Moving toward co-production: five ways to get a grip on collaborative implementation of Movement Behaviour curricula in undergraduate medical education
DOI:
https://doi.org/10.36834/cmej.74083Abstract
Several “calls to action” have imposed upon medical schools to include physical activity content in their overextended curricula. These efforts have often neither considered medical education stakeholders’ views nor the full complexity of medical education, such as competency-based learning and educational inflation. With this external pressure for change, few medical schools have implemented physical activity curricula. Moreover, Canada’s new 24-Hour Movement Guidelines focus on the continuum of movement behaviours (physical activity, sedentary behaviour, and sleep). Thus, a more integrated process to overcome the “black ice” of targeting all movement behaviours, medical education stakeholder engagement, and the overextended curriculum is needed. We argue for co-production in curriculum change and offer five strategies to integrate movement behaviour curricula that acknowledge the complexity of the medical education context, helping to overcome our “black ice.” Our objectives were to investigate 24-Hour Movement Guideline content in the medical curriculum and develop an integrated process for competency-based curriculum renewal. Stakeholders were equal collaborators in a two-phased environmental scan of 24-Hour Movement Guideline content in the Queen’s University School of Medicine. Findings and a working curriculum map highlight how new, competency-based content may be embedded in an effort to guide more relevant and feasible curriculum changes
References
Slavin S, D'Eon FM. Overcrowded curriculum is an impediment to change (Part A). Can Med Educ J. 2021;12(4):1-6.
https://doi.org/10.36834/cmej.73532
Slavin S, D'Eon FM. Overcrowded curriculum is an impediment to change (Part B). Can Med Educ J. 2021;12(5):1-5.
https://doi.org/10.36834/cmej.73813
Joy E, Blair SN, McBride P, Sallis R. Physical activity counselling in sports medicine: a call to action. Br J Sports Med. 2013;47(1):49-53.
https://doi.org/10.1136/bjsports-2012-091620
Thornton JS, Frémont P, Khan K, et al. Physical activity prescription: A critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine. Br J Sports Med. 2016;50(18):1109-14.
https://doi.org/10.1136/bjsports-2016-096291
Shah S, McCann M, Yu C. Developing a national competency-based diabetes curriculum in undergraduate medical education: a Delphi study. Can J Diabetes 2020;44(1):30-36.e2. https://doi.org/10.1016/j.jcjd.2019.04.019
Fowles JR, O'Brien MW, Solmundson K, Oh PI, Shields CA. Exercise is medicine Canada physical activity counselling and exercise prescription training improves counselling, prescription, and referral practices among physicians across Canada. Appl Physiol Nutr Metab. 2018;43(5):535-9. https://doi.org/10.1139/apnm-2017-0763
Holtz KA, Kokotilo KJ, Fitzgerald BE, Frank E. Exercise behaviour and attitudes among fourth-year medical students at the University of British Columbia. Can Fam Physician. 2013;59(1).
Roberts A, Wilson R, Gaul CA. Incorporating exercise prescriptions into medical education. BC Med J. 2021;63(6).
Solmundson K. Is current medical training preparing physicians to prescribe exercise to their patients? BC Med J. 2018;(April):170-1.
Obeso VT, Phillipi CA, Degnon CA, et al. A systems-based approach to curriculum development and assessment of core entrustable professional activities in undergraduate medical education. Med Sci Educ. 2018;28(2):407-16.
https://doi.org/10.1007/s40670-018-0540-7
Frank JR, Snell L, Englander R, Holmboe ES. Implementing competency-based medical education: moving forward. Med Teach. 2017;39(6):568-73. https://doi.org/10.1080/0142159X.2017.1315069
Hsu T, De Angelis F, Al-asaaed S, et al. Ten ways to get a grip on designing and implementing a competency-based medical education training program. Can Med Educ J. 2021;81-7.
https://doi.org/10.36834/cmej.70723
Canadian Society for Exercise Physiology. Canadian 24-hour movement guidelines for adults ages 18-64 years: an integration of physical activity, sedentary behaviour, and sleep [Internet]. 2020. Available from: https://csepguidelines.ca/adults-18-64/ [Accessed DATE]
Canadian Society for Exercise Physiology. Canadian 24-hour movement guidelines for adults 65 years and older: An integration of physical activity, sedentary behaviour, and sleep [Internet]. 2020. Available from: https://csepguidelines.ca/guidelines/adults-65/ [Accessed Nov 4, 2021].
Canadian Society for Exercise Physiology. Canadian 24-hour movement guidelines for the early years (0-4 years): An integration of physical activity, sedentary behaviour, and sleep [Internet]. 2017. Available from: https://csepguidelines.ca/guidelines/early-years/
Canadian Society for Exercise Physiology. Canadian 24-hour movement guidelines for children and youth (5-17 years): An integration of physical activity, sedentary behaviour, and sleep [Internet]. 2016. Available from: https://csepguidelines.ca/guidelines/children-youth/
Rosenberger ME, Fulton JE, Buman MP, et al. The 24-Hour activity cycle: a new paradigm for physical activity. Med Sci Sports Exerc. 2019;51(3):454-64.
https://doi.org/10.1249/MSS.0000000000001811
Tremblay MS, Ross R. How should we move for health? The case for the 24-hour movement paradigm. Can Med Assoc J. 2020;192(49):E1728-9.
https://doi.org/10.1503/cmaj.202345
Wattanapisit A, Tuangratananon T, Thanamee S. Physical activity counseling in primary care and family medicine residency training: a systematic review. BMC Med Educ. 2018;18(1):1-7. https://doi.org/10.1186/s12909-018-1268-1
Cusano R, Busche K, Coderre S, Woloschuk W, Chadbolt K, McLaughlin K. Weighing the cost of educational inflation in undergraduate medical education. Adv Heal Sci Educ. 2017;22(3):789-96. https://doi.org/10.1007/s10459-016-9708-3
Drost JM, Lucas PH, Patchett DC, Hatley MR, Johnson DC, Scales R. Introducing lifestyle medicine within the Mayo Clinic Alix School of Medicine in Arizona. Am J Lifestyle Med. 2021;15(6):612-8.
https://doi.org/10.1177/15598276211007824
Trilk JL, Worthman S, Shetty P, et al. Undergraduate Medical Education: Lifestyle Medicine Curriculum Implementation Standards. Am J Lifestyle Med. 2021;15(5):526-30.
https://doi.org/10.1177/15598276211008142
Canadian Institutes of Health Research. Knowledge translation [Internet]. 2019. Available from: https://cihr-irsc.gc.ca/e/29529.html [Accessed on Aug 27, 2020].
Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: Time for a map? J Contin Educ Health Prof. 2006;26(1):13-24.
https://doi.org/10.1002/chp.47
Munce S, Kastner M, Cramm H, et al. Applying the knowledge to action framework to plan a strategy for implementing breast cancer screening guidelines: an interprofessional perspective. J Cancer Educ. 2013;28(3):481-7. https://doi.org/10.1007/s13187-013-0490-0
Dagnone D, Stockley D, Flynn L, et al. Delivering on the promise of competency based medical education - an institutional approach. Can Med Educ J. 2019;10(1):e28-38. https://doi.org/10.36834/cmej.43303
McKimm J, Jones PK. Twelve tips for applying change models to curriculum design, development and delivery. Med Teach [Internet]. 2018;40(5):520-6. https://doi.org/10.1080/0142159X.2017.1391377
Légaré F, Zhang P. Barriers and facilitators: strategies for identification and measurement. In: Straus SE, Tetroe J, Graham ID, editors. Knowledge translation in healthcare: Moving from evidence to practice [Internet]. 2nd ed. John Wiley & Sons, Ltd.; 2013. p. 121-36. Available from: http://books.google.com/books?hl=en&lr=&id=08o7iuBlr0kC&oi=fnd&pg=PA121&dq=Subsection+3+.+3+Barriers&ots=VFCpULijUQ&sig=6Loq9v7wI7cq8T_6Nh-RDKuMstQ
Rogers EM. Diffusion of Innovations. 5th ed. New York, NY: The Free Press; 2003.
Frank JR, Snell LS, Cate O Ten, et al. Competency-based medical education: Theory to practice. Med Teach. 2010;32(8):638-45. https://doi.org/10.3109/0142159X.2010.501190
Queen's University School of Medicine. Undergraduate medical education competency framework: curricular goals & competency-based objectives [Internet]. Kingston, ON; 2018. Available from: https://elentra.healthsci.queensu.ca/assets/documents/redbook.pdf
Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach. 2007;29(7):642-7. https://doi.org/10.1080/01421590701746983
Veale P, Busche K, Touchie C, Coderre S, McLaughlin K. Choosing our own pathway to competency-based undergraduate medical education. Acad Med. 2019;94(1):25-30. https://doi.org/10.1097/ACM.0000000000002410
Caccia N, Nakajima A, Kent N. Competency-based medical education: the wave of the future. J Obstet Gynaecol Canada [Internet]. 2015;37(4):349-53. http://dx.doi.org/10.1016/S1701-2163(15)30286-3
Biggs J. Enhancing teaching through constructive alignment. High Educ. 1996;32(3):347-64. https://doi.org/10.1007/BF00138871
Kulasegaram K, Mylopoulos M, Tonin P, et al. The alignment imperative in curriculum renewal. Med Teach [Internet]. 2018;40(5):443-8. https://doi.org/10.1080/0142159X.2018.1435858
Carraccio C, Englander R, Van Melle E, et al. Advancing competency-based medical education: a charter for clinician-educators. Acad Med. 2016;91(5):645-9. https://doi.org/10.1097/ACM.0000000000001048
Shelton PG, Corral I, Kyle B. Advancements in undergraduate medical education: Meeting the challenges of an evolving world of education, healthcare, and technology. Psychiatr Q. 2017;88(2):225-34. https://doi.org/10.1007/s11126-016-9471-x
International Association of Medical Colleges. LCME accreditation standards [Internet]. Available from: https://www.iaomc.org/lcme.htm
Brannan M, Bernardotto M, Clarke N, Varney J. Moving healthcare professionals - a whole system approach to embed physical activity in clinical practice. BMC Med Educ. 2019;19(1):1-7. https://doi.org/10.1186/s12909-019-1517-y
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Tamara L Morgan, Theresa Nowlan Suart, Michelle S Fortier, Jennifer R Tomasone
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.