Things That Make the Curriculum Work

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Things That Make the Curriculum Work

• Prof Dr. Wim Gijselaers
• Maastricht University
• The Netherlands

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Things That Work in the Netherlands

• Introduction of Nation-Wide Standards
• Protocol for External Assessment of Programs
• Capacity to develop policies of Curriculum Reform
• Blueprint Training of Doctors 2001
• Competition and Market Forces
• National Rankings
• Use of Educational Expertise
• For development refinement of curricula
• For defining standards, policies competitiveness

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Curriculum Organization
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Problems with Curriculum Innovation

• One of the central lessons we think we have
  learned about previous rounds of innovation is
  that they failed because they didnt get at
  fundamental, underlying, systemic features of
  school life they didnt change the behaviors,
  norms and beliefs. Consequently, these reforms
  ended up being grafted on to existing practices,
  ...
• Dull and incompetent teachers taught the new
  content dully and incompetently.
• Evans, R. (1996). P. 5

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The Maastricht Case I

• Maastricht Medical School founded 1974
• Institutions philosophy (1972)
• Professional Development and specialization are
  not to be confined to the narrow limits of one
  faculty or department.
• Greater emphasis is to be put on the training of
  physicians for primary health care tasks. Better
  balance among the somatic, behavioral and social
  aspects of health care, promoting teamwork
  between physicians and other primary health care
  professionals
• Appropriate educational methods are to be
  developed

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Focus on Organizational Structure
A
Clinical discipline
Course 1 Course 2, etc
x
Curriculum projects
B
Departments
x
C
x
Basic Science
Clerkship 1 Clerkship 2, etc.
x
D
x
x
E
x x
x
x
Primary Care
Skills training 1 Skills training 2, etc.
x
x
Funding through project participation
x
F
x
G
x
Teacher training Other support projects
x x
x
Social Science
x
H
x
x
x
x
Fixed minimum for departments
x
x
x
x
x
x
x
x
x
x
x
x
Curriculum Committee
Faculty Board
x
x
x
Bouhuijs, P. (1990)
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Resistance Confusion

• Resistance from chairs of departments
• I dont understand PBL, but I know it wont
  work.
• My department is unanimously against PBL (A
  chair who never saw a small group tutorial).
• PBL is fantastic, but it would never work on our
  students.
• If PBL is so good, why isnt it used at
  Harvard?
• Confusion and anger from individual teachers
• I dont know how detailed a case should be!
• Can I show my students last years exam?
• What can I do to make my students work?
• Suppose some students miss important
  objectives!
• Students will not learn about the inherent logic
  of my discipline. A good lecture series is really
  necessary.

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Frustration Adherence

• Students
• Students need to learn about the innovation
• Training for students with new instructional
  methods
• Students dont like change
• Afraid that the innovation will worsen their
  situation
• Students stick to procedures, unless their
  teachers understand the nature of the innovation
• Solving the case gets the primary learning goal
  or learning from text books gets their primary
  goal
• Students like to learn
• Students learn by themselves when they start to
  like the learning environment
• Motivation control (example courses on
  psychosomatic disorders)

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Continuous Improvement

• A substantial amount of educational research
  educational development
• About 7 fte involved in course design, course
  evaluation and curriculum governance
• A strong belief in doing right things right
• Benchmarking in international networks
• An organizational structure that prevented
  disasters caused by relentless departments
• Students who worked together with staff in course
  design

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Academic Research on Medical Education
Contact Hours
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A Tale of Two Cities

• It was the best of times, it was the worst of
  times, it was the age of wisdom, it was the age
  of foolishness, it was the epoch of belief, it
  was the epoch of incredulity, it was the season
  of Light, it was the season of Darkness, it was
  the spring of hope, it was the winter of despair,
  we had everything before us, we had nothing
  before us,
• Dickens, C. (1859). A Tale of Two Cities

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New Vienna Medical Curriculum
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The First Period of Innovation

• Curriculum Level
• Departments needs define thematic courses
• Different departments teach the same contents
  within and between courses. Some contents get
  lost in the curriculum (walking kidney)
• The new curriculum is overloaded
• Old curriculum seeps into the new curriculum
• Course Level
• Teachers forget about the original expectations
• Teachers teach old lectures in new courses
• Teachers dont know how to work together with
  students
• Student Level
• Lets move to the learning goals, dont waste
  time.
• They never refer to the original case. Telling
  about what everyone read

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Managing the Innovation

• Need for Change
• Innovation addresses real Problems

• Performance Dip
• A period of decline in organizational performance

• Process
• Cooperation
• Participation
• Communication
• Training support
• Rewards
• Evaluation

• History of Change
• Leaders
• Resources
• External Support
• Teaming

• Stages of Change
• Loss
• Incompetent
• Confusion
• Conflict

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Things That Make the Curriculum Work

• Introduction of a Nation-Wide Standards
• Protocol for External Assessment of Programs
• Capacity to develop policies of Curriculum Reform
• Blueprint Training of Doctors 2001
• Competition and Market Forces
• National Rankings
• Use of Educational Expertise
• For development refinement of curricula
• For defining standards, policies competitiveness

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452 fte Staff 354 fte Support
Administration 1350 students
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External Assessment

• Dutch Review Committees (1992, 1997)
• Medical Faculties meet general objectives
  insufficiently
• Students final level is too dependent on own
  dedication and coincidental circumstances
• Recommendations
• The clinical program should not exist of separate
  clerkships, but it should also address subjects
  surpassing these clerkships like ethics and
  professional behavior

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Standards

• Several program revisions, but
• Integration of theory and practice failed
• 1993 Proposal to reschedule clerkships
• Insufficient support from faculty
• 1995 Introduction Practical Medical training
• Theory and practice became different streams
• Clerkships are unstructured learning situations
• Students encounter 8 9 patients per week
• Many activities have little value for students
• Large differences between students and supervisors

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Educational Expertise

• 7 years
• Post Graduate Experience

2.5
2.0
Number of Solutions
1.5
1.0
.5
0 yr
1 yr
2 yr
3 yr
7 yr
15 yr
30 yr
4 yr
10 yr
Level of Expertise
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(No Transcript)
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Intermezzo about Organizational Performance

• How should Crews (Pilots) be selected by
  airlines, to minimize human error?
• How should OR teams be selected by hospitals, to
  minimize medical mistakes?

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Communication OR Teams

• Social Factors
• Tension in team communication affects novices in
  surgery. They respond with
• withdrawing from the communication or mimicking
  the senior staff surgeon
• intensifying rather than resolving interpersonal
  conflict
• Academic Medicine (2002). Lingard et al.
• Cognitive Factors
• Age related deficits
• analytic (controlled) processing, whereas
  non-analytic (automatic) processing remains
  intact.
• older adults infuse personal experience into
  problem representations
• Academic Medicine (2002). Eva, K.W.
• Teams with higher error rates worked in open
  atmosphere
• Teams with low rates were led by authoritarian
  managers
• Edmondson (1996). Journal of Applied Behavioral
  Science

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Features of Successful Curricular Change

• Leadership
• Leaders advocacy of organizational vision
• Human Resource Development
• Training Support
• Reward structure
• Participation by organization members
• Politics
• Use of formal informal power structures
• Cooperative climate
• Evaluation
• Bland (2000). Academic Medicine, 75 (6), 575-594

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Working With Difficult Things

• Leadership Human Resource Development
• Realigning internal funding allocations
• 1 approach
• Training programs and provision of release time
• Leadership cooperative climate
• Maintenance of academic culture and positive
  climate
• Successful leaders use power together with
  participative and cultural value behavior

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Performance Dip

• Often noted decrease in organizations
  performance that occurs as the new program is
  implemented
• Do not allow so much restructuring that the
  curriculum reform is subverted
• It usually takes between 3 5 years before the
  reform is institutionalized and dust, smoke and
  clouds have disappeared

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Things That Make Your Curriculum Work

• Course coordinators
• Provide schooling for the Themen Block
  Coordinators
• Give them a small budget for add-ons
• Curriculum committee
• Schooling in program management
• Develop a training program on Medical Education
• Studiendekanat
• Staff coordinators
• Budget for projects supporting curriculum reform
• Develop a long term vision on good curriculum
  governance
• Develop a Communication strategy
• Budget for management buy out of research time

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Workshop Curriculum Management for Competent
Professionals