The following abstracts have been accepted for presentation at this meeting in Poster format in the category of Curriculum.  Those selected for Oral Poster Presentations are so designated in the far right column.
 
 

A12	CHALLENGES OF CURRICULUM CHANGE IN MEDICAL INSTITUTIONS OF PAKISTAN Prof. D.S.Akram, MBBS, MD(USA), MPH (USA)*, Head of the Department of Paediatrics, Unit-I, National Coordinator, C.O.M.E., Dow Medical College, Karachi, Pakistan Pakistan is a signatory to the Edinburgh Declaration of 1988. As such the Government has been committed to improving medical education in the country. Since 1996 a change in medical education was initiated, based on a Community Oriented Medical Education (C.O.M.E.) approach. This was initiated by the Government of Pakistan. Four colleges, one in each Province of the country were targeted. A curriculum has been made and teachers trained in the methodology. The challenges faced in this respect were not only a change in teaching methodology but a change in the implementation of a student oriented, interactive, integrated curriculum in over populated Government administered colleges. Pakistan is a developing fund depleted country. But medical education in Government Institutions is virtually free of cost. Due to repeated political pressure, the colleges have up to 450 students per class. How did we manage to plan the implementation of the C.O.M.E. Methodology in classes with large number of students? Such challenges are not only administrative but question the very essence of interactive teaching. Using a limited number of faculty, with a high student to teacher ratio, innovative techniques have been used. Community based education is also a challenge with limited resources and large number of students. How has it been planned?  Solutions to demands of high student, teacher ratio and limited resources may be useful for other Institutions faced with a similar situation. These are presented with examples illustrating implementation methods to accommodate our unique situation.
A13	STEP 1 USMLE SCORES IN A PBL CURRICULUM: ELEVEN YEARS EXPERIENCE W. Baldwin*, P. Bankston, R. Haak, P. Smith, W.M. Anderson, S. Echtenkamp, and P.G. Iatridis, Indiana University School of Medicine, Northwest Center, Gary, IN  46408  U.S.A. Purpose:  To compare scores of students in a modified Problem Based Learning (PBL) curriculum (n=175) to national means on Step 1 of USMLE for the years 1991 to 2000.  Method:  Student performance on Step 1 of USMLE for the years 1991 to 2000 were compared to national means by paired t test. Also performance in the years 1994-1999 were compared to national means by paired t test after adjusting for entering Grade Point Average and Medical College Admission Test scores. Results:  Total scores on Step 1 for the years 91-00 showed that PBL students from the NW Center for Medical Education (one of the regional centers of Indiana University School of Medicine) scored significantly higher than the national mean with a p value equal to 0.0008. This was also true on five of the eight discipline scores for the years 1991-1998. The p values for Biochemistry = 0.00, Gross Anatomy = 0.01, Histology = 0.03, Microbiology = 0.02 and Pathology = 0.00. The p value in Physiology was 0.06. Two discipline scores, Behavioral Science (p = 0.18) and Pharmacology (p = 0.24) were higher then national means, but not at the 0.05 level of significance. Discipline scores were not reported after 1998. When the results for the years 1994-1999 were normalized by correcting for variations in student performance on MCAT and GPA, NW Center student's total scores were significantly higher then the national mean with p = 0.0002.  Conclusions:  Medical students exposed to the PBL as practiced at the NW Center score significantly higher than the national mean on Step 1 of USMLE.
A14	TEACHING CRITICAL CRITIQUE, COMMUNICATION, AND CONFLICT RESOLUTION SKILLS IN A PROBLEM-BASED LEARNING COURSE USING THE MYERS-BRIGGS TYPE INDICATOR  Robert L. Bill, DVM, MS, PhD*; S. Kathleen Salisbury, DVM, MS; Larry G. Adams, DVM, PhD, Department of Veterinary Clinical Sciences, Purdue University School of Veterinary Medicine, West Lafayette, IN  47907-1248 U.S.A. Background:  Purdue University’s School of Veterinary Medicine uses a small group tutorial format for the problem-based learning courses (Applications & Integrations I, II, III, IV) in the first 2 years of the veterinary curriculum. In the Applications & Integrations courses, students are dependent upon each other to reach the academic goals, and are required to honestly critique their peers’ performances in helping the group attain those goals. It is widely observed, although largely anecdotally reported, that small groups go through a period of relative tranquility and cooperation during the first few weeks of working together. However, the need for group members to contribute equally, and the different ways group members go about doing that, inevitably leads to a period of increasing friction and tension within the group. This conflict development provides a perfect teaching/learning opportunity for students to understand how interpersonal conflicts can arise on a professional team and how they can be resolved in a constructive manner.  The Process:  Prior to the beginning of the school year, the 1st year students are sent a survey and required to answer questions regarding their professional goals, their familiarity with different domestic animal species, and several questions from the Myers-Briggs Type Indicator (MBTI). The small groups for the Applications & Integrations I course are formed based upon even distribution students according to their E (Extrovert) and I (Introvert) rating on the MBTI, and on their large animal and small animal background. The other three axes of the MBTI (iNtuitive/Sensing, Thinking/Feeling, Judging/Perceiving) are recorded on each student but not used in the group selection process. In the past, the inadvertent clustering of "quiet" students into one group has resulted in a group that was slow to participate in the problem-based process, and was difficult for the faculty facilitators to engage the members in open discussion. Using a balance of E and I personalities in the group has significantly helped to prevent this. Approximately 4 weeks into the semester, the point at which we typically begin to notice conflict within the groups, we have a 2-hour session on how conflict can arise based upon difference in traits identified by the MBTI. The students receive their MBTI results, and this is followed by a general discussion of what the different MBTI axes indicate. Next, scenarios are described that illustrate conflicts related to specific MBTI types. This is followed by an open discussion session in which students relate personal experiences with similar conflicts in, and out of, their groups. Focus is on recognition of conflict patterns, defusing conflict, and accepting other people’s ways of achieving similar goals. It is common for students to do further reading on MBTI applications and to talk to each other in group using MBTI references (e.g. "Janet is an ‘I’ so let’s make sure we ‘E’s’ aren’t shutting her out of discussions"). This exercise provides our students with important tools for understanding and resolving conflict they will encounter in their future.
A15	HERBAL MEDICATIONS IN SELECTED NEUROLOGICAL CONDITIONS: A SELF-STUDY MODULE Gloria A. Casale, M.D*. and Harold Traurig, Ph.D.** *Health Resources & Services Administration, Rockville, MD. 20857; **Anatomy & Neurobiology, University of Kentucky College of Medicine, Lexington, KY  40536 U.S.A. Herbal medications have been used to treat neurological symptoms since ancient times. Since many patients self-medicate with herbal substances, student physicians must be aware of the efficacy and safety of phytochemicals. We have developed a self-study module that presents available basic and clinical evidence about the efficacy, mechanisms of action and contraindications of the active ingredients in St. John's Wort (SJW), Feverfew (FF), Ginkgo biloba (GB) and Valerian (VAL). These herbal substances are commonly selected as self-medications by patients for neurological complaints.  The self-study module presents available evidence that hyperforin and hypericin in SJW alleviate mild to moderate depression, the parthenolide in FF relieves migraine headache, quercetin, a glycoside in GB, increases cerebral blood flow and cerebral function, and that valeric acid, valepotriates and sequiterpenes in VAL exert sedative effects by influencing gamma aminobutyric acid functions. Also emphasized is the available evidence urging caution in prescribing or self-medicating with herbal substances because of important side effects and significant interactions with other medications. For example, certain herbal substances can exert significant effects on iron absorption (SJW), digoxin therapy (SJW), cerebral hemodynamic (GB) and hemostatic (GB, FF) functions. The self-study module emphasizes that a complete medication history must include querying patients about herbal self-medication behaviors.
A16	A COMBINED CLINICAL AND ANATOMICAL PATHOLOGY CURRICULUM FOR A COMMUNITY MEDICAL SCHOOL  G.E.Corrigan MS, MD, PhD*, University Medical Center, Louisiana State University, Lafayette, LA  70506 U.S.A. Anticipating the development of community medical schools, a curriculum for a pathology program within a four year orthodox medical school curriculum is designed. The role of pathology as the bridge between basic and clinical sciences is maintained by positioning it at the basic science - clinical science interface and by emphasizing procedural pathology i.e the pathology of fine needle aspirates and biopsies. The fact that pathology is the cheapest and most direct method of exposing students to the academic details of disease provides the stimulus for maintaining a substantial portion of the second year for the teaching of pathology. The use of the microscope, teaching slide sets, mounted specimens, photographic slides is maintained and supplemented by pathology informatics. Laboratory exercises based on diagnostic and therapeutic procedures teach the utility and relevance of pathology. The student interface is through lectures, small groups, and laboratory sessions. Clinical pathology relies heavily on point-of-care testing and mastery of physicians office laboratory procedures. The use of the internet is unrestricted but secondary, while pathology informatics and coding is integrated into systemic sectors. The testing is cumulative, limited, and utilizes all modalities with multiple choice formating of the midterm test. The faculty is limited and tenured professor biased; intensive contact is programmed. The choice of assistants and textbooks is left to the professor; the depth of familiarity is at the level of Robbins's and Ravel's texts. A weekly CPC autopsy conference is integral to the curriculum; concepts in critical thinking and decision analysis are promoted; holistic organismic autopsy-based diagnosis is emphasized. Depth of detail and economy are goals.
A17	FACULTY COLLABORATION AND CONTENT INTEGRATION IN A CLINICAL PRESENTATION CURRICULUM Peter Dane, D.O.*, Dennis Baker, Ph.D., John Howell, Ph.D., Michael Adelman, D.O. and Steve Clay, D.O. Ohio University  College of Osteopathic Medicine, Athens, OH  45701 U.S.A. In the fall of 1999, after three years of planning, OUCOM implemented a new curriculum called the Clinical Presentation Continuum (CPC). Development of this new curriculum was influenced by our previous five years experience with a PBL curriculum, in which twenty percent of the students enroll yearly. The PBL curriculum utilizes small group learning and is student directed. The new CPC curriculum (taken by 80% of students) also uses small group learning but is more faculty directed. Instead of several traditional discipline-based courses, the CPC is composed of only two courses (Medical Knowledge and Clinical Skills) which are structured around a series of clinical presentations – eg. cough, chest pain, headache, etc. Multidisciplinary teams, comprised of faculty from the basic sciences, social sciences and clinical departments, plan and develop the content of each block. Curricular content is defined by learning objectives linked to analytical schemas that serve as cognitive maps to enhance understanding. Lectures function to orient students to complex new content or to help them with conceptually difficult material and are limited in number. Students also have two small group learning sessions per week plus early clinical experiences with community physicians. In the small group learning sessions, students discuss cases that provide a memorable context for the integration of basic science, social science and clinical science principles. Once per week, each class engages in a two-hour synthesis and integration session (S & I) in which students are led in a case discussion that illustrates and brings together content addressed throughout the week.
A18	A COURSE FOR PROFESSIONAL DEVELOPMENT OF PHYSIOTHERAPY STUDENTS Carina A Eksteen,*  Marie Tshibangu, Christopher Govender.  University of Pretoria, Pretoria,  South Africa. Practicing physiotherapy in a rapid changing social and health care environment, requires not only developing one’s own professional skills, but also developing Physiotherapy as a profession. Professional development cannot only take place because students learn to act as professionals during clinical experiences and interaction with tutors, peers, clinical supervisors, and practicing physiotherapists. Professional development of students should be based on basic academic subjects, like clinical reasoning is based on the basic medical and physical sciences. Professional development is characterized by self-assessment, reflection and self-judgement, understanding and accepting the lifestyle of others different from your own, pursuing certain norms in life, acting independently but with corresponding responsibility, competency as problem solver, and forming interpersonal collaborations with other professionals or lay people. Research question:  Which basic subjects from the social sciences will enhance the professional development of physiotherapy students? Action  research methodology:  Discussion groups with key informants from the academic, private and public clinical sectors, S A Physiotherapy Society and Department of Health.  Aims of discussion groups:  To identify the competencies and skills which will enable a physiotherapist to meet the challenges of clinical practice in a changing society and health care environment; to construct a curriculum for a course in professional development and leadership.  Results:  Knowledge and skills in four different aspects of professional development were identified: personal skills, managerial skills, interpersonal skills, knowledge and skills for managing a private practice. Themes under each heading were listed.  The course was constructed and implemented over a period of four years. Evaluation of the course at the end of the four years was done by a representative group of key informants (mostly different from the first group of key informants). Conclusion:  The course was regarded as successful, relevant, and fulfilling its purpose. Suggestions for improvement were suggested and implemented. The course was re-evaluated after two years again, and suggestions for change were made. Future action will entail the ongoing change to equip students with the latest knowledge and skills which will enable them to be successful professionals  in a changing society and health care environment. More detail on the content of the subjects will be displayed on the poster.
A19	INTEGRATION OF BASIC SUBJECTS IN THE PHYSIOTHERAPY CURRICULUM Carina A Eksteen*, Department of Physiotherapy, University of Pretoria, Pretoria,  South Africa  Practicing Physiotherapy as profession in a changing  social and health care environment, demands that professionals be grounded in a combination of basic social as well as basic medical sciences.  The primary challenge is to integrate the external factors  such as epidemiology of disease and disability, etc, which help to define the outline of the curriculum together with the  body of knowledge of Physiotherapy. The further challenge is to develop a detailed integrated holistic curriculum in which the basic subjects will form the basis for  the development of  a professional physiotherapist.  With a wide variety of basic subjects, the teaching approach must facilitate students to integrate the knowledge from the various academic subjects into  holistic a  professional body of knowledge and not to experience it as compartmentalized   knowledge and skills that they need to acquire in the various subjects.  In order to achieve this, the following principles were adopted in the physiotherapy curriculum of the University of Pretoria. The core of the integration of the basic subjects lies in the way that the problems in a PBL physiotherapy curriculum are formulated  Subjects in the basic medical sciences, as well as the social sciences are organized in such a  sequence that learners first have to acquire the cognitive, psychomotor and communication skills required to solve a simplistic physiotherapy problem in clinical context and/or context of a realistic professional situation. The formulated problems in physiotherapy, must enhance the learning of other basic subjects  to justify its relevance to development of a professional physiotherapist. Therefore to facilitate holistic learning enhance the obtaining and integration of cross-field information to solve the problems.  This requires that learners need to implement an inductive approach to learning at the beginning of the course to solve a problem in Physiotherapy.  Problems must be formulated in such a way that the solution of the problem must be carried through to implementation in practice. As learners progress through the course,  they are more able to use a hypo-thetico deductive reasoning process, integrated with the inductive reasoning process.  It thus seems obvious that the success of  integrating the basic subjects from the social, as well as medical sciences, depends on the problems formulated in physiotherapy, which will enhance not only versatile problem solving, integration of  the knowledge and skills base of the social and medical sciences, but also professional development of the students.
A20	INFLUENCE OF ELECTIVE PBL COURSES ON BOARD PERFORMANCE E. P. Finnerty, Ph.D.*, Department of Physiology/Pharmacology, Des Moines University, Des Moines, IA  50312 U.S.A. To test the influence of elective PBL courses on performance of COMLEX 1 (Osteopathic Licensure examination analogous to USMLE 1) we evaluated the records of students from our classes of 2000-2002. These students had the opportunity to take an elective course in Biochemistry and/or Microbiology in addition to the traditional courses. Significant differences were noted with an ANOVA analysis in the COMLEX performance among the PBL groups (p=0.001) with the Biochemistry only and Biochemistry and Microbiology (Both) groups performing higher than the None (no PBL course) group.     Biochemistry Microbiology Both None Mean +/- SD 527.8+/-69.9* 530.8+/-38.4 539.1+/-72.6* 503.3+/67.3 n 156 12 43 297 To assess if these difference may be attributable to the self-selected students being academically stronger we examined undergraduate GPA and Total MCAT scores. No differences among the PBL course groups in COMLEX 1 scores were noted for GPA, but the Both PBL group had significantly higher Total MCAT scores (p=0.02) than the None group. Using Total MCAT score as a covariate still yielded a significant influence of PBL on COMLEX 1 with ANCOVA. The Both PBL group also demonstrated a significantly higher medical school GPA (p=0.07) compared to the None group (87.5 ? 3.6 vs. 85.7 ? 4.3 respectively). This study suggests that though participation in the elective PBL courses may have contributed to the stronger performance on COMLEX 1, academically stronger students were more likely to take the elective courses and this may explain much of that performance.
A21	CATALYZING CURRICULAR CHANGE Dixie L. Fisher, Ph.D.*, Win May, Ph.D., M.D., University of Southern California, Keck School of Medicine, Los Angeles, CA  90033  U.S.A. In late 1999, the University of Southern California Keck School of  Medicine Curriculum Review Committee (CRC) began a major curriculum  revision effort aimed at integrating the basic and clinical sciences  (primarily through the use of cases), emphasizing problem solving  activities, and increasing the use of self-directed, collaborative, and  electronic learning. The Curriculum Review Coordinating Committee (CRCC),  formed to implement and oversee the changes, included the Associate Dean  for Curriculum, (a clinician) as chair, four basic scientists, three additional clinicians, and 2 medical educators. Faculty system chairs were  selected and they and their committees were given responsibility for  developing the new core and other system curricula consistent with the educational goals of the School of Medicine and the mission of the CRCC.  In the fall of 2000, the CRCC added additional medical education faculty to the committee and assigned one to two medical educators to assist each  system committee with their instructional design. After serving on the  committees for a short time, the medical education faculty realized that  the "new" curriculum looked a lot like the old curriculum-only compressed  into shorter days with a sprinkling of added cases. Medical education  faculty formed an Instructional Plan Support Group (IPSG) to attempt to  influence curriculum change toward that envisioned by the CRCC. The IPSG  believed that a template designed to compel the system committees into connecting their schedule with each session's objectives, content, teaching and assessment methods, and also state how these elements were related to the overall educational goals, would drive the curriculum. The Instructional Plan template and review form that emerged catalyzed the curriculum revision process in a momentous way. Both the CRCC and the system committees suddenly realized that a new schedule "did not a new  curriculum make." With the help of the new tools developed by the Division  of Medical Education, progress toward real reform is underway.
A22	HUMAN FUNCTION: AN INTERDISCIPLINARY COURSE FOR FIRST YEAR MEDICAL STUDENTS  Charles L. Harris*, Robert Goodmana, James M. Shumway and Diana Beattieb, Departments of Physiology and Biochemisty, Robert C. Byrd Health Sciences Center, West Virginia University School of Medicine, Morgantown, WV  26506  U.S.A. In 1997, the WVU School of Medicine began curriculum revision for the first two years of the program leading to the M.D. degree. The approach decided upon was a modular approach: Human Function (Biochemistry, Human Genetics and Physiology), Human Structure (Anatomy and Histology) and Neurobiology. The Human Function Module elected to totally integrate the subject matters, and to design a new course offering. A steering committee, which also included faculty from the departments of Medicine and Pediatrics, brainstormed as a group, establishing the broad outline of the course: Basic Concepts in Cell Biology; Cellular Processes; Reproduction; Homeostasis and Whole Body Integration. This organization allowed us to include basic material and to avoid many redundancies. Teaching faculty designed and disseminated the new course outline to clinical departments for input. They asked "what topics are the most important for the modern practice of medicine and which ones are missing from our current offerings". With this input, faculty groups planned the lecture outline for each section of the course and reported back to the steering committee. The last stages involved alignment of the sections of the course. PBL and two problem solving sessions per week were added to the lectures, and a web page was designed and implemented to accompany the laptop program established for first year medical students at this same time. Human Function is a 16-hour course involving 18 basic science faculty and 16 clinicians (clinical correlations). We have taught this course for three years now, with only minor revisions in years 2 and 3. In terms of outcomes, students performed satisfactorily on our examinations, with averages very close to those seen in the old curriculum. Performance on NBME shelf examinations was at or very close to the national mean in both Biochemistry and Physiology, also similar to results when these courses were separate entities. Entrance data for the three classes were also similar to previous classes (MCAT, G.P.A.) Student satisfaction with the course is quite high, particularly with regard to the integration of disciplines, course organization and PBL/problem solving experiences.
A23	INTEGRATION OF STRUCTURAL INFORMATION WITHIN THE MEDICAL CURRICULUM Jim Johnson* and Craig Henkel Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC  27157-1010  U.S.A. Anatomical concepts were previously taught at Wake Forest University School of Medicine through two concurrent curricula. A sequential series of basic science courses was used to deliver structural concepts within a traditional medical curriculum. At the same time a separate cohort of students acquired the same information through a parallel curriculum featuring problem based learning (PBL). In both curricula, the knowledge of human structure and development acquired in the first two "preclinical" years was applied to the "clinical years" of the curriculum. We report here the ongoing development of strategies for teaching human anatomy within a new hybrid medical curriculum. The evolution of the new curriculum design has yielded an amalgam of features and learning venues derived from both programs. Anatomical concepts are no longer taught as separate academic disciplines but instead integrated together and selectively taught within the context of clinical practice. An initial foundation is provided by a brief overview of the structure and development (microscopic to macroscopic) of all systems and regions of the body. The development of learning modules is an important strategy during this early phase. Students are directed within modules through learning activities that exploit teaching paradigms derived from the traditional gross anatomy, microanatomy and neuroanatomy laboratory venues intermixed with clinical case studies, intranet database archives and independent study. Students later develop a more advanced appreciation of how structure is related to the Pathophysiology of organ systems. Throughout this period the learning of anatomical concepts is applied to clinical problems. This process is competed during core and advanced clinical clerkships that apply advanced anatomical expertise to clinical practice. A major objective of this plan is to provide a pathway to better integrate and apply knowledge of human structure to clinical practice over all 4 years of the curriculum and to augment the student's capacity for lifelong learning. Basic science and clinical instruction are being integrated together by incorporating faculty resources and directed lab experience with independent study throughout all phases of the new hybrid curriculum.
A24	AN ELECTIVE MEDICAL SCHOOL PROBLEM-BASED LEARNING BIOCHEMISTRY COURSE EMPLOYING STUDENTS AS FACILITATORS T.J. Mueller, Ph.D.*, T. Breithaupt, Ph.D. and D. Hills, Ph.D., Department of Biochemistry and Nutrition, College of Osteopathic Medicine and Surgery, Des Moines University Osteopathic Medical Center, Des Moines, IA   50312  U.S.A. For the past seven years the Department of Biochemistry and Nutrition has offered first year medical students an elective Problem-Based Learning (PBL) course that can be taken in conjunction with the regular Medical Biochemistry course. Both courses are offered at the beginning of the first year. Originally, the PBL course was offered as an #8220;honors” course. The presumption was that the course would appeal to the stronger students in the class. Thirty-two students enrolled the first year it was offered, a class size that could readily be accommodated by the department of six faculty members. Since the initial offering of the PBL course, enrollment has increased dramatically and 75-95 students (class size ~200) have been enrolled for the last four years. Interest in this course has been high and has attracted not just the high achievers. This is supported by an analysis of subsequent class rank that indicates broad appeal to students across the class. Fifty-seven percent of enrollees were equally distributed between the top two quartiles. Twenty-five percent were in the third quartile and eighteen percent ranked in the lower quartile of the class. For the past six years, second year osteopathic medical students who took the course during their first year were recruited as group facilitators. These students were selected via an application process. Interest in participating as facilitators has been high. Forty-eight applications for ten positions were received this past year. Student ratings of the facilitators’ performance have been equivalent to those of the faculty facilitators. There appears to be evidence of substantial interest among our medical students in learning methods that involve active learning, small group discussion and problem solving activities. There also appears to be evidence that second year students with experience in the PBL setting can be effective facilitators and can be used to overcome shortages in faculty size.	ORAL
A25	PRACTICE PROFILE PROJECT: A CASE-BASED APPROACH TO CURRICULUM REVISION-CHALLENGES AND BENEFITS Elza Mylona,Ph.D.*, Allan Abbott, M.D., James Dixon, Ph.D., University of Southern California Keck School of Medicine, 1975 Zonal Avenue, KAM 216, Los Angeles, CA  90089-9024  U.S.A. Medical schools are challenged with maintaining a curriculum that appropriately addresses the basic sciences, incorporates the principles of all clinical specialties, and prepares the students with the knowledge, skills and attitudes for medical practice today. The exponential growth in medical education and the increasing emphasis on specialization makes it difficult to maintain a balanced core curriculum. It is a complex task to make changes in the curriculum of a conventional school. A case-based approach to curriculum revision was chosen as a means to balance the breadth and depth of material. The objective of this project entitled the practice Profile Project is twofold: 1) to make the basic sciences more relevant to the medical students' education and to the practice of medicine by relating basic science principles directly to their clinical significance and 2) to ascertain the reaction of the faculty and students. The Practice Profile Project is one component of a substantial revision of the entire USC curriculum. A major emphasis of the revision process is the systematic introduction of clinical cases through out Years I-IV. This process is intended to increase the clinical relevance of the curriculum utilizing a core library of clinical cases. An organ system (CV) in Year II has been selected for initial implementation of case-based curriculum revisions. Faculty have been trained to reorient their teaching to the case-based model designed. Students have been encouraged to orient to the case learning objectives/questions through small group discussions, examinations and electronic case-based tutorials. Results from questionnaires and focus groups revealed the need for faculty development as an essential element to the success of the project. Student's preparation is also critical.
A26	PROGRESS TESTING AS AN INSTRUMENT FOR CURRICULUM CHANGE - THE AACHEN APPROACH J.Rotgans* and F.Lampert; Medical Faculty, Office of the Dean, University of Technology Aachen, Germany Learning activities are primarily guided by examinations. Traditionally, knowledge is tested by written examinations with open questions. Mostly, reliability is poor because students prepare themselves in such a way that knowledge is stored in short term memory. Changing from a traditional to a modern curriculum includes the problem to operationalise an examination format, which not only helps to store knowledge in long term memory but also prevents from learning by heart, i.e. for which preparation is impossible. Such a format is the ProgressTest (PT). This test is characterised by a set of correct/not correct/? (’I don’t know’)-to-answer statements at the final examination level to be taken by all student’ cohorts - from freshmen to senior students - at the same day four times per year: Progress in study should result in an increase of knowledge measured by the PT.  In Aachen, at the Chair of Conservative Dentistry only – as a scout for its Medical Faculty to find its way to an innovative, for Germany, model curriculum in medicine and dentistry as well –, the curriculum is changed successively towards modern concepts since 1993. Four years ago the PT was introduced. Since then fourteen tests had been taken by five cohorts: The first three with 125 open questions, the following with 300 statements. The actual caesura are defined as: (1) the mean minus one standard deviation, corrected by the standard error of the mean and the standard error of the measurement (which includes reliability) and (2) the cut-off score at 30, 40, 50, 60, 70% respectively for each succeeding test. All original test books are returned to the students together with the correct answers. Thus, if failed, students are not only in the position to check possible false scores, but are encouraged also to check the prototype answers for evidence, e.g. by studying actual literature. If necessary, as result of a serious academic discourse with faculty about the results of students’ scrutiny, scores may be corrected. Analysis of the results shows the tremendous increase of reliability from the .40-ies to the .90-ies for traditional tests and the progress tests respectively. Inherent are, for example, the increase of (1) students’ acceptance and intrinsic motivation, (2) agreement about fail decisions, (3) scientific attitude and (4) content validity (by the item bank construction procedure). Thus, progress testing is more an instrument to encourage learning as a selective test procedure. From our experiences we conclude that progress testing is an efficient instrument to change a traditional curriculum according to the principles of evidence-based education smoothly but insistently.	ORAL
A27	DEVELOPMENT OF A HYBRID CURRICULUM COMBINING PROBLEM-BASED LEARNING WITH TRADITIONAL DIDACTIC TEACHING S. Kathleen Salisbury, DVM, MS*, Larry G. Adams, DVM, PhD, Robert L. Bill, DVM, PhD, Department. of Veterinary Clinical Sciences, Purdue University School of Veterinary Medicine, West Lafayette, IN  47907-1248 U.S.A. Criticisms of veterinary medical curricula have included emphasis on passive transfer of content (rather than development of thinking and problem-solving skills), poor integration of subjects, and failure to demonstrate the clinical relevance of the basic sciences. To address these concerns, a hybrid curriculum was developed which integrated a significant component of problem-based learning (PBL) into a traditional didactic curriculum. The objectives of this curriculum are to actively engage the student in the educational process, to promote independent learning and information management skills, to foster the development of problem-solving and critical thinking, to promote interdisciplinary integration of subject matter, to show the relevance of the basic sciences, and to promote the development of effective communication and teamwork skills. A series of 4, 3-credit PBL courses were developed in the first 2 years of the 4-year DVM curriculum and the traditional didactic courses were scaled back so that the total required credit load per semester did not exceed 18 credits. In the PBL courses, the students are assigned to groups of 6 or 7 with a faculty tutor. The tutorial groups meet for 2-hour sessions, 3 times per week, to work through clinical cases (3-5 sessions per case). The cases require the students to integrate and apply basic science concepts in order to diagnose and treat the patient. The students are responsible for identifying the patient’s problems and determining what knowledge they need to acquire to make a diagnosis (Learning Issues). Each case includes a brainstorming session in which the students are challenged to approach a new problem they have not previously encountered and apply their collective existing knowledge and experiences to develop hypotheses to explain the problem. Brainstorming sessions encourage the students to speculate and verbalize their thoughts without worrying that they must arrive at the "one right answer." They later research their hypotheses to determine if they are correct. At the end of each 2-hour tutorial session, the students divide the Learning Issues among the group members. Each student is responsible for utilizing a variety of resources to investigate their Learning Issues. During the following session, the students teach each other what they have learned and apply the information to the case to draw conclusions. Then they are given additional information about the case by the tutor and repeat the process of identifying and researching Learning Issues. At the end of the case, each group submits a list of their key Learning Issues from which a Master Learning Objectives List is created. This is the course content for which the students are held accountable. After the completion of a case, the entire class meets for a 1-hour Wrap-up Session in which key concepts embodied in the case are discussed. The tutors meet to critique the completed case and preview the next case. The roles of the tutors are to guide the group (not teach), pose questions that help the students to develop a thorough understanding of the basic science concepts, and evaluate the students. Students are evaluated by two written examinations, an individual oral examination, tutor evaluations, peer evaluations and self evaluations.
A28	INCORPORATION OF NUTRITION INTO THE FIRST AND SECOND YEARS OF A NEWLY ESTABLISHED INTEGRATED MEDICAL CURRICULUM  Katherine A. Sukalski *, Vikki L. McCleary, and Richard C. Vari, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND  58203  U.S.A. The Curriculum Committee at the UND School of Medicine and Health Sciences (SMHS) has developed a list of longitudinal themes (nutrition, geriatrics, genomics, etc.) to be incorporated into the medical curriculum. A multidisciplinary committee consisting of physicians, basic scientists and nutritionists was charged with assessment of the depth and breadth of the nutrition content of the undergraduate medical curriculum at the UNDSMHS one year after replacement of a traditional didactic, discipline-centered format with one integrated across disciplines by organ systems. In addition to lectures and labs, students spend six hours each week working through cases, identifying basic sciences issues they need to master in order to understand the diagnosis and treatment of the patient. Students work independently on these learning issues and teach each other in the small group setting. A comparison was done of the nutrition topics in Years 1 and 2 in the basic science component of the 1999/2000 academic year to topics reported as essential to medical education (Feldman EB Am J Clin Nutr 1995: 62:512-7). Significant inclusion of essential material was indicated by an identified objective in the lecture notes or faculty-determined objective at the end of a case. Of the 26 topics identified as essential by Feldman, the following representation in the curriculum was found; 15 in both lectures and cases, 6 in lecture only, 2 in cases only, and 3 topics were not represented. There were multiple occurrences of almost all topics, indicating significant depth and breadth of coverage. Identified nutrition objectives were evenly distributed between lecture and case-based learning. The committee examined the cases used in the first two blocks (August - December) which focus on biochemistry, cell biology, genetics, immunology and the cardiovascular, respiratory and musculoskeletal systems. Suggestions were made to the Block Design Teams for inclusion of nutritionally relevant material prior to use of the cases in the Fall of 2000. A comparison of the sixteen cases from the Fall of 1999 to Fall of 2000 revealed an increase of nutrition objectives from 11 to 19 and increased inclusion of nutritionally relevant information within the cases themselves. An organized process has been established to monitor the curriculum for nutrition content at the UND SMHS and to recommend specific remedies to the block design teams that should increase appropriate and relevant nutrition content in under-represented areas. The goal is to make continued improvement of nutrition content in the first two years and to apply the process to years 3 and 4 as a means towards an enhanced nutritional education experience for undergraduate medical students.	ORAL
A29	THE DIFFERENCE BETWEEN DISEASE AND ILLNESS: INTRODUCING MEDICAL STUDENTS TO BREAST CANCER EARLY IN THE CURRICULUM Patrick W. Tank*, Linda A. Deloney, E. Robert Burns, C. James Graham, Department of Anatomy, University of Arkansas for Medical Sciences, Little Rock, AR  72205  U.S.A. At the University of Arkansas for Medical Sciences (UAMS), the initiation of an Introduction to Clinical Medicine (ICM) course provided new opportunities to teach students about breast cancer. Previously, first-year medical students had been exposed to the gross anatomy and microscopic anatomy of the breast in the first semester without emphasis on clinical issues or the illness experiences of patients who are diagnosed with breast cancer. Training in the psychosocial issues of breast cancer patients had been sporadic and scattered throughout the four year curriculum. As a consequence, students have had difficulty integrating the basic science, clinical, and psychosocial aspects of breast cancer. This paper describes the process of developing a breast cancer teaching module that encompasses portions of three courses that run concurrently in the first year curriculum. A description of the module will be presented as a template for development of other integrated, disease-based teaching modules in a traditional preclinical medical curriculum. The basic science foundation necessary to understanding the process of breast cancer was presented to the class in the following sequence: A Gross Anatomy lecture and laboratory on the thoracic wall, the breast and its lymphatic drainage was presented in the morning. In the afternoon of the same day, the Microscopic Anatomy lecture and laboratory topic was the blood-vascular and lymphatic vessel systems, including the formation of tissue fluid and the major causes of edema such as lymphatic obstruction. The following morning, functional histology and embryology of the breast and lymph node were presented, followed by a laboratory session. That afternoon, a two-hour breast clinical correlation was presented by the Chief of the UAMS Breast Service. The students were allowed to process the basic science and clinical correlation information for two more school days before they met a panel of four breast cancer patients in various stages of coping with their disease. The women on the panel represented different ages, cultures, and ethnicity. This ICM session was designed to enable students to distinguish between a disease state and illness experience. Information on breast cancer risk factors and appropriate screening recommendations was included in prerequisite reading for the panel discussion. Issues raised by the students and discussed by the panel included the psychological and social impact of a breast cancer diagnosis; the effect of mastectomy and hair loss on self-image; the impact of cancer treatment on the individual's family, independence, ability to work, and insurability; appropriate methods for delivering "bad news;" and community resources to support breast cancer patients. Students reflected on the learning experiences through their written journals. Student evaluation of the module will be discussed.
A30	HAS A GENERALIST EARLY CLINICAL EXPERIENCE HARMED THE BASIC SCIENCES AT EASTERN VIRGINIA MEDICAL SCHOOL?  John A. Ullian, PhD*, Christine C. Matson, MD, Office of Education, Eastern Virginia Medical School, Norfolk, VA  23507  U.S.A. In 1994, Eastern Virginia Medical School received two national grants and support from the Commonwealth of Virginia to produce more generalist physicians. The resulting curricular changes included decreasing basic sciences curricular time in M1 and M2 to allow time for a two-year early clinical experience (ECE) program. The ECE began the first week of medical school, and included large group didactics, small group sessions, extensive use of standardized patients, and (beginning in the second semester) a longitudinal mentorship with a generalist community physician in whose office students practiced their newly-learned clinical skills. Faculty differed from the beginning on the expected impact of these changes. Some believed that the competition (for time and interest) with clinical training would reduce students' grasp of basic science fundamentals. Others believed that the ECE would help students understand the relevance to practice of what they were learning in the basic sciences, thus increasing their interest and knowledge. What has actually occurred? Student performances on USMLE Step 1 and 2 exams have improved. From the last cohort without ECE to most recent results, EVMS student performance on Step 1 improved 16% in passing rate, 26 points in mean scores. Likewise, Step 2 improvements were 7% in passing rate and 25 points. Almost all students now pass both on their first attempt. Our entering students now have higher MCAT averages, which may contribute to the improved USMLE performances. Evaluation data show that students strongly value the ECE, especially the mentorship and the standardized patients. Surveys queried three cohorts of students entering M4 about the ECE's impacts. Questions involving the basic sciences were (with means, based on 1 = strongly disagree to 5 = strongly agree): "Competition for study time due to the time I devoted to [ECE] caused more harm to my medical education than the benefits I gained from the experience" (2.44); "I understand some of the basic science material better because of [the ECE] (2.73); "I became more interested in the basic sciences because of my [ECE] (2.36). Overall, we have seen no evidence that replacing basic science curricular time with the ECE has harmed students' learning of the basic sciences. We cannot attribute students' improved USMLE performances to a single source (e.g., higher MCAT scores, more effective and competitive recruiting, improved basic science courses, the ECE, or other). Overall, students do not believe that the ECE has helped (or hindered) their understanding or interest in the basic sciences. Variability in student responses to the survey and anecdotal information from students and faculty remind us that these overall findings do not apply to each student, but in general the ECE seems to have had little negative impact, and possibly some positive impact on students' understanding of the basic sciences.	ORAL
A31	PROBLEM-BASED LEARNING GROUP PERFORMANCE ON WRITTEN EXAMS: LACK OF EFFECT OF FACILITATOR Carol F. Whitfield, Ph.D.*, Pennsylvania State College of Medicine, Hershey, PA  17033  U.S.A. Penn State College of Medicine preclinical curriculum has a significant amount of problem-based learning (PBL) for all students. We have two 3-hr. PBL sessions per week in the first year, and three 3-hr sessions per week in the second year. There are 16 groups of 6-8 students in each of the first and second year classes. Because of the small total number of faculty, there is no possibility of using only content experts as facilitators. Courses are divided into units of instruction, and some units are further divided to minimize the time commitment of facilitators. Group composition remained the same for the entire course, but in 83% of units and sections of units, the facilitators changed. The goal of this study was to analyze the data from the 1998-1999 and 1999-2000 academic years, to determine if there was a significant difference between groups in the end-of-unit written exam performance. A group's performance in different sections of a course was also examined, to see if a switch in facilitators made a difference in its ranking.  Exam scores were collected from 22 units of instruction. It was not possible to separate the exam questions that students could answer only from their study of the PBL cases from those whose content was also related to lecture material. Therefore the entire exam score was used in the analysis. If a difference was found, the areas of interest of the facilitators was compared to the content of the unit. Analysis was done by the Kruskal-Wallace analysis of variance. Group rank performance by quartile in each course was also examined.  In only one of the 22 units, exam means of the 16 groups were different (p<0.05). The unit was in the renal unit of a course, Reproduction, Development and Renal. The highest mean exam score was made by a group facilitated by a Ph.D. in Biostatistics, and the lowest score was made by a group facilitated by an M.D. in Psychiatry. Looking at group performance within a course, 49% of individual groups remained in the same quartile in all sections of the course, 28% of groups went up to a higher quartile after the first unit or section, and 23% went down, whether facilitators changed or remained the same. These results indicate that end-of-unit written exam grades do not differ between groups and that performance is more dependent on the randomized composition of the group than on the subject area of the facilitator.	ORAL