Curriculum design for primary care physicians.

A curriculum is a complex entity. Stenhouse' wrote that 'a curriculum is an attempt to communicate the essential principles and features of an educational proposal in such a form that it is open to critical scrutiny and capable ofeffective translation into practice.' In thinking about the development of education for general practice, it is necessary to consider a range of practical learning activities and to discuss how they fit together to contribute to the diverse range of knowledge and skills needed by a modern general practitioner. The educational aims for general practice training can be described broadly under five headings. The most important will always be to promote the high quality of patient care. Next it is essential to facilitate professional development and to equip the doctor with the ability to continue to learn new skills relevant to the developing requirements of general practice throughout his career. It is essential to encourage intellectual integrity and professional curiosity. Doctors need to remain alert and stimulated through many years of hard work and the challenge is to provide an educational climate that will contribute to the prevention of 'burn-out'. Finally attention must be given to encourage professional survival despite the stress of modern medical practice in a changing climate of political and economic difficulties. Medical students have always been required to memorize vast amounts of factual information, even though much of this information goes rapidly out of date. In their early clinical training, doctors need to concentrate on acquiring practical skills in dealing with patients, in performing medical procedures, in management and in many other spheres. Experienced doctors have to go on learning throughout their careers to stay in touch with medical progress. It is important to consider some educational premises before planning the content and methods to be included within the curriculum. Knowles2 has described some of the principles of adult learning. He suggests that adults desire and enact a tendency towards self-directedness although, at times, they may be very dependent on others. Adults' experiences are a rich resource for learning. They learn more effectively through experiential techniques ofeducation such as discussion or problem solving. Adults are sensitive to their specific learning needs generated by real life tasks or problems. Adult education programmes, he suggests, should be based around 'life application' categories and sequenced according to learners' readiness to learn. Finally he observes that adults are competencybased learners in that they wish to apply newly based skills and knowledge to their immediate circumstances. Adults are, therefore, performance centred in their orientation to learning.