What are the needs to be met by the training programme?

The needs to be met by a curriculum are often ignored or taken for granted. There are merits in stepping back and considering these. More attention needs to be paid to the mission of a medical school with regards to its social accountability and the extent to which it trains doctors to work in the community it serves.

The traditional curriculum may not train doctors who are motivated and equipped to work in rural areas. In Australia, Canada and other countries where this is seen as a healthcare need, significant resources have been allocated to support curricula and training facilities with an emphasis on medical practice in rural settings. Matching the education programme to healthcare needs is important and of concern not just for the medical school but also for the range of stakeholders including the government, the public at large and other healthcare professions. The role of the doctor and how he or she fits into the healthcare team should be pivotal in the creation of a medical programme.

Another issue that merits more consideration is the response by medical schools to globalisation and the international dimensions of medical practice. Schools need to recognise the greater mobility in the medical workforce and the importance of graduating doctors who have the skills necessary as global citizens.

What are the expected learning outcomes?

Key to a curriculum are the learning outcomes expected of the learner. We highlighted in Section 2 the importance of learning outcomes and the move away from an emphasis on the education process to an outcome-based education model where the emphasis is on the product. We looked at how learning outcomes can be expressed and communicated relating to technical competencies and clinical skills; approaches to practice embracing an understanding of the basic sciences, appropriate attitudes and decision-making strategies; and personal development and professionalism. Decisions about the learning outcomes should inform the answers to the questions that follow.

What content should be included?

With the rapid expansion of medical and scientific knowledge and the development of new specialties, information overload is now a major problem facing medical education. While the content has expanded, the time available in the curriculum has remained relatively constant. Decisions need to be taken regarding what is to be included in the core curriculum and what is omitted. There has been considerable debate about the coverage in the undergraduate curriculum of anatomy and other basic sciences and whether it is possible to provide an overview and necessary understanding without embracing the detailed basic science and anatomical knowledge covered in the past.

There will be an agreed core content which has to be mastered by all students, with opportunities to study other subjects through electives or student-selected courses, as described in Chapter 17.

Doctors can now readily access information when they require it, through the internet and other sources. The core content curriculum must provide students with the vocabulary, understanding and skills necessary to identify and interpret this information.

How should the content be organised?

With the learning outcomes and the content determined, the next step is to consider how the curriculum should be organised and the content sequenced. The traditional approach in medical education has been to introduce students first to the basic medical sciences and normal function, structure and behaviour of the human body. As students progressed through the curriculum to the later years, the focus was on abnormal function and the development of clinical skills. Later, students developed their clinical competence on the job as they managed patients. This sequence, while having much to commend it, has disadvantages. The relevance of the content is not obvious to the student and, as we discuss in Chapter 2, as a consequence the learning may be less effective. How content can be arranged and sequenced in a way that leads to more effective and efficient learning as students progress through their training is important and is covered in Chapter 12.

What educational strategies should be adopted?

Educational strategies may be seen as the key element in a curriculum with the curriculum labelled in terms of the educational strategy, e.g. a ‘problem-based curriculum’ and ‘a community orientated curriculum’. The SPICES model for curriculum planning identifies six educational approaches and presents each on a continuum (Fig. 11.1).

Fig 11.1 The SPICES model of educational strategies.

What teaching methods should be used?

In the medical curriculum, traditional teaching approaches include lectures, small group activities and clinical clerkships together with textbooks and other learning resources. All of these have a role to play. A more recent feature is the adoption of new learning technologies including e-learning and the use of simulators perhaps located in a clinical skills centre.

Student support for and learning from each other has always been a feature of the education process. A more recent development has been peer-assisted learning where students are formally involved in the education of their peers or more junior students.

A description of traditional approaches and the introduction of exciting newer methods is provided in Section 4.

How should assessment be carried out?

A key element in the curriculum and one that significantly influences students’ behaviour is assessment. It is essential that assessment matches closely the expected learning outcomes. Decisions have to be taken about the overall assessment strategy and the appropriate instruments to be adopted with this in mind. The objective structured clinical examination (OSCE) and assessment portfolios have been introduced to meet the need for more authentic and performance assessment instruments. Work-based assessment is growing in popularity particularly in postgraduate education. Section 5 describes established and newer approaches to assessment and the key issues that have to be addressed when an assessment programme is planned.

How should details of the curriculum be communicated?

With the increased sophistication of the undergraduate and postgraduate curriculum and the use of strategies such as problem-based learning and integration, students and trainees require assistance with understanding:

Teachers and trainers, too, may have difficulty in grasping their role in the process and in appreciating what is expected of their students in the phase of the programme for which they have responsibility.

If the curriculum is to succeed, effective communication about the curriculum and what is expected of teachers and students is necessary. This can be achieved through clear documentation and meetings with staff and students. The curriculum document should include:

What educational environment or climate should be fostered?

Important, but often ignored in the consideration of the curriculum, is the educational climate or environment. This is the overall atmosphere of the school or wherever learning is taking place. It embraces, for example, the extent to which students feel they are studying in a supportive or threatening environment and whether the environment encourages teamwork and collaboration, appropriate professional behaviour, and creativity. A number of instruments are available that allow the educational environment to be measured. This topic is discussed in Chapter 18.

How should the process be managed?

It should be obvious by now that the development and management of a curriculum is a substantial activity that requires careful planning and allocation of time and resources. Most medical schools and postgraduate bodies have recognised this and have set up committees charged with responsibility for the curriculum. A curriculum planning committee should represent all the stakeholders. Both hospital- and community-based interests should be represented, and junior and senior staff and students should be included.

Individual members of staff should be allocated responsibility for implementing the different aspects of the programme including:

It is important that staff who contribute to the education programme are recognised and rewarded for their efforts. This should include promotion on the basis of their contribution to teaching and the scholarship of education.

Educational programmes that are most successful have strong leadership from deans or clinical directors with support given by them for changes and innovations in the curriculum.

Reflect and react