Changing face of medical curricula

doi:10.1016/S0140-6736(00)04134-9

The Lancet

Volume 357, Issue 9257, 3 March 2001, Pages 699-703

https://doi.org/10.1016/S0140-6736(00)04134-9 Get rights and content

Summary

The changing role of medicine in society and the growing expectations patients have of their doctors means that the content and delivery of medical curricula also have to change. The focus of health care has shifted from episodic care of individuals in hospitals to promotion of health in the community, and from paternalism and anecdotal care to negotiated management based on evidence of effectiveness and safety. Medical training is becoming more student centred, with an emphasis on active learning rather than on the passive acquisition of knowledge, and on the assessment of clinical competence rather than on the ability to retain and recall unrelated facts. Rigid educational programmes are giving way to more adaptable and flexible ones, in which student feedback and patient participation have increasingly important roles. The implementation of sustained innovation in medical education continues to present challenges, especially in terms of providing institutional and individual incentives. However, a continuously evolving, high quality medical education system is needed to assure the continued delivery of high quality medicine.

Section snippets

Changes in medicine and society

However indebted new doctors are to individual teachers, few will leave medical school confident that their own medical course has prepared them completely for their chosen career. Whether or not it is inevitable that the curriculum lags behind this challenge, there is no doubt that the content of current courses is under pressure from numerous external forces. Shifts in disease patterns and personal goals are continually altering what society expects of its doctors. The delivery of health care

Changes in curriculum design

The prototype medical curriculum in Europe was a first degree course lasting 5–7 years in which basic sciences, taught in the early years, were sharply demarcated from clinical exerience and learning, whereas a 4-year postgraduate course was the norm in USA. In the clinical years, hospital specialties dominated, and there was little scope for students to pursue individual interests. There was also often little regard for the needs and expectations of the health-care system in which the medical

Changes in curriculum content

The General Medical Council's (GMC) report Tomorrow's Doctors,⁹ sets out 13 principal recommendations, which have had a major impact on curricula in UK and beyond. Central to the GMC's recommendations is that the burden of factual information imposed on students should be substantially reduced. The GMC recommends learning through curiosity rather than by rote, and stresses the importance of encouraging appropriate attitudes of mind and behaviour. Proficiency in clinical skills is linked to the

Changes in curriculum delivery

As passive absorption of didactically-delivered information has been replaced with active learning, based on curiosity and problem solving, so the teaching methods used to deliver today's medical curricula have also changed. Integrated, problem-based curricula were piloted in sites in North America such as McMaster, and now form the core teaching methods of many universities, including Manchester²⁶ and Liverpool.¹⁸ In Australia, six of the 11 medical schools use problem-based learning; the

Implementing curricular change

The challenges of implementing and sustaining curricular reform are well recognised and have been described in a number of studies. At the University of Washington, for example, “curricular drift” developed 5 years after a major curricular reform, with both basic scientists and clinicians showing regression to the mean in terms of reintroducing teaching topics, and expanding teaching time, partly in response to financial pressures. At the University of Trondheim, Norway, the introduction of a

Undergraduate and postgraduate curricula

The concept of a spiral curriculum in which topics are visited and revisited at time intervals, at different levels of intensity, and often with a different emphasis—eg, basic science, pathology, clinical science—has been important in curriculum design in many schools, and also in understanding the relation between undergraduate teaching and postgraduate training.³⁰ A medical course designed to produce a “stem” or “pluripotential” doctor is followed by a programme of specialist or generalist

Achieving change

Medical education is changing rapidly, and many challenges remain for the future. Leadership of change is essential; balancing the need for academic stability, to build up a core of respected and skilled teachers, is at the centre of effective curriculum reform.

Feedback from students and patients is critical. Students will not know initially what they have to face and many parts of the curriculum, clearly vital, will often seem unpopular, so that excellent communication between staff and

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SeriesChanging face of medical curricula

Summary

Section snippets

Changes in medicine and society

Changes in curriculum design

Changes in curriculum content

Changes in curriculum delivery

Implementing curricular change

Undergraduate and postgraduate curricula

Achieving change

Medical curricula in European countries

WHO European Center for Integrated Health Care Services

Can general internal medicine be taught in general practice? An evaluation of the University College London model

Med Educ

Academic medicine meets managed care: a high-impact collision

Acad Med

The patient-centredness of consultations and outcome in primary care

Br J Gen Pract

Revalidation for doctors in the United Kingdom: the end or the beginning?

BMJ

Revalidation in Australia and New Zealand: approach of Royal Australasian College of Physicians

BMJ

Revalidation of doctors in Canada

BMJ

The primary care specialties working together: a model of success in an academic environment

Acad Med

Tomorrow's doctors: recommendations on undergraduate medical education

Medical students' evaluations of curriculum innovations at ten North American medical schools

Acad Med

Psychological stress and burnout in medical students: a five-year prospective longitudinal study

J R Soc Med

US graduate medical education, 1999–2000

JAMA

The consortium of graduate medical schools in Australia: formal and informal collaboration in medical education

Med Educ

Problem-based medical education: development of a theoretical foundation and a science-based professional attitude

Med Educ

[Medical education in Norway: one common education, four different models]. [Norwegian]

Tidsskrift Norske Laegeforening

Series
Changing face of medical curricula