“No Fear” Curricular Change

PURPOSE: To assess the effect of the W. K. Kellogg Foundation's five-year (9/91 to 9/96) primary care curricular change initiative involving seven sites and 27 schools with respect to courses offered, graduates' specialty choices, and valued school features (e.g., reputation, research, productivity, school climate) and to track how well the schools possessed or developed the processes associated with enduring curricular change. METHOD: Information was collected via pre- and post-surveys of faculty and students, site visits, annual reports, and medical students' specialty match results. RESULTS: In general, the schools either possessed or developed the institutional, curricular design, and curriculum features associated with successful curricular change. Further, the initiative had a positive or neutral impact on most of the valued features: 199 courses were revised or developed, including 138 offered in the community, involving 141 interdisciplinary faculty. Comparing 1991-1997 data, the average percentage increases in students' selecting primary care from the involved schools were greater than the national percentages. In 1997, a larger percentage of project school graduates selected primary care than the national average. CONCLUSION: Medical schools can make major curricular changes and achieve intended outcomes (e.g., new and/ or revised courses, multidisciplinary instruction, instruction in the community, and changes in specialty choice), and this can occur without negatively impacting other valued school aspects.