This paper aims to describe an outcome-based curriculum development process at a medical school that has difficulty in advancement from the higher stage outcomes to the individual lesson outcomes, and to propose a way to implement it practically.

We reviewed the objectives, strategies and previous products of the school's taskforce activities and suggested the principle of bidirectional approaches of outcome based curriculum development.

The developing strategy identified such as firstly, the evaluation of present curriculum and then, the review of the outcomes developed previously with considering the nation-wide environmental change in medical education. Then, we selected one example course which was focused the resources of the school to, and finally the product of the example course was propagated to the other courses with central monitoring.

Bidirectional model of ‘Top-down’ plus ‘Bottom-up’ approaches could be an efficient way to develop the outcome-based curriculum in a medical school, which has difficulties to advance the developing process due to various reasons including limited resources.

Undergraduate medical students should learn oral presentation skills, which are central to physician-physician communication. The purpose of this study was to compare checklist scores with global ratings for evaluation of oral case presentation and to investigate interrater agreement in the scoring of checklists.

The study group included twenty-one teams of undergraduate medical students who did clerkship for 2 weeks in the department of Laboratory Medicine of Mokdong Hospital, School of Medicine, Ewha Womans University from January 2005 to October 2006. Three faculty raters independently evaluated oral case presentations by checklists, composing of 5 items. A consensus scores of global ratings were determined after discusssion. Inter-rater agreement was measured using intraclass correlation coefficient(ICC). As the ICC values approaches 1.0, it means higher inter-rater agreement.

The mean of consensus global ratings was significantly higher than that of checklists by three faculty raters(12.6±1.7 vs 11.1±2.0, P<0.001). Spearman's correlation coefficient between global ratings and checklist scores was r=0.82(P<0.01). The overall scores of checklist were significantly different among three raters (12.3±2.0, 10.8±2.8, 10.0±2.7, P<0.05). ICC values in the scoring of checklists were as follows ; for overall scores, 0.750 ; for individual checklist items, 0.350-0.753.

These results suggest that checklist scores by faculty raters could be one of the most useful tools for evaluation of oral case presentation, if checklist would be modified to make less ambiguous and more objective and faculty raters would have opportunities to be educated and trained for evaluation skills of oral case presentation.

Comparing with the traditional curriculum which provides mainly basic medical science training in the first 2 years, the early exposure to clinical medicine is a major trend of medical education through recent decades. However the timing, extent, content and methods of the 'early clinical education' are not defined clearly and the application is various. Preparing the transformation of the curriculum from undergraduate to graduate entry at Ewha medical school, the concepts of 'early clinical exposure' into our new curriculum needs to be clear. We want to decide how early and how deep and what contents of clinical knowledge and skills are to be introduced in the new curriculum.

Literature review. Interview with a developer and the participants of the 'early clinical education' curricula which has been applied in the Carver College of Medicine, University of lowa since 1998.

The early exposure of clinical knowledge and skills has been introduced world widely and many curricula have it as early as the very week of entrance. Problem based learning, standardized patient program, clinical skill labs and clinical mentoring, etc. are being used with various modification. Early clinical education enhanced the loaming interest and professional minds to the medical students as well as their achievements.

The early clinical education will be applied to the new curriculum of the graduate school of medicine starting 2007 in Ewha Medical School.