Development of a palliative education assessment tool for medical student education.

Studies assessing palliative care education in U.S. medical schools reveal that little attention is paid to this topic. Although core competencies have been defined, few schools have implemented effective means to incorporate formal palliative care education into undergraduate curricula. To promote reform, each school needs to conduct a thorough assessment to identify palliative care content throughout the four-year curriculum. The authors developed an innovative assessment instrument to facilitate curricular mapping of palliative care education. The Palliative Education Assessment Tool (PEAT) comprises seven palliative care domains: palliative medicine, pain, neuropsychologic symptoms, other symptoms, ethics and the law, patient/family/nonclinical caregiver perspectives on end-of-life care, and clinical communication skills. Each domain details specific curricular objectives of knowledge, skills, and attitudes. Designed as a flexible self-assessment tool, PEAT helps determine the existence of palliative care education, which usually is found in various formats throughout a medical school's curriculum and thus sometimes "hidden." PEAT enables educators to describe a specific, multidimensional aspect of the curriculum and use the information for strategic planning, educational reform, and evaluation. The curricular reform implications of such an instrument are broader than palliative care assessment. A modified version of PEAT can be used to assess systematically other topics that are taught in various formats in the curriculum and to develop collaborative approaches to fulfilling the educational objectives of those topics.     

A systematic review of resident research curricula.

PURPOSE: To review in a systematic manner the published curricula for training house officers in research. METHOD: Articles were identified by searching the Medline, Educational Resources Information Center, and Science Citation Index databases, educational Web sites, and bibliographies of captured articles, and by contacting experts who had developed resident research curricula. Demographic information, curriculum development steps, educational strategies, evaluation methods, and outcomes were abstracted. RESULTS: The search identified 41 articles describing curricula. The most common curricular objectives were to increase house officers' research productivity and improve their critical appraisal skills. Only one curriculum was designed with the goal of producing academic physicians. Among many instructional methods, conducting research projects, exposing learners to role models or mentors, and providing house officers with multiple opportunities to present their work were common. Only 27 articles (66%) articulated goals or objectives, and 11 included (27%) needs assessments. Evaluation methods were often rudimentary, frequently limited to learners' self-assessments or authors' anecdotal reports. Five (12%) reported pre-post-intervention testing of learners' knowledge. No curricula were evaluated as prospective pretest-posttest controlled trials. A minority of articles reported costs, obstacles encountered, or modifications made in the curriculum. CONCLUSION: Successful educational interventions should incorporate needs assessments, clearly defined learning objectives, and evaluation methods. While many curricula for resident research exist, the lack of detailed developmental information and meaningful evaluations hinders educators interested in adopting these curricula.     

Medical students' education in the ambulatory care setting: background paper 1 of the Medical School Objectives Project.

The present article is the first MSOP Background Paper. In planning the Medical School Objectives Project (MSOP), the Association recognized that certain changes in medical students' education were occurring already in some schools, and that it would be important to gain insight into and monitor these changes to provide ideas and information to help schools design curricular changes to foster students' achievements of the objectives and recommendations set forth in the MSOP Reports published in 1998 and reprinted in Academic Medicine. This background paper provides an overview of the strategies being developed by medical schools to carry out education in the ambulatory care setting. This report is based on site visits in 1997 to 26 U.S. medical schools conducted by two of the authors (CEH and GAK), who also used information from 12 additional schools that were not visited and consulted individuals responsible for the evaluation of five grant programs dedicated to national curriculum reform. The authors define and discuss in detail the use of the three main strategies that their research uncovered: (1) longitudinal preceptorships, (2) multispecialty clerkships, and (3) activities that are community oriented and population based to provide medical students the kinds of educational experiences they need to understand and practice in the ambulatory care setting. The authors then discuss issues and challenges related to the implementation of these curricular changes: curricular management issues; developing and maintaining a network of practicing physicians willing to serve as preceptors; evaluating curricular innovations; and assessing students' performances. The authors conclude with general observations about the need for ambulatory care education, the difficulties that have been--and continue to be--met and overcome to implement it, and the recommendation that relevant learning experiences should be incorporated into existing course work or clinical experiences.     

Training U.S. medical students to care for the chronically ill.

PURPOSE: The growing prevalence of chronic illness has important implications for the training of all physicians. The authors assessed the degree to which undergraduate medical curricula explicitly address chronic care competencies selected through literature and expert review. METHOD: In 2001, trained student assistants interviewed directors of required medical school courses (internal medicine, pediatrics, family practice, and ambulatory care clerkships; longitudinal care; and other relevant courses) at 16 representative U.S. medical schools sampled by geography, curriculum reform activity, and primary care orientation of graduates. Course directors were asked whether chronic care competencies were addressed using specific curricular methods (written objectives, course materials, observational evaluations, written/oral examinations, other required course activities), and to rate the importance (1 = not important; 5 = essential) of each competency for their course and for the overall undergraduate curriculum. RESULTS: All 70 eligible course directors responded. Of 49 chronic care competencies, 29 (59%) received mean importance ratings for a course of >/=3, but only 14 (29%) were addressed using two or more specific curricular methods. Course directors gave highest importance ratings (mean > 3.9) to screening for abuse, awareness of patients' sociocultural perspectives, and protecting patients' confidentiality. They gave lowest importance ratings (mean 相似文献   

Enhancing behavioral science education at the Ohio State University College of Medicine.

The social and behavioral sciences play key roles in patient health outcomes. Given this reality, successful development of social and behavioral science curricula in medical education is critically important to the quality of patients' lives and the effectiveness of health care delivery systems. The Institute of Medicine, in a recent report, recommended that medical schools enhance their curricula in these areas and identified four institutions as "exemplars" of social and behavioral science education. The authors describe an ongoing curriculum development and improvement process that produced one such exemplary program at The Ohio State University College of Medicine.The authors provide a historical perspective on behavioral science education, discuss issues that led to curricular change, and describe the principles and processes used to implement reform. Critical factors underlying positive change are addressed: increase active learning, recruit a core group of small-group facilitators who are primary care physicians, diversify teaching methods, support student-directed educational initiatives, enhance student-teacher relationships, centralize course administration, obtain funding, implement a faculty development program, and apply curriculum quality improvement methods. Outcome data from evaluations completed by both students and small-group physician faculty are presented, and future directions regarding further revision are outlined. The authors believe that the strategies they describe can be applied at other institutions and assist behavioral science educators who may experience the challenges typically encountered in this important field of medical education.     

Cultural competence teaching in U.S. pediatric clerkships in 2006.

PURPOSE: Cultural sensitivity may be especially important in the care of children, and national pediatric associations have issued policy statements promoting cultural competence in medical education. The authors conducted a national survey to investigate the current state of cultural competence teaching and learning within U.S. pediatric clerkships. METHOD: The authors surveyed 125 U.S. pediatric clerkship directors concerning the presence or absence of cultural curricula, content, teaching methods, and evaluation. Question types were multiple-choice single/best answer, checklists, five-point Likert-type scales, and free-text responses. RESULTS: Of 100 respondents (80% response rate), most agreed or strongly agreed that teaching culturally competent care is important (91%), enhances the physician/patient/family relationship (99%), and improves patient outcomes (90%). Twenty four of 98 respondents (25%) reported cultural competence teaching. The most common teaching methods were lectures (63%), experiential learning through community activities (58%), and small-group discussions (54%). Only 14 respondents reported any curricular evaluation, the commonest methods being student surveys, clinical case presentations, and standardized patient experiences. Top factors facilitating curriculum development were culturally diverse populations of patients, students, faculty, and hospital staff, and faculty interest and expertise. Top challenges included lack of protected time for program development, funding, and faculty expertise. CONCLUSIONS: Few U.S. pediatric clerkships currently provide cultural competence curricula. The authors' suggestions to promote cultural competence teaching include providing faculty development opportunities and developing and disseminating teaching materials and evaluation tools. Such dissemination is important to graduate physicians, who can provide culturally sensitive pediatric care to the changing U.S. population.     

Community-based clinical education at the University of Birmingham Medical School.

Throughout the United Kingdom, medical schools have begun to make significant changes in the content and delivery of their undergraduate curricula in response to a number of social and educational forces. In particular, many schools have begun to focus increasingly on community-based education. This and other changes mirror developments that have taken place in other countries and in the context of other health care systems, with such forerunners as Harvard, Maastricht, and McMaster having had a fundamental influence. In this article, the authors describe the forces for curricular change in the United Kingdom and the specific recommendations for change made by the General Medical Council. They then discuss in detail the new curriculum at the University of Birmingham medical school, focusing in particular on a community medicine module, where students spend ten days per academic year learning in general medical practices in and around the city of Birmingham.     

The teaching of cultural issues in U.S. and Canadian medical schools.

PURPOSE: Despite the importance of culture in health care and the rapid growth of ethnic diversity in the United States and Canada, little is known about the teaching of cultural issues in medical schools. The study goals, therefore, were to determine the number of U.S. and Canadian medical schools that have courses on cultural issues, and to examine the format, content, and timing of those courses. METHOD: The authors contacted the deans of students and/ or directors of courses on cultural issues at all 126 U.S. and all 16 Canadian medical schools. Using a cross-sectional telephone survey, they asked whether each school had a course on cultural sensitivity or multicultural issues and, if so, whether it was separate or contained within a larger course, when in the curriculum the course was taught, and which ethnic groups the course addressed. RESULTS: The response rates were 94% for both U.S. (118) and Canadian (15) schools. Very few schools (U.S. = 8%; and Canada = 0%) had separate courses specifically addressing cultural issues. Schools in both countries usually addressed cultural issues in one to three lectures as part of larger, mostly preclinical courses. Significantly more Canadian than U.S. schools provided no instruction on cultural issues (27% versus 8%; p = .04). Few schools taught about the specific cultural issues of the largest minority groups in their geographic areas: only 28% and 26% of U.S. schools taught about African American and Latino issues, respectively, and only two thirds of Canadian schools taught about either Asian or Native Canadian issues. Only 35% of U.S. schools addressed the cultural issues of the largest minority groups in their particular states. CONCLUSIONS: Most U.S. and Canadian medical schools provide inadequate instruction about cultural issues, especially the specific cultural aspects of large minority groups.     

Embryology in the medical curriculum

Embryology as a field is in a period of unprecedented change in its knowledge base. Similarly, this is a period of great change in medical curricular planning. One of the most significant questions in embryology education for medical students is how much of the "new" molecular embryology to mix with the "old" developmental anatomy approach. The other question is the most effective venue for instruction in medical embryology. Not all medical curricula have the same objectives; nor do they use the same educational approach. With that in mind, this review outlines several ways in which medical embryology can be offered and how it can be integrated into the medical curriculum. It also lays out topics that are worthy of inclusion in a modern embryology course or sequence.     

The integration of pathology into the clinical years of undergraduate medical education: a survey and review of the literature

Pathology as a basic science discipline traditionally is a component of the preclinical medical school curriculum. While there have been regional and nationwide surveys reporting on the curricular organization and instructional formats of preclinical pathology instruction, the extent of required pathology integration into the clinical medical school curriculum, particularly as it relates to practical issues of patient management, has not been studied. A survey soliciting information about required pathology programs in the clinical years was distributed to the members of the Undergraduate Medical Educators Section of the Association of Pathology Chairs (APC). A literature search of such programs was also performed. Thirty-seven respondents representing 30 medical schools (21% of the 140 Liaison Committee on Medical Education-accredited medical schools in the APC) described a total of 16 required pathology programs in the clinical years. An additional 10 programs were identified in the literature. Advantages of required pathology activities in the clinical years include educating medical students in effective utilization of anatomic and clinical pathology for patient care and exposing them to the practice of pathology. Reported challenges have been competition for curricular time in the clinical years, attitudinal resistance by clerkship directors, failure to recognize pathology as a clinical discipline, and insufficient number of faculty in pathology departments. By survey sample and literature review, there has been relatively little progress in the integration of required pathology exposure into the clinical years. Development of practice-related pathology competencies may facilitate introduction of such curricular programs in the future.     

Innovative approaches to educating medical students for practice in a changing health care environment: the National UME-21 Project.

In today's continually changing health care environment, there is serious concern that medical students are not being adequately prepared to provide optimal health care in the system where they will eventually practice. To address this problem, the Health Resources and Services Administration (HRSA) developed a $7.6 million national demonstration project, Undergraduate Medical Education for the 21st Century (UME-21). This project funded 18 U.S. medical schools, both public and private, for a three-year period (1998-2001) to implement innovative educational strategies. To accomplish their goals, the 18 UME-21 schools worked with more than 50 organizations external to the medical school (e.g., managed care organizations, integrated health systems, Area Health Education Centers, community health centers). The authors describe the major curricular changes that have been implemented through the UME-21 project, discuss the challenges that occurred in carrying out those changes, and outline the strategies for evaluating the project. The participating schools have developed curricular changes that focus on the core primary care clinical clerkships, take place in ambulatory settings, include learning objectives and competencies identified as important to providing care in the future health care system, and have faculty development and internal evaluation components. Curricular changes implemented at the 18 schools include having students work directly with managed care organizations, as well as special demonstration projects to teach students the knowledge, skills, and attitudes necessary for successfully managing care. It is already clear that the UME-21 project has catalyzed important curricular changes within 12.5% of U.S. medical schools. The ongoing national evaluation of this project, which will be completed in 2002, will provide further information about the project's impact and effectiveness.     

Enhancing palliative care education in medical school curricula: implementation of the palliative education assessment tool.

The authors report the results of a Robert Wood Johnson Foundation-funded project that catalyzed New York State medical schools to develop and implement strategic plans for curricular change to enhance palliative care education. The project used the Palliative Education Assessment Tool for curricular mapping of palliative care education throughout each school's four-year curriculum and used site visits to facilitate strategic planning within each institution. Of the 14 New York State medical schools, 13 participated in the project. Ten provided strategic plans for change, with a total of 71 specific goals (median = 5 per school). Of these goals, 67 (94.4%) had been implemented or were in the active-planning process one year after the plans were created. Overall, palliative care content was enhanced in four curricular areas: basic science courses, ethics and humanities courses, clerkship rotations, and faculty development in palliative care. The process of self-assessment, curriculum mapping of a specific thematic area, and strategic planning for change appears to have successfully enhanced the palliative care content in the medical schools' curricula.     

Creating sustainable curricular change: lessons learned from an alternative therapies educational initiative.

The authors describe the process by which a curriculum was developed to introduce complementary and alternative medicine topics at multiple levels from health professional students to faculty, as part of a five-year project, funded by a grant from the National Institutes of Health, at the University of Texas Medical Branch in Galveston, Texas, from 2001 to 2005. The curriculum was based on four educational goals that embrace effective communication with patients, application of sound evidence, creation of patient-centered therapeutic relationships, and development of positive perspectives on wellness. The authors analyze the complex and challenging process of gaining acceptance for the curriculum and implementing it in the context of existing courses and programs. The developmental background and context of this curricular innovation at this institution is described, with reference to parallel activities at other academic health centers participating in the Consortium of Academic Health Centers for Integrative Medicine. The authors hold that successful curricular change in medical schools must follow sound educational development principles. A well-planned process of integration is particularly important when introducing a pioneering curriculum into an academic health center. The process at this institution followed six key principles for successful accomplishment of curriculum change: leadership, cooperative climate, participation by organization members, politics, human resource development, and evaluation. The authors provide details about six analogous elements used to design and sustain the curriculum: collaboration, communication, demonstration, evaluation, evolution, and dissemination.     

Guidelines for preclerkship bioterrorism curricula.

PURPOSE: To develop medical school curriculum guidelines related to bioterrorism to ensure that future medical graduates are armed with the critical knowledge, skills, and attitudes to face this emerging threat. METHOD: An Internet-based Delphi survey was performed in 2002 under the auspices of the Association of Medical School Microbiology and Immunology Chairs involving 64 medical educators in microbiology, immunology, and infectious diseases representing 54 U.S. medical schools. A 12-member bioterrorism expert reference panel participated in the final phase of the survey. RESULTS: Study participants identified the top educational objectives for the following bioterrorism-related curriculum categories: general issues, biodefense, public health, infection control, infectious diseases, and toxins. CONCLUSION: The study focused on preparedness training through the development of curricular guidelines in predominantly preclerkship medical education by identifying basic science and clinical laboratory aspects of putative biologic weapons organisms and toxins, clinical manifestations of bioterrorist attacks, treatment strategies, epidemiology, and prophylaxis.     

Cross-cultural education in U.S. medical schools: development of an assessment tool.

PURPOSE: Medical education is responding to an increasingly diverse population and to regulatory and quality-of-care requirements by developing cross-cultural curricula in health care. This undertaking has proved problematic because there is no consensus on what elements of cross-cultural medicine should be taught. Further, less is known about what is being taught. This study hypothesized that a tool could be developed to assess common themes, concepts, learning objectives, and methods in cross-cultural education. METHOD: In 2001, 31 U.S. medical schools were invited to provide the researchers all written and/or Web-based materials related to implementing cross-cultural competency in their curricula. A tool was developed to measure teaching methods, skill sets, and eight content areas in cross-cultural education. RESULTS: A total of 19 medical schools supplied their curricular materials. There was considerable variation in approaches to teaching and in the content of cross-cultural education across the schools. Most emphasized teaching general themes, such as the doctor-patient relationship, socioeconomic status, and racism. Most also focused on specific cultural information about the ethnic communities they served. Few schools extensively addressed health care access and language issues. CONCLUSIONS: This assessment tool is an important step toward developing a standard nomenclature for measuring the success of cross-cultural education curricula. On the national level, the tool can be used to compare program components and encourage the exchange of effective teaching tools by promoting a common language, which will be essential for developing and implementing curricula, for comparing programs, and evaluating their effects on quality of care.     

Implementing a problem-based learning curriculum in an Argentinean medical school: implications for developing countries.

The authors review the difficulties that Argentina's medical schools, particularly the public ones, are likely to face when implementing a problem-based learning (PBL) curriculum, describe the barriers that were faced by their medical school as it implemented PBL, and point out the implications for medical education in developing countries with conditions and education programs similar to those in Argentina. Specifically, they (1) outline the basic requirements for successful implementation of a PBL curriculum, (2) describe the training contradiction in Argentina between a complex and heterogeneous health care system that forces specialization and medical schools' attempts to train generalists, and (3) review the effects on curriculum change of the size and the training levels of the student population and the availability of human and financial resources. This information indicates the context in which the Rosario University School of Medicine designed a new PBL curriculum and implemented it in 2002. The authors close by suggesting that schools in developing countries that are in circumstances similar to that of Rosario should consider whether a PBL curriculum is even appropriate for them, and should realize the difficulties (discussed in the article) they will have to overcome. Also, uncertainties about the efficacy of PBL create a case for exploring alternatives to PBL, including hybrid curricula. Considering the available research on curricular innovations such as PBL and the particular situations of their countries may help schools anywhere avoid wrong decisions about what curricula to implement.     

Ethics education in U.S. medical schools: a study of syllabi.

PURPOSE: Despite attempts to describe the "ideal" medical ethics curriculum, few data exist describing current practices in medical ethics education to guide curriculum directors. This study aimed to determine the scope and content of required, formal ethics components in the curricula of U.S. medical schools. METHOD: A questionnaire sent to all curriculum directors of four-year medical schools in the U.S. (n = 121) requested course syllabi for all required, formal ethics components in the four-year curriculum. Syllabi were coded and analyzed to produce a profile of course objectives, teaching methods, course contents, and methods for assessing students. RESULTS: Questionnaires were returned by 87 representatives of the schools (72%). A total of 69 (79%) required a formal ethics course, and 58 (84%) provided their ethics course syllabi. Analysis and codification of all syllabi identified ten course objectives, eight teaching methods, 39 content areas, and six methods of assessing students. The means for individual schools were three objectives, four teaching methods, 13 content areas, and two methods of assessment. The 58 syllabi either required or recommended 1,191 distinct readings, only eight of which were used by more than six schools. CONCLUSIONS: Ethics education is far from homogeneous among U.S. medical schools, in both content and extensiveness. While the study of syllabi demonstrates significant areas of overlap with recent efforts to identify an "ideal" ethics curriculum for medical students, several areas of weakness emerged that require attention from medical educators.     

Status of gross anatomy in the U.S. and Canada: Dilemma for the 21st century

As a component of a recent academic review, the Department of Anatomy and Neurosciences faculty at the University of Texas Medical Branch in Galveston, Texas, developed a questionnaire designed to compare the curricula, direction, and challenges of their department with the approximately 140 anatomy departments in the U. S. and Canada. The response was overwhelming in that over 80% of the schools returned a completed questionnaire. One of the areas of interest revealed by this survey was a growing concern over significant changes in both medical school curricula and the future of anatomy departments. Most departments still used traditional lectures to present course material and the majority of the scheduled contact hours were in the dissection laboratory; however, other teaching formats, such as case studies and small group discussions, accounted for significantly more of the teaching effort. Nearly 20% of the schools were making major modifications in their teaching methods. The general trend was to include more integrated, problem-based learning and computer-assisted teaching while reducing overall content, didactic lectures, and rote memorization. The role and need for traditionally trained gross anatomists in medical education appeared to be diminishing as curricular reform moved toward more student-directed, faculty-facilitated programs. Concurrently, the recruitment and career development of gross anatomy faculty appeared to be influenced more by funding status than by academic training or teaching experience, as most departmental chairman were willing to hire non-anatomists and “train” them to assume an often reduced teaching load in gross anatomy courses. In addition, fewer graduate students were being trained in classical gross anatomy, a trend that better suited the emerging student-directed medical school curricula. The reduction in classically trained anatomists also appeared to reflect the widespread practice whereby anatomy faculty were rewarded far more for research than for teaching. Although the continued inclusion of gross anatomy in medical education appeared to be assured, its traditional mode of presentation and academic prominence will likely change by the turn of the century. © 1994 Wiley-Liss, Inc.     

Resources in bioethics at osteopathic medical schools.

PURPOSE: Medical students must have some exposure to bioethics, whether it be at the undergraduate or the postgraduate level. The authors sought to determine the range and ranking of topics taught in bioethics courses at U.S. osteopathic medical schools. METHOD: A qualitative study using a repeated-measures design was used to determine curricular offerings at all 19 U.S. osteopathic medical schools. Nominal groups were held to identify an initial topics list. A modified reactive Delphi technique was constructed and three survey iterations were administered. RESULTS: Bioethics is taught in all osteopathic medical schools, although the numbers of hours dedicated to the subject in the course of a four-year curriculum vary greatly (range 0-40). To further differentiate a curriculum in bioethics, the respondents were asked to rank bioethics topics as essential, foundational, or peripheral to the undergraduate medical curriculum. A total of 16 topics, including confidentiality, informed consent, truth-telling, death and dying, palliative care, and refusal of care, were identified as "essential" for a bioethics curriculum. CONCLUSIONS: Bioethics is taught at osteopathic medical schools, but further studies are needed to recommend guidelines to standardize the curriculum.