Approaching Curricular Reform
Presenters: Yerko Berrocal, MD, MHPE from Alice L. Walton School for Medicine, Kathryn Huggett, PhD from Larner College of Medicine at the University of Vermont, and Robert Opoka, PhD from Aga Khan University
[The following blog was generated by Doug McKell and Akshata Naik]
This seminar was co-presented by three speakers who presented different approaches to medical school curriculum design. They were Dr. Kathryn Huggett from an established medical school, Dr. Yerko Berrocal from a newly founded medical school, and Dr. Robert Opoka from an international medical school. Each presenter shared their perspective, expertise, challenges, and experience on curricular reform.
Dr. Kathryn Huggett began the webinar by highlighting information to help the audience prepare for curricular reform at their school. She stated that her goal was to identify critical considerations using evidence from literature and practical information to support curricular reform at other medical schools for schools considering curricular reform. This process requires careful pre-planning because of many interrelated components, especially during the evaluation and implementation stages. Dr. Huggett referred to several information resources and tools for effectively managing this process. She stated that curricular reforms are usually performed due to internal considerations, such as improving student learning outcomes and aligning assessments, or external considerations, such as matching updated accreditation standards and discipline-based organizational expectations. She emphasized that curricular reform involves evaluating what you teach and how you teach it. Several health professional organizations, including IAMSE, offer resources such as evidence-based active learning strategies, curricular objectives, assessment plans, and curricular objectives. For example, a curriculum committee could use the Universal Design Framework or the Integrated Course Design framework as a pedagogical foundation. Dr. Huggett recommended an excellent resource for curriculum development, “The Six-Step Approach to Curriculum Development” by Patricia Thomas, David Kern, and colleagues. Managing curricular reform is challenging at medical schools since one needs to implement a new curriculum while simultaneously delivering the current curriculum efficiently. She stresses that achieving a change of this magnitude means that administrators, instructional designers, curriculum coordinators, faculty, and students must be included in this process at the beginning, middle, and during the transition. She offered several ideas for executing this process, such as creating a task force and forming multidisciplinary committees, subcommittees, and working groups. Establishing effective communication strategies between various committees and working groups was also stressed.
One of the essential aspects of curricular reform is faculty support in terms of providing time and resources to undertake this process. Institutions and faculty must establish clear expectations regarding the type of support that will be provided, for whom, when, and for how long. For example, creating new course materials and valid assessments requires faculty time and understanding of evidence-based pedagogy. She stated that it is critical to understand that curricular reform is an iterative process where feedback needs to be collected, implemented, and evaluated. Dr. Huggett concluded by referencing two concepts as a reality check on curriculum progress. The first is the Zone of Feasibility, which includes the new teaching methods or policies that go beyond current practice but are realistic in the current context. The second is the Zone of Tolerance, defined as the amount of change the community will accept or tolerate. She stated that if the proposed changes in the Zone of Feasibility are more powerful than the Zone of Tolerance, they will likely be opposed. Although the zones cannot be quantified objectively and vary from school to school, acknowledging these forces is critical for successful curricular reform.
Dr. Yerko Berrocal discussed curricular reform at a new medical school, “Alice. L. Walton School of Medicine in Arkansas,” which will enroll its charter class in July 2025. It is a four-year innovative, evidence-based, integrated curriculum called ARCHES, which engages students via active learning. Dr. Berrocal acknowledged that many ideological battles are fought in the curricular reform process. He believes it is at this point when medical school faculty and administrators should ask themselves the following questions. What personal and professional qualities should our students develop? Where does foundational science belong in the curriculum – and why? What skill set and examination skills should be acquired – and how should we access them? How long will this take? What are the competencies and outcomes we should expect? Dr. Berrocal believes that a new medical school curriculum that has answered these questions can better prepare students for modern healthcare demands. It is built on a competency-based education that ensures students achieve specific competencies, including incorporating ongoing medical advancements.
Additionally, he stressed that a commitment to lifelong learning should be instilled in all medical students through curricular reform, especially because of the increased prevalence of chronic diseases and the importance of preventative medicine. Modern medical school curricula should also emphasize the importance of individual mental well-being, reduce stigma, and diminish burnout. Dr. Berrocal discussed the importance of considering learning theories while developing a curriculum. At his medical school, they used the six-step approach to curriculum development. Although there were several discussions and arguments regarding curricular reform creation, it was helpful to reach a consensus at the beginning from all faculty and stakeholders. All curriculum decisions should be made based on the school’s statement of
vision, mission, and values. Dr. Berrocal stressed that although following the six steps in numerical order is unnecessary, one needs to cover all six steps for effective curricular reform. He then described a few challenges one might face during curricular reform. First is the resistance to change by longstanding faculty members because they are set in how they teach, the modalities they use, and the assessments they have created. He also mentioned involving the admissions committee and enrollment department well in advance. Another challenge is ensuring the curriculum covers all topics without overwhelming students and meets the required accreditation standards. Another challenge is working with the diversity represented by students in each medical school cohort. He singled out the need to build in formative assessments to evaluate the new curriculum regarding the skills and competencies they teach our students. The data collected, analyzed and reported should inform any curricular change. Robust assessment and evaluation mechanisms must be an integral part of the change process to find areas of improvement in the curriculum on an ongoing basis. Additionally, schools must weigh the pros and cons of various available tools and technologies before implementing them into their curricula.
The final part of the webinar presentation was by Dr. Robert Opoka from Aga Khan University. Dr. Opoka stated that his medical school was especially interested in a curricular program that focused on using innovative methodologies that can set a standard for quality in the region. From the beginning, they had a clear goal to create a unique modern curriculum., Dr. Opoka reported that most established medical schools used a teacher-centered, classroom-based, lecture-based teaching method in their geographic region. In contrast, the newer medical schools have begun implementing a problem-based curriculum with smaller learning groups. At his medical school, the goal is to have a similar contemporary curriculum while retaining theories of learning relevant to their region and the common diseases and, at the same time, applicable worldwide. He also mentioned that these core values must be considered at the beginning of a curricular reform. However, they realized that although they were a 20-year-old medical school, they did not have the necessary infrastructure to develop their residency programs, specifically an educationally integrated hospital system. In the meantime, they focused on developing the medical school curriculum to engage all stakeholders, solicit feedback, and go through an iteration process, which was completed in 2020. They began by focusing on the infrastructure. The first step they made was to establish a teaching hospital. He stressed that it is essential to have medical education experts to help you as you develop and implement a curriculum so that they are not just part-time but fully committed and fully engaged people. They are now in the second year of implementing the new medical school curriculum, where the medical school programs in East Africa are six years, with students entering directly after high school. They started with 70 students per class, which they thought was manageable. The biggest challenge they faced was building better infrastructure. For example, if a library needed to expand and required more land, getting it approved was a big challenge. Another challenge was changing faculty and content expert mindsets about adopting educational innovations due to lack of time, sometimes lack of interest, and sometimes due to disagreements among themselves.
This seminar presentation was unique in the sense that attendees got a sneak peek into the
process of curricular reform from experts at schools with different levels of set curricula.