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PubMed2004

An integrated undergraduate pain curriculum, based on IASP curricula, for six health science faculties.

Pain education, especially for undergraduates, has been identified as important to changing problematic pain practices, yet, no published data were found describing an integrated, interprofessional pain curriculum for undergraduate students. Therefore, this project aimed to develop, implement, and evaluate an integrated pain curriculum, based on the International Association for the Study of Pain curricula [http://www.iasp-pain.org/curropen.html], for 540 students from six Health Science Faculties/Departments. Over an 18-month period, the University of Toronto Centre for the Study of Pain's Interfaculty Pain Education Committee developed a 20-h undergraduate pain curriculum to be delivered during a 1-week period. Students from Dentistry, Medicine, Nursing, Pharmacy, Physical Therapy, and Occupational Therapy participated as part of their 2nd or 3rd year program. Teaching strategies included large and small groups, Standardized Patients, and 63 facilitators. Evaluation methods included: (a) pre- and post-tests of the Pain Knowledge and Beliefs Questionnaire (PKBQ) and (b) Daily Content and Process Questionnaire (DCPQ) to obtain feedback about process, content, and format across the curriculum's 5 days. A significant improvement in pain knowledge and beliefs was demonstrated (t = 181.28, P < 0.001), although non-responders were problematic at the post-test. DCPQ overall ratings of 'exceeding or meeting expectations' ranged from 74 to 92%. Ratings were highest for the patient-related content and panel, and the small-group discussions with Standardized Patients. Overall evaluations were positive, and statistically significant changes were demonstrated in students' pain knowledge and beliefs. This unique and valuable learning opportunity will be repeated with some modifications next year.

Curriculum↗

PubMed1997

The Women's Health Curriculum by a problem-based learning method for medical students at the University of California, San Francisco.

OBJECTIVES: Our objectives were to (1) expand and strengthen the women's health curriculum at the University of California, San Francisco, and (2) evaluate the responses of both medical students and faculty to this curriculum. STUDY DESIGN: A written evaluation of the curriculum in women's health was completed by both students and faculty. Variables studied included mean scores of cases, the overall course score, and the preferences of medical students for faculty specialty in teaching the small groups. RESULTS: The overall course evaluation score was 7.81 (range 1 to 10). For those students who had both faculty from internal medicine or family medicine and obstetrics and gynecology, there was a strong preference that obstetrician-gynecologists teach the majority of the cases. CONCLUSIONS: The new case-based curriculum in women's health was enthusiastically received by both medical students and faculty.

Adolescent↗

PubMed2002

Housestaff performance is improved by participation in a laparoscopic skills curriculum.

BACKGROUND: After the implementation of a laparoscopic skills curriculum, we studied two questions: (1) can skills curriculum participation improve performance and (2) can we identify housestaff who may benefit from early instruction in laparoscopic technical skills? METHODS: We administered a six-task laparoscopic skills curriculum to postgraduate year (PGY) 2 and PGY3 surgical housestaff. Six laparoscopic tasks were divided into two groups: generalized skills and task specific skills. All participants were evaluated during a pretest and were placed in the novice group (total score less than 600) or in the intermediate skill (IS) group (total score 600 or more). Each participant had two 1-hour practice/instruction sessions and 2 weeks for independent practice. After these sessions, a posttest was administered. RESULTS: Novices and intermediate skill participants demonstrated significant improvement in general skills and task specific skills. However, comparison of novice and IS group learners revealed that IS group learners were significantly more proficient in the performance of general skills, but the performance of task specific skills failed to demonstrate a difference between the two groups. On posttest, there was no significant difference in overall score between novices and IS participants. CONCLUSIONS: Overall ability and performance of generalized skills by all housestaff are improved with a laparoscopic skills curriculum; however, the performance of novices improved the greatest. Task specific skills did not discriminate novices from more advanced learners. Early testing of housestaff may identify those individuals who could benefit from intervention and instruction prior to performing the laparoscopic skills in the operating room.

Clinical Competence↗

PubMed1987

The pediatric general surgery undergraduate medical curriculum: what should medical students learn?

Pediatric general surgery should be included in the undergraduate medical curriculum for reasons of improving the total surgical care of infants and children, to enable teachers to serve as role models to students considering a career in pediatric surgery and to ensure survival of pediatric surgery in the medical school curriculum. A survey of recent medical literature and surgical textbooks revealed little or no discussion concerning the aims, objectives, content, and design of the pediatric surgical curriculum. A survey of 15 Canadian medical schools showed that students are assigned very little didactic time for pediatric surgery (average total seven hours) and only 25% of graduates proceed to a clerkship in pediatric surgery, usually as an elective. The Association hereby proposes an undergraduate medical education curriculum in pediatric surgery for Canadian medical schools in order to stimulate discussion and achieve uniform input of pediatric surgery in the undergraduate medical program.

Canada↗

PubMed2003

Addressing the need for education: curriculum development for nurses about intellectual and developmental disabilities.

People with disabilities and national and international agencies are voicing their views, forcing health care providers to look at how people with disabilities are treated in the health care system and to find ways to help them achieve equal access to quality care. Education about nursing care of patients with I/DD is limited in basic nursing education programs and for nurses who are in practice. A number of developmental disabilities nursing projects are addressing this need with curriculum development that has validated the need for education and has begun testing the various methods of instruction. As the curriculum is disseminated in written or Internet-accessible formats, nurses in education and practice will be able to find resources that target a specific topic area or a set of comprehensive instructions to acquire a better understanding of the comprehensive needs of people with I/DD and better ways to provide care. There is a need for a greater integration of curriculum about nursing care of people with developmental disabilities into basic nursing education at all levels and further evaluation of the impact of this curriculum on nursing care for people with I/DD. The hope is that these efforts can improve the education of nurses and other health care providers for the direct benefit of individuals with intellectual disabilities.

Adolescent↗

PubMed1997

The European core curriculum for radiotherapy technologists.

BACKGROUND: The Radiotherapy Technologist is the third member of the team responsible for the accurate delivery of radiotherapy to the cancer patient. Educational standards have been established for both radiotherapists and medical physicists and our group recognised the need to also standardise the education of radiotherapy technologists. MATERIALS AND METHODS: The project commenced in 1990 and was completed by 1994 when an agreed core curriculum was presented at a consensus conference. All aspects of curriculum development and education delivery were reviewed during this four year period. RESULTS: Core topics were identified. educational entry standards described and a duration of three years, consistent with European Union mobility regulations, agreed. CONCLUSIONS: The core curriculum describes the standard necessary to be achieved for entry into the profession to ensure the optimum treatment is offered to all patients throughout the European Union. Regular review of the core curriculum should be carried out to ensure the defined standards are maintained.

Curriculum↗

PubMed1999

The biosciences in the pre-registration nursing curriculum: staff and students' perceptions of difficulties and relevance.

This paper considers the problematic position of the biological sciences in pre-registration nurse education--'The Bioscience Question'. There is no consensus and little research on the appropriate content and depth of bioscience knowledge required by nurses. Attempts to apportion curriculum time for the biosciences are confounded by the difficulty experienced by nursing students with this area. Within one university department, a survey was undertaken to investigate the perceptions of pre-registration students, and their teachers, of the teaching and learning of biological science, in comparison with other areas of the curriculum. Our findings concur with others that the biosciences are a source of disproportionate difficulty and anxiety to nursing students. Among the students, but not the lecturers, there was some, by no means universal, support for the suggestion that these problems could be reduced by a reallocation of curriculum time in favour of the biosciences. Although it was agreed that bioscience theory should be related more closely to nursing practice, there was no evidence that this lessened the students' difficulties with the subject. In contrast to lecturers, students felt the biosciences to be one of the areas of the pre-registration curriculum most relevant to clinical practice.

Adaptation, Psychological↗

PubMed2000

A needs assessment for a palliative care curriculum.

To ensure the success of a new curriculum at an institution, information about the educational needs of learners, available resources, and potential obstacles needs to be systematically collected and analyzed prior to the development and implementation of the actual curriculum. This process, known as needs assessment, is important in the development of palliative care training for internal medicine residents, because internal medicine has only recently begun to address these issues in a formalized way and palliative care is a relatively new topic in medical education and clinical medicine. Therefore, institutional issues and resistance, lack of knowledge and appropriate attitudes among trainees and faculty, and a paucity of educational models for individual internal medicine training programs present potential obstacles. Although curricula that have been developed by national organizations can serve as "guideposts, " these documents are unable to address the specific needs and culture of an individual institution. This paper outlines a systematic methodology of needs assessment for palliative care curricula at individual institutions that could be applied to the development and implementation of palliative care training for different groups of learners. An institution-specific needs assessment was developed based upon the findings of a systematic literature review and interviews with experts in palliative medicine and medical education. The following methods were utilized: 1) an anonymous survey; 2) focus groups; 3) topic rankings; and 4) individual interviews. The needs assessment revealed the following educational, clinical, and institutional information: 1) interns had very little exposure to palliative care in medical school; 2) there was no formalized system formal education and clinical exposure; 3) tremendous interest in palliative care education existed; 4) patients, families, physicians, and nurses perceived a need to improve the quality of palliative care; and 5) there are several political, logistical, and resource (time and financial) obstacles that needed to be addressed. An institution-specific needs assessment is an important part of the successful development and implementation of any new curriculum for medical residents and was specifically necessary for our palliative care program. As a result of the needs assessment process, a curriculum consisting of ten units of case-based and problem-based teaching was successfully implemented.

Curriculum↗

PubMed2001

Evaluation of a peaceful conflict resolution and violence prevention curriculum for sixth-grade students.

PURPOSE: To evaluate a Social Cognitive Theory-based violence prevention curriculum among sixth-grade students. METHODS: The evaluation was conducted using a quasi-experimental pretest-posttest control group design. Students were pretested 2 weeks before the intervention started and were posttested 2 weeks after it ended. The study was conducted in four middle schools serving children and adolescents living in or around public housing in a southeastern city. The participants included all sixth-grade students who were predominantly African-American (88.7%), 41% lived in public housing, and 80% lived in homes with an employed head of household. The intervention schools had 292 students, and the control schools 412 students. The Peaceful Conflict Resolution and Violence Prevention Curriculum is a 13-module skills-building curriculum based on Social Cognitive Theory. It taught identification of situations that could result in violence; avoidance, confrontation, problem-solving, and communication skills; conflict resolution skills; the conflict cycle; the dynamics of a fight; and how to express anger without fighting. MAIN MEASURES: The primary outcome variable was a five-item scale assessing the frequency of fighting and weapon carrying behaviors (alpha =.72) and a scale measuring intentions to use violence in 11 hypothetical situations (alpha = .81). Levels of exposure to violence and victimization (alpha = .82) and depression (alpha = .86) were also assessed. The data were analyzed with general linear modeling with repeated measures. RESULTS: At pretest, the intervention and control groups did not differ in gender, age, depression, exposure to violence, or any other demographic variable. A group x time interaction effect (p = .029) was found in the use of violence scale. From pretest to posttest there was a decrease in the use of violence by students in the intervention group and an increase in the use of violence in the control group. Most of the changes were accounted for by changes in the frequencies of carrying concealed guns and fighting resulting in injuries requiring medical treatment. A group x time interaction effect (p = .002) was also found for the intention to use violence scale. Students in the intervention group did not change their mean scores from pretest to posttest, whereas students in the control group increased in their mean intention to use violence scale scores. Neither interaction effect was influenced by gender, exposure to violence, or level of depression. CONCLUSION: The Peaceful Conflict Resolution and Violence Prevention curriculum appears to have positive short-term effects on self-reported use of violence and intentions to use violence by these middle-school students.

Adolescent↗

PubMed2002

[Curriculum and structure of modern medical education].

The Medical Faculty of the University of Zurich compiles a fundamental restructuring of the Medical curriculum. Basic conditions represent the new Swiss Federal law for the education in medical professions (MedBG), heterogeneous implementation stages of curriculum reforms of other Swiss Medical Faculties of the medicine as well as efforts to improve mobility of students. The strategy of the curriculum reform is represented based on the principles decided by the Faculty. The authors demonstrate the corresponding organizational structures and give a future view focusing on aspects of the implementation and the dynamic adaptation of curriculum items.

Curriculum↗

PubMed1999

Extending community involvement in the medical curriculum: lessons from a case study.

OBJECTIVES: Recent reports have stressed the importance of developing medical students' understanding of primary and community care and their ability to work in health-care teams. DESIGN: An innovative 3-year project aimed to achieve this understanding by broadening the range of health-care professionals and community organizations contributing to the medical curriculum. SETTING: King's College School of Medicine, London. SUBJECTS: Undergraduate medical students. RESULTS: Through partnerships with three local community health care trusts, non-medical health care disciplines in the teaching hospital and a range of voluntary and statutory services, students have been introduced to a broader spectrum of care. This has taken place both within the core curriculum and through the development of special study modules. CONCLUSIONS: Involving teachers and organizations which have not traditionally contributed to medical education raises philosophical issues around the aims and rationale of their involvement and practical issues such as gaining curriculum time, recruiting suitable teachers and gaining credibility for the courses. We analyse the benefits and difficulties inherent in broadening the curriculum in this way and assess the lessons our experience provides for the future expansion of such learning, both locally and nationally.

Community Health Services↗

PubMed1999

Single-handed practices--their contribution to an undergraduate teaching network in the first year of the new curriculum.

OBJECTIVES: The new curriculum at King's College School of Medicine and Dentistry, which commenced in September 1996, requires all medical undergraduates to have a general practice placement throughout the 5 years of their medical education. DESIGN: This paper discusses recruitment, training and support of teaching practices for the new curriculum, reviews the distribution of single-handed general practices in the network and, via a selection of monitoring and evaluation procedures, discusses the implications of a policy which is inclusive of single-handed practices. The findings relate to the experience of the first semester of the first year of the new curriculum. It also examines the contributions that single-handed practices have made to the teaching network and the kind of support needed, if single-handed practices are to continue to contribute to the King's teaching network. SETTING: King's College School of Medicine and Dentistry. SUBJECTS: Medical undergraduates. RESULTS: The findings of this paper revealed that over a third of general practice provision is via single-handed practices in South-east London. Within the undergraduate teaching network, 10% of practices are single-handed. Students are welcomed and receive a learning experience comparable to those students in larger practices. Attendance at training events has proved difficult for some of these tutors, but the extra input from the department, in order to address this deficit, has not been onerous. Indeed, single-handed practices have not been unique with regard to difficulties in attendance at training events. CONCLUSIONS: The study concludes that single-handed practices can make satisfactory provision for undergraduates in the new curriculum and there is no evidence from this study to suggest otherwise.

Curriculum↗

PubMed2000

Evaluation of an integrated curriculum using problem-based learning in a clinical environment: the Manchester experience.

DESCRIPTION OF COURSE: In 1994, a new problem-based leaning (PBL) curriculum for year 1 medical students was introduced at the University of Manchester. The use of PBL has continued into the clinical clerkships. Year 3 of the curriculum is based entirely in a clinical environment with PBL groups meeting in three teaching hospitals. During this year, all students undertake two integrated 14-week modules with overarching themes. Each week, groups of eight students discuss a trigger problem connected to the relevant theme. The steps the groups use in the PBL process have been amended to encourage students to link their discussion with clinical experience. EVALUATION: At the end of each module, all 309 students were requested to complete an evaluation questionnaire. The response rates were 80% (n=247) and 89% (n=275) for the two core modules. RESULTS: The students have remained 'happy with the way the course is going' (83% at the end of module 2). They were also asked to rate a number of statements on a 5-point Likert scale (5=strongly agree). Concerning PBL, the students remained confident about working in a group (median 4), producing a set of learning objectives (median 4) and linking clinical experience with other knowledge (median 4). However, there were changes over the year. Fewer students agreed at the end of module 2 that 'the working problems were stimulating' (P=0.002) or 'motivated them to learn' (P < 0.001), but the clinical firms were seen as providing more appropriate experience (P=0.01) and being aware of the new curriculum and responding to it (P=0.018). We also surveyed the PBL tutors and had 65 returns from 78 people involved in the 38 PBL groups in year 3. The great majority of these are doctors employed by the National Health service. Virtually all the responders were happy to continue being a tutor (97%) and would recommend it to a colleague (93%). CONCLUSIONS: The evaluation has been positive with PBL having been successfully implemented in a clinical environment. We have identified significant changes over the year, which we need to address as we consolidate the curriculum.

Clinical Clerkship↗

PubMed2002

What are the clinical skills levels of newly graduated physicians? Self-assessment study of an intended curriculum identified by a Delphi process.

OBJECTIVE: To compare and contrast the learned and an intended curricula of practical clinical skills across the three Danish medical schools. CONTEXT: The three Danish medical schools had comparable discipline-based curricula with 3 years of mainly basic science and 3(1/2) years of mainly clinical education. Danish physicians work as pre-registration house officers (PRHOs) for 1(1/2) years after graduation. METHODS: An anonymous questionnaire listing 210 practical clinical skills was mailed to 226 newly graduated Danish physicians. They were asked if they could meet the minimum level for each of the skills listed as identified by a previous Delphi study. RESULTS: The response rate was 80%. None of the responders met the minimum of all the 210 skills. Only 8% (14) met the minimum level for at least 90% (189) of the skills. On average the responders met the minimum of 74% (155) of the skills. More than 90% of the responders mastered basic history and examination skills. The responders did not meet 28 medical emergency procedures. CONCLUSIONS: We found that the learned curriculum of clinical skills constituted 75% of the intended curriculum. Those responsible for pre- and postgraduate medical education should be aware of the discrepancy between expected and learned curriculum. We discuss the role of experts in the process of defining the core curriculum.

Clinical Competence↗

PubMed2002

Teaching invasive perinatal procedures: assessment of a high fidelity simulator-based curriculum.

OBJECTIVE: Learning curves pose a difficult problem in the teaching of technical skills: how do you teach procedural skills without compromising patients' health? A simulator-based curriculum has been designed to minimize the risks to patients undergoing amniocentesis by shifting the learning curve away from patients and into the laboratory. This study evaluated the effectiveness of a high-fidelity simulator-based curriculum in improving the performance of amniocentesis by obstetric trainees. DESIGN: Thirty trainees received a course on the practice of amniocentesis. The curriculum consisted of a lecture, a syllabus, and a hands-on training session with the simulator. Pre- and post-training performance were evaluated with two rating scales. Training and performance evaluation were completed using the same simulator. The effectiveness of the simulator-based workshop and the effect of year of training were assessed using a two-way analysis of variance. RESULTS: Performance scores improved from a mean score of 55% to 94% using checklist scoring and from 57% to 88% using global ratings. The two-way analysis of variance revealed a significant effect of training (F1,60 = 43.57; P < 0.001) accounting for 45% of the variance in scores, and a significant effect of experience level (F2,60 = 9.16; P < 0.001) accounting for 25% of the variance in scores. CONCLUSIONS: A comprehensive curriculum based on a high-fidelity simulator was effective at improving skills demonstrated on the simulator. The challenge remains to establish that skills acquired on a simulator are transferable to the clinical setting.

Amniocentesis↗

PubMed2000

Action research to improve the pre-registration midwifery curriculum--Part I: An appropriate methodology.

OBJECTIVE: To improve the pre-registration midwifery curriculum locally and influence national policy and guidelines for these programmes. DESIGN: Action research provided the framework for the study where a multi-method approach was largely qualitative to attempt to capture the context and complexity in which the midwifery programme operates. The study comprises a synthesis of two separate but interwoven research projects: a national study about the effectiveness of midwifery education (the EME project) and an evaluation and re-design of the three year pre-registration midwifery programme in a large multi-sited university in England. SETTING: A large university in England. PARTICIPANTS: The EME project 39 case study students, their teachers, practice-based mentors/assessors, preceptors and supervisors of midwives or managers; 50 students from the local university's midwifery programme, their teachers and practice-based mentors/assessors from six sites; 41 women who gave birth to their babies in a large teaching hospital in the East Midlands; and a professional network of experienced midwives whose role is to advise the statutory body regulating midwifery programmes in England. FINDINGS: Overall the three-year, pre-registration route into midwifery was found to be an effective preparation for contemporary midwifery practice as judged against a model of a competent midwife at the point of registration. However, there was evidence to suggest that not all students are equipped to practise competently and confidently in contexts of uncertainty and change in the National Health Service. Factors which emerged as influencing curriculum effectiveness related to: recruitment and selection; curriculum structure, appropriateness; and robustness of assessment schemes; the preparation of and support for assessors; and the role of the midwife teacher in assessment in practice settings. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Diagnosing problems and initiating actions as a collaborative process formed an important part of designing and implementing an 'ideal' curriculum in constrained health and higher education contexts. The need for on-going dialogue, critical reflection, and research to facilitate and assess learning more effectively in the 'caring' professions emerged as necessary to ensure that only competent practitioners have a license to practise.

Curriculum↗

PubMed1999

'Stories' or 'snapshots'? A study directed at comparing qualitative and quantitative approaches to curriculum evaluation.

The focus of this paper is a study designed to explore the validity of quantitative approaches of student evaluation in a pre-registration degree programme. As managers of the students' education we were concerned that the quantitative method, which used lecturer criteria, may not fully represent students' views. The approach taken is that of a process-type strategy for curriculum evaluation as described by Parlett and Hamilton (1972). The aim of the study is to produce illuminative data, or students' 'stories' of their educational experiences through use of semi-structured interviews. The results are then compared to the current quantitative measurement tools designed to obtain 'snapshots' of the educational effectiveness of the curriculum. The quantitative measurement tools use Likert scale measurements of teacher-devised criterion statements. The results of the study give a rich source of qualitative data which can be used to inform future curriculum development. However, complete validation of the current quantitative instruments used was not achieved in this study. Student and teacher agendas in respect of important issues pertaining to the course programme were found to differ. Limitations of the study are given. There is discussion of the options open to the management team with regard to future development of curriculum evaluation systems.

Adolescent↗

PubMed2000

Fit for practice: Project 2000 student nurses' views on how well the curriculum prepares them for clinical practice.

This paper presents the findings from a small study, which compared student nurses' views on how well they felt the Project 2000 curriculum had prepared them for their first clinical placements. The views of two student nurse cohorts were obtained using a questionnaire developed for the purpose. The curriculum for the 'old' cohort allowed very little clinical time during the first 18 months and focused on academic classroom-based learning. The curriculum was subsequently restructured so that students on the 'new' curriculum experienced greater emphasis on practice and theory to practice links, and undertook their first clinical placement much earlier on in their course. Although statistical analysis of difference between the two cohorts suggests that students from the 'new' cohort felt they were better prepared, the actual differences in scores was small. The findings of this study provide only modest evidence of improvement in 'new' student nurses' views of how well they felt they had been prepared for their first placement.

Attitude of Health Personnel↗