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      Implementation of a competency-based medical education approach in public health and epidemiology training of medical students

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          Abstract

          Background

          There is increasing agreement among medical educators regarding the importance of improving the integration between public health and clinical education, understanding and implementation of epidemiological methods, and the ability to critically appraise medical literature. The Sackler School of Medicine at Tel-Aviv University revised its public health and preventive medicine curriculum, during 2013–2014, according to the competency-based medical education (CBME) approach in training medical students. We describe the revised curriculum, which aimed to strengthen competencies in quantitative research methods, epidemiology, public health and preventive medicine, and health service organization and delivery.

          Methods

          We report the process undertaken to establish a relevant 6-year longitudinal curriculum and describe its contents, implementation, and continuous assessment and evaluation.

          Results

          Central competencies included: epidemiology and statistics for appraisal of the literature and implementation of research; the application of health promotion principles and health education strategies in disease prevention; the use of an evidence-based approach in clinical and public health decision making; the examination and analysis of disease trends at the population level; and knowledge of the structure of health systems and the role of the physician in these systems. Two new courses, in health promotion, and in public health, were added to the curriculum, and the courses in statistics and epidemiology were joined. Annual evaluation of each course results in continuous revisions of the syllabi as needed, while we continue to monitor the whole curriculum.

          Conclusions

          The described revision in a 6 year-medical school training curriculum addresses the currently identified needs in public health. Ongoing feedback from students, and re-evaluation of syllabus by courses teams are held annually. Analysis of student’s written feedbacks and courses evaluations of “before and after” the implementation of this intervention is taking place to examine the effect of the new curriculum on the perceived clinical and research capacities of our 6-year students.

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          Most cited references31

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          Toward a shared language for competency-based medical education

          The paradigm shift brought about by the advent of competency-based medical education (CBME) can be characterized as an adaptive change. Currently, its development and implementation suffer from the lack of a lingua franca. A shared language is needed to support collaboration and dissemination across the world community of medical educators. The International CBME Collaborators held a second summit in 2013 to explore this and other contemporary CBME issues. We present the resulting International CBME Collaborator's glossary of CBME terms. Particular attention is given to the terms competency, entrustable professional activity (EPA), and milestone and their interrelationships. Medical education scholars and enthusiasts of the competency-based approach are encouraged to adopt these terms and definitions, although no doubt the vocabulary of CBME will continue to evolve.
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            Statistics teaching in medical school: Opinions of practising doctors

            Background The General Medical Council expects UK medical graduates to gain some statistical knowledge during their undergraduate education; but provides no specific guidance as to amount, content or teaching method. Published work on statistics teaching for medical undergraduates has been dominated by medical statisticians, with little input from the doctors who will actually be using this knowledge and these skills after graduation. Furthermore, doctor's statistical training needs may have changed due to advances in information technology and the increasing importance of evidence-based medicine. Thus there exists a need to investigate the views of practising medical doctors as to the statistical training required for undergraduate medical students, based on their own use of these skills in daily practice. Methods A questionnaire was designed to investigate doctors' views about undergraduate training in statistics and the need for these skills in daily practice, with a view to informing future teaching. The questionnaire was emailed to all clinicians with a link to the University of East Anglia Medical School. Open ended questions were included to elicit doctors' opinions about both their own undergraduate training in statistics and recommendations for the training of current medical students. Content analysis was performed by two of the authors to systematically categorise and describe all the responses provided by participants. Results 130 doctors responded, including both hospital consultants and general practitioners. The findings indicated that most had not recognised the value of their undergraduate teaching in statistics and probability at the time, but had subsequently found the skills relevant to their career. Suggestions for improving undergraduate teaching in these areas included referring to actual research and ensuring relevance to, and integration with, clinical practice. Conclusions Grounding the teaching of statistics in the context of real research studies and including examples of typical clinical work may better prepare medical students for their subsequent career.
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              Innovations in curriculum design: A multi-disciplinary approach to teaching statistics to undergraduate medical students

              Background Statistics is relevant to students and practitioners in medicine and health sciences and is increasingly taught as part of the medical curriculum. However, it is common for students to dislike and under-perform in statistics. We sought to address these issues by redesigning the way that statistics is taught. Methods The project brought together a statistician, clinician and educational experts to re-conceptualize the syllabus, and focused on developing different methods of delivery. New teaching materials, including videos, animations and contextualized workbooks were designed and produced, placing greater emphasis on applying statistics and interpreting data. Results Two cohorts of students were evaluated, one with old style and one with new style teaching. Both were similar with respect to age, gender and previous level of statistics. Students who were taught using the new approach could better define the key concepts of p-value and confidence interval (p < 0.001 for both). They were more likely to regard statistics as integral to medical practice (p = 0.03), and to expect to use it in their medical career (p = 0.003). There was no significant difference in the numbers who thought that statistics was essential to understand the literature (p = 0.28) and those who felt comfortable with the basics of statistics (p = 0.06). More than half the students in both cohorts felt that they were comfortable with the basics of medical statistics. Conclusion Using a variety of media, and placing emphasis on interpretation can help make teaching, learning and understanding of statistics more people-centred and relevant, resulting in better outcomes for students.
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                Author and article information

                Contributors
                +972-3-5303923 , racheld@gertner.health.gov.il
                Journal
                Isr J Health Policy Res
                Isr J Health Policy Res
                Israel Journal of Health Policy Research
                BioMed Central (London )
                2045-4015
                20 February 2018
                20 February 2018
                2018
                : 7
                : 13
                Affiliations
                [1 ]ISNI 0000 0001 2107 2845, GRID grid.413795.d, Unit for Cardiovascular Epidemiology, The Gertner Institute, , Chaim Sheba Medical Center, ; Ramat Gan, Israel
                [2 ]ISNI 0000 0004 1937 0546, GRID grid.12136.37, Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, , Tel Aviv University, ; Tel Aviv, Israel
                [3 ]ISNI 0000 0004 0575 344X, GRID grid.413156.4, Quality Unit, Rabin Medical Center, ; Petah Tikva, Israel
                [4 ]ISNI 0000 0004 0575 344X, GRID grid.413156.4, Department of Medicine E, , Beilinson Hospital, Rabin Medical Center, ; Petah-Tiqva, Israel
                [5 ]ISNI 0000 0004 1937 0546, GRID grid.12136.37, Sackler Faculty of Medicine, , Tel Aviv University, ; Tel Aviv, Israel
                [6 ]ISNI 0000 0001 2107 2845, GRID grid.413795.d, Cancer & Radiation Epidemiology Unit, Gertner Institute, , Chaim Sheba Medical Center, ; Ramat Gan, Israel
                Article
                194
                10.1186/s13584-017-0194-8
                5819693
                29463297
                4f0d5e67-4284-4049-8b48-463dccae813c
                © The Author(s). 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 July 2017
                : 4 December 2017
                Categories
                Integrative Article
                Custom metadata
                © The Author(s) 2018

                Economics of health & social care
                Economics of health & social care

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