Title Curriculum Development for Medical Education A Six-Step Approach-19-23 - WR.pdf ✅

8 Curriculum Development for Medical Education EXAMPLE: Educational Strategies. Based on the above example of a targeted needs assessment, ob- jectives for the ADE curriculum focused on increasing awareness, skill development, and the reinforce- ment of desired behaviors. Two two-hour workshops were scheduled during protected educational time that engaged learners in applying an efficient, user-friendly worksheet to identify patients at risk, to identify high-risk medications, using Beers (18) and STOPP (19) criteria, that were candidates for re- moval or replacement, and to develop an action plan. The worksheet was applied to a sample case and two or three patients from the resident practice. Identifying and addressing ADE risk was reinforced through the distribution of pocket cards, placing the worksheets on the practice website for easy ac- cess, faculty development of clinic preceptors, and feedback of evaluation data from the electronic medical record (17). EXAMPLES: Congruent Educational Methods. Lower-level knowledge can be acquired from reading or lectures or, asynchronously, through online modules. Case-based, problem-solving exercises that actively involve learners are methods that are more likely than attendance at lectures to improve clinical reasoning skills. The development of physicians as effective team members is more likely to be promoted through their participation in and reflection on interprofessional cooperative learning and work experiences than through reading and discussing a book on the subject. Interviewing, physical examination, and procedural skills will be best learned in simulation and prac- tice environments that supplement practice with self-observation, observation by others, feedback, and reflection. Step 5: Implementation Implementation involves the implementation of both the educational intervention and its evaluation. It has several components: obtaining political support; identifying and procuring resources; identifying and addressing barriers to implementation; in- troducing the curriculum (e.g., piloting the curriculum on a friendly audience before presenting it to all targeted learners, phasing in the curriculum one part at a time); ad- ministering the curriculum; and refining the curriculum over successive cycles. Imple- mentation is critical to the success of a curriculum. It is the step that converts a mental exercise to reality. Step 6: Evaluation and Feedback This step has several components. It usually is desirable to assess the performance of both individuals (individual assessment) and the curriculum (called “program evalu- ation”). The purpose of evaluation may be formative (to provide ongoing feedback so that the learners or curriculum can improve) or summative (to provide a final “grade” or evaluation of the performance of the learner or curriculum). Evaluation can be used not only to drive the ongoing learning of participants and the improvement of a curriculum but also to gain support and resources for a curriculum and, in research situations, to answer questions about the effectiveness of a specific curriculum or the relative merits of different educational approaches. THE INTERACTIVE AND CONTINUOUS NATURE OF THE SIX-STEP APPROACH In practice, curriculum development does not usually proceed in sequence, one step at a time. Rather, it is a dynamic, interactive process. Progress is often made on
Overview: A Six-Step Approach to Curriculum Development 9 two or more steps simultaneously. Progress on one step influences progress on another (as illustrated by the bidirectional arrows in Figure 1). As noted in the discussion and examples above, implementation (Step 5) actually began during the targeted needs assessment (Step 2). Limited resources (Step 5) may limit the number and nature of ob- jectives (Step 3), as well as the extent of evaluation (Step 6) that is possible. Evaluation strategies (Step 6) may result in a refinement of objectives (Step 3). Evaluation (Step 6) may also provide information that serves as a needs assessment of targeted learners (Step 2). Time pressures, or the presence of an existing curriculum, may result in the development of goals, educational methods, and implementation strategies (Steps 3, 4, and 5) before a formal problem identification and needs assessment (Steps 1 and 2), so that Steps 1 and 2 are used to refine and improve an existing curriculum rather than develop a new one. For a successful curriculum, curriculum development never really ends, as illus- trated by the circle in Figure 1. Rather, the curriculum evolves, based on evaluation results, changes in resources, changes in targeted learners, and changes in the material requiring mastery.