Mind the gap!

Abstract

Context and setting The University of Ribeirão Preto Medical School, in Brazil, has a curriculum structured across 6 years. The first 4 years incorporate a problem-based learning approach and are integrated, community-based and student-centred. They are followed by 2 years of clinical internship. The faculty members responsible for clinical education are not involved in the first 4 years. As a result, the values and attitudes developed in Years 1−4 are not sustained or enhanced in the clinical years. Why the idea was necessary A total of 70 faculty members teach in Years 1–4 and 75 teach in clinical internships. There is a 15% overlap between the groups. The small number of faculty who teach across the 6 years has resulted in a gap in the educational structure that is reflected in differences in student attitudes, behaviours and assessment results between the first 4 years and the last 2 years. A significant renewal project is underway to address gaps in the curriculum and in faculty development efforts. Guidelines for the accreditation of Brazilian medical schools emphasise the need for coherent programmes. Our curriculum documents focus on student- and community-centred, integrated programmes, but our clinical internships are teacher- and hospital-centred, with specialty-oriented experiences. What was done This project had 2 phases. Phase 1 involved the defining of competencies, objectives and learning opportunities. Phase 2 aligns assessment methods with objectives. Phase 1 involved bridging the gaps in both the curricular structure and faculty understanding of the 6-year programme. A survey was conducted to identify student and faculty perceptions of the education and assessment provided during clinical internships. Four workshops were conducted to sensitise people to and raise awareness of the problem. We took advantage of the accreditation visit to motivate faculty and introduce change. The initial plan was to change both years of the internship but we recognised the need to begin on a smaller scale and learn from the process. Focus groups were conducted with faculty from the infectious diseases rotation to build a curriculum blueprint based on the Accreditation Council for Graduate Medical Education Outcome Project (2006) (http://www.acgme.org/Outcome/) and the Association of American Medical Colleges guideline Educating Medical Students, Report 1 (1999) (http://www.aamc.org/meded/msop/). The blueprint will serve as a guide for developing a coherent curriculum that includes competencies, objectives, educational opportunities and appropriate assessment methods. Evaluation of results and impact The survey data from students and faculty guided the discussion around curriculum and assessment in the internship. During the first 4 workshops we worked with faculty to introduce concepts of competency, integration and how to link assessment methods to learning methods (experiences in clinical rotations). We also developed a blueprint for a rotation in infectious diseases that connects the internship to the first 4 years, thereby aligning competencies, objectives, opportunities and adequate assessment methods. We have scheduled a training programme on assessment methods focusing on internship faculty members. The gap is narrowing slowly but work will continue with other faculty and other rotations until it is closed.