The History, the Present, and the Future of Curricula in Health Professions Education PDF

The History, the Present, and the Future of Curricula in Health Professions Education QHPE 610 Innovation in Curriculum Plan and Design History of Medical Education Nineteenth century was the great era of Paris, London, and Edinburgh, wherein hospital-based teaching departed from Oxford's and...

The History, the Present, and the Future of Curricula in Health Professions Education QHPE 610 Innovation in Curriculum Plan and Design History of Medical Education Nineteenth century was the great era of Paris, London, and Edinburgh, wherein hospital-based teaching departed from Oxford's and Cambridge's academic methods. Experimental methods and specialization started becoming more dominant. Three new laboratory-based disciplines transformed basic teaching: physiology, pathology, and bacteriology. When migrated, it was a doctor with wisdom and a background in the humanities and sciences who paved the way for the role of the USA. Report The report in 1910 to Carnegie Foundation: Many un-standardized US medical schools No proper curricula 2 Quote-History ‘An overproduction of uneducated and ill-trained medical practitioners with no regard for public welfare or interest’ (Abraham Flexner (1886–1959)) 3 Apprenticeship Apprenticeship is a system for training a new generation of practitioners. Its lengths vary significantly across sectors, professions, roles, and cultures. 4 Advantages and Disadvantages of Different Approaches Discipline-Based Approach The Master-Apprentice Model (Society-Based Education) Disadvantage Advantages Failed to train physicians -> Everything taught to the More appropriate, given the increasing students is easily forgotten or abandoned when information load and health problems. students enter the ‘hidden curriculum’ of the hospital All stages of education are offered in classes, wards. So, there was a need for greater emphasis laboratories, and hospitals. on science in medical education. Students get the chance to encounter cases of health problems from the first year of education, which enable them to handle the problems they will encounter more comfortably owing to past experiences. 5 Medical Education Reformation Reforming Medical Education (1910) 6 Flexner’s Observations Flexner has the following observations: Great variability Lax admission standards Passive learning, anaemic curricula, and poor facilities Faculty of practitioners No accreditation, certification, or residency training Flexner: Medical Education in the United States and Canada (1910) 7 Key Findings Here is a list of key findings from the Flexner Report written in 1910: Medical schools were small ‘proprietary’ trade schools owned by one or more doctors and run to make a profit. Entrance requirements were non-existent. Students were subjected to endless lectures, textbook readings, and memorization of facts. The students observed more than they participated. Laboratory and clinical work were not to be found. Faculty was not involved in research activity. Doctors varied enormously in their scientific understanding of human physiology. The regulation of the medical profession by state governments was minimal or non-existent. 8 Medical Education: Changes and Impact Landmarks in History 1904 - AMA created the Council on Medical Education (CME) Objective: Restructure the American medical education 1908 - The CME asked the Carnegie Foundation for the advancement of teaching to survey the American medical education. Elimination of medical schools that failed to meet CME’s standards Flexner visited the 155 medical schools in the US and Canada All differed in curricula, methods of assessment, and requirement for admission and graduation Several schools received praise for excellent performance John Hopkins Harvard Western Reserve McGill University of Toronto 9 What Changes were Brought? Using the Johns Hopkins University as the ideal, Flexner recommended the following: Admission to a medical school should require: A high school diploma At least 2 years of college or university study The duration of medical education should be 4 years, and its content should be decided by the CME Proprietary medical schools should either close or be incorporated into the existing universities Medical schools should appoint full time clinical professors 10 What was the Impact? Flexner study had the following impact: Higher admission and graduation standards Adherence to the protocols of mainstream science 60% of American medical schools fell short of the standard and were closed It concluded that there were too many medical schools in the US Faculty should engage in research Practitioners should be scientists 11 Closure of Schools Many American medical schools fell short of the standard advocated in the Flexner Report, and subsequent to its publication, nearly half of such schools merged or closed outright. In 1904 160 M.D. granting institutions and 28,000 students By 1920 Only 85 M.D. granting institutions and 13,800 students By 1935 Only 66 medical schools operated in the USA 12 Consequences of Medical Education Reforms Here is a list of the consequences of medical education reforms: Full-time clinical faculty Medical school hospital clinical ties Complete redesigning of curriculum, training, finances, faculty roles, and compensation of clinical experiences and links between hospitals and schools. A physician receives at least six, and preferably, eight years of post-secondary formal instruction. Medical training adheres closely to the scientific methods. Average physician quality increased significantly. No medical schools can be created without the permission of CME. 13 Consequences of Medical Education Reforms (Cont.) The annual number of medical school graduates declined. Restrictions in the supply of physicians and rise in the incomes of the remaining practitioners. The report created a single model of medical education: An education in medicine, wrote Flexner, ‘involves both leaning and learning how; the student cannot effectively know, unless he knows how’. The physician as a social instrument… whose function is fast becoming social and preventive, rather than individual and curative. 14 Flexnerian Curriculum Year 1 Pre-clinical Year 2 Year 3 Clinical Year 4 15 Science 16 General Practice Education Program (GPEP) 1993 GMC Tomorrow’s Doctors (100 recommendations) 1984 GPEP (AAMC) (skills of physicians in 21st century) 1968 Royal Commission –UK (changing role GPs) Rappleye (AAMC) (behavioural elements and clinical 1932 skills) 1910 Flexner (infrastructure & prior knowledge ) 17 Article Surprise! Over the last 60 years, most medical schools have done little to correct the major shortcomings … even though these deficiencies have been documented repeatedly! Ref.: AAMC, (1992) With modifications 18 Quotes on Medical Education Curriculum ‘The preclinical/clinical divide, … each part of the course proliferating without moderating influence on the other and without coordinated examination of the overall aims of the course.’ (GMC–UK, 1993) ‘Medical students were involved mainly in compartmentalized discipline specific learning and consequently often lacked the ability to integrate, evaluate and apply knowledge across disciplines to solve common medical problems.’ (Abrahamson, 1996) 19 Quotes on Medical Education Curriculum(Cont.) ‘My medical education began three times, what I learnt in the medical school was no use in the hospital, what I learnt in the hospital was no use in general practice.’ (Julian Tudor Hart) ‘If you think that you can run an organization in the next 10 years as you've run it in the past 10 years you're out of your mind.’ (CEO of Coca Cola) 20 Quote on Trends and Direction of Change ‘If you think that you can run an organization in the next 10 years as you've run it in the past 10 years you're out of your mind.’ (CEO of Coca Cola) 21 Evolution and Trend: Part 1 Evolution Trends Increase in knowledge Patient-centered education Better informed society Evidence-Based Medicine Easy accessibility to Best Evidence Medical medical information for Education public Without high quality information upfront, it's very difficult for any patient to make the right decision when it comes to their health and what treatment plan best suits them. 22 Evolution and Trend: Part 2 Evolution Trends Patients safety Part of curriculum Simulation (manikins & role plays) Measurement of patient safety culture enables the identification of strengths and areas for improvement. This information can be used to develop appropriate interventions. 23 Evolution and Trend: Part 3 Evolution Trends Advances in information E-learning options technology Webinars Emergence of the digital Networking in medical students education at various levels E-learning and incorporating multi-media potentially allows active learning with the content designed by educators and encourages interaction. 24 Evolution and Trend: Part 4 Evolution Trends Increasing reports in Incorporation of medical medical errors e.g., to Err professionalism and is Human ethics in medical education Patient rights Unintentional medical errors have an impact on patients and their families. They may also contribute to adverse mental and emotional effects on the involved provider. Staff must report any error, behaviour, conduct, or system issue affecting patient safety. 25 Evolution and Trend: Part 5 Evolution Trends Unavailability of skillful Study guides teachers Virtual Learning Increased faculty turn- Environment (VLE) over Distance Learning A critical best practice for medical teachers is having a thorough knowledge of their field. As such, being knowledgeable is a core component of effective teaching. 26 Evolution and Trend: Part 6 Evolution Trends Social accountability Licensure requirements Multicultural societies Academic standards Accreditation Collaboration & cooperation The American Medical Association exhorts physicians to advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being. 27 Other Trends in Medical Education Here is a list of other trends in medical education: Integration (horizontal and vertical) Multi-professional education Community-based education (CBE) Peer-assisted learning (PAL) Problem-based learning (PBL) Task-based learning (TBL) Outcome-based education (OBE) Core and electives Spiral curriculum Entrustable professional activities 28 Curriculum Development for Medical Education So, in summary, we need a better design and management of our current curriculums. That is why certain attention was paid to this, and the curriculum design course is a foundation of your master’s degree to allow you to study and understand how to not only design a curriculum, but to be able to manage it according to the six steps, which were intended to be taught to you with the help of the reading. 29 The Six Steps (Cont. 1) 1. Problem ID and General Needs Assessment Health Care Problem Current Approach Ideal Approach 2. Targeted Needs Assessment Learners Learning Environment 3. Goals and Objectives Broad Goals Specific Measurable Objectives 4. Educational Strategies Content Method 30 The Six Steps (Cont. 2) 5. Implementation Obtaining Political Support Securing Resources Addressing Barriers Introducing the Curriculum Administering the Curriculum 6. Evaluation and Feedback Individual Learners Program 31 Think and Reflect Can you run an organization in the next 10 years as you have run it in the past 10 years? 32 References American Medical Association. (n.d.). AMA Declaration of Professional Responsibility. https://www.ama-assn.org/delivering-care/public-health/ama-declaration-professional- responsibility ARİCİ, D. (2020). Medical Faculty - National Core Curriculum 2020. Tıp Eğitimi Dünyası. https://doi.org/10.25282/ted.716873 Balcioglu, H., Bilge, U., & Unluoglu, I. (2015). A historical perspective of medical education. Journal of Education in Science, Environment and Health, 1(2), 111. https://doi.org/10.21891/jeseh.80818 Dokur, M., & Ulutaşdemir, N. (2018). Mezuni̇yet öncesi̇ tip EĞİTİMİ Ulusal çeki̇rdek eği̇ti̇m programi-2014 ve ACİL Tip Eği̇ti̇mi̇: Aci̇l tip i̇le İLGİLİ Temel heki̇mli̇k Uygulamalarinin DEĞERLENDİRİLMESİ. Sağlık Akademisi Kastamonu. https://doi.org/10.25279/sak.354620 Magzoub, M. E., & Schmidt, H. G. (2000). A taxonomy of community-based medical education. Academic Medicine, 75(7), 699–707. https://doi.org/10.1097/00001888-200007000-00011 Williams, B. W., Byrne, P. D., Welindt, D., & Williams, M. V. (2016). Miller's pyramid and core competency assessment: A study in relationship construct validity. Journal of Continuing Education in the Health Professions, 36(4), 295–299. https://doi.org/10.1097/ceh.0000000000000117 33 Credits The following faculty is attributed with the slides and ideas of this session: Dr. Abdellatif Hamdy Abdelwahab 34