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      Cross-sectional comparison of spiral versus block integrated curriculums in preparing medical students to diagnose and manage concussions

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          An integrated curriculum is designed to be repetitive yet progressive and the concept has rapidly established itself within medical education. National organizations have recommended a shift to a spiral curriculum design, which uses both vertical and horizontal integration. This study examined differences between the recently implemented integrated spiral (class of 2019) and conventional block (classes of 2016–2018) MD curricula at the University of British Columbia (UBC) with respect to knowledge of concussion.


          Cross-sectional online survey (FluidSurveys: Fluidware, Ottawa, ON), distributed via email to UBC medical students during the 2015–2016 academic year. Questions focused on demographic data, knowledge of concussion definition, and management considerations. Differences in responses across the two groups were assessed using chi-square tests. Ordinal Likert-scale data were analyzed using Mann-Whitney U-Tests. Statistical significance was determined a priori at p < 0.05.


          One hundred forty eight medical students (57% female) responded with 78 students in the spiral curriculum and 70 students the block curriculum. Important differences between responses from spiral versus block curricula students included: formal exposure to concussion-related educational material (10.8 h spiral vs. 3.95 h block), understanding concussions can occur without direct head impacts (90% spiral vs. 70% block, X 2 1,148 = 9.41, p = 0.002) and identifying long-term consequences (dementia: 90% spiral vs. 66% block, X 2 1,148 = 12.57, p < 0.0001; second impact syndrome: 80% spiral vs. 57% block, X 2 1,148 = 8.60, p = 0.003; Parkinsonism: 47% spiral vs. 17% block, X 2 1,148 = 14.87, p < 0.001). Block students identified the need for a full neurological exam ( X 2 1,148 = 17.63, p < 0.001) and had greater clinical exposure to acute concussion (47% block vs. 14% spiral, X 2 1,148 = 19.27, p < 0.001) and post-concussion syndrome (37% block vs. 19% spiral, X 2 1,148 = 5.91, p = 0.015).


          The findings from this preliminary study suggest the spiral curriculum design, which emphasizes and revisits clinical competencies, promotes a strong understanding and retention of knowledge in highly prevalent clinical conditions such as concussion.

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          Most cited references 11

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          What is a spiral curriculum?

           R Harden (1998)
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            Effectiveness of problem-based learning curricula: research and theory.

             J Colliver (2000)
            This article provides a critical overview of problem-based learning (PBL), its effectiveness for knowledge acquisition and clinical performance, and the underlying educational theory. The focus of the paper is on (1) the credibility of claims (both empirical and theoretical) about the ties between PBL and educational outcomes and (2) the magnitude of the effects. The author reviewed the medical education literature, starting with three reviews published in 1993 and moving on to research published from 1992 through 1998 in the primary sources for research in medical education. For each study the author wrote a summary, which included study design, outcome measures, effect sizes, and any other information relevant to the research conclusion. The review of the literature revealed no convincing evidence that PBL improves knowledge base and clinical performance, at least not of the magnitude that would be expected given the resources required for a PBL curriculum. The results were considered in light of the educational theory that underlies PBL and its basic research. The author concludes that the ties between educational theory and research (both basic and applied) are loose at best.
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              The integrated curriculum in medical education: AMEE Guide No. 96.

              The popularity of the term "integrated curriculum" has grown immensely in medical education over the last two decades, but what does this term mean and how do we go about its design, implementation, and evaluation? Definitions and application of the term vary greatly in the literature, spanning from the integration of content within a single lecture to the integration of a medical school's comprehensive curriculum. Taking into account the integrated curriculum's historic and evolving base of knowledge and theory, its support from many national medical education organizations, and the ever-increasing body of published examples, we deem it necessary to present a guide to review and promote further development of the integrated curriculum movement in medical education with an international perspective. We introduce the history and theory behind integration and provide theoretical models alongside published examples of common variations of an integrated curriculum. In addition, we identify three areas of particular need when developing an ideal integrated curriculum, leading us to propose the use of a new, clarified definition of "integrated curriculum", and offer a review of strategies to evaluate the impact of an integrated curriculum on the learner. This Guide is presented to assist educators in the design, implementation, and evaluation of a thoroughly integrated medical school curriculum.

                Author and article information

                (250) 807-8271 , sarah.fraser@alumni.ubc.ca
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                9 January 2019
                9 January 2019
                : 19
                [1 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, ; Kelowna, BC Canada
                [2 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, MD/PhD Program, University of British Columbia, ; Vancouver, BC Canada
                [3 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, Experimental Medicine Program, Faculty of Medicine, University of British Columbia, ; Vancouver, BC Canada
                [4 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, School of Health and Exercise Sciences, University of British Columbia Okanagan, ; ART 180, 3333 University Way, Kelowna, V1V 1V7 BC Canada
                © The Author(s). 2019

                Open AccessThis 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.

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                © The Author(s) 2019


                concussion, integrated, spiral curriculum, curriculum design, medical education


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