Lessons learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders.

OBJECTIVE: Recent educational reform in US medical schools has created integrated curricular structures. This study investigated how stakeholders in a newly integrated curriculum - students, course directors and curriculum leaders - define integration and perceive its successes and challenges during its first year. METHODS: We conducted interviews with curriculum reform leaders, course directors and first year medical students. Interview transcripts were analysed for themes, which were compared within and across stakeholder groups. RESULTS: Three curriculum leaders, four Year 1 course directors and six Year 1 medical students were interviewed. Fifteen students participated in a group interview. Four major themes emerged: interdisciplinary teaching; interdisciplinary faculty collaboration; building curricular links, and sequencing and framing curricular content. Cross-group analysis revealed participant agreement that an integrated curriculum required interdisciplinary teaching, clinical application and careful oversight. Differences among groups were also identified. Faculty (course directors and curriculum leaders) discussed faculty collaboration and the challenges of faculty buy-in and course implementation. Students highlighted the impact of integration on their learning and the challenges of sequencing and scaffolding content. Both students and course directors focused on course monitoring and conceptual links for student learning. CONCLUSIONS: Integrating a curriculum is a complex process. It is differentially understood and experienced by students and faculty, and can refer to instructional method, content, faculty work or synthesis of knowledge in the minds of learners. It can occur at different rates and some subjects are integrated more easily than others. We point to some specific considerations as medical schools embark on curriculum reform.

Developing educational leaders: the teaching scholars program at the University of California, San Francisco, School of Medicine.

A Teaching Scholars Program (TSP) was established in 1998 in the University of California, San Francisco (UCSF), School of Medicine with the mission of building knowledgeable and skilled educational leaders, teachers, and scholars. Conducted through the Office of Medical Education (OME), the TSP is a 10-month program that accepts 12 scholars per year. Financial support for the program, including salary support for co-directors and staff, is provided by the OME. Scholars' departments are required to provide release time for one afternoon per week for 10 months. The TSP provides participants with an intensive weekly seminar series, collaborative learning experiences, mentored projects, and a network of educational colleagues. The weekly seminars use an interactive format to address topics within seven targeted areas: (1) learning theory; (2) teaching methods; (3) curriculum development/evaluation; (4) assessment of learning; (5) leadership and organizational change; (6) career development; and (7) educational research. Since its inception, 76 scholars have graduated from or are currently enrolled in the TSP. The majority are clinicians at assistant professor rank, although four basic scientists, two medical students, and three OME staff members have also participated in the program. The TSP is highly valued by participants, and preliminary evaluation data suggest that the program has resulted in an increase in educational research, scholarly activities, and the number of skilled and knowledgeable faculty with major leadership roles in medical education at UCSF. Challenges facing the TSP include scholar release time, mentoring time, and follow-up contact to encourage TSP graduates' postgraduation productivity, continuing educational development, and support.

Promoting research in medical education at the University of California, San Francisco, School of Medicine.

Over the past seven years, educational innovations and scholarship have flourished at the University of California, San Francisco, (UCSF) School of Medicine. Prior to 1998, there was no infrastructure to support educational research and yet a few faculty members published in medical education journals and were active in national professional associations. With the initiation of curriculum reform in 1998, a great deal of excitement about education was generated and innovative new educational programs were envisioned. These changes became opportunities for educational scholarship. With the development of an Office of Medical Education in 1997 and the Haile T. Debas Academy of Medical Educators in 2001, the infrastructure was in place to expand educational research and the scholarship of teaching. The components of this support include educational leadership, faculty development, the Teaching Scholars Program, the Office of Educational Research and Development, the Academy, a Fellowship in Medical Education Research, collaborative research, and extramural grants. As a result of these investments, the number of UCSF faculty members who are involved in educational research has increased significantly. There has been a four-fold increase in peer-reviewed articles published in medical education journals and a greater increase in the publication of educational abstracts, editorials, chapters, and books, plus presentations at U.S. professional association meetings. In this article, the authors describe the changes that have occurred at UCSF to achieve these results.

What it's really like: the complex role of medical students in end-of-life care.

BACKGROUND: Medical student end-of-life care training provides insight into the hidden curriculum and physician professional development. DESCRIPTION: Second-year medical students at a university medical center listen to a panel discussion of 4th-year students and residents describing their end-of-life care experiences during clerkships. This discussion is intended to provide "anticipatory guidance" to 2nd-year students about challenging situations they might encounter on the wards. The purpose of this study was to analyze the content of the panel discussions by 4th-year students and residents to better understand their views of the end-of-life care curriculum. EVALUATION: We performed a qualitative content analysis of transcripts from 2 years of panel discussions. Participants' comments focused primarily on the complexity of the role of medical students in end-of-life care. Three major themes emerged in the sessions: defining professional identity, conflicting expectations, and limited medical experience. CONCLUSIONS: The role of medical students in end-of-life care can be complex, confusing, and contradictory. Emotional support and elucidating the hidden curriculum may assist students with the process of physician enculturation and end-of-life care education.