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1.  A Model for Persistent Improvement of Medical Education as Illustrated by the Surgical Reform Curriculum HeiCuMed 
Background: Heidelberg Medical School underwent a major curricular change with the implementation of the reform curriculum HeiCuMed (Heidelberg Curriculum Medicinale) in October 2001. It is based on rotational modules with daily cycles of interactive, case-based small-group seminars, PBL tutorials and training of sensomotor and communication skills. For surgical undergraduate training an organisational structure was developed that ensures continuity of medical teachers for student groups and enables their unimpaired engagement for defined periods of time while accounting for the daily clinical routine in a large surgery department of a university hospital. It includes obligatory didactic training, standardising teaching material on the basis of learning objectives and releasing teaching doctors from clinical duties for the duration of a module.
Objective: To compare the effectiveness of the undergraduate surgical reform curriculum with that of the preceding traditional one as reflected by students' evaluations.
Method: The present work analyses student evaluations of the undergraduate surgical training between 1999 and 2008 including three cohorts (~360 students each) in the traditional curriculum and 13 cohorts (~150 students each) in the reform curriculum.
Results: The evaluation of the courses, their organisation, the teaching quality, and the subjective learning was significantly better in HeiCuMed than in the preceding traditional curriculum over the whole study period.
Conclusion: A medical curriculum based on the implementation of interactive didactical methods is more important to successful teaching and the subjective gain of knowledge than knowledge transfer by traditional classroom teaching. The organisational strategy adopted in the surgical training of HeiCuMed has been successful in enabling the maintenance of a complex modern curriculum on a continuously high level within the framework of a busy surgical environment.
doi:10.3205/zma000741
PMCID: PMC3149464  PMID: 21818239
Medical education; undergraduate surgery curriculum; evaluation
2.  Teaching Musculoskeletal Physical Diagnosis Using A Web-based Tutorial and Pathophysiology-Focused Cases 
Objective:
To assess the effectiveness of an experimental curriculum on teaching first-year medical students the musculoskeletal exam as compared to a traditional curriculum.
Background:
Musculoskeletal complaints are common in the primary care setting. Practitioners are often deficient in examination skills and knowledge regarding musculoskeletal diseases. There is a lack of uniformity regarding how to teach the musculoskeletal examination among sub-specialists. We propose a novel web-based approach to teaching the musculoskeletal exam that is enhanced by peer practice with pathophysiology-focused cases. We sought to assess the effectiveness of an innovative musculoskeletal curriculum on the knowledge and skills of first-year medical students related to musculoskeletal physical diagnosis as compared to a traditional curriculum. The secondary purpose of this study was to assess satisfaction of students and preceptors exposed to this teaching method.
Methods:
This quasi-experimental study was conducted at a single LCME-accredited medical school and included a convenience sample from 2 consecutive classes of medical students during the musculoskeletal portion of their physical diagnosis class. We conducted a needs assessment of the traditional curriculum used to teach musculoskeletal examination. The needs assessment informed the development of an experimental curriculum. One class (control group) received the traditional curriculum while the second class (experimental group) received the experimental curriculum, consisting of a web-based musculoskeletal tutorial, pathophysiology-focused cases, and facilitator preparation. We used multiple-choice questions and musculoskeletal OSCE scores to assess differences between knowledge and skills in the 2 groups.
Results:
The sample consisted of 140 students in each medical school class. There were no statistically significant differences between the 2 groups. One hundred seven students from the control group and 120 students from the experimental group took the multiple-choice examination. The average score was 66% (95% CI= 59.7–72.3) for the control group and 66% (95% CI = 60.5–71.5) for the experimental group. There was no difference between the median musculoskeletal OSCE scores between the 2 groups. The experimental group was satisfied with the new teaching method and gained the additional benefit of a persistent resource.
Conclusions:
This web-based experimental curriculum was as effective as the traditional curriculum for teaching the musculoskeletal exam. Additionally, users were satisfied with the web-based training and benefited from a persistent resource.
doi:10.3885/meo.2009.Res00301
PMCID: PMC2779618  PMID: 20165527
cases; curriculum; musculoskeletal; OSCE; physical exam; tutorial; website
3.  Integrated medical school ultrasound: development of an ultrasound vertical curriculum 
Background
Physician-performed focused ultrasonography is a rapidly growing field with numerous clinical applications. Focused ultrasound is a clinically useful tool with relevant applications across most specialties. Ultrasound technology has outpaced the education, necessitating an early introduction to the technology within the medical education system. There are many challenges to integrating ultrasound into medical education including identifying appropriately trained faculty, access to adequate resources, and appropriate integration into existing medical education curricula. As focused ultrasonography increasingly penetrates academic and community practices, access to ultrasound equipment and trained faculty is improving. However, there has remained the major challenge of determining at which level is integrating ultrasound training within the medical training paradigm most appropriate.
Methods
The Ohio State University College of Medicine has developed a novel vertical curriculum for focused ultrasonography which is concordant with the 4-year medical school curriculum. Given current evidenced-based practices, a curriculum was developed which provides medical students an exposure in focused ultrasonography. The curriculum utilizes focused ultrasonography as a teaching aid for students to gain a more thorough understanding of basic and clinical science within the medical school curriculum. The objectives of the course are to develop student understanding in indications for use, acquisition of images, interpretation of an ultrasound examination, and appropriate decision-making of ultrasound findings.
Results
Preliminary data indicate that a vertical ultrasound curriculum is a feasible and effective means of teaching focused ultrasonography. The foreseeable limitations include faculty skill level and training, initial cost of equipment, and incorporating additional information into an already saturated medical school curriculum.
Conclusions
Focused ultrasonography is an evolving concept in medicine. It has been shown to improve education and patient care. The indications for and implementation of focused ultrasound is rapidly expanding in all levels of medicine. The ideal method for teaching ultrasound has yet to be established. The vertical curriculum in ultrasound at The Ohio State University College of Medicine is a novel evidenced-based training regimen at the medical school level which integrates ultrasound training into medical education and serves as a model for future integrated ultrasound curricula.
doi:10.1186/2036-7902-5-6
PMCID: PMC3701608  PMID: 23819896
Curriculum; Focused ultrasound; Medical education; Ultrasonography; Undergraduate medical education
4.  Impact of a Pre-Clinical Clinical Skills Curriculum on Student Performance in Third-Year Clerkships 
ABSTRACT
BACKGROUND
Research on the outcomes of pre-clinical curricula for clinical skills development is needed to assess their influence on medical student performance in clerkships.
OBJECTIVE
To better understand the impact of a clinical-skills curriculum in the pre-clinical setting on student performance.
DESIGN
We conducted a non-randomized, retrospective, pre-post review of student performance evaluations from 3rd-year clerkships, before and after implementation of a clinical-skills curriculum, the Colleges (2001–2007).
MAIN RESULTS
Comparisons of clerkship performance data revealed statistically significant differences favoring the post-Colleges group in the Internal Medicine clerkship for 9 of 12 clinical-skills domains, including Technical Communication Skills (p < 0.023, effect size 0.16), Procedural Skills (p < 0.031, effect size 0.17), Communication Skills (p < 0.003, effect size 0.21), Patient Relationships (p < 0.003, effect size 0.21), Professional Relationships (p < 0.021, effect size 0.17), Educational Attitudes (p < 0.001, effect size 0.24), Initiative and Interest (p < 0.032, effect size 0.15), Attendance and Participation (p < 0.007, effect size 0.19), and Dependability (p < 0.008, effect size 0.19). Statistically significant differences were identified favoring the post-Colleges group in technical communication skills for three of six basic clerkships (Internal Medicine, Surgery, and Pediatrics).
CONCLUSIONS
Implementation of a pre-clinical fundamental skills curriculum appears to be associated with improved clerkship performance in the 3rd year of medical school, particularly in the Internal Medicine clerkship. Similar curricula, focused on teaching clinical skills in small groups at the bedside with personalized mentoring from faculty members, may improve student performance. Continued efforts are needed to understand how to best prepare students for clinical clerkships and how to evaluate outcomes of similar pre-clinical skills programs.
doi:10.1007/s11606-009-1032-7
PMCID: PMC2710476  PMID: 19521738
medical education; clinical skills; medical students; pre-clinical; curriculum
5.  Patient safety education for undergraduate medical students: a systematic review 
BMC Medical Education  2011;11:33.
Background
To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Incorporating the knowledge of how to do this into the medical student curriculum is an urgent necessity. This paper aims to systematically review the literature about patient safety education for undergraduate medical students in terms of its content, teaching strategies, faculty availability and resources provided so as to identify evidence on how to promote patient safety in the curriculum for medical schools. This paper includes a perspective from the faculty of a medical school, a major hospital and an Evidence Based Medicine Centre in Sichuan Province, China.
Methods
We searched MEDLINE, ERIC, Academic Source Premier(ASP), EMBASE and three Chinese Databases (Chinese Biomedical Literature Database, CBM; China National Knowledge Infrastructure, CNKI; Wangfang Data) from 1980 to Dec. 2009. The pre-specified form of inclusion and exclusion criteria were developed for literature screening. The quality of included studies was assessed using Darcy Reed and Gemma Flores-Mateo criteria. Two reviewers selected the studies, undertook quality assessment, and data extraction independently. Differing opinions were resolved by consensus or with help from the third person.
Results
This was a descriptive study of a total of seven studies that met the selection criteria. There were no relevant Chinese studies to be included. Only one study included patient safety education in the medical curriculum and the remaining studies integrated patient safety into clinical rotations or medical clerkships. Seven studies were of a pre and post study design, of which there was only one controlled study. There was considerable variation in relation to contents, teaching strategies, faculty knowledge and background in patient safety, other resources and outcome evaluation in these reports. The outcomes from including patient safety in the curriculum as measured by medical students' knowledge, skills, and attitudes varied between the studies.
Conclusions
There are only a few relevant published studies on the inclusion of patient safety education into the undergraduate curriculum in medical schools either as a selective course, a lecture program, or by being integrated into the existing curriculum even in developed countries with advanced health and education systems. The integration of patient safety education into the existing curriculum in medical schools internationally, provides significant challenges.
doi:10.1186/1472-6920-11-33
PMCID: PMC3128569  PMID: 21669007
6.  Teaching lesbian, gay, bisexual and transgender health in a South African health sciences faculty: addressing the gap 
BMC Medical Education  2013;13:174.
Background
People who identity as lesbian, gay, bisexual and transgender (LGBT) have specific health needs. Sexual orientation and gender identity are social determinants of health, as homophobia and heteronormativity persist as prejudices in society. LGBT patients often experience discrimination and prejudice in health care settings. While recent South African policies recognise the need for providing LGBT specific health care, no curricula for teaching about LGBT health related issues exist in South African health sciences faculties. This study aimed to determine the extent to which LGBT health related content is taught in the University of Cape Town’s medical curriculum.
Methods
A curriculum mapping exercise was conducted through an online survey of all academic staff at the UCT health sciences faculty, determining LGBT health related content, pedagogical methodology and assessment.
Results
127 academics, across 31 divisions and research units in the Faculty of Health Sciences, responded to the survey, of which 93 completed the questionnaire. Ten taught some content related to LGBT health in the MBChB curriculum. No LGBT health related content was taught in the allied health sciences curricula. The MBChB curriculum provided no opportunity for students to challenge their own attitudes towards LGBT patients, and key LGBT health topics such as safer sex, mental health, substance abuse and adolescent health were not addressed.
Conclusion
At present, UCTs health sciences curricula do not adequately address LGBT specific health issues. Where LGBT health related content is taught in the MBChB curriculum, it is largely discretionary, unsystematic and not incorporated into the overarching structure. Coordinated initiatives to integrate LGBT health related content into all health sciences curricula should be supported, and follow an approach that challenges students to develop professional attitudes and behaviour concerning care for patients from LGBT backgrounds, as well as providing them with specific LGBT health knowledge. Educating health professions students on the health needs of LGBT people is essential to improving this population’s health by providing competent and non-judgmental care.
doi:10.1186/1472-6920-13-174
PMCID: PMC3877956  PMID: 24373219
LGBT health; Health professions education; Heteronormativity; Homophobia; South Africa
7.  Simulated Electronic Health Record (Sim-EHR) Curriculum: Teaching EHR Skills and Use of the EHR for Disease Management and Prevention 
Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum’s general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts.
In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care.
doi:10.1097/ACM.0000000000000149
PMCID: PMC4035239  PMID: 24448035
8.  The organization and implementation of community-based education programs for health worker training institutions in Uganda 
Background
Community-based education (CBE) is part of the training curriculum for most health workers in Uganda. Most programs have a stated purpose of strengthening clinical skills, medical knowledge, communication skills, community orientation of graduates, and encouragement of graduates to work in rural areas. This study was undertaken to assess the scope and nature of community-based education for various health worker cadres in Uganda.
Methods
Curricula and other materials on CBE programs in Uganda were reviewed to assess nature, purpose, intended outcomes and evaluation methods used by CBE programs. In-depth and key informant interviews were conducted with people involved in managing CBE in twenty-two selected training institutions, as well as stakeholders from the community, Ministry of Health, Ministry of Education, civil society organizations and local government. Visits were made to selected sites where CBE training was conducted to assess infrastructure and learning resources being provided.
Results
The CBE curriculum is implemented in the majority of health training institutions in Uganda. CBE is a core course in most health disciplines at various levels – certificate, diploma and degree and for a range of health professionals. The CBE curriculum is systematically planned and implemented with major similarities among institutions. Organization, delivery, managerial strategies, and evaluation methods are also largely similar. Strengths recognized included providing hands-on experience, knowledge and skills generation and the linking learners to the communities. Almost all CBE implementing institutions cited human resource, financial, and material constraints.
Conclusions
The CBE curriculum is a widely used instructional model in Uganda for providing trainee health workers with the knowledge and skills relevant to meet community needs. Strategies to improve curricula and implementation concerns need further development. It is still uncertain whether this approach is increasing the number graduates seeking careers in rural health service, one of the stated program goals, an outcome which requires further study.
doi:10.1186/1472-698X-11-S1-S4
PMCID: PMC3059476  PMID: 21411004
9.  Developing a competency-based curriculum in HIV for nursing schools in Haiti 
Background
Preparing health workers to confront the HIV/AIDS epidemic is an urgent challenge in Haiti, where the HIV prevalence rate is 2.2% and approximately 10 100 people are taking antiretroviral treatment. There is a critical shortage of doctors in Haiti, leaving nurses as the primary care providers for much of the population. Haiti's approximately 1000 nurses play a leading role in HIV/AIDS prevention, care and treatment. However, nurses do not receive sufficient training at the pre-service level to carry out this important work.
Methods
To address this issue, the Ministry of Health and Population collaborated with the International Training and Education Center on HIV over a period of 12 months to create a competency-based HIV/AIDS curriculum to be integrated into the 4-year baccalaureate programme of the four national schools of nursing.
Results
Using a review of the international health and education literature on HIV/AIDS competencies and various models of curriculum development, a Haiti-based curriculum committee developed expected HIV/AIDS competencies for graduating nurses and then drafted related learning objectives. The committee then mapped these learning objectives to current courses in the nursing curriculum and created an 'HIV/AIDS Teaching Guide' for faculty on how to integrate and achieve these objectives within their current courses. The curriculum committee also created an 'HIV/AIDS Reference Manual' that detailed the relevant HIV/AIDS content that should be taught for each course.
Conclusion
All nursing students will now need to demonstrate competency in HIV/AIDS-related knowledge, skills and attitudes during periodic assessment with direct observation of the student performing authentic tasks. Faculty will have the responsibility of developing exercises to address the required objectives and creating assessment tools to demonstrate that their graduates have met the objectives. This activity brought different administrators, nurse leaders and faculty from four geographically dispersed nursing schools to collaborate on a shared goal using a process that could be easily replicated to integrate any new topic in a resource-constrained pre-service institution. It is hoped that this experience provided stakeholders with the experience, skills and motivation to strengthen other domains of the pre-service nursing curriculum, improve the synchronization of didactic and practical training and develop standardized, competency-based examinations for nursing licensure in Haiti.
doi:10.1186/1478-4491-6-17
PMCID: PMC2535593  PMID: 18759986
10.  THE VAXED PROJECT: An Assessment of Immunization Education in Canadian Health Professional Programs 
BMC Medical Education  2010;10:86.
Background
Knowledge & attitudes of healthcare providers (HCP) have significant impact on frequency with which vaccines are offered & accepted but many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can be integrated into formal education curricula.
Methods
(i) A questionnaire was sent to all Canadian nursing, medical & pharmacy schools to assess immunization-related curriculum content (ii) A 77-item web-based, validated questionnaire was emailed to final-year students in medicine, nursing, & pharmacy at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum.
Results
The curriculum review yielded responses from 18%, 48%, & 56% of medical, nursing, & pharmacy schools, respectively. Time spent on immunization content varied substantially between & within disciplines from <1 to >50 hrs. Most schools reported some content regarding vaccine preventable diseases, immunization practice & clinical skills but there was considerable variability and fewer schools had learning objectives or formal evaluation in these areas. 74% of respondents didn't feel comfortable discussing vaccine side effects with parents/patients & only 21% felt they received adequate teaching regarding immunization during training.
Conclusions
Important gaps were identified in the knowledge of graduating nursing, medical, & pharmacy trainees regarding vaccine indications/contraindications, adverse events & safety. The national curriculum review revealed wide variability in immunization curriculum content & evaluation. There is clearly a need for educators to assess current curricula and adapt existing educational resources such as the Immunization Competencies for Health Professionals in Canada.
doi:10.1186/1472-6920-10-86
PMCID: PMC3002370  PMID: 21110845
11.  DEVELOPING AN INTEGRATED ORGAN/SYSTEM CURRICULUM WITH COMMUNITY-ORIENTATION FOR A NEW MEDICAL COLLEGE IN JAZAN, SAUDI ARABIA 
Background:
Jazan province is located in the south-west of the Kingdom of Saudi Arabia. The province is offlicted with a wide spectrum of diseases and therefore have a special need for more health services. The Faculty of Medicine at Jazan has been following the traditional curriculum since its inception in 2001. The traditional curriculum has been criticized because of the students inability to relate what they learned in the basic sciences to medicine, thus stifling their motivation. It was felt that much of what was presented in preclinical courses was irrelevant to what the doctor really needed to know for his practice. The College therefore, decided to change to an integrated curriculum.
Design:
The study was conducted in 2004-2005 in the Faculty of Medicine, Jazan University. It began with a literature survey/search for relevant information and a series of meetings with experts from various institutions. A Curriculum Committee was formed and a set of guiding principles was prepared to help develop the new curriculum. A standard curriculum writing format was adopted for each module. It was decided that an independent evaluation of the new curriculum was to be done by experts in medical education before submission for official approval. There were several difficulties in the course of designing the curriculum, such as: provision of vertical integration, the lack of preparedness of faculty to teach an integrated curriculum, and difficulties inherent in setting a truly integrated examination.
Curriculum:
The program designed is for 6 years and in 3 phases; pre-med (year 1), organ/system (years 2 and 3), and clinical clerkship (years 4, 5, and 6). This is to be followed by a year of Internship. The pre-med phase aims at improving the students’ English language and prepare them for the succeeding phases. The organ/ system phase includes the integrated systems and the introductory modules. The curriculum includes elective modules, early clinical training, behavioral sciences, medical ethics, biostatistics, computer practice, and research methods. The curriculum provides active methods of instruction that include: small group discussion/ tutorials, problem-based learning (PBL), case-study/ clinical presentations, seminars, skills practice (clinical skill lab), practical, demonstration, and student independent learning. Methods of evaluating students include continuous and summative assessment.
Conclusion:
The new curriculum adopted by the Jazan Faculty of Medicine is an integrated, organ/ system based, community-oriented, with early clinical skills, elective modules, and innovative methods of instructions.
PMCID: PMC3410155  PMID: 23012158
Community oriented education; Curriculum development/evaluation; Interdisciplinary medical education; Problem-based learning
12.  Attitudes of medical students to medical leadership and management: a systematic review to inform curriculum development 
BMC Medical Education  2011;11:93.
Background
There is a growing acknowledgement that doctors need to develop leadership and management competences to become more actively involved in the planning, delivery and transformation of patient services. We undertook a systematic review of what is known concerning the knowledge, skills and attitudes of medical students regarding leadership and management. Here we report the results pertaining to the attitudes of students to provide evidence to inform curriculum development in this developing field of medical education.
Methods
We searched major electronic databases and citation indexes within the disciplines of medicine, education, social science and management. We undertook hand searching of major journals, and reference and citation tracking. We accessed websites of UK medical institutions and contacted individuals working within the field.
Results
26 studies were included. Most were conducted in the USA, using mainly quantitative methods. We used inductive analysis of the topics addressed by each study to identity five main content areas: Quality Improvement; Managed Care, Use of Resources and Costs; General Leadership and Management; Role of the Doctor, and Patient Safety. Students have positive attitudes to clinical practice guidelines, quality improvement techniques and multidisciplinary teamwork, but mixed attitudes to managed care, cost containment and medical error. Education interventions had variable effects on students' attitudes. Medical students perceive a need for leadership and management education but identified lack of curriculum time and disinterest in some activities as potential barriers to implementation.
Conclusions
The findings from our review may reflect the relatively little emphasis given to leadership and management in medical curricula. However, students recognise a need to develop leadership and management competences. Although further work needs to be undertaken, using rigorous methods, to identify the most effective and cost-effective curriculum innovations, this review offers the only currently available summary of work examining the attitudes of students to this important area of development for future doctors.
doi:10.1186/1472-6920-11-93
PMCID: PMC3247079  PMID: 22082174
13.  "That never would have occurred to me": a qualitative study of medical students' views of a cultural competence curriculum 
Background
The evidence is mixed regarding the efficacy of cultural competence curricula in developing learners' knowledge, attitudes and skills. More research is needed to better understand both the strengths and shortcomings of existing curricula from the perspective of learners in order to improve training.
Methods
We conducted three focus groups with medical students in their first year of clinical training to assess their perceptions of the cultural competence curriculum at a public university school of medicine.
Results
Students evaluated the informal curriculum as a more important source of learning about cultural competence than the formal curriculum. In terms of bias in both self and others, the cultural competence curriculum increased awareness, but was less effective in teaching specific interventional skills. Students also noted that the cultural competence curriculum did not always sufficiently help them find a balance between group-specific knowledge and respect for individual differences. Despite some concerns as to whether political correctness characterized the cultural competence curriculum, it was also seen as a way to rehumanize the medical education experience.
Conclusion
Future research needs to pay attention to issues such as perceived relevance, stereotyping, and political correctness in developing cross-cultural training programs.
doi:10.1186/1472-6920-6-31
PMCID: PMC1481591  PMID: 16729888
14.  Web-based Curriculum 
OBJECTIVE
To address the need for women's health education by designing, implementing, and evaluating a self-study, web-based women's health curriculum.
DESIGN
Cohort of students enrolled in the ambulatory portion of the medicine clerkship with comparison group of students who had not yet completed this rotation.
PARTICIPANTS/SETTING
Third- and fourth-year medical students on the required medicine clerkship (115 students completed the curriculum; 158 completed patient-related logs).
INTERVENTION
Following an extensive needs assessment and formulation of competencies and objectives, we developed a web-based women's health curriculum completed during the ambulatory portion of the medicine clerkship. The modules were case based and included web links, references, and immediate feedback on posttesting. We discuss technical issues with implementation and maintenance.
MEASUREMENTS AND MAIN RESULTS
We evaluated this curriculum using anonymous questionnaires, open-ended narrative comments, online multiple-choice tests, and personal digital assistant (PDA) logs of patient-related discussions of women's health. Students completing the curriculum valued learning women's health, preferred this self-directed learning over lecture, scored highly on knowledge tests, and were involved in more and higher-level discussions of women's health with faculty (P <.001).
CONCLUSIONS
We present a model for the systematic design of a web-based women's health curriculum as part of a medicine clerkship. The web-based instruction resolved barriers associated with limited curriculum time and faculty availability, provided an accessible and standard curriculum, and met the needs of adult learners (with their motivation to learn topics they value and apply this knowledge in their daily work). We hypothesize that our web-based curriculum spurred students to later discuss these topics with faculty. Web-based learning may be particularly suited for women's health because of its multidisciplinary nature and need for vertical integration throughout medical school curricula.
doi:10.1111/j.1525-1497.2005.40062.x
PMCID: PMC1490044  PMID: 15693931
women's health; computer-assisted instruction; medical education; adult learning; personal digital assistant
15.  Implementation of palliative care as a mandatory cross-disciplinary subject (QB13) at the Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany  
Background: By means of the revision of the Medical Licensure Act for Physicians (ÄAppO) in 2009, undergraduate palliative care education (UPCE) was incorporated as a mandatory cross sectional examination subject (QB13) in medical education in Germany. Its implementation still constitutes a major challenge for German medical faculties. There is a discrepancy between limited university resources and limited patient availabilities and high numbers of medical students. Apart from teaching theoretical knowledge and skills, palliative care education is faced with the particular challenge of imparting a professional and adequate attitude towards incurably ill and dying patients and their relatives.
Project description: Against this background, an evidence-based longitudinal UPCE curriculum was systematically developed following Kern’s Cycle [1] and partly implemented and evaluated by the students participating in the pilot project. Innovative teaching methods (virtual standardised/simulated patient contacts, e-learning courses, interdisciplinary and interprofessional collaborative teaching, and group sessions for reflective self-development) aim at teaching palliative care-related core competencies within the clinical context and on an interdisciplinary and interprofessional basis.
Results: After almost five years of development and evaluation, the UPCE curriculum comprises 60 teaching units and is being fully implemented and taught for the first time in the winter semester 2014/15. The previous pilot phases were successfully concluded. To date, the pilot phases (n=26), the subproject “E-learning in palliative care” (n=518) and the blended-learning elective course “Communication with dying patients” (n=12) have been successfully evaluated.
Conclusion: All conducted development steps and all developed programmes are available for other palliative care educators (Open Access). The integrated teaching formats and methods (video, e-learning module, interprofessional education, group sessions for reflexive self-development) and their evaluations are intended to make a contribution to an evidence-based development of palliative care curricula in Germany.
doi:10.3205/zma000948
PMCID: PMC4330636
cross-disciplinary subject; QB13; palliative care curriculum; interprofessional education; virtual simulated/standardised patient contact; e-learning, group sessions for self-development and self-reflection; attitude towards palliative care
16.  A Framework for Developing, Implementing, and Evaluating a Cancer Survivorship Curriculum for Medical Students 
Journal of General Internal Medicine  2009;24(Suppl 2):491-494.
ABSTRACT
BACKGROUND
Cancer survivorship care is not adequately addressed in current medical school curricula.
OBJECTIVES
To develop, implement, and evaluate a modular cancer survivorship curriculum that is portable to other educational settings and is designed to provide medical students with a foundation of knowledge, attitudes, and skills related to care for cancer survivors.
PROGRAM DESCRIPTION
An expert consensus panel developed a set of learning objectives related to cancer survivorship to guide the development of educational modules, such as computer-based self-instructional modules, problem-based learning cases, videos, and clinical exercises. Course and clerkship chairs were directly involved in the development and implementation of the modules.
EVALUATION
A cohort study with a historical control group demonstrated that fourth-year medical students increased their knowledge in survivorship issues and their self-reported level of comfort in care activities compared to similar students who did not receive the survivorship curriculum.
CONCLUSIONS
Our framework resulted in a cancer survivorship curriculum that was implemented in a modular manner across the medical curriculum that improved learning and that is potentially portable to other educational settings.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-009-1024-7) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-009-1024-7
PMCID: PMC2763154  PMID: 19838856
cancer survivorship; medical education
17.  Determinants of Medical Students' Perceived Preparation To Perform End-of-Life Care, Quality of End-of-Life Care Education, and Attitudes Toward End-of-Life Care 
Journal of Palliative Medicine  2010;13(3):319-326.
Abstract
Background
Medical students' learning about end-of-life care can be categorized into three learning modalities: formal curriculum, taught in lectures; informal curriculum, conveyed through clinical experiences; and “hidden curriculum,” inferred from behaviors and implicit in medical culture. In this study, we evaluated associations between survey items assessing these learning modalities and students' perceptions of their preparation, quality of education, and attitudes toward end-of-life care.
Methods
Data were collected from a national survey of fourth-year medical students (n = 1455) at 62 medical schools in 2001. Linear regression analyses were performed to assess associations between formal, informal and hidden end-of-life care curricula and students' perceived preparedness to provide end-of-life care, quality of end-of-life care education and attitudes toward end-of-life, controlling for students' demographics and clustered by school.
Results
Students reporting more exposure to formal and informal curricula felt more prepared and rated their end-of-life care education higher. Students with more exposure to a hidden curriculum that devalued end-of-life care perceived their preparation as poorer and had poorer attitudes toward end-of-life care. Minority students had slightly more negative attitudes but no differences in perceived end-of-life care preparation.
Conclusions
Medical students' sense of preparedness for end-of-life care and perceptions of educational quality are greater with more coursework and bedside teaching. By contrast, the hidden curriculum conveying negative messages may impair learning. Our findings suggest that implicit messages as well as intentional teaching have a significant impact on students' professional development. This has implications for designing interventions to train physicians to provide outstanding end-of-life care.
doi:10.1089/jpm.2009.0293
PMCID: PMC2883506  PMID: 20178433
18.  Palliative care for the elderly - developing a curriculum for nursing and medical students 
BMC Geriatrics  2010;10:66.
Background
Delivering palliative care to elderly, dying patients is a present and future challenge. In Germany, this has been underlined by a 2009 legislation implementing palliative care as compulsory in the medical curriculum. While the number of elderly patients is increasing in many western countries multimorbidity, dementia and frailty complicate care. Teaching palliative care of the elderly to an interprofessional group of medical and nursing students can help to provide better care as acknowledged by the ministry of health and its expert panels.
In this study we researched and created an interdisciplinary curriculum focussing on the palliative care needs of the elderly which will be presented in this paper.
Methods
In order to identify relevant learning goals and objectives for the curriculum, we proceeded in four subsequent stages.
We searched international literature for existing undergraduate palliative care curricula focussing on the palliative care situation of elderly patients; we searched international literature for palliative care needs of the elderly. The searches were sensitive and limited in nature. Mesh terms were used where applicable. We then presented the results to a group of geriatrics and palliative care experts for critical appraisal. Finally, the findings were transformed into a curriculum, focussing on learning goals, using the literature found.
Results
The literature searches and expert feedback produced a primary body of results. The following deduction domains emerged: Geriatrics, Palliative Care, Communication & Patient Autonomy and Organisation & Social Networks. Based on these domains we developed our curriculum.
Conclusions
The curriculum was successfully implemented following the Kern approach for medical curricula. The process is documented in this paper. The information given may support curriculum developers in their search for learning goals and objectives.
doi:10.1186/1471-2318-10-66
PMCID: PMC2955033  PMID: 20854665
19.  The development and implementation of a curriculum to improve clinicians' self-directed learning skills: a pilot project 
Background
Clinicians need self-directed learning skills to maintain competency. The objective of this study was to develop and implement a curriculum to teach physicians self-directed learning skills during inpatient ward rotations.
Methods
Residents and attendings from an internal medicine residency were assigned to intervention or control groups; intervention physicians completed self-directed learning curricular exercises.
Results
Among the 43 intervention physicians, 21 (49%) completed pre- and post-curriculum tests; and 10 (23%) completed the one-year test. Immediately after exposure to the curriculum, the proportion of physicians defining short- and long-term learning goals increased [short-term: 1/21 (5%) to 11/21 (52%), p = 0.001; long-term: 2/21 (10%) to 15/21 (71%), p = 0.001]. There were no significant changes post-curriculum in the quantity or quality of clinical question asking. The physicians' mean self-efficacy (on a 100-point scale) improved for their abilities to develop a plan to keep up with the medical literature (59 vs. 72, p = 0.04). The effects of the curriculum on self-reported learning behaviors was maintained from the immediate post-curriculum test to the one-year post curriculum test: [short-term learning goals: 1/21 (5%) pre-, 11/21 (52%) immediately post-, and 5/10 (50%) one-year after the curriculum (p = 0.0075 for the pre- vs one-year comparison); long-term learning goals: 2/21 (10%) pre-, 15/21 (71%) immediately post-, and 7/10 (70%) one-year (p = 0.0013 for the pre- vs one-year comparison). At one-year, half of the participants reported changed learning behaviors.
Conclusions
A four-week curriculum may improve self-directed learning skills.
doi:10.1186/1472-6920-3-7
PMCID: PMC270081  PMID: 14572314
Medical education; physician learning
20.  A Ten-Month Program in Curriculum Development for Medical Educators: 16 Years of Experience 
BACKGROUND
Despite increased demand for new curricula in medical education, most academic medical centers have few faculty with training in curriculum development.
OBJECTIVE
To describe and evaluate a longitudinal mentored faculty development program in curriculum development.
DESIGN
A 10-month curriculum development program operating one half-day per week of each academic year from 1987 through 2003. The program was designed to provide participants with the knowledge, attitudes, skills, and experience to design, implement, evaluate, and disseminate curricula in medical education using a 6-step model.
PARTICIPANTS
One-hundred thirty-eight faculty and fellows from Johns Hopkins and other institutions and 63 matched nonparticipants.
MEASUREMENTS
Pre- and post-surveys from participants and nonparticipants assessed skills in curriculum development, implementation, and evaluation, as well as enjoyment in curriculum development and evaluation. Participants rated program quality, educational methods, and facilitation in a post-program survey.
RESULTS
Sixty-four curricula were produced addressing gaps in undergraduate, graduate, or postgraduate medical education. At least 54 curricula (84%) were implemented. Participant self-reported skills in curricular development, implementation, and evaluation improved from baseline (p < .0001), whereas no improvement occurred in the comparison group. In multivariable analyses, participants rated their skills and enjoyment at the end of the program significantly higher than nonparticipants (all p < .05). Eighty percent of participants felt that they would use the 6-step model again, and 80% would recommend the program highly to others.
CONCLUSIONS
This model for training in curriculum development has long-term sustainability and is associated with participant satisfaction, improvement in self-rated skills, and implementation of curricula on important topics.
doi:10.1007/s11606-007-0103-x
PMCID: PMC1852913  PMID: 17443374
curriculum development; faculty development
21.  A Ten-Month Program in Curriculum Development for Medical Educators: 16 Years of Experience 
BACKGROUND
Despite increased demand for new curricula in medical education, most academic medical centers have few faculty with training in curriculum development.
OBJECTIVE
To describe and evaluate a longitudinal mentored faculty development program in curriculum development.
DESIGN
A 10-month curriculum development program operating one half-day per week of each academic year from 1987 through 2003. The program was designed to provide participants with the knowledge, attitudes, skills, and experience to design, implement, evaluate, and disseminate curricula in medical education using a 6-step model.
PARTICIPANTS
One-hundred thirty-eight faculty and fellows from Johns Hopkins and other institutions and 63 matched nonparticipants.
MEASUREMENTS
Pre- and post-surveys from participants and nonparticipants assessed skills in curriculum development, implementation, and evaluation, as well as enjoyment in curriculum development and evaluation. Participants rated program quality, educational methods, and facilitation in a post-program survey.
RESULTS
Sixty-four curricula were produced addressing gaps in undergraduate, graduate, or postgraduate medical education. At least 54 curricula (84%) were implemented. Participant self-reported skills in curricular development, implementation, and evaluation improved from baseline (p < .0001), whereas no improvement occurred in the comparison group. In multivariable analyses, participants rated their skills and enjoyment at the end of the program significantly higher than nonparticipants (all p < .05). Eighty percent of participants felt that they would use the 6-step model again, and 80% would recommend the program highly to others.
CONCLUSIONS
This model for training in curriculum development has long-term sustainability and is associated with participant satisfaction, improvement in self-rated skills, and implementation of curricula on important topics.
doi:10.1007/s11606-007-0103-x
PMCID: PMC1852913  PMID: 17443374
curriculum development; faculty development
22.  Working toward decreasing infant mortality in developing countries through change in the medical curriculum 
Background
High infant and maternal mortality rates are one of the biggest health issues in Pakistan. Although these rates are given high priority at the national level (Millennium Development Goals 4 and 5, respectively), there has been no significant decrease in them so far. We hypothesize that this lack of success is because the undergraduate curriculum in Pakistan does not match local needs. Currently, the Pakistani medical curriculum deals with issues in maternal and child morbidity and mortality according to Western textbooks. Moreover, these are taught disjointedly through various departments. We undertook curriculum revision to sensitize medical students to maternal and infant mortality issues important in the Pakistani context and educate them about ways to reduce the same through an integrated teaching approach.
Methods
The major determinants of infant mortality in underdeveloped countries were identified through a literature review covering international research produced over the last 10 years and the Pakistan Demographic Health Survey 2006-07. An interdisciplinary maternal and child health module team was created by the Medical Education Department at Shifa College of Medicine. The curriculum was developed based on the role of identified determinants in infant and maternal mortality. It was delivered by an integrated team without any subject boundaries. Students' knowledge, skills, and attitudes were assessed by multiple modalities and the module itself by student feedback using questionnaires and focus group discussions.
Results
Assessment and feedback demonstrated that the students had developed a thorough understanding of the complexity of factors that contribute to infant mortality. Students also demonstrated knowledge and skill in counseling, antenatal care, and care of newborns and infants.
Conclusions
A carefully designed integrated curriculum can help sensitize undergraduate medical students and equip them to identify and address complex issues related to maternal and infant mortality in underdeveloped countries.
doi:10.1186/1447-056X-10-11
PMCID: PMC3180395  PMID: 21871130
Curriculum; Infant Mortality;  Maternal Mortality
23.  Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students 
Medical Education Online  2014;19:10.3402/meo.v19.22522.
Background
To encourage medical students’ use of patient-centered skills in core clerkships, we implemented and evaluated a Telephone Follow-up Curriculum focusing on three communication behaviors: tailoring education to patients’ level of understanding, promoting adherence by anticipating obstacles, and ensuring comprehension by having patients repeat the plans.
Methods
The intervention group consisted of two different cohorts of third-year medical students in longitudinal clerkships (n=41); traditional clerkship students comprised the comparison group (n=185). Intervention students telephoned one to four patients 1 week after seeing them in outpatient clinics or inpatient care to follow up on recommendations. We used surveys, focus groups, and clinical performance examinations to assess student perception, knowledge and skills, and behavior change.
Results
Students found that the curriculum had a positive impact on patient care, although some found the number of calls excessive. Students and faculty reported improvement in students’ understanding of patients’ health behaviors, knowledge of patient education, and attitudes toward telephone follow-up. Few students changed patient education behaviors or called additional patients. Intervention students scored higher in some communication skills on objective assessments.
Conclusion
A patient-centered communication curriculum can improve student knowledge and skills. While some intervention students perceived that they made too many calls, our data suggest that more calls, an increased sense of patient ownership, and role modeling by clerkship faculty may ensure incorporation and application of skills.
doi:10.3402/meo.v19.22522
PMCID: PMC4000921  PMID: 24767705
education; medical; undergraduate; clinical clerkship; patient-centered care; physician–patient relationship; continuity of patient care
24.  Integrative vs. Traditional Learning from the Student Perspective 
Background: The interdisciplinary surgery block of the reformed undergraduate curriculum HeiCuMed includes daily cycles of interactive case-based seminars, problem-based tutorials, case presentation by students, skills and communication training, and bedside teaching. The teaching doctors receive didactic training. In contrast, the previous traditional course was based on lectures with only two weekly hours of bedside teaching. Didactic training was not available.
Objective: The present work aims at analysing the importance of active participation of students and the didactic components of the reformed and traditional curricula, which contribute to successful learning as evaluated by the students.
Method: Differentiated student evaluations of the undergraduate surgical courses between 1999 and 2008 were examined by correlation and regression analyses.
Results: The evaluation scores for organisation, dedication of the teaching staff, their ability to make lessons interesting and complex topics easily understandable, and the subjective gain of knowledge were significantly better in HeiCuMed than in the traditional curriculum. However, the dependence of knowledge gain on the didactic quality was the same in both curricula. The quality of discussions and the ability of the teaching doctors to promote active student participation were important to the subjective gain of knowledge in both seminars and practical courses of the reformed curriculum as well as for the overall evaluation of the practical courses but not the gain of knowledge in the traditional curriculum.
Conclusion: The findings confirm psychological-educational perceptions, that competent implementation of integrative didactical methods is more important to successful teaching and the subjective gain of knowledge than knowledge transfer by traditional classroom teaching.
doi:10.3205/zma000740
PMCID: PMC3149460  PMID: 21818238
Medical education; reform curriculum; sugery; didactics
25.  Teaching Residents to Work with Torture Survivors: Experiences from the Bronx Human Rights Clinic 
Journal of General Internal Medicine  2008;23(7):1038-1042.
Introduction
Despite the 1984 United Nations’s Convention Against Torture calling to train doctors to work with torture survivors, many physicians are unaware of their obligation and few are taught the requisite clinical skills.
Aim
To describe the development, implementation, and evaluation of a curriculum to teach residents to work with torture survivors.
Participants
Medicine residents in New York City
Program Description
A 2-component curriculum consisting of a series of workshops and clinical experiences, which provide content, skills, and practices regarding the medical, psychological, ethical, and legal aspects of evaluating and caring for torture survivors.
Curriculum Evaluation
All 22 trainees received surveys before and after training. Surveys assessed residents’ relevant prior experience, beliefs, skills, and attitudes regarding working with torture survivors. At baseline, 23% of residents described previous human rights trainings and 17% had work experiences with torture survivors. Before the curriculum, 81% of residents reported doctors should know how to evaluate survivors, although only 5% routinely screened patients for torture. After the curriculum, residents reported significant improvements in 3 educational domains—general knowledge, sequelae, and self-efficacy to evaluate torture survivors.
Discussion
This curriculum addresses the disparity between doctors’ obligations, and training to work with torture survivors. It is likely to achieve its educational goals, and can potentially be adapted to other residencies.
doi:10.1007/s11606-008-0592-2
PMCID: PMC2517941  PMID: 18612740
torture; survivors; doctors; New York City; resident education

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