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Collaborative Curriculum Resources Project (Preclerkship) |
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Collaborative Curriculum Project Resources (Preclerkship)
The Collaborative Curriculum Project (CCP) focuses on clinical competencies necessary for beginning the traditional M3 clerkship year. The competencies were identified through the consensus of experienced educators from the primary care disciplines. The CCP has two components: an overall compendium of suggested competencies and a delineation of six priority areas that merit greater emphasis in the preclerkship years in order ultimately to improve the outcomes of medical education. These priority areas were empirically validated through an independent randomized survey of clerkship directors in six core third-year disciplines, forming a nationally based blueprint for suggested curriculum enhancement. Note that the intent of these documents is NOT to prescribe curricula for any school, but rather to provide suggestions for greater emphasis, to describe the range of clinical competencies appropriate to the preclerkship years cast in behaviorally measurable terms, and to cite current best practices with regard to teaching methods, student assessment, resources required, faculty development, and budgetary considerations.
The CCP intentionally does not address competencies for learning the traditional basic sciences, but rather includes those that address interaction with the organism above the level of cells, tissues, and organs: the whole person, and higher levels of social complexity (dyads, families and other groups, the community, and the larger environment). We invite colleagues who teach sciences basic to the practice of medicine and other educators at the preclerkship level to review these suggested competencies and consider additional ways that teaching of the competencies can be integrated within their courses. Because most medical school curricula are already packed with essential materials, these suggested competencies clearly will challenge educators to address important choices regarding what is really essential "core curricula" for the preclerkship years. Given this challenge, we have included suggestions for integration of learning experiences for accomplishing these objectives within existing courses. Different schools may choose to address them in varying ways appropriate to their resources and settings. We hope that the document will be particularly helpful to those charged with developing a new clinical patient-centered course for preclerkship students, and for stimulating conversations among year 1-2 and year 3 faculty about appropriate competencies with which students should enter the clerkships.
Learning in medicine occurs across a continuum, from the life experience gained prior to beginning medical school, through the traditional four years of medical student education, through professional residency /fellowship training, and continually through one's professional career. Thus, when the CCP began the project early in 2002, we decided to use the ACGME's six-domain rubric for professional competencies as a structure within which to develop our work. The progressive adoption of this rubric by others, as well as feedback from colleagues at preliminary multiple national presentations on our product, has validated the usefulness of this decision. Because the ACGME domains are directed primarily at the level of residency training and actual care of patients, we were challenged to adapt the format to the preclerkship level, at which only recently have most medical students had some clinical experience. The competencies described may at first appear precocious for first- and second-year medical students; but we have attempted to titrate the level of competence described to the foundational, rather than practice level. Some competencies not traditionally included at the preclerkship level are included, with the rationale that fundamental attitudes are formed from the beginning of medical education, and that failure to include, for instance, multidisciplinary approaches in year 1 would convey a message in itself. This has been the medical educator's dream challenge: to describe systematically the sequence of competencies in knowledge, skills, and attitudes that must be achieved at the basic level, in order to reach the highest possible level of competencies in all domains, including attitudes and values, prior to entering residencies.
Readers will appreciate that multiple areas in a medical student curriculum will overlap the ACGME domain areas. We chose to describe some competencies under multiple domains, as an indication of their importance (e.g., communication skills, life cycle issues, and team-based care are found in several sites, and active/lifelong learning objectives are seen in nearly all domains).
We hope that the reader will perceive those themes that are interwoven through this document: that the patient's concerns, values, and outcomes must be the center of care; that partnering with an activated patient is essential; that self-awareness is essential to being an effective physician; that improving the process of care and health outcomes is the physician's responsibility and requires a systems-based approach; and that the first two years are only the foundation of an active learning process for which the student of medicine will be responsible throughout life.
Currently the following CCP reources are available from this site:
Competency-based Curriculum Resource for Pre-Clerkship Education (using ACGME structure)
Areas for Greater M1-2 Curricular Emphasis: Recommendations of the Collaborative Curriculum Project
Six priority areas referred to in this document have been validated through an independent survey. The survey findings have just been published in Academic Medicine : (Windish D, Paulman P, Goroll A and Bass E: Do clerkship directors think medical students are prepared for the clerkship years? Acad Med. 79(1): 56-61; January 2004).