Vitalizing the evaluation of curricular implementation: a framework for attending to the "how and whys" of curriculum evolution.

As curricular reforms are implemented, there is often urgency among scholars to swiftly evaluate curricular outcomes and establish whether desired impacts have been realized. Consequently, many evaluative studies focus on summative program outcomes without accompanying evaluations of implementation. This runs the risk of Type III errors, whereby outcome evaluations rest on unverified assumptions about the appropriate implementation of prescribed curricular activities. Such errors challenge the usefulness of the evaluative studies, casting doubt on accumulated knowledge about curricular innovations, and posing problems for educational systems working to mobilize scarce resources. Unfortunately, however, there is long-standing inattention to the evaluation of implementation in health professions education (HPE). To address this, we propose an accessible framework that provides substantive guidance for evaluative research on implementation of curricular innovations. The Prescribed-Intended-Enacted-Sustainable (PIES) framework that is articulated in this paper, introduces new concepts to HPE-with a view to facilitating more nuanced examination of the evolution of curricula as they are implemented. Critically, the framework is theoretically grounded, integrating evaluation and implementation science as well as education theory. It outlines when, how, and why evaluators need to direct attention to curricular implementation, providing guidance on how programs can map out meaningful evaluative research agendas. Ultimately, this work is intended to support evaluators and educators, seeking to design evaluation studies that provide more faithful, useful representations of the intricacies of curricular change implementation.

Evaluating and implementing an opportunity for diversity and inclusion in case-based learning.

Problem-based learning (PBL) and case-based learning (CBL) often mention social identities only if this information is directly relevant to diagnosis, which can inadvertently perpetuate stereotypes in trainee learning. Using a student-developed resource entitled "Portraying Social Identities in Medical Curriculum: A Primer," we analyzed cases for social identities, identified gaps, and proposed changes, including use of a validated name bank to reflect diversity as represented by local census data. Through this innovation, suggestions were provided to represent the social determinants of health in CBL cases. Other medical schools can use our innovation to improve the social diversity of their medical curriculums.

Bien souvent, l'apprentissage par résolution de problèmes (ARP) et l'apprentissage par les cas (APC) ne touchent aux identités sociales que si ce type d'information contribue directement au diagnostic, ce qui peut involontairement perpétuer les stéréotypes dans l'apprentissage des étudiants. À l'aide d'une ressource élaborée par les étudiants, intitulée « Portraying Social Identities in Medical Curriculum : A Primer ¼ (la représentation des identités sociales dans les programmes d'études médicales : une introduction), nous avons analysé des cas d'identités sociales, identifié des lacunes et proposé des changements, notamment l'utilisation d'une banque de noms validée reflétant la diversité qui ressort des données du recensement local. Grâce à cette innovation, des suggestions ont été faites pour représenter les déterminants sociaux de la santé dans les cas étudiés dans l'APC. Nous invitons les facultés de médecine à se servir de notre ressource pour mieux rendre compte de la diversité sociale dans leurs programmes d'études.

Developing a Framework of Integrated Competencies for Adaptive Expertise in Integrated Physical and Mental Health Care.

Phenomenon: Despite the emergence of the integrated care (IC) model, IC is variably taught and is challenged by current siloed competency domains. This study aimed to define IC competencies spanning multiple competency domains. Approach: Iterative facilitated discussions were conducted at a half-day education retreat with 25 key informants including clinician educators and education scientists. Seven one-on-one semistructured interviews were subsequently conducted with different interprofessional providers in IC settings within a Canadian context. Data collection grounded in patient cases with a physical illness and concurrent mental illness (medical psychiatry) were used to elicit identification of complex patient needs and the key medical psychiatry knowledge and skills required to address these needs. A thematic analysis of transcripts was performed using constant comparison to iteratively identify themes. Findings: Participants described 4 broad competency domains necessary for expertise in IC: (a) extensive integrated knowledge of biopsychosocial aspects of disease, systems of care, and social determinants of care; (b) skills to establish a longitudinal alliance with the patient and functional relationships with colleagues; (c) constructing a comprehensive understanding of individual patients' complex needs and how these can be met within their health and social systems; and (d) the ability to effectively meet the patient's needs using IC models. These 4 domains were linked by an overarching philosophy of care encompassing key enabling attitudes such as proactively pursuing depth to understand patient and system complexity while maintaining a patient-centered approach. Insights: The study addresses how development of IC expertise can be fostered by integration of individual IC competency domains. The findings align with previous research suggesting that competencies from existing frameworks are being enacted jointly in expert capabilities to meet the complex needs of patients, in this case with comorbid physical and mental health concerns.

The alignment imperative in curriculum renewal.

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.

Who's connected to whom and how: a model of evolving relationships and roles in faculty development and curriculum development during curriculum renewal and innovation.

This article was migrated. The article was marked as recommended. Faculty development and curriculum development are essential to the work of academic health sciences institutions. Through collegial conversations, more intense dialogue, and 'workshopping', we have identified a new model of how these two practices can be effectively integrated. We propose that this new model can create a system of knowledge mobilization and quality improvement that will greatly enhance curricular renewal and innovation. We invite and welcome comments and feedback from the health professions education community.