Major Curriculum Revision Research Articles

Beginning a new medical school curriculum amidst a global pandemic.

The University of Maryland School of Medicine embarked on our first major curriculum revision since 1994 with a plan to implement this Renaissance Curriculum in August 2020. However, in the Spring of 2020, the coronavirus disease (COVID‐19) pandemic disrupted clinical care and medical education on a large scale requiring expeditious modifications to our Renaissance Curriculum as well as our traditional Legacy Curriculum in order to meet our goal of educating the next‐generation of physicians. The rippling effects of the COVID‐19 pandemic led to major changes in the delivery of the pre‐clerkship curriculum, the way we assessed and evaluated students, entry into the clinical environment, length of clinical rotations, and orientation for our new medical students. We relied on “new” technology, digital medical resources, and the creativity of our educators to ensure that our learners continue to acquire the skills necessary to become skilled clinicians in these unprecedented times.

Procedural democracy: Perceptions of the latest curriculum revision in British Columbia, Canada

In a historical review of curriculum revisions carried out in British Columbia, Canada, the author argued that these revisions were undemocratic in the sense that the revisions were carried out by a small selection of individuals associated with the Ministry/Department of Education. This article begins with a brief review of previous findings along with a discussion of how democracy, and in particular, procedural democracy, are understood. Procedural democracy is argued to relate to the public’s knowledge about government-initiated changes, ability to provide feedback, and how this feedback is attended to by those in government. This article then discusses the research methods and findings of a study carried out with British Columbian teachers and curriculum developers at a time when a major curriculum revision is occurring. The survey was designed based on the theoretical model of procedural model of democracy described. The findings focus on looking at the perceptions of teachers and curriculum developers regarding the process of curriculum reform carried out in British Columbia.

Exploring Racism and Health: An Intensive Interactive Session for Medical Students.

Growing recognition of the deleterious effects of racism on health has led to calls for increased education on racism for health care professionals. As part of a larger curriculum on health equity and social justice, we developed a new educational session on racism for first-year medical students consisting of a lecture followed by a case-based small-group discussion. Over the academic years of 2016-2017, 2017-2018, and 2018-2019, a total of 536 first-year medical students participated in this mandatory session. The course materials were developed as a collaboration between faculty and students. The lecture was delivered in a large-group format; the small-group case-based discussion consisted of 10-12 students with one upper-level student facilitator. The majority of respondents for the course evaluation felt that the course had met its stated objectives, and many commented that they had an increased awareness of the role of racism in shaping health. Students felt that the small-group activity was especially powerful for learning about racism. Active student involvement in curriculum development and small-group facilitation was critical for successful buy-in from students. Additional content on bias, stereotyping, and health care disparities will be the focus of faculty development programs and will also be integrated into the clerkships to build on these important topics as students are immersed in clinical care.

An examination of student outcomes in studio chemistry

Twenty years ago, a major curriculum revision at a large, comprehensive university in the Western United States led to the implementation of an integrated lecture/laboratory (studio) experience for our engineering students taking general chemistry. Based on these twenty years of experience, construction of four purpose-built studio classrooms to house the majority of the remaining general chemistry courses was completed in 2013. A detailed study of the effects of the entire ecology of the studio experience on student success was initiated at that time. Data from content knowledge pre- and post-tests, learning attitudes surveys, and student course evaluations show positive effects on student performance, the development of more expert-like learning attitudes, increased student engagement, and increased student–instructor interactions vs. the previous separate lecture and laboratory instruction for non-engineering students. Our data also show that an associated new peer Learning Assistant program increases student engagement while also having positive impacts on the Learning Assistants themselves.

Creating the Medical Schools of the Future

Despite wide consensus on needed changes in medical education, experts agree that the gap continues to widen between how physicians are trained and the future needs of our health care system. A new model for medical education is needed to create the medical school of the future. The American Medical Association (AMA) is working to support innovative models through partnerships with medical schools, educators, professional organizations, and accreditors. In 2013, the AMA designed an initiative to support rapid innovation among medical schools and disseminate the ideas being tested to additional medical schools. Awards of $1 million were made to 11 medical schools to redesign curricula for flexible, individualized learning pathways, measure achievement of competencies, develop new assessment tools to test readiness for residency, and implement new models for clinical experiences within health care systems. The medical schools have partnered with the AMA to create the AMA Accelerating Change in Medical Education Consortium, working together to share prototypes and participate in a national evaluation plan. Most of the schools have embarked on major curriculum revisions, replacing as much as 25% of the curriculum with new content in health care delivery and health system science in all four years of training. Schools are developing new certification in quality and patient safety and population management. In 2015, the AMA invited 21 additional schools to join the 11 founding schools in testing and disseminating innovation through the consortium and beyond.

Leadership of the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health in Its First Century.

This commentary reviews the contributions of each of the 7 Chairs of the Department of Epidemiology from the Department's inception in 1919 to the advent of the Centennial Celebration of the Johns Hopkins Bloomberg School of Public Health in 2016. The founding Chair, Wade Hampton Frost (1919–1938), was among the handful of foundational thinkers in the discipline of epidemiology. Kenneth Maxcy (1938–1954) and Philip Sartwell (1954–1970) oversaw the Department through the epidemiologic transition from a preponderance of morbidity and mortality due to infectious diseases to a preponderance of noncommunicable diseases. Abraham Lilienfeld (1970–1975) and Leon Gordis (1975–1993) were perhaps best known for their mastery of teaching, influencing generations of both medical and public health students. Jonathan Samet (1994–2008) oversaw a major curriculum revision and expanded the Department significantly, and David Celentano (2008–) is working to rebalance the practice of epidemiology with the etiological foundations of epidemiology. All Chairs were a product of their times, and their research focus and portfolios influenced the direction of the Department. Future generations of Johns Hopkins students will be influenced directly or indirectly by the heritage of these Chairs' actions and those of their faculty.

Considering Reflection From the Student Perspective in Higher Education

This article reports the findings of a project to reexamine reflection from the student perspective that took place after a major curriculum revision. The project used a hermeneutically inspired action research method that involved interviewing 17 undergraduate theology students after a two-semester practicum to ascertain the ways in which students understand and use reflection in practice and as a means of establishing identity. The data revealed key themes that surround students’ understanding of reflection: (a) Students think and write about reflection in detached ways, (b) there is a connection between reflection and self-understanding and self-definition, and (c) crisis plays a role in reflection. The article concludes with further discussions of these themes and with recommendations for pedagogical practice.

Teaching Patient- and Family-Centered Care: Integrating Shared Humanity into Medical Education Curricula.

The University of Michigan Medical School (UMMS) implemented a major curriculum revision to incorporate patient- and family-centered care concepts.

The last place to look: the place of pupil councils within citizen participation in Scottish schools

This article critically examines pupil councils as a means of developing pupils’ citizenship participation. It draws on findings across two research projects. The first study is a mixed method study commissioned by Learning and Teaching Scotland (LTS) that reviews the range of participatory activities in Scottish schools and their contribution to Scotland’s major curriculum revision, the Curriculum for Excellence (CFE). The second is a longer ethnographic study examining young people’s experience of participation projects in more detail. The findings lend strength to the argument that pupil councils as a stand-alone approach are not an effective means of citizenship participation. When pupil councils are complemented by other participation activity across spheres of school interaction, young people’s understanding of and interest in participation can be greatly enhanced. The article examines the cross curricular linkages schools are making, the barriers that impede such linkages and the benefits derived from successful coordinated approaches in light of criteria for ‘graduated participation’ developed through decades of work internationally on children’s participation.

GRISTO: an integrated learning experience in Gross Anatomy and Histology for Dental Students, learning outcomes and student perspectives on curriculum change (532.4)

In a major curriculum revision we unified two separate disciplines (Gross Anatomy and Histology) into a combined course with integrated methods of instruction and assessment (GRISTO).Through creative course design, we constructively aligned content, decreased didactic lectures and increased opportunity for student engagement, group work and self‐regulated learning (flipped classrooms, peer teaching, virtual labs). In doing so we improved sequencing and cohesion between Anatomy and Histology and removed unnecessary redundancy. Implementation of GRISTO recovered 50hrs/student in the curriculum.We also hypothesized that an integrated Anatomy and Histology learning experience would lead to improved learning outcomes and student satisfaction for both disciplines.To test this hypothesis we compared student performance in assessment tasks completed after participating in pre‐GRISTO (2011) and GRISTO (2012, 2013) learning experiences. Both disciplines exhibited a right‐shift in grade distributions for GRISTO students coupled with fewer failing grades. Learning outcomes were improved in Histology (2011: 82.5%, 2012: 85.6%, 2013: 87.1%) and unchanged in Anatomy (range 87.0‐87.2%).Focused course evaluations for GRISTO (2012: n=65, 2013: n=41) revealed a strong preference for an integrated learning experience (95%) and student ratings on standardized questions reached an all‐time high.

The Impact of ePortfolios on Students’ Learning

LeBow College of Business at Drexel University in Philadelphia, PA, a private higher educational institution with an emphasis on technology and co-operative education, first implemented an ePortfolio program to undergraduate business students during the academic year of 2006-2007, which occurred after a prior one-year development and pilot program. The introduction of the ePortfolio was in conjunction with a major curriculum revision across the College. Although electronic portfolios had been used in various academic disciplines such as education, nursing and graphic design for several years, its application with students of business was relatively new. A number of researchers have found a positive impact of portfolios (Campbell, 2000; Baume and Yorke, 2003; Reese and Levy, 2009) but few have researched the impact on learning, in particular the students’ perceptions of learning, in a business curriculum. Based on five years of data, our study suggests that the use of ePortfolios across and through the business curriculum may have a positive effect on students’ perception of learning.

A Study of Knowledge & Awareness of Medical Doctors Towards Radiation Exposure Risk At Tikur Anbessa Specialized Referral And Teaching Hospital, Addis Ababa, Ethiopia.

Increasing concern has recently been expressed in the literature that the referring doctor's knowledge of radiation doses incurred during radiological procedures is inadequate. Such information may be particularly relevant when the expansion of imaging technology is considered. Hence the objective of this work is to assess the awareness of physicians about radiation dose and hazards of radiation. The study was performed among medical doctors at Tikur Anbessa Specialized Referral Teaching Hospital, the largest medical school in the country. A 135 self administered questionnaire was circulated randomly from a range of specialties; out of which 114 questionnaires were completed and used in the study giving a response rate of 85%. Participants were asked about the radiation dose from a chest radiograph, the annual dose from background radiation, and cancer risk from several common radiological procedures. A mean score of 7.1 out of 19 was achieved. 12 doctors had received formal training about ionizing radiation, and these participants scored higher than those with no previous training in this area. Our survey suggested that clinicians' awareness of radiation doses imparted during common radiological procedures, and the consequent risk to the individual patient is poor. A major curriculum revision of both undergraduate and graduate medical education regarding awareness on radiation is mandatory to improve this deficiency.

University of Medicine and Dentistry of New Jersey (UMDNJ)—New Jersey Medical School

The Dean is the chief academic officer of the medical school. Management of the educational programs is a shared responsibility of the academic departments and the Office of Education reporting to the Vice Dean. The faculty organization solicits and provides input to the Committee on Committees, which selects members for the nine standing committees that are approved by the Faculty Council (Figure 1). The Committee on Academic Programs and Policies (CAP2), a standing committee of Faculty Council, is charged with the design, evaluation, revision, approval, and oversight of the curriculum and overall educational program. CAP2 also makes recommendations to the Dean and to the Faculty Council regarding implementation of various programs. CAP2 represented by faculty, students, and administrators (ex officio) is a surrogate for the faculty at large. Members on the CAP2 are not representational of the various departments. The Dean or his designee, the Vice Dean, in concert with the CAP2 provides the strategic leadership in managing the educational programs and developing policies and procedures. The Vice Dean works closely with the academic departmental chairs, course and clerkship directors, and faculty to implement innovations in education, assessment, and evaluation as they pertain to undergraduate medical education. Two subcommittees report to the CAP2—the Preclinical and Clinical advisory subcommittees, which consist of course and clerkship directors, respectively. Subcommittees assist in achieving horizontal and vertical integration of the curriculum. A major curriculum revision was rolled out in 2004-05 (see Curriculum Renewal Process). Interdepartmental and interdisciplinary courses are managed jointly by departments and the Office of Education (OE). Office of Education

University of Miami Leonard M. Miller School of Medicine

University of Miami Leonard M. Miller School of Medicine

Case Western Reserve University School of Medicine and Cleveland Clinic

Case Western Reserve University School of Medicine and Cleveland Clinic

PBL in the Undergraduate MD Program at McMaster University: Three Iterations in Three Decades

When the undergraduate MD program of McMaster University admitted its first cohort of 20 students in 1969, it heralded a major change in medical school pedagogy that has influenced the education of medical students around the world. The three-year PBL curriculum, which emphasized small-group tutorials, self-directed learning, a minimal number of didactic presentations, and student evaluation that was based almost entirely on performance in the tutorial, represented a radical departure from traditional curricula. Since the inception of the original curriculum in 1969, there have been two major curriculum revisions, the most recent of which was in 2005. The original curriculum attempted to integrate both basic science and clinical science into the biomedical problems. The second iteration of the curriculum focused on priority health problems and centered on a list of common medical problems as the foundation for curriculum organization, on the basis that an understanding of the management of common conditions included areas of knowledge that would be essential for clinical competence. Under the third, current curriculum, the COMPASS (concept-oriented, multidisciplinary, problem-based, practice for transfer, simulations in clerkship, streaming) model was adopted. Under this concept-based system, emphasis is placed on underscoring the underlying concepts in the curriculum with a logical sequencing of both the concepts and the body systems. This article briefly reviews the history of the development of the undergraduate MD program at McMaster and the three curricula that have been developed during the past three decades.

Louisiana State University Health Sciences Center in Shreveport.

Louisiana State University Health Sciences Center in Shreveport.

Developing a Medical Humanities Concentration in the Medical Curriculum at the University of Rochester School of Medicine and Dentistry, Rochester, New York

To the author's knowledge, the University of Rochester School of Medicine and Dentistry is the only medical school in the United States that offers a concentration or minor in medical humanities for medical students. This article presents how the author first thought of offering a concentration in medical humanities and explains the educational elements students must satisfy. In 1998, the university underwent a major curriculum revision, dubbed the "double-helix" curriculum because of its goal of intertwining basic science and clinical medicine over all four years of medical school. As course director of the Medical Humanities Seminars for more than ten years, the author saw this change as an opportunity to expand the humanities curriculum. The number of sessions and courses offered in the first two years doubled as part of the transition to the new curriculum. In addition, the author proposed to the medical school curriculum steering committee to approve a concentration in clinical ethics and humanities. The concentration option motivates students to continue to pursue their humanistic interests in the third and fourth years of medical school. About 25% of the student body has signed up in the first two years the concentration has been available.

360 degrees: planning a new pediatric clerkship.

Mount Sinai School of Medicine is midway through a major curriculum revision. The immediate goal for the core third-year clerkships was to create a modular schedule with varied and integrated clinical experiences. Some clerkships were lengthened; others, blended. Clerkship directors were asked to find ways to ally with those also in their 12-week module. Content material, only presented at Mount Sinai, was to be delivered at all affiliate sites. Each clerkship had one year to prepare. Core pediatrics faced multiple challenges. Once an eight-week clerkship, pediatrics was condensed into a six-week block and paired with ob-gyn at the same affiliate sites. Material presented during weekly, lecture-based didactic sessions at Mount Sinai was to be delivered at all sites, some of which were considerable distances away. To enable students to have both content and clinical experiences at the same site, new teaching formats and techniques had to be utilized and faculty retrained to implement their new roles. Three approaches met both conditions: (1) interactive case-based learning of clerkship content objectives, (2) use of Web-based instruction to provide resources to all sites, and (3) the identification and training core educators to deliver this new content material. Generalist and specialist pediatricians prepared clinical cases. Each author was given a case-writing template, so that all cases included objectives, references, a case presentation, and guiding questions. Cases were written with extended answers to each of eight standard questions, including key teaching points, to create a teacher's manual. Three faculty members reviewed each case to assure that the content matched the objectives for the module and that cases were written at an appropriate level for third-year medical students. Weekly seminars are now interactive, small-group, and Web-based. Cases use multimedia resources and integrate multiple clinical disciplines. The structure of the seminars, modeled on adult learning theory, include review of the basic approach to patients, organization of data, and generation of a prioritized differential diagnosis. The seminars also review basic management principles for a variety of common pediatric conditions. Core educators were designated to facilitate the cases at each clinical site. They were given instructions for case facilitation, a detailed teacher's manual, and a multimedia CD-ROM. The teacher's manual contains the course syllabus as well as extended case discussions. The accompanying CD-ROM contains photographic images, growth charts, x-rays, microscopy, and sound files. Computers are available at each site and are linked to WEB-CT, the program supporting the Mount Sinai undergraduate online curriculum. We have not yet reached 360 degrees in revising our clerkship. Feedback from both students and clinician educators has been extremely positive. Future plans include further enhancement of the cases to incorporate clinical pathology, genetics, laboratory medicine, radiology, and evidence-based medicine. We will also develop and implement a faculty development program to equip our faculty with tools for effective, time-efficient, case facilitation. Starting anew with a few core organizing principles and a multidisciplinary approach has enhanced the learning for both faculty and students.

Report on Key Points Arising from Visioning Process on Prosthetic and Orthotic Education Done at the British Columbia Institute of Technology

The Prosthetics and Orthotics Department at the British Columbia Institute of Technology (BCIT) in Vancouver, Canada, has recently completed a visioning process which was done as part of a curriculum review. This report presents and discusses the key points emerging from the process. It is anticipated that the results of the visioning process will provide a basis for a major curriculum revision to the BCIT’s prosthetics and orthotics program.