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Teach Learn Med. 2020 Feb 24:1-9. doi: 10.1080/10401334.2020.1724791. [Epub ahead of print]

Development of Learning Objectives to Guide Enhancement of Chronic Disease Prevention and Management Curricula in Undergraduate Medical Education.

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Medical Education Outcomes, American Medical Association, Chicago, Illinois, USA.
Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Department of Humanities, Health & Society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA.
Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA.
Department of Family and Community Medicine and Department of Education Resources, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.
Departments of Medicine and Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Improving Health Outcomes, Chronic Disease Prevention, American Medical Association, Chicago, Illinois, USA.
Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Department of Psychiatry and Neurology, University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA.
Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA.
Department of Medical Education, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA.
Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.


Phenomenon: Chronic disease is a leading cause of death and disability in the United States. With an increase in the demand for healthcare and rising costs related to chronic care, physicians need to be better trained to address chronic disease at various stages of illness in a collaborative and cost-effective manner. Specific and measurable learning objectives are key to the design and evaluation of effective training, but there has been no consensus on chronic disease learning objectives appropriate to medical student education. Approach: Wagner's Chronic Care Model (CCM) was selected as a theoretical framework to guide development of an enhanced chronic disease prevention and management (CDPM) curriculum. Findings of a literature review of CDPM competencies, objectives, and topical statements were mapped to each of the six domains of the CCM to understand the breadth of existing learning topics within each domain. At an in-person meeting, medical educators prepared a survey for the modified Delphi approach. Attendees identified 51 possible learning objectives from the literature review mapping, rephrased the CCM domains as competencies, constructed possible CDPM learning objectives for each competency with the goal of reaching multi-institutional consensus on a limited number of CDPM learning objectives that would be feasible for institutions to use to guide enhancement of medical student curricula related to CDPM. After the meeting, the group developed a survey which included 39 learning objectives. In the study phase of the modified Delphi approach, 32 physician CDPM experts and educators completed an online survey to prioritize the top 20 objectives. The next step occurred at a CDPM interest group in-person meeting with the goal of identifying the top 10 objectives. Findings: The CCM domains were reframed as the following competencies for medical student education: patient self-care management, decision support, clinical information systems, community resources, delivery systems and teams, and health system practice and improvement. Eleven CDPM learning objectives were identified within the six competencies that were most important in developing curriculum for medical students. Insights: These learning objectives cut across education on the prevention and management of individual chronic diseases and frame chronic disease care as requiring the health system science competencies identified in the CCM. They are intended to be used in combination with traditional disease-specific pathophysiology and treatment objectives. Additional efforts are needed to identify specific curricular strategies and assessment tools for each learning objective.


Undergraduate medical education; chronic care; health systems science; modified Delphi; prevention

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