This document discusses principles of curriculum development in medical education. It covers: 1) Goals of medical education which include meeting patient/society needs, balancing basic and clinical sciences, and developing knowledge, attitudes, and problem-solving skills. 2) Major changes in curricula over time from apprenticeship to discipline-based, organ-system based, and now outcome-based models. 3) Examples of outcome-based frameworks used internationally to define competencies in areas like patient care, medical knowledge, and professionalism.

1. Principles for
Curriculum Development
Hirotaka Onishi, MD, MHPE
International Research Center for Medical Education
Graduate School of Medicine, the University of Tokyo

2. Textbooks

3. What Did You Learn in the
Last Class?
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4. 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)

5. Educational System
Elementary School 6 yrs
Junior High School 3 yrs
High School 3 yrs
University 4 yrs (Medical, Dental,
Pharmaceutical Curriculum 6 yrs)

6. Medical Career
Medical School 6 yrs
Postgraduate Training 2 yrs
Fellowship 3-5? Yrs
Continuing Medical Education

7. 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

8. 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

9. 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

10. Why Outcome-based
Education?
 Information explosion
 Changing public expectation
 Accountability
 Informing curriculum decisions
 Integrating teaching and assessment
 Planning the continuum of education

11. Framework of
Outcome-based Education
Educational Environment
Support
Assessment
How to learn
(Methods)
What to learn
(Contents)
Medical
Students
Educational
Outcome

12. 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

13. Examples of OBE (2)
(CanMEDS 2000, 1996)

14. 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

15. 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

16. 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)

17. 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

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

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 to only 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

22. Group Discussion
 What was the model of the curriculum
you have experienced or known?
 Any idea of which direction health
professional education curricula goes.