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The McMaster M.D. program: a case study of renewal in medical education.

This paper presents four aspects of health professions education at McMaster University: (1) a review of the key elements of the history and distinctive approach of the Doctor of Medicine (M.D.) program; (2) a description of the process and substance of curriculum change over the past decade, focusing on a major revision of the M.D. program that began in 1983; (3) a summary of the findings of follow-up studies of McMaster M.D. program graduates; and (4) an analysis of the current context within which the Faculty of Health Sciences (of which the M.D. program is a part) is operating and a description of strategies for renewal that are being implemented. The evidence and experience to date support the assertion that satisfactory--and in some ways special--physicians can be prepared using the "McMaster approach" to medical education, but that continuous review and periodic major revisions of the educational program are both necessary and possible; they must occur in concert with developments in other sectors of Faculty of Health Sciences activities.

Attitude of Health Personnel↗

Implementing the Roy model: challenges for nurse educators.

The experience of selecting and implementing a nursing model appropriate to the nursing course in the first year of the generic baccalaureate programme of the University of Ottawa School of Nursing is described. Many challenges surfaced for the professors in year one as this curriculum change was implemented. Four challenges: (1) adapting the course to be congruent with the Roy model, (2) developing teaching tools suitable for student learning, (3) sequencing of content for student learning, and (4) obtaining competent role models, and how they were met, are discussed.

Adaptation, Psychological↗

Social class, gay men and AIDS prevention.

The relationship between sexuality, gay communities and class is potentially a very large problem for AIDS prevention. Class is a historical process which interacts with sexuality in ways still little understood. The complexities of modern class structures need full acknowledgement; labour market groupings are internally divided, and cultural privilege and exclusion are important. A community survey in New South Wales of men who have sex with men shows the class selectiveness usual in such research. An exploration of correlates of labour market position, income and education finds few relationships with attachment to milieu except for involvement with gay organisations, and minor differences in broad measures of sexuality but some class differences in HIV risk-taking and some differences in exposure to information and in attitude. An exploration of several cases from a life-history study of working-class gay men shows the impact of class circumstance on the formation of sexual relationships and points to the accessibility of unlabelled homosexual activity in working-class milieux. Research on working-class education points to the importance of curriculum change in overcoming class exclusion, and is moving towards empowerment models of great relevance in AIDS education.

Acquired Immunodeficiency Syndrome↗

[The indicators for a restructuring of the nursing degree curriculum: the expectations of professionals and a curriculum assessment by former students].

Two kinds of evidence were used to guide curriculum changes in the Nursing School of Ribeirão Preto (University of São Paulo): 1) a survey of nurses' expectations on their profession, their functions, the other members of the team and on the Nursing School teachers; 2) graduates' (ex-students) curriculum evaluation. We inquired 115 nurses working in 5 general hospitals of Ribeirão Preto, and had a return of 49 questionnaires (42.6%). This questionnary was delivered by the authors personally to the nurses, along with guidances on answering and date for return, and had 9 opened questions. The classification of answers makes possible to assert: the assistance function is the most emphasized by nurses; the student's expectations change during the professional practice; 60% of the informants considered the content of the curriculum disciplines adequate; 69.4% considered the habilitations dispensable.

Attitude of Health Personnel↗

A comparative study of adult developmental patterns of RN and generic students in a baccalaureate nursing program.

The current influx of RN students into baccalaureate nursing programs has led to many curriculum changes that are based on the unverified assumption that the RN students are "different." This study examined the differences and similarities among RN and generic nursing students using a conceptual framework designed by Weathersby (1977) which incorporated into a single framework Levinson's life stage, Loevinger's ego development, and Kolb's learning styles theories in order to trace the adult development patterns of generic and RN students. Three instruments were used: The Washington University Sentence Completion Test, the Kolb Learning Style Inventory, and Tarule's Educational Experience Inventory. The sample consisted of 49 RNs and 30 generic students enrolled at a large southern state university. The results of the analyses revealed significant difference between RN and generic students on the variables life stages and ego development but not on learning styles. These results substantiated the premise that RN and generic students differ significantly in their stages of adult development, and consequently affect the students' perception and expectations of the educational process.

Adult↗

The leadership/management role: a differentiating factor for ADN/BSN programs?

The resurgence of the ADN/BSN issue relative to educational preparation and roles and the concomitant development of positions taken by the professional associations and National Commission on Nursing pointed to the need for study of current ADN/BSN curricula and utilization of graduates. Based upon a brief historical literature review and ADN/BSN competency statements, the leadership/management role was selected for study as a possible differentiating factor between these programs. Findings from a statewide study of ADN and BSN programs and a representative sample of nurse executives indicated that an education and service dilemma exists relative to this role. The majority of ADN program directors noted that a leadership/management component should be part of ADN curricula, whereas BSN program directors did not concur. Nurse executives utilized ADN graduates in leadership/management positions and stated that length of experience was an influencing factor in selection. Numerous other findings showed a discrepancy in beliefs and practices among educators and nurse executives. This survey demonstrates the need for curriculum changes and role clarification. The leadership/management role may be a viable area for consideration.

Administrative Personnel↗

Alternative pathways for training the general internist and the medical subspecialist.

Considerable attention is being directed from within the discipline of internal medicine to a perceived need for changes in the curriculum for postgraduate training of the internist. Much of this attention has been focused on the training required to properly prepare the general internist for the evolving system of health care. A proposal is presented to change the pattern of training of both the general internist and the medical subspecialist. After 2 years of core training, the general internist would enter 2 additional years of training that would include new material and additional experience in areas such as ambulatory and continuity care. After the core experience, the subspecialist would begin training in the subspecialty. The general internist would be certified as such, and the subspecialist would be certified only in the subspecialty. The proposal is based on the assumptions that 1) more general physicians are needed to meet the nation's health care needs; 2) more time will be required to properly train the general internist; 3) all of the additional and expanded training experiences for the generalist are not essential for training the subspecialist; and 4) the generalists of the future will not come from the ranks of subspecialists. The training needs of the general internist and the subspecialist should be viewed as separate, and curriculum changes should be considered without the restrictions of current patterns of training.

Curriculum↗

Attitudes of graduates toward occupational therapy education.

Recently graduated occupational therapists were surveyed to determine their perceptions of the adequacy of their professional training. Through a mailed questionnaire, therapists evaluated their undergraduate professional preparation based upon their clinical experiences since graduation. Additional suggestions were solicited regarding possible areas of curriculum change, and the survey gave special attention to the area of interpersonal skill development. Responses were examined for areas of commonality and possible use in curriculum planning and modification. Results indicated that recent graduates see a need for more and earlier patient contact, increased attention to the development of administrative and managerial skills, and courses designed to facilitate skills necessary for effective interpersonal relationships.

Attitude of Health Personnel↗

The impact of a resident-directed survey on the education curriculum of a university surgical training program.

Surgical training programs use various objective and subjective means to evaluate housestaff performance. However it is less clear how to assess the quality of the educational experience the program itself provides. This study examines the use of a resident-directed survey as a means of identifying and rectifying weakness in a surgical training curriculum. Multiple choice questionnaires covering each of 14 senior rotations were prepared by chief residents and distributed to all senior surgical residents in April 1989 (year I). The survey covered factors considered vital to resident education, including operative experience, input into preoperative and postoperative decisions, autonomy, and time demands, and an overall rating (OR) of the educational quality of the rotations. Responses were numerically graded: 1, appropriate; 0, fair; -1, inadequate (or "excessive" for the variable "time demands"). The results, which were presented and discussed at a departmental retreat that spring, prompted specific curriculum changes for the 1989-1990 academic year. An identical survey was conducted the next spring (year II). Major reorganizational changes were made in three of the four negatively rated rotations from year I. The OR for each of the rotations improved dramatically in year II (average increase of 0.64/rotation; p less than 0.05). None of the eight favorably rated rotations in year I suffered a reduction in OR as a result of the changes. Case load, intraoperative involvement, and input in both preoperative and postoperative decisions correlated most frequently with favorable ORs in both years. This study shows that a resident survey is an effective tool for critically assessing the education curriculum of a surgical training program.

Curriculum↗

Changes in demographics at the University of Oklahoma College of Medicine.

Efforts in recruitment and retention of students by the University of Oklahoma College of Medicine have resulted in an increased size of applicant pool to the college over the past three years. Curriculum changes and programmatic innovations have provided new opportunities for students and incentives to remain in the State of Oklahoma. Continuing and expanding recruitment efforts can be enhanced by the active participation and support of the physicians of the state.

Education, Medical↗

Tobacco use cessation curricula in the U.S. dental schools and dental hygiene programs.

Tobacco-related health problems are the most preventable forms of illness in the United States. By assuming proactive tobacco use cessation counseling roles, dentists and dental hygienists can help reduce the number of people who currently use tobacco. The literature reports that many oral health professionals feel unprepared to assume such roles. To help combat the problem of tobacco-related illness and to help prepare dentists and dental hygienists to assume tobacco use cessation counseling roles, dental schools and dental hygiene programs need to develop appropriate didactic and clinical tobacco use cessation curriculum content. To date, there are limited national data addressing the extent of tobacco use cessation education in dental schools and dental hygiene programs. Studies of medical schools have revealed a need for increased curriculum content on tobacco use prevention and cessation. Further, tobacco use cessation training programs for medical students, practicing dentists, and dental hygienists have resulted in increased student and provider confidence when tobacco use cessation counseling roles were assumed. This study surveyed all dental schools and dental hygiene programs in the U.S. to determine if tobacco-related curriculum content exists, and if so, to what extent. Variables addressed included allocated hours, subject content, scope, department responsible, workplace smoking policy, importance, and future curricular directions. Questionnaires were mailed to all dental hygiene program directors and dental school academic deans. Study findings suggest that dental and dental hygiene students receive limited tobacco use cessation education, and respondent schools have no immediate plans for curriculum change in this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗

[Dentists and the prevention of oral cancer].

The authors, after participating on the European Conference on Dentists and Cancer Prevention, part of the program Europe Against Cancer, describe the main conclusions of the working groups, namelly on epidemiology and etiology of oral cancer, participation of dentists on community based programs for primary and secondary prevention of pré-cancer and cancer, as well as the curriculum changes proposed for Dental degree and the role of continuous education and of dental societies in this field.

Curriculum↗

General practice residency training and the osteopathic profession: trends and issues for the 1990s.

With the 1989-1990 training year, the length of postinternship residency training in osteopathic general practice will increase from 1 to 2 years. The longer residency is expected to give trainees a more complete and more competitive education and to protect them against discrimination regarding hospital privileges. With this change comes the opportunity to evaluate the current status of residency training in the field and to use the data as the basis for making rational predictions and recommendations for the future of the specialty. The author considers the effect of curriculum changes on the operation of training residents in osteopathic general practice. He examines the structure of the new training program and discusses issues pertaining to osteopathic general practice.

Education, Medical↗

Recent changes in the dental curriculum in Japan.

Information on curriculum changes was obtained from 25 of Japan's 29 dental schools. Twelve of the schools reported changes in the last 5 years. There has been some extension of inter-disciplinary teaching, more integration of previously separate courses and improved orientation at the beginning of new courses. Japanese dental education has not been influenced by significant changes in dental disease for the changes noted in other industrialized countries have not yet made an impact in Japan. Among aims for the future are (1) to shift curriculum emphasis from dental caries to periodontal disease, (2) to develop a better understanding of the dental needs of the elderly (3) and to improve the comprehension of relevant general health problems. An extensive internship programme has recently been introduced in Japan.

Curriculum↗

NP education: observations from a national perspective.

During the past decade (1976-1986), both the number of nurse practitioner programs and the federal funding of those programs peaked. The majority of programs now offer a master's rather than a certificate and the orientation of the curriculum changed from treatment of disease to health promotion.

Certification↗

Keeping the focus on nursing.

Keeping the curriculum focused on nursing will take the best efforts of nursing educators, administrators, and practitioners. Nursing knowledge based on systematic study has expanded and is now developing more quickly than ever. This, along with the recognized need for general education courses in the curriculum, has helped nursing move into the mainstream of higher education. New approaches to curriculum organization and to teaching nursing should be considered in the effort to provide the best possible education. The many advances made by nursing education and practice in the past century now challenge us to consider curriculum changes that could significantly alter our traditional approaches.

Clinical Competence↗

Extramural training of medical students: lessons from Southeast Asia.

Several medical schools in Southeast Asia have identified deficiencies in their undergraduate medical education that result in inappropriate training of students for the health-care problems that exist in their respective countries. Curriculum changes have been made that take students out of the laboratory and the subspecialty-oriented university hospital and place them in extramural programs in the community. Both the deficiencies identified and the solutions developed merit study by North American medical educators, especially those teaching primary care in family practice.

Community Health Services↗

Study of the opinion and level of knowledge about AIDS problem among secondary school students and teachers in Alexandria.

The level of knowledge and the opinion about HIV/AIDS problem of 571 students (179 females, 392 males) and 211 teachers (85 females, 126 males) were assessed using an interview-questionnaire. The results explored the little priority given to sex education in Egyptian schools in addition to the very minor role of schools as source of knowledge (about AIDS problem) for students and teachers who revealed much interest towards the problem and wanted to know more about it, reflecting the need for urgent organized health educational programme.

Acquired Immunodeficiency Syndrome↗