Post graduate medical education

Since 1994, higher education policy has been committed to equity of access for all, irrespective of race and gender. We investigated progress towards these goals in the education of medical doctors, with an emphasis on gender. Databases from the Department of Education (DoE), Health Professions Council of South Africa (HPCSA) and University of Cape Town (UCT) Faculty of Health Sciences were used to explore undergraduate (MB ChB) trends at all eight medical schools and postgraduate (MMed) trends at UTC. Nationally women have outnumbered men in MBChB enrollments since 2000, figures ranging between 52% and 63% at seven of the eight medical schools in 2005. However, the rate of change in the medical profession lags behind and it will take more than two decades for female doctors to outnumber male doctors. A study of UCT postgraduate enrollments shows that females had increased to 42% of MMed enrollments in 2005. However, female postgraduate students were concentrated in disciplines such...

Abstract
Postgraduate Medical Education (PGME) in Sudan started at the University of Khartoum with a
postgraduate diploma in obstetrics in 1953. Following this, two other universities started
providing such training: Gezira and Juba University. In 1995, the training was handed over to the
Sudan Medical Specialisation Board. There is scarce research evaluating the quality of the
training since the inauguration of PGME in Sudan.
Permission to conduct the study was received from SMSB, and the study was reviewed and
approved by the Sudanese National Technical Ethical Committee, (Certificate No. 2-12-2016).
This study aimed at evaluating PGME in Sudan from stakeholder perspectives and at developing
standards for improving the quality of the training. A mixed study (quantitative and qualitative)
approach was used in this study by applying validated tools to evaluate the internal medicine
programme in particular.
The data were collected from the trainee residents (n = 189), trainers (n = 161), patients (n =
389), hospital directors (n = 6), deans of the colleges of medicines (n = 3), and representatives
from the programme administration (n = 2) using surveys (for trainers and trainees).
Interviews were conducted with hospital directors, deans of colleges of medicine, and
programme directors, in addition to focus group discussions with the trainees (six rounds
attended by 48 trainees). Further document analysis was performed to compare the curriculum,
policies, and regulations with regional and international curricula and regulations. Moreover, a
wiremen approach was used in the development of the standards. The statistical software used
for quantitative data analysis was SPSS version 22.0 for Windows. Various descriptive statistics
were employed, and coding and thematic analyses were performed to analyse the qualitative
data. The preliminary data, including suggestions for improving the programme from
stakeholders, were discussed with a panel of experts at the Sudan Medical Specialization Board.
The evaluation revealed some strengths and areas that need improvement in the internal
medicine programme, namely in the curriculum, delivery of the training, learning environment,
and assessment of the trainees. Finally, the suggested standards were developed. It has been
globally realised that high quality and safe patient care can only be provided if doctors are well
prepared for this task through residency training, and thus the implementation of these standards
could result in high quality and safe patient care.

Objectives: To evaluate students’ perceptions of the learning environment and to assess any differences in perception re-lated to students’ performance and their year of study.
Methods: A descriptive cross-sectional study was performed of 638 students from the second, sixth and tenth semesters at the Faculty of Medicine at Gezira University, Sudan. This study employed the Arabic-translated Dundee Ready Educa-tion Environment Measure. The main predictor variables were the study year and academic performance. Descriptive statistics and one-way analysis of variance with a post hoc Tukey-Kramer multiple comparisons test were used for data analysis.
Results: The overall score for this study was 122/200 (SD=16.6), indicating a positive perception of the learning environment. The overall mean score was 109.94/200 (SD=21.2) for Semester 2 students, 122.9/200 (SD=20.29) for Semester 6 students, and 116.53 (SD=20.12) for Semester 10reflecting a significant difference in students’ per-ceptions in different years of study (F(2,2422)=3.21, p=0.04). There was also a significant difference between the mean overall scores with respect to academic performance. High-achieving students’ mean DREEM score was 126 (SD=24.4); while low-achieving students’ mean DREEM score was 102 (SD=26.25) (F(2,2453)=3.53, p=0.029).
Conclusions: High achievers’ perceptions of the learning en-vironment are significantly better than those of low achiev-ers. A significant difference was observed between students in different years of study. The differences in students’ aca-demic performance should be further investigated, targeting specific domains. A large-scale study is required to differen-tiate between the weakness and the strength of each academic level.
Keywords: Students’ perception, learning environment, study year, performance, Sudan

BACKGROUND Postgraduation in Community Medicine finds few takers and those who do take it up as a career option have many concerns regarding the course. To understand the issues involved, a qualitative method called VIPP was used, which is a people centered approach to identify issues from the perspectives of those involved. This study is set to identify the problems faced by postgraduate students in Community Medicine regarding their course of study.

OBJECTIVES: The Accreditation Council for Graduate Medical Education milestones provide a framework of specific interpersonal and communication skills that surgical trainees should aim to master. However, training and assessment of resident nontechnical skills remains challenging. We aimed to develop and implement a curriculum incorporating interactive learning principles such as group discussion and simulation-based scenarios to formalize instruction in patient-centered communication skills, and to identify best practices when building such a program.

Case description and objective: This article describes the challenges faced in the rehabilitation of a person with quadruple amputation, the pre-prosthetic difficulties faced and subsequent functional improvement after prosthetic fitting and training. Study Design: Case report Treatment: The rehabilitation program was started with pre-prosthetic phase, comprising of physical and mental adaptation to the condition with necessary interdepartmental support with stump preparation, and then progressed to prosthetic phase, in which the patient was fitted and trained with mechanical prostheses. Outcomes: The patient graduated from being wheelchair bound to independent ambulation without any mobility aid using all four extremities prostheses successfully. Conclusion: The successful rehabilitation of a person with quadruple amputation with mechanical prostheses is a challenge. But with prior motivation, planned progressive training and psychosocial counselling, it can serve as an example to help such cases in a low socioeconomic country like India.

Counseling a family confronted with the birth of a periviable neonate is one of the most difficult tasks that a neonatologist must perform. The neonatologist's goal is to facilitate an informed, collaborative decision about whether life-sustaining therapies are in the best interest of this baby. Neonatologists are trained to provide families with a detailed account of the morbidity and mortality data they believe are necessary to facilitate a truly informed decision. Yet these complicated and intensely emotional conversations require advanced communication and counseling skills that our current fellowship-training strategies are not adequately providing. We review educational models for training neonatology fellows to provide antenatal counseling at the threshold of viability. We believe that training aimed at teaching these skills should be incorporated into the neonatal-perinatal medicine fellowship. The optimal approaches for teaching these skills remain uncertain, and there is a need for continued innovation and outcomes-based research.

Despite its contribution to global disease burden, diarrhoeal disease is still a relatively neglected area for research funding, especially in low-income country settings. The SNOWS consortium (Scientists Networked for Outcomes from Water and Sanitation) is funded by the Wellcome Trust under an initiative to build the necessary research skills in Africa. This paper focuses on the research training needs of the consortium as identified during the first three years of the project. We reviewed the reports of two needs assessments. The first was a detailed needs assessment led by one northern partner, with follow-up visits which included reciprocal representation from the African universities. The second assessment, led by another northern partner, focused primarily on training needs. The reports from both needs assessments were read and stated needs were extracted and summarised. Key common issues identified in both assessments were supervisory skills, applications for external researc...

Objectives To evaluate a unique pre-registration house of®cer (PRHO) rotation involving half a week in general practice over a 4-month period. House of®cers' and supervisors' views were sought on the value of this type of rotation. Design Qualitative study using semi-structured interviews. Setting A four-partner postgraduate training practice in a deprived urban part of Northeast England. Subjects Pre-registration house of®cers and supervisors. Results House of®cers gained in educational and clinical terms from their period in general practice. They had a high level of individual supervision and teaching and encountered a wider spectrum of illness than in hospital. They found certain aspects of general practice stressful. The supervision required was greater than that needed for a registrar. The supervision of house of®cers requires support and possibly further education for the supervisor. Conclusions General practice can provide valuable supervised experience at this stage of a doctor's career.

Residency programs have been integral to the development, expansion and progression of family medicine as a discipline. Three reports formed the foundation for graduate medical education in family medicine: Meeting the Challenge of Family Practice, The Graduate Education of Physicians, and Health is a Community Affair. In addition, the original core concepts of comprehensiveness, coordination, continuity, and patient centeredness continue to serve as the foundation for residency training in family medicine. While the Residency Review Committee for Family Medicine of the Accreditation Council for Graduate Medical Education has provided the requirements for training throughout the years, key organizations including the Society of Teachers of Family Medicine, the American Academy of Family Physicians, the Association of Family Medicine Residency Directors, and the American Board of Family Medicine have provided resources for and supported innovation in programs. Residency Program Solut...

This paper describes the introduction of the training of non-technical skills on a mandatory course for surgical trainees. The training consisted of an introduction to non-technical skills in a plenum session and was followed by a full-scale simulation with debriefing in which participants reflected on their actions. Evaluations showed that > 90% of the participants found that the subject was relevant for their further training and some requested more simulation training. The course hereby addresses several of the Danish seven roles of a fully trained specialist doctor.

Transitioning from an associate degree to a baccalaureate degree for respiratory therapists has been suggested as a new entry-level educational standard. One potential risk for this change is that it may limit the diversity of potential applicants for entry-level education. A diverse workforce is important to achieve the goal of reducing healthcare disparities. This study evaluated characteristics of therapists who completed associate and baccalaureate degree entry-level education. A secondary analysis of data collected from the 2009 AARC Respiratory Therapist Human Resource Survey explored relationships between the choice of entry-level associate or baccalaureate education and variables of gender, race, salary, career advancement, and job satisfaction. There were no differences between therapists with entry-level associate and baccalaureate degrees in gender, race, number of additional healthcare credentials, numbers of life support credentials, wages, delivering respiratory care b...

Commitment and development of competences in clinical research in residency training programs in Chile Background: In Chile, residency training programs (RTP) take place in a stimulating academic environment for the promotion of clinical research skills. However, research is not a frequent curricular outcome. Accreditation of these programs by the National Accreditation Commission is an opportunity to improve the trainee's research competences. Aim: To analyze in the RTP curricula, the explicit intention to carry out clinical research and its correlation with the scientifi c productivity of professors and residents. Material and Methods: Fifty six training study programs corresponding to six primary specialties and six derived specialties, offered by seven universities holding accreditation tenure for RTP from the Chilean Association of Medicine Faculties (ASOFAMECH) up to 2005, were analyzed. The analysis included each academic program, courses and/or rotations and professors and residents' productivity, measured as publications accredited in the Institute for Scientifi c Information (ISI), between 1999 and 2007. Results: RTP are based on a tutorial educational model, where the close relationship between professors and residents is essential for the expected fi nal outcome. Simultaneously, the programs' curricula revealed a high intentionality towards clinical research. However, professors' publications of ISI indexed articles showed a low and irregular scientifi c productivity. Conclusions: The gap between the declared training in clinical research and the effective ISI productivity is an awareness call with respect to the contribution that RTP could provide to accreditation, to professors and residents, and in general to health improvement in the country.

Interest in emergency radiology as a distinct subspecialty within radiology continues to rise in the USA and globally. While acute care imaging has been performed since the earliest days of the specialty, fellowship training in emergency radiology is a relatively new phenomenon. The purpose of this study was to examine the current status of emergency radiology training in the USA, using data derived from the official websites of US residency training programs. The most current list of radiology residency programs participating in the 2017 match was obtained from the official Electronic Residency Application Service (ERAS) website. The total number of emergency radiology fellowships was recorded after visiting available websites of each academic radiology program. The total number of subspecialty fellowships offered by each academic radiology program was also recorded. There were 12 confirmed emergency radiology fellowships offered in the USA for a combined total of 22 fellowship positions. Eleven programs were 1 year in duration, with one program offering a one-or two-year option. One hundred eight of the 174 (approximately 62 %) surveyed academic radiology programs offered at least one subspecialty fellowship. Emergency radiology fellowships are on the rise, paralleling the growth of emergency radiology as a distinct subspecialty within radiology.

  The examination of the appropriate professional degree for preparation as an athletic trainer is of interest to the profession. Descriptive information concerning universal outcomes is needed to understand the effect of a degree change.   To obtain and compare descriptive information related to professional athletic training programs and a potential degree change and to determine if any of these factors contribute to success on existing universal outcome measures.   Cross-sectional study.   Web-based survey.   We contacted 364 program directors; 178 (48.9%; 163 undergraduate, 15 postbaccalaureate) responded.   The survey consisted of 46 questions: 45 questions that dealt with 5 themes (institutional demographics [n = 13], program admissions [n = 6], program outcomes [n = 10], program design [n = 9], faculty and staff [n = 7]) and 1 optional question.   Descriptive statistics for all programs were calculated. We compared undergraduate and postbaccalaureate programs by examining uni...

BACKGROUND AND OBJECTIVES Medical schools and residencies lack training in communication skills with patients with disabilities, thereby creating potential barriers to care. To address this shortcoming, the Department of Family Medicine at Lehigh Valley Health Network developed an innovative program in which the patients themselves serve as medical educators. The P-DAT (Patients With Disabilities as Teachers) program is designed to teach basic communication skills and disability etiquette to promote sensitivity to issues unique to this patient population. As such, it conforms to the established principles of the patient-centered medical home. METHODS Two persons with disabilities who were patients of the residency-affiliated clinic underwent training to become educators. In the resulting interactive education session with medical students, the P-DAT educators describe their daily routines and health care experiences while encouraging their learners to ease anxieties in interacting w...

Residents play a pivotal role in the education of medical students and junior house staff but are rarely provided with the tools to help them teach effectively. Residents value their roles as teachers and desire training programs in teaching skills. Teaching skills courses for residents have been shown to improve residents' self-confidence and self-assessed use of effective teaching behaviors. They have also been shown to improve residents' evaluations by students. The Institute for Medical Education at the Mount Sinai School of Medicine has developed a successful, multidisciplinary curriculum to improve the teaching and leadership skills of all of our residents at the Mount Sinai Hospital and its affiliate institutions. The Resident Teaching Development Program (RTDP) has already been implemented in the departments of Medicine, Surgery, Pediatrics, Psychiatry, and Obstetrics and Gynecology. This adaptable, seven-hour curriculum has been well received by residents and facult...

Changing societal demands on doctors necessitate changes in the training of gynaecologists. Adapting this training will need well-thought-out and comprehensive planning that addresses the needs of the major stakeholders: society, patients, and doctors themselves. Doctors need to be cognizant of societal issues such as rapidly rising healthcare costs and budgetary crises, and be able to participate in the solutions. This demands effective medical leadership, which has been a neglected area in postgraduate training. It has become increasingly evident that a holistic view of the patient rooted in proper teamwork and systems-based practice is essential to provide patient-centered care. Specialists need to expand their skill set to participate in this kind of care. Furthermore, the feminisation of the medical profession and a new generation of doctors rejecting the constraints of the traditional model of medical care introduce new professional perspectives. This manuscript briefly review...

In the old system of care, primary care physicians were the Jacks (and Jills) of all trades. They managed chronic disease, provided urgent care, and ensured preventive care. Over the past several decades, society has changed. While the population has aged, the physician workforce has not grown proportionally, and costs have risen. Meanwhile, nonphysician providers, guided by sound algorithms, have been shown to deliver straightforward chronic disease management and urgent care that is similar or better in quality and cost than that provided by physicians. Time-limited physician outpatient visits are now dominated by pressing acute care issues that overshadow preventive care. Facing increasing demands and decreasing payment, a new system of primary care is emerging, one grounded in interprofessional practice and population management. How, then, should the physician workforce adapt to provide primary care to an aging, ailing, and expanding population in this new system?

About 15 years ago, the Swiss Society of Pathology has developed and implemented a board examination in anatomical pathology. We describe herein the contents covered by this 2-day exam (autopsy pathology, cytology, histopathology, molecular pathology, and basic knowledge about mechanisms of disease) and its exact

To examine otolaryngology resident interest in subspecialty fellowship training and factors affecting interest over time and over the course of residency training STUDY DESIGN: Cross-sectional study of anonymous online survey data. Residents and fellows registered as members-in-training through the American Academy of Otolaryngology-Head and Neck Surgery. Data regarding fellowship interest and influencing factors, including demographics, were extracted from the Section for Residents and Fellows Annual Survey response database from 2008 to 2014. Over 6 years, there were 2422 resident and fellow responses to the survey. Senior residents showed a statistically significant decrease in fellowship interest compared with junior residents, with 79% of those in postgraduate year (PGY) 1, 73% in PGY-2 and PGY-3, and 64% in PGY-4 and PGY-5 planning to pursue subspecialty training (P < .0001). Educational debt, age, and intended practice setting significantly predicted interest in fellowship...

OBJECTIVES To determine the frequency of depression among post graduate medical trainees in a teaching hospital of Pakistan and to explore the associated factors contributing to depression in them. METHODS It's a cross-sectional study at the Aga Khan University Hospital, Karachi. It was done in June 2008 till August 2008. Zung Self-Rating Depression Scale was administered among 172 post graduate trainees. Self administered questionnaires were used to assess the associated demographic and work related risk factors. Adjusted odds ratios (OR) were calculated by logistic regression. RESULTS The survey response rate was 172 (82.69%). Depression in the overall sample was 103 (59.88%), of which 58 (33.66%) were moderate to markedly depressed. Multiple logistic regression analysis revealed that working hours less than 76 hours (OR 3.71; CI = 1.67, 8.23) and 76-90 hours (OR 3.15; CI = 1.42, 6.97) and none or occasional peer support (OR 2.05; CI = 1.01, 4.18) were independent predictors f...

Commitment and development of competences in clinical research in residency training programs in Chile Background: In Chile, residency training programs (RTP) take place in a stimulating academic environment for the promotion of clinical research skills. However, research is not a frequent curricular outcome. Accreditation of these programs by the National Accreditation Commission is an opportunity to improve the trainee's research competences. Aim: To analyze in the RTP curricula, the explicit intention to carry out clinical research and its correlation with the scientifi c productivity of professors and residents. Material and Methods: Fifty six training study programs corresponding to six primary specialties and six derived specialties, offered by seven universities holding accreditation tenure for RTP from the Chilean Association of Medicine Faculties (ASOFAMECH) up to 2005, were analyzed. The analysis included each academic program, courses and/or rotations and professors and residents' productivity, measured as publications accredited in the Institute for Scientifi c Information (ISI), between 1999 and 2007. Results: RTP are based on a tutorial educational model, where the close relationship between professors and residents is essential for the expected fi nal outcome. Simultaneously, the programs' curricula revealed a high intentionality towards clinical research. However, professors' publications of ISI indexed articles showed a low and irregular scientifi c productivity. Conclusions: The gap between the declared training in clinical research and the effective ISI productivity is an awareness call with respect to the contribution that RTP could provide to accreditation, to professors and residents, and in general to health improvement in the country.

Journal clubs have typically been held within the walls of academic institutions and in medicine have served the dual purpose of fostering critical appraisal of literature and disseminating new findings. In the last decade and especially the last few years, online and virtual journal clubs have been started and are flourishing, especially those harnessing the advantages of social media tools and customs. This article reviews the history and recent innovations of journal clubs. In addition, the authors describe their experience developing and implementing NephJC, an online nephrology journal club conducted on Twitter.

A career in pediatrics can bring great joy and satisfaction. It can also be challenging and lead some providers to manifest burnout and depression. A curriculum designed to help pediatric health providers acquire resilience and adaptive skills may be a key element in transforming times of anxiety and grief into rewarding professional experiences. The need for this curriculum was identified by the American Academy of Pediatrics Section on Medical Students, Residents and Fellowship Trainees. A working group of educators developed this curriculum to address the professional attitudes, knowledge, and skills essential to thrive despite the many stressors inevitable in clinical care. Fourteen modules incorporating adult learning theory were developed. The first 2 sections of the curriculum address the knowledge and skills to approach disclosure of life-altering diagnoses, and the second 2 sections focus on the provider's responses to difficult patient care experiences and their needs to develop strategies to maintain their own well-being. This curriculum addresses the intellectual and emotional characteristics patient care medical professionals need to provide highquality, compassionate care while also addressing active and intentional ways to maintain personal wellness and resilience.

This article summarizes the hands-on course-Establishing a Simulation Center for Surgical Skills: What to Do and How to Do It-proposed and developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Technology Committee at the SAGES 2006 annual meeting in Dallas, Texas. The lecture portion was presented to approximately 60 attendees and included information on the ACS Initiative, curriculum development, teaching with simulation, validation, finances, and a technology update, as detailed in the following sections. A lab allowing handson use of 10 different physical and computerized simulators was provided to approximately 40 participants. The ACS Program for Accreditation of Education Institutes (Dr. Sachdeva) The ACS recently launched a program to accredit education institutes. The aims of the program are to advance surgical skills education and to enhance access to educational opportunities within and among institutions. Learner groups targeted by the program are surgeons in practice, surgery residents, medical students, members of the surgical team, and surgical patients. Educational underpinnings The critical role of structured teaching, learning, and assessment of surgical skills has been the subject of

PURPOSE: Simulated patient care has gained acceptance as a medical education tool but is underused in surgical training. To improve resident clinical management in critical situations relevant to the surgical patient, high-fidelity full patient simulation training was instituted at Baystate Medical Center in 2005 and developed during successive years. We define surgical patient simulation as clinical management performed in a high fidelity environment using a manikin simulator. This technique is intended to be specifically modeled experiential learning related to the knowledge, skills, and behaviors that are fundamental to patient care. We report 3 academic years' use of a patient simulation curriculum. METHODS: Learners were PGY 1-3 residents; 26 simulated patient care experiences were developed based on (1) designation as a critical management problem that would otherwise be difficult to practice, (2) ability to represent the specific problem in simulation, (3) relevance to the American Board of Surgery (ABS) certifying examination, and/or (4) relevance to institutional quality or morbidity and mortality reports. Although training started in 2005, data are drawn from the period of systematic and mandatory training spanning from July 2006 to June 2009. Training occurred during 1-hour sessions using a computer-driven manikin simulator (METI, Sarasota, Florida). Educational content was provided either before or during presimulation briefing sessions. Scenario areas included shock states, trauma and critical care case management, preoperative processes, and postoperative conditions and complications. All sessions were followed by facilitated debriefing. Likert scalebased multi-item assessments of core competency in medical knowledge, patient care, diagnosis, management, communication, and professionalism were used to generate a performance score for each resident for each simulation (percentage of best possible score). Performance was compared across PGYs by repeated-measures analysis of variance and Wilcoxon rank sum tests.

The aim of this project was to analyze and compare the educational experience in rheumatology specialty training programs across European countries, with a focus on self-reported ability. An electronic survey was designed to assess the training experience in terms of self-reported ability, existence of formal education, number of patients managed and assessments performed during rheumatology training in 21 core competences including managing specific diseases, generic competences and procedures. The target population consisted of rheumatology trainees and recently certified rheumatologists across Europe. The relationship between the country of training and the self-reported ability or training methods for each competence was analyzed through linear or logistic regression, as appropriate. In total 1079 questionnaires from 41 countries were gathered. Self-reported ability was high for most competences, range 7.5-9.4 (0-10 scale) for clinical competences, 5.8-9.0 for technical procedur...

Results. The development of expertise in anaesthesia rests on the ability to reconcile and interpret many sources of knowledge—clinical, social, electronic, and experiential—and formal theoretical learning. Experts have mastered technical skills but are also able to understand the ...

Purpose: Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large NHS teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff. Method: This article features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact. Findings: Factors that contributed to a positive educational environment included: trainees and educators feeling valued, the presence of supportive leaders, and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation, and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educational culture and offered suggestions for further improvement including the provision of ongoing feedback to learners about their performance. Originality: Research aimed at recognising and resolving the perceived tensions between the priorities of education and healthcare delivery has been flagged as a gap in the literature. We argue that developing and enhancing collaborative leadership and educational culture within an organization can reduce these tensions for those working on the front line. Future work should focus on addressing the perceived distinction between the two within services.

BACKGROUND Postgraduation in Community Medicine finds few takers and those who do take it up as a career option have many concerns regarding the course. To understand the issues involved, a qualitative method called VIPP was used, which is a people centered approach to identify issues from the perspectives of those involved. This study is set to identify the problems faced by postgraduate students in Community Medicine regarding their course of study.

Objective: A multidisciplinary curriculum committee representing internal medicine, family medicine, and psychiatry developed and implemented an eight-week experience for third-year students (n = 145) at Case Western Reserve University (CWRU). These faculty hoped that a standardized, multidisciplinary approach to teaching common ambulatory topics would eliminate redundancies within the existing third-year curriculum, improve collaboration among disciplines, and optimize faculty time at different teaching hospitals. Description: As a part of restructuring our third-year curriculum, an eight-week outpatient block was developed, with four weeks of family medicine, three weeks of internal medicine, and one week of psychiatry. Clerkship directors from these disciplines met regularly over a seven-month period to plan a standardized curriculum for addressing primary care knowledge and skills. The planning committee set aside one full day each week during the eight-week rotation for formal interdisciplinary instruction; the clinical activities and assignments for the other days were determined by disciplinespecific planning groups. In the planning process, the committee began with an inquiry process wherein the clerkship directors and staff compared and contrasted lecture schedules, instructional materials, teaching approaches, and evaluation methods used by the individual disciplines. The committee then selected topics for the weekly interdisciplinary instruction for their relevance in the ambulatory setting, using these discussions and published national guidelines. Curricular responsibility was determined through a process of negotiation and resource assessment. The planning committee adopted common evaluation methods, such as an OSCE at the end of the rotation, and agreed to use active learning methods, such as case-based instruction. They also developed a standard set of printed and Web-based instructional materials for students and faculty to use during the rotation. Though the planning committee thought it important to standardize the curriculum, they decided to rotate instruction among three teaching hospitals in order to optimize available resources and minimize faculty fatigue. Students' performances during this rotation were applied to their final clerkship grades in the three participating clerkships. Discussion: Approximately 50 students have completed the new curriculum, which started in July 2000. Although implementing the curriculum has been arduous, we have enjoyed working with colleagues from other disciplines and institutions. Curricular redundancies have been reduced, which has relieved teaching commitments for faculty at each institution and has standardized the instruction for students assigned to the different hospitals. Any type of curricular integration results in less instructional time and a need for increased communication. An ongoing dilemma is distinguishing what ''must be taught'' from what ''should be taught'' to third-year students. Each discipline has different priorities and resources, which has resulted in an eight-hour multidisciplinary day filled with more lecture and less case-based discussion and skill workshops than initially desired. The curriculum committee is examining how to modify the curriculum so as to shorten instructional time and to accommodate more interactive teaching activities. We also hope to improve communication among faculty at different institutions as more become involved with this program.