Implementing Curriculum Change: Choosing Strategies, Overcoming Resistance, and Embracing Values

ASPIRE for excellence in curriculum development

The objective of the ASPIRE award programme of the International Association for Health Professions Education is to go beyond traditional accreditation processes. Working in partnership with the ASPIRE Academy, the programme aims to encourage and support excellence in health professions education, in part by showcasing and exemplifying best practices. Each year ASPIRE award applications received from institutions across the globe describe their greatest achievements in a variety of areas, one of which is curriculum development, where evaluation of applications is carried out using a framework of six domains. These are described in this paper as key elements of excellence, specifically, Organisational Structure and Curriculum Management; Underlying Educational Strategy; Content Specification and Pedagogy; Teaching and Learning Methods and Environment; Assessment, Monitoring and Evaluation; Scholarship. Using examples from the content of submissions of three medical schools from very different settings that have been successful in the past few years, achievements in education processes and outcomes of institutions around the world are highlighted in ways that are relevant to their local and societal contexts.

Building a strong foundation from the ground up: the impact of a medical student substance use disorder organization on curriculum and community

Due to the increasing rates of substance use disorders (SUDs), accidental overdoses, and associated high mortality rates, there is an urgent need for well-trained physicians who can grasp these complex issues and help struggling patients. Preparing these physicians occurs through targeted education and clinical exposure in conjunction with medical school curricula in the field of addiction medicine. Medical students can often feel overwhelmed by the medical school curriculum and changes to the curriculum take time, money, and administrative commitment to ratify. Implementing a student organization dedicated to SUD education can be a solution to provide clinical exposure, education and student autonomy in their medical school experience. At Wayne State University School of Medicine, Detroit vs. Addiction (DvA) is a student-run organization that is filling the gap in SUD education for medical students whilst providing assistance to the community. DvA not only extends clinical education for physicians in training, but it also provides the medical school with an opportunity to allow students to create a blueprint for education initiatives that can be incorporated as a mainstay in the school's technical trainings. Herein, we describe the evolution of this organization and its activities.

How to create a faculty-centered curriculum support system: Launching the Academic Support Center (ASC) to inspire excellence in curriculum change

PURPOSE

To define faculty needs and services requested for the implementation of a faculty-centered curriculum support system (i.e., Academic Support Center [ASC]) to assist curriculum redesign.

METHODS

Faculty and students were invited to participate in 60-min, one-on-one interviews to describe pain points in teaching and identify possible support services needed. Benchmarking through surveys of academic deans was also conducted to determine what services other institutions offer. Qualitative memos from interviews and survey data were analyzed to identify salient challenges and outline possible services that could benefit the school. This information was used to create a strategic plan for the ASC. Full-time faculty were requested to evaluate the ASC 6 and 12 months following the launch of the center in 2019.

RESULTS

Fifty interviews were conducted with department chairs (n = 10), full-time faculty (n = 36), and students (n = 4). Six pain points identified by participants were time, resources, knowledge, confidence, organizational structure, and organizational culture. Participants generated solutions related to supporting teaching and learning, enhancing faculty experience, and assisting educational evaluation. Twenty-two schools responded to the benchmarking survey-approximately half acknowledged a centralized curriculum support service (n = 12, 54.5% of respondents). Services often focused on instructional design, education technology, and faculty onboarding to education. Faculty feedback following the ASC launch was generally positive and demonstrating progress toward the three priorities.

CONCLUSION

Needs assessment and benchmarking data can inform the design and implementation of centers that offer faculty-centered support structures around teaching, educational scholarship, and curriculum change.

"I don't think the problem's the student…I think it's us": Engaging faculty in curriculum innovation

PURPOSE

The need to innovate predoctoral dental education is well established; however, there are few recent reports to guide substantial curriculum transformation. The purpose of this study was to describe faculty perspectives on their vision of future graduates, curriculum needs, and potential barriers to a successful redesign. This information would be used to inform strategic planning for the predoctoral curriculum transformation.

METHODS

Eighty full-time faculty from the University of North Carolina Adams School of Dentistry participated in 60-minute focus groups in March 2018. Focus group questions were developed to elicit perceptions about the current curriculum, what the dental graduate should know in 2040, and what is needed to engage faculty in curriculum change. Transcripts of the focus group sessions were analyzed by a third-party research group using qualitative thematic analysis to identify pertinent themes shared by participants.

RESULTS

Faculty identified that developing clinical skill that engages multiple specialties, student time to engage in advocacy activities, and opportunities to integrate biomedical, clinical, and behavioral sciences as critical features of the curriculum. They believed the 2040 graduate should be able to critically evaluate literature, exhibit strong leadership skills, and adapt to the changing healthcare environment. To better engage faculty in curriculum change, there needs to be dedicated time, sufficient resources, a clear plan, and greater collaboration across the school.

CONCLUSION

When embarking on curriculum transformation, engagement with faculty is a critical component of the change process. Focus groups can be used as a technique to better understand faculty perspectives about curricular needs and the overall vision.

Nationwide introduction of a new competency framework for undergraduate medical curricula: a collaborative approach

Switzerland recently introduced PROFILES, a revised version of its national outcomes reference framework for the undergraduate medical curriculum. PROFILES is based on a set of competencies adapted from the CanMEDS framework and nine entrustable professional activities (EPAs) that students have to be able to perform autonomously in the context of a predefined list of clinical situations. The nationwide implementation of such a competency- and EPA-based approach to medical education is a complex process that represents an important change to the organisation of undergraduate training in the various medical schools. At the same time, the concepts underlying PROFILES also have to be reflected at the level of the Federal Licencing Examination (FLE) and the national accreditation process. The vice-deans for education mandated a Swiss Working Group for PROFILES Implementation (SWGPI) to elaborate a guide presenting the principles and best practices based on the current scientific literature, to ensure the coherence between the future developments of the medical curricula and the evolution of the FLE, and to propose a coordinated research agenda to evaluate the implementation process. On the basis of the literature and analysis of our national context, we determined the key elements important for a successful implementation. They can be grouped into several areas including curricular design and governance, the assessment system and entrustment process, faculty development and change management. We also identified two dimensions that will be of particular importance to create synergies and facilitate exchange between the medical schools: a systematic approach to curriculum mapping and the longitudinal integration of an e-portfolio to support the student learning process. The nationwide collaborative approach to define strategies and conditions for the implementation of a new reference framework has allowed to develop a shared understanding of the implications of PROFILES, to promote the establishment of Swiss mapping and e-portfolio communities, and to establish the conditions necessary for ensuring the continuous alignment of the FLE with the evolving medical curricula.

Reforma da Atenção Hospitalar para modelo de saúde baseada em valor e especialidades multifocais

Resumo A saúde pública em Brasília sofreu diversas melhorias desde sua implementação devido à mudança do perfil econômico, social e de escolaridade da população. Foi realizada uma reforma na Atenção Hospitalar por gestão baseada em evidências, através de um conjunto normativo que estabeleceu o ordenamento dos Serviços Hospitalares de Emergência, Atenção Ambulatorial Secundária, Regulação de Serviços de Saúde e modelagem organizacional da Secretária de Saúde do Distrito Federal. Tais mudanças permitiram que os profissionais nos seus diferentes níveis de atenção estejam interligados. Ou seja, os profissionais passam a prestar um serviço de saúde de forma contínua para a população, proporcionando um cuidado de saúde integral ao paciente. Essa abordagem garante ganho de eficiência no tratamento do paciente, pois os profissionais multifocais e focais trabalham de maneira integrada. Com a implementação da gestão da organização por processos de trabalho e o planejamento adequado, foi possível redesenhar o modelo assistencial utilizado nos dias atuais, permitindo através da gestão do conhecimento a ampliação do acesso e da interatividade, proporcionado ao cidadão através do modelo de gestão em saúde que agregue valor.