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Ilkiw JE, Nelson RW, Watson JL, Conley AJ, Raybould HE, Chigerwe M, Boudreaux K. Curricular Revision and Reform: The Process, What Was Important, and Lessons Learned. JOURNAL OF VETERINARY MEDICAL EDUCATION 2017; 44:480-489. [PMID: 28876993 DOI: 10.3138/jvme.0316-068r] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Beginning in 2005, the Doctor of Veterinary Medicine program at the University of California underwent major curricular review and reform. To provide information for others that follow, we have documented our process and commented on factors that were critical to success, as well as factors we found surprising, difficult, or problematic. The review and reform were initiated by the Executive Committee, who led the process and commissioned the committees. The planning stage took 6 years and involved four faculty committees, while the implementation stage took 5 years and was led by the Curriculum Committee. We are now in year 2 of the institutionalizing stage and no longer refer to our reform as the "new curriculum." The change was driven by a desire to improve the curriculum and the learning environment of the students by aligning the delivery of information with current teaching methodologies and implementing adult learning strategies. We moved from a department- and discipline-based curriculum to a school-wide integrated block curriculum that emphasized student-centered, inquiry-based learning. A limit was placed on in-class time to allow students to apply classroom knowledge by solving problems and cases. We found the journey long and arduous, requiring tremendous commitment and effort. In the change process, we learned the importance of adequate planning, leadership, communication, and a reward structure for those doing the "heavy lifting." Specific to our curricular design, we learned the importance of the block leader role, of setting clear expectations for students, and of partnering with students on the journey.
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Preston R, Larkins S, Taylor J, Judd J. Building blocks for social accountability: a conceptual framework to guide medical schools. BMC MEDICAL EDUCATION 2016; 16:227. [PMID: 27565709 PMCID: PMC5002162 DOI: 10.1186/s12909-016-0741-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/15/2016] [Indexed: 05/10/2023]
Abstract
BACKGROUND This paper presents a conceptual framework developed from empirical evidence, to guide medical schools aspiring towards greater social accountability. METHODS Using a multiple case study approach, seventy-five staff, students, health sector representatives and community members, associated with four medical schools, participated in semi-structured interviews. Two schools were in Australia and two were in the Philippines. These schools were selected because they were aspiring to be socially accountable. Data was collected through on-site visits, field notes and a documentary review. Abductive analysis involved both deductive and inductive iterative theming of the data both within and across cases. RESULTS The conceptual framework for socially accountable medical education was built from analyzing the internal and external factors influencing the selected medical schools. These factors became the building blocks that might be necessary to assist movement to social accountability. The strongest factor was the demands of the local workforce situation leading to innovative educational programs established with or without government support. The values and professional experiences of leaders, staff and health sector representatives, influenced whether the organizational culture of a school was conducive to social accountability. The wider institutional environment and policies of their universities affected this culture and the resourcing of programs. Membership of a coalition of socially accountable medical schools created a community of learning and legitimized local practice. Communities may not have recognized their own importance but they were fundamental for socially accountable practices. The bedrock of social accountability, that is, the foundation for all building blocks, is shared values and aspirations congruent with social accountability. These values and aspirations are both a philosophical understanding for innovation and a practical application at the health systems and education levels. CONCLUSIONS While many of these building blocks are similar to those conceptualized in social accountability theory, this conceptual framework is informed by what happens in practice - empirical evidence rather than prescriptions. Consequently it is valuable in that it puts some theoretical thinking around everyday practice in specific contexts; addressing a gap in the medical education literature. The building blocks framework includes guidelines for social accountable practice that can be applied at policy, school and individual levels.
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Affiliation(s)
- Robyn Preston
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Judy Taylor
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Jenni Judd
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
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Venance SL, LaDonna KA, Watling CJ. Exploring frontline faculty perspectives after a curriculum change. MEDICAL EDUCATION 2014; 48:998-1007. [PMID: 25200020 DOI: 10.1111/medu.12529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/24/2014] [Accepted: 05/27/2014] [Indexed: 06/03/2023]
Abstract
CONTEXT Curriculum renewal is an essential and continual process for undergraduate medical education programmes. Although there is substantial literature on the critical role of leadership in successful curricular change, the voices of frontline faculty teachers implementing such change have not been explored. We aimed not only to examine and understand the perceptions of faculty members as they face curriculum change, but also to explore the influences on their engagement with change. METHODS We used a constructivist grounded approach in this exploratory study. Sixteen faculty members teaching in the pre-clinical years were interviewed on their perspectives on a recent curricular change in the undergraduate medical programme at a single Canadian medical school. Constant comparative analysis was conducted to identify recurring themes. RESULTS Faculty teachers' engagement with curriculum change was influenced by three critical tensions during three phases of the change: (i) tension between individual and institutional values, which was prominent as change was being introduced; (ii) tension between drivers of change and restrainers of change, which was prominent as change was being enacted, and (iii) tension between perceived gains and perceived losses, which was prominent as teachers reflected on change once implemented. CONCLUSIONS We propose a model of faculty engagement with curricular change that elucidates the need to consider individual experiences and motivations within the broader context of the institutional culture of medical schools. Importantly, if individual and institutional values are misaligned, barriers to change outweigh facilitators, or perceived losses prevail; subsequently faculty teachers' engagement may be threatened, exposing the medical education programme to risk.
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Affiliation(s)
- Shannon L Venance
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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White J, Paslawski T, Kearney R. 'Discovery learning': an account of rapid curriculum change in response to accreditation. MEDICAL TEACHER 2013; 35:e1319-e1326. [PMID: 23444887 DOI: 10.3109/0142159x.2013.770133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND/AIMS The purpose of this study was to explore the attitudes and experiences of leaders responsible for making rapid changes to a medical school curriculum in response to an adverse accreditation report. The new curriculum was based on the principles of problem-based learning ('Discovery Learning'), with changes to the way that students were assessed. METHODS We conducted semi-structured interviews with leaders responsible for education at the school two and a half years after the adoption of the new curriculum. We coded the resulting transcripts to identify major and minor themes expressed by participants. RESULTS Thirty-five senior leaders, administrators and course directors were invited for the interview; 14 (40%) were interviewed. Five main themes were noted in the data: (1) organization and control of the curriculum; (2) changes in the practices of teaching and learning; (3) effects on faculty members; (4) sources of resistance and (5) attitudes to curriculum change in general. CONCLUSION This study demonstrates that major curriculum change can be achieved successfully in a short period of time. This study also illustrates some of the problems associated with making rapid changes to the medical school curriculum, and highlights the importance of attitudes to change amongst the leadership of a medical school.
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Affiliation(s)
- J White
- University of Alberta, Edmonton, Alberta, Canada.
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Davidson LK. A 3-year experience implementing blended TBL: active instructional methods can shift student attitudes to learning. MEDICAL TEACHER 2011; 33:750-753. [PMID: 21592018 DOI: 10.3109/0142159x.2011.558948] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Medical educators have been encouraged to adopt active instructional strategies that require learners to engage in and direct their own learning. These innovations may be seen as disruptive and face early challenges due to student resistance. We report 3 years of experience implementing a blend of team-based learning (TBL) and online learning modules in an undergraduate medical course. Three sequential cohorts of first year medical students were surveyed exploring how they valued different instructional methods during a period of evolving curricular design. In addition to a demonstrated increase in acceptance of new teaching methods, there was a shift in student perceptions of the relative merits of didactic, online and TBL teaching. Medical students' appreciations of different instructional methods are influenced by the maturity of instructional design. Educational change is best viewed through a longer term lens, acknowledging the necessity for teachers to develop experience in implementing new methods in the context of their institution.
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Maccarrick G, Kelly C, Conroy R. Preparing for an institutional self review using the WFME standards - an international medical school case study. MEDICAL TEACHER 2010; 32:e227-32. [PMID: 20423250 DOI: 10.3109/0142159x.2010.482396] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Curriculum reform poses significant challenges for medical schools across the globe. This paper describes the reforms that took place at the medical school of the Royal College of Surgeons in Ireland (RCSI) between 2005 and 2008 and the institutional self review process that accompanied these reforms. RESULTS Although fully accredited with the Irish Medical Council the RCSI sought additional detailed review of all aspects of its undergraduate medical program. Five medical educationalists were invited to visit the College in 2005 and again in 2008 to act as 'critical friends' and guide the self review using the World Federation for Medical Education (WFME) standards which had recently been adopted in Ireland. CONCLUSION The process of institutional self review (as opposed to more high stakes accreditation) can bring about significant reform, especially when supported by a panel of 'critical friends' working alongside faculty to help guide and support sustained curriculum reform. The WFME standards continue to provide a useful framework to consider all medical education activities within a medical school engaged in continuous renewal. Adequate preparation for such reviews is critical to the success of such an undertaking and should be supported by a comprehensive communication strategy and project plan.
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Goldstein EA, Maclaren CF, Smith S, Mengert TJ, Maestas RR, Foy HM, Wenrich MD, Ramsey PG. Promoting fundamental clinical skills: a competency-based college approach at the University of Washington. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:423-33. [PMID: 15851451 DOI: 10.1097/00001888-200505000-00003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The focus on fundamental clinical skills in undergraduate medical education has declined over the last several decades. Dramatic growth in the number of faculty involved in teaching and increasing clinical and research commitments have contributed to depersonalization and declining individual attention to students. In contrast to the close teaching and mentoring relationship between faculty and students 50 years ago, today's medical students may interact with hundreds of faculty members without the benefit of a focused program of teaching and evaluating clinical skills to form the core of their four-year curriculum. Bedside teaching has also declined, which may negatively affect clinical skills development. In response to these and other concerns, the University of Washington School of Medicine has created an integrated developmental curriculum that emphasizes bedside teaching and role modeling, focuses on enhancing fundamental clinical skills and professionalism, and implements these goals via a new administrative structure, the College system, which consists of a core of clinical teachers who spend substantial time teaching and mentoring medical students. Each medical student is assigned a faculty mentor within a College for the duration of his or her medical school career. Mentors continuously teach and reflect with students on clinical skills development and professionalism and, during the second year, work intensively with them at the bedside. They also provide an ongoing personal faculty contact. Competency domains and benchmarks define skill areas in which deepening, progressive attention is focused throughout medical school. This educational model places primary focus on the student.
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Affiliation(s)
- Erika A Goldstein
- University of Washington School of Medicine (UWSOM) Colleges, Seattle, WA 98195-7430, USA.
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Managing the Curriculum and Managing Change. INTERNATIONAL HANDBOOK OF RESEARCH IN MEDICAL EDUCATION 2002. [DOI: 10.1007/978-94-010-0462-6_34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
Over the past two decades, the majority of medical schools in the USA have embarked upon curricular initiatives to enhance the teaching of ambulatory or office-based primary care. Identifying characteristics of these primary care experiences that make for the most effective learning is a top priority in medical education research. In this paper we examine what is known about the influence of variability in the structure of primary care experiences on student learning outcomes. We examine the questions of how rotations are scheduled, who does the teaching and where the teaching takes place. Given the variability in curricula across the 125 accredited medical schools in the USA and the absence of agreed-upon objectives, outcomes or assessment measures for primary care education, it is not surprising that the current literature has fallen short in providing definitive answers. There is much debate about the benefits of community vs. campus sites, longitudinal vs. block experiences, and the influence of specialty training of the preceptor, but little in the current literature to guide and substantiate a programme's choice. What can be concluded with relative confidence is that clinics currently offer more active student experiences than do private offices, that students may be more satisfied with rural experiences than with urban or suburban experiences, and that longitudinal and block experiences have different learning advantages. Research in primary care medical education will benefit from the current movement towards a cross-institutional consensus on educational objectives and outcome measures and on the general application of a more rigorous research methodology.
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Affiliation(s)
- R J Kurth
- Division of General Internal Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
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Robins LS, White CB, Fantone JC. The difficulty of sustaining curricular reforms: a study of "drift" at one school. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2000; 75:801-805. [PMID: 10965857 DOI: 10.1097/00001888-200008000-00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In 1997, five years after a major curricular reform at the University of Michigan Medical School, the authors revisited the Goals for Medical Education (written by faculty to guide the reform process) to identify factors that had facilitated or hindered their achievement. By reviewing responses to identical questionnaires circulated to faculty in 1993 and again in 1997, they learned that considerably more lectures were being used to deliver curricular content in the first-year curriculum than the faculty thought was ideal, and that less social science, humanities, and ethics material was being presented in the first year than the faculty thought was ideal. The authors also learned that consensus between faculty basic scientists and faculty clinicians about the content that would make up an ideal first-year curriculum had diverged since adoption of the new curriculum. Movement toward decreasing the amounts of social sciences, humanities, and ethics in the first year of medical school was particularly pronounced among the basic scientists, who felt this material was being taught prematurely and at the expense of essential basic science content. In contrast, by 1997 much closer agreement had developed between the two groups regarding time they would allocate for lectures; this agreement unfortunately reflected a stagnation in the adoption of active learning methods. Movement toward increasing the amount of time for lectures in the first-year curriculum was particularly pronounced among the clinicians, who reported feeling more and more pressured to bring in clinical revenues. Based on faculty comments and the school's experience with centralized governance and centralized funding, the authors propose a direct linkage between institutional funding to departments and the teaching effort of faculty in the departments, and sufficient, centralized funding to relieve pressure on faculty and to foster educational creativity. They maintain that this may be the most effective way to guarantee ongoing innovation, support interdisciplinary teaching, and subsequently move the curriculum and teachers completely away from content that is isolated within traditional department structures. At the same time they acknowledge that changing faculty attitudes presents a challenge.
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Affiliation(s)
- L S Robins
- University of Washington School of Medicine, Seattle, USA
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Bland CJ, Starnaman S, Wersal L, Moorehead-Rosenberg L, Zonia S, Henry R. Curricular change in medical schools: how to succeed. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2000; 75:575-94. [PMID: 10875502 DOI: 10.1097/00001888-200006000-00006] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Society's changing needs, advancing knowledge, and innovations in education require constant changes of medical school curricula. But successful curricular change occurs only through the dedicated efforts of effective change agents. This study systematically searched and synthesized the literature on educational curricular change (at all levels of instruction), as well as organizational change, to provide guidance for those who direct curricular change initiatives in medical schools. The focus was on the process of planning, implementing, and institutionalizing curricular change efforts; thus, only those articles that dealt with examining the change process and articulating the factors that promote or inhibit change efforts were included. In spite of the highly diverse literature reviewed, a consistent set of characteristics emerged as being associated with successful curricular change. The frequent reappearance of the same characteristics in the varied fields and settings suggests they are robust contributors to successful change. Specifically, the characteristics are in the areas of the organization's mission and goals, history of change in the organization, politics (internal networking, resource allocation, relationship with the external environment), organizational structure, need for change, scope and complexity of the innovation, cooperative climate, participation by the organization's members, communication, human resource development (training, incorporating new members, reward structure), evaluation, performance dip (i.e., the temporary decrease in an organization's performance as a new program is implemented), and leadership. These characteristics are discussed in detail and related specifically to curricular change in medical school settings.
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Affiliation(s)
- C J Bland
- Department of Family Practice and Community Health, University of Minnesota Medical School, Minneapolis 55455-0392, USA.
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Weiss LB, Lee S, Levison SP. Barriers and solutions to implementing a new curriculum: lessons from the women's health education program at MCP Hahnemann School of Medicine. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 2000; 9:153-60. [PMID: 10746518 DOI: 10.1089/152460900318641] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The integration of new knowledge into the medical school curriculum is a difficult process. This article proposes effective strategies for overcoming obstacles to curricular integration of women's health and sex and gender topics. Some techniques developed to overcome barriers to the integration of new material into an existing curriculum include faculty development, faculty rewards, development of competencies and assessment tools, interdisciplinary team teaching, standardized patients, and reference resources. An interdisciplinary approach to implementing women's health education, as with most new curricular material, is endorsed for integration of the new field into the medical school curriculum. This proposed model results in general institutional participation and support, especially from senior level leadership. The outlined process enables students and faculty to learn techniques for incorporating emerging information in all disciplines, helping them to become "life-long learners."
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Affiliation(s)
- L B Weiss
- Department of Medicine and the Institute for Women's Health, MCP Hahnemann University School of Medicine, Philadelphia, Pennsylvania 19129, USA
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Katz DL, Nawaz H, Ahmadi R, Jekel JF, DeLuca VA, Cashman S, Fulmer HS. An integrated residency in internal and preventive medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2000; 75:41-49. [PMID: 10667874 DOI: 10.1097/00001888-200001000-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The importance of preventive and population-based principles in clinical practice is widely acknowledged. The challenge of imparting these principles in either undergraduate or postgraduate medical education has, however, not been fully met. The necessary skills are provided comprehensively by preventive medicine residency programs, but at the expense of clinical training. Sequential residencies in primary care and preventive medicine, the currently available means of obtaining thorough preparation in both clinical and population-based principles, represent an inefficient, generally unappealing, and non-integrated approach. In response to these concerns, and in an effort to make preventive medicine training appeal to a wider audience, the authors developed and implemented a residency program fully integrating internal and preventive medicine. The program meets, and generally exceeds, the requirements of both specialty boards over a four-year period. The program provides extensive training in clinical, preventive, and public health skills, along with case management and cost-effective care, conferring the MPH degree and leading to dual board eligibility. The model is ideally wed to the demands of the modern health care environment in the United States, is extremely attractive to applicants, and may warrant replication both to train academic and administrative leaders and to raise the standards of preventive and public health practice in primary care.
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Affiliation(s)
- D L Katz
- Department of Preventive Medicine, Griffin Hospital, Derby, Connecticut 06418, USA.
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Field MJ, Sefton AJ. Computer-based management of content in planning a problem-based medical curriculum. MEDICAL EDUCATION 1998; 32:163-171. [PMID: 9743768 DOI: 10.1046/j.1365-2923.1998.00194.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The Faculty of Medicine at the University of Sydney has undertaken a major educational change from a traditional didactic 6-year, undergraduate entry programme to a 4-year problem-based programme to which only graduates are admitted. We have used two computer-based tools which proved invaluable in developing and managing the content of the new curriculum. The first, developed using a commercial database and made available on the Faculty's Intranet, provided a means for eliciting appropriate problems, organizing content fields and searching the information. The second, based on a spreadsheet, provided a means of displaying agreed content on implementation grids, both for self-directed learning and conventional teaching sessions. Both provided ready access for scrutiny, interactions, review and planning by staff and they greatly enhanced the process of understanding the nature of the new curriculum, and thus in reassuring staff about the change. By merging the two tools, a definitive curriculum database is emerging.
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Affiliation(s)
- M J Field
- Department of Educational Development and Evaluation, Faculty of Medicine, University of Sydney, NSW, Australia
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