Several factors contribute to the trend toward earlier clinical learning in undergraduate medical education programs. This excerpt outlines factors driving significant change at a large Caribbean medical school which prepares students for practice in the United States-consistent with adult learning theory.

1. EARLY CLINICAL LEARNING:
WHAT FOR, WHAT IF, AND HOW?
Sharon Morang, MBA-Director of Curriculum
James Grogan, PhD-Assistant Dean of Curriculum
Mary Coleman, PhD, MD-Dean
Association for Medical Education in Europe
Glasgow, Scotland
2010

2. The medical university is a propriety school held by a publicly traded company
with commitment toward developing healthcare education leadership.
Enrollment is nearly 400 students per entering class, beginning three times per
year.
1. Large percentage (65%) enter primary care
2. Student body and faculty are diverse
3. Faculty work assigned is primarily teaching
4. The education program occurs in
geographically distinct regions:
a. Basic sciences in the
Caribbean region
b. Clinical clerkship training
in the United States
What is unique?

3. Background
Several factors contribute to the trend toward earlier clinical learning in undergraduate medical
education programs. We outline factors driving significant change at a large Caribbean medical school
preparing students for practice in the United States that are consistent with adult learning theory.
Summary of Work
Planning for curriculum change has involved modification of the existing clinical education program and
increased emphasis on learning competencies related to professionalism, systems, improvement, and
patient centered care. Factors which were challenging in creating a strategy toward inclusion of greater
clinical learning were increased class sizes and faculty ambivalence towards change.
Summary of Results
We summarize measures and parameters of these factors which have led to formulation of plans for
curricular change.
Conclusions
The resulting program implementation suggests that students’ earlier clinical learning experiences can
be improved by enhancing existing programs, such as community medicine projects and problem-
based learning, while also implementing new early learning experiences through the use of
standardized patients and simulations.
Abstract

4. Recommendations
from Accrediting Institute of Medicine
Greater emphasis on
competencies, clinical Organizations recommendations
education, and EBM
Increase early clinical
exposure Address patient
Proposed safety, systems,
changes to Drivers for cultural
Licensure Exam Change competence,
science
40% first time foundations
pass rate
Inadequate writing
and examination
Feedback from
skills Student performance on
Clinical Faculty
internal assessments
regarding student
(Comprehensive NBME)
preparation
Drivers of Curriculum Change
These drivers were integral to underscoring the need for change while
providing an opportunity to apply adult learning theory.

5. Outcomes of Curriculum Revisions
Greater requirements for written case histories
Creation of a Department of Integrated Medicine
Doubled semester 3 clinical exposure
Expansion of hi-fi simulation and task-trainers into first 4 semesters
Hired more US trained clinicians and visiting faculty
Initiated Standardized Patient Program
Use of WebSP and Doc.com for feedback on clinical skills
Addition of service learning to allow more contact with real patients
Adoption of an organ systems-based curriculum

6. What went well:
 Key changes implemented:
 Engagement of faculty in module
development teams across departments.
.
 Increased number and feedback on
written case histories (H & Ps) for
students.
..
 Adoption of team approach to integrated
interactive clinical cases that emphasize
relevance of basic science concepts and
applications to clinical medicine.
 Clarification of processes and ideas
through workshops:
.
 Simulation
..
.
 Utilization of technology software to
 Clinical Cases improve education
 Support of students by participation in  Incremental change process with respect
development teams for requested implementation delays
Reflections on Transition
Process

7. Barriers to Change
A. Lack of engagement of all
department chairs
B. Increased enrollment
simultaneous with curriculum
change with closing of a second
campus
C. Unclear communications to
students regarding registration
caused delays in implementation
D. Not all faculty provided new
learning objective to support the
implementation
Reflections continued…

8. 1. Clinical learning experiences were increased demonstrating the
application of adult learning theory.
2. In an environment of sustained growth in student numbers, making
curricular changes is challenging and evokes strain on mid-level
administration.
3. Despite efforts to communicate reasons for change and processes to
achieve outcomes, morale was a continual challenge.
4. Curricular change needs resources such as software technology to
support database maintenance and extra administrative assistance.
5. Changes not directly related to original goals can be implemented during
periods of curriculum change.
6. Incremental changes contribute to easing anxiety amongst faculty
toward curriculum change.
Findings

9. References
Grant, J. (2006). Principles of curriculum
design. Understanding Medical Education
monograph series. Oxford: Education,
Blackwells Press.
AAMC. (2008). Recommendations for Clinical
Skills Curricula for Undergraduate Medical
Education. Association of American
Medical Colleges.
Merriam, S., Caffarella, R. & Baumgartner,
L. (2007). Learning in Adulthood: A
comprehensive guide, 2nd edition. San
Francisco: Jossey-Bass.