【基础医学】基础与临床课程整合与落实.ppt

基礎與臨床課程基礎與臨床課程之整合與落實之整合與落實高雄醫學大學高雄醫學大學 醫學院醫學院劉克明劉克明 副院長副院長Changing 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 Lancet 357,699,2001.2The 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)Excellent 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 interventions7)High-quality doctors delivering high-qualityHigh-quality doctors delivering high-quality medical care.medical care.3Reforms in Medical Education1.Recommended courses:Integrate teaching of basic sciences with clinical and social sciences,Make use of community and hospital healthcare settings,Increase overall patient contact,Provide greater student choice.42.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 Modernize 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 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.5Curriculum 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 between 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&supervised“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.62.Student 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,7Key units:1.Being a Doctor,Being a Patient;15 weeks2.Locomotion;15 weeks3.Blood and skin;12 weeks 4.Circulation;12 weeks 5.Respiration;12 weeks6.Homeostasis and Hormones;12 weeks7.The Senses;12 weeks 88.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 weeks14.Preparation for Pre-Registration,5 weeks9Student select study(SSS)1.Study of an area in detail:Study of an area in detail:Each unit of the Each unit of the programmeprogramme,student will,student will take one of the following domains:take one of the following domains:a.Anatomy,a.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,102.Scientific method in medicine: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 Science,Environmental Science,i.Risk and Decision Theory.Risk and Decision Theory.11澳洲醫學委員會澳洲醫學委員會（Australian Medical Council,AMC）要求各醫學院之醫學教育目標，要發展年輕醫師必備的知識、技巧與專業態度之特質，才能安全有效的執行醫療，而且具備適當基礎而能終身學習以及在任何醫學領域接受進一歩訓練。12澳洲各醫學院依照AMC之要求，訂出醫學教育的課程主題(Curriculum Themes)，做為新課程的規劃與評量的骨架，也提供醫學教育學程目標（Program Goals）的骨架，亦即醫學生在修畢四年課程時，應該要獲得之最基本的知識、技能、態度、價值觀等，以做為實習醫師之準備。13 這四個課程主題的名稱雖然依不同醫學院而有所差異，但其基本精神與重點都是一樣的。雪梨大學醫學院之四個課程主題（Curriculum Themes）為：1.Basic and Clinical Science Theme，2.Patient and Doctor Theme，3.Community and Doctor Theme，4.Personal and Professional Development Theme.14The Univ.of Sydney Medical 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.15Features of the curriculum include:1.a student-centered approach;2.a focus on clinical reasoning;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.16Four themes extend throughout the four years of the University of Sydney Medical Program:1.basic 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 for 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.17 The relative contributions of the themes vary at different stages of the curriculum,with an initial focus on basic science and early clinical skills and a growing emphasis on clinical knowledge,skills and judgment.181.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 problem-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 Doctor 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 or more electives.one or more electives.Outline of the curriculum:Years 1 and 219Years 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 supported by information technology,6.basic science uptakes,207.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.PerinatalPerinatal&Womens Health,&Womens Health,d.Community Practice.Community Practice.8.elective term:minimum of 8 wks of supervised experience,9.rural practice:8 weeks.21Year 1 Curriculum 1 Foundation Studies 1.03 Myocardial infarction Problem Mr.Sarichs chest pain Learning Topic 1(LT 1)BCS(Basic&Clinical Sciences)Phy (Physiology)Mechanisms of pain,22 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,23LT 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 cardiac disease,Risk factors for cardiac disease,LT 7LT 7 BCS(Basic and Clinical Sciences)BCS(Basic and Clinical Sciences)McarMcar(Cardiology)(Cardiology)Overview of management,Overview of management,LT 8LT 8 BCS(Basic and Clinical Sciences)BCS(Basic and Clinical Sciences)BS(Behavior Science)Treatment adherence,BS(Behavior Science)Treatment adherence,24 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 chest25 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 injury26Session BCS1 BCS An,Pa Heart and coronary arteries,Session BCS2 BCS Bi Analysis of cardiac iso-enzymes,Session C-Dr(community and Doctor)C-Dr PH(Public Health)Introduction to Community Doctor,27 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 cardiovascular system.28Conclusion(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 students have clinical contact from the outset of the programme;291.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 students,6.group work as preparation for multidisciplinary7.team working.30Conclusion(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 teaching,314.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.32Conclusion(III)For a successful 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 and 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 professional,6.colleagues,to society,and to colleagues,to society,and to themselfthemself,7.information and communication technology skills.information and communication technology skills.33Conclusion(IV)The Tendency of Medical training:1.More student centered,More student centered,2.Emphasis on active 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 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.34Conclusion(V)一個成功的整合課程要由醫學院負責規劃，亦即是一個成功的整合課程要由醫學院負責規劃，亦即是Central ControlCentral Control，由各種由各種committeecommittee來研擬、規劃，來研擬、規劃，而不是傳統的而不是傳統的departmental controldepartmental control能完成的課程。能完成的課程。全國醫學院可考慮參照美國加州八所大學的醫學院全國醫學院可考慮參照美國加州八所大學的醫學院，或澳洲雪梨大學等四個大學醫學院成立聯盟，互相，或澳洲雪梨大學等四個大學醫學院成立聯盟，互相支持醫學教育的發展，共享教學資源（醫學人文與倫支持醫學教育的發展，共享教學資源（醫學人文與倫理等課程、師資、理等課程、師資、PBLPBL個案、標準病人、模擬病人、個案、標準病人、模擬病人、圖書期刊等），並可維持各醫學院一致的醫學教育品質。圖書期刊等），並可維持各醫學院一致的醫學教育品質。確定台灣未來醫師應具備的特質，各醫學院可以參酌這些確定台灣未來醫師應具備的特質，各醫學院可以參酌這些特質，發展醫學教育課程的主題（特質，發展醫學教育課程的主題（Curriculum ThemesCurriculum Themes），），貫徹於各學期的課程中，以培育台灣社會需求的優秀醫貫徹於各學期的課程中，以培育台灣社會需求的優秀醫師，達到師，達到TMACTMAC要求醫學院進行醫學教育改革的目的。要求醫學院進行醫學教育改革的目的。35THE 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