What is core? Guidelines for the core curriculum in paediatrics

A key point that the UK General Medical Council addressed in its recommendations on the undergraduate medical education was the concept of `core curriculum' (General Medical Council 1993). Although enthusiastic for the idea of reducing factual overload, many medical teachers found themselves facing the task of how to define what a core curriculum is, what should be included and why. Predictably, our initial response is to include common and important topics, but how common is common, and how does one determine the relative importance of topics? We do not claim to have unravelled all the ambiguities surrounding the subject nor to have resolved all the controversies that are inevitably encountered. We hope, however, to describe some of the principles that governed our approach and put forward some guidelines, that may contribute to the debate.     

Play in the classroom: a descriptive study of preschool teachers’ beliefs

The purpose of this study was to describe preschool teachers’ intervention during children's free play. A Weberian sociological framework was used to examine teachers’ beliefs and thus their decisions about play. Three preschool teachers were video filmed during free play and later interviewed about observed intervention episodes. The teachers were prompted to talk about what happened during the event, what they were thinking about, and for what reason they intervened. The teachers held differing beliefs and their actions were related to their belief systems. The teachers based their decisions upon their personal system of educational principles concerning how teachers should teach, how children learn, and early childhood curriculum. The reasons for intervention fell into one of the three Weberian constructs: cultural influences, social‐political influences, and economic influences. Cultural influences included decisions based upon the child's language development, social development, or value development. Social‐political influences included decisions based upon the teacher's role, conflict of rules, learning and the curriculum, and timing of play. Economic influences included decisions based upon the scarcity of goods, particularly the supply of materials and the teacher's time.     

Preschool teachers' views on competence in the context of home and preschool collaboration

The purpose of this article is to analyse and discuss preschool teachers' views regarding competence within their profession in the context of home and preschool collaboration. The question addressed is as follows: In what situations do preschool teachers perceive that their competence becomes visible for parents? The results, based on interviews with 30 preschool teachers, show that preschool teachers work consciously to draw attention to specific competencies related to children's learning and development and the preschool curriculum. The ability to establish dialogue with parents and gain their trust is seen as particularly important for establishing and maintaining collaboration between preschool and the home. Furthermore, the participants recognise that parents seek their competence in daily matters concerning the child's well-being. The competencies that preschool teachers emphasise and those they believe parents ask for do not, therefore, always coincide. The results of this study can contribute to a better understanding of the prerequisites for preschool–home collaboration.     

Disease prevention and health promotion: a study of medical students and teachers

All students at the Royal Free Hospital School of Medicine (n = 508 ) were surveyed on their self-reported smoking and drinking habits, attitudes to disease prevention and health promotion in general, attitudes towards the teaching of disease prevention and health promotion, and their perception of what was taught at the beginning of the 1993–1994 academic year (response rate 75.2%). The teaching staff (n = 271 ) were also surveyed on their attitudes towards the teaching of disease prevention and health promotion, and their perception of what was taught (response rate 74.2%). Seventeen per cent of the students reported they were current smokers and 81% drank alcohol. Four factors were extracted from the responses to the items on disease prevention and health promotion in general and these represented the importance of health, a patient-centred approach, patient responsibility and a doctor-centred approach. Clinical students and those who were older were more likely to have a ‘patient-centred’ approach to disease prevention and health promotion. Sixty per cent of clinical and 44% of pre-clinical teachers aimed to teach about disease prevention and health promotion. The topics reported by students as most likely to have been taught in detail are smoking and health, alcohol and health, immunization, and breast and cervical screening. However, all these topics were reported as having been taught in detail by less than 50% of the students. The majority of students and teachers believe that teaching about disease prevention and health promotion should be integrated into all years of the curriculum and all clinical firms. Teachers were significantly less likely than students to believe that students should learn more about disease prevention and health promotion, and that learning about prevention is as important as learning about diagnosis and treatment. We believe that, in order to build on the positive features highlighted in this study, agreed aims and objectives should be developed and teaching about disease prevention and health promotion should be integrated both horizontally and vertically throughout the curriculum.     

Special study modules: an opportunity not to be missed

The General Medical Council's (GMC's) Tomorrow's Doctors has proposed a radical rethink of undergraduate medical education. The two main planks of the proposals are the core curriculum and special study modules (SSMs) or options. Medical schools around the country have been much exercised in creating their core curricula but there has been less time given to a consideration of the SSMs. This paper looks at the GMC's proposals for SSMs and emphasizes their importance in introducing innovation and originality. Three different categories of SSM are described and a justification made for including each in the curriculum. The focus is on what non-medical subjects might contribute to medical education.     

Views, behaviours and perceived staff development needs of doctors and surgeons regarding learners in outpatient clinics

INTRODUCTION: The need to use outpatient clinics as a major learning environment in hospitals for students and doctors-in-training is clear. However, consultant supervisors perceive major barriers to this and continue to rely heavily on traditional inpatient learning. This quantitative study examines what approaches consultant supervisors employ in outpatient learning, together with what they perceive themselves to use and what they would value in further training. METHODS: We observed learning episodes for students and doctors-in-training in medical and surgical clinics. A questionnaire on outpatient teaching was also sent to consultant doctors and surgeons. This was based on these observations and focus groups with students and doctors-in-training. RESULTS: There was an overall survey response rate of 62% (194/311). The dominant forms of learning we observed were 'arms-length' supervision for doctors-in-training and 'modelling' for students. Only 7% of learning episodes involved a doctor-in-training doing something under direct supervision. In contrast to the observation results, consultants considered that students and doctors-in-training received a lot of direct supervision and interaction. For example, 45% considered that doctors-in-training 'may see patients with me in a joint consultation'. Only 30% of respondents would be interested in staff development in learning in outpatient clinics. CONCLUSIONS: Although consultants reported that they frequently used an active approach to learning in outpatient clinics, modelling was used predominantly for students and arms-length supervision was used for doctors-in-training.     

The essential role of the student in curriculum planning

Medical school curricula are planned, written and organized by academic and clinical staff within medical schools. While these medical educators may well be experts in their given field, they lack first-hand experience of what it is to be a medical student in 1995. For a medical curriculum to be an effective means of learning for today's students, it must be written with a knowledge of their priorities, needs and abilities. The way in which this can be best achieved is by the inclusion of current students in all stages of designing a new curriculum.
In my second year of medicine at Flinders University, I became involved in planning for the new Graduate Entry curriculum. In the role of student advocate, I have found I am able to offer teaching staff a unique perspective, the student perspective , on various issues.
Students, through experience from their own education, are able to give advice on student resources and facilities and are in a favourable position to judge other aspects of curricula, such as the balance and relevance of course content and assessment. Students need to realize the valuable insight they have to offer their faculties and the way in which this can benefit future students. It is by actively seeking student involvement and using their input, that faculties will be able to create a consumer-friendly curriculum.     

Medical faculty as humanistic physicians and teachers: the perceptions of students at innovative and traditional medical schools

BACKGROUND AND OBJECTIVES: The training of caring physicians represents an important goal of medical education. Little is known however, on whether medical faculty constitute good role models for teaching humanistic skills to medical students. In this study, we examined to what extent medical students at innovative and traditional schools perceived their teachers as humanistic physicians and teachers. We also explored whether pre-clinical and clinical students shared the same perceptions. METHODS: A mail survey was conducted in Canada of all second-year students and senior clerks at one innovative medical school (problem-based learning (PBL), patient-centred, community-oriented) and three traditional medical schools. Students were asked to what extent they agreed or disagreed that the majority of their teachers behaved as humanistic physicians and teachers; 10 statements were used. Overall, 65% of the 1039 students returned the questionnaire. RESULTS: Over 25% of second-year students and 40% of senior clerks did not agree that their teachers behaved as humanistic caregivers with patients or were good role models in teaching the doctor-patient relationship. More than half of second-year students and senior clerks did not agree that their teachers valued human contact with them or were supportive of students who had difficulties. There were few differences in the way medical students at innovative and traditional schools perceived their teachers' humanistic qualities. At the pre-clinical level however, there were more students from the innovative school than from the traditional schools (around 60% vs. 40%, P < 0.005) who agreed that their teachers valued human contact with them and were supportive of students. CONCLUSION: Our results indicate that the PBL curriculum fosters better teacher-student relationships during the pre-clinical years. They also suggest that an unacceptably large number of medical students are taught by physicians who seem to lack compassion and caring in their interactions with patients. This study questions the adequacy of medical faculty as role models for the acquisition of caring competence by medical students.     

Standards for medical educators

Context In the current UK socio‐political climate of mounting regulation of professional practice, a debate on the topic of standards amongst medical teachers seems timely. The role of teacher is increasingly recognised as a core professional activity for all doctors and one that cannot be left to chance, aptitude or inclination. As a consequence, faculties have developed a plethora of teacher training programmes for medical teachers. But what is good medical teaching? Unless we know what it is, how can we develop it? One possible approach is to develop clear and comprehensive standards, defining what we mean by competent or effective clinical teaching. Methods In this article we have evaluated and compared two models of standards for clinical educators. The first is the outcome‐based approach developed at Dundee Medical School and the second is the scholarship model devised initially by Boyer and then elaborated by Glassick and Fincher et al. The key features of both models are briefly described and their comparative strengths and problematic aspects explored. Conclusion Both models offer interesting and stimulating ideas and together they provide an instructive contrast. They make a valuable contribution to the ongoing process of improving the provision of medical education.     

Task-based learning: the answer to integration and problem-based learning in the clinical years

INTRODUCTION: Integrated teaching and problem-based learning (PBL) are powerful educational strategies. Difficulties arise, however, in their application in the later years of the undergraduate medical curriculum, particularly in clinical attachments. Two solutions have been proposed - the use of integrated clinical teaching teams and time allocated during the week for PBL separate from the clinical work. Both approaches have significant disadvantages. Task-based learning (TBL) is a preferred strategy. In TBL, a range of tasks undertaken by a doctor are identified, e.g. management of a patient with abdominal pain, and these are used as the focus for learning. Students have responsibility for integrating their learning round the tasks as they move through a range of clinical attachments in different disciplines. They are assisted in this process by study guides. METHOD: The implementation of TBL is described in one medical school. One hundred and thirteen tasks, arranged in 16 groups, serve to integrate the student learning as they rotate through 10 clinical attachments. RESULTS: This trans-disciplinary approach to integration, which incorporates the principles of PBL offers advantages to both teachers and students. It recognizes that clinical attachments in individual disciplines can offer rich learning opportunities and that such attachments can play a role in an integrated, as well as in a traditional, curriculum. In TBL, the contributions of the clinical attachments to the curriculum learning outcomes must be clearly defined and tasks selected which will serve as a focus for the integration of the students' learning over the range of attachments.     

What should we teach? A consensus method to determine curriculum content

The content of an undergraduate curriculum is usually decided upon by the appropriate University Department. Such a Department is staffed exclusively by specialists in the field. The technique described in this paper is one which uses the perception of a wide variety of doctors, including specialists in the field, other specialists and general practitioners, to determine what should be taught to undergraduate students. The outcome of this study reveals that there is substantial agreement on what basic materials should be taught in an undergraduate curriculum in Ophthalmology. There is a substantial agreement throughout the profession on the basic required competencies in Ophthalmology, but it is clear that general practitioners are much more demanding in their requirements from the undergraduate curriculum than are specialists. Ophthalmologists are the least demanding of the undergraduate. The consensus technique described in this paper is a practical and formative method of obtaining valuable data for use in curriculum construction.     

What Hong Kong Teachers and Parents Think about Thinking

Thinking skills are critically important for later success in school. However, teachers and parents may have different perceptions of what constitutes thinking skills and the extent to which thinking skills should be taught in the classroom. Their views on their respective roles in fostering thinking skills may also differ. Such disagreements about both pedagogy and curriculum reflect differences in beliefs concerning the value of thinking skills. A survey questionnaire was administered to forty teachers and forty parents of Hong Kong preschoolers. Teachers and parents revealed their ideas about: (1) what constitutes thinking skills; (2) their perceptions on the importance of thinking skills in the lives of children, within and outside the classroom, for the present and in the future; (3) what strategies they employ to foster thinking skills in young children; and (4) their perceived roles in facilitating thinking skills. Whether from teachers or parents, the responses revealed the need for more adult understanding and support for children's thinking as a process. Responses were analyzed according to the coding system developed by Leah Adams. Implications for teacher and parent education are discussed.     

Australian teachers' understandings of the health promoting school concept and the implications for the development of school health

The health promoting school has emerged as a comprehensive framework to enhance the health status and health potential of school students. It requires teachers to be proactive in a number of areas beyond the formal curriculum. The success of health promoting schools will depend largely on what teachers know about its building blocks and the likelihood that they will be adopted. A number of teachers were interviewed and surveyed in a sequential study to ascertain their understanding of what constitutes a health promoting school. The findings indicate that teachers think mainly about school health in terms of the curriculum; have little understanding of how community partnerships might work; are very supportive of the concept; and have limited preservice and inservice training in health issues. It is argued that the growth of health promoting schools will be dependent on comprehensive professional development programmes; the production of resources which link teachers' perceived core business - teaching the mandated curriculum - to the building blocks of the health promoting school; closer collaboration between the health and education sectors; and a recognition by the community that schools cannot easily address (and solve) society's health concerns.Keywords: health promoting school; school health; teachers understandings      

Play in the classroom: a descriptive study of preschool teachers' beliefs

The purpose of this study was to describe preschool teachers' intervention during children's free play. A Weberian sociological framework was used to examine teachers' beliefs and thus their decisions about play. Three preschool teachers were video filmed during free play and later interviewed about observed intervention episodes. The teachers were prompted to talk about what happened during the event, what they were thinking about, and for what reason they intervened. The teachers held differing beliefs and their actions were related to their belief systems. The teachers based their decisions upon their personal system of educational principles concerning how teachers should teach, how children learn, and early childhood curriculum. The reasons for intervention fell into one of the three Weberian constructs: cultural influences, social-political influences, and economic influences. Cultural influences included decisions based upon the child's language development, social development, or value development. Social-political influences included decisions based upon the teacher's role, conflict of rules, learning and the curriculum, and timing of play. Economic influences included decisions based upon the scarcity of goods, particularly the supply of materials and the teacher's time.     

A framework for developing excellence as a clinical educator

The current emphasis on providing quality undergraduate and postgraduate medical education has focused attention on the educational responsibilities of all doctors. There is a greater awareness of the need to train doctors as educators and courses have been set up to satisfy this need. Some courses, such as those on how to conduct appraisal, are specific to one task facing a medical educator. Other courses take a broader view and relate educational theory to practice. In this paper we describe an outcome-based approach in which competence in teaching is defined in terms of 12 learning outcomes. The framework provides a holistic approach to the roles of the teacher and supports the professionalism of teaching. Such a framework provides the basis for the development of a curriculum for teaching excellence. It helps to define important competences for different categories of teachers, communicate the areas to be addressed in a course, identify gaps in course provision, evaluate courses, assist in staff planning and allow individuals to assess their personal learning needs. The framework is presented to encourage wider debate.     

Context in medical education: the informal ethics curriculum

As some formal bioethics instruction has become the norm in American medical schools, a trend has emerged toward increased attention to context in both bioethics education and bioethical decision-making. A focus on classical dilemmas and a textbook knowledge of principles is yielding its previous dominance to permit a more detailed examination of ethical behaviour in actual practice in medicine. After documenting and analysing this emerging trend in bioethics education and its parallel in bioethics theory and research, we turn to the context of medical education itself to look beyond formal bioethics instruction to the ' informal curriculum ' that is so central to the moral development of medical students and residents.
A qualitative research strategy is being used to study the informal curriculum through analysing tape-recorded informal conversations students and residents have with their friends and colleagues at work about issues bearing on their professional development. Data presented are documenting 'the unwritten code' for medical students on a surgical clerkship and the senior residents' informal ways of producing a ' practical ethics of conduct ' that shapes understanding of what is good, skilful, and right on that surgical service. How conceptions of appropriate conduct are conveyed, rewarded and sanctioned also reveals how professional demeanour is taught, permitting discussion about what should be retained and what changed. The context in which ethical issues arise enhances understanding of ethical practice in medicine.     

Humanizing medicine: a special study module

As medical schools begin to implement their new curricula under the guidance of Tomorrow's Doctors, the authors wish to raise some discussion on the form and content of the special study module (SSM) component. In order to do this they put forward in this paper proposals for an SSM in Medicine and Literature. This course has been designed jointly and will be run concurrently in three Scottish medical schools: Glasgow, Aberdeen and Dundee. Arguments for the course's acceptability to faculties of medicine and to students are discussed and its inclusion in the curriculum in terms of its educational impact, skills training, effect on personal development and broadening of the student's perspective are justified. The course structure, content and assessment procedures are described and a reading list proposed. The General Medical Council points out that SSMs should be seen as opportunities for innovation and this course demands a different educational approach from the standard objectives-led approach of most medical education. A process-led model is more appropriate as it stresses the way that students develop while taking the course rather than the end point reached at its finish.     

The integration ladder: a tool for curriculum planning and evaluation

Integration has been accepted as an important educational strategy in medical education. Discussions about integration, however, are often polarized with some teachers in favour and others against integrated teaching. This paper describes 11 points on a continuum between the two extremes. * Isolation * Awareness * Harmonization * Nesting * Temporal co-ordination * Sharing * Correlation * Complementary * Multi-disciplinary * Inter-disciplinary * Trans-disciplinary As one moves up the ladder, there is less emphasis on the role of disciplines, an increasing requirement for a central curriculum, organizational structure and a requirement for greater participation by staff in curriculum discussions and planning. The integration ladder is a useful tool for the medical teacher and can be used as an aid in planning, implementing and evaluating the medical curriculum.     

The new Dundee medical curriculum: a whole that is greater than the sum of the parts

The medical undergraduate curriculum at the University of Dundee has evolved in response to changing needs. The new curriculum, introduced in 1995, combines idealism and pragmatism. Underpinning it is the concept that the curriculum is an educational programme where the whole is greater than the sum of the parts. The concepts contributing to this are: the spiral nature of the curriculum, with its three interlocking phases; a body-system-based approach, with themes running through the curriculum, providing a focus for the students' learning; a core curriculum with special study modules or options; the educational strategies adopted, including elements of problem-based and community-based learning and approaches to teaching and learning that encourage the students to take more responsibility for their own learning; an approach to assessment which emphasizes the overall objectives of the course; an organization and management of the curriculum; and an allocation of resources designed to support the educational philosophy.     

Education beyond competencies: a participative approach to professional development

Medical Education 2010: 44 : 404–411 Objectives New curricula for UK medical training emphasise work‐based learning and assessment of competencies. It is debatable whether competency‐orientated training is sufficient to prepare doctors for consultant clinical, managerial and professional roles. This article describes a novel approach to postgraduate medical education in palliative medicine for a small group of consultants and specialty trainees. The aim of the study was to extend learning beyond the behaviourist focus of competencies by sharing experience and knowledge through discussion of professional practice. Methods Seven doctors met weekly for a 2‐hour specialty education session. Participative action research was conducted over four cycles in 2008. Qualitative analysis of semi‐structured group discussions and interviews, together with participants’ comments, modified the programme’s structure and content. Results Participants developed a framework for discussion of educational subjects based on the specialty curriculum. Thematic analysis suggested that they valued others’ experience and found learning through discussion with colleagues supportive and stimulating. Early preference for ‘free‐flowing’ discussion was modified by recognition that structure in planning, preparation and summarising enhanced learning. The framework changed from a learner‐led approach to one of collaboration with clearer roles for consultants and trainees. Conclusions It is important that doctors’ education encompasses opportunities to share and develop expertise with experienced colleagues. The group developed an education programme for small‐group learning based on social constructivist principles and learning within a community of practice. This was facilitated by the context for learning in palliative medicine and may be applicable to other specialties with small groups of trainees.