Mandin H, Harasym P, Eagle C, Watanabe M
Department of Anesthesia, University of Calgary Faculty of Medicine, Alberta, Canada.
Acad Med. 1995 Mar;70(3):186-93. doi: 10.1097/00001888-199503000-00008.
Currently, medical curricula are structured according to disciplines, body systems, or clinical problems. Beginning in 1988, the faculty of the University of Calgary Faculty of Medicine (U of C) carefully evaluated the advantages and disadvantages of each of these models in seeking to revise their school's curriculum. However, all three models fell short of a curricular structure based on current knowledge and principles of adult learning, clinical problem solving, community demands, and curriculum management. By 1991, the U of C had formulated a strategic plan for a revised curriculum structure based on the way patients present to physicians, and implementation of this plan has begun. In creating the new curriculum, 120 clinical presentations (e.g., "loss of consciousness/syncope") were defined and each was assigned to an individual or small group of faculty for development based on faculty expertise and interest. Terminal objectives (i.e., "what to do") were defined for each presentation to describe the appropriate clinical behaviors of a graduating physician. Experts developed schemes that outlined how they differentiated one cause (i.e., disease category) from another. The underlying enabling objectives (i.e., knowledge, skills, and attitudes) for reaching the terminal objectives for each clinical presentation were assigned as departmental responsibilities. A new administrative structure evolved in which there is a partnership between a centralized multidisciplinary curriculum committee and the departments. This new competency-based, clinical presentation curriculum is expected to significantly enhance students' development of clinical problem-solving skills and affirms the premise that prudent, continuous updating is essential for improving the quality of medical education.
目前，医学课程是按照学科、身体系统或临床问题来构建的。从1988年开始，卡尔加里大学医学院（U of C）的教员们在试图修订该校课程时，仔细评估了每种模式的优缺点。然而，所有这三种模式都未能达到基于成人学习、临床问题解决、社区需求和课程管理的当前知识与原则的课程结构要求。到1991年，卡尔加里大学已经根据患者向医生就诊的方式制定了修订课程结构的战略计划，并且该计划已经开始实施。在创建新课程时，定义了120种临床症状表现（例如，“意识丧失/晕厥”），并根据教员的专业知识和兴趣将每种表现分配给个人或小组教员进行开发。为每种表现定义了最终目标（即“做什么”），以描述即将毕业的医生应有的适当临床行为。专家们制定了方案，概述了他们如何区分一种病因（即疾病类别）与另一种病因。实现每种临床症状表现最终目标的潜在促成目标（即知识、技能和态度）被分配为各部门的职责。一种新的管理结构逐渐形成，其中中央多学科课程委员会与各部门之间建立了合作关系。这种基于能力的新临床症状表现课程预计将显著提高学生临床问题解决技能的培养，并肯定了谨慎、持续更新对于提高医学教育质量至关重要这一前提。
