Capturing curricula.

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MEDICAL SCHOOL EDUCATIONAL LEADERS ARE ACcustomed to frequent survey requests about curriculum content. The range of topics involved provides a window into various pressures for curricular content from within and outside the profession, reflecting changes in medical knowledge, technology, or the social context in which medicine is practiced or sometimes seemingly motivated more by popular or political currency. In the midst of the last decade, for example, there was considerable interest in the teaching of bioterrorism—to some extent appropriate to a need for readiness on the part of physicians but likely also aimed at better positioning the academic medical community for public approval and funding. Another survey a few years ago explored the teaching of biological evolution in medical schools. Taken together, perhaps as a meta-analysis of published information through the years, there would be a great deal to learn from these studies about the evolution of medical curricula and their responsiveness to shifts in cultural norms. The study reported by Obedin-Maliver and colleagues in this issue of JAMA provides useful information about curricular content at North American medical schools as it relates to the care of lesbian, gay, bisexual, and transgender (LGBT) people. There seems little question that survey respondents see LGBT issues as deserving of more attention in medical education. When evaluating the overall quality of their curricula, 70% responded “fair,” “poor,” or “very poor.” Given that deans’ offices receive multiple similar survey requests each month and necessarily pick and choose those to which they wish to devote time, the 85% response rate alone is indicative of a high level of interest. The findings that these leaders report students’ opportunities to learn about LGBT issues inadequate, would find it helpful to have more generally available curricular materials, and wish the faculty were more willing to teach in these areas are perhaps the most compelling aspects of the study. This snapshot of LGBT-related education seems to indicate missed educational opportunities that are important to medical students. At the same time, it illustrates one of the problems inherent in ad hoc survey methods for assaying medical school curricula. According to the primary outcome measure of hours of curricular instruction, LGBTrelated content, to the extent it is offered, is predominantly found in the first 2 curricular years. This approach may well overlook significant learning opportunities in the clerkship years in which didactic sessions might not even be indexed in the main school curricular database in sufficient detail to capture, for example, portions of a presentation about sexually transmitted infection prevention that addresses women having sex with women. Even in the preclinical environment, the most effective student learning about LGBT issues is likely incorporated into a problembased learning case or brought into a formative exercise with standardized patients in a clinical skills course. These learning opportunities are difficult to tally as “hours.” The authors acknowledge all this but defend their method by noting the ubiquity of its use, past and present. In 1999, the Association of American Medical Colleges (AAMC) introduced its Curriculum Management and Information Tool (CurrMIT), a relational database intended as a central repository of information on medical school curricula serving various needs in curriculum development, research, and tracking of national trends. CurrMIT remains a work in progress, useful in accessing very basic information about curricular structure and content but unable to compete for schools’ attention with the various commercial and locally developed systems that more directly address institution-specific needs, and therefore not fully embraced. The AAMC curriculum inventory portal (CIP), now under development, involves a more comprehensive interface with local systems and may provide significant enhancements in cross-institutional benchmarking and educational research and more robust means of answering questions like those pursued in the study by ObedinMaliver et al. Eventually, the CIP project hopes to link core competencies, learning objectives, curricular content, and assessment strategies across the continuum of medical education. Eventually it may also be possible to explore curricular trends over time—of interest not only to historians of medi-