A New Look at Medical Curricula

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Medical schools need to change their curricula from focusing on knowledge about diseases and their management, to curricula that give priority to patient safety, quality of care, diagnostic process, and medical decision making. Dr. Sklar eloquently described such needs in his January 2017 editorial.1 Below are some possible approaches and challenges that medical schools may face.
First, while diagnostic errors are associated with higher morbidity compared with other causes of medical errors, there are no significant changes in medical curricula to handle this problem. One way to address this is through the engagement of patients and their families in effective interactions with health care providers to develop accurate, well-conceived treatment plans reflecting medical information as well as the social and cultural needs of patients. Therefore, there is a need for shifting the curriculum away from a knowledge-based approach to become more integrated, patient centered, task based, and able to accommodate these needs in the training.2 However, challenges facing such change may include patient health literacy, and lack of time and mechanisms to accommodate such changes by physicians in medical encounters.
Second, we should see diagnostic errors as an opportunity for teaching diagnostic excellence in the training. It is not enough to teach diagnostic process—we need to discuss cases that highlight errors in diagnosis at the same time. We must also consider how we can build a culture that supports constructive feedback when error does occur.3
Third, assessment procedures should provide ongoing assessment data to teachers, including error pattern analysis for modification of instruction methods and individualization of instruction based specifically on students’ performance.
We have to remember that the curriculum is not just what we plan on paper, it is about the successful implementation of what we planned to achieve as reflected in the outcomes of day-to-day practices and teaching. One would wonder if Dr. Sklar plans to write another editorial addressing these challenges and approaches to facilitate such a shift in medical curricula to address diagnostic errors.
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