Transcript Modifying the Curriculum to Address Major Health Problems (focus

Overcoming the Disconnect between
Desired Outcomes and Educational Design
MODIFYING THE CURRICULUM TO
ADDRESS MAJOR HEALTH
PROBLEMS
John Horton, M.B., Ch.B.
Professor of Oncology and Medicine
USF College of Medicine and Moffitt Cancer Center
A case in point:
Designing medical education about
CANCER
Modifying the Curriculum to Address
Major Health Problems
Focus on Cancers
Chief cancer killers (USA):
lung*, breast*, colorectal
Well-controlled cancer (USA):
cervix uteri*
*for discussion
Interventions known to minimize mortality
and morbidity
Example 1: lung cancer*
smoking prevention
smoking cessation
cessation maintenance
*and cardiovascular and pulmonary diseases
Interventions (continued)
Example 2: Breast cancer
screening and early diagnosis
-clinical examination
-mammography
Example 3: Cervix cancer
screening with cervical cytology
Example I:
Lung Cancer: Population Needs
Smoking prevention (eg. schools)
Smoking cessation
Cessation maintenance
Achieved by:
Public health policies
Physician interventions
Status of Physician Education regarding
smoking cessation:
~1980’s:
a. Comfortable with advising smokers
to quit – 4%
b. Medical schools with curriculum
content on smoking cessation –
13%
Curriculum content/experiences required to
develop competency in smoking
prevention/cessation
a. Epi, biology, pathology, clinical
manifestations of smoking-related diseases
b. Addiction science
c. Pharmacology (eg. Nicotine, SSRI’s)
d. Behavior modification science
e. Experience in smoking cessation clinics
f. Systems for recognition/implementation (eg.
40% of breast cancer pts. are smokers!)
Continuous Curriculum Review Process
Assessment of Current USF Curriculum:
Satisfactory:
# a  d.
Inadequate:
# e – cessation clinics
# f - systems for recognition/
implementation
Response by USF Curriculum
#ad
Continue
#e
Elective in development
#f
Plans still pending
Example 2:
Breast Cancer: Population Needs
Population screening and early
diagnosis*
Treatment
Follow-up/symptom control
* for discussion
Competencies needed by general
physicians to address breast cancer
mortality and morbidity
a. Understand the biology and clinical
manifestations of breast cancer
b. Perform risk-assessment history and
adequate breast examination
c. Follow guidelines for mammography
d. Participation in a systems-approach to
ensure compliance to screening guidelines
e. Refer patients for diagnosis and treatment
Continuous Curriculum Review
Assessment of current USF curriculum
# a. OK
# b. Improvements being instituted
# c. OK
# d. no formal activity
Example 3:
Carcinoma of Cervix Uteri
1. Key for control is population screening
with cervical cytology
2. Invasive cervical cancer is now a rare
disease in screened populations in the
USA and Europe
3. Exceptions when poor compliance
or lack of insurance
Carcinoma of the Cervix in Poland
1950-1975
death rates decreasing
1975-1990
death rates increased*
* change in public policy.
Gynecologists read pap smears themselves
Note: exception in 1 county where central
cytology review was maintained
Conclusions:
1. Define key health problems and choose
which to address.
2. Define ideal physician behavior/activity to
address the problem
3. Evaluate the current curriculum to determine
if it provides the needed competencies for
the medical graduates.
4. If not, identify the deficiencies and implement
modifications in the curriculum.