Core Core curriculumcurriculum

Fadhil Alamran, MRCS glasg, Fadhil Alamran, MRCS glasg, FIBMS, postdoctoral fellowship FIBMS, postdoctoral fellowship Colorado university, Colorado university, cardiothoracic surgeon M.D.cardiothoracic surgeon M.D.

‘‘The drug, doctor’The drug, doctor’

The idea that the patient responds, The idea that the patient responds, not just to a pharmacological not just to a pharmacological substance, but to the person of the substance, but to the person of the doctor; the atmosphere the doctor doctor; the atmosphere the doctor generates and what the interaction generates and what the interaction means to both of them ------this is the means to both of them ------this is the aim of ideal core of curriculum aim of ideal core of curriculum

Overview:A powerful strategy in

medical education = Core + (SSMs) special study modules or (SSCs) Student Selected Components

This strategy :curriculum overload,knowledge, skills and attitudes allows students to take more responsibilityprovides a curriculum framework

Background

‘information explosion’ - intolerable burden for the student. Curriculum developers need to make provision for the inclusion of new topics such as palliative care without neglecting traditional course content such as anatomy. There is also an increasing recognition that while students may not be able to study all areas in depth, there is a need to provide an opportunity for them to have time scheduled to study some subjects in more depth

What is the Core Curriculum?There are different perceptions of what constitutes ‘core’

Core Core curriculumcurriculum

• Core as essential aspects of all subjects or disciplines: the key aspects of the subjects studied in the curriculum. • Core as essential competences for practice: • Core as a study of what are perceived as the key disciplines: • Core as transferable areas of study relevant to many disciplines:

The concept of the core curriculum and options or SSMs be described as the seven Cs:

Certification: Capability: Comprehensiveness:. Consistency:. Constructivism: Choice: Compacted curriculum:

Determination of core

A range of stakeholders can contribute to what should be included in a core curriculum. government, the public, the professions, students and teachers within an institution

• The importance of the topic in key decisions to be taken by a doctor • The commonness or rarity of the problem • The extent to which one can generalise from the subject to other topics in medicine. The core curriculum will change with time and should reflect medical trends and changes

Core + (SSMs) special study

Advantages

opportunity for students to study in greater depth an area of their choosing

integrated themes, giving a multidisciplinary and multiprofessional direction to the curriculum.

SSMs recognise the importance of generic competences or transferable skills

SSMs allow significant extension of the range of subjects or topics covered in the curriculum

Advantages, Advantages, contin.contin.SSMs can utilise a range of teaching

resources

SSMs can be attractive, both to staff and students.

A menu of interesting SSMs may attract potential students and influence their choice

Topics covered in Topics covered in SSMs SSMs

i.An extension of the core ii) A topic related to medicine but not included in detail in the core: eg, computing, information technology, history of medicine. iii) A topic not related directly to medicine: eg a foreign language, business

Important criteria for the Important criteria for the selection of SSMsselection of SSMs

contribution they can make to overall course learning outcomes

availability of suitable resources in the medical school.

Is the subject consistent with the school’s learning outcomes

Might the SSM help the students in their choice of a future career?

Does the SSM lead to mastery of learning skills, and information retrieval relevant to the practice of medicine?

• At least one senior member of staff must have their organisation and coordination as a major personal responsibility. This person must have the authority of the appropriate committees within the university.

• Adequate resources must be made available, eg finance, library facilities etc.

• There should be some flexibility in the duration of SSMs, eg, one, two or four weeks or longer.

Management of SSMs

• The number of SSM slots offered should be greater than the number of places required by students.

• Guidelines and advice should be offered to students concerning their choice of SSMs and what is expected of them.

• SSMs should be assessed as stringently as the core, preferably with an external examiner.

Management of SSMs contin.

Four approaches can be identified to implement a curriculum with core and SSM components. Each has its advantages and disadvantages.

Relationship between Core and SSMs

Integrated Approach:Concurrent Approach:Intermittent Approach:Sequential Approach: Students proceed to SSMs only when they have

demonstrated mastery of the core.

Relationship between Core and SSMs contin.

Time allocation for Core Time allocation for Core and for SSMs and for SSMs

SSMs take up between 20-40% of the curriculum. The balance between core and SSMs will be influenced by, among other things, the amount of core to be covered and the resources available to provide a wide range of learning opportunities.

Students should be expected to demonstrate a high level of mastery of the core of a course on completion of the curriculum. The assessment should be competetive and using MCQs and case study is more accurate in assessment even sor basic science

In the assessment of SSMs, decisions must be taken as to whether to adopt a pass/fail system or a grading system and how that influences the overall assessment of students. The assessment may be a written test, essay, dissertation, oral or practical exam. External examiners are important in helping to maintain standards comparable between different SSMs.

Student Assessment

Increasing demands on postgraduate training, with greater specialisation, rapid expansion, new developments in medicine and time constraints, are arguments for the introduction of a core training programme with SSMs. For greater emphasis on teaching and on research.

Postgraduate studies –core -SSMs

Need to integrate the Need to integrate the corecore

Students’ basic scientific Students’ basic scientific knowledge ‘?’ in the traditional knowledge ‘?’ in the traditional core is inadequate for clinical core is inadequate for clinical medicine –this is from feedback of medicine –this is from feedback of the european and american core the european and american core curriculum in the previous decadecurriculum in the previous decade

Integration of the core Integration of the core && Evidence of Evidence of Integration Integration

GeneticsGeneticsAnatomyAnatomyBiochemistryBiochemistryMicrobiologyMicrobiology

ImmunologyImmunology PathologyPathologyPharmacologyPharmacologyPhysiologyPhysiology

NeuroscienceNeuroscience

Basic Sciences Integration: Basic Sciences Integration: What and how?What and how?

SystemsSystems

OrganOrgan Biological Biological

Molecular to cells, tissues, and systemsMolecular to cells, tissues, and systems From normal to abnormal biologyFrom normal to abnormal biology

Integration of normal and abnormal biologyIntegration of normal and abnormal biology Integration of different disciplinesIntegration of different disciplines

Integration of core will Integration of core will lead to integration of lead to integration of assessmentassessment

Using clinical problem solving Using clinical problem solving questions for first year studententquestions for first year studentent

A A miraculous rescuemiraculous rescue

An 8-year old boy, Maurice, has been lying under An 8-year old boy, Maurice, has been lying under water for more than 15 minutes. Fortunately a water for more than 15 minutes. Fortunately a passer-by succeeds in bringing him out of the passer-by succeeds in bringing him out of the water. Mouth-to-mouth resuscitation is applied water. Mouth-to-mouth resuscitation is applied immediately. Everyone is astonished to notice immediately. Everyone is astonished to notice that the boy is still alive. At the moment Maurice that the boy is still alive. At the moment Maurice is on the intensive care ward of the local hospital is on the intensive care ward of the local hospital and is out of danger of life. According to his and is out of danger of life. According to his medical attendant, he is expected to recover medical attendant, he is expected to recover completely.completely.

ExplainExplain why it is possible for the boy to survive why it is possible for the boy to survive after lying under water for more than 15 minutesafter lying under water for more than 15 minutes

Assessment of efficacy Assessment of efficacy of the Coreof the Core

Communication skills “holy grail” Communication skills “holy grail” and final end result for the and final end result for the assessment of Core is through assessment of Core is through clinical skill of graduateclinical skill of graduate

Assessing clinical skillsAssessing clinical skills

1.1. WHY do we need to assess ?WHY do we need to assess ?

2.2. WHAT do we want to WHAT do we want to measure ?measure ?

WHY do we assess ? WHY do we assess ?

To ensure safety of patientsTo ensure safety of patientsour responsibility to the publicour responsibility to the public

Achievement of a minimum standardAchievement of a minimum standardresponsibility to the candidate and responsibility to the candidate and

UniversityUniversity

In principle…

WHY do we assess ?WHY do we assess ?

Formative: to give feedback and Formative: to give feedback and advice regarding the coreadvice regarding the core

Summative: to gradeSummative: to grade

Qualificative or licensingQualificative or licensing

In practice: the purpose

WHAT do we measure ?WHAT do we measure ?

To test not only To test not only presencepresence of of knowledgeknowledge

……but also the but also the applicationapplication of of knowledge and the coreknowledge and the core

In principle…

Aim of clinical assessmentAim of clinical assessment

Certification of competence - pass / failCertification of competence - pass / fail a state (and legal) requirementa state (and legal) requirement

Grading in rank orderGrading in rank orderfor employment / placement purposesfor employment / placement purposes

A competition for the award of a prizeA competition for the award of a prize Feed back for core competencyFeed back for core competency

In principle…a four-fold aim

OSCE assessment OSCE assessment is is valuable for core valuable for core assessmentassessment

At least 6 clinical stops with different At least 6 clinical stops with different clinical situationsclinical situations

Two examiners at every encounter, each Two examiners at every encounter, each examiner giving an individual examiner giving an individual assessmentassessment

Highly structured examination and Highly structured examination and detailed assessment of skillsdetailed assessment of skills

Examiners from other Universities for Examiners from other Universities for process evaluation and quality controlprocess evaluation and quality control

What happens to What happens to candidates who fail ?candidates who fail ?

Review of performance – a formative Review of performance – a formative exerciseexercise

Counselling at a personal levelCounselling at a personal level

Specific attention and individual training Specific attention and individual training

Repeat assessment after a period of timeRepeat assessment after a period of time Common candidate failure causes should Common candidate failure causes should

give feed back to the core assessmentgive feed back to the core assessment

liberate the medical curriculum The introduction of core and

special study modules allows great efficiency in the use of time and facilitates achievement of significant and highly desirable curriculum objectives.

Conclusion

• Integration of the core is Integration of the core is mandatory need to counteract mandatory need to counteract information explosioninformation explosion

• Integration of assessment is a Integration of assessment is a sequele sequele

• assess clinical competences is assess clinical competences is good feedback for core good feedback for core competencycompetency

Conclusion contin.