Six education strategies have been identified relating to the curriculum in a medical school. Each issue can be represented as a spectrum or continuum: student-centred/teacher-centred, problem-based/information-gathering, integrated/discipline-based, community-based/hospital-based, elective/uniform and systematic/apprenticeship-based. The factors supporting a more towards each end of the continuum are presented for each strategy. Newer schools tend to be more to the left on the continuum, established schools more to the right. Each school, however, has to decide where it stands on each issue and to establish its own profile. This SPICES model of curriculum strategy analysis can be used in curriculum planning or review, in tackling problems relating to the curriculum and in providing guidance relating to teaching methods and assessment.

The curriculum is a sophisticated blend of educational strategies, course content, learning outcomes, educational experiences, assessment, the educational environment and the individual students' learning style, personal timetable and programme of work. Curriculum mapping can help both staff and students by displaying these key elements of the curriculum, and the relationships between them. Students can identify what, when, where and how they can learn. Staff can be clear about their role in the big picture. The scope and sequence of student learning is made explicit, links with assessment are clarified and curriculum planning becomes more effective and efficient. In this way the curriculum is more transparent to all the stakeholders including the teachers, the students, the curriculum developer, the manager, the public and the researcher. The windows through which the curriculum map can be explored may include: (1) the expected learning outcomes; (2) curriculum content or areas of expertise covered; (3) student assessment; (4) learning opportunities; (5) learning location; (6) learning resources; (7) timetable; (8) staff; (9) curriculum management; (10) students. Nine steps are described in the development of a curriculum map and practical suggestions are made as to how curriculum maps can be introduced in practice to the benefit of all concerned. The key to a really effective integrated curriculum is to get teachers to exchange information about what is being taught and to coordinate this so that it reflects the overall goals of the school. This can be achieved through curriculum mapping, which has become an essential tool for the implementation and development of a curriculum. Faced with curricula which are becoming more centralized and less departmentally based, and with curricula including both core and optional elements, the teacher may find that the curriculum map is the glue which holds the curriculum together.

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Task-based learning: the answer to integration and problembased learning in the clinical years RM Harden, J Crosby, MH Davis, PW Howie & AD StruthersIntoduction Integrated teaching and problem-based learning (PBL) are powerful educational strategies. Dif®culties arise, however, in their application in the later years of the undergraduate medical curriculum, particularly in clinical attachments. Two solutions have been proposed ± the use of integrated clinical teaching teams and time allocated during the week for PBL separate from the clinical work. Both approaches have signi®cant disadvantages. Task-based learning (TBL) is a preferred strategy. In TBL, a range of tasks undertaken by a doctor are identi®ed, e.g. management of a patient with abdominal pain, and these are used as the focus for learning. Students have responsibility for integrating their learning round the tasks as they move through a range of clinical attachments in different disciplines. They are assisted in this process by study guides.Method The implementation of TBL is described in one medical school. One hundred and thirteen tasks, arranged in 16 groups, serve to integrate the student learning as they rotate through 10 clinical attachments.Results This trans-disciplinary approach to integration, which incorporates the principles of PBL offers advantages to both teachers and students. It recognizes that clinical attachments in individual disciplines can offer rich learning opportunities and that such attachments can play a role in an integrated, as well as in a traditional, curriculum. In TBL, the contributions of the clinical attachments to the curriculum learning outcomes must be clearly de®ned and tasks selected which will serve as a focus for the integration of the students' learning over the range of attachments.

An attitude scale was devised to discriminate between the extremes of doctor-centred, disease-oriented as opposed to patient-centred, problem-oriented (the DP scale). Four groups of subjects (214 in all) were tested with a Likert-type questionnaire based on this scale. Significant differences in attitude between the groups were found. Educational implications are discussed.