Development of a global curriculum for professional psychology: implications of the Combined-Integrated model of doctoral training

This article considers the development of a global training curriculum and qualification in professional psychology, with particular emphasis on the Combined-Integrated (C-I) model. The C-I model exposes professional psychology trainees to two or more of the practice areas (i.e., clinical, counseling, school/educational). The authors argue that the C-I approach is one that is well suited to the development of a global training curriculum due to its emphasis on broadly training psychologists as well as its respect for diversity and integration of various theoretical and professional orientations. A survey of training programs in 16 countries/regions on six continents found significant variation in training, minimal qualifications, and roles of the professional psychologist. The authors recommend that an international group of psychologists develop a regionally flexible, but common, training curriculum and qualification that would include a five- to six-year competency-based qualification. Ways in which the C-I training model may serve to integrate and globalize professional psychology are discussed.     

Curriculum content and evaluation of resident competency in anatomic pathology: a proposal

In response to new requirements laid down by the Accreditation Council for Graduate Medical Education (ACGME), the Association of Directors of Anatomic and Surgical Pathology (ADASP) has developed a detailed curriculum, as well as guidelines for assessing competence, for resident training in anatomic pathology, focused principally on the core competencies in patient care and medical knowledge. The proposed curriculum described herein is offered as a template for potential use (with or without any necessary local modifications) by pathology training programs. Other areas of competency (eg, practice-based learning, interpersonal/communication skills, professionalism, and systems-based practice) are covered elsewhere on the Program Directors in Pathology and ACGME websites.     

Medical information processing: An interactive course for the Internet

Medical students in Germany have to study the basics of medical information processing within a special curriculum which is part of the ecological course. This curriculum offers an introduction to principles of medical informatics. Starting with a conventional textbook, a computer-based training (CBT) program has been developed using the technologies of the internet and the World Wide Web (WWW). Features of the program include a well structured presentation of the information within the software and a high degree of interactivity. Early experiences suggest that this program enhances the learning in the domain of medical information processing. The program may be viewed via the URL: htfp.//www.med-rz.uni-sb.de/med_fak/imbei/projekt.     

Attitudes of medical students and family practice residents toward geriatric patients.

The federal government, as well as teaching institutions, are concerned about the current negative attitudes of doctors, medical students, and paramedical personnel toward the elderly. Increased life expectancy at birth and lowered birth rates are changing the demographics of America. As the number of elderly citizens increases, greater demands are being placed on medical educators to train physicians who can meet the "geriatric imperative." The Institute of Medicine has recommended that comprehensive humanistic medical education in geriatrics be integrated throughout the curricula of medical schools. Research is needed to see if change can be implemented in physician training to improve attitudes toward the elderly. Previous attempts to improve medical students'' attitudes toward the elderly have met with mixed success. Control groups have seldom been used. It is important to determine whether the effects of medical education extends beyond the immediate boundaries of a training curriculum. This article reports the results of a study on negative attitudes toward the elderly among residents, medical students, and physician''s assistant students in the family medicine department at the King/Drew Medical Center in Los Angeles, California.     

Perspective: a proposed medical school curriculum to help students recognize and resolve ethical issues of global health outreach work

Medical students' interest in global health outreach work is intense and growing. Yet, medical students' global health outreach work is fraught with ethical complexity: Students must make challenging resource allocation decisions in an unfamiliar setting while providing complicated care with evolving expertise across power gradients and geographical as well as cultural boundaries. Inadequate training in the recognition and resolution of the ethical issues inherent in this work likely endangers future service work participation and undercuts the efficacy of medical students' global health outreach work. The author describes how the medical school curriculum can empower medical students to recognize and resolve ethical issues encountered in global health outreach work. To achieve this goal, he proposes a curriculum in the ethics of global health outreach to train students to understand (1) the ethical justifications for global health outreach work, (2) the drivers of global health disparities, (3) the key ethical issues raised by global health outreach, and (4) how to resolve ethical quandaries encountered during global health outreach work through collaboration. Beyond specific topical content, a medical school curriculum in the ethics of global health outreach should emphasize the importance of local collaboration and longitudinal mentorship of medical students. Medical school training in the recognition and resolution of the ethical issues attendant on global health outreach work prepares students not only for more sophisticated work in international settings but also for the ethical complexities of medical practice closer to home.     

Outline of a medical genetics curriculum for internal medicine residency training programs.

To keep pace with the rapid advances in medical genetics, internal medicine residency training programs need to train internists to develop new attitudes, knowledge bases, and skill sets. Currently, such programs have no medical genetics curriculum. Thus, to set a minimum standard for genetics education in the context of training in internal medicine, the Internal Medicine Residency Training Program Genetics Curriculum Committee was formed, with members representing professional organizations of medical geneticists, internists, genetic counselors, internal medicine and genetics residency program directors, and internal medicine residents. The committee's task was to develop a concise outline of a medical genetics curriculum for residents in internal medicine in accordance with requirements of the Residency Review Committee for Internal Medicine of the Accreditation Council for Graduate Medical Education. The curriculum outline was drafted and circulated for comment. Before publication, the final document was approved by those member organizations that had a policy of approving curricula. Key learning objectives of the curriculum include appreciation of the rapid advances in genetics, the need for lifelong learning, the need for referral, and the role of genetic counselors and medical geneticists, as well as developing the ability to construct and analyze a three-generation pedigree. A wide variety of teaching methods can be useful in these regards, including didactic lectures, multimedia CD- ROMs, and clinical experience. Teaching should be related to clinical experiences whenever possible. The curriculum developed by the committee and presented in this article will assist in teaching residents the attitudes, knowledge, and skills they will require.     

Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal

Ten years have passed since the Graylyn Conference Report on Laboratory Medicine Clinical Pathology training was issued. Over that period, the Accreditation Council for Graduate Medical Education substantially revised the requirements for training programs; the American Board of Pathology amended both the requirements and the periods needed for certification; and the discipline itself, along with the broader discipline of pathology, evolved significantly. Recently, a curriculum proposal in anatomical pathology was published as a potential template to be used by training programs to help meet these new and evolving needs. Toward the same end, the Academy of Clinical Laboratory Physicians and Scientists has now developed a template for a curriculum in clinical pathology (laboratory medicine), taking into account newly designated and revised areas of residency core competency, the alterations in training requirements promulgated by the Accreditation Council for Graduate Medical Education and American Board of Pathology, and the rapidly developing nature of the discipline itself. The proposed clinical pathology curriculum defines goals and objectives for training, provides guidelines for instructional methods, and gives examples of how outcomes can be assessed. This curriculum is presented as a potentially helpful outline for use by pathology residency training programs.     

Founding a new College of Medicine at Florida State University.

In 2000, the Florida State University (FSU) College of Medicine was founded, becoming the first new allopathic medical school in the United States in over 20 years. The new medical school was to use community-based clinical training for the education of its students, create a technology-rich environment, and address primary care health needs of Florida's citizens, especially the elderly, rural, minorities, and underserved. The challenges faced during the creation of the new school, including accreditation and a leadership change, as well as accomplishments are described here. The new school admits a diverse student body made possible through its extensive outreach programs, fosters a humane learning environment through creation of student learning communities, has a distributed clinical training model-with clinical campuses in Orlando, Pensacola, Sarasota and Tallahassee, and with 70% of training occurring in ambulatory settings-and utilizes 21st-century information technology. The curriculum focuses on patient-centered clinical training, using the biopsychosocial model of patient care throughout the entire medical curriculum, promotes primary care and geriatrics medicine through longitudinal community experiences, relies on a hybrid curriculum for delivery of the first two years of medical education with half of class sessions occurring in small groups and on a continuum of clinical skills development throughout the first three years, and uses an interdisciplinary departmental model for faculty, which greatly facilitates delivery of an integrated curriculum. The first class was admitted in 2001 and graduated in May 2005. In February 2005, the FSU College of Medicine received full accreditation from the Liaison Committee on Medical Education.     

Exposing the hidden curriculum influencing medical education on the health of Indigenous people in Australia and New Zealand: the role of the Critical Reflection Tool

The disparity in health status between Indigenous and non-Indigenous people in Australia and New Zealand is widely known, and efforts to address this through medical education are evidenced by initiatives such as the Committee of Deans of Australian Medical Schools' Indigenous Health Curriculum Framework. These efforts have focused primarily on formal curriculum reform. In this article, the authors discuss the role of the hidden curriculum in influencing the teaching and learning of Indigenous health (i.e., the health of Indigenous people) during medical training and suggest that in order to achieve significant changes in learning outcomes, there needs to be better alignment of the formal and hidden curriculum. They describe the Critical Reflection Tool as a potential resource through which educators might begin to identify the dimensions of their institution's hidden curricula. If used effectively, the process may guide institutions to better equip medical school graduates with the training necessary to advance changes in Indigenous health.     

Using children as simulated patients in communication training for residents and medical students: a pilot program.

Medical schools are charged with the challenge of teaching effective communication skills, a core competency for residents and medical students. Especially challenging is the task of developing effective methods for training residents and students to communicate with children with mental health issues. The authors describe a pilot program at Mercer University School of Medicine that used pediatric standardized patients (SPs), ages 9-19, to aid in training residents and medical students in complex interviewing skills addressing mental health issues. New curriculum components for four pediatric problems, anorexia nervosa, depression, separation anxiety, and attention deficit hyperactivity disorder (ADHD), were designed and implemented by the authors in 2002-04. The training sessions were evaluated by the participating SPs as well as the residents and medical students in training. The components of the training were a lecture and subsequent practice using pediatric SPs and adults acting as their mothers. Evaluation included the qualitative analysis of SPs' reactions to participation in the training as described during a posttraining-session focus-group, as well as questionnaire responses by residents and medical students. The children role-playing the scenario of a difficult-to-manage situation and their adult "parent" actors voiced strongly positive reactions to participating in training residents and medical students. The reactions of physicians in training were also positive. The authors thus conclude that child and adolescent actors can be effectively used as SPs to train residents and students in complex interviewing skills, even in cases involving children with challenging mental health issues.     

调整课程设置 优化教学内容 培养医学物理专业人才

目的：通过对泰山医学院放射学院医学物理学专业建设内容进行详细阐述,展开对医学物理专业本科人才培养模式的探索,以期为我国医学物理本科人才培养提供一定的实践经验。方法：从医学物理学专业设置的历史背景出发,对人才培养方案、理论教学体系、实践教学体系、就业质量等方面的建设与取得的成果及建设特色进行详细的阐述。结果：通过修订教学计划、更新课程体系、优化教学内容、丰富教学方法,对人才培养方案、理论教学体系、实践教学体系进行调整与优化。结论：泰山医学院放射学院在＂医学物理人才培养方案与课程设置＂方面进行了有益的探索,增强了实践教学体系建设,提高了学生的实践动手能力,取得了一定的经验和成就,本科生的培养质量明显提高。     

Training program at medical school of Chieti, Italy

We describe the changes in medical training program offered at the G. D'Annunzio University Medical School in Chieti-Pescara, Italy, which took place over the last decade. The new curriculum differs from the previous one in several important aspects, including limited number of students admitted to school depending on the estimated needs for physicians, obligatory class attendance, student attendance in preclinical laboratories, formative credits as a measure of student activity, and elective subjects. Furthermore, all medical graduates are allowed to take the State exam to obtain the licence to practice, which was not the case previously. As a result of these major changes, a higher number of students graduates in due time. The changes made in the medical education curriculum in Italy have enabled Italian medical graduates to work in European Community Hospitals, because their medical degree is recognized in other EU countries. The main motif that drives the Medical School in Chieti-Pescara is the achievement of high quality in medical education and biomedical research by creating as strong a relationship between education and research as possible.     

The association between students' research involvement in medical school and their postgraduate medical activities

The authors examined the impact of students' research involvement during medical school on their postresidency medical activities. The three medical schools involved--The Pennsylvania State University College of Medicine (PSU), The University of Connecticut School of Medicine (UCONN), and The University of Massachusetts Medical School (UMASS)--have nearly indistinguishable applicant, matriculant, and curriculum profiles. However, at PSU a research project is a curriculum requirement for students who did not do medical research prior to entering medical school. Questionnaires were sent to all graduates from the classes of 1980, 1981, and 1982. A total of 567 graduates completed the questionnaires, an overall response rate of approximately 76%. Medical school research experience was reported by 83% (183) of the PSU graduates, 34% (52) of the UCONN graduates, and 28% (54) of the UMASS graduates. When compared on a school-by-school basis, the graduates from the three schools did not differ with respect to residency specialty training, fellowship training, academic appointments, career practice choices, or postgraduate research involvement. However, when all the graduates studied were examined as a single group, medical school research experience was found to be strongly associated with postgraduate research involvement.     

Sixteen years' experience with a required third-year family medicine clerkship at Jefferson Medical College.

Jefferson Medical College has developed a program to successfully meet the goal of teaching ambulatory care to all medical students, by providing each of its 223 third-year students with a required six-week clerkship in family medicine. The structured clerkship takes place at one of seven residency-based family practice centers, is supplemented by a formal curriculum, and is based on the active clinical involvement of caring for patients under full-time family medicine faculty supervision. This clerkship has been in existence for 16 years, and has added over 400,000 student-patient encounters to the clinical education of over 3,500 students. Student evaluations of the clerkship have rated it the highest of the six required core clerkships at Jefferson. In addition, over 16% of Jefferson graduates have entered family medicine residency training programs, a rate higher than that of any other school in the northeastern United States, and significantly higher than the average for all U.S. medical schools (12%). Jefferson's experience suggests that ambulatory care can be taught as a core component of the clinical education of all medical students. To be successful, however, strong institutional support, a structured curriculum, an adequate number of patients, a dedicated faculty, a sufficient number of training sites, an appropriate evaluation process, and significant financial support are all necessary.     

Clinical academies: innovative school-health services partnerships to deliver clinical education.

During the past five years (2001-2006), the University of Bristol Medical School has developed and implemented a new model for delivering clinical education: the clinical academy. The principal features of the model are (1) having both in-Bristol and out-of-Bristol campuses for clinical education, (2) innovative partnerships with local health care providers, (3) local leadership of educational delivery, and (4) the recruitment and training of new cadres of clinical teachers.The seven clinical academies consist of two academies based in traditional acute-care teaching hospitals in the city of Bristol and five academies in the surrounding counties. The same Bristol curriculum is delivered in every clinical academy by locally recruited hospital specialists and family physicians. Each academy is led by an academy medical dean, who has local responsibility for program delivery, quality assurance, academic and personal support for students, and finances on behalf of the university.Medical students rotate between clinical academies every half academic year, alternately based in and outside of Bristol. They learn clinical medicine and develop clinical competence as apprentice members of a local multiprofessional learning community. The medical school now has enough high-quality clinical placements to accommodate increasing numbers of medical students whilst keeping a "human-scale" educational environment.Clinical academies are thus the key components of a decentralized system of curriculum delivery; they differ in concept and purpose from the new academies of medical educators in the United States that offer a centralized focus for the educational mission.     

Laboratory medicine in the compulsory postgraduate clinical training system--newly revised program in Nihon University School of Medicine

In 1999, the 4th report of the discussion group on 21st century medicine and health care proposed that it was necessary to establish in medical education a core curriculum emphasizing carefully selected basic content and to greatly expand the number of subjects that students might take electively. Following this report, a model core curriculum was made by the research and development project committee for medical educational programs in 2001. Similarly, the necessity of establishing a standardized postgraduate training curriculum and system has been discussed for many years. The Departments of Education and Technology and Welfare and Labor proposed a new curriculum named "Objectives in postgraduate clinical training" in order to ensure the quality of the medical doctors licensed to practice medicine in postgraduate clinical training in 2002. Following this new curriculum, Nihon University School of Medicine revised and enlarged its postgraduate program. All graduates are required to enter a full rotation program including general disciplines for two years. In addition to this basic curriculum, an elective curriculum will be added, providing attractive training programs based on medical trainees' needs. The training program in Laboratory Medicine is administered in the 2nd year as an elective program.