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Nutrition and cancer: a curriculum and short student research experiences.

In 1988, Louisiana State University Health Sciences Center (LSUHSC) received an NCI/NIH R25 grant to strengthen nutrition-cancer education in the medical school and to provide short cancer-related research experiences for students. Support for the nutrition-cancer curriculum component of the grant was limited to the first five years, while renewal of the research component was possible on a competitive basis. After the initial five-year award ended, the administration of LSUHSC assumed the support of the nutrition-cancer curriculum. This curriculum, modified over time, continues to be taught in each year of medical school and culminates with a required clinical nutrition course in the fourth year. The teaching of nutrition continues to be very successful and is well received by students and faculty. The research component, renewed twice, has achieved its goals over the same period. As a consequence of the initial award and the commitment of the administration, nutrition education at LSUHSC remains strong and is well established.

Curriculum↗

Development and implementation of a curriculum in communication skills and psycho-oncology for medical oncology fellows.

BACKGROUND: Over a ten-year period, the authors developed and implemented a disease-trajectory-based curriculum in communication skills and psycho-oncology for oncology fellows. METHODS: The basic format is a weekly ward round centered on a patient interview and subsequent discussion. More recently, this has been supplemented by a written curriculum. RESULTS: Former fellows and current trainees perceive this training o be an important component of their overall training. CONCLUSION: This kind of curriculum is one effective model for teaching communication skills and psycho-oncology to medical oncology trainees.

Adaptation, Psychological↗

Design, implementation, and evaluation of a longitudinal cancer curriculum.

The University of Massachusetts Medical School's two year preclinical curriculum is organized by organ system and controlled by the basic science departments. It is followed by two years of required and elective clinical clerkships. An evaluation of cancer teaching in the preclinical curriculum using criteria derived from the Cancer Education Objectives for Medical Schools was conducted. Deficiencies in cancer teaching were documented and the need for an organized cancer education program established. The administration then allotted 18 hours for cancer teaching spread over the two years of the preclinical curriculum. Supported by an R25 Cancer Education Grant, the Longitudinal Cancer course (LCC), was developed in an attempt to effectively utilize the scattered class time to meet a significant number of American Association for Cancer Education Objectives. In addition, interdisciplinary teaching of the more common cancers was facilitated and faculty were supported in their use of cancer related examples to illustrate relevant materials in the basic sciences. Evaluation of the LCC after a three-year trial has shown that, without strong administrative support, it is a very inefficient method of cancer teaching. While students appreciated class content and met a significant number of course objectives, they found the longitudinal format of the course unsatisfactory and recommended that the course be consolidated into a block. R25 grant support was being sought to implement a proposal to consolidate cancer teaching when the R25 program was suspended. Without external support, implementation will be difficult because it will require serious disruption of an established course. Such a change will require resources that are not readily available in this era of fiscal constraint.

Curriculum↗

Nutrition education curriculum at the University of Nevada School of Medicine.

This article describes a developing nutrition education curriculum for the University of Nevada School of Medicine, a small and progressive, community-based medical school. The curriculum has been planned to reflect the longitudinal, interdisciplinary, and comprehensive integration of nutrition into new required and existing courses so that timely delivery of knowledge and development of skills will occur in the basic science years followed by direct application in the clinical clerkships. The availability of the "Nutrition and Cancer Education Objectives" is timely and provides overall direction and curricular goals for the simultaneous development of nutrition-cancer education. The coordination of the four-year curriculum of the entire medical school can be specifically targeted for the incorporation of this needed information synergistically at a most opportune time.

Chronic Disease↗

Role of conceptual models in a physical therapy curriculum: application of an integrated model of theory, research, and clinical practice.

The Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada, recently implemented a Master of Physical Therapy (MPT) entry-level degree program. As part of the curriculum design, two models were developed, a Model of Best Practice and the Clinical Decision-Making Model. Both models incorporate four key concepts of the new curriculum: 1) the concept that theory, research, and clinical practice are interdependent and inform each other; 2) the importance of client-centered practice; 3) the terminology and philosophical framework of the World Health Organization's International Classification of Functioning, Disability, and Health; and 4) the importance of evidence-based practice. In this article the general purposes of models for learning are described; the two models developed for the MPT program are described; and examples of their use with curriculum design and teaching are provided. Our experiences with both the development and use of models of practice have been positive. The models have provided both faculty and students with a simple, systematic structured framework to organize teaching and learning in the MPT program.

Biomedical Research↗

The effectiveness of a novel, algorithm-based difficult airway curriculum for air medical crews using human patient simulators.

INTRODUCTION: Airway management is one of the most important skills possessed by flight crews. However, few data exist about the efficacy of various educational approaches. Traditional models for airway training, including cadaver labs, operating room exposure, and clinical apprenticeships, are scarce and offer variable educational quality. The objective of this analysis was to evaluate the effectiveness of a simulator-based difficult airway curriculum in a large, aeromedical company. METHODS: Simulation training was integrated into existing airway training for all crew members; an original difficult airway algorithm was used to guide scenarios. To evaluate its effectiveness, rapid sequence intubation (RSI) success before and after curriculum implementation was determined. In addition, crew members rated their confidence with various aspects of airway management before and after exposure to the airway workshops. RESULTS: First attempt and overall ETI success improved from 71.3% and 89.3% before (n=261) to 87.5% and 94.6% after (n=504) implementation of the algorithm and simulation training, whereas the incidence of hypoxic arrests during RSI decreased from 2.7% to 0.2% (p<0.01 for all comparisons). Crew members reported improvements in confidence with regard to all aspects of airway management following participation in the simulation workshops. CONCLUSIONS: A novel, integrated airway management curriculum using treatment algorithms and simulation appeared to be effective for improving RSI success among air medical crews in this program.

Air Ambulances↗

Learning for interprofessional and inter-agency practice in the new social work curriculum: evidence from an earlier research study.

The UK Government's consultation document, A Quality Strategy for Social Care (2000) seeks consistency and excellence in care services and enhanced service partnerships. It states that this requires improved training for social workers and raises the prospect of a new social work curriculum in which learning for interprofessional and inter-agency practice will be strengthened. The document stresses the importance of evidence in decision-making in social care and this principle applies equally to training but there are few recent research findings on interprofessional and inter-agency learning in the social work curriculum. There are, however, findings from an earlier study which contributed to the mid-1990s review of the Diploma in Social Work but which have not previously been published in the mainstream media. These findings are reported and show: the kinds of organisations and professions with whom social work practitioners were in close contact in their jobs; the importance attached by social workers to defined skills in working with them; the perceived usefulness of training in developing relevant knowledge and skills; perceptions of shared training; and marked differences of learning experience reported by practitioners who had taken different training courses. Each set of findings is described and used as the basis of questions for the new social work curriculum.

Attitude of Health Personnel↗

Developing common learning: the new generation project undergraduate curriculum model.

This paper describes the curriculum model developed for an ambitious interprofessional education programme for health and social care professions implemented in two universities in the south of England (the New Generation Project). An outline of how the New Generation Project has interpreted the meaning of interprofessional learning is presented first. This is followed by an outline of the structure of the programme, describing both learning in common and interprofessional learning components. The pedagogies underpinning this curriculum initiative are presented and an integrated pedagogical model, facilitated collaborative interprofessional learning, is proposed. The New Generation Project curriculum is then discussed as an extension of an established typology of interprofessional education.

Allied Health Occupations↗

Establishing a women's health curriculum using the Delphi Method.

CONTEXT: A Women's Health Initiative Task Force was formed with the collaboration of five primary care medical specialties at the University of Texas Medical Branch (UTMB) at Galveston to address the education of medical students about important issues related to women's health. OBJECTIVE: To identify and prioritize key concepts in issues related to women's health Methods: Literature review and three generational Delphi Method. RESULTS: The content was identified for development of a curriculum in Women's Health for medical students and resident physicians. Objectives, tasks, skills, learning opportunities, and learning materials were defined, and the curriculum is being designed to produce, within all specialties, parallel and consistent opportunities to educate students about issues important for women's health. CONCLUSION: The rankings of topics gathered though the Delphi Method will be used to develop a curriculum in Women's Health Issues that defines objectives, tasks, skills, learning opportunities, and learning materials for the purpose of educating UTMB medical students and resident physicians about the health needs of women.

Curriculum↗

Integrating an end-of-life curriculum into the internal medicine clerkship.

OBJECTIVE: To integrate an end-of-life curriculum into the third-year internal medicine clerkship via communication skills training with standardized patients and a community hospice experience. DESCRIPTION: Clerkship directors identified a lack of exposure to end-of-life issues and hospice care as gaps in our third-year medical student curriculum. This curriculum was implemented to address these deficiencies.

Clinical Clerkship↗

End-of-life curriculum reform: outcomes and impact in a follow-up study of internal medicine residency programs.

BACKGROUND: In 1998 we initiated a pilot project to evaluate the feasibility of recruiting and training internal medicine residency programs in methods designed to enhance and integrate end-of-life (EOL) instruction and assessment into their curriculum. OBJECTIVE: To evaluate participants' assessment of the training program and the 12-month impact of the training on the 32 residency programs' EOL teaching. DESIGN: Prospective multi-institutional study. MEASUREMENT AND RESULTS: After participating in training, all participants agreed/strongly agreed that the skills-related objectives of the training were met. Mean ratings of intention to continue with the program were consistent across trainees representing different academic ranks (F = 2.8, p = 0.07), levels of experience in EOL education (F = 1.3, p = 0.28), and involvement in other national EOL training programs (F = 1.5, p = 0.23). Twelve months after training, most programs (78%) continued with the project and had initiated EOL curriculum reform in seven key EOL domains.). CONCLUSIONS: The study suggests that focused training in EOL teaching methods and institutional change strategies can facilitate EOL curriculum reform.

Curriculum↗

Barriers and solutions to implementing a new curriculum: lessons from the women's health education program at MCP Hahnemann School of Medicine.

The integration of new knowledge into the medical school curriculum is a difficult process. This article proposes effective strategies for overcoming obstacles to curricular integration of women's health and sex and gender topics. Some techniques developed to overcome barriers to the integration of new material into an existing curriculum include faculty development, faculty rewards, development of competencies and assessment tools, interdisciplinary team teaching, standardized patients, and reference resources. An interdisciplinary approach to implementing women's health education, as with most new curricular material, is endorsed for integration of the new field into the medical school curriculum. This proposed model results in general institutional participation and support, especially from senior level leadership. The outlined process enables students and faculty to learn techniques for incorporating emerging information in all disciplines, helping them to become "life-long learners."

Curriculum↗

A model for integrating women's health issues into a problem-based curriculum.

The process of incorporating new material into an existing medical curriculum frequently produces lengthy debate, political maneuvering, and competition for curricular time. The faculty of the Women's Health Education Program at MCP-Hahnemann School of Medicine, developed a stepwise process, or framework, for including women's health teaching for students in the problem-based curriculum. This process can be applied to the integration of any body of information. The key elements of the process are to define the full scope of what needs to be taught, develop teaching objectives, identify opportunities to introduce the information into the curriculum, develop strategies that capitalize on existing curricula, enlist the collaboration of a broad range of key faculty, develop evaluation tools, and assess whether students have achieved the expected competencies.

Curriculum↗

Integrating nutrition as a theme throughout the medical school curriculum.

More than one-third of adult Americans are obese. A major portion of the diseases that cause the highest morbidity and mortality, eg, heart disease, cancer, diabetes, stroke, and hypertension, can be attributed to diet. Yet, despite the demand for more nutrition education, few medical schools have an adequate nutrition curriculum. Many medical schools are reducing the number of lecture hours in favor of problem-based tutorial discussions, so an addition of another mandatory lecture course is not likely. The organization of nutrition as a theme throughout the 4-y medical school curriculum can pull together many hours of nutrition information taught during various courses, eg, biochemistry, physiology, pathophysiology, clinical clerkships, and electives. Emphasis should be placed on the identification of available resources (eg, faculty throughout the medical school and affiliated hospitals, textbooks, research, and clinical experiences) and applied to practical clinical situations so that students are able to identify, assess, and appropriately manage the frequent nutritional problems seen in outpatients and inpatients. Strategies and techniques such as curriculum analysis, computer-aided instruction modules, Internet Web sites, case-based tutorial discussions, use of physician nutrition specialists and dietitians, administratively separate nutrition units, observed structured clinical examinations, and faculty development are listed and discussed in this article.

Curriculum↗

Development of a case-based integrated nutrition curriculum for medical students.

The Nutrition Education and Prevention Program at the University of Pennsylvania School of Medicine is a successful program that can be used as a model for the development and implementation of a case-based nutrition curriculum across the 4-y medical school experience. This article gives a broad overview of the development, implementation, evaluation, and dissemination processes used by the Nutrition Education and Prevention Program administration and core faculty group at the University of Pennsylvania School of Medicine. Beginning in 1990, the nutrition curriculum was initiated with the assistance of several funding sources. The program was structured using a multidisciplinary faculty group of physicians and registered dietitians from multiple departments, centers, and institutes. The outcome of this process is a textbook, Medical Nutrition and Disease, currently required by numerous medical schools, residency programs, and other health professional programs across the nation. With the use of data from the Association of American Medical Colleges All Schools Survey of Graduating Medical Students, perceptions of the adequacy of nutrition education were tracked over time. In 1991, 80% of University of Pennsylvania medical students felt that nutrition coverage was inadequate compared with 10% of medical students in 1998, a significant change resulting from the nutrition program's effect. The University of Pennsylvania School of Medicine has developed and implemented a successful nutrition curriculum, despite national trends. The case-based integrated curricular model presented in Medical Nutrition and Disease and on our Web site, www.med.upenn.edu/nutrimed, can be used by medical institutions and other health professionals.

Clinical Clerkship↗

The interaction of curriculum type and implementation method on 1-year smoking outcomes in a school-based prevention program.

Studies have shown that the effectiveness of programs or curricula may depend in part on who delivers the material. In adolescent health education programs, peer leaders are often recruited to implement programs because they are more persuasive to other adolescents than adults. Teachers also systematically vary how groups are constructed in school-based health education programs. This study compared the effects of three leader and group selection methods within the context of two tobacco prevention programs. Eight schools received a social influences program (Chips) and eight received a program with a multicultural emphasis (Flavor). Within these 16 schools 84 classrooms consisting of 1486 students were randomly assigned to one of three leader and group creation conditions: (i) leaders defined as those who received the most nominations by students and groups created randomly (random group), (ii) same as (i) but groups created by assigning students to the leaders they nominated (network), and (iii) leaders and groups created by teachers (teacher). One year follow-up data showed that main effects of the curriculum and network assignments were non-significant on smoking initiation when entered alone. Interaction terms of curriculum and assignment methods, however, were significant such that the network and teacher conditions were less effective than the random group condition with Chips, and more effective than random group condition with Flavor. These data show that school-based prevention programs should be evaluated in light of who implements the program. Even a peer-led program will be differentially effective based on how leaders are selected and how groups are formed, and this effect may be curriculum dependent.

Child↗

They tried reality therapy, but he froze in a cave: curriculum deficits.

Social workers increasingly are called on to work with mentally ill people, but in most cases they are not trained to do so. There is a significant lag between what researchers have found, particularly in the biological fields, and what educators teach in social work schools. This article describes curriculum deficits in teaching about mental illness and the devastating consequences of those deficits. It then outlines a suggested curriculum and appropriate teaching methods. Social workers are called to take the lead in curriculum reform; when they do, students will follow.

Adult↗

Implementing the Public Health Social Work Forward Plan: a research-based prevention curriculum for schools of social work.

In 1985, the Division of Maternal and Child Health of the U.S. Public Health Service funded a major working conference entitled "Public Health Social Work in Maternal and Child Health: A Forward Plan." Curriculum recommendations for schools of social work were made, including a recommendation for the integration of health and mental health content in the education of social workers within a public health conceptual framework. In 1986, the National Institute of Mental Health funded a three-year program to develop and evaluate a research-based prevention training curriculum for dissemination to schools of social work and other primary care professional schools. This article examines the Michigan Prevention Training and Curriculum Development Project from the perspective of the recommendations of the Public Health Social Work Forward Plan.

Curriculum↗