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Transformative Curriculum Design

Colleen M. Halupa
A.T. Still University, US
LeTourneau University, US

ABSTRACT

This chapter will discuss the principles of transformative curriculum design to include:
curriculum models, objective outcome creation, scaffolding of curriculum, curriculum mapping,
linkage of assessment to objectives and objectives to program outcomes, program evaluation and
strategies for curriculum design including technology. In addition, some recent best practices in
health program curriculum design will be presented as well as emerging models. Last, some
specific designs related to health sciences curriculum and programs will be presented.

Key Words: Backwards Design, Bloom’s Taxonomy, Instructional Technology, Intentional

Design, Curriculum Strategies, Linkage, Scaffolding, Program Evaluation, Collaborative
Curriculum Design.

WHAT IS TRANSFORMATIVE CURRICULUM?

The definition of transformative education described in Chapter One by Stevens-Long, Schapiro and
McClintock (2012) noted in order for metamorphosis in learning to occur, there must be “an educational
program or event designed to foster learning experiences that result or catalyze a transformational
outcome” (p. 184). Stevens-Long et al. also point out transformative education is a “planned educational
program, experience, intervention or set of pedagogical practices” (p. 184). Essentially, transformative
education cannot occur without transformative curriculum design.

WHY TRANSFORMATIVE DESIGN?

In the past, universities created curriculum for the specific population of students that selected to attend
that institution. Today online learning opportunities have taken the focus from one limited by geography
to a more global perspective. Diamond (2011) noted globalization has changed the American university
and has caused it to respond with changes in curriculum because of the following factors:

 Education is now without borders

 Universities are less of a physical presence and more of a virtual one
 Increased competition
 Blurring of state and private institutions in regards to fundraising
 Decentralized decision making

Diamond posits many organizations and faculty find it “less risky to do nothing than to try and change”
(Loc 276). He notes technologies impact on teaching and learning is very significant. The convergence
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of these factors requires careful planning and development of faculty in curriculum creation, teaching and
technology. In addition, university curricula often do not produce the intended results. Although highly
valued, in some cases faculty autonomy has resulted in programs where intended outcomes may not be
achieved. This is particularly true in the United States where faculty independence is the rule rather than
the exception.

Curriculum is a “key driver” in student engagement and retention according to Bovill, Bulley and Morss
(2011, p. 197). It is cheaper to keep a current student than it is to recruit a new one. Current U.S. college
dropout rates are higher than ever. Harvard University in 2011 conducted its “Pathways to Prosperity”
study and found only 56% of students complete a bachelors’ degree within six years of starting school.
This is not to infer that curriculum needs to be less robust; rather, it means curriculum must be designed
with the learner rather than the teacher in mind.

Developing a quality curriculum initially is an extremely time-intensive task. This can also be daunting to
faculty. After it is completed however, the content can be used in the future to significantly decrease
faculty preparation time. Faculty also must be sure to continually improve and update their courses as
changes occur. This should be done when there are significant changes in the field, in response to student
feedback, in response to industry standards and in response to programmatic evaluation. Ultimately,
although the process is time consuming, in the end it is worth it since the curriculum that is created is
robust and will enhance rather than possibly detract from student learning.

One thing that prevents faculty from intentionally designing their courses is lack of knowledge about
pedagogy, andragogy and heutagogy. Most faculty members are experts in their field, but are not
necessarily experts in creating content to facilitate others in the learning process. Most teach the way they
were taught; many learned what they did not want to do from teachers who did not deliver material in a
way that facilitated their own learning. Many universities are responding by creating centers for teaching
and learning to provide information for faculty content experts to learn how to deliver information
effectively to students. This includes information on both face-to-face and online course design through
faculty development opportunities and training. In essence, someone can be an expert nurse, physician or
pharmacist, but may very well not be an expert in educational methods. This is not due to intentional
wrong doing on the part of the faculty members; instead, it is lack of knowledge of how the brain works
and what enhances and detracts from student learning. Faculty development can help fill these gaps.

Lecture is still the most commonly used educational practice in the United States. However, lecture is a
passive activity rather than an active one. To promote transformative learning, active assignments should
compromise a significant portion of the learning process and lectures, although still needed, take a back
seat. Students need to interact and develop a sense of how to obtain information and use it in order to
transform from memorization of facts to a quest for knowledge and application of knowledge to acquire
critical thinking skills. Students are not empty vases to be filled; instead, they are intelligent beings who
need to learn to stand on their own in the workplace to apply what they have learned in the classroom. In
most fields, knowledge is nothing without application. This is particularly true in health programs.

In 14 plus years of reviewing other universities’ and faculty’s curriculum, serving as a program chair, and
supervising over 300 online courses as an assistant dean and director of university curriculum, several
common problems have come to light. The most common problems are a lack of measurable program
outcomes/objectives, course objectives that are not measurable and assessments that do not match the
level of the stated objectives. For example, true competency cannot be measured by a four-part multiple
choice test when the objective requires the student to evaluate or synthesize the content. Multiple choice
tests usually only measure knowledge and comprehension level learning. Some courses at universities
have missing outcomes and course objectives. Others have no linkage between course objectives and
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program outcomes. Yet others have no linkage between program outcomes and institutional goals and
mission. This will be discussed further in the Curriculum Mapping section of this chapter.

CURRICULUM MODELS

There are numerous curriculum models that can be used to create an intentionally designed
comprehensive program or course. Many faculty members may not even know these models exist. Those
that do may have a definitive preference for one model over another.

Many of these models recommend that when creating curriculum faculty begin with the end in mind.
Design models include Instructional System Design (ISD) which has been used extensively by the United
States Air Force (USAF) in creating technical education curriculum. This method is particularly effective
since USAF technical education is accelerated as well as competency-based. One ISD model is the
ADDIE model, developed by Florida State University which is systematic, reliable,empirical and consists
of five stages (Dick, Carey & Carey, 2014):

 Analysis
 Design
 Development
 Implementation
 Evaluation

In the analysis phase, the institutional goals are identified to ensure that the curriculum that is being
created is aligned with institutional goals. Faculty should identify the areas that must be covered in the
curriculum. When this is done at a programmatic level, faculty must consider best practices in the field,
employer needs (which can be accomplished through employer surveys of graduates or through industry
representation on program curriculum committees), regional and programmatic accreditation. At this
point a cost benefit analysis should also be done to determine if the curriculum solution is feasible and
provides the most benefit to students and the university.

In the design phase, measurable outcomes and objectives must be identified. At the programmatic level,
program outcomes must be created which align with institutional goals. At the course level, measureable
course objectives must be created which align with program outcomes. In this step, the sequence and
structure of an educational program or an individual course is outlined. Assessments which will measure
the objectives will be drafted and instructional strategies will be considered.

In the development phase, learning activities are created and a system for performance tracking and
evaluation of the program or course is instated. In the implementation phase, the course(s) are taught for
the first time. A pilot test of three classes is optimal to ensure curriculum is meeting course or program
outcomes. In this phase, statistics can be calculated on objective tests (multiple choice, true/false and
matching) to calculate standard deviation indexes to identify questions that are confusing or improperly
written as well as to find questions with incorrect answer keys.

In the evaluation phase, the course or program is evaluated holistically. What worked well? What could
be improved? The overall effectiveness is measured and changes are made as needed.

A second model is the Dick and Carey model (1978) which looks at the following 10 factors:

 Instructional goals
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 Instructional analysis (what skills are needed?)

 Entry behaviors and learner characteristics
 Performance objectives
 Criterion-references test items
 Instructional strategy
 Instructional Materials
 Formative evaluation
 Revise instruction
 Summative evaluation

A historical model upon which many curriculum models are based upon is Robert Gagne’s Nine Event of
Instruction which was formulated in 1965. The steps according to Gagne are as follows:

 Gain attention
 Inform learners of objectives
 Stimulate recall of prior learning
 Present the content
 Provide learning guidance
 Illicit performance through practice
 Provide feedback
 Assess performance
 Enhance retention and transfer knowledge to the job.

One popular curriculum model is named backwards design as noted by Wiggins and McTighe (2005).
However, after having to use the instructional systems design method, which is another backwards design
model, to create an accelerated college program where students attended class eight hours a day for 15
months, creating assessments first can be extremely difficult if not impossible. It is important to keep the
end result in mind at all times. However, some such as Diamond (2011) advocate that the goals for the
program or the course must be determined first before assessments can ever be created. This is an
effective way to create an intentionally designed course since many feel paralyzed in trying to create
assessments before the goals.
In the curriculum design process, the program or course goals should be determined. Next it is important
to think about how best to facilitate effective learning in the students in order to meet the goals, objectives
or outcomes. So often faculty get so caught up in creating lectures and tests they lose sight of how to
facilitate this effective learning. This evaluation and reflection on what will promote active,
transformational learning in students is key to the curriculum creation process.

All these models can be very effective in either traditional or transformative curriculum creation. The
difference in transformative curriculum lies in the presentation of the material. In the ADDIE model this
is in the “implementation” step. In Gagne’s model this is in the “present the content” step. No matter
what model is used, the key is to provide content and experiences that allow students to interact with the
content themselves to enhance learning and to avoid delivering content in a teacher-centric model. The
focus must remain student-centric and must be meaningful and relevant as well as student rather than
teacher-driven. In addition, it is important that a model be selected and followed to ensure consistency
and high quality in the curriculum that is created.

No matter what model is used, the most popular method used to create outcomes and assessments even
today is Bloom’s taxonomy which was created by Benjamin Bloom in 1956. Bloom’s colleague Anderson
and others updated this taxonomy in 2001. Both taxonomies are displayed in Tables 2.1 below:
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Level Bloom’s Taxonomy Anderson et al.’s Taxonomy

1 (Lowest) Knowledge Knowledge
2 Comprehension Comprehension
3 Application Application
4 Analysis Analysis
5 Synthesis Evaluate
6 (Highest) Evaluate Create

Table 2.1 Comparison of Bloom’s (1956) and Anderson et al.’s (2001a) Taxonomies

Outcomes and Objectives

Before any curriculum or objectives are created, first it must be decided at what taxonomy level the
student is expected to perform. If the course is part of major course work, program outcomes must first
be developed so course objectives can link to these outcomes. These program outcomes must be
measurable. In addition the objectives created for each course in a program must also be measurable.

Objectives have three parts:

 The condition
 The taxonomy level
 The criteria

Here is an example:

Using a hematology atlas, the student will identify the presented immature white blood cells presented
with no more than two attempts.

In this example, “Using a hematology atlas” provides the condition or what students are able to access to
complete the objective. The taxonomy in this example is identify which is a knowledge or
comprehension-level level task. The last portion is the criteria “with no more than two attempts.” The
three part objective is most commonly used in psychomotor objectives. In cognitive objectives, the
condition may be inferred; this occurs when students are assessed based on the materials they have just
learned. The criteria may also be inferred by the presence of a grade scale which denotes that a passing
grade is 60 or 70%; in this case, that is the criteria for successful performance in regards to that objective.

There are three major types of objectives. These are cognitive, psychomotor, and affective. Cognitive
objectives are didactic objectives that signify learning of concepts or mental performance. An example of
a cognitive objective would be:

The student will:

Identify the parts of the human eye with 80% or more accuracy.

Psychomotor objectives are those where a student actually has to physically do or perform some action
or task.

Using the supplied parasitology atlas, under the microscope identify ova on provided slides with
80% or greater accuracy.
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This psychomotor objective contains the three portions of the objective: condition, taxonomy and criteria.

Affective skills are changes in attitudes, feelings and emotions.

The student demonstrates empathy towards her patients and communicates in an appropriate
manner during each clinical rotation.

In addition, course objectives should be SMART:

S Specific
M Measurable
A Attainable
R Realistic
T Time Limited

There are specific verbs that collate to the different levels of Bloom’s or Anderson’s taxonomy. Examples
for verbs appropriate to each taxonomy level can be found in Tables 2.2 to 2.4 below.

Knowledge Describe Select Identify Label

List Name Outline Select
State Relate Quote

Comprehension Explain Discuss Translate Summarize

Distinguish Classify

Application Apply Interpret Predict Solve

Use Illustrate

Analysis Analyze Differentiate Discriminate Relate

Modify Categorize Compare Contrast
Infer Prioritize Correlate Devise

Synthesis Create Design Compose Develop

Formulate Generate Revise Synthesize
Summarize Arrange Compose Construct
Plan Devise Summarize Relate
Compile Produce Adapt Hypothesize

Evaluation Appraise Assess Argue Conclude

Defend Evaluate Justify Interpret
Predict Support Select Estimate

Table 2.2 Taxonomy Verbs: Cognitive Objectives

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Knowledge Arrange Label Match Reproduce

Comprehension Locate Select Use Sketch

Solve

Analysis Breakdown Diagram Separate Experiment

Synthesis Assemble Construct Create Prepare

Rearrange Combine Integrate

Evaluation Appraise Choose Measure Test

Table 2.3 Taxonomy Verbs: Psychomotor Objectives

Receiving Follows Has an Listens Asks

awareness of

Responding Assists Aids Helps Greets

Cooperates Agrees

Valuing Demonstrates Explains Proposes Initiates

belief

Organizing Defends Identifies Integrates Relates

Internalizing Influences Verifies Serves Displays

Participates Supports

Table 2.4 Taxonomy Verbs: Affective Objectives

Assessments and Bloom’s Taxonomy

Assessments must also link to the taxonomy level of the objective. The student’s performance must be
measured to the same level as indicated in the objective. This is called curriculum mapping and will be
explained in more detail later on in this chapter.
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There are assessments that are more appropriate to some taxonomy levels than to others. In Table 2.5
below are some suggested types of assessments categorized by the taxonomy level they are most
appropriate for. For all of the examples in this chapter, Bloom’s taxonomy will be used.

TAXONOMY APPROPRIATE ASSESSMENTS TO MATCH TAXONOMY

LEVEL OF LEVEL
OBJECTIVE
Knowledge Objective Tests
 Multiple choice
Basic Facts  True/False
 Matching
Short fill-in-the blank questions
Homework assignments (open book)
Comprehension Short papers
Problem sets
Understand one or Class discussion
more concepts Concept maps
Creation of videos
Creation of wikis
Simple read and comprehend case studies
Classification of facts
Paraphrasing content
Summary speeches or presentations
Bulletin boards or pictorials of a concept
Objective tests or objective tests combines with short fill-in the blank
test questions
Application Tests
 Multiple choice tests where additional choices must be made (a
Use material to and c are correct, a and c are correct, none are correct, etc.)
make or do  Mathematical calculations using two or more concepts
something  Short essay (1-2 paragraphs)

Performance
 Experiments
 Completing specific tasks and being able to articulate why
 Select appropriate procedures for a task
 Speech or video combining multiple concepts
Papers
Projects
Project Plan
Assignments where two or more concepts must be combined
Diagrams
Case studies consisting of more than just recall

Analysis Research papers

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Comprehensive Case Studies

Examine Laboratories
relationships Debates
Critiques
Creation of charts
Tests
 Compare and contrast questions
 Strengths, weaknesses, opportunities and threats (SWOT)
 Essays
 Multiple choice questions where students must clearly
discriminate relevant and irrelevant concepts, elements or intent
 True and False and Matching Questions should NOT be used

Evaluation Project Evaluation

Needs Assessment
Examine, Papers
categorize or Critiques
critique something Journals of Diaries
which exists Product Reviews
Creating of operating instructions or technical guidance
Complex problem sets
Case studies
Tests
 Essays
 Evaluations
 Objective tests should NOT be used

Synthesis Musical compositions

Performances
Create something Essays
new Business Plans
Websites
Presentations
Webpages
New programs

Table 2.5 Types of Assessments Categorized by Taxonomy Level

EMERGING CURRICULUM MODELS

Although the ADDIE model has stood the test of time, there are some emerging curriculum models that
are generated additional interest in the education and corporate training fields. Two of these are the
Successive Approximation Model (SAM) and Competency-Based Education (CBE).
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SAM was created by Michael Allen a software developer. This model is specific for e-learning and uses
the concept of iterative design. Iterative design includes the following steps:

 Prototyping
 Testing
 Analyzing
 Refining

Iterative design is widely used in engineering and software development. The goal is to take smaller steps
that are not as rigid as those outlined in the ADDIE model. Allen notes in an interview with Lori Friefeld
that the waterfall design in ADDIE requires near perfection in each step before the next step is taken. He
notes “perfection is a dangerous goal” (Freifeld, 2012, p. 1) because each item affects many other items.
As one changes, so may another which can be, in fact, infinite. This prolongs the design process. Allen
notes in order for a model to be effective it should: 1) be iterative, 2) support collaboration, 3) be efficient
and effective and 4) be manageable (Freifeld, 2012).

Allen & Sites (2012a and 2012b) note the three steps of the SAM model as follows:

 Preparation Phase (Background)

o Information gathering
o Savvy start (all involved have a voice)

 Iterative Design Phase (Prototype-Design-Review)

o Project planning
o Additional design

 Iterative Development Phase (Implement, Develop, Evaluate)

o Design proof
o Alpha test
o Beta test
o Gold test

The SAM model has some distinct advantages and disadvantages according to ELearning World (2014):

Advantages
 Less linear and more true to life
 Considers various points of view (instructional designer, faculty, students, administration)
 Done in small steps with multiple evaluations
 More efficient since resource needs can change during multiple mini-evaluations
 Collaborative and team-based
 Acknowledges mistakes will occur; numerous evaluations allow for corrections of mistakes
 Works more as development does in the corporate world for products

Disadvantages
 Because mistakes are expected, not all potential outcomes may be evaluated as they should be at
the onset
 May be more risky and time consuming
 Variety of inputs can lead to a lack of coherence in final product
 Intense collaboration can increase the time for a finished product
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The SAM model is intended to be more responsive in a technology-driven world.

The second emerging model is Competency-Based Education (CBE). Most courses designed using the
ADDIE and other traditional models are based on the Carnegie Unit where in order to earn one credit
hour of college credit, a student has to engage with course materials for at least 37.5 hours; a three hour
course requires 112.5 hours of engagement. In CBE, the Carnegie Unit for “time in the seat” is no longer
considered. Instead, students complete material at their own pace by completing assignments that lead to
specific competencies.. This model still requires carefully honed course competencies that are measurable
to ensure the students are meeting minimum content mastery requirements. Essentially, CBE is
personalized learning similar to Montessori education for K-12 students (U.S. Department of Education,
2014).

In CBE learning is broken down into discrete units that are not tied to courses or topics. Rather,they are
tied to mastery and assessment of specific objectives. Learning modules can be stacked in different ways
so students can create their own programs and determine the skills and competencies they want to
include. For example, a nurse and a business student may both complete the same competency, but draw
on different content to do so. This leads to stackable credentials which are less costly than a traditional
university education. In addition, in CBE, employers provide feedback on the skills they expect new
graduates to have to prepare them for the workplace (Weise, 2014). Universities that use this model
include Western Governors and the University of Southern New Hampshire. In 2014, Purdue, the
University of Michigan and the University of Wisconsin also began offering CBE degrees (Fain, 2014).

The Council for Adult and Experiential Learning (CAEL) are strong proponents of CBE and prior
learning assessment (PLA) to decrease the overall cost of higher education for adults. This organization
provides grants through the Lumina Foundation to fund university PLA and CBE initiatives (CAEL,
2014).

Hoogland, Pass and Jochems (2005) recommend Instructional System Design (ISD) to create CBE
curriculum. The 4C-ID model was developed specifically for CBE by van Merriënboer in 1997. The steps
of this model include:

 Design sequenced learning tasks

 Provide supportive information
 Provide just-in-time information
 Promote practice

It is likely more curriculum models other than the two just mentioned will continue to emerge as higher
education continues to undergo metamorphosis.

CURRICULUM MAPPING

Curriculum mapping is critical when beginning the process of course design. With curriculum mapping
you can ensure that the proper linkage between all course elements (assessments and objectives) and
program elements (course objectives and program outcomes). There are numerous ways to do curriculum
mapping, but this process can also be helpful when performing program evaluation. Curriculum maps
demonstrate the relationships between course elements and ensure important information is not missed. It
also can help identify duplicate information in multiple courses so a decision can be made as to where this
material should be presented. This is especially important if the information presented is in conflict.
With different faculty teaching courses, this may not be easily identified without a curriculum mapping/
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program evaluation process. In addition, this provides the opportunity to replace duplicated material with
other needed course material.

In addition, course material should be scaffolded. Lower taxonomies of learning may primarily be present
in freshman and sophomore courses, for instance, but at least one or more objectives in these courses
should require students to perform at the apply level or above. In addition, higher level junior and senior
courses in major program coursework should have the majority of the objectives at the “apply” level or
higher so students can obtain deeper learning. Graduate education should be comprised primarily of
higher level learning objectives once basic concepts have been reviewed or initially taught.

Course Mapping

In Table 2.6, one example of a curriculum mapping tool for a course is provided. With this particular
tool, it is easy to determine if there is linkage between course assessments, objectives and program
outcomes as you read the map from right to left. In Table 2.5 there is a sample of a curriculum mapping
tool with some course assessments, objectives and assessments included.

Module, Unit or Program Course Assessments

Week Outcomes Objectives
Supported (if
course is part of
a program)

Table 2.6 Sample Horizontal Curriculum Mapping Tool for a Course

This horizontal tool allows the course reviewed to easily match the course program outcomes to the
course objectives and assessments to ensure that all taxonomy levels are appropriately matched. It also
allows the viewers to visualize and ensure all course objectives have been met to ensure students attained
specific competencies. Table 2.7 provides an example of this tool filled in with information from a unit.
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Module, Unit or Program Course Assessments

Week Outcomes Objectives
Supported (if
applicable)
Unit 2 Program Outcome 1 1. Describe the Assignment 1: Quiz 1
Evaluate the health health delivery
delivery system of process in the United Assignment 2: Case
the United States and States and its impact Study: Create a
other countries in on health budget for Hospital X
order to effectively organizations.
manage a health care 4. Create budgets,
organization. staffing plans, quality
improvement plans
and health and safety
procedures for a
medical facility.

Table 2.7 Sample Curriculum Mapping Tool for the First Week of a Course

If you look at Table 2.7, you will note that the taxonomic verb in the description of the assessment is
“create.” This is the 4th highest level in Bloom’s taxonomy and the highest level in Anderson’s adaption
of Bloom. For this example, Bloom’s taxonomy will be used since this is the more common version.

If you read from right to left you will see two course objectives; one is at the lowest level (knowledge)
and the other is at the 4th level of Bloom’s taxonomy (create). Objective one is a lower level objective
and may be present in multiple units as students learn different portions of the health delivery system.
Objective 2 is a higher level objective utilizing a Bloom’s taxonomy level 4 verb (create) which matches
the level of the assessment (which is also Blooms level 4-- create). Both of these objectives support the
program outcome listed. Note that the objective level should never be higher than the program outcome
level; if it is, then the course is being taught at a higher level than program outcomes require; in this case,
the linkage between these elements would be broken. Although not demonstrated in this specific
example, the same program outcomes can be supported and assessed multiple weeks; in addition the same
course objectives can also be assessed multiple weeks. Usually when this occurs, the objectives are first
assessed at lower taxonomy levels and the completion of the objective culminates at the highest
assessment taxonomy which matches the program outcome or course objective.

The next consideration is the assessments that are assigned to assess and ensure competency in specific
tasks must also be at the appropriate level. There are specific assessment methods that measure specific
taxonomy levels. This was displayed in Table 2.5 above.

In addition, program outcomes, course objectives and assessments may also be mapped in a vertical
fashion. An example of this is displayed in Figure 2.1 below.

Unit 2

Program Outcome(s) Supported

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Program Outcome 1: Evaluate the health delivery system of the United States and other countries
in order to effectively manage a health care organization.

Course Objective(s) Supported

Course Objective 1: Describe the health delivery process in the United States and its impact on
health organizations.
Course Objective 4: Create budgets, staffing plans, quality improvement plans and health and
safety procedures for a medical facility.

Assessment(s)
Assignment 1: Quiz 1 (Objective 1)

Assignment 2: Case Study: Create a budget for Hospital X (Objective 4)

Figure 2.1 Example of Vertical Curriculum Mapping for a Course

This mapping is completed for each week or module within the course to ensure all objectives are tested
to the appropriate level and to ensure that course objectives are linked to program outcomes as applicable.
In general education courses that are not linked to program outcomes, the program outcome column can
be deleted or left blank.

Program Mapping

Major degree programs must support one or more institutional goal. Then each objective in each
course must lead to one or more program outcomes. This process is presented in Figure 2.2
below.
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Institutional Goals

Program Outcomes
or Competencies

Course Objectives
Object sseseseves
ives

Individual Course Assessments

Figure 2.2 Curriculum Mapping and Linkage

To perform curriculum mapping for a program, the course name and course objectives for each course
need to be recorded. It works well to place these on large “post it” notes that can be placed around the
room. The first step is to identify if there are any course objectives that are not tied to the program
outcomes. If there are, these need to be evaluated to determine if they are pertinent and should be
included. If they are not, then they should be eliminated.

If objectives are evident that should be linked, but cannot be, to existing program outcomes, it is possible
the program outcomes need to be revised. Most program outcomes are written in a very general sense so
usually it is not difficult to link course objectives to program outcomes.

The next step is to look for duplication in course objectives. If there is duplication, was it intentional
because a concept has to be reinforced? For example, in Clinical Laboratory Science, antibody antigen
reactions can be taught in Immunohematology, Serology, Immunology and Microbiology. Is it necessary
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to review the basics about this concept in each one of these classes? Probably not, but it might be
beneficial to review them in reference to how they work in the body in Immunology and how they work
in the laboratory environment to identify antigens and antibodies that are present in Immunohematology.
If this duplication is eliminated from the other two courses, it allows additional needed material to be
covered or allows additional time for remediation.

Finally program outcomes must then be linked to institutional goals to provide a complete linkage from
these organizational goals to the assessments students must complete in each course. In all cases, both
program outcomes and course objectives must be assessed at the highest level indicated in their
taxonomies. They should not be assessed at a lower level or students will not have obtained appropriate
competencies. Nor should they be assessed at a higher level. If they are, students are being assessed at a
level that is higher than is required. This can indicate that perhaps sufficient time has not been devoted to
other objectives of like importance. If assessments are selected that are consistently higher than the
course objectives or program outcomes, then perhaps one these needs to be revised.

PROGRAM EVALUATION

Kuo, Wei, Chen, Wang, Ko and Yang (2012) note, “Evaluation is an integral part of instructional
design.”(p. 250). Evaluations can be both formative and summative. One common model used for
evaluation is Stufflebeam’s Context, Input, Process and Product (CIPP) which provides a holistic
evaluation. Context describes the setting in which the evaluation takes place, as well as what it being
evaluated. Input is the information discovered or provided to identify program needs. The Process is
decision-making along the way that ensures the program is going as intended. This includes a strengths,
weaknesses, opportunities and threats (SWOT) analysis. Evaluation occurs when the program is
compared to the stated goals and objectives to ensure they have been met (Stufflebeam, 2002). For
example, in the creation of a Clinical Laboratory Science program, specific program goals and outcomes
will be formulated. This must be created in concert with the National Accrediting Agency for Clinical
Laboratory Science (NAACLS) which provides programmatic accreditation. If the program were to be
created in a small private university in an area where there are a lot of two year graduates from
community college programs, this would be the context for the program. The input would include
NAACLS standards as well as community input as to what is needed in that area. The process part of this
model would occur from the time the program outcomes are formulated and the initial classes are created
throughout the graduation of the first class and beyond. Last, after the initial graduates took their national
certification exam, the performance of these graduates as well as input from the employers of the
graduates can be used to evaluate the success of the program. Changes in the program would then be
enacted to attempt to improve performance.

Kuo et al. (2012) recommend a model based on Stufflebeam’s CIPP model as well as several others to
integrate technology into formal curriculum. They are:

 Clarify product/program goals and objectives

 Define the purpose of the evaluation
 Determine evaluation questions
 Plan the evaluation
 Develop instruments of measure
 Submit evaluation proposal
 Edit proposal and resubmit (optional)
 Schedule appointments for evaluation
 Conduct evaluation
 Organize and analyze results.
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 Report results
 Publish results

This model mirrors in many ways the process of conducting educational or other types of research.
Determining the goals and objectives is the most critical step in the process.

Program evaluation is formative and summative. When a new educational program is being created,
curriculum mapping should be done after a curriculum model is selected. The program outcomes should
be determined first. Next a degree plan should be created that outlines the courses for the program major.
Course descriptions can be created and course objectives. At this point taxonomies for each objective
should be selected. During this process any regional or programmatic accreditation agencies or standards
in the field must be addressed to ensure all are included in the program. Then, when faculty are tasked to
create the assessments and material for each course, they must create these assessments to meet the
appropriate taxonomy level for the objective. During the process, it must be ensured that every objective
in every course is linked to program outcomes. In addition, every assessment must be linked to a course
objective at the appropriate taxonomy level.

Summative program evaluation occurs as needed. Informal summative evaluation occurs whenever it is
recognized that something does not work properly within a course. At this point it is changed as
necessary. However, it is critical to ensure that the linkage between course assessments and objectives is
not broken when changes are made. Summative program evaluation usually occurs annually when
graduate, employer and course surveys, national exam pass rates, etc. are analyzed and evaluated
cumulative to identify trends and problems.

Finally, a summative curriculum program evaluation should be done every two to three years or more
often if needed. In this evaluation program outcomes are evaluated to ensure they still meet the needs of
the field and the institution. Courses are checked to ensure linkage to program outcomes and assessments
has not been broken. At this time the program as a whole can be evaluated to ensure no significant
changes should occur based on annual data analysis.

A sample program and course evaluation tool can be found in Appendix I.

CREATING TRANSFORMATIVE CURRICULUM

Wilson and Parrish (2010) note the ambition of creating transformative learning experiences can be
daunting to faculty and to instructional designers. The ultimate question is do faculty and students really
want transformative learning curriculum? In some cases the answer is no. Some faculty may be resistant
to doing things other than what they have been doing in the classroom for years. Some students act
passively like empty vessels waiting to be filled. However, as Wilson and Parrish note, there is a great
deal to be learned about transformative instructional experiences. It is a field where little research has
occurred, primarily because reaching the state of transformation is very difficult to measure.

Wilson and Parrish describe Johnson’s (2009) unpublished dissertation at Brigham Young University
where he notes transformative curriculum: “ 1) is linked and connected to the life of the learner, 2) is
challenging, yet attainable, and 3) is inspiring to students and teachers” (p. 6). Wilson and Parrish’s
recommendations concerning facilitative conditions for Transformative Learning Experiences are
displayed in Table 2.8 below:
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Applying Design Align learning activities, objectives and assessments

Fundamentals
Formulate activities based on instructional research and learning
theory consistent with the organization’s values
Use a systems design model for revision and improvement
Use media to enhance instruction
Provide authentic, meaningful instruction with learner
engagement
Crafting the Learning Use pacing, conflict resolution and heightened experience
Experience
Challenge and surprise learners; make them challenge their
assumptions
Use interactive media to bring the world to students in new ways
Create immersive challenges and environments
Touch on learner’s key concerns and interests
Encourage learner engagement, investment and ownership
Encourage reflection, sharing, risk-taking and truth-telling
Teaching/Facilitation: Build trust through timely, empathetic, competent engagement
Inspiring Learning
Show caring, professionalism, respect and commitment
Provide timely guidance, feedback and assessment
Stay focused on core goals to provide a coherent learning
experience

Table 2.8 Wilson and Parrish (2010) TLE Guidelines

Because faculty are not, in general, curriculum experts, it is optimal to have faculty work with
instructional designers who understand how to facilitate the delivery of information to students efficiently
and effectively. Instructional designers can assist with crafting measurable objectives, selecting
assessments that are appropriate for the taxonomy level of the objectives, the use of technology and best
practices in face-to-face and online delivery. Instructional designers can also serve as the “student view”
when a course is being designed. This view is crucial for identifying missing information and potential
design problems. In addition, instructional designers also can review courses to ensure all required
elements are present in the course syllabi and that any other required information is available to the
student in a place where it can be easily found. This is especially critical when designing hybrid or online
courses where the faculty member is not immediately available to ask questions.

COLLABORATIVE COURSE DESIGN

Who should weigh in on course design? Faculty and their deans of course, but also the use of
instructional designers is becoming more and more popular since they are well versed in technology,
design and pedagogy. Bovill, Cook-Sather and Felten (2011) assert, “students are an important resource
but are rarely consulted about their educational experience” (p. 1). They recommend faculty explore ways
to make students “full participants in the design of teaching approaches, courses and curricula” (p. 1). A
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student’s journey to knowledge and enlightenment is enhanced when the students become their own
teachers and faculty members facilitate and also learn through this process. This must be done with
caution because a negative effect can occur if students are involved in the process and their feedback is
discarded and not considered.

In cooperation with the Andrew Mellon Foundation, Bryn Mawr University has created a Students as
Learners and Teachers (SaLT) program which provides a forum for cross talk for students and faculty
about curriculum. Students serve as consultants in courses they are not enrolled in and meet with the
faculty member to create goals and objectives. The student observes one course per week taught by that
faculty member and also may interview students. The student then shares his/her observations with the
faculty member. This SaLT program is transformative because both students and faculty engage in a cycle
of self-reflection. At Elon University, students weigh in on course design in the creation of course design
teams (CDTs). One to two faculty members are grouped with between two and six students and using a
backwards design approach, they develop a course. The students must have already completed the course
to participate. These teams meet weekly for three months (Bovill et al., 2011).

At the University of Dublin, students and faculty collaborated to create a first year geography curriculum
that serves about 400 students per year. Third and fourth year students were paid to create the curriculum
with faculty in a virtual format to support residential student learning. At Queen Margaret University in
Edinboro, Scotland, the curriculum in environmental justice is dictated by student interests and changes
each time it is offered. When students can step back from the process of getting through and passing a
course, it provides them time to really understand and critique the material and effectiveness of delivery.
Dialogue between students and faculty provide differing points of view and rationales on why material is
taught a specific way. This collaboration leads to more understanding for students and faculty. Bovill et
al. (2011, p. 7) recommend the following:

 Make students partners in pedagogical planning and break down traditional roles
 Facilitate dialogue to exchange information about varying points of view
 Foster collaboration and encourage faculty and students to take more responsibility for the
learning process
 Facilitate new relationships between faculty and students

This process is not at all easy. It may be very difficult for some faculty to give up control of the classroom
and accept feedback on what is presented and how it is presented. Some faculty still see themselves as
the delivers of information and the students as the accepters of that information and feel students have
nothing relevant to add. In addition, faculty who are already overloaded may not want to devote the extra
time this process requires. This is not a one-time process; curriculum must continually be transformed as
needed. Bovill et al. (2011) note an additional problem in that some curriculum is strictly designated by
professional requirements and accreditation requirements and this may limit students’ involvement in
some aspects of the creation. This also has the potential to forge a new relationship between students and
instructional designers that does not exist in most university settings.

ONLINE CURRICULUM AND TECHNOLOGY IN TRANSFORMATIVE LEARNING

The number of students taking at least one online class almost doubled from 2008 to 2013; 45% of
students were taking online courses in 2013 (Bolkan, 2013). In 2014 the Babson Research Group reported
7.1 million students were taking at least one online class (Kolowich, 2014).
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Can transformative learning occur in an online or hybrid setting? According to Taylor (2007) and Boyer,
Maher and Kirkman (2006) it most certainly can. Online learning is particularly suited to transformative
education because many online courses are writing intensive. These writing opportunities can be used to
assist students in gaining deeper knowledge and reflect on their learning (Taylor, 2007). In addition,
students who are unlikely to speak up in the traditional classroom effectively engage in discourse in an
online setting. Boyer et al. asserted including curricular methods such as a self-directed format,
reflection and collaborative group work can lead to transformation. Many faculty members are still
skeptical about the online environment even though numerous research studies have found that there are
no significant differences between face-to-face and properly designed online or hybrid learning.

In 1995 and 2005, Berge identified important roles for online teachers which were: pedagogical, social,
managerial and technical. Anderson, Rourke, Garrison and Archer (2001) suggested three roles for
faculty in online teaching: instructional design and organization, facilitating discourse, and direct
instruction. Coppola, Hiltz and Rotter (2002) noted professor roles included cognitive, affective and
managerial. Baran, Correia and Thompson (2011) note there are three dimensions that should be
promoted by online faculty in transformational learning. These include promoting critical reflection,
empowerment and integrating technology into pedagogical inquiry. Empowerment in this instance is
reflective of the teacher’s ability to empower students to be responsible for their own learning.

Garrison and Kanuka (2004) note there is now a continuum of e-learning that ranges from enhanced face-
to-face instruction with online supplementary material and testing, to blended or hybrid learning which
combines online and face-to-face instruction to true online learning. In order to transform online learning,
institutions must also have a reliable, accessible technology infrastructure with minimal downtime.

Henderson (2010) also posits that specific activities can enhance transformative learning in the online
setting. This includes writing assignments that cause students to critically reflect on their values and
beliefs, creating a collegial and informal environment where students are encouraged to share personal
information and pictures through introductions. Video and audio messages from the professor provide a
sense of “connectiveness.” In addition, faculty support is crucial in order for transformative learning to
occur. This can include formative and summative feedback, high levels of engagement in discussions and
forums, as well as quick response.

King (2002) looked at faculty transformation in regards to technology in her population of 205 university
faculty who participated in professional development activities over the course of seven years. During
this time the faculty were engaging in formal courses in educational technology. Data was collected
through survey and through journaling as well as end-of course reflective assignments and interviews of
58 faculty. King identified four stages in faculty in regards to technology and transformative learning:
“1) fear and uncertainty, 2) testing and exploring, 3) affirming and connecting and 4) forming new
perspectives” (p. 4). The faculty in this study transformed from inexperienced technology users to
independent learners of technology. This, in turn, considerably affected their teaching practice.

Kuo, Wei, Chen, Wang, Ko and Yang (2012) note technology has power and potential but, “inspires and
thrills some people, but confuses—even alienates—others” (p. 250). They go on to say technology
impacts “humans, society and the environment” (p. 251). But it is crucial to note in learning this impact
can enhance or detract from the educational process, depending on how it is used.

Henderson (2010) recommends the use of various tools to transform the online environment for students
to include webcasting, podcasting, video, photography, social media, wikis, blogs, and online journaling
features. Other technologies include Skype, Google Hangouts and programs such as Blackboard
Collaborate and Adobe Connect for synchronous meetings. Adobe Connect also has a whiteboard feature
so faculty can perform calculations that the student can readily see on the screen. Other programs that
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can enhance online learning through technology are programs such as Doceri and Camtasia which both
have virtual whiteboard features that can be used in voiceover PowerPoint slides. In addition there is a
plethora of free technology tools that can be used. These include animation programs such as Animoto
and others. A partial list is included in Appendix I However, faculty must ensure these free tools are
compatible with the institution learning management system and will work on mobile devices as well. In
addition, American with Disabilities Act (ADA) requirements must also be considered for students who
require accommodation. Most importantly, the time students must devote to the technology should
NEVER be more than they devote to the content. It is recommended that only one or two technology
tools be used in a class because there are still learners who are overwhelmed and anxious about
technology. In addition, if the technology fails, the learning still must go on.

Transformational learning requires a disorienting event. In many cases, technology can serve as this
disorienting event for many learners because it can be disruptive for learners. Although those of
traditional college age grew up in an age where the Internet and technology have always been present,
many are not users of productivity technology or instructional technology that supports specific tasks.
Instead their technology skills may be limited mostly to video games, surfing the web and social media
interaction. However, learners are still “multi-connected, multi-deviced and live in an app driven world”
according to Miller (2012). Technology allows learner-driven education where students can work at their
own pace and information is available where and when they need it. This is called a “personal learning
environment” (McLoughlin & Lee, 2010, p. 3). Technology serves a purpose in scaffolding this learning
of key competencies and skills.

The 2013 Horizon report from the New Media Consortium published by Educause notes in the Creative
Classroom Research Model showcased in this report, content and curricula should have the following
elements:

1) Emotional Intelligence
2) Cross and trans-disciplinary
3) Open educational resources
4) Meaningful activities

Emotional intelligence, which is supported by reflection in transformative education, can be supported by

the inclusion of multimedia in courses as well as inclusion of soft skill concepts that build self-awareness
as well as empathy and appreciation of diversity. Cross and trans-disciplinary concepts can be enhanced
by technology as well, particularly in the online environment where students are geographically separate.
Wikis and blogs can be used for group communication and activities across disciplines.

An example of a technology tool that supports both emotional intelligence and cross and transdiscplinary
activities is the educational game “Contagion” by Pearson’s Center for e-Learning. Pearson has been
experimenting in gamification since 2012. In this game, students from multiple disciplines: health care,
political science, biology, philosophy and journalism can get involved with dealing with a global
pandemic that is spreading throughout the country. Pearson has also experimented with other games,
such as one in courtroom procedures. Technology tools such as Contagion can facilitate the
interprofessional education experience in the health care classroom.

Open educational resources and creative commons items are available. Some are free while others may
require that the university library pay a database fee. These tools can help reduce the cost of education
for students. Open educational resources and e-books in particular, have not taken off as quickly as
Educause predicted in their 2011 report. One reason for this is at this time, students do not like e-books
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and prefer to have paper copies (Gregory, 2008; Fedaro, 2010; Foasberg, 2011; Heick, 2012; Staiger,
2012; Gilber & Fister, 2014; Ertl, 2014).

Transformative learning principles also call for meaningful activities. Technology can be used to create
meaningful activities for distance learners as well as those in the classroom. Examples are such things as
virtual case studies which are being offered by publishers such as Jones and Bartlett, gamification as
previously mentioned and augmented reality. Providers of augmented reality include Adapt Courseware
(adaptcourseware.com) which has programs in business, the humanities, mathematics and history and the
social science. There are some applications in augmented reality for health care at this time; these are
outlined in the textbook “Virtual, Augmented Reality and Serious Games for Health Care 1” published
by authors Ma, Jain and Anderson in 2014 through Springer publishing. The health arena is an excellent
market for additional gamification and augmented reality opportunities. For example as a reflective
transformative practice, a young physician can practice telling a family that their loved one has died
virtually to practice empathy and ensure he/she will maintain composure before this occurs with an actual
patient. Augmented reality applications are also being created in areas of complicated surgeries (van der
Sangen, 2014). Bower, Howe, McCredie, Robinson and Grover in 2014 noted augmented reality “is
poised to profoundly transform education as we know it” (p. 1). Google Glass offers opportunities for an
increase in the availability of augmented reality. Oh and Kim (2014) successfully implemented
augmented reality for mobile devices, so eventually it is likely this will proliferate education in the future.

The Horizon Report published by the New Media Consortium through Educause also outlines the top six
important developments in educational technology for 2014. These projections change yearly and in
some years they change quite significantly. For example, in 2011 the Horizon Report projected that the
following technologies would be utilized in higher education:

 Cloud Technologies by 2012-2013

 Increased use of electronic books and multimedia (2012-2013)
 Increased use of mobile devices (2012-2013)
 Augmented reality (2013-2014)
 Gamification (2013-2014)
 Gesture-based computing (2015-2016)
 Learning analytics (data mining) (2015-2016)
 Web 3.0 semantic web which includes virtual reality and personal learning agents (2016+)

At the time of this writing, the predictions of the 2011 Horizon report have almost all occurred. Cloud
technologies and mobile devices abound. There are educational augmented reality and gamification
programs. Use of multimedia has increased, but electronic textbooks have not taken off as expected

The Horizon report is published in the spring at the following New Media Consortium web site. In the
2014 report they predicted the changes in technology that will continue to occur. In this report they did
not classify it by expected year because technology changes so rapidly. These technologies were broken
into the categories and are displayed in Table 2.9:

Consumer Technologies

 3D Video
 Electronic Publishing
 Mobile Apps
 Quantified Self
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 Tablet Computing
 Telepresence
 Wearable Technology

Digital Strategies

 BYOD (Bring Your Own Device)

 Flipped Classroom
 Games and Gamification
 Location Intelligences
 Makerspaces
 Preservation/Conservation Technologies

Internet Technologies

 Cloud Computing
 The Internet of Things
 Real-Time Translation
 Sematic Applications
 Single sign-on
 Syndication tools

Social Media Technologies

 Collaborative Environments
 Collective Intelligence
 Crowdfunding
 Digital Identity
 Social Networks
 Tacit Intelligence

Visualization Techniques

 3D Printing
 Augmented Reality
 Information Visualization
 Visual Data Analysis
 Volumetric and Holographic displays

Enabling Technologies

 Affective Computing
 Cellular Networks
 Electrovibration
 Flexible displays
 Geolocation
 Location-based services
 Machine learning
 Mobile broadband
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 Natural use interfaces

 Near field communication
 Next-Generation Batteries
 Open Hardware
 Speech-Speech translation
 Virtual assistant
 Wireless Power

Source: New Media Consortium, Horizon Report 2014

Table 2.9 Technologies Predicted for the Future

Educause (2014) also has an e-learning maturity index that can be used to determine how far along an
institution is in regards to its use of technology. This tool measures:

 Synergy of e-learning systems

 Priority placed on e-learning
 Ongoing technology evaluation and training
 Policies and governance
 Investment in faculty and staff

The tool provides a score based on the question you asked in each area from a scale of one to five with
five being the highest score.

Faculty also must ensure they have appropriate technological knowledge and must keep up with new
trends in order to facilitate transformative learning. This does not mean a faculty member should
experiment with every new tool that becomes available but instead should have a basic knowledge of
technology applications. Aydin (2005) noted important faculty roles are content expert, instructional
designer and materials producer. In order to produce these materials, faculty must have some
technological expertise. Koehler and Mishra (2005) also described these roles and coined the term
“technological, pedagogical and content knowledge or TPCK” (Miller, 2012, p. 2; Voogt, Fisser, Roblin,
Tondeur & van Braak, 2012, p. 109). Without these skills faculty cannot develop effective learning
utilizing technology for their online or residential classrooms.

In Appendix II is a faculty technology self-assessment. This assessment includes productivity software

as well as use of a Learning Management System (LMS). This checklist was adapted from a checklist
posted online by Embry Riddle University in 2011. Significant updates and changes were made to this
checklist. This example is for a Blackboard LMS and a Panopto faculty video capture system, but it can
be adapted for other systems. Faculty should not be expected to have all of these skills; instead this
assessment provides a form of reference for technological applications they may not be aware of.

RESEARCH IN TRANSFORMATIVE LEARNING IN THE HEALTH SCIENCES

Phillipi in 2010 noted transformative learning in health care has really not been explored. However,
changes are beginning to occur that may change the landscape of health education in the future. Although
health education has been traditionally provided at public institutions, the number of private universities
with health programs has been increasing. In addition, corporate partnerships have begun to proliferate
the health education field. Massively Open Online Courses (MOOCs) are readily available at no cost and
in some cases, certificates can be obtained for paying a nominal fee and completing all required
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competencies. The Khan Academy has partnered with Stanford Medical School to provide health
information globally. The Institute for Healthcare Open Improvement School has 625 chapters in 65
countries (Crisp & Chen, 2014).

Rather than just practitioners, the global call for health care professionals is for them to become experts as
well as change agents. The Commission on the Education for Health Professionals in the 21st Century is
looking towards a three stage health care transformative educational experience. The first stage is the
informative stage where health professions gain knowledge to become experts in their field. The second
stage is the formative stage where practitioners gain appropriate values and behaviors. The third stage is
the transformative education stage where health professionals learn to become change agents (Crisp &
Chen, 2014). Change, particularly in regards to health, begins with education.

Crisp and Chen (2014) call for academics and professionals to think globally about education in the health
sciences. They note the entire health care educational process needs to be transformed since health care
concerns are global. Workers must be able to respond to patient diversity. “The knowledge base of the
profession is global in scope and there is increasing cross-national transfer of technology, expertise and
services” (p. 950). This is needed in response to the ever increasing number of foreign doctors in the
United States and the increase in medical tourism. Other factors include epidemics (such as the Ebola
virus epidemic in Africa in 2014) and disease related to climate change. The global spread of viruses,
such as SARS, requires professionals in health who can think and react outside their normal scope of
practices. This cannot occur without changes in the education process for health professionals. Health
care imbalances occur within countries (rural versus urban disparities) and globally between nations. In
addition, health care worker education varies greatly between countries.

Crisp and Chen (2014) also note the world demographics are changing and that is having a great impact
on the need for health professionals who have been educated in a manner that provides global focus.
Populations in many countries are aging. In addition, populations are becoming more urbanized as well
as mobile. This has changed global health focus from nutrition and maternity-related morbidity and
mortality to increasing diseases of urban populations, including chronic disease (such as heart disease),
musculoskeletal disorders and mental health issues. Crisp and Chen all for a change in health systems but
this cannot first occur without changes in the educational process. They note the Commission on the
Education for Health Professionals in the 21st century has set forth the idea of shared competencies and a
third generation of systems-based education. This would include both horizontal integration of training
from the undergraduate level to clinical training, common core competencies for health professions as
well as local competencies.

Curran, Sharpe, Flynn and Button (2010) support this view in their call for interprofessional education
(IPE) to meet global health needs. They note health education in the U.S. and Canada have not kept pace
with changing health needs. IPE can provide collaboration at the local as well as global levels. Curran et
al. performed a longitudinal study of student attitudes towards interprofessional health teams in Canada.
In 2005 medical and nursing students were less receptive to IPE, in 2006 medical students again had
significantly lower scores and in 2007 pharmacy students were found to be most receptive to IPE. As
health gains additional global focus, IPE will play an important role in meeting universal health needs;
however, the current health education process does not usually incorporate this important competency that
is needed to meet future health needs.

In 2013, the World Health Organization published a report called “Transforming and Scaling Up Health
Professionals Education and Training.” These guidelines were designed to provide a framework for
changing the educational process. The initial goals were to transform the health professionals’
educational experience to meet worldwide health needs and strengthen population health outcomes.
WHO calls for a transformative educational process where the education and health institutions
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collaborate to best decide on how to meet health needs. This included “dynamic curricula and supportive
learning environments” (p. 12). WHO outlined nine curriculum-related recommendations to scale up
educational processes. They are:

 Faculty development
 Implementation of higher education policies
 Adaptive curricula
 Direct entry of graduates from other health professions
 Targeted admissions policies
 IPE in both graduate and undergraduate education
 Accreditation of health professions education where it does not exist
 Continual professional development and in-service training
 Political commitment to health education and health reform

In addition to IPE, WHO calls for additional use of e-learning in the health professions to scale health
providers in countries where shortages exist. In regards to the educational process, WHO calls for:
 More community-focused approaches
 Greater use of problem-based learning approaches
 Orientation of curricula to work in rural settings
 Special curricula for rural students
 Curricula preparing health workers to work in underserved and rural areas with diverse
and disadvantaged communities (p. 18).

They note curricula should be relevant to student future practices and should include group and case-
based learning experiences.

Medical Education

Medical education has continued to undergo significant transformation in the last two to three decades,
particularly in regards to technology as well as readiness for clinical practice. Diagnostic testing
primarily replaced diagnostic skills for a time; however, this is changing and the importance of clinical
skills as well as relationship skills has once again gained importance.

Van Schawyck et al. (2013) described an integrated rural medical education for students in South Africa
and did targeted extensive interviews on the 8 students and 10 physician preceptors involved in this pilot
program. Two educational models were implemented; the first was the traditional disciple-specific
training model where students rotated to various areas. This was supplemented by training at a rural
health clinic where students were tasked to utilize the discipline-specific training they had received to see
patients as they presented with undifferentiated problems. Students noted the LIC learning experience
was vastly different than their discipline-based training and they grew as learners. They also reported the
patient had become the focal point of their assessment rather than the disease process. Even more
significant the students felt it enhanced their critical reasoning and increased their self-confidence. In
addition, students enjoyed the opportunity to see patients as they would once they became practitioners
with the additional guidance of their preceptors available. Overall, it was a rich clinical learning
experience for both students and preceptors.

Hirsh, Walters and Poncelet (2012) note international leaders in medical education have called for the
“transformation of clinical learning” (p. 548). This transformation is expected to contribute to meeting
the needs in the health care model of today compounded by changing systems of healthcare financing and
delivery, addressing the needs of patient populations, shortages of health care workers and the financial
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burdens placed on medical schools while higher education is undergoing rampant change. One model
that has worked well to address these needs is the Longitudinal Integrated Clerkship Model which has
been used successfully in the United States, Australia and Canada, as an alternative to traditional clock
scheduling in medical school. In this model rather than seeing patients for a short time and moving on to
the next rotation, students are involved in comprehensive care of a patient over time. Hirsh et al. note this
is an effective “disruptive innovation or event” that was classified as a component of transformational
learning by Mezirow. Patient care is managed from different perspectives and multiple disciplines across
the continuum of care much as it would be in a family medicine model. The authors note this method
works well across health delivery systems from the most rural to the most urban and all levels in between.
It is used effectively in the remote regions of Australia as well at Harvard Medical School in urban
Cambridge, Massachusetts. Students have described this process as “learning to be rather than learning to
do” (p. 550). In the three case studies presented, all students in this type of program matched or exceeded
standardized competence and clinical assessment scores of their traditionally trained peers.

Dartmouth University Medical School transformed its curriculum by including more quality and change-
based experiential learning experiences to prove to students they can make a difference in the lives of
their communities and their patients (Ogrinc, Nierenberg & Bataldon, 2011). Eubank, Geffken, Orzano
and Ricci (2012) note at Dartmouth adaptive leadership principles were also embedded into the medical
school curriculum for family medicine to create physicians who are change agents rather than experts in
medical science. The skills being taught are outlined in Table 2.10
below:

Process Skills Evidence

Personal mastery Aware of personal assumptions and emotions*
Realistic reflection*
Communication Listening, persuading, asserting, bridging and attracting
Explore unconscious assumptions*
Collaboration Giving and seeking feedback
Awareness of others assumptions*
Accountability
Conflict resolution
Systems Thinking Critically analyze assumptions and resulting constraints*
Recognize archetypes and interrelationships*
Change Management Understand the uncertainty of change*
Increase motivation
Negotiation
Reframe assumptions*

*Note: all of these are common characteristics in Mezirow’s transformational learning theory

Table 2.10 Eubank et al.’s Adaptive Leadership Process Skills for Family Medicine Students

The process outlined by Eubank’s et al. is based on practice reflections and experiential learning. The
experiential learning model used was the one outlined by Kolb (1984) which includes: 1) Concrete
Experience, 2) Reflective Observation, 3) Abstract Conceptualization, and 4) Active Experimentation.
To be effective, Eubanks et al. note all four styles so this learning tool was given to residents to help them
identify their preferences. The researchers also noted although it may be assumed that future physicians
are open to learning, this in fact can be a false assumption since these types of high achievers tend to
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greatly fear failure. The fear can lead to unrealistic assumptions that physicians must be taught to
challenge within themselves. The authors recommend a coaching style to enact this transformation in
these students to give them new frames of reference regarding medicine and most importantly,
themselves.

Coulehan and Granek (2012) discuss the use of narrative medicine, reflective writing and reflective
practice in the medical curriculum at Stony Brook Medical College in New York. Donaghy and Morss
(2000) defined reflective capacity as higher level activities where providers critically evaluate and reflect
on their experiences in order to lead to new knowledge and understanding. Coulehan and Granek note
providers must be willing to accept and learn from their own mistakes and correct them. Reflection is an
excellent exercise to facilitate this process. In addition, reflection enhances empathy and compassion and
leads to a lessening of provider detachment which has been promoted in medical education for the last
several decades. They note reflective writing is more effective as a formative rather than a summative
tool.

Wald, Borkan, Scott Taylor, Anthony and Reis (2012) created a tool to evaluate medical student’
reflective capabilities. Their methods included reflective writing groups for students in clerkships and
residency, journaling, portfolios, video essays and integration of written feedback from faculty mentors.
They created a rubric that requires the assessor to do the following: read the entire narrative, differentiate
detailed items in the narrative that meet rubric criteria, determine the overall “gestalt” of the narrative,
and defend the assignment level and learning outcomes (p. 44). This method was used to evaluate
curriculum outcomes and professional development of the medical students for characteristics such as
empathy, reflective capacity and professionalism. Their goal was to create and refine in the future a tool
that could actually measure these characteristics which are very difficult to measure quantitatively as well
as qualitatively but are crucial in medical professionals.

Bleakley and Brennan (2011) discussed the changes in curriculum design that were undertaken at
Peninsula Medical School in the United Kingdom to assist student readiness to undertake clinical
practice. These curriculum revisions included additional experiential learning so students would have
personal as well as clinical skills. They measured two cohorts who were entering their medical clinical
education phase after completion of medical school; about half were Peninsula graduates and the other
half matriculated from other medical schools. Peninsula students rated their capabilities higher in 14 out
of 15 capabilities; the one capability rated higher by the non-Peninsula cohort was caring for patients of
other cultures. Peninsula graduates were most able to deal with uncertainty including recognizing it,
managing it and communicating it.

Harris, Snell, Talbot and Harden (2010) described the change to a competency-based medical education
model in the UK (Tomorrow’s Doctors Initiative, Canada) and in the Netherlands (National
Undergraduate Framework in the Netherlands). These approaches are in the process of transforming
traditional medical curriculum. Harris et al. note the lack of a consistent language in medical education is
making this transformation somewhat difficult as is the need to change from a system based on
summative feedback to one based on formative feedback. This approach requires a backwards design
where future physician competencies and desired outcomes are first identified and then the curriculum is
built to meet these competencies. The researchers note this competency-based framework is designed to
encourage reflection and lifelong learning by making the future physicians independent learners. The
authors note the key to competency based medical education does not come from a checklist but instead
from rich curriculum where every assessment and exercise can be easily linked to the required outcomes
which as the end product. This does not mean the educational process is linear; instead the process is less
linear and multi-dimensional. Most importantly these frameworks do identify clearly the destination but
do not dictate how the student gets there. Therefore, they can be used with multiple teaching strategies
which is a distinct strength of this model. Every learner is different and has distinct learning styles and
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preferences; this framework can be used within all of these. The authors note that strategies that make
this style most successful include: student-centered instruction, active engagement, flexible design and
alignment of activities. In addition, the assessment process must be authentic for this type of curriculum
to be most effective. As students gain mastery, their performance must be diagnosed to identify areas
where each student is weak and needs additional training. The education posed within these frameworks
are not “one size fits all” and may require additional work on the part of the faculty members for students
to reach the highest levels of transformation.

Nursing

Although nursing is a field with constant patient contact and emphasizes the importance of experiences
and relationships, transformative learning experiences can still enhance traditional nursing educational
experiences. Eynard, Breaux and Dozer (2013) reported transformative learning in nursing students in a
service learning project for children of poverty in Louisiana. Students were required to keep a journal
about their experiences. Rozmus, Jones, Meyers, Hercules and Schumann (2014) describe flipping
traditional nursing clinical education model which uses a three semester didactic education followed by a
fourth semester clinical immersion experience. In this immersion students work 36-40 hours a week in
the clinical setting. This model however exacerbates the problem of insufficient clinical preceptors due to
nursing faculty shortages. In the Pacesetter model students begin clinical rotation in their second
semester in the areas where they have already completed their didactic education. This facilitates the best
use of clinical time since students already have the required didactic knowledge to perform successfully.
The students spend 2-3 weeks in their clinical rotations until the 4th semester when they complete clinical
training in the remaining five clinical areas. The researchers used the 2010 nursing class cohort and
divided the students randomly into the traditional and Pacesetter models. When means scores were
statistically compared, there were no statistically significant differences between the Pacesetter and
traditional curriculum except in Psychiatric and Mental Health Care and Reproductive Care. In these two
areas, the Pacesetter students scored significantly higher. Both of these rotations in the Pacesetter
students were completed before the 4th semester. The nursing certification (NCEX) pass rates and
graduation rates were similar for both groups.

According to Smith, Witt, Klaasen, Zimmerman and Cheng (2012) nursing students often feel they do not
have time to devote for their didactic courses when they are in clinical rotation. They created a
transformative learning experience in their nursing legal and ethics course to help students recognize the
importance of this topic to their practice. The research population consisted of 60 nursing students. They
included case study scenarios. One third of the randomly selected students were released from class time
for one hour a week to work on their case study using High Fidelity Human Simulation (HFHS) which
was done in groups of four to five students. Another one third of the students conducted the discussion
online. A third group did the case studies via pencil and paper. None of the students rated this case study
exercise lower than average on a student evaluation; however the HFHS students showed a statistically
significant difference from the other two groups and rated the exercise much higher. The researchers felt
this transformative experience enabled students to learn the value of this topic.

Other Health Professions

Perhaps the fields that can benefit most from transformative learning experiences are those outside the
scope of nursing and medicine since these two health roles are more clearly defined. The roles of allied
health and other health professionals in patient care is not nearly as evident to students who are training in
these fields. Chastonay, Vu, Humair, Mpinga and Bernheim (2012) outlined the implementation of a
transformative problem-based community health training program at the University of Geneva. This
approach was initially implemented in the mid1990s as part of an integrated curriculum. The community
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health program was developed in three major steps: 1) initial process led by a small group of highly
motivated faculty, 2) later development was interdisciplinary in nature and 3) continuing oversight by
this multi-disciplinary group. Over a 15 year period, 460 students went through this program with 55-97
faculty members. Some of the major focus within the program was a humanistic, ethical approach with
community immersion. Student satisfaction with this program was “globally high” (p. 8), in fact, higher
than they had been under the previous program. There was an 8% increase in national exam scores. Part
of this transformative program was reflective writing on the health issues in the community the students
were presented with. In addition, students also reported feeling a high level of competency that was
maintained after graduation.

Gordon, Booth and Bywater (2010) describe the use of e-learning as a way to teach students
interprofessional education (IPE), which in and of itself, is transformative in nature. The curriculum was
given to students in social work, physiotherapy, occupational therapy, nursing, sports and exercise
science, and students in radiotherapy. This curriculum tied in the roles all of these professions play in
care of the patients. In particular, IPE can assist students in what are traditionally considered ancillary
roles understand the importance of their field and how their actions impact patient care.

Pennington, Simpson, McConnell, Fair and Baker (2013) note the key component to transformation in
science and health are team members with a shared commitment of finding solutions to the problem,
varying expertise and collaboration. Cross disciplinary collaboration leads to highly creative thinking.
This is one reason subject matter experts should not write curriculum in a vacuum and should seek out the
expertise of others including curriculum design specialists, members of the community, faculty from
various disciplines and those practicing in the field.

McCusker (2013) used Action Research in social worker training in the UK to teach social workers to
transform their learning process by critically evaluating their own motivations and assumptions in
reference to disadvantaged service users. In this 12-week course. the number of hours of didactic lecture
for 38 students was reduced to allow students more time for critical thinking evidenced in classroom
discussion. There were five reflection seminars scheduled and lecture material was revised to reflect
responsive teaching. Quinney and Parker’s (2010) scale was used to rate student self-efficacy and focus
groups were used. Twenty two students completed the class and 100% of the students reported positive
changes to their “knowledge, values and skills required for effective social work practice” (p. 15). Ten
participants noted very significant change. McCusker recommends that learning activities that
“encourage the application of knowledge to practice can facilitate transformative learning (p. 16).

FUTURE RESEARCH DIRECTIONS

At this point in time, there is very limited research in transformative educational principles in health
sciences education. In fact, there is only limited research on transformative learning in general other than
small qualitative studies that look at reflective journaling. Because transformative learning is internal, it
lends itself primarily to qualitative research. Although very valuable, qualitative research cannot lend
itself to conclusions that can easily be generalized to larger population groups. One researcher, King as
mentioned in chapter 1, has attempted to quantify transformative learning; in addition the author has
piloted a set of two quantitative instruments for students and faculty to self-assess their progress on the
journey to transformative learning. There is great opportunity for researchers in curriculum and
transformative learning in health sciences and other fields to explore these concepts quantitatively in
larger and varied population groups.

SUMMARY
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As technology proliferates throughout higher education, curriculum is likely to become even more
transformative and robust in both the online and face-to-face classrooms. However, there will continue to
be friction caused by educators who want total autonomy and instructional designers and accreditation
compliance managers who want to be able to show a demonstrated linkage from course assessments all
the way to the institutional goals. Technology, although helpful, will provide additional challenges. The
major challenge that will be faced by most educational institutions is how to obtain additional funding to
purchase necessary software and hardware for these fast-moving technological changes. Other challenges
include ensuring technology is incorporated into curriculum design appropriately and where needed.
Technology should never overshadow content.
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2

References

Adaptcourseware. (2014). Retrieved at http://adaptcourseware.com/

Allen, M. & Sites, R. (2012). Leaving ADDIE for SAM. Alexandria, VA: ASTD Press

Allen, M. & Sites, R. (2013). Leaving ADDIE for SAM (PDF document). Retrieved from
http://www.slideshare.net/alleninteractions/leaving-addie-for-sam

Anderson, L. W., Krathwohl, D. R., Airasian, P. W., Cruikshank, K. A., Mayer, R. E., Pintrich, P. R., ...
& Wittrock, M. C. (2001a). A taxonomy for learning, teaching, and assessing: A revision of Bloom's
taxonomy of educational objectives, abridged edition. White Plains, NY: Longman.

Anderson, T. Rourke, L., Garrison, D. & Archer, W. (2001b). Assessing teaching presence in a computer
conferencing context. Journal of Asynchronous Learning Networks, 5(2), 1-17.

Aydin, C. (2005). Turkish mentor’s perceptions of roles, competencies and resources for online teaching.
Turkish Online Journal of Distance Education, 63 (3), 1-5. Retrieved from http://tojde.anadolu.edu.tr/

Baran, E., Correia, A. & Thompson, A. (2011). Transforming online teaching practice: Critical analysis
of the literature on the roles and competencies of online teachers. Distance Education, 32 (3), 421-439.
doi:10.1080/0157919.2011.610293

Berge, Z. (2005). The role of the online instructor/facilitator. Educational Technology, 35 (1), 22-30.

Berge, Z. (2009). Changing instructor’s roles in virtual worlds. Quarterly Review of Distance Education,
9 (4), 407-415.

Bleakley, A & Brennan, N. (2011). Does undergraduate curriculum design make a difference to readiness
to practice as a junior doctor? Medical Teacher, 33, 459-467. doi: 10.3109/014215X2010.540067

Bloom, B. (1956). Taxonomy of educational objectives. Volume 1 cognitive domain. New York:
McKay.

Bolkan, J. (2013, June 24). Report: Students taking online classes jumps 96% over 5 years. Campus
Technology. Retrieved at http://campustechnology.com/articles/2013/06/24/report-students-taking-
online-courses-jumps-96-percent-over-5-years.aspx

Bovill, C., Bulley, C. J. & Morss, K. (2011, April). Engaging and empowering first-year students through
curriculum design perspectives from the literature. Teaching in Higher Education, 16 (2), 297-209.
doi:10.1080/13562517.2010.515024

Bovill C., Cook-Sather, A. & Felten, P. (2011). Students as co-creators of teaching approaches, course
design and curricula: Implications for academic development. International Journal for Academic
Development, 16 (2), 133-145.
 3
3

Bower, M., Howe, C., McCredie, N., Robinson, A., & Grover, D. (2014). Augmented Reality in
education–cases, places and potentials. Educational Media International, 51(1), 1-15.

Boyer, N.R., Maher, P. A. & Kirkman, S. (2006). Transformative learning in online settings: The use of
self-direction, metacognition and collaborative learning. Journal of Transformative Education, 4, 335-
361. Doi: 10.1177/1541344606295318

Chastonay, P., Vu, N. V., Humair, J., Mpinga, E. K. & Bernheim, L. (2012). Design, implementation and
evaluation of a community health training program in an integrated problem-based medical curriculum:
A fifteen-year experience at the University of Geneva Faculty of Medicine. Medical Education Online,
17, 1-12. Retrieved at http://dx.doi.org/10.3402/meo.v17i0.16741

Coppola, N., Hiltz, S. & Rotter, N. (2002). Becoming a virtual professor: Pedogogical roles and
asynchronous learning networks. Journal of Management Information Systems, 18 (4), 169-189.

Coulehan, J. & Granek, I.A. (2012). “I hope I’ll continue to grow”: Rubrics and reflective writing in
medical education. Academic Medicine, 87, 8-10. doi: 10.1097/ACM.0b013 e31823a98ba

Council for Adult and Experiential Learning. (2014). Retrieved from www.cael.org

Crisp, N. & Chen, L. (2014). Global supply of health professionals. The New England Journal of
Medicine, 4 (370), 950-957. doi:10.1056/NE/Mra1111610

Curran, V. R., Sharpe, D. Flynn, K. & Button, P. (2010). A longitudinal study of the effect of an
interprofessional education curriculum on student satisfaction and attitudes towards interprofessional
teamwork and education. Journal of Interprofessional Care, 24 (1), 41-52. doi:
10.3109/13561820903011927

Diamond, R. (2011). Designing and assessing courses and curricula: A practical guide. 3rd edition.
Kindle e-book edition: Amazon.

Dick, W., & Carey, L. (1978). The systematic design of introduction. Illinois: Scott & Co.

Dick, W., Carey, L. & Carey, J. (2014). Systematic design of instruction. 8th edition. Amazon Kindle
Edition.

Donaghy, M.E. & Morss, K. (2000). Guided reflection: A framework to facilitate and assess reflective
practice within the discipline of physiotherapy. Physiotherapy Theory and Practice, 16 (3), 3-14.

Educause. (2014). E-learning maturity index. Available for purchase through Educause.

ELearning World. (2014). The new frontier of successive approximation model. Retrieved from
http://www.yourelearningworld.com/the-new-frontier-of-successive-approximation-model/

Ertl, A. (2014). The slow crawl towards e-textbooks. Current Trends in Publishing (Tendances de
l'édition): student compilation étudiante, 1.

Eubank, D., Geffken, D., Orzano, J. & Ricci, R. (2012). Teaching adaptive leadership to family medicine
residents: What? Why? How? Families, Systems and Health, 30 (3), 241-252.
 3
4

Eynard, A.S., Breaux, P., & Dozar, K. (2013). Transformative learning in nursing students through a
service learning project with a vulnerable community. Journal of Nursing Education and Practice, 3 (3),
35-43. doi: 10.5430/jnep.v3n3p35

Fain, P. (2014, October 28). Big ten and the next big thing. Inside Higher Ed. Retrieved from
https://www.insidehighered.com/news/2014/10/28/competency-based-education-arrives-three-major-
public-institutions

Fedaro, L. W. (2010, October 19). In a digital age, students still cling to paper textbooks. New York
Times. Retrieved at http://www.nytimes.com/2010/10/20/nyregion/
20textbooks.html?pagewanted=all&_r=1&

Foasberg, N. M. (2011). Adoption of e-book readers among college students: A survey. Information
technology and libraries, 30(3).

Freifeld, L. (2012, October 18). Criteria for the ideal instructional design process model. Training.
Retrieved from http://www.trainingmag.com/content/criteria-ideal-instructional-design-process-model

Gagne, R.M. (1965). The conditions of learning. New York: Holt, Rinehart and Winston.

Garrison, D. R. & Kanuka, H. (2004). Blended learning: Uncovering its transformative potential in
higher education. Internet and Higher Education, 7, 95-105. doi: 10.1016/j.iheduc.2004.02.001

Gilbert, J., & Fister, B. (2014). The perceivediImpact of e-books on student reading practices: A local
study. College & Research Libraries, crl14-587.

Gordon, F., Booth, K. & Bywater, H. (2010, September). Developing an e-pedagogy for interprofessional
learning: Lecturers’ thinking on curriculum design. Journal of Interprofessional Care, 24 (5), 536-548.
Doi: 10.3109/13561820903520336.

Gregory, C. L. (2008). But I want a real book. Reference & User Services Quarterly, 47(3), 266-273.

Harris, P., Snell, L., Talbot, M. & Harden, R.M. (2010). Competency-based medical education
Implications for undergraduate programs. Medical Teacher. 32, 646-650. doi:
103109/0142159X.2010.500703

Harvard University. (2011). Pathways to prosperity. Retrieved from

http://www.gse.harvard.edu/news_events/features/2011/Pathways_to_Prosperity_Feb2011.pdf

Heick, T. (2012, July 21) 10 reasons students aren’t using digital textbooks. Retrieved from
http://www.teachthought.com/technology/10-reasons-students-arent-using-digital-textbooks/

Henderson, J. (2010). An exploration of transformative learning in the online environment. 26th Annual
Conference on Distance Teaching and Learning. Board of Regents of the University of Wisconsin
System.

Hirsh, D., Walters, L. & Poncelet, A. N. (2012). Better learning, better doctors, better delivery system:
Possibilities from a case student of longitudinal integrated clerkships. Medical Teacher, 34, 548-554.
doi: 10.3109/0142159X.2012.698745
 3
5

King, K. P. (2002, May). A journey of transformation: A model of educator’s learning experiences in

educational technology. Proceedings from the Annual Meeting of the Adult Education Research
Conference. Retrieved from http://www.adulterc.org/proceedings/2002/
papers/king.pdf

Koehler, M. & Mishra, P. (2005). What happens when teachers design educational technology? The
development of technological pedagogical content knowledge. Journal of Educational Computing
Research, 32, 131-152.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development.
Englewood Cliffs, N. J: Prentice Hall.

Kolowich, S. (2014, January 16). Exactly how many students take online courses. Chronicle of Higher
Education. Retrieved at http://chronicle.com/blogs/wiredcampus/exactly-how-many-students-take-
online-courses/49455

Kuo, L. H, Wei, H. M., Wang, M. C., Ko, M. . & Yang, H. J. (2012). International Journal of Education
and Information Technologies, 3 (6), 250-259.

McCusker, P. (2013). Harnessing the potential of constructive developmental pedagogy to achieve

transformative learning in social work education. Journal of Transformative Education, 11, 1, 3025. doi:
10.1177/1541344613482522

McLoughlin, C & Lee, M. J. (2010). Personalised and self-regulated learning in the Web 2.0 era:
International exemplars of innovative pedagogy using social software. Australasian Journal of
Educational Technology, 26 (1), 28-43.

Miller, A. (2012, November). Disruptive and transformative education: Designing learning in the digital
age. eLearn, Association of Computing and Machinery. Retrieved at:
http://elarnmag.acn.org/archive.cfm?aid=2398997

New Media Consortium. (2011) Horizon report. Retrieved at

http://net.educause.edu/ir/library/pdf/hr2011.pdf

New Media Consortium. (2013) Horizon report. Retrieved from http://www.nmc.org/publications/2013-

horizon-report-higher-ed

New Media Consortium. (2014) Horizon report. Retrieved from: http://cdn.nmc.org/media/2014-nmc-

horizon-report-he-EN-SC.pdf

Ogrinc, G., Nierenberg, D.W. & Bataldon, P. B. (2011). Building experiential learning about quality
improvement into a medical school curriculum: The Dartmouth experience. Health Affairs, 30 (4), 716-
722. doi: 10.1377/hlthaff.2011.0072

Oh, Y. & Kim, E. (2014). Efficient 3D visualization system of design drawing based on mobile
augmented reality. Advances in Computer Science and Its Applications Lecture Notes in Electrical
Engineering, 279, 805-810. Retrieved at http://link.springer.com/chapter/10.1007%2F978-3-642-41674-
3_115
 3
6

Pennington, D.D., Simpson, G. L., McConnell, M.S., Fair, J.M. & Baker, R. J. (2013). Transdisciplinary
research, transformative learning, and transformative science. Bioscience, 63 (7), 564-573. Retrieved
from: http://www.jstor.org/stable/10.1525/bio.2013.63.7.9

Phillipi, J. (2010). Transformative learning in healthcare. PAACE Journal of Lifelong Learning, 19, 39-
54.

Quinney, A. & Parker, J. (2010). Developing self-efficacy in research skills: Becoming research-minded.
In H. Burgess & J. Carpenter (EDS.) The outcomes of social work education: Developing evaluation
methods (pp. 16-25). Southampton, England: Higher Education Academy Subject Centre for Social
Policy and Social Work, University of Southampton School of Social Sciences.

Rozmus, C. L., Jones, D., Meyers, S., Hercules, P. & Schumann, R. (2014). Pacesetter curriculum: An
experimental design evaluation of a clinical immersion model for nursing education. Journal of Nursing
Education and Practice, 4 (6), 60-68. doi: 10.5430/jnep.v4n6p60

Smith, K.V., Witt, J., Klaasen, J.A., Zimmerman, C. & Cheng, A. (2012, February 8). High fidelity
simulation and legal ethical concepts: A transformative learning experience. Nursing Ethics, 1-9. doi:
10.1177/096973301423559

Staiger, J. (2012). How e-books are used. Reference & User Services Quarterly, 51(4), 355-365.

Stevens-Long, J., Schapiro, S. A., & McClintock, C. (2012). Passionate scholars: Transformative
learning in doctoral education. Adult Education Quarterly, 62 (2), 180-198.

Stufflebeam, D.L. (2002). The CIPP model for evaluation. In Evaluation in Education and Human
Services (G.F. Madaus and D.L. Stufflebeam, Eds.). New York: Kluwer Academic Publishers.

Taylor. E. W. (2007, March/April). An update of transformative learning theory: A critical review of the
empirical research (1999-2005). International Journal of Lifelong Education, 26 (2), 173-191.
Doi:10.1080/026013701219475.

U.S. Department of Education. (2014). Competency-based learning or personalized learning. Retrieved

from http://www.ed.gov/oii-news/competency-based-learning-or-personalized-learning.

van der Sangen, K. (2014, June 6). Augmented reality-revolutionizing medicine and healthcare.
Retrieved from http://www.healthtechevent.com/technology/augmented-reality-revolutionizing-medicine-
healthcare/

Van Merriënboer, J. J. G. (1997). Training complex cognitive skills: A four component instructional
design model for technical training. Englewood Cliffs, N.J.: Educational Technology Publications.

Van Schawyck, S.C., Bezuidenhout, J., Conradie, H. H., Fish, T., Kok, N. J., Van Deerden, B.H. & de
Villiers, M.R. (2013, September). “Going rural:”: Driving change through a rural medical education. The
International Journal Rural and Remote Health Research, 1-7. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/24803108

Voogt, J. Fisser, P., Roblin, N.P., Tondeur, J & van Braak, J. (2012). Technological pedagogical content
knowledge – a review of the literature. Journal of Computer Assisted Learning, 29, 109-121. Doi
10.1111/j.1365-2729.2012.00487.x
 3
7

Wald, H.S., Borkan, J. M., Scott Taylor, J., Anthony, D. & Reis, S. P. (2012, January). Fostering and
evaluating reflective capacity in medical education: Developing the REFLECT rubric for assessing
reflective writing. Academic Medicine, 87 (1), 41-50.

Weise, M. (2014, Nov 10). Got skills? Why online competency-based education is the disruptive
innovation for higher education. Educause Review Online. Retrieved at
http://www.educause.edu/ero/article/got-skills-why-online-competency-based-education-disruptive-
innovation-higher-education

Wiggins, G. & McTighe, J. (2005). Understanding by design. Virginia: Merrill Prentice Hall

Wilson, B.G., & Parrish, P. (2010, May). Transformative learning experience: Aim higher, gain more.
Retrieved at http://carbon.ucdenver.edu/~bwilson/TLE.pdf

World Health Organization. (2013). Transforming and scaling up health professionals education and
training: World Health Organization Guidelines 2013. Retrieved from
http://www.who.int/hrh/resources/transf_scaling_hpet/en/

ADDITIONAL READING

Alahiotis, S. N., & Karatzia‐Stavlioti, E. (2006). Effective curriculum policy and cross‐curricularity: Analysis
of the new curriculum design of the Hellenic Pedagogical Institute. Pedagogy, Culture & Society, 14(2),
119-147.

Allen, G. (2011). Practicing teachers and web 2.0 technologies: Possibilities for transformative learning.
ProQuest/UMI.

Anderson, J. M., Aylor, M. E., & Leonard, D. T. (2008). Instructional design dogma: creating planned
learning experiences in simulation. Journal of Critical Care, 23(4), 595-602.

Armstrong, E. G., Doyle, J., & Bennett, N. L. (2003). Transformative professional development of
physicians as educators: Assessment of a model. Academic Medicine, 78(7), 702-708.

Butler, D., Jackiw, N., Laborde, J. M., Lagrange, J. B., & Yerushalmy, M. (2010). Design for
transformative practices. In Mathematics Education and Technology-Rethinking the Terrain (pp. 425-
437). New York: Springer Publishing.

Bovill, C., Cook‐Sather, A., & Felten, P. (2011). Students as co‐creators of teaching approaches, course
design, and curricula: implications for academic developers. International Journal for Academic
Development, 16(2), 133-145.

Clouder, L. (2009). Promotion of reflective learning, teaching and assessment through curriculum
design. Connecting Reflective Learning, Teaching and Assessment, 8.

Confrey, J., & Lachance, A. (2000). Transformative Teaching Experiments through Conjecture-Driven
Research Design. ERIC Document ED478316

Cousin, G. (2006). An introduction to threshold concepts. Planet, (17), 4-5.

Cranton, P. (1994). Self-directed and transformative instructional development. The Journal of Higher
Education, 726-744.
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8

Cullen, R., Harris, M., & Hill, R. R. (2012). The learner-centered curriculum: Design and implementation.
Hoboken New Jersey: John Wiley & Sons.

Cullingford, C., & Blewitt, J. (Eds.). (2013). The Sustainability Curriculum: The challenge for higher
education. New York: Routledge

Diamond, R. (2011). Designing and assessing courses and curricula: A practical guide. 3rd edition.
Kindle e-book edition: Amazon.

Dick, W., & Carey, L. (1978). The systematic design of introduction. Illinois: Scott & Co.

Dick, W., Carey, L. & Carey, J. (2014). Systematic design of instruction. 8th edition. Amazon Kindle
Edition.

Duncan, M., Alperstein, M., Mayers, P., Olckers, L., & Gibbs, T. (2006). Not just another multi-
professional course! Part 1. Rationale for a transformative curriculum. Medical Teacher, 28(1), 59-63.

Edelson, D. C. (2002). Design research: What we learn when we engage in design. The Journal of the
Learning sciences, 11(1), 105-121

Edwards, T. M. (2012). Transformative learning theory as a framework for designing experiences in virtual
worlds as appropriate to counsellor education. Retrieved from www. inter-disciplinary. net/wp-
content/uploads/2012/02/edwardsepaper. pdf.

Garrison, D. R., & Kanuka, H. (2004). Blended learning: Uncovering its transformative potential in higher
education. The internet and higher education,7(2), 95-105.

Goss, H. B., Cuddihy, T. F., & Michaud-Tomson, L. (2010). Wellness in higher education: a transformative
framework for health related disciplines. Asia-Pacific Journal of Health, Sport and Physical
Education, 1(2), 29-36

Grimmett, P. P., & Halvorson, M. (2010). From Understanding to Creating Curriculum: The Case for the
Co‐Evolution of Re‐Conceptualized Design With Re‐Conceptualized Curriculum. Curriculum
Inquiry, 40(2), 241-262.

Huang, R., Ma, D., & Zhang, H. (2008). Towards a design theory of blended learning curriculum.
In Hybrid Learning and Education (pp. 66-78). Berlin: Springer Berlin Publishing

Ion, R., Cowan, S., & Lindsay, R. (2010). Working with people who have been there: the meaningful
involvement of mental health service users in curriculum design and delivery. Journal of Mental Health
Training, Education and Practice, 5(1), 4-10.

Kleiman, P. (2008). Towards transformation: conceptions of creativity in higher education. Innovations in

Education and Teaching International, 45(3), 209-217

Kress, G. (2000). A curriculum for the future. Cambridge Journal of Education,30(1), 133-145.

Lachman, N., & Pawlina, W. (2006). Integrating professionalism in early medical education: The theory
and application of reflective practice in the anatomy curriculum. Clinical Anatomy, 19(5), 456-460.

Land, R., Cousin, G., Meyer, J. H., & Davies, P. (2005). Threshold concepts and troublesome knowledge
(3): implications for course design and evaluation. .Improving Student Learning–Equality and Diversity,
Oxford: OCSLD.
 3
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Lewis, T. (2006). Design and inquiry: Bases for an accommodation between science and technology
education in the curriculum? Journal of Research in Science Teaching, 43(3), 255-281.

McLachlan, J. C., Bligh, J., Bradley, P., & Searle, J. (2004). Teaching anatomy without cadavers. Medical
Education, 38(4), 418-424.

McPherson, M., & Baptista-Nunes, M. (2007). Negotiating the path from curriculum design to e-learning
course delivery: a study of critical success factors for instructional systems design. In Creating New
Learning Experiences on a Global Scale (pp. 232-246). Berlin: Springer Publishing

Mentkowski, M., Rogers, G., Doherty, A., Loacker, G., Hart, J. R., Rickards, W., ... & Roth, J.
(2000). Learning that lasts: Integrating learning, development, and performance in college and beyond.
New York: Jossey-Bass.

Moström, J. E., Boustedt, J., Eckerdal, A., McCartney, R., Sanders, K., Thomas, L., & Zander, C. (2008,
September). Concrete examples of abstraction as manifested in students' transformative experiences.
InProceedings of the Fourth international Workshop on Computing Education Research (pp. 125-136).
ACM.

Petrina, S. (2004). The politics of curriculum and instructional design/theory/form: Critical problems,
projects, units, and modules. Interchange, 35(1), 81-126.

Ross, V. (2012). From transformative outcome based education to blended learning. Futures, 44(2), 148-
157.

Sharpe, R., & Oliver, M. (2007). Designing courses for e-learning. Rethinking Pedagogy for a Digital Age,
41-51.

Stubbs, W., & Schapper, J. (2011). Two approaches to curriculum development for educating for
sustainability and CSR. International Journal of Sustainability in Higher Education, 12(3), 259-268

Wiggins, G. & McTighe, J. (2005). Understanding by design. Virginia: Merrill Prentice Hall
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KEY TERMS AND DEFINITIONS

Backwards Design: A curriculum design process outlined by Wiggins and McTighe where course
design begins with the end in mind and curriculum is based ultimately on what students will have to be
able to know and perform.

Bloom’s Taxonomy: A system of verbs that represent five different levels of learning (from the most
simplistic to the most complex) designed by Benjamin Bloom in 1956.

Collaborative Curriculum Design: Acurriculum design process where multiple faculty, instructional
designers, technology experts and even students give input on the content and delivery of a course or
program of study.

Curriculum Strategies: Models and methods of creating curriculum based on pedagogy, andragogy and
heuterogy.

Intentional Design: The practice of outlining a course or program to ensure all requirements
(accreditation, programmatic accreditation, experts in the field, theoretical content) are included in a
course or program from a student perspective.. Intentional design ensures course objectives are linked to
program outcomes and/or institutional goals.

Instructional Technology: Technology that is used to enhance the educational process such as video
lecture capture systems, educational games, augmented, reality, etc.

Linkage/Scaffolding: The building of curriculum to ensure all course objectives are needed, to prevent
duplication and to ensure that each part of the curriculum from assessments to course objectives to
program outcomes to institutional goals build upon one another.

Program Evaluation: In a curriculum sense, program evaluation is a curriculum mapping process that
should occur periodically to ensure that over time, as revisions occur, to ensure the linkage or scaffolding
of course items are not broken. In a more comprehensive program evaluation, the curriculum is mapped
but other factors such as student graduate rates, student surveys, national certification exam pass rates,
employer surveys, etc. are formally evaluated and reported to benchmark the efficacy of the program.
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APPENDIX I

(Excel Spreadsheet separate document)

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APPENDIX II

Recommended Faculty
Technology Competencies
Introduction:

In today’s ever changing world of education, there are many basic skills faculty
must have to successfully navigate productivity tools and learning
management systems.

This is a list of core competencies that are recommended. Some are very basic
while others are more advanced. You can check the box for the skills you feel
you have mastered. You can then use this list to identify any competencies and
skills you may need.

Information Technology Competencies

FILE MANAGEMENT
Open files.
Save files using both the Save and Save As commands
Copy and backup files.
Delete files.
Create folders.
Move files and folders using drag and drop
Organize files into an efficient pattern for workflow and backup purposes.
Rename files and folders.
Find Files scattered in various locations.

OPERATING SYSTEMS
Open multiple windows
Minimize and maximize windows.
Organize the content of a window.
Organize the content of the desktop.
Change the display resolution and color depth to correspond to connected monitors or
data projectors.
Utilize built-in Help system of operating system and appropriate applications.
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PERIPHERAL DEVICES
Print a document.
Cancel the printing of a document.
Change current printer from one to another.
Proper care and handling of removable media.

WORD PROCESSING
Manipulate word processing file formats.
Import and export to various word processing file types.
Understand advantages of saving files in PDF format
Manipulate text in a word processing document.
Enter and edit text.
Delete text
Copy and paste text.
Move text.
Apply and remove text styles such as bold, italic, and underline.
Apply and remove text styles such as bold, italic, and underline.
Apply appropriate fonts and font sizes to text.
Utilize spelling and grammar checking tools.
Insert special characters (math equations and physics symbols)
Enter comments to students to aid in assessment and feedback
Create new page using page break tool
Add tables in a document
Utilize appropriate page layout commands.
Change the margin of the document
Change the indentation of selected text.
Create automatic lists utilizing bullets and numbers.
Change the spacing of a document (i.e. single space, double space, etc.).
Add headers and footers to a document.
Add page numbers to a document.
Add footnotes to a document.

EMAIL
Utilize the e-mail program to communicate effectively with the university community.
Access the e-mail program and download messages.
Open and read messages received in the Inbox.
Reply and forward messages.
Create new e-mail messages and address them appropriately.
Edit the text of a new e-mail message.
Send a newly created e-mail message.
Add a file attachment to an e-mail message.
Open attachments received in e-mail.
Create and organize an e-mail address book
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Create an address list utilizing the entries of the address book.

File e-mail using rules and folders.
Add contacts
Create a contact list

INTERNET
Manipulate an internet browser program.
Set the homepage that is automatically downloaded when the program is opened.
Enter the address of an internet site and connect to that site.
Create a favorites/bookmark to a site for quick return to that site.
Change the name of a favorites/bookmark.
Delete a favorite/bookmark.
Organize multiple favorites/bookmarks using folders.
Set the program preferences to adjust how a web page is rendered to the
screen. (i.e. fonts, colors, etc.)
Print web pages.
Save web pages to a local drive for later review.
Mail links to web pages.

SPREADSHEET
Manipulate spreadsheet file formats.
Import and export to various spreadsheet file types.
Manipulate information in spreadsheet cells.
Enter numbers, dates, and labels (text) into cells.
Copy and paste information into cells.
Delete information from cells, rows, and columns.
Move information from one area to another.
Create basic formulas using functions (sum, average, count, etc.)
Create charts and graphs based on information entered into cells.
Utilize spelling and grammar tools.
Print selected cells, charts, and graphs.
Import and export to various graphic file types.
Utilize a scanner to digitize a photograph or image.
Save and Open graphic files downloaded from the internet.
Utilize various levels of compression with associated file formats.

GRAPHICS
Manipulate graphics file formats.
Import and export to various graphic file types.
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Utilize a scanner to digitize a photograph or image.

Save and Open graphic files downloaded from the internet.
Utilize various levels of compression with associated file formats.
Manipulate graphic elements in a paint/photographic program.
Scale a graphic image to change its size.
Crop a graphic image to cut out unwanted parts of the image.
Rotate a graphic image.
Utilize the basic paint and color tools to draw basic shapes.
Apply filters to graphic images.
Change the color depth of an image.
Manipulate graphic elements in a draw program.
Utilize the line and shape tools to create basic shapes.
Utilize color, pattern, and line width tools to modify how the shape tools
work.

PRESENTATION SKILLS
Utilize presentation tools to create slide show document.
Manipulate built-in templates by selecting and modifying slide styles.
Add slides to a presentation.
Enter, modify, and format text.
Add table, charts, and graphs.
Add graphic images and clipart.
Use the outliner function.
Insert and modify transitions between slides.
Re-arrange the order of slides in the presentation.
Utilize the drawing tools to create basic shapes.
Add an audio file to a presentation.
Package the presentation to be a self-contained slide show.
Design slides using appropriate page layout and presentation design
techniques, i.e. 6 X 6 rule, white space, color usage, etc.
Use animation features to control information display.
Use appropriate methods to reduce file sizes

5
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INSTRUCTIONAL TECHNOLOGY COMPETENCIES

INSTRUCTIONAL TECHNOLOGY ASSISTANCE

Contact IT Support
Know location of Faculty Resources and Tutorials

LEARNING MANAGEMENT SYSTEM (EXAMPLE SPECIFIC TO

BLACKBOARD) FOR INSTRUCTORS TEACHING A STANDARD TEMPLATE
COURSE
Log in to personal Blackboard site
Know username and password
Post instructor information
Access and review system announcements and policies.
Locate and access courses currently taught
Locate various services such as course rosters.
Post an announcement.
Set an availability time limit on a posted item
Set course items to be available for specified time periods.
Add links in the External Links area
Add, modify, and remove student groups.
Access the student view of the course
Know where Edit Mode button is and ensure it is on
Understand file restrictions (Course Cannot Exceed 100 MB)
Know how to create folders and upload items in institutional content
Input grades
Ensure gradebook matches point level of assignments
Back-up the grade book to an Excel file using the Export tool.
Send an entire class e-mail utilizing Blackboard e-mail system.
Administer a test in Blackboard, i.e., including setting time limits, setting the number
of attempts, check for student responses if the students loses a connection in the
middle of a tests and clear attempts.
Use the Chat function in Blackboard
Design a test to generate random questions from a pool in Blackboard.
Make the course available to students.
Utilize the course site to distribute multimedia content such as images, audio, and
video.
Utilize digital drop box
Syncing SafeAssign
Provision Panopto lecture capture system
Using Grademark (if applicable)
Use Croc-A-Doc Institutional content
Add files to Institutional Content
Print reports
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VIDEO
Create video with a webcam
Upload video files to YouTube
Set privacy setting on YouTube

OTHER
Utilize any supplementary material provided on publisher’s website

LEARNING MANAGEMENT SYSTEM FOR FACULTY CREATING THEIR

OWN COURSES
Organize course in a user-friendly format.
Set the weighting percentage to grade columns.
Add or remove a course banner.
Add assignments/tests.
Make the course available to students.
Create an assessment in Blackboard
Create a question pool in Blackboard
Design a test to generate random questions from a pool in Blackboard.
Utilize various question types (True/False, MC) in a Blackboard assessment.
Create a discussion board forum.
Ability to choose to allow/disallow anonymous discussion board postings.
Add or remove content items such as documents, spreadsheets, or a slide presentation
to a course.
Add, modify, or remove users from the course.
Set tracking and monitor student views of items.
Create folders and organize items within the folders.
Utilize course statistics to determine what areas of the course are being utilized by
which students.
Enable/disable area availability, communication areas, and tools.
Utilize calendar and have ability to separate public and private dates.
Utilize the Task tool to assign the students course or assignment related tasks.
Change button styles and title
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APPENDIX III

PROJECT REQUESTED:

DATE REQUESTED:

PROJECT SPECIFICS:

*************************************************************************************
CURRICULUM DEPARTMENT USE ONLY
ESTIMATED TIME TO COMPLETE:
PRIORITY:
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CRITERIA
PRIORITY RATING RATIONALE
Supports organizational priority
Dean/Program Director priority
New program (date needed (_____)
Program revision
External regulatory priority
Business/partnership priority
Dual credit priority
Continuing education profit priority
Faculty priority
Global priority
Brand priority
Remedial priority
Grant/gift priority
Research partnership priority
Community impact priority
Routine course addition
Idea validated through current
research

PEDAGOGY RATING RATIONALE

Impacts effective course design and
delivery
Increases clarity and quality of
intended outcome
Increases quality of assessment and
delivery platform
Increases quality of pedagogy and
student engagement in course
Supports creative/transformative
learning
Project has depth; has major impact
on organizational norms of
pedagogy and faculty beliefs
Project has spread; can sustain
change and influence policy
Project has research potential, able
to test a specific teaching or
learning theory

SYSTEM CHANGE RATING RATIONALE

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Requires significant implementation

support
Value for money
Whole system change potential
Accreditation
requirement/strengthening

ORGANIZATIONAL BENEFIT RATING RATIONALE

Supports student success
Potential to increase retention
Potential to decrease grad rates
Increases academic standards
Profit potential (attach proforma)
Expands service to students
Has positive net profit within two
offerings (attach proforma)
Required to replace an
organizational gap
Increase pathway to new or existing
program (transfer or new students)

TECHNOLOGY (If Applicable) RATING RATIONALE

Ease of adaptation
Quality of user experience
Comprehensiveness and integration
Maximizing learning potential
Maximizing delivery potential
Revenue to cost reduction potential

RATING SCALE

Likely to succeed and produce transformative outcomes

Can succeed; a few aspects lacking full potential

Requires substantial attention or is likely not to succeed