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.

At the University of Calgary Faculty of Medicine in 1991, the authors sought to determine the effects of tutors' levels of content expertise on learning issues generated within problem-based learning (PBL) tutorials. For an integrative course taken prior to clinical clerkships, the 70 students in the class of 1992 divided into ten small groups, which were facilitated alternately by content experts and non-experts. The authors found that--across 35 simulated-patient case encounters (24 with non-experts and 11 with experts)--when the groups had tutors with expertise in the clinical cases studied, the groups generated approximately twice as many learning issues per case, and these issues were approximately three times more congruent with the case objectives. In addition, when the groups had expert tutors they spent approximately twice as much time per case in overcoming identified learning deficiencies. The authors conclude that it is important for tutors (1) to be well informed about cases and case objectives and (2) to be well versed in the PBL tutoring process.

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