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Integration of the Case-Based Series in Population-Oriented Prevention into a problem-based medical curriculum.

This article describes the pilot testing of the Case-Based Series in Population-Oriented Prevention (C-POP) and accompanying evaluation instruments in a problem-based medical curriculum at the University of Rochester Medical Center. Several of the cases were successfully taught in the curriculum, but the evaluation instruments revealed no change in population-oriented skills or orientation. Issues of implementation and evaluation of the C-POP curriculum are discussed.

Clinical Clerkship↗

Preventive medicine teaching cases in the preclinical undergraduate medical curriculum.

The implementation of the Case-Based Series in Population-Oriented Prevention (C-POP) at the University of California at Davis Medical School is described. The implementation and planning for the integration of a case-based curriculum into a previously didactic-focused preventive medicine course are discussed. Issues include flexibility of the curriculum, student acceptance of case-based learning, and effect of preceptor availability and training on the successful implementation of the C-POP curriculum.

California↗

Diagnostic radiology in an integrated curriculum: evaluation of student appraisal.

RATIONALE AND OBJECTIVES: This study determined student perceptions of the effectiveness of an integrated radiology curriculum in a 6-year undergraduate medical school program. MATERIALS AND METHODS: Student perceptions of the effectiveness of an integrated radiology curriculum were assessed with a self-administered questionnaire that was developed in house and consisted of Likert-type and open-ended items. The questionnaire was distributed to 1997-1998 and 1998-1999 cohorts of 2nd- to 6th-year medical students. Quantitative data were analyzed by using descriptive statistics. RESULTS: Ninety-nine of 173 students (57% response) returned completed questionnaires. Overall, students perceived integrated radiology teaching as satisfactorily achieved and useful in facilitating learning. Compared with students in the 2nd and final years of undergraduate medical education and training, those in years 3-5 considered integrated radiology teaching to be very effective. Results of the survey suggest future modifications to improve the effectiveness of integrated radiology teaching. CONCLUSION: Radiology can be successfully integrated into modern medical curricula. Student comments indicate the need to structure and organize the integrated teaching better and to introduce it earlier in the medical school curriculum.

Curriculum↗

Radiologists as clinical tutors in a problem-based medical school curriculum.

RATIONALE AND OBJECTIVES: The authors sought to evaluate the experience of radiologists teaching in a problem-based pre-clinical medical school curriculum. MATERIALS AND METHODS: The undergraduate medical school curriculum at Wake Forest University includes 2 problem-based preclinical years that integrate basic and clinical sciences. Sixteen radiology fellows served as general clinical tutors for 5-9 weeks, each guiding the work of six 2nd-year students, often in tandem with a basic science tutor. On completion of the tutoring. the radiologists and the students were surveyed by means of a questionnaire. A follow-up group interview was conducted with the radiologists. RESULTS: The response rate to the questionnaire was 81% for the radiologists and 47% for the students. On average, radiologists spent 6.1 hours weekly on preparation and tutoring and 3.5 hours in total on administration and grading. All radiologists thought tutoring was rewarding, but seven of the 13 respondents (54%) disliked assigning grades. Radiologists spent less time teaching radiology residents and performing research, but few thought their clinical work was adversely affected. Nearly half of the radiologist-tutors thought that the preliminary orientation and training provided to them by the medical school was not adequate, and nearly all of them thought that they could have been better prepared. All of the medical students improved their perceptions of radiologists after having had a radiologist as a tutor, and most thought that the radiologist-tutors performed as well as or better than tutors from other disciplines. CONCLUSION: Radiologists can be successful as general tutors in a problem-based medical school curriculum. benefiting both radiologists and students. Better orientation and training by the medical school would improve the program.

Curriculum↗

A perspective on radiology residency curriculum guidelines: results of the 1995 survey of program directors.

RATIONALE AND OBJECTIVES: The development of curriculum guidelines for radiology residency has been found to be favored by 80% of program directors (PDs) nationwide. I surveyed PDs to develop a consensus of opinion concerning minimum training requirements in the subspecialty rotations. METHODS: A survey developed by members of the Ad Hoc Curriculum Committee of the Association of Program Directors in Radiology was mailed to all U.S. PDs. RESULTS: One hundred forty-one (82%) completed responses were received. There was agreement among the PDs about the minimum length of training needed in the various subspecialties. Seventy-four percent of the PDs supported the concept of developing educational objectives and goals in each subspecialty and of specifying procedures in which residents should be trained. Only a minority of PDs thought that the training guidelines should specify minimum numbers of procedures. CONCLUSION: The consensus of PDs is that the radiology residency curriculum should include a minimum of 3 months in each of the following categories: chest radiology, gastrointestinal radiology, musculoskeletal radiology, pediatric radiology, cardiovascular and interventional radiology, sonography, and body computed tomography (CT) scanning. In neuroradiology, inclusive of neuroangiography, neuro CT scanning, and neuro magnetic resonance (MR) imaging, a resident should spend 4 months. At least 2 months should be devoted to each of the following: uroradiology, mammography, body MR imaging, and emergency radiology. A majority of PDs also favored developing educational objectives for each of the subspecialty rotations.

Curriculum↗

Twenty five years of medical informatics education at Heidelberg/Heilbronn: discussion of a specialized curriculum for medical informatics.

The specialized university curriculum for medical informatics (MI) at the University of Heidelberg/School of Technology Heilbronn is one of the oldest educational approaches in the field of MI and has been successful now for 25 years with about 1000 graduates (Diplom-Informatikerin der Medizin or Diplom-Informatiker der Medizin). It belongs to the category of dedicated master's programs for MI and is based on the concept of MI as a medical discipline of its own. It is oriented towards the total spectrum of MI ranging from health care economics, biosignal and medical image processing, medical documentation, to information and knowledge processing in medicine. It is a 4.5 years program with a strong emphasis on the methodological foundations of MI and on practical education in a number of specific laboratories. A total of 35 students are admitted each semester and in total about 440 students are enrolled. The faculty consists of 17 full-time members and about 25 part-time lecturers. The authors report on characteristics, structure and contents of the new fifth version of the curriculum and discuss the features of a specialized curriculum for MI with respect to the challenges for MI in the 21st century.

Artificial Intelligence↗

Geriatric medicine curriculum consultations for family practice residency programs: american academy of family physicians residency assistance program/hartford geriatrics initiative.

Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. These programs have an average of only seven full-time equivalent physician faculty. This report summarizes results of the Residency Assistance Program/Hartford Geriatric Initiative (RAP/HGI) geriatric medicine curriculum consultations for family practice (FP) residency programs conducted from 1996 to 2001. This project was developed as part of the RAP in family practice. Ten experienced FP educators were selected and trained as special consultants. Between 1996 and 2001, 39 FP residency programs participated in the 1- to 4-day RAP/HGI consultations. The programs were diverse in size and location. The consultations reached 308 family practice residency faculty members involved in training 807 residents. Program evaluations of the consultants were uniformly in the very good to excellent range, with a mean rating of 4.6 (5-point scale, with 5 indicating excellent). At the end of the initial consultation visit, the residency program faculty and the consultant developed short-term goals for geriatrics program development. Eighty-five percent (33/39) of the programs submitted their curriculum goals in writing. The mean number of goals per program was 4.8 (range = 3-11). Of the 33 programs with written goals, follow-up was documented for 29 programs. Seventy-nine percent of the programs' self-defined educational goals were met during the 6 to 12 months of follow-up (range 50-100%). Ten of the programs implemented all of their educational goals. The RAP/HGI project demonstrated that achievable geriatric medicine curriculum improvements could occur as part of an onsite consultation process.

Connecticut↗

A synthesis of caring praxis and critical social theory in an emancipatory curriculum.

As several schools of nursing in New Zealand are accepting the challenge to prepare nurses better in order to meet changing health care needs, one lecturer discusses the design and implementation of a new degree curriculum at Manawatu Polytechnic. The author has drawn from educational, nursing and feminist literature to provide a background for the central concepts in order to explain their role in the development of the curriculum. It is contended that the caring imperative is central in all student-educator-clinician relationships when the purpose of the curriculum is to emancipate students to become nurses who care for individuals, families and communities in a transformative way. The transformative teacher is also aware of the power of open and regular dialogue when teaching caring within a critical social paradigm, and has a responsibility to ensure students understand the mandate for social action. It is through such consciousness-raising that nurses are empowered to both provide the best possible nursing care, and become agents of social change through an overhauled health care system.

Curriculum↗

Conceptualizing advanced nursing practice: curriculum issues to consider in the educational preparation of advanced practice nurses in the UK.

The findings from a Florence Nightingale Scholarship to the USA and Canada, investigating the educational preparation of advanced practice nurses, are reported. The author considers a number of issues facing curriculum designers who might wish to develop clinically based advanced practice nurse programmes in the UK. Utilizing the experimental nature of personal visits, along with the available literature, the strategy adopted by some American and Canadian universities is highlighted to exemplify curriculum issues likely to be encountered in the UK. A definition of advanced nursing practice is provided as a foundation for discussion on curricular construction. This is followed by a discussion on advanced role nomenclature and components and characteristics of the 'nurse practitioner', 'clinical nurse specialist', 'nurse consultant' and 'nurse clinician', in order to clarify terminology and disentangle different advanced practice roles. The issues examined include the academic level of advanced practice nurse programmes; the determination of curricular content based on both a 'generalist' and 'specialist' model of practice; factors considered when exploring advanced practice competencies; and the resource implications for delivering opposing curriculum models. The paper suggests that there is a unique opportunity for advanced practice nursing to establish a key collaborative relationship in the delivery of health care, based on a nursing model, graduate study and the integration of key nursing and related concepts into clinical practice.

Curriculum↗

Early effects of a new problem-based clinically oriented curriculum on students' perceptions of teaching.

OBJECTIVES: To compare the course experiences of medical students in a new problem-based (PBL) undergraduate medical course with those of their peers in a conventional curriculum. DESIGN: Whole class questionnaire survey using a pre-validated research instrument. SETTING: University of Liverpool, UK. SUBJECTS: First and second year medical students RESULTS: New curriculum students were more satisfied with their course when compared to their conventional course peers. Problem solving, team working and motivation scores were significantly higher amongst new course (PBL) students. New course students were more anxious about clarity of objectives and standard of work required. CONCLUSIONS: Early evidence suggests that curriculum reform from conventional teaching to a small group problem analysis programme results in improvement in student satisfaction with teaching and the development of appropriate learning skills.

Curriculum↗

A process evaluation of medical ethics education in the first year of a new medical curriculum.

BACKGROUND: Despite the recent increase in activity in the field of medical ethics education, few evaluative studies have been carried out. Most studies have taken place in North America, in curricula where teaching is discipline-based, and have concentrated on outcome rather than on the curricular processes adopted. AIM: To evaluate the process of medical ethics education in the first year of a new learner-centred, problem-based, integrated medical curriculum. METHOD: A qualitative, multi-method approach was adopted using open questionnaires, focus groups and tutor evaluation rating scales. The study involved all 238 students in the first year of the new medical curriculum, and the 30 clinical tutors who facilitated ethics learning. A stratified sampling technique was used to choose focus group participants. RESULTS: Small group teaching proved highly acceptable to both students and tutors. Tutors' teaching skills were central to its effectiveness. Tutors played an important role in promoting students' appreciation of the relevance of medical ethics to clinical practice, and in establishing a climate where constructive criticism of colleagues' actions is acceptable. Course integration, including the provision for students of clinical experiences on which to reflect, was an important aid to learning. Students and tutors were noted to be driving the ethics curriculum towards having a contextual rather than theoretical base. CONCLUSION: This evaluation identified those aspects of the medical ethics course which contributed to its effectiveness and those which detracted from it. This information will be used to inform future development.

Curriculum↗

The integration ladder: a tool for curriculum planning and evaluation.

Integration has been accepted as an important educational strategy in medical education. Discussions about integration, however, are often polarized with some teachers in favour and others against integrated teaching. This paper describes 11 points on a continuum between the two extremes. * Isolation * Awareness * Harmonization * Nesting * Temporal co-ordination * Sharing * Correlation * Complementary * Multi-disciplinary * Inter-disciplinary * Trans-disciplinary As one moves up the ladder, there is less emphasis on the role of disciplines, an increasing requirement for a central curriculum, organizational structure and a requirement for greater participation by staff in curriculum discussions and planning. The integration ladder is a useful tool for the medical teacher and can be used as an aid in planning, implementing and evaluating the medical curriculum.

Curriculum↗

Perceptions of how well graduates are prepared for the role of pre-registration house officer: a comparison of outcomes from a traditional and an integrated PBL curriculum.

INTRODUCTION: Most medical schools in the UK have been engaged in major curriculum reform based on their premises of what might improve undergraduate medical education. In 1994 the course at the medical school of the University of Manchester changed to an integrated course using problem-based learning throughout and with increased emphasis on community-based medical education. This study explores whether the new curriculum has produced any differences in perceptions of how well graduates are prepared for the role of pre-registration house officer. METHODS: A postal questionnaire was used to survey 1998 Manchester graduates (traditional course) and 1999 Manchester graduates (new course), three months into their first pre-registration house officer placement. A similar questionnaire was sent to the educational supervisors who were supervising the graduates. The questionnaire was designed to measure perceptions of levels of preparedness for the role of pre-registration house officer, using a list of broad areas of competence and specific skills listed in the General Medical Council's 'The New Doctor'. RESULTS: Graduates rated the new course significantly more effective for 12 of the 19 broad competences and eight of the 13 specific skills that were listed. The 'new' graduates rated their understanding of disease processes lower than the 'traditional' graduates, but there was no difference in the ratings given by the educational supervisors for this. Overall the educational supervisors rated the new course as better preparing graduates in five of the competences. CONCLUSIONS: Overall, the evaluation shows that a major change in curriculum approach has changed the profile of the perceived preparedness of graduates for entering professional practice.

Clinical Competence↗

Early introduction of clinical skills teaching in a medical curriculum--factors affecting students' learning.

OBJECTIVE: To evaluate the effects of the early introduction of clinical skills teaching on students' learning following an overhaul of the curriculum of a traditional Asian medical school. METHODS: Randomly selected medical students in Year I and II were invited to participate in 30 focus group interviews while all students were asked to assist with the questionnaire survey. Most students were contacted personally to help them understand the objectives of the study. Confidentiality was emphasised and a non-faculty interviewer was recruited for the interviews. RESULTS: Two hundred and eight of Year I/Year II students attended the lunchtime focus group interviews (response rate=86.7%) while 252 (73.5%) students returned the questionnaire. The majority of them (87%) agreed or strongly agreed that it was good to introduce clinical skills in the early years of the curriculum. They reflected that the course enhanced their learning interest and made them feel like doctors. They also made many constructive suggestions on how the course could be improved during the interactive focus group interviews so that the negative effects could be minimised. CONCLUSION: It is useful to introduce clinical skills in the early years of a medical curriculum. A comprehensive course evaluation, using both quantitative and qualitative methods, helps to collect useful information on how the course can be improved.

Clinical Competence↗

The impact of three years' ethics teaching, in an integrated medical curriculum, on students' proposed behaviour on meeting ethical dilemmas.

OBJECTIVE: To evaluate the impact of 3 years' ethics teaching (30 hours mainly small group teaching in year 1, 14 hours mainly lecture-type teaching in years 2 and 3) on students' proposed behaviour on encountering ethical dilemmas. DESIGN: Cohort design. SETTING: University of Glasgow Medical School. SUBJECTS: A cohort of 111 students entering Glasgow University's new learner-centred, integrated medical curriculum; where ethics learning is formally assessed in years 1 and 5 only; in October 1996. MAIN OUTCOME MEASURE: Student answers consistent with consensus professional judgement on the ethical dilemmas posed by the vignettes of the Ethics and Health Care Survey Instrument. RESULTS: The instrument was completed pre- and post- year 1 and post- year 3 by 77%(85) of the cohort. There is a significant increase in the number of consensus answers given following the first year of the curriculum, but no further improvement was found. The odds ratio for giving the consensus answer post- year 1 relative to pre- year 1 was 1.42, 95% Confidence Interval (1.19, 1.71), P = 0.0001. Comparing post- year 3 to pre- year 1, odds ratio 1.30 (1.08, 1.57), P = 0.0062. Post- year 3 compared to post- year 1, odds ratio 0.91 (0.76, 1.10), P = 0.34. CONCLUSIONS: While small group ethics teaching can be effective in developing students' normative identification with the profession of medicine, its effectiveness is dependent on the amount of small group teaching provided. The lack of formal assessment in years 2 and 3 is also felt to contribute to the lack of impact. This information will inform future curriculum development.

Curriculum↗

A web-based presentation of an undergraduate clinical skills curriculum.

AIMS: The aim of this study was to use information and communications technology to present a curriculum of clinical skills in a user-friendly format. SETTING: A UK undergraduate medical school with a problem-based curriculum and a strong emphasis on proficiency in clinical skills. STUDY DESIGN: Case study describing the qualitative analysis of users' requirements and development of a web-based learning portfolio. EVALUATION: The study involved direct observation of users during a 'think-aloud' protocol, a validated software users' measurement inventory and a 17-item questionnaire designed to test whether 'SkillsBase' met its users' requirements. RESULTS: Students wanted a clear and flexible presentation of their skills curriculum that was easy to navigate, offered instructional material and standards for self- and peer assessment, offered useful Internet links, allowed them to compare their progress with school standards and peer norms, and could be used as a learning portfolio. During the think-aloud protocol, students made very few errors in data interpretation or navigation, and found SkillsBase easy to learn and aesthetically pleasing to use. They rated it higher on all measures of usability than standard commercial software. The questionnaire showed that it met most aspects of its design specification, although many students were doubtful that they would use its reflective function. It is available for inspection at http://www.skillsbase.man.ac.uk/. CONCLUSIONS: SkillsBase meets the design specification for a training and reflective aid to learning clinical skills and is very usable.

Clinical Competence↗

The 'Collaborative Care' curriculum: an educational model addressing key ACGME core competencies in primary care residency training.

AIM: The 'Collaborative Care' curriculum is a 12-month senior resident class project in which one evidence-based clinical guideline is designed, implemented and evaluated in our residency practice. This curriculum specifically addresses three of the six Accreditation Council for Graduate Medical Education (ACGME) core competencies: Practice-Based Learning and Improvement, Interpersonal and Communication Skills and System-Based Practices. Additionally, the project enhances the quality of patient care within the model family practice centre in a family practice residency. METHODS: During the project, the third-year residency class selects the disease, develops the clinical guideline, leads its implementation and guides the evaluation process. Select faculty members serve as mentors and coach the resident class through each phase of the project. Specific educational objectives are developed for each content area: evidence-based medicine, clinical guideline development, continuous quality improvement and team leadership. A series of seminars are presented during the project year to provide 'just-in-time' learning for the key content and skills required for each step in the project. By working together to develop the practice guideline, then working with nurses and allied health staff to implement the guideline and review its effectiveness, the resident team gains competence in the areas of practice-based learning and improvement, interpersonal and communication skills and system-based practices. RESULTS: The self-reported level of resident confidence in skill acquisition for each content area was measured for each resident at the time of graduation from the residency programme. Results from the first 2 years of this curriculum are reported (resident n = 12), and demonstrate a high level of physician confidence in the skills addressed and their utility for future practice. CONCLUSIONS: The senior resident seminar and team project model reported here creates learning experiences that appear to address at least three of the ACGME general competency expectations: practice-based learning and improvement, interpersonal communication skills, and systems-based practice. From the initial resident feedback, this educational model seems to establish a high level of physician confidence in the skills addressed and their utility for future practice.

Clinical Competence↗

The impact of the basic skin cancer triage curriculum on provider's skin cancer control practices.

OBJECTIVE: To evaluate the effect of a 2-hour, multicomponent educational intervention on provider skin cancer control practices. DESIGN: Nonrandomized intervention study. The intervention was a 2-hour curriculum designed to augment provider skin cancer control practices through instruction in basic skin cancer triage (BSCT) and a brief summary of skin cancer epidemiology, prevention, and counseling. SETTING: Five staff-model health maintenance organizations in southeastern New England. PARTICIPANTS: Convenience sample of primary care providers. Providers older than age 75, individuals in practice for less than 1 year, or individuals planning to retire in the next 2 years were excluded from the study. Twenty-two of 28 participants completed the study. RESULTS: Providers completed preintervention and postintervention surveys asking them to rate their attitudes towards skin examination and skin cancer counseling and to rate the frequency of their skin cancer control practices, using 5-point Likert scales. We independently assessed provider behavior through surveys of their patients, eliciting information on provider practices before and after BSCT participation. Following participation in the curriculum, there was significant improvement in provider attitudes towards the total body skin examination but not towards skin cancer prevention counseling. Significant increases in provider self- reported skin cancer control practices during an initial visit with a new patient (2.17 to 3.21, P <.0001) and a routine visit with a patient at high risk for melanoma (2.15 to 3.00, P <.0001) were demonstrated. Analysis of the patient exit interviews independently confirmed these changes in practice patterns. CONCLUSIONS: The study results suggest that the BSCT curriculum may be a useful tool in increasing the practice of skin cancer control measures by primary care providers.

Curriculum↗