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PubMed2003

Students' attitudes and potential behaviour with regard to whistle blowing as they pass through a modern medical curriculum.

OBJECTIVE: To examine students' attitudes and potential behaviour with regard to whistle blowing as they progress through a modern undergraduate medical curriculum. DESIGN: Cohort design. SETTING: University of Glasgow Medical School. SUBJECTS: A cohort of students entering Glasgow University's new learner-centred, integrated medical curriculum in October 1996. METHODS: Students' pre- and post-Year 1, post-Year 3 and post-Year 5 responses to the whistle blowing vignette of the Ethics in Health Care Instrument (EHCI) were examined quantitatively and qualitatively. Analysis of students' multichoice answers enabled measurement of movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes in students' reasoning behind their decisions of whether or not to whistle blow were also identified. RESULTS: There was little improvement in students' performance as they progressed through the curriculum in terms of their proposed behaviour on meeting the whistle blowing scenario. There was also no improvement in the quality of justifications provided. Students' reasoning on whether or not to whistle blow was found to change as the curriculum progressed. CONCLUSIONS: The EHCI has the potential to elicit students' attitudes towards ethical issues at entry to medical school and to measure change as they progress through the curriculum. Students should be encouraged to contemplate dilemmas from all ethical standpoints and consider relevant legal implications. Whistle blowing should be addressed as part of the wider domain of professionalism.

Adult↗

PubMed2003

The autopsy in modern undergraduate medical education: a qualitative study of uses and curriculum considerations.

AIM: Medical education has undergone dramatic changes over the past decade. In the UK, the General Medical Council (GMC), the driving force behind curriculum reform, now requires curricula to be founded on a base of educational theory and research. This qualitative study investigated the roles of the autopsy within the context of the modern medical curriculum. METHODS: Using a phenomenological methodology, a non-representative 'theoretical sample' was selected to include medical educators with a wide range of teaching experience and responsibilities and disparate views both for and against the autopsy. Semistructured, tape-recorded interviews were undertaken to investigate the roles of the autopsy within the medical curriculum. Anonymised interview transcripts were subjected to a themed content analysis. RESULTS: Theoretical saturation was reached after 9 interviews. No new themes were added by a further 5 interviews. All the interviews were polythematic. In all, 43 themes were identified. In addition to confirming overt uses of the autopsy reported in previous studies, educators identified issues of curriculum design and development, the impact on the hidden curriculum, and a range of disadvantages and alternatives to the autopsy. CONCLUSIONS: Educators continue to perceive the autopsy as having a multifactorial role in providing the doctors of tomorrow with the appropriate knowledge and attitudes needed for the practice of medicine in the 21st century.

Autopsy↗

PubMed1997

Impact of an evidence-based medicine curriculum based on adult learning theory.

OBJECTIVE: To develop and implement an evidence-based medicine (EBM) curriculum and determine its effectiveness in improving residents' EBM behaviors and skills. DESIGN: Description of the curriculum and a multifaceted evaluation, including a pretest-posttest controlled trial. SETTING: University-based primary care internal medicine residency program. PARTICIPANTS: Second- and third-year internal medicine residents (N = 34). INTERVENTIONS: A 7-week EBM curriculum in which residents work through the steps of evidence-based decisions for their own patients. Based on adult learning theory, the educational strategy included a resident-directed tutorial format, use of real clinical encounters, and specific EBM facilitating techniques for faculty. MEASUREMENTS AND MAIN RESULTS: Behaviors and self-assessed competencies in EBM were measured with questionnaires. Evidence-based medicine skills were assessed with a 17-point test, which required free text responses to questions based on a clinical vignette and a test article. After the intervention, residents participating in the curriculum (case subjects) increased their use of original studies to answer clinical questions, their examination of methods and results sections of articles, and their self-assessed EBM competence in three of five domains of EBM, while the control subjects did not. The case subjects significantly improved their scores on the EBM skills test (8.5 to 11.0, p = .001), while the control subjects did not (8.5 to 7.1, p = .09). The difference in the posttest scores of the two groups was 3.9 points (p = .001, 95% confidence interval 1.9, 5.9). CONCLUSIONS: An EBM curriculum based on adult learning theory improves residents' EBM skills and certain EBM behaviors. The description and multifaceted evaluation can guide medical educators involved in EBM training.

Adult↗

PubMed2003

[Teaching of psychosomatic medicine and psychotherapy as an element of the Dresden DIPOL-Curriculum -- the PBL-course "Nervous system" and psyche].

A federal law, the "Approbationsordnung für Arzte", regulates Medical education in Germany. In 2002 a revised version of this law demanded of the medical faculties to implement interdisciplinary and problem-based (PBL) courses in their curriculum. Already in 1998 the faculty of medicine of the TU Dresden decided to reform the traditional curriculum. The reform-curriculum is being created in close co-operation with the Harvard Medical School. It is a hybrid curriculum retaining traditional elements as lectures and bedside teaching with PBL-tutorials and a special doctor-patient-communication-training, which is based on role-play exercises. Psychosomatic Medicine is taught together with neurology and psychiatry as a major topic of the 7,5-week PBL-course "Nervous System and Psyche" but there are also lectures and special skills training exercises in other PBL-courses like "Oncology" or "Emergency medicine". Data of the external evaluation showed, that the students accepted psychosomatic topics of the curriculum very well. This paper describes concept, implementation and evaluation data of the PBL-course "Nervous System and Psyche".

Clinical Competence↗

PubMedDate not supplied

A new curriculum for a new millennium.

In the last few years of the 20th century, many factors converged at Auburn University School of Nursing, giving faculty the opportunity to explore beliefs about curriculum and the nursing profession's role in the 21st century. The result of this opportunity was the creation of a new curriculum that brings to life the conviction that nursing is not bound by the 4 walls of a hospital, but is a humanistic discipline that can be practiced anywhere. This article explains the intersection of variables that influenced the development of a new curriculum, including the call by nursing leaders for educators to drastically change their approach to the education of students. We describe the process of developing a community-based curriculum, with innovative examples of clinical and theory experiences on a semester-by-semester basis. Strategies to address obstacles to implementation of a community-based curriculum are included.

Alabama↗

PubMed2001

Basic science curriculum in vascular surgery residency.

Recognizing the importance of basic science teaching in surgical education, the leadership of the Association of Program Directors in Vascular Surgery (APDVS) appointed a panel to gather information and to present its findings at the 1999 annual fall meeting of the Apdvs. A questionnaire was distributed to the program directors present. In addition, information was gathered from the American Board of Surgery regarding the basic science content in the vascular surgery item pool on the vascular surgery qualifying examination (VQE). The vascular surgery unit of the surgical resident curriculum was also analyzed. Fifty-three program directors (64%) completed the questionnaire. Although only two program directors felt that their residents were better prepared to answer basic science questions, the results of the Vqe showed that the examinees do not, as a group, perform differently on basic science items than on clinical management questions. In addition, only a minority of program directors (15%) use a specific method to monitor the learning process of their residents. The majority of the program directors responding (75%) felt that they were capable of teaching basic science to residents. Interestingly, almost half the 53 respondents (47%) said that a basic science curriculum should be comprehensive, not exclusively relevant to the clinical setting. Vqe content outline and the vascular surgery unit of the surgical resident curriculum revealed great emphasis on clinically relevant basic science information. The Apdvs panel recommends that a basic science curriculum should be comprehensive, yet clinically pertinent, and completely integrated with the clinical curriculum. In terms of how to teach basic science in vascular residencies, the panel supports teaching conferences that are problem-based with a faculty member acting as the "resource person" and with specific goals set for the conferences. The panel also suggested establishing a Web site that provides a series of questions, the answers of which could be readily available to trainees and program directors. such immediate feedback could be of great help to program directors to focus the learning process of their residents and monitor its progress.

Curriculum↗

PubMed2002

Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linköping, Sweden.

Problem-based learning (PBL), combined with early patient contact, multiprofessional education and emphasis on development of communications skills, has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping (FHS), Sweden, which was started in 1986. Important elements in the curriculum are vertical integration, i.e. integration between the clinical and basic science parts of the curriculum and horizontal integration between different subject areas. This article discusses the importance of vertical integration in an undergraduate medical curriculum, according to experiences from the Faculty of Health Sciences in Linköping, and also give examples on how it has been implemented during the latest 15 years. Results and views put forward in published articles concerning vertical integration within undergraduate medical education are discussed in relation to the experiences in Linköping. Vertical integration between basic sciences and clinical medicine in a PBL setting has been found to stimulate profound rather than superficial learning, and thereby stimulates better understanding of important biomedical principles. Integration probably leads to better retention of knowledge and the ability to apply basic science principles in the appropriate clinical context. Integration throughout the whole curriculum entails a lot of time and work in respect of planning, organization and execution. The teachers have to be deeply involved and enthusiastic and have to cooperate over departmental borders, which may produce positive spin-off effects in teaching and research but also conflicts that have to be resolved. The authors believe vertical integration supports PBL and stimulates deep and lifelong learning.

Biological Science Disciplines↗

PubMed2003

Planning and implementing an undergraduate medical curriculum: the lessons learned.

In 1995 Dundee medical school introduced an integrated, systems-based spiral curriculum with a number of innovative features. The medical school has now had eight years' experience of the curriculum. This paper describes the changes that have taken place in the curriculum over the eight years. Evidence from internal and external reviews and student examination data are used to identify the lessons learned from implementing the curriculum. The Dundee experience, the approaches to the curriculum described and the conclusions reached are relevant to all with an interest in medical education.

Adaptation, Psychological↗

PubMed2004

How we derived a core curriculum: from institutional to national--Ankara University experience.

As the first phase of a major curricular change in a large medical school the core curriculum had to be determined. The criteria for the inclusion of topics in the core curriculum were defined for both clinical and basic sciences. A large group of faculty members have worked in 11 sub-groups to determine the core knowledge, skills and attitudes for undergraduate medical students. During this work 608 clinical topics have been reviewed. Four-hundred and eighty five of them (79%) have been included in the core curriculum. Clinical and basic science knowledge, skills and attitudes relevant to these topics have been defined and classified. A total of 1610 cognitive, 428 psychomotor skills and 247 attitudes have been named. Thus the core curriculum defined is not just a set of diseases, conditions and symptoms but also includes the details of each and every topic. Starting from this point the medical school has participated actively in defining the national core curriculum, which has also been determined according to the same criteria.

Curriculum↗

PubMed2004

Effect of curriculum reform on graduating student performance.

With the aim of evaluating the efficacy of a new curriculum implemented in the Faculty of Medicine of Ribeirão Preto (University of São Paulo, Brazil), a yearly objective assessment of both cognitive and practical skills of undergraduate (sixth year) students was performed. All graduating student underwent a multiple-choice questions (MCQs) test and groups of 18-20 students were randomly assigned to OSCEs for either clinical (real and standardized patients) or procedure (manikins) skills. The average MCQs score for the students graduating in the new curriculum (63.1, SD = 8.9, n = 261) was significantly higher (p < 0.001) than for the previous curriculum (55.3, SD = 8.1, n = 222). Results for practical exams showed that the new curriculum was associated with significantly improved performance in five out of the six stations for procedure skills, but in only two of the 10 clinical skills stations. Final evaluation of graduating students revealed deficiencies in the local curriculum and may serve as a guide to take measures to correct them.

Analysis of Variance↗

PubMed2004

Using information contained in the curriculum management information tool (CurrMIT) to capture opportunities for student learning and development.

The purpose of this paper is to examine how West Virginia University Medical School used the AAMC Curriculum Management Information Tool (CurrMIT) to map the undergraduate medical school curriculum. Information gleaned from this analysis identified what students are expected to learn, how they learn and how they are assessed. Information about the curriculum was entered into CurrMIT, creating a comprehensive picture of the curricular landscape. Learning outcomes were parceled out according to a competence-based framework. In addition, learning methods and assessment measures were identified. A total of 639 learning outcomes were identified across several competences. A total of 13 learning methods and 13 assessment measures were also identified in the undergraduate curriculum. The results suggest that students are expected to acquire varied knowledge, skills and attitudes. Further, students are presented with diverse learning methods and assessment measures. The curriculum map ascertains whether the program's components, such as learning outcomes, learning approaches and assessment methods, are designed and linked to further students' learning. This analysis will lead to curricular improvements. The implications of this work can help faculty, students and other academic stakeholders shift tacit expectations of learning and development to a curricular reality and, in turn, help prepare future physicians for the changing field of medicine.

Curriculum↗

PubMed2005

Does change from a traditional to a new medical curriculum reduce negative attitudes among students? A quasi-experimental study.

The authors investigated whether a new type of medical school curriculum-with problem-based learning, integrated preclinical and clinical phases, and increased levels of contact between students, patients and teachers--is associated with lower levels of students' negative attitudes towards medical training than is a traditional medical school curriculum. This association was found, and was confirmed by a comparison between students in a university that had changed from a traditional curriculum to a new curriculum. Curriculum design may explain differences in students' attitudes towards medical school.

Adult↗

PubMed2006

Not just another multi-professional course! Part 1. Rationale for a transformative curriculum.

Undergraduate inter- and multi-professional education has traditionally aimed to develop health professionals who are able to collaborate effectively in comprehensive healthcare delivery. The respective professions learn from and about each other through comparisons of roles, responsibilities, powers, duties and perspectives in order to promote integrated service. Described here is the educational rationale of a multi-professional course with a difference; one that injects value to undergraduate health professional education through the development of critical cross-field knowledge, skills and attitudes that unite rather than differentiate professions. The aim of this course, offered at the Faculty of Health Sciences, University of Cape Town, is to lay an integrated, pan-professional foundation for the advancement of collective commitment to and understanding of national health and social development objectives such as primary health care, human rights and professionalism. Pan-professional refers to curriculum content that is core and of critical relevance to all participating professions. What is learned, how it is learned, how learning is facilitated and how it is applied, has been co-constructed by a multi-professional design team representing a range of health professions (audiology, medicine, occupational therapy, nursing, physiotherapy and speech therapy) and academic disciplines (anthropology, sociology, psychology, history, African studies and social development, information technology and language literacy). Education specialists facilitate the ongoing design process ensuring that the structure and content of the curriculum complies with contemporary adult learning principles and national higher education imperatives. Designing the original curriculum required the deconstruction of intra-professional and disciplinary canons of knowledge and ways of 'doing things' in order to identify and develop shared interpretations of critical epistemology and axiology for health professional practice in the South African context. This enabled the alignment of the learning objectives, at first year level, of all the represented professions. The educational rationale guiding the curriculum design process is discussed in Part 1 of two articles. Part 2 describes the 'nuts and bolts' or practicalities of the curriculum design process.

Curriculum↗

PubMedDate not supplied

Development of a school-based drug abuse prevention curriculum for high-risk youths.

This paper presents the rationale for and description of the empirical curriculum development process in Project Towards No Drug Abuse (Project TND), which is a five-year grant funded by the National Institute on Drug Abuse. First, the target population is described, continuation high-school youths who are at high risk for drug abuse. The rationale for developing a classroom-based curriculum tailored for them is also provided. Second, a brief description is provided of state-of-the-art generic social influences drug abuse prevention programming, which has been found to be the most effective among young adolescents. There is a the need to consider other prevention activities, particularly those that include motivational variables, to maximize prevention efforts among higher-risk youths. Third, five types of curriculum development studies are discussed that led to a curriculum that is being implemented with continuation high-school students at schools in five counties in southern California. Finally, the contents of the final curriculum product is provided, which consists of motivation, skills-training, and decision-making components.

Adolescent↗

PubMed2002

Palliative care curriculum development: a model for a content and process-based approach.

To ensure its success, a new curriculum has to meet the needs of learners, patients, and the institution. A review of the literature indicates that despite a tremendous need for palliative care services and a lack of appropriate knowledge and attitudes among physicians, few palliative care curricula for medical residents have been developed. Most are developed by national organizations, and as a result can not meet the individual needs of different institutions. This paper outlines the process of developing a palliative care curriculum in the context of available institutional resources that meets the learners' needs. The development of a curriculum can be divided into four phases: needs assessment, curricular design, implementation, and evaluation. Content (curricular content, instructional strategies and available resources for the curriculum and the developmental process) and process (methods through which the curriculum is developed and institutional issues are addressed) issues that are pertinent to the successful completion of each phase are discussed. Two hypothetical institutions are used to illustrate relevant issues. Methods that have been successfully used to develop residency curricula are discussed.

Curriculum↗

PubMed2006

The evolution of Nutrition in Medicine, a computer-assisted nutrition curriculum.

The primary mission of the Nutrition in Medicine (NIM) project is to provide tools to facilitate the nutrition training of undergraduate medical students. NIM has developed and distributed a CD-ROM-based nutrition curriculum to medical schools since 1995. However, the medical school environment is changing rapidly; there is pressure to do more in less time, and many schools are emphasizing independent and integrated learning. The need for a nutrition curriculum that is more flexible and more accessible has driven the evolution of the NIM curriculum from CD-ROM-based delivery into a more modular curriculum with Web delivery. Such changes facilitate access and eliminate the need for installation of CD-ROMs and the associated technical support issues. In addition, the instructional units are smaller and more modular. Eventually, the authoring system will allow instructors to put together a course to meet their specific instructional needs. Our future plans also include custom-tailoring that will allow students to opt out of learning material on the basis of pretest scores if they are already proficient in the content. In this update, we provide a detailed description of the new system and the rationale for the modifications we made. Furthermore, we describe how each change addresses barriers to nutrition education as identified from our surveys and others and from direct user feedback. These innovative strategies should allow a better fit of NIM within diverse medical school environments and help to promote incorporation of the curriculum into more medical schools.

Computer-Assisted Instruction↗

PubMed1991

Do we teach what we preach? Comparing the content of a problem-based medical curriculum with primary health care data.

The content of a problem-based medical curriculum has been analysed with reference to educational and medical characteristics. The data have been compared with primary health care data obtained from the Registration Network Family Practices, a computerized health information system in the southern part of the Netherlands. The analysis reveals differences between curriculum and health care data on several aspects such as reasons for encounter/complaints, problems/diagnoses, chronic diseases, health problems of children and referrals to specialists. Although the analysed material reflects only part of the curriculum, it can be concluded that the primary care orientation of the curriculum is meagre and that a critical review of the patient cases used in the problem-based curriculum is needed.

Curriculum↗

PubMed1977

A problem-solving curriculum design in physical therapy.

A systematic process used in planning a basic professional physical therapy curriculum design focused on problem solving is delineated and illustrated in this article. Disadvantages and advantages of the present subject-centered curriculum design are enumerated, as well as results of independent evaluations of the proposed alternative curriculum design. A method for validation of a curriculum design without implementation is discussed. The article is presented to stimulate thought and discussion by physical therapy educators about the processes used to plan curricula and about the content of an alternative curriculum design in physical therapy.

Curriculum↗