Chinese University of Hong Kong Faculty of Medicine

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Chinese University of Hong KongFaculty of Medicine


“No endeavor worth doing can be completed without cooperative effort” D Johnson


Knowledge

Tomorrow's DoctorTomorrow's Doctor

The necessary . . .

Skills

AttitudesAttitudes

The revised medical curriculumThe revised medical curriculum

• Faculty owned (vs departmentally developed)

– Design

– Scope and topics

– Timetabling – Lecture materials vetted by Faculty to reduce

• Duplication• Omission• Compression

– Assessment

System-based, integrated knowledgeEnhanced skills & affective developmentSystem-based, integrated knowledgeEnhanced skills & affective development

AttitudesEthics & professionalism

Skills

1. Communication

2. Life-long Learning

3. Clinical

Knowledge

1. Foundation 2. Cardiorespiratory

3. GI & nutrition 4. Haematology, infection &

immunity 5. Homeostasis: renal, endrocrin.,

metabol. 6. Musculo-skeletal

7. Neuroscience 8. Reproduction, sex, develpmnt

& growth 9. Health & society10. Mechanism diseases &

therapeutic appr.

11. Human structure

Core curriculum is designed & delivered by:

11 system panels

3 skills panels

clinical modules

Active learningActive learning

• Small group sessions (> 2/3 of student contact time)

• Life long learning skills– Computer literacy– Evidence-based medicine

• phrasing clinical questions, electronic library search, critical appraisal, integrate research findings into clinical decision making

• Web-enhanced learning

• Selective study modules – 30% of curriculum– networking, organizational independent research skills

0

20

40

60

80

100

Old New

Changes in Proportional Time Allocated to Passive and Active Teaching Protocols

(Old and New Curricula)

Curricula

Percent

Passive Active Passive Active

Early clinical contact & smoother transition to internshipEarly clinical contact & smoother transition to internship

• Early clinical contact: yr 1– Ward visits– Clinical skills laboratory– Real patient contact

• Transition to internship– Pre internship: end of yr 5

Faculty-owned student assessmentFaculty-owned student assessment

• Continuous assessments– Tutorials, Seminars, Practicals– Debates

– Family follow-up project

• Formative assessments – Web-based MCQs

• Summative assessments– Skills

• OSCEs & OSPEs

• Poster & verbal presentations (SSM) – Knowledge

• end of panel • end of yr integrated paper

Continuous assessment used:

•to facilitate learning

•to monitor progress•by panels•by self

•to reduce stress•contribute to final

grade

Continuous assessment used:

•to facilitate learning

•to monitor progress•by panels•by self

•to reduce stress•contribute to final

grade

Jr Med & Surg

Clerkship

C&F Med

O&G

PaedPsy

A&E

Sr Med & Surg

Clerkship

Med & Surg

Subspecialties

Year 1 Year 2 Year 3 Year 4 Year 5 Year 1 Year 2 Year 3 Year 4 Year 5

Selected Study Modules

Skills – communication, clinical, life long learning

Cardio-resp, GI-Nutr, Health-Soc,Cardio-resp, GI-Nutr, Health-Soc,

Homeostasis, MusculoskeletalHomeostasis, Musculoskeletal

Cardio-resp, GI-Nutr, Health-Soc,Cardio-resp, GI-Nutr, Health-Soc,

Homeostasis, MusculoskeletalHomeostasis, Musculoskeletal

Human Structure

Foundation

Language, IT,

PE

1st Prof Exam 2nd Prof Exam 3rd Prof Exam I

3rd Prof Exam II

Pre-internship

Haem- Inf- Imm, Mechn Disease Haem- Inf- Imm, Mechn Disease NeuroscienceNeuroscienceHaem- Inf- Imm, Mechn Disease Haem- Inf- Imm, Mechn Disease NeuroscienceNeuroscience

Reproduction, Sex, Development & Growth

Clinical Skills

Basic Medical& Clinical Sciences

Clinical Skills

Att

itu

des

Yr 1

Yr 2

Yr 3

Yr 4

Yr 5

Proportional allocation to knowledge, skills & attitudes across yearsProportional allocation to knowledge, skills & attitudes across years

Yr 1

Yr 2

Yr 3

Yr 4

Yr 5

Structured InterviewStructured Interview

• Personal aspiration and motivation for & expectation of a career in medicine.

• General knowledge about medicine:

– the science, the profession, & the health care system.

• Appreciation of moral & ethical issues.

• Social & cooperative spirit:

– teamwork and community involvement

• Communication & language skills.

Selection Criteria for InterviewSelection Criteria for Interview

JUPAS applicants

• HKCEE results: 5A’s + 2B’s

• HKALE results

• School Principal’s Nomination Scheme

• Sports Excellence Scheme

• Self-nomination Scheme

• Disabled Student Scheme

EAS applicants

• HKCEE results: 7A’s

Selection Criteria for InterviewSelection Criteria for Interview

Non-JUPAS applicants

• GPA: > 3.5

• First class honour

• GCE O-level: 6A’s

• GCE A-level: 4A’s

Selection for AdmissionSelection for Admission

JUPAS applicants:

• 60% on WGPA

• 40% on interview score

EAS applicants:• Interview score only

Non-JUPAS applicants:• Interview score only

Ongoing Review of Admission Process Ongoing Review of Admission Process

• Workshop at annual faculty curriculum retreat – review & discuss current issues

• Improve interview validity & reliability

– briefing and instructions for new interviewers

– structured interview, independent marking

– decrease variability of panel performance

– statistical review of individual performance

• On-going statistical comparisons – entry scores and undergraduate performance

Ensuring Clinical CompetenceEnsuring Clinical Competence

• Early clinical exposure

• Clinical skill laboratory

• Log-book

• Interactive web-based clinical case study

• Pre-internship program

• Intern education

System-based Integrated CurriculumSystem-based Integrated CurriculumH

um

an s

truct

ure

Su

bje

ct P

an

el S

tud

y

Sele

cted

Stu

dy M

od

ule

NervousDisorder

ChildHealth

ReproductiveMedicine

Mobility

ENT/Eye/Skin/ID

Pre-interntraining

Surgery

Medicine

Surgery

Medicine

Final MB

1 2 3 4 5

SSM

BasicClinicalSkillsSP

SSPS SSM

Clin

ical Exp

eri

en

ce

Clin

ical Exp

eri

en

ce

SSMSPS

Early Clinical ExposureEarly Clinical Exposure

Clinical Skill Lab

Teaching in Clinical Skill LabTeaching in Clinical Skill Lab

Logbooks Logbooks (hard & soft copy (hard & soft copy versions)versions)

(8) New Entry

(4) Summary Count

(2) Module 4 Logbook

(10) View Grand Round List

An Interactive Web-based Clinical Case Scenario

Students are encouraged to think & guided by pop-up prompts

Fracture Through A Cyst :

Does this look like a cyst – there is a periosteal reaction? Is it common to have such a reaction with a simple cyst ?

Students cannot move on to the next stage unless they submit their answer

Teacher assesses individual student responses & provides guidance

Pre-internship Program 2002Pre-internship Program 200211

Apr

il: (P

re-t

est)

25 M

ay: (

Pos

t-te

st)

1 Ju

ly

Module 1

17 A

pril

4 M

ay

3 weeks

Module 2

7 M

ay

24 M

ay

3 weeks 5 weeks

HO

LID

AY

Pre Internship Activities (17 April to 24 May 2002)Pre Internship Activities (17 April to 24 May 2002)

Mon Tues Wed Thurs Fri Sat

AM Ward Rounds & Practicing Basic Procedures

PM4S APEP 4S 4S

4:00-5:00 Patient and Family Communication

Ward Rounds & Practicing Basic

Procedures

4S APEP 4S 4S

Patient and Family Communication

Pre-internshipPre-internship

Cross Matching

Pre- Post Assessments

Internship TrainingInternship Training

• OrientationOrientation

• SupervisorsSupervisors

• LogbookLogbook

• Practice tips workshopsPractice tips workshops

• Mock interviewMock interview

Blood TakingBlood Taking

Hospital Phlebotomists

Hospital Phlebotomists

Averaged Quarterly Assessments of Interns’ SkillsAveraged Quarterly Assessments of Interns’ Skills

1996 - 20021996 - 2002

0

20

40

60

80

100

Poor Average Good Excellent

Pe r

cent

age s

Monitoring & EvalMonitoring & Evaluation

Benching MarkingBenching Marking

• Locally

• International schools of high repute

Comparing CUHK, UAlberta & Licensing Groups Comparing CUHK, UAlberta & Licensing Groups

Components of Licensing Examination using UAlberta’s MCQs

%

0102030405060708090

100

Surgery O&G Basic Science Total

CUHK Alberta Licensing Group

Comparing CUHK, UAlberta & Licensing Groups

0102030405060708090

100

Surgery

Licenciates

U Alberta

CUHK

Section of the Examination Using Alberta’s Items

Percent

Randomized Controlled Educational Randomized Controlled Educational TrialsTrials

• Determining impact of newly introduced pedagogy

– e.g. web-based enhanced learning

Difference between Intervention & Control Groups Statistically Significant

Pre and Post Trials (Historical Cohorts)Pre and Post Trials (Historical Cohorts)

• Performance of interns compared

– 2 alumni groups prior to curriculum revisions

– 1 alumni group following changes in yr 5• 3 week professional enhancement module • 6 week pre internship

3.30

3.40

3.50

3.60

3.70

3.80

3.90

4.00

4.10

4.20

4.30

1st Rot * 2nd Rot *

No PreInternship (last yr) Had PreInternship

Mean of Overall Performance in ALL Hospitals

* Difference is statistical significant at = 0.05.

***

3.30

3.40

3.50

3.60

3.70

3.80

3.90

4.00

4.10

4.20

4.30

1st Rot * 2nd Rot *

No PreInternship (last yr) Had PreInternship

Clinical Judgement in ALL Hospitals

***

* Difference is statistical significant at = 0.05.

Pre and Post Trials (Historical Cohorts)Pre and Post Trials (Historical Cohorts)

• Performance of students compared

– 3 yrs prior to curriculum revisions

– 1 group following changes in yr 1

1

2

3

4

5

6

10th 20th 30th 40th 50th 60th 70th 80th 90th

2001-02

1998-01

“I deepened my interest in the subject matter of this course [item 120] ”

Percentile Points for all Class Medians for Medical Year One Only

Strongly Agree

Agree

Slightly Agree

Slightly Disagree

Disagree

Strongly Disagree

1st Yr Students’ Ratings of New Curriculum

1st Yr Students’ Ratings of Former Curriculum

1

2

3

4

5

6


2001-02

1998-01

“The objectives of the course were clearly defined [item 276] ”


Strongly Agree

Agree

Slightly Agree

Slightly Disagree

Disagree

Strongly Disagree



1

2

3

4

5

6


2001-02

1998-01

“Overall, I am satisfied with the course [item 812] ”


Strongly Agree

Agree

Slightly Agree

Slightly Disagree

Disagree

Strongly Disagree



Monitoring Monitoring

• Regardless of directions found

– an evidence-based approach

• has informed curriculum & instructional designs

• will continue to do so



