{'fraction_non_alphanumeric': 0.019761904761904762, 'fraction_numerical': 0.002857142857142857, 'mean_word_length': 4.8185595567867034, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A history of curriculum reform: the Sherbrooke story

Those of us who have done it recognise just how difficult a task changing a school-wide curriculum can be. Jacques Des Marchais and his colleagues at Sherbrooke in Quebec, Canada, were amongst the very first to attempt and succeed at this in recent years. Between 1985 and 1991, Des Marchais and his fellow staff introduced extensive undergraduate curriculum reform within a traditional medical school using the twin pillars of problem-based learning (PBL) and community orientation as their framework. They have now published a book describing their experiences and setting out not just the steps they took along the way, but also the detail of the changes they made. The book is comprised of four sections. The reform initiative focuses on planning for change and describes a four-stage process: perceiving the need for change; seeking out and selecting a solution; planning for implementation of the solution; and adopting the solution. In explaining the content of the reform, the text describes the major elements of the new programme including PBL, assessment, integration of medical humanities and reform of clinical clerkships. It goes on to outline the conditions for the reform, describing the crucial roles played by programmes of staff development and tutor training. It then proceeds to evaluate the reform, describing the evaluation system and giving a student perspective on the new programme as well as considering the continuing problems faced by the programme within its own local health care and political setting. Wherever possible, the book strives to be evidence-based. It includes some very useful examples of materials used in planning the syllabus and the cases used in PBL, descriptions of studies conducted to evaluate the effectiveness of the assessment strategy and an outline of the evaluation strategy adopted by the school. Success in a large-scale project such as the one described in this book does not result from the efforts of just one person. Des Marchais is generous in his recognition of the huge contributions made by many of his colleagues, both in laying the groundwork for reform and throughout the project. However, strong, entrepreneurial leadership is essential and it is clear from the book that the Sherbrooke team were fortunate indeed in being led by a charismatic individual with excellent clinical credentials, training and experience in education and, above all, the determination to succeed. The book sets out to be informative and analytical and the result is an excellent record of a process of curriculum reform based not just on a skilful management strategy, but on a scholarly and reflective approach. Because we live in a time of much reform in medical education, it may be difficult for readers to recognise the extent of the achievement described in the book. Henk Schmidt best describes the significance of the Sherbrooke reform in his Preface to the English edition of the book: I was sceptical. I had seen many attempts at innovation of this kind fail. In fact, I did not, at that time, know of a single success in turning around an existing medical school . Since Sherbrooke there have been other successes at traditional schools in North America, in parts of Europe including England and Scotland, and in Australia. But sustainable change on a large scale has yet to be achieved in any country, although the results of national initiatives launched in the 1990s in both the USA and the UK have yet to be realised. On the upside, we have learned a lot about overcoming barriers to change from these experiences and from those described at Harvard, Johns Hopkins and Newcastle, New South Wales. But on the downside (or, as I prefer to say, the challenging side), as the new century starts, further, and possibly more dramatic, changes to medical education loom large as health services reconfigure in response to political and social demands. If you are the sort of person who sees this as a challenge, then read the Sherbrooke story; there’s a lot to learn and think about. If you aren’t that type, read it anyway, because you never know: someday in a medical school near you...