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PubMed2006

Pre-registration house officers' views on studying under a reformed medical curriculum in the UK.

In 1996 the University of Liverpool introduced a new curriculum based on the recommendations published in Tomorrow's Doctors. This work examines how graduates of that course view their undergraduate curriculum and whether they consider it prepared them well for the pre-registration year. Five focus groups were arranged with a selection of graduates from the first cohort to graduate from the reformed curriculum in order to ascertain their views on the course and how it had prepared them to work as pre-registration house officers (PRHOs). The focus groups were tape-recorded, transcribed and analysed. The PRHOs felt they had been well prepared for the PRHO year, citing the clinical experience of the final year, communication skills classes and the Clinical Skills Resource Centre as having been particularly beneficial. There were concerns about their basic science knowledge base although this had not affected their ability to work as PRHOs. They had criticisms of the way part of their course had been structured but overall they were happy with the content of the course. A reformed medical curriculum in the UK can prepare graduates well to work as junior doctors and can take away some of the anxiety associated with graduation; therefore, to that extent curriculum reform has worked. However, anxiety about undertaking the role of junior doctor seems to have been replaced by anxiety about knowledge base, despite having adequate knowledge to work as PRHOs. Students undertaking a reformed curriculum are wary about being the first people to use their training in the workplace. This factor may need to be considered when further reforms are introduced.

Attitude of Health Personnel↗

PubMed2004

A user's guide to enhancing geriatrics in an undergraduate medical school curriculum: the ten-step model to winning the "geriatric game".

In 1999, the University of Rochester School of Medicine and Dentistry committed to major restructuring of its undergraduate medical school curriculum. A distinguishing feature of this reform was the planned emphasis on and integration of several core topics or themes throughout the 4 years of the curriculum. One of these curricular themes was aging. The faculty in geriatrics was presented with an unparalleled opportunity to develop a geriatrics curriculum of major proportions through the development of an aging theme. Through a user's guide approach based on the authors' experience to date, this article identifies the 10 steps necessary to "win the geriatric game" successfully integrating an aging theme into an undergraduate medical school curriculum. Since the initiation of the aging theme, several new courses, cases, and conferences have been added or enhanced, affecting all 4 years of the curriculum. Key operational challenges included successful engagement of course directors, tracking the actual experience of the aging theme, and evaluation of students' attainment of learning objectives and eventual career choices. The authors' experience suggests that an aging theme can successfully enhance the geriatrics curricular content of undergraduate education and strongly affect students across all 4 years. This 10-step approach may serve as a model for other universities committed to integrating geriatrics across the full undergraduate medical curriculum.

Aged↗

PubMed2007

Development and implementation of new educational concepts in a dental curriculum.

The Academic Centre for Dentistry Amsterdam introduced a fully renewed 5-year dental curriculum in September 2003. In this article, the educational principles and didactic choices that form the basis of the curriculum development are presented and attention is given to the process of development and the implementation strategy that constitute such an important part of the success of introducing a new curriculum. Special characteristics of the new curriculum are the clinical training practice, professional conduct, the elective profiles and academic education. In clinical practice, groups of students from different levels run a group practice in which they learn to work together, delegate tasks, solve clinical problems and apply evidence-based dentistry. In the new curriculum students learn to conduct themselves as professionals. In the third and in the fifth year, students choose an elective profile oriented, respectively, on research and on clinical knowledge and skills. Academic education is an important spearhead in this curriculum in which students not only learn why research is important to dentistry but also how dentists can use research to their own benefit. In development and implementation, a stepwise approach was used in which as many people as logistically possible were involved.

Competency-Based Education↗

PubMedDate not supplied

Lessons learned while developing "Clinical Trials Education for Native Americans" curriculum.

This paper highlights lessons learned while developing the Clinical Trials Education for Native Americans (CTENA) curriculum. The CTENA is a culturally specific clinical trials education curriculum that evolved from another ongoing NCI-supported project, Clinical Trials Education for Colorado Providers. The multicultural team learned many lessons while developing, pretesting, and revising this curriculum. These include allocating sufficient time and resources to tailor presentations for diverse tribal settings and workshop participants, addressing barriers to participation in clinical trials through culturally appropriate strategies, providing information to foster informed decision making related to participation, and writing as a team to increase cultural breadth of examples and interactive experiences. There are multiple challenges to developing and implementing a culturally acceptable curriculum on clinical trials within medically underserved communities. Both the multicultural team and the curriculum benefited from the collaborative process, resulting in a culturally relevant clinical trials curriculum that will assist Native Americans to make informed choices about clinical trials participation. The lessons shared here, which may need to be modified to be culturally relevant to other underrepresented communities, may be beneficial to others developing similar curricula for other medically underserved populations.

Clinical Trials as Topic↗

PubMed2006

"That never would have occurred to me": a qualitative study of medical students' views of a cultural competence curriculum.

BACKGROUND: The evidence is mixed regarding the efficacy of cultural competence curricula in developing learners' knowledge, attitudes and skills. More research is needed to better understand both the strengths and shortcomings of existing curricula from the perspective of learners in order to improve training. METHODS: We conducted three focus groups with medical students in their first year of clinical training to assess their perceptions of the cultural competence curriculum at a public university school of medicine. RESULTS: Students evaluated the informal curriculum as a more important source of learning about cultural competence than the formal curriculum. In terms of bias in both self and others, the cultural competence curriculum increased awareness, but was less effective in teaching specific interventional skills. Students also noted that the cultural competence curriculum did not always sufficiently help them find a balance between group-specific knowledge and respect for individual differences. Despite some concerns as to whether political correctness characterized the cultural competence curriculum, it was also seen as a way to rehumanize the medical education experience. CONCLUSION: Future research needs to pay attention to issues such as perceived relevance, stereotyping, and political correctness in developing cross-cultural training programs.

Adult↗

PubMed2002

Assessing education in palliative medicine: development of a tool based on the Association for Palliative Medicine core curriculum.

The Association for Palliative Medicine (APM) of Great Britain and Ireland has developed a core curriculum for palliative medicine. To establish the appropriateness of this core curriculum as a standard against which training can be measured, we have examined how doctors from different medical, social and cultural backgrounds view its various elements. In 1998, we succeeded in tracing 304 of 390 doctors, past students of the University of Wales College of Medicine's Diploma in Palliative Medicine. Each was sent a postal questionnaire that asked them to rate the importance to their own clinical practice of each element of the APM core curriculum. Two-hundred sixty-three questionnaires were returned--a response rate of 87%. The ages ranged from 30 to 71 (mean 44) years; 56% (147) were female. Forty per cent (105) were general practitioners, and 37% (97) hospice and 23% (61) hospital-based. Eighty-three per cent (220) were from the UK, 5% (14) from the rest of Europe, 8% (21) from the Far East and 3% (8) from other countries. The majority of respondents agreed that all elements of the APM core curriculum were of 'very great' or 'great' importance to their current clinical practice. Respondents' medical, social or cultural setting had only very minor effects on their attitude to individual elements. The elements of the curriculum perceived as being of greatest importance were: communication with patients and their families, assessment, diagnosis and treatment of pain, multiprofessional team working and psychological responses to illness and bereavement. Clinicians from a wide variety of backgrounds confirm the relevance of the APM core curriculum. This justifies its adoption as the audit standard against which the quality of training and educational programmes in Palliative Medicine should be judged.

Adult↗

PubMed2001

A suggested outline for writing curriculum development journal articles: the IDCRD format.

BACKGROUND: During the past decade, medical school and residency faculty have been active in developing and revising curricula for medical education programs. Many of these curriculum development efforts ultimately are published in peer-reviewed professional journals as articles or abstracts. Unlike research publications, no uniform format currently exists for reporting curriculum development efforts in the peer-reviewed literature. SUMMARY: A suggested format for organizing curriculum development manuscripts consists of the introduction, development, curriculum, results, and discussion (IDCRD). Detailed descriptions of each section are discussed herein. CONCLUSIONS: The IDCRD manuscript outline is intended to provide useful guidance to medical educators in publishing their curriculum development efforts. Journal editors are encouraged to recognize the importance of providing uniform descriptions of curricula so that readers can benefit from the experience of others and replicate successful curriculum efforts.

Curriculum↗

PubMed2003

Effects of a revised preclinical curriculum on students' perceptions of their cognitive behaviors, attitudes to social issues in medicine, and the learning environment.

BACKGROUND: A modular, systems-based preclinical curriculum acceptable to faculty members who had rejected problem-based learning was introduced in 1997. PURPOSE: To evaluate to what extent the new curriculum is meeting some of its major goals. METHODS: We administered selected scales from 3 survey instruments to the last 2 classes in the old curriculum and the first 3 in the new curriculum. We also compared our results with those from other medical schools that had used the same scales. RESULTS: The new curriculum has had positive effects on students' perceptions of the learning environment (effect sizes mostly small to medium, d = .03 to .60) but less effect on their attitudes to social issues in medicine or on their preference for conceptualization versus memorization when studying (most effect sizes below small; largest d = .026). Our results are similar to those for problem-based learning curricula for the learning environment scales and to traditional curricula for the cognitive behavior scales. CONCLUSIONS: Some of the goals for the new curriculum are being achieved almost to the levels reported for problem-based curricula.

Analysis of Variance↗

PubMed2005

Teaching about family violence: a proposed model curriculum.

BACKGROUND: Medical schools around the country have initiated ad hoc teaching around family violence issues, especially child abuse and intimate partner violence (IPV). However, these activities typically are not integrated with other aspects of the curriculum, or with each other. Consequently, students do not have the opportunity to learn the broader issues related to family violence prevention and intervention. DESCRIPTION: To address these concerns, students at the Southern Illinois University (SIU) School of Medicine participated in an elective to develop a model family violence curriculum encompassing child abuse, IPV, sexual assault, and elder abuse. The activities use standardized patients and resource people, including hotline and shelter staff, legal professionals, and law enforcement. EVALUATION: This article describes the family violence teaching activities at SIU preceding Curriculum 2000 and the proposed model curriculum including principles guiding the curriculum, the curriculum sequence, and descriptions of the proposed patient cases and related activities. CONCLUSIONS: Family violence teaching in medical schools is merely a first step. Continuing medical education in violence-related issues must also be available.

Curriculum↗

PubMed1992

Modernizing the animal science curriculum: is change needed?

To identify an animal science curriculum is difficult because it is a "moving target" due to changing needs and demands of our society and, more specifically, to changes in the backgrounds and interests of students. Therefore, animal science curriculums not only should change, but must change, if they are to succeed. With new technological innovations and discoveries that either modify, supplement, or change basic concepts and approaches, it is paramount that changes in courses as well as in the curriculum conform. Because of the applied nature of animal science and because of the many unknowns yet to be discovered, the curriculum should be under continual scrutiny. However, we must not fix something when it is not broken. For all practical purposes, a curriculum reflects a philosophy of what subjects should be included to complete a plan of study. After a philosophy has been established the base curriculum will seldom change significantly. When it does, it will be the result of a change in people's philosophies rather than a reflection of industry needs or student interests. Teachers should not forget how to teach most effectively the material and must never lose sight of their goal of molding students into knowledgeable, wise, and responsible citizens in our society.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Husbandry↗

PubMed1994

A model for critical thinking within the context of curriculum as praxis.

The curriculum may be informed by a technical, practical, or emancipatory interest. Curricula informed by these three interests are referred to as curriculum as product, curriculum as practice, and curriculum as praxis (Grundy, 1989) respectively. When curricula are viewed from different perspectives, it is plausible to suggest that each perspective requires a different conceptualization of critical thinking. The literature search revealed that critical thinking has been equated with problem solving, which is congruent with a curriculum-as-product orientation. The purpose of this paper is to provide an overview of a conceptual model for critical thinking that is congruent with an orientation to the curriculum as praxis. The model is derived from the work of Freire (1972), Habermas (1972), and Grundy (1989). The key concepts of the model are knowledge, critical reflection, and action. There is a reciprocal relationship between knowledge and action, which is mediated by critical reflection.

Cognition↗

PubMed1996

Analysis of the orthopedic content in an occupational therapy curriculum from a clinical reasoning perspective.

OBJECTIVES: Recent studies have suggested that occupational therapists working with adults with physical disabilities do not use narrative reasoning in practice as much as they use procedural reasoning. This focus on procedural reasoning may be partially shaped by the occupational therapy educational process. The purpose of this analysis was to see whether one accredited occupational therapy curriculum was promoting narrative reasoning relative to its information on adult orthopedics. METHOD: An accredited occupational therapy undergraduate and certificate curriculum was analyzed from both student and faculty perspectives to see what types of clinical reasoning were most emphasized relative to treatment of adults with orthopedic injuries. The student analysis, done by a senior as part of an independent study, looked at the clinical reasoning content of journal articles, an occupational therapy textbook, and occupational therapy lectures relative to adult orthopedic injuries. The faculty analysis, part of a curriculum revision process and independent of the student analysis, looked at the clinical reasoning content of all courses in the curriculum. RESULTS: The student and faculty analyses concurred that although narrative reasoning is taught in this curriculum, narrative reasoning concepts are not well integrated into the adult physical dysfunction course that deals with adult orthopedic injuries. CONCLUSION: Occupational therapy educators may not be integrating narrative reasoning into more procedurally oriented physical dysfunction courses as fully as possible and may, therefore, be fostering procedurally oriented practice in physical dysfunction settings. Curricula evaluations, like the one described in this article, can be a mechanism for examining the types of clinical reasoning emphasized in a given curriculum for a given diagnostic group.

Adult↗

PubMed1992

Changing the curriculum for internal medicine residency training.

The academic leadership of internal medicine is considering fundamental changes in the curriculum for internal medicine residency training. The impetus to change the curriculum is derived from various socioeconomic changes during the past 10 years. These changes have resulted in a drastically shortened length of stay of patients in hospitals, an emphasis on outpatient care by reimbursement agencies, and a sharp decline in the numbers of U.S. medical graduates selecting careers in internal medicine. Curriculum change will mandate that we define the roles of general internists and subspecialists in the delivery of primary care and that we re-define how we train these two groups of internists. We must focus attention on the issue of service compared with education and must confront the issue of how best to train foreign medical graduates. Any curriculum change will also have to accommodate residents selecting careers in research in order to ensure an adequate supply of physician-scientists. Before implementing any change in curriculum, we must put into place a rigorous, prospective evaluation system. We must be able to accurately assess both positive and negative outcomes of these changes and make necessary midcourse corrections. The impetus for curriculum change in internal medicine will, it is hoped, ultimately benefit the public, the trainees, and the practice of internal medicine.

Ambulatory Care Facilities↗

PubMed2000

A case-oriented web-based curriculum in geriatrics for third-year medical students.

OBJECTIVES: This paper describes the development, implementation, and evaluation of a case-oriented, web-based curriculum in geriatric medicine for third-year medical students. DESIGN: Single cohort, pre/post trial. SETTING: University of Kansas School of Medicine, Kansas City, Kansas. PARTICIPANTS: Third-year medical students (n = 130). INTERVENTION: A web-based curriculum, offered during a clinical geriatrics clerkship, is composed of 13 case-oriented, web-based modules spanning key topics in geriatric medicine. Each module topic is also reviewed in a post-module, faculty-led discussion session. MEASUREMENTS: A pre-and post-rotation test of knowledge was completed. Student feedback about the curriculum was collected through web-based and written evaluation. MAIN RESULTS: Pre-and post-rotation comparison of examination scores demonstrated an average increase of 13 correct items on a 40-item exam. Seventy-five percent of students rated each module favorably at the time of completion (range 53-89%). Most modules (10/13) were rated as excellent or good after all modules had been completed. CONCLUSIONS: A case-oriented web-based curriculum in geriatrics was rated favorably by third-year medical students. Students' knowledge increased in key geriatric topics. Student feedback allows for continuous improvement of the curriculum. This model of curricular innovation may be useful for other institutions seeking to develop or enhance geriatric medicine content in the medical school curriculum.

Attitude of Health Personnel↗

PubMedDate not supplied

Evaluation of a predoctoral implant curriculum: does such a program influence graduates' practice patterns?

PURPOSE: Didactic predoctoral dental implant education is part of the curriculum in most US dental schools. However, fewer than half offer laboratory instruction, and only a few allow dental students to place and restore dental implants. The additional time necessary for laboratory and clinical experience encroaches on an already crowded curriculum. Is the additional time necessary in the curriculum for laboratory and clinical experience by dental students reflected by the practice patterns of graduates who have completed such a program over the past 10 years? MATERIALS AND METHODS: A survey was designed to determine the implant practice patterns of graduates of the Creighton School of Dentistry, Omaha, Nebraska, for the 10-year period 1988 to 1997. These graduates had all participated in a formal undergraduate didactic and laboratory curriculum in implant dentistry. Approximately half also had the opportunity to place and/or restore dental implants while students. The survey was also sent to graduates (also 1988 to 1997) from a midwestern dental school without a formal laboratory or clinical component (used as a control group). The data were analyzed statistically. RESULTS: In comparison to the control group (56% versus 23%), more than twice as many Creighton graduates restore dental implants as a part of their general practice, surgically place more dental implants, refer more implant patients to surgical specialists, and seek more continuing education hours related to implant dentistry. These conclusions were all supported by statistical analysis of the data. DISCUSSION: Student clinical experience with implant dentistry appears to significantly increase the incorporation of implant dentistry into future dental practices. Even if clinical experience was not an option, a school curriculum which included both didactic and laboratory participation still significantly increased the number of graduates who included implant dentistry in their practices. CONCLUSION: The inclusion of laboratory and clinical experience in implant dentistry in the CUSD undergraduate curriculum resulted in significantly greater participation in implant dentistry at the general practice level.

Adult↗

PubMed2003

Developing an "evidence-based medicine and use of the biomedical literature" component as a longitudinal theme of an outcomes-based medical school curriculum: year 1.

This paper describes the new outcomes-based curriculum at the University of Miami School of Medicine, a model curriculum for the first decade of the twenty-first century. The new curriculum has a strong emphasis on evidence-based medicine (EBM), implemented throughout its four years as a component of one of its longitudinal themes. The "EBM and Use of the Biomedical Literature" component, which begins at orientation, was developed and is implemented by the Louis Calder Memorial Library, the center of EBM focus and activity for the curriculum and other initiatives at the University of Miami/Jackson Memorial Medical Center. The authors are unaware of any published reports of library-centric EBM initiatives as part of a longitudinal theme of a four-year outcomes-based curriculum. Other innovations of the EBM component in the new curriculum to date include use of Blackboard and CATmaker software programs for self-paced, interactive educational opportunities.

Curriculum↗

PubMed2003

Military unique curriculum: identifying and prioritizing content.

We have identified and prioritized a series of objectives that warrant inclusion in the continuum of military medical education. Although participants in the 16th Conference on Military Medicine also discussed whether each objective should be taught at the medical student, resident, or staff physician level, to a large extent this distinction is not helpful, since many, if not most, of these topic areas would likely require incorporation at each of these three levels to achieve the desired level of competence in staff physicians. Incorporation of new curricular elements poses a significant challenge, since it is already difficult to fit the existing curriculum into the available time. It is not reasonable to consider increasing the number of lecture hours. Therefore, it is probable that some elements of the existing curriculum will need to be pared down or eliminated to incorporate new material. In the past, when new material has been added to the existing curriculum, such as when the pathogenesis of human immunodeficiency virus was added, it has generally been done at the individual teacher or at most departmental level. Although this approach has the advantage of having a subject matter expert decide how best to insert new material within the fabric of the existing curriculum, there are a couple of problems with widespread use of this approach. First, some of these new objectives may not fit clearly within an existing course curriculum or department's educational mission. Second, such an approach may not provide the degree of coordination that is necessary to ensure that a new curricular item is adequately covered in all respects, and it may result in unnecessary overlap in instruction when different professors incorporate similar elements. Therefore, the prioritization of newer curricular items, as has been done during this conference, may serve as a useful guide in this process. However, a corresponding effort is needed to identify and prioritize existing curricular components. Decisions need to be made regarding what, within the existing curriculum, should be cut out or reduced to make room for some or all of these new objectives. Finally, a decision needs to be made regarding which of these identified objectives should be inserted and when and within which courses they should be taught. These are important decisions that should not be left to the whims of chance. As the responsible recipients of Uniformed Services University and Health Professions Scholarship Program medical school graduates, the services' Surgeons General need to take an active role in helping to make these decisions. The outcome of these decisions will have a direct impact on the capabilities that these future junior medical officers will bring to the patients they will care for and to the line commanders that they will support.

Curriculum↗

PubMedDate not supplied

Teachers' perspective on barriers to implementing physical activity curriculum guidelines for school children in Toronto.

BACKGROUND: Teachers in Ontario are expected to implement the physical activity guidelines in the health and physical education (HPE) curriculum document that was introduced in 1998. This study examined Toronto teachers' perspective on barriers to implementing these guidelines. METHODS: Forty-five teachers from five Toronto elementary schools in which generalist classroom teachers provide physical education classes participated in focus groups. An experienced moderator facilitated each session. Themes were inductively generated from the data. RESULTS: Participants reported that children were not engaged in moderate or vigorous physical activity daily and for the expected duration. Participants identified three categories of barriers to implementing the curriculum guidelines: lower priority for HPE, lack of performance measures for physical activity, and lack of sufficient infrastructure. First, they reported that the new curriculum expectations for other subjects were demanding, which left little time to focus on physical education. They felt that resource support for the HPE curriculum was not sufficient and that physical education specialists were necessary but unavailable to implement the curriculum. Second, participants felt accountable to both government and parents for high student performance on standardized tests in subjects deemed to be of higher priority. Third, participants reported inadequate facilities and equipment, use of portables for classrooms, cancelling physical education to have events in the gymnasium, and unavailability of teachers to supervise off-school physical activity. CONCLUSION: The study suggests that participating teachers perceive physical education to be a low priority in the educational system, making it difficult for them to meet the HPE curriculum expectations.

Curriculum↗