Curricular Goals and Objectives

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In an article entitled “The Case for Core Curriculum”, author James Bradshaw raises concerns regarding university teaching that should cause some unease as we consider our medical courses and curriculum.  “The tide seems to be turning”, he writes, “with business leaders lamenting that, although the new talent arriving at their doorsteps has deep technical knowledge, it lacks the skills needed to put this knowledge to full use”. (http://www.theglobeandmail.com/news/national/time-to-lead/why-university-students-need-a-well-rounded-education/article4610406/)

Rather disturbingly, this observation echoes the growing concern among postgraduate training directors and clinical faculty that our graduates seem adept and comfortable providing factual information, but considerably less so when challenged to assess undifferentiated patient presentations and integrate factual information into cogent and practical management plans.  Lest we dismiss such commentary as isolated rumblings, it’s useful to keep in mind that the results for Queen’s graduates on the MCC Part 2 examination would seem to support the contention that our graduates struggle in the domains of clinical reasoning and comprehensive patient management, in sharp distinction to their well above average performance in knowledge-based components of the Part 1 examination.  Although the effects of our revised curriculum and enhanced assessment practices are not yet influencing examination results, it would seem unwise to simply dismiss these observations.

Bradshaw goes on to point out that, at the university undergraduate level, there exist political, logistic and economic barriers to providing integrated educational experiences that address what we, in the medical education context, would term “competencies” rather than traditional discipline-based content.  Indeed, we are well aware of the challenges of blending traditional disciplines and developing both content and assessment that address what many refer to as the “softer skills” relevant to medical practice, such as critical thinking, communication with disparate populations, collaboration, and the ability to advocate effectively for patients, health system delivery, and oneself.

Our curricular goals and objectives, as well as our Competency Framework (see “Curricular Goals and Competency based Objectives”), was developed in 2007 and has served as the central focus for the restructuring of curriculum and assessment methods that has allowed us to both develop a much more effective learning experience for our students, and achieve compliance with all accreditation standards.  The principles it espouses should remain our central guiding force.  However, the observations noted above should cause us to consider whether a clearer definition of the expectations we have for our graduating students is in order, recognizing that many of the competencies we espouse (professionalism, advocacy, communication, collaboration) are not ends in themselves, but necessary components of a graduates “competence” to assess, diagnose and manage patients with a variety of clinical presentations.

I’ll be encouraging a dialogue on this issue at our major committees and among our Course Directors.  This blog seems an appropriate place to start.  Feel free to provide feedback.

 

2 Responses to Curricular Goals and Objectives

  1. John Fisher says:

    Hi Tony, I enjoyed your blog, which in turn led me to the Bradshaw article in the Globe and the following. Bradshaw’s premise could be rephrased in a more positive light; in addition to the presence of “deep technical knowledge” one needs the skills “to put this knowledge to full use”. Knowledge and its application are not either/or outcomes. If objective measures show a trend for MD graduates of Queen’s to be more comfortable in “factual information” than assessing “undifferentiated patient presentations”, this is an area that requires thoughtful solutions; solutions that embrace the career journey for physicians and ensure that a bag is packed for the trip. The contents of the bag, as well as the ability to utilize/apply what is in the bag, or even how to repack as necessary, are co-dependent skillsets. Some of the apparent truths quoted by Bradshaw are clearly for effect, such as those from a former Harvard President that “…anything you learn is going to become obsolete within a decade, and so the most important kind of learning is about how to learn.” The former is so patently false that it detracts from the real grain of truth, which is the need for University graduates to know how to learn and to apply their knowledge. If our graduates “ have trouble communicating and working in teams, and often struggle to see complex problems from a variety of angles”, then we need to devise ways that address the problem without losing the fundamental core competency required for a medical expert. Your call to assess, define and alter our curriculum to ensure that expectations for Queen’s grads are appropriate and achievable is one that deserves widespread support. The devil is in the details, and more effective learning experiences for our students will benefit from a bag that is packed for the journey, whether it is from our medical curriculum or from the increasingly advanced standing/ knowledge-base of those entering our medical school. After all, Bradhsaw’s premise “that education is still defined as acquiring general knowledge, developing the powers of reasoning and judgment, and generally preparing intellectually for mature life”, is not a bad guiding principle.

  2. Thanks John, for the thoughtful comment. I love the “packing the bag for the journey” image. I believe our faculty have made real progress over the past few years in developing curriculum that not only provides the scientific and factual basis that supports medical practice, but also learning opportunities that challenge students to apply that information in clinical applications. This is reflected in a reduction in our didactic content from over 80% to about 40% of teaching hours, with the introduction of small group, case based sessions devoted to clinical problem solving. Thanks to a very active Professional Foundations Committee chaired by Ruth Wilson and supported by Sheila Pinchin, we’ve also developed a very robust Life Long Learning curriculum, and Heather Murray has developed considerable curricular content addressing the need for information acquisition and critical appraisal. However, we’ve been concentrating on the pre-clerkship. The next target is our expanded two year clerkship, where Sue Moffatt is in the process of developing and introducing Core Curriculum to reinforce these concepts to students more “primed” by clinical experience to understand their relevance, and Andrea Winthrop and her committee are looking at ways to blend these competencies into clinical experiences. All this to say, you’re quite right – the journey’s off to a good start and I believe we know where we’re going, but much left to do.

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