Curriculum reform at the University of Natal Medical School : purging content and changing paradigm.
Sommerville, Thomas Edward.
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This work discusses issues of curriculum in terms of a case study of curriculum reform at a South African medical school, from the viewpoint of a clinical department of which teaching input is predominantly postgraduate rather than undergraduate. Concepts of curriculum and content are explored. A distinction is drawn between different uses of the term 'paradigm'. The context underlying the current educational climate nationally and internationally is described, and the course of medical education and teaching in anaesthesia traced historically. Results of a questionnaire circulated amongst general practitioners in KwaZulu-Natal, and informal interactions and semi-structured interviews with members of staff and students at the medical school, are documented. The general practitioners were broadly in favour of the changes contemplated by the Curriculum Development Task Force and indicated support for movement towards newer modes of teaching and learning. Staff and students were more equivocal about proposed change, conceding their conservatism and pointing out practical problems with initiating change in the direction envisaged, but appearing willing to proceed. Anaesthetics staff on the whole seemed more optimistic about change; they differed from the GPs, other staff and students in advising against attempting to teach specific - as against generic - anaesthetic skills to undergraduates. The responses of the different groups' opinions are discussed against the national and international background in terms of curricular paradigm, educational strategies, curriculum content and aspects of change. It is concluded that Medicine in general has operated in the natural science paradigm and that a degree of inertia has resisted changes suggested for at least the past century. The impetus for change from within medical schools, the profession and society at large is now such that transition directly to a critical mode, strongly influenced by postmodernism, is pending, the effect being that of a Kuhnian paradigm shift. The interdependence of curriculum as a whole and of content - one of its elements - is noted. Local teaching changes in Anaesthetics are compared with those of the faculty as a whole and the interaction of the now fragmented elements of anaesthesia core teaching with the reform process are sketched.