Anthony Sanfilippo

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.