Curriculum DevelopmentCurriculum Development

Harvey J. Hamrick, MD

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UNC Department of Pediatrics

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Introduction

• Principles of curriculum development are essential to the design of effective educational experiences

• The curriculum for a course of instruction is the framework or educational map which directs the entire activity and ensures its success. It outlines a process whereby selected expertise is transformed into learner acquisition.

• Faculty members who plan educational activities need to be well versed in the basic principles of curriculum development. The purpose today is to present these principles in a concise and understandable manner.

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Process

• Curriculum development, like any other creative endeavor, starts with planning and organization. It requires that you think about why the proposed instruction is important and how it can be provided so that the intended learner outcomes occur.

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Process

• In medical education, a systematic process has evolved consisting of five steps which guide one in developing a competency-based curriculum. This is also referred to as an outcomes-based curriculum. The competencies/outcomes must be specifically articulated and individually addressed in terms of how the learner will acquire the desired knowledge, skill or attitude, and how acquisition of that competency will be measured or accessed.

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Process

• Adherence to such a process often does not occur. Faculty in charge of student, resident, or fellow training tend to resist such structure because it seems confining and does not reflect “how doctors learn”. Medical learning experiences (i.e. rotations, lectures, tutorials at the bedside, self study, etc.) often are presented in very general terms without much thought about specific outcomes.

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Process

Rationale for Resisting Curriculum Development

• Competency in medicine requires the highest level of interpersonal, cognitive, and procedural skills in the context of an ever changing and expanding knowledge base. Therefore, time spent in creating rigid competency-based curricula is not a good investment

• Faculty know what learners need. Therefore, faculty are expected to point out, teach, and model for learners the important knowledge areas, attitudes, and skills. Learners are expected to pick up on the cues (i.e. take responsibility for their own education) and thereby become proficient.

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Process

Rationale for Resisting Curriculum Development

• Faculty know whether or not a learner is progressing appropriately by observing and working with the learner in the clinical arena.

• Objective tests are a good backup method of assessment.

• There is no hard evidence that well designed curricula give better results than “traditional” approaches to teaching in medical settings.

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Process

• Accreditation requirements are mandating change and the expectation is that each curricular component (i.e. clinical rotation, lecture series, required experience) within a training program will have a competency-based curriculum so that faculty and learners know what is expected. In that light, faculty knowledge of the steps involved in planning instructional experiences is important.

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Process

Clarification of Terms and Concepts

• Competency-based curriculum: A curriculum where intended learner competencies are stated as specific learning objectives. Each objective is linked with a plan which describes how it will be acquired and how acquisition will be measured.

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Process

Clarification of Terms and Concepts• Six Core Competencies of the ACGME:

The intent of the ACGME is for the Core Competencies to constitute a central theme throughout a residency curriculum. There is a major national emphasis on developing innovative assessment tools to enhance the role of the Core Competencies in medical education.

Patient Care (PC) Professionalism (P)

Medical Knowledge (MK) Practice-based Learning (PBL)

Interpersonal & Communication Skills (I&CS)

Systems-based Practice (SBP)

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Five Steps in Planning a Course of Instruction

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Step 1: Needs Assessment

• Why is this instruction important?

• What is its priority among competing needs?

• Who are the learners?

• What level of preparation will be required of

learners?

• What are the desired outcomes?

• How will success be measured?

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Step 2: Goals and Objectives (G&Os)

• Rationale for developing G&Os

►G&Os are the educational steps which define the content and outcomes

►G&Os provide an organizational framework for the content

►G&Os provide conciseness and clarity to learner expectations

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Step 2: G&Os

• Basics of Developing G&Os►Start with an “Overall Educational Goal” ►Develop specific learning objectives which relate to

the “Overall Educational Goal”.►Each objective should consist of a concise

statement►Use active verbs like “apply” rather than

“consider how one would use” or “describe” rather than “be familiar with”.

►Limit the number of objectives to those which can be accomplished within the timeframe of the course

►Link each objective with specific teaching methods/strategies and with specific outcome measures

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Step 3: Teaching Strategies/Methods

• Important to “fit” the teaching method to the objective►Acid/base concepts (i.e. higher level

cognitive functions) may require several approaches to “connect” with the average learner.

►Surgical procedures may require precise simulations

►Attitudinal and communication objectives may require specific demonstrations or didactic sessions.

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Step 3: Teaching Strategies/Methods

• The number of potential configurations of teaching methods, strategies, styles, formats, tools, etc. is extensive.

- Large group lecture - Assigned readings- Small group seminar - Prepared study

materials

- One-on-one tutorial - Simulations and demonstrations

- Case-based rounds - Computer-based learning

- Topic-based rounds - Self instruction units

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Step 4: Implementation

• What must be done to make it happen?• Specific questions which must be addressed:

►What is the timeline within the present environment?

►What are the required fiscal, administrative, and faculty resources?

►What are the physical space/facility requirements and what is the availability?

►What are the technological and equipment needs?

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Step 5: Evaluation

• Link desired learner outcomes to evaluation techniques►Written and oral exams

►OSCEs for physical diagnoses

►Proficiency tests for skills

►Observed performance (procedures, exam, communication skills)

►Attitudinal ratings

►Learner self-assessment interviews

►Learner presentation (case or didactic topic) evaluation

►Small group participation

►Evaluation of written work

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Step 5: Evaluation

• Establish assessment techniques for program performance

►Review “scorecard” for achieving learner outcomes

►Critique implementation process (timeline, teaching methods, use of resources, effectiveness of individual sessions)

►Obtain learner feedback

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Example

Objective → Competency/

Outcome

How Taught → Teaching Strategy/ Teaching Method

How Measured → Assessment/ Evaluation

Core Competency

Perform accurate TM exam

Videotape on TM landmarks

One-on-one tutorial using teaching otoscope for landmarks and pneumatic otoscope for mobility

Demonstration of patient restraint methods and techniques for removing cerumen

Student demonstrates successful TM exam on three separate patients

PC, MK

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Example

Objective → Competency/Outcome

How Taught → Teaching Strategy/ Teaching Method

How Measured → Assessment/ Evaluation

Core Competency

Demonstrate ability to diagnose and manage common acute medical problems in the Pediatrics ED

Selected readings

Case-based conferences

One-on-one supervision by ED faculty

Faculty observations of resident performance in ED setting

Resident self evaluation exercise

Written case-based exercises completed by residents

PC, MK

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Example

Objective → Competency/Outcome

How Taught → Teaching Strategy/ Teaching Method

How Measured → Assessment/ Evaluation

Core Competency

Demonstrate ability to suture simple lacerations

One-on-one tutorial using pig’s feet

One-on-one supervised repair

Required handout on wound assessment, cleaning, and use of local anesthesia

Certification by faculty of three successful repairs

Cognitive written exam

PC, MK

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Example

Objective → Competency/ Outcome

How Taught → Teaching Strategy/ Teaching Method

How Measured → Assessment/ Evaluation

Core Competency

Provide telephone advice to parents of acutely ill children

Standard protocols

Session with HealthLink

One-on-one supervised calls

Guided “role playing” calls

Parent satisfaction report

MK, PC, I&CS, PBL, P

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Conclusion

• It is important to develop a curriculum for any course of instruction

• Use the five basic steps as a guide:►Needs assessment

►G&Os

►Teaching Methods

►Implementation plan

►Evaluation to include learner achievement and program effectiveness

• Curriculum development should be a flexible, dynamic, and creative process which enhances faculty teaching expertise and results in more efficient and productive learners.

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