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PubMed1999

The core content of the undergraduate curriculum in Manchester.

AIM: To identify the core content for the new undergraduate medical curriculum in Manchester. METHOD: The initial step was to produce a list of 'index clinical situations' (ICSs), for which a newly graduated doctor must have a required level of competence. Using repeated consultation with consultants and general practitioners involved in medical education in the North-West of England, a list of 215 ICSs was agreed. Specialists and generalists were then asked to identify the components of the knowledge base and the performance (skills) base for each ICS. The knowledge base was divided into technical (biomedical facts/concepts) and contextual (effect/management of disease within the individual, family and society) domains. The performance base was divided into intellectual (problem solving and decision making) and interpersonal (history, examination, communication and procedural skills) domains. RESULTS: Forty specialties were consulted and 11,021 items (defined as a piece of knowledge, a concept or a skill) were identified. There was considerable overlap in the items listed, such that when the returns for each ICS were amalgamated, the 215 ICSs contained 6434 items with a mean of 34 +/- 14.2 per situation (range 6-85). UTILISATION: We have used the defined ICSs in the design of the trigger material used in the weekly problem-based learning sessions. Over 4 years almost all (207/215, 96%) of the ICS are covered, with many being revisited at several points in the curriculum.

Competency-Based Education↗

PubMed2000

The role of basic sciences in a problem-based learning clinical curriculum.

BACKGROUND: Very little is known about the use of problem-based learning (PBL) during the later years of the undergraduate medical course and how it influences further acquisition of basic science knowledge. Similarly to many other Faculties, the PBL approach is used at Manchester in years 1 and 2, but more unusually, the curriculum continues to be centred on PBL in the clinical modules. OBJECTIVES: To explore whether and how basic science learning was continued in year 3 of the PBL clinical curriculum. METHODS: 10 of the weekly problems from the two core modules in year 3 were analysed to determine: (a) whether the design teams were using basic science objectives in devising the problems, and (b) whether PBL student groups were setting basic science learning objectives. The basic science knowledge of year 3 and 4 students was also measured. RESULTS: Similar numbers of objectives were being set by the management groups for each weekly problem (Heart, lung and blood (HLB) module, median 15, range 11-20; Nutrition, metabolism and excretion (NME) module, median 13, range 9-21). In the basic sciences, there was a median of 3 objectives per problem (range 0-6) in the NME module, but only 1 objective (0-2) per problem in the HLB module. The objectives set by six PBL groups in each module were analysed. Overall, agreement was reached on 130 occasions (62%) between the design team basic science objectives and those set for themselves by the student groups. In addition, there was a median of 2 (range 1-8) new basic science objectives brought out by the PBL groups that were not listed by the HLB module design team. In the NME module, there was again a median of 2 new objectives (range 0-6). The performance of year 3 and year 4 students in the multiple-choice questions progress test was analysed. For the 65 basic science questions, the year 3 mark was 40.8 +/- 12.3% compared with 57.1 +/- 12.3% for year 4 (P < 0.0001). CONCLUSIONS: (a) The design teams are setting basic science objectives; (b) the working problems are triggering students to set learning objectives in the basic sciences; (c) most of the objectives being set by the design teams are being triggered in the majority of group sessions; (d) the students knowledge of basic sciences increases in years 3-4.

Curriculum↗

PubMed2002

Child health and obstetrics-gynaecology in a problem-based learning curriculum: accepting the limits of integration and the need for differentiation.

BACKGROUND AND OBJECTIVES: The University of Manchester's undergraduate curriculum was reorganised in 1994. Problem-based learning (PBL) was chosen as the central educational method throughout the 5 years. A thematic interdisciplinary style provided a framework around which to select and integrate content. The theme for family, reproductive and child health for the 14-week Families and Children Module (FCM) in year 4 integrated content from obstetrics-gynaecology, paediatrics (including child psychiatry), genetics and public health. This paper focuses on the FCM which has put to test some of the principles of integration. METHODS: The educational process and outcome of the FCM was evaluated with information from (1) Open Forum feedback sessions (2) student questionnaires and (3) students' performance in an objective structured clinical examination (OSCE). RESULTS: Significant problems were encountered during the first year of the FCM (1997--98). An Open Forum for all students and staff was convened after each module in order to address the level of concern. Students' responses to questionnaires reflected the overall impression obtained from the Open Forum. Difficulties appeared to be more than the anxieties and challenges inherent in organisational change and were not simple practical timetabling problems. Tutors perceived a loss of coherence and student contact; students reported difficulties maintaining sufficient continuity of focus in clinical and academic learning experiences. The intended level of integration of paediatrics and obstetrics-gynaecology was unmanageable. Consequently, the FCM (1998-99) was divided into separate attachments for clinical learning and experience in paediatrics and obstetrics-gynaecology, each of 7 weeks' duration. Further open feedback sessions revealed that the modifications implemented in 1998-99 were associated with positive experiences for students and tutors. Comparison of responses to the evaluation questionnaires showed that students' overall rating of the module was higher (P=0.002) for 1998-99 (mean 3.4, SD 0.9) than for 1997-98 (mean 3.0, SD 1.1). CONCLUSIONS: We emphasise that horizontal integration can result in an experience of disintegration for students and tutors. Certain disciplines, such as paediatrics and obstetrics-gynaecology, may not have enough in common for full curriculum integration.

Curriculum↗

PubMed2002

Anatomy 1999-2000: the curriculum, who teaches it and how?

AIM: To review the impact of Tomorrow's Doctors on anatomical teaching in the UK and Ireland. To establish in particular whether a consensus has emerged on: (a) the duration and format of teaching, and (b) the impact on staffing and on the four main anatomical disciplines of gross anatomy, histology, embryology and neuroanatomy. METHOD AND RESULTS: A postal survey of 28 anatomy departments was carried out. This yielded a response rate of 75%. Twelve departments used systems-based curricula, five used problem-based curricula, and four used a traditional regional format. There were variable levels of integration between the anatomical disciplines and subjects outside anatomy. Dissection taught over the first 2 years was retained in 76% of the courses, frequently supplemented with demonstrations, with an average of 2 hours of practical work for every hour of lecture. Staff/student ratios varied with the type of curriculum: dissection room teaching and problem-based curricula were associated with higher numbers of either full or part-time clinically qualified teachers. Teaching was supported by a high proportion of part-time clinically qualified staff, giving an overall average staff/student ratio of 19.8 in a dissection class. CONCLUSIONS: There is considerable variation in duration and staffing of anatomy teaching, according to the type of curriculum. This suggests there may well be substantial variation in the level, content and depth of anatomical curricula across the country, and that this should be quantified.

Anatomy↗

PubMed2003

A follow-up of medical graduates of a problem-based learning curriculum.

INTRODUCTION: There is little information available on the effects of problem-based undergraduate curricula on doctors and their performances after graduation. Therefore, we conducted a questionnaire study of all graduates of the new medical programme at the Faculty of Health Sciences, Linköping University. METHODS: All 446 medical students who had graduated from the new programme were asked to fill in a questionnaire about selected activities during their studies and their careers after graduation. They were also asked to evaluate the quality of their undergraduate education retrospectively. Statistical analysis was performed using descriptive, multivariate and bivariate approaches. RESULTS: A total of 77% of the graduates responded. They showed a high degree of overall contentment with their undergraduate education and felt well prepared for professional life during their preregistration period and specialist education (mean = 4.0 on a 6-point Likert scale ranging from 0 to 5). They felt especially well prepared in terms of skills for communication with patients, collaboration with other health professionals and development of critical thinking/scientific attitudes. The students' age at the beginning of their studies correlated positively with their contentment as graduates, especially in terms of preparation for patient communication and collaboration with other health professionals. No differences between students originally admitted via a local admission procedure and those admitted via a national procedure were detected concerning retrospective evaluation of undergraduate medical education. CONCLUSION: Graduates of the new curriculum showed a high degree of satisfaction with their undergraduate education and its preparation of them for medical practice. Specifically, they were very content with the particular emphases of the new curriculum.

Adult↗

PubMed2003

The limits of tutors' comfort zones with four integrated knowledge themes in a problem-based undergraduate medical curriculum (Interview study).

PURPOSE: To explore how a cohort of problem-based learning (PBL) tutors (with diverse medical and other content expertise) conceptualised their students' integrated learning agenda, particularly for content less familiar to the vast majority, such as public health elements. SETTING: Problem-based undergraduate medical curriculum, The University of Liverpool, in its first-ever year. PARTICIPANTS: Foundation PBL tutors for Year 1 students, Semester 1. METHOD: A cross-sectional, semistructured telephone interview study was undertaken during spring 1997, with open-ended questions about Semester 1 experience of the four main themes. Qualitative data were analysed inductively and iteratively for emerging patterns and instances. RESULTS: All 34 tutors responded. Of these, 26/34 (76%) were male and 23 (68%) were medically qualified. Towards the end of each approximately (median) 20-minute interview, reflecting on the curriculum themes, tutors mostly identified with the basic/clinical science theme (Structure and Function). Almost half articulated a clear division (implicitly or explicitly 'fact' versus 'non-fact') between it and the 'other three' themes of behavioural science, population science, and ethicolegal aspects of professional practice, respectively. Only 14/34 (41%) of tutors (including both public health doctors) outlined the public health-based theme adequately without disclosing confusion, antagonism/indifference or difficulties/uncertainty. CONCLUSION: This study provides baseline qualitative insights about new PBL tutors' insecurities when facilitating student discussion across integrated content. Given the difficulties of recruiting suitable educators into this role and potential resource limitations, staff retention and development strategies still must confront the reality of PBL tutors' bemusement when they are placed outwith their usual comfort zones.

Adult↗

PubMed2004

First year medical student stress and coping in a problem-based learning medical curriculum.

OBJECTIVE: To examine the prevalence of psychological morbidity, sources of stress and coping mechanisms in first year students in a problem-based learning undergraduate medical curriculum. DESIGN: Longitudinal cohort questionnaire survey. SETTING: Glasgow University Medical School. PARTICIPANTS: All first year students (n = 275) in the 1997-98 intake. MAIN OUTCOME MEASURES: Scores on the 12-item General Health Questionnaire (GHQ-12), sources of stress and coping strategies. RESULTS: The prevalence of psychological morbidity and mean GHQ-12 scores increased significantly between term 1 and term 3, with no significant gender differences. Principal stressors were related to medical training rather than to personal problems, in particular uncertainty about individual study behaviour, progress and aptitude, with specific concerns about assessment and the availability of learning materials. The group learning environment, including tutor performance, and interactions with peers and patients caused little stress. Students generally used active coping strategies. Both stressor group scoring and coping strategies showed some variation with gender and GHQ caseness. CONCLUSIONS: Increased student feedback and guidance about progress throughout the year and the provision of adequate learning resources may reduce student stress. Educational or pastoral intervention regarding effective coping strategies may also be beneficial. Continued follow-up of this cohort could provide information to inform further curriculum development and, if appropriate, aid the design of programmes for the prevention of stress-related problems.

Adolescent↗

PubMed1999

A medicolegal curriculum for internal medicine residents.

Many residents lack knowledge about medicolegal issues. To assess the ability of 64 primary care residents to learn legal medicine, we studied the impact of a medicolegal curriculum in a randomized, controlled study. We measured residents' medicolegal knowledge using a novel test, the Legal Medicine Evaluation (LME). We found that the mean LME score of residents exposed to the curriculum increased 15.5 points (on a 100-point scale) to 65.9 ( p <.01), while the mean LME score of control residents increased only 3.5 points, to 53.5 ( p =. 05). Clearly, residents can learn basic medicolegal principles. Thus, observed deficiencies in medicolegal knowledge most likely arise from inadequate medicolegal instruction.

Chi-Square Distribution↗

PubMed2000

Evaluation of a national curriculum reform effort for the medicine core clerkship.

BACKGROUND: In 1995, the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM) developed and disseminated a new model curriculum for the medicine core clerkship that was designed to enhance learning of generalist competencies and increase interest in general internal medicine. OBJECTIVE: To evaluate the dissemination and use of the resulting SGIM/CDIM Core Medicine Clerkship Curriculum Guide. DESIGN: Survey of internal medicine clerkship directors at the 125 medical schools in the United States. MEASUREMENTS AND MAIN RESULTS: The questionnaire elicited information about the use and usefulness of the Guide and each of its components, barriers to effective use of the Guide, and outcomes associated with use of the Guide. Responses were received from 95 clerkship directors, representing 88 (70%) of the 125 medical schools. Eighty-seven (92%) of the 95 respondents were familiar with the Guide, and 80 respondents had used it. The 4 components used most frequently were the basic generalist competencies (used by 83% of those familiar with the Guide), learning objectives for these competencies (used by 83%), learning objectives for training problems (used by 70%), and specific training problems (used by 67%); 74% to 85% of those using these components found them moderately or very useful. The most frequently identified barriers to use of the Guide were insufficient faculty time, insufficient number of ambulatory care preceptors and training sites, and need for more faculty development. About 30% or more of those familiar with the Guide reported that use of the Guide was associated with improved ability to meet clerkship accreditation criteria, improved performance of students on the clerkship exam, and increased clerkship time devoted to ambulatory care. CONCLUSION: This federally supported initiative that engaged the collaborative efforts of the SGIM and the CDIM was successful in facilitating significant changes in the medicine core clerkship across the United States.

Baltimore↗

PubMed2002

The internal medicine subinternship: a curriculum needs assessment.

Despite broad acceptance of the internal medicine subinternship rotation by the undergraduate medical education community, only a small fraction of programs provide students with explicit learning objectives. To design a curriculum for the medical subinternship, we surveyed 3 different groups of educational stakeholders--subinternship directors, residency program directors, and housestaff--in order to identify and prioritize the competencies that should be learned during this rotation. This study provides a starting point for the development of a structured curriculum for the fourth-year subinternship rotation.

Clinical Competence↗

PubMed2003

Use of an outcomes research collaborative training curriculum to enhance entry-level dietitians' and established professionals' self-reported understanding of research.

This project pilot tests a unique outcomes research training curriculum that prepares entry-level dietitians (goal 1) and provides established dietetics professionals with the resources to successfully execute an outcomes research plan (goal 2). The learning objectives for each goal were met via lectures and assignments in two courses, one taught in the fall and one in the winter semester of the second (senior) year of the Coordinated Program at the University of Missouri. At their respective healthcare facilities, registered dietitian (RD) preceptors along with the students progressed through all stages of the research process, from proposal development to data presentation. At the completion of the process, a questionnaire was administered to students and preceptors to evaluate the curriculum. Fourteen of the 15 possible student respondents and four of the five possible RD preceptors returned their questionnaires. Salient findings as well as actions to be taken in subsequent course offerings include: (a) clarify expectations, (b) limit geographical distance, (c) increase in-class time, (d) limit project scope, (e) add more statistics training/practice, (f) introduce outcomes research earlier, (g) preceptors' participation was positive. This endeavor allowed us to acquire the information and experience required to make outcomes research training a more significant component of dietetics education.

Cooperative Behavior↗

PubMedDate not supplied

Transition to community-based nursing curriculum: processes and outcomes.

As the health care delivery system evolves, nurse educators must prepare graduates who can meet the comprehensive health needs of communities in a variety of settings. This article describes one college's process of curricular change from a traditional to community-based format. The concepts that guided curriculum development and implementation are presented, along with the outcomes that have resulted from this change. Lessons learned as the curriculum was restructured are described.

Community Health Nursing↗

PubMed1999

Delphi technique: one cycle of an action research project to improve the pre-registration midwifery curriculum.

Facilitating a unified interpretation of new or re-designed curricula can be problematic in multi-sited universities. This paper discusses the use of the Delphi technique when implementing an innovative pre-registration midwifery curriculum. It formed one of the action research cycles of the author's doctoral study and was used in an attempt to seek the views of all midwife teachers and achieve a critical mass consensus. The most important issues that emerged from the Delphi process were grouped into four categories. These four categories (the teacher's base site, communications, staff development and administration issues) formed the agenda for a staff away day. The outcome of the process was the generation of a list of priorities and actions for curriculum implementation and the identification of ways in which staff development needs might be met more effectively. An unexpected, but equally important, outcome was the way it helped with team building and agreement on positive actions for its further development.

Attitude of Health Personnel↗

PubMed2000

[Implementation of a quality management system for the curriculum in emergency medicine education].

Medical teaching, training and education in basic and advanced life support were improved by basic quality management procedures. 3rd year medical students (n = 276) of two consequent semesters were questionnaired about their acute emergency medicine curriculum. While Group A (n = 134) received a standard course, the new course for group B (n = 142) was reorganised on the basis of the results of group A. Interventive educational measures were an increased number of models provided for exercising the students skills, and an extension of megacode training possibilities. Participation of students in course design improved the overall performance in respect of knowledge, skills and decision-making (p < 0.05). Curriculum acceptance and intrinsic motivation of students however were not positively influenced by practical training compared to traditional knowledge transfer.

Curriculum↗

PubMedDate not supplied

Using multiple data sources for curriculum revision.

Traditionally, curriculum revisions have been made based primarily on guidelines and standards set forth by professional organizations that identify a core of knowledge that pediatric nurse practitioners (PNPs) must know regardless of their practice setting. However, the number and complexity of pediatric health conditions managed by PNPs have expanded beyond this core knowledge. To meet the PNP's changing role and employment needs, curriculum revisions based on the information gathered from surveys of alumni, employers, and a national survey of PNP graduates, as well as on traditional standards and guidelines, were made.

Accreditation↗

PubMed2002

Effects of conflict resolution training integrated into a high school social studies curriculum.

The authors examined the effectiveness of conflict resolution and peer mediation training among California high school students. The authors randomly assigned 2 of 4 classes to receive 5 weeks of conflict resolution and peer mediation training integrated into the required social studies curriculum. The remaining 2 classes studied the same social studies curriculum for an identical amount of time (105 min every other day) without conflict resolution and peer mediation training. The authors investigated 2 issues. The 1st was the effectiveness of the conflict resolution and peer mediation training. The trained students, compared with the untrained students, learned the integrative negotiation and peer mediation procedures better, applied the procedures more completely, chose an integrative over a distributive approach to negotiation, and developed more positive attitudes toward conflict. The 2nd issue was the impact of the training program on academic achievement. Integrating conflict resolution and peer mediation training into an academic course promoted higher achievement, greater long-term retention of the academic learning, and greater transfer of academic learning in social studies to language arts.

Adolescent↗

PubMed2002

Relations between background, process and outcome in the first semester of a new, problem-based medical curriculum.

The authors investigated the relations between students' background (gender, age, study experience), learning process (learning approach, independent study time) and outcome (examination results, satisfaction) in the first semester of a new, integrated undergraduate medical curriculum, combining PBL and conventional learning methods. Data were obtained from official records and from a questionnaire answered by 113 students (response rate 92%). Variables were subjected to multivariate analyses. Significantly more males than females reported a strategic learning approach, and these students were less satisfied and more prone to fail on the exam. Time used on independent study did not predict examination results. The authors suggest that in a problem-based curriculum, the strategic males should be identified and supervised to improve the qualitative aspects of their study behaviour.

Adult↗

PubMed2002

Role of a medical students' association in improving the curriculum at a faculty of health sciences.

The Joyce and Irving Goldman School of Medicine, Faculty of Health Sciences at the Ben Gurion University of the Negev encourages students to take part in the development and evaluation of the teaching experience. These special relations between the school and the students contribute not only to changes in the curriculum but also to increased involvement of faculty and students in the community. This article reviews the special relationship between the Faculty of Health Sciences and its medical students through the Medical Students Association (ASRN). During the last decade, BGU medical students have initiated innovative programmes some of which have recently become integrated into the curriculum. These include: prevention of sexual violence among youth, decreasing white-coat fear in small children ('Teddy Bear hospital') and participation in home-hospice activities. By encouraging students to become equal partners in faculty development and rejecting the traditional paternalistic mode of teacher-student relationships, the faculty has created an improved learning experience, and increased student motivation and levels of communication between the teachers and the future clinicians.

Child, Preschool↗