‘Compass’ curriculum more structured, builds strong foundation

HAMILTON | Four decades ago, McMaster University’s brand-new medical school was launched with a new style of curriculum called problem-based learning. The then-controversial approach has since been adopted by medical schools around the world and has become the accepted model.

Rather than look back and say, “I told you so,” the Michael G. DeGroote School of Medicine recently set out to improve upon the model it pioneered. A few years ago, its faculty gathered up the wealth of education research on topics such as the cognitive psychology of learning and used it to completely overhaul the curriculum.

The result is Compass: the next generation of problem-based learning. Key elements include a reorganized preclerkship phase, a more structured clerkship and a new professional competencies program. The first Compass cohort is now in its clerkship phase and will graduate from the three-year program next May.

“We had a great opportunity because McMaster has always been the centre of evidence-based medicine. It was a great opportunity to be the centre of evidence-based medical education as well,” said Dr. Anthony Levinson, director of e-learning innovation at the medical school and holder of the John R. Evans Chair in Health Sciences Educational Research and Instructional Development at McMaster.

“What has emerged is evidence-based problem-based learning,” he said.

Compass continues to capitalize on the learning advantages of small groups of students actively engaged in clinical problems, but with more structure and more clearly defined elements.

“For example, the tutorial problems are more intentionally sequenced, where they’re sort of building on a conscious sequence of clinical concepts or problems. In the past they were not always structured that way,” Dr. Levinson explained in an interview.

The Compass pre-clerkship phase revolves around medical foundations, focusing on key medical concepts, such as homeostasis or host defence, rather than organ systems.

“So rather than talking about cardiology per se, we were interested in people understanding oxygen exchange as it applied to clinical conditions,” Dr. Levinson said. “There’s less of a focus on particular diseases, there’s less of a focus on particular organ systems or disciplines, and we were trying to get across important concepts.”

This is one of the areas influenced by education research, which indicated that exposing people to concepts, then reinforcing them with practice problems and feedback, makes students far more likely to be able to solve problems in future.

“Our goal in the medical foundations is to give people core knowledge and understanding at a conceptual level, so when they are in the clinical setting, they are able to apply deep thinking and problem-solving skills at a conceptual level to clinical problems that present,” Dr. Levinson said.

Integration
In between each of the foundation segments is an integration week—another important application of education theory.

Dr. Levinson.

“In the integration week you have an opportunity to consolidate the learning, to get mixed practice problems that bring together concepts from within the medical foundations that link up with professional competencies topics, and that also link up with previous topics and concepts you’ve covered up to then,” Dr. Levinson said.

A rigorously designed professional competencies curriculum runs through preclerkship and clerkship. This new curriculum includes tutorials and sessions devoted to topics such as communication, ethics, professionalism and life-long learning.

The clerkship phase is also more rigorously structured in the Compass curriculum. Instead of just making sure students are exposed to various clinical situations in each of the core clerkships, there are clearer objectives in terms of the competencies and learning objectives expected from each rotation, as well as electronic tools to not only deliver curriculum content, but also to track progress and identify learning gaps.

“Part of this involves creating a much more systematic database of what’s expected and what’s offered within the curriculum—and then having mechanisms to track the students’ progress and either remediate it or just make sure that they’re accomplishing the necessary competencies,” Dr. Levinson said.

Compass takes full advantage of new media. Dr. John Kelton, dean of McMaster’s faculty of health sciences, told the Medical Post that the entire curriculum at the school of medicine has been made available electronically.

“We now have students at more than 60 sites across Ontario, and because everybody’s got fast linkages, you can deliver the same content in Belleville or Peterborough or Simcoe—any place,” he said, adding that this technology has been a key factor in developing its two new satellite schools: one in Kitchener-Waterloo starting this year, and another in St. Catharines starting next year.

Upgraded facilities
The school of medicine has also upgraded other facilities. Last spring, it completed the most extensive renovations to its library in 30 years. It also joined forces with other departments in McMaster’s faculty of health to build a state-of-the-art centre for clinical simulation, a $2-million extension to McMaster’s Clinical Learning Centre. The new addition houses three high-fidelity simulation rooms and a re-configurable ward space for simulations, as well as McMaster’s standardized patient program, in which trained actors present with clinical scenarios.

“All of the changes in our library, in our curriculum, in our mode of delivery have now come together,” Dr. Kelton said.

Last June, the medical school received a $50-million commitment from Hamilton businessman David Braley, president of Orlick Industries Ltd. The gift includes $10 million for a Family Medicine Centre, $15 million to fund Canada’s first human embryonic stem cell library, and $25 million earmarked for research and capital.

As the first Compass cohort moves into clerkship, Dr. Levinson said evaluation thus far—including feedback from faculty members who have taught in both the old and new curricula—has been very positive.

“I think the preclerkship was a huge success. We have every indication that it’s doing what it was supposed to be doing in terms of bringing students more in touch with key foundational concepts,(and)better and more rigorous training in the professional competencies”

Dr. Levinson noted the Michael G. DeGroote School of Medicine is already attracting notice from other schools interested in adopting aspects of the Compass curriculum.

“We were unique many years ago in terms of problem-based learning. I think what we’ve done now has actually propelled us forward in terms of the systematic application of learning theory and education research to curriculum design and implementation,” he said. “It’s a more subtle revolution than going to problem-based learning years ago, but I think it’s a very successful quiet revolution.”