Curriculum Development for Outcome Based Learning Zilvinas Dambrauskas 2012

Goals Why are we responsible to society? What society expects from us? What are we doing really well? What could we do better? What are the possible solutions?

Why are we responsible to society? The public is educated, inquisitive and demanding: system is very expensive, funds are limited - the system must be efficient and cost-effective; professional services must be based on current scientific evidence; it is expected that in the future the quality of services, patient treatment outcomes, and the general public health indicators will improve.

What society expects from us? The future (present?) doctors will: have a good theoretical and practical expertise have excellent interpersonal skills be able to work in teams to use the resources wisely have other attributes (altruism, responsibility, making ethical decisions, etc.) be able to work effectively in a constantly changing environment (society's expectations, scientific innovation)

Best teaching practice Improved teaching outcomes

What are we doing right? À Define “Fundamental Knowledge” E=mc2 ­ Teach the Fundamentals ® Test for Knowledge of à Hope for the Best

What are we doing right? ECG Auscultation Palpation X-Ray À ­ ® Ã Define Teach the Assess the Hope for “Fundamental Fundamentals Clinical Skills the Best Clinical Skills”

Courtesy of Ronald Harden

Courtesy of Ronald Harden

Courtesy of Ronald Harden

What needs our attention? “The only way to get somewhere, you know, is to figure out where you’re going before you go there.” —— John Updike, Rabbit Run, 1960 “It is a highly questionable practice to label someone as having achieved a goal when you don’t even know what you would take as evidence of achievement.” ——R. F. Mager, Preparing Educational Objectives, 1962

What needs our attention? What do current recommendations suggest? Traditional teaching and subjects are of value More emphasis on general skills Most important is the synthesis between the general and specific knowledge and/or skills.

What needs our attention? The Accreditation Council for Graduate Medical Education (ACGME): Specific medical knowledge Patient care and nursing Learning and development in the workplace Interpersonal skills Professionalism Health system orientated medical practice The Tuning Project (Medicine), The Tomorrow’s Doctor, The Scottish Doctor...

Good curriculum Students should acquire the skills and knowledge as determined by the curriculum Students and residents move to the next study level only when they are ready enough Curriculum allows for timely identification of insufficient knowledge or skills Graduates will be able to work independently

Good curriculum Well-balanced Comprehensive but not overloaded Promoting growth Student centered Focus on learning

External factors

External factors Internal factors

Good assessment Good assessment drives learning process Feedback is an essential element The criteria for success are known in advance

Good assessment Transparent evaluation system Combines formative and summative assessment; Study and evaluation must be a uniform system Examinations must be diverse and complex

Teaching and learning strategy Curriculum content PBL Evaluation process Assessment Teaching and learning strategy

Teacher Content Competences Skills Knowledge Clear Aims Goals Outcomes Appropriate Subjects Clinical skills Professionalism Teaching Methods Practical training Role model Implementation Timing Feasibility Explicit Blocks/units PBL, etc. Feedback Students Teachers Stakeholders

Other possible solutions Introduce new training and evaluation systems: objective structured clinical situations / exams use of dummies and decoy simulators for training and practical skills simulated patients e-learning practical training

Is it working? Evidences?

Is it working? Evidences? Obvious advantages Changes in learning behavior: autonomy, better and faster acquisition of practical skills; Clear recommendations for students Studies and tests are closer to reality Changes can be assessed quantitatively and qualitatively

Is it working? Evidences? No adverse changes National exam results the same or better No negative feedback from students or teachers Requires limited financial and human resources (at least in the beginning)

Is it working? Interesting? Initial assessment using ABCDE approach Diagnosis Initial treatment 

Is it working? Interesting? Wound Rash

Is it working? Interesting? Assessment using ABCDE approach

Is it working? Interesting? Diagnosis and initial treatment       Practical skill performance:

Questions? ?

Summary We are responsible to society for medical education Society has clear expectations, and this is an important factor driving the changes Many of the theoretical knowledge and practical skills we teach really well In studies and surveys of faculty, staff, employers and patients show what needs to be done better or just differently We know our way... So now we just need to reach our destination ...