What issues are raised by evaluating problem-based undergraduate medical curricula? Making healthy connections across the literature.

Abstract

There have been various waves and ripples of undergraduate medical curricular reform over recent decades. Such programme-wide innovation can attract exceptional suspicion and scrutiny about its worth, fueled by adverse reactions to change. It also raises expectations of what programme evaluation can reveal about the experience, achievements and 'added value' of the medical students or doctors. Problem-based undergraduate medical curricula are expected, for example, to fulfil elusive 'true' (outcome) descriptors of educational quality. The aim here was to explore the rationale, approach and challenges for undergraduate medical programme evaluation, particularly for problem-based curricula. The main focus was on internal, formative evaluation: Why undertake educational evaluation? What is the evaluative context of problem-based learning? What philosophy has guided programme evaluation of innovative undergraduate medical curricula? What can educational, health care and other evaluation frameworks offer? What can be learned from examples of published accounts of problem-based undergraduate medical programme evaluation? Where to from here? Ideally, evaluators of medical education should be explicit about their rationale, highlight local curricular context and special features, balance process-measures with outcome-measures (including unplanned outcomes), and be eclectic in methods. 'Healthier links' with the health care evaluation and educational evaluation literature could be beneficial. It remains to be seen, however, whether the medical educational changes that the General Medical Council's Tomorrow's Doctors triggered in the United Kingdom will stimulate important advances in educational evaluation.