Principles for Curriculum Development

Hirotaka Onishi, MD, MHPE

International Research Center for Medical EducationGraduate School of Medicine, the University of Tokyo

Textbooks

What Did You Learn in the Last Class?

Goals of Medical Education Begin with patient/society needs Balance between basic sciences, clinical

studies, and clinical practice Balance of knowledge, attitude, and skills Not only recalling information but also using

it to solve problems (deep knowledge)

Educational System

Elementary School 6 yrs

Junior High School 3 yrs

High School 3 yrs

University 4 yrs (Medical, Dental, Pharmaceutical Curriculum 6 yrs)

Medical Career

Medical School 6 yrs

Postgraduate Training 2 yrs

Fellowship 3-5? Yrs

Continuing Medical Education

Name of Medical Education for Each Career Level in Japan

Undergraduate Medical

Education

Preparatory Subjects

Basic Sciences

Clinical Medicine

Postgraduate Medical

Education

Residency

Fellowship

Entrance Exam

CAT

License Exam

Major Changes in Medical Education Curricula

1. Until 1850: Basically OJT (on-the-job training) Basic science was not developed widely

2. 1850~1950: Discipline-based curriculum Microbiology, Physiology, Public health…

3. 1950s~60s: Organ-system-based curriculum Cardiology, Gastroenterology… Basic science and clinical medicine are integrated

4. 1970s~: PBL （ problem-based learning ） Faculty-resource-intensive

5. 2000~: Outcome-based education

Innovative CurriculumThe SPICES model

Harden, 1984

Systematic Traditional

Student-centred Teacher-centred

Problem-based Passive acquisition

Integrated Discipline-based

Community Hospital-based

Elective Standardized

Systematic Opportunistic

Why Outcome-based Education? Information explosion Changing public expectation Accountability Informing curriculum decisions Integrating teaching and assessment Planning the continuum of education

Framework of Outcome-based Education

Educational Environment

Support

Assessment

How to learn(Methods)

What to learn(Contents)

Medical Students

Educational Outcome

Examples of OBE (1) 6 outcomes of Postgraduate training:

ACGME (Accreditation Council for Graduate Medical Education) ACGME Outcome Project: http://www.acgme.org/Outcome/

Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice

Examples of OBE (2)(CanMEDS 2000, 1996)

Examples of OBE (3)

IIME (Institute for International Medical Education):

GMER (Global Minimum Essential Requirements) in medical education

Med Teach 2002, 24, 130–135

ClinicalSkills

Population Health

Scientific Foundations

Professional Values,

Attitudes

Critical Thinking

Information Management

Communication Skills

Examples of OBE (4)The Scottish Deans’ Medical Curriculum Group’s Three circle model (Simpson et al. Med Teach 2002, 24, 136-143)

Medical informatics

Patient management

Patient investigation

Clinical skills

Communication

Practical procedures

Health promotion and disease prevention

Personal development

Role of the doctor within the health service

Attitudes, ethical understanding and

legal responsibilities

Decision-making skills and clinical reasoning and judgement

Basic, social and clinical sciences and underlying

principles

What the

doctor is able to do

Points of OBE Integrated competencies (e.g.

critical thinking and professionalism) are more clearly targeted.

Assessment for comprehensive performance is more emphasized

Nowadays “competency” is often used instead of “outcome” if mentioned for curriculum

(e.g. competency-based curriculum)

Quality Assurance of Medical Education in Japan

Admission policy Combination of nationwide achievement test and schools’

own examination (most have interview) Diploma (graduating) policy

No external examiner, schools’ own policy Institutional systems for quality assurance

Not specific National standards for quality assurance

Guidelines for curriculum: Nationwide core curriculum + Common Achievement Test (for 4th year)

Quality assurance for undergraduate clinical teaching is difficult to implement

Accreditation System in Japan In 2002, the Higher Education bureau, MOE

declared the amendment of the 3rd paragraph of Article 69 of the School Education Act.

All the universities have to undergo self-evaluation process and accreditation by a certified body every 7 years.

This has become effective since 2004. No specific accreditation system for medical

education

Program Accreditation in Japan Post-graduate professional schools (Law,

Business, Accounting, and Midwifery) must undergo self-evaluation and take external “program evaluation” by accreditation bodies every 5 years according to the School Education Act.

Program certification only to only post-graduate professional schools.

Pharmaceutical Education Accreditation in Japan Japan Accreditation Board for Pharmaceutical

Education (JABPE) is now starting self-evaluation. Full-scale external evaluation will start in 2012. After 2012, all pharmacy schools will take accreditation.

Program certification by JABPE is voluntary activities. They are non-governmental bodies. These activities aspire their educations to be fit to their global standards.

Why Accreditation? To assure the standardized medical

education To prepare for practitioners’ mobility to

another country

In 2010 ECFMG states that all the examinees must graduate from internationally accredited medical schools after 2023

Group Discussion What was the model of the curriculum

you have experienced or known? Any idea of which direction health

professional education curricula goes.