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Throughout this century there have been many efforts to reform the medical curriculum. These efforts have largely been unsuccessful in producing fundamental changes in the training of medical students. The author challenges the traditional notion that changes to medical education are most appropriately made at the level of the curriculum, or the formal educational programs and instruction provided to students. Instead, he proposes that the medical school is best thought of as a "learning environment" and that reform initiatives must be undertaken with an eye to what students learn instead of what they are taught. This alternative framework distinguishes among three interrelated components of medical training: the formal curriculum, the informal curriculum, and the hidden curriculum. The author gives basic definitions of these concepts, and proposes that the hidden curriculum needs particular exploration. To uncover their institution's hidden curricula, he suggests that educators and administrators examine four areas: institutional policies, evaluation activities, resource-allocation decisions, and institutional "slang." He also describes how accreditation standards and processes might be reformed. He concludes with three recommendations for moving beyond curriculum reform to reconstruct the overall learning environment of medical education, including how best to move forward with the Medical School Objectives Project sponsored by the AAMC.
Managing a medical school curriculum is a difficult challenge. The body of knowledge is large, diverse, and changing. Continuous oversight is required to ensure the proper balance of learning opportunities, to eliminate redundancies, and to fill in gaps. Within the context of the integrated problem-based learning curriculum at the University of Hawaii John A. Burns School of Medicine (JABSOM), the authors describe a 2003 transition from a paper-based method of curriculum tracking to an online international database. The tool chosen, the Curriculum Management and Information Tool (CurrMIT), allows for myriad ways of entering data and structuring the curriculum, but presents unique challenges as well. The authors describe how this new tool was implemented at JABSOM, which included initial data entry by course directors, who provided close scrutiny of course content and took the opportunity to more closely align course objectives with course content. A keyword meta-data strategy was adopted to tag each curriculum element. Despite some difficulties, the resulting ease and accuracy of report generation has produced significant benefit to course directors and to the curriculum oversight committee, and has allowed even further improvement in the educational process. This strategy has been successfully adopted and adapted by other institutions.
INTRODUCTION: The results of the United States Medical Licensing Examination Step 1 and 2 examinations are reported for students enrolled in a problem-based and traditional lecture-based curricula over a seven-year period at a single institution. There were no statistically significant differences in mean scores on either examination over the seven year period as a whole. There were statistically significant main effects noted by cohort year and curricular track for both the Step 1 and 2 examinations. These results support the general, long-term effectiveness of problem-based learning with respect to basic and clinical science knowledge acquisition. CONTEXT: This paper reports the United States Medical Licensing Examination Step 1 and Step 2 results for students enrolled in a problem-based and traditional lecture-based learning curricula over the seven-year period (1992-98) in order to evaluate the adequacy of each curriculum in supporting students learning of the basic and clinical sciences. METHODS: Six hundred and eighty-nine students who took the United States Medical Licensing Examination Step 1 and 540 students who took Step 2 for the first time over the seven-year period were included in the analyses. T-test analyses were utilized to compare students' Step 1 and Step 2 performance by curriculum groups. RESULTS: United States Medical Licensing Examination Step 1 scores over the seven-year period were 214 for Traditional Curriculum students and 208 for Parallel Curriculum students (t-value = 1.32, P=0.21). Mean Step 2 scores over the seven-year period were 208 for Traditional Curriculum students and 206 for Parallel Curriculum students (t-value=1.08, P=0.30). Statistically significant main effects were noted by cohort year and curricular track for both the Step 1 and Step 2 examinations. CONCLUSION: The totality of experience in both groups, although differing by curricular type, may be similar enough that the comparable scores are what should be expected. These results should be reassuring to curricular planners and faculty that problem-based learning can provide students with the knowledge needed for the subsequent phases of their medical education.
The Faculty of Veterinary Medicine in Utrecht has recently introduced two major curriculum changes in order to keep pace with developments in research (the vast increase in scientific knowledge), in society (the quality awareness of veterinary clients), and in the veterinary profession, where a species and sector differentiation can be observed. After about 15 years during which the curriculum remained more or less unchanged, a radical curriculum revision was introduced in 1995. A further revision, with the introduction of separate study tracks, began in 2001. The 2001 curriculum focuses on academic and scientific training, active learning and problem solving, training in communication and professional behavior, and lifelong learning. It is divided into a four-year core curriculum, in which a broad, cross-species pathobiological insight is central, and a two-year track curriculum, through which students achieve a starting competence in a specific species or sector. The main teaching methods are tutorials and group tasks; practical work is used mainly to achieve specific veterinary skills. Teaching hours represent 30-35% of all study hours. Self-teaching is encouraged by providing study materials, self-teaching questions, teachers assigned to assist with self-teaching, and adequate facilities. The five tracks offered are Companion Animals/Equine; Food Animals; Veterinary Public Health; Veterinary Research; and Veterinary Administration and Management. All students follow a uniform 30-week clinical rotation program, while the track program is 42 weeks. A summary of admission procedures is given, as well as the times and procedures for track selection.
The decade of the 80's has seen the implementation of the problem-based curriculum (PC) (also called "parallel" or "student-centred" curriculum) in several medical schools in the United States. This new educational technique emphasizes active student participation and a hands-on learning process supplemented by judicious intervention by the faculty teachers. The students (often volunteers) are usually selected for their motivation rather than for highest intelligence or class ranking. For a period of two years, they meet twice or thrice-weekly in group sessions to explore problem cases developed by faculty for that special purpose. We describe the parallel curriculum here in some detail and suggest that medical educators in India give serious consideration to implementation of such a curriculum or its modification in their institutions. Medical graduates will benefit from the hands-on emphasis of this curriculum as well as the development of a disciplined approach in the handling of clinical problems. PC diminishes the stress levels associated with the traditional curriculum and lets the students play an active role in their education. PC will make them better prepared to face challenges during their clinical years and subsequent careers and should offset some of the weaknesses in the current educational system.
AIM: To produce updated state-of-the-art recommendations for harmonised medical specialist training in radiotherapy within Europe. MATERIAL AND METHODS: The Minimum Curriculum for the Theoretical Education in Radiation Oncology in Europe from 1991 was updated under consideration of new developments in medicine in general, and in radiotherapy and its basic sciences in particular. Recent medical developments, national guidelines and training programmes from European countries, as well as equivalent documents from the USA and Australia were reviewed by an expert panel jointly appointed by the European Society of Therapeutic Radiology and Oncology and the European Board of Radiotherapy. A draft document prepared by this group was circulated among the national and professional societies for radiotherapy in Europe for review before a European consensus conference took place in Brussels in December 2002. RESULTS: The updated European Core Curriculum for Radiotherapists (Radiation Oncologists) was endorsed by representatives of 35 European nations during the Brussels consensus conference on December 14, 2002. Compared to the earlier version the updated document contains specific recommendations not only for the 5 year training curriculum but also for organisatoric and infrastructural aspects of teaching departments, and for supplementation of the training by formal teaching courses. CONCLUSION: The updated European core curriculum is an important step on the way to fully harmonise medical specialist training in Europe and to guarantee equal access for all European citizens to highest quality medical care. The responsibility for the implementation of the standards and guidelines set in the updated Core Curriculum for radiotherapy (radiation oncology) will lie with the local and/or national training bodies and authorities.
INTRODUCTION: Managed care in its numerous forms is continuing to change the face of the healthcare system in the United States. IMPACT OF MANAGED CARE ON MEDICAL EDUCATION: As managed care continues to invade the market, it has a substantial influence in shaping the parameters of graduate medical education. Various surveys have shown that residents are under-trained in managed care principles and practice. There is a clear need for a residency curriculum that fully prepares students to keep pace with modern markets. EDUCATIONAL METHODOLOGY: This manuscript describes a curriculum which emphasizes the role of the primary care physician, cost-effective practice, multidisciplinary practice and evidenced-based strategies. Educational methods and concepts presented here are based on the recommendations of healthcare educators, extensive literature searches and United States advisory panels. After the curriculum is completed, the resident will: 1. Practice cost-effectively under 100% capitation and learn proper risk management. 2. Utilize epidemiological thinking and community-oriented primary care. 3. Function as a part of healthcare team and understand how to achieve cost-effective care for patients. 4. Practice the principles of continuous quality improvement and assess patient satisfaction. 5. Practice and adopt evidence-based medicine and guidelines. 6. Become skilled with computers including facility with literature searches, databases and the internet. 7. Practice a full spectrum of primary care emphasizing patient education and psychosocial health. 8. Understand the ethical issues pertinent to managed care practices. EVALUATION: The residency curriculum committee will evaluate the managed care curricular elements on an on-going basis. CONCLUSION: This comprehensive curriculum for primary care residents can help ensure success in the new healthcare marketplace.
INTRODUCTION: In an attempt to address the rural medical workforce maldistribution and the concurrent inappropriate caseload at the urban tertiary teaching hospitals, Flinders University and the Riverland Division of General Practice decided to pilot, in 1997, an entire year of undergraduate clinical curriculum in Australian rural general practice. This program is called the Parallel Rural Community Curriculum (PRCC). This paper is a discussion of the aims of the programme; student selection; practice recruitment; curriculum structure, and academic content, together with lessons learnt from the evaluation of the first cohort of students' experience of the course. METHODS: Independent external evaluators undertook a thematic analysis of a series of structured interviews of students and faculty involved in both the PRCC and the traditional curriculum. The mean examination results were determined and a rank order comparison of student academic performance was undertaken. RESULTS: The eight selected volunteer students reported greater access to patients and clinical learning opportunities than their mainstream counterparts and learned clinical decision making in the context of the whole patient, their family, and the available community resources. They identified patients with 'core' clinical conditions and had a longitudinal exposure to common diseases, whereas hospital-based peers had a cross-sectional exposure to highly filtered illness. The PRCC students' academic performance improved in comparison with that of their tertiary hospital peers' and in comparison to their own results in previous years. CONCLUSION: The PRCC curriculum has cut across the traditional clinical discipline boundaries by teaching in an integrated way in rural general practice. It has affirmed the potential role of true generalist physicians in undergraduate medical education.
PURPOSE: To canvas perceptions and experiences of students who had failed Year 2 of a traditional medical program and who chose to remain in the conventional program (n = 6) or had swapped to Curriculum 2001 (C2001), a problem-based learning (PBL) curriculum (n = 14). METHODS: A year after their decision regarding curriculum choice, students were canvassed (largely open-ended survey) about this decision and about their perceptions of their curricular experiences. RESULTS: C2001 students were positive about their PBL experiences. Overwhelmingly, their decision to swap streams had been a good one. They identified PBL features as supporting their learning. Repeating traditional curriculum students were, however, more circumspect in their opinions. CONCLUSIONS: C2001 students had clearly embraced PBL. They were now medical students, largely because of PBL activities underpinned by a sound educational philosophy. This unique case study has provided additional evidence that PBL students are generally more content with their studies than their conventional curriculum counterparts.
This the second in a series of three articles discussing curriculum models for associate and baccalaureate degree programs in health information management (HIM). Part I discussed the development of the models and presented a composite summary of selected key sections within the models. Part II focuses on the educational outcomes, curriculum content, and clinical experience expectations for the baccalaureate degree curriculum model. Part III will do the same for the associate degree curriculum model.
The University of Vermont College of Medicine received its Vermont Generalist Curriculum (VGC) subcontract as one of the second-cycle Interdisciplinary Generalist Curriculum (IGC) Project schools from 1995 to 1998. The Vermont program was jointly codirected by the chairs of family practice and pediatrics and the program director for internal medicine on a rotating basis and was overseen by a multidisciplinary steering committee that included generalists, basic scientists, specialists, and students. This committee provided guidance and support in recruitment of preceptors, continuous assessment and improvement of the courses, development of a clinical correlation manual for students in clinical offices, and cooperation around a jointly sponsored annual primary care meeting that included a joint scientific program, a research forum, and a faculty development workshop. The VGC has provided a pilot for many innovative curricular changes that have served as models for the school-wide curriculum redesign process currently under way at VERMONT: While the funding for this project ended in 1998, the changes, innovations, and collaboration born out of the project are valuable enough for the dean's office to maintain the VGC's funding and its steering committee for the future.
The author discusses an approach to successful curriculum revision that provides faculty with a renewed sense of individual and collective ownership of curriculum change. The framework for curriculum revision includes the components of commitment, change, collaboration, collegiality, consensus, communication, closure, and celebration, and the processes used to actualize these concepts.
This study assessed the effects of curriculum on technical features within curriculum-based measurement in reading. Curriculum was defined as the difficulty of material and the basal series from which students read. Technical features were the criterion validity and developmental growth rates associated with the measurement. Ninety-one students took a commercial, widely used test of reading comprehension and read orally for 1 minute from each of 19 passages, one from each grade level within two reading series. Correlations between the oral reading samples and the test of reading comprehension were similar across difficulty levels and across series. Developmental growth rates also remained strong regardless of difficulty level and series.
Two kinds of evidence were used to guide curriculum changes in the Nursing School of Ribeirão Preto (University of São Paulo): 1) a survey of nurses' expectations on their profession, their functions, the other members of the team and on the Nursing School teachers; 2) graduates' (ex-students) curriculum evaluation. We inquired 115 nurses working in 5 general hospitals of Ribeirão Preto, and had a return of 49 questionnaires (42.6%). This questionnary was delivered by the authors personally to the nurses, along with guidances on answering and date for return, and had 9 opened questions. The classification of answers makes possible to assert: the assistance function is the most emphasized by nurses; the student's expectations change during the professional practice; 60% of the informants considered the content of the curriculum disciplines adequate; 69.4% considered the habilitations dispensable.
Recent technological advances and an escalation of knowledge in dentistry have highlighted the need to revise the current undergraduate dental curriculum at the University of the Witwatersrand. This imperative is reinforced on one hand by manifest problems in content, structure and sequencing of the existing curriculum, and on the other hand by the need to urgently address contemporary South African issues. Revision will also offer the opportunity to incorporate modern educational practice and philosophy. This paper proposes that the contents, sequence and duration of the curriculum must be determined by the knowledge demands of dentistry (global issues) as well as by local constraints. It suggests early clinical contact and changes in syllabus content, pedagogy and assessment practices in an undergraduate course of slightly reduced duration.
A new family practice residency curriculum in the format of the special requirements for residency training is proposed. This new curriculum consolidates the original principles of family practice with current developments in medical practice and changes in society. The emphasis is on increased flexibility, a competency-based curriculum, an extensive evaluation and audit system, curricular control by family practice faculty, increased ambulatory care training, a commitment to the biopsychosocial model and community-oriented primary care, and the reiteration of the basic core of medical knowledge and clinical skills.