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Emerging Trends in Medical Education. Khalid Bin Abdulrahman, MD Professor of Family Medicine & Medical Education Dean, College of Medicine Al-Imam University, Riyadh. Saudi Arabia. Emerging Trends. Changes. Emerging trends . Previous state. Reasons Status .

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Emerging trends in medical education l.jpg

Emerging Trends inMedical Education

Khalid Bin Abdulrahman, MD

Professor of Family Medicine & Medical Education

Dean, College of Medicine

Al-Imam University, Riyadh. Saudi Arabia


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Emerging Trends

Changes

Emerging trends

Previous state

Reasons

Status


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Emerging Trends in Medical Education

Changes

Emerging trends in medical curriculum

Traditional medical curriculum

Reasons

Status

How/Problems


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New Trends in:

  • curriculum development

  • faculty development

  • teaching & learning

  • clinical training

  • student selection

  • student assessment

  • student support

  • leadership & management


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The Key Challenges in Health Reform

  • Relevance:

  • Quality:

  • Cost-effectiveness:

  • Equity:


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Historical update … What brought us to where we are today

"[Medical Schools have] the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public."

World Health Organization, 1995


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Dr. Charles Boelen, Chief Medical Officer for WHO's

Programme on Educational Development of Human Resources for Health in Geneva,

published an article entitled "The Five Star

Doctor" in the June 1993 issue of the WHO Journal of "Changing Medical Education and Medical Practice".


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The Emerging of the FIVE-STAR DOCTOR

The five-star doctor is;

  • Care provider

  • Decision-maker

  • Communicator

  • Community leader

  • Manager


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Emerging Trends in UK

Strong partnerships between universities and NHS

Education Institutes rather than departments

Authentic Clinical Skills Labs

Vertical Integration of Basic Sciences

Support for all Transitions

European Option

con’t…


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Emerging Trends in UK

Portfolio Assessments

Links with Public and International Health

High % of community-based teaching

Few full-time staff, multiple individual contracts for teaching



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New curriculum models

  • Defined by organization of content

    • integrated, organ-based curriculum

    • integrated, clinical presentation/task-based curriculum

    • age-based developmental curriculum

  • Defined by teaching/learning method

    • problem based curriculum

    • case based curriculum


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New curriculum models

  • Defined by teaching/learning approach

    • core and optional model

  • Defined by learning objectives

    • competency/outcome based curriculum

  • Defined by social responsibility

    • community oriented curriculum


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Curriculum models

  • Discipline based curriculum

  • Coordinated thematic curriculum

  • Problem-based curriculum

  • Task-based curriculum

  • Outcome-based curriculum

  • Competency oriented curriculum

  • Objective-based curriculum


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years

years

6

6

Clinical

Sciences

5

5

4

4

Basic

Sciences

3

3

2

2

1

1

Traditional curriculum

Revised curriculum

Clinical

sciences

Basic

sciences


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Year

C o n t e n t

1

Emergency care and regulatory systems

2

Stages of life and diagnostics

3

Chronic disorders

4

Small disciplines

5

Clerkships

6

Participation in research and patient care

New curriculum structure

Practice

Theory

Independent learning

Dependent learning


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The SPICES Model

  • Student-centered vs Teacher-centered

  • Problem-based vs Subject-based

  • Integrated vs Discipline-based

  • Community-based vs Hospital-base

  • Elective vs Standard program

  • Systematic vs Opportunistic

Harden RM, Sowden S. Educational strategies in curriculum development: The SPICES model. Med Educ 1984;18:284-297.



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The Spiral Curriculum

Linking the previous three years at a higher academic level

Decision making and

assessment of quality

Tools of research methods

and critical appraisal

Basic sciences and

understanding of health


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Keys to Success

  • All sessions should be internally coherent and also link to each other.


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Keys to Success

  • All sessions should be internally coherent and also link to each other.


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Diagram of linkage across the courses in PreClerkship (years 1 and 2)

Course in year 1

Course in year 2

Minor gaps and fills will remain


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Diagram of linkage across the courses in 1 and 2)Clerkship (years 3 and 4)

Course in year 3

Course in year 4

Minor gaps and fills will remain


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Diagram of linkage across the courses in 1 and 2)Clerkship (years 3 and 4)

Course in year 1

Course in year 2

Course in year 3

Course in year 4


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Sir William Osler 1919 1 and 2)

“The art of medicine is to be

learned only by experience, ‘it is not an inheritance; it cannot be revealed. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you become an expert”


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A simple model of competence 1 and 2)

Does

Behavior

Shows how

Professional authenticity

Knows how

Cognition

Knows what


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Six core competences 1 and 2)

  • Medical Knowledge

  • Patient Care

  • Interpersonal & Communication Skills

  • Professionalism

  • Practice-based Learning

  • Systems-based Practice



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Types of Faculty Development 1 and 2)Areas for Further Work

  • Instructional development

  • Professional development

  • Leadership development

  • Organizational development

Irby, 1995,


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Roles of Faculty 1 and 2)

Facilitator

Assessor

Role model

Planner

Information provider

Resource developer


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New Trends in Student selection 1 and 2)

  • High validity & reliability test

  • Student maturity

  • The target students


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New Trends in Student Support 1 and 2)

  • The learning styles.

  • Facilitate learning

  • Life-long learning & SDL

  • Counseling services

  • Study skills courses

  • Need-based learning


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Julian Tudor Hart 1 and 2)

  • “My medical education began three times. What I learnt at medical school was no use in the hospital. What I learnt in the hospital was no use in general practice.”

  • Julian Tudor Hart (paraphrased)



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  • Tailored block evaluations (cocktail of methods)

  • Overall more qualitative and descriptive evaluations, longitudinally monitored, using a portfolio and mentoring system with an emphasis on reflection and meta-cognitive skills



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    Teacher 1 and 2)-centered

    Content oriented

    Teacher: sage on the stage

    Focus: transmit knowledge

    Learner: passive, receive, learn information

    Example: lecture

    Learner-centered

    Learner oriented

    Teacher: Guide on the side

    Focus: Guide understanding

    Learner: active, construct, learn to think

    Example: case based

    Conceptual of teaching



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    Why Use Patient Simulation? 1 and 2)

    Pyramid of Learning and Retention


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    Simulation Modalities 1 and 2)

    Low-tech

    » Simple 3-D organ models

    » Basic mannequin / Skill trainers models

    » Animal models / Human cadavers

    » Simulated / standardized patients (SPs)

    High-tech

    » Screen-based simulators (software / web)

    » Realistic procedural simulators

    » Realistic interactive patient simulators

    » Virtual reality / Surgical simulators






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    Debriefings with video allows discussion of alternatives and pros & cons of CRM behaviors & technical choices


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    New Trends in Leadership & Management pros & cons of CRM behaviors & technical choices


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    QABME - Standards pros & cons of CRM behaviors & technical choices

    1993

    2003


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    Trends in medical education pros & cons of CRM behaviors & technical choices

    • student-activating instructional methods (PBL; case-based; task-based learning)

    • integration of basic sciences and clinical disciplines in teaching and assessment

    • emphasis on clinical and communication skills

    • broadening of clinical training settings (community-based teaching; skills laboratories)

    • increasing validity and reliability of assessment systems (standardized patients; OSCEs)


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    Future of Medical Education pros & cons of CRM behaviors & technical choices

    • adaptive curricular planning (tailored to the individual student)

    • virtual university approach

    • multi-professional concept of training

    • integration of basic and postgraduate medical education (early specialization)


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    Thank you for listening pros & cons of CRM behaviors & technical choices


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