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Tendency of Medical Curriculum Reforms

Tendency of Medical Curriculum Reforms. Yeu-Jhy Chang, MD Stroke Section Department of Neurology Chang Gung Memorial Hospital, Linkou. Outline. Why do we change? Have we fulfilled the expectation of the society? The past and present curricular models Clinical Presentation Curriculum

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Tendency of Medical Curriculum Reforms

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  1. Tendency of Medical Curriculum Reforms Yeu-Jhy Chang, MD Stroke Section Department of Neurology Chang Gung Memorial Hospital, Linkou

  2. Outline • Why do we change? Have we fulfilled the expectation of the society? • The past and present curricular models • Clinical Presentation Curriculum • How about the future at CGU? In Taiwan?

  3. Outline • Why do we change? Have we fulfilled the expectation of the society? • The past and present curricular models • Clinical Presentation Curriculum • How about the future at CGU? In Taiwan?

  4. Why It Should Be Changed? • If it is not broken, don’t change it!

  5. Programme for International Student Assessment (PISA) Finland ranked No. 1 in the PISA’s 2006 survey in the area of science, followed by Hong Kong and Canada. In Finland, all school teachers receive their training at universities and are certifiedafter obtain a Master’s degree. The number of applicants for teaching greatly outnumbers the teaching spots available. Teachers are well paid and hold high status within the work force.

  6. PISA 2006

  7. PISA 2003

  8. Finish Teachers Teaching qualifications are prescribed by law and vary for different kinds of teachers These national requirements guarantee that the standard of teacher education remains high. All teaching have clearly defined objectives. The curriculum emphasizes doing (problem solving). Learning activities reflect a balance between left and right brain activities.

  9. Curricular Problems in the Past and Present (1) Redundancies, duplications, and irrelevant information Lack of integration among basic, clinical, humanities, and biopsychosocial sciences Too much emphasis on memorization and recall Difficult to meaningfully sequence content

  10. Curricular Problems in the Past and Present (2) Knowledge gaps Information overload Reduced learning by teaching out of context Too much lecturing (Passive learning) Excessive class time

  11. Medical Curricula of 11 Medical Schools in Taiwan賴其萬教授：調整醫學系課程建議報告書 • 基礎醫學課程：鮮少有臨床醫學老師參與規劃，而基礎醫學和臨床醫學老師之間缺乏溝通，致使整合課程無法落實。 • 臨床醫學課程： • 學校一般對附設醫院培訓內容無法介入、管控。 • 醫學生在臨床實習期間大多並未實際參與病人照顧。

  12. 當前美國（台灣亦然）高等教育的現況 • 大學生從大學帶走的知識和心智習慣，較少取決於課程內容，而是取決於教學品質。因此， • 課程多、內容嚴謹，不代表學生「學得好」。 • 如果教學品質好、學生的興趣、價值觀或認知能力，會保留得多。 大學教了沒？：哈佛校長提出的8門課 高希均序

  13. 當前美國（台灣亦然）高等教育的現況 • （一）大學校長與教授們，並不積極及有系統的來改善大學教育品質。 • （二）「教學方法」變成了教授個人的特權，難以共同討論及改善。 　　 • （三）由於「教學方法」難以改進，使得課程增加，卻不保證學習進步。　　 • （四）大學排行榜與教學品質脫鉤。　　 • （五）國際排名反應的是大學研究聲譽，而非教學品質。 大學教了沒？：哈佛校長提出的8門課 高希均序

  14. Solutions for Resolving Curricular Problems Re-categorization: create a new blueprint Create new courses: with new names, that help integrate basic, clinical, and behavioral sciences Identify the needs: based on students and faculties

  15. KnowledgeComprehensionApplicationAnalysisSynthesisEvaluation Performance Diagnosis Treatment Reasoning Evidence Judgment & data management Value, Cost-Benefit Experience, Intuition, Bias Evidence and data Collection Analysis Synthesis Evaluation The Outcome By: Paul PL Chang

  16. The Social Contract R. Cruess & S. Cruess.Perspectives in Biology and Medicine 2008;51(4):579–98.

  17. EXPECTATIONS: THE PUBLIC AND THE MEDICAL PROFESSION R. Cruess & S. Cruess.Perspectives in Biology and Medicine 2008;51(4):579–98.

  18. 醫師的角色與特質（Roles and Attributes of a Physician） 治療者(The Healer) 傾聽 能力 承諾 保密 洞察力 利他主義 值得信任 心胸開放 廉正與誠實 關懷與熱情 全心照顧與陪伴 倫理與道德行為 對職業的責任感 尊重病人治癒的潛能 尊重病人的尊嚴與自主權 R. Cruess & S. Cruess 修改自賴其萬教授提供檔案

  19. 醫師的角色與特質（Roles and Attributes of a Physician） 專業人員 (The Professional) 治療者(The Healer) 自律 自主性 團隊合作 對社會的責任感 廉正與誠實 關懷與熱情 全心照顧與陪伴 倫理與道德行為 對職業的責任感 尊重病人治癒的潛能 尊重病人的尊嚴與自主權 傾聽 能力 承諾 保密 洞察力 利他主義 值得信任 心胸開放 專業的素養(Professionalism) R. Cruess & S. Cruess 修改自賴其萬教授提供檔案

  20. Relationship-Center Education • Student-Centervs. Teacher-Center Education • Dean vs. Teachers • Inter-discipline • Inter-colleague

  21. Outcome-Based Education • 知識Knowledge • 技術Skill • 能力Competence • 執行力Performance • 完成力Capability (The power or ability to generate an outcome)

  22. KASH makes cash. K Knowledge 專業的知識 A Attitude 正確的態度 S Skills 圓融的技巧 H Habit 良好的習慣 工作成就 = 工作能力（知識 + 技巧） x 工作態度（態度 + 習慣）

  23. KASHO makes much more cash. K Knowledge 專業的知識 A Attitude 正確的態度 S Skills 圓融的技巧 H Habit 良好的習慣 O Organization culture 機構的文化 (Decided by the Leader’s will) 學習 (Learning) = 情緒(Emotion) + 動機(Motivation)  

  24. 一個真正的臨床醫學教師可評估及掌握學生的學習狀態一個真正的臨床醫學教師可評估及掌握學生的學習狀態 Paul PL Chang

  25. Within 2 weeks: Auditory Visual Kinesthetic 5% after 24 hours Active Passive & Immediate use

  26. Role Modeling • The process whereby faculty members exhibit knowledge, attitudes, and skills, demonstrate and articulate expert thought processes, and manifest positive (negative) professional behaviors and characteristics. After Irby: J Med Ed, 1986

  27. Role modeling We do not only teach by what we say, but by who we are and what we do? “Are you eating properly and getting plenty of exercise?”

  28. Outline • Why do we change? Have we fulfilled the expectation of the society? • The past and present curricular models • Clinical Presentation Curriculum • How about the future at CGU? In Taiwan?

  29. Curricular Models of North America 106 80 20 20 １７６５～Apprenticeship-based (師徒制） １８７１～Discipline-based (學科制） １９５１～Body System-based (器官系統制） １９７１～Problem-based (問題導向制） １９９１～Clinical Presentation-based (臨床表現制）

  30. Characteristics of five curricular modelsNorth American medical education, 1765 to the present

  31. Comparison of Problem-based learning (PBL) and Clinical presentation curriculum (CPC)

  32. Outline • Why do we change? Have we fulfilled the expectation of the society? • The past and present curricular models • Clinical Presentation Curriculum • How about the future at CGU? In Taiwan?

  33. Cloudy Picture 1

  34. Cloudy Picture 2

  35. Broad Clear Picture

  36. A Piece of Picture (1)

  37. A Piece of Picture (2)

  38. A Piece of Picture (3)

  39. Broad Picture vs. A Piece of Picture 2 1 2 1 3 3

  40. Clinical Presentation Curriculum 教導人體組織、生理、病理的相關反應 臨床表現 使用模擬病人、Case presentation、Demonstration 解決此臨床問題的思考流程 各種致病因、標準疾病型 Lecture, Demonstration 情境練習及應用 PBL, Bedside/ambulatory teaching

  41. Sample of Mackay Project • 4. Medical skill program • 4.1 Culture, Health, Wellness • 4.2 Communication • 4.3 Bioethics • 4.4 End of life • 4.5 Medical skills: History taking, collecting data, diagnosis, treatment & follow-up • 4.6 Physical examination • 4.7 Well physicians (做個身心健全的醫師)

  42. Renal – Electrolyte System • 1. Urinary Retention, Obstruction, Abnormal image findings • 2. Dysuria, Frequency • 3. Scrotal Mass (Testicular pain) • 4. Hematuria • 4.1 Hematuria, Extrarenal • 4.2 Hematuria, Intrarenal, Extraglomerular • 4.3 Hematuria, Glomerular • 5. Proteinuria • 6. Generalized Edema • 7. Renal Failure, Acute/Chronic • 8. Polyuria • 9. Hypertension • 9.1 Pregnancy Associated Hypertension • 9.2 Malignant Hypertension • 9.3 Hypertension in the elderly • 9.4 Hypertension in the Pediatric Age Group • 10. Abnormal Serum Sodium Concentration • 10.1 Hyponatremia • 10.2 Hypernatremia

  43. Sample Scheme Urinary Frequency Frequency/Dysuria Polyuria Water diuretic Osmotic diuretic External Internal Irritable bladder Infectious vulvovaginitis Excessive intake Excessive loss Diabetes insipidus Primary polyuria Urethritis Prostatitis Urinary tract infection Gonococcal C. Trachomatis Trichomonas Acute urethral syndrome Pyelonephritis Cystitis E. Coli Klebsiella Enterococci Proteus Pseudomonas Seratia

  44. Outline • Why do we change? Have we fulfilled the expectation of the society? • The past and present curricular models • Clinical Presentation Curriculum • How about the future at CGU? In Taiwan?

  45. Teaching Qualifications (1) Many countries (e.g. Japan) are trying to mimic the Finish education system. To maximize performance, the coach/teacher/tutor must be highly trained and dedicated. In medicine, many teachers teach the way they were taught (i.e., they have no formal training) There is a need to elevate the qualification, training and reward of teachers in medical education – some are even poor role models.

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