An Approach to Curriculum

DevelopmentGME Lunch n Learn Series

Cuc MaiSeptember 2012

• Common Program Requirements:• Competency-based goals and objectives for each

assignment at each educational level

• Internal Medicine Specific Program Requirements:• For each rotation or major learning experience, the

competency based goals and objectives (the written curriculum) must contain the educational plan, goals and objectives, educational methods, and the evaluation tools that the program will use to assess the resident’s competence.

ACGME Program Requirements

Recognize key components of curriculum development

Demonstrate how each of these components can be used to benefit learners and promote scholarly activity

Identify resources to improve curriculum development skills

Goals & Objectives

A Six Step Approach to Curriculum Development

Develop a curriculum to teach residents about how to diagnose and treat musculoskeletal diseases and increase number of joint injections performed during residency.

Example Case

Builds a rationale for the curriculum Focuses the curriculums’ goals and

objectives Focuses the educational and evaluation

strategies Makes you an expert and scholar

Step 1: Problem Identification & General Needs Assessment

Step 1. Problem Identification

Step 1. General Needs Assessment

Musculoskeletal disorders are common and a major cause of disability

Patients want quick access Training increases confidence and decreases

referrals National organizations recommend training in

musculoskeletal exam; diagnosis; management Preferred training is in clinical practice with

trained preceptors

Step 1. Problem Identification & General Needs Assessment Example

Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med 2004; 19: 524-529.

Assess the differences between your specific learners and the general audience

Assesses the environment to help tailor the intervention

Prevents duplication Identifies stakeholders and builds

relationships with stakeholders

Step 2: Targeted Needs Assessment

Methods for collecting information:◦ Reviewed existing training◦ Senior resident exit survey, Survey of current residents,

& Focus group of residents Findings:

◦ Strong desire for training◦ Low levels of training and clinical experience and self

rated proficiency◦ Wrong case mix in Rheumatology and Orthopedics◦ Preferred direct supervision of patient care by

practitioners with expertise in musculoskeletal medicine

Step 2. Targeted Needs Assessment Example

Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med 2004; 19: 524-529.

Goal: broad educational goal

Objective: specific measurable objective

Step 3: Goals & Objectives

Helps prioritize Direct content Identify learning methods Enable and direct evaluation Provides clear communication to learners,

faculty, and stakeholders Required

Step 3. Goals & Objectives

Types of Objectives◦ Learner Objectives

Cognitive, Affective, Psychomotor◦ Process Objectives

Curriculum Implementation Measures◦ Patient/Healthcare Outcome Objectives

Patient Outcomes: pt satisfaction Healthcare/System Outcomes: board pass rate

Step 3. Objectives

Who will do how much of what by when?◦ Who (1)◦ Will do (2)◦ How much (3)◦ Of What (4)◦ By When (5)

Step 3. Writing Objectives

Step 3. Writing Objectives & Bloomberg’s taxonomy

Step 3. Objectives Example

Maintain congruence between objectives and methods

Use multiple educational methods Choose methods that are feasible

Step 4. Educational Strategies

Table 5.2 Matching Educational Methods to Objectives*Type of Objective

Educational MethodCognitive: Knowledge

Cognitive: Problem-Solving

Affective: Attitudinal

Psychomotor: Skills or

Competence

Psychomotor: Behavioral or Performance

+++ + + +Lectures +++ + + +Programmed learning +++ ++ +Discussion ++ ++ +++ + +Reflection on experience +++ +++ +++Feedback on performance + ++ ++ +++ +++

Small-group learning ++ ++ ++ + +Problem-based learning ++ +++ + +Team-based learning +++ +++ ++ + +Learning projects +++ +++ + + +Role models + ++ + ++Demonstration + + + ++ ++Role plays + + ++ +++ +Artificial models and simulation + ++ ++ +++ +

Standardized patients + ++ ++ +++ +Real life experiences + ++ ++ +++ +++Audio or video review of learner + +++ +

Behavioral / environmental interventions**

+ + +++

Step 4. Educational Strategies

Musculoskeletal Curriculum:◦ Development of workshops and syllabus materials

on diagnosis and management for common musculoskeletal disorders, including injection therapy.

◦ Institution of a new primary care musculoskeletal clinic supervised by Internal Medicine preceptors with a special interest in musculoskeletal diseases.

Step 4. Educational Strategies Example

Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med 2004; 19: 524-529.

Identify Resources◦ Personnel, Time, Facilities, Funding

Obtain Support◦ Internal vs. External

Develop Administrative Mechanisms Anticipate and Address Barriers

◦ Competing Demands, Attitudes Develop a Plan for Introducing Curriculum

◦ Pilot, Phase In, Full Implementation

Step 5. Implementation

Musculoskeletal clinic◦ Financial analysis and feasibility analysis had to

be done◦ Administrative support was obtained.◦ Plan discussed with Rheumatology and

Orthopedics

Step 5. Implementation Example

Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med 2004; 19: 524-529.

Need to determine if goals are met Provides information for improvement Documents accomplishments Specifics to Consider

◦ Evaluation Questions Address learner objectives

◦ Evaluation Design Consider internal and external validity Posttest, Pretest/Postest/Control Group

6. Evaluation & Feedback

Recognize and apply these 6 steps to curriculum development◦ Problem Identification & General Needs

Assessment, Targeted Needs Assessment, Goals & Objectives, Educational Strategies, Implementation, Evaluation & Feedback

Define objectives in specific and measurable language◦ Who will do how much of what by when?

Use references to help your faculty develop curriculum for your learners

Conclusions

Kern D, Thomas P, Hughes M, Barker L, Bass E, Carrese J, Wolfe L. The Six-Step Approach to Curriculum Development. SGIM Workshop. 5/2009.

Kern D. Curriculum Development for Medical Education. Second Edition.

Thomas P, Kern D. Internet Resources for Curriculum Development in Medical Education. An Annotated Bibliography. J Gen Intern Med. 2004; 19: 599-605.

References