Implementation of a Competency-based Curriculum in Medical Pharmacology Joseph A. Near1, Talmage R. Bosin1, and John B. Watkins III1 1Medical Sciences, Indiana University School of Medicine, Jordan Hall 104, Bloomington, IN 47405-7005

1
Implementation of a Competency-based Curriculum
in Medical PharmacologyJoseph A. Near1, Talmage
R. Bosin1, and John B. Watkins III11Medical
Sciences, Indiana University School of Medicine,
Jordan Hall 104, Bloomington, IN 47405-7005
ABSTRACT The traditional major emphasis of
medical education programs has been the
acquisition of basic scientific knowledge and
practical skills in well-defined subject areas.
Lecture and role modeling served as the principle
means of instruction. Changes in the practice
environment, the recognition that alternative
instructional models may be desirable in some
cases, and the fact that instruction in the
traditional subject areas does not prepare
students for all aspects of medical practice have
driven recent curricular changes at many schools.
Indiana University School of Medicine has
multiple instructional sites distributed
throughout the state. It has adopted a
school-wide plan that specifies desired
educational outcomes and provides an instrument
for rating student achievement, but leaves the
specifics of implementing this plan to be
developed by faculty at individual instructional
sites. In this report we describe the use of new
media and pedagogical methods in a two-semester
course on the principles of pharmacology. The
general goals of these changes were to help
students develop and assess competency in several
of the areas specified in the school-wide plan.
The general conclusion is that these changes not
only furthered the broader educational goals of
the competency-based curriculum, but also may
exert a positive influence on student learning of
discipline-specific material.
SPECIFIC WAYS COMPETENCIES ARE ADDRESSED IN PHARMACOLOGY SPECIFIC WAYS COMPETENCIES ARE ADDRESSED IN PHARMACOLOGY
Effective Communication Essay type questions on examinations.Oral question and answer sessions.Required oral presentation of a drug overdose case.Collaborative learning on clinical problems and case studies.
Basic Clinical Skills Use of clinical case studies.Discussion of how blood chemistry data may be modified by drugs.Discussion of the effects of drugs on normal clinical function.
Using Science to Guide Diagnosis, Management, Therapeutics, and Prevention Objective and subjective examinations.Use of in-class clinical problems and case studies.
Life Long Learning Discussion of newly-developed agents and how accurate information about them can be obtained.Demonstrating that continuing education in drug availability, utility and mechanism is a must.Use of tools made available on the Web for self-assessment of content mastery.
Self-awareness, Self-care, and Personal Growth Discussion of drug abuse in general and abuse by physicians in particular.Emphasis of the importance of recognizing and getting appropriate treatment for major depressive disorders in self.Discussion of how patient drug abuse can affect diagnosis, treatment, outcome and patient-physician relationship
Social and Community Contexts of Health Care Discussion of available alternative therapies.Discussion of the importance of determining whether patients are using nutritional/herbal supplements.Class discussion of the effects of various drug treatments on a patients quality of life.Discussion of how adverse effects of drugs impact quality of life and patient compliance.
Moral Reasoning and Ethical Judgment Ethical dilemmas in prescribing decisions, drug abuse and drug overdose cases.Recognition of the importance of informed choice.
Problem Solving Specific pharmacokinetic and drug dosing problems on exams and quizzes.Clinical problems and case studies.
Professionalism and Role Recognition Effective role modeling on the part of all who help team teach these courses.Discussion and practice of effective prescription writing.Discussion of the interaction between physicians and pharmacists as parts of a health care team.Cooperation in small student groups while solving pharmacokinetic and drug dosing problems.
DEFINITIONS OF THE NINE COMPETENCIES Effective
Communication - The competent graduate listens
attentively and communicates with patients,
families, and health care team members. The
graduate establishes the rapport necessary to
form and maintain a therapeutic relationship with
the patient. Basic Clinical Skills - The
competent graduate elicits and records a complete
and accurate history and performs a skillful
examination appropriate to a variety of patient
encounters. The graduate correctly selects,
proficiently performs, and accurately interprets
selected clinical procedures and laboratory
tests. Using Science to Guide Diagnosis,
Management, Therapeutics, and Prevention - The
competent graduate knows and can explain the
scientific underpinnings, at the molecular,
cellular, organ, whole body, and environmental
levels for states of health and disease based
upon current understanding and cutting edge
advances in contemporary basic science. This
information is used to diagnose, manage, and
prevent the common health problems of
individuals, families, and communities by
collaborating with them. Graduates develop
problem lists and differential diagnoses, carry
out additional investigations, implement
interventions with consultation and referral as
needed, determine outcome goals, recognize and
utilize prevention opportunities, monitor
progress, share information and educate, and
adjust therapy and diagnosis according to
results. Lifelong Learning - The competent
graduate is aware of the limits of personal
knowledge and experience. He/she actively pursues
clear learning goals, exploits new opportunities
for intellectual and professional growth, is
capable of critical, reliable, and valid self
assessment, and applies the knowledge gained to
the practice of his/her profession. Self
Awareness, Self Care, and Personal Growth - The
competent graduate approaches the practice of
medicine with awareness of his/her limits,
strengths, weaknesses, and vulnerabilities.
He/she assesses personal values and priorities to
develop and maintain an appropriate balance of
personal and professional commitments. Graduate
seeks help and advice when needed for his/her own
difficulties and develops appropriate coping
strategies. Graduate recognizes his/her effect on
others in professional contacts. He/she seeks,
accurately receives, and appropriately responds
to performance feedback. The Social and Community
Contexts of Health Care - The competent graduate
recognizes the diverse factors that influence the
health of individuals and communities identifies
the socio-cultural, familial, psychological,
economic, environmental, legal, political, and
spiritual factors impacting health care and
health care delivery and responds to these
factors by planning and advocating the
appropriate course of action at both the
individual and community level. Moral Reasoning
and Ethical Judgment - The competent graduate
recognizes the ethical issues of medical practice
and health policy identifies alternatives in
difficult ethical choices systematically
analyzes conflicting considerations supporting
different alternatives and formulates, defends,
and implements a course of action acknowledging
this ethical complexity. The graduate fuses a
willingness to recognize the nature of the value
systems of patients and others with commitment to
his/her own system and the ethical choices
necessary to maintain his/her own ethical
integrity. Problem Solving - The competent
graduate recognizes and thoroughly delineates
problems. The graduate develops an informed
action plan, acts to resolve problems, and
subsequently assesses the results of his/her
actions. Professionalism and Role Recognition -
The competent graduate recognizes the powerful
impact of his/her professional attitudes and
behavior on others and consistently displays the
highest standards of excellence, duty, and
accountability to patients. The graduate values
the humanity of all patients and does not exploit
patients for personal gain. He/she appreciates
his/her role in working collaboratively with
others to meet the health care needs of
individuals and communities.
INTRODUCTION There have been at least two major
revolutions of the past two decades in medicine
one involves the explosive technologic growth in
both diagnosis and treatment of diseases, and the
second pertains to the organizational and payment
structures for health services. Medical education
programs have focused on a core curriculum
knowledge base that includes advancing
developments in science and technology (Cantor et
al. 1991). In addition, many schools have begun
to devote energy to training physicians for
changes in the practice environment (Halpern et
al, 2001 Finnochio et al., 1995 Hewson and
Fishleder, 1998). Several reports have
recommended changes in curricular goals and
objectives (Marston and Jones, 1992 ONeil
1993). Some of the changes include rewriting of
core directives by internal medicine clerkship
directors (Society of General Internal Medicine,
1999) and a nationally funded initiative at 18
medical schools to encourage educational
partnerships and curricular innovations to teach
students about practicing high-quality, cost
effective medicine (Rabinowitz et al., 2001). A
recent synopsis of curricular change at 10
institutions reveals the extent of the
transformations that some schools have willingly
undertaken (AAMC, 2000). Indiana University
School of Medicine (IUSM) is the second largest
medical school in the United States, with an
enrollment of approximately 1120 students in the
first four years. In the early 1990s the school
began developing a faculty-owned plan for
curricular change, entitled the Primary Care
Initiative, designed to educate physicians that
are better prepared for practice in the 21st
century. This effort culminated in the seminal
document, The Indiana Initiative Physicians for
the 21st Century in 1996, which recommended that
nine competencies be integrated into the
curriculum throughout medical school. Although it
is modeled to some degree after the MD-2000
program at Brown University Medical School, which
requires that students demonstrate nine
abilities before graduation, adoption of a
competency-based curriculum at IUSM was
complicated by a number of factors arising from
the size and structure of the school. First, this
radically different way of organizing and
evaluating instruction required enormous
cooperation, creativity, and labor from the
several hundred IUSM faculty members involved in
instructing medical students. Second, the diverse
nature of the statewide system, in which students
may attend the first two years at one of nine
sites around the state (Bloomington, Evansville,
Fort Wayne, Gary, Indianapolis, Lafayette,
Muncie, South Bend, or Terre Haute) before
aggregating in Indianapolis for the final two
years, presents both obstacles and opportunities.
While the obstacles are primarily administrative,
each site has unique pedagogic differences in
approach that allow and perhaps even encourage
experimentation with different educational
methods. Thus the plan attempts to establish a
careful balance between school-wide agreement on
educational goals on one hand, and diversity with
regard to instructional methods on the other.
With a clear statement of goals and an
administrative process for evaluation in place, a
trial program began in academic year 1998/1999
with full implementation in 1999/2000. While the
school-wide plan describes the desired
educational goals and provides an instrument for
rating student achievement, methods for achieving
these educational goals were intentionally left
to be determined by individual centers,
departments, course directors and instructors.
The objective of this paper is to describe the
implementation of new media and pedagogical
methods in a two-semester course on the
principles of pharmacology for 2nd year medical
students at IUSM-Bloomington.

• SUMMARY AND CONCLUSIONS
• We used a variety of methods to integrate the
  competency curriculum into a medical pharmacology
  course.
• Student reaction to changes was generally
  positive, as assessed by informal discussions at
  the end of the course. Students generally favored
  including more exercises and problem-solving
  sessions and fewer lectures.
• While contact hours actually decreased, student
  learning of discipline-specific material did not
  appear to be affected as judged by performance on
  objective examinations.
• Exercises and other practices designed to further
  student insight and learning in areas addressed
  by the competencies complement and enhance
  student learning of discipline-specific material.

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