Evaluating a curriculum map for undergraduate medical education: a critical analysis through different stakeholder lenses

Abstract In 2018, UCL Medical School commissioned a programme ‘Curriculum Map’ (CM). As the project’s lead, I theorised, designed and co-constructed the CM. My adopted theoretical position equated curriculum with syllabus, acknowledging that whilst this reflected the ‘formal’ curriculum, it did not capture the ‘informal’ or ‘hidden’ curricular elements. This doctoral research is a retrospective critical examination of the CM exercise. The professional practice problem addressed was whether the CM was judged by users as being ‘fit for purpose’. To address three research questions, the attitudes of key stakeholders (students and self) were analysed, examining the CM’s perceived purpose and drivers and asking whether it had accurately reflected the whole syllabus, including the professional ‘soft skills’. The role of institutional and national educational metrics in curriculum mapping was examined. An interpretivist paradigm using a novel ‘bricolage’ methodological framework of self-study and hermeneutic phenomenology was used. This blended approach drew on meaning and interpretation of data. Multi-method data collection was used to generate three discrete datasets (autoethnographic data; pan-student primary survey; student focus groups), which were synthesised using reflective thematic analysis. Descriptive statistics were used to analyse limited quantitative data. The findings were triangulated, looking for congruence in overall arguments. Data from stakeholders were synthesised into five themes; power in medical education (metrics drive practice, assessment drives learning); troubling trustworthiness, fairness and social justice; the hidden curriculum of ‘hard over soft’; navigating uncertainty and finding compromise; and building legacy. Different stakeholder lenses brought convergence and divergence to the data. My multiple positionality brought personal (reflexive), professional and political lenses to this ‘insider research’. As other UK medical schools are undertaking CM projects, it is anticipated that this work will have impact for the undergraduate community of practice. It may also have broader relevance in postgraduate medical education and other healthcare disciplines

Medical student perceptions of reflective practice in the undergraduate curriculum [version 1; peer review: awaiting peer review]

INTRODUCTION: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students’ attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. METHODS: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. RESULTS: Five key themes emerged around student attitudes to RP, which were grouped into three domains: ‘value of RP’, ‘barriers to engagement’, and ‘strategies for enabling RP’. ‘Value of RP’ centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. ‘Barriers to engagement’ centred on the purpose and tokenism of RP and in the third domain, ‘strategies for enabling RP’, the theme of student agency in RP emerged strongly. CONCLUSION: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum

Twelve Tips for specialists teaching generalists

Generalist clinicians play a vital role as the spine of a modern healthcare system. As a result of the breadth of their practice, they require high quality continuous professional development (CPD) training to keep up with important developments in all areas of their practice. Specialist clinicians are often well placed to provide such training but should recognise the ways in which this may differ from undergraduate and postgraduate training, and design tailored education that takes account of power dynamics, professional roles, and contemporary healthcare challenges. Prior engagement with the learning group to understand their aims and priorities is a crucial first step. Case-based learning, practical diagnostic and referral tips, patient communication and information advice, prioritising discussion and feedback, and reflecting on changes in evidence and guidelines are all suggested areas of focus that can provide a framework to design effective and engaging training for generalist groups

‘Decolonising the Medical Curriculum‘: Humanising medicine through epistemic pluralism, cultural safety and critical consciousness

The Decolonising the Curriculum movement in higher education has been steadily gaining momentum, accelerated by recent global events calling for an appraisal of the intersecting barriers of discrimination that ethnic minorities can encounter. While the arts and humanities have been at the forefront of these efforts, medical education has been a ‘late starter’ to the initiative. In this article, we describe the pioneering efforts to decolonise the undergraduate medical curriculum at UCL Medical School (UCLMS), London, by a group of clinician educators and students, with the aim of training emerging doctors to treat diverse patient populations equitably and effectively. Throughout this process, students, faculty and members of the public acted as collaborative ‘agents of change’ in co-producing curricula, prompting the implementation of several changes in the UCLMS curriculum and rubric. Reflecting a shift from a diversity-oriented to a decolonial framework, we outline three scaffolding concepts to frame the process of decolonising the medical curriculum: epistemic pluralism, cultural safety and critical consciousness. While each of these reflect a critical area of power imbalance within medical education, the utility of this framework extends beyond this, and it may be applied to interrogate curricula in other health-related disciplines and the natural sciences. We suggest how the medical curriculum can privilege perspectives from different disciplines to challenge the hegemony of the biomedical outlook in contemporary medicine – and offer space to perspectives traditionally marginalised within a colonial framework. We anticipate that through this process of re-centring, medical students will begin to think more holistically, critically and reflexively about the intersectional inequalities within clinical settings, health systems and society at large, and contribute to humanising the practice of medicine for all parties involved

Practical tips for teaching academic integrity in the digital age

Background: Medical education, as with other areas of healthcare education, is susceptible to cheating, with national and international examples cited in the literature. There are documented examples in the lay press, but limited scholarly activity in the field, which can be a challenging area to research and tackle. We have begun to explicitly address academic integrity within our undergraduate curriculum, including a focus on plagiarism, self-plagiarism, and covert sharing of questions. We believe this is an important curricular topic as exhibiting unprofessional behaviours can correlate with professional practice and can potentially have implications for practitioners and patients. Aim: To present 12 tips on teaching academic integrity in the digital age to medical students. Method: The tips presented are based on our experiences of teaching academic digital integrity to medical students, primarily in the form of a scenario based quiz. We do also extrapolate from content on academic integrity elsewhere within our professionalism syllabus. Results: The tips suggest that early, contemporary and contextualised material that is co-produced with students may offer a useful prophylactic approach to teaching about academic integrity. Conclusions: The principles presented could be adapted to other healthcare students and settings, including postgraduate education

Medical student perceptions of reflective practice in the undergraduate curriculum [version 3; peer review: 1 approved, 1 approved with reservations]

INTRODUCTION: Reflective practice (RP) forms a core component of medical professionalism but, despite its benefits, it remains largely undervalued among medical students. The aim of this study was to explore medical students’ attitudes and barriers to engagement with RP in the undergraduate programme at a UK based medical school. METHODS: This was a qualitative study based on the methodology of phenomenology. All penultimate year medical students at University College London Medical School (n=361) were approached for this study and altogether thirteen participants were recruited, with data collected through two focus group discussions. Thematic analysis was used to generate the coding framework. RESULTS: Five key themes emerged around student attitudes to RP, which were grouped into three domains: ‘value of RP’, ‘barriers to engagement’, and ‘strategies for enabling RP’. ‘Value of RP’ centred on the themes of humanising medicine and developing empathy, developing professionalism and RP as a tool for sense-making. ‘Barriers to engagement’ centred on the purpose and tokenism of RP and in the third domain, ‘strategies for enabling RP’, the theme of student agency in RP emerged strongly. CONCLUSION: Overall, the value of RP was not fully appreciated until students began their clinical placements. Potential strategies identified by participants for optimising engagement included student co-design and positioning RP within a broader pastoral role early in the undergraduate curriculum