02.Background for curriculum development
•Download as PPTX, PDF•
0 likes•70 views
Background for curriculum development in health professions education
Recommended
Recommended
More Related Content
What's hot
What's hot (18)
Similar to 02.Background for curriculum development
Similar to 02.Background for curriculum development (20)
More from 東京大学医学系研究科医学教育国際研究センター
More from 東京大学医学系研究科医学教育国際研究センター (20)
Recently uploaded
Recently uploaded (20)
02.Background for curriculum development
- 1. Background for Curriculum Development Hirotaka Onishi, MD, MHPE International Research Center for Medical Education Graduate School of Medicine, the University of Tokyo
- 2. Textbooks
- 3. Goals of Medical Education Begin with patient/society needs Balance between basic sciences, clinical studies, and clinical practice Balance of knowledge, attitude, and skills Not only recalling information but also using it to solve problems (deep knowledge)
- 4. Educational System Elementary School 6 yrs Junior High School 3 yrs High School 3 yrs University 4 yrs (Medical, Dental, Pharmaceutical Curriculum 6 yrs)
- 5. Medical Career Medical School 6 yrs Postgraduate Training 2 yrs Fellowship 3-5? Yrs Continuing Medical Education
- 6. Name of Medical Education for Each Career Level in Japan Undergraduate Medical Education Preparatory Subjects Basic Sciences Clinical Medicine Postgraduate Medical Education Residency Fellowship Entrance Exam CAT License Exam
- 7. Major Changes in Medical Education Curricula 1. Until 1850: Basically OJT (on-the-job training) Basic science was not developed widely 2. 1850~1950: Discipline-based curriculum Microbiology, Physiology, Public health… 3. 1950s~60s: Organ-system-based curriculum Cardiology, Gastroenterology… Basic science and clinical medicine are integrated 4. 1970s~: PBL（problem-based learning） Faculty-resource-intensive 5. 2000~: Outcome-based education
- 8. Innovative Curriculum The SPICES model Harden, 1984 Systematic Traditional Student-centred Teacher-centred Problem-based Passive acquisition Integrated Discipline-based Community Hospital-based Elective Standardized Systematic Opportunistic
- 9. Framework of Outcome-based Education Educational Environment Support Assessment How to learn (Methods) What to learn (Contents) Medical Students Educational Outcome Harden, 1999
- 10. Why Outcome-based Education? Information explosion Changing public expectation Accountability Informing curriculum decisions Integrating teaching and assessment Planning the continuum of education
- 11. Examples of OBE (1) 6 outcomes of Postgraduate training: ACGME (Accreditation Council for Graduate Medical Education) ACGME Outcome Project: http://www.acgme.org/Outcome/ Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice
- 12. Examples of OBE (2) (CanMEDS 2000, 1996)
- 13. Examples of OBE (3) IIME (Institute for International Medical Education): GMER (Global Minimum Essential Requirements) in medical education Med Teach 2002, 24, 130–135 Clinical Skills Population Health Scientific Foundations Professional Values, Attitudes Critical Thinking Information Management Communication Skills
- 14. Examples of OBE (4) The Scottish Deans’ Medical Curriculum Group’s Three circle model (Simpson et al. Med Teach 2002, 24, 136-143) Medical informatics Patient management Patient investigation Clinical skills Communication Practical procedures Health promotion and disease prevention Personal development Role of the doctor within the health service Attitudes, ethical understanding and legal responsibilities Decision-making skills and clinical reasoning and judgement Basic, social and clinical sciences and underlying principles
- 15. Points of OBE Integrated competencies (e.g. critical thinking and professionalism) are more clearly targeted. Assessment for comprehensive performance is more emphasized Nowadays “competency” is often used instead of “outcome” if mentioned for curriculum (e.g. competency-based curriculum)
- 16. Quality Assurance of Medical Education in Japan Admission policy Combination of nationwide achievement test and schools’ own examination (most have interview) Diploma (graduating) policy No external examiner, schools’ own policy Institutional systems for quality assurance Not specific National standards for quality assurance Guidelines for curriculum: Nationwide core curriculum + Common Achievement Test (for 4th year) Quality assurance for undergraduate clinical teaching is difficult to implement
- 17. What is accreditation? All the higher education institutes must prove their quality of education. Each faculty/school must check if the education system follows detailed educational standard and issues an inspection report. Professional evaluators visit the faculty/ school to check if any gaps between the report and the site visit. After evaluators confirm the level of the faculty/school, they issue a certification. In another 5 to 10 years’ period each faculty/school must take the next accreditation.
- 18. Accreditation System in Japan In 2002, the Higher Education bureau, MOE declared the amendment of the 3rd paragraph of Article 69 of the School Education Act. All the universities have to undergo self- evaluation process and accreditation by a certified body every 7 years. This has become effective since 2004. No specific accreditation system for medical education until 2017, when JACME was started.
- 19. Program Accreditation in Japan Post-graduate professional schools (Law, Business, Accounting, and Midwifery) must undergo self-evaluation and take external “program evaluation” by accreditation bodies every 5 years according to the School Education Act. Program certification only for post-graduate professional schools.
- 20. Pharmaceutical Education Accreditation in Japan Japan Accreditation Board for Pharmaceutical Education (JABPE) is now starting self-evaluation. Full-scale external evaluation will start in 2012. After 2012, all pharmacy schools will take accreditation. Program certification by JABPE is voluntary activities. They are non-governmental bodies. These activities aspire their educations to be fit to their global standards.
- 21. Why Accreditation? To assure the standardized medical education To prepare for practitioners’ mobility to another country In 2010 ECFMG states that all the examinees must graduate from internationally accredited medical schools after 2023 https://www.ecfmg.org/accreditation/
- 22. Wrap Up Historically medical education curricula have been changed with the change in the basic science, educational theory/ concept, etc. Nowadays outcome (competency)-based education is a trend. For quality assurance accreditation for each university/school/faculty is another change. In Japan accreditation system for medical curricula was started in 2017 by JACME.
Editor's Notes
- These are reference books for this class. You do not have to buy them but they help you understand the contents if you like.
- This is the figure of whole educational system including primary education (elementary school), secondary education (junior high and high school) and higher education. 12-year primary and secondary education is also called as K-12 (from kindergarten). In higher education level, students have to spend at least four years to complete the study. Medical, dental and pharmaceutical curricula is set as six years.
- As for the medical career, after six years of medical school they take medical license examination in Japan. After they pass the exam they must go through two-year mandatory training to be registered as a medical doctor by the Ministry of Health. After that many doctors enter any residency program for 3-5 years. Some specialties like internal medicine have also subspecialty training such as cardiology, gastroenterology, etc. to become a subspecialty specialist. After such programs, medical doctors should take continuing medical education to maintain their knowledge and skills for the future practice.
- This is the relationship between the curricula and related assessment systems. All the applicants must take entrance examination for their preferable medical schools. Most applicants take the test provided by the national test center and also the test prepared by each medical school. CAT stands for Common Achievement Test, for those who completed all the preclinical education courses. Here clinical medicine means practical training for medical students, so preclinical education includes in-class education of clinical medicine. CAT consists of CBT (computer-based testing) and OSCE (objective structured clinical examination). The same system is applied for dental and pharmaceutical students. Final-year health professional students can take license examination. Currently license examination has only paper-based multiple-choice questions (MCQs).
- This is the slide for the changes in medical education curricula. Before 1850 all the training was on-the-job, that means students helped senior doctors practice in the clinical settings and learned how such role models were doing. No formal education was offered because at that time theoretical background was too weak to teach. In the middle of 19th century, microbiology, physiology, public health, etc. had developed as basic sciences for medical practice. They became discipline for clinical medicine taught in the training facilities such as colleges or universities. In that period, basic sciences (anatomy, biochemistry, pathology…) and clinical medicine (internal medicine, surgery…) were separated. This system is called as discipline-based curriculum. Such education was continued for about 100 years but some medical schools are still using this system. In 1951 Case Western University in Ohio State, the USA, has started organ-system-based curriculum. The main difference from discipline-based education is to integrate basic sciences and clinical medicine in each organ-based system. For example, cardiology course has anatomy and physiology of heart and vessels, how to have medical interview with heart disease patients, etc. In the discipline-based curriculum, some students feel less motivated because they feel difficulty in using the knowledge of basic sciences only for heart disease patients. In late 1960s McMaster University in Canada has started problem-based learning. PBL consists of scenario-based group discussion and self-learning after small-group activity. Normally faculty facilitator does not teach the student but just give students feedback or directional change so students will be able to learn by themselves. This is related with the paradigm change of education into student-centered system. However, some medical schools adopted PBL but abolished after several years because it is too faculty-resource-intensive. From 2000 onward, outcome-based education becomes a major curricular framework. Both students and teachers target at from 5 to 12 outcomes or competence domains as the requirement for each student. Outcomes mostly include public health, professionalism, etc. because they are regarded very important in every context.
- SPICES model was proposed by Professor Harden in 1984. Traditional curricula were using mainly right items but Harden told left items would be more innovative and demanded by future students. Student-centered, problem-based and integrated curricula are described in the previous slide. Community-based education became more important because patients’ length of stay became shorter and it would be very difficulty for students to understand the longer clinical course of the patients. Elective curricula is one of the basic concepts of student-centered curriculum. Systematic curriculum means quality assurance of students’ learning. For example, if clinical students do not directly see SLE patients, their learning for such patients may have weakness. To fill such a gap, medical educators are able to use simulation, virtual patient (computer software of clinical reasoning with patients’ information), case-based discussion, etc.
- This is the figure of outcome-based education. Please imagine the level of freshman medical students in the beginning. To train them to be an independent physician, you should consider assessment and educational environment first related with the outcomes, and then construct what to learn and how to learn.
- These are the reasons why outcome-based education is needed. The amount of information needed for medical students became much more than before. People think they need more patient safety than before because around the year 2000 medical accidents became more publicly known issues. Accountability for medical education is also more demanded. Local governments see medical education more critically so disclosing key information became more popular. From educational changes, integration of teaching and assessment became more important than before. Continuum of medical education from undergraduate to postgraduate and life-long learning is also a newer topic.
- ACGME is the accrediting body for the graduate education (residency) in the USA. They proposed this 6 outcome model in 1998. Outcome project has much information regarding assessment tools, lower level competencies, etc.
- CanMEDS 2000 is an initiative to make medical education outcome-based. Their outcomes seem more nonspecific and vague statements.
- IIME is the medical education institute of worldly renown medical educators and Chinese leaders working in the US. When they proposed GMER, some medical educators protested the movement because they thought the same global framework for medical education seems unrealistic for developing countries.
- Not only the north American countries but also UK have initiated the movement of OBE. Three-layers of circle are more concrete for students and teachers to understand.