LAUSR

Like most young children I was fascinated by animal life and probably like most young children, I sadly ruined the life of many a poor creature by capturing it and keeping it hidden at home, studying it until it eventually perished or escaped. I kept tadpoles in a small pool in the garden and was fascinated to be able to see how they changed into frogs. I was equally fascinated by the life cycle of the butterfly, from egg to adult. What fascinated me most however was the chrysalis stage; what was going on inside? I wanted to see what was happening – how could something as ordinary as a larva change (metamorphose) into something as beautiful and completely different as the butterfly? In their opening editorial to this series of themed papers, Harden et al. (2018) likened the last forty years of Medical Teacher to the transition from chrysalis to butterfly and by reflecting on the change in medical education of the last 40 years of Medical Teacher, considered how we have attempted to gain an insight into what is going on within the chrysalis, and see what changes have or are occurring. When Wilkes and colleagues suggest in their paper that “an ideal model for training the next generation of physicians is within a high functioning, integrated health care delivery system where outcomes are defined by the health of the community served”, they present their own model of healthcare educationthey are describing what is happening in their own chrysalis and how their butterfly will look different to others (Wilkes et al. 2018). They suggest however that change is slow and the butterflies (health practitioners) we produce are not presently the right ones for the ever-changing and diverse societies we live in. I would suggest that most readers would agree with this need to change and produce quality practitioners ready for the twenty-first century. I think most would also find it difficult to argue against their comments related to the speed of delivery. One only has to look at just a few of the major changes that are believed to have influenced medical education to recognize the slow process of change. Despite their longevity of innovation, concepts such as Problem-Based Learning (Barrows and Tamblyn 1980), the Objective Structured Clinical Examination (OSCE) (Harden et al. 1975) and Social Accountability (Boelen and Heck 1995) are still being researched by many as to their overall value. Surprisingly these “innovations” are still absent in many medical curricula throughout the world. I would contest however, that change is occurring, albeit slowly. Progress is how you define it and any movement in a sustained positive direction is progress. To change, one has to change and to many faculty involved in curriculum design and development it must seem that they are sitting at the edge of a continuing explosion that is demanding change – an explosion of advances in medical science and a parallel but symbiotic explosion in medical education. Harden et al. (2018) draw our attention to this through the tremendous increase in medical education publications. From a scientific, societal, administrative, technology and research stance, change is occurring and we need to find newer ways of educating our potential and existing health force to match these new advances. Expectations of the users of the service, including patients are also changing; demands are high and frequently made higher by the popular press and social media. Mark Zuckerberg (co-founder of Facebook) presents these expectations as a specific goal when he states that, as a society “we can cure all diseases in our children's lifetime” (Zuckerberg 2016). Not only are we expecting the curriculum content to change but its supportive infrastructure as well. In their paper that takes a reflective look at the changing landscape of medical education in the UK, Brice and Corrigan call for a specific change towards those involved in medical education; “A stronger professional architecture to support careers in medical education is needed to ensure that those involved in teaching medical students and doctors have the necessary training, time, resources and incentives to do it effectively” (Brice and Corrigan 2010). To celebrate its 40 years in existence, Medical Teacher is running a series of themed papers that look at changes that have occurred in various curricula elements; the specific theme this month is curricula development and we have selected twelve papers, from around the world, that look at specific and significant changes in curricula over the past 10 years. Each paper shows commonality with the others whilst also describing their own unique approach to curriculum development. Out of the 12 papers presented, ten describe the changes that affect the whole curriculum, whilst the other two describe changes to specific elements of the curriculum. The paper by Arja et al. (2018) looks at the importance of evaluating the curriculum. Despite some of the small numbers used in this research, explained by the school being an offshore Caribbean Medical School, they clearly explore the change cycle and demonstrate the need for a