Curriculum revision: product innovation for quality outcomes

The education of any professional discipline rests on a curricular foundation that reflects the discipline's theory and knowledge bases, practice patterns, and unique skills. In addition, professional health care education must respond to and reflect changes in technology, societal definitions of health and wellness, and broad social issues such as access to care, health care funding, and changing patient demographics. These issues are interwoven with efforts to also provide high-quality education with positive learning outcomes. In this article, the authors describe a school of nursing's efforts to revise its curriculum to reflect a professional shift in focus to community-based nursing practice and the goals of the federal health goals outlined in Healthy People 2010. The revision also served as the starting point for a change in the process through which the college will seek accreditation in the future; this process-Academic Quality Improvement Program-requires institutions of higher learning to use a continuous quality model as its base.     

Toward diversity-responsive medical education: taking an intersectionality-based approach to a curriculum evaluation

Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a ‘narrow’ or a ‘broad’ definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at using an intersectionality-based approach to define diversity-related learning objectives and to evaluate how biomedical and sociocultural aspects of diversity were integrated into a medical curriculum in the Netherlands. We took a three-phase mixed methods approach. In phase one and two, we defined essential learning objectives based on qualitative interviews with school stakeholders and diversity literature. In phase three, we screened the written curriculum for diversity content (culture, sex/gender and class) and related the results to learning objectives defined in phase two. We identified learning objectives in three areas of education (medical knowledge and skills, patient–physician communication, and reflexivity). Most diversity content pertained to biomedical knowledge and skills. Limited attention was paid to sociocultural issues as determinants of health and healthcare use. Intersections of culture, sex/gender and class remained mostly unaddressed. The curriculum’s diversity-responsiveness could be improved by an operationalization of diversity that goes beyond biomedical traits of assumed homogeneous social groups. Future efforts to take an intersectionality-based approach to curriculum evaluations should include categories of difference other than culture, sex/gender and class as separate, equally important patient identities or groups.     

It's all in the delivery! An analysis of instructional strategies from effective health education curricula

BACKGROUND: This study explores the relationship between instructional strategies and effective health education curricula. METHODS: A content analysis of 10 health education curricula was conducted to determine if they include common instructional strategies for actively engaging students in acquisition of health skills. To be included, the curricula had to (1) be research‐based and proven via empirical testing to positively influence the health behaviors and (2) address 1 of Centers for Disease Control and Prevention's 6 priority health risk behaviors. RESULTS: Content analysis revealed 5 active learning strategies incorporated to involve students in acquiring health skills. Role play, group cooperation, and small group discussion were found in all 10 curricula. To a lesser extent, interactive technology and team games were also included. CONCLUSION: When combined with previous research regarding the characteristics of effective teachers, it becomes clear that effective health education is delivered by teachers who employ a wide repertoire of active learning strategies while devoting substantial instructional time to those specific strategies that involve students in skills practice.     

The testing of clinical skills in dietetic students prior to entering clinical placement

Background One of the most important requirements for contemporary education of a health care professional is to develop a framework for theory and practise which results in attainment of professional competencies suitably robust for a lifetime of practise ( Howe, 2002 ). In the context of those educating preregistration dietitians, this offers the challenge of presenting the student with innovative curricula designed to deliver the appropriate level of knowledge and understanding together with emphasis on skill and attitude development. The purpose of this study was to allow preregistration students the opportunity to practise key clinical skills prior to clinical placement and test skills acquisition using the model of an objective structured clinical examination (OSCE). Methods The learning experience of the student was altered to accommodate a more conceptually‐driven, problem‐centred, case‐based approach. The curriculum was adjusted to incorporate a short clinical skills programme where emphasis was deliberately placed on skill acquisition. At the conclusion of this clinical skills programme, and prior to the students entering clinical placement, skill performance by students was tested using the OSCE. The method of testing was also evaluated by students. Results The OSCE was delivered to 37 preclinical students. Four of the test candidates (11%) failed in at least one of the skill areas: these students performed similarly during clinical placement. Twenty‐one (57%) students returned the post‐OSCE questionnaire. Twenty (95%) students reported a positive experience; 20 (95%) students reported initial anxiety that diminished as the test progressed. Conclusion The Project Team was confident with the novel approach taken in re‐designing the curriculum: to include a dedicated clinical skills programme, together with addition of the testing of clinical skills using the OSCE model. These curriculum changes were deemed to be highly appropriate additions to the student experience in determination of skill performance of students prior to clinical placement.     

Introducing a problem-based unit into a lifespan nutrition class using a randomized design produces equivocal outcomes

Problem-based learning (PBL) is a tutorial, student-centered, problem-driven educational strategy adopted by medical and allied health educators to positively influence self-directed learning, critical thinking, and learning behavior. PBL was examined in dietetics education through random assignment of 32 undergraduate dietetics students for two weeks to either a problem-based or a lecture-based case format for the infant and elderly units of a 16-week lifespan nutrition course. Random assignment followed stratification for gender and earlier course examination performance. Expert validation of PBL curricular components and noted differences in discussion structure and information resources verified curriculum distinctiveness. Main outcome measures were pre- and post-Cognitive Behavior Survey scores for memorization, reflection, and positive learning experience scales, unit and course evaluations and unit examination scores. Students in problem-based modules demonstrated greater gains in reflective thinking with stable memorization, suggesting improved critical thinking skills. Tenets that problem-based learning promotes knowledge retention and provides a more positive learning experience were not upheld. Knowledge acquisition was not hindered by a problem-based approach. We conclude that gains in reflective thinking and evidence of increased self-directed learning argue for inclusion of PBL in dietetics curricula and that a problem-based education will help dietitians successfully respond to professional development needs.     

Teaching and learning teamwork: competency requirements for healthcare managers

This paper addresses an essential element of postgraduate health service management education - development of individual competencies to enhance teamwork among health service managers. A survey of qualified health service managers in the state of Victoria, Australia revealed a set of individual competencies that the managers felt made a positive contribution to the success of workplace teams. The identified competencies included skills in leadership and communication; clinical knowledge and knowledge of organizational goals and strategies; motives such as commitment to the organization, to quality, to working collaboratively and to a consumer focus; and respect for others as a trait. Building on acknowledged teaching and learning theories, a teamwork teaching and learning model was successfully introduced into the postgraduate health services management curriculum at La Trobe University in Melbourne.     

Moving interprofessional learning forward through formal assessment

Medical Education 2010: 44 : 396–403 Context There is increasing agreement that graduates who finish tertiary education with the full complement of skills and knowledge required for their designated profession are not ‘work‐ready’ unless they also acquire interpersonal, collaborative practice and team‐working capabilities. Health workers are unable to contribute to organisational culture in a positive way unless they too attain these capabilities. These capabilities have been shown to improve health care in terms of patient safety, worker satisfaction and health service efficiency. Given the importance of interprofessional learning (IPL) which seeks to address these capabilities, why is IPL not consistently embedded into the education of undergraduates, postgraduates and vocationally qualified personnel through formal assessment? Methods This paper offers an argument for the formal assessment of IPL. It illustrates how the interests of the many stakeholders in IPL can benefit from, and contribute to, the integration of IPL into mainstream professional development and tertiary education. It offers practical examples of assessment in IPL which could drive learning and offer authentic, contextual teaching and learning experiences to undergraduates and health workers alike. Conclusions Assessment drives learning and without formal assessment IPL will continue to be viewed as an optional topic of little relative importance for learners. In order to make the next step forward, IPL needs to be recognised and endorsed through formal assessment, both at the tertiary education level and within the workplace environment. This is supported by workforce initiatives and tertiary education policy which can be used to specify the capabilities or generic skills necessary for effective teamwork and collaborative practice.     

The development and pilot-testing of a training curriculum in adolescent medicine and health.

PURPOSE: To select and propose a set of knowledge, attitudes, and skills essential for the care of adolescents; to encourage the development of adolescent health multidisciplinary networks; and to set up training programs in as many European countries as possible. METHODS: The curriculum was developed by 16 physicians from 11 European countries with various professional specializations. In line with modern guidelines in medical education, it is a modular, flexible instrument which covers the main teaching areas in the field, such as basic skills (i.e. setting, rights and confidentiality, gender and cultural issues) as well as specific themes (i.e. sexual and reproductive health, eating disorders, chronic conditions). It consists of 17 thematic modules, each containing detailed objectives, learning approaches, examples, and evaluation methods. RESULT: Two international one-week summer schools were used to assess the feasibility and appropriateness of the curriculum. The overall evaluation was good, with most of the items surpassing three on a four-point Likert scale. However, it pointed to several aspects (process and content) which will need to be refined in the future, such as an increase in interactive sessions (role playing), and a better mix of clinical and public health issues.     

Using Service-Learning to Teach Mental Health and Research Skills

ABSTRACT

This paper describes how an occupational therapy program used service-learning to integrate the learning objectives for mental health and research curriculum content. The service-learning program assisted participants diagnosed with mental illness to achieve success in higher education and/or related goals and served as a clinical program within a research curriculum for entry-level graduate occupational therapy students. The occupational therapy students served as mentors for the participants. The purpose of the program for the occupational therapy students was to teach research skills, clinical skills, and increase comfort in working with the mental health population. Seventy-eight occupational therapy students participated in the program over four academic years. A case example of a student/participant mentoring relationship is provided. Results indicated that the occupational therapy students gained comfort with the population and competence in their clinical and research skills.     

A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention

A longitudinal quantitative study in an English faculty of health and social care explored the effects of a pre-qualifying interprofessional curriculum for students from 10 professional programmes. Students on the interprofessional curriculum completed questionnaires containing four attitude scales on entry to the faculty, during their second year and at the end of their final year. At qualification, 581 students (76.9% of those qualifying) completed scales concerning their communication and teamwork skills, their attitudes towards interprofessional learning, their perceptions of interaction between health and social care professionals, and their opinions about their own (inter)professional relationships. Questionnaires were completed at both entry and qualification by 526 students (69.8% of those qualifying), and at all three points by 468 students (61.9% of those qualifying). A comparison group of 250 students (67.6% of those qualifying) on the previous uniprofessional curricula also completed questionnaires at qualification. Students on the interprofessional curriculum showed no significant change in their self-assessment of their communication and teamwork skills between entering the faculty and qualification. However, there was a negative shift in their attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own professional relationships at qualification. Students with previous experience of higher education were comparatively positive about their communication and teamwork skills, as were female students about interprofessional learning. However, the strongest influence on students' attitudes at qualification appeared to be professional programme. This suggests that interprofessional education does not inhibit the development of profession-specific attitudes. Students who qualified on the interprofessional curriculum were more positive about their own professional relationships than those who qualified on the previous uniprofessional curricula. These data suggest that experiencing an interprofessional curriculum has an effect on students' attitudes at qualification, particularly with regard to their positive perception of their own professional relationships.