Medical Curriculum Reform Research Articles

Effects of comprehensive educational reforms on academic success in a diverse student body

Calls for medical curriculum reform and increased student diversity in the USA have seen mixed success: performance outcomes following curriculum revisions have been inconsistent and national matriculation of under-represented minority (URM) students has not met aspirations. Published innovations in curricula, academic support and pipeline programmes usually describe isolated interventions that fail to affect curriculum-level outcomes. United States Medical Licensing Examination (USMLE) Step 1 performance and graduation rates were analysed for three classes of medical students before (matriculated 1995-1997, n=517) and after (matriculated 2003-2005, n=597) implementing broad-based reforms in our education system. The changes in pipeline recruitment and preparation programmes, instructional methods, assessment systems, academic support and board preparation were based on sound educational principles and best practices. Post-reform classes were diverse with respect to ethnicity (25.8% URM students), gender (51.8% female), and Medical College Admissions Test (MCAT) score (range 20-40; 24.1% scored ≤ 25). Mean±standard deviation MCAT scores were minimally changed (from 27.2±4.7 to 27.8±3.6). The Step 1 failure rate decreased by 69.3% and mean score increased by 14.0 points (effect size: d=0.67) overall. Improvements were greater among women (failure rate decreased by 78.9%, mean score increased by 15.6 points; d=0.76) and URM students (failure rate decreased by 76.5%, mean score increased by 14.6 points; d=0.74), especially African-American students (failure rate decreased by 93.6%, mean score increased by 20.8 points; d=1.12). Step 1 scores increased across the entire MCAT range. Four- and 5-year graduation rates increased by 7.1% and 5.8%, respectively. The effect sizes in these performance improvements surpassed those previously reported for isolated interventions in curriculum and student support. This success is likely to have resulted from the broad-based, mutually reinforcing nature of reforms in multiple components of the education system. The results suggest that a narrow reductionist view of educational programme reform is less likely to result in improved educational outcomes than a system perspective that addresses the coordinated functioning of multiple aspects of the academic enterprise.

Remarks for Basic Medical Education Quality Improvement of Yonsei University in Korea

Medical Students’ competencies depend on the medical school curriculum. Basic medical education, in particular, is an important starting point for further medical competency development. We aimed to identify the most important areas of reform in the basic medical education curriculum of Yonsei Medical School. To accomplish this, we sought case studies of different medical schools and discussion points for quality improvement methods. A qualitative comparison method saturated through the systematic discussions on the emerging thematic approaches to determine the current directions in medical school curriculum reform. The discussions, which involved 7 experts, spanned 8 months and were based on a literature review, with focus on the 7 selected case studies. From the discussions, we concluded that in order to improve basic medical education curriculum, the following measures need to be carried out. First, an outcome-based curriculum is to be designed. The expected outcome is to be deliberately and succinctly defined and should be expressed as teaching and learning objectives. Second, the core subjects and elective subjects are to be classified on the basis of the aim, content, and passage level of the subjects. Hence, the core curriculum must be treated as a standard part of medical knowledge, and the elective curriculum must be richer and more in-depth. Third, universities should institutionalize regular evaluation of their departments. Appropriate and just evaluations should be made, and feedback given to the school’s administrative department. Fourth, the departmental and administrative management of the basic medical education curriculum should be harmonized with each other. Finally, teaching and learning resources are to be increased and diversified and made available to professors and students for basic medical education.

The addition of an upper-extremity curriculum in medical school education and its assessment

This study assessed the impact of changes made to address the inadequate upper-extremity education through preclinical medical school curriculum reform. After the administration of a new upper-extremity curriculum, which also increased the time devoted to three preclinical medical school courses from 7.25 to 21.25 hours, second-year medical students were evaluated for mastery of these concepts through a national validated objective examination, and attitude and skill through clinical confidence and subjective surveys. After implementation of the new upper-extremity curriculum, students had significantly greater confidence in their ability to perform a physical examination but not in identifying differential diagnoses of the upper-extremity. Students were more satisfied with the amount of time spent on the musculoskeletal system but their performance in the national examination did not change.

Historical Context for the Growth of Medical Professionalism and Curriculum Reform in Taiwan

Medical school curricular reform to address humanism is now a prominent issue in Taiwan. Taiwan's community of medical professionals have for the last 100 years played a leading role in the nation's modernization and democratization. With the democratic opening of 1990, they took up the cause of humanistic reform of medical education. Although the reform has not sufficiently specified the depth and breadth of professionalism to be achieved through the medical school curriculum, it points at least to the most desired professionalism goals. Collaboration with the international community, particularly with Taiwanese-American medical educators and researchers who bring their experience back to Taiwan, has been a potent force for the advancement of the humanities and professionalism in medical education. This paper presents the definition of professionalism and the history of the medical profession from the perspective of medical education in Taiwan, and discusses recent transitions.

Review Paper: Gender Competencies in the Medical Curriculum: Addressing Gender Bias in Medicine

Gender inequalities in health and gender bias in medicine are interrelated challenges facing health care providers and educators. Women and girls are disadvantaged in accessing health care because of their low social status and unequal treatment in medical care. Gender bias has long been inherent in clinical practice, medical research, and education. This can be traced to the medical curriculum that shapes the perceptions, attitudes, and behavior of the future doctor. The author advocates medical curricula change to address gender inequalities in health and gender bias in medicine. She analyses the reasons for integration of gender competencies in the medical curriculum, discusses what gender competencies are, and reviews ways to in-build gender competencies and their assessment. Efforts to change and gender sensitize medical curricula in developed and developing countries are also reviewed. The review hopes to contribute to strategic medical curriculum reform, which would lead to gender-sensitive health services and equity in health.

Medical curriculum reform in Sun Yat-sen University: implications from the results of GMER evaluation in China

Created by interlocking economies, a global language, the informatics revolution and rapid travel, globalization has penetrated all aspects of human life including science, environment, public health and medicine. Physicians are now members of a global community. The global physician should possess universal core essential competences required for medical practice throughout the world. The Institute for International Medical Education (IIME), created by the China Medical Board (CMB) of New York, has developed the “ global minimal essential requirements” (GMER) that define the knowledge, skills, professional behavior and ethics that all physicians must have regardless of where they received their general medical education and training. The IIME initiated a pilot project in China in October, 2003, to evaluate the graduates of the 7- or 8-year track program of eight leading medical schools, including Medical School of Sun Yat-sen University. The results of GMER evaluation indicated strengths and areas for improvement of our school in relation to international standards, which greatly re-invigorate our enthusiasm on medical curriculum reform on the new 8-year track program in Medical School of Sun Yat-sen University. The modifications of our medical curriculum for the new 8-year track program based on the results of GMER evaluation are discussed in this paper.

Survey of attitudes towards curriculum reforms among medical teachers in different socio-economic and cultural environments

Background: Curriculum reforms in medical schools require cultural and conceptual changes from the faculty.Aims and Methods: We assessed attitudes towards curriculum reforms in different academic, economic, and social environments among 776 teachers from 2 Western European medical schools (Belgium and Denmark) and 7 medical schools in 3 countries in post-communist transition (Croatia, Slovenia, Bosnia and Herzegovina). The survey included a 5-point Likert-type scale on attitudes towards reforms in general and towards reforms of medical curriculum (10 items each).Results: Teaching staff from medical schools in Bosnia and Herzegovina had a more positive attitude towards reforms of medical curriculum (mean score 36.8 out of maximum 50 [95% CI 36.1 to 37.3]) than those from medical schools in Croatia or Slovenia (30.7 [29.8 to 31.6]) or Western Europe (27.7 [27.1 to 28.3]) (P < 0.001, ANOVA). Significant predictors of positive attitudes towards medical curriculum reform in post-communist transition countries, but not in Western European schools, was younger age, as well as female gender in Bosnia and Herzegovina.Conclusions: Factors influencing faculty attitudes may not be easy to identify and may be specific for different settings. Their identification and management is necessary for producing sustainable curriculum reform.

Medical Education and Curriculum Reform: Putting Reform Proposals in Context

:The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care; emphasizes that the clinical work needs to be systematized in so far as that it feasible; promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders. Keywords: Curriculum reform, evaluation criteria, systematization, multi-disciplinary teamwork, responsible autonomy

Questioning the "big assumptions". Part I: addressing personal contradictions that impede professional development.

The ultimate success of recent medical curriculum reforms is, in large part, dependent upon the faculty's ability to adopt and sustain new attitudes and behaviors. However, like many New Year's resolutions, sincere intent to change may be short lived and followed by a discouraging return to old behaviors. Failure to sustain the initial resolve to change can be misinterpreted as a lack of commitment to one's original goals and eventually lead to greater effort expended in rationalizing the status quo rather than changing it. The present article outlines how a transformative process that has proven to be effective in managing personal change, Questioning the Big Assumptions, was successfully used in an international faculty development program for medical educators to enhance individual personal satisfaction and professional effectiveness. This process systematically encouraged participants to explore and proactively address currently operative mechanisms that could stall their attempts to change at the professional level. The applications of the Big Assumptions process in faculty development helped individuals to recognize and subsequently utilize unchallenged and deep rooted personal beliefs to overcome unconscious resistance to change. This approach systematically led participants away from circular griping about what was not right in their current situation to identifying the actions that they needed to take to realize their individual goals. By thoughtful testing of personal Big Assumptions, participants designed behavioral changes that could be broadly supported and, most importantly, sustained.

Questioning the "big assumptions". Part II: recognizing organizational contradictions that impede institutional change.

Well-designed medical curriculum reforms can fall short of their primary objectives during implementation when unanticipated or unaddressed organizational resistance surfaces. This typically occurs if the agents for change ignore faculty concerns during the planning stage or when the provision of essential institutional safeguards to support new behaviors are neglected. Disappointing outcomes in curriculum reforms then result in the perpetuation of or reversion to the status quo despite the loftiest of goals. Institutional resistance to change, much like that observed during personal development, does not necessarily indicate a communal lack of commitment to the organization's newly stated goals. It may reflect the existence of competing organizational objectives that must be addressed before substantive advances in a new direction can be accomplished. The authors describe how the Big Assumptions process (see previous article) was adapted and applied at the institutional level during a school of medicine's curriculum reform. Reform leaders encouraged faculty participants to articulate their reservations about considered changes to provided insights into the organization's competing commitments. The line of discussion provided an opportunity for faculty to appreciate the gridlock that existed until appropriate test of the school's long held Big Assumptions could be conducted. The Big Assumptions process proved useful in moving faculty groups to recognize and questions the validity of unchallenged institutional beliefs that were likely to undermine efforts toward change. The process also allowed the organization to put essential institutional safeguards in place that ultimately insured that substantive reforms could be sustained.

Curriculum or syllabus: which are we reforming?

Although the concept of 'curriculum' is complex, a common understanding of the term by those involved in medical education is essential, given the current climate of medical curriculum development and reform. It has not previously been established that such a common frame of reference exists. We polled a sample of medical educators with a range of teaching experience and responsibility in an attempt to discover what they understood by 'curriculum' (and whether or not the concept could be articulated). A sample of medical students was similarly polled. In total, 85% of staff and 34.9% of the students responded. The responses obtained were subjected to a content analysis. The answers received were polythematic in 87.5% of cases, dominant themes including 'curriculum as a syllabus', 'curriculum as a meta-syllabus', and 'curriculum as a means to an end'. Our data show that the nature of curriculum is complex and does not lend itself to dictionary-style definitions. Moreover, the majority of those polled view 'curriculum' in two-dimensional terms, tending to equate it to 'syllabus'. This may have significant implications for curriculum reform.

Medical curriculum reform in North America, 1765 to the present: a cognitive science perspective.

Since 1765, five major curricular reform movements have catalyzed significant changes in North American medical education. This article describes each reform movement in terms of its underlying educational practices and principles, inherent instructional problems, and the innovations that were carried forward. When considering the motivating factors underlying these reform movements, a unifying theme gradually emerges: increasing interest in, attention to, and understanding of the knowledge-base structures and cognitive processes that characterize and distinguish medical experts and novices. Concurrent with this emerging theme is a growing realization that medical educators must call upon and utilize the literature, research methods, and theoretical perspectives of cognitive science if future curricular reform efforts are to move forward efficiently and effectively. The authors hope that the discussion and perspective offered herein will broaden, stimulate, and challenge educators as they strive to create the reform movements that will define 21st-century medical education.

Changing the Medical School Curriculum to Improve Patient Access to Primary Care

The problems of access to health care by the underinsured demand a systematic response. One of the critical components of that response is medical curriculum reform, with the intent to graduate adequate numbers of physicians to do primary care, to work with the underinsured and the uninsured, and to practice in rural areas. One state, Minnesota, has developed a unique response to these needs, demonstrating problem solving very much in keeping with many of the recommendations in the literature. Highlighted in this article is the University of Minnesota's Rural Physician Associate Program, a predoctoral curriculum innovation functioning for 20 years to help resolve the issue of physician maldistribution in the state. The Rural Physician Associate Program provides students with many of the skills needed to provide primary care, it is cost-effective, and it has brought a number of benefits to the participating communities.

Skepticism About Loss of Skepticism!-Reply

In Reply. — We welcome Dr Prichard's constructive critique of our editorial 1 calling for reform of the medical curriculum and the National Board examinations. It is our hope that the ensuing dialogue will represent one of the first steps toward correcting what we see as serious problems and deficiencies in the current system. We would be the first to admit that there are no hard data to cite for either side in this debate. Our editorial was based on observations made during many years of teaching at our respective medical schools. It may well be that the first step in reforming medical education in the United States should be the collection of some objective information on which to base recommendations concerning the content of the proposed new curriculum for American medical education in the 21st century. However, such information is not easily obtained or quantified. How does one measure

Reform of Medical Curriculum

Reform of Medical Curriculum