Chinese University of Hong Kong Faculty of Medicine

2. Chinese University of Hong KongFaculty of Medicine “No endeavor worth doing can be completed without cooperative effort” D Johnson

3. Tomorrow's Doctor The necessary . . . Knowledge Skills Attitudes

4. The revised medical curriculum • Faculty owned (vs departmentally developed) • Design • Scope and topics • Timetabling • Lecture materials vetted by Faculty to reduce • Duplication • Omission • Compression • Assessment

5. Knowledge 1. Foundation 2. Cardiorespiratory 3. GI & nutrition 4. Haematology, infection & immunity 5. Homeostasis: renal, endrocrin., metabol. 6. Musculo-skeletal 7. Neuroscience 8. Reproduction, sex, develpmnt & growth 9. Health & society 10. Mechanism diseases & therapeutic appr. 11. Human structure • Skills • Communication • Life-long Learning • Clinical System-based, integrated knowledgeEnhanced skills & affective development Core curriculum is designed & delivered by: 11 system panels 3 skills panels • clinical modules Attitudes Ethics & professionalism

6. Active learning • Small group sessions(> 2/3 of student contact time) • Life long learning skills • Computer literacy • Evidence-based medicine • phrasing clinical questions, electronic library search, critical appraisal, integrate research findings into clinical decision making • Web-enhanced learning • Selective study modules – 30% of curriculum • networking, organizational independent research skills

7. Percent Passive Active Passive Active Curricula

8. Early clinical contact & smoother transition to internship • Early clinical contact: yr 1 • Ward visits • Clinical skills laboratory • Real patient contact • Transition to internship • Pre internship: end of yr 5

9. Faculty-owned student assessment • Continuous assessments • Tutorials, Seminars, Practicals • Debates • Family follow-up project • Formative assessments • Web-based MCQs • Summative assessments • Skills • OSCEs & OSPEs • Poster & verbal presentations (SSM) • Knowledge • end of panel • end of yr integrated paper • Continuous assessment used: • to facilitate learning • to monitor progress • by panels • by self • to reduce stress • contribute to final grade

10. Year 1 Year 2 Year 3 Year 4 Year 5 Jr Med & Surg Clerkship Sr Med & Surg Clerkship Med & Surg Subspecialties Selected Study Modules C&F Med O&G Paed Psy A&E Skills – communication, clinical, life long learning Cardio-resp, GI-Nutr, Health-Soc, Homeostasis, Musculoskeletal Foundation Haem- Inf- Imm, Mechn Disease Neuroscience Reproduction, Sex, Development & Growth Human Structure Language, IT, PE 3rd Prof Exam II 1st Prof Exam 2nd Prof Exam 3rd Prof Exam I Pre-internship

11. Proportional allocation to knowledge, skills & attitudes across years Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Basic Medical & Clinical Sciences Attitudes Clinical Skills Clinical Skills

12. Structured Interview • Personal aspiration and motivation for & expectation of a career in medicine. • General knowledge about medicine: • the science, the profession, & the health care system. • Appreciation of moral & ethical issues. • Social & cooperative spirit: • teamwork and community involvement • Communication & language skills.

13. Selection Criteria for Interview • JUPAS applicants • HKCEE results: 5A’s + 2B’s • HKALE results • School Principal’s Nomination Scheme • Sports Excellence Scheme • Self-nomination Scheme • Disabled Student Scheme • EAS applicants • HKCEE results: 7A’s

14. Selection Criteria for Interview • Non-JUPAS applicants • GPA: > 3.5 • First class honour • GCE O-level: 6A’s • GCE A-level: 4A’s

15. Selection for Admission • JUPAS applicants: • 60% on WGPA • 40% on interview score • EAS applicants: • Interview score only • Non-JUPAS applicants: • Interview score only

16. Ongoing Review of Admission Process • Workshop at annual faculty curriculum retreat • review & discuss current issues • Improve interview validity & reliability • briefing and instructions for new interviewers • structured interview, independent marking • decrease variability of panel performance • statistical review of individual performance • On-going statistical comparisons • entry scores and undergraduate performance

17. Ensuring Clinical Competence • Early clinical exposure • Clinical skill laboratory • Log-book • Interactive web-based clinical case study • Pre-internship program • Intern education

18. System-based Integrated Curriculum 1 2 3 4 5 Basic Clinical Skills Nervous Disorder Medicine SPS SSM Surgery Child Health Human structure SPS SSM SPS Medicine Reproductive Medicine Subject Panel Study Selected Study Module Surgery Mobility SSM Clinical Experience Clinical Experience Final MB ENT/Eye/ Skin/ID Pre-intern training

19. Early Clinical Exposure

20. Clinical Skill Lab

21. Teaching in Clinical Skill Lab

22. Logbooks (hard & soft copy versions)

23. (8) New Entry

24. (4) Summary Count

25. (2) Module 4 Logbook

26. (10) View Grand Round List

27. An Interactive Web-based Clinical Case Scenario Students are encouraged to think & guided by pop-up prompts Fracture Through A Cyst : Does this look like a cyst – there is a periosteal reaction? Is it common to have such a reaction with a simple cyst ? Students cannot move on to the next stage unless they submit their answer Teacher assesses individual student responses & provides guidance

28. Pre-internship Program 2002 11 April: (Pre-test) 25 May: (Post-test) HOLIDAY 24 May 1 July 17 April 7 May 4 May Module 1 Module 2 5 weeks 3 weeks 3 weeks

29. Pre Internship Activities (17 April to 24 May 2002) Ward Rounds & Practicing Basic Procedures 4S APEP 4S 4S Patient and Family Communication

30. Pre-internship Pre- Post Assessments Cross Matching

31. Internship Training • Orientation • Supervisors • Logbook • Practice tips workshops • Mock interview

32. Blood Taking Hospital Phlebotomists

33. Averaged Quarterly Assessments of Interns’ Skills 1996 - 2002 Percentages

34. Monitoring & Evaluation

35. Benching Marking • Locally • International schools of high repute

36. Comparing CUHK, UAlberta & Licensing Groups % CUHK Alberta Licensing Group 100 90 80 70 60 50 40 30 20 10 0 Surgery O&G Basic Science Total Components of Licensing Examination using UAlberta’s MCQs

37. Comparing CUHK, UAlberta & Licensing Groups Percent Section of the Examination Using Alberta’s Items

38. Randomized Controlled Educational Trials • Determining impact of newly introduced pedagogy • e.g. web-based enhanced learning

44. Difference between Intervention & Control Groups Statistically Significant

45. Pre and Post Trials (Historical Cohorts) • Performance of interns compared • 2 alumni groups prior to curriculum revisions • 1 alumni group following changes in yr 5 • 3 week professional enhancement module • 6 week pre internship

46. * * * Mean of Overall Performance in ALL Hospitals *Difference is statistical significant at  = 0.05.

47. * * * Clinical Judgement in ALL Hospitals *Difference is statistical significant at  = 0.05.

48. Pre and Post Trials (Historical Cohorts) • Performance of students compared • 3 yrs prior to curriculum revisions • 1 group following changes in yr 1

49. 1st Yr Students’ Ratings of New Curriculum 1st Yr Students’ Ratings of Former Curriculum “I deepened my interest in the subject matter of this course [item 120] ” Strongly Agree Agree Slightly Agree Slightly Disagree Disagree Strongly Disagree Percentile Points for all Class Medians for Medical Year One Only

50. 1st Yr Students’ Ratings of New Curriculum 1st Yr Students’ Ratings of Former Curriculum “The objectives of the course were clearly defined [item 276] ” Strongly Agree Agree Slightly Agree Slightly Disagree Disagree Strongly Disagree Percentile Points for all Class Medians for Medical Year One Only