Overall, Dr. Fraser’s comments tend to provide an excellent overview of the tasks and challenges associated with curriculum development.  Although it is evident that curriculum development demands an investment of time and careful planning, such efforts will help to ensure that physicians in training will be better prepared for the health care challenges of tomorrow.

Contents

Research on Curriculum Development

In 1997 the Federated Council for Internal Medicine Task Force developed a Guide to Curriculum Development that could be of significance for a variety of disciplines.  In describing one of the important values of a curriculum, the Task Force notes that a “curriculum should enable learners to develop competencies, and it should specify those competencies in a way that program directors can use to shape the learning experiences in their institutions.”  The Task Force also suggest that while the “competencies” tend to justify the experiences”, the “experiences of clinical practice” also tend to “define the competencies”.  Overall, the Task Force recommends that “each program should design a curriculum that responds to the constraints and opportunities of its setting and the aspirations of its constituency”.  In addressing some of the major planning considerations regarding curriculum development, Kern, Thomas, Howard, and Bass (1998) recommend a “six-step approach” that begins with “problem identification”, followed by “needs assessment” of the various learner groups, the development of “goals and objectives”, “educational strategies”, “implementation” of the curriculum, and“ evaluation and feedback”.  While having outlined a “six-step approach” to curriculum development, these authors recognize that in reality, the development of a curriculum “does not usually proceed in sequence, one step at a time”.  Instead, “it is a dynamic, interactive process” where “one step influences progress on another”.  Thus, “progress is often made on two or more steps simultaneously”.  In their explanation of clerkship curriculum evaluation, DaRosa, Prystowsky, and Nahrwold (2001) suggest that “it is critical that clerkships, regardless of discipline, plan a curriculum that provides a ‘generalist’exposure relevant to student learning needs, regardless of their future chosen disciplines”.  Quirk (1994) emphasizes the need for the inclusion of competencies and skill development that are relevant.  Quirk suggests that if “the material to be presented is too basic or too far removed to spend extra time explaining the clinical relevance, then its inclusion in the curriculum should be questioned”.  Douglas, Hosokawa, and Lawler (1988) note that a “curriculum integrates all parts of the learning experiences by describing the scope and sequence of the teaching and learning that will take place”.  According to these authors, “scope is the breadth and depth of the material to be covered”, while “sequence” pertains to “the order of learning experiences”.  Of major importance to note, yet often overlooked when considering the importance of a curriculum, Douglas, Hosokawa, and Lawler indicate that a “curriculum is the basis for systematic evaluation and improvement of teaching and learning.” Quirk also notes this often overlooked feature and suggests that “medical schools should require teachers to participate in faculty development programs” which results in continuous learning for both trainee and trainer.  With this emphasis on teaching and learning, the curriculum content and outcomes are automatically enhanced to assist us in developing physicians who will be successful in the health care world of today and tomorrow.

Clinical teachers and trainees are encouraged to review these and other studies in more detail.  Please continue to add to your teaching/learning “tool kit”.