↗

PubMed2004

Core curriculum and special study modules at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak.

INTRODUCTION: The Faculty of Medicine and Health Sciences (FMHS), follows a problem-based learning, integrated and community-based curriculum which reflects the specific needs of doctors working in Sarawak. Using paediatrics as an example, this paper describes the process of development of core content (knowledge, procedural and communication skills, attitudes), additional knowledge and special study modules at the FMHS. OBJECTIVES: In 2003, the Department of Paediatrics and Child Health conducted a workshop to evaluate and update its 5-year-old curriculum. METHODS: The wise-men approach was adopted. Local and guest academicians (including members of the Department of Community Medicine and Basic Health Sciences), consultants, registrar, house officer and nursing staff of the Paediatric Department of Sarawak General Hospital (SGH), paediatric nursing lecturer and members of Medical Education Unit were involved. The review was based on three approaches: Problem/Task-based learning; Spiral curriculum; Outcome-based education. RESULTS: Core content and additional knowledge topics were modified. The special study modules were retained, but their duration was reduced. It was recommended that the curriculum should be reviewed at regular intervals. DISCUSSION: To select the core content and additional knowledge topics, clear and specific criteria were developed. Some topics were dropped, others were added, and some were moved from core to the additional knowledge section. CONCLUSION: It was a rewarding activity. The reviewed curriculum was received well by both the students and faculty. The enthusiasm and cooperation extended, especially by the faculty at SGH in the implementation of this curriculum, was remarkable.

Curriculum↗

PubMed2001

Institutionalization of a palliative and end-of-life care educational program in a medical school curriculum.

Stimulated by support from an R25 grant from the National Cancer Institute, we assembled a multidisciplinary team to design, implement, evaluate, and institutionalize in our medical school curriculum a training program to enable all students to graduate with basic competency in palliative and end-of-life care. In the fall of 1994, we reviewed the medical curriculum extensively to determine the need and optimal sites for integration of new educational modules. The freshman and junior years were found most suitable for our purposes; hence, behavioral objectives targeted at the freshman and junior medical student as learner were designed for the domain of palliative and end-of-life care. By 1996, negotiations with the medical school curriculum committee and with individual course masters secured permission and time allotments to include new coursework as required elements. We integrated approximately 20 hours of required training into the medical school curriculum, accomplished by modules that utilized small group learning, didactic presentations, out-of-classroom assignments, and practicum/experiential teaching methods. Freshman year curriculum consisted of a 3-hour module that considers the role of the physician in end-of-life care. Junior year training included a 1-hour module on advance directives and a 16-hour classroom and practicum course on hospice and end-of-life care. Performance-based assessment revealed that the students achieved the behavioral objectives. Furthermore, the students perceived benefit from the training and concluded that palliative care education should be a required part of their medical school experience. In September 2000, the medical school's Clinical Years Committee officially designated the palliative and end-of-life care training modules a mandatory part of the curriculum, with satisfactory completion a requirement for graduation.

Attitude to Death↗

PubMed1992

Evaluation of a model curriculum on substance abuse at The Johns Hopkins University School of Medicine.

Beginning in 1985, The Johns Hopkins University School of Medicine developed a model curriculum on alcohol abuse to enhance the education of medical students in issues related to the abuse of alcohol and other drugs. By 1987, preclinical courses (given in years one and two) reflected the goals of the curriculum; however, integration of the curriculum into the clinical courses (given in years three and four) was only partially successful. This paper reports on nine annual surveys of students (the classes of 1989-1992) that were conducted from 1987 to 1990 to measure the effects of the curriculum, using previously validated instruments to record the students' knowledge, attitudes, beliefs in role responsibility, and confidence in clinical skills. Significant improvements occurred in the students' attitudes, beliefs in role responsibility, and confidence in skills during their preclinical years. These positive changes were stronger, and better sustained during the clinical years, in students who participated in special programs or elective courses focusing on substance abuse; the positive changes were not always sustained in other students. The authors suggest that enhanced experiential sessions, elective programs, and greater emphasis during the clinical years on issues relating to substance abuse are necessary for maintaining the desirable educational outcomes of a substance abuse management curriculum, and that an intensive program against a backdrop of curriculum reform is a useful model.

Baltimore↗

PubMed1993

U.S. medical schools' valuing of curriculum time: self-directed learning versus lectures.

BACKGROUND: As medical schools implement curriculum changes to address the relevancy of medical education to today's health care needs, examining schools' grading systems and their valuing of curriculum hours has become a priority. METHOD: In 1991-92 all 126 U.S. medical schools were surveyed regarding various issues related to the schools' grading systems and valuing of curriculum time, including the ways in which the schools achieved a balance between lectures and self-directed learning activities. RESULTS: A total of 122 schools responded. Forty-eight schools calculated grade-point averages and used them to compute and publish class ranks; 72 published grade-point averages. Fifty schools reported curriculum revisions that decreased lecture hours, incorporated small-group discussion, or used problem-based learning and/or assessments using standardized patients. These 50 schools fell into four categories: had a system to balance lecture time and self-directed learning (11 schools); were moving toward such a system (27 schools); had tried but failed to balance lecture time and self-directed learning (one school); and had no policy to achieve a balance (11 schools). CONCLUSION: The survey results indicate that most schools have not established systems for the valuing of curriculum time that include balancing values for lecture time and values for self-directed learning. If needed curriculum reforms are to be implemented effectively, they must be valued meaningfully.

Curriculum↗

PubMed1995

Developing a "clinical presentation" curriculum at the University of Calgary.

Currently, medical curricula are structured according to disciplines, body systems, or clinical problems. Beginning in 1988, the faculty of the University of Calgary Faculty of Medicine (U of C) carefully evaluated the advantages and disadvantages of each of these models in seeking to revise their school's curriculum. However, all three models fell short of a curricular structure based on current knowledge and principles of adult learning, clinical problem solving, community demands, and curriculum management. By 1991, the U of C had formulated a strategic plan for a revised curriculum structure based on the way patients present to physicians, and implementation of this plan has begun. In creating the new curriculum, 120 clinical presentations (e.g., "loss of consciousness/syncope") were defined and each was assigned to an individual or small group of faculty for development based on faculty expertise and interest. Terminal objectives (i.e., "what to do") were defined for each presentation to describe the appropriate clinical behaviors of a graduating physician. Experts developed schemes that outlined how they differentiated one cause (i.e., disease category) from another. The underlying enabling objectives (i.e., knowledge, skills, and attitudes) for reaching the terminal objectives for each clinical presentation were assigned as departmental responsibilities. A new administrative structure evolved in which there is a partnership between a centralized multidisciplinary curriculum committee and the departments. This new competency-based, clinical presentation curriculum is expected to significantly enhance students' development of clinical problem-solving skills and affirms the premise that prudent, continuous updating is essential for improving the quality of medical education.

Alberta↗

PubMed2001

The Interdisciplinary Generalist Curriculum Project at the University of Illinois at Chicago College of Medicine.

The Interdisciplinary Generalist Curriculum (IGC) Project was initiated at the University of Illinois at Chicago (UI-Chicago) College of Medicine to link an ongoing longitudinal primary care experience with a didactic curriculum emphasizing generalism. The result of this educational initiative was a more extensive reform of the preclinical curriculum than originally had been planned. The IGC Project catalyzed a critical analysis of the first- and second-year curriculum that continues and that has resulted in the integration of all of the early clinical course work under a single longitudinal curriculum. The IGC Project also established a model for interdisciplinary collaboration in course and curriculum design and expanded the walls of the university to include greater numbers of community-based generalist preceptors. This modestly funded and focused educational initiative had unanticipated and far-reaching implications for educational activities throughout the College of Medicine at UI-Chicago.

Chicago↗

PubMed2002

The hidden curriculum in multicultural medical education: the role of case examples.

Explicit cross-cultural learning experiences in medical education are provided within the context of implicit experiences provided by a greater "hidden curriculum." The authors conducted a content analysis of 983 cases presented in the 1996-1998 year one and year two curriculum at the University of Minnesota Medical School to determine in what ways they might embody elements of the hidden curriculum, i.e., how they either supported or undermined explicit messages about diverse patient populations. Cases were coded for demographic variables, potential risk factors, and diagnoses or presenting problems. The findings revealed that cases featuring males out-numbered those featuring females; this ratio differed across courses, and appeared to differ from the actual epidemiology of the conditions. Sexual orientation was specified infrequently. When sexual orientation and behavior were specified, these appeared in the context of a risk assessment for particular diseases (e.g., HIV infection). Most cases did not provide racial or ethnic descriptions. For many of the ethnic descriptors, links to genetic, cultural, or socioeconomic factors were apparent; no such link was apparent when the racial terms "white" or "Caucasian" were used. Analysis of the 983 cases shows that the pattern of demographics and associations of particular groups with diseases or risk factors in cases conveys messages, as does the lack of mention of sexual orientation and race or ethnicity. These messages are inconsistent with and may undermine the formal multicultural medical curriculum. The results suggest a need for formal deliberation of this aspect of the curriculum by curriculum planners.

Cultural Diversity↗

PubMed2002

Care at the end of life: a novel curriculum module implemented by medical students.

End-of-life (EOL) and palliative care education in medical school curricula stand at a crossroads. Consensus has emerged that these topics merit systematic instruction throughout medical school training, yet curricula all too often consist of sporadic lectures focused on bioethics instead of clinical skills. The medical student authors identified a deficit in their curriculum, and designed and implemented an EOL curriculum module for their colleagues. In early 2000 the authors surveyed senior medical students about their experiences with EOL and palliative education, identifying deficits in clinical training and recommendations for interventions. They then designed a case-based educational module to teach EOL communication skills to medical students commencing clinical training. Faculty with national and local experience with EOL and palliative care reviewed the curriculum. Twelve of these faculty were oriented to the curriculum and then taught it in pairs to groups of 12 to 16 medical students in 2000 and 2001. The curriculum develops skills, attitudes, and knowledge relevant for communicating bad news and establishing treatment options in the EOL setting by utilizing trigger videos, group discussion, role plays, and case discussions. Approximately 75% of the 86 eligible students attended the module in 2000 and 2001. Feedback has guided the curriculum's refinement by the medical student authors. In addition, a standardized patient exercise, introduced in 2001, allowed students to reinforce the skills learned during the module.

Curriculum↗

PubMed2002

The role of spirituality in patient care: incorporating spirituality training into medical school curriculum.

OBJECTIVE: To answer the call for the implementation of spirituality into medical school curriculum,(1) UMKC-School of Medicine has incorporated experiential spirituality instruction into the third year of a six-year combined BA-MD degree program. The multifaceted objective of the program is to (1) expand students' conceptualization of the patient as person to include dimensions of spiritual beliefs and needs, (2) develop an understanding of how patients' spiritual belief systems impact their health, (3) recognize how the student's spiritual beliefs impact his or her practice of medicine, and (4) highlight the value of the chaplain as a member of the health care team. With increased understanding of the role spirituality plays in healing as well as the spiritual services available to patients, students will be able to serve the needs of their patients. DESCRIPTION: To accomplish this objective, students participate in lectures on spirituality, small-group activities focusing on skills such as taking/crafting spiritual histories, and an on-call experience with a hospital chaplain. During the oncall experience, students shadow a chaplain for approximately six hours. The experience includes discussing philosophies of spirituality and medicine with the chaplain, rounding with the chaplain, visiting and praying with patients when requested, comforting family members, and assisting with advance directive discussions and paperwork. After completing the experience, the students are required to write a reflective essay examining the following components: (1) the interaction between the chaplain and other members of the health care team, (2) the utilization of alternative interview and history taking methods, (3) the connection between spirituality and illness as illustrated through patient encounters, and (4) the insights gained from the experience that can be applied to the practice of medicine. DISCUSSION: The writing of one's spiritual history and the on-call experience were integrated into a new portion of the curriculum. The components were initially met with some reticence. In the beginning, students had difficulty distinguishing spirituality from religion and were concerned that the curriculum would take away from their study of "real medicine." To ease concerns regarding the spiritual history, the course director modeled the objectives by sharing her own spiritual journey. Participation in the on-call experience substantially changed students' negative attitudes toward the curriculum. Essays revealed that the on-call experience had greatly impacted their view of the chaplain as well as their practice of medicine. Specifically, students demonstrated an understanding of the role of spirituality in healing, identified key components of the chaplain role in the hospital setting, shared ways in which they would utilize chaplains in the future, and discovered personal struggles. Crafting one's spiritual history, the on-call experience, and essays will continue to be a required part of the third-year curriculum. Modifications include adding the option of constructing one's own advance directive and striving for increased diversity of spiritual perspectives. The data provided in the essays and course evaluations will be utilized in several ways to determine the success of the curriculum and to answer critical research questions in the areas of spirituality and medical education.

Curriculum↗

PubMed2005

Teaching medical students about medical errors and patient safety: evaluation of a required curriculum.

PURPOSE: To assess the effectiveness of a brief curriculum about patient safety and medical errors with third-year medical students. METHOD: From 2000-03, third-year medical students at New York Medical College, Valhalla, New York, were required to participate in a new curriculum on patient safety and medical errors during their family medicine clerkships. Five hundred seventy-two students participated in a four-hour curriculum that included interactive discussion, readings, a videotape session with a standardized patient, and a small-group debriefing facilitated by a family physician. Before and after participating in the curriculum, students were asked to complete questionnaires on self-awareness about patient communication and safety. Curriculum evaluations and follow-up surveys were also distributed. Responses to each statement on the before and after questionnaires were compared using the Wilcoxon signed-rank test for matched data. RESULTS: Five hundred eleven (89%) students reported that the opportunity to present an error to a patient increased their confidence about discussing this issue with patients, and 537 (94%) students reported that they strongly agreed or agreed that the standardized patient and feedback exercise was a useful learning experience. A total of 535 before and after questionnaires were used in the analysis. A comparison of before and after questionnaire data revealed statistically significant increases in the self-reported awareness of students' strengths and weaknesses in communicating medical errors to patients (p <or= .01). CONCLUSION: These findings suggest that awareness about patient safety and medical error can be increased and sustained through the use of an experiential curriculum, and the students rated this as a valuable experience.

Attitude of Health Personnel↗

PubMed2006

Are discharge summaries teachable? The effects of a discharge summary curriculum on the quality of discharge summaries in an internal medicine residency program.

BACKGROUND: Interns are often required to dictate discharge summaries without formal training. We investigated the impact of a curriculum aimed at improving the quality (i.e., complete, organized, succinct, internally consistent, and readable) of interns' discharge summaries. METHOD: Fifty-nine medicine interns were randomized to a: (1) control group; (2) discharge summary curriculum; or (3) curriculum plus individualized feedback. Pre- and post-intervention, seven discharge summaries were graded using a 9-item instrument. T-tests, analysis of covariance, and effect sizes assessed group differences. RESULTS: There were multiple, significant within-group improvements for the intervention groups and between group differences post-intervention. The average effect size was large when the curriculum plus feedback group was compared to the control group (.70) and moderate when compared to the curriculum only group (.36). CONCLUSIONS: Interns who received instruction on discharge summary skills improved the quality and of their discharge summaries. Adding feedback to the curriculum provided more benefit.

Curriculum↗

PubMedDate not supplied

Outline of a medical genetics curriculum for internal medicine residency training programs.

To keep pace with the rapid advances in medical genetics, internal medicine residency training programs need to train internists to develop new attitudes, knowledge bases, and skill sets. Currently, such programs have no medical genetics curriculum. Thus, to set a minimum standard for genetics education in the context of training in internal medicine, the Internal Medicine Residency Training Program Genetics Curriculum Committee was formed, with members representing professional organizations of medical geneticists, internists, genetic counselors, internal medicine and genetics residency program directors, and internal medicine residents. The committee's task was to develop a concise outline of a medical genetics curriculum for residents in internal medicine in accordance with requirements of the Residency Review Committee for Internal Medicine of the Accreditation Council for Graduate Medical Education. The curriculum outline was drafted and circulated for comment. Before publication, the final document was approved by those member organizations that had a policy of approving curricula. Key learning objectives of the curriculum include appreciation of the rapid advances in genetics, the need for lifelong learning, the need for referral, and the role of genetic counselors and medical geneticists, as well as developing the ability to construct and analyze a three-generation pedigree. A wide variety of teaching methods can be useful in these regards, including didactic lectures, multimedia CD- ROMs, and clinical experience. Teaching should be related to clinical experiences whenever possible. The curriculum developed by the committee and presented in this article will assist in teaching residents the attitudes, knowledge, and skills they will require.

Accreditation↗

PubMed1982

Personality type and curriculum preference in primary care.

The study was conducted to examine the impact which personality types may have on the selection process of two preclinical medical school curricula. The two curricula run concurrently at the University of New Mexico School of Medicine. One curriculum has a conventional-lecture format, and the other a new student-centered curriculum, which is designed to graduate students planning careers in rural primary-care. Results indicated that those students preferring the innovative curriculum were personality types unlikely to enter rural primary-care, whereas students preferring the conventional curriculum had personality profiles more consistent with those making rural primary-care career choices. Discussion deals with the implications of personality type and curriculum choice in terms of the curriculum goals and educational method.

Career Choice↗

PubMed1982

Medical students' attitudes toward basic sciences: influence of a primary care curriculum.

The emerging popularity of family medicine and primary care among medical students with an attendant pressure for clinical relevance in pre-clinical coursework and early clinical exposure has raised questions in the minds of many academicians about the students' perceived value of basic sciences in such an educational environment. A comparison was made of attitudes toward the basic sciences between students in two, concurrent, pre-clinical medical school curricula at the University of New Mexico School of Medicine. The conventional curriculum offers a teacher-centered, 2-year curriculum of basic sciences taught predominantly by basic scientists in a lecture format. The experimental curriculum entitled the Primary Care Curriculum (PCC), offers a student-centered, 2-year curriculum in which pertinent basic and clinical science learning is derive primarily from common, primary care, patient problems, discussed in small group tutorials. There are no formal lectures. Half the tutors are primary care clinicians, half basic scientists. Attitude scales were administered in two successive classes of students in both curricula at the beginning of the first and second terms of the first year. Increased cynicism toward the curriculum and its relevance to future practice was observed among conventional, but not among PCC students. This findings lends supports to the hypothesis that modification in educational methods in general and relevant, primary care experience in particular can favourably influence students' attitudes toward basic sciences.

Attitude of Health Personnel↗

PubMed2004

The impact of a modern medical curriculum on students' proposed behaviour on meeting ethical dilemmas.

OBJECTIVE: To evaluate the impact of a modern medical curriculum on students' proposed behaviour on encountering ethical dilemmas. DESIGN: Cohort design. SETTING: University of Glasgow Medical School. SUBJECTS: The first intake of students into Glasgow's new curriculum (n = 238). Main outcome measure Student answers consistent with consensus professional judgement on the ethical dilemmas posed by the vignettes of the Ethics and Health Care Survey Instrument. RESULTS: The probability of giving a consensus answer was lowest pre-Year 1 and highest post-Year 1. It reduced slightly post-Years 3 and 5, but remained significantly higher than at pre-Year 1. The performance of students undertaking a 1-year intercalated BSc, however, appeared to regress on testing post-Year 4. CONCLUSIONS: While the first year of the curriculum had a positive impact on students, the remainder of the curriculum did not impact to the same extent. These findings support the recommendation that small group teaching, the predominant teaching method in Year 1, should be preferred to lecture and large group teaching, the predominant method of the remaining curricular years. Full integration of ethics and law teaching within the rest of the curriculum is recommended, particularly during the clinical years. This has training implications for all medical teachers involved in the curriculum. The assessment of ethics should be incorporated into all formal examinations. It is recommended that ethics be addressed as part of a wider approach to professionalism in order to promote integration.

Cohort Studies↗

PubMed2005

Developing an outcome-focused core curriculum.

BACKGROUND: Many UK medical schools have modified their curricula to meet the requirements of the General Medical Council and other external agencies. In particular, efforts have been focused on increasing integration and reducing factual overload through the definition of a core curriculum. Various approaches to curriculum change have been adopted in an attempt to meet such demands. PURPOSE: This paper describes a curriculum development process, which commences with a clear vision, adopts an outcome-based approach and identifies clear statements of learning outcomes. The process led to the development of an outcome-focused core curriculum structured around clinical problems, which is available to all students and staff. CONCLUSION: A model of curriculum development has evolved which is relatively simple in concept, and appears to be easy to comprehend by students, teaching staff and visitors from other institutions. It provides a practical framework for managing the difficult problems of integration and factual overload. It should be of general interest and applicability to other schools with health professional programmes looking for a realistic and acceptable way of defining a core curriculum.

Clinical Competence↗

PubMed2006

Student evaluation of the clinical 'curriculum in action'.

AIM: To examine how students' evaluations of the environment, process and outcome of clinical learning interrelated and correlated with assessment results. METHOD: A post hoc study in the 3rd of 5 years in a student-centred, horizontally integrated, objective-based medical curriculum. In the last week of each module, students evaluated what they had learned and how they had learned it using a previously validated, web-based scale. The interrelationships between scale variables and their relationships with summative assessment results were tested using factor analysis, correlation analysis and stepwise multiple regression analysis. RESULTS: Student evaluation yielded 4 summary measures: 2 reflected learning outcomes ('real patient learning' and 'curriculum coverage'), 1 reflected process ('quality of instruction') and 1 reflected environment ('conditions for learning'). They fitted a causal model according to which instruction, conditions for learning and curriculum coverage favoured real patient learning. Real patient learning was rated higher in women than men, and the measures were associated more strongly in women. Performance in end-of-year summative assessments was predicted strongly by mid-year performance but by no other measure. CONCLUSIONS: Students' evaluations of their learning environment and instructional processes correlated with their assessments of 2 outcomes of the curriculum in action: curriculum coverage and real patient learning. There was little shared variance between those measures and students' performance in summative assessments. Given its formative potential, students' evaluation of their curriculum in action could play a useful part in learner-centred clinical education. There is a possibility, which needs further research, that women's evaluations have greater predictive validity than men's. Assessment performance should be regarded not as a solitary gold standard but as just 1 measure of educational outcome.

Attitude of Health Personnel↗