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1.  Development, Implementation, and Outcomes of an Initiative to Integrate Evidence-Based Medicine Into an Osteopathic Curriculum 
Context
In response to the American Osteopathic Association’s Commission on Osteopathic College Accreditation (COCA) standards set forth in 2008, osteopathic medical schools are restructuring curricula to demonstrate they are teaching the seven core competencies and integrating evidence-based medicine (EBM) throughout all 4 years of training.
Objective
To describe and evaluate the efforts of a college of osteopathic medicine to integrate EBM concepts into its curriculum while maintaining existing course content and faculty contact hours.
Design
One-group pre- and posttest study.
Setting
Kirksville College of Osteopathic Medicine-A.T. Still University (KCOM) in Missouri.
Participants
KCOM course directors in workshop series I (n=20) and KCOM faculty workshop series II (n=14).
Intervention
A faculty development workshop series based on the diffusion of innovations model was instituted to facilitate cultural change, gain faculty support, and accelerate the implementation of EBM throughout KCOM’s curriculum.
Outcome measures
Faculty attitudes, confidence levels, and the number of courses that included instruction of EBM concepts were measured in August 2007 and May 2008.
Results
Faculty attitudes about integrating EBM into the curriculum and confidence levels measured pre- and postworkshop series found that 21 of 26 participants believed they improved their ability to locate primary EBM resources using the Internet; 21 of 28 improved their ability to teach EBM concepts to students. Fifteen of 16 faculty course directors agreed to find ways to incorporate EBM into their classes. Review of KCOM’s course syllabi in April 2009 demonstrated a statistically significant difference (P<.001) in the number of faculty teaching EBM concepts after the faculty development workshop series concluded in March 2008 compared to before the series commenced in March 2006. An unexpected outcome was the implementation of a faculty-conceived, standalone EBM course in fall 2007.
Conclusions
A workshop series based on the diffusion of innovations model is effective in garnering faculty support for the implementation of a change in curriculum that emphasizes EBM content without increasing faculty contact hours or eliminating existing curricular content. A faculty development model emphasizing a “bottom-to-top” approach is effective in achieving workplace culture changes and seamless curricular transitions. Results have shown that a consensus building model is conducive to engaging faculty and garnering its support to effect curricular change, which, ultimately, ensures success.
PMCID: PMC3142697  PMID: 21068224
2.  Competence, commitment and opportunity: an exploration of faculty views and perceptions on community- based education 
BMC Medical Education  2013;13:167.
Background
Community-Based Education (CBE) is an instructional approach designed and carried out in a community context and environment in which not only students, but also faculty and Health Professionals’ Education (HPE) institutions must be actively engaged throughout the educational experience. Despite the growing evidence of CBE being an effective approach for contemporary HPE, doubts about its successful implementation still exist. This study has explored HPE structure, policies and curriculum from the point of view of faculty members to gain understanding about the prevailing practices and to propose recommendations that nurtures and promotes CBE.
Method
A purposive sample was drawn from three major cities of Pakistan- Karachi, Rawalpindi and Islamabad. Out of twelve HPE institutions present in these cities we selected six, which provided a sound representation of medical and nursing colleges around the country. At each institution we had two Focus Group Discussions; in addition we interviewed registrars of medical and nursing councils and two CBE experts.
Results
The factors effecting implementation of CBE as perceived by study participants are categorized as: preparation of faculty members; institutional commitment and enthusiasm; curricular priorities and external milieu. Within each theme, participants recurrently described structural and curricular deficiencies, and lack of commitment and appreciation for community based teaching, service and research permeating at all levels: regulatory bodies, institutional heads and faculty members.
Conclusions
The factors highlighted by our study and many others suggest that CBE could not perpetuate effectively within HPE. To enhance the effectiveness of CBE approach in a way that mutually benefits local communities as well as HPE institutions and health professionals, it is important that reforms in HPE must be strategized in a holistic fashion i.e. restructuring and aligning its polices, curriculum and research priorities.
doi:10.1186/1472-6920-13-167
PMCID: PMC4029465  PMID: 24330679
3.  Better data for teachers, better data for learners, better patient care: college-wide assessment at Michigan State University's College of Human Medicine 
Medical Education Online  2011;16:10.3402/meo.v16i0.5926.
When our school organized the curriculum around a core set of medical student competencies in 2004, it was clear that more numerous and more varied student assessments were needed. To oversee a systematic approach to the assessment of medical student competencies, the Office of College-wide Assessment was established, led by the Associate Dean of College-wide Assessment. The mission of the Office is to ‘facilitate the development of a seamless assessment system that drives a nimble, competency-based curriculum across the spectrum of our educational enterprise.’ The Associate Dean coordinates educational initiatives, developing partnerships to solve common problems, and enhancing synergy within the College. The Office also works to establish data collection and feedback loops to guide rational intervention and continuous curricular improvement. Aside from feedback, implementing a systems approach to assessment provides a means for identifying performance gaps, promotes continuity from undergraduate medical education to practice, and offers a rationale for some assessments to be located outside of courses and clerkships. Assessment system design, data analysis, and feedback require leadership, a cooperative faculty team with medical education expertise, and institutional support. The guiding principle is ‘Better Data for Teachers, Better Data for Learners, Better Patient Care.’ Better data empowers faculty to become change agents, learners to create evidence-based improvement plans and increases accountability to our most important stakeholders, our patients.
doi:10.3402/meo.v16i0.5926
PMCID: PMC3022704  PMID: 21249172
competencies; assessment; medical education; outcomes; systems
4.  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
5.  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
6.  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
7.  Designing a Cultural Competency Curriculum: Asking the Stakeholders 
Hawaii Medical Journal  2010;69(6 Suppl 3):31-34.
Background
The design of a cultural competency curriculum can be challenging. The 2002 Institute of Medicine report, Unequal Treatment, challenged medical schools to integrate cross-cultural education into the training of all current and future health professionals. However, there is no current consensus on how to do this. The Department of Native Hawaiian Health at the John A. Burns School of Medicine formed a Cultural Competency Curriculum Development team that was charged with developing a curriculum for the medical school to address Native Hawaiian health disparities. By addressing cultural competency training of physicians, the team is hoping to help decrease the health disparities found in Native Hawaiians. Prior attempts to address culture at the time consisted of conferences sponsored by the Native Hawaiian Center of Excellence for faculty and clinicians and Problem Based Learning cases that have imbedded cultural issues.
Objective
Gather ideas from focus groups of Native Hawaiian stakeholders. The stakeholders consisted of Native Hawaiian medical students, patients and physicians. Information from the focus groups would be incorporated into a medical school curriculum addressing Native Hawaiian health and cultural competency training.
Methodology
Focus groups were held with Native Hawaiian medical students, patients and physicians in the summer and fall of 2006. Institutional Review Board approval was obtained from the University of Hawaii as well as the Native Hawaiian Health Care Systems. Qualitative analysis of tape recorded data was performed by looking for recurrent themes. Primary themes and secondary themes were ascertained based on the number of participants mentioning the topic.
Results
Amongst all three groups, cultural sensitivity training was either a primary theme or secondary theme. Primary themes were mentioned by all students, by 80% of the physicians and were mentioned in all 4 patient groups. Secondary themes were mentioned by 75% of students, 50% of the physicians and by 75% of patient group. All groups wanted medical students to receive cultural sensitivity training, and all wanted traditional healing to be included in the training. The content of the training differed slightly between groups. Students wanted a diversity of teaching modalities as well as cultural issues in exams in order to emphasize their importance. They also felt that faculty needed cultural competency training. Patients wanted students to learn about the host culture and its values. Physicians felt that personal transformation was an important and effective tool in cultural sensitivity training. Cultural immersion is a potential teaching tool but physicians were concerned about student stages of readiness and adequate preparation for cultural competency training modalities such as cultural immersion.
Conclusions
Cultural competency or sensitivity training was important to patients, students and physicians. The focus group data is being used to help guide the development of the Department of Native Hawaiian Health's cultural competency curriculum.
PMCID: PMC3123146  PMID: 20539999
8.  The philosophy of chiropractic: an action research model of curriculum review 
The philosophy of chiropractic has always been regarded as an integral and indispensable component of the curriculum at chiropractic colleges. This study describes a review process in which instruments were designed to survey students and faculty to obtain information concerning curricular aspects of philosophy at the Canadian Memorial Chiropractic College. Approximately one half of the student body (N = 292) and sixty percent of the full-time and part-time faculty members (N = 66) responded to the surveys. The students who were surveyed indicated that philosophy was a very important part of their chiropractic education and they felt that their needs in this regard were not being met by the present program. Further, they perceived most faculty as being unappreciative of philosophy. The results from the faculty survey were at odds with the students’ perceptions and indicated that the faculty members were favourably disposed towards philosophy and felt that it should be an integral part of the students’ educational experience. The information gained from these surveys was subsequently used as a catalyst to stimulate discussion in a series of student/faculty focus groups on philosophy. These discussions helped to clarify some curricular philosophical issues and resulted in specific modifications to the philosophy program in the areas of content, format, faculty, and evaluation methods.
PMCID: PMC2485449
chiropractic; philosophy; curriculum
9.  Competency-based medical education in two Sub-Saharan African medical schools 
Background
Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME).
Institutional reviews
This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes are highlighted. Both schools used similar processes in developing their CBME curricula, with early and significant stakeholder involvement. Competencies were determined taking into consideration each country’s health and education systems. Final competency domains were similar between the two schools. Both schools established medical education departments to support their new curricula. New teaching methodologies and assessment methods were needed to support CBME, requiring investments in faculty training. Both schools received external funding to support CBME development and implementation.
Conclusion
CBME has emerged as an important change in medical education in Sub-Saharan Africa with schools adopting it as an approach to transformative medical education. Makerere University and the University of Ibadan have successfully adopted CBME and show that CBME can be implemented even for the low-resourced countries in Africa, supported by external investments to address the human resources gap.
doi:10.2147/AMEP.S68480
PMCID: PMC4266263  PMID: 25525404
CBME; medical education; competency domains; competencies; curricular reforms
10.  Association of Medical Students' Reports of Interactions with the Pharmaceutical and Medical Device Industries and Medical School Policies and Characteristics: A Cross-Sectional Study 
PLoS Medicine  2014;11(10):e1001743.
Aaron Kesselheim and colleagues compared US medical students' survey responses regarding pharmaceutical company interactions with the schools' AMSA PharmFree scorecard and Institute on Medicine as a Profession's (IMAP) scores.
Please see later in the article for the Editors' Summary
Background
Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors.
Methods and Findings
Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA) PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty–industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH) funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50–2.00] versus 1.77 [1.50–2.18], adjusted to compare scores on the same scale). Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11–0.44; marketing representative access policies, r = 0.51, 95% CI 0.36–0.63). Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19–0.72; IMAP score, OR 0.45, 95% CI 0.19–1.04) and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15–0.69; IMAP score, OR 0.37, 95% CI 0.14–0.95) than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly versus privately funded school did not alter the association. Policies limiting gifts, meals, and speaking bureaus were associated with students reporting having not received gifts and having not interacted with marketing representatives. Policy dimensions reflecting the regulation of industry involvement in educational activities (e.g., continuing medical education, travel compensation, and scholarships) were associated with perceived separation between faculty and industry. The study is limited by potential for recall bias and the cross-sectional nature of the survey, as school curricula and industry interaction policies may have changed since the time of the survey administration and study analysis.
Conclusions
As medical schools review policies regulating medical students' industry interactions, limitations on receipt of gifts and meals and participation of faculty in speaking bureaus should be emphasized, and policy makers should pay greater attention to less research-intensive institutions.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Making and selling prescription drugs and medical devices is big business. To promote their products, pharmaceutical and medical device companies build relationships with physicians by providing information on new drugs, by organizing educational meetings and sponsored events, and by giving gifts. Financial relationships begin early in physicians' careers, with companies providing textbooks and other gifts to first-year medical students. In medical school settings, manufacturers may help to inform trainees and physicians about developments in health care, but they also create the potential for harm to patients and health care systems. These interactions may, for example, reduce trainees' and trained physicians' skepticism about potentially misleading promotional claims and may encourage physicians to prescribe new medications, which are often more expensive than similar unbranded (generic) drugs and more likely to be recalled for safety reasons than older drugs. To address these and other concerns about the potential career-long effects of interactions between medical trainees and industry, many teaching hospitals and medical schools have introduced policies to limit such interactions. The development of these policies has been supported by expert professional groups and medical societies, some of which have created scales to evaluate the strength of the implemented industry interaction policies.
Why Was This Study Done?
The impact of policies designed to limit interactions between students and industry on student behavior is unclear, and it is not known which aspects of the policies are most predictive of student behavior. This information is needed to ensure that the policies are working and to identify ways to improve them. Here, the researchers investigate which medical school characteristics and which aspects of industry interaction policies are most predictive of students' reported behaviors and beliefs by comparing information collected in a national survey of US medical students with the strength of their schools' industry interaction policies measured on two scales—the American Medical Student Association (AMSA) PharmFree Scorecard and the Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database.
What Did the Researchers Do and Find?
The researchers compared information about reported gift acceptance, interactions with marketing representatives, and the perceived adequacy of faculty–industry separation collected from 1,610 medical students at 121 US medical schools with AMSA and IMAP scores for the schools evaluated a year earlier. Students at schools with the highest ranked interaction policies based on the AMSA score were 63% less likely to accept gifts as students at the lowest ranked schools. Students at the highest ranked schools based on the IMAP score were about half as likely to accept gifts as students at the lowest ranked schools, although this finding was not statistically significant (it could be a chance finding). Similarly, students at the highest ranked schools were 70% less likely to interact with sales representatives as students at the lowest ranked schools. These associations became statistically nonsignificant after controlling for the amount of research funding each school received from the US National Institutes of Health (NIH). Policies limiting gifts, meals, and being a part of speaking bureaus (where companies pay speakers to present information about the drugs for dinners and other events) were associated with students' reports of receiving no gifts and of non-interaction with sales representatives. Finally, policies regulating industry involvement in educational activities were associated with the perceived separation between faculty and industry, which was regarded as adequate by most of the students at schools with such policies.
What Do These Findings Mean?
These findings suggest that policies designed to limit industry interactions with medical students need to address multiple aspects of these interactions to achieve changes in the behavior and attitudes of trainees, but that policies limiting gifts, meals, and speaking bureaus may be particularly important. These findings also suggest that the level of NIH funding plays an important role in students' self-reported behaviors and their perceptions of industry, possibly because institutions with greater NIH funding have the resources needed to implement effective policies. The accuracy of these findings may be limited by recall bias (students may have reported their experiences inaccurately), and by the possibility that industry interaction policies may have changed in the year that elapsed between policy grading and the student survey. Nevertheless, these findings suggest that limitations on gifts should be emphasized when academic medical centers refine their policies on interactions between medical students and industry and that particular attention should be paid to the design and implementation of policies that regulate industry interactions in institutions with lower levels of NIH funding.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001743.
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice document, which describes what is required of all registered doctors in the UK
Information about the American Medical Student Association (AMSA) Just Medicine campaign (formerly the PharmFree campaign) and about the AMSA Scorecard is available
Information about the Institute on Medicine as a Profession (IMAP) and about its Conflicts of Interest Policy Database is also available
“Understanding and Responding to Pharmaceutical Promotion: A Practical Guide” is a manual prepared by Health Action International and the World Health Organization that medical schools can use to train students how to recognize and respond to pharmaceutical promotion
The US Institute of Medicine's report “Conflict of Interest in Medical Research, Education, and Practice” recommends steps to identify, limit, and manage conflicts of interest
The ALOSA Foundation provides evidence-based, non-industry-funded education about treating common conditions and using prescription drugs
doi:10.1371/journal.pmed.1001743
PMCID: PMC4196737  PMID: 25314155
11.  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
12.  Musculoskeletal education: a curriculum evaluation at one university 
BMC Medical Education  2010;10:93.
Background
The increasing burden of illness related to musculoskeletal diseases makes it essential that attention be paid to musculoskeletal education in medical schools. This case study examines the undergraduate musculoskeletal curriculum at one medical school.
Methods
A case study research methodology used quantitative and qualitative approaches to systematically examine the undergraduate musculoskeletal course at the University of Calgary (Alberta, Canada) Faculty of Medicine. The aim of the study was to understand the strengths and weaknesses of the curriculum guided by four questions: (1) Was the course structured according to standard principles for curriculum design as described in the Kern framework? (2) How did students and faculty perceive the course? (3) Was the assessment of the students valid and reliable? (4) Were the course evaluations completed by student and faculty valid and reliable?
Results
The analysis showed that the structure of the musculoskeletal course mapped to many components of Kern's framework in course design. The course had a high level of commitment by teachers, included a valid and reliable final examination, and valid evaluation questionnaires that provided relevant information to assess curriculum function. The curricular review identified several weaknesses in the course: the apparent absence of a formalized needs assessment, course objectives that were not specific or measurable, poor development of clinical presentations, small group sessions that exceeded normal 'small group' sizes, and poor alignment between the course objectives, examination blueprint and the examination. Both students and faculty members perceived the same strengths and weaknesses in the curriculum. Course evaluation data provided information that was consistent with the findings from the interviews with the key stakeholders.
Conclusions
The case study approach using the Kern framework and selected questions provided a robust way to assess a curriculum, identify its strengths and weaknesses and guide improvements.
doi:10.1186/1472-6920-10-93
PMCID: PMC3012667  PMID: 21143996
13.  Health research barriers in the faculties of two medical institutions in India 
Background
Health policy formation refers to the design of a conceptual framework to find possibilities, facilitate feasibilities, and identify strong and weak points, as well as insufficiencies, by research. Doing research should clarify qualities and standards for policy and decision-making to enable the success of development of health care in a country. Evaluation of the impact of health interventions is particularly poorly represented in public health research. This study attempted to identify barriers and facilitators of health research among faculty members in two major institutions in India, ie, the All India Institute of Medical Sciences (AIIMS) and the University College of Medical Sciences (UCMS) and Guru Tegh Bahadur (GTB) Hospital in Delhi.
Methods
The participants were asked to fill in a questionnaire that canvassed individual characteristics, ie, years of experience, place of work, academic rank, final educational qualification, work setting, educational group, primary activity, and number of publications in the previous 5 years. Barriers and facilitators were categorized into personal, resources, access, and administration groups. The data were processed using SPSS version 16, independent t-tests, Chi-square tests, and multivariate logistic regression.
Results
The total number of faculty members at both institutions was 599, 456 (76%) of whom participated in this study. The primary activities reported by faculty at UCMS (teaching) and Faculty at AIIMS reported (Research and Provision of health care services) as a major activity (P < 0.01). The majority of faculty members at UCMS and GTB Hospital were professors, whereas most of the faculty members at AIIMS were associate professors (P < 0.01). Of 47 barriers and facilitating factors, there were 26 barriers and 21 facilitating factors at AIIMS and 39 barriers and eight facilitating factors at UCMS. Faculty members at UCMS had 6.572 times more barriers to health research than those at AIIMS.
Conclusion
Close proximity between AIIMS and the Indian Council of Medical Research and the National Medical Library, housing, transport, and a good reference library with an adequate knowledge support system provided suitable opportunities for faculty members at AIIMS to do research. To overcome the barriers, institutions must have enough financial support, decreased nonessential clinical, laboratory, and service schedule duties on the part of faculty members, preparation of good and relevant statistical courses and workshops, and access to good statistical software packages.
doi:10.2147/JMDH.S27841
PMCID: PMC3422115  PMID: 22973109
health research; barriers; facilitators; medical institutions
14.  Is faculty development critical to enhance teaching effectiveness? 
Industrial Psychiatry Journal  2010;19(2):138-141.
India has the highest number of medical colleges in the world and, consequently, the highest number of medical teachers. The unprecedented growth of medical institutions in India in the past two decades has led to a shortage of teachers and created a quality challenge for medical education. In recent years, though medical advances have been understood and adopted by many institutions, the same is not true for educational planning and implementation. There is a need for well-trained faculty who will help improve programs to produce quality graduates. The existing teachers’ training programs are insufficient; both in number and aspects they cover, to meet this demand. Provision of faculty development related to teaching and assessment strategies is widely perceived to be the essential ingredient in the efforts to introduce new curricular approaches and modify the educational environment in academic medicine. Analyses of the outcomes of efforts to revise health professions curricula have identified the availability and effectiveness of faculty development as a predictor of the success or failure of reform initiatives. This article will address faculty development for the purpose of enhancing teaching effectiveness and preparing instructors for potential new roles associated with curriculum changes.
doi:10.4103/0972-6748.90349
PMCID: PMC3237134  PMID: 22174541
Education; faculty development; India; medical; teaching
15.  Analysing the hidden curriculum: use of a cultural web 
Medical Education  2013;47(2):134-143.
CONTEXT Major influences on learning about medical professionalism come from the hidden curriculum. These influences can contribute positively or negatively towards the professional enculturation of clinical students. The fact that there is no validated method for identifying the components of the hidden curriculum poses problems for educators considering professionalism. The aim of this study was to analyse whether a cultural web, adapted from a business context, might assist in the identification of elements of the hidden curriculum at a UK veterinary school.
METHODS A qualitative approach was used. Seven focus groups consisting of three staff groups and four student groups were organised. Questioning was framed using the cultural web, which is a model used by business owners to assess their environment and consider how it affects their employees and customers. The focus group discussions were recorded, transcribed and analysed thematically using a combination of a priori and emergent themes.
RESULTS The cultural web identified elements of the hidden curriculum for both students and staff. These included: core assumptions; routines; rituals; control systems; organisational factors; power structures, and symbols. Discussions occurred about how and where these issues may affect students’ professional identity development.
CONCLUSIONS The cultural web framework functioned well to help participants identify elements of the hidden curriculum. These aspects aligned broadly with previously described factors such as role models and institutional slang. The influence of these issues on a student’s development of a professional identity requires discussion amongst faculty staff, and could be used to develop learning opportunities for students. The framework is promising for the analysis of the hidden curriculum and could be developed as an instrument for implementation in other clinical teaching environments.
doi:10.1111/medu.12072
PMCID: PMC3562476  PMID: 23323652
16.  Description of a Research-Based Health Activism Curriculum for Medical Students 
Journal of General Internal Medicine  2006;21(12):1325-1328.
INTRODUCTION
Few curricula train medical students to engage in health system reform.
AIM
To develop physician activists by teaching medical students the skills necessary to advocate for socially equitable health policies in the U.S. health system.
SETTING
Montefiore Medical Center, the University Hospital of the Albert Einstein College of Medicine, Bronx, NY.
PROGRAM DESCRIPTION
We designed a 1-month curriculum in research-based health activism to develop physician activists. The annual curriculum includes a student project and 4 course sections; health policy, research methods, advocacy, and physician activists as role models; taught by core faculty and volunteers from academic institutions, government, and nongovernmental organizations.
PROGRAM EVALUATION
From 2002 to 2005, 47 students from across the country have participated. Students reported improved capabilities to generate a research question, design a research proposal, and create an advocacy plan.
DISCUSSION
Our curriculum demonstrates a model for training physician activists to engage in health systems reform.
doi:10.1111/j.1525-1497.2006.00608.x
PMCID: PMC1924746  PMID: 16961754
medical education; professionalism; health care reform; curriculum evaluation
17.  Implementation of Integrated Learning Program in neurosciences during first year of traditional medical course: Perception of students and faculty 
Background
Our college introduced an integrated learning program (ILP) for first year undergraduates with an aim to develop, implement and evaluate a module for CNS in basic sciences and to assess the feasibility of an ILP in phase I of medical education in a college following traditional medical curriculum.
Methods
The idea of implementing ILP for Central Nervous System (CNS) in phase one was conceived by curriculum development committee drawn from faculty of all phases. After a series of meetings of curriculum development committee, inputs from basic science and clinical departments, a time table was constructed. Various teaching learning methods, themes for integrated didactic lectures, case based learning and clinical exposure were decided. Basic science faculty were made to participate actively in both case based learning and hospital visits along with clinical experts. The completed program was evaluated based on structured questionnaire.
Results
Sixty percent students rated the program good to excellent with reference to appreciation, understanding and application of basic science knowledge in health and disease. Seventy eight percent felt that this program will help them perform better in later days of clinical training. However sixty percent students felt that ILP will not help them perform better at the first professional examination. Seventy two per cent of faculty agreed that this program improved understanding and application of basic science knowledge of students. Ninety percent of faculty felt that this program will help them perform better in later days of clinical training.
Conclusion
The adoption of present integrated module for CNS and the use of multiple teaching learning methods have been proven to be useful in acquisition of knowledge from the student satisfaction point of view. Students and faculty expressed an overall satisfaction towards ILP for CNS. The study showed that it is possible to adopt an integrated learning module in the first year of medical course under a conventional curriculum.
doi:10.1186/1472-6920-8-44
PMCID: PMC2569025  PMID: 18811978
18.  Development and evaluation of a questionnaire to measure the perceived implementation of the mission statement of a competency based curriculum 
BMC Medical Education  2012;12:109.
Background
A mission statement (MS) sets out the long-term goals of an institution and is supposed to be suited for studying learning environments. Yet, hardly any study has tested this issue so far. The aim of the present study was the development and psychometric evaluation of an MS-Questionnaire (MSQ) focusing on explicit competencies. We investigated to what extent the MSQ captures the construct of learning environment and how well a faculty is following - in its perception - a competency orientation in a competency-based curriculum.
Methods
A questionnaire was derived from the MS “teaching” (Medical Faculty, Heinrich-Heine University Düsseldorf) which was based on (inter-) nationally accepted goals and recommendations for a competency based medical education. The MSQ was administered together with the Dundee Ready Education Environment Measure (DREEM) to 1119 students and 258 teachers. Cronbach’s alpha was used to analyze the internal consistency of the items. Explorative factor analyses were performed to analyze homogeneity of the items within subscales and factorial validity of the MSQ. Item discrimination was assessed by means of part-whole corrected discrimination indices, and convergent validity was analyzed with respect to DREEM. Demographic variations of the respondents were used to analyze the inter-group variations in their responses.
Results
Students and teachers perceived the MS implementation as “moderate” and on average, students differed significantly in their perception of the MS. They thought implementation of the MS was less successful than faculty did. Women had a more positive perception of educational climate than their male colleagues and clinical students perceived the implementation of the MS on all dimensions significantly worse than preclinical students. The psychometric properties of the MSQ were very satisfactory: Item discrimination was high. Similarly to DREEM, the MSQ was highly reliable among students (α = 0.92) and teachers (α = 0.93). In both groups, the MSQ correlated highly positively with DREEM (r = 0.79 and 0.80, p < 0.001 each). Factor analyses did not reproduce the three areas of the MS perfectly. The subscales, however, could be identified as such both among teachers and students.
Conclusions
The perceived implementation of faculty-specific goals can be measured in an institution to some considerable extent by means of a questionnaire developed on the basis of the institution’s MS. Our MSQ provides a reliable instrument to measure the learning climate with a strong focus on competencies which are increasingly considered crucial in medical education. The questionnaire thus offers additional information beyond the DREEM. Our site-specific results imply that our own faculty is not yet fully living up to its competency-based MS. In general, the MSQ might prove useful for faculty development to the increasing number of faculties seeking to measure their perceived competency orientation in a competency-based curriculum.
doi:10.1186/1472-6920-12-109
PMCID: PMC3515351  PMID: 23134815
19.  Islam and family planning: changing perceptions of health care providers and medical faculty in Pakistan 
Training health care providers and medical college faculty about the supportive nature of Islam toward family planning principles addressed their misconceptions and enhanced their level of comfort in providing family planning services and teaching the subject.
Training health care providers and medical college faculty about the supportive nature of Islam toward family planning principles addressed their misconceptions and enhanced their level of comfort in providing family planning services and teaching the subject.
ABSTRACT
A USAID-sponsored family planning project called “FALAH” (Family Advancement for Life and Health), implemented in 20 districts of Pakistan, aimed to lower unmet need for family planning by improving access to services. To enhance the quality of care offered by the public health system, the FALAH project trained 10,534 facility-based health care providers, managers, and medical college faculty members to offer client-centered family planning services, which included a module to explain the Islamic viewpoint on family planning developed through an iterative process involving religious scholars and public health experts. At the end of the FALAH project, we conducted a situation analysis of health facilities including interviews with providers to measure family planning knowledge of trained and untrained providers; interviewed faculty to obtain their feedback about the training module; and measured changes in women's contraceptive use through baseline and endline surveys. Trained providers had a better understanding of family planning concepts than untrained providers. In addition, discussions with trained providers indicated that the training module on Islam and family planning helped them to become advocates for family planning. Faculty indicated that the module enhanced their confidence about the topic of family planning and Islam, making it easier to introduce and discuss the issue with their students. Over the 3.5-year project period, which included several components in addition to the training activity, we found an overall increase of 9 percentage points in contraceptive prevalence in the project implementation districts—from 29% to 38%. The Islam and family planning module has now been included in the teaching program of major public-sector medical universities and the Regional Training Institutes of the Population Welfare Department. Other countries with sizeable Muslim populations and low contraceptive prevalence could benefit from this module.
doi:10.9745/GHSP-D-13-00019
PMCID: PMC4168576  PMID: 25276535
20.  Palliative Care teaching in Germany – concepts and future developments  
Background: Following recent modifications of the Medical Licensure Act (ÄApprO) in the year 2009, palliative care was introduced as a compulsory 13th cross-disciplinary subject (Q13) in the undergraduate curriculum. Its implementation must have taken place before the beginning of the final year (´practical year´) in August 2013 and has to be substantiated for the medical exams taking place in October 2014.
Very diverse structures pertaining to palliative care teaching were described in previous surveys at various medical faculties in Germany. As a result, the current and future plans and concepts related to content and exams of a mandatory Q13 course at the respective faculty sites should be ascertained.
Methods: Since 2006, the German Medical Students' Association (bvmd) has been carrying out a bi-annual survey at all medical faculties in Germany regarding the current situation of teaching in the field of palliative care.
After designing and piloting an online survey in May 2010, a one-month online survey took place. The data was assessed using a descriptive approach.
Results: 31 of 36 medical faculties took part in the survey. At the time of questioning, 15 faculties already taught courses according to the requirements of the new ÄApprO; at three sites the Q13 is yet to be introduced commencing in 2012. A teaching curriculum for Q13 already existed at 15 faculty sites, partly based on the curricular requirements of the German Association for Palliative Medicine (DGP). Six sites described an implementation process as yet without an independent curriculum. Most of the faculties aim for 21-40 course hours, which will for the most part be provided as lectures, seminars or less often in more assisted and intense formats.
The majority of the participating faculties intend an examination containing multiple choice questions. At 8 universities there is an independent Chair for palliative medicine (5 more are planned); this was linked with a higher degree of mandatory teaching in alignment with the requirements of the ÄApprO. A broad spectrum of educationally-involved occupational groups, specialist disciplines and external co-operating partners, were mentioned.
Conclusion: The infrastructural prerequisites of the present curricular concepts and the degree of implementation of the Q13 according to the requirements of the new ÄApprO diverge significantly among the various medical faculties. The efforts made to produce a qualitatively high standard of teaching with regard to the multifaceted questions concerning the support for severely and terminally ill patients is as much reflected in the survey, as the special implications of an independent Chair for palliative medicine for the implementation of the requirements by law. The participation of various occupational groups in this survey as well as the broad spectrum of those involved highlights the interdisciplinary and multi-professional dimension of teaching in palliative care.
doi:10.3205/zma000817
PMCID: PMC3374143  PMID: 22737202
Palliative care; cross-disciplinary subject; implementation process; curriculum; examinational didactics
21.  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
22.  A Curriculum Review and Mapping Process Supported by an Electronic Database System 
Curriculum mapping and review is now an expected continuous quality improvement initiative of pharmacy professional programs. Effectively implementing and sustaining this expectation can be a challenge to institutions of higher education and requires dedicated faculty members, a systematic approach, creativity, and—perhaps most importantly—demonstrated leadership at all levels of the institution. To address its specific situation and needs, the University of Oklahoma College of Pharmacy implemented a peer review process of ongoing curriculum mapping and evaluation. An electronic Pharmacy Curriculum Management System (PCMS) was developed to support faculty efforts to manage curricular data, monitor program outcomes, and improve communications to its stakeholders on 2 campuses and across the state.
PMCID: PMC2630156  PMID: 19214253
curriculum; curriculum mapping; assessment; evaluation; instructional technology
23.  Higher professional education for general medical practitioners: key informant interviews and focus group findings. 
BACKGROUND: If higher professional education (HPE) for general practitioners (GPs) is to be implemented, then key stakeholders will need to be supportive. AIM: To investigate stakeholders' beliefs about the concept of HPE, its funding, and relationships to education and care. METHOD: Interviews were conducted using a topic guide with a health authority (HA) representative, the Local Medical Committee Chair, the Medical Audit Advisory Group Chair, a GP tutor from each of the six health authorities in the old South West region, and a senior member of the three academic GP departments and the two Royal College of General Practitioners faculties in the region. Focus groups were held with GP registrars on both vocational training schemes (VTSs) and on the one HPE course in the region. These were recorded, transcribed verbatim, and analysed for emergent themes that were triangulated with the ideas expressed in the focus groups; the same topic guide was used for both. RESULTS: Of 29 key informants, 24 were interviewed. Six focus groups were held (the one HPE group and five out of the nine VTSs), after which no new ideas emerged. There is a transition period, after becoming a new principal (NP) and before becoming a fully competent independent GP, during which NPs need support. Benefits would include receiving peer support to reduce stress during the transition, enhanced non-clinical competencies, becoming a better skilled GP, avoiding the negative personal impact of a career as a GP, and helping recruitment. To improve patient care there must be a link between education and service provision. Funding is the major consideration in setting HPE; mixed funding is best coming from top-sliced General Medical Services (GMS), the HA, and regional educational funds. Barriers might include NPs' practice workload, their enthusiasm, and their partners' attitudes. The other key is a local enthusiast to initiate a course and coordinate the 'players'. The curriculum would be principally non-clinical and should be agreed by learners and the course tutor together, taking advice from various interested parties. CONCLUSION: There is a need for HPE for new NPs. It will require funding external to individual practices or NPs and a local enthusiast. Top-slicing of GMS funds is one source of funding, with additional funds from regional education and HAs. HPE must be related to service provision, to NP needs, and to vocational training.
PMCID: PMC1313677  PMID: 10897513
24.  Assessment of Streams of Knowledge, Skill, and Attitude Development Across the Doctor of Pharmacy Curriculum 
Objective. To continue efforts of quality assurance following a 5-year curricular mapping and course peer review process, 18 topics (“streams”) of knowledge, skills, and attitudes were assessed across the doctor of pharmacy (PharmD) curriculum.
Design. The curriculum committee merged the 18 topics into 9 streams. Nine ad hoc committees (“stream teams”) of faculty members and preceptors evaluated the content, integration, and assessment for their assigned streams across the 4 professional years. Committees used a reporting tool and curriculum database to complete their reviews.
Assessment. After each team presented their findings and recommendations at a faculty retreat, the 45 faculty members were asked to list their top priorities for curriculum improvement. The 5 top priorities identified were: redefinition and clarification of program outcomes; improved coordination of streams across the curriculum; consistent repetition and assessment of math skills throughout the curriculum; focused nonprescription and self-care teaching into an individual course; and improved development of problem solving.
Conclusions. This comprehensive assessment enabled the college to identify areas for curriculum improvement that were not readily apparent to the faculty from prior reviews of individual courses.
doi:10.5688/ajpe75583
PMCID: PMC3142981  PMID: 21829257
curricular assessment; curriculum; streams of knowledge; curricular mapping
25.  Mentoring Undergraduate Students in Neuroscience Research: A Model System at Baldwin-Wallace College 
As neuroscience research and discovery undergoes phenomenal growth worldwide, undergraduate students are seeking complete laboratory experiences that go beyond the classic classroom curriculum and provide mentoring in all aspects of science. Stock, in-class, laboratory experiences with known outcomes are less desirable than discovery-based projects in which students become full partners with faculty in the design, conduct and documentation of experiments that find their way into the peer-reviewed literature. The challenges of providing such experiences in the context of a primarily undergraduate institution (PUI) can be daunting. Faculty teaching loads are high, and student time is spread over a variety of courses and co-curricular activities. In this context, undergraduates are often reluctant, or ill equipped, to take individual initiative to generate and perform empirical studies. They are more likely to become involved in a sustained, faculty-initiated research program. This paper describes such a program at Baldwin-Wallace College. Students frequently start their laboratory activities in the freshman or sophomore year and enter into a system of faculty and peer mentoring that leads them to experience all aspects of the research enterprise. Students begin with learning basic laboratory tasks and may eventually achieve the status of “Senior Laboratory Associate” (SLA). SLAs become involved in laboratory management, training of less-experienced students, manuscript preparation, and grant proposal writing. The system described here provides a structured, but encouraging, community in which talented undergraduates can develop and mature as they are mentored in the context of a modern neuroscience laboratory. Retention is very good - as most students continue their work in the laboratory for 2–3 years. Student self-reports regarding their growth and satisfaction with the experiences in the laboratory have been excellent and our neuroscience students’ acceptance rate in graduate, medical and veterinary schools has been well above the College average. The system also fosters faculty productivity and satisfaction in the context of the typical challenges of conducting research at a PUI.
PMCID: PMC3670787  PMID: 23741198
Neuroscience pedagogy; Neuroscience education; Interdisciplinary studies; Baldwin-Wallace College

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