From Traditional to Patient-Centered Learning: Curriculum Change as an Intervention for Changing Institutional Culture and Promoting Professionalism in Undergraduate Medical Education

Abstract

The authors reframe a curriculum change from a traditional lecture-based to an integrated patient-centered approach as an intervention for changing the culture and hidden curriculum of an institution in ways that promote professionalism. Within this context, the authors articulate some of the inherent process and relational factors brought about by these curricular changes that are essential elements of this intervention process. In 1998 the University of North Dakota School of Medicine and Health Sciences (UNDSMHS) introduced a new preclinical patient-centered learning (PCL) curriculum for first- and second-year medical students. Case-based, small-group learning forms the critical foundation of the PCL process, and an integrated basic and clinical science didactic component supports this process. At the student level, the case-based PCL process generates innovative opportunities for professionalism education from the explicitly articulated formal content that arises naturally from the cases, but more importantly from the implicit values inherent to the PCL small-group process itself--humanism, accountability, pursuit of excellence, and altruism. Further, the organizational changes necessary for the transformation to the PCL curriculum required process changes at student, faculty, and administrative levels that have resulted in a cultural shift toward relationship centeredness within the institution. The authors describe the evolution and structure of the PCL curriculum at UNDSMHS and how this curricular transformation has served as an intervention that promotes professionalism and institutional culture change through (1) processes at the student level that present new opportunities for professionalism education, and (2) processes at student, faculty, administrative, and institutional levels that have created an institutional culture that supports, models, and promotes relationship-centered professional values.

Teaching professionalism in medical education: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25

“…In a similar vein, Christianson et al advocate a patientcentred curriculum in early years of training as a way to bring about organisational cultural shift towards an outward rather than inward focus, countering the hidden curriculum and enhancing development of professionalism (Christianson et al 2007). …”

‘Discovery Learning’: An account of rapid curriculum change in response to accreditation

“…We hypothesize this was because pre-clinical education was not perceived as belonging to any one Department in particular, and because all Departments were required to contribute equally to the tutor training. During the process of change, we appear to have been successful in communicating and building relationships with the faculty, and in providing them with the skills needed for them to change the way they teach; these factors have been identified as being of critical importance and are demonstrated by the high rates of workshop participation, course participation and retention of tutors (Rollins et al 1999;Christianson et al 2007).…”

A Novel Structured Format for Engaging Pharmacy Students in Bioethics Discussions

“…9 Various formats for teaching ethics and professionalism to health care students have been described, including small-group case discussion, peer-review, role-play, and self-reflection. [10][11][12][13] While ethical concepts can be communicated via lecture-style presentations, exposure to ethically-challenging situations allows students to visualize and reflect how actions affect others and society as a whole. Rosenstein and colleagues found that psychiatric fellows, following the completion of a course on ethics, showed a desire for a more interactive format.…”