School Curriculum Research Articles

Kids save lives: Who should train schoolchildren in resuscitation? A systematic review

AimCPR training for schoolchildren to increase bystander CPR-rates is widely applied. HCPs are regarded as the instructor gold standard, but using non-HCP instructors (e.g., peer-tutors, schoolteachers, medical students) challenges that. This systematic review assesses whether cardiopulmonary resuscitation (CPR) training for children led by peer-tutors, schoolteachers, or medical students results in different learning outcomes to training by health-care professionals (HCPs). MethodsWe searched studies that compared CPR training for schoolchildren (population) delivered by peer-tutors, schoolteachers, or medical students (intervention), with training led by HCPs (comparison), assessing student knowledge, skills, willingness and/or confidence to perform CPR (outcome). We included randomized and non-randomized controlled trials (study design). Medline, Embase, Psychinfo, Cinahl, Cochrane, Scopus, Web of Science, and Eric were searched from inception until December 23rd, 2023 (timeframe). Two independent reviewers performed title, abstract, full text screening, bias assessment, and grading of certainty of evidence. We followed the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) guidelines, and registered the review with PROSPERO. ResultsOf 9′092 studies identified, 14 were included. Comparison of intervention groups to HCP-led training showed similar overall results (knowledge, skills, self-confidence). Superior results for HCP training were only reported for ‘ventilation volume’, while schoolteachers and medical students achieved superior knowledge transfer. A meta-analysis was possible for ‘compression depth’ between peer-tutors and HCPs showing no significant differences. Certainty of evidence was ‘low’ to ‘very low’. ConclusionThis systematic review of CPR training for school children revealed that peer-tutors, schoolteachers and medical students achieve similar educational outcomes compared to those of HCPs. Non-HCPs training schoolchildren is an appropriate cost-efficient alternative and easy to implement in school curricula.

Navigating the tech-savvy generation; key considerations in developing of an artificial intelligence curriculum

The progress in artificial intelligence (AI) technology has greatly changed various facets of society. This study aimed to explore aspects that need to be considered in developing AI curriculum for senior high schools in Indonesia. The qualitative approach employed in this study. The researchers utilized focus group discussions with schools’ management and students at seven cities and group interviews with students at three cities. The results show that some schools want AI as an extracurricular activity, while others want it as a mandatory subject. School management and teachers aim for 2-3 competent AI instructors in each school. If no teachers are available, training will be provided to ICT, mathematics, or physics teachers for about a year to become AI educators. All participants agree on the importance of teaching students about AI applications and discussing ethical issues related to AI.

Principal decision-making in implementing Merdeka Curriculum in elementary schools: a review

Principal decision-making in implementing Merdeka Curriculum in elementary schools: a review

Shaping National Character in Early Grade Elementary School Students Through Social Sciences Learning in the Medeka Curriculum Era

By looking at the Merdeka curriculum in primary schools, this research investigates the role of social studies education in fostering Indonesian character in primary school students. This curriculum aims to provide students with a strong, genuine understanding and respect for Indonesian culture while adhering to the values derived from Pancasila, which is the identity of the Indonesian nation. Social studies education becomes important in order to foster the character of students, including the cultivation of moral values in themselves both in the home, school and community environment. The data collected in this study were collected through surveys and analyzed through the literature study method. Data were obtained from various sources, including academic journals, student documents, and relevant research topics. This research found that social studies education can improve students' understanding of the daily life that must be carried out by applying the nation's values in their daily lives. It can also help them learn academically and support them in interacting and collaborating to solve everyday problems, which helps them in making the right choices for their brighter future.

School Social Workers' Responses to Racial Injustice During COVID-19: A Need for Anti-Racist Practice in K-12 Schools

ABSTRACT This qualitative study examines how school social workers (SSWers) responded to the U.S. racial injustices highlighted by the media during the first year of the COVID-19 pandemic. SSWers were interviewed during what some scholars dubbed a “moment of reckoning and crisis” following the murder of George Floyd and the subsequent nationwide demonstrations for justice that aimed to challenge racialized police violence (Villarreal Sosa 2022, p. 67). Seventeen SSWers in K–12 public schools from various school districts across three states (Minnesota, Colorado, and Nevada) completed two key informant interviews related to their experiences during the spring and fall semesters of 2020. A constructivist grounded theory approach, including three coding cycles, was used to analyze participant narratives. A substantive theory for understanding SSWers’ responses (or lack of responses) to racial injustices during this period emerged. The findings provide an initial understanding of how SSWers’ responded to racial injustice during this moment of crisis and some of the factors that impacted their responses. The most common responses to racial injustice during this moment of crisis included: 1) engaging in conversations about race and racism and 2) participating in learning opportunities about race, racism, and racial justice. Our theory highlights how (lack of) structural support influenced SSWers’ responses. Implications for school social work (SSW) practice, curriculum, and research are discussed.

Determination of Attitudes and Knowledge Levels of Pediatricians about Pediatric Medicolegal Problems in Turkey

Objective: In recent years, allegations of medical errors in Turkey have been increasing. These allegations are generally concentrated on the issue of consent. Since most children are medically and legally incapable of making their own decisions on consent issues and the decision is made by the legal representative instead, various legal and ethical dilemmas arise. Pediatrics ranks first in lawsuits filed for medical errors. In our study, we aimed to evaluate the awareness of forensic legal issues among pediatricians. Materials and Methods: Our study is prospective and cross-sectional. Participants were asked 25 questions based on 14 possible case examples. They were asked to give a score between 1 and 5 points for each question about their feeling of adequacy regarding the information, consent, documents, and procedures that should be done according to these cases. Mann‒Whitney U and Kruskal‒Wallis tests were used statistically; p<0.05 was considered significant. Results: Two hundred nine pediatricians answered the questions. Sixty-six percent of the participants were working in tertiary care hospitals. Pediatricians were undecided about feeling adequate regarding the necessary information, consent, documents, and procedures to be performed for children (3.19/5) and felt inadequate when facing the refusal of treatment (2.77/5). There was no statistically significant difference between feeling competent in terms of title and professional seniority. Only 2% of the pediatricians stated that children under 12 years of age have the power of discernment, and only 7% stated that children over 15 years of age do not have the power of discernment. Conclusion: The general conclusion we reached in our study is that pediatricians do not feel adequate even concerning basic legal issues such as information, consent, and refusal of treatment. Therefore, they need to gain knowledge of these issues. For this reason, educational activities such as adding legal education to the medical school curriculum, legal training for pediatricians, and regular seminars effectively eliminate the lack of knowledge on this issue and prevent lawsuits.

Strengthening the Language of Love as a Prevention Measure School Bullying Prevention

Bullying in schools is a complex problem that requires serious attention. This study aims to examine the potential for strengthening love language as one of the effective prevention efforts in bullying cases in schools. The study focuses on literature that discusses the relationship between love language, positive social bonds, and prosocial behavior. The methodological procedure of this article uses a literature review approach. The results of the study show that love language with indicators of affirmative words, acts of service, gifts, quality time, and physical touch has great potential in creating an inclusive and supportive school climate. This study also identifies several factors that can affect the success of the implementation of love language in efforts to prevent bullying in schools, namely; training for educators, parent involvement, and support from the school environment. The practical implications of this study are the importance of integrating love language in school curricula and counseling programs to prevent and overcome bullying in schools.

Voluntary Work for Children in the Republic of Croatia

In today's uncertain world events, it is necessary to promote volunteering from early education. Therefore, it is important and necessary to introduce such extracurricular activities from the first grade of primary school. In the Republic of Croatia, there are various humanitarian organizations that gladly accept any kind of help. Therefore, we need to find teachers who will use their influence to motivate children for humanitarian action and make them aware of the importance of empathy and helping others on a daily basis. This study shows the activities of first-graders to fourth-graders of primary school in the Republic of Croatia. The school curricula in 21 Croatian counties were randomly analysed, and the results are represented in this study. The results show that teachers who organize volunteer activities for their students have a greater level of agreement with the statements that a positive attitude of teachers about volunteering encourages volunteer activities in school. It also helps to enrich the school prevention program by establishing a volunteer club within the school, where volunteering should be encouraged in the classroom class. Volunteering should be encouraged at the school's Student Council, and volunteering should be planned in the school curriculum for participants who do not organize volunteer activities for their students. It can be concluded that teachers have positive attitudes about volunteering within the school. However, participants show significant differences in attitudes regarding gender and personal experience of volunteering.

A Self-Efficacy Theory-Based Study on the Teachers’ Readiness to Teach Artificial Intelligence in Public Schools in Sri Lanka

Objectives . This article explores teacher readiness for introducing artificial intelligence (AI) into Sri Lankan schools, drawing on self-efficacy theory. Similar to some other countries, Sri Lanka plans to integrate AI into the school curriculum soon. However, a key question remains: Are teachers prepared to teach this advanced technical subject to schoolchildren? Assessing teacher readiness is crucial, as it is intricately linked to the overall success of this initiative and will inform the development of appropriate policies. Participants . This study surveyed over 1,300 Sri Lankan public school teachers who teach Information and Communication Technology (ICT) using the snowball sampling approach. The respondents represent approximately 20% of the total ICT teacher population in Sri Lanka. Their readiness to teach AI was assessed using a general teacher self-efficacy scale specifically developed based on the well-established Self-Efficacy Theory. While key demographic factors like gender, education level and educational background were also collected, their impact analysis is not included in this article. Study Method . The study was conducted based on the premise that teachers’ readiness to teach AI hinges on their self-efficacy towards teaching AI in the classroom. This premise was substantiated through a review of existing research, and a conceptual model of teachers’ self-efficacy for AI instruction was developed. To assess this model, a nationwide survey targeting school ICT teachers was conducted. The questionnaire used in the survey was based on existing research on evaluating teacher self-efficacy. Data analysis, focusing on testing and validating the conceptual model, primarily employed the PLS-SEM approach. Findings . This study identified several key findings: (1) Teachers generally reported low self-efficacy regarding their ability to teach AI; (2) Teachers’ self-efficacy was most influenced by their emotional and physiological states, as well as their imaginary experiences related to teaching AI; (3) Surprisingly, mastery experiences had a lesser impact on their self-efficacy for teaching AI; and (4) Neither vicarious experiences (observing others teach AI) nor verbal persuasion had a significant impact on teachers’ self-efficacy. Additionally, the study revealed that the teachers’ own level of expertise in AI, along with their social capital, is insufficient to deliver a standard AI curriculum. Conclusions . The analysis of the results found that Sri Lankan teachers currently lack the readiness to teach AI in schools effectively. Potential lapses in certain sources of self-efficacy were also identified. It further revealed the need for a more systemic approach to teacher professional development. Therefore, the study recommends further research exploring the potential of incorporating a socio-technical systems perspective into the government’s teacher training initiatives.

Inclusive School Policies and Practices and the Well-Being of LGBTQ + Students in Portugal

Abstract Introduction The school context can be particularly problematic for youth who identify as lesbian, gay, bisexual, trans, and queer or who hold other sexual and gender-minoritized identities (LGBTQ +). To address this issue, LGBTQ + inclusive policies and practices have been implemented in many schools around the world. Methods A cross-sectional sample of 989 LGBTQ + and cisheterosexual high school students residing in Portugal completed an anonymous online survey in 2020/21. Participants were asked about their perceptions of LGBTQ + inclusive policies and practices in their school, namely, an inclusive curriculum, comprehensive policies, and information and support regarding sexual orientation and gender identity in their school. We further examined associations between these perceptions and LGBTQ + student well-being (depression, resilience, and self-esteem). Results Perceptions of the existence of an inclusive school curriculum were lower among LGBTQ + students compared to their cisheterosexual peers. In addition, LGBTQ + students who perceived the curriculum as less inclusive were more likely to report higher levels of depression and lower levels of resilience and self-esteem. Conclusions The findings suggest that LGBTQ + students perceive the school curriculum to be less inclusive, and this is associated with poorer well-being. Policy Implications Concrete policies and practices that improve school climate and promote the well-being of LGBTQ + students are paramount. These may include awareness-raising activities for students and discussion of LGBTQ + issues in the classroom. Therefore, cultural competency training for school staff is essential.

Assessing attitudes toward research and plagiarism among medical students: a multi-site study.

Research involves the systematic collection and analysis of data to enhance understanding of a particular phenomenon. Participation in medical research is crucial for advancing healthcare practices. However, there has been limited focus on understanding the factors that motivate medical students to engage in research. Additionally, in the era of e-learning, the easy accessibility of online resources has contributed to a widespread 'copy-paste culture' among digital-native students, which is recognized in academia as plagiarism. Existing studies suggest that a contributing factor to the increasing prevalence of plagiarism is students' limited understanding of this act. The purpose of this study was to assess medical students' attitudes toward research and plagiarism, and to evaluate the psychometric properties of the Attitudes Toward Research (ATR) and Attitudes Toward Plagiarism (ATP) questionnaires. This was a multicenter study conducted among medical undergraduate and postgraduate students attending the three medical universities who were involved in research. Students' attitudes toward research and plagiarism were assessed using the ATR and ATP questionnaires. The research instruments underwent translation and cultural adaptation in accordance with internationally accepted methodology. The psychometric properties of the ATR and ATP, including validity and reliability, were assessed. Confirmatory factor analysis was used to test the model's fit to the data. The ATR and ATP questionnaires were completed by 793 medical students who were involved in research (647 undergraduates and 146 PhD students). Cronbach's alpha coefficients of 0.917 and 0.822 indicated excellent and good scale reliability for the ATR and ATP questionnaires, respectively. The five-and three- factor structures of ATR and ATP have been validated with maximum likelihood confirmatory analysis, and the results demonstrated an adequate level of model fit (TLI = 0.930, CFI = 0.942 and TLI = 0.924, CFI = 0.943, respectively). Medical students showed a high degree of positive attitudes toward research and favorable scores across all three domains of attitudes toward plagiarism. In multivariate regression models, age was found to be positively associated with favorable attitudes of research usefulness, positive attitudes, relevance to life subscales and total ATR scale (p < 0.001), while PhD study level was related to research anxiety (p < 0.001) and favorable attitudes across all three ATP domains (p < 0.001). Medical students who were involved in research showed a high degree of favorable attitudes toward research and plagiarism. Adjusting medical school curricula to include research courses would broaden the students' interest in scientific research and maximize their impact on the full preservation of research ethics and integrity.

Exploring Teachers’ Perceptions on Pedagogies used in Implementation of IRE Competence-Based Curriculum in Secondary Schools in Wakiso District

Exploring Teachers’ Perceptions on Pedagogies used in Implementation of IRE Competence-Based Curriculum in Secondary Schools in Wakiso District

Queer Civics, Hermeneutical Injustice, and the Cis‐Straight Nation‐State: Reading the Illusion of LGBTQ+ Inclusion through the (Queer) Child

AbstractIn this article, James Joshua Coleman and Jon Wargo interrogate the (queer) child as a concept and specter that haunts civic life in the United States. Whereas scholars across a range of fields and standpoints have questioned the value of LGBTQ+ inclusion in public school curricula, and society more broadly, together Coleman and Wargo wonder at the capacity of civics education to include queer (as opposed to LGBTQ+) citizens within the cis‐straight nation‐state. To explore this possibility, they read across two bills: (1) H.R. 9197 (Stop the Sexualization of Children Act), and (2) Illinois House Bill 246 (Inclusive Curriculum Law). In so doing, they highlight how the (Queer) Child operates as an organizing binary logic within these bills and examine how hermeneutical injustice impedes the formation of a truly queer civics education. Specifically, Coleman and Wargo demonstrate how hermeneutical injustice limits the nature of inclusion for LGBTQ+ citizens, both for exclusionary, anti‐LGBTQ+ policy and for seemingly inclusive legislation. Pointing to scenes that demonstrate hermeneutical justice and queer survivance, they conclude by suggesting the construction of a queer civics education that stands outside the binary logics of the cis‐straight nation‐state.

Development of a leadership and management module for the undergraduate medical curriculum.

Physicians play an important role in management and governance of healthcare systems, yet many lack formal leadership training and skills. Despite leadership training through placements in wards at a graduate level, this should take place early on (undergraduate level), to lay the foundations for future physicians to consider a career choice in leadership positions long before entering practice. The fundamentals of leadership and management should be incorporated in the medical curriculum, with input from experts in the area such that relevant concepts are appropriately adapted with a healthcare context. We developed a pilot leadership and management module for undergraduate medical students, drawing from sources such as the UK National Health System and General Medical Council, primary literature, and undergraduate business school curricula. Students in their clinical years (4-6) of an undergraduate, six-year medical degree, were invited to participate in five 2-hour online sessions. Participants completed a questionnaire before and after module completion to assess whether individual perspectives on 22 skills relevant to leadership knowledge, and their self-rated competence in each one, changed following module attendance. Sixteen medical students participated in the study. Module attendance resulted in mean self-reported competence increase in 18 of the 22 skills, with "inspire others", "public speaking", "coding and billing", "risk management" and "conflict resolution" displaying the largest positive change. Free-text comments provided encouraging feedback regarding the module and its contents, and the teaching method of such skills (case-studies or more applied scenarios, as opposed to taught lectures). The positive changes in student perceptions and self-reported competence in leadership skills that are not traditionally included in the undergraduate medical curriculum, but are part of the business curriculum, further support the importance of inter-professional learning. Our findings are expected to inform the development of a module that could be incorporated in undergraduate medical curricula as part of future research with larger sample size and objective measures of skill competence.

The modality of historical thinking in the latest Greek primary school curriculum and the new challenges in history education

AbstractThis paper refers to the concept of ‘historical thinking’ as it appears in the three versions of the recent Greek History Curriculum for primary school. It is a comparative study of the discourse of the three versions of the recent history curriculum for primary school. The methodological approach of this study was founded on Critical Discourse Analysis. The main purpose of this paper is to explore the meaning and context of this term as presented in the three versions of the history curriculum and to compare the findings of the study with corresponding references in the international literature regarding the terms of ‘historical thinking’. This study demonstrated that this term is not the same in all three versions of the curriculum. In the first version of the curriculum the term ‘historical thinking’ is mentioned autonomously and we also separately identify the term ‘critical thinking’, while in the second and third versions a synthesis of the term is observed, which eventually becomes ‘critical historical thinking’. As a result of this observation, the use of the terms is critically and comparatively studied. The main conclusion is that the term ‘critical historical study’ refers much more to the development of general skills and competences with cognitive characteristics and much less to the critical understanding of the historical past. Furthermore, the conclusions of this study suggest a perspective for historical thinking in contemporary curricula with new challenges such as the relationship of historical education with artificial intelligence and children's representations.

Cultivating partnerships to incorporate health promotion modules into primary school curricula: a case study in France

School-based health promotion (HP) emerged from the settings-based approach. Children from disadvantaged neighborhoods benefit from HP in their school. Teachers deliver HP modules but need additional resources. This case study aimed to form a transdisciplinary partnership in a socially disadvantaged area to co-develop and embed HP modules into existing curricula. A 3-stage framework was used in this study. Stage 1 cultivated partnerships, reviewed evidence and existing data. Stage 2 generated ideas and co-developed HP modules. Stage 3 trialed the modules within primary school classrooms. Stage 1 resulted in a partnership between city authorities, a primary school and a comprehensive cancer center all located in the same community in France. The reviewed data and evidence provided 18 examples of school-based HP programs and showed that the school is in a highly disadvantaged neighborhood with a large immigrant population. Stage 2 developed 3 HP modules: “Taste and Science Week,” “Nutrition Weeks,” and “Breakfast Week,” each embedded as add-ins into existing math and science lessons and workshops. Finally, stage 3 trialed the modules in 10 first to fifth grade classrooms impacting 214 total students. Transdisciplinary partnerships help co-create and support evidence-driven HP programs. This collaborative approach enabled primary school teachers to effectively embed the HP modules into pre-existing math and science curricula. Families and volunteers are an integral part of successful HP programs however, limited participation was a challenge. Further research is needed to evaluate indicators such as student academic success and health behavior change.

Fit to teach evolution? Pre- and in-service teachers’ knowledge and acceptance of evolution

ABSTRACT Students need a clear grasp of evolution to understand biology and the world’s current environmental crises. Science teachers are essential in fostering evolution knowledge in their students. Numerous European studies have shown that science teachers possess a broad spectrum of alternative conceptions of evolution, and their acceptance of evolution varies. School curricula increasingly include key concepts of evolution from early grades on. However, studies are limited that examine differences in understandings and acceptance of evolution in different country contexts. This study investigated the knowledge and acceptance of evolution in Swiss science teachers: 1352 pre- and in-service year K-9 teachers were surveyed using two established questionnaires (KAEVO 2.0 and ATEVO). The results showed that as a group, pre-service kindergarten and primary school teachers had a poor grasp of evolution, while pre-and in-service lower secondary school teachers had moderate knowledge. However, we found that knowledge of evolution varied a great deal across the groups and that teachers in all groups had a range of alternative conceptions of evolution. Acceptance of evolution was high for all groups. Given that currently, prospective teachers on some educational tracks do not study evolution at all, our findings have important implications for teacher education in the sciences.

School contextualization with indigenous group’s socio-educational methods and pedagogies

This article presents a method for contextualizing school education and initial teacher training, using the case of Mapuche in schools in central-southern Chile to change the ambivalence of teaching in an indigenous context. The analysis is based on a dispositionalist-contextualist theoretical framework and the results of empirical research projects on Mapuche socio-educational knowledge. It examines the co-construction of intercultural knowledge by researchers and parents. It concludes with a Mapuche educational knowledge base that can contextualize the school curriculum and teacher training plans.

The Myers-Briggs type indicator association with United States medical student performance, demographics, and career values.

The Myers-Briggs Type Indicator (MBTI) is a self-reported personality test that has continued to gain popularity and traction across industries. The MBTI assesses individuals within four dichotomous categories corresponding to ways to, ultimately, assign one of sixteen personality types. Prior studies indicate that physicians trended towards certain personality traits and medical students with a particular trait performed lower academically. Due to the recency of these studies, however, there is a substantial knowledge gap in the relationship between medical student MBTIs and academic performance, demographics, and career interests. Therefore, the purpose of this study is to investigate this relationship amongst 4-year allopathic U.S. medical students and determine if there is substantial correlation to implement MBTI results in creating personalized student support services in school curriculum. This study was a single institution, cross-sectional study of 83 medical students. A survey was emailed to all students with the MBTI personality test paper edition, in addition to questions regarding specialty interest, learning style preference, and career values. Each student's responses were de-identified after pairing with the respective students' academic performance data and demographic information. Chi-square tests were used to compare MBTI data with categorical data such as demographic characteristics while independent sample t-tests were used to compare MBTI data with numerical variables like academic performance. Our findings suggest statistically significant associations between Introversion (I) with older age and Thinking (T) with male students. Additionally, Thinking (T) students performed better academically, valued variety in patient care (breadth of patients and pathologies seen), and the specific type of patient contact (longitudinal vs. short-term, etc.). Conversely, Feeling (F) students trended towards people-oriented specialties. Regarding learning styles and study environments, Extroverted (E) and Judging (J) types preferred hands-on learning, though Judging (J) types also preferred a quiet environment. No other statistically significant differences were found amongst the remaining variables. Medical schools should utilize student MBTI results to individualize student academic and career support as our study indicates various significant associations between some of the personality types. While not a "one-size-fits-all," the MBTI can be used as a potential starting point for specialty exploration and learning styles.

A case study on development of a spiral oral health curriculum for medical students.

Inadequate oral healthcare remains a critical public health issue in children and adults in the US affecting adverse social, psychological, economic, and health outcomes. Medical clinicians have a clear role in addressing oral health issues and improving outcomes. Oral health guidelines for health profession schools were developed by the Association of American Medical Colleges (AAMC) oral health core competencies, and the newer Center for Integration of Primary Care and Oral Health's (CIPCOH) Entrustable Professional Activities (EPAs). However, the majority of health professional school deans and residency directors in the US report they are not satisfied with the oral health knowledge and skills of their learners at graduation. To address this issue, faculty at the University of Massachusetts Chan Medical School (UMCMS) have worked for the past decade to develop and implement a true spiral curriculum building on lessons of knowledge, skills, and attitudes throughout the 4-year student experience. The current UMCMS curriculum involves most courses at the medical school, has community-based and interprofessional components, and is taught using multimedia. Most of the curriculum is mandatory with selective opportunities for those in specialty tracks or who are seeking more hands-on training. Our study evaluated the UMCMS curriculum using the AAMC and CIPCOH EPA guidelines. Findings show that all students receive training in 42 of 48 AAMC oral health competencies and seven of seven CIPCOH oral health EPAs with the opportunity to explore oral health further through elective courses. Assessments of students show they perform well and evaluation of the oral health curricula by students are positive. Although our oral health curriculum is robust, the next steps include expanding the evaluation of students to ensure they universally meet competencies. We expect that this case study can serve as a map for creating a generalizable, spiral curriculum for other medical schools.