Generation 4

The Medical Curriculum at SGUL

SGUL has continued to look for ways of improving links between the process of student learning and the needs of the practitioner. This effort to mirror medical and healthcare practice is best illustrated by reviewing stages in the evolution of our teaching methods. Our teaching and learning activities have increasingly adopted the approaches of practitioners in medicine and healthcare in a way that builds on generations of pedagogical paradigms. These paradigms we described as G1-4:

G1 - ‘traditional’ teaching in medicine, which would normally begin with modules in single discipline bioscience which in themselves had little relationship to ultimate learner needs (1980s).

G2 - the teaching moved to a body systems approach, e.g. respiratory system, which had greater relevance to clinical specialties e.g. chest physicians (1990s).This was a useful advance, but students still did not practise the competencies of practitioners, in solving even moderately complex problems.

G3 - began with the process of learning through scenarios based on practice which tied in sound knowledge and skills to the needs of the eventual practitioner. A common variant of this style in medicine is Problem-Based Learning (PBL) which ties in learning, developing decision-making, and problem solving skills. Students work through the patient case page by page with a facilitator, discussing the case, exploring possible diagnoses, investigations and treatments identifying learning objectives, and possible solutions as they go.

G4 – This is the next generation, proposed and described below

Limitations of G3

Although PBL has proved effective and popular, particularly for the first year of our course, there are constraints in its paper-based nature. The paper cases used in tutorials can only proceed in a single direction. In this regard, cases in G3 are linear. Learners can only follow one path. Such cases may have limited use in developing clinical reasoning, and are unrealistic for emulating real life, where there are frequently several ways to tackle a problem and mistakes made may not be immediately obvious. This approach may be less engaging for senior students than more complex, multi choice scenarios. Moreover learning is mainly y done away from context of the case ,when students explore the learning objectives they have gathers

G4: THE NEXT GENERATION Hence SGUL’s proposal to move to G4 - integrated, adaptive and authentic case-based learning. The aim of the G4 model is for medical students to engage in collaborative learning activities that more directly mimic the competencies of experienced medical practitioners. The proposed project integrates learning resources and technologies around a core interactive case based technology - the virtual patient (VP) - and will seamlessly blend online and face-to-face learning.

In 2000 St George’s Faculty of Medicine expanded its existing undergraduate medical education provision by providing a novel fast-track problem-based (PBL) MBBS curriculum for medicine taught over four years. Uniquely, this programme was open to graduates from any discipline including arts, humanities, law etc. In 2007 St George’s merged its undergraduate medical courses into a single course, with separate entry pathways for graduates, school-leavers, and non-traditional learners from under-represented sectors. The key phase where all these learners come together is a transitional year, known as the T year, which alternates PBL blocks with clinical attachments. Thereafter, all students are integrated for senior and final clinical attachments.