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Constructing a CanMED Curriculum
Zubair AminSami Ayed
What is not a curriculum?
• Not a syllabus
• Not a time-table or lecture
• Not a listing of lectures by discipline
• Not a teaching program developed in isolation
• Not a program without room for improvement
Defining a Curriculum Backward
Prideaux, D. BMJ 2003;326:268-270
“If you are not certain of where you are going you may very well end up somewhere else (not even know it).”
Robert Mafer
Residents and Fellows
Competencies
What to learn - content
How to learn – educational strategy
How to assess
How to provide support
Advantages of Competency Based Curriculum
• Relevance– Relationship between the curriculum and practice of
medicine
• Accountability– Clarity of roles and responsibilities
• Flexibility– Allows greater variations in course delivery and
educational strategy
• Assessment – Fairer and robust assessment
ACGME Six Competencies
• Patient Care • Medical Knowledge • Practice Based Learning and Improvement• Systems Based Practice• Professionalism• Interpersonal Skills and Communication
GMC Tomorrow’s Doctors
• “In accordance with Good Medical Practice, graduates will make the care of patients their first concern, applying their knowledge and skills in a practical and ethical manner and using their ability to provide leadership and to analyse complex and uncertain situations.”
Overarching outcome
The doctor as a scholar
and scientist
The doctor as apractitioner
The doctor as a professional
Common Global Outcomes: Profile of a Physician
Expertise in medical sciences and clinical competency Skilled in communications with patients and with colleagues Caring and ethical in approach Life-long learner; practice-based improvements and
quality improvement principles Knowledgeable about the context
Existing Curricula
Typical Existing Curriculum
• Rudimentary
• Contents are mostly rules and regulations; very little description of competencies
• No description of teaching and learning apart from rotations and their duration
• Promotion typically depends on passing a MCQ paper
• No scope for mentoring, trainee support
• No description of skills progression
• No revision; sometimes quite outdated
Framework for New Curriculum
What we know will be different in the future
• New applications of science and technology• More cost pressures: physicians as stewards of limited
resources• Patient demographics will be different• More use of computers/information technology• More population-based thinking: more emphasis on
prevention/wellness• Increased accountability• More interdisciplinary practice• More ambulatory care
Adopted from a presentation by Prof Ed Hundert, former President of Case Western Reserve University
Proposed Curriculum: Philosophical Orientations
• Competency-based• Graded responsibility for the physicians• Better supervisory frameworks• Clearer demarcations what should be achieved
at each stage of training• Core curriculum with elective and selective
options• Independent learning within a formal structure
Expanded range of competencies
• Balanced representation of knowledge, skills, and professionalism
• Incorporation of new knowledge and skills for the present and the future
Evidence-Based approach
• Demographic data (e.g., disease prevalence) • Practice data (e.g., procedures performed)• Patient profile (e.g., outpatient versus
inpatient)• Catered towards future needs
Holistic Assessment
• Higher emphasis of continuous assessment• Balanced assessment methods • Portfolio and log-book to support learning and
individualized assessment• In-built formative assessment
Our Approach
• Customization to Saudi Arabia• Incorporating good practices from local
centers• Getting help from overseas centers• Centralized support
Few Unique Elements
• List of most important/high priority topics• Rotation specific competencies• Universal topics• Core-specialty topics• Work-based assessment and examination • Mentoring guidelines • E-portfolio and log-book
Accident/Emergency Consultation/liaison OPD
Child abuse Child abuse Attention deficit hyperactivity disorder
PTSD PTSD Autism spectrum disorders
Nonspicific aggression Adjustment disorders Communication Disorders
Panic disorder Dilirium Intellectual Disabilities
Acute Stress Disorder
Elimination disorders Learning Disorder
Depressive disorders Depressive disorders Depressive disorders
Selective Mutism Motor Disorders
Bipolar disorder
Medication-Induced Movement Disorders and Other Adverse Effects of Medication and overdose
Obsessive compulsive disorder Obsessive compulsive disorder
Catatonia Associated With Another Mental Disorder
Catatonic Disorder Due to Another Medical Condition
Anxiety disorders
Psychotic disorders Psychotic disorders Psychotic disorders
Children’s High Priority Conditions
Training level Evaluation Item
Content Relative % Passing score
R1
Annual (Rotations) evaluation
Continuous Assessment 40% 40% 50% End-Year
Evaluation Exam
MCQ 40
60% Clinical (OSCE) 20%
R2
Annual evaluation
Continuous Assessment 40% 40% 50% Evaluation
Exam MCQ 40% Clinical Exam 20%
60%
1st part Examination
100 MCQs
70%
R3
Annual evaluation
Continuous Assessment 40% 40%
60% Evaluation
Exam MCQ 40%% Clinical Exam 20%
60%
R4
Annual evaluation
Continuous Assessment 70-80% 70-80% 60% Evaluation
Exam Clinical Exam 20-30%
20-30%
2nd Part Examination
Written 200 MCQs (50%) 50%
70%
Clinical (OSCEs)
The OSCEs format consist of 6-10 stations including 15-20 cases which will vary from history taking case scenario, short cases and data interpretation…etc. (50%)
(50%)
50%
Universal Topics
• Universal Topics Learning Outcomes
Mentoring of Residents
• Assigned mentor for each resident and fellow• Long term relationship between mentor and
resident• Defined minimum frequency of meeting
– 1 hour/fortnight • Monitoring of trainee’s progression• Providing guidance and resources
E-Portfolio and Logbook
• Integral to demonstrate competencies • Continuous learning and assessment• Regular feedback • Joint responsibility on the trainee to
determine the achievement of competency• Electronic portfolio (T-Res System)
Changing Metaphors for Realigned, Redesigned Learning Organizations
Industrial Age
Classrooms, libraries, and labs
Teaching
Seat time-based education
Classroom-centered instruction
Information acquisition
Distance education
Continuing education
Time out for learning
Michael G. Dolence and Donald M. Norris
Information Age
Network
Learning
Achievement-based learning
Network learning
Knowledge navigation
Distance-free learning
Perpetual learning
Fusion of learning and work
Transforming Higher EducationA Vision for Learning in the 21st Century
Current Status
• Process started: August 2013• Group formed: 32 (includes nursing and other
healthcare professionals)• Approved by the Scientific Committee: 10
Curriculum Development versus Implementation
“Discussions on curriculum are often limited
to who ‘covers’ what, an approach more
suited to barn painting than to education.”
Timothy Goldsmith, Science 2002
Affinity Groups
• Group 1: Dissemination• Group 2: Stakeholder Engagement• Group 3: Faculty Training• Group 4: Monitoring and Evaluation
Dissemination
• Goal: A transparent, portable curriculum that is widely accessible to all stakeholders 24/7.
• What steps should we take to achieve the goals?
Stakeholder’s Engagement
• Goal: Shifting the mentality from ‘your curriculum’ to ‘my curriculum’
• Who are the stakeholders of the new curriculum?
• How do we ensure that stakeholders address the issue as their own?
Faculty Training
• It is said “We do not need curriculum development, we need faculty development.”
• How can we create a community of passionate faculty?
• What skills are missing? What knowledge upgrading is necessary?
Monitoring and Evaluation
• “If you do not measure, you can not get better.”
• What should we measure to judge success?• How should we measure what need to be
measured?
Strategy: Resistance versus Impact
Low Resistance/High Impact High Resistance/High Impact
Low Resistance/Low Impact High Resistance/Low Impact
RISE Principle
• Resource: – Appropriate human and material resources
• Incentive– Reward, recognition
• Support– Removing barrier, facilitating work
• Expertise– Ability and credibility