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Curriculum Development and Assessment in Medical Education Sultan Qaboos University College of Medicine and Health Sciences 22 April 2009 Professor Nigel Bax Academic Unit of Medical Education School of Medicine and Biomedical Sciences University of Sheffield, UK

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Curriculum Development and Assessment in Medical Education Sultan Qaboos University


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    1. Curriculum Development and Assessment in Medical Education Sultan Qaboos University College of Medicine and Health Sciences 22 April 2009 Professor Nigel Bax Academic Unit of Medical Education School of Medicine and Biomedical Sciences University of Sheffield, UK n.d.s.bax@sheffield.ac.uk

    2. 2,800 international students from 122 countries

    3. Becoming a doctor • Cost ($) • 800 • 2009 600,000

    4. How is the world making better doctors? ‘Scottish Doctor’ ‘Tomorrow’s Doctor’ ‘Good Medical Practice’ CanMEDS 2000 World Federation for Medical Education Accreditation Council for Graduate Medical Education WHO/EMRO Gulf Cooperation Council Institute for International Medical Education Association of American Medical Colleges

    5. Questions we need to answer: • What are the features of a medical professional?

    6. Questions we need to answer: • What are the features of a medical professional? • How do students and doctors develop these attributes?

    7. Questions we need to answer: • What are the features of a medical professional? • How do students and doctors develop these attributes? • How do we know that they have them?

    8. Questions we need to answer: • What are the features of a medical professional? • How do students and doctors develop these attributes? • How do we know that they have them? • Are we selecting the right people for admission?

    9. Questions we need to answer: • What are the features of a medical professional? • How do students and doctors develop these attributes? • How do we know that they have them? • Are we selecting the right people for admission? Selection – Curriculum – Assessment – Work as a doctor

    10. ‘He who causes the death of a patient shall lose his hands.’ Hammurabi – about 4000 years ago

    11. ‘He who causes the death of a patient shall lose his hands.’ Hammurabi – about 4000 years ago ‘I do not want two diseases, one nature- made, one doctor-made.’ Napoleon Bonaparte, 1820

    12. Key books from 1000 years ago • Kitab Kamil as-sin’a at-tibbiya • ‘The Complete Book on the Art of Medicine’ • Isagoge by Johanituis • Massa’il fi’l tib by Hunayn Ibn Ishaq • ‘Medical Questions’

    13. Key books from 1000 years ago • Kitab Kamil as-sin’a at-tibbiya • ‘The Complete Book on the Art of Medicine’ • Isagoge by Johanituis • Massa’il fi’l tib by Hunayn Ibn Ishaq • ‘Medical Questions’ The first book about Problem Based Learning?

    14. Abraham Flexner (1886 – 1959)

    15. Abraham Flexner • Report in 1910 to Carnegie Foundation • Many unstandardised US medical schools • No proper curricula

    16. Abraham Flexner • Report in 1910 to Carnegie Foundation • Many unstandardised US medical schools • No proper curricula “an overproduction of uneducated and ill trained medical practitioners with no regard for public welfare or interest”

    17. Abraham Flexner • Report in 1910 to Carnegie Foundation • Many unstandardised US medical schools • No proper curricula “an overproduction of uneducated and ill trained medical practitioners with no regard for public welfare or interest” • Recommendations • Pre-clinical science programme • Clinical programme

    18. Flexnerian curriculum Year 1 Pre-clinical Year 2 Year 3 Clinical Year 4

    19. Post-Flexnerian trends • Outcome based curricula • Curriculum integration • Adoption of adult learning principles • Self-directed/Problem Based Learning • Student determination of learning • Move to community based education • Professionalism

    20. Mortality rates and density of healthcare workers Ghanim Alsheikh WHO/EMRO, 2006

    21. Mortality rates and density of healthcare workers

    22. Staff per 1,000 population: European countries, USA and Australia 15 5 UK USA 10 4 Aust USA 3 Aust 5 2 UK Nurses Doctors 1 0 0

    23. Planning for curriculum revisionThe SPICES model

    24. Student Centred Teacher Centred Didactic/ Information Gathering Problem Based Integrated Discipline Based Community Based Hospital Based Structured Electives/Options Apprenticeship/ Opportunistic Systematic SPICES Model

    25. Student Centred Teacher Centred Didactic/Information Gathering Problem Based Integrated Discipline Based Community Based Hospital Based Structured Electives/Options Apprenticeship/ Opportunistic Systematic Sheffield Present Future

    26. Student Centred Teacher Centred Didactic/Information Gathering Problem Based Integrated Discipline Based Community Based Hospital Based Structured Electives/Options Apprenticeship/ Opportunistic Systematic Karolinska Institutet, Stockholm Present Future

    27. Student Centred Teacher Centred Didactic/ Information Gathering Problem Based Integrated Discipline Based Community Based Hospital Based Structured Electives/Options Apprenticeship/ Opportunistic Systematic Universityof Wollongong, Australia Past curricula Future curriculum (Hospital doctors) (Community doctors)

    28. Student Centred Teacher Centred Didactic/ Information Gathering Problem Based Integrated Discipline Based Community Based Hospital Based Structured Electives/Options Apprenticeship/ Opportunistic Systematic National University of Singapore

    29. Vision Statement The University of Sheffield strives to produce excellent medical graduates. The medical curriculum will be outcome focussed where the aim is to produce graduates who are able to fulfil their role as junior doctors in the NHS and who also possess the generic skills expected of students attending a research-led university. The course will feature increased opportunities to see patients in the community; a high degree of integration; an emphasis on facilitating student learning; and an increase in student choice. The course will be organised on a body system basis with a progressive emphasis on learning around undifferentiated patient problems. The instructional approach will consist of a spine of problem, case and patient-based integrated learning activities complemented by a range of other teaching and learning activities. There will be an increase in systematic teaching of some components to ensure competence in key areas. Students will be expected to become progressively more self-directed, aided by increasing reliance on IT-based and distance learning materials and activities. Assessment, both formative and summative, will be closely matched to defined outcomes. The curriculum will be managed centrally by a multidisciplinary team, including those with a stake in the outcome of medical education. The Department of Medical Education, the Administration and an IT-based curriculum management system will provide support. A monitoring system will be established to evaluate the implementation of the curriculum and to support a process of continuous improvement.

    30. Vision Statement The University of Sheffield strives to produce excellent medical graduates. The medical curriculum will be outcome focussed where the aim is to produce graduates who are able to fulfil their role as junior doctors in the NHS and who also possess the generic skills expected of students attending a research-led university. The course will feature increased opportunities to see patients in the community; a high degree of integration; an emphasis on facilitating student learning; and an increase in student choice. The course will be organised on a body system basis with a progressive emphasis on learning around undifferentiated patient problems. The instructional approach will consist of a spine of problem, case and patient-based integrated learning activities complemented by a range of other teaching and learning activities. There will be an increase in systematic teaching of some components to ensure competence in key areas. Students will be expected to become progressively more self-directed, aided by increasing reliance on IT-based and distance learning materials and activities. Assessment, both formative and summative, will be closely matched to defined outcomes. The curriculum will be managed centrally by a multidisciplinary team, including those with a stake in the outcome of medical education. The Department of Medical Education, the Administration and an IT-based curriculum management system will provide support. A monitoring system will be established to evaluate the implementation of the curriculum and to support a process of continuous improvement. Community based learning Assessment drives learning and matches outcomes