Outcome-Based
Learning and Teaching
Yeu-Jhy Chang, MD
Department of Neurology
Chang Gung Memorial Hospital, Linkou
1
Outline
• Introduction of models of medical
education
• What is outcome-based learning?
• How to establish the learning outcomes?
• General principles of teaching and
assessment for outcome-based learning
• Take home message
2
A story frequently told by educators
concerns a young lad and his dog, Fido.
• ‘I taught Fido how to whistle,’ the boy proudly tells
his father.
• When asked to demonstrate this remarkable
achievement, the boy commands, ‘Fido, whistle!’
Fido wags his tail vigorously but not whistle.
• ‘I thought you said you taught Fido how to
whistle. I didn’t hear him whistle,’ the father says
to his son who replies. ‘I said I taught him how to
whistle, I didn’t say he learned it!’
3
The Flexnerian Model
(‘Planning Forwards’)
1. Define “Fundamental knowledge”
2. Teach the fundamentals
3. Test for knowledge of fundamentals
4. Hope for the best?
?
＝
•
•
•
•
What is
“Fundamental
knowledge”
(1)
(2)
(3)
(4)
4
Competency-Based Model
(‘Planning Backwards’)
• 1. Define the successful graduate
• 2. Design measures and standards of
performance
• 3. Develop learning experiences
5
Outcome-Based Education
• All too often, we, as teachers, focus too much
on what we teach rather than on what our
students learn.
• Outcome-based education emphasizes what
we expect students will have achieved
when they complete their course.
• These learning achievements go beyond
just knowing; rather, they describe what
learners can actually do with what they know.
6
Definition of Outcome-Based
Education
• What we expect of our graduates and
holds us accountable to provide an
education that achieves those
endpoints.
• It’s not only good education, it is good
public policy.
7
Three features of outcomebased education
• The (1) development of clearly defined and
published learning outcomes that must be
achieved before the end of a course.
• The (2) design of a curriculum with educational
strategies and learning opportunities to ensure
the achievement of the learning outcomes.
• An (3) assessment process matched to the
learning outcomes with the assessment of
individual students to ensure that they achieve
the outcomes.
The Scottish Doctor 3, 2008
8
Working Definition of Learning
outcomes are:
• Statements of what a student should know,
understand and/or be able to demonstrate
after completion of a process of learning.
• The learning activity could be, for example, a lecture, a
module or an entire program.
• Learning outcomes must not simply be a “wish list” of
what a student is capable of doing on completion of the
learning activity.
• Learning outcomes must be simply and clearly
described.
• Learning outcomes must be capable of being validly
assessed.
9
From the definitions we see:
• Emphasis on the learner.
• Emphasis on the learner’s ability to do something.
• Focus on teaching – aims and objectives and use of
terms like know, understand, be familiar with.
– Aims: Give broad purpose or general intention of the module.
– Objectives: Information about what the teaching of the module
hopes to achieve.
• Outcomes: Focus on what we want the student to be
able to do - use of terms like define, list, name, recall,
analyze, calculate, design, etc.
– Learning outcomes are not designed to replace the traditional
way of describing teaching and learning but to supplement it.
10
Good Doctors
The expectation of population
• Patients need good doctors.
• Good doctors make the care of their
patients their first concern: they
– are competent,
– keep their knowledge and skills up to date,
– establish and maintain good relationships
with patients and colleagues,
– are honest and trustworthy, and
– act with integrity.
Good Medical Practice, General Medical Council (GMC), UK 2006
11
The Social Contract
R. Cruess & S. Cruess. Perspectives in Biology and Medicine 2008;51(4):579–98.
12
EXPECTATIONS: THE PUBLIC AND THE
MEDICAL PROFESSION
Patients’/public’s expectations of
medicine
Medicine’s expectations of
patients/public
Fulfill role of healer
Assured competence of physicians
Timely access to competent care
Altruistic service
Morality, integrity, honesty
Trustworthiness (codes of ethics)
Accountability/transparency
Respect for patient autonomy
Source of objective advice
Promotion of the public good
Trust sufficient to meet patient’s
needs
Autonomy sufficient to exercise
judgment
Role in public policy in health
Shared responsibility for health
Balanced lifestyle
Rewards: nonfinancial (respect,
status), financial
R. Cruess & S. Cruess. Perspectives in Biology and Medicine 2008;51(4):579–98.
13
醫師的角色與特質
（Roles and Attributes of a Physician）
治療者(The Healer)
傾聽
能力
承諾
保密
洞察力
利他主義
值得信任
心胸開放
廉正與誠實
關懷與熱情
全心照顧與陪伴
倫理與道德行為
對職業的責任感
尊重病人治癒的潛能
尊重病人的尊嚴與自主權
R. Cruess & S. Cruess 14
修改自賴其萬教授提供檔案
醫師的角色與特質
（Roles and Attributes of a Physician）
治療者(The Healer)
傾聽
廉正與誠實
能力
關懷與熱情
承諾
全心照顧與陪伴
保密
倫理與道德行為
洞察力
對職業的責任感
利他主義
尊重病人治癒的潛能
值得信任
心胸開放 尊重病人的尊嚴與自主權
專業人員
(The Professional)
自律
自主性
團隊合作
對社會的責任感
R. Cruess & S. Cruess 15
修改自賴其萬教授提供檔案
Knowledge
Comprehension
Application
Analysis
Synthesis
Evaluation
Evidence
Reasoning
Judgment & data
management
Evidence and data
Collection
Analysis
Synthesis
Evaluation
Value, Cost-Benefit
Experience, Intuition, Bias
Performance
• Diagnosis
• Treatment
The Outcome
A Good Doctor
16
By: Paul PL Chang
Outcome-Based Education
• 知識Knowledge
• 技術Skill
• 能力Competence
• 執行力Performance
• 完成力Capability (The power or ability to
generate an outcome)
17
Advantages of Choosing
Established Outcomes
• The easier way for a medical school to
create an outcome-based curriculum is to
adopt outcomes that others have defined.
• Using an already established list of
outcomes has the advantages of ease,
simplicity, comparability and established
credibility.
18
Disadvantages of Choosing
Established Outcomes
• Simply adopting someone else’s list has
its own drawbacks.
• The faculty and students may not feel the
same sense of ownership, unique
characteristics of the school may not be
represented or sufficiently emphasized,
and the outcomes may be interpreted
differently from what was originally
intended.
19
2001
美國畢業後醫學教育評鑑委員會
(ACGME)之六大臨床核心能力
 醫學知識 (Medical knowledge)
 人際與溝通技巧 (Interpersonal and
communication skills)
 系統為基礎的醫療 (System-based practice)
 病人照顧與臨床技能 (Patient care & clinical skill)
 專業素養 (Professionalism)
 執業中學習與改進 (Practice-based learning and
improvement)
Mnemonics: MIS 3P
20
BROWN'S NINE ABILITIES
• 1. Effective Communication (C)
• 2. Basic Clinical Skills (P1)
• 3. Using Basic Science in the Practice of Medicine
(P1&P3)
• 4. Diagnosis, Management, and Prevention (K, P1&P3)
• 5. Lifelong Learning (P3)
• 6. Self-awareness, Self-care, and Personal Growth (P2)
• 7. The Social and Community Contexts of Health Care
(P2)
• 8. Moral Reasoning and Ethical Judgment (P2)
• 9. Problem Solving (P1)
21
Good Medical Practice
• 1. Good clinical care
• 2. Maintaining good medical practice
• 3. Teaching and training, appraising
and assessing
• 4. Relationships with patients
• 5. Working with colleagues
• 6. Probity
• 7. Health
General Medical Council, UK, 2006
22
THE SCOTTISH DOCTOR
learning outcomes
The 12 domains and the three circle outcomes model
23
THE SCOTTISH DOCTOR 3rd Edition Scottish Deans’ Medical Education Group April 2008
長庚醫學系的願景
•1. 培養更具人文素養及良醫氣質的醫學生
•2. 建立更完善與不斷進步的課程規劃及授課
品質
•3. 培養術德兼備及具研究理想的良醫
•4. 鼓勵師生參與偏遠地區及社區的醫療服務
•5. 加強和國際知名醫學院的交流及學生交換
•6. 追求卓越以達國內及國際一流醫學院醫學
系
24
長庚醫學系畢業生應具備的
七大核心能力(1)
• 1.臨床照護病人能力 (Patient Care)：能展現愛心、關懷與同
理心，提供病人適切有效的照護，以解決其健康問題。
• 2.完整與優質的專業醫學知識 (Medical Knowledge)：能理解
與應用生物、心理、社會、種族、文化等與健康相關知識，並
懂得運用專業相關的基礎與臨床醫學知識處理、分析與研究病
人問題。
• 3.實作為基礎之終身、自我學習與改進 (Practice-Based
Learning and Improvement)：能具備評估現行醫療照護內容，
經過終身、自我學習，吸收科學實證資料並評判資料之可靠性
與在病人的適用性，從而改善病患照護；追求醫療品質改善。
• 4.人際關係及溝通技巧 (Interpersonal and Communication
Skills)：能有良好的人際關係與溝通技能以便與病人、家屬、
同儕及醫療團隊進行資訊交換與溝通，建立團隊合作及良好的
傾聽、表達與同理心。
25
長庚醫學系畢業生應具備的
七大核心能力(2)
• 5.專業精神及倫理 (Professionalism)：能展現負責任、
尊重、紀律、與愛心之專業態度，堅守醫學倫理原則及對
各種病人能包容跨文化間差異；對病人年齡、性別、種族
、宗教差異具一定的理解與敏感度及以病人為優先之利他
主義觀念。
• 6.制度與體系下之醫療工作 (System-Based Practice)：
能夠認知健康照護制度與體系之運作及緣由；有效整合所
有資源以提供適切醫療照護；著重病患安全並避免系統性
錯誤，檢討各項醫療決策及操作內容，評估系統資源內容
減少系統性錯誤。
• 7.生物醫學研究能力 (Biomedical Research Ability):
具備文獻評析、彙整能力及研究構思、設計與執行之基本
能力。
26
KASH makes cash.
• K Knowledge 專業的知識
• A Attitude
正確的態度
• S Skills
圓融的技巧
• H Habit
良好的習慣
• 工作成就 = 工作能力（知識 + 技巧）
x 工作態度（態度 + 習慣）
27
Passive
Within 2 weeks:
5%
Auditory
Visual
after
24 hours
Active
Kinesthetic
&
Immediate 28
use
28
Methods
Student
centered
Selfdirected
Team
work
Cognitive
Affective
Psychomotor
+++
+
+
++
++
+
+
+++
+++
+
+++
+++
+++
Role play
+
+++
+++
++
+
++
Video
+
++
++
Hand-on
+
Simulation
+
++
Brain storm
+
+
Lecture
Discussion
PBL
Case
+++
++
+
++
+++
+++
+++
+
+++
+++
+++
+
+++
++
++
+
++
++
29
+
Overview of Assessment of Learning Outcomes
Clinical
Skills
Practical
Procedures
Patient
Investigation
Patient
management
Health
promotion
and disease
prevention
Communi
cation
Skills
OSCE
+++
+++
+++
+++
+++
+++
OSSE
+++
+++
+++
+++
+++
OSPE
+++
+++
+++
+++
+++
OSLER
+++
+
+++
+++
+++
Short cases
+++
OSCE Objective Structured
Clinical Exam; OSSE Objective
Structured Scientific Exam;
OSPE Objective Structured
Practical Exam; OSLER
Objective Structured Long
Examination Record
+++
+++
MCQ
+++
+++
++
EMI
+++
+++
+++
MEQ
+++
+++
++
CRQ
+++
+++
+++
Progress Test
Logbook
+++
Case histories
+++
Certificate of
competence
+++
+++
+++
++
+++
+++
+++
Video
Viva / Oral
+++
+
+
+
MCQ Multiple Choice Question; EMI Extended Matching Items; MEQ Modified Essay Question; CRQ Constructed Response Question.
+++
30
KASHO makes much more cash.

•
•
•

K Knowledge 專業的知識
A Attitude 正確的態度
S Skills 圓融的技巧
•
H Habit 良好的習慣
•
O Organization culture 機構的文化
(Decided by the Leader’s will)
• 學習 (Learning) = 情緒(Emotion) + 動機(Motivation)
31
Take Home Message
Learner-Centered and Outcome-based Teaching
• To define the outcomes before your
teaching.
• To design the curriculum
– to establish the learning environment
– to encourage the motivation of learners
for teaching.
• To assess the achievement of
learners
– to reflect yourself.
32
 Learning has to be done by
the learner, not for the learner.
* Teaching as engineering
effective learning environments.
Thank You for Your Attention!
33