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Student involvement in the development of integrated curricula

Context and setting In the UK there is no national undergraduate curriculum. Each medical school sets its own curriculum, which must comply with guidance set by the General Medical Council and published in Tomorrow’s Doctors. Medical schools vary in their approaches to defining curricular content. Traditionally, this was determined through a process of negotiation by teaching leads within and between specialties, according to historical power dynamics. Why the idea was necessary Imperial College was formed in 1997 as the result of the merging of three London medical schools. Many of the existing undergraduate subject curricula arose from an unstructured amalgamation of learning objectives. Moreover, students reported differences in educational experience according to the hospital site of their clinical attachments. Teaching leads agreed that there was a need for each specialty to develop a curriculum with clear, structured core objectives. A process for achieving this was initially developed for obstetrics and gynaecology (O&G). What was done Informed by guidance in Tomorrow’s Doctors and by the curriculum for postgraduate O&G training produced by the Royal College of Obstetricians and Gynaecologists (RCOG), we created a list of learning objectives, structured within modules. A panel of local experts was convened. This included O&G doctors, general practitioners, and accident and emergency doctors, all of whom were active in undergraduate education (n = 16). The expert panel did not meet face-to-face, but were surveyed using a modified Delphi technique by one of the study authors (NL-B). Panel members were asked to classify objectives as essential, important or expert. The threshold for consensus was set at 75%. NL-B then facilitated three focus groups of newly qualified doctors (n = 16) in order to explore issues relating to modules lacking consensus. At a meeting of the O&G Curriculum Committee, we presented the anonymised results of the Delphi survey. Those learning objectives classified as important or essential were included as core learning objectives. For areas lacking consensus, the relevant focus group themes were discussed as a means of deciding how to define, and whether to include, particular learning objectives. The final document was accepted by all Curriculum Committee members. Evaluation of results and impact The final curriculum document included 130 core learning objectives, 91 of which were classified as essential. Our results were triangulated with the RCOG national undergraduate O&G curriculum, which was published after our study had been completed. Although it differed in format and presentation, the Imperial College document was similar in content to the RCOG curriculum, emphasising both core generic and subject-specific competencies. Engaging a broad spectrum of local opinion in the development of a specialty undergraduate curriculum produced a document whose content was similar to national specialty guidelines, but whose genesis was inclusive. Local ownership of the process facilitated its implementation. In the absence of a cross-specialty national undergraduate curriculum, a modified Delphi technique supplemented by focus groups of newly qualified doctors appears to be a legitimate tool for developing undergraduate specialty curricula.