Medical Education Strategies for implementing curriculum change

BMJ 1992;305:1482-5 The General Medical Council has announced that British medical education must change,' but what strategies can be used to implement the desired reforms? Most people accept that the way in which a subject is taught can have as much impact on what students learn as the content of the course. A recent review by the Oxford Centre for Staff Development identified five aspects of educational programmes that are associated with students adopting undesirable shallow learning techniques and failing to grasp the underlying principles of the topic.2 The five features are heavy workload; excessive amount of course material; little opportunity to pursue subjects in depth; little choice over topics or methods of study; and an anxiety provoking assessment system that rewards or tolerates regurgitation of factual information. Dr Reg Jordan, the academic subdean at Newcastle medical school, likes to quote these points when talking about medical education because people inevitably assume that they are describing the traditional British medical course. In fact, none of the studies on which they are based was of medical education, although there is no reason why the general principles should not apply more widely. Many of the strategies that have been used to implement change in medical curricula are designed to tackle such problems with the traditional course. Much discussion about curriculum strategy is couched in educational jargon that may exclude many people from debates about the best approach. There is also a danger that people will become obsessed with the processes and forget the underlying aims. This danger has been highlighted by Professor Ron Harden and his colleagues at the Centre for Medical Education at the University of Dundee. They warn that too often the strategic concepts become "a thin gold veneer to a curriculum package" or come to be "ends in themselves, while the real aims and purposes of the curriculum are forgotten." In an attempt to encourage schools to think about why they are adopting certain approaches the centre has developed a model for curriculum design based on six key strategic concepts.3 The "SPICES" model represents the innovative extremes of six spectra (fig 1), and staff should consider the pros and cons of each extreme before deciding what approach works best in their setting. I shall now use the SPICES model to look at some common strategic approaches to change in medical education.