IN PROGRESS: ANNUAL FEATURE: MEDICAL STUDENT EDUCATION AND ASSESSMENT APPROACHES: Focus on Family
Objective: Since 1995, a three-generation “standardized family,” the McQs, has been successfully implemented as a core curriculum in the third-year family medicine clerkship. In July 1999, the standardized family was expanded into two other clerkships (internal medicine and pediatrics), with the goal of creating an interdisciplinary core curriculum in primary care across three clerkships.
Description: The McQ Standardized Family curriculum is centered around a simulated or “virtual” family and is implemented using case-based clinical problem-solving modules conducted in small groups. This curriculum reinforces continuity of care principles by focusing on the longitudinal care of McQ family members in all case discussions.1 With support from a UME-21 (Undergraduate Medical Education for the 21st Century) Associate Partnership grant from the U.S. Health Resources and Services Administration, the standardized family was expanded into the core curricula of the pediatrics and internal medicine clerkships by adding new members and a greater breadth of medical issues. Internal medicine, for example, added a new elder member in order to address geriatrics learning objectives. Curricular interventions were developed collaboratively by the clerkship directors, and they include simulated medical records for each family member and encounters with actual standardized patients portraying family members. Through the UME-21 Associate Partnership, a managed care partner (Fallon Health Care System) and a linking organization (the Meyers Primary Care Institute) participated in the expanded curriculum, integrating managed care objectives and materials across the three clerkships (e.g., use of a drug formulary and clinical guidelines).
Discussion: The standardized family curriculum addresses learning objectives that distinguish the ambulatory primary care disciplines: continuity of care, family-centered care, common acute and chronic problems, cost-effective care, outpatient record keeping, evidenced-base ambulatory care, managed care, and preventive medicine. To assess the effectiveness of the expanded standardized family in meeting these objectives, three evaluation measures are being used. (1) A written survey, developed to measure student self-assessment ratings of “confidence” and “competence” in relation to curricular objectives, was administered to all students completing the third year in June 1999 (the non-intervention “control” group) and to students entering the third year in July 1999 (the baseline, premeasure “intervention” group). The intervention cohort will be resurveyed at the end of the third-year curriculum to assess post-intervention changes compared with the control group not experiencing the expanded standardized family curriculum. (2) A written evaluation, addressing curriculum components relevant to the individual clerkship (i.e., quality and effectiveness of curricular materials and small-group teaching) is completed by students at the end of each clerkship. (3) The Association of American Medical Colleges' Graduating Student Survey targets many of the objective areas of the standardized family curriculum (i.e., continuity of care, managed care, preventive medicine). The students' responses to selected relevant items before and after the new curriculum will be compared.
Our experience supports that the standardized family curriculum can be implemented across clerkships and that it provides a model for developing a multidisciplinary and integrated core curriculum in primary care. The curriculum's effectiveness in attaining its primary care learning objectives will be assessed when analysis of data currently being gathered from multiple evaluation measures is completed.
1. Pugnaire MP, Leong SL, Quirk ME, Mazor K, Gray JM. The standardized family: an innovation in primary care education at the University of Massachusetts. Acad Med. 1999;74(1 supp):S90–S97.
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