The difficulty of sustaining curricular reforms: A study of "drift" at oneschool

In 1997, five years after a major curricular reform at the University of Mi chigan Medical School, the authors revisited the Goals for Medical Educatio n (written by faculty to guide the reform process) to identify factors that had facilitated or hindered their achievement. By reviewing responses to i dentical questionnaires circulated to faculty in 1993 and again in 1997, th ey learned that considerably more lectures were being used to deliver curri cular content in the first-year curriculum than the faculty thought was ide al, and that less social science, humanities, and ethics material was being presented in the first year than the faculty thought was ideal. The author s also learned that consensus between faculty basic scientists and faculty clinicians about the content that would make up an ideal first-year curricu lum had diverged since adoption of the new curriculum. Movement toward decr easing the amounts of social sciences, humanities, and ethics in the first year of medical school was particularly pronounced among the basic scientis ts, who felt this material was being taught prematurely and at the expense of essential basic science content. In contrast, by 1997 much closer agreem ent had developed between the two groups regarding time they would allocate for lectures; this agreement unfortunately reflected a stagnation in the a doption of active learning methods. Movement toward increasing the amount o f time for lectures in the first-year curriculum was particularly pronounce d among the clinicians, who reported feeling more and more pressured to bri ng in clinical revenues. Based on faculty comments and the school's experience with centralized gove rnance and centralized funding, the authors propose a direct linkage betwee n institutional funding to departments and the teaching effort of faculty i n the departments, and sufficient, centralized funding to relieve pressure on faculty and to foster educational creativity. They maintain that this ma y be the most effective way to guarantee ongoing innovation, support interd isciplinary teaching, and subsequently move the curriculum and teachers com pletely away from content that is isolated within traditional department st ructures. At the same time they acknowledge that changing faculty attitudes presents a challenge.