SES09: Teaching the Competencies:
Thinking Outside-of-the-Box
2010 ACGME Annual Education Conference
Bardia Behravesh, MA &
Alice Edler, MD, MA, MPH
Department of Graduate Medical Education
Session Objectives
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Identify innovative teaching methods used by
your residency programs and share them
across programs.
Leverage existing resources within your
institution to teach the ACGME General
Competencies.
Use a systematic curriculum design
approach to develop curriculum.
Background
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In 2008, Stanford GME conducted a needs
assessment with the goal of identifying ways
in which it could better serve its residency
programs.
63 of 75 Program Directors responded to an
online survey.
Following the survey, 69 of 75 Program
Directors were interviewed.
Findings
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46% of respondents requested centralized
teaching of the competencies (i.e. delivered
by the Dept of GME).
23% of respondents requested more
information about educational techniques
and resources.
19% of respondents requested web-based
learning modules that teach the
competencies.
Goals
1.
2.
Identify educational techniques and
resources to share across programs.
Identify avenues for centrally teaching the
competencies (including the utilization of
web-based learning modules).
Goal 1: Techniques & Resources
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Initial approach: Searched the web for teaching and
evaluation methods (best practices) to post to the
Dept of GME web site.
Challenges:
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Limited resources available online
Cost
Thinking Outside-of-the-Box: Which programs are
currently using innovative methods to teach the core
competencies (i.e. what ideas can we borrow from
our own programs and share across all programs)?
Program Innovations
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Solicited voluntary submission of innovative
teaching strategies by Program Directors.
Flagged innovative teaching strategies
during internal program reviews.
Collected strategies into a spreadsheet and
posted to the Dept of GME web site.
Exercise 1
1.
2.
Review the learning activities described in
the handout.
Using the blank fields, describe an
innovative activity developed by your own
program that you could potentially share
with other programs within your institution.
Goal 2: Centralized Education

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Initial approach: Looked at developing and/or
purchasing web-based learning modules.
Challenges:
–
–
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In-house development is costly.
Off-the-shelf solutions do not fit needs exactly.
Customization of off-the-shelf solutions difficult/costly.
Thinking Outside-of-the-Box: What existing content
(already available at our institution) can we leverage
to teach the competencies?
Regulatory Compliance Training
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Stanford satisfies various regulatory requirements
through the use of online training.
Topics include:
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Patient Rights
HIPPA
Emergency Codes
Quality Management
Cultural Diversity
Residents are required to complete the modules on
a yearly basis.
Mapping Content to Competencies
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Determined what web-based learning
modules were available.
Used a spreadsheet to map the modules to
the competencies.
Posted spreadsheet to the Dept of GME web
site.
Mapping Content to Competencies
ACGME Competency
Module
Length (min)
Frequency
MK
PC
PBLI
CIS
Prof
X
X
Patient Rights (PA)
30
Yearly
Rapid Regulatory
60
Bi-Annual
LIFE Curriculum: Fatigue
30
Bi-Annual
X
Code of Conduct
20
Yearly
X
Cultural Diversity
20
Bi-Annual
Emergency Codes
5
1x
HIPAA
30
Yearly
Quality Improvement
20
Yearly
Respiratory Precautions
25
Bi-Annual
X
Restraints/Seclusion
20
1x
X
X
SBP
X
X
X
X
X
X
X
X
X
X
X
E-learning as a “springboard”
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A web-based learning module should not be
thought of as PRIMARY and SUFFICIENT
for competency education.
Pre-existing curriculum can act as a
springboard for additional learning.
Partner the goals and objectives of the preexisting curriculum with those of additional
learning activities.
Systematic Curriculum Development
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Two commonly used curriculum design
approaches in medical education:
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Tyler’s principles for curriculum and instruction
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–
Tyler R, “ Basic Principles of Curriculum and instruction”
Chicago, University of Chicago Press, 1949
Kern’s six step approach to curriculum
development
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Kern D, Thomas P, Howard D, Bass E, “Curriculum
Development for Medical Education”, Baltimore, Johns
Hopkins University Press 1998
Pro’s of Tyler Rationale
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Simple and straight forward
Starts with Goals and Objectives
Good for institutional curriculum
development
Good for modification of pre-existing
curriculum
Teacher-oriented
Tyler’s Four Questions
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What educational purposes should the
curriculum seek to attain?
What learning experiences should be
selected to achieve these goals and
objectives?
How should these learning experiences be
organized?
How can the effectiveness of these
experiences be evaluated?
Goals and Objectives
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Goals: Overall outcomes
Objectives: Criteria by which the educational
materials are selected and the content is
outlined. Based on:
–
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Values
Needs
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Learner
Society
Objectives = The Desired Educational Ends
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The changes in learner behavior/attitudes
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Not what the teacher does
Not a content list
Not a vague abstraction but concrete change
Behavioral and Attitudinal Aspects of
Objectives
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Understanding of the important facts and
principles
Familiarity with the sources of information
Ability to interpret data
Ability to apply principles
Ability to interpret results of investigation
Broad and mature interests
Selecting Educational Experiences
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Real and attainable
Satisfying to the learner
Multiple and reinforcing
Organization of Educational
Experiences
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Sequencing
–
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Increasing complexity, if needed (graduated
responsibility)
Reinforcing
Implementation
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Political support for program
Procurement of resources (room,
standardized patients, etc)
Piloting, if possible
Introduction
Barriers to implementation
Evaluation of the Curriculum
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Multi-source evaluation of the
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Written Curriculum
Educational Milieu
Administration of the Curriculum
Faculty
Learner
Exercise 2
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Review the sample e-learning module and consider
the following questions:
1.
2.
3.
4.
What competency-based goals and objectives could this
module address?
If we were to use this module as a springboard, what
additional learning experiences could we combine with this
module to develop a competency-based curriculum?
How would you sequence the learning experiences,
including the use of this module?
How would you evaluate the effectiveness of your new
curriculum in teaching the desired competencies?
Summary
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Resident learning need not be bounded by
program-specific curricula.
Rather than develop completely from
scratch, look for pre-existing practices and
content that can be leveraged.
Look across programs for best practices.
Look at the institutional level for resources.
Questions?
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Feel free to contact us:
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Bardia Behravesh, MA – bbehrave@stanford.edu
Alice Edler, MD, MA, MPH – aedler@stanford.edu