The Teaching Center
Curriculum Development
Harvey J. Hamrick, MD
The Teaching Center
UNC Department of Pediatrics
The Teaching Center
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
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
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
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
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
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
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
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
Process
Clarification of Terms and Concepts
• Six Core Competencies of the ACGME:
Patient Care (PC)
Professionalism (P)
Medical Knowledge (MK)
Practice-based Learning
(PBL)
Interpersonal & Communication
Skills (I&CS)
Systems-based Practice
(SBP)
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.
The Teaching Center
Five Steps in Planning a
Course of Instruction
The Teaching Center
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
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
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
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
Step 3: Teaching Strategies/Methods
• The number of potential configurations of
teaching methods, strategies, styles, formats,
tools, etc. is extensive.
- Large group lecture
- Small group seminar
- One-on-one tutorial
- Case-based rounds
- Topic-based rounds
- Assigned readings
- Prepared study
materials
- Simulations and
demonstrations
- Computer-based
learning
- Self instruction units
The Teaching Center
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
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
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
Example
Objective →
Competency/
Outcome
How Taught →
Teaching Strategy/
Teaching Method
How Measured →
Assessment/
Evaluation
Core Competency
Perform accurate
TM exam
Videotape on TM
landmarks
Student
demonstrates
successful TM
exam on three
separate patients
PC, MK
One-on-one
tutorial using
teaching otoscope
for landmarks and
pneumatic
otoscope for
mobility
Demonstration of
patient restraint
methods and
techniques for
removing cerumen
The Teaching Center
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
Faculty
observations of
resident
performance in ED
setting
PC, MK
Case-based
conferences
One-on-one
supervision by ED
faculty
Resident self
evaluation
exercise
Written casebased exercises
completed by
residents
The Teaching Center
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
Certification by
faculty of three
successful repairs
PC, MK
One-on-one
supervised repair
Required handout
on wound
assessment,
cleaning, and use
of local anesthesia
Cognitive written
exam
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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
Guided “role
playing” calls
MK, PC, I&CS,
PBL, P
Session with
HealthLink
One-on-one
supervised calls
Parent
satisfaction report
The Teaching Center
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.