The alignment imperative in curriculum renewal

Abstract

Rationale: There are perennial calls for MD curricula to reform in order to meet the changing needs of students, patients, and society. And yet, efforts at renewal have also been suggested to have minimal impact on the pedagogy and outcomes of medical education. One reason may be misalignment between the components of the curriculum during design and implementation. The University of Toronto MD program recently renewed its undergraduate preclinical Foundations curriculum. Mindful of the pitfalls of misalignment, the renewal process focused deliberately on alignment between the various components of the curriculum: instructional methods, student assessment, faculty development, and the larger purpose of serving students and society.

Innovation: Educational evidence was used to drive the alignment process which resulted in three major changes. First, we created a spiral curriculum centered on 72 virtual patient cases designed to integrate content and prepare students for clinical learning. Second, we introduced a novel medical psychiatry component to address a core societal need in mental health. This exposed students early to experiences of complexity, ambiguity, and integrated patient care. Lastly, a shift to assessment for learning and programmatic assessment was designed and implemented concurrently to reinforce the pedagogy of the curriculum. Synchronous faculty development was developed for the new roles required of faculty.

Conclusions: Early program evaluation shows alignment of these curricular components requires ongoing attention and resources in order to be successful. The potential benefits of this alignment are well prepared students who can meet the needs of their patients and society in an increasingly complex health system.

Acknowledgments

We would like to acknowledge the generous support and hard work of the staff and faculty at the MD Program and the broader Faculty of Medicine who made the renewal possible. We also acknowledge the students of the MD program who have made this renewal a success and contribute every day to the positive atmosphere and ongoing improvement of our program.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes on contributors

Kulamakan Kulasegaram, PhD, is a Wilson Centre Scientist and Assistant Professor, Department of Family & Community Medicine at the University of Toronto. His research examines educational assessment from psychometric and cognitive perspectives. His contributions informed the preclinical curriculum renewal, including development of the Foundations student assessment framework.

Maria Mylopoulos, PhD, is a Scientist and Associate Director of Training Programs at the Wilson Centre and an Associate Professor, Department of Paediatrics at the University of Toronto. Her research explores the development and maintenance of expertise. Her contributions informed the preclinical curriculum renewal, including development of the medical-psychiatry curriculum.

Paul Tonin, BA, is Manager, Strategic Operations and Policy, MD Program at the University of Toronto. He has over fifteen years of senior administrative experience in a university environment, including supporting and managing curriculum and policy development, quality assurance/accreditation, and governance. He helped manage implementation of the Foundations curriculum.

Stacey Bernstein, MD, is Clerkship Director, MD Program at the University of Toronto. She is an Associate Professor, Department of Paediatrics and a hospitalist at The Hospital for Sick Children. She recently led the development and implementation of a longitudinal integrated clerkship.

Pier Bryden, MD, is Director of Program Integration, MD Program at the University of Toronto. She is an Associate Professor and Vice Chair, Education, Department of Psychiatry, and staff psychiatrist at The Hospital for Sick Children. She previously served as Preclerkship Director and co-led the preclinical curriculum renewal process.

Marcus Law, MD, MBA, MEd, is Foundations Director, MD Program at the University of Toronto. He is an Associate Professor, Department of Family & Community Medicine and serves as Director of Medical Education at the Michael Garron Hospital. He co-led the preclinical curriculum renewal process.

Jana Lazor, Ed.D, is Director of Faculty Development, MD Program at the University of Toronto and an Associate Professor, Department of Family & Community Medicine, University of Toronto, and Integrated Senior Scholar in the Centre for Faculty Development, St. Michael’s Hospital. She led team that developed the Faculty Development strategy to support curriculum renewal.

Richard Pittini, MD, MEd, is Director of Assessments and Evaluations, MD Program at the University of Toronto. He is a clinician educator at Sunnybrook Health Sciences Centre and Associate Professor of Obstetrics and Gynaecology. He led the visioning and alignment of programmatic assessment and the assessment for learning philosophy as well as the development and implementation of Progress Testing.

Sanjeev Sockalingam, MD, MHPE, is Director of Curriculum Renewal, Medical Psychiatry Alliance and Deputy Psychiatrist-in-Chief at the University Health Network. He is an Associate Professor, Department of Psychiatry, University of Toronto. He led the development of the medical psychiatry curriculum as part of the MD Program preclinical curriculum renewal.

Glendon R. Tait, MD, MSc, is Director of Student Assessment, MD Program at the University of Toronto. He is an Associate Professor in the Department of Psychiatry and practices Consultation-Liaison Psychiatry with Sinai Health System. He led the renewal of the student assessment framework for the Foundations curriculum.

Patricia Houston, MD, MEd, is Vice Dean of the University of Toronto MD Program. She is a Professor, Department of Anethesia and has served in a number of leadership roles at St. Michael’s Hospital, including Vice President, Education. She was responsible for oversight of implementation of the Foundations curriculum.

Additional information

Funding

This work is supported in part by the Medical Psychiatry Alliance, a collaborative health partnership of the University of Toronto, the Centre for Addiction and Mental Health, the Hospital for Sick Children, Trillium Health Partners, the Ontario Ministry of Health and Long-Term Care and an anonymous donor.