Curriculum Hours Research Articles

Case Western Reserve University School of Medicine and Cleveland Clinic

Case Western Reserve University School of Medicine and Cleveland Clinic

Duty-Hour Requirements Put Residents in Ethical Quandary

Duty-Hour Requirements Put Residents in Ethical Quandary

Evolution and Revolution: The Curriculum Reform Process at UCSF

The challenges, problems, and solutions for developing a more streamlined and integrated curriculum at the University of California, San Francisco, School of Dentistry (UCSF) centered on thematic streams are presented. The central feature of the approach was that the curriculum reform efforts were initiated, developed, and implemented for the 2004-05 academic year primarily as a grassroots faculty effort with support by the administration. In addition, the issues in obtaining the consensus support of the faculty, students, and administration in order to proceed to implementation are discussed. Under the direction of a newly created position of assistant dean of curricular affairs and a faculty curriculum oversight group initiated in 2002, curriculum hours were adjusted to thirty-two hours per week. Departments conformed to this schedule, resulting in reductions in all areas of the curriculum, except clinical instruction, in order to provide time for independent study and electives. A new two-week introduction to the curriculum and an online course support system were also instituted. The new courses were generally well reviewed by students and faculty. Formal course evaluations and focus groups provided specific indications of needed adjustments. National Board scores were monitored and found to be unchanged from past experience. Curriculum change at UCSF required many changes in faculty behavior, including interdepartmental collaboration and efforts to improve teaching. Although many issues were anticipated and addressed in this multiyear reform process, careful faculty and administrative oversight continues to be required to maintain this structure. Continuing challenges include better integration of course materials and incorporating more learner-centered teaching strategies into the curriculum.

Comments: Industry/Academia Dialogue

Editor's column SPE's 2008 Colloquium on Petroleum Engineering Education brought together educators and industry professionals from various sectors to look at the state of industry/university relations and to examine how well each is doing in developing professionals. The event, held near Houston, attracted 93 attendees, two-thirds of those from industry. Speakers from both industry and academia focused on several important issues, including the skills that today's graduates need to succeed, petroleum engineering faculty shortages, and how industry and universities can better help each other. Susan Howes of Chevron and Lloyd Heinze of Texas Tech University were cochairs of the event. With the shortfall of technical talent already confronting the industry, such dialogue is more important than ever. Among the colloquium's objectives were toDevelop a common understanding of the industry's needs and how universities, operators, the service sector, and government, can fill those needs.Develop a common understanding of petroleum department challenges in meeting industry's needs and identify possible solutions.Review the qualifications required of today's graduate engineers so universi-ties can develop the proper curriculum.Discuss the evolving roles of academia, industry, the service sector, government, and SPE in undergraduate, graduate, and post-graduate continuing education.Strengthen industry/education/government partnerships. One subject that attracted quite a bit of discussion was the value of a petroleum engineering degree vs. a broader energy degree. Another issue concerned how much universities should squeeze into the available curriculum hours vs. looking to industry to teach selected skills in the first few years of employment. Petroleum engineering faculty shortages also attracted attention. Facing a shortage of people, the industry is hiring faculty away at a time when universities are experiencing more enrollment demand. "Universities are facing their own big crew change," says Ron Hinn of Oxy, who was on the planning committee for the event. One of the major results from the colloquium was a request to industry from academia for more support. Among the suggestions were for industry to provide more funding for endowed chairs and research, create "externships" for professors so they could work in industry for a summer, underwrite the costs of select faculty to attend SPE conferences, allow employees to take sabbaticals from work so they could teach for a semester or two at universities, and establish programs for retirees to teach at universities. Members of industry called for universities to graduate students with higher competency levels in business acumen and economic insight in addition to having the core science and engineering skills. The mutual dialogue will continue at this year's SPE Annual Technical Conference and Exhibition, with a session planned to further discuss some of the issues that arose at the colloquium. All presentations from the colloquium and the list of corporate supporters have been posted on the Petroleum Engineering Educators’ Network on SPE's website.

The Impact of Targeted Shortened Preclinical Exercises on Student Perceptions and Outcomes

The Harvard School of Dental Medicine (HSDM) introduced problem-based learning (PBL) into the dental curriculum in 1994 as a part of curriculum reform. During the reorganization, departments were consolidated, and courses were taught in an interdisciplinary fashion rather than in a discipline-based approach. The changes required a reduction in lecture and preclinical clock hours, which might have affected student performance and anxiety levels. The objectives of this study were to 1) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics before and after PBL implementation; 2) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics with other schools nationwide; 3) measure students' perceptions of their levels of stress and self-confidence at two time points during their preclinical and clinical years; 4) investigate the correlation between the number of preclinical hours and the students' stress level and self-confidence; and 5) evaluate the impact of shortened preclinical hours on the performance of HSDM students on the National Board Dental Examination Parts I and II. A survey regarding the students' level of stress, self-confidence, and preparation to treat patients during preclinical laboratory exercises was distributed to the HSDM classes of 2005 and 2006 (n=70). The HSDM preclinical curriculum hours were compared to national data as reported by the American Dental Association (ADA). Cross-tabulations were constructed, and the Fisher's exact test was conducted to examine the relationships between the variables. We found that HSDM preclinical hours in Endodontics, Operative, and Prosthodontics were significantly lower than at other schools. During the preclinical exercises, the Prosthodontics preclinical exercises were found to be the most stressful and provided the lowest self-confidence in treating patients as compared to the other preclinical subject areas. HSDM students' scores on the National Board Part I and II examinations continue to be among the highest in the nation and have not been affected by the change in curriculum. We conclude that the change in HSDM's curriculum that resulted in targeted, shorter preclinical exercises has not affected clinical and didactic outcomes, but may have affected the anxiety that students feel when entering the clinic.

Introductory Experiential Education: A Means for Introducing Concepts of Healthcare Improvement

Introductory Experiential Education: A Means for Introducing Concepts of Healthcare Improvement

Undergraduate clinical orthodontic experience: a discussion paper

Undergraduate clinical orthodontic experience may be expressed in a variety of ways. The most common way (used, inter alia, in the DentEd school visits) is by number of curriculum hours. Other ways include the number of patients seen, or number of procedures carried out. Whilst any of these methods may allow comparison between cohorts of students within a school or between schools, none of them are suitable to determine how much experience is 'satisfactory', nor do they indicate what the student should know, understand, or be able to do, to be considered 'satisfactory', and hence fit to graduate. This situation may be addressed by the use of competences and/or learning outcomes, and in 2004 the Association for Dental Education in Europe (ADEE) adopted a document that contained one major competence and five supporting competences in orthodontics. This paper considers the shortcomings of conventional methods of recording orthodontic experience in relation to the acquisition of these competences, and some ways in which staff and students may assess competence.

Use of Web-based materials to enhance anatomy instruction in the health sciences

Teaching anatomy by dissection is under considerable pressure to evolve and/or even be eliminated, and curricular hours in the dissection laboratory are decreasing. As a possible means of easing this pressure, an online interactive anatomy program has been created to enhance the dissection experience, observational learning, and three-dimensional comprehension of human anatomy. An assessment was made of the utility of the program in preparing students for dissection laboratories and for examinations. The efficacy of the application was evaluated by first-year students and faculty with pre- and post-use surveys in anatomy courses at three medical schools. It was found that students felt better prepared if they utilized the Web site prior to their dissection laboratory, and faculty reported spending less time explaining basic concepts or techniques. It is concluded that a comprehensive online program significantly enhances the quality and efficiency of instruction in human anatomy in the dissection laboratory and could prove to be a useful tool at other institutions.

Long-Term Evaluation of Required Coursework in Palliative and End-of-Life Care for Medical Students

In response to the nationwide need for improved care of patients at end of life, our medical school implemented approximately 20 hours of mandatory coursework on the care of dying patients for all students, with satisfactory completion required for graduation. We now report a long-term evaluation of this coursework. DESIGN/SUBJECTS/MEASUREMENTS: A 74-item questionnaire concerning attainment of palliative care and other medical school course objectives, postgraduate practice encounters with patients at end of life, and postgraduate behaviors in palliative care was mailed to all students who graduated from our medical school in 2000, 2001, and 2002. Responses were graded by a Likert-type scale. Additionally, the Association of American Medical Colleges Medical School Graduation Questionnaire (AAMC/GQ) reports for all schools and for our medical school were queried for data regarding palliative care. The return rate of the questionnaire was 54%. The respondents perceived the training to be valuable and effective. They displayed good postgraduate palliative care practices such as choosing to use opiates other than meperidine for pain in the end-of-life setting. Fifty-three percent of the respondents reported that dying patients were often or frequently under their care since graduation. Despite evidence for the efficacy of the training, the respondents perceived that preparedness in certain palliative care domains was somewhat below preparedness in benchmark medical school competencies such as assessment/management of hypertension and diabetes. The AAMC/GQ surveys indicated that for the years 2000-2002, at least 20% more of our graduates perceived that their training in pain management and palliative care was adequate than did all other medical students graduating nationwide. The evaluation provides support for the conclusion that mandatory training in palliative and end-of-life care is effective, perceived to be valuable, and contributes to good palliative and end-of-life care practices in our graduates. Furthermore, the training meets a significant demand in our graduates' clinical practice: end-of-life care. However, expanded medical school emphasis and curriculum hours are still needed for palliative care topics, because preparedness in palliative care skills was perceived to be inferior to benchmark medical skills. To our knowledge, this is the first report of a rigorous summative evaluation of the efficacy of required coursework in palliative and end-of-life care in a U.S. medical school curriculum.

Competency versus hours: An examination of a current dilemma in nurse education

In Europe student nurses have to work within a framework of curriculum hours, the regulations governing which were determined almost three decades ago. European Higher Education institutions involved in the delivery of nurse education are constrained by this European Union legislation that harks back to an era of apprenticeship rather than modern day educational approaches. This article describes the background to current educational practices and discusses the conflict between legal requirements, enshrined in professional regulations and the realities of competency driven educational philosophy.

Dental Education in India and Japan: Implications for U.S. Dental Programs for Foreign‐Trained Dentists

An understanding of international dental education systems is critical for the education of foreign-trained dentists in U.S. dental programs. However, there is little information on this topic. This article provides information regarding 1) dental history, 2) dental school system, 3) curriculum/examination at dental school, and 4) dental licensure in India and Japan. There are 185 dental schools in India and twenty-nine in Japan. The number of first-year dental students is 12,872 and 2,647 in India and Japan, respectively. A five-year dental education, which includes 4,035 curriculum hours, leads to the B.D.S. degree in India, whereas a six-year dental education program, which includes 5,060 curriculum hours, leads to the D.D.S. degree in Japan. No undergraduate predental study is needed prior to entry into dental school in both countries. In India, the entrance examination is extremely competitive; however, there is no nationwide licensure examination. In Japan, dental schools use more sophisticated dental materials and equipment in the clinical phases of the curriculum than in India, but there is no clinical examination at the time of graduation. Several implications for U.S. dental programs for foreign-trained dentists with respect to screening applicants and curriculum development are discussed.

Why a clinical prevention and population health curriculum framework?

The accompanying article1Allan J, Barwick TA, Cashman S, et al. Clinical prevention and population health: curriculum framework for health professions. Am J Prev Med 2004;27:471–476.Google Scholar describes the Clinical Prevention and Population Health Curriculum Framework (Framework), unanimously approved by the Healthy People Curriculum Task Force representing seven clinical health professions. The Task Force was convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers with support from the Department of Health and Human Services' Office of Disease Prevention and Health Promotion and Health Resources and Services Administration. It represents a unique collaborative effort aimed at developing a common framework and common strategy for improving clinical health professional education. To understand the construction of this document, its selection of content, and its future potential, it is important to appreciate the strategy and goals behind its development. The required level of core content in this area was assumed to be similar enough across key health professions that a common curriculum framework could be developed while still allowing each profession to tailor its own curriculum. The goal of the Framework is to provide a structure for (1) communication and collaboration within and among health professions, (2) organizing curriculum, and (3) monitoring curriculum. A consistent title and common terminology were considered essential to facilitate communication among the professions. It is strongly recommended that all participating clinical health professions adopt the terminology “clinical prevention and population health” to describe this content area. It is also recommended that the four components be called evidence base for practice, clinical preventive services–health promotion, health systems and health policy, and community aspects of practice. The four components of the Framework are designed to provide a common structure for the curriculum. The 19 domains organized under these four components serve as a checklist for monitoring curriculum and potentially for ensuring that students' knowledge is appropriately examined using standardized testing methods. A number of compromises were inherent in the process of developing the Framework. The first compromise was between incorporating the Framework content into the overall curriculum versus teaching the materials as dis- crete courses. The Framework encourages inclusion of components of the Framework throughout the degree program, but also stresses the need for integration and synthesis of the materials near the end of the health professional degree program using case studies, experiential learning, or other active participation teaching methods. A second compromise was between providing basic knowledge and skills and providing an introduction to more advanced or specialized content areas. Basic knowledge and skills are emphasized. Introductions to selected issues relevant to all health professionals such as health policy, global health, and environmental health are included in the Framework. Hard choices were made to ensure that the curriculum is realistic and acceptable to the participating clinical health professions. It was decided to exclude other important but more specialized curricula such as leadership skills, administrative knowledge, and program planning and evaluation. Finally, it was recognized that there are limitations in the ability to create a common curriculum framework. Thus, the Task Force intentionally avoided recommendations regarding the number of curriculum hours as well as the specific methods for instruction or testing. Despite some inherent limitations, the Clinical Prevention and Population Health Curriculum Framework is expected to serve as a vehicle for communication, organization, and monitoring of curricula. It is a work in progress that is intended for ongoing discussion and revision. We invite the readership of the American Journal of Preventive Medicine to actively participate in this process. The collaboration among health professions demonstrated in the development of the Framework will hopefully mark the beginning of a continuing effort to make clinical prevention and population health a central feature of clinical health professional education and an opportunity for interprofessional education. Clinical prevention and population health: Curriculum framework for health professionsAmerican Journal of Preventive MedicineVol. 27Issue 5PreviewThe Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. Full-Text PDF

Jefferson Medical College of Thomas Jefferson University.

Jefferson Medical College of Thomas Jefferson University.

Educational programs in US medical schools, 2002-2003.

To better provide medical students with the knowledge, skills, attitudes, and values they will need as physicians, US medical schools continue to make ongoing changes to their staffing and curricula. To review the status of US medical education in the 2002-2003 academic year, compared with 1997-1998. The Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire, the Association of American Medical Colleges (AAMC) Databook, and the AAMC Data Warehouse: Applicant Matriculant File. Data evaluated included those on medical school faculty, applicants, and students; curriculum hours devoted to new multidisciplinary or nontraditional subject areas (eg, cultural diversity, evidence-based medicine, medical ethics, medical informatics); and methods used to evaluate student learning. The number of full-time faculty members in the 126 LCME-accredited medical schools increased from 96 773 in 1997-1998 to 109 526 in 2002-2003 (+13.2%). The number of applicants entering decreased from 43 016 in 1997-1998 to 33 625 in 2002-2003 (-21.8%). The number of enrollees remained virtually unchanged from 1997-1998 (66 748) to 2002-2003 (66 677). Most medical schools have incorporated new subject areas into their curricula, although time devoted to these areas varies across schools. Schools typically use written examinations (National Board of Medical Examiners subject tests and/or internally prepared examinations) to assess factual knowledge, and observations by faculty members and residents to assess clinical skills. Use of standardized methods (eg, an objective structured clinical examination [OSCE]) to assess clinical skills is variable; 82 schools use a final third- or fourth-year comprehensive OSCE; 53 require a passing OSCE score for graduation. While the number of applicants to US medical schools has continued to decline, student numbers are constant. The number of full-time faculty members has increased. Schools are incorporating new subject areas into their curricula, and the use of standardized methods of assessing clinical skills, while variable, is generally increasing.

Preclinical Restorative Training

In conjunction with its problem-based learning curriculum, Harvard School of Dental Medicine (HSDM) developed a shortened preclinical restorative training curriculum. This study compared our curriculum with those in other dental schools and examined student reaction to it. Twenty-nine U.S. dental schools responded to a survey regarding the length of their preclinical course in Operative Dentistry. Nationally, preclinical courses ranged from 179 hours to 280 hours (mean +/- SEM = 193 +/- 9 hours; n = 29). In marked contrast, the new seventy-five-hour preclinical curriculum at Harvard was the lowest of any school, and significantly lower than the U.S. average (p < 0.01). In Harvard's previous curriculum, students spent 232 curriculum hours. Reactions of Harvard students to this compact preclinical curriculum were surveyed using a three-topic, three-category survey instrument. Results indicated that, prior to beginning clinical patient care, approximately 80 percent of students felt that the course was too short and 20 percent just right. Conversely, and retrospectively, after completing their dental school training, only 35 percent felt it was too short, and 65 percent felt it was just right. Retrospectively, in terms of clinical preparedness, 55 percent felt adequately prepared and 35 percent felt well prepared to treat their patients. No significant change was noted between Part II National Board scores following the change to the reduced curricula time. The average National Board Part II scores prior to initiating the new curriculum was 86.3, and afterwards, it was 86.2. Further, for the North East Regional Board, HSDM students in the past four years demonstrated a 98 percent overall success rate with 100 percent primary pass in the operative dentistry part of the examination. These results suggest that an abbreviated preclinical training is not only possible, but may make time available for training opportunities in other areas, such as aesthetic dental procedures and new biomaterials.

Orthodontic teaching practice and undergraduate knowledge in British dental schools

Aim: The aim was to survey current orthodontic teaching practice in the undergraduate syllabus at British dental schools and to test the abilities of undergraduate students according to the requirements of the GDC regulations. Materials and methods: Information collected by means of a questionnaire sent to each dental school in 1998 was compared with similar data from 1994. The orthodontic knowledge and treatment planning ability of students was assessed by a multiple-choice examination paper completed by a random 10% sample of students from each dental school. Results: In 1998 on average 195 curriculum hours were devoted to orthodontics and each student treated five patients. The teaching of fixed appliances had increased considerably between 1994 and 1998. The average MCQ score was 58% (range 39–72%). Students scored well on questions that tested basic knowledge but much less well when they were required to apply that knowledge. Only three schools felt that it was realistic to expect undergraduates to formulate orthodontic treatment plans, as they are required to do by the GDC. Conclusion: Results support the view that undergraduate orthodontic training should concentrate on diagnosis and recognition of problems rather than on providing limited exposure to treatment techniques.

Orthodontic teaching practice and undergraduate knowledge in British dental schools

The aim was to survey current orthodontic teaching practice in the undergraduate syllabus at British dental schools and to test the abilities of undergraduate students according to the requirements of the GDC regulations. Information collected by means of a questionnaire sent to each dental school in 1998 was compared with similar data from 1994. The orthodontic knowledge and treatment planning ability of students was assessed by a multiple-choice examination paper completed by a random 10% sample of students from each dental school. In 1998 on average 195 curriculum hours were devoted to orthodontics and each student treated five patients. The teaching of fixed appliances had increased considerably between 1994 and 1998. The average MCQ score was 58% (range 39-72%). Students scored well on questions that tested basic knowledge but much less well when they were required to apply that knowledge. Only three schools felt that it was realistic to expect undergraduates to formulate orthodontic treatment plans, as they are required to do by the GDC. Results support the view that undergraduate orthodontic training should concentrate on diagnosis and recognition of problems rather than on providing limited exposure to treatment techniques.

A national survey of training in substance use disorders in residency programs.

To determine the amount of formal training in substance use disorders that occurs in selected residency programs and to identify the perceived barriers to such training. A national survey was conducted of program directors in emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic medicine, pediatrics and psychiatry. In 1997, program directors were mailed a brief survey to determine the extent to which required training in substance use disorders occurred and the median number of hours devoted to substance use disorders training. Follow-up telephone surveys were conducted with faculty designated in the survey as responsible for substance-related disorders training to determine type of training and barriers to training. Of 1,831 program directors, 1,183 (64.6%) responded to the brief survey. The percentage of programs with required substance use disorders training ranged from 31.8% in pediatrics to 95.0% in psychiatry, with 56.3% for all programs combined. The median number of curricular hours ranged from 3 (emergency medicine and OB/GYN) to 12 (family medicine). Time was perceived to be the most common barrier to additional training. Consistent training for all residents in the initial diagnosis and management of substance use disorders has not been achieved. New strategies that integrate into existing residency structures are needed to improve substance use disorders training. Faculty development in substance use disorders and review of current substance use disorders training as part of the residency review process should facilitate this endeavor.

A survey of undergraduate orthodontic education in 23 European countries.

This paper reports on a survey of teaching contents and time allocation within the undergraduate orthodontic curriculum in European countries in 1997, and on whether or not these countries set a formal undergraduate examination in orthodontics. A questionnaire and an explanatory letter were mailed to all members of the EURO-QUAL BIOMED II project. Answers were validated during a meeting of project participants and by fax when necessary. Completed questionnaires, which were subsequently validated, were returned by orthodontists from 23 countries. They indicated that orthodontics was taught in all undergraduate curriculums of the countries surveyed. The number of hours in the undergraduate curriculum devoted to orthodontics was reported as varying from 135 to 500 hours with a mean of 245 hours. The time reported as allocated to theory, clinical practice, laboratory work, diagnosis, and treatment planning varied widely. In general, clinical practice and theory were reported as being allocated most curriculum hours, whilst diagnosis, laboratory work, and treatment planing were reported as receiving relatively less time. Removable appliances were reported to be taught in 22 of the 23 countries, functional appliances in 21 countries and fixed appliances in 17 countries. An undergraduate examination in orthodontics was reported by 20 countries. It was concluded that orthodontics occupies a small proportion of the undergraduate curriculum in dentistry in most countries, the emphasis is on theory and clinical work, and that removable appliances, functional appliances, and certain aspects of fixed appliances are taught in the majority of countries that responded to the questionnaire

Adequacy of medical school gross anatomy education as perceived by certain postgraduate residency programs and anatomy course directors.

In light of the many changes that have been made in medical gross anatomy instruction, an attempt was made to determine the adequacy of medical student preparation in gross anatomy upon arrival at a postgraduate residency program and whether the adequacy of preparation had changed in the last 10 years. To address these questions, a survey was mailed to all of the programs in four postgraduate residencies in the United States. This survey requested information about the importance of gross anatomy to the discipline, the adequacy of resident preparation, how today's residents compare to those of 10 years ago, and in what areas they are deficient. Another survey was mailed to all medical school anatomy departments to follow changes in curriculum, teaching methods, curriculum hours, and staffing in gross anatomy. Overall, of the surveys mailed, 79% were returned, 78% from the residency programs, and 81% from the anatomy departments. A majority of the residency programs report that gross anatomy is either extremely important or very important to mastery of their discipline and rank it as the most important basic science. Overall, 57% of the residency program directors felt that residents need a refresher in gross anatomy upon arrival, 29% felt that they were adequately prepared, whereas 14% felt they were seriously lacking. Fifty-six percent of the residency programs indicated that the residents are as prepared as those of 10 years ago, 41% indicated that they are less prepared, and only 4% said that they were better prepared. There were significant differences in the responses between the different residency programs. The residency programs indicated that residents need to arrive more proficient in clinical applications, general knowledge, and cross-sectional applications. Anatomy departments continue to modify their curriculum and teaching methods, decrease the curriculum hours and faculty devoted to gross anatomy, and foresee problems obtaining qualified gross anatomy teachers in the future.