Introduction: New LCME accreditation standards will require medical schools to monitor curriculum and content and to develop a curriculum inventory over the next 1--2 years. There is little literature on the use of curriculum mapping to evaluate Problem-Based Learning (PBL) curriculum. Equipping medical students with knowledge and skills to care for our rapidly aging population is critical. We describe how developing a curriculum map for geriatric medicine core competencies during preclinical education helped identify areas to target revision of curricula. Research question: How can a curriculum map be utilized to examine course content in geriatric core competencies in the preclinical PBL curriculum? Methods: The John A. Burns School of Medicine (JABSOM) utilizes the PBL approach as a primary mode of instruction in the preclinical years, mainly during courses MD1-MD4 (first year), and during MD6 and MD7 (second year). The AAMC has published guidelines for geriatric medicine curriculum in the form of 26 Minimum Geriatric Competencies for Medical Students in 8 major categories: Medication Management; Cognitive and Behavioral Disorders; Self-Care Capacity; Falls, Balance and Gait Disorders; Health Care Planning and Promotion; Atypical Presentation of Disease; Palliative Care; and Hospital Care for Elders. We reviewed all (75) paper cases in the JABSOM preclinical PBL curriculum individually for the presence of these competencies and the degree of emphasis for each one. We plotted each of the PBL cases on a “curriculum map”: a table with rows containing the cases and columns containing the year level, topic, method of instruction, course, form of evaluation, and the 26 AAMC geriatric medicine medical student competencies. Using Microsoft Excel’s pivot table feature, we were able to identify gaps and redundancies in the curriculum. Results: Geriatric medicine topics were covered in all preclinical courses spread throughout the first and second years at JABSOM. The category of “Medication Management” was heavily emphasized as a major learning issue in 11 PBL cases from different blocks. The category of “Cognitive and Behavioral Disorders” was covered in 8 PBL cases; “Palliative Care” was covered in 5 PBL cases. In contrast, “Hospital Care for Elders” was a major learning issue in only 3 PBL cases. Competencies for hazards of hospitalization, restraint use and pressure ulcer surveillance were not found in any of the PBL cases. We also examined whether the sequence of topics was appropriate for the student’s level of training. Coverage of geriatric physiology was found in 2 PBL cases during the first year, and in 1 PBL case at the end of the second year. Coverage of medication management was found in 4 PBL cases in the first year, and 7 PBL cases in year 2. We also identified gaps in evaluation. While geriatrics competencies were covered as major learning issues in all courses, 2 of the 6 course exams did not include questions on these issues. Discussion: While curriculum mapping will be necessary in meeting AAMC inventory requirements in the future, the Curriculum Mapping of Geriatric Medicine Core Competencies at JABSOM has already proven to be an effective strategy. During our analysis, we found that we covered many LCME survey topics important for accreditation (e.g. care of the disabled, abuse, end--of--life care, health care systems). Through examination of the preclinical curriculum, we identified areas of deficiency, and also that the sequence was not ideal. Greater emphasis on geriatric physiology should occur earlier in the preclinical years, and coverage of optimal medication management should occur in later courses. Greater discussion regarding “Hospital Care for Elders,” including the important topics of patient safety and discharge planning towards the end of the second year, would also help better prepare students for their clinical years. Revisions to the curriculum and examinations are planned. We also plan to expand our analysis to include interprofessional education and cultural competence.

Curriculum Mapping of Geriatric Medicine Core Competencies in the Preclinical Problem- Based Learning Curriculum at the John A Burns School of Medicine, University of Hawaii

Alfred Lua, MD; Aida Wen, MD; Misty Yee, MS; Monica Stitt--Bergh, PhD; Christina Bell, MD PhD; Richard Kasuya, MD MSEd; Damon Sakai, MD; Kamal Masaki, MD The research reported on this poster was supported by: The John A. Hartford Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii; Pacific Health

Research Institute; Kuakini Medical Center; Honolulu Department of Veterans Affairs; National Institute on Aging. The investigators retained full independence in the conduct of this research.

The Problem Based Learning (PBL) approach is the primary mode of instruction in the preclinical years Data Collection -  PBL paper cases and final exams were obtained from the Course Directors of Blocks MD1, MD2, MD3, MD4, MD6, and MD7 -  A total of 75 PBL cases were reviewed (MD1-7) -  Course Exams were reviewed to determine if and how much geriatric content was evaluated -  Each PBL case was evaluated to determine which AAMC Geriatric Core Competencies were covered as explicit Learning

Issues or Objectives Curriculum Map -  Every PBL case was listed chronologically, according to the order in which students encountered each paper case, with the

year level indicated in the first column, the Course number in the 2nd column, and the paper case topic in the 4th column -  The evaluation of geriatric learning objectives were indicated by recording the number of geriatric questions found on each

final course exam in the 3rd column -  The degree to which the geriatric learning objectives were emphasized in each PBL case was quantified using diamonds in

the remaining columns

Ø  Curriculum mapping is an essential tool for teachers and learners for course content analysis and curriculum development.

Ø  Curriculum mapping can be used for the curriculum inventory process through the longitudinal examination of topics found on the LCME accreditation survey that cross organ systems or disciplines.

1.  To analyze the UH JABSOM PBL curriculum across all preclinical courses for the presence and degree of emphasis of the 26 Geriatric Core Competencies.

2.  To identify areas of improvement using a curriculum map.

Curriculum Map - A visual representation of the structure of program curricula. Curriculum maps often describe educational format, course content, learning objectives, educational experiences, evaluation, and a timetable for progress. Since early 2000, there has been a trend towards increasing use of curriculum maps among UK and Canadians Schools. In a 2009 study of UK and Canadian medical schools1:

-  19% Schools Completed a Map -  55% were in the process of building a map -  16% were planning to build a map

-In the United States, the Curriculum Inventory became available in Feb. 2014 to all AAMC member schools to upload their curriculum data as a way to better monitor and ensure uniform standards in medical education2. The creation of A Geriatric Curriculum Map was felt to be a good strategy to conduct a comprehensive inventory and analysis of our curriculum, to ensure adequate inclusion of geriatric core competencies. The curriculum map focused on the pre-clinical PBL cases used during first two years of medical training.

Many of the Geriatric Core Competencies were covered through the two-year pre-clinical PBL curriculum. Areas heavily emphasized were: •  Medication Management, Cognitive and Behavioral Disorders, and Palliative

Care. Gaps in the curriculum included: •  Geriatric physiology •  Hospital Care for Elders Sequence: •  Geriatric physiology should be covered earlier. •  Medication managements should be covered later. Evaluation: •  2 of the 6 course exams did not include questions pertaining to geriatric topics.

Ø  The project successfully demonstrated the feasibility and usefulness of curriculum maps for curriculum evaluation and development.

Ø  The visual representation of the curricula components made it easier to see which areas could be improved.

Ø  Based on our findings, revisions to the content, sequence, and evaluation of the geriatric curriculum are planned.

Limitations: Ø  The current geriatric curriculum map was a pilot and did not include all aspects

of the pre-clinical training. Ø  In the future, other components of the curriculum should be included, such as

lectures and standardized patient experiences. Ø  Ideally, the actual teachers should participate in the curriculum map

construction. However, they will be included in discussions about curriculum revisions.

Future Directions: We would also like to use this curriculum mapping strategy for analysis of

interprofessional education and cultural competence curriculum.

1.  Willett, Timothy G. "Current Status of Curriculum Mapping in Canada and the UK."Medical Education 42.8 (2008): 786-93. Print. 2. "Curriculum Inventory and Reports (CIR) - Initiatives - AAMC." Curriculum Inventory and Reports (CIR) - Initiatives - AAMC. N.p., n.d. Web. 10 Mar. 2014