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Innovations in Medical Education

Reynaldo O. Joson, MD, MHPEd, MHA, MSc Surg


UPM Centennial Professorial Chair, 2008

June 9, 2008; June 16, 17, 18, 19, 2008

What is the concept of innovation before we talk of innovations in medical education?

Innovation can occur in any field, organization development, medical education, non-medical
education, hospital administration, economics, governance, business administration, etc. So,
lets discuss first the concept of innovation in a generic sense. Answering the following
questions may facilitate bringing out the concept of innovation.

Is innovation the same as invention?


Is innovation the same as creativity?
Is innovation considered something original?
What is adoption of innovation?
What is the difference between innovation and trend?
Can an innovation be patented?
What is the goal of innovation?
How significant should the positive change be to qualify as an innovation?
What is innovation?

Is innovation the same as invention?

A look at Merriam-Webster dictionary shows practically the same definition for invention and
innovation - a device, contrivance, method, or process originated or developed after study and
experiment.

Thus, loosely used, invention and innovation are the same particularly in terms of something new
and this something new has significant value. However, invention usually refers to the first
publicized occurrence of something significantly new and of significant value while innovation
is a derivation of an invention or something already in existence in the world. Nowadays,
invention is usually used to refer to a newly created device while innovation is usually used
to refer to a strategy, method, process or service that is a modification of something already in
existence, modification of something traditional or something conventional.

Is innovation the same as creativity?

Strictly speaking, innovation is the same as creativity since all innovations typically involve
creativity and begin with creative ideas. However, if a successful implementation of creative
ideas is a prerequisite for innovation to be said to be present and if the creative ideas are not
successfully implemented, then there is no innovation. Thus, mere creativity of ideas is not the
same as innovation. The creative ideas must be able to produce a new strategy, method, process
or service before one can say an innovation is present.
Is innovation considered something original?

Strictly speaking, all innovations are considered something original in the sense that they are
new. However, they are not original in the sense of an invention. They are original in the sense
that it is something new as a result of a modification of something already in existence,
modification of something traditional or something conventional.

Question: Is adoption of a publicized innovation developed in another institution or organization


considered an innovation in the institution or organization adopting it? Strictly speaking, the
answer is NO. There is no innovation in the adopting institution or organization. There is just an
adoption of a publicized innovation. However, if there are significant changes made in the
publicized innovation, then there is innovation. Note: there is a tendency to say that innovation
is taking place within an organization or institution. One has to qualify whether the innovation is
really an innovation or an adoption, en toto or with some adjustment to resources and culture.

Question: What is the difference between trend and innovation? Trend is the general direction in
which something tends to move. It is the current practice. It is the vogue. It is the prevailing
practice at a certain time. Trend connotes continual change. As such, trend connotes innovation,
usually an adoption of an innovation of somebody or an institution by a large group of people or
institutions or a community.

Question: Can an innovation be patented? Strictly speaking, it can. However, in practice,


nobody goes to the trouble of patenting an innovation of a strategy, method, process or service.
It is just publicized and published hoping in the long run, the innovators and their innovations are
recognized in the literature and in recognition ceremonies a psychic investment.

What is the goal of innovation?

The goal of innovation is positive change, to make something / someone better in terms of
effectiveness and efficiency. The latter will be in terms of achieving and accomplishing the
mission and objectives of an organization or institution or an assigned / expected functions and
tasks.

How significant should the positive change be to qualify as an innovation?

The goal of innovation is a positive change. The innovation should be a radical or significant
change which is put to use (not just ideas) and which produces substantial improvement in
strategy, method, process or service in terms of value and appreciated by stakeholders.

Thus, what is innovation?

Innovation refers to the significant changes in traditional and conventional strategy, method,
process or service resulting from creative ideas, put into use, that create substantial improvement
in terms of value, and appreciated by stakeholders.

What are innovations in medical education?


Innovations in medical education are significant changes in traditional and conventional conduct
of medical education; resulting from creative ideas; put into use; creating substantial
improvement in terms of curriculum, teaching-learning strategy, evaluation method, and
physician-graduates; and appreciated by stakeholders (educators and students).

Categories of innovations in medical education that can lead to significantly improved


processes and products (physician-graduates)

Innovations in medical curriculum


Innovations in teaching-learning strategy
Innovations in evaluation method

Innovations in Medical Curriculum

Medical curriculum is a program of study in the field of medicine. The program is a package (or
sum total) of learning objectives, content, teaching-learning strategy, and evaluation method.

When do we say a medical curriculum is innovative or is an innovative medical curriculum?


When do we say a course study, say on anatomy, physiology, ophthalmology, or surgery for the
medical students is innovative or is an innovative course study?
When do we say a residency training program is innovative or is an innovative training program?

When do we say that a medical curriculum, a course study for the medical students, or a
residency training program is traditional? (Note: to speak of innovations in medical curriculum,
we must know what is a traditional or conventional medical curriculum and to say that there is
innovation, we must show that there is a modification of the traditional or conventional medical
curriculum.)

Innovative Medical Curriculum

Traditional / conventional Innovations


(goals = better graduates /
more effective / efficient
processes)
(goals = more responsive to
the health care needs of the
community and country;
NEED-based innovations)
(other goals ?????)
Learning objectives / Competent generalist Competent generalist
terminal competencies physician physician
(others ?????) Physician-teacher
Physician-researcher
Physician-administrator
Self-directed physician-
learner
(others ?????)
Content Subjects and content Over and above those
prescribed by the board of prescribed by the board of
medicine / association of medicine / association of
medical schools medical schools
(others ?????) (others ?????)
Teaching-learning strategy Lectures Other than lectures
(others ?????) (others ?????)
Evaluation method Written exams Written exams
(others ?????) Oral exams
Practical exams
(others ?????)
Concept of traditional vs Traditional medical Innovative medical
innovative medical curriculum = curriculum = innovations in
curriculum Traditional learning traditional learning
objectives, content, objectives; content,
teaching-learning strategy, teaching-learning strategy,
and evaluation method and evaluation method (all
or just one or two
(Traditional = time of components, particularly
Flexner Medical Report - teaching-learning strategy
1910 or conventional at and evaluation
present?????) method ?????)

Innovative Course Study

Traditional / conventional Innovations


(goals = better graduates /
more effective / efficient
processes)
(goals = more responsive to
the health care needs of the
community and country;
NEED-based innovations)
(other goals ?????)
Learning objectives / Traditional / conventional Over and above the
terminal competencies learning objectives / traditional / conventional
terminal competencies learning objectives /
terminal competencies
(others ?????)
Content Traditional / conventional Over and above the
content traditional / conventional
content
(others ?????)
Teaching-learning strategy Lectures Other than lectures
(others ?????) (others ?????)
Evaluation method Written exams Written exams
(others ?????) Oral exams
Practical exams
(others ?????)
Concept of traditional vs Traditional course study = Innovative course study =
innovative course study Traditional learning innovations in traditional
objectives, content, learning objectives; content,
teaching-learning strategy, teaching-learning strategy,
and evaluation method and evaluation method (all
or just one or two
(Traditional time when components, particularly
conventional course study teaching-learning strategy
started or conventional at and evaluation
present?????) method ?????)

Innovative Residency Training Program

Traditional / conventional Innovations


(goals = better graduates /
more effective / efficient
processes)
(goals = more responsive to
the health care needs of the
community and country;
NEED-based innovations)
(other goals ?????)
Learning objectives / Competent specialist Competent specialist
terminal competencies physician physician
(others ?????) Physician-teacher
Physician-researcher
Physician-administrator
Self-directed specialist
physician-learner
(others ?????)
Content Subjects and content Over and above those
prescribed by the specialty prescribed by the specialty
board board
(others ?????) (others ?????)
Teaching-learning strategy Lectures Other than lectures and
Traditional / conventional traditional / conventional
clinical training strategy clinical training strategy
(others ?????) (others ?????)
Evaluation method Written exams Written exams
(others ?????) Oral exams
Practical exams
(others ?????)
Concept of traditional vs Traditional residency Innovative residency
innovative residency training program = training program =
training program Traditional learning innovations in traditional
objectives, content, learning objectives; content,
teaching-learning strategy, teaching-learning strategy,
and evaluation method and evaluation method (all
or just one or two
(Traditional time when components, particularly
conventional course study teaching-learning strategy
started or conventional at and evaluation
present?????) method ?????)

SPICES Model (Harden, 1984)

The SPICES model is a model of curriculum strategy analysis formulated by Harden et al in


1984 which is commonly used in curriculum planning or review, in tackling problems relating to
the curriculum and in providing guidance relating to teaching methods and assessment.

In the SPICES model, six education strategies have been identified relating to the curriculum in a
medical school. Each issue can be represented as a spectrum or continuum: student-
centred/teacher-centred, problem-based/information-gathering, integrated/discipline-based,
community-based/hospital-based, elective/uniform and systematic/apprenticeship-based.

The SPICES model can be used in the analysis of medical curriculum, whether traditional or
innovative or with tendency to be innovative. Traditional curricula tend to be on the left of the
continuum while innovative ones, more on the right, or SPICES.

S Student-centred ------------------------ Teacher-centred

P Problem-based ------------------------- Information-gathering

I Integrated ---------------------------- Discipline-based

C Community-based -------------------- Hospital-based

E Electives ----------------------------- Standard Programme

S Systematic -------------------------- Apprenticeship-based


Trends in Medical Education

Education for Capability


Community Orientation in Medical Education (COME)
Self-directed/learner-centred learning
Problem-based Learning (PBL) and Task-based Learning (TBL)
Integration and Early Clinical Contact
Continuing Professional Development (CPD)
Unity between Education and Practice
Evidence-based medical education
Communication and information technology (C&IT)

Azim MA, Urban D, Sayeeda R: Trends in medical education: Challenges and directions
for need-based reforms of medical training in South-East Asia. Ind J Med Sci 2004. 58
(9): 369-380

Standardized Patients
Collaborative Learning
Interactive Learning
Integrated Learning
Individualized Instructions
Distance Education
Computer-aided instructions
E-mail based
Web-based
Videoconferencing
Others

Innovations in Teaching-learning Strategy

Teaching-learning strategy is a program of teaching-learning methods, activities, and tools.

When do we say a teaching-learning strategy is innovative?

When do we say that a teaching-learning strategy is traditional? (Note: to speak of innovations


in teaching-learning strategy, we must know what is a traditional or conventional teaching-
learning strategy and to say that there is innovation, we must show that there is a modification of
the traditional or conventional teaching-learning strategy.)

Innovations in Teaching-learning Strategy

Traditional / conventional Innovations


(goals = more effective /
efficient teaching-learning
strategy, methods, and
processes)
(goals = improved
graduates)
Teaching-learning strategy Lectures Other than lectures
(other traditional Active learning strategy
strategy?????) Individualized learning
Problem-based learning
Task-based learning
Collaborative cooperative
learning
Integrative learning
Evidence-based medicine
Facilitating tools such as IT
(e-learning), standardized
patients, etc.
Environmental setting such
as community-based
learning, clinical learning,
etc.
(Others ?????)
Concept of traditional vs Traditional = utilizing Innovative = innovations in
innovative teaching- traditional teaching-learning traditional teaching-learning
learning strategy strategy, method, and strategy
process

Innovations in Evaluation Method

Evaluation method is a program of assessing and evaluating degree of achievement of learning


objectives by the learners.

When do we say an evaluation method is innovative?

When do we say that an evaluation method is traditional? (Note: to speak of innovations in


evaluation methods, we must know what is a traditional or conventional evaluation method and
to say that there is innovation, we must show that there is a modification of the traditional or
conventional evaluation method.)

Innovations in Evaluation Method

Traditional / conventional Innovations


(goals = more effective /
efficient processes)
(goals = more valid, more
reliable, more efficient
assessment methods)
Evaluation Method Written exams Other than traditional
Oral exams evaluation methods
(Other traditional Practical exams
method ?????) OSCE
Standardized patients
(others ?????)
Concept of traditional vs Traditional = utilizing Innovative = innovations in
innovative evaluation traditional evaluation traditional evaluation
method method method

Appreciation by stakeholders (educators and students)

Innovations in medical education to be of value must be appreciated by stakeholders (educators


and students).

They must be attractive to stakeholders.

Clear description of innovation


Most likely to be effective (in the context of the pedagogical principles)
Relevant, practical, realistic, and efficient (in the context of the learners and resources in
the community)

Recognition and Incentives for Innovations in Medical Education

There is a trend and appreciation for innovations in medical education.

Global

Conventions on Innovations in Medical Education (annually)


USA
Europe
Australia
Etc.

Awards contests (annually)

Karolinska Institutet Prize for Research in Medical Education (50,000 Euro - prize)

Grants

FAIMER(Foundation for Advancement of International Medical Education and Research)

FAIMER Institute
Education Innovation Project

A major goal of the program is the completion of an education innovation project, proposed by
Fellows in their initial application to the Institute, and then implemented at their home institution
during the interval period.
Project proposals typically involve one or more of the following areas: problem-based learning,
student assessment, information technology, community-based health professions education,
program evaluation, faculty development, medical student certification, comprehensive
curriculum revision and integration, and distance learning.

Faculty from UPCM given grants (2007 to 2008):

Dr. Leilani Nicodemus (2007)


2-track family medicine residency training program integrated curriculum
Dr. Coralie D. Dimacali (2008)

2007 Fellows and Education Innovation Projects


FAIMER
Titles Fellows
2-track family medicine residency training Leilanie Nicodemus, MD, University of the
program integrated curriculum Philippines College of Medicine, PHILIPPINES
The curricular reform at Javeriana University Mary Bermudez, MD, MSc, Pontificia
School of Medicine Program Universidad Javeriana, COLOMBIA
The curricular reform at Javeriana University Ivan Solarte, MD, Pontificia Universidad
School of Medicine Program Javeriana, COLOMBIA
A program to impart communication skills at Jugesh Chhatwal, MBBS, MD, Christian Medical
undergraduate level (interns) College, Ludhiana, INDIA
An urgent need to integrate professionalism with Venkatesh Doreswamy, MBBS, MD (Physiology),
medical education M.S. Ramaiah Medical College, INDIA

Improving patients' medical education Amam Mbakwem, MBBS, FWACP, University of


Lagos, NIGERIA
Synchronizing teaching of pre-clinical subjects in Yinusa Raji, PhD, MSc, BSc, University of
problem-based learning Ibadan, NIGERIA
Training undergraduate medical students to Si Mui (Debra) Sim, BSc, PhD, Universiti
develop good prescribing skills Malaya, MALAYSIA
Improving health supervision in pediatrics Astrid Valenzuela, MD, Universidad del
Desarrollo, CHILE
Diploma in HPE at the Egyptian national level Wagdy Youssef, MD, PhD, Suez Canal University,
through e-learning EGYPT

Improving the reliability of examiners with the Gboyega Ogunbanjo, MBBS, MFamMed, FCFP
OSCE at undergrad level (SA), FACTM, FACRRM, University of
Limpopo, SOUTH AFRICA
Performance-based assessment in undergraduate Yucel Gursel, MD, Dokuz Eylul Universitesi,
medical education TURKEY
Public health impact of medical school and Bishnu Hari Paudel, MD, DGO, FCCP, PhD, B.P.
community posting effect on intern Koirala Institute of Health Sciences, NEPAL
Faculty development in standardized clinical Payal Bansal, MBBS, MS (Surgery), PG Dip
skills assessment (Health Education), Bharati Vidyapeeth Medical
College, INDIA

Local
Faculty Recognition and Awards

Faculty Awards for Innovations in Medical Education UPCM 2001 (under the
deanship of Dr. Ramon Arcadio) lasted up to 2002

Hope this incentive and recognition program on innovation in medical education will be
revived.

Faculty Promotion

Promotion data sheet of UPCM - 2008

Teaching portfolio (Academic programs and coursed developed. Teaching materials produced, eg,
textbook, course modules, laboratory manuals, syllabi, teaching innovations)
Author(s) and title Year
prepared

List of inventions, patents, copyrights, software, and other intellectual property rights (IPR)
Invention, patent, copyright, or other IPR [with very brief Year awarded
description]

Strategies in Facilitating Development of Innovations in Medical Education

Know the present trends in medical education.

Adopt one or two innovations and then develop an original innovation.

However, after knowing the trends, one may develop an original innovation without passing through a
phase of adoption of a publicized innovation (if he /she can).

References

Internet

Google search
Innovation definition
Trend definition
Innovations in medical education
Merriam-Webster Online Dictionary
Wikipedia

Karolinska Institutet

http://ki.se/ki/jsp/polopoly.jsp?d=130&a=16841&l=en&newsdep=130

FAIMER

http://www.faimer.org/education/institute/project.html

UPCM Records

Faculty Awards on Innovations of Medical Education (2001)


Faculty Promotion Data Sheet (2008)

E-learning

Dr. Alvin Marcelo


Dr. Nemuel Futagana

Moodle
http://www.moodle .org

Nicenet
http://www.nicenet.org

Azim MA, Urban D, Sayeeda R: Trends in medical education: Challenges and directions for
need-based reforms of medical training in South-East Asia. Ind J Med Sci 2004. 58 (9): 369-380

Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: the SPICES model.
Med Educ 1984 Jul;18(4):284-97.

Medical education, with its intensive pattern of basic science lectures followed by an equally exhausting clinical
teaching programme, was rapidly becoming an ineffective and inhumane way to prepare students, given the
explosion in medical information and new technology,and the rapidly changing demands of future practice.
(Boud and Feletti, 1997)

LEARNING BEYOND JUST COURSE CONTENT AND KNOWLEDGE ACQUISITION