1. 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

2. 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

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

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

5. 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

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

7. Ideal Approach ( A Loop)
Create a “full scope” template, include:
Characteristics of learners and teacher
Goals
Objectives
Identify and incorporate relevant competencies
ACGME
AAFP

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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