1. Curriculum Development Harvey J. Hamrick, MD The Teaching Center UNC Department of Pediatrics The Teaching Center

2. 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. The Teaching Center

3. 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. The Teaching Center

4. 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. The Teaching Center

5. 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. The Teaching Center

6. 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. The Teaching Center

7. 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. The Teaching Center

8. 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. The Teaching Center

9. 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. The Teaching Center

10. 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) The Teaching Center

11. Five Steps in Planning a Course of Instruction The Teaching Center

12. 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? The Teaching Center

13. 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 The Teaching Center

14. 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 The Teaching Center

15. 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. The Teaching Center

16. 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 The Teaching Center

17. 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? The Teaching Center

18. 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 The Teaching Center

19. 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 The Teaching Center

20. 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 The Teaching Center

21. Example Objective → Competency/Outc ome 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 The Teaching Center

22. 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 The Teaching Center

23. 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 The Teaching Center

24. 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. The Teaching Center