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PubMed1992

Guidelines on undergraduate curriculum in the UK. Education Committees of Arthritis and Rheumatism Council and British Society for Rheumatology.

Symptomatic locomotor abnormalities are common in medical in-patients, form a significant part of a general practitioner's workload, and are the single most important factor influencing disability in later life. That any qualifying doctor should have basic competencies with respect to the locomotor system thus seems appropriate. A survey of medical schools undertaken jointly by the Arthritis and Rheumatism Council (ARC) and British Society for Rheumatology (BSR) in 1990, however, suggests that the locomotor system still has a relatively low priority in undergraduate medical training. In 1990 therefore, the Education Committees of ARC and BSR established a joint working party to define guidelines on an undergraduate curriculum for rheumatology. These guidelines were discussed and developed at a Workshop in Oxford, and circulated to the Deans and Chairmen of Curriculum Committees at all UK Medical Schools in October 1991. It is hoped these guidelines will encourage inclusion of basic rheumatological competencies within the 'core' curriculum for all medical undergraduates.

Curriculum↗

PubMed1991

Integrating substance abuse education in the medical student curriculum.

Physicians miss the diagnosis of substance abuse in significant numbers of patients, partly because of a lack of education about identifying and treating those patients. This article describes an attempt to integrate substance abuse into the curriculum of a traditionally organized medical school. Faculty selection, determination of the skills and knowledge needed, and methods for enriching the curriculum to include substance abuse are described. Problems encountered during the project, benefits of implementing the curriculum changes, and recommendations for other medical schools choosing to implement such a program also are provided.

Curriculum↗

PubMed1979

Developing the medical curriculum at King Abdulaziz University.

The kingdom of Saudi Arabia has placed a high priority on medical education. King Abdulaziz University is developing a medical curriculum aimed at being responsive to the health needs of the people of the kingdom. In creating the curriculum, planners devoted considerable time and effort to studying health manpower resources and needs, regional developments, demographic patterns, socioeconomic and cultural factors, general education development plans, vital statistics, and existing and projected health facilities. These and many other factors played a role in determining the format and the content of the curriculum, which is intended to produce individuals for leadership roles as medical educators, medical practitioners, and researchers.

Adolescent↗

PubMed1987

Family practice residents' evaluation of a competency-based psychiatry curriculum.

The authors report the formal evaluation of a competency-based curriculum in psychiatry in a family practice residency program at a community hospital five years after the program was implemented. In interviews, the 35 residents in the program in 1985 responded to a questionnaire on their understanding of and attitude toward the requirements of the competencies and the difficulties they encountered in documenting the competencies. All but two of the residents were aware of the nature of the curriculum, but only 43 percent had completed one or more of the 15 required competencies. The residents' attitude toward the requirements of demonstrating specific competencies in psychiatry during the residency were generally negative, although they were favorable toward required competencies in other disciplines. The results of the present study identify specific problems in implementing such a curriculum. Successful implementation may have been impeded by the novelty of the new educational format and a lack of reinforcement by faculty members.

Competency-Based Education↗

PubMed1989

The development of a medical ethics curriculum in a General Internal Medicine Residency Program.

Since 1984, a three-year curriculum in medical ethics has operated at Rhode Island Hospital as part of the General Internal Medicine Residency Program at the Rhode Island Hospital and Brown University. The residency program was founded in 1980 to develop a model training program for internal medicine residents with a primary care focus. The three objective of the curriculum are (1) to enable residents to recognize the ethical implications of both inpatient and outpatient clinical cases, (2) to teach residents to recognize ethics issues and alternatives in order to arrive at a well-rounded clinical strategy, and (3) to help them learn to communicate sensitively with patients and others about these ethics issues and proposed management plans. The six major topics covered by the curriculum (for example, informed consent) are co-taught in a seminar format by one or more of the three members of the multidisciplinary ethics faculty (a philosopher, an internist, and a communications specialist) and experienced physicians. The authors describe the program, the roles of the various faculty members, the program's focus on case discussions, the receptivity of the residents and faculty to the program, the use and training of a multidisciplinary faculty, efforts aimed at evaluation, and future directions of the program.

Bioethical Issues↗

PubMed1994

Long-term follow-up of an alternative medical curriculum.

BACKGROUND: The Alternative Curriculum (AC), an elective program at the University of Virginia School of Medicine that enrolled a total of 48 students in 1973 and 1974, was one of many demonstration and pilot programs conducted during the 1970s. Its principal features were (1) a three-year time span; (2) early, prolonged, and intensive instruction in clinical skills; (3) intensive consideration of behavioral, social, economic, ethical, and legal aspects of medicine in a patient-centered curriculum; (4) an extensive course in sexuality; (5) an independent study format for two preclinical courses; (6) instruction in cardiopulmonary resuscitation; and (7) participation in the activities of the local rescue squad. In view of continuing questions about the structure and content of medical school curricula, it seemed worthwhile to try to determine what effects the program might have had on the participants during medical school and in their subsequent careers. METHODS: In 1991, data on the AC participants were collected, largely by means of a survey but also by examination of the participants' medical school records and determination of their current professional status. RESULTS: Of the 48 participants, 44 were available for the survey, and 37 returned completed questionnaires. The great majority of the respondents had positive opinions about the program's three-year time span, morale during the program, and beneficial effects of the program's special content during their clerkships, postgraduate training programs, and subsequent careers. They thought they had had enough time to make informed specialty choices and did not think that their participation in the AC had been a handicap in getting the internships they wanted. Fewer than half of the students thought that the AC had influenced their career choices, and only 26% were currently in primary care specialties. CONCLUSION: The AC was successful in improving students' morale during the preclinical segment, preparing them for clerkships, and increasing their sensitivity to the patient as a whole. That the program was not effective in inducing students to enter primary care specialties supports the view that curriculum content is not a major factor in students' choices of specialty.

Career Choice↗

PubMed1996

Developing and evaluating the student assessment system in the preclinical problem-based curriculum at Sherbrooke.

BACKGROUND: Students' learning was used as an outcome measure in the first phases of the major curriculum reform started in 1987 by the Université de Sherbrooke Faculty of Medicine, which shifted from a traditional to a student-centered, problem-based learning (PBL) and community-oriented program. The system for evaluating preclinical students' learning is intended to reinforce the integration of basic and clinical sciences. METHOD: To discover whether the evaluation system was fulfilling its intended goals, the authors used data from the classes of 1991-1993 to assess the reliability and validity of three evaluation instruments. The three instruments were (1) written examinations composed of multiple-choice questions (MCQs), short-answer questions (SAQs), and problem-analysis questions (PAQs); (2) PBL tutor rating forms that evaluate students' reasoning skills, communication and group-interaction skills, and autonomy and humanism; and (3) clinical skills evaluations, including objective structured clinical examinations (OSCEs). The weights allocated to the instruments reflected how the faculty valued each evaluation dimension in each of the three phases of the preclinical curriculum. RESULTS: Reliability indexes improved throughout the system implementation. The written examinations proved to have content validity according to the PBL learning objectives. As evaluated by students, the PAQs were found to be at a taxonomic level that assessed ability to analyze information a third of the time in the first year of implementation of the PBL curriculum and 17% in the second year. Variations and correlations of students' mean performances across instructional units and between the evaluation instruments led to the development of a student longitudinal performance profile to be used before yearly promotion decisions are proposed. The profile was introduced in the fifth year of PBL implementation. CONCLUSION: The system allows students to learn higher-taxonomic-level content and fulfills the institution's social responsibility of judging program outcomes and promoting qualified students, although evaluation by PBL tutors is still psychometrically questionable and the measurement of students' reasoning and ability to analyze problems is still an unfinished evaluation task.

Clinical Competence↗

PubMed1996

Exploratory factor analysis of students' ratings of a problem-based learning curriculum.

PURPOSE: To identify the factor structure underlying medical students' initial experience with a problem-based learning (PBL) curriculum and to examine the stability of this structure as students acquire further experience with PBL. METHOD: The PBL curriculum at the Michigan State University College of Human Medicine begins in the students' second year and is divided into 11 domains. In 1992-93 students were asked to evaluate their learning experiences in the first and last domains of their first PBL semester, by using a five-point Likert scale to rate 19 items. Principal-components analysis and varimax rotation were used to identify the factors underlying the students' ratings. RESULTS: Ratings of the first and last domains were available from 101 and 71 students, respectively. Analysis yielded four meaningful factors: learning materials, small-group process, tutor effectiveness, and academic support. These four factors shifted in relative importance as the students progressed through the curriculum: for the first domain, tutor effectiveness accounted for the highest percentage of variance in the data; for the last domain, this factor ranked third, after learning materials and small group process. Internal reliabilities for the ratings of the last domain of the semester were higher and more consistent, ranging from .92 to .97. CONCLUSION: The students' initial dependence on the tutor progressed to an emphasis on learning resources. This shift is congruent with the theoretical model of the dynamics of PBL. The results suggest that the survey instrument provides a reliable measure of the multidimensional constructs underlying students' experience with PBL.

Curriculum↗

PubMed1997

A national survey to define a new core curriculum to prepare physicians for managed care practice.

All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of curricular components exist but in s some cases needed to be modified to more clearly relate to managed care practice, and that their findings may provide a useful starting point for making decisions about curricular reform.

Curriculum↗

PubMed1999

A longitudinal ethics curriculum for medical students and generalist residents at the Medical College of Georgia.

Medical ethics is an important instructional area for both the undergraduate student pursuing a generalist education and generalist residents. With the support of a Generalist Physician Initiative (GPI) award from The Robert Wood Johnson Foundation, the Medical College of Georgia has implemented a longitudinal experience in clinical ethics spanning the four undergraduate years to make this area more meaningful and clinically relevant. This report outlines the structure and content of this four-year curriculum, which has been developed and implemented in a stepwise fashion since 1996. Course themes and students' activities during the four years are described. Since 1997, a shared curriculum in ethics--developed for residents in internal medicine, family medicine, and pediatric generalist programs--has been provided in combined interdepartmental conferences as part of a broader interdepartmental generalist curriculum. Early evaluation findings and plans for future evaluation programs are also described.

Curriculum↗

PubMed2000

The development of professionalism: curriculum matters.

The authors propose that professionalism, rather than being left to the chance that students will model themselves on ideal physicians or somehow be permeable to other elements of professionalism, is fostered by students' engagement with significant, integrated experiences with certain kinds of content. Like clinical reasoning, which cannot occur in a vacuum but must be built on particular knowledge, methods, and the development of skills, professionalism cannot flourish without its necessary basis of knowledge, methods, and skills. The authors present the need for an intellectual widening of the medical curriculum, so that students acquire not only the necessary tools of scientific and clinical knowledge, methods, and skills but also other relevant tools for professional development that can be provided only by particular knowledge, methods, and skills outside bioscience domains. Medical students have little opportunity to engage any body of knowledge not gained through bioscientific/empirical methods. Yet other bodies of knowledge-philosophy, sociology, literature, spirituality, and aesthetics are often the ones where compassion, communication, and social responsibility are addressed, illuminated, practiced, and learned. To educate broadly educated physicians who develop professionalism throughout their education and their careers requires a full-spectrum curriculum and the processes to support it. The authors sketch the ways in which admission, the curriculum (particularly promoting a sociologic consciousness, interdisciplinary thinking, and understanding of the economic/ political dimensions of health care), and assessment and licensure would function.

Clinical Competence↗

PubMed2001

How did we make the Interdisciplinary Generalist Curriculum Project work? School-level efforts to facilitate success.

This article examines how the schools funded by the Interdisciplinary Generalist Curriculum (IGC) Project handled the process of planning and implementing their proposals; incorporated the IGC requirements as templates for changes in educational programs and organizational infrastructures; and identified key educational and management issues that emerged over time. How collaboration flourished at each IGC school was the central functional ingredient for successful implementation. Shared power and support from the dean were essential for success. The need for excellent channels of communication among all constituencies in the process of curricular change cannot be overemphasized. The most common approach was the addition of the new interdisciplinary clinical curriculum to the existing, usually discipline-based, curriculum, with attempts to establish integrative horizontal connections among concurrent courses in years one and two. The integration, sequencing, and correlating of basic science and clinical material occupied much of the IGC course directors' time in the early stages. Several approaches were used to help ensure a beneficial initial clinical experience for medical students, while accepting that a uniform experience for all students was not attainable or necessary. Encouraging active learning on the part of students was a goal of IGC schools' planning in and of itself. The splash of establishing interdisciplinary communication structures and greater melding of disciplinary cultures that occurred at and among the IGC schools appeared to lead to ripple effects that were recognized within the first year of planning and early implementation.

Communication↗

PubMed2001

The Interdisciplinary Generalist Curriculum Project at the University of California, San Francisco.

The Interdisciplinary Generalist Curriculum (IGC) Project came at a pivotal time in curriculum development at the University of California, San Francisco, School of MEDICINE: In the three years prior to the project, the curriculum committee had considered implementation of early longitudinal clinical experiences. This had not been proposed as a primary care experience. Introduction of generalist skills, with the goal of increasing numbers of students choosing generalist residencies, presented significant challenges at this tertiary care and research-oriented medical school. The new IGC course, Foundations of Patient Care, consists of on-campus lectures, small-group sessions, physical examination skills instruction, and a six-quarter preceptorship. As proposed, the school increased teaching of generalist skills and competencies and developed a large pool of primary care preceptors. There was no change in the number of graduates choosing primary care. The strong collaboration that resulted from the development of this new course served as a catalyst for major curricular reform now under way at this medical school.

Curriculum↗

PubMed2001

The Interdisciplinary Generalist Curriculum Project at the University of Wisconsin Medical School: the Generalist Partners Program.

The Generalist Partners Program (GPP) provides all University of Wisconsin Medical School students with a comprehensive generalist core curriculum through early clinical experiences, interactive faculty presentations, and small-group discussions during the first two years of medical school. The GPP is the first component of a comprehensive, longitudinal generalist curriculum offered during all four years of medical education. Faculty members from family medicine, general internal medicine, and general pediatrics work together to develop the learning goals and provide the curriculum for the GPP courses. Each of the 145 entering first-year medical students is matched with a community-based physician, the generalist practice partner, and the students participate in early clinical experiences at this site throughout their first two years of medical education. Students' clinical experiences are presented and discussed in case-based small-group sessions led by the school's generalist faculty. A core lecture series on professionalism, communication skills, evidence-based medicine, and the organization of the health care system supplements the early clinical experiences.

Curriculum↗

PubMed2001

Self-reported competency ratings of graduates of a problem-based medical curriculum.

PURPOSE: To study the self-reports of professional competencies by graduates of a problem-based medical curriculum. METHOD: All graduates from a medical school and a faculty of health sciences with a problem-based curriculum were sent a questionnaire asking them to compare their own performances in 19 domains with those of colleagues trained at schools with conventional curricula. RESULTS: Overall, alumni of the medical school rated themselves as better than colleagues who were trained at schools with conventional curricula for cooperation skills, problem-solving skills, skills relevant to running meetings, and the ability to work independently. There was no difference for possession of general academic knowledge and writing reports or articles. The self-reported ratings of better competencies were maintained after correcting the data for self-overestimation. CONCLUSION: The problem-based medical curriculum appears to contribute to the development of professional competencies. Further study is needed, however, to control for the effect of selection bias and respondents' emotional commitment to their alma mater.

Attitude of Health Personnel↗

PubMed2003

Medicine and the arts in the undergraduate medical curriculum at the University of Oslo Faculty of Medicine, Oslo, Norway.

The authors describe a course titled Medicine and the Arts, established in 1996, that is part of the first semester of the undergraduate medical curriculum at the University of Oslo Faculty of Medicine. The course comprises four two-hour seminars on literature, visual arts, architecture, and music. The core objectives of the course are to demonstrate how art can be a source of personal and professional development, and also how art represents a source of insight into patients' experiences and the social, cultural, and historical context of medical practice. The course emphasizes that art is ambiguous and many layered and that its interpretation requires sensitivity, engagement, imagination, and reflection. Fostering these skills is a major aim of the course because these skills are also essential for clinical competence and professional development. The course's seminars are integrated into the curriculum but are not compulsory. Although the topics covered by the course have not been explicitly addressed in the formal examination of students, there has been some discussion about doing so, which would be a signal that those topics are as important as others in the curriculum.

Curriculum↗

PubMed1991

Curriculum for musculoskeletal radiology.

Although general suggestions have been made regarding a radiology residency curriculum, no specific list of entities has been offered. Over the past ten years, we have developed a resident-run morning conference in musculoskeletal radiology that is supervised by faculty and covers a specific curriculum. We offer our curriculum as an example that may assist other departments in developing their own curricula.

Curriculum↗

PubMed2003

An innovative curriculum for primary care neonatology.

This article describes the design of an innovative curriculum for pediatric residency newborn nursery rotation. In 1989, the Accreditation Committee for Graduate Medical Education added the requirement of newborn care to pediatric residency training; in 1996, the Accreditation Committee for Graduate Medical Education expanded that requirement. Specifically, certification required 4 weeks of newborn care, separate from any neonatal intensive care experience, and with at least 2 weeks in a newborn nursery. In response, we designed a structured newborn nursery curriculum for our pediatric residency training program. Three areas of focus were identified, from which the content and the strategies for teaching were derived. The areas of focus were (1). primary care, (2). confluence of levels of care that arise in newborn care, and (3). limitations and advantages of the structure and the environment of the rotation. The curriculum was implemented on a pediatric level 1 (PL-1) rotation entitled "primary care neonatology."

Boston↗