Understanding community health medical education through action research

Abstract

students would be assigned several case scenarios to review prior to the lecture. The respective faculty member would spend the 2 hours reviewing these cases and any other material that he or she felt was relevant. Why the idea was necessary There were several problems with this structure. Firstly, students rarely did any preparation for the sessions, which made the lectures much less interactive. Secondly, faculty members made numerous complaints about the time commitment necessary for the curriculum. Specifically, lectures were held at 15.00-17.00 hours on 2 days per week, which interfered with the faculty members' other clinical duties. To minimise this disruption, approximately 40 different faculty members delivered lectures over the course of the year. This led to a great deal of variability in the content and quality of the sessions. Finally, students complained that the 2-hour sessions were too long. What was done The structure of the junior core curriculum was changed in July 2009. Each division was given the responsibility of writing two to six cases covering the clinical objectives of their specialty. In addition, each case included one to three multiplechoice questions and detailed discussions of the answers. Students are expected to read the case, answer the questions and review the discussions online in preparation for 1-hour sessions with faculty members from each subspecialty. The curriculum coordinator sends the distribution of student answers to the faculty member prior to the session. The faculty member reviews key concepts from the cases, addresses questions that were missed by large proportions of students and discusses additional relevant material within his or her specialty. Evaluation of results and impact The change has resulted in a 50% decrease in the number of faculty hours spent on clerkship lectures. Further, the number of faculty members who deliver these sessions has decreased from approximately 40 to 21, resulting in much less variability. This decrease in the number of lecturers has also allowed us to conduct focused faculty development with each lecturer. The elimination of the 15.00 hours lecture has also substantially limited the disruption to clinic schedules. Faculty members have noted much better student participation and preparation for the lectures.Student evaluations of the clerkship have included fewer complaints about ineffective lecturers. The overall scores on anonymous evaluation forms filled out by students at the end of the rotation have not significantly changed. The mean shelf score is unchanged. In conclusion, the implementation of online case-based learning prior to a discussion with a professor from the respective specialty has resulted in decreased demands on faculty time and created a consistent teaching team without loss of student approval or impact on National Board of Medical Examiners scores.