Department of Medical Education, College of Medicine, University of Illinois at Chicago, Illinois 60612-7309, USA.
Med Educ. 2011 Jan;45(1):87-94. doi: 10.1111/j.1365-2923.2010.03727.x.
Although firmly grounded in Flexner's legacy of ideas, today's medical curriculum, as both an entity and a process, has become more and more complex. The curriculum as an entity is portrayed according to five key elements: the expected competencies and roles; the learners at the centre of the enterprise; assessment linking competencies and learners; the conditions and resources for learning; and a multifaceted socio-politico-cultural context in which the learning occurs. Significant developments have also occurred in the disciplines of curriculum studies, cognitive psychology and organisational change over the past century, as well as in institutional best practices, that help us to better understand and plan curricular innovations.
Practical advice is offered to help curriculum developers in designing or reforming the medical curriculum. The key points of this are: (i) while focusing reform and innovation on specific elements of the curriculum, consider how those elements affect other elements and vice versa, in positive and negative ways; (ii) while grounding the reform or innovation in sound conceptual frameworks, seize any opportunities to formulate a research agenda that can build upon and advance our understanding of curricular innovations, and, (iii) moving beyond considering the curriculum as an entity, use deliberative and leadership processes that can lead to enduring curriculum reform.
尽管牢牢扎根于范氏理念的传承，但如今的医学课程，无论是作为一个实体还是一个过程，都变得越来越复杂。课程作为一个实体，根据五个关键要素来描绘：预期的能力和角色；以学习者为中心的企业；将能力和学习者联系起来的评估；学习的条件和资源；以及学习发生的多方面社会政治文化背景。在过去的一个世纪里，课程研究、认知心理学和组织变革等学科以及机构最佳实践也取得了重大发展，这有助于我们更好地理解和规划课程创新。
为帮助课程开发者设计或改革医学课程，提供了实用建议。这方面的要点是：(i) 在关注课程具体要素的改革和创新时，考虑这些要素如何以积极和消极的方式影响其他要素，反之亦然；(ii) 在将改革或创新建立在合理的概念框架的基础上时，抓住任何机会制定研究议程，可以在课程创新的理解上建立并推进，并，(iii) 超越将课程视为一个实体，使用审议和领导过程，可以导致持久的课程改革。
