Medical Sciences Education Development Understanding Curricula Education Essay

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Newcastle University introduced a new undergraduate curriculum in 2001. Students start year 3 with 15 week introduction to Foundation of Clinical Practice (FOCP). This is followed by three 8 week Junior Rotations: Reproductive & Child Health; Chronic Illness, Disability & Rehabilitation; and a composite block of mental health (4 wks), Infectious Disease (2wks) and Public Health (2 wks).

The FOCP course is designed to provide teaching and learning opportunities to build on basic knowledge. This includes 9 weeks of formal, structured teaching to provide a solid foundation before moving on to the clinical experience of patient contacts.

Through the 15 weeks the students are divided into groups with individual support to students. It also includes teaching in general practice which takes place in groups of 2 or 3 students.

I lead week 8 which is about diabetes and the critically ill patients. I have chosen this curriculum to discuss as I participated in its delivery. It is a learner centred curriculum in which the students are required to take the initiative, with the teacher acting as a facilitator encouraging teaching to be shared by the whole team.

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By attending outpatients clinics and GP practices, the students will concentrate on how medical problems present, also being able to deal with undifferentiated illness which comes through the door. Also how illness fits within the spectrum of health and disease and the influence of psychological and social factors on physical health.

Identify and describe the educational approach that relates to your programme:

The Foundation of Clinical Practice is designed to be a learner centred programme. It helps students to build on previous knowledge they acquired from phase 1 and 2. The students are expected to take the initiatives in their own learning with the teacher acting as a facilitator. Diabetes module is taught as part of FOCP in a multi professional learning approach. The core material includes basic knowledge about diabetes, patho-physiology and management of diabetes emergencies followed by history taking and examination in small groups. Annual review of patients with diabetes, chronic complications and practical sessions on blood glucose monitoring are also included.

Learner centred ideology focuses on the individual and his or her needs rather than the society need or the academic achievement. It mainly focuses on individual growth and believes this to be lying within each students own and unique capabilities (Schiro 2008). In general people are the source of content of the curriculum, and this occurs through interaction with the environment which makes the learning process unique to each individual. The role of the teacher is to facilitate these interactions and hence stimulate their growth in a constructive way (Schiro 2008). Learner centred curricula are often described as units of works and through interaction with others including peers, teachers and environment, students generally develop their own learning. Teachers facilitate learning by creating the right environment. This in turn stimulates students' growth and helps them acquire knowledge and construct learning for themselves (Schiro 2008).

The curriculum is a result of an active process of interaction of teachers, and students looking at what happens in the classroom and the ways students and teachers prepare for the learning process and how is it evaluated. It differs from informal education as it has a context and teachers roughly have an idea of what is about to happen (Ross 2000). In a learner centred or a process driven curriculum, students are capable learners and have the ability to develop naturally if they find the appropriate environment . The learner development is usually best achieved when it is self directed. In this curriculum there are no clear divisions between subjects and disciplines with a great degree of flexibility guided by the interest of the learners rather than rigid subjects set up by the curricula designers. The role of the teacher is to enable and facilitate learning rather than to transmit knowledge. For this reason the quality of the teachers is vital and can be a source of strength or weakness in this curriculum (Ross 2000).

It has been described that learner centred curriculum should help the students to develop their own understanding of the world. The responsibility for learning is generally determined by the students' needs, their interest and the pace in which they learn. The centre of the learning is the student or the learner and not the entire class room and hence all effort should be made to organize the learning process around and for the learner's needs (Ross 2000).

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In the learner centred curriculum there is a degree of flexibility and the students have a voice in the way teaching can take place. Teachers and students can work together to develop this with a scope for variation as the outcomes are not the defining feature of the curriculum (Smith 2000).

Assessment in the learner centred curriculum concentrate on the student's growth and make every effort to establish student's needs for further growth by providing the right learning environment. Hence assessment is intended for the learner's benefit and not set at a predetermined level, ranking or comparing students to each other. The purpose of the assessment is to diagnose the learner's ability to grow and also for the learner to be able to reflect on his or her progress (Schiro 2008). However, assessment in the learner centred curriculum can be quite a challenge particularly in the context of the weak student as it tends to underestimate his or her qualities. It can also be a challenge especially when students and their parents pay more attention to subject success or failure rather than the context in which learning takes place (Smith 2000). One of the central features of the assessment in the learner centred ideology is the ability of the learners to self assess their own learning whenever possible and this is believed to be best achieved through interaction with peers, materials, environment and teachers rather than authorities (Schiro 2008).

Evaluation in the learner centred curriculum aims at learner's benefit and the learner is engaged and forms an integral part of the process .It also help the curriculum designers and teachers to improve on the designed and the delivered curriculum respectively. It is a holistic process which includes observations on students' growth and also feedback about what areas in the curriculum need improvement and how to apply these changes. The accountability in the evaluation of this curriculum lies with the teachers or the educators rather than the authority or the learner (Schiro 2008).

In the learner centred curriculum adopted by Newcastle University, problem based learning plays a vital part in this curriculum for the medical school. It applies findings of cognitive psychology to educational practice and promotes deep learning. It also helps to enhance self directed skills and motivates students and this in turn makes it more enjoyable to students and teachers alike. However, it impedes a high demand on staff time and can be proven difficult, especially in the context of large numbers of students attending the medical school nowadays. This has challenged the changing role of the teachers to deliver such a curriculum in which they need to understand how people learn and plan and design the best curricular model and teaching strategies when delivering this curriculum (Spencer 1999). It should be emphasized that, in the problem based learning we have to be careful not to be focused on the fact that students should only acquire certain skills but it is rather important for them to be able to apply these skills in the real world (Smith 2000).

Critically compare the programme with the educational approach:

This is the third year medical student's first real experience of working in a hospital. They learn skills they will need to develop over the next 2 years which includes history taking, physical examination and clinical skills such as blood pressure, blood glucose monitoring etc. It is designed to provide students with learning opportunities to build on basic knowledge that the students have developed during previous years. Comparing this programme to the learner centred curriculum, the students are stage 3 MBBS medical students, who successfully completed phase 1 and 2 and hence build on previous knowledge from earlier studies.

The students are expected to take the initiatives in their learning by preparing for the course and are encouraged to grow and construct new meaning after interaction with the environment (Schiro, 2008; Ross, 2000). The course is focused around real cases and the students make use of the study guide and reading lists to help them learn about the condition themselves. They will have the chance to see and talk to patients with diabetes and chronic complications and examine their eyes and feet and review their diet. Furthermore they will have the chance to see how people with long term diseases are empowered to self manage their own chronic condition. By attending outpatients clinics in GP practices, the students will concentrate on how medical problem present; also be able to deal with undifferentiated illness, which comes through the door. Also how illness fits within the spectrum of health and disease and the influence of psychological and social factors on physical health. In this course students are active players and are at the centre of the programme. The learning outcomes, assessment, evaluation and staff resources are mapped and designed around them. The students are clearly labelled as the core of the programme and form a rich source of its content with other elements of the curriculum radiate from them.

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Teachers are part of multidisciplinary specialist diabetes team; they are not clearly predetermined but depend on the availability of the members of the MDT team to facilitate teaching on the week. They help facilitate students' interaction with each other and with patients and guide students through the patient's journey and to make meaning of the psychosocial and environmental impact of the disease on people with chronic disease like diabetes. This course can clearly be compared to the learner centred curriculum in which teacher's help students' growth by providing them with the appropriate material and stimulus from which students can make meaning and fulfil their needs (Schiro, 2008).

The assessment of this course forms an integral and essential part of the programme and is explicitly labelled in its curriculum. It includes formative assessments which are performed throughout the course and form a guide to the student progress and help the students to grow, develop and progress but do not count towards the student's final grade. On the other hand summative assessment is undertaken at the end of each course and counts towards the student's grade. Students are assessed using a variety of methods includes a final MCQ, (MOSLER), (OSCE) and clinical encounters and presentations of specific topics relevant to that placement or rotation. The assessment is closely related and linked to the intent of the diabetes module. It is designed to indicate that the students have specific skills related to diabetes and for example can perform blood glucose monitoring but it is not about whether students have achieved the competences and the required skills to perform a specific task. The logbook outcomes at this stage are not competencies. Teachers and educational supervisors need to sign the logbooks to say that the students have done the procedure, but not that they are competent at it. The assessment in this programme and as described in the previous section compare very well to a learner centred curriculum rather than a social efficiency or a competency based ideology.

The methods used to evaluate the programme consist of informal instant feedback and formal evaluation online questionnaires which feedback to the medical school training board. The goal of the evaluation in this programme is to contribute to the improvement of the programme. The key strength feature of the evaluation in this programme is that it leads to constant changes in the learning opportunities available to students. It also has an impact on the teaching strategies and learning resources available for the module and in other words can be used to redesign the curriculum using students' satisfaction and feedback. The evaluation of this course follows a learner centred or a process driven ideology in which it links to future improvement of the course guided by the learners needs and interest (Schiro 2008)

Suggestions for improvement:

Identify and describe 2 weakness/ flaws within the chosen curriculum:

In last year's FOCP, the diabetes module included two lectures, one on "what is diabetes" and the second on "diabetes emergencies". The feedback from the students is that they felt the day should include fewer lectures and encourage more self directed learning in forms of tutorials and presentations by students. Also small group teaching and more hands on sessions and spending more time with patients with diabetes to take history and elicit signs and instant feedback from tutors.

The second identified weakness of this course is the way assessment is designed. It includes a final MCQ, MOSLER, OSCE and clinical exam which all form part of summative assessments while the formative assessments for the course have less consideration. Generally in the learner centred curriculum there should be more emphasis on formative assessment which should form an integral part of learner needs, growth and development and clear links to the contents of the programme.

Suggest 2 concrete and realistic changes to improve programme:

Following on from students' evaluation of last year, I have identified that the students need to do more case presentations and need to spend more time in small groups to facilitate small group discussion and more opportunities to perform medical examination and work in small groups with the chance to self and peer assessment. I have already implemented some of the changes in this year's course with a positive feedback from the students both formally and informally. The application of the change in teaching strategies will have an impact especially when planning the number of cases and tutors to facilitate the small group teaching for next year programme.

I am also planning to develop more varied formative assessments tools including MCQ and online resources and e-learning modules with instant feedback to enhance and facilitate formative assessment. The idea is that these forms of assessments will not count towards the final result but facilitate students' progress and development. This initiative if taken enthusiastically by the students should hopefully lead to improvements in the assessment of this learner centred programme.

Curricular Outline Checklist

Appendix Document (b) for Understanding Curricula Submission

Element

Included (yes/no)

Comments

Detail of learner(s)

Yes

Stage 3 MBBS

Students completed phase 1 and 2

Build on previous knowledge

Length of programme

Yes

15 Weeks (Full FOCP)

1 Week Diabetes Module

Some flexibility within weeks but time table does exist

Description of the teachers

No

Includes Consultant, Registrars, Diabetes nurses, Podiatrist, Dieticians, Optician, and Research fellows but generally flexible

Not clearly defined, all working in department available at the time of course

The aim(s) and expected learning outcomes of the programme of learning

Yes

Clearly defined for the diabetes module and included in the study guide

The syllabus

Yes

Study guide, course guide developed locally and distributed centrally. Part of the MBBS curriculum

Teaching strategies

Yes

Lectures, small group , workshops demonstrations and self directed

Session plans included

No

Session plans are not included with each session (gives flexibility)

Methods used to assess learning

Yes

Formative-informal

Summative , MCQS, Written papers , OSCE, MOSLAR

Assessment is linked to learning outcomes

Methods used to evaluate teaching/programme

Yes

Formal : questionnaires

Informal -instant feedback