Curriculum design in context

Abstract

Curriculum change derives from academic, political, economic, social, and professional imperatives (Jackson 2002). This chapter addresses these drivers and their effects. Drawing on the wider curriculum literature, and applying this to the problems of curriculum development and change in medicine, we conclude that the essential unifying feature of curricula is diversity, reflected in the need for locally relevant, contextual curricula. A catalyst for widespread establishment of medical education units inside UK medical schools was the appointment of facilitators to oversee integrated curricula (Leinster 2011). Simultaneously, medical education has become a global discipline with its current dominant ideas often being mediated locally through medical education specialists sharing a worldview. Such an approach to planning the curriculum is, we argue, detrimental to local effectiveness. For medical education to be effective and relevant, it must derive its solutions locally, relating the educational process to medical knowledge and practice; and to the link between medical schools and the healthcare system. Michael Apple’s (2004) influential view is that a curriculum is an ideological statement, expressing values, beliefs and aspirations; aligning the institution with other similar institutions. It cannot be a neutral document, but is a process that must reflect relevant values deriving from the local political, cultural, professional, and social context. Importantly, curriculum theory adopts a neutral position towards the discipline’s knowledge base. When that discipline is medicine, this becomes a tendentious stance. We will therefore explore the tension deriving from the increasing international homogenization of ideas at a time when heterogeneity is required to address the cultural, social, philosophical, and healthcare needs of different societies and contexts. A curriculum encompasses both the institution’s view about the profession that it is producing, as well as describing how best to produce that next generation. In neither of these cases is there a robust, or even consistent, research base of evidence. In all circumstances, therefore, the curriculum must be a unique and tailored invention, based on judgement. Clarkson (2009, p. 8), in relation to comparative education, states simply that ‘transposing one entire educational system on to another is never an option’. Just as what constitutes ‘medicine’ varies across contexts, the same is true of what constitutes an effective curriculum, pedagogy, or andragogy, which, despite its lack of evidence base, has swept the higher education world as the current theory of choice (Knowles, 1980). Education and the provision of healthcare to populations and communities are equally social and political enterprises, reflecting time, context, and social condition. They are not objective functions. There is no robust evidence base. Education is contextual; based and rooted in its own culture and conditions. A truly integrated curriculum is one that is embedded within the needs of its own setting, using the opportunities of its surroundings, and feeding from and into its own society and history. Of course, curriculum designers should be fully cognisant of the range of options for design and delivery, not to copy or import, but to inform judgement. None should be seen as an essential postulate. Curriculum designers should perhaps not always innovate especially when existing practice has delivered the doctors that are required. We believe, with Stenhouse (1976, p. 142) that ‘curriculum research and development ought to belong to the teacher’. The practising profession itself must be the driving force for the development of curricula fully integrated with the development of the healthcare service and the knowledge and skill base of the profession.