Undergraduate medical curricula are required to change and evolve in order to reflect the evolving and changing needs of contemporary medical practice. Making substantial changes to the form and delivery of medical education is challenging. While there is a growing body of research that focuses on curriculum change, relatively little attention is given to the notion of curriculum reform as a process rather than an outcome. In addition, the buildings and learning spaces where curriculum reform and undergraduate medical education are enacted contribute to people's experiences of these spaces. However, this aspect of context is currently neglected in the medical education literature. This thesis investigates the influences, vision, intentions and unintended consequences associated with an undergraduate medical curriculum reform and how the learning place and space of the medical school (where a curriculum is translated) is understood and experienced by key stakeholders (e.g., building designers, teaching faculty and students). Ontologically and epistemologically grounded within the social constructivist paradigm, the overall thesis aim was achieved through four overlapping empirical studies. Using a qualitative exploratory case study approach, data were gathered from document analysis, interviews and focus groups, and enriched by different theoretical concepts. Findings demonstrated that both (re)designing a medical curriculum and the learning space and place where reform is enacted and where teaching and learning occur is extremely complex, multifactorial and shaped and impacted by a myriad of influences and external and internal drivers for change; influenced by numerous voices and differing opinions and perspectives, different values systems, local traditions, history, geographical location and overall context. Finally, as a contribution to scholarship, the collective findings in this thesis advances our understanding of the complexities and unintended consequences associated with curriculum reform and the space and place of learning.

Men die earlier than women in the majority of the countries in the world, including Canada. Men also seek medical care less frequently than their female counterparts and often rather late in the stage of their disease. As well, family physicians traditionally have had very poor, if any, training in male health issues during their residency training. This is true for Canadian family physicians, but also for most family physicians in the world. A literature search was performed to evaluate the training in male health issues around the world. There appears to be a scarcity of literature on this topic. An assessment was conducted to determine how much male health training is delivered in Canadian Family Medicine Residency Training Programs. It turned out to be none to very little in these programs. At the same time, a needs assessment was conducted to determine the need for male health training in these programs and what the content of such training should be. Based on the information obtained through this needs assessment, a draft male health curriculum was created and circulated to an Expert Panel for their critique. The feedback of the Expert Panel was then incorporated into the final version of a proposed curriculum on Male Health for Family Medicine Residency Training Program.

Introduction: CardioPulmonary Resuscitation (C.P.R.) is a critical clinical intervention widely recognised (Laws, 2001) to evoke stress in attending clinicians. Little is known about how junior clinicians (doctors) understand their early experiences in performing C.P.R., or whether their preparation could be improved. Problem: Undergraduate medical students have traditionally reported anxiety (Duns et al., 2008) at participating in CardioPulmonary Resuscitation. A recent systematic review of best practice in C.P.R. education focused on clinical knowledge and skills, but not emotional preparation (Mosley et al, 2012). No study has critiqued whether doctors’ pre-qualification anxieties align with their clinical reality. Less is known about the extent of their post hoc support needs. Methodology: Previous studies of doctors’ experience (Morgan and Westmoreland, 2002) have used exclusively quantitative data collection. Early qualitative data on young nurses’ experience of C.P.R (Ranse and Arbon, 2008), which used a focus group method, has identified: the experience of a chaotic environment; inadequate post-C.P.R. debrief; and unrealistic rehearsal in training. This qualitative study has used 1:1 interviewing and a Philosophical Hermeneutic (Gadamer 1975) lens to explicate how young doctors experience (and make sense of) their early attempts at C.P.R. The sociological framework of Symbolic Interactionism (Blumer, 1969, Charon, 2010, Mead, 1934) was deployed to offer a human interaction based interpretation of participants’ accounts. An experiential learning theory (Jarvis et al., 2003) offered further insights into the dimension of experiential learning. 3 Results: Eighteen participants were interviewed over 18 months. Using NVIVO 9 software, a thematic analysis technique, and a hierarchical analysis ladder (Spencer et al., 2003), four major themes were identified: 1. Current C.P.R. education is, at a skills and knowledge level, comprehensive and adequate. 2. Simulation rehearsal practises higher responsibilities than those clinically experienced, and usually fails to accommodate the “ambient” conditions of the real event. 3. C.P.R. offers novice clinicians a variety of experiential learning opportunities about leadership and about professional expectations of personal resilience (stoicism) as a doctor. 4. Participant support needs are usually unique, contextually generated, and largely unrecognised. Almost invariably unidentified, these needs reflect a variety of emotional states experienced during C.P.R.: surreality; exhilaration; satisfaction; or distress. Implications: This study has demonstrated the feasibility of 1:1 interviewing to generate deep, rich and granular accounts. Analysis through the lenses of Philosophical Hermeneutics, the sociological framework Symbolic Interactionism and the revised experiential learning theories of Jarvis offered unique perspectives and understandings of these experiences. The influence of “ambient” contextual conditions during C.P.R. has been partially, though not exhaustively, explicated. Whilst educational rehearsals should attempt simulation of reality, not all realities can be simulated. Post hoc support needs are unrecognised and educational responses unquantified. A modern duty of care to staff should require high quality interventions in three areas: pre hoc preparation; intra hoc conduct; and post hoc support.

Made available in DSpace on 2016-04-27T16:57:20Z (GMT). No. of bitstreams: 1 Gastao Rubio de Sa Weyne.pdf: 3029917 bytes, checksum: 68293006e4323a48923cbe0c40aafbf2 (MD5) Previous issue date: 2012-10-01 / This work aims the identification, analysis and discussion about the epistemological obstacles presented when it is questioned the resistance for inclusion, in the curriculum, in the medical courses of mathematical subjects as Biomathematics, Bioinformatics. Simulation, Mathematical Models and Optimization. Based on mixed criterions of antiquity, tradition, conservativeness , positive evaluation from official agencies, press information, opinions of medicine educators and texts from consecrated books of history of medicine, was studied the programs of six faculties of medicine of Brazil and sixteen faculties og medicine of some developed countries, being verified tha Biostatistics is accepted for all this faculties. The epistemological obstacles are from historic origin or proceeding for old and wrong knowledge, curriculum structures, educators, concerned to profile of future physicians, traditionalism, conservativeness, corporative spirit, ideology and relations of power. It was adopted, as base for orientation, the studies of Brousseau, founded on Bachelard, about the epistemological obstacles. It is give a proposal about the medicine curriculum, including Biomathematics in the first year and Mathematical Models, together Biostatistics in the second year in the courses of medicine / Neste trabalho procura-se identificar, analisar e discutir os obstáculos epistemológicos que se apresentam quando se questiona a resistência à inclusão, nos currículos dos cursos de Medicina, de disciplinas que abordem conteúdos de Matemática, como Biomatemática, Bioinformática, Simulação, Modelos Matemáticos e Otimização. Com base em critérios mistos de antiguidade, tradição, avaliações positivas de órgãos oficiais, conceito junto à mídia, opiniões e professores de Medicina e informações extraídas de consagradas obras de História de Medicina, foram estudados os currículos de seis Faculdades de Medicina do Brasil e dezesseis Faculdades de Medicina de alguns países desenvolvidos, constatando-se que a disciplina Bioestatística é amplamente aceita. Os obstáculos epistemológicos encontrados são de origem histórica ou oriundos de conhecimentos anteriores equivocados, relativos a estruturas curriculares, professores, perfil do formando, tradicionalismo, conservadorismo, corporativismo, critérios, desequilíbrios, ideologia e relações de poder. Adotou-se, como base de orientação, os estudos de Brousseau, fundados em Bachelard, sobre os obstáculos epistemológicos. Como proposta de currículo sugere-se a inclusão da disciplina Biomatemática no primeiro ano do curso de Medicina e da disciplina Modelos Matemáticos em Medicina, a ser ministrada no segundo ano do aludido curso, juntamente com Bioestatística