Clinical Presentation Curriculum Research Articles

Integrating basic, clinical, and health system science in a medical neuroscience course of an integrated pre-clerkship curriculum.

Basic science, clinical science, and health system science (HSS) have become three pillars of integration upon which modern, post-Flexner, medical education is now based. Because of this new approach to curricular integration in a clinical presentation curruculum, medical training is now placed in the context of healthcare delivery. This study described the design, implementation, and assessment of an integrated teaching strategy, including the effect on students' performance in a medical neuroscience course's summative and formative examinations of an integrated clinical presentation curriculum. The integrated teaching of basic science content, clinical case discussion, and HSS was performed in the first year of an allopathic integrated pre-clerkship curriculum. The two cohorts were from two different years, spring 2018 and 2019. The acceptance of the integrated teaching strategy by medical students was above 80% in all categories that were assessed, including enhancing the integrated experience in learning basic and clinical science materials in the context of HSS; understanding of the learning lessons; facilitation of self-directed learning; provision of a better learning environment; and a holistic understanding of materials including the relevance of HSS issues in the discussion of neurological cases in the medical career of the students. More than 90% of the students scored ≥70% in summative questions mapped to the four learning objectives of the integrated teaching session. The objectives are the correlation of structure to specific functions (94.0 ± 0.21), clinical anatomical features of the nervous system (95.0 ± 0.27), cross-sectional features of the nervous system (96.0 ± 0.31), and the effect of lesions on the structure and functional pathways of the nervous system (97.0 ± 0.34). This result was significantly higher when compared to students' performance in the non-integrated teaching cohort (p < 0.05). Formative assessments (F(7,159) = 92.52, p < 0.001) were significantly different between the two groups. When medical students were evaluated using the same questions for formative assessment, they performed better in the integrated teaching cohort (*p < 0.05) compared to the non-integrated teaching cohort (**p < 0.05).

Effectiveness of Clinical Presentation (CP) Curriculum in teaching clinical medicine to undergraduate medical students: A cross-sectional study.

Introduction: The Clinical Presentation (CP) curriculum was first formulated in 1990 at the University of Calgary, Canada. Since then, it has been adopted at various medical schools, including Patan Academy of Health Sciences (PAHS), a state-funded medical school in a low-income country (LIC), Nepal. This study aims to evaluate the perceived effectiveness of the CP curriculum by students and faculty at PAHS, and test knowledge retention through a surprise non-routine exam administered to students. Method: This is a cross-sectional study to evaluate the efficacy of the CP curriculum in teaching clinical medicine to the first batch of MBBS students of PAHS School of Medicine. Ethical approval was obtained from the Institutional Review Committee (IRC)-PAHS (Ref no std1505911069). Perceived effectiveness was evaluated using a set of questionnaires for faculty and students. A total of 33 students and 34 faculty filled the perception questionnaires. Subsequently, a questionnaire consisting of 50 Multiple Choice Questions (MCQs) from different clinical medicine disciplines was administered to test students’ knowledge retention. Out of 49 students, 38 participated in the surprise non-routine exam. Result: A significantly higher number of faculty preferred the CP curriculum compared to the traditional system of teaching clinical medicine (16 vs 11, Kruskal Wallis: 0.023, ie. P-value < 0.05). A significantly higher number of the students liked and recommended CP curriculum in the clinical year of medical education (20 vs. 13 with p-value < 0.05). In the non-routine surprise exam, two thirds of the students scored 60% or above. Conclusion: Both faculty and students perceive that the CP curriculum system is an effective teaching and learning method in medical education, irrespective of their different demographic and positional characteristics. The students’ overall performance was good in surprise, non-routine exams taken without scheduling or reminders.

Effectiveness of Clinical Presentation(CP)Curriculum in teachingclinicalmedicine to undergraduate medical students: A cross-sectional study.

Introduction: TheClinical Presentation (CP) curriculum was first formulated in 1990 at the University of Calgary, Canada. Since then, it has been adopted atvariousmedical schools, including Patan Academy of Health Sciences (PAHS), a state-funded medical school in a low-income country (LIC), Nepal. This study aims to evaluate the perceived effectiveness of the CP curriculum by students and faculty at PAHS, and test knowledge retention through a surprise non-routine exam administered to students. Method: This is a cross-sectional study to evaluate the efficacy of the CP curriculum in teaching clinical medicine to the first batch of MBBS students of PAHS School of Medicine. Ethical approval was obtained fromtheInstitutional Review Committee (IRC)-PAHS(Refno std1505911069). Perceived effectiveness was evaluated using a set of questionnaires for faculty and students. A total of 33 students and 34 facultyfilledthe perception questionnaires. Subsequently, a questionnaire consisting of 50 Multiple Choice Questions (MCQs) from different clinical medicine disciplines was administered to test students' knowledge retention. Out of 49 students, 38 participated in the surprise non-routine exam. Result:A significantly higher number of facultypreferredtheCP curriculum compared to the traditional system of teaching clinical medicine (16 vs 11, Kruskal Wallis: 0.023,ie. P-value < 0.05). A significantly higher number of the studentsliked and recommended CP curriculum in the clinical year of medical education (20 vs. 13 with p-value < 0.05). In the non-routine surprise exam,two thirdsof the students scored 60% or above. Conclusion: Both faculty and students perceive that the CP curriculum system is an effective teaching and learning method in medical education, irrespective of their different demographic and positional characteristics. The students' overall performance wasgoodin surprise, non-routine exams taken without scheduling or reminders.

Development and implementation of clinical presentation curriculum at PAHS School of Medicine

Patan Academy of Health Sciences School of Medicine (PAHS SOM) has implemented innovative curriculum in line with its mission of producing technically competent and socially responsible doctors. One important strategy is the Clinical Presentation (CP) curriculum.&#x0D; During clinical years undergraduate medical students are taught through CP comprising of 112 common CPs. Each presentation have a schema which is a diagnostic reasoning map. Using the schema, graduates are able to scientifically approach clinical problems, categorize them into diagnostic categories with the help of their basic science knowledge, clinical findings and investigation results to gradually proceed from general and broader categories to more specific categories and finally coming down to the closest possible diagnosis or diagnoses. The diseases or conditions covered by each CPs are outlined while some overlapping and repetitions are expected. The teachings are done as small group sessions with 8-12 students and therefore demands more faculty time.&#x0D; With committed faculties and supportive leadership, successful implementation of the curriculum has been possible at PAHS SOM and the first four batches of students trained in this curriculum have already graduated and serving the society

Evaluating Medical Students' Clinical Reasoning in Psychiatry Using Clinical and Basic Science Concepts Presented in Session-level Integration Sessions.

The objective of this study was to evaluate improvement in clinical reasoning by preclinical medical students following participation in a clinical presentation curriculum that included both course and session-level integration of psychiatric and basic science concepts. A Script Concordance Test (SCT) for psychiatry was developed to assess differences in clinical reasoning in the students. Pre- and post-integration session tests were used to evaluate clinical reasoning among second-year medical students (MSII) who attended three integration sessions. Scores were compared between experts and medical students, and the validity and reliability of the SCT for psychiatry was assessed. MSII scores improved 11% between the pre-and post-test (p < .001). There was no significant difference in scores between experts and MSII after attending the integration sessions. The SCT for psychiatry that was developed and used in this study provides reliable and valid results. The concepts included in the integration sessions for this study highlighted possibilities for helping novice learners elaborate causal networks with the intention of cultivate illness script formation and clinical reasoning. Additional studies in this area should be considered to further enhance understanding of the possible benefits of this curriculum model.

Integrated and Flipped: 5 Years’ Experience of Integrating Active Learning in an Integrated Course

The Commonwealth Medical College (TCMC) accepted its first class of students in 2009. Being a new medical school gave a group of pioneering faculty members a unique opportunity, to develop a curriculum unencumbered by tradition. The Clinical Presentation Curriculum model provided the framework for an integrated course which utilized podcasts and active learning techniques to facilitate student learning using a flipped classroom approach. In this monograph, we describe how we developed the TCMC model of an integrated system course for the second year medical students reflecting on our 5 years’ experience with this integrated and flipped classroom model.

Mapping of Medical Microbiology Content in a Clinical Presentation Curriculum.

Clinically important microbes, and the pathogenesis, symptoms and diagnosis of their corresponding infectious diseases were integrated into clinical schemes within a clinical presentation curriculum. Decisions on microbe placement considered a variety of factors, including spaced reinforcement of major pathogens. We report here the map of our integrated medical microbiology curriculum.

Outcome-Based Curriculum Development at Inje University College of Medicine

This paper focuses on the outcome-based curriculum of Inje University College of Medicine to describe our curriculum development process and results. Starting in 2006, we have revised the curriculum based on the competency-based clinical presentation curriculum. We stated clearly the learning outcomes from the social needs and educational goal of our university. We defined 8 exit outcomes and specified phase outcomes, course outcomes, lesson outcomes, and outcome objectives. By 2012, we identified 128 clinical presentations and 149 basic scientific concepts. Various evaluation and assessment methods and teaching-learning strategies were assigned to each outcome. Problem-based learning, standardized patient practice, and learning portfolios are the main strategies of our curriculum. We have performed a progress test to assess the level of achievement of students’ outcomes. We have also collected feedback from students and faculty members about the curriculum, including every lesson, course, and the overall curriculum. To maintain this change of the curriculum, we reorganized the curriculum committee, educational faculty and teams, and administrative support system. To fine tune this curriculum, we have held three 3-day workshops on curriculum development and weekly meetings. We believe this is just the beginning of developing the curriculum of Inje University. Further upgrades will be necessary to continue to improve medical education.

Faculty Assessment of an Innovative Approach to Medical Education

The Clinical Presentation (CP) Model and inductive reasoning process is an innovative approach to undergraduate medical education delivery used at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA). Embedding cohorts of students into community campus settings during the second, third and fourth year is equally as innovative and a unique model for training future physicians that fosters contextual learning. We investigated faculty impressions of the CP Curriculum (CPC), inductive reasoning process and the early contextual learning experience. Electronic surveys were sent to 36 Mesa campus faculty and 23 Regional Directors of Medical Education (RDME) at each of the 11 National Association of Community Health Centers (NACHC) affiliated Community Health Campuses (CHC’s) in nine states.1 A total of 40 respondents (68%) completed the survey. Seventy percent of faculty respondents indicated that they “Completely Understand or “Understand Very Well” the CP Model as a teaching tool. Ninety-five percent of respondents stated they understand the application of “inductive vs. deductive” processes as they apply to medicine, and 88% expressed that they understood at least “Somewhat” how to use the CP Model to arrive at a diagnosis in “real life”. More than half (53%) indicated that placing the medical student in the contextual learning campus beginning in year 2 is the “right idea that is implemented at the right time”. Since about half of faculty surveyed indicated that they understand the inductive reasoning aspect of the CP Model very well or well, additional faculty development training is warranted. In the classroom, 70% reported including clinical presentation schemes 80–100% of the time during instruction. Clinical faculty were statistically significantly more likely to indicate that placing the medical students in the community health clinic settings at the beginning of their second year is the right idea at the right time.

The Process of Developing a Clinical Presentation Curriculum

authors reviewed the existing medical literature to provide practical insight into the clinical presentation curriculum introduced by University of Calgary in 1994, developing a roadmap to accomplish full implementation and evaluation. In the clinical presentation based curriculum, schemata (schemes) are organized by experts from terminal objectives, and are considered to have two functions: first, to serve as frameworks around which students can learn new information and secondly, to provide an approach to clinical problem solving. We conclude that there should be further meticulous review of this new system and a prospective evaluation of the students’ ability to benefit from it before launching a program based on the indiscreet adoption of a fashionable curricular reform.

Developing a clinical presentation curriculum in veterinary education: a cognitive perspective

There is a discrepancy between the knowledge of veterinary medicine graduates and professional and society expectations. The main reason for this discrepancy is the conventional curricula, which rely on backward reasoning or disease-centered medical education. The aim of the present study was to develop a scheme as the most important step in the creation of a full clinical presentation (CP) module. Vomiting was chosen in this study as a common CP in dogs. Three series of focused questions were developed. The physiological mechanisms (visceral, cortical, vestibular, metabolic, and chemical) were chosen to reconstruct the top layer of the scheme. To reconstruct the second and third layers of the scheme, anatomical concepts were applied to define the subcategories. To design the fourth layer, the disease classes which result in vomiting in each of the physiological schemes were considered. We believe that introducing “vomiting in dog” to veterinary medical students as a leading presentation meets the students' requirements because it uses clinical presentations as the organizing core structure.

What Factors Affect Studentsʼ Overall Ratings of a Course?

Medical students are typically asked to complete course evaluations, but little is known about how students decide to rate courses. This study sought to examine the student feedback process by exploring the dimensionality of a course evaluation tool and examining the relationship between resulting factors and the overall rating of a course. During the 2007-2008 academic year, all first- and second-year students were asked to provide feedback on various aspects of curricular content, delivery, and assessment for seven courses taught in the first two years of a clinical presentation curriculum. The authors examined the structure of the evaluation instrument using principal component factor analysis and used multiple linear regression to study the relationship between factors and overall course ratings. Four stable and reliable factors were identified (assessment of students, small-group learning, basic science teaching, and teaching diagnostic approaches) that accounted for about 50% of the total variance in overall course ratings. Student assessment displayed the strongest association with overall course ratings, and for second-year students it was the only variable associated with overall course ratings. Of the four factors, student assessment was by far the strongest predictor of overall course ratings, and this association strengthened over time. These results are consistent with the "peak-end rule" and "negativity dominance" for rating emotional experiences.

Integrating immunology into a case based medical curriculum (51.3)

Abstract Several innovations in the delivery of the pre-clinical medical curriculum have focused on non-discipline approaches. These include Problem Based Learning, Team Based Learning and the Clinical Presentation (CP) Curriculum. All these approaches require the integration of various science disciplines into clinical scenarios organized by organ systems. The CP Curriculum involves integrating didactic material in the context of approximately 125 clinical presentations (i.e. chest pain, hematuria, shortness of breath). During the pre-clinical years, a clinician provides an overview of the clinical problems which might be seen followed by a series of basic science presentations relevant to the clinical presentation. Incorporation of immunology into a CP curriculum requires coverage of both basic concepts and pathophysiology of immunologic diseases in each organ system. Our approach is to use a small number of clinical presentations (sore throat, recurrent infections) to cover basic concepts. This is followed by presentations in each organ system during which disease mechanisms and additional immunological concepts are introduced. This presentation will review the ability to include topics identified by USMLE as well as those identified by ASM in such a curriculum along with data on the performance of students enrolled in a medical school using this approach.

Teaching pharmacology in a clinical presentation curricular model

The objectives is to evaluate the ability to introduce basic medical pharmacology to medical students in their first two years of medical education by integrating that content in the curricular strategy of a Clinical Presentation model. This curricular strategy introduces all basic science content from the beginning of the medical education experience in the context of a series of clinical presentations or chief complaints (e.g. Sore Throat or Dyspnea). Pharmacology is being introduced by variety of teaching methods including use of a prototype formulary, unveiling those drugs using a Drug of the Day e‐mail notification system to highlight a new drug in the context of the Clinical Presentation being covered, evaluating pharmacokinetics and pharmacodynamics using full body adult and pediatric simulators and traditional classroom teaching methods (team based learning, small group discussions, interactive didactic). The evaluation of this method of introducing pharmacology will be done by collecting informal feedback from students (e.g. e‐mail correspondence), audience response system question/answer data from within interactive didactic sessions, formative and summative exam results on pharmacology‐related items, and qualitative data (e.g. focus group feedback) and to the extent possible students scoring on pharmacologically related questions on the National Board of Medical Examiners Comprehensive Basic Science Exam and US Medical Licensing Examination Step 1 . This project will begin as the first class of the Paul L. Foster School of Medicine begins in July 2009 and the project will continue for a minimum of 3 years (as the first two classes progress through the clinical presentation curriculum of their first two years of medical education).

Teaching strategies and academic performances of undergraduates in quaid-I-azam medical college, bahawalpur.

to assess the outcomes and competencies of medical undergraduates regarding their learning abilities after introducing Clinical Presentation Curriculum (CPC) instead of Traditional Curriculum in Quaid-i-Azam Medical College, Bahawalpur. a cross-sectional comparative study. 3rd and 4th year MBBS class during session 2004-2005 at Quaid-i-Azam Medical College (QMC), Bahawalpur. Five hundred students of 3rd year and 4th year MBBS who were taught for 176 and 172 hours respectively, appeared in 20 tests during session 2004-2005, were included in the study. Students were taught pathology according to Traditional Curricular model for 88 and 86 hours, respectively during college hours. Ten class tests each of 3rd and 4th year MBBS were taken and scores recorded. In the next step, the same group of students were taught in accordance with CPC model for 88 and 86 hours respectively in college hours. Ten class tests each were taken and scores recorded. A standardized questionnaire was given to all 500 students after finishing with each curricular model and then the results were compared on SPSS 8.0 regarding their study trends, thinking abilities, intellectual skills and liking of CPC. Chi-square test was used to get significance values and percentages were used for the evaluation of differences. This study detected the positive effects of CPC model not only on study trends and thought process but also had the beneficial effects on learning potential of students in QMC where traditional curriculum was being followed for teaching students. When compared with traditional curricula, CPC model significantly ( p =< 0.01) improved the learning methods to improve knowledge and intellectual skills e.g; group discussions, internet use, reading latest and relevant journals and visits to wards and concerned teachers. Academic performances of these students significantly (p =< 0.01) improved regarding their class test attendance, class room attendance and marks obtained in tests when compared with traditional curricula. Similarly, there was significant (p =< 0.01) increase in divergent thinkers. CPC, introduced in 3rd and 4th year MBBS of QMC, Bahawalpur, with traditional curriculum, significantly improved the academic performance, learning behaviour and intellectual skills of students.

Retention of Basic Science Knowledge: A Comparison Between Body System-Based and Clinical Presentation Curricula

Background: When the University of Calgary implemented the clinical presentation (CP) curriculum in 1994, it was prospectively decided to administer the National Board of Medical Examiner's Comprehensive Basic Science Exam (CBSE) as a measure of students' basic science knowledge retention. Purpose: The exam performance from 2 classes (1995, 1996) of the previous system-based (SB) curriculum was compared to exam performance of 2 classes (2000, 2002) of the CP curriculum. Methods: Data analyses employed 2 statistical models (covariate multiple linear regression and hierarchical mixed effects), and effect sizes were computed. Results: Differences between CBSE mean scores produced by students from the SB and CP curricula showed a curricular effect on students' retention of basic science knowledge. However, preexisting differences between groups were found to be in the small-to-medium range. Conclusion: Evidence supporting the potential of schemes within a CP curriculum and their relation to basic science knowledge retention was observed. Effect size for the CP curriculum on students' retention of basic science knowledge was substantial; however, a notable part of that difference can be accounted for by extraneous and confounding factors. Further research utilizing more rigorous designs to investigate the relation between schemes and basic science retention is warranted.

Clinical Problem Solving and the Clinical Presentation Curriculum

Clinical Problem Solving and the Clinical Presentation Curriculum

Clinical Problem Solving and the Clinical Presentation Curriculum

Clinical Problem Solving and the Clinical Presentation Curriculum

Use of scheme-based problem solving: an evaluation of the implementation and utilization of schemes in a clinical presentation curriculum.

The University of Calgary has implemented a new curriculum which is organized according to 120 ways in which patients may present to a physician. Students are taught scheme-based problem solving rather than the more typical hypothetico-deductive or search and scan approach to problem resolution. This study sought to determine the extent to which faculty and students were implementing and utilizing scheme-based problem solving. All classes taught within the new clinical presentation curriculum were surveyed at the year end. Participants included four classes of first-year students and three classes of second-year students. Using a 5-point scale, students responded to survey items regarding scheme implementation and utilization. Data were analysed using MANOVA (multivariate analysis of variance) and revealed significant differences among classes in both first- and second-year students. Increments in scheme implementation and utilization by instructors and students were observed, although instructors' utilization of schemes lagged behind that of students. A levelling effect to the benefits of schemes for problem solving was also evident. First-year students reported schemes to be very useful for learning and organizing new information. Although it has taken time to implement curriculum change, the student response to schemes has been favourable. Faculty development and further generation of pictorial/spatial representations for all schemes, to ensure that all clinical presentations provide pathways that students can use for both learning and problem solving are recommended. Whether students who utilize schemes are more successful problem solvers is not yet known but will be the subject of study as soon as scheme delivery is predominant.

Implementing a Clinical Presentation Curriculum: Impact on Student Stress and Workload

Background: Student stress and workload are important features to consider in the evaluation of innovative curricula. Description: In 1994, The University of Calgary Medical School implemented an undergraduate curriculum organized according to clinical presentations (CP). To monitor levels of perceived stress and workload, we administered a questionnaire to the first 2 classes (1997 and 1998) in the CP curriculum. Measures of student stress were compared to stress levels reported by Year 1 and Year 2 students (classes of1993 and 1994) from the previous, body-system-based curriculum. Evaluation: Students in the CP curriculum reported less stress due to volume and complexity of material and examinations. All classes in the CP curriculum reported more stress due to ambiguity of expectations. Although the work demands of individual courses varied, the overall workload in the CP curriculum was manageable and stable. Conclusions: Various features of the CP curriculum generated less stress, and a balanced workload was achieved.