August 2016
Electives
A New Approach to Medical Curriculum Ana Rita Gonçalves da Costa Ramalho
ANEM/PorMSIC - Portugal
arita.gcr@gmail.com
Not so many years from now, every graduate in medicine was supposed to have been exposed exactly to the same information as their colleagues. We were dealing with an outcome-based system which, because of the inherent difficulty of determining what should be the competencies of a physician, precipitated the need to define them. That’s when emerged The CanMEDS Initiative, which was successful in defining a list of essential ingredients for outcomes-based medical education1. This was in 2007, and in 2014 we could read a whole issue of AMEE reporting the role of electives in undergraduate medical education2. Due to the constraints of the increasing knowledge in health sciences, the diversity of interests of medical students, and the limited amount of educational time, we have seen an increasing investment of medical schools in elective courses. I bring the example of the Faculty of Medicine – University of Porto (FMUP), which has allocated 10% of ECTS in electives regarding clinical, biomedical, human and epidemiological sciences, in an innovative approach to medical curricula. But what are electives? What makes them so unique? Are they so different from the classic, nuclear classes? Absolutely! They are so distinctive that there isn’t even a standard definition of an “elective”. They are a part of the non-traditional curriculum, allowing medical students to simultaneously maximize and individualize their competences, to broaden aptitudes in a tailor-made curriculum according to personalized interests. The number of systematic reviews concerning the impact of electives in undergraduate medical students has been growing, reflecting the importance given to this new kind of non-formal curriculum. Those reports tell us that electives increase students’ self-reported confidence in their clinical skills (some even evaluated pre- and post-assessments to demonstrate improved skill level3), www.ifmsa.org
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they influence career choices by rising student interest in specific specialties, and they promote their wellness4. So, whether you are a passionate for global health and you are willing to understand different healthcare systems and to learn how to manage uncommon diseases, or your future career is still unclear and you prefer spending your time exploring different specialties, the electives are the answer that you were looking for. Our schools can facilitate the process, but the choice is up to us! We now have the ability (the capability was already in our hands) to decide what kind of doctors we want to be. This is no more a one-school decision; this is our decision. References 1. JR Frank, D Danoff. “The CanMEDS initiative: implementing an outcomes-based framework of physician competencies”. Medical Teacher, 2007. 2. Andrew Lumb, Deborah Murdoch-Eaton. “Electives in undergraduate medical education: AMEE Guide No. 88”. Medical Teacher. 2014. 3.
Morley SK, Hendrix IC. “Information Survival Skills: a medical school elective.” J Med Libr Assoc. 2012; 100: 297-302.
4.
Agarwal A, Wong S et al. “Elective courses for medical students during the preclinical curriculum: a systematic review and evaluation”. Med Educ Online 2016, 20: 26615.