Inducing curricular change: initial evaluation of outcomes

Abstract

Context and setting Data on interns obtained during their 1-year pre-registration service were used to induce curriculum change. The initiative resulted in a 5-year, semi-integrated, organ system-based curriculum implemented in 1998. It is the third curriculum to be initiated since our medical school was established in 1965. Why the idea was necessary In 1994, Ministry of Health consultants who supervised our graduates indicated that, although the graduates excelled in knowledge and skills, they lacked leadership qualities, interpersonal and communication skills, teamwork skills, and knowledge of medical economics and recent advances in medicine. What was done A curriculum review carried out in 1996 resulted in the New Integrated Curriculum (NIC). This consisted of 3 vertical strands: the scientific basis of medicine; personal and professional development (PPD), and doctor, patient, health and society (DPHS). The scientific basis of medicine curriculum covers appropriate content with reduced didactic teaching and increased student-centred and patient-oriented learning activities. The PPD strand addresses the development of appropriate attitude, character and ethics, with elective programmes included in all 3 phases. The elective programmes are aimed at developing managerial and research skills, and skills in oral, written and poster presentations. The DPHS module includes a community and family case study programme which exposes students to patients, their families and communities, and provides opportunities to practise medical ethics, communication and managerial skills, and to appreciate the psychosocial aspects of health and illness. A patient (under the care of a faculty member) and his or her family are assigned to a pair of students in Year 1 and this bond is maintained for 3 years. Problem-based learning (PBL) was introduced to further improve integration, communication skills, attitude and teamwork, and to emphasise clinical relevance early in the pre-clinical years. Evaluation of results and impact In 2004 and 2005, survey questionnaires were sent to consultants at 25 general hospitals 8 months into the intern postings (first and second cohorts). Self-rated competency surveys were completed by the students at the end of their final year. All the surveys used a 5-point Likert scale to indicate responses to the various statements related to both the outcomes achieved by interns and self-rated competency levels achieved in the final year. The consultants indicated that the NIC graduates had adequate knowledge and were competent (average score > 3.5) in history taking, clinical examination, differential diagnosis and patient management. Ratings of the graduates' communication skills, ability to work independently and within a team, and sensitivity to patients' needs were all > 3.6, validating the efficacy of the NIC goals. However, the graduates' performance in dealing with medical emergencies (3.4) and writing death reports (3.5) was regarded as less satisfactory and they were still considered to possess inadequate knowledge of medical economics (2.8) and insufficient awareness of recent advances in medicine (3.0). The feedback from hospital consultants was generally consistent with the findings from students' self-rated competency surveys. These initial data show that although the new curriculum has met many of its objectives, further work is required in some areas.