Core curriculum

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Core curriculum

• Fadhil Alamran, MRCS glasg, FIBMS, postdoctoral
  fellowship Colorado university, cardiothoracic
  surgeon M.D.

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The drug, doctor

• The idea that the patient responds, not just to
  a pharmacological substance, but to the person of
  the doctor the atmosphere the doctor generates
  and what the interaction means to both of them
  ------this is the aim of ideal core of curriculum

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Overview
A powerful strategy in medical education Core
(SSMs) special study modules or (SSCs) Student
Selected Components
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This strategy curriculum overload, knowledge,
skills and attitudes allows students to take
more responsibility provides a curriculum
framework
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Background information explosion -
intolerable burden for the student. Curriculum
developers need to make provision for the
inclusion of new topics such as palliative care
without neglecting traditional course content
such as anatomy. There is also an increasing
recognition that while students may not be able
to study all areas in depth, there is a need to
provide an opportunity for them to have time
scheduled to study some subjects in more depth
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Core curriculum
What is the Core Curriculum? There are
different perceptions of what constitutes core
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Core as essential aspects of all subjects or
disciplines the key aspects of the subjects
studied in the curriculum. Core as essential
competences for practice Core as a study
of what are perceived as the key disciplines
Core as transferable areas of study relevant
to many disciplines
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The concept of the core curriculum and options or
SSMs be described as the seven Cs
Certification Capability Comprehensiveness.
Consistency. Constructivism Choice
Compacted curriculum
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Determination of core A range of
stakeholders can contribute to what should be
included in a core curriculum. government, the
public, the professions, students and teachers
within an institution The importance of the
topic in key decisions to be taken by a doctor
The commonness or rarity of the problem The
extent to which one can generalise from the
subject to other topics in medicine. The core
curriculum will change with time and should
reflect medical trends and changes
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Advantages
Core (SSMs) special study
opportunity for students to study in greater
depth an area of their choosing
integrated themes, giving a multidisciplinary
and multiprofessional direction to the
curriculum.
SSMs recognise the importance of generic
competences or transferable skills
SSMs allow significant extension of the range of
subjects or topics covered in the curriculum
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Advantages, contin.
SSMs can utilise a range of teaching resources
SSMs can be attractive, both to staff and
students.
A menu of interesting SSMs may attract potential
students and influence their choice
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Topics covered in SSMs

• An extension of the core
• ii) A topic related to medicine but not
  included in detail in the core eg,
• computing, information technology, history of
  medicine.
• iii) A topic not related directly to medicine
  eg a foreign language, business

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Important criteria for the selection of SSMs
contribution they can make to overall course
learning outcomes
availability of suitable resources in the
medical school.
Is the subject consistent with the schools
learning outcomes
Might the SSM help the students in their choice
of a future career?
Does the SSM lead to mastery of learning skills,
and information retrieval relevant to the
practice of medicine?
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Management of SSMs

• At least one senior member of staff must have
  their organisation and coordination as a major
  personal responsibility. This person must have
  the authority of the appropriate committees
  within the university.
• Adequate resources must be made available, eg
  finance, library facilities etc.
• There should be some flexibility in the
  duration of SSMs, eg, one, two or four weeks or
  longer.

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Management of SSMs contin.

• The number of SSM slots offered should be
  greater than the number of places required by
  students.
• Guidelines and advice should be offered to
  students concerning their choice of SSMs and what
  is expected of them.
• SSMs should be assessed as stringently as the
  core, preferably with an external examiner.

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Relationship between Core and SSMs

• Four approaches can be identified to implement a
  curriculum with core and SSM components. Each
  has its advantages and disadvantages.

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Relationship between Core and SSMs contin.

• Integrated Approach
• Concurrent Approach
• Intermittent Approach
• Sequential Approach
• Students proceed to SSMs only when they have
  demonstrated mastery of the core.

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Time allocation for Core and for SSMs

• SSMs take up between 20-40 of the
  curriculum. The balance between core and SSMs
  will be influenced by, among other things, the
  amount of core to be covered and the resources
  available to provide a wide range of learning
  opportunities.

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Student Assessment

• Students should be expected to demonstrate a high
  level of mastery of the core of a course on
  completion of the curriculum. The assessment
  should be competetive and using MCQs and case
  study is more accurate in assessment even sor
  basic science
• In the assessment of SSMs, decisions must be
  taken as to whether to adopt a pass/fail system
  or a grading system and how that influences the
  overall assessment of students. The assessment
  may be a written test, essay, dissertation, oral
  or practical exam. External examiners are
  important in helping to maintain standards
  comparable between different SSMs.

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Postgraduate studies core -SSMs

• Increasing demands on postgraduate training,
  with greater specialisation, rapid expansion, new
  developments in medicine and time constraints,
  are arguments for the introduction of a core
  training programme with SSMs. For greater
  emphasis on teaching and on research.

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Need to integrate the core

• Students basic scientific knowledge ? in the
  traditional core is inadequate for clinical
  medicine this is from feedback of the european
  and american core curriculum in the previous
  decade

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Integration of the core Evidence of
Integration

• Genetics
• Anatomy
• Biochemistry
• Microbiology
• Immunology Pathology
• Pharmacology
• Physiology
• Neuroscience

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Basic Sciences Integration What and how?

• Systems
• Organ Biological
• Molecular to cells, tissues, and systems
• From normal to abnormal biology
• Integration of normal and abnormal biology
• Integration of different disciplines

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Integration of core will lead to integration of
assessment

• Using clinical problem solving questions for
  first year studentent

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A miraculous rescue

• An 8-year old boy, Maurice, has been lying under
  water for more than 15 minutes. Fortunately a
  passer-by succeeds in bringing him out of the
  water. Mouth-to-mouth resuscitation is applied
  immediately. Everyone is astonished to notice
  that the boy is still alive. At the moment
  Maurice is on the intensive care ward of the
  local hospital and is out of danger of life.
  According to his medical attendant, he is
  expected to recover completely.
• Explain why it is possible for the boy to survive
  after lying under water for more than 15 minutes

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Assessment of efficacy of the Core

• Communication skills holy grail and final end
  result for the assessment of Core is through
  clinical skill of graduate

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Assessing clinical skills

• WHY do we need to assess ?
• WHAT do we want to measure ?

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WHY do we assess ?
In principle

• To ensure safety of patients
• our responsibility to the public
• Achievement of a minimum standard
• responsibility to the candidate and University

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WHY do we assess ?
In practice the purpose

• Formative to give feedback and advice regarding
  the core
• Summative to grade
• Qualificative or licensing

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WHAT do we measure ?
In principle

• To test not only presence of knowledge
• but also the application of knowledge and the
  core

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Aim of clinical assessment
In principlea four-fold aim

• Certification of competence - pass / fail
• a state (and legal) requirement
• Grading in rank order
• for employment / placement purposes
• A competition for the award of a prize
• Feed back for core competency

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OSCE assessment is valuable for core assessment

• At least 6 clinical stops with different clinical
  situations
• Two examiners at every encounter, each examiner
  giving an individual assessment
• Highly structured examination and detailed
  assessment of skills
• Examiners from other Universities for process
  evaluation and quality control

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What happens to candidates who fail ?

• Review of performance a formative exercise
• Counselling at a personal level
• Specific attention and individual training
• Repeat assessment after a period of time
• Common candidate failure causes should give feed
  back to the core assessment

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Conclusion

• liberate the medical curriculum
• The introduction of core and special study
  modules allows great efficiency in the use of
  time and facilitates achievement of significant
  and highly desirable curriculum objectives.

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Conclusion contin.

• Integration of the core is mandatory need to
  counteract information explosion
• Integration of assessment is a sequele
• assess clinical competences is good feedback for
  core competency