Evaluation of a national process of reforming curricula in postgraduate medical education

Abstract

Context: A national reform of the postgraduate medical education in Denmark introduced (1) Outcome-based education, (2) The CanMEDS framework of competence related to seven roles of the doctor, and (3) In-training assessment. Objectives: The purpose of the study was to evaluate the process of developing new curricula for 38 specialist training programmes. The research question was: which conditions promote and which conditions impede the process? Methods: Evaluation of the process was conducted among 76 contact-persons, who were chairing the curriculum development process within the specialties. Quantitative and qualitative data from a questionnaire survey and telephone interviews were triangulated for data analysis. Results: The response rate of the questionnaire survey was 83% (63/76). Twenty-six telephone interviews were conducted. Identified promoting factors included positive attitude and motivation in faculty and support from written guidelines and seminars. Identified impeding factors included insufficient pedagogical support, poor introduction to the task, changing and inconsistent information from authorities, replacement of advisors, and stressful deadlines. Conclusions: This study identified promoting and impeding factors in a national postgraduate curriculum development process. Surprisingly the study indicates that pedagogical support provided throughout a process in some aspects might not be useful. General suggestions regarding curriculum reform processes are formulated.

Facilitators and barriers to a nationwide implementation of competency-based postgraduate medical curricula: A qualitative study

“…The national and regional implementation activities were effective mechanisms for communication, interpersonal influence, knowledge sharing and learning, and social networking. This is consistent with previously published work on the importance of communication and interpersonal influence in innovation processes (Rogers 2003), including processes in the context of undergraduate medical education (Bland et al 2000), and PGME (Lillevang et al 2009). …”

“…It has been shown that such targeted support accelerates and facilitates processes of implementation (Rogers 2003). However, in a PGME curriculum reform in Denmark, educational support had in some aspects an impeding impact on the process (Lillevang et al 2009). As in the Netherlands, in Denmark, the professionals required and requested additional educational support for implementing the renewed PGME curricula.…”

“…In Denmark, the renewal of PGME curricula has been documented. While stakeholders were positive toward the task of developing new curricula, they found this task quite difficult and gained insufficient support during the process (Lillevang et al 2009). Despite these interesting findings, the Danish study lacked an underlying theoretical framework, and the clinicians responsible for implementing and using the PGME curricula in practice were not interviewed.…”

“…Although it is universally agreed that implementation of competency-based PGME curricula involves major challenges (Ringsted et al 2003(Ringsted et al , 2006Ten Cate & Scheele 2007;Scheele et al 2008;Lurie et al 2009;Wasnick et al 2010), the implementation process and the factors influencing it have received little attention (Lillevang et al 2009). In Denmark, the renewal of PGME curricula has been documented.…”

What are we preparing them for? Development of an inventory of tasks for medical, surgical and supportive specialties

“…Calls from society for more transparency with regard to the content and quality of medical education have been the prime drivers of the fairly recent shift to competency-based postgraduate medical education and training in many, mainly Western, countries (Maudsley et al 2000;Jones et al 2001;Leach 2001;Carraccio et al 2002;Frank 2005;Scheele et al 2008;Lillevang et al 2009). The introduction of competencybased curricula was based on the assumption that such training would provide future physicians with better preparation for the full scope of contemporary medical practice or, in the words of the Royal College of Physicians and Surgeons of Canada, would train 'better physicians' (Frank 2005).…”