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Background
In 2000, the Health Resources and Services
Administration (HRSA), in the interest of fostering curricular reform
in medical schools, awarded a four-year contract to the Society
of Teachers of Family Medicine (STFM) to develop a curricular resource
manual for use by medical educators who design curricula intended
to train physicians to practice in the 21 st century. Numerous studies have addressed
the need for medical education reform, and the Division of Medicine
and Dentistry (DMD) in recent years has supported reform efforts
focusing on specific components of medical school education. Since
2000, with the issuance of Healthy People 2010 , the rapid
advances emanating from the Human Genome Project, and the graying
of America, a sense of urgency has prompted the government to be
more proactive within the medical education community. The
DMD developed this project to provide medical school faculty with
a resource document that will assist them in developing curricula
to address important national health and society issues for medical
students who will practice in the 21 st century.
Purpose
The purpose of this project was: to engage
the leaders in the family medicine education community, as well
as their colleagues in the primary care disciplines of internal
medicine and pediatrics, in a critical examination of the current
curricula addressing prerequisites for third-year clerkships; for
the family medicine education community to examine the family medicine
clerkship; to examine elective opportunities following third-year
clerkships (fourth year) for preparation for residency, specifically
in family medicine but of potential broader application to all medical
school graduates; and finally to examine curricula in special topic
areas of critical importance to the federal government. The
special topics of critical interest included substance abuse, including
mental health; genetics; geriatrics, including end-of-life and palliative
care; informatics; oral health; and the national health objectives
as detailed in Healthy People
2010 . This critical examination process was to lead
to the development of a resource product describing what competencies
should be expected of medical students in the preclerkship, family
medicine clerkship, and post-clerkship levels of medical student
education, as well as in these special topic areas identified by
the government.
Theoretical Framework for the Resource
In the past
ten years, significant collaborative projects, funded by medical
education entities, the federal government, and private foundations,
have called for curricular reform with increasing urgency. The
FMCR Executive and Advisory Committees reviewed this significant
body of literature and used it, in conjunction with an iterative
process, to inform the conceptual framework on which this resource
is based. There is little disagreement that medical education
is a continuum, which begins prior to medical school, continues
through the four years of medical school into graduate medical education,
and proceeds throughout the physician's lifespan as lifelong learning. There
is increasing consensus that the Accreditation Council for Graduate
Medical Education's (ACGME) Outcome Project, with its defined competency
structure, is driving significant change in graduate medical education. Given
the continuum of medical education and the remarkable congruency
of all the broad-based calls for medical education reform with the
ACGME competency structure, the Advisory Committee made the decision
to utilize this conceptual framework for our project, accomplishing
a linkage between undergraduate and graduate medical education.
Development of the Resource
After achieving consensus
to utilize the ACGME competency rubric, the Executive and Advisory
Committees created two workgroups to address the four components
of the resource manual.
For the preclerkship component, the workgroup consisted of equal representation from the primary care disciplines of internal medicine, pediatrics, and family medicine. This workgroup created a two-part document: a consensus document addressing significant current competency challenges in the preparation of students for third-year clerkships, and a broad and detailed document regarding an array of competencies for students entering third-year clerkships. The consensus document recommendations were corroborated by an independent national study of third-year clerkship directors. Considerable discussion was held regarding the content of the broad competency document and, utilizing the ACGME structure, the focus was on competencies addressing the whole person, family, community, and the larger environment. This clearly was a decision not to engage the basic science educators at this level, but to define a different focus of competencies. Obviously, the densely packed nature of the first two years' curriculum and resource competition create significant challenges for the future.
For the family medicine clerkship component, a group of senior family medicine educators developed a matrix structure, including family medicine principles, family medicine clerkship themes, and the ACGME competency structure. Commonly taught/occurring problems in family medicine were used to help clerkship faculty teach the above themes and competencies.
For the post-clerkship component, input came from the FMCR Advisory Committee, from the FMCR's Clerkship/Post-Clerkship workgroup, from family medicine residency directors, and from a series of presentations at national meetings of educators. The Executive Committee took all of this input and used the broad competency document created by the primary care participants in the preclerkship group, elevating levels of competency and including recommendations specifically focused on the needs of students entering family medicine residencies.
Finally, special topic teams (which included topic area experts from among the workgroups) engaged in creating the resources addressing the governmental areas of special interest. As with previous components, this one was organized using the ACGME competency structure. The Advisory Committee ultimately reviewed all components of the resource. Additionally, various STFM groups provided input on some of the special topic area resources. Toward the end of contract funding, several consultants provided input into several special topics and into the entire resource.
Input from the Medical Education Community
Throughout
the entire contract process, continuous feedback and commentary
were solicited from various stakeholder groups through more than
40 peer-reviewed presentations/exhibits at national and regional
meetings of the AAMC and family medicine, internal medicine, and
pediatrics organizations, as well as eight meetings of the Advisory
Committee. A designated evaluation expert and team of external consultants
with curricular expertise conducted a final evaluation of the project
process.
Outcomes: Four Components of the Resource
The four components of the FMCR Resource are:
- Collaborative Curriculum Project Resources (Preclerkship)
- Family Medicine Clerkship Curriculum Resources
- Post-Clerkship Training Resource
- Special Topic Resources
The government contract calls for creation of a resource, not a prescriptive curriculum. It is clearly recognized that the contextual environments at all 126 allopathic medical schools and the 20 osteopathic colleges of medicines are diverse and their curricular needs are different. Given this reality, this resource was purposely designed so end users could extract individual components that match their institution's curricular needs. Each of the four components is cross- referenced by ACGME competency, specific goals and objectives, recommended resources, implementation strategies, evaluation strategies, faculty development recommendations, and comments on resource challenges. Certainly, a given institution could use a specific component as the basis for a defined curriculum, but the government's expressed intent was not to create prescriptive curriculum documents.
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