Designing and Implementing a Competency and Evidence Based Curriculum in Maternal Child Health Alice Fornari, Ed.D. Francesco Leanza, M.D. Janet Townsend, M.D. Montefiore Medical Center Residency Program in Family and Social Medicine Albert Einstein College of Medicine

Objectives: Participants will be able to: Identify a six-step approach to curriculum development Understand how to apply components of curriculum development to a curricular template, using maternal and child health as an example Identify curricular challenges in residency education

Kern, DE et al., “Curriculum Development for Medical Education: A Six Step Approach,” Johns Hopkins University Press, 1998

Problem Identification and Needs Assessment Health Care Problem Current Approach Ideal Approach

Identify a Health Care Problem Relevant to Practice Define the scope: patient population and aspects of population health category of care: i.e. prevention, disease-model, normal life cycle context of care setting subject matter: theory, core knowledge and skills and psychosocial components Health care Problem: MCH curriculum needs and integration Current Approach: Experts on the faculty, Existing curriculum- don’t reinvent the wheel Ideal Approach

Current (Traditional) Approach Identify existing curricula in the department Identify existing teaching sites Identify internal experts Conduct literature searches

Ideal Approach ( A Loop) Create a “full scope” template, include: Characteristics of learners and teacher Goals Objectives Identify and incorporate relevant competencies ACGME www.acgme.org/outcome/comp/compMin.asp AAFP www.aafp.org/x16524.xml

Ideal Approach-continued Teaching and learning activities Goals and objectives drive structure and content of activities Incorporate evidence-based best practices Provide current information/resources Assessment of the learner Feedback to the learner Evaluate outcome and improve process and content

Needs Assessment of Targeted Learners and Teachers Needs of the learners: Pretest to evaluate prior/current knowledge Self evaluation of competency by learner prior to beginning curricular unit Needs of the teachers: Self-contained modular curriculum is available Site based General v. expert skills- OB, HIV, Geriatrics, EBM Access to technology, if applicable

Goals and Objectives Must be specific and measurable What knowledge and skill(s) do you want the learner to have upon completion of the curricular unit? Bloom’s Taxonomy (see handout) Connect to competency based assessment: knowledge, skills and attitudes (AAFP, ACGME) Clarify/anchor expectations of learner Resources internal and external

Educational Strategies and Implementation Obstetrics Rotation 2 months of PGY-1 Faculty: Didactic and “Hands-On” NSVD Curriculum Prenatal Care Fetal Heart Tracings Breast Feeding Curriculum Common intrapartum Complications

Educational Strategies and Implementation Learner-Centered Teaching Curriculum as a formalized intervention Competencies AAFP** ACGME** **Drives content and structure

Educational Strategies and Implementation Learner-Centered Teaching Individual (resident) Education Plan Self assessment to create learner’s goals and objectives for the rotation* Pre-test and Post Test* Self-reflection *On CD-ROM

Curriculum KNOWLEDGE: Self Assessment* Pre and Post Test* Didactics Case-based* Evidence-based Case-directed readings* ALSO Course Evidence-based Journal Club debate Practice-based Inquiry SKILLS: Direct observed participation in patient care Discussion of each case Reflection by learner/resident: individual and dialogue among peers and teachers

Curriculum Attitudes: Self Assessment* Pre and Post Test* Case-directed readings* Direct observed participation in patient care Debriefing of specific cases Reflection by learner/resident: individual and dialogue among peers and teachers

Evaluation and Feedback Pre and Post Test*/In-service Competency Assessment Self Assessment* 360/Global Assessment Patient assessment of resident (continuity) Support staff assessment of resident Nursing assessment of resident Faculty assessment of resident Chart review for measurable objectives Course Evaluation by Resident Resident Evaluation of Teaching

Evaluation and Feedback DONE Curricular Template Case Pre and Post Test Self Assessment Case-directed readings Patient experience Teacher evaluation of learner Resident evaluation of teaching TO DO Content Validity 360 Evaluation Patients Nursing Chart Reviews TO IMPROVE Resident evaluation of curriculum as an effective tool Update case-directed readings

Lessons Learned Pilot early to allow time for revision Pilot with learners at one site Compile all material in one place (digital and hard copy) for future reference Curriculum available Hard copy manual for learners and teachers CDROM or Internet Consult your experts Engage teachers and learners in the process Buy-in Review frequently and respond to feedback Reassess needs of learners and teachers frequently Simple is better Automation is best

Summary Multiple Teaching and Learning Strategies Direct Patient Care Didactics by experts Cases simulating real scenarios Journal Club-using EBM Debriefing of actual cases Reflection by learner-individual and with peers and teachers Assessment of Learning Pre/Post Test Pre/Post Self-Assessment Direct observation and evaluation by faculty Chart review by faculty Patient feedback Evaluation Resident: content & process Resident evaluation of teaching and curriculum

Grant Support HRSA (Health Resources Services Administration) Grant “Graduate Medical Education in Obstetrics/Gynecology, Pediatrics, Family Practice and Summer Mentors Program” # 5 T16 MC00014-03-00

Discussion Experiences and challenges to curricular development and revision? What can you bring home to your training program? Web-Based Curricular Resources: FMDRL: Family Medicine Digital Resource Library TBA MedPortal: AAMC www.aamc.org/meded/mededportal/