Curriculum and Goals and Objectives

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Curriculum and Goals and Objectives

• W. Thomas Lawrence, M.P.H., M.D.
• Section of Plastic Surgery
• Kansas University Medical Center

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What Are They?

• Mentioned Regularly in PIF and Educational
  Literature
• You Will Receive RRC Citations If You Dont Have
  Them
• Dr. Bob Ruberg and AACPS Colleagues Wrote a
  Plastic Surgery Curriculum
• I used to include the book in my PIF as my
  curriculum- I suspect others did too

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Are They Necessary?

• We All Completed Plastic Surgery Training and Are
  Competent Plastic Surgeons
• Dont We Know Intuitively What Our Residents Need
  to Know?
• Shouldnt We Just Run Our Training Programs Like
  the Ones We Trained In?
• Cant We Just Look at the Table of Contents of
  McCarthys (soon to be Mathes) Text, Selected
  Readings or Corequest to Determine What Our
  Residents Need to Learn About?

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Do They Really Make a Difference?

• Havent Plastic Surgery Residents Achieved Enough
  Educational Milestones To Be Aware of What they
  Need to Learn by This Point?

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Do They Really Make a Difference?

• Has the Quality of Education Provided to
  Residents Not Changed Significantly Since Writing
  Goals and Objectives Became Required?
• No Scientific Studies have Demonstrated Improved
  Products of Plastic Surgery Training Programs Due
  to the Presence of a Well Defined Curriculum and
  Goals and Objectives

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Do We Want the Specialty to Remain Static or to
Continually Improve?

• Specialty of Plastic Surgery is Defined by the
  Products of our Training Programs
• If We Want the Specialty to Continually Improve,
  We Need to Continually Improve Our Training
  Programs
• What Worked For Us May Not Be the Best Training
  Model
• Bright Individuals Will Achieve Success in Spite
  of Less than Ideal Training

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If You Want to Produce a Silk Purse, It is Best
to Start with Silk.

• Applicants Are Getting Better
• Integrated/ Co-ordinated Programs Are Attracting
  Stellar Medical Students
• Diminished Number of Independent Programs Has
  Increased Competition for 2-3 Year Positions
• We Owe It To These Talented Individuals to
  Provide Superb Training

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• If You Want Excellence, First Have a Clear Idea
  of What You Want to Produce
• Peters and Waterman- 1982
• Development of Curriculum with Goals and
  Objectives Forces us to Evaluate This

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What is a Curriculum?

• Word Derived from Greek word for Course as Used
  in Describing Chariot Races
• Webster says A Fixed Series of Studies
  Required.in a Major Field of Study
• Kern, Thomas, Howard and Bass Define it as a
  Planned Educational Experience

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What is a Plastic Surgery Curriculum?

• Totality of Educational Experiences That Allow
  Residents to Achieve Competence in the Cognitive,
  Personal and Psychomotor Skills Required to be
  Effective Plastic Surgeons

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What is a Curriculum?

• Dynamic and Interactive
• Changes Related to Evaluations, Changing Needs
  and Changing Educational Tools
• Constantly Evolving

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Curriculum Defined by 4 Questions in Technologic
Model

• What Educational Purposes are Sought?
• What Experiences Can be Provided to Attain These
  Purposes?
• How Can These Experiences Be Organized?
• How Can This Be Evaluated?

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Limitations of Technologic Model

• Does Not Include Clinical Judgment, Decision
  Making in Uncertain Situations, Ethics, Values
• Does Not Incorporate Interpersonal Interactions
  of Teacher and Learner

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Other Types of Curricula

• Syllabus Based
• List of Topics
• Easy to Transpose to Lecture Series
• Objectives Based
• Based on Learning Goals and Objectives
• Includes Specific Measures of Competence

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Considerations in Curriculum Development

• Construct to Achieve Societally Valued Skills and
  Values
• Construct Around Continuity of Care Experience to
  Achieve Self-Actualization

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Challenges of Curricula in Clinical Specialties

• Lack of Predictability in Terms of Exposure to
  Clinical Problems
• Creates Difficulties in Co-ordination of Didactic
  and Clinical Exposures
• Creates Uncertainty in Quality and Quantity of
  Experiences
• Creates Difficulty in Creating Graduated
  Responsibilities

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Process Based Curricula

• Differ from Syllabus and Objectives Based
  Curricula which are more Product Based
• Aspects More Applicable to Clinical Teaching
• Involves Preoperative Study and Planning,
  Intraoperative Teaching and Skill Development,
  Postoperative Patient Care and Assessment
• More Individualized to Learner Skills and
  Preferred Learning Methods

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Process Based Curricula

• Places More Responsibility on Learner
• Forces Learner to be more Proactive and Less
  Reactive
• Fosters Abilities in Learners to Assess Knowledge
  Base, Formulate Questions, Think Critically and
  Interpret Data Efficiently
• Requires Immediate Feedback
• Contributes to Development of Skills for Lifetime
  Learning

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Optimal Plastic Surgery Curricula

• All Types of Curricula have Limitations
• Clinical Curricula Best Incorporate Aspects of
  All
• Product Based Components Define Desired Skillset
  for Individual Finishing Program
• Process Based Components Often Applicable to
  Clinical Teaching

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Steps in Curriculum Development

• Problem Identification and General Needs
  Assessment
• Identify Problem
• Educate Residents in Plastic Surgery
• Who are the Involved Parties?
• Residents, Faculty, Other Health Care Providers,
  Patients, Society
• Includes Assessment of both Current Approach and
  Ideal Approach
• Varying Current Approaches
• Different Ideas of Ideal Approach
• May Vary in Different Environments

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Steps in Curriculum Development

• 2. Needs Assessment of Targeted Learners
• Varies Somewhat Depending on Prerequisite
  Training and Experiences
• Involves Knowledge, Analytic Capabilities,
  Interpersonal Skills and Psychomotor Skills
• Must Consider Predisposing Factors-
• Knowledge, attitudes and Beliefs That Influence
  Motivation to change
• Different Learning Method Preference
• Must Consider Reinforcing Factors and Motivating
  factors

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Steps in Curriculum Development

• Goals and Objectives
• Educational Strategies
• Includes Didactic Lectures, Audiovisual Aids,
  Clinical Discussions, Clinical Experiences,
  Practical Laboratories, Simulations via
  Standardized Patients or Virtual Reality
• Different Techniques Teach Different Things
  Better
• Some Learn Better by Different Methods
• Reinforcement of Information
• Maintains Interest

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Steps in Curriculum Development

• Implementation
• Obtain Support and Resources
• Faculty
• Support Staff
• Space
• Support from Hospital and Institution
• Identify Barriers to Implementation
• Money
• Competing Specialties
• Others in Specialty
• Introduction of the Curriculum
• May Pilot or Phase In
• Curriculum Refinement

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Steps in Curriculum Development

• 6. Evaluation and Feedback
• Formative- Ongoing Feedback
• Summative- Final Assessment
• Assess Learners and Process
• Involve all Stakeholders
• Dean, Department Chair, Other Program Directors
• Need Good Evaluation Methodology
• Introduction of the Curriculum
• Curriculum Refinement

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Steps in Curriculum Development

• Evaluation and Feedback

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Curriculum Ultimately Involves Series of
Educational Experiences

• Designed to Allow Achievement of Goals and
  Objectives
• Curriculum is Not Really List of Experiences
  Designed to Provide Education, It is What Happens
  During These Experiences

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Curriculum

• Clinical Experiences
• Exposure to Clinical Problems in Clinic or ER
• Opportunity to Further Assess the Problem with
  History, Physical Examination and Other
  Appropriate Tests
• Carry out Therapeutic Interventions either
  Operatively or Nonoperatively
• Clinically Manage the Patient Through Treatment
• Assess the Results of the Intervention in the
  Inpatient and Outpatient Settings both
  Immediately Long Term

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Curriculum

• Didactic Experiences
• Lectures on Specific Topics
• Patient Based Discussions of Different Clinical
  Problems in Preoperative Conferences, Interesting
  Case Conferences, Morbidity and Mortality
  Conferences etc.
• Anatomic Dissections
• Evaluation of Pathologic Specimens
• Training Labs e.g. Microsurgery, Facial Plating
• Mock Patients

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Possible Components of Hand Surgery Curriculum

• Clinical Exposure Through Hand Call (Verified on
  PSOL)
• Didactic Lectures on Hand Problems
• Anatomic Dissections of Hands
• Pathologic Evaluation when Appropriate e.g.
  Dupuytren's
• Microsurgery Lab for Developing Skills for
  Revascularization or Nerve Repair
• Involvement in Radiologic Evaluations, EMG, and
  Hand Rehabilitation Therapy

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Curriculum Components

• Significant Overlap in What is Taught
• Different Experiences Vary in Terms of Impact on
  Different Types of Learners

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Components of Curriculum

• Can Vary in Different Locales in That Educational
  Resources Differ e.g. Orthopedic Contribution Can
  be Significant or Unavailable
• Customize the Curriculum for Your Own Program

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Goals and Objectives

• Guideposts That Identify What We Want Our
  Residents to Learn

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Dictionary Definitions

• Goal
• The End Toward Which Effort is Directed
• Objectives
• Something Toward Which Effort is Directed

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What is a Goal?

• A Global Statement Regarding Competency in a
  Specific Area
• Example Develop Expertise in the Evaluation and
  Management of Traumatic Hand Injuries

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Goals

• Goals Make You Add Your Personal Philosophy to
  What the Textbook Provides
• Make Educational Program More Coherent and
  Integrated

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Goals

• Formed From a List of Skills and Knowledge the
  Resident is Expected to Acquire During Training
• Ideally Should be Linked as a Progression of
  Goals from the More General to the More Specific

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What is an Objective?

• A Precise Statement of What a Student Should Be
  Able to Do to In Order to Demonstrate That He Has
  Learned Successfully Engel 1975
• A Full Sentence Describing a Specific Skill that
  Should be Obtained
• The Nature of Particular Activities to Be
  Carried Out Must Be Precisely Conveyed

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What is an Objective?

• Objectives Should Clearly Describe a Residents
  Performance or Behavior Indicative of a Learning
  Outcome
• Examples
• Perform an Examination of FDS Function in the
  Hand
• Perform an Examination of the Sensory
  Distribution of the Median Nerve in the Hand

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Objectives

• Who?
• Will Do?
• How Much?
• Of What?
• By When ?

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Types of Objectives

• Cognitive- Knowledge
• Affective- Attitude
• Psychomotor- Skill or Competence
• Psychomotor- Behavior or Performance
• Process- e.g. Attendance
• Outcome

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Objectives

• Based on Goals
• Leave No Question As to What the Resident Is
  Expected to Learn
• But They-
• Dont Dictate How Learning is to be Done
• Leave the Teacher and Resident to Select Suitable
  Techniques

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Orders of Objectives

• First
• Ability to Reproduce Material in Same Form
  Learned
• Second
• Reflect Understanding of an Organized Body of
  Concepts and Principles
• Third
• Require Application of Theories, Concepts and
  Principles to Unencountered Problems

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Organization of Curriculum

• Objectives
• Content Method of Organization
• Evaluation

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Principles For Writing Goals and Objectives- Med
Council of Canada

• Review Existing Objectives/Literature/Reports
• Identify Professional Attributes of Ideal MD
• Develop a Basic Educational Philosophy
• Assign Priority to Problem Solving
• Deduce Objectives from Terminal Practice-based
  Behaviors
• Establish Scientific Basis for Clinical Practice
• Establish a Maintenance Evaluation Method

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Steps in Writing Objectives

• Identify the Goals of Learning
• Break Goals into Component Learning Outcomes
• Identify Current Learner Competencies
• Determine those Outcomes that Need to be
  Addressed in Learning Sessions
• Write Learner Centered Objectives
• Arrange Learner Objectives into Reasonable
  Teaching Sessions

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Donts in Writing Objectives

• Describe the Learning Process Instead of Outcome
  e.g. Increase Knowledge of ____
• Indicate the Type of Learning Involved Rather
  than Outcome e.g. Have Conference on ___
• Write a List of Topics

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Why Do We Need Them?

• Experts Feel They Facilitate Learning
• If you dont know where youre going, youre
  never going to get there.
• A quality education rarely results from
  unplanned actions. Ralph Tyler
• If you want excellence, first have a clear
  vision of what you want to produce. Peters
  Waterman

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Why Use Objectives?

• Help Residents Organize Knowledge
• Help Residents Classify Patterns of Information
• Provide Faculty with Guidance

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Why Do This?

• Residents deserve to know what is to be learned
• Residents deserve to know what is expected of
  them
• Residents deserve to know how and on what they
  will be graded

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Why Do This?

• Helps Guide Residents in Using Their Time
  Effectively
• Helps Residents Prioritize Learning

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Why Do This?

• Faculty need to know what to teach
• Faculty need to know what to reinforce
  clinically
• Faculty need their knowledge and clinical skills
  updated

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Why Do We Need Them?

• Required by the RRC

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What Does the RRC Require?

• Goals and Objectives for
• Each Rotation
• Each Year of Training

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Learning Styles- Kolb

• Concrete Experience
• Learn Best from Clinical Exposure, Hands On Labs
• Reflective Observer
• Learn Best from Case Discussions
• Abstract Conceptualizer
• Learn Best from Lectures Independent Reading
• Active Experimenter
• Learn Best from Clinical Experiences

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Other Factors Affecting Learning in Adults

• Gender
• Males Tend to be More Black/White and Feel That
  One Right Answer Can Be Provided to any Given
  Problem
• Females Tend to be More Intuitive and Feel
  Solutions to Problems are More Situational
• Generational
• Baby Boomer Concerned About Global Benefit of
  Knowledge
• Gen Xer Concerned About Whats In It For Me