Application of Bloom’s Taxonomy of Learning Domains in Medical Education

1. Application of Bloom’s Taxonomy of Learning Domains in Medical Education Joy-Telu Hamilton-Ekeke (PhD) Department of Curriculum and Instruction, Faculty of Education, Niger Delta University, Bayelsa State

2. Learning Objectives • At the end of the workshop/presentation, participants should be able to: • Formulate test questions that will measure mastery of subject matter • Demonstrate understanding of key verbs for the various categories (domains) of learning • Appraise the three domains of Bloom’s Taxonomy of learning domains • Explain the different categories in each domain

3. Approach • It is going to be an interactive workshop • Resource person will first expose participants to the premises underpinning Bloom’s Taxonomy of learning domain and then explain the three domains and the various categories of learning behaviours under each domain. • At the end of the presentation, participants will be grouped and asked to formulate test questions based on Bloom’s Taxonomy in their different specialties which will then be criticized by all with the resource person moderating.

4. Introduction • Taxonomy enable educational training and learning objectives to be planned and measured properly – improving the effectiveness of developing ‘mastery’ instead of simply transferring facts for mindless recall. • Bloom believed that education should focus on ‘mastery’ of subjects and the promotion of higher forms of thinking, rather than a utilitarian approach to simply transferring of facts - the lowest level of training

5. Bloom’s aim • Bloom’s aim was to develop a system of categories of learning behaviour to assist in the design and assessment of educational learning. • Bloom demonstrated decades ago that most teaching tended to be focused on fact-transfer and information recall – the lowest level of training – rather than true meaningful personal development.

6. Objectives of the paper • This has remained a central challenge for educators and trainers in modern times. • Bloom’s Taxonomy has therefore provided a basis for ideas which have been used (and developed) around the world by academics, educators, teachers and trainers, for the preparation of learning evaluation materials, and also provided the platform for the complete ‘Bloom’s Taxonomy’ (Cognitive, Affective and Psychomotor Domains).

7. Explanation of Bloom’s Taxonomy • Bloom’s Taxonomy underpins the classical ‘Knowledge, Attitude, Skills’ structure of learning method and evaluation. This taxonomy of learning behaviours can be thought of as ‘the goals of the learning processes. That is, after a learning episode, the learner should have acquired new skills knowledge, and/or attitudes. • The model also serves as a sort of checklist, by which training is planned to deliver all the necessary development for students, and a template for assessing the validity and coverage of any existing curriculum, or an entire training and development programme for a large organisation.

8. In the first publication, Bloom and his team of researchers produced an elaborate compilation for the cognitive and affective domains, but none for the psychomotor domain. • Their explanation for this oversight was that they have little experience in teaching manual skills within the college level. If they were lecturers of medicine they would not have had this excuse because the health science curriculum in general has a lot of psychomotor skills embedded in it. • Little wonder why most Colleges of medicine have ‘state of the art’ simulation workshops/laboratories for the inculcation of psychomotor skills.

9. Definition of terms • Taxonomy means ‘a set of classification principles’ or ‘structure’ • Domain simply means ‘category’ • Bloom’s Taxonomy model is in three parts, or ‘overlapping domains’ and these are: • Cognitive domain (intellectual capability, i.e., knowledge, or ‘think’) • Affective domain (feelings, emotions and behaviour, i.e., attitude, or ‘feel’) • Psychomotor domain (manual and physical skills, i.e., skills, or ‘do’)

10. These three domains as applied to the Health Sciences curriculum means for each topic in the curriculum to be taught, the lecturer should first of all identify the (content to be learnt) knowledge to be inculcated (cognitive), the corresponding attitude to be developed (affective) and the corresponding skills to be acquire (psychomotor) for that particular topic. • These could then be stated as ‘Learning objectives’ to guide and direct the teaching process and ‘outcome measures’ for the evaluation of the teaching/learning process.

11. Application of Bloom’s domain to medical curriculum • These three domains as applied to the medical curriculum means for each topic in the curriculum to be taught, the lecturer should first of all identify the (content to be learnt) knowledge to be inculcated (cognitive), the corresponding attitude to be developed (affective) and the corresponding skills to be acquire (psychomotor) for that particular topic. • These could then be stated as ‘Learning objectives’ to guide and direct the teaching process and ‘outcome measures’ for the evaluation of the teaching/learning process.

12. The learner should benefit from the development of knowledge and intellect (Cognitive Domain); attitude and beliefs (Affective Domain); and the ability to put physical and bodily skills into effect – to act (Psychomotor Domain). • Collectively these concepts which make up the whole Bloom Taxonomy continue to be useful and very relevant to the planning and design of: school, college and university education, adult and corporate training courses, teaching and lesson plans, and learning materials; they also serve as a template for the evaluation of: training, teaching, learning and development, within every aspect of education and industry.

13. Premise of Bloom’s Taxonomy • Each of the three learning domains (Cognitive, Affective and Psychomotor) has different categories under them. In each of the three domains Bloom’s Taxonomy is based on the premise that the categories are ordered in degree of difficulty. • An important premise of Bloom’s Taxonomy is that each category (or ‘level’) must be mastered before progressing to the next. As such the categories within each domain are levels of learning development, and these levels increase in difficulty.

14. Cognitive Domain The cognitive domain involves knowledge and the development of intellectual skills. This includes the recall or recognition of specific facts, procedural patterns, and concepts that serve in the development of intellectual abilities and skills.

15. For instance in the Health Science Curriculum, a course like ‘Gross Anatomy’ which is one of the beginning courses for medical students would involve the possession of knowledge of anatomy sufficient for medical education and will be evaluated with a demonstration of theoretical and practical knowledge of gross and microscopic structures in human anatomy. • The course ‘Gross Anatomy’ could also involve the introduction of students to simple clinical applications of basic anatomy which could be evaluated by the understanding of the anatomical basis of various clinical conditions and specific aberrations of human anatomic structures.

16. Cognitive Domain • The cognitive domain involves knowledge and the development of intellectual skills • Knowledge • Comprehension • Application • Analysis • Synthesis • Evaluation

17. Knowledge which involves recall of data or information and is the least difficult and must be mastered before the next one can take place, e.g. state the differences in anatomical structures. • Comprehension involves demonstration of understanding of meaning, translation, interpolation, and interpretation of instructions and problems. It also includes stating a problem in one’s own words, e.g. summarise the structures and viscera of the head and neck. • Application is the use of a concept in a new situation or unprompted use of an abstraction. It involves applying what was learned in the classroom into novel situations outside the classroom (in the work place), e.g. apply the knowledge of anatomy in clinical setting.

18. Analysis involves separating materials or concepts into component parts so that its organisational structure may be understood. It includes distinguishing between facts and inferences, e.g. distinguish between anatomical variants that occur (both normal and abnormal. • Synthesis involves building a structure or pattern from diverse elements. Putting parts together to form a whole, with emphasis on creating a new meaning or structure, e. g. compose up to date anatomical nomenclature. • Evaluation involves making judgements about the value of ideas or materials e.g. evaluate clinical syndromes produced by disturbances in the developmental process.

19. Matrix detailing the Cognitive Domain

20. Affective Domain • Affective Domain comprises of the manner in which things are dealt with emotionally, such as feelings, values, appreciation, enthusiasms, motivations and attitudes. • One of the behavioural objectives of surgery M.B.B.S curriculum is to produce medical graduates with sound ethical behaviours and an adequate demonstration of professionalism; to diagnose and manage patients as products of his/her socio-economic milieu and attend to them in a socially-responsive manner.

21. Know the various means of communication including how to obtain an informed consent and break bad news. These are then measured in terms of attitudes which are accord with global standards. • For instance in a course like ‘Surgery-in-General’ which involves organisation of patients’ care and ward procedures, history taking and physical examination could be measured in terms of effective communication skills (verbal and non-verbal) and efficient clinical practice, respect for patients values, feelings and decisions.

22. Categories of Affective Domain • Receiving phenomena • Responding to phenomena • Valuing • Organisation • Internalising values

23. Receiving phenomena: this includes awareness, willingness to hear, selected attention, e.g. listening to bedside clinical teaching, attending tutorials and taking part in clinical demonstrations. • Responding to phenomena involves active participation on the part of the learners. Attends and reacts to a particular phenomenon. Learning outcomes may emphasise compliance in responding, willingness to respond, or satisfaction in responding (motivation) e.g. perform socially responsive surgery.

24. Valuing: this is the worth or value a person attaches to a particular object, phenomenon, or behaviour. This range from simple acceptance to the more complex state of commitment, valuing is based on the internalisation of a set of specified values, while clues to these values are expressed in the learner’s overt behaviour and is often identifiable e.g. demonstrate history taking, physical examination (respecting social, religious and ethnic differences). • Organisation includes organising values into priorities by contrasting different values, resolving conflicts between them, and creating a unique value system. The emphasis is on comparing, relating, and synthesising values, e.g. formulate, diagnose and management of patients.

25. Internalising values also referred to as characterisation involves having a value system that controls behaviour. The behaviour is pervasive, consistent, predictable, and most importantly, characteristic of the learner. Instructional objectives are concerned with the student’s general patterns of adjustment (personal, social, emotional), e.g. demonstration of ethical behaviour and professionalism in terms of strengthening skills in recognising and interpreting symptoms and signs of general surgery diseases.

26. Matrix detailing Affective Domain

27. Psychomotor Domain • This domain includes physical movement, coordination, and use of the motor-skill areas. Development of these skills requires practice and is measured in terms of speed, precision, procedures or techniques in execution which is basically what the Health Sciences curriculum in generally is based on specially surgery. • The psychomotor domain was later developed and elaborated by three of Bloom’s scholars/tutees: Simpson (1972), Harrow (1972) and Dave (1975).

28. Dave version of psychomotor domain • The Dave version of the Psychomotor Domain is featured most prominently here because in my view it is more opt and succinct in its application to the health sciences curricula as it is most relevant and helpful for work- and life-related development. • Although the Psychomotor Domains suggested by Simpson and Harrow are relevant and helpful for certain types of adult training and development that take them out of their comfort zone, as well as the teaching and development of young people and children.

29. Dave’s Psychomotor Domain Taxonomy consisted of five categories or levels starting with simplest behaviour to the most complex. • Imitation • Manipulation • Precision • Articulation • Naturalisation

30. Imitation – This is observing and patterning behaviour after someone else. Performance maybe of low quality. Example: trying out an act after seen it demonstrated - (catitarisation on manikins). • Manipulation – This is being able to perform certain actions by following instructions and practicing. Example: creating work on one’s own, after taking lessons, or reading about it e.g. been able to manipulate a microscope or a sterilising machine or an ECG machine.

31. Precision - This is refining, becoming more exact. Few errors are apparent. Example: working and reworking something, so it will be ‘just right’, e.g. been able to carry out a simple surgical operation like an appendectomy. • Articulation – This is coordinating a series of actions, achieving harmony and internal consistency. Example: is been able to diagnose surgical emergencies and been able enable to institute life saving first aid and basic life support.

32. Naturalisation – This is having high level performance become natural, without needing to think much about it. This is the level of automaticity that comes with regular practice and familiarity. • In case of surgical curriculum it involves the mastery of clinical features of common surgical diseases and to be able to synthesise the features into clinical diagnosis. And how to investigate a patient to refine the differential diagnoses to a definitive diagnosis and the treatment of common surgical diagnosis. • It also includes how to diagnose clinically uncommon surgical diseases, including syndromes, interpretation of results of common investigations and recommendation for further advanced investigations, minimal invasive surgery.

33. Matrix detailing Dave’s psychomotor domain

34. Conclusion • Bloom’s Taxonomy is a wonderful reference model for all involved in teaching, training, learning, coaching – in the design, delivery and evaluation of these development methods • Bloom’s Taxonomy provides a simple, quick and easy checklist to start to plan any type of personal development; • As with any checklist, it helps to reduce the risks of overlooking some vital aspects of the development required. The more detailed elements within each domain (matrix) provide additional reference points for learning design and evaluation, whether for a single lesson, session or activity, or training need, or for an entire curriculum;

35. As with so many of the classical models involving the development of people and organisations, you actually have a choice as to how to use Bloom’s Taxonomy. It’s a tool – or more aptly – a toolbox. Tools are most useful when the user controls them; not vice-versa. Use Bloom’s Taxonomy in the ways that you find helpful for your own situation.

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