Using the SPICES model to develop innovative teaching opportunities in ambulatory care venues

Integrating basic, clinical, and health system science in a medical neuroscience course of an integrated pre-clerkship curriculum

Basic science, clinical science, and health system science (HSS) have become three pillars of integration upon which modern, post-Flexner, medical education is now based. Because of this new approach to curricular integration in a clinical presentation curruculum, medical training is now placed in the context of healthcare delivery. This study described the design, implementation, and assessment of an integrated teaching strategy, including the effect on students' performance in a medical neuroscience course's summative and formative examinations of an integrated clinical presentation curriculum. The integrated teaching of basic science content, clinical case discussion, and HSS was performed in the first year of an allopathic integrated pre-clerkship curriculum. The two cohorts were from two different years, spring 2018 and 2019. The acceptance of the integrated teaching strategy by medical students was above 80% in all categories that were assessed, including enhancing the integrated experience in learning basic and clinical science materials in the context of HSS; understanding of the learning lessons; facilitation of self-directed learning; provision of a better learning environment; and a holistic understanding of materials including the relevance of HSS issues in the discussion of neurological cases in the medical career of the students. More than 90% of the students scored ≥70% in summative questions mapped to the four learning objectives of the integrated teaching session. The objectives are the correlation of structure to specific functions (94.0 ± 0.21), clinical anatomical features of the nervous system (95.0 ± 0.27), cross-sectional features of the nervous system (96.0 ± 0.31), and the effect of lesions on the structure and functional pathways of the nervous system (97.0 ± 0.34). This result was significantly higher when compared to students' performance in the non-integrated teaching cohort (p < 0.05). Formative assessments (F(7,159) = 92.52, p < 0.001) were significantly different between the two groups. When medical students were evaluated using the same questions for formative assessment, they performed better in the integrated teaching cohort (*p < 0.05) compared to the non-integrated teaching cohort (**p < 0.05).

Medical Education in Costa Rica. From Flexner to COVID-19: Integrative Answers for Old and New Challenges

This monograph describes key aspects of medical education in a middle-income country such as Costa Rica, with an emphasis on public education. The main strengths and challenges of our curriculum are presented, as well as some recently implemented modernization measures to address the challenges described. Special attention is given to simulation training in medicine to promote systematic and integrative medical education in a problem-solving context. The SPICES model of educational strategies is used as a paradigm for curricular analysis. Finally, the impact of the COVID-19 pandemic on student, faculty, and staff acceptance of the curriculum modernization measures introduced is briefly discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01886-w.

The continuing use of the SPICES model in 'SAVOURING' curriculum development

The SPICES model, described by Harden, Sowden, and Dunn in Medical Education 1984, presents a way of re-focussing a traditional curriculum by the addition of various educational strategies or 'SPICES'. These 'SPICES', Student-centred learning, a Problem-based approach, Integrated learning, Community-based education, Elective elements, and a Systematic approach meet perceived deficiencies in a conventional teaching programme and can contribute to the delivery of a reformed curriculum which addresses the educational needs of contemporary healthcare professionals.The evidence: During almost 40 years now the SPICES model has achieved international recognition as a key approach to curriculum development. Its importance in the design, delivery, and audit of a curriculum remains relevant today as is evidenced by:The number of citations in the medical education literature.Its inclusion as a key element of curriculum development in standard texts of medical education.Its prominence as a component of established Certificate, Diploma and Masters courses in medical education.The number of presentations or posters on curriculum development in the annual AMEE conference.The international reports of its use in the design and delivery of a curriculum.The international reports of its use in individual course design.In curriculum design for other healthcare disciplines.In its role in curriculum auditing and reform.The continuing usefulness: This article revises the principles of the SPICES model. It reflects on examples of its continuing international use; its use for curriculum design and development in a variety of healthcare disciplines; and its role in curriculum audit and revision. It also comments on some of the suggested alternatives and modifications described.