Overcoming the Disconnect between Desired Outcomes and Educational Design MODIFYING THE CURRICULUM TO ADDRESS MAJOR HEALTH PROBLEMS John Horton, M.B., Ch.B. Professor of Oncology and Medicine USF College of Medicine and Moffitt Cancer Center

A case in point: Designing medical education about CANCER

Modifying the Curriculum to Address Major Health Problems Focus on Cancers Chief cancer killers (USA): lung*, breast*, colorectal Well-controlled cancer (USA): cervix uteri* *for discussion

Interventions known to minimize mortality and morbidity Example 1: lung cancer* smoking prevention smoking cessation cessation maintenance * and cardiovascular and pulmonary diseases

Interventions (continued) Example 2: Breast cancer screening and early diagnosis -clinical examination -mammography Example 3: Cervix cancer screening with cervical cytology

Example I: Lung Cancer: Population Needs Smoking prevention (eg. schools) Smoking cessation Cessation maintenance Achieved by: Public health policies Physician interventions

Status of Physician Education regarding smoking cessation: ~1980’s: a. Comfortable with advising smokers to quit – 4% b. Medical schools with curriculum content on smoking cessation – 13%

Curriculum content/experiences required to develop competency in smoking prevention/cessation a.Epi, biology, pathology, clinical manifestations of smoking-related diseases b.Addiction science c.Pharmacology (eg. Nicotine, SSRI’s) d.Behavior modification science e.Experience in smoking cessation clinics f.Systems for recognition/implementation (eg. 40% of breast cancer pts. are smokers!)

Continuous Curriculum Review Process Assessment of Current USF Curriculum: Satisfactory: # a  d. Inadequate: # e – cessation clinics # f - systems for recognition/ implementation

Response by USF Curriculum # a  dContinue # eElective in development # f Plans still pending

Example 2: Breast Cancer: Population Needs Population screening and early diagnosis* Treatment Follow-up/symptom control * for discussion

Competencies needed by general physicians to address breast cancer mortality and morbidity a. Understand the biology and clinical manifestations of breast cancer b. Perform risk-assessment history and adequate breast examination c. Follow guidelines for mammography d. Participation in a systems-approach to ensure compliance to screening guidelines e. Refer patients for diagnosis and treatment

Continuous Curriculum Review Assessment of current USF curriculum # a.OK # b. Improvements being instituted # c. OK # d.no formal activity

Example 3: Carcinoma of Cervix Uteri 1. Key for control is population screening with cervical cytology 2. Invasive cervical cancer is now a rare disease in screened populations in the USA and Europe 3. Exceptions when poor compliance or lack of insurance

Carcinoma of the Cervix in Poland death rates decreasing death rates increased* * change in public policy. Gynecologists read pap smears themselves Note: exception in 1 county where central cytology review was maintained

Conclusions: 1.Define key health problems and choose which to address. 2.Define ideal physician behavior/activity to address the problem 3.Evaluate the current curriculum to determine if it provides the needed competencies for the medical graduates. 4.If not, identify the deficiencies and implement modifications in the curriculum.