The well-known SPICES model to signify modern medical education was published in 1984. Is it time to revisit the model?
Thirty years ago, in 1984, Harden, Sowden & Dunn(1) published the seminal article Educational Strategies in Curriculum Development: the SPICES model in Medical Education. The significance of this paper was not that the authors presented many new insights. Indeed, most of the curriculum developments that the acronym of SPICES summarizes had been documented in the 1970s or earlier. Nevertheless, the brilliance of combining these developments in one acronym has helped medical educators around the world to explain and remember what was meant with ‘modern medical education’ in 1984.
For those who are not aware of the six features, here’s the list in its original wordings: Student-centred; Problem-based; Integrated; Community-based; Electives; Systematic [clinical teaching]. The authors presented these features as contrasting with six ‘traditional’ opposites: teacher-centred; information gathering; discipline-based; hospital-based; standard program; apprenticeship based or opportunistic. The article is carefully balanced, presenting arguments pro and con, both for the SPICES and for their antagonists. Yet the SPICES have proven a fairly accurate depiction of what schools would consider modern education; space does not allow me the expand on this much here, but even today many medical educators would agree that a student-centred, integrated and problem oriented curriculum with electives and focused on community –based health care with systematic clinical teaching methods would signify a relatively modern curriculum.
Recently, I used the SPICES model successfully to discuss the modernization of undergraduate medical education in countries of the eastern European neighbouring area, that were once Soviet countries. This “MUMEENA” project, with 10 institutions and seven countries involved, led by the University of Leeds, is now finishing with a number of significant improvements. So thank you Ronald Harden and colleagues for providing this tool. Meanwhile, is in not odd that after thirty years and thousands of publications in the medical education literature about new developments, SPICES would still be the hallmark for modern medical education? Have we not proceeded? I would like to say: yes and no.
I firmly believe that the SPICES model in its original form has lost little of its strong value. But of course we have progressed. The letters have been used with different meanings to show development, even by Harden (2,3), and I regret that. Rather, we might think of newer developments that can be placed on top of the SPICES model, or added as new ingredients – for a richer flavour. The peculiar thing is, when I started thinking of these new developments, SPICES kept coming back as an unavoidable acronym. So why not talk about new SPICES? SPICES 2.0 would sound like this. S - simulation-based preparation for practice; P - portfolio-based monitoring; I - individualized workplace learning; C - competency-based education; E - electronic media support; S - structured workplace assessment. Each of these, and anyone can think of the related antagonists, were not or hardly present in medical education in 1984. Many modern schools now however show most of these features.
My proposal may be questioned as still other words could fill the SPICES letters. E.g., Interprofessional education has been suggested as the I, but I believe that the introduction of interprofessional education, how desired and necessary it may be, still needs a way to go before it can be signified as a standard for modern education. Who knows that 30 years further we will have a SPICES 3.0. model? This SPICES 2.0 reasoning has been described more extensively in a book that resulted from the MUMEENA project and that is currently being prepared for publication.
1. Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development: the SPICES model. Med Teach. 1984;18:284–97.
2. Dent J, Harden R, editors. A practical guide for medical teachers. 3rd ed. Edinburgh: Churchill Livingstone Elsevier; 2009.
3. Harden RM, Laidlaw JM. Essential skills for a medical teacher. An introduction to teaching and learning in medicine. 1st ed. Edinburgh: Churchill Livingstone Elsevier; 2012.