Christopher B. Reznich

A Suggested Outline for Writing Curriculum Development Journal Articles: The IDCRD Format

Background: During the past decade, medical school and residency faculty have been active in developing and revising curricula for medical education programs. Many of these curriculum development efforts ultimately are published in peer-reviewed professional journals as articles or abstracts. Unlike research publications, no uniform format currently exists for reporting curriculum development efforts in the peer-reviewed literature. Summary: A suggested format for organizing curriculum development manuscripts consists of the introduction, development, curriculum, results, and discussion (IDCRD). Detailed descriptions of each section are discussed herein. Conclusions: The IDCRD manuscript outline is intended to provide useful guidance to medical educators in publishing their curriculum development efforts. Journal editors are encouraged to recognize the importance of providing uniform descriptions of curricula so that readers can benefit from the experience of others and replicate successful curriculum efforts.

A repurposed tool: the Programme Evaluation SOAP Note

Medical Education 2010: 44 : 298–305

Designing a Course

“Dr. Samuels did that for years. Now that he’s gone, we need a new EBM course. Can you take that on?”

Gateway assessments of medical students for programme development.

computeror manikin-based simulation. A key limitation of this technique is that the presence of a simulator cues the learner to anticipate an abnormality. Why the idea was necessary We were interested in determining whether students would correctly identify actual abnormal findings during an SP encounter. We therefore developed cases specifically for SPs with known physical abnormalities for our senior medical student clinical skills examination. What was done Cases were developed for 2 experienced SPs with stable cardiovascular abnormalities. The presenting problem for each case was neurological, but the case history was constructed to ensure that a cardiovascular examination would be warranted as part of the focused physical examination. Case 1 was portrayed by an SP with a mechanical aortic valve. Physical findings included a loud metallic valvular click and a grade II)III ⁄ VI systolic murmur. Case 2 was portrayed by an SP with chronic renal failure. His physical findings included a grade II)III ⁄ VI systolic murmur. Students were allowed 15 minutes with the patient, followed by 10 minutes to document pertinent interview and physical examination findings. All student)SP encounters were videotaped. Evaluation of results and impact A total of 53 students encountered these cases. Notes were reviewed for written documentation of the abnormal cardiac findings. Correct documentation for each SP were: case 1 (n 1⁄4 27) valvular click 6 (22%), murmur 6 (22%); case 2 (n 1⁄4 26) murmur 10 (38%). None of the students who described the click in case 1 also correctly described the murmur. Across both cases, 5 additional students documented the presence of a murmur, but described it incorrectly. A total of 23 students (43%) specifically wrote no murmur, rub or gallop for cardiac auscultation. Video review showed that all 23 of these students performed a technically sufficient examination to detect the murmur. Documentation of any cardiovascular examination was missing from 9 notes. The limited correct documentation of the abnormal cardiac findings we observed is quite concerning. We initially thought that students might have missed the abnormalities due to inadequate examinations; however, videotape review suggested otherwise. Deliberate disregard of findings in the SP is a possible explanation, although students are instructed to accept all information obtained from SPs. Careless documentation may explain the lack of inclusion of findings, but the specific recording of no murmur, rub or gallop in a substantial percentage of notes suggests that the students simply did not identify the auscultatory abnormalities. Students must both master the technical skills of the physical examination and learn to differentiate between normal and abnormal findings. Assessments using SPs are typically used to observe how well students select and perform specific, focused examinations. By using SPs with stable physical findings, student skill in detecting abnormalities can also be determined. We are continuing to develop cases for SPs with actual physical findings to enrich the assessment of our students.

Investing in success: student experiences in a structured, decelerated preclinical medical school curriculum

Purpose Many students in the Michigan State University College of Human Medicine (CHM) are non-traditional with unique needs and experiences. To meet these needs, in 1988 CHM developed a structured Extended Curriculum Program (ECP), which allows students to take longer than 2 years to complete the preclinical curriculum. This work examined the reasons why students extended their programs, their perceptions of that experience, and the outcome with respect to satisfaction and success in their careers after graduation. Methods The analysis used data from the college database, follow-up surveys of residency directors and graduates, surveys of graduates who extended, and the AMA Physician Masterfile. Results Graduates who responded to the survey were evenly split between those who extended for academic reasons and those who extended for other reasons. Although feelings about extending were mixed at the time of extension, nearly all respondents agreed that extending was the right decision in the long run. Extended students continued to face academic challenges having lower basic science averages, lower USMLE Step 1 and 2 first attempt pass rates, and more instances of repeated clerkships compared to those who did not extend, however, most were able to secure a residency in the specialty they desired and had comparable career satisfaction ratings. Conclusions The ECP allows some students to complete medical school who otherwise may not have been able to do so. This analysis has provided valuable information that was used to improve the program, allowing CHM to continue its mission of training a diverse set of students to be exemplary physicians.

A family medicine clerkship curriculum in medication errors.

medical council approving the new course. The longterm aim of this change in the medical curriculum is to develop research-aware GPs who are able to engage in evidence-based medicine. What was done Each student is required to undertake a research project relevant to his or her placement community. Students are encouraged to identify local issues as topics and to discuss them with their teachers and university academic supervisors, who mentor their progress at all stages. Students are also required to apply for ethics approval for their projects and are given relevant information about research design. Finally, each student is required to write a formal report and disseminate his or her results to relevant stakeholders, peers and academics. Evaluation of results and impact The impact of the programme on the research capacity of the students will be evaluated using preand post-placement surveys. Ten areas of research will be investigated, namely: defining a research question or idea; writing a research protocol; finding relevant literature; critically reviewing literature; using quantitative research methods; using qualitative research methods; analysing and interpreting results; writing and presenting a research report; publishing results, and applying for research funding. The programme has the potential to increase understanding of local health issues in regional, rural and remote communities, to increase engagement with and acceptance of medical students in these communities, and to increase the engagement of the community in research. Moreover, GPs and students will have increased appreciation of the possibilities for undertaking research in their environment, regardless of location. Finally, successive cohorts of students may become involved in longitudinal research projects in the placement community, in which data collection is ongoing and survey analysis is undertaken annually. Currently, all students have selected their projects and have prepared proposals for submission to the university ethics committee. Areas of research chosen by the students include patients’ awareness of stroke symptoms, osteoporosis risk factors, choices for breast cancer treatments, clinical best practice audits, and patient willingness to allow medical students to be involved in the consultation process.

Pilot test of a problem-based learning preceptor certification examination.

from teaching staff on student performance. Student feedback, provided through an online course evaluation, indicated that this SSM was valued as it improved student confidence, allowed for the development of teaching skills and practice, and provided opportunities for meeting younger patient groups and gaining insights into their social backgrounds. It introduced students to reflective thinking and had a positive effect on the development of professional attitudes. Students also appreciated the opportunity to do something quite different from the usual content of the standard MBBS curriculum.

Integrating information management knowledge and skills in the pre-clinical curriculum

Context and setting A new system to monitor, evaluate and report on areas affecting the teaching and learning processes that accompanied curriculum change was developed through establishing an evaluations office at the Nelson R. Mandela School of Medicine (NRMSM). Why the idea was necessary The functioning of the new evaluations office was constraint by combining evaluations and implementation functions because of severe staff shortages during the implementation phase of problem-based learning (PBL). The purpose of this study was to investigate the efficacy of continuing a separate student feedback system through an evaluations office, as a means of providing direction for curriculum review as well as support for student learning and staff development activities at NRMSM. What was done To determine the usefulness of student feedback data, we conducted qualitative analysis of the feedback on 5 curriculum units in Year 2 (during 2004) and compared it with similar Year 2 student feedback (during 2005). The results were provided to student representatives, PBL facilitators and faculty members to determine the value of this evaluation system. The data were also made available to a panel of the Health Professions Council of South Africa (HPCSA) during an accreditation visit in 2005. Evaluation of results and impact After learning that student feedback had effected substantial changes in the Year 2 curriculum, students had an increased sense of their empowerment to partake in and influence curriculum decisions. They were grateful for the changes made that resulted in an improved teaching and learning climate. These included: a formally structured dissection programme; improved sequence of curricular learning units to avoid competition for textbooks; more structured feedback sessions after assessments; the inclusion of question and answer sessions at regular intervals to address issues before the conclusion of units; a noticeable increase in structured interactive large-group resource sessions; the availability of lecturers’ notes ⁄presentations, and the inclusion of subject study guides. Students were also appreciative of individual feedback they received based on facilitator reports, as were facilitators of their feedback from students. The 2005 student feedback revealed some remaining concerns focusing on the negative attitudes of some faculty members who did not allow discussion during lectures, did not make notes available, were not always audible to the class, or who cancelled classes without prior notification. Students provided suggestions to improve learning, including: more health care contacts and hospital visits during learning units; more specific objectives in PBL cases, and improved study guides in all curriculum units. The importance of the above data and the evaluations system was confirmed by the HPCSA’s recommendations. These included the separation of staff development and curriculum evaluation functions from that of curriculum implementation because of potential conflicts of interest. It is important that curriculum evaluation units demonstrate efficacy of their functions to all stakeholders, including students, faculty and administrators. The present study documented the utility of student feedback in improving the teaching and learning climate during the implementation of a new curriculum in a resource-constrained setting. Moreover, the importance of separating curriculum implementation from evaluation and staff development functions was confirmed.

Creating Online Lessons: A Faculty Development Seminar Series

The World Wide Web is being used increasingly to deliver instruction in medical education. Consequently, there is a need to train faculty in developing and implementing online instruction. We developed and implemented a seminar series to teach faculty to create educationally sound, well-designed online instruction. Instruction was delivered to 15 participants via a six-session seminar on developing web-based lessons, supplemented with web-based instruction. First, the participants learned the basics of instructional design via a web-based module. They then completed content outlines for their online lessons prior to the first seminar. Lesson development, web site development and the use of a web-based instructional shell to imp lement the online lessons were each taught in two two-hour sessions. Eight participants developed online lessons and four actually implemented them. Feedback was mostly positive, with suggestions for improvement. All eight participants who completed the series said they would recommend it to their colleagues. Because a longitudinal workshop type of seminar series requires a large amount of participant time outside of class, a six-month seminar series may be too long. It is important at the beginning of the series to help participants select topics suitable for online instruction and to help them narrow their topics. We may change the attendance guidelines so faculty would attend only the session on instructional design and have their staff attend the technical sessions on web site design, HTML editing and online course delivery systems. This would better match the actual practice of faculty designing the instruction and staff developing it.

Training in basic computer skills for academic physicians: The certificate of added qualification approach

Background: In the course of an academic fellowship program, many of the physicians participating expressed the need for computer skills training. Purpose: The purpose of the tutorial program was to promote the effective and efficient learning of academic computer skills within the context of a busy fellowship program. Methods: A series of self‐instructional tutorials was developed, including competency tests and practice tasks. Physician fellows participated in the voluntary computer skills tutorial program. Topics included system software, word processing, and graphics. Competency testing led to a “Certificate of Added Qualification,”; (CAQ) in computer skills. Results: Eleven of 20 (55%) physician fellows completed all CAQ requirements during their fellowship program. The results of a follow‐up questionnaire indicated that 95% of the CAQ participants reported using computers at least several times per week. Conclusion: By focusing on the tasks computer novices immediately need to perform, and keeping t...