Medical Curriculum Development Research Articles

Competency 1. Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds

The ability to communicate effectively with patients, families, and the public is a critical skill for the medical professional and has been directly related to the outcomes of clinical care. 1 Stewart M. Effective physician–patient communication and health outcomes: a review. Can Med Assoc J. 1995; : 152-159 Google Scholar The importance of this is reflected in the medical education literature in consensus statements on essential elements of communication, 2 Simpson M. Buckman R. Stewart M. et al. Doctor–patient communication: the Toronto consensus statement. BMJ. 1991; 303: 1385-1387 Crossref PubMed Scopus (599) Google Scholar , 3 Participants in the Bayer-Fetzer Conference on Physician–Patient Communication in Med Educ Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med. 2001; 76: 390-393 Crossref PubMed Scopus (584) Google Scholar in guidelines for medical school curriculum development, 4 Association of American Medical Colleges Medical School Objectives Project, Report III. Contemporary Issues in Medicine: Communication in Medicine. Association of American Medical Colleges, Washington, DC1999 Google Scholar , 5 General Medical Council Tomorrow's Doctors: Recommendations on Undergraduate Med Educ. General Medical Council, London, UK1993 Google Scholar and through increased emphasis placed on communication skills by professional practice organizations and accrediting bodies. 6 Communications Self-Evaluation Process (COM-SEP) Committee Minutes. American Board of Internal Medicine, Philadelphia, Pa1999 Google Scholar , 7 Tate P. Foulkes J. Neighbour R. et al. Assessing physicians' interpersonal skills via videotaped encounters: a new approach for the Royal College of General Practitioners membership examination. J Health Commun. 1999; 4: 143-152 Crossref PubMed Scopus (43) Google Scholar

Knowledge, Experience, and Anxieties of Young Classical Singers in Training

Young classical singers in training have a wide variety of knowledge about the anatomy and physiology of the voice and vocal pathology and harbor anxiety about treatment of vocal fold disorders. This study aimed to examine differences in knowledge, experience, and anxiety across levels of training at elite conservatories and young artist programs in the United States. Prospective cohort questionnaire. Undergraduate (50), master's (35), and doctoral/young artist (25) singers (n=110) were given an 80-point questionnaire assessing experience with vocal pathology, otolaryngologists, speech pathologists, and participation in choir or teaching. Participants were asked questions to test their medical knowledge in vocal anatomy, physiology, and care. They were also asked questions about their anxiety about medical visits and vocal pathology and about their habits in the care of their own voices. There was no statistically significant difference in test scores for vocal knowledge across the three levels of training (P=0.47). Mean scores were just above 50% with standard deviations around 12-13 points. The lowest score was 26% and the highest score was 84%. Doctoral/young artist-level participants were more anxious regarding general office visits to an otolaryngologist compared with undergraduate and master's level participants. There were no other significant differences by level of training regarding anxiety about vocal pathology, scope examinations, or visits to a speech pathologist. There were no significant differences in self-reported levels of knowledge. All groups of young singers expressed marked interest in expanding their knowledge of anatomy and physiology, speech pathology, care of the vocal mechanism, and vocal disorders. More advanced singers do not have significantly greater knowledge of vocal form and function and are more anxious about visits to otolaryngologists and vocal pathology; a clear majority of singers indicate interest in knowing more. There is thus ample opportunity for innovation in the development of medical curricula in the instruction of young singers and clear interest in more knowledge on their part.

A Survey of Handoff Practices in Emergency Medicine

This study aimed to assess practices in emergency department (ED) handoffs as perceived by emergency medicine (EM) residency program directors and other senior-level faculty and to determine if there are deficits in resident handoff training. This cross-sectional survey study was guided by the Kern model for medical curriculum development. A 12-member Council of Emergency Medicine Residency Directors (CORD) Transitions in Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to the CORD listserv. There were 147 responses to the anonymous survey, which were collected using an online tool. At least 41% of the 158 American College of Graduate Medical Education EM residency programs were represented. More than half (56.6%) of responding EM physicians reported that their ED did not use a standardized handoff. There also exists a dearth of formal handoff training and handoff proficiency assessments for EM residents.

STUDY OF PATIENTS’ ACCEPTABILITY AND ATTITUDE TOWARDS THE UNDERGRADUATE MEDICAL STUDENTS IN A TERTIARY CARE TEACHING HOSPITAL OF EASTERN INDIA

Background: Patients have always been part of medical education. The patients’ co-operation with the undergraduate medical students is vital in clinical education. Patient contact is an integral component of medical education, training and assessment. It provides students and doctors with an opportunity to learn and to develop their professional skills, attitudes and identity. Patients can also benefit from involvement in teaching and training, by increasing their own knowledge, and indirectly through improved training of the medical workforce. Recent reforms of medical education now use more structured and extensive patient contact. Patients should be actively involved in the development, review and implementation of Medical curriculum. But lack of experience of the large number students may evoke negative attitude and acceptability of patients which may sometimes adversely affect the clinical teaching environment. Lots of studies conducted on this area in the different part of the world with varying results with different cultural patients with socio-demographic variation. In this area there was need of more studies especially at this part of the world, Burdwan Medical College, India, where there was no such study conducted before. Objective: In this study my objective was to explore the attitude & acceptability of the undergraduate medical students by the patients in a tertiary care teaching hospital of eastern India. Methods: This study was conducted among 560 patients in OPD & inpatients in Burdwan Medical College, Burdwan , India, from March 2012- June 2012, using predesigned structured questionnaires. Results: Among 560 patients 545 patients responded. Male patients were 54.678% & female were 45.32%. Hindu patients were 37.064% (n=202) and Muslim patients were 62.935% ( n=343). Higher acceptance of both male& female undergraduate medical students at the rate of 86.972% (n=474) by the patients when there was medical examination with the presence of doctors. Whereas only 30.09% (n=164) acceptance of both male& female students by the patients when there was no doctors. In general there was higher acceptance of both sexes’ students by the patients when there was no direct contact with the patients, e.g. taking history of illness, presenting at the OPD clinic, reading the patients file etc. 69.908% (n=381) of patients felt comfortable with the presence of medical students, while 79.266% (n=432) of patients gave favorable opinion regarding the improvement of the quality of health care with the presence of undergraduate medical students. Conclusion: Though a large number of patients did not accept the students without the presence doctor, but majority of the patients showed overall positive attitude towards the involvement of medical students.  Key Words: Medical Students, Medical Education, Patients’ acceptability, OPD Clinic.

Training clinicians to accurately perceive their patients: Current state and future directions

ObjectiveTo review the literature on training clinicians’ person perception accuracy, or the ability to correctly judge patients’ states and traits. To present the importance of training this skill, share evidence it is a trainable skill, and suggest evidence-based recommendations for implementing training. MethodsWe conducted a literature review on person perception training studies developed for or implemented with clinicians. We also summarized measures to evaluate training efficacy, barriers to implementation, and future research directions. ResultsTraining studies exist to improve clinicians’ ability to perceive patients’ emotions, pain, distress, and depression. These varied in training approach, length of training, and study design. Ten of 13 studies showed training benefited person perception accuracy. ConclusionsThe medical literature and previous meta-analysis on person perception training across contexts demonstrate that training person perception accuracy can be effective. Examples of effective trainings provide suggestions of best-practices for future efforts in this area. Practice implicationsMore evidence is needed to create and implement trainings which produce not only differences in accuracy but also in patient care and outcomes. Medical curriculum developers and researchers should collaborate to create effective person perception trainings for clinicians.

An Outcome-Based Approach in Medical Curriculum Development

An outcome-based curriculum is perceived to be one alternative educational approach in medical education. Nonetheless, it is difficult for curriculum developers to convert from traditional curriculum to an outcome-based curriculum because research documenting its development process is rare. Therefore, this study aims to introduce the development process and method of outcome-based curriculum. For the purpose of this study, we used diverse data analyses, such as an existing literature search, development model analysis, and case analysis. We identified five phases from the analysis. First, the curriculum developers analyze the physician’s job or a high performer in a medical situation. Second, curriculum developers extract outcomes and competencies through developing a curriculum, affinity diagraming, and critical incident interviews. Third, curriculum developers determine the proficiency levels of each outcome and competency evaluation methods. Fourth, curriculum developers conduct curriculum mapping with outcomes and competencies. Fifth, curriculum developers develop an educational system. Also, it is important to develop an assessment system for the curriculum implementation in the process of developing the outcome-based curriculum. An outcome-based curriculum influences all the people concerned with education in a medical school including the professors, students, and administrative staff members. Therefore, curriculum developers should consider not only performance assessment tools for the students but also assessment indicators for checking curriculum implementation and managing curriculum quality

Establishment of First Skills Lab in Pediatric Department – Kasr Alainy School of Medicine

BackgroundIn the new era of medical curriculum development, the undergraduate medical students are expected to perform certain practical skills competently. Our aim is to evaluate the extent to which skills lab can achieve required learning outcomes. MethodsAfter an establishment of practical skills lab (PSL), training of staff members, preparation of guidelines and checklists, and running of the first training course; an anonymous questionnaire was distributed to the students in order to evaluate students’ responses to skills teaching. ResultsOur results showed that the undergraduate medical students had high expectations to skills training, and that students’ expectations were nearly met, 90.4% thought that skills can be taught in PSL, 78% found PSL allows students to achieve an adequate level of competence, 53.2% found that skills acquired in PCSL can be transferred directly to patients, 80.7% found that PCSL build up students’ self confidence. Evaluation of training characteristics showed that 85.5% found that teachers of skills lab are committed to teaching, and 82.7% found that educational materials offered to them were helpful in skills learning. ConclusionThe PSL was positively evaluated by undergraduate students and there is a need for extra hours for independent training to increase students’ self confidence.

The Process of Medical Curriculum Development in Malaysia

The first medical school established in Malaysia was the Faculty of Medicine at the University of Malaya in 1963 (Danaraj, 1988). Today, there are 33 medical schools, both public and private. All medical schools require accreditation by the National Accreditation Board and the Malaysian Medical Council. These two regulatory bodies set the minimum standards for accreditation and they include standards that pertain to curricular issues. Apart from adhering to major broad principles, medical schools generally are given a free hand in designing and developing their own curricula. The faculty members of the school determine the nature of the curriculum with the dean playing a vital role in moderating competing demands from the various academic departments. The influence of the Medical Education Department or Unit varies. The Ministry of Health, as the predominant employer of doctors, gives regular feedback to the deans on the performance of their graduates. There has not been any major initiative to involve other important stakeholders, including the public, in the design and development of medical curricula in the country.

Adolescent Medicine Curriculum at Faculty of Medicine, Universiti Teknologi MARA, Malaysia

This article, using the example of the development of an Adolescent Medicine curriculum, highlights the challenges that academicians face and the roles that stakeholders play in the development of medical curricula. To develop the curriculum, apart from using a number of resources, the authors conducted a symposium that was attended by some of the stakeholders. Learning outcomes were identified and the criteria for selection of the content of the curriculum were developed. The teaching/learning methods were recognised and the assessment strategies were formulated. The students felt that this course helped them in: (a) communicating with adolescents, (b) performing examination of adolescent patients, and (c) understanding adolescents’ views on different psychosocial issues. In this paper, the authors summarise the reasons that convinced the faculty to include Adolescent Medicine in its undergraduate teaching programme. The authors also describe the role that different stakeholders played and what further can be achieved by their involvement in such exercises.

Prevalence Of ENT Diseases In Children: Hospital Based Study

Background: Nepal is a landlocked and developing country with 34.6% children under 14 years of ageas well a big population under the line of poverty. Socioeconomic status, family type, overcrowding and provision of health care facilities act as risk factors for ENT disorders. There is a lack of data on pediatric ENT disorders from various Nepalese populations. This study was undertaken to determine the hospital prevalence of ENT disorders in pediatric population and their relationship with sociodemographic factors.Objectives:This study was undertaken to determine the hospital prevalence of ENT disorders in pediatric population and their relationship with socio-demographic factors in a tertiary care hospital in Nepal.Methods: This is a prospective analytic study, conducted at Department of ENT, Head & Neck Surgery between January 2010 and December 2010 in the Ear, Nose and Throat (ENT) Department, Gandaki Medical College Charak Hospital, Pokhara, Nepal. All patients aged 16 years or younger presented ear diseases to the ENT clinic of the hospital seen by ENT surgeons were enrolled into the study.Results: Among 1632 children, ENT diseases were found to be more common among male children (60%). The male to female ratio is 1.5:1. Most of the children were living in joint family (64.16%). Diseases of auditory system (57.84%) were the most common group of ENT problems among the pediatric population, followed by pharyngo-esophageal (23.53%) and nasal disorders (18.63%). Most common otologic disorder was ear wax (40.9%). Among problems associated with nose, rhinitis (23.4%) was most common. Pharyngitis was troubling (44.8%) of our study population.Conclusion:Improvement of health education, socioeconomic status and health facilities will be helpful in reducing the prevalence of ENT diseases. A study on the prevalence of the Ear Nose throat and Head and Neck diseases in developing country like Nepal can provide basic data which can be relevant and beneficial to the development of medical ENT curriculum in the regional setup and subsequent medical practice.

Are online student evaluations of faculty influenced by the timing of evaluations?

Student evaluations of faculty are important components of the medical curriculum and faculty development. To improve the effectiveness and timeliness of student evaluations of faculty in the physiology course, we investigated whether evaluations submitted during the course differed from those submitted after completion of the course. A secure web-based system was developed to collect student evaluations that included numerical rankings (1-5) of faculty performance and a section for comments. The grades that students received in the course were added to the data, which were sorted according to the time of submission of the evaluations and analyzed by Pearson's correlation and Student's t-test. Only 26% of students elected to submit evaluations before completion of the course, and the average faculty ratings of these evaluations were highly correlated [r(14) = 0.91] with the evaluations submitted after completion of the course. Faculty evaluations were also significantly correlated with the previous year [r(14) = 0.88]. Concurrent evaluators provided more comments that were statistically longer and subjectively scored as more "substantive." Students who submitted their evaluations during the course and who included comments had significantly higher final grades in the course. In conclusion, the numeric ratings that faculty received were not influenced by the timing of student evaluations. However, students who submitted early evaluations tended to be more engaged as evidenced by their more substantive comments and their better performance on exams. The consistency of faculty evaluations from year to year and concurrent versus at the end of the course suggest that faculty tend not to make significant adjustments to student evaluations.

Northern Ontario School of Medicine

Northern Ontario School of Medicine

Ponce School of Medicine

Ponce School of Medicine

Analysis of the psychological impact of Problem Based Learning (PBL) towards self directed learning among students in undergraduate medical education

The psychological impact of a learning tool towards self directed learning is an important outcome of medical education. Although problem based learning is believed to facilitate self directed learning, previous studies have reported conflicting results. This longitudinal survey explored the perceived psychological changes in self directed learning for two and a half years in an undergraduate phase 1 medical education program with an integrated problem-based learning curriculum. 170 of 200 students (response rate, 85%) completed the Self-Directed Learning Readiness Scale at five different time points: at the beginning of each semester year and at program completion. Scores were significantly lower during the first semester compared with other years, and fifth semester scores were significantly higher than in previous years. Scores on the three subscales (i.e., self-management, desire for learning, and self-control) increased significantly during the five semesters years of the programme. These findings support self-directed learning as a maturational process seen psychologically by the students. Implications for medical faculty and curriculum development are discussed.

Reform in medical education

There is a worldwide concern about the existing curricula of Medical Education (ME) and its effectiveness in producing capable graduates. The current wonder is about the outcome of medical schools conducting their educational programs based on such curricula and whether they are competent enough to meet today's health problems and disease control. Knowledge, skills and attitude of the graduates compose the extent of their competence as physicians are the elements to be considered in the development of medical curriculum. Despite the fact that these essential elements of education are well realized by most academicians for almost a century, today the numbers of institutions that have incorporated these elements in their curriculum development are not very many. The majority of medical schools worldwide still lack a well defined Reform in their medical education curricula that can cover the abovementioned domains of effective medical education. Quite number of national, regional and international congregations emphasiz(ing)ed a serious action to be taken on the issue of Reform in ME. According to the currently available theories in education and effective learning the outcome of the educational process should posse two essential characteristics namely: and LIFE LONG knowledge. The Quality Assurance (QA) of the learning process demands planners and designers of Educational Programs (EPs) to mastery the knowledge of education and to be more familiar with the elements that make the learners firmly informed, skilled enough and confident to make the right decisions. Learner centered EPs provide the opportunity for paced thinking strategies that help the learner to develop thinking skills hence better conceptualization of the learning issue(s). Innovative approaches in ME like Organ Based (OB) or Clinical Presentation (CP) curricula are among methods utilized in the Reform practice. These new approaches rely heavily on the Horizontal and Vertical integration of basic and clinical contents of the EP. Add to these issues the emphasis on the Social Accountability of medical schools and the way this is translated into practical and cognitive contexts. The latter will add to the quality of the graduate physicians as major players in the society's health status and promotion. It should be emphasized that reform in ME is a necessity today yet the same time a task that demands heavy efforts. An outcome based ME program and curriculum requires the gathering of large number of staff in both basic medical and clinical sciences who should be well informed in the theories of effective learning and education in order to compose a curriculum that can produce physicians who are well equipped with medical knowledge and at the same time have promotional impact on individual and society's health.

Aprendizagem Baseada em Problemas na formação médica e o currículo tradicional de Medicina: uma revisão bibliográfica

Este artigo analisa estudos que comparam a utilização da Aprendizagem Baseada em Problemas (ABP) na formação médica com o desenvolvimento de currículo tradicional de Medicina. O desenho metodológico, caracterizado como uma revisão da literatura sobre o assunto, realizada a partir de uma abordagem qualitativa, apoia-se na busca de artigos em bases de dados e bibliotecas virtuais, publicados de 1998 a 2008, com os termos medicina, graduação, aprendizagem baseada em problemas e ensino tradicional. O material foi estudado a partir da técnica de análise de conteúdo temática. A discussão se desenvolve a partir dos resultados acerca do uso da ABP na graduação médica em comparação aos resultados de cursos de currículo tradicional. Conclui-se que o uso da ABP na graduação médica pode ser uma alternativa na implementação das diretrizes brasileiras para a formação médica.

A Retrospective Analysis of Veterinary Medical Curriculum Development in The Netherlands

Over the past two decades, the Faculty of Veterinary Medicine of Utrecht University (FVMU) has introduced major curriculum changes to keep pace with modern veterinary educational developments worldwide. Changes to program outcomes have been proposed according to professional and societal demands, with more attention paid to generic competencies and electives and species/sector differentiation. Furthermore, changes in educational approaches and the educational organization have been proposed, aiming at a transition from teacher-centered education toward more student-centered education. Curriculum development is a complex and difficult process, with many elements interacting. For a new curriculum to become valid, curriculum elements and their interrelation-such as statements of intent (also called outcomes, goals, or objectives), content, teaching and learning strategies, assessment strategies, and context-need to be addressed in the educational philosophy (i.e., the intended curriculum). This paper describes a document analysis of the major curriculum reforms of the FVMU. Curriculum committee reports were critically analyzed to gain insight into the intentions of the curriculum designers and the match between the curriculum elements, as described by Prideaux. The results show that the reports paid considerable attention to generic competency training, especially to academic training, and to the introduction of more student-centered teaching and learning strategies. However, little attention was paid to assessment strategies and the statements of intent were defined rather broadly. Curriculum evaluation (i.e., what is delivered to the students and how is the curriculum experienced) is needed at all curriculum levels. Possible mismatches between levels need to be identified.

Planning and Implementing a Systems-Based Patient Safety Curriculum in Medical Education

Using a successful 6-step approach to medical curriculum development, a multidisciplinary systems-based safety curriculum for first-year medical students was developed and implemented. A targeted needs assessment was completed based on students' perceptions of patient safety. Goals and objectives identified were the following: (1) provide a practical framework to identify defects, (2) identify patient hazards, (3) investigate an adverse event, (4) understand incident reporting, (5) understand the impact of teamwork and communication in safety, (6) acquire skills to improve teamwork and communication, and (7) learn to disclose medical mistakes. Students were able to identify many of the teamwork and communication problems entrenched in our current health care culture. Interactive learning was important to the learning process and, on evaluation, deemed a valuable experience. The findings indicate that this is an effective curriculum development strategy and that systems-based patient safety was effective in changing perceptions of patient harm and the provider's role in patient safety.

73. "I just don't want to kill anybody": The first six months of postgraduate trainings

This paper describes a qualitative study that used focus groups and individual interviews to explore newly graduated medical students’ experience of the first six months of a postgraduate training programme. This study explored the residents’ concerns, changes that occurred and the influences the residents attributed to those changes during the first six months, this paper focuses on the residents’ experience of responsibility during this initial training period. Residents felt there was a huge leap in responsibility when they made the transition from being a medical student to being a doctor, specifically in the areas of knowledge, practice management, and relationships. This paper describes how the residents felt there was a disconnect between their experience of responsibility as a medical student and their experience of responsibility as a doctor. Residents were concerned they lacked the necessary medical experience and expertise for someone wearing the title “doctor”. It was not until residents felt relatively confident that they were not going to harm patients with their knowledge that they were able to begin the process of understanding what it meant to be the family physician, which allowed them to begin identifying with the role of family medicine resident. This process took weeks for some residents and several months for others. This study lays the groundwork for better understanding the transition experience from undergraduate to postgraduate training from the resident’s perspective. This paper focuses specifically on the concerns residents had adjusting to their new responsibilities and the implications this might have for medical educators and curriculum developers. 
 Hirsh DA., Ogur B, Thibault GE, Cox M. “Continuity” as an Organizing Principle for Clinical Education Reform. The New England Journal of Medicine 2007 (Feb):858-866.
 Kendall ML, Hesketh EA, Macpherson SG. The learning environment for junior doctor training – what hinders, what helps. Medical Teacher 2005; 25:619 – 24.
 Luthy C, Perrier A, Perrin E, Cedrascht C, Allaz AF. Exploring the major difficulties perceived by residents in training: a pilot study. Swiss Medical Weekly 2004; 134:612-17.

Promoting lay participation in medical school curriculum development: lay and faculty perceptions

Although medical schools are encouraged to increase community involvement in medical student training, little information is available about how best to achieve this. While lay community members are not medical 'experts', as recipients of health care services they have vested interests in ensuring optimal health care for themselves and their families. This study explored and compared lay and faculty perceptions around lay participation in medical curriculum development at one medical school. Thirty-two lay volunteers responded to a newspaper advertisement. Seventeen volunteers subsequently participated in 1 of 3 lay focus group discussions. Ten academic staff attended a separate faculty focus group. The 3 lay participants and 1 faculty focus group transcripts were analysed independently and then compared using an iterative process of theme identification and hypothesis testing. Contrasting perspectives of lay and faculty participants were evident in all aspects of the focus group discussions. For lay participants, some sharing of curriculum ownership by medical experts with the lay community was regarded as necessary to create environments that legitimised lay status and acknowledged the importance of lay perspectives. Faculty participants presumed ownership of curriculum development, giving rise to a paternalistic approach to controlling resources and an assumed responsibility (as experts) to define the parameters of lay participation. The results of this study have highlighted many of the challenges inherent in the process of lay participation in medical curriculum development. A model is proposed to facilitate and promote lay participation in medical curriculum development.