Stewart Mennin

The New Mexico experiment: educational innovation and institutional change.

Over the past ten years the University of New Mexico School of Medicine has conducted an educational experiment featuring learner-centered, problem-based, community-oriented learning. The experiment was introduced into an established institution by means of an innovative educational track running parallel to the more conventional curriculum. Students in the innovative track, compared with those in the conventional tract, tended to score lower on the National Board of Medical Examiners (NBME) Part I examination (basic sciences) and higher on NBME Part II (clinical sciences), received higher clinical grades on clinical clerkships, and experienced less distress. They were more likely than conventional-track students to retain their initial interest in or switch their preference to careers in family medicine. The parallel-track strategy for introducing curriculum reform succeeded in fostering institutional acceptance of continuing educational innovation. Generic steps in overcoming institutional barriers to change are identified.

Self-organisation, integration and curriculum in the complex world of medical education

Context  The world of medical education is more complex than ever and there seems to be no end in sight. Complexity science is particularly relevant as medical education embraces a movement towards more authentic curricula focusing on integration, interactive small‐group learning, and early and sustained clinical and community experiences.

Residency performance of graduates from a problem‐based and a conventional curriculum

Summary. Performance of 130 graduates in residency from a community‐oriented, problem‐based medical curriculum, and from a parallel, conventional track, were compared on eight dimensions: knowledge, communication with patients, independent learning ability, teamwork, patient education, critical thinking ability, attention to health care costs, and self‐assessment. Ratings were obtained from three evaluators: a doctor‐supervisor, a nurse and the resident him/herself. The study was undertaken to identify differences between graduates from the two curricular tracks. Differences were observed in the areas of health care costs (supervisors) and communication with patients (residents), and a trend was observed in patient education (supervisors) and knowledge (nurses). The outcomes of the study are discussed in light of the literature on residency performance, and in terms of the educational experiences that characterize the two medical curricula.

Reflections on Relevance, Resistance, and Reform in Medical Education.

This chapter reflects upon the collective experiences of the eight schools participating in the Robert Wood Johnson Foundations “Preparing Physicians for the Future: A Program in Medical Education,” highlighting the lessons learned over the five years of the program. The authors set the context and give a short history of the program. They discuss the ways in which the processes of change occurred at the eight schools, commenting on issues of leadership, governance, communication, faculty development, integration, instructional methods, student assessment, and program evaluation (all of which received lengthier treatment in earlier chapters). The authors conclude that changes in all of these areas are necessary for successful reform of medical education.

Distress and attitudes toward the learning environment: Effects of a curriculum innovation

The emergence of innovative curricula provides unique opportunities to examine how a modification in the learning environment might influence stress and attitudes among students in medicine. In 1979, the University of New Mexico School of Medicine implemented a problem‐based, community‐oriented, student‐centered curriculum that runs concurrently with the larger traditional track. This longitudinal investigation compares the perceptions of distress and attitudes toward the learning environment of students in these two tracks. The Symptom Questionnaire and the Learning Environment Questionnaire were used to measure distress levels and attitudes toward the learning environment. Students completed these instruments at orientation (first semester) and during the second, third, and fourth semesters of the first 2 years of medical school. The innovative‐track students’ perceptions of distress were significantly lower during the first 2 years of medical school than those of the traditional‐track students. Their e...

The cost of problem‐based vs traditional medical education

Summary. It is generally accepted that teachers’ salaries are a major factor in the cost of medical education. Little is known about the effects of curriculum on teaching time. A comparison of teaching time devoted to each of two different medical education curricula is presented. In a traditional teacher‐centred, subject‐oriented curriculum, 61% of the total teaching effort expended by twenty‐two teachers took place in the absence of students, i.e. in preparation for student contact. Only 39% of the effort devoted by these teachers to medical education took place in the presence of students. In a problem‐based, student‐centred curriculum which focuses upon small‐group tutorial learning and early extended primary care experience in a rural community setting, 72% of the total teaching effort devoted to medical education was spent with students and only 28% was spent in preparation for student contact. Overall, there were no differences in the total amount of teaching time required by each of the two curricular approaches to medical education. There were, however, major differences in how teachers spent their teaching time.

Measuring the effects of an international health professions faculty development fellowship: the FAIMER Institute

While there are many examples of evaluations of faculty development programs in resource rich countries, evaluation of transnational programs for faculty from developing countries is limited. We describe evaluation of the effects of the FAIMER Institute, an international health professions education fellowship that incorporates not only education content, but also leadership and management topics and, in addition, strives to develop a sustained community of educators. Data were obtained via retrospective pre/post surveys, as well as interviews. Results indicate that participating health professions faculty from developing countries are augmenting their knowledge and skills in education leadership, management, and methodology, and applying that knowledge at their home institutions. Fellows’ perceptions of importance of, and their own competence in, all curriculum theme areas increased. Interviews confirmed a nearly universal gain of at least one leadership skill. Findings suggest that the high-engagement experience of the FAIMER model offering integration of education and leadership/management tools necessary to implement change, provides knowledge and skills which are useful across cultural and national contexts and results in the development of a supportive, global, professional network.

The change process and medical education.

Successful innovators in medical education accurately diagnose institutional barriers to innovation and employ effective strategies for overcoming these barriers. These institutional barriers and successful strategies are described with illustrative vignettes. They are generic to medical schools all over the world.

Research in assessment: Consensus statement and recommendations from the Ottawa 2010 conference

Medical education research in general is a young scientific discipline which is still finding its own position in the scientific range. It is rooted in both the biomedical sciences and the social sciences, each with their own scientific language. A more unique feature of medical education (and assessment) research is that it has to be both locally and internationally relevant. This is not always easy and sometimes leads to purely ideographic descriptions of an assessment procedure with insufficient general lessons or generalised scientific knowledge being generated or vice versa. For medical educational research, a plethora of methodologies is available to cater to many different research questions. This article contains consensus positions and suggestions on various elements of medical education (assessment) research. Overarching is the position that without a good theoretical underpinning and good knowledge of the existing literature, good research and sound conclusions are impossible to produce, and that there is no inherently superior methodology, but that the best methodology is the one most suited to answer the research question unambiguously. Although the positions should not be perceived as dogmas, they should be taken as very serious recommendations. Topics covered are: types of research, theoretical frameworks, designs and methodologies, instrument properties or psychometrics, costs/acceptability, ethics, infrastructure and support.

University and practice-based physicians' input on the content of a surgical curriculum

BACKGROUND The specific knowledge and skills students learn during surgical rotations are reconsidered in light of recent changes in medical school curricula. The purpose of this study was to determine the priorities of a surgical curriculum based on input from three groups; surgical faculty (SF), primary care faculty (PCF), and community-based , practicing primary care physicians (PCP). METHODS A questionnaire was developed in which SF (n=54), PCF (n=85), and PCP (n=876) were asked to rank the importance of 145 areas of knowledge and 48 areas of clinical skills on a 5-point Likert-type scale. Responses were rank ordered by the mean of importance ratings for each group. Differences among groups were evaluated using ANOVA. RESULTS Response rates were best for faculty (100%) SF, 88% PCF, 61% PCP). All three groups were best considered general surgery related topics and general skills very important. Primary care physicians and PCF consistently ranked otolaryngology, ophthalmology, and orthopedic topics and skills higher than did SF. Surgery faculty ranked invasive surgical procedures higher than did PCP while PCP ranked orthopedic procedural skills more highly. CONCLUSIONS There is significant overlap among physicians about what medical students should learn during surgical rotation. Differences between groups centered on surgical subspecialty knowledge and clinical skills. These results provide a broad perspective about required subjects for a core surgical clerkship curriculum, which should include surgical subspecialty training.