Constructing a CanMED Curriculum

Zubair AminSami Ayed

What is not a curriculum?

• Not a syllabus

• Not a time-table or lecture

• Not a listing of lectures by discipline

• Not a teaching program developed in isolation

• Not a program without room for improvement

Defining a Curriculum Backward

Prideaux, D. BMJ 2003;326:268-270

“If you are not certain of where you are going you may very well end up somewhere else (not even know it).”

Robert Mafer

Residents and Fellows

Competencies

What to learn - content

How to learn – educational strategy

How to assess

How to provide support

Advantages of Competency Based Curriculum

• Relevance– Relationship between the curriculum and practice of

medicine

• Accountability– Clarity of roles and responsibilities

• Flexibility– Allows greater variations in course delivery and

educational strategy

• Assessment – Fairer and robust assessment

ACGME Six Competencies

• Patient Care • Medical Knowledge • Practice Based Learning and Improvement• Systems Based Practice• Professionalism• Interpersonal Skills and Communication

GMC Tomorrow’s Doctors

• “In accordance with Good Medical Practice, graduates will make the care of patients their first concern, applying their knowledge and skills in a practical and ethical manner and using their ability to provide leadership and to analyse complex and uncertain situations.”

Overarching outcome

The doctor as a scholar

and scientist

The doctor as apractitioner

The doctor as a professional

Common Global Outcomes: Profile of a Physician

Expertise in medical sciences and clinical competency Skilled in communications with patients and with colleagues Caring and ethical in approach Life-long learner; practice-based improvements and

quality improvement principles Knowledgeable about the context

Existing Curricula

Typical Existing Curriculum

• Rudimentary

• Contents are mostly rules and regulations; very little description of competencies

• No description of teaching and learning apart from rotations and their duration

• Promotion typically depends on passing a MCQ paper

• No scope for mentoring, trainee support

• No description of skills progression

• No revision; sometimes quite outdated

Framework for New Curriculum

What we know will be different in the future

• New applications of science and technology• More cost pressures: physicians as stewards of limited

resources• Patient demographics will be different• More use of computers/information technology• More population-based thinking: more emphasis on

prevention/wellness• Increased accountability• More interdisciplinary practice• More ambulatory care

Adopted from a presentation by Prof Ed Hundert, former President of Case Western Reserve University

Proposed Curriculum: Philosophical Orientations

• Competency-based• Graded responsibility for the physicians• Better supervisory frameworks• Clearer demarcations what should be achieved

at each stage of training• Core curriculum with elective and selective

options• Independent learning within a formal structure

Expanded range of competencies

• Balanced representation of knowledge, skills, and professionalism

• Incorporation of new knowledge and skills for the present and the future

Evidence-Based approach

• Demographic data (e.g., disease prevalence) • Practice data (e.g., procedures performed)• Patient profile (e.g., outpatient versus

inpatient)• Catered towards future needs

Holistic Assessment

• Higher emphasis of continuous assessment• Balanced assessment methods • Portfolio and log-book to support learning and

individualized assessment• In-built formative assessment

Our Approach

• Customization to Saudi Arabia• Incorporating good practices from local

centers• Getting help from overseas centers• Centralized support

Few Unique Elements

• List of most important/high priority topics• Rotation specific competencies• Universal topics• Core-specialty topics• Work-based assessment and examination • Mentoring guidelines • E-portfolio and log-book

Accident/Emergency Consultation/liaison OPD

Child abuse Child abuse Attention deficit hyperactivity disorder

PTSD PTSD Autism spectrum disorders

Nonspicific aggression Adjustment disorders Communication Disorders

Panic disorder Dilirium Intellectual Disabilities

Acute Stress Disorder

Elimination disorders Learning Disorder

Depressive disorders Depressive disorders Depressive disorders

Selective Mutism Motor Disorders 

Bipolar disorder

Medication-Induced Movement Disorders and Other Adverse Effects of Medication and overdose

Obsessive compulsive disorder Obsessive compulsive disorder

Catatonia Associated With Another Mental Disorder

Catatonic Disorder Due to Another Medical Condition 

Anxiety disorders

Psychotic disorders Psychotic disorders Psychotic disorders

Children’s High Priority Conditions

Training level Evaluation Item

Content Relative % Passing score

R1

Annual (Rotations) evaluation

Continuous Assessment 40% 40% 50% End-Year

Evaluation Exam

MCQ 40

60% Clinical (OSCE) 20%

R2

Annual evaluation

Continuous Assessment 40% 40% 50% Evaluation

Exam MCQ 40% Clinical Exam 20%

60%

1st part Examination

100 MCQs

70%

R3

Annual evaluation

Continuous Assessment 40% 40%

60% Evaluation

Exam MCQ 40%% Clinical Exam 20%

60%

R4

Annual evaluation

Continuous Assessment 70-80% 70-80% 60% Evaluation

Exam Clinical Exam 20-30%

20-30%

2nd Part Examination

Written 200 MCQs (50%) 50%

70%

Clinical (OSCEs)

The OSCEs format consist of 6-10 stations including 15-20 cases which will vary from history taking case scenario, short cases and data interpretation…etc. (50%)

(50%)

50%

Universal Topics

• Universal Topics Learning Outcomes

Mentoring of Residents

• Assigned mentor for each resident and fellow• Long term relationship between mentor and

resident• Defined minimum frequency of meeting

– 1 hour/fortnight • Monitoring of trainee’s progression• Providing guidance and resources

E-Portfolio and Logbook

• Integral to demonstrate competencies • Continuous learning and assessment• Regular feedback • Joint responsibility on the trainee to

determine the achievement of competency• Electronic portfolio (T-Res System)

Changing Metaphors for Realigned, Redesigned Learning Organizations

Industrial Age

Classrooms, libraries, and labs

Teaching

Seat time-based education

Classroom-centered instruction

Information acquisition

Distance education

Continuing education

Time out for learning

Michael G. Dolence and Donald M. Norris

Information Age

Network

Learning

Achievement-based learning

Network learning

Knowledge navigation

Distance-free learning

Perpetual learning

Fusion of learning and work

Transforming Higher EducationA Vision for Learning in the 21st Century

Current Status

• Process started: August 2013• Group formed: 32 (includes nursing and other

healthcare professionals)• Approved by the Scientific Committee: 10

Curriculum Development versus Implementation

“Discussions on curriculum are often limited

to who ‘covers’ what, an approach more

suited to barn painting than to education.”

Timothy Goldsmith, Science 2002

Affinity Groups

• Group 1: Dissemination• Group 2: Stakeholder Engagement• Group 3: Faculty Training• Group 4: Monitoring and Evaluation

Dissemination

• Goal: A transparent, portable curriculum that is widely accessible to all stakeholders 24/7.

• What steps should we take to achieve the goals?

Stakeholder’s Engagement

• Goal: Shifting the mentality from ‘your curriculum’ to ‘my curriculum’

• Who are the stakeholders of the new curriculum?

• How do we ensure that stakeholders address the issue as their own?

Faculty Training

• It is said “We do not need curriculum development, we need faculty development.”

• How can we create a community of passionate faculty?

• What skills are missing? What knowledge upgrading is necessary?

Monitoring and Evaluation

• “If you do not measure, you can not get better.”

• What should we measure to judge success?• How should we measure what need to be

measured?

Strategy: Resistance versus Impact

Low Resistance/High Impact High Resistance/High Impact

Low Resistance/Low Impact High Resistance/Low Impact

RISE Principle

• Resource: – Appropriate human and material resources

• Incentive– Reward, recognition

• Support– Removing barrier, facilitating work

• Expertise– Ability and credibility