Title outcome based education-handout.pdf ✅

Chapter 20 Section 3: Educational strategies S. R. Smith Outcome-based curriculum Introduction 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 dem- onstrate this remarkable achievement, the boy com- mands, ‘Fido, whistle!’ Fido wags his tail vigorously but does 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!’ All too often, we, as teachers, focus too much on what we teach rather than on what our students learn. Outcome-based education emphasises 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 actu- ally do with what they know. Outcome-based education defines what we expect of our graduates and holds us accountable to provide an education that achieves those endpoints. It is not only good education, it is good public policy. Medical schools around the world are increasingly embracing the concepts of outcome-based educa- tion (Liu et al 2006, Simpson et al 2002, Smith et al 2003). National and international bodies in medical education have espoused these principles, urging and even requiring their constituents to comply (ACGME 2001, Schwartz & Wojtczak 2002). Planning backwards The traditional model of medical education (‘planning forwards’) begins with the delineation of the knowl- edge fundamental to medicine, teaching that knowl- edge, then testing whether students have learned that information, typically by some form of closed-book examination (Fig. 20.1). The hope is that acquisition of this knowledge base will lead to students becoming good doctors. The outcome-based model (‘planning backwards’) goes in the opposite direction, starting with the good doctor and working backwards (Fig. 20.2). The fac- ulty designing the curriculum begins by defining the attributes of the successful graduate, then they fig- ure out how they would know whether students had attained those outcomes, then they create learn- ing opportunities that would enable the students to achieve them. Choosing outcomes The easiest way for a medical school to create an out- come-based curriculum is to adopt outcomes that oth- ers have defined. Abilities in nine areas were described at Brown Medical School (Smith et al 2003): 1. Effective communication 2. Basic clinical skills 3. Using basic science in the practice of science 4. Diagnosis, management, and prevention 5. Lifelong learning 6. Professional development and personal growth 7. The social and community contexts of healthcare 8. Moral reasoning and clinical ethics 9. Problem solving. The ‘Scottish doctor’ model has 12 outcomes, cat- egorised into three elements (Simpson et al 2002): • What the doctor is able to do: cc clinical skills cc practical procedures cc patient investigations cc patient management cc health promotion and disease prevention cc communication cc medical informatics. “The only way to get somewhere, you know, is to figure out where you’re going before you go there” Updike 1960 “l”
162 SECTION 3: Educational strategies • How the doctor approaches his or her practice: cc basic, social and clinical sciences cc attitudes, ethical understanding and legal responsibilities cc decision-making skills and clinical reasoning. • The doctor as a professional: cc the role of the doctor within the health service cc personal development. The US Accreditation Council on Graduate Medical Education (ACGME 2003) lumps the outcomes into a smaller set of six general competencies: • patient care • medical knowledge • practice-based learning and improvement Define “Fundamental knowledge” Flexnerian Model Teach the fundamentals Test for knowledge of fundamentals Hope for the best ? Test fo r Knowledge What is “Fundamental Knowledge” Fig. 20.1 The Flexnerian model Develop learning experiences Competency-based model Design measures and standards of performance Define the successful graduate Fig. 20.2 Competency-based model Outcomes should be few in number, self-evident, A and easily understood
Chapter 20: Outcome-based curriculum 163 • interpersonal and communication skills • professionalism • systems-based practice. Using an already established list of outcomes has the advantages of ease, simplicity, comparability and established credibility. However, simply adopting someone else’s list has its own drawbacks. The faculty and students may not feel the same sense of owner- ship, unique characteristics of the school may not be represented or sufficiently emphasised, and the out- comes may be interpreted differently from what was originally intended. If a school chooses to create its own list of out- comes, it ought to maximise the amount of partici- pation in the process to increase the buy-in from students and staff. Since the only requirement of par- ticipants is that they have an opinion on what qualities they appreciate in their own doctors, everyone can be part of the process, from PhD basic scientists to stu- dents to clinical professors. A nominal group process technique can be used to maximise participation and minimise the impact of overbearing personalities. Each person in the group is allowed to add a desirable attribute of a good doctor. This continues in a ‘round-robin’ fashion until no new attributes are suggested. Attributes may be grouped together, with the permission of the persons who pro- posed them. Participants then vote by placing a star next to the attribute they believe is most important and ticks alongside to the three attributes they feel are next most important. The stars are counted as two points and ticks as one point. The votes are tallied and the attributes with the highest votes are selected as the outcomes. “It is a highly questionable practice to label someone as having achieved a goal when you don’t even know what you would take as evidence of achievement” Mager 1962 “l”