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Student performances on Step 1 and Step 2 of the United States Medical Licensing Examination following implementation of a problem-based learning curriculum.

PURPOSE: To examine students' performances on Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE) following the implementation of a problem-based learning curriculum. METHOD: Performances on Step 1 of the USMLE for four classes at the University of Missouri-Columbia School of Medicine that completed a new problem-based learning curriculum (1997, 1998, 1999, and 2000) were compared with those of the last two classes to learn in the traditional curriculum (1995 and 1996). Performances on Step 2 of the USMLE for the classes of 1997, 1998, and 1999 were also compared with those of the classes of 1995 and 1996. The authors analyzed matriculation data (GPAs and MCAT scores) for all six classes. They compared all data with those of U.S. and Canadian first-time USMLE takers. RESULTS: The mean scores were higher on USMLE Step 1 for classes in the problem-based learning curriculum than for classes in the traditional curriculum. The mean scores for Step 2 were above the national mean for classes in the revised curriculum and below the national mean for classes in the traditional curriculum. The admission profiles of these classes were essentially the same before and after the change in curriculum. CONCLUSIONS: Major PBL revisions of the curriculum did not compromise the performances of medical students on the licensing examinations; in fact, they may have contributed to higher scores.

Canada↗

The first batch of graduates of a new medical curriculum in Asia: how their teachers see them.

OBJECTIVE: To examine teachers' views of the first batch of graduates of a revised medical curriculum in Asia. METHODS: A cross-sectional study using a structured questionnaire was carried out to obtain the views of all the clinical teachers involved in teaching final year students of the old curriculum in 2000-01 and the new curriculum in 2001-02 at the University of Hong Kong, which commenced curricular reform in 1997. RESULTS: Nearly 62% of respondents felt that better graduates were being produced with the new curriculum. The majority of them rated the new curriculum students better in nearly all the major goals of the new curriculum, such as self-directed learning initiative, problem solving skills, interpersonal skills and clinical performance in patient care. However, the core knowledge of the new curriculum students was of concern to some teachers. CONCLUSION: This study focused on the first complete cycle of a revised medical curriculum in Asia. Teachers' views of the new curriculum students were highly positive and they felt that better graduates were being produced.

Attitude↗

Web-based curriculum. A practical and effective strategy for teaching women's health.

OBJECTIVE: To address the need for women's health education by designing, implementing, and evaluating a self-study, web-based women's health curriculum. DESIGN: Cohort of students enrolled in the ambulatory portion of the medicine clerkship with comparison group of students who had not yet completed this rotation. PARTICIPANTS/SETTING: Third- and fourth-year medical students on the required medicine clerkship (115 students completed the curriculum; 158 completed patient-related logs). INTERVENTION: Following an extensive needs assessment and formulation of competencies and objectives, we developed a web-based women's health curriculum completed during the ambulatory portion of the medicine clerkship. The modules were case based and included web links, references, and immediate feedback on posttesting. We discuss technical issues with implementation and maintenance. MEASUREMENTS AND MAIN RESULTS: We evaluated this curriculum using anonymous questionnaires, open-ended narrative comments, online multiple-choice tests, and personal digital assistant (PDA) logs of patient-related discussions of women's health. Students completing the curriculum valued learning women's health, preferred this self-directed learning over lecture, scored highly on knowledge tests, and were involved in more and higher-level discussions of women's health with faculty (P<.001). CONCLUSIONS: We present a model for the systematic design of a web-based women's health curriculum as part of a medicine clerkship. The web-based instruction resolved barriers associated with limited curriculum time and faculty availability, provided an accessible and standard curriculum, and met the needs of adult learners (with their motivation to learn topics they value and apply this knowledge in their daily work). We hypothesize that our web-based curriculum spurred students to later discuss these topics with faculty. Web-based learning may be particularly suited for women's health because of its multidisciplinary nature and need for vertical integration throughout medical school curricula.

Adult↗

The development and implementation of a curriculum to improve clinicians' self-directed learning skills: a pilot project.

BACKGROUND: Clinicians need self-directed learning skills to maintain competency. The objective of this study was to develop and implement a curriculum to teach physicians self-directed learning skills during inpatient ward rotations. METHODS: Residents and attendings from an internal medicine residency were assigned to intervention or control groups; intervention physicians completed self-directed learning curricular exercises. RESULTS: Among the 43 intervention physicians, 21 (49%) completed pre- and post-curriculum tests; and 10 (23%) completed the one-year test. Immediately after exposure to the curriculum, the proportion of physicians defining short- and long-term learning goals increased [short-term: 1/21 (5%) to 11/21 (52%), p = 0.001; long-term: 2/21 (10%) to 15/21 (71%), p = 0.001]. There were no significant changes post-curriculum in the quantity or quality of clinical question asking. The physicians' mean self-efficacy (on a 100-point scale) improved for their abilities to develop a plan to keep up with the medical literature (59 vs. 72, p = 0.04). The effects of the curriculum on self-reported learning behaviors was maintained from the immediate post-curriculum test to the one-year post curriculum test: [short-term learning goals: 1/21 (5%) pre-, 11/21 (52%) immediately post-, and 5/10 (50%) one-year after the curriculum (p = 0.0075 for the pre- vs one-year comparison); long-term learning goals: 2/21 (10%) pre-, 15/21 (71%) immediately post-, and 7/10 (70%) one-year (p = 0.0013 for the pre- vs one-year comparison). At one-year, half of the participants reported changed learning behaviors. CONCLUSIONS: A four-week curriculum may improve self-directed learning skills.

Clinical Competence↗

Implementation of integrated medical curriculum in Japanese medical schools.

Recently, various integrated medical curricula, which can be defined as courses with subject matter classified by organ systems rather than according to departments such as surgery and internal medicine, are beginning to be introduced to bedside-learning in Japan. For example, in such an integrated medical curriculum, lectures in the course on neurological diseases would be given by a team that would include neurosurgeons, neurologists, and pathologists. Using medical education on neurological diseases as an example of an integrated medical curriculum, we analyzed the factors related to the neurological disease course as an example of an integrated medical curriculum in the clinical medicine course at our school. We also compared our course with those of all private medical schools in Japan, using the syllabuses of these private medical schools for the comparison, and considered elements that measured interdisciplinary participation in presenting the curriculum. For an integrated medical curriculum to gain interdisciplinary acceptance, the curriculum should be constituted using all medical disciplines related to the specific organ involved in the disease process under study, including both basic medicine and clinical medicine. In addition, teachers should be informed of the rationale for such a curriculum to promote their participation and a textbook on the integrated medical curriculum is needed. A curriculum committee should play an important role in promoting this type of medical education.

Curriculum↗

Problem Based Learning, curriculum development and change process at Faculty of Medicine, Makerere University, Uganda.

INTRODUCTION: The faculty of Medicine, (FOM) Makerere University Kampala was started in 1924 and has been running a traditional curriculum for 79 years. A few years back it embarked on changing its curriculum from traditional to Problem Based Learning (PBL) and Community Based Education and Service (COBES) as well as early clinical exposure. This curriculum has been implemented since the academic year 2003/2004. The study was done to describe the steps taken to change and implement the curriculum at the Faculty of Medicine, Makerere University Kampala. OBJECTIVE: To describe the steps taken to change and implement the new curriculum at the Faculty of Medicine. METHODS: The stages taken during the process were described and analysed. RESULTS: The following stages were recognized characterization of Uganda's health status, analysis of government policy, analysis of old curriculum, needs assessment, adoption of new model (SPICES), workshop/retreats for faculty sensitization, incremental development of programs by faculty, implementation of new curriculum. CONCLUSION: The FOM has successfully embarked on curriculum change. This has not been without challenges. However, challenges have been taken on and handled as they arose and this has led to the implementation of new curriculum. Problem based learning can be adopted even in a low resourced country like Uganda.

Adult↗

Training tomorrow's clinicians today--managed care essentials: a process for curriculum development.

OBJECTIVE: To develop a managed care curriculum for primary care residents. DESIGN: This article outlines a 4-stage curriculum development process focusing on concepts of managed care organization and finance. The stages consist of: (1) identifying the curriculum development work group and framing the scope of the curriculum, (2) identifying stakeholder buy-in and expectations, (3) choosing curricular topics and delivery mechanisms, and (4) outlining the evaluation process. Key elements of building a curriculum development team, content objectives of the curriculum, the rationale for using problem-based learning, and finally, lessons learned from the partnership among the stakeholders are reviewed. RESULTS: The curriculum was delivered to an entering group of postgraduate-year 1 primary care residents. Attitudes among residents toward managed care remained relatively negative and stable over the yearlong curriculum, especially over issues relating to finance, quality of care, control and autonomy of practitioners, time spent with patients, and managed care's impact on the doctor-patient relationship. Residents' baseline knowledge of core concepts about managed care organization and finance improved during the year that the curriculum was delivered. Satisfaction with a problem-based learning approach was high. CONCLUSION: Problem-based learning, using real-life clinical examples, is a successful approach to resident instruction about managed care.

Curriculum↗

A medical informatics curriculum for 21st century family practice residencies.

BACKGROUND AND OBJECTIVES: An informatics curriculum was developed by integrating evidence-based medicine, communication and behavioral sciences, patient education, and computer skills. Introduction of an electronic medical record (EMR) to our family practice center was a focal point of this training. Our objective was to measure whether the new curriculum improved our residents' informatics skills and computer knowledge. METHODS: Before and after institution of the curriculum, residents' self-rated skills and attitudes were measured with a questionnaire. They also took an objective test of informatics skills after the curriculum was implemented, and their scores were compared to scores from five other control residencies that did not use the curriculum. RESULTS: The curriculum, including use of the electronic record, was successfully implemented and tested. The curriculum improved residents' self-ratings of informatics knowledge and computer skills, but the objective test did not show a significant difference between programs. CONCLUSIONS: After implementation of a medical informatics curriculum, residents self-reported an improvement in computer and informatics skills. The objective measurement of knowledge did not demonstrate the benefit of our curriculum compared to other programs.

Computer Literacy↗

[Self-reported level of practical skills after the revision of a medical school curriculum in Trondheim].

BACKGROUND: The medical curriculum of the University of Trondheim was recently changed from a traditional (2.5 years preclinical studies followed by 3.5 years clinical studies) to an integrated, problem-based approach. This study examines self-reported levels of skills in practical procedures before and after internship among doctors educated under the old vs. the new curriculum. MATERIALS AND METHODS: Between 1996-99 (old curriculum) and 1999-2001 (new curriculum) all doctors who had graduated from the University of Trondheim were asked to indicate their level of skills in 88 practical clinical procedures before and after their hospital internships. RESULTS: Of the 174 interns included, 114 replied on both occasions (66%). Before internship, graduates with the new curriculum reported a significant better level of skills than those with the old curriculum. After internship, however, no difference according to curriculum could be observed. The gender difference in the self-reports from students under the old curriculum was absent. INTERPRETATION: The new problem-based curriculum seems to have improved the practical level of skills prior to internship. This difference does, however, disappear after hospital internship.

Adult↗

Curriculum or syllabus: which are we reforming?

Although the concept of 'curriculum' is complex, a common understanding of the term by those involved in medical education is essential, given the current climate of medical curriculum development and reform. It has not previously been established that such a common frame of reference exists. We polled a sample of medical educators with a range of teaching experience and responsibility in an attempt to discover what they understood by 'curriculum' (and whether or not the concept could be articulated). A sample of medical students was similarly polled. In total, 85% of staff and 34.9% of the students responded. The responses obtained were subjected to a content analysis. The answers received were polythematic in 87.5% of cases, dominant themes including 'curriculum as a syllabus', 'curriculum as a meta-syllabus', and 'curriculum as a means to an end'. Our data show that the nature of curriculum is complex and does not lend itself to dictionary-style definitions. Moreover, the majority of those polled view 'curriculum' in two-dimensional terms, tending to equate it to 'syllabus'. This may have significant implications for curriculum reform.

Journal Article↗

Integration of pharmacology into a problem-based learning curriculum for medical students.

The purpose of this study is threefold: (1) to describe a method of integration of pharmacology subject matter with other disciplines, in a problem-based learning (PBL) curriculum employed at the Northwest Center for Medical Education (NWCME), Indiana University School of Medicine; (2) to present various evaluation methods employed to assess students' learning of pharmacology knowledge; and (3) to compare the academic performance of students who underwent a traditional curriculum versus the PBL curriculum in terms of class evaluations and the standard national board medical licensure examinations. The PBL curriculum is designed for the first 2 years of medical education and consists of six sequential steps: steps 1 and 2 deal with biochemistry and anatomy respectively; steps 3, 4 and 5 deal with physiology, neuroscience and general pathology/microbiology respectively; and step 6 is a multidisciplinary step, which integrates basic science subjects with clinical medicine, emphasizing the mechanism of disease in an organ-system approach. In the PBL curriculum students start learning pharmacology within 6 months of admission. The content and process of pharmacology are spread across the first and in the second year. The pharmacology content is divided into three segments, each of which is integrated with other basic science subjects that have maximum mutual relevance. The three segments are as follows: the general and systemic pharmacology (50%) was included in step 3; the neuropharmacology and toxicology (35%) part was included in step 4; the third segment consisted of antimicrobial agents, anticancer and antiinflammatory agents (15%) and was included in step 5. The class evaluation of student performance in the PBL curriculum consisted of two elements, the content examinations and the process evaluations, which include the tutorial and the triple-jump evaluations of problem-solving skills. In order to assess the overall academic performance of the PBL curriculum and traditional curriculum groups, three classes of students who took the PBLC were compared with three classes of students who underwent a TC for performance in terms of class grades and scores of National Board examinations (NBMEI and/or USMLE I). The PBL curriculum students performed as well as or better than the TC students as measured by the NMBEI and/or USMLE I. The gain in pharmacology knowledge of PBL students is accompanied by the presence of a positive experience that learning pharmacology is enjoyable. Our experience suggests that the segmental integration approach of instruction coupled with a system of content (internal and external examinations) and process (tutorial and triple-jump) evaluations, as outlined in this paper is a contextualized learning method that offers an effective way of imparting pharmacology knowledge to medical students.

Education, Medical, Undergraduate↗

Development of a CD-ROM Internet Hybrid: a new thoracic surgery curriculum.

The TSDA Prerequisite Curriculum Committee has successfully developed the content for a didactic curriculum to be mastered by the residents before their matriculation in a thoracic surgical residency program. In addition the committee assembled an innovative electronic format consisting of a CD-ROM Internet Hybrid to teach this curricular material. By use of a serialized CD-ROM Internet Hybrid it is possible to store relatively dense high bandwidth portions of the curriculum including video and audio materials on the CD-ROM and yet allow constant updating and interaction of the other portions of the curriculum. In addition, it is possible to track the performance and utilization by the residents during the entire course of their residency program. By studying the relationship between the utilization of the curriculum, particularly as it relates to certain subject areas, and comparing that to performance or standardized examinations as well as other measurements of resident satisfaction, the efficacy of the prerequisite curriculum will be tracked during the upcoming years. It is anticipated that the process of developing the content of the prerequisite curriculum will allow the residents and program directors to focus on the subject material currently deemed necessary for successful initiation of a thoracic surgery residency, and that by keeping this subject material outline up-to-date, the changing spectrum of what we anticipate our residents will know at the time of their matriculation will continue to mature. Although electronic-based education has been available for a number of years, a prospective randomized study comparing it with traditional textbook-based learning is novel. Multiple attempts have been made to implement Web-based or CD-ROM-based educational tools in other specialties with variable results. It is our anticipation that successful completion of this project will not only allow for the use of an innovative highly technical means of education for our residents but may in turn become broadly applicable to many other types of educational projects within thoracic surgery education. This may also be applicable to other types of educational projects in the postgraduate education industry and other venues as well. The conduct of a scientific study monitoring the impact of this curriculum project as well as the acceptance of the project by the resident is also relatively unique and will be scrutinized by numerous professional medical and educational groups.

CD-ROM↗

Defining the true therapeutics and clinical pharmacology curriculum in a Canadian medical school: implications for change.

Concern over rational drug therapy has led to the close scrutiny of clinical pharmacology and therapeutics teaching. Course syllabuses and timetables portray the official curriculum but rarely reflect true pharmacology and content. The teaching of clinical pharmacology and therapeutics can be uniquely and comprehensively analyzed with a computer-based curriculum data base that has the capacity to identify overlap, integration, omissions, and correlations. We have developed such a system and applied it to the analysis of one medical school curriculum. Pharmacology and therapeutics teaching represents 22% of the curriculum; however, the majority occurs outside the pharmacology-controlled courses. Overlap is extensive and unplanned. Our data indicate that the true curriculum differs greatly from that in curriculum schedules and probably from that in the minds of most curriculum planners and teachers. Collaboration among pharmacologists and clinical pharmacologists and many other curriculum officers and teachers is essential if education in this area is to be improved.

Canada↗

Aspects of curriculum policy in preregistration nursing education in the Republic of Ireland: issues and reflections.

AIMS: This paper sets out to examine critically aspects of curriculum policy related to preregistration nursing education in the Republic of Ireland. BACKGROUND: Following a period of industrial unrest concerned with pay, promotional opportunities and conditions of employment amongst nurses and midwives in the Republic of Ireland, a Commission on Nursing was established in March 1997. Along with a series on recommendations pertaining to the role and the professional development of nurses and midwives, the final report of the Commission on Nursing contained recommendations on the educational preparation of nurses. Specifically, the Commission recommended that the future framework for preregistration nursing education in the Republic of Ireland be based on a 4-year degree programme, fully integrated into higher education. As a means of giving effect to this recommendation, the Commission also recommended the establishment of a Nursing Education Forum, whose task it was to develop a strategic framework for the introduction of the proposed preregistration nursing degree programme. The Forum published its final report in October 2000 and this report constituted the most explicit statement of official policy on the nursing curriculum in the Republic of Ireland. DESIGN: The paper constitutes a critical analysis of selected aspects of the report of the Nursing Education Forum, in the light of scholarly literature on curriculum philosophy and curriculum policy. SUMMARY OF CONTENT: The paper considers some of the implications for curriculum development and design arising out of the recommendations of the Nursing Education Forum. Among a list of core principles underpinning curriculum regulation and design, the report included the principle of 'eclecticism'. The paper considers this principle with reference to nursing epistemology, pedagogical practice and curriculum policy, and seeks to challenge some of the assumptions underlying this principle. CONCLUSIONS: The epistemological identity and the structural integrity of primary forms of knowledge in the preregistration curriculum need to be maintained if students are to develop their knowledge and understanding of nursing science.

Curriculum↗

A hidden curriculum: mapping cultural competency in a medical programme.

BACKGROUND: Cultural competency can be understood as those learned skills which help us understand cultural differences and ease communication between people who have different ways of understanding health, sickness and the body. Recently, medical schools have begun to recognise a need for cultural competency training. However, few reports have been published that articulate and evaluate cultural competency in medical curricula. AIM: This study was performed in order to evaluate the current status of cultural competency training at a medical school in southern Sweden. METHODS: We used a multimethod approach to curriculum evaluation. We reviewed the published list of learning objectives for the medical programme, interviewed curriculum directors and individual teachers for each term about course content and carried out focus group interviews with students in all stages of the medical programme. RESULTS: Cultural competency is a present but mostly hidden part of the curriculum. We found learning objectives about cultural competency. Teachers reported a total of 25 instances of teaching that had culture or cultural competency as the main theme or 1 of many themes. Students reported few specific learning instances where cultural competency was the main theme. Students and teachers considered cultural competency training to be integrated into the medical programme. Cultural competency was not assessed. CONCLUSION: This evaluation showed places in the curriculum where cultural competency is a present, absent or hidden part of the curriculum. The differences between the 3 perspectives on the curriculum lead us to propose curriculum changes. This study illustrates how triangulation with a multifactorial methodology leads to understanding of the current curriculum and changes for the future.

Cultural Diversity↗

Adoption and integration of simulation-based learning technologies into the curriculum of a UK Undergraduate Education Programme.

CONTEXT: At a time of significant changes in medical education world-wide, the international dimensions and global issues relating to the application of new learning technologies have been recognised. OBJECTIVE: The aim of this paper is to describe the adoption and integration within the curriculum in one United Kingdom (UK) medical school of 'Harvey', the Cardiology Patient Simulator, and the UMedic multimedia computer-based cardiology curriculum - resources developed in a medical school in the USA. PARTICIPANTS: The integration of the resources into the curriculum is described by 3 teachers actively involved in the cardiology curriculum of the UK medical school and 3 teachers associated with the development of resources in the USA. ASPECTS CONSIDERED: The review considers the adoption of Harvey and UMedic in the UK in programmes in relation to: curricular issues, training needs, learning outcomes, curriculum content and sequences of content, educational strategies, teaching and learning methods, assessment, communication about the curriculum and management of the curriculum. CONCLUSIONS: Learning resources, in the form of simulators and computer-based learning modules, developed in one country can be successfully adopted and implemented in another. Facets that facilitated the adoption included close liaison between the developers of the resources in the USA and the implementers in the UK, and careful and systematic planning including in-depth integration of the simulation-based resources into the required curriculum rather than their relegation to a peripheral ad hoc position. The successful use of simulators such as Harvey requires the presence of a 'champion', a clinician educator and a supporting administrative staff who ensure the simulator's appropriate use.

Cardiology↗

Considerations for curriculum design.

Educational values held by academic and clinical faculties subtly but strongly influence curriculum design in physical therapy education. Five major value orientations, Curriculum as the Development of Cognitive processes, Curriculum as Technology, Curriculum as Self-Actualization, Curriculum as Social Reconstruction-Relevance, and Curriculum as Academic Rationalism, are presented. The suggestion is made that these underlying value-orientations influence the choice of curriculum design more than do "available resources." A second component of curriculum design, i.e., evaluation of student performance, also influences and is influenced by the direction and development of physical therapy curricula. A plea is made for expressive objectives and outcome objectives to be considered along with instructional or behavioral objectives to yield more comprehensive and creative appraisals of student growth.

Curriculum↗

An application of computers to curriculum review and planning.

A computer-based curriculum data base was developed at the University of Toronto Faculty of Medicine to provide curriculum planners accurate information on what was being taught, who was teaching, and where in the curriculum subjects were being taught. In this paper, the authors report the use of the curriculum data base, its implications for curriculum management and planning, and plans for its further development and use. Applications that address problems of curriculum overlap, integration, and correlation are discussed. The results indicate that the medical school curriculum can be successfully stored and analyzed by computer and that the data base and system can provide valid descriptions of curriculum content in nonclinical courses.

Computers↗