PAPER 08/CE/45
A REVISED STRUCTURE FOR THE EDINBURGH MBChB CURRICULUM BASED
ON LEARNING OUTCOMES
Outcomes-based education
Outcomes-based education is an approach which has gained acceptance in medical education
in recent years. It starts by defining the curriculum Outcomes at the time of graduation. These
Outcomes are defined to match the requirements of medical clinical practice. The curriculum
is then aligned to support students in achieving these Outcomes. There are many advantages
to such an approach, but perhaps the main one is that students, graduates, employers (the
National Health Service), patients and society have a much clearer statement of what they can
expect from medical graduates entering the workplace. Medical schools are then accountable
for the degree to which those expectations are met.
An entire issue of “Medical Teacher” was devoted to outcomes-based education in 2007 –
Vol 29, issue 7. For an overview see Harden RM. Outcome-based education; the future is
today. Medical Teacher, 2007; 29: 625-629.
Fig 1. A model for an outcomes-based curriculum
Important questions for a medical school which aspires to an outcomes-based approach are :
 Is there a clear statement of the learning outcomes?
 Are these communicated effectively to staff and students and recognised by them?
 Is the course content explicitly and clearly aligned with the outcomes?
 Are the educational strategies, educational environment and learning opportunities
chosen to support achievement of the outcomes?
 Is the strategy and structure for assessment and student progression explicitly and
clearly aligned with the outcomes?
 Is student selection informed by the outcomes?
How are the outcomes decided?
Graduating outcomes for a UK medical curriculum can be subject to various influences:

Discussion and negotiation within the Medical School and with NHS partners

The guidance to medical schools from the General Medical Council, "Tomorrow's
Doctors" (2009). The GMC inspects medical schools regularly to establish whether
they are following this guidance. The 2009 version for the first time contains an
explicit, multi-level Outcomes framework, which has been subjected to very
extensive discussion, review and consultation.

“The Scottish Doctor – a competent and reflective practitioner” – published by the
Scottish Deans Medical Education Group after a national consultation process (2002).
Has been very influential world-wide as a model for such approaches.

“The Tuning Project (Medicine) – learning outcomes/competences for undergraduate
medical education in Europe” – a consensus statement, based on a Europe-wide
survey funded by the European Commission, published by the University of
Edinburgh (2008). Currently the basis of ongoing work on curriculum harmonisation
in support of the mandatory mutual recognition of medical degrees in Europe.
There is a growing consensus about the essential outcomes of primary medical degrees and
how they are best described and presented, and there is already considerable convergence
between these different influences.
Proposal to CAFMG
It is proposed that the Edinburgh curriculum is now structured and described in terms of
the curriculum Outcomes, and its assessment strategy and framework aligned with that
change. Since the medical school will be accountable for the achievement of the GMC
“Tomorrow’s Doctors” outcomes by all its graduates, and will required in future years to
show evidence of this, it seems strategically desirable to use those outcomes as the primary
basis for the new structure - albeit with appropriate adjustments and additions to reflect the
particular nature and character of the Edinburgh graduate.
TD 2009 specifies 15 major curriculum Outcomes. Experience suggests that this is quite a
large number to manage effectively at curriculum level. A very simple adjustment, as shown
below (Table 1) reduces the number to 12, and makes alignment with the current Edinburgh
structure, the Scottish Doctor, and the Tuning Project more straightforward.
Outcomes as the end-product of curriculum Themes
A simple and logical approach to linking curriculum content to the outcomes is to say that
each Outcome is supported by an Outcome Theme. These Themes then encompass the
teaching, learning and assessment in all five years of the curriculum. Each Theme has an
identified Theme Head, supported by a team of staff active in this area. The assessments
related to each Theme accumulate and allow us to be sure that graduates, at the time of
graduation, have been adequately assessed in each of the Outcomes.
Level 2 outcomes
All existing outcome frameworks have some degree of hierarchical structure, usually referred
to as Levels. These are not defined in terms of the importance of the outcomes, but rather the
level of detailed specification, and to some degree, their scope and dimensions. This can be a
source of confusion – e.g. in the “Scottish Doctor”, the major outcomes are referred to as
Level 2. TD 2009 has an “overarching outcome” which could be said to be Level 1, then three
subdivisions which could be Level 2, before the major outcomes.
It is proposed that for simplicity, the Edinburgh “major Outcomes” are referred to as Level
1. A series of more detailed Level 2 Outcomes would be mapped under each Level 1
Outcome.
Obviously this process cannot be undertaken in detail until the Level 1 structure is agreed, but
would be a key task for the coming academic year.
PVTs and KCTs
An important question is how to deal with areas of learning that were separately identified in
our previous curriculum structure as “Portfolio Vertical Themes” or “Key Clinical Topics”,
but which would not figure overtly in the Level 1 outcomes. Examples include pain,
disability, nutrition, life cycle, and clinical conditions such as diabetes. Other than the rather
vague label of “topic” (“a general consideration suitable for argument… a matter”:
Chambers Dictionary) , there is no single descriptive term that will fit all of these
conceptually. Pain is primarily a symptom, life cycle is a concept, diabetes is a disease.
However, it is reasonably straightforward to define them in terms of the learning outcomes to
be achieved – e.g. the ability to manage pain effectively; understanding of the influence of the
life cycle on human health and disease; ability to investigate, diagnose and manage patients
with diabetes.
It is proposed that these areas of learning are redefined as Level 2 Outcomes and mapped
to a Level 1 Outcome/Theme.
Clearly they do not all fit neatly under a single Level 1 Outcome and there is inevitably some
degree of empiricism involved. In practice however, the important thing is that these areas are
clearly identified, and that students learn about them and are assessed – not necessarily the
detail of where exactly they are placed in the Outcomes framework. Similarly, such a process
should not be interpreted as diminishing the perceived importance of these areas of learning.
At this stage the particular emphasis and character of the Edinburgh curriculum can be
reflected in the formulation of the Level 2 outcomes.
The Portfolio would have to move to a slightly less specific remit – effectively it would be a
tool for learning and assessment about any and all of the Outcomes, but with a focus on those
which lend themselves particularly to portfolio-based learning. Such a structure has already
been outlined by Dr Helen Cameron.
Blueprinting of Assessments
Blueprinting is the process by which the content of an integrated examination is mapped on a
matrix grid against the Outcomes. This allows us to track the assessment of students over
time under each Outcome, and therefore allows us to assure the General Medical Council that
our graduates have been adequately assessed in each outcome at the time of graduation. This,
in turn, allows the General Medical Council to enter graduates on the Medical Register and
provide them with a provisional license to practise.
Learning objectives
Learning objectives define discrete items of teaching, learning and assessment for the various
components of the course – e.g. a lecture, module, or attachment. They can be viewed as the
building blocks of the Outcome Themes, provided they have been explicitly mapped against
the Outcome Themes. This is currently being undertaken as part of the OPAL Project, but
cannot be finalised until the new curriculum structure is confirmed. In such a model, every
learning objective relates to a learning opportunity, module or attachment, but at the same
time is a building block of an Outcome Theme, contributing to achievement of a graduating
Outcome.
Table 1. Proposed Edinburgh Level 1 outcomes, with corresponding TD 2009 statements.
EDINBURGH MBChB LEVEL 1
OUTCOMES
GMC TOMORROW’S DOCTORS
2009
OVERARCHING OUTCOME
An Edinburgh medical graduate will be a caring,
competent, confident, ethical and reflective
practitioner, equipped for high personal and
professional achievement, able to provide
leadership and to analyse complex and uncertain
situations.
GMC150. Medical graduates are
tomorrow’s doctors. In accordance with
Good Medical Practice, they must make
the care of patients their first concern,
applying their knowledge and skills in a
competent and ethical manner, using their
ability to provide leadership and to
analyse complex and uncertain situations.
THE DOCTOR AS SCHOLAR AND SCIENTIST
1. BIOMEDICAL AND CLINICAL
SCIENCES
GMC152. Apply to medical practice the
biomedical scientific principles, method
and knowledge of: anatomy, biochemistry,
cell biology, genetics, immunology,
microbiology, molecular biology,
nutrition, pathology, pharmacology and
physiology.
2. PSYCHOLOGICAL ASPECTS OF
MEDICINE
GMC153. Apply psychological and social
principles, method and knowledge to
medical practice.
3. SOCIAL SCIENCES AND PUBLIC
HEALTH
Social sciences part of GMC153, but in
Edinburgh clearly part of Outcome 3.
GMC154. Apply to medical practice the
principles, method and knowledge of
population health and the improvement of
health and health care.
4. EVIDENCE-BASED MEDICINE AND
RESEARCH
GMC 155. Apply scientific method and
approaches to medical research.
THE DOCTOR AS PRACTITIONER
5. CONSULTING WITH A PATIENT
GMC 157. Carry out a consultation with a
patient.
6. CLINICAL PRESENTATIONS,
DIAGNOSIS AND MANAGEMENT
GMC 158. Diagnose and manage clinical
presentations.
7. CLINICAL COMMUNICATION
GMC159. Communicate effectively with
patients and colleagues in a medical
context.
8. EMERGENCY CARE, FIRST AID,
RESUSCITATION AND PRACTICAL
PROCEDURES
GMC160. Provide immediate care in
medical emergencies, including first aid
and resuscitation.
9. PHARMACOLOGY AND
THERAPEUTICS
GMC161. Prescribe drugs safely,
effectively and economically.
10. MEDICAL INFORMATICS
GMC 163. Use information effectively in
a medical context.
THE DOCTOR AS PROFESSIONAL
11. MEDICAL ETHICS, LEGAL AND
PROFESSIONAL RESPONSIBILITIES
GMC165. Behave according to ethical and
legal principles.
12. PERSONAL AND PROFESSIONAL
DEVELOPMENT
GMC166. Reflect, learn and teach others.
GMC167. Learn and work effectively
within a multi-professional team.
GMC168. Protect patients and improve
care.
Professor Allan Cumming
Director of Undergraduate Learning and Teaching, CMVM
29/07/09