Evolution of the New Pathway curriculum at Harvard Medical School: the new integrated curriculum

In 1985, Harvard Medical School adopted a "New Pathway" curriculum, based on active, adult learning through problem-based, faculty-facilitated small-group tutorials designed to promote lifelong skills of self-directed learning. Despite the successful integration of clinically relevant material in basic science courses, the New Pathway goals were confined primarily to the preclinical years. In addition, the shifting balance in the delivery of health care from inpatient to ambulatory settings limited the richness of clinical education in clinical clerkships, creating obstacles for faculty in their traditional roles as teachers. In 2006, Harvard Medical School adopted a more integrated curriculum based on four principles that emerged after half a decade of self-reflection and planning: (1) integrate the teaching of basic/population science and clinical medicine throughout the entire student experience; (2) reestablish meaningful and intensive faculty-student interactions and reengage the faculty; (3) develop a new model of clinical education that offers longitudinal continuity of patient experience, cross-disciplinary curriculum, faculty mentoring, and student evaluation; and (4) provide opportunities for all students to pursue an in-depth, faculty-mentored scholarly project. These principles of our New Integrated Curriculum reflect our vision for a curriculum that fosters a partnership between students and faculty in the pursuit of scholarship and leadership.     

Problem-based learning in biochemistry at Ziauddin Medical University,Karachi, Pakistan

Since its inception in 1996, Ziauddin Medical University has integrated problem-based learning (PBL) in its curriculum, a strategy introduced for the first time in Pakistan. This was aimed at overcoming various drawbacks in the traditional methods of teaching such as irrelevant subject matter and lack of integration between disciplines. The main features of new curricula and a system-integrated course are outlined. A problem is quoted from the same course and its methodology is discussed. Assessment of the program through a questionnaire given to students, showed they perceived that the PBL approach adopted consistently across the curriculum contributed to the development of their information management, critical reasoning, communication and team- linked skills. However, the challenges are information access, the role of tutor, and coping with the ambiguity of knowledge and reasoning.     

Using a high-fidelity patient simulator with first-year medical students to facilitate learning of cardiovascular function curves

Students are relying on technology for learning more than ever, and educators need to adapt to facilitate student learning. High-fidelity patient simulators (HFPS) are usually reserved for the clinical years of medical education and are geared to improve clinical decision skills, teamwork, and patient safety. Finding ways to incorporate HFPS into preclinical medical education represents more of a challenge, and there is limited literature regarding its implementation. The main objective of this study was to implement a HFPS activity into a problem-based curriculum to enhance the learning of basic sciences. More specifically, the focus was to aid in student learning of cardiovascular function curves and help students develop heart failure treatment strategies based on basic cardiovascular physiology concepts. Pretests and posttests, along with student surveys, were used to determine student knowledge and perception of learning in two first-year medical school classes. There was an increase of 21% and 22% in the percentage of students achieving correct answers on a posttest compared with their pretest score. The median number of correct questions increased from pretest scores of 2 and 2.5 to posttest scores of 4 and 5 of a possible total of 6 in each respective year. Student survey data showed agreement that the activity aided in learning. This study suggests that a HFPS activity can be implemented during the preclinical years of medical education to address basic science concepts. Additionally, it suggests that student learning of cardiovascular function curves and heart failure strategies are facilitated.     

Undergraduate education in gerodontology in Germany: the Leipzig Programme

Objective: To evaluate students’ attitude towards the clinical component of the Leipzig Programme of undergraduate Education in Gerodontology (LPEG). Background: Undergraduate student education has long been recognised as a mainstay of fostering the aims of gerodontology. Extramural clinical education with direct exposure to various groups of vulnerable elderly is known to contribute to the formation of positive attitudes. LPEG has been designed to include didactic components and six visits to a long‐term care facility (LTC) spread over 4 of the 5 years of the dental course. Methods: A structured questionnaire with 10 items was administered to 230 students (60.9% female) on three occasions in 2004–05. Total return was 411 questionnaires. The mean age of respondents was 24.3 (SD 2.67) years. Students were asked to indicate the degree of their agreement with seven statements presented using a 5‐point scale. A choice of responses which characterised the course was offered to mark all those deemed agreeable. Results: The vast majority of students responded positively. In the students perception there was no significant difference (Kruskal–Wallis p = 0.24) in the amount of knowledge acquired between subjects participating once, twice or three times. ‘Interesting’ and ‘feel pity for patients’ were the two items that received the most support. Respondents expressed the wish to accompany up to 10 patients during their course with a mean of 3.5 (SD 2.9) but 31 (7.5%) subjects did not wish to see any frail elderly patients at all. Conclusion: The LPEG is well received by dental students. A complex subject including overarching social skills has been integrated seamlessly into the dental curriculum.     

Determining undergraduate curriculum content in plastic surgery

The purpose of this study was to determine the cognitive knowledge and clinical skills related to plastic surgery that are essential for inclusion in an undergraduate curriculum. A questionnaire was distributed to surgical clerkship directors, plastic surgeons, and 1980 graduates of four medical schools. Respondents were asked to rate (0-3) the importance of 74 knowledge items and 28 clinical skills in relation to the knowledge/proficiency necessary for students to achieve prior to graduating from medical school (0 = unnecessary, 3 = indepth knowledge/proficiency important). Results of the questionnaire enabled the determination of mean response scores and the hierarchical ranking of questionnaire items. There was a high degree of correlation between the rankings of the three groups of respondents indicating agreement on knowledge and clinical skills in plastic surgery that are essential, as well as those nonessential, for the competent practice of medicine.     

Learning styles of medical students change in relation to time

The aim of the present study was to investigate if any changes exist in the learning styles of medical students over time and in relation to different curriculum models with these learning styles. This prospective cohort study was conducted in three different medical faculties, which implement problem-based learning (PBL), hybrid, and integrated curriculum models. The study instruments were Kolb's Learning Style Inventory (LSI) and a questionnaire describing the students' demographic characteristics. Sample selection was not done, and all first-year students (n = 547) were targeted. This study was designed in two phases. In the first year, the study instruments were delivered to the target group. The next year, the same instruments were delivered again to those who had fully completed the first questionnaire (n = 525). Of these, 455 students had completed the instruments truly and constituted the study group. The majority of the students were assimilators and convergers in both the first and second years. A change in learning style was observed between 2 yr in 46.9% of the students in the integrated curriculum, in 49.3% of the students in the hybrid curriculum, and 56.4% of the students in the PBL curriculum. The least and most changes observed between the learning style groups were in assimilators and divergers, respectively. Curriculum models and other independent variables had no significant effect on the change between learning styles. The learning styles of medical students may change over time. Further followup studies in larger groups are needed to clarify this relation.     

新形势下医学课程整合的现状与建议

随着医学教育方式不断被创新与改善,单一的医学课程教育模式已经不能满足于新形势下医学生的培养。医学课程整合可以将学科知识串联在一起,形成有机的融合。其具有综合性、多元化的特点,便于医学生对所学知识的理解与应用。目前,在实行医学课程整合中存在着师资力量薄弱、学生素质参差不一、医学院校课程设置不合理、教学资源缺乏以及缺少统一的课程整合的评价标准等现状问题。因此有效的实施医学课程整合,仍需各医学院校因地制宜采取相应措施,通过调整课程结构、提升师生素质,建立起有效的评价措施等手段来促进与改善医学课程整合。     

Maximising the impact: using REF Case Studies to enhance first-year undergraduates’ appreciation of research integration in their degree

ABSTRACT

Integration of research into undergraduate degree programmes has been shown to have a beneficial effect on student learning, however, integrating activities which help first-year students to feel engage with research activity within their discipline has proved challenging. This study describes the use of Impact Case Studies created for the Research Excellence Framework (REF) assessment in the UK to develop a module for first-year students allowing them to engage with research undertaken at their own institution which has achieved significant impact. Using a mixed methods approach, the module was evaluated using the validated Student Perceptions of Research Integration Questionnaire, together with additional items relating to the design and delivery of the module, and open responses. It was shown that undertaking the module improved students’ perception of research integration, and had raised their awareness of the value of research carried out at their university. They also agreed that they had developed the intended skills and recognised the value of these for both further study and future employment. The value of this approach to increasing student awareness of research, and the transferability of the use of REF Case Studies to other levels of university study are discussed.     

Innovations in human genetics education. Incorporation of genetics into a problem-based medical school curriculum.

There has been recent interest in the development of problem-based human genetics curricula in U.S. medical schools. The College of Human Medicine at Michigan State University has had a problem-based curriculum since 1974. The vertical integration of genetics within the problem-based curriculum, called "Track II," has recently been revised. On first inspection, the curriculum appeared to lack a significant genetics component; however, on further analysis it was found that many genetics concepts were covered in the biochemistry, microbiology, pathology, and clinical science components. Both basic science concepts and clinical applications of genetics are covered in the curriculum by providing appropriate references for basic concepts and including inherited conditions within the differential diagnosis in the cases studied. Evaluations consist of a multiple-choice content exam and a modified essay exam based on a clinical case, allowing evaluation of both basic concepts and problem-solving ability. This curriculum prepares students to use genetics in a clinical context in their future careers.     

Three Primary Color Wheel

This longitudinal study (2001–09) of two Hong Kong secondary schools highlights six issues with an integrated arts curriculum: first, integration of knowledge and skills negatively precedes the integration of learners’ construction of meaning; second, integration is perceived as challenging the profession's status; third, teachers are unaccustomed to co-teaching; fourth, teachers have little prior experience conceptualizing cross-discipline teaching and learning; fifth, Hong Kong's current systemwide education reform places arts integration as a relatively low priority; and sixth, because integrated arts curriculum implementation is not mandatory, the vagaries of individual school management create a plethora of integration approaches that confound the task of forging a common definition. Remedial recommendations include cascading “seed projects” to broaden teachers’ views of integrated arts and teaching, facilitating supportive school timetabling, and sharing integrated learning outcomes in the individual schools.     

生物化学与分子生物学本研教学一体化探索与实践

生物化学(Biochemistry)和分子生物学(Molecular Biology)课程是生命科学领域人才培养的基石。本研究以这些课程为桥梁,从知识框架重构、教学案例建设、教学资源共享、教学手段更新、立德树人格局的建立等方面入手,以学科特色科研成果案例和在线教学平台为支撑,通过课程教学实践,探索了以科研育人为导向,以课程建设为根基,以交流合作为推动力的本研一体化课程改革模式,搭建了“交流、实践、开放、信息化”的共享空间,实现了本、研教学以汲取知识为动力的自由、自主融合,使学生培养成效得到了提升。     

Combination of didactic lecture with problem-based learning sessions in physiology teaching in a developing medical college in Nepal

Physiology teaching as an essential part of medical education faces tremendous criticism regarding curriculum design, methods of implementation, and application of knowledge in clinical practice. In the traditional method of medical education, physiology is taught in the first year and involves little interdisciplinary interaction. The Manipal College of Medical Sciences, Pokhara, Nepal (affiliated with the Kathmandu Univ.) started in 1994 and adopted an integrated curriculum drawn along the lines of the student-centered, problem-based, integrated, community-based, elective-oriented, and systematic (SPICES) medical curriculum. Here, physiology is taught for the first 2 yr of the 4.5-yr Bachelor of Medicine, Bachelor of Surgery course. Methodology adopted is as follows. For a particular topic, objectives are clearly defined and priority content areas are identified. An overview is given in a didactic lecture class to the entire batch of 100 students. Tutorial classes are conducted thereafter with smaller groups of students (25/batch) divided further into five subgroups of five students each. In these sessions, a problem is presented to the students as a focus for learning or as an example of what has just been taught. Each problem was accompanied with relevant questions to streamline the students' thought processes. A tutor is present throughout the session not as an instructor but as a facilitator of the learning process. A questionnaire sought students' opinion on the usefulness of this approach, relevance of the combination of problem-based learning (PBL) sessions and didactic lectures in understanding a particular topic and relating clinical conditions to basic mechanisms, and improvement of performance on the university final examination. The majority of the students opined that the combination of didactic lectures and PBL sessions was definitely beneficial regarding all the above-mentioned aspects of learning. The university results corroborated their opinion. Thus it may be considered that a judicious mixture of didactic lectures and PBL sessions is beneficial as a teaching module of physiology in medical schools.     

Effect of High-Fidelity Simulation on Medical Students’ Knowledge about Advanced Life Support: A Randomized Study

High-fidelity simulation (HFS) is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS), in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal perception of knowledge) and an objective section (measuring level of knowledge) containing 100 questions about algorithms, technical skills, team working/early warning scores/communication strategies according to ALS guidelines. All students participated in 3 frontal lessons before being randomized in group S, undergoing a HFS session, and group C, receiving no further interventions. After 10 days from the end of each intervention, both groups answered a questionnaire (post-test) with the same subjective section but a different objective one. The overall number of correct answers of the post-test was significantly higher in group S (mean 74.1, SD 11.2) than in group C (mean 65.5, SD 14.3), p = 0.0017, 95% C.I. 3.34 – 13.9. A significantly higher number of correct answers was reported in group S than in group C for questions investigating knowledge of algorithms (p = 0.0001; 95% C.I 2.22–5.99) and team working/early warning scores/communication strategies (p = 0.0060; 95% C.I 1.13–6.53). Students in group S showed a significantly higher score in the post-test subjective section (p = 0.0074). A lower proportion of students in group S confirmed their perception of knowledge compared to group C (p = 0.0079). HFS showed a beneficial effect on knowledge of ALS among medical students, especially for notions of algorithms and team working/early warning scores/communication.     

Evaluating the impact of physical renovation, computerization, and use of an inquiry approach in an undergraduate, allied health human anatomy and physiology lab

This paper describes and evaluates a major renovation of a human anatomy and physiology lab for allied health students. A Howard Hughes Medical Institute award funded an extensive collaboration between faculty involved in teaching the course and faculty with expertise in industrial and furniture design. The resulting physical lab has unique features designed to improve work in groups, student movement, and integration of computers with wet laboratories. The anatomy curriculum was switched from fetal pig dissections to the use of human cadavers, computer animations, and plastic models. An inquiry approach was integrated into the physiology curriculum. Student attitude surveys suggest that the physical and curricular changes resulted in a significant increase in student learning. An experiment designed to specifically test the effect of new vs. old equipment did not support a benefit to new equipment independent of changes in the lab physical environment and curriculum. Because the improvements in student attitude surveys occurred in the physiology but not the anatomy labs, we suggest that at least a portion of the increase is due to the institution of the inquiry approach.     

Improving achievement through problem-based learning

In this study, the effect of problem-based learning on students' academic achievement and performance skills in a unit on he human excretory system was investigated. Sixty-one 10th grade students, from two full classes instructed by the same iology teacher, were involved in the study. Classes were randomly assigned as either the experimental or the control group and were pre- and post-tested to determine their academic achievement and performance skills before and after the treatment. The experimental group was taught with problem-based learning while the control group received traditionally-designed biology instruction. Results showed that although there was no pre-existing difference between two groups, students instructed with problem-based learning earned significantly higher scores than those instructed with traditionally-designed biology instruction — in terms of academic achievement and performance skills. Students in the experimental group appeared to be more proficient in the use and organisation of relevant information, in constructing knowledge and moving toward better conclusions.     

An integrated,modular approach to data science education in microbiology

We live in an increasingly data-driven world, where high-throughput sequencing and mass spectrometry platforms are transforming biology into an information science. This has shifted major challenges in biological research from data generation and processing to interpretation and knowledge translation. However, postsecondary training in bioinformatics, or more generally data science for life scientists, lags behind current demand. In particular, development of accessible, undergraduate data science curricula has the potential to improve research and learning outcomes as well as better prepare students in the life sciences to thrive in public and private sector careers. Here, we describe the Experiential Data science for Undergraduate Cross-Disciplinary Education (EDUCE) initiative, which aims to progressively build data science competency across several years of integrated practice. Through EDUCE, students complete data science modules integrated into required and elective courses augmented with coordinated cocurricular activities. The EDUCE initiative draws on a community of practice consisting of teaching assistants (TAs), postdocs, instructors, and research faculty from multiple disciplines to overcome several reported barriers to data science for life scientists, including instructor capacity, student prior knowledge, and relevance to discipline-specific problems. Preliminary survey results indicate that even a single module improves student self-reported interest and/or experience in bioinformatics and computer science. Thus, EDUCE provides a flexible and extensible active learning framework for integration of data science curriculum into undergraduate courses and programs across the life sciences.     

Can learning style predict student satisfaction with different instruction methods and academic achievement in medical education?

The curriculum of our medical school has a hybrid structure including both traditional training (lectures) and problem-based learning (PBL) applications. The purpose of this study was to determine the learning styles of our medical students and investigate the relation of learning styles with each of satisfaction with different instruction methods and academic achievement in them. This study was carried out with the participation of 170 first-year medical students (the participation rate was 91.4%). The researchers prepared sociodemographic and satisfaction questionnaires to determine the characteristics of the participants and their satisfaction levels with traditional training and PBL. The Kolb learning styles inventory was used to explore the learning styles of the study group. The participants completed all forms at the end of the first year of medical education. Indicators of academic achievement were scores of five theoretical block exams and five PBL exams performed throughout the academic year of 2008-2009. The majority of the participants took part in the "diverging" (n = 84, 47.7%) and "assimilating" (n = 73, 41.5%) groups. Numbers of students in the "converging" and "accommodating" groups were 11 (6.3%) and 8 (4.5%), respectively. In all learning style groups, PBL satisfaction scores were significantly higher than those of traditional training. Exam scores for "PBL and traditional training" did not differ among the four learning styles. In logistic regression analysis, learning style (assimilating) predicted student satisfaction with traditional training and success in theoretical block exams. Nothing predicted PBL satisfaction and success. This is the first study conducted among medical students evaluating the relation of learning style with student satisfaction and academic achievement. More research with larger groups is needed to generalize our results. Some learning styles may relate to satisfaction with and achievement in some instruction methods.     

Self-reported confidence, attitudes and skills in practical procedures among medical students: questionnaire study

The aim of our study was to investigate the influence of gender, loss of academic year(s), confidence and attitudes of students on the clinical experience gained by undergraduate education. The survey was conducted during 2004 and 2005 in a sample of 182 students of the 5th and the 6th year at J.J. Strossmayer University School of Medicine in Osijek. The participants were grouped and matched according to their gender, regular studying, the number of time(s) student has performed certain practical medical procedure and the self-confidence arisen by performing one. Furthermore, participants were grouped and compared due to their own assessment of their own practical and theoretical medical knowledge, courses which provide them the least and oppositely--the most practical medical knowledge and their attitude toward current medical faculty curriculum on clinical courses as well as the possibilities of improving them. Fisher's exact test and chi2-test were used to estimate statistical differences between the groups and the parameters in research, while coefficient of contingency was introduced with the aim of defining their correlation. The results showed statistically significant differences between male students who performed more practical medical procedures than female (p < 0.001), non-repeaters performed medical procedures more often than repeaters (p < 0.001, C = 0.658) while repeaters thought higher of their theoretical knowledge than non-repeaters (p < 0.005). Data analysis showed statistically significant correlation between clinical experience and the level of confidence (C = 0.944). This study confirmed influence of male gender, regular studying, better opinion about one's own practical skills and higher confidence in one's own work on greater number of clinical skills performed during undergraduate education.     

Benefits of teaching medical students how to communicate with patients having serious illness: comparison of two approaches to experiential, skill-based, and self-reflective learning

Innovative approaches are needed to teach medical students effective and compassionate communication with seriously ill patients. We describe two such educational experiences in the Yale Medical School curriculum for third-year medical students: 1) Communicating Difficult News Workshop and 2) Ward-Based End-of-Life Care Assignment. These two programs address educational needs to teach important clinical communication and assessment skills to medical students that previously were not consistently or explicitly addressed in the curriculum. The two learning programs share a number of educational approaches driven by the learning objectives, the students' development, and clinical realities. Common educational features include: experiential learning, the Biopsychosocial Model, patient-centered communication, integration into clinical clerkships, structured skill-based learning, self-reflection, and self-care. These shared features - as well as some differences - are explored in this paper in order to illustrate key issues in designing and implementing medical student education in these areas.