1. Core curriculum Fadhil Alamran, MRCS glasg, FIBMS, postdoctoral fellowship Colorado university, cardiothoracic surgeon M.D.

2. ‘The drug, doctor’ The idea that the patient responds, not just to a pharmacological substance, but to the person of the doctor; the atmosphere the doctor generates and what the interaction means to both of them ------this is the aim of ideal core of curriculum

3. Overview: A powerful strategy in medical education = Core + (SSMs) special study modules or (SSCs) Student Selected Components

4. This strategy : curriculum overload, knowledge, skills and attitudes allows students to take more responsibility provides a curriculum framework

5. Background ‘ information explosion’ - intolerable burden for the student. Curriculum developers need to make provision for the inclusion of new topics such as palliative care without neglecting traditional course content such as anatomy. There is also an increasing recognition that while students may not be able to study all areas in depth, there is a need to provide an opportunity for them to have time scheduled to study some subjects in more depth

6. What is the Core Curriculum? There are different perceptions of what constitutes ‘core’ Core curriculum

7. Core as essential aspects of all subjects or disciplines: the key aspects of the subjects studied in the curriculum. Core as essential competences for practice: Core as a study of what are perceived as the key disciplines: Core as transferable areas of study relevant to many disciplines:

8. The concept of the core curriculum and options or SSMs be described as the seven Cs: Certification: Capability: Comprehensiveness:. Consistency:. Constructivism: Choice: Compacted curriculum:

9. Determination of core A range of stakeholders can contribute to what should be included in a core curriculum. government, the public, the professions, students and teachers within an institution The importance of the topic in key decisions to be taken by a doctor The commonness or rarity of the problem The extent to which one can generalise from the subject to other topics in medicine. The core curriculum will change with time and should reflect medical trends and changes

10. Core + (SSMs) special study Advantages opportunity for students to study in greater depth an area of their choosing integrated themes, giving a multidisciplinary and multiprofessional direction to the curriculum. SSMs recognise the importance of generic competences or transferable skills SSMs allow significant extension of the range of subjects or topics covered in the curriculum

11. Advantages, contin. SSMs can utilise a range of teaching resources SSMs can be attractive, both to staff and students. A menu of interesting SSMs may attract potential students and influence their choice

12. Topics covered in SSMs i.An extension of the core ii) A topic related to medicine but not included in detail in the core: eg, computing, information technology, history of medicine. iii) A topic not related directly to medicine: eg a foreign language, business

13. Important criteria for the selection of SSMs contribution they can make to overall course learning outcomes availability of suitable resources in the medical school. Is the subject consistent with the school’s learning outcomes Might the SSM help the students in their choice of a future career? Does the SSM lead to mastery of learning skills, and information retrieval relevant to the practice of medicine?

14. At least one senior member of staff must have their organisation and coordination as a major personal responsibility. This person must have the authority of the appropriate committees within the university. Adequate resources must be made available, eg finance, library facilities etc. There should be some flexibility in the duration of SSMs, eg, one, two or four weeks or longer. Management of SSMs

15. The number of SSM slots offered should be greater than the number of places required by students. Guidelines and advice should be offered to students concerning their choice of SSMs and what is expected of them. SSMs should be assessed as stringently as the core, preferably with an external examiner. Management of SSMs contin.

16. Four approaches can be identified to implement a curriculum with core and SSM components. Each has its advantages and disadvantages. Relationship between Core and SSMs

17. Integrated Approach: Concurrent Approach: Intermittent Approach: Sequential Approach : Students proceed to SSMs only when they have demonstrated mastery of the core. Relationship between Core and SSMs contin.

18. Time allocation for Core and for SSMs Time allocation for Core and for SSMs SSMs take up between 20-40% of the curriculum. The balance between core and SSMs will be influenced by, among other things, the amount of core to be covered and the resources available to provide a wide range of learning opportunities.

19. Students should be expected to demonstrate a high level of mastery of the core of a course on completion of the curriculum. The assessment should be competetive and using MCQs and case study is more accurate in assessment even sor basic science In the assessment of SSMs, decisions must be taken as to whether to adopt a pass/fail system or a grading system and how that influences the overall assessment of students. The assessment may be a written test, essay, dissertation, oral or practical exam. External examiners are important in helping to maintain standards comparable between different SSMs. Student Assessment

20. Increasing demands on postgraduate training, with greater specialisation, rapid expansion, new developments in medicine and time constraints, are arguments for the introduction of a core training programme with SSMs. For greater emphasis on teaching and on research. Postgraduate studies – core -SSMs

21. Need to integrate the core  Students’ basic scientific knowledge ‘?’ in the traditional core is inadequate for clinical medicine –this is from feedback of the european and american core curriculum in the previous decade

22. Integration of the core & Evidence of Integration GeneticsAnatomyBiochemistryMicrobiology ImmunologyPathology PharmacologyPhysiologyNeuroscience

23. Basic Sciences Integration: What and how? Systems Organ Biological Organ Biological Molecular to cells, tissues, and systems Molecular to cells, tissues, and systems From normal to abnormal biology From normal to abnormal biology Integration of normal and abnormal biology Integration of normal and abnormal biology Integration of different disciplines Integration of different disciplines

24. Integration of core will lead to integration of assessment Using clinical problem solving questions for first year studentent Using clinical problem solving questions for first year studentent

25. A miraculous rescue An 8-year old boy, Maurice, has been lying under water for more than 15 minutes. Fortunately a passer-by succeeds in bringing him out of the water. Mouth-to-mouth resuscitation is applied immediately. Everyone is astonished to notice that the boy is still alive. At the moment Maurice is on the intensive care ward of the local hospital and is out of danger of life. According to his medical attendant, he is expected to recover completely. Explain why it is possible for the boy to survive after lying under water for more than 15 minutes

26. Assessment of efficacy of the Core Communication skills “holy grail” and final end result for the assessment of Core is through clinical skill of graduate Communication skills “holy grail” and final end result for the assessment of Core is through clinical skill of graduate

27. Assessing clinical skills 1. WHY do we need to assess ? 2. WHAT do we want to measure ?

28. WHY do we assess ? To ensure safety of patients To ensure safety of patients our responsibility to the public Achievement of a minimum standard Achievement of a minimum standard responsibility to the candidate and University In principle…

29. WHY do we assess ? Formative: to give feedback and advice regarding the core Formative: to give feedback and advice regarding the core Summative: to grade Summative: to grade Qualificative or licensing Qualificative or licensing In practice: the purpose

30. WHAT do we measure ? To test not only presence of knowledge …but also the application of knowledge and the core In principle…

31. Aim of clinical assessment Certification of competence - pass / fail Certification of competence - pass / fail a state (and legal) requirement a state (and legal) requirement Grading in rank order Grading in rank order for employment / placement purposes A competition for the award of a prize A competition for the award of a prize Feed back for core competency Feed back for core competency In principle…a four-fold aim

32. OSCE assessment is valuable for core assessment At least 6 clinical stops with different clinical situations At least 6 clinical stops with different clinical situations Two examiners at every encounter, each examiner giving an individual assessment Two examiners at every encounter, each examiner giving an individual assessment Highly structured examination and detailed assessment of skills Highly structured examination and detailed assessment of skills Examiners from other Universities for process evaluation and quality control Examiners from other Universities for process evaluation and quality control

33. What happens to candidates who fail ? Review of performance – a formative exercise Review of performance – a formative exercise Counselling at a personal level Counselling at a personal level Specific attention and individual training Specific attention and individual training Repeat assessment after a period of time Repeat assessment after a period of time Common candidate failure causes should give feed back to the core assessment Common candidate failure causes should give feed back to the core assessment

34. liberate the medical curriculum The introduction of core and special study modules allows great efficiency in the use of time and facilitates achievement of significant and highly desirable curriculum objectives. Conclusion

35. Integration of the core is mandatory need to counteract information explosion Integration of the core is mandatory need to counteract information explosion Integration of assessment is a sequele Integration of assessment is a sequele assess clinical competences is good feedback for core competency assess clinical competences is good feedback for core competency Conclusion contin.