An Approach to Curriculum Development

1. An Approach to Curriculum Development GME Lunch n Learn Series Cuc Mai September 2012

2. ACGME Program Requirements • Common Program Requirements: • Competency-based goals and objectives for each assignment at each educational level • Internal Medicine Specific Program Requirements: • For each rotation or major learning experience, the competency based goals and objectives (the written curriculum) must contain the educational plan, goals and objectives, educational methods, and the evaluation tools that the program will use to assess the resident’s competence.

4. Goals & Objectives • Recognize key components of curriculum development • Demonstrate how each of these components can be used to benefit learners and promote scholarly activity • Identify resources to improve curriculum development skills

5. A Six Step Approach to Curriculum Development

6. Example Case • Develop a curriculum to teach residents about how to diagnose and treat musculoskeletal diseases and increase number of joint injections performed during residency.

7. Step 1: Problem Identification & General Needs Assessment • Builds a rationale for the curriculum • Focuses the curriculums’ goals and objectives • Focuses the educational and evaluation strategies • Makes you an expert and scholar

8. Step 1. Problem Identification

9. Step 1. General Needs Assessment

10. Step 1. Problem Identification & General Needs Assessment Example • Musculoskeletal disorders are common and a major cause of disability • Patients want quick access • Training increases confidence and decreases referrals • National organizations recommend training in musculoskeletal exam; diagnosis; management • Preferred training is in clinical practice with trained preceptors Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med 2004; 19: 524-529.

11. Step 2: Targeted Needs Assessment • Assess the differences between your specific learners and the general audience • Assesses the environment to help tailor the intervention • Prevents duplication • Identifies stakeholders and builds relationships with stakeholders

13. Step 2. Targeted Needs Assessment Example • Methods for collecting information: • Reviewed existing training • Senior resident exit survey, Survey of current residents, & Focus group of residents • Findings: • Strong desire for training • Low levels of training and clinical experience and self rated proficiency • Wrong case mix in Rheumatology and Orthopedics • Preferred direct supervision of patient care by practitioners with expertise in musculoskeletal medicine Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med 2004; 19: 524-529.

14. Step 3: Goals & Objectives • Goal: broad educational goal • Objective: specific measurable objective

15. Step 3. Goals & Objectives • Helps prioritize • Direct content • Identify learning methods • Enable and direct evaluation • Provides clear communication to learners, faculty, and stakeholders • Required

16. Step 3. Objectives • Types of Objectives • Learner Objectives • Cognitive, Affective, Psychomotor • Process Objectives • Curriculum Implementation Measures • Patient/Healthcare Outcome Objectives • Patient Outcomes: pt satisfaction • Healthcare/System Outcomes: board pass rate

17. Step 3. Writing Objectives • Who will do how much of what by when? • Who (1) • Will do (2) • How much (3) • Of What (4) • By When (5)

18. Step 3. Writing Objectives & Bloomberg’s taxonomy

20. Step 3. Objectives Example

21. Step 4. Educational Strategies • Maintain congruence between objectives and methods • Use multiple educational methods • Choose methods that are feasible

22. Step 4. Educational Strategies

23. Step 4. Educational Strategies Example • Musculoskeletal Curriculum: • Development of workshops and syllabus materials on diagnosis and management for common musculoskeletal disorders, including injection therapy. • Institution of a new primary care musculoskeletal clinic supervised by Internal Medicine preceptors with a special interest in musculoskeletal diseases. Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med 2004; 19: 524-529.

24. Step 5. Implementation • Identify Resources • Personnel, Time, Facilities, Funding • Obtain Support • Internal vs. External • Develop Administrative Mechanisms • Anticipate and Address Barriers • Competing Demands, Attitudes • Develop a Plan for Introducing Curriculum • Pilot, Phase In, Full Implementation

25. Step 5. Implementation Example • Musculoskeletal clinic • Financial analysis and feasibility analysis had to be done • Administrative support was obtained. • Plan discussed with Rheumatology and Orthopedics Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med 2004; 19: 524-529.

26. 6. Evaluation & Feedback • Need to determine if goals are met • Provides information for improvement • Documents accomplishments • Specifics to Consider • Evaluation Questions • Address learner objectives • Evaluation Design • Consider internal and external validity • Posttest, Pretest/Postest/Control Group

27. Conclusions • Recognize and apply these 6 steps to curriculum development • Problem Identification & General Needs Assessment, Targeted Needs Assessment, Goals & Objectives, Educational Strategies, Implementation, Evaluation & Feedback • Define objectives in specific and measurable language • Who will do how much of what by when? • Use references to help your faculty develop curriculum for your learners

28. References • Kern D, Thomas P, Hughes M, Barker L, Bass E, Carrese J, Wolfe L. The Six-Step Approach to Curriculum Development. SGIM Workshop. 5/2009. • Kern D. Curriculum Development for Medical Education. Second Edition. • Thomas P, Kern D. Internet Resources for Curriculum Development in Medical Education. An Annotated Bibliography. J Gen Intern Med. 2004; 19: 599-605.