"No fear" curricular change: Monitoring curricular change in the W. K. Kellogg foundation's national initiative on community partnerships and health professions education

Purpose. To assess the effect of the W. K. Kellogg Foundation's five-year ( 9/91 to 9/96) primary care curricular change initiative involving seven sit es and 27 schools with respect to courses offered, graduates' specialty cho ices, and valued school features (e.g., reputation, research, productivity, school climate) and to track how well the schools possessed or developed t he processes associated with enduring curricular change. Method. Information was collected via pre- and post-surveys of faculty and students, site visits, annual reports, and medical students' specialty marc h results. Results. In general, the schools either possessed or developed the institut ional, curricular design, and curriculum features associated with successfu l curricular change. Further, the initiative had a positive or neutral impa ct on most of the valued features: 199 courses were revised or developed, i ncluding 138 offered in the community, involving 141 interdisciplinary facu lty. Comparing 1991-1997 data, the average percentage increases in students ' selecting primary care from the involved schools were greater than the na tional percentages. In 1997, a larger percentage of project school graduate s selected primary care than the national average. Conclusion. Medical schools can make major curricular changes and achieve i ntended outcomes (e.g., new and/or revised courses, multidisciplinary instr uction, instruction in the community, and changes in specialty choice), and this can occur without negatively impacting other valued school aspects.