Transcript Constructing a CanMED Curriculum Zubair Amin Sami Ayed What is not a curriculum? • Not a syllabus • Not a time-table or lecture • Not a listing.

Constructing a CanMED
Curriculum
Zubair Amin
Sami Ayed
What is not a curriculum?
• Not a syllabus
• Not a time-table or lecture
• Not a listing of lectures by discipline
• Not a teaching program developed in isolation
• Not a program without room for improvement
Defining a Curriculum Backward
Prideaux, D. BMJ 2003;326:268-270
“If you are not certain of where you are going you may
very well end up somewhere else (not even know it).”
Robert Mafer
Competencies
What to learn - content
How to learn –
educational strategy
How to assess
How to provide support
Residents and Fellows
Advantages of Competency Based
Curriculum
• Relevance
– Relationship between the curriculum and practice of
medicine
• Accountability
– Clarity of roles and responsibilities
• Flexibility
– Allows greater variations in course delivery and
educational strategy
• Assessment
– Fairer and robust assessment
ACGME Six Competencies
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Patient Care
Medical Knowledge
Practice Based Learning and Improvement
Systems Based Practice
Professionalism
Interpersonal Skills and Communication
GMC Tomorrow’s Doctors
• “In accordance with Good Medical Practice,
graduates will make the care of patients their
first concern, applying their knowledge and
skills in a practical and ethical manner and
using their ability to provide leadership and to
analyse complex and uncertain situations.”
Overarching
outcome
The doctor as a
scholar
and scientist
The doctor as a
practitioner
The doctor as a
professional
Common Global Outcomes:
Profile of a Physician

Expertise in medical sciences and clinical competency
 Skilled in communications with patients and with
colleagues
 Caring and ethical in approach
 Life-long learner; practice-based improvements and
quality improvement principles
 Knowledgeable about the context
Existing Curricula
Typical Existing
Curriculum
• Rudimentary
• Contents are mostly rules and regulations;
very little description of competencies
• No description of teaching and learning
apart from rotations and their duration
• Promotion typically depends on passing a
MCQ paper
• No scope for mentoring, trainee support
• No description of skills progression
• No revision; sometimes quite outdated
Framework for New Curriculum
What we know will be different in the future
• New applications of science and technology
• More cost pressures: physicians as stewards of limited
resources
• Patient demographics will be different
• More use of computers/information technology
• More population-based thinking: more emphasis on
prevention/wellness
• Increased accountability
• More interdisciplinary practice
• More ambulatory care
Adopted from a presentation by Prof Ed Hundert, former President of Case Western
Reserve University
Proposed Curriculum:
Philosophical Orientations
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Competency-based
Graded responsibility for the physicians
Better supervisory frameworks
Clearer demarcations what should be achieved at
each stage of training
• Core curriculum with elective and selective
options
• Independent learning within a formal structure
Expanded range of competencies
• Balanced representation of knowledge, skills,
and professionalism
• Incorporation of new knowledge and skills for
the present and the future
Evidence-Based approach
• Demographic data (e.g., disease prevalence)
• Practice data (e.g., procedures performed)
• Patient profile (e.g., outpatient versus
inpatient)
• Catered towards future needs
Holistic Assessment
• Higher emphasis of continuous assessment
• Balanced assessment methods
• Portfolio and log-book to support learning and
individualized assessment
• In-built formative assessment
Our Approach
• Customization to Saudi Arabia
• Incorporating good practices from local
centers
• Getting help from overseas centers
• Centralized support
Few Unique Elements
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List of most important/high priority topics
Rotation specific competencies
Universal topics
Core-specialty topics
Work-based assessment and examination
Mentoring guidelines
E-portfolio and log-book
Children’s High Priority Conditions
OPD
Consultation/liaison
Accident/Emergency
Attention deficit hyperactivity
disorder
Child abuse
Child abuse
Autism spectrum disorders
PTSD
PTSD
Communication Disorders
Adjustment disorders
Nonspicific aggression
Intellectual Disabilities
Dilirium
Panic disorder
Learning Disorder
Elimination disorders
Acute Stress Disorder
Depressive disorders
Depressive disorders
Depressive disorders
Bipolar disorder
Motor Disorders
Selective Mutism
Obsessive compulsive
disorder
Obsessive compulsive disorder Medication-Induced
Movement Disorders and
Other Adverse Effects of
Medication and overdose
Anxiety disorders
Catatonic Disorder Due to
Another Medical Condition
Catatonia Associated With
Another Mental Disorder
Psychotic disorders
Psychotic disorders
Psychotic disorders
Training level
R1
Evaluation
Item
Content
Relative %
Annual
(Rotations)
evaluation
Continuous Assessment 40%
40%
End-Year
Evaluation
Exam
R2
R4
60%
Annual
evaluation
Continuous Assessment 40%
40%
Evaluation
Exam
MCQ 40%
Clinical Exam 20%
60%
1st part
Examination
R3
50%
MCQ 40
Clinical (OSCE) 20%
100 MCQs
Continuous Assessment 40%
Evaluation
Exam
MCQ 40%%
Clinical Exam 20%
60%
Annual
evaluation
Continuous Assessment 70-80%
70-80%
Evaluation
Exam
Clinical Exam 20-30%
Written
200 MCQs (50%)
The OSCEs format consist of 6-10
stations including 15-20 cases which
will vary from history taking case
scenario, short cases and data
interpretation…etc. (50%)
50%
70%
Annual
evaluation
2nd Part
Examination Clinical
(OSCEs)
Passing score
40%
60%
60%
20-30%
50%
(
5
50%
0
%
)
70%
Universal Topics
• Universal Topics Learning Outcomes
Mentoring of Residents
• Assigned mentor for each resident and fellow
• Long term relationship between mentor and
resident
• Defined minimum frequency of meeting
– 1 hour/fortnight
• Monitoring of trainee’s progression
• Providing guidance and resources
E-Portfolio and Logbook
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Integral to demonstrate competencies
Continuous learning and assessment
Regular feedback
Joint responsibility on the trainee to
determine the achievement of competency
• Electronic portfolio (T-Res System)
Changing Metaphors for Realigned,
Redesigned Learning Organizations
Industrial Age
Information Age
Classrooms, libraries, and labs
Network
Teaching
Learning
Seat time-based education
Achievement-based learning
Classroom-centered instruction
Network learning
Information acquisition
Knowledge navigation
Distance education
Distance-free learning
Continuing education
Perpetual learning
Time out for learning
Fusion of learning and work
Michael G. Dolence and Donald M. Norris
Transforming Higher Education
A Vision for Learning in the 21st Century
Current Status
• Process started: August 2013
• Group formed: 32 (includes nursing and other
healthcare professionals)
• Approved by the Scientific Committee: 10
Curriculum Development versus
Implementation
“Discussions on curriculum are often limited
to who ‘covers’ what, an approach more
suited to barn painting than to education.”
Timothy Goldsmith, Science 2002
Affinity Groups
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Group 1: Dissemination
Group 2: Stakeholder Engagement
Group 3: Faculty Training
Group 4: Monitoring and Evaluation
Dissemination
• Goal: A transparent, portable curriculum that
is widely accessible to all stakeholders 24/7.
• What steps should we take to achieve the
goals?
Stakeholder’s Engagement
• Goal: Shifting the mentality from ‘your
curriculum’ to ‘my curriculum’
• Who are the stakeholders of the new
curriculum?
• How do we ensure that stakeholders address
the issue as their own?
Faculty Training
• It is said “We do not need curriculum
development, we need faculty development.”
• How can we create a community of passionate
faculty?
• What skills are missing? What knowledge
upgrading is necessary?
Monitoring and Evaluation
• “If you do not measure, you can not get
better.”
• What should we measure to judge success?
• How should we measure what need to be
measured?
Strategy: Resistance versus Impact
Low Resistance/High Impact
High Resistance/High Impact
Low Resistance/Low Impact
High Resistance/Low Impact
RISE Principle
• Resource:
– Appropriate human and material resources
• Incentive
– Reward, recognition
• Support
– Removing barrier, facilitating work
• Expertise
– Ability and credibility