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Curriculum development in medicine (Problems with undergrad curriculum…
Curriculum development in medicine
Flexner report of 1910 highly influential
Wise words: "The physician's function is fast becoming social and preventative, rather than individual and curative"
Curriculum on paper, curriculum in action and curriculum that is experienced
Curriculum as people's reactions and responses to the intention of education
Problems with undergrad curriculum
Factual overload
Inappropriate processes
Lack of structure
Lack of integration
Lack of relevance
The emergence of PBL as the quasi standard
Post-grad issues
Preparedness for practice
Structural issues (e.g. internships, residencies)
Competency-based education
What is it for??
Things specific to professional education
Concepts similar to quality improvement
"The practical knowledge made available through tradition is not mechanically or passively reproduced: it is constantly being reinterpreted and revised through dialogue and discussion about how to pursue... the tradition"
Also think the true expert v the experienced non-expert
Must learn to exercise judgement
The doctor first determines what is the right thing to do... then moves (often imperceptibly and very quickly) towards deciding what the best thing to do is in the particular instance. [Is this System 1 and 2 thinking at play?]
Good practice entirely dependent upon phronesis - "practical wisdom". Some teaching programs and curriculum don't get the learners to this level.
Model to cultivate the educated practitioner (true expert)
"Wise teacher works imperceptibly in all three models, drawing on each for particular educational purposes"
Stenhouse model
Product
Process - appropriate where the curricular intention is to help people understand what is being taught
Research - harder to depict, probably the most appropriate curriculum model for learning medicine at any level
The problem of implementation
There is a disconnect translating the curriculum into practice
A vision
For curriculum initiators. Curriculum should demonstrate how:
Teachers and learners will be prepared
Resources are made available
These resources are going to work
Evaluation is going to improve things
For teachers and learners
They are central to the effectiveness of the curriculum
Practice implications:
Must understand the principles of curriculum development
Learn from the mistakes of the past
To date most curriculum dev has taken a top down approach
Authentic medical practice should be the primary focus
Knowledge underpinning performance is highly complex
Knowledge acquired separate from practice is largely ineffective
The "research model" most appropriate for teaching/learning medicine
Learning medicine is best done through relationship of learner and teacher
Minimum specs are appropriate
Curriculum should be conceived as that which underpins effective teaching and learning