Content Integration Changes

This subsection reports out findings shared from both interviews and open-ended survey responses regarding faculty experiences. These findings answer the research sub question asking what has been most effective and most challenging about change. This feedback focuses on the most recent content integration initiative, when the first-year basic science courses came together to form the year-long modular-based PrISM course.

Most Effective Aspects of Content Integration

Instructors identified benefits for both students and themselves. Some have very positive things to say and write about the integration initiative when it comes to these outcomes, but as we will see in the section that follows, there was substantial critical feedback shared surrounding this initiative. First, this review on the most effective aspects and strengths of content integration.

Faculty reported they think it is better for students to learn about all aspects of a topic at one time rather than in the past when they may first understand one aspect about a topic, such as how a piece of the anatomy looks early on, but they wouldn’t understand how it works until a few months later, and then even later they would learn what happens if something goes wrong in the body. It also empowers students to be more self-directed and puts the onus of their learning on themselves and encourages it to be applied instead of just memorized:

I think it allowed the students to take a little bit more ownership of the material. They were expected to interact with it a little bit more, make it their own a little bit earlier on and apply it. I think that helped to motivate them to see how the material was important and to figure out whatever way is best for them to learn the material. And for the faculty to get a better sense earlier on, about what was working or what was problematic. I think it was earlier feedback both ways, both the students and for the faculty.

in context which makes linkages more evident and help students better understand why various topics are so important beyond memorization for exams.

For faculty-related benefits, repeatedly instructors observed that the most valuable aspect of content integration was motivating faculty from different disciplines to really work together and interact in ways they hadn’t been afforded before. They felt it was very helpful and beneficial to sit down in a room full of colleagues teaching a multitude of disciplines covering various aspects of an organ system or topic and get different perspectives. Several mentioned that this leads to creating a better-designed curriculum and helps break through the patter of everyone operating and teaching in their own little bubble or silo.

It was useful to me to have exposure to other disciplines which enriches my own teaching and to be able to refer to something that another faculty member said is good. It's good for continuity.

Most Challenging Aspects of Content Integration:

Participants were not shy giving feedback in this area, yet kept their comments and notes professional. Instructors offered constructive feedback in an effort to reflect back on lessons learned and what they hope may go differently in future changes. Quotes in this section, like all sections, include both interview transcripts as well as written responses to open-ended survey questions.

These challenges are around the integration of the pre-clerkship courses into two year-long integrated courses. The loudest challenge heard in both interviews and surveys centered around the top-down approach of the decision to integrate the first-year

curriculum into one, long course without adequate time and resources to ensure its success.

If you want this type of pedagogical approach, then you have to support it, you can't expect people to do something with nothing. And that seems to be the age old approach around this place, I would say that's probably my biggest frustration, is wanting the newest shiniest thing for the students, but not being willing to invest in what it takes to develop that newest, shiniest thing. That's frustrating.

Comments were made about wishing there had been an opportunity for all instructors to be able to provide input and have a voice in the decision before it was made. Most module directors only had the opportunity to provide input after the decision was made. Some felt they ultimately would have been in favor of the decision, but there was resentment about not being allowed to be a part of it.

Respondents shared strong opinions about changes which are sometimes forced from administrative leadership to copy what other medical schools are doing, yet they would like to see more evidence-based research demonstrating why the change is needed. Some worry about jumping on fads that will be popular today but may be gone tomorrow.

Many also expressed that there is little funding, support, or adequate resources to ensure that these types of systematic changes happen most effectively, and that the

redesign for the content integration happened too quickly. Faculty members needed to put in a great amount of time and effort to get the integration design completed and

students) that the decision happened in such a manner, regardless of the need to implement with time to adjust before the next LCME accreditation.

From above there was a strict time limit set, which we all were a little bit miffed about. Change is one thing, but limited time and resources was definitely another issue here.

Module directors wished for more involvement in the decision with bigger opportunities to provide input. They did not feel there was enough reflection from all.

A general lack of communication and demanding mandates from the school/administration to implement change, without consultation of the faculty is an ongoing issue. Our transition to PrISM was marred by administrative overreach and an unrealistic timeline. This significantly overburdened the faculty and limited the amount of actual, beneficial change that was achieved.

Some instructors reported that they had experiences with other large redesigns, either in other Boston University programs or external programs, which were far more inclusive. Groups had full-day retreats where all instructors were invited before actual decisions were made and there was an open forum to discuss the potential facilitators and barriers to changes. This allowed for well-informed decisions after hearing input from multiple perspectives.

In this case, several instructors felt that too many decisions were made at an administrative leadership level behind closed doors and that they were asked for input only after over-arching decisions to implement this new curriculum had been made.

Some expressed resentment about this as well as about how the leadership team was chosen. Multiple respondents commented that there was no explanation provided about strategy for the initiative, or the why behind it. Many mentioned or wrote about their confusion regarding why two of the three co-directing leaders were from the same department, and there was initially no representation from another larger department. (Note: this has changed since the initial implementation in 2015). Still, some express that the overall culture is political and wish for more transparency, better communication around the vision and goals, as well as researched evidence to back large shifts affecting the direction of the curriculum.

It happened very quickly. It happened without any reflection. All of a sudden, we were given, we were told there was going to be a new course and we were told who the leadership was and the leadership had two [module directors from the same department].

Several expressed frustration with the one-size-fits-all approach taken to reduce lecture content. They seemed to understand that this was the only approach that could be applied in the very small window to design and implement these changes for the next academic year, yet others from various departments expressed a level of unfairness with the approach and would have liked to have been afforded more time to carefully and systematically look at all content in all courses and piece together a puzzle of the curriculum more collaboratively.

They took a very blanket approach. In some modules, that shouldn't have had content cut, they had their 10-15% in other modules that could have

had 20% or 30% cut, they also only cut 10% or 15%. As opposed to taking a more appropriate approach. I think that came out of the time limit. It takes time to look at that effectively and figure out what's going to work best and see how that's all going to fit in the big block schedule, and we just did not have the time to do it. It was, "okay, this is what you've got; you need to make it smaller by this much.”

This section documented recurring themes that came up in the three threads, and others will be discussed on their implications in Chapter Five. The next section describes what faculty had to report about goals of recent and upcoming changes to BUSM

curriculum and what they would recommend for successful future change initiatives.

4.5 Goals of Recent/Future Changes & Faculty Recommended Best Practices