Two residents can complete the same rotation and come away with very different learning experiences. One may receive close observation, useful questions and specific feedback. Another may complete a demanding workload with little discussion of their performance. A curriculum review needs to examine how the programme makes learning opportunities available throughout clinical work.
An analysis of Sudan’s internal medicine residency curriculum found clear objectives, organised content and defined management, alongside areas needing improvement in teaching, assessment and the learning environment. The study used document analysis guided by Harden’s Ten Questions. Its findings concern the planned curriculum of one programme.
Harden’s framework examines how a programme’s needs, objectives, content, teaching, assessment, communication, environment and management fit together. Applied to residency, this invites a practical line of inquiry. If a rotation promises development in clinical reasoning, where will residents explain their decisions? Who will observe them? What information will help the supervisor judge progress? Tracing these connections makes the educational purpose of a placement easier to examine.
The paper proposes making the review more specific through a guiding competency framework, content defined for each training year, entrustable professional activities and developmental milestones, and preparation of training staff. Together, these prompts direct attention to progression: the responsibilities a resident is preparing to take on and the support needed to reach the next stage.
Assessment can provide evidence from everyday practice. Research on the mini-clinical evaluation exercise, or mini-CEX, examined residents’ performance across different clinical settings and patient problems, including interviewing, examination, clinical judgement and professionalism. An illustrative application would be to observe a focused part of a consultation, discuss the resident’s reasoning and agree on one improvement to revisit. A later encounter could then explore whether the resident has addressed that point. This gives feedback a purpose beyond recording a score.
The conditions for teaching also deserve scrutiny. WFME’s 2015 postgraduate standards call for time for teaching and supervision, development of trainers, and feedback from those providing and receiving training. A programme reviewing these conditions could ask how observation fits into the working day, who provides supervision when the usual trainer is absent, and whether residents can raise learning concerns safely. The answers help identify responsibilities that need clearer organisation.
Consider a ward-round teaching plan. Before the round, a supervisor could identify a focused learning aim with the resident. Afterwards, they could briefly review one decision and its reasoning. This is a proposed teaching arrangement whose feasibility should be tested locally: the team would need to consider workload, patient needs and available supervision.
A focused review could start with one rotation, comparing its stated learning opportunities with resident feedback, supervisors’ observations and assessment records. Each identified gap should lead to a named responsibility and a practical change. Reviewing that change with residents and trainers would help establish whether the learning opportunity had become part of routine practice.
Read the full paper on curriculum analysis in clinical residency training.