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1、基础与临床课程基础与临床课程之整合与落实之整合与落实2Changing Face of Medical Curricula1.Changes in medicine and society,2.Changes in focus of health care,3.Changes in curriculum design,4.Changes in curriculum content,5.Changes in curriculum delivery,6.Implementing curricular change7.Achieving change R Jones et al. The Lance
2、t 357, 699, 2001.3The Center of Effective Curriculum Reform1)Leadership of change is essential,Leadership of change is essential,2)Balancing the need for academic stability,Balancing the need for academic stability,3)Groups of respected & skilled teachers, Groups of respected & skilled teachers, 4)E
3、xcellent communication between staff & students,Excellent communication between staff & students,5)Feedback from students and patients.Feedback from students and patients.6)Rigorous evaluation of curriculum reform Rigorous evaluation of curriculum reform & educational interventions & educational int
4、erventions7)High-quality doctors delivering high-qualityHigh-quality doctors delivering high-quality medical care. medical care. 4Reforms in Medical Education1.Recommended courses: Integrate teaching of basic sciences with clinical and social sciences, Make use of community and hospital healthcare s
5、ettings, Increase overall patient contact, Provide greater student choice.52.New Courses:New Courses: To encourage learning method that directly To encourage learning method that directly link new knowledge to patient care, link new knowledge to patient care, Modernize approaches to basic science Mo
6、dernize approaches to basic science (in particular anatomy), (in particular anatomy), Increase emphasis on appropriate consultation Increase emphasis on appropriate consultation skills and traditional learning, skills and traditional learning, Promote a more human and supportive Promote a more human
7、 and supportive learning environment, learning environment,3.To selecting candidates for medical education, To selecting candidates for medical education, To the assessments that underpin the To the assessments that underpin the direction of student learning. direction of student learning.6Curriculu
8、m design1.Integration: Integration: Integrate student learning by focusing on Integrate student learning by focusing on patients throughout the course, patients throughout the course, No traditional divide between clinical and No traditional divide between clinical and non-clinical phases, nor betwe
9、en basic non-clinical phases, nor between basic and applied science, and applied science, Learning around desired outcomes & systemically Learning around desired outcomes & systemically rehearse clinical and technical skills through rehearse clinical and technical skills through simulated & supervis
10、ed “near life” situation, simulated & supervised “near life” situation, Aim to reduce apprenticeship “tag along with me” Aim to reduce apprenticeship “tag along with me” learning, which risks wide variation in student learning, which risks wide variation in student opportunities. opportunities.72.St
11、udent selection modules: to acquire critical appraisal and research skills, student selected modules: 30% of course time are draw on: social sciences and humanities, and professional fields such as law and health economics,8Key units:1.Being a Doctor, Being a Patient; 15 weeks2.Locomotion; 15 weeks3
12、.Blood and skin; 12 weeks 4. Circulation; 12 weeks 5.Respiration; 12 weeks6.Homeostasis and Hormones; 12 weeks7.The Senses; 12 weeks 98.Digestion and Nutrition; 12 weeks9.Reproduction; 14 weeks 10.Growth and Development; 14 weeks 11.The Elective; 8 weeks12.The Mind; 14 weeks 13.Emergency Care; 14 we
13、eks14.Preparation for Pre-Registration, 5 weeks10Student select study (SSS) 1.Study of an area in detail:Study of an area in detail: Each unit of the programme, student will Each unit of the programme, student will take one of the following domains: take one of the following domains: a. Anatomy, a.
14、Anatomy, b. Biochemistry & cell biology, b. Biochemistry & cell biology, c. Epidemiology, d. Ethics, c. Epidemiology, d. Ethics, e. Health Economics, f. Law, e. Health Economics, f. Law, g. Physiology, h. Psychology, g. Physiology, h. Psychology, i. Sociology, i. Sociology,112.Scientific method in m
15、edicine:3.Studies outside medicine:a.Language, b. Creative Writing,Language, b. Creative Writing,c.World Art,World Art,d.History (& History of Medicine),History (& History of Medicine),e.World Development,World Development,f.Linguistics,Linguistics,g.American Studies,American Studies,h.Environmental
16、 Science,Environmental Science,i.Risk and Decision Theory.Risk and Decision Theory.12澳洲医学委员会澳洲医学委员会（Australian Medical Council , AMC） 要求各医学院之医学教育目标，要发展年轻医师必备的知识、技巧与专业态度之特质，才能安全有效的执行医疗，而且具备适当基础而能终身学习以及在任何医学领域接受进一歩训练。13澳洲各医学院依照AMC之要求，订出医学教育的课程主题(Curriculum Themes)，做为新课程的规划与评量的骨架，也提供医学教育学程目标（Program Go
17、als）的骨架，亦即医学生在修毕四年课程时，应该要获得之最基本的知识、技能、态度、价值观等，以做为实习医师之准备。14 这四个课程主题的名称虽然依不同医学院而有所差异，但其基本精神与重点都是一样的。悉尼大学医学院之四个课程主题（Curriculum Themes）为：1.Basic and Clinical Science Theme，2.Patient and Doctor Theme，3.Community and Doctor Theme，4.Personal and Professional Development Theme.15The Univ. of Sydney Medical
18、 Program Characterized by:1.a four-year graduate-entry web-based curriculum2.uses problem-based learning to enable students to become life-long learners, effective practitioners of contemporary medicine.16Features of the curriculum include:1.a student-centered approach;2.a focus on clinical reasonin
19、g;3.integration of subjects within & across years;4.early clinical experience;5.use of new information technologies;6.assessment with an emphasis on feedback & self-evaluation;7.opportunities for research.17Four themes extend throughout the four years of the University of Sydney Medical Program:1.ba
20、sic and clinical science (50%),basic and clinical science (50%),munity and doctor (25%),community and doctor (25%),3.patient and doctor (12.5%),patient and doctor (12.5%),4.personal and professional development (12.5%).personal and professional development (12.5%). The themes provide the framework f
21、or the goals The themes provide the framework for the goals of the program, the development of the curriculum of the program, the development of the curriculum and for assessment. and for assessment.18 The relative contributions of the themes vary at different stages of the curriculum, with an initi
22、al focus on basic science and early clinical skills and a growing emphasis on clinical knowledge, skills and judgment.191.three PBL (each 1.5 hrs.) three PBL (each 1.5 hrs.) 2.Up to six lectures related to the weekly Up to six lectures related to the weekly problem- issues relevant to all themes pro
23、blem- issues relevant to all themes but with an emphasis on basic science, but with an emphasis on basic science,3. two Basic and Clinical Science sessions 3. two Basic and Clinical Science sessions ( generally 1.5 hrs), ( generally 1.5 hrs),4. two Patient and Doctor sessions 4. two Patient and Doct
24、or sessions ( up to1.5 hrs) in hospital, ( up to1.5 hrs) in hospital,5.either one Community and Doctor or aeither one Community and Doctor or a Personal and Professional Development Personal and Professional Development session or a joint session (1.5 hrs), session or a joint session (1.5 hrs),6.one
25、 or more electives.one or more electives.Outline of the curriculum:Years 1 and 220Years 3 and 4:1.lectures and seminars relevant to all four themes,2.evidence-based medicine presentations,3.structured “hands on” demonstrations,4.interactive case presentation,5.problem-based learning exercises suppor
26、ted by information technology,6.basic science uptakes,217.clinical rotation in year 4 (9 wks each):a.Psychological Medicine & Psychological Medicine & Drug and Alcohol Studies, Drug and Alcohol Studies,b.Child & Adolescent Health,Child & Adolescent Health,c.Perinatal & Womens Health,Perinatal & Wome
27、ns Health,d.Community Practice.Community Practice.8.elective term: minimum of 8 wks of supervised experience,9.rural practice: 8 weeks.22Year 1 Curriculum 1 Foundation Studies 1.03 Myocardial infarction Problem Mr. Sarichs chest pain Learning Topic 1 (LT 1) BCS (Basic & Clinical Sciences) Phy (Physi
28、ology) Mechanisms of pain,23 LT 2 (Learning Topic 2) BCS (Basic & Clinical Sciences) An (Anatomy) Structures of the chest,LT 3 BCS (Basic and Clinical Sciences) Pa (Pathology) Pathogenesis of arterial disease,LT 4 BCS (Basic and Clinical Sciences) Bi (Biochemistry) Hypoxia, Ischemia & cell death,24L
29、T 5LT 5 Pt-Dr (Patient and Doctor) BS (Behavior Science) Pt-Dr (Patient and Doctor) BS (Behavior Science) Communication in a medial emergency, Communication in a medial emergency,LT 6LT 6 C-Dr. (Community and Doctor) PH (Public Health) C-Dr. (Community and Doctor) PH (Public Health) Risk factors for
30、 cardiac disease, Risk factors for cardiac disease,LT 7LT 7 BCS (Basic and Clinical Sciences) BCS (Basic and Clinical Sciences) Mcar (Cardiology) Mcar (Cardiology) Overview of management, Overview of management,LT 8LT 8 BCS (Basic and Clinical Sciences) BCS (Basic and Clinical Sciences) BS (Behavior
31、 Science) Treatment adherence, BS (Behavior Science) Treatment adherence,25 Lecture 1 BCS (Basic and Clinical Sciences) Pa (Pathology) Cell injury, ageing and death,Lecture 2 PPD (Personal and Professional Development) PHE (Epidemiol), EBM EBM in practiceLecture 3 BCS An (Anatomy) Structure of the c
32、hest26 Lecture 4 BCS (Basic and Clinical Sciences) Bi (Biochemistry) Glucose utilization in cells,Lecture 5 BCS Phy (Physiology) Membrane excitability,Lecture 6 BCS Pa (Pathology) Normal artery and Responses to injury27Session BCS1 BCS An, Pa Heart and coronary arteries,Session BCS2 BCS Bi Analysis
33、of cardiac iso-enzymes,Session C-Dr (community and Doctor) C-Dr PH (Public Health) Introduction to Community Doctor,28 Session Pt-Dr Communication Pt-Dr (Patient and Doctor) Med (Medicine) Open and closed questions, Session Pt-Dr Skills Pt-Dr (Patient and Doctor) Med (Medicine) Introduction to the c
34、ardiovascular system.29Conclusion ( I )The curriculum is characterized:1.the integration of learning around Presentation rather than by individual discipline or speciality (eg anatomy, cardiology) grouped in problem-based units;2.the use of clinical settings to pull together core classroom learning
35、students have clinical contact from the outset of the programme;301.the use of primary care as a core setting to show the range of common conditions and normal variation throughout the programme;2.student-centred learning;3.reflective practice;4.predetermined learning outcomes that are shared with s
36、tudents,6.group work as preparation for multidisciplinary7.team working.31Conclusion ( II )1.Traditional lecture-based training has largely given way to a more skills- based and problem-solving approach, with group learning and strong IT support.2.Some lectures,3.Small group academic and clinical te
37、aching,324.A wide range of teaching methods is used, including PBL,5.IT-based learning, practical classes in the laboratories and dissecting room,6.Seminars, guided individual study, clinical skills practice and clinical symposia,7.All supported by regular tutorials.33Conclusion (III)For a successfu
38、l professional career, For a successful professional career, students will learn:students will learn:1.learning how to learn,learning how to learn,munication skills,communication skills,3.working effectively in multi-professional teams,working effectively in multi-professional teams,4.the personal a
39、nd ethical attitudes essential for the personal and ethical attitudes essential for good professional practice, good professional practice,5.an appreciation of their responsibilities to theiran appreciation of their responsibilities to their patients, to their professional, patients, to their profes
40、sional,6.colleagues, to society, and to themself,colleagues, to society, and to themself,7.information and communication technology skills.information and communication technology skills.34Conclusion (IV)The Tendency of Medical training:1.More student centered,More student centered,2.Emphasis on act
41、ive learning rather than onEmphasis on active learning rather than on the passive acquisition of knowledge, the passive acquisition of knowledge,3.Emphasis on assessment of clinical competenceEmphasis on assessment of clinical competence rather than on the ability to retain and recall rather than on
42、 the ability to retain and recall unrelated facts,unrelated facts,4.Student feedback and patient participation are Student feedback and patient participation are increasing important roles. increasing important roles.35Conclusion (V)一个成功的整合课程要由医学院负责规划，亦即是一个成功的整合课程要由医学院负责规划，亦即是Central ControlCentral
43、Control，由各种，由各种committeecommittee来研拟、规划，来研拟、规划，而不是传统的而不是传统的departmental controldepartmental control能完成的课程。能完成的课程。全国医学院可考虑参照美国加州八所大学的医学院全国医学院可考虑参照美国加州八所大学的医学院，或澳洲悉尼大学等四个大学医学院成立联盟，互相，或澳洲悉尼大学等四个大学医学院成立联盟，互相支持医学教育的发展，共享教学资源（医学人文与伦支持医学教育的发展，共享教学资源（医学人文与伦理等课程、师资、理等课程、师资、PBLPBL个案、标准病人、模拟病人、个案、标准病人、模拟病人、图书期刊等），并可维持各医学院一致的医学教育质量。图书期刊等），并可维持各医学院一致的医学教育质量。确定台湾未来医师应具备的特质，各医学院可以参酌这些确定台湾未来医师应具备的特质，各医学院可以参酌这些特质，发展医学教育课程的主题（特质，发展医学教育课程的主题（Curriculum ThemesCurriculum Themes），），贯彻于各学期的课程中，以培育台湾社会需求的优秀医贯彻于各学期的课程中，以培育台湾社会需求的优秀医师，达到师，达到TMACTMAC要求医学院进行医学教育改革的目的。要求医学院进行医学教育改革的目的。36THE END大大谢谢谢谢听听莅莅家家临临讲讲! !
