Curriculum mapping as a tool to facilitate curriculum development: a new School of Medicine experience.

BACKGROUND: Every curriculum needs to be reviewed, implemented and evaluated; it must also comply with the regulatory standards. This report demonstrates the value of curriculum mapping (CM), which shows the spatial relationships of a curriculum, in developing and managing an integrated medical curriculum. METHODS: A new medical school developed a clinical presentation driven integrated curriculum that incorporates the active-learning pedagogical practices of many educational institutions worldwide while adhering to the mandated requirements of the accreditation bodies. A centralized CM process was run in parallel as the curriculum was being developed. A searchable database, created after the CM data was uploaded into an electronic curriculum management system, was used to ensure placing, integrating, evaluating and revising the curricular content appropriately. RESULTS: CM facilitated in a) appraising the content integration, b) identifying gaps and redundancies, c) linking learning outcomes across all educational levels (i.e. session to course to program), c) organizing the teaching schedules, instruction methods, and assessment tools and d) documenting compliance with accreditation standards. CONCLUSIONS: CM is an essential tool to develop, review, improve and refine any integrated curriculum however complex. Our experience, with appropriate modifications, should help other medical schools efficiently manage their curricula and fulfill the accreditation requirements at the same time.

A comparison of standardized measures of psychosocial variables with single-item screening measures used in an urban obstetric clinic.

OBJECTIVE: To compare standardized, psychometrically sound measures of psychosocial variables and physical violence with single-item measures currently used for screening purposes in an obstetric clinic. STUDY DESIGN: Two hundred multiethnic women were interviewed during scheduled prenatal visits at an urban perinatal center. Participants previously completed a standard perinatal self-administered inventory, which included several single-item psychosocial questions. Medical and obstetric history, current risk factors, and intrapartum complications were collected from medical records. RESULTS: Correlational analyses indicated that single-item self-report measures were more appropriate for certain types of variables than for others. Specifically, for anxiety, depression, and social support, single-item measures were significantly correlated with standardized, psychometrically sound measures, whereas this was not true for stress and domestic violence. CONCLUSION: It may be appropriate to rely on self-reported single-item measures to detect some psychosocial risk factors in clinical settings for the purposes of referral. When assessing for domestic violence, single-item measures may not be adequate, as personal interviews using a standardized, psychometrically sound measure resulted in higher rates of reporting.

Maternal obesity and pregnancy outcomes.

PURPOSE OF REVIEW: The rates of obesity are increasing rapidly in the United States and other countries. Because obesity is a major factor in the development of many chronic diseases, it is an important individual and public health issue. This review focuses on the pregnancy complications associated with maternal obesity. RECENT FINDINGS: Maternal obesity adversely impacts pregnancy outcome primarily through increased rates of hypertensive disease (chronic hypertension and pre-eclampsia), diabetes (pregestational and gestational), cesarean section and infections. It is associated with a higher rate of venous thromboembolic disease and respiratory complications, and may be an independent risk factor for neural tube defects, fetal mortality and preterm delivery. Maternal obesity also increases the risk of delivering a large for gestational age or macrosomic neonate, who is in turn at an increased risk of subsequent childhood obesity and its associated morbidity. SUMMARY: Recommendations regarding the counselling of obese pregnant women and specific guidelines for the obstetrician, family physician, or midwife managing the pregnancy are presented. Cultural and political changes with the potential to decrease the epidemic of obesity in our society are discussed.

Substance abuse and polyhydramnios.

OBJECTIVE: Maternal drug use is known to have fetal central nervous system depressive effects as manifested by decreased biophysical profile scores. Drug effects on the amniotic fluid index (AFI), one variable of the biophysical profile, are not well documented. Our objective was to determine the effects of maternal drug use on the AFI. STUDY DESIGN: Over an 18-month period from July 1997 to December 1998, consecutive cases of women with toxicology-proven drug use during pregnancy were identified. AFI values and the rate of polyhydramnios in substance users were compared with those observed at our institution in more than 6400 patients undergoing ultrasound testing during the same period as the cases. RESULTS: Sixty-three toxicology-positive cases were identified. Although there was no significant difference between mean AFI values, the incidence of polyhydramnios (AFI >24 cm) was significantly higher in substance users (28.6%) than in control patients (3.9%) (P <.005). CONCLUSION: Maternal substance abuse is associated with a significantly higher incidence of polyhydramnios and should be considered a possible etiologic factor in women with apparent idiopathic polyhydramnios.

Intrauterine growth restriction is accompanied by decreased renal volume in the human fetus.

OBJECTIVE: Intrauterine growth-restricted fetuses are at risk for the development of adult hypertension and related cardiovascular diseases. Congenital oligonephropathy has been postulated as the primary mechanism. The objective of our study was to determine whether ultrasonically obtained in utero measurements of renal volume or renal artery Doppler blood flow differ between fetuses that are intrauterine growth restricted and fetuses that are not. STUDY DESIGN: The study population consisted of women who were referred for a prenatal ultrasound evaluation at a large community medical center. The women were divided into two groups: women with fetal biometry that was consistent with intrauterine growth restriction and women with biometry within normal range. Information was collected on maternal demographics and other factors known to affect fetal growth. We performed detailed fetal renal anthropomorphic and Doppler blood flow measurements in addition to standard fetal biometric measurements on all patients, specifically comparing renal volume and renal artery flow data between the two groups. RESULTS: No differences were observed in maternal age, race, parity, or fetal gestational age. Renal volume in the intrauterine growth-restricted fetuses was 31% (95% CI, 20%-40%), which was less than that in the group of fetuses that were not intrauterine growth restricted after an adjustment was made for gestational age. The ratio of renal volume to estimated fetal weight was 15% (95% CI, 1%-26%), which was less than the same ratio in the fetuses that were not intrauterine growth restricted. There were no differences seen in the renal artery Doppler measurements. CONCLUSION: Intrauterine growth restriction appears to be associated with a decrease in fetal renal volume. Because renal volume is a likely proxy for nephron number, this study supports the hypothesis that intrauterine growth restriction may be linked to congenital oligonephropathy and potentially to hypertension in later life.