Commentaries

98 Academic Psychiatry, 25:2, Summer 2001

Model CurriculaThe Way We Teach, The Way We Learn

David A. Goldberg, M.D.

Dr. Goldberg is at the California Pacific Medical Center, SanFrancisco, California. Address reprint requests to Dr. Goldberg,Dept. of Psychiatry, California Pacific Medical Center, 2340 ClaySt., San Francisco, CA 94115.

Copyright � 2001 Academic Psychiatry.

Psychiatric education is undergoing importantchanges. Traditional teaching strategies that use

lectures, readings, and class discussion are now beingaugmented by student-based interactive learning ex-periences (e.g., problem-based learning and case-based teaching). With the rapid and in-depth infor-mation sources that are being developed through theInternet, there is increasing attention being paid toindependent learning and Web-based discussion andteaching exercises, as well as collaborations amongeducators. A more varied and flexible attitude towardeducation is evolving with the appreciation thatmany of us teach and learn best in different ways. Inthe midst of these changes and new opportunities, wefind ourselves at an excellent time to reconsider theplace of model curricula within our medical studentand graduate education programs.

Model curricula have had a checkered history inpsychiatric education. The ideas behind them, how-ever, are compelling and deserve continued attention.Psychiatric knowledge has been growing at a stag-gering rate, and educational resources within indi-vidual departments are increasingly limited. Hence,a curriculum, developed by experts, that can be usedin multiple educational sites around the country (andeven around the world) seems a natural evolution forour field. If a model curriculum could be successful,it would meet a variety of needs. Perhaps most im-portantly, it could provide educators at any given sitea current, organized lecture or course in the widestpossible range of subject areas in psychiatry. Medicalstudent educators and residency training directorswould be able to import teaching methods and course

content developed by the best and the brightest in ourfield. Educators could use these training modules lo-cally and adapt them in ways that could fit their per-sonal style and experience. The scores of hoursneeded to develop a seminar of quality at each sitecould thereby be greatly diminished, and our edu-cators could be utilized more efficiently and effec-tively. With shared experience, educators could col-lectively develop new teaching methods that utilizeadult learning models and new advances in technol-ogy. A secondary advantage could be greater consis-tency and a shared knowledge base that could bewidely disseminated.

Who could argue with the logic of this position?Unfortunately our experience to date has been lessthan satisfactory. In fact, there is no model curriculumthat is being used extensively today. I will first outlinethe problems with the model curricula that have beenavailable and then outline some of the aspects ofmodel curricula that could enhance their usefulnessand success.

Why have model curricula been so disappointingup until this time? First we must define what wemean by model curricula. At the simplest level, this isa single lecture or a series of lectures on a topic thatis presented in outline form and often contains anannotated bibliography. Additions to this basic struc-ture include slides and test questions. The other endof the spectrum is a model curriculum for a largebody of knowledge, such as the one described byGlick and colleagues in this issue of the journal. Thiswas a complex undertaking involving numerous au-thors, with lecture outlines, slides, bibliographies,various methods of presentation, and a variety ofideas about how to integrate the didactic materialinto a clinical-educational system including links tosupervision and other available resources.

There has been no systematic study of the use of

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model curricula. There is considerable indirect evi-dence that these curricula have not been successfullyembedded in our educational programs. This evi-dence comes from discussions among graduate andmedical student directors, the absence of any singlecurriculum as a widely known successful examplewithin the field, and numerous comments by senioreducators who feel that model curricula have notbeen useful. There are a number of reasons for this.The first is that in spite of the possibility for constantupdating of the content, model curricula have a staticfeel to them. Using them can make otherwise sea-soned educators feel like substitute teachers. Thesense of ownership is often lost. The idea that “theteacher is the curriculum” reflects this difficulty. Ed-ucators are left to their own idiosyncratic and intui-tive skills in trying to teach someone else’s material.Another difficulty has been the incomplete develop-ment of specific teaching and learning methods thatcan be utilized with aspects of the curriculum. Eitherit is left to the individual teacher to decide what todo or there is a lot of information that is intended tobe delivered in a lecture format. The integration ofactive adult-learning models with model curriculahas yet to be realized. Another important dimensionthat can cause difficulty is the fact that a teacher whois highly knowledgeable in a given field may takeissue with the content and emphasis that has beenpresented in the model curriculum. It can take moretime to edit the model curriculum than to prepareone’s own. A teacher who knows little about the sub-ject can feel insecure or even dishonest teaching asubject in which he or she has marginal competence.Teaching must be a dynamic, evolving, living expe-rience if it is to be enjoyed by the teacher and be mosteffective for students. The challenge of adapting afixed program in a dynamic way remains to be met.

The Psychopharmacology Curriculum devel-oped by the American Society of Clinical Psycho-pharmacology (ASCP) has many of the componentsthat should be included in a successful portable edu-cational program. Dr. Glick and colleagues obtainedinput from the field, gathered a group of prominenteducators and consultants, and developed a curric-ulum that is intended to span levels of training. Theywisely included instructions on how teachers can usethe lecture outlines along with slides, literature, andWeb-based references. Perhaps most innovative, theypresent a sequence of courses through all years of

training, a course on research methods, and ways thematerial can be learned in supervised formats, suchas medication clinics, case-based discussions, andjournal clubs. The focus is on how as well as what toteach. The curriculum also includes course evalua-tions and useful clinical rating scales.

This is a sophisticated, multimodal approach tocurriculum development. Furthermore, the grouphas remained committed to improving their work byreceiving feedback from people using it and makingmodifications. Because I have not used this curricu-lum to teach, I cannot specifically critique it. I will,however, list areas that need attention if this, or any,model curriculum is to have a good chance of on-going success. The areas are 1) scope and content;2) pedagogy; 3) ongoing updating, feedback and “col-lective authorship;” and 4) evaluation/assessment.

The scope of a model curriculum includes thesubject matter, range and experience of the students,and the teachers. The larger the scope, the more thereis a need for a “buy-in” from everyone involved. Thestakes are much higher. Field-testing, development,justification (proof of effectiveness and validity), andactive discussion/consultation are all essential, butare costly and time-consuming. There is great valuein taking on a sequence of courses because there is anopportunity for thoughtful progression in learning(based on previous knowledge), the establishment ofa comprehensive body of information that is a corefor psychiatrists, and links with other education (su-pervision) in the program as well as with othersources (literature and the Internet).

Clinical education is best developed when con-ceptualized as sequential and linked to the rest of theprogram, and when it has a relevant, shared coreknowledge base. Glick and colleagues attempted toactualize all of these areas. They considered the ques-tions of what, how much, and depth of content. Themore authors, however, the greater the chance for in-consistency, omissions, and unnecessary depth in ob-scure areas. Developing this or any curriculum bycommittee can be hazardous, since a “voice” and co-hesion can be lost. Few people should construct thecourse, including scope of material, teaching andlearning methods, structure and outline of content foreach seminar, links to supervision, and ways to in-tegrate it into the overall curriculum. Expert consul-tants can then be used to flesh out the content, pro-vide updates, and suggest links to ongoing study.

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Expert educators can develop assessment compo-nents and ways to research the outcomes of the useof the modules.

Teaching and learning methods have been un-dergoing exciting growth in recent years. The moveto student as self-educator, active adult-learningmodels, creative use of technology, and case-basedgroup learning are all enriching the field. The tradi-tional lecture format is on the wane. A transitionalphase has been the lecture with ongoing slides. Manyof the portable curricula use this as the main teachingstrategy, along with class discussion. Lectures are stillnecessary for large groups, but are limited in small-group teaching. Although we still want students tolearn in groups with the inspiration, knowledge, andguidance of a skilled educator, the most interestingand effective ways need to go far beyond the lecture/slide format. In model curricula, the lecture notes andslides aren’t created by the teacher—which leads to apotentially dead classroom ambience. Certainly, oneway to correct for this is to have each teacher add hisor her own slides and interactive exercises. However,when experienced and creative teachers abandon theprepared script and use only bits and pieces from thecurriculum, the substantive value of the externalcourse may be lost. Our current challenge is to con-struct a model curriculum with enough structure,content, and flexibility to be useful in an ongoingway, but also to enable individual teachers a range ofcreativity and individualization. A parallel here is forthe model curriculum to enable students to learn ontheir own (and in peer groups), using cases, readings,CD-ROMs, and Web discussions, and to use thegroup (plus teacher) to expand on areas, stimulatefurther curiosity, and apply knowledge. This ap-proach utilizes adult-learning methods. A model cur-riculum that is primarily a group of lectures withslides developed by numerous experts for each dis-crete area and put together by a “steering group” willlikely not succeed.

Ongoing, collaborative development is anothercritical issue. Glick and colleagues have just finishedanother revision of their curriculum on the basis ofsuggestions from the field. Assuming the originalcourse content and methodology are reasonably con-sistent and of high quality, this approach can be ex-tremely useful. One helpful addition has been a moreextensive presentation on how to use the curriculumand the availability for individual consultation. A

more comprehensive approach to development and“collective ownership” is therefore possible. One wayto achieve this is to construct the model curriculumto allow for maximum flexibility. Each seminar, mod-ule, and learning exercise should be able to be usedby individual teachers in ways that are most conso-nant with their approach to presenting the material.Although this approach does not benefit from the ef-ficiency and comprehensive impact of using the cur-riculum in its entirety, it opens up possibilities forbroader acceptance and use. The evolution of the cur-riculum can then occur through the use of a websiteor listserve in which educators can present and dis-cuss a wide range of uses and modifications of theoriginal curriculum. The original authors can incor-porate widely supported changes, additions, and cre-ative uses in the ongoing new iterations of the cur-riculum. In fact, the curriculum could be Web-basedand evolve steadily through interactive discussionsand demonstrations of effectiveness.

The model curriculum Learning Psychotherapy, de-veloped by Bernard Beitman, M.D. and Dongmei Yue(1), is an example of this kind of national collabora-tion in ongoing development. The authors have setup a listserve for teachers around the country to dis-cuss ways in which they are using and modifying thecurriculum according to their specific preferences. Al-though this “experiment” has just begun this year, ithas already demonstrated the tremendous usefulnessof having people using the same structured curricu-lum talk in some detail about specific teaching exer-cises and the ways in which individual moduleswithin the overall course can be modified and taughtin creative ways. Anyone involved with this projectcan then use these ideas in the ongoing teaching ofthe course at their site. We would hope that the mod-ification that has found broader acceptance can thenbe incorporated into revisions of this model curricu-lum. Also, Dr. Beitman is planning annual meetings,which will primarily consist of collective discussionof the use of the model curriculum, with subsequentadditions and changes. In this way, a curriculum thatwas essentially developed by two people can have abroader shared authorship and develop into a moreuseful and flexible teaching tool.

A model curriculum also offers us the potentialto develop experience in the evaluation of the effec-tiveness of a teaching method, as well as assessmentsof specific competencies. When multiple training pro-

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grams are using the same the curriculum, it is thenpossible to have a much wider basis for evaluatingits effectiveness in a variety of ways. These includethe evaluation of knowledge and clinical skills thatare learned from the curriculum and comparingdifferent teaching strategies using the same basiccontent.

The assessment of clinical skills is receiving tre-mendous attention now and will continue to do sointo the future. The use of model curricula with on-going discussion and experimentation across thecountry can be an extremely effective vehicle inwhich to spawn assessment methodologies. The Weband e-mail (listserves) now provide us with the mech-anism through which to collaborate efficiently. Na-tional meetings can be another mechanism throughwhich this development can be presented and dis-cussed periodically. Another technological advance,CD-ROMs, also offers tremendous new creative op-portunities for individual student learning as part ofthe model curriculum. They also can contain an as-sessment/feedback component. We will then be ableto compare independent learning in this way withgroup learning around shared tests and determinewhat kinds of education might be best offered in dif-ferent contexts.

A new era in psychiatric education is possible.Our students are increasingly utilizing adult-learning

strategies to self-educate and are facile with comput-ers and ongoing advances in technology. The moretraditional model of independent reading and lec-tures with seminar-based discussion still has impor-tant uses in education but must now give way tomore interactive, collaborative, and self-directedlearning methods. Psychiatric educators are devel-oping new teaching strategies with the use of activelearning models and technology. The Internet hasopened up the possibility for national and interna-tional collaboration among educators in the devel-opment and assessment of shared learning methods.There is a central place within this context for theblossoming of what has been called a model curric-ulum up until this time. The term portable educationalmodules is also coming into use. Success will dependon the ways in which we structure and develop por-table curricula so that they can be used flexibly andfurther refined through the collaborative efforts of themultiple educators who are using them. The use ofadult-learning models, integration with clinical su-pervision and case-based studies furthering peda-gogy in the use of these models, and independentstudent learning through access to multiple infor-mation sources will be the bedrock on which theseeducational programs can prosper. If we, as educa-tors, can find ways to collaborate meaningfully andfind the financial resources to support development,we can begin a new era for education in psychiatry.

Reference

1. Beitman BD, Yue D: Learning Psychotherapy: A Time-Efficient, Research-Based, and Outcome-Measured TrainingProgram. New York, WW Norton, 1999