Evaluating the medical curriculum: Bias, problems, solutions.

Medical school curriculums have increasingly shifted to an integrated curriculum and have been replacing lecture with 'flipped classroom' approaches. Analyses of the benefits of the integrated curriculum and flipped classroom model typically report enhanced student performance. However, the question is whether institutional self-evaluation of curricular success is biased to demonstrate success that may not objectively exist and/or whether such biased data are presented during Liaison Committee on Medical Education (LCME) site visits. An objective determination of curricular effectiveness requires an absence of bias and of efforts to put an institutional 'thumb on the scale' to obtain desired results. In addition, bias may exist in the rationale for implementing these curricular changes in the first place; these can include, for example, with respect to career advancement as well as ideological motivation. Thus, in this paper I examine potential problems with institutional bias with evaluation of curriculum and how to overcome these.