Congruence in the medical curriculum

How to make sure the plan How to make sure the plan comes togethercomes together

David Taylor

Liverpool

The first thingThe first thing

Is to decide what you want to doIs to decide what you want to do And keep checking that it is still what And keep checking that it is still what

you want to do!you want to do!

In the UK there is little In the UK there is little flexibilityflexibility

The GMC have produced two The GMC have produced two documentsdocuments Tomorrow’s DoctorsTomorrow’s Doctors The New DoctorThe New Doctor

Between them they define what we Between them they define what we have to make sure the students have to make sure the students knowknow

Our handbook gives a generic Our handbook gives a generic syllabussyllabus

Subject knowledge & understandingSubject knowledge & understanding As ‘core’, students will be able to synthesize, appraise, As ‘core’, students will be able to synthesize, appraise,

explain, and apply the relevant information/evidence about:explain, and apply the relevant information/evidence about: the structure and mechanisms of the body in health the structure and mechanisms of the body in health

and disease, from molecules up to the whole organism and disease, from molecules up to the whole organism related to:related to:

normal and abnormal structure and function of the body and its normal and abnormal structure and function of the body and its defence mechanisms; the natural history, symptoms, and signs defence mechanisms; the natural history, symptoms, and signs of disease; and the biological rationale for therapy and the of disease; and the biological rationale for therapy and the processes underlying its complicationsprocesses underlying its complications

variability in the role of the determinants of health and disease, variability in the role of the determinants of health and disease, the presentation of disease, and the response to therapythe presentation of disease, and the response to therapy

clinical diagnosis and management of common conditionsclinical diagnosis and management of common conditions The interrelationships of social, psychological, economic, The interrelationships of social, psychological, economic,

political, environmental, cultural factors on health and political, environmental, cultural factors on health and diseasedisease

Our first stepOur first step

Was to decide which 200 cases a Was to decide which 200 cases a student would need to be familiar student would need to be familiar with when they graduatedwith when they graduated We finally agreed on about 208We finally agreed on about 208

Core CasesCore Cases

ThenThen

We decided which cases the students We decided which cases the students would study through PBLwould study through PBL

PBL modulesPBL modules

ScenarioScenario

Then Then

The students determine the learning The students determine the learning objectives in their PBL groups – they objectives in their PBL groups – they can see every groups’ learning can see every groups’ learning objectivesobjectives

Learning objectivesLearning objectives

Which we examineWhich we examine

Not just knowledge but Not just knowledge but skillsskills

Communicating effectivelyCommunicating effectively Working in a team Working in a team Being aware of limitations Being aware of limitations Understanding disease processesUnderstanding disease processes Managing time effectively Managing time effectively Developing appropriate attitudes towards Developing appropriate attitudes towards

personal health and wellbeingpersonal health and wellbeing Recognition of social and emotional factors Recognition of social and emotional factors

in illness and treatmentin illness and treatment

Providing care for people of different Providing care for people of different cultures cultures

Coping with uncertainty Coping with uncertainty Making the best use of laboratory and other Making the best use of laboratory and other

diagnostic services diagnostic services Using informatics as a tool in medical Using informatics as a tool in medical

practice practice Understanding the purpose and practice of Understanding the purpose and practice of

audit, peer review and appraisalaudit, peer review and appraisal Understanding the relationship between Understanding the relationship between

primary and social care and hospital careprimary and social care and hospital care Using opportunities for disease prevention Using opportunities for disease prevention

and health promotionand health promotion Being aware of legal and ethical issuesBeing aware of legal and ethical issues

Understanding the principles of Understanding the principles of evidence-based medicine evidence-based medicine

Diagnosis, decision making and the Diagnosis, decision making and the provision of treatment including provision of treatment including prescribingprescribing

Keeping accurate records Keeping accurate records Obtaining valid consent Obtaining valid consent Calculating accurate drug dosages Calculating accurate drug dosages Writing a prescription Writing a prescription

VenepunctureVenepuncture Arterial blood sampling Arterial blood sampling Suturing Suturing Performing an electrocardiogram Performing an electrocardiogram Basic cardiopulmonary resuscitation Basic cardiopulmonary resuscitation Administering oxygen therapy safely Administering oxygen therapy safely Correctly using a nebulizer Correctly using a nebulizer Inserting a nasogastric tube Inserting a nasogastric tube Urinary catheterizationUrinary catheterization Control of haemorrhageControl of haemorrhage

Each yearEach year

We review the cases in the light We review the cases in the light of the learning objectives the of the learning objectives the students are obtainingstudents are obtaining

And the examination resultsAnd the examination results

And change the cases And change the cases accordinglyaccordingly

Each yearEach year

And we review the content of one of And we review the content of one of the four subject themesthe four subject themes S&F, IGS, PP, PPDS&F, IGS, PP, PPD

A senior committee of subject A senior committee of subject specialists does the initial workspecialists does the initial work

Then the programme team makes Then the programme team makes the agreed changesthe agreed changes

Periodic reviewPeriodic review

20062006years 1 & 2years 1 & 2 20072007years 3 & 4years 3 & 4 20082008year 5year 5 20092009whole programme whole programme

university plus external advisorsuniversity plus external advisors General Medical CouncilGeneral Medical Council

20102010year without review!year without review! 20112011I will be 55 …I will be 55 …