The curriculum is dead! Long live the curriculum! Designing an undergraduate medicine and surgery curriculum for the future

Where changing social circumstances demand reform of medicine, this in turn provokes new thinking in medical education. Curriculum changes, however, are often ill conceived, consisting of syllabus (content) modification, rather than careful consideration of fundamental principles and theory shaping a curriculum process initiative. The undergraduate medicine and surgery curriculum of the future must address some basic fault lines in current provision, such as medical culture's failure to democratise work practices ensuring patient safety. While acquiring a reputation as innovative and progressive, and after a decade of success with current provision, Peninsula Medical School (UK) has recognised the need to develop its curriculum for the future. Such a curriculum will be guided by best evidence from medical education to inform pedagogical practices and by sophisticated curriculum theory. Drawing on social learning pedagogies and curriculum reconceptualisation models for guidance, and incorporating evaluation of its current provision and published evaluations of other curricula (particularly Longitudinal Integrated models), fundamental principles were conceived to guide curriculum reform.     

The concept and practicability of a core curriculum in basic medical education

The core curriculum is defined as that which is common rather than essential. It is considered at different levels: institutional, national and global. As its size is inversely proportional to variability in healthcare needs, the core becomes smaller as the geographical unit becomes larger. A rationale for identifying the core is established at all three levels. The risk of stereotypy among curricula and dampening of innovation can be avoided if a significant part of the curriculum is elective, and if schools are free to determine how the core should be achieved. Focusing exclusively on the minimum discourages excellence. Many of the potential disadvantages of a core curriculum can be avoided if the core is combined with options. The core should emphasize higher-order cognitive and process skills and should be reviewed intermittently in the light of trends in healthcare and education. It should be developed in consultation with curriculum implementers using a competency-based approach. In developing international standards, societal relevance of the curriculum should not be sacrificed at the altar of standardization. The scientific bases of medicine, process skills and desirable practices in educating the basic doctor are fertile areas in which to look for international standards.     

Assessing learning in the adaptive curriculum

Abstract

Background: Medical education is a dynamic process that will continuously evolve to respond to changes in the foundations of medicine, the clinical practice of medicine and in health systems science.

Purpose: In this paper, we review how assessing learning in such a dynamic environment requires comprehensive flexible and adaptable methodological approaches designed to assess knowledge attainment and transfer, clinical skills/competency development, and ethical/professional behavior. Adaptive assessments should measure the learner’s ability to observe where changes in health care delivery are needed and how to implement them. Balancing formative and summative assessments will promote reflective learning so that each student will reach her/his highest potential. From the programmatic perspective, measuring the design and delivery of instruction in relation to students? efforts to achieve competency will improve learning and foster continuous professional development of faculty and advance the science of learning.

Approach: We describe how two medical schools are approaching adaptive assessment, including using portfolio systems that encompass teaching and learning experiences while offering real-time longitudinal tracking of digital data toward improving learning and provide curricula continuous improvement cycles. Using latest technologies, portfolios produce actionable data displays with precise guidance for learning and program development.     

The Breakfast Club: case study of a teaching-autopsy curriculum

A decision prohibiting student access to coronial autopsies in Auckland, New Zealand, was recently discussed in the British Medical Journal (O'Grady, ). Clinical and ethical implications aside, the prohibition brought an end to the Breakfast Club, a remarkable community of post-mortem learning. Over 20 years of voluntary attendance at autopsy, this group of students established a self-directed curriculum based around daily encounters at the post-mortem table. The success of the group testifies to the ongoing value of the autopsy as a medical teaching medium in the current era.     

The adaptive medical curriculum: A model for continuous improvement

Abstract

This paper describes the medical curriculum designed to foster adaptive expertise. Engaging in the formal and informal curriculum, students learn to achieve desired outcomes in novel situations, perform comfortably with uncertainty, and are often recognized for creative problem-solving. Students learn by asking and answering their own and others’ questions. They readily operate at the metacognitive level, anticipating events, self-monitoring, and checking decisions and emotions. A key function of the reflective process is to identify gaps or shortcomings in the thinking process. The adaptive learner shifts into reflective thinking when confronted with complex contextual and situational demands. We are only beginning to understand how to create educational pathways to foster adaptive learning. An essential focus is the adaptive teacher who frames learning and assessment around predictive analytics, reflective spaced practice, and authentic learning material. To be effective, the teacher must engage the learner outside the formal classroom in the parallel curriculum. A major premise is that learning occurs individually and together with peers, teachers, and team members in multiple contexts. During the learning process, the learner readily operates at the metacognitive level, anticipating behavior, self-monitoring and assessing, and checking theirs and others decisions and emotions. The adaptive medical curriculum provides the pathway for such learning.     

Facilitating reflection in an undergraduate medical curriculum

A reflective practitioner is one of the desired outcomes of medical education. This paper describes the introduction of a reflective assignment in the first year of a medical curriculum. Students completed written reflective assignments for which individual and group feedback was provided. Tutors reflected on their roles throughout the development and implementation of this new assignment. The majority of students completed the assignments and while some students became highly involved in the task others worked at a surface level. Tutors found the process time consuming and less enjoyable than working directly with students who need to be supported in the development of skills necessary for reflective practice.