Morgan Tamara L, Suart Theresa Nowlan, Fortier Michelle S, McFadyen Isaac Kelman, Tomasone Jennifer R
School of Kinesiology and Health Studies, Queen's University, Ontario, Canada.
Undergraduate Medical Education, School of Medicine, Queen's University, Ontario, Canada.
Can Med Educ J. 2025 Feb 28;16(1):38-64. doi: 10.36834/cmej.78603. eCollection 2025 Feb.
Medical students must demonstrate competency in health promotion and illness prevention; however, movement behaviour promotion content is lacking in medical curricula. Canada's 24-Hour Movement Guidelines (24HMG) present an opportunity to transform medical curricula to promote movement behaviours within a 24-hour paradigm. We previously co-produced a 24HMG curriculum map and 14 curriculum objectives at one Canadian medical school. The aim of this study was to gain consensus on the curriculum map and objectives among faculty and medical students and explore implementation determinants.
This study followed a concurrent nested mixed methods design using a modified Delphi method to assess the level of (dis)agreement with map components followed by interviews to explore the implementability of the map. A preliminary survey was distributed to collect demographic and movement behaviour data, followed by three online modified Delphi surveys. Suggested improvements to the map were solicited through open-text boxes. Interviews were semi-structured and conducted online. Interview data were analyzed using content analysis guided by the Consolidated Framework for Implementation Research (CFIR) 2.0.
Consensus was reached on 156/180 items (86.7%) in Survey 1 (faculty, 6; students, 8), 49/51 items (96.1%) in Survey 2 (faculty, 4; students, 7), and 8/8 items (100%) in Survey 3 (faculty, 3; students, 7). Implementation determinants encompassed all five CFIR 2.0 domains, mostly the inner setting (e.g., culture, structural barriers).
Reciprocity and open communication between medical schools and external change agents should be prioritized when co-producing curriculum change in the present landscape of inflation and medical professional burnout.
医学生必须在健康促进和疾病预防方面展现出能力；然而，医学课程中缺乏运动行为促进方面的内容。加拿大的《24小时运动指南》（24HMG）为转变医学课程以在24小时模式下促进运动行为提供了契机。我们之前在一所加拿大医学院共同制作了一份24HMG课程地图和14项课程目标。本研究的目的是在教师和医学生中就课程地图和目标达成共识，并探索实施的决定因素。
本研究采用了一种并发嵌套混合方法设计，使用改进的德尔菲法来评估对地图组件的（不）一致程度，随后进行访谈以探索地图的可实施性。首先分发一份初步调查问卷以收集人口统计学和运动行为数据，随后进行三次在线改进德尔菲调查。通过开放文本框征求对地图的改进建议。访谈采用半结构化并在线进行。使用由实施研究综合框架（CFIR）2.0指导的内容分析法对访谈数据进行分析。
在第一次调查（教师6人，学生8人）的180项中有156项（86.7%）达成共识，在第二次调查（教师4人，学生7人）的51项中有49项（96.1%）达成共识，在第三次调查（教师3人，学生7人）的8项中有8项（100%）达成共识。实施决定因素涵盖了CFIR 2.0的所有五个领域，主要是内部环境（如文化、结构障碍）。
在当前通货膨胀和医学职业倦怠的背景下，医学院与外部变革推动者在共同制定课程变革时，应优先考虑互惠和开放沟通。
