Writing Program Objectives: an essential start to an effective curriculum

1. Writing Program Objectives: an essential start to an effective curriculum Dr Jessica Servey, Lt Col, USAF MC Department of Family Medicine

2. Traditional Medical Education Large group activities Testing Questioning Apprenticeship Felt a “limit” to the knowledge Topic based

3. Pre-clinical years Lecture and classroom Small groups Writings vs multiple choice Initial patient encounters

4. Clinical Years Hands-on teaching Dependent on patients seen Challenge to ensure at the same level

5. Objectives for today Justify the reasons for objectives Discuss criteria for a clearly defined objective List several action verbs used in creating objectives Apply the criteria and language to create objectives for the individual learner’s course Begin assembling the curriculum instruction and evaluation based on objectives

6. Curriculum Development

7. Curriculum Development Example

8. LCME, 2007 revision • ED-1 • The medical school faculty must define the objectives of its educational program. The objectives must serve as guides for establishing curriculum content and provide the basis for evaluating the effectiveness of the educational program. • ED-1-A • The objectives of the educational program must be stated in outcome based terms that allow assessment of the student progress in developing the competencies that the profession and the public expect of the physician

9. Barriers to writing objectives Time Training Classify and organize level of the learner Person writing objectives may not be testing/evaluating Peer usage is questionable Not intuitive as physicians Feedback on clarity questionable

10. Is it a goal or objective? • Goals • Broad statements • Visionary • Objectives support the goals • Example: • The medical student must demonstrate knowledge about established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences and the application of this knowledge to patient care and population health.

11. Objectives are………… • Building blocks of a curriculum • Tell all stakeholders clearly the outcomes to expect • Rationale for What you are doing and How you accomplish it • “What”is the content • “How” is your educational methods • Knowing where you are going ensures that you have a chance of getting there!

12. Stakeholders in Medical Curricula Learners – students, residents, fellows, attendings Teachers Administrators – PDs, Deans, ACGME, LCME, etc Individual patients and families Society

13. How to Write Objectives • Think about what you want the learner to accomplish • Be realistic to the level of learner, resources, and generalizability • Think about what the learner should accomplish (look at national standards) • Creating the actual objectives • Make sure the objective is measurable (can evaluate it) • Quantify the degree specifically (will match evaluation) • Does it match the condition (course, lecture) • Use action verbs • Have a manageable number of objectives • Are the objectives appropriate to my level (course, lecture,etc) • Reread later to make sure you understand it

14. Step 1: Thinking • Deciding what you want the learner to accomplish • Is there a national standard? • Needs assessment? • Learners • Teachers • For us-----the residency directors

15. Step 2: Creating the Objectives • Based on • Audience • Behavior – cognitive, psychomotor, affective • Measurable, Observable • Condition – Environment • Attainable in the constraints of the course • Degree – Level of learning needed to complete the course • Appropriate for the level of the learner Who Will “do” What By when How much/how well

16. Example By the end of the gynecology rotation (WHEN), the second year FM resident (WHO) will have demonstrated (WILL DO) appropriate speculum placement, pap smear technique, and cervical cultures (WHAT) at least 5 times correctly (HOW MANY)

17. Behavior and Degree of Learning • Cognitive • Psychomotor • Affective Knowledge Comprehension Application Analysis Synthesis Evaluation Motor Skills: Novice, Beginner, Competent, Proficient Receive Respond Value Organize Characterize

18. Considerations about “degree” of learning Be realistic about your learner Know your resources (systems, educators, support staff) Can you really evaluate that objective? Can you expect EVERY learner to meet that milestone? Is that objective nationally required at the learner level? What level is your objective……broad course vs lecture

19. Condition • Time-frame • Location • Resources • Viewpoint (macroscopic vs microscopic) • Changes specificity • Course • Block • Lecture

20. Examples

21. Psychomotor Objective • Residents will learn the technique of joint injections • By the end of the Family Medicine residency the resident will perform at least one of each of the following by taught protocol: • Subacromial and intraarticular shoulder injection • Knee injection or aspiration • Lateral and medial epicondylitis • One other joint injection or aspiration not listed above

22. Affective Objective • Students will appreciate educating the patient and partnering to make a plan. • What is this? How do I evaluate or teach this? • At the end of the Family Medicine clerkship the student will rate as valuable the physician’s role in educating the patient during the encounter

23. Cognitive Objective • At the end of a 1 month surgery clerkship the student will be able to manage burns • What type of burns? Will they have to perform treatment or cognitively know? What exactly will the student do? Will every student see this? • At the end of a single month surgery clerkship, the student will be able to distinguish the three severities of burns, and discuss the initial management.

24. Step 3: Using action verbs • Verbs to avoid • Learn • Understand • Appreciate • Believe • Know

25. Examples of effective action words Cite Count Associate Classify Apply Calculate Analyze Appraise Combine Summarize Visualize Reconstruct Select Interpret Discriminate Identify Perform Differentiate Integrate Use Locate Distinguish Reorganize Outline Infer Demonstrate

26. Psychomotor Objective • Residents will learn the technique of joint injections • By the end of the Family Medicine residency the resident will perform at least one of each of the following by taught protocol: • Subacromial and intraarticular shoulder injection • Knee injection or aspiration • Lateral and medial epicondylitis • One other joint injection or aspiration not listed above

27. Affective Objective • Students will appreciate educating the patient and partnering to make a plan. • At the end of the Family Medicine clerkship the student will • rate as valuable the physician’s role in educating the patient during the encounter • select a plan to display partnering with the patient

28. Cognitive Objective • At the end of a 1 month surgery clerkship the student will be able to manage burns • At the end of a single month surgery clerkship, the student will be able to distinguish the three severities of burns, and discuss the initial management.

29. Step 4: Limiting objectives • Have a manageable number for your “program” • Course objectives vs lecture objectives • Courses have larger number • Courses have broader objectives • Lectures having more specific and fewer

33. Step 5: Review the objectives Have peer read them Reread them later Ensure the evaluation links to the objective

34. How to Write Objectives • Think about what you want the learner to accomplish • Be realistic to the level of learner, resources, and generalizability • Think about what the learner should accomplish (look at national standards) • Creating the actual objectives • Make sure the objective is measurable (can evaluate it) • Quantify the degree specifically (will match evaluation) • Does it match the condition (course, lecture) • Use action verbs • Have a manageable number of objectives • Are the objectives appropriate to my level (course, lecture,etc) • Reread later to make sure you understand it

35. Practice Each person will write 2 objectives for a course or lecture Discuss with partner Discuss how you will evaluate the objective

36. Curriculum Development

37. Example building on objectives Evaluation: Multiple choice tests Clinical Reasoning assignment Participation evaluation Small Group Short lecture & small group Written Assignment Lecture Instructional Methods Content: Normal Menstrual cycle Terms of abnormal cycle length Diagnoses the cause abnormal cycle length and the physiology Diagnostic tests to differentiate the etiologies Objective: At the end of the GU/reproductive module the student will discuss the normal menstrual cycle, etiologies of abnormal cycle lengths and apply the use of diagnostic tests

38. Objectives…….. Are essential building blocks of the curriculum Require deliberate time and thought to create Must match the evaluation of the learner Use action verbs Clearly articulate what outcomes will be assessed to all stakeholders Answer the questions: Who, Will do What, When, and at what degree (How much, How well, How many)

39. References Wehrli G. The Nuts and bolts or Curriculum and Assessment. J Clin Apheresis 26:29-46,2011. http://www.sgim.org/userfiles/file/SC04_Kern_David_201191.pdf Kern, DE,ThomasPA,Howard DM. editors. Curriculum Development for Medical Education: A Six-Step Approach. 2nd ed. Baltimore: The Johns Hopkins University Press, 2009. Harden, RM. AMEE guide no. 21: Curriculum mapping: a tool for transparent and authentic teaching and learning. Medical Teacher, 23(1), 2001. Acknowledge: Multiple handouts from MSU Faculty Development Fellowship and DrYensin