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Curriculum design and development

mark Manu

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Cu r r icu lu m de sign a n d de ve lopm e n t

Au t h or :
Ju dy M cKim m MBA, MA ( Ed) , BA ( Hons) , Cert Ed, I LTM
Head of Curriculum Developm ent , School of Medicine
I m perial College Cent re for Educat ional Developm ent

This paper was first writ t en in 2003 as part of a proj ect led by t he London
Deanery t o provide a web- based learning resource t o support t he educat ional
developm ent for clinical t eachers. I t was revised by Judy McKim m in 2007 wit h
t he int roduct ion of t he Deanery’s new web- based learning package for clinical
t eachers. Each of t he papers provides a sum m ary and background reading on a
core t opic in clinical educat ion.

Aim s

• Provides an overview of t he m ain concept s involved in course design and

This paper:

• Raises awareness of fact ors which cont ribut e t o effect ive learning
planning

• Enables you t o incorporat e educat ional t heory int o everyday pract ice

Le a r n in g ou t com e s
Aft er st udying t his paper, you w ill be able t o:
• Describe approaches t o curriculum developm ent and design
• Plan a course or session using an out com e based approach
• Writ e learning obj ect ives/ out com es which com m unicat e t he int ended
learning t o st udent s and ot hers
• Recognise fact ors w hich cont ribut e t o effect ive t eaching and learning in
your own pract ice
• Out line im plicat ions of curriculum change
• Select appropriat e st rat egies in changing a curriculum for your profession
• Make a m ore effect ive cont ribut ion t owards curriculum design

• I nt roduct ion
Con t e n t

• Curriculum developm ent – an int roduct ion

• Course design and planning – t he broad cont ext
• Curriculum developm ent – st rat egies and m odels
- st rat egies of curriculum developm ent
- obj ect ives m odel
- process m odel

• The elem ent s of t he curriculum :

- m odels of curriculum developm ent

- aim s and learning out com es

- cont ent
- t eaching and learning m et hods
- assessm ent

• I m plem ent ing t he curriculum

- learning resources

• Monit oring and evaluat ing t he curriculum

•
•
References
Furt her reading

I n t r odu ct ion
This paper is designed t o provide clinical t eachers wit h som e of t he background
t heory relat ing t o curriculum design and course developm ent , highlight ing som e
of t he m ain approaches and recent t rends in m edical and healt hcare educat ion.
This paper is designed t o be st udied alongside Teaching and Learning in t he
clinical cont ext .

As wit h m ost act ivit ies in educat ion, curriculum developm ent is not carried out in
isolat ion from ot her act ivit ies, but is part of an it erat ive planning, developm ent ,
im plem ent at ion and review cycle. I t should be not ed t hat t he t erm can be used t o
describe developm ent at different levels: large- scale curricular reform ( eg. t he
nat ional review of undergraduat e m edical educat ion which was carried out by all
UK m edical schools bet ween 1993 – 1996 or t he int roduct ion of t he Foundat ion
curriculum ) , m odificat ion of exist ing program m es or m aking sim ple changes t o
one’s own lessons. However, t he sam e principles apply in a range of cont ext s and
t o bot h large and sm all- scale act ivit ies. Som e form s of e du ca t ion a l
de ve lopm e n t include curriculum developm ent alt hough usually educat ional
developm ent refers t o any kind of developm ent act ivit y in an educat ional cont ext .

Cu r r icu lu m de ve lopm e n t – a n in t r odu ct ion

The word cu r r icu lum derives from t he Lat in currere m eaning ‘t o run’. This
im plies t hat one of t he funct ions of a curriculum is t o provide a t em plat e or design
which enables learning t o t ake place. Curricula usually define t he learning t hat is
expect ed t o t ake place during a cou r se or pr ogr a m m e of st u dy in t erm s of
knowledge, skills and at t it udes, t hey should specify t he m ain t eaching, learning
and assessm ent m et hods and provide an indicat ion of t he learning resources
required t o support t he effect ive delivery of t he course. A curriculum is m ore t han
a syllabus. A sylla bu s describes t he cont ent of a program m e and can be seen as
one part of a curriculum . Most curricula are not developed from scrat ch and all
operat e wit hin organisat ional and societ al const raint s.

The curriculum t hat is writ t en and published, for exam ple as course
docum ent at ion, is t he officia l or for m a l curriculum . The aim of educat ional
developm ent is t o ensure t hat t he official curriculum is delivered as t he funct ional
curriculum and t here is not a m ism at ch as developm ent t urns int o
im plem ent at ion. The official curriculum can also be dist inguished from t he
h idde n , u n officia l or cou n t e r cu r r icu lu m . Paul Willis’ work on t he sociology of
schooling for exam ple describes how t he inform al pupil group com prising working
class ‘lads’ has it s own sub- cult ure and count er curriculum which involves
‘m ucking about ’, ‘doing not hing’ and ‘having a laff’ ( Willis, 1977, pp62- 63) . The
hidden curriculum describes t hose aspect s of t he educat ional environm ent and
st udent learning ( such as values and expect at ions t hat st udent s acquire as a
result of going t hrough an educat ional process) which are not form ally or explicit ly
st at ed but which relat e t o t he cult ure and et hos of an organisat ion. This highlight s
t hat t he pr oce ss of learning is as im port ant as it s pr odu ct and as t eachers we
need t o be aware of bot h t he form al and inform al fact ors which im pact on
learning.
Fu r t h e r r e a din g
I f you are int erest ed in t he ant hropological or sociological aspect s which underpin
learning in m edical educat ion t hen you m ay find reading t wo very different
account s of m edical school t raining fascinat ing. The classic st udy of m edical
undergraduat es is Howard Becker et al’s Boys in Whit e ( 1961) and for a m ore
recent st udy Sim on Sinclair’s book Making doct ors: an inst it ut ional apprent iceship
( 1997) is an account of undergraduat e m edical educat ion at Universit y College
London ( UCL) . I t covers aspect s of ‘official’ and ‘unofficial’ life in m edical school,
focussing on t he acquisit ion and t ransm ission of knowledge, power and hierarchy,
gender and race issues and how t he st udent s deal wit h t he curriculum and t heir
various clinical experiences.

Le a r n in g a ct ivit y a nd r e fle ct ion

Thinking about your undergraduat e educat ion, can you list som e exam ples of t he
form al curriculum ?
And som e exam ples of t he hidden or unofficial curriculum ?
Are t here any inst ances where t hese m ay conflict and im pact on learning?

M y t hou gh t s

Som e exam ples of t he form al curriculum m ight include t he prospect us, course
guides, lect urers handout s et c.
And of t he unofficial curriculum m ight include Freshers’ w eek, rugby and ot her
sport s clubs and event s, t reat ing fem ale or Asian st udent s different ly, t he
different ‘t ribes and t errit ories’ found in different specialt ies eg. surgery or general
pract ice
Conflict s and im pact on learning m ight include exam ples where drinking t he night
before m eans t hat st udent s com e int o t eaching sessions lat e ( or not at all in t he
m orning) , som e t eachers regularly t im e t he first t eaching session at 0930 because
t hey know t hat if t hey st art t eaching earlier, t hen few st udent s will be t here.
Th e cu r r icu la r cycle

Peyt on and Peyt on ( 1998) not e t hat t he curricular cycle “ involves developm ent
t hrough needs assessm ent , design and im plem ent at ion phases. Aft er t his,
out com es are review ed and evaluat ed against t he original needs assessm ent .
Needs change wit h societ al expect at ions. The em phasis on different aspect s varies
wit h t he part icipant s’ and t eachers’ perceived needs. The dynam ic curriculum
requires change and resource m anagem ent ”

N e e ds a sse ssm e n t

Ou t com e The Curricular Cycle D e sign

I m ple m e n t a t ion

Fig 1 From Peyt on and Peyt on, 1998

I n developing a new program m e, or m odifying an exist ing one, t here are a

num ber of st ages w hich m ust be com plet ed w it hin t he curricular cycle as list ed
below.

St a ge s of cu r r icu lu m de ve lopm e n t

• Det erm ine and agree t he educat ional or professional cont ext in which t he
program m e is t o be developed and delivered
• Define t he needs of t he learners in line wit h t he requirem ent s of
professional bodies
• Det erm ine t he aim s and broad learning out com es of t he program m e
• I dent ify ideas and const raint s
• Agree t he broad st ruct ure and fram ework of t he program m e, t he m ain
areas of t eaching and learning, t he sequence of t he m ain t opics and t he
key assessm ent s
• Allocat e t he det ailed developm ent of each t opic or course area in t erm s of
defining obj ect ives and learning out com es t o individuals or t eam s
• Course t eam s t o develop coherent program m es which have defined
learning out com es, t im et ables, cont ent , appropriat e t eaching, learning and
 assessm ent m et hods and which ut ilise relevant and available learning
resources
• I m plem ent and refine t he program m e
• Develop an appropriat e and deliverable evaluat ion st rat egy
• Review and revise t he course in line w it h feedback – has it m et t he
ident ified needs of t he learners and ot her st akeholders?

These st eps are described in m ore det ail in t he subsequent sect ions.

Cou r se de sign a n d pla n n in g – t h e br oa d con t e x t

Th e e du ca t ion a l a n d pr ofe ssion a l con t e x t m ust be discussed and clearly

defined. This can reflect a num ber of fact ors: current or prevailing educat ional or
social ideology, cult ure, polit ics, econom y, st udent s, t eachers and parent s,
com m erce and indust ry, professional bodies, exam boards, funding bodies and
hist ory or influence of t he past . I n any discipline, t here m ay be current t rends in
general educat ion w hich need t o be addressed and specific t rends or issues in
m edical or healt hcare educat ion which relat e t o t he healt hcare syst em or cont ext .
Theories of a du lt le a r n in g, st u de n t ce n t r e d le a r n in g, a ct ive le a r n in g and
se lf- dir e ct e d le a r n in g m ay all influence t he overall program m e philosophy as
m ay ot her opport unit ies or st udent needs such as t he need for flexible learning
program m es ( eg. dist a n ce or ope n le a r n in g) . Program m es m ay be m odula r in
st ruct ure or cr e dit ba se d, depending on t he organisat ion wit hin which t he
curriculum is being designed.

The diagram below shows how m edical educat ion has m oved from a m ore t eacher
cent red, didact ic approach t o a m ore st udent cent red approach.

Tr e n ds in M e dica l Edu ca t ion Cu r r icu lu m Pla n n in g & D e sign :

FLEXN ER TO H ARD EN

Fle x n e r ( 1 9 1 1 ) H a r de n ( 1 9 8 4 ) : t h e SPI CES m ode l

Teacher- cent red St udent - cent red

Knowledge giving Problem - based
Discipline led I nt egrat ed
Hospit al orient ed Com m unit y orient ed
St andard program m e Elect ives ( + core)
Opport unist ic Syst em at ic
( apprent iceship)

The above approaches have been refined and cont ext ualised, reflect ing t rends
t owards a m ore m ult i- or int erprofessional approach as well as t he im pact of
com put er- based t echnology which allows for m ore flexible delivery in t erm s of
t im e and locat ion.
Tr e n ds in M e dica l Edu ca t ion : PRI SM S

• Pract ice based linked wit h professional developm ent

• Relevant t o st udent s and com m unit ies
• I nt erprofessional and int erdisciplinary
• Short er courses t aught in sm aller unit s
• M ult isit e locat ions
• Sym biot ic ( organic whole)
Bligh, Prideaux, Parsell ( 2001)

Higher Educat ion as a whole has been subj ect t o m any changes and
developm ent s im posed bot h by governm ent s and by changing public
expect at ions. I n m edical and healt hcare educat ion, t here have been addit ional
changes reflect ing change in t he NHS and in t he roles, responsibilit ies and public
percept ions of t he professions. Scandals such as Alder Hey, Brist ol and Shipm an
have not only underm ined public confidence in t he way t hat healt hcare
professions and organisat ions are m onit ored and m anaged, but have led also t o
an increased em phasis in account abilit y, qualit y cont rol and self- regulat ion. All
t hese fact ors have t o be t aken int o account in developing m edical and healt hcare
curricula.

Le a r n in g a ct ivit y a nd r e fle ct ion

Can you t hink of som e of t he key t rends in m edical and healt hcare educat ion
which should be t aken int o account when developing curricula?

Som e of t he key t rends m ight include:

• Managing large st udent num bers on m ult iple sit es

• I nt roduct ion of nat ional curricula/ com m on learning
out com es/ benchm arking
• Em phasis on cont inuing professional developm ent - st art s at undergraduat e
level and leads t o licensing and revalidat ion for pract ising doct ors and ot her
healt hcare workers
• A redefining of qualit y assurance t o m easure defined out com es/ st andards
and prot ocols and increase account abilit y
• I nclusion of t ransferable skills in all courses: com m unicat ion skills,
m anagem ent skills, audit , evidence- based m edicicine, dat a handling,
inform at ion ret rieval
• At t em pt s t o increase m ult i- professional and int er- professional learning
• I ncreased use of I T, WWW and video- conferencing as a learning t ool

I n m edical and healt hcare educat ion, alt hough t here are no ‘nat ional curricula’ as
such, a num ber of report s and recom m endat ions have been produced by st at ut ory
bodies which m ust be adhered t o by curriculum planners in order t o ensure t hat
t he program m e m eet s t he needs of vocat ional educat ion and t raining. The
organisat ion which will deliver t he course m ay also have requirem ent s concerning
form s of assessm ent and t hese m ay be explicit or im plicit . Nat ional professional
st andards or requirem ent s include guidelines ( eg. t he General Medical Council’s
recom m endat ions on undergraduat e m edicine “ Tom orrow’s Doct ors” , 1993,
2002) , st andards ( eg. t hose produced by t he Nat ional Boards for Nursing and t he
UKCC [ now t he Nursing and Midwifery Council] ) or a syllabus/ learning out com es
( eg. t hose produced for post graduat e m edical educat ion) which curriculum
planners should use as t em plat es or checklist s when designing t heir courses or
t eaching sessions.

The t eachers’ t oolkit it em St e ps in la r ge - sca le cu r r icu lu m de ve lopm e n t is

useful if you are int erest ed in large scale curriculum reform .

More recent ly in t he UK, be n ch m a r k in g st a n da r ds have been produced in all

subj ect disciplines, t hese specify curriculum aspect s which should form part of
higher educat ion program m es at undergraduat e level and against which
‘inspect ions’ or a ca de m ic r e vie w s and in st it u t ion a l a u dit s will be carried out .
The linked paper Evaluat ing Teaching and Learning set s t he UK educat ional
qualit y cont ext and describes nat ional init iat ives in m ore det ail.

As well as underst anding t he cont ext in which t he st udent s or t rainees are

learning, it is im port ant t hat t he t eacher is aware of t he e du ca t ion a l n e e ds of
t h e le a r n e r s. This m eans t hinking about t he needs of t he learners bot h as a
group and as individuals. When t eaching a group of learners t here are m any
issues t o consider in t erm s of how a t eacher’s st yle m ay influence t he group,
group dynam ics, how t o deal wit h quiet or disrupt ive st udent s and how t o ut ilise
learning resources t o best advant age.

I n m edical educat ion, as we have seen above, t here has been a shift from a
‘t eacher as expert ’ st yle of curriculum ( which m ay ut ilise m ore didact ic t eaching
m et hods such as lect ures) t owards m ore le a r n e r ce n t r e d approaches.

Le a r n in g a ct ivit y a nd r e fle ct ion

What do you t hink w e m ean by learner cent red?

What act ivit ies would be m ore appropriat e t o t his sort of learning?

M y t hou gh t s
By learner cent red w e m ean t aking t he needs of t he learners int o account rat her
t han t he needs of t he t eachers or adm inist rat ors. This m eans t hinking about
issues such as gender, background and previous experience or educat ion of t he
learners, learning st yles, barriers t o learning such as dyslexia or ot her disabilit y,
et c.
Act ivit ies should be varied, designed t o enable people t o cont ribut e, allow act ive
part icipat ion in learning sessions, ensuring equal access t o facilit ies, et c.

This shift reflect s work done by people such as Brookfield and Ram sden who
ident ify specific differences bet ween t he way in which adult s and children learn.

The m ain charact erist ics of a du lt le a r n in g are:

• t he learning is purposeful
 • part icipat ion is volunt ary
• part icipat ion should be act ive not passive
• clear goals and obj ect ives should be set
• feedback is required
• opport unit ies for reflect ion should be provided

Acknowledgem ent of t he needs of adult learners should be built in t o t he process

of curriculum developm ent and delivery at all st ages, and has part icular relevance
t o t he select ion of t eaching, learning and assessm ent m et hods.

When planning or delivering a session or course t o t each a group, t he t eacher

m ight ask:

What level of underst anding and experience have t hey got ?

What should I be expect ing from t he group in t erm s of knowledge, skills
and at t it udes?
What t opics and course areas have t hey been st udying before t his
part icular course/ session?
What are t hey going on t o do and what specifically should I be preparing
t hem for?
Does m y t eaching ( in t erm s of level, pace and cont ent ) appear t o be
m eet ing t heir needs?
Have I built in opport unit ies for flexibilit y t o address unforeseen learning
needs?

I t is also im port ant t o t hink about individual st udent / t rainees’ learning needs. So,
in addit ion t o t he above quest ions, when t eaching individual st udent s t he t eacher
m ight ask:

Does t he st udent / t rainee have any part icular learning needs or difficult ies?
Has t he learner experienced difficult ies wit h any course areas or t opics
previously which m ight affect his/ her progress?
Does m y t eaching seem appropriat e for t his learner’s needs and st yle of
learning?

Research has dem onst rat ed t hat , alt hough individuals learn in different ways and
bring different experiences and backgrounds t o learning, t here are cert ain t ypes
of act ivit ies which can enable learning t o occur.
What do you t hink t hese are?

Teaching and learning in t he clinical cont ext describes som e of t he t heoret ical
background and act ivit ies affect ing learning.

But , t o sum m arise som e key aspect s of learning:

• Learning can be seen t o occur in four dom ains ( eg. Bloom et al, 1956
and ot hers) : cognit ive ( knowledge and int ellect ual skills) , affect ive
( feelings and at t it udes) , int erpersonal ( behaviour and relat ionships wit h
ot hers) and psychom ot or ( physical skills)
• I ndividuals can be seen t o have differ ent learning st yles and so courses
 should be designed wit h a variet y of learning ( and t eaching) m et hods
• Learners need t o be t reat ed as people and t here should be opport unit ies
for t hem t o m ake cont ribut ions which are valued by t eachers
• Effect ive learning is act ive – people learn best when t hey are engaged in
an act ive process
• Learning has t o be relevant t o learners’ own experience and needs and
t o be set wit hin a clear cont ext or fram ework. Relevance applies at a
variet y of levels: t o t he overall st ruct ure of t he course or subj ect ( eg.
m edicine or physiot herapy) or t o t he use of part icular t erm inology
• Learning out com es or obj ect ives help learners t o learn because t hey
define what t he learner has t o do, t he out com es should be explicit and
clearly linked t o delivery and assessm ent
• Effect ive learning needs t o be done in a safe environm ent . Learning is
not alw ays easy and learners m ust feel com fort able and able t o m ake
m ist akes. Feedback should be const ruct ive and t im ely.

Cu r r icu lu m D e ve lopm e n t - St r a t e gie s a n d m ode ls

I n t he last sect ion, we looked at how, when planning a course, t eachers and
course developers need t o t hink about t heir learners’ needs in t erm s of t he broad
cont ext of undergraduat e and post graduat e educat ion, vocat ional t raining, t he
needs of professional bodies and t he requirem ent s from t heir own organisat ion.

Th e sor t of qu e st ion s t h a t cu r r icu lu m pla n n e r s m igh t a sk a t t h e

st a r t of t h e pr oce ss sh ou ld inclu de :

• What sort of healt hcare worker do we want ?

• How will w e reflect healt h service changes and dem ands from
ext ernal agencies?
• How will w e ensure links t o post graduat e requirem ent s and
t raining ( specialist vs generalist ) ?
• What should t he curriculum be like in t erm s of cont ent , st ruct ure
& funct ion?
• How should we est ablish links t o assessm ent and evaluat ion?
• How will w e ident ify and overcom e barriers t o change?

St r a t e gie s of cu r r icu lu m de ve lopm e n t

Any curriculum needs t o be developed in t he light of t he organisat ion or cont ext in
which it is going t o be delivered. I f a t eacher is developing a sm all part of a
course or program m e, t hen t his m ust fit ( in t erm s of approach, level and cont ent )
wit h t he overall course. I f a new course is being designed and developed t hen
t here are a num ber of approaches t hat can be t aken and issues t hat need t o be
addressed t o m eet t he needs of all st akeholders involved. McKim m ’s descript ion of
undergraduat e m edical curriculum developm ent from a proj ect m anagem ent
approach can be found in Robert s and Ludvigsen, 1998, pp.101- 118.

A st rat egic issue w hich needs t o be considered is whet her t he course design,
delivery and m anagem ent is ce n t r a lise d or de ce n t r a lise d. This is oft en out of
t he hands of individuals involved in course developm ent but has im pact on all
aspect s of curriculum developm ent . Cent ralisat ion can be seen at bot h nat ional
and organisat ional levels. Cent ralised curricula t end t o be m ore st ruct ured and
orderly and it is easier t o ensure uniform it y and a st andard approach t o t eaching
and learning. A cent ralised curriculum m ay allow bet t er access t o a wide pool of
expert ise but be less sensit ive t o local needs. Decent ralised curricula t end t o be
m ore appropriat e t o st udent s’ local needs and oft en ensure bet t er ownership of
t he course by t eachers. Decent ralisat ion can allow for a variet y of approaches t o
design and delivery and enable com parisons of t he st rengt hs and weaknesses of
each.

I t can be useful t o view curriculum developm ent and design in t he light of t wo

m ain schools of t hought , t he obj e ct ive s m odel and t he pr oce ss m odel. Alt hough
t he t wo m odels are not m ut ually exclusive, t hey do represent t wo different
philosophical approaches.

Obj e ct ive s m ode l

The obj ect ives m odel t akes as it s m aj or prem ise t he idea t hat all learning should
be defined in t erm s of what st udent s should be able t o do aft er st udying t he
program m e, in t erm s of learning out com es or learning obj ect ives.

See t he sect ion below on t he elem ent s of t he curriculum for furt her det ails of
learning out com es and obj ect ives in pract ice.

Curriculum design according t o t his m odel follow s four st eps:

• Reach agreem ent on broad aim s and specific obj ect ives for t he course
• Const ruct t he course t o achieve t hese obj ect ives
• Define t he curriculum in pract ice by t est ing capacit y t o achieve obj ect ives
• Com m unicat e t he curriculum t o t eachers

Care m ust be t aken not t o focus on t he obj ect ives t o a t rivial level or narrow
specificat ion as t his lim it s t he t eacher and valuable learning experiences m ay be
lost . Using an obj ect ives m odel enables t he const ruct ion of assessm ent s which
can be designed against t he learning obj ect ives. The obj ect ives m odel is in st ep
wit h current developm ent s in t he UK at nat ional level which includes t he use of
su bj e ct be n ch m a r k in g and pr ogr a m m e spe cifica t ion s.

The obj ect ives m odel is a syst em at ic approach t o course planning. I t form s part of
Out com es Based Educat ion ( OBE) which st at es t hat “ educat ors should t hink about
t he desirable out com es of t heir program m es and st at e t hem in clear and precise
t erm s. They should t hen work backwards or ‘design down’ in t he j argon of OBE, t o
det erm ine t he appropriat e learning experiences which will lead t o t he st at ed
out com es. By using an out com e approach, educat ors are forced t o give prim acy t o
what learners w ill do and t o organise t heir curricula accordingly” ( Prideaux, 2000) .
Th e obj e ct ive s ( ou t com e s) m ode l
Curriculum ideas

Evaluat ion Obj ect ives/ out com es

Cont ent , m et hods, resources

Pr oce ss m ode l
The process m odel assum es t hat cont ent and learning act ivit ies have an int rinsic
value and t hey are not j ust a m eans of achieving learning obj ect ives and t hat
t ranslat ing behavioural obj ect ives is t rivialising. St enhouse ( 1975) argued t hat
t here w ere four fundam ent al processes of educat ion:
• Training ( skills acquisit ion)
• I nst ruct ion ( inform at ion acquisit ion)
• I nit iat ion ( socialisat ion and fam iliarisat ion wit h social norm s and values)
• I nduct ion ( t hinking and problem solving)

He claim ed t hat behavioural obj ect ives were only im port ant in t he first t w o
processes and t hat in init iat ion and induct ion it would not be possible t o use
obj ect ives. From t his it was suggest ed t hat behavioural obj ect ives were
inappropriat e for PBL, professional developm ent or clinical problem solving.

Approaches t o course design under t he process m odel include t he “ int ellect ual
approach, which exam ines t he subj ect m at t er in t erm s of assum pt ions held in t he
discipline wit h regard t o a part icular body of inform at ion, knowledge and skills. I t
asks ‘should t he course be t aught at t he m icro- or t he m acro- level of concept ual
analysis?’” ( Fry, Ket t eridge and Marshall, 1999) . Creat ive or experient ial
approaches involve learning “ t hrough experience and generally t hrough t he
dynam ics of a group process. Out com es are defined in t he exist ent ial m om ent of
learning” ( Fry, Ket t eridge and Marshall, 1999) .

PBL approaches can fit under t he out com es or process approach alt hough ‘pure’
PBL allows t he learner t o define t heir ow n learning goals and places em phasis on
t he process of underst anding t he problem . This is norm ally seen as obj ect ive
based t hrough inference rat her t han obj ect ive defined. PBL courses can event ually
becom e syst em at ic. The process m odel depends a lot on t he qualit y of t he t eacher
and it can be m ore difficult t o set st andardised, valid and reliable assessm ent s
because perform ance is not being m easured against st at ed obj ect ives but against
ideas and course cont ent .
Th e pr oce ss m ode l
Curriculum ideas

Evaluat ion Cont ent , m et hod

Out com es

“ The debat e about obj ect ives raged in t he 1970s and 1980s and alt ernat ive
approaches t o curriculum design t hat did not depend on st at em ent s of specific
obj ect ives such as Reynolds and Skilbeck’s ‘sit uat ional m odel’ becam e popular. By
t he end of t he 1980s a reasonable com prom ise was reached. Obj ect ives should be
specific and clear but not necessarily behaviourally st at ed” ( Prideaux, 2000) . I n
t he 1990s, out com es based educat ion ( OBE) has been devised and Harden and
ot hers at Dundee have developed t his approach in m edical educat ion.

The best approach t o curriculum design is t o com bine t he best of bot h approaches
according t o st udent need, t eacher experience and organisat ional st ruct ure and
resources. For exam ple, it is useful t o design t he overall shape of t he course, t he
m ain aim s and learning obj ect ives, broad cont ent areas and t im e allocat ion
cent rally but t hen devolve out t he det ailed planning and design t o t hose t eachers
who will be delivering t he course so t hat t hey have ownership of t heir
program m e. The way in which t he GMC or t he Nursing Boards define broad
curricular t hem es and out com es for m edical or nursing schools are exam ples of a
devolved approach. I t is im port ant t o ret ain som e cent ral cont rol of t he course
however so t hat t he result s of evaluat ion and feedback can be addressed and t hat
changes in one part of t he course can be m ade sensibly in t he light of t he im pact
of change on ot her course elem ent s. At nat ional level, agencies wit h st at ut ory
responsibilit y for m edical and healt h professionals’ educat ion and t raining ar e
responsible for ensuring t hat courses delivered by separat e organisat ions are
designed and delivered in line wit h t heir recom m endat ions, obj ect ives or
st andards. At organisat ional level, t here should be inbuilt qualit y m onit oring
m echanism s which aim t o ensure t hat t eaching and learning, wherever it occurs,
is of a high qualit y.

Prideaux ( 2000) st at es t hat he “ finds it difficult t o explain t he difference bet ween

a significant and w ort hwhile obj ect ive and a w ell- writ t en and well- defined
out com e and again I ask m yself whet her such fine dist inct ions really m at t er. I t is
not t he st at em ent s of obj ect ives or out com es t hat in t hem selves t hat ar e
im port ant but t he quest ions t hat m ust be posed and answered in arriving at t heir
definit ion.
Quest ions such as t hose list ed below are im port ant :
• What are t he significant and enduring out com es of m edical educat ion?
• How can we ensure t hat such out com es are included in t he curricula of
m edical schools?
• How can we ensure t hat t he com plex and difficult t o define out com es are
included along wit h t hose t hat are m ore easily discerned?
• How can we ensure t hat learning experiences t hat lead t o t he st at ed
out com es are select ed and used?
I t is t o t hese quest ions t hat m edical educat ors should const ant ly and consist ent ly
t urn” .

Le a r n in g a ct ivit ie s a n d r e fle ct ion

Think about a course in which you are involved as a t eacher.

How has t his course been developed – according t o t he obj ect ives or t he process
m odel?
What do you t hink are t hen m ain advant ages and disadvant ages of each?

M ode ls of cu r r icu lu m de ve lopm e n t

I n m edical and healt hcare educat ion and t raining, t he learners are required t o
acquire a com plex m ix of knowledge, skills and at t it udes; t hey are expect ed t o be
able t o synt hesise and apply t heir learning t o new and oft en dem anding
sit uat ions, t hey are also expect ed t o be life lon g le a r n e r s, acquiring and ut ilising
skills and at t it udes such as st udy skills and self- m ot ivat ion t hroughout t heir
working lives. I n addit ion, learners are working in a const ant ly changing
environm ent and because t hey work wit h people ( including pat ient s, colleagues
and carers) t hey are const ant ly having t o adapt t heir knowledge t o m eet
expect at ions from a range of people.

When we t hink about designing a course, as well as t hinking about t he needs of

t he learners and t heories of learning, we also need t o t hink about how t he overall
design of t he program m e ( t im et abling and sequencing, t eaching and learning
m et hods) will enable st udent s or t rainees t o acquire t he defined know ledge, skills
and at t it udes. Whichever design we choose, t here always has t o be a sequence of
learning, st udent s need t o acquire cert ain inform at ion or skills before t hey can
m ove ont o underst and or apply ot hers. During a learning process, t here is alway s
a shift from t he m ore sim ple ‘building blocks’ t o underst anding com plex principles,
a shift from ‘novice’ t o ‘expert ’. This is oft en defined as a spir a l cu r r icu lu m , one
in which learning is seen as a developing process wit h act ive reinforcem ent and
assessm ent at key st ages coupled w it h t he acquisit ion of new know ledge and
skills. As curriculum planners, we need t o facilit at e t his process for our st udent s
and ensure t hat st udent s are ready t o m ove ont o t he next st age of learning.
Assessm ent of som e sort is usually used t o det erm ine readiness t o m ove from one
st age t o anot her.
The m aj orit y of m edical educat ion program m es in use t oday ( whichever m odel
t hey adopt ) would st ress t hat t hey em body and ut ilise a st u de n t ce n t r e d
approach. This approach em phasises adult learning m et hods and approaches and
uses a ct ive le a r n in g ( in w hich st udent s part icipat e act ively in t he learning
process) rat her t han a m ore didact ic, t eacher- led approach which t radit ionally saw
st udent s as passive recipient s of know ledge, as ‘em pt y vessels’. A program m e
em bodying st udent cent red approaches would t ypically be designed t o enable
st udent s t o define som e of t heir own learning obj ect ives, select learning resources
and decide t he sequence and pace of learning, t he program m e would also help
t hem t o develop lifelong learning skills. This approach is m ore resource int ensive
as it relies on sm aller groups and m uch m ore advance planning is needed by
t eachers. St udent s m ay also need preparat ion in t he shift from m ore didact ic
t eaching.

I n undergraduat e m edical educat ion, t here are a few prevailing curricular m odels
which em body different approaches t o t eaching and learning.

Un de r gr a du a t e M e dica l Cu r r icu lu m M ode ls

• Tr a dit ion a l pr e clinica l/ clin ica l m ode ls

• I n t e gr a t e d ( h ybr id) m ode ls
• Pr oble m ba se d le a r n in g
• Gr a du a t e e n t r y, 4 ye a r pr ogr a m m e s

The t radit ional pr e - clin ica l/ clin ica l m odel separat es ( bot h concept ually and
t em porally) pre- clinical know ledge and skills from clinical knowledge and skills.
This m odel was t he prevailing m odel of m edical educat ion worldwide unt il t he last
t went y years and is st ill com m on across t he world, part icularly in form er Soviet
count ries, Sout hern Europe and Sout h Am erica. Alt hough t he t radit ional approach
has oft en been crit icised for separat ing t he underpinning ‘science’ from clinical
m edicine and which m any people feel is best learned in a clinical cont ext , it is
oft en easier t o develop and deliver a t radit ional course wit hin t he st ruct ure and
organisat ion of m edical schools. Many schools are divided int o clinical and non-
clinical depart m ent s and on a pract ical level, int egrat ion can oft en be a difficult t o
achieve. Barriers such as physical separat ion, funding m echanism s and int er-
depart m ent al rivalries are oft en difficult t o overcom e.

I n som e count ries ( such as Aust ralia, Nort h Am erica and Canada) m any m edical
courses are designed as gr a du a t e e n t r y program m es, usually of about four
years durat ion and w hich focus on clinical m edicine. I n a way, t hese program m es
separat e pre- clinical from clinical m edicine, alt hough graduat e ent ry program m es
are in t hem selves int egrat ed program m es. St udent s ent ering such courses would
be expect ed t o have obt ained a good first degree in a relevant subj ect and passed
an ent ry t est . A num ber of graduat e ent ry program m es are now in place in t he
UK and research t hat considers how t he graduat es from t hese courses com pare
wit h t hose who have com e t hrough a five- year program m e is ongoing.

I n m any count ries, t he t radit ional approach has largely been m odified t owards a
m ore int egrat ed approach t o curriculum planning and design. An in t e gr a t e d
a ppr oa ch is st ill subj ect cent red but t ranscends t he t radit ional subj ect
boundaries. Teaching unit s from subj ect disciplines are fused t oget her around a
m eaningful organising t hem es/ concept such as body syst em s or com m unit y
m edicine. I n m edical educat ion t he t erm ve r t ica l in t e gr a t ion describes t he
blurring of boundaries bet ween pre- clinical and clinical courses whereas
h or izon t a l in t e gr a t ion describes how knowledge and skills from m any
disciplines are clust ered around t hem es such as body syst em s ( eg. a
cardiovascular syst em s course m ight include t he anat om y, physiology,
biochem ist ry, pat hology, clinical m edicine, sociology, epidem iology, et c. relat ing
t o t he cardiovascular syst em ) .

The int e gr a t e d a ppr oa ch:

Posit ive a spe ct s:

• Dem onst rat es int errelat ionship bet ween disciplines and encourages
holist ic view of pat ient s’ problem s
• Harden ( 1984) suggest s t hat int egrat ed courses enable st udent s t o
learn m eaningful set s of inform at ion which are m ore easily ret ained
and applied t o ot her sit uat ions. They can encourage t he
developm ent of higher- level obj ect ives eg. applicat ion of
knowledge, analyt ical skills and problem solving
• Team t eaching and collaborat ion bet ween subj ect st aff is prom ot ed.
• I nt egrat ed courses m ay also enable sharing of resources bet ween
depart m ent s and t eachers

Lim it a t ion s:
• Som e subj ect s/ t opics m ay be om it t ed or over t aught and close
supervision and cent ral m anagem ent of t he curriculum is needed t o
avoid t his
• Organisat ional boundaries such as depart m ent s and funding
m echanism s m ay creat e barriers t o int egrat ion

One of t he m ost influent ial approaches t o m edical educat ion has been pr oble m
ba se d le a r n in g ( PBL) as developed by Barrows, Harden and ot hers. PBL aim s t o
st im ulat e st udent s t o observe, t hink, define, st udy, analyse, synt hesise and
evaluat e a problem . The ‘problem s’ or cases are writ t en t o sim ulat e real life
clinical problem s w hich are m ult idim ensional and which encourage st udent s t o
t hink as t hey would in real life clinical sit uat ions. Medical schools t hat have used a
PBL approach include McMast er ( Canada) and Newcast le ( Aust ralia) and som e UK
schools have also int roduced a PBL course.

Have a look at t he PBL sect ion in t he Learning resources paper for m ore
inform at ion about PBL and how t o put it int o pract ice.

Adva n t a ge s of a PBL cu r r icu lu m :

• Helps a st udent t o develop skills in solving healt h relat ed problem s
• Prom ot es self direct ed learning and spirit of enquiry
• Provokes a sense of crit ical t hinking and reasoning
• Ret ent ion and applicat ion of knowledge is reinforced in a sim ilar
way t o t hat in t he clinical cont ext
• Develops int egrat ed body of knowledge based on real and com m on
 problem s

Cr it iqu e s of a PBL a ppr oa ch :

• PBL approach is very dem anding of bot h t eachers and learners
especially if t hey have no prior knowledge or experience of t he
m et hod
• I t requires increased sense of responsibilit y from st udent s and
flexibilit y from t eachers
• Teachers are not always happy in t he role of facilit at or and m ay feel
‘exposed’ because of lack of specialist knowledge
• St udent s m ay feel t hat t heir t eachers are not ‘expert s’ when t hey
act in facilit at or role
• Ext ensive learning resources are needed
• Requires good t eam work and underst anding bet ween st aff and
st udent s
• Tradit ional, st andardised assessm ent m et hods are difficult t o apply
as m ay not be a uniform body of know ledge as st udent s define own
learning goals

Many m edical courses ( at undergraduat e and post graduat e levels) ut ilise a

m odified ( as opposed t o a ‘pure’) PBL approach t o learning. This can be seen
m ore like case- based learning ut ilising clinical scenarios or a m eans of enabling
st udent s t o develop problem solving skills. Learning using t his m et hod is very
com m on in m any higher educat ion program m es such as engineering or
m anagem ent which encourage st udent s t o develop proj ect m anagem ent , t eam
working and problem solving skills. Alt hough t hese skills are oft en acquired
t hrough a PBL course, ‘pure’ PBL has a different focus from t his and is designed t o
enable st udent s t o t ake cont rol of t heir own learning, define t heir own learning
goals and work individually and in t eam s t o achieve t he agreed learning
out com es.

Clinical m edicine at all levels t ends t o t ake a com pe t e n cy- ba se d approach t o t he

‘t raining’ elem ent of t he curriculum . The idea of com pet ences can be found in
m any areas of vocat ional t raining, m ost com m only used in NVQs ( Nat ional
Vocat ional Qualificat ions) where t rainees are assessed against st at ed
com pet ences and are deem ed eit her ‘com pet ent ’ or ‘not yet com pet ent ’.

I n m edicine, t he idea of being ‘com pet ent ’ or ‘not yet com pet ent ’ has been
developed by t he use of clinical log books which are signed off by supervisors
once t he st udent has dem onst rat ed com pet ence. I n post graduat e t raining, t he
skills and procedures expect ed at each level are clearly defined. Korst ( 1973)
suggest s t hat it is vit al t o ident ify t hose skills w it h which all st udent s/ t rainees
should show a high degree of com pet ence and ot hers wit h which only fam iliarit y
m ight be expect ed ( Newble and Cannon, 1990 p 80) . For curriculum planners,
decisions should be m ade on how ‘com pet ence’ will be defined and det erm ined,
whet her a m ore black and whit e approach ( com pet ent vs not yet com pet ent ) is
t aken or whet her t here will be expect ed degrees of com pet ence. For exam ple,
t here would be widespread agreem ent t hat all m edical graduat es should be able
t o t ake blood or int erpret an X- ray but t here m ight be different expect at ions as t o
exact ly w hat m ight be expect ed bot h from st udent s at different st ages of t he
course and as t o t he cont ext s and definit ions of such com pet ences.
Assessm ent s such as OSCEs ( Obj ect ive st ruct ured clinical exam inat ions) are
widely used t o m easure com pet ence in clinical skills. See t he Assessm ent paper
for a det ailed explanat ion of com pet ency t est ing.

Pr in ciple s of com pe t e n cy ba se d a ppr oa ch :

• Syst em at ic, based on learning out com es/ com pet encies deem ed
essent ial for healt h workers once working
• Provides t rainees wit h high qualit y learning act ivit ies designed t o
help t hem m ast er each t ask, periodic feedback designed t o allow
t rainees t o correct perform ance as t hey go along
• Requires t rainees t o perform t asks t o high level of com pet ency in
work like set t ing
• I ndividual st udent differences in t he m ast ery of a t ask are as m uch
t o do wit h t he learning environm ent as t he learners t hem selves

I n planning a com pet ency based program m e or session ( eg. clinical skills t eaching
session) , five st eps need t o be t aken:

St ep 1 carry out a needs analysis of cont ext and of act ivit ies which will be
required

St ep 2 carry out a t ask analysis - put m aj or act ivit ies int o sub t asks or
com ponent s, result ing in a list of specific know ledge, skills and at t it udes t hat
dist inguish t hose who perform a t ask com pet ent ly from t hose who do not . This
becom es t he inst ruct ional cont ent t he t rainee will learn.

St ep 3 deriving t he obj ect ives from t he com pet encies required, set crit erion for
perform ance, obj ect ives m ust be realist ic, m easurable, achievable and specific.

St ep 4 defining t eaching and learning st rat egies

St ep 5 det erm ining assessm ent st rat egies

I n pract ice we oft en find t hat a m ix of approaches and m et hods are m ost
appropriat e and hardly any m odern healt hcare curricula are purely subj ect based,
int egrat ed, PBL or com pet ency based but are synt hesised. Choices m ust be m ade
about t he approach in t he light of t he specific needs and cont ext and t hen once
t he course is designed, it should be adhered t o as m uch as possible.

Le a r n in g a ct ivit y a nd r e fle ct ion

Com pare your own undergraduat e t raining wit h a current program m e.

How would t hese be defined according t o t he different m odels described above?
What do you t hink are t he advant ages and disadvant ages of each?
Can you t hink of how ideas from t hese m odels could be used t o im prove a course
in which you are involved?
Th e e le m e n t s of t h e cu r r icu lu m

The form al curriculum ( course or program m e) can be seen as com prising a

num ber of elem ent s which fall wit hin t he curricular cycle. As curriculum planners,
we need t o ensure t hat t hese elem ent s are addressed wit hin our overall st rat egy
and specific professional or organisat ional cont ext . Once t hese elem ent s are in
place and t he program m e is being im plem ent ed ( eit her t hrough pilot ing or fully)
t hen syst em at ic evaluat ion of t he program m e can t ake place.

A Curriculum developm ent proform a is available t o download from t he Teachers

t oolbox. This proform a provides a m eans for course developers t o gat her and
collat e inform at ion needed for course planning int o one docum ent which can form
t he basis of course handbooks or validat ion docum ent at ion.

Ke y a spe ct s of t h e cu r r icu lu m
• Aim s
• Learning out com es/ obj ect ives ( knowledge, skills and at t it udes)
• Cont ent
• Teaching and learning m et hods
• Assessm ent m et hods
Support ing elem ent s:
• Learning resources ( t eachers, support st aff, funding,
books/ j ournals, I T support , t eaching room s)
• Monit oring and evaluat ion procedures
• Clinical placem ent act ivit ies
• Recruit m ent and select ion procedures, including prom ot ional
m at erials
• St udent support and guidance m echanism s

The m ain aspect s list ed above are described in m ore det ail in t he next sect ions.
There are a num ber of issues w hich need t o be t aken int o account in t he
developm ent and delivery of courses which are covered in ot her papers. For
exam ple Ensuring equalit y of opport unit y in t eaching and learning considers equal
opport unit ies but for a brief int roduct ion in relat ion t o curriculum developm ent see
Annex 1: I m plem ent ing equal opport unit ies
The a im s a n d le a r n in g ou t com e s/ obj e ct ive s need t o be developed in order t o
ensure t hat t he goal of producing com pet ent graduat es is achieved. Aim s
describe w hat t he t eacher is t rying t o achieve ( eg. t o encourage st udent s t o
develop self direct ed learning skills) whereas goa ls usually describe what t he
course or organisat ion is t rying t o achieve ( eg. t o inculcat e professional values
and at t it udes) . These t erm s are oft en used int erchangeably.

Le a r n in g ou t com e s guide t eachers/ t rainers on what is expect ed of t he learners

on com plet ion of t he educat ion/ t raining program m e. Learning out com es also
guide st udent s on what t hey are expect ed t o be able t o do in t erm s of knowledge,
skills and at t it udes aft er com plet ing t he program m e or part s of it . Correct
int erpret at ion of out com es will guide bot h learners and t eachers on t he choice of
relevant learning and t eaching m et hods t o achieve t he int ended learning. Those
responsible for set t ing exam inat ions and ot her assessm ent s w ill also need t o
int erpret t he out com es appropriat ely so t hat learners’ perform ance is t est ed
appropriat ely by relevant assessm ent t echniques.

Ham ilt on, writ ing about m edical educat ion, not es t hat “ clarit y of int ended
educat ional out com e is …. essent ial, usually expressed t hrough educat ional
obj ect ives and m ust underlie curriculum , st udent assessm ent , program m e
evaluat ion and st udent select ion….. defined educat ional out com es m ust be t he
reference point for t he evaluat ion of graduat es and …m ust ult im at ely relat e t o t he
m at ure professional role of t he graduat e” ( 1999) . I n course planning t hen, we
m ust t hink beyond our own session or course t o where t he st udent s are going
next and for what cont ext we are preparing t hem . Ham ilt on goes on t o say t hat
“ t he t ask for t he fut ure is t o ensure t hat we address out com es t hat widen t he
scope of role and responsibilit y of graduat es, are long in t heir t im e line and deep
in t heir relevance t o professional developm ent ” ( 1999) .

Course planners, at what ever level, need t o t hink about t he relat ionship bet ween
learning out com es or obj ect ives, t eaching and learning act ivit ies, assessm ent and
evaluat ion. Const ruct ing a sim ple t able on which t he obj ect ives can be m apped
against t he ot her act ivit ies can be a useful st art ing point , even when planning a
single t eaching session. An exam ple is shown below of obj ect ives which m ight be
found in a first year undergraduat e m edical or nursing course and a blank Course
m apping m at rix which can be used t o assist wit h course planning can be found in
t he Teachers Toolbox.

Obj ect ives should:

• “ be writ t en in t he fut ure t ense
• ident ify im port ant learning requirem ent s
• be achievable and assessable
• use language which st udent s can underst and
• relat e t o explicit st at em ent s of achievem ent ” ( d’Andrea, V. in Fry,
Ket t eridge and Marshall, 1999)

Le a r n in g Te a ch in g a n d le a r n in g a ct ivit ie s Asse ssm e n t

obj e ct ive s/ ou t com e s
On com plet ion of t he
session t he st udent will
be able t o:
1 describe t he St udent s t o find relevant art icles on Short answer
m echanism s cont rolling
blood pressure
2 t ake an accurat e
blood pressure reading
using a range of
equipm ent
t he I nt ernet relat ing t o cont rol of quest ions as part
blood pressure as preparat ory work of exam inat ion
Mini lect ure on m echanism s
cont rolling blood pressure
Q&A discussion t o ensure
underst anding
Pract ical dem onst rat ion by t eacher OSCE st at ion
followed by st udent s pract ising in
pairs in t he clinical skills lab w it h
feedback from t eacher

We st art t o writ e learning obj ect ives wit h a sim ple st em which describes what t he
st udent will be able t o do as a result of our t eaching int ervent ion, such as:

On com plet ion of t he session/ course/ program m e, t he st udent / t rainee w ill be able
t o:

Then we writ e what t hey will be able t o do, t his is t he learning obj ect ive it self and
should always cont ain an operat ive word such as perform or describe. These
words vary depending on whet her t he obj ect ives are knowledge, skills or
at t it udinal obj ect ives. For exam ple, we m ight use t he t erm s define, list , nam e,
recall or record for t he ‘knowledge level’ of t he cognit ive dom ain, t his is a lower
level t han say t he ‘analysis’ level for which we m ight use words such as analyse,
t est or dist inguish. Bloom ’s t a x on om y is oft en used t o classify t hese t hree
dom a in s.

To read m ore about different t heories of learning, download/ review Learning

t heories from t he Teachers t oolbox now.

By producing obj ect ives which ensure coverage of each of t he levels in t he

dom ains as well as t hose which cover deep, surface and st rat egic approaches t o
learning, t his helps t eachers and course planners. Teaching and learning
st rat egies can also be planned which encourage and facilit at e learning in t he
different dom ains and which encourage appropriat e learning st rat egies. Learners
should be m ade aware of t he obj ect ives at t he st art of t he course or session, t ry
not t o cover t oo m any out com es in one session and t ry t o be clear as t o what you
are aim ing t o achieve.

One of t he st rengt hs of course planning using an obj ect ives approach is t hat t he
obj ect ives can be used as t he m easure for assessing st udent perform ance.
Teachers can t urn well- writ t en obj ect ives around int o assessm ent quest ions or as
a st art ing point for designing an exam inat ion. Being aware of t he different
dom ains and of different approaches t o learning and of learning st yles and
preferences m eans t hat t eachers and course planners can t ake a m ore syst em at ic
approach t o course planning.

Le a r n in g a ct ivit ie s a n d r e fle ct ion

Find som e exam ples of learning out com es or obj ect ives from a course w it h which
you are fam iliar.

Do you t hink t hese are good exam ples or could t hey be im proved?

For your next t eaching session, st art by writ ing som e learning out com es. Try t o
det erm ine how t hese will relat e t o t eaching and learning m et hods and t o
assessm ent using t he m at rix.

The con t e n t of part s of t he curriculum has t o be st udied in relat ion t o ot her part s
so t hat t he curriculum form s a coherent learning program m e. I t should com prise
and reflect a select ion of knowledge, skills, values and at t it udes relevant and
valued by t he profession, subj ect disciplines and by t he wider societ y. The cont ent
is usually derived from obj ect ives which form t he basis for program m e
developm ent and can be sim ply defined as t he knowledge, skills, at t it udes and
values t o be learned. I n som e count ries such as t he form er Soviet bloc, a nat ional
curriculum is defined which st ipulat es all areas of course cont ent in t erm s of hour s
t o be t aught , t his t ype of curriculum im poses severe const raint s on course
planners and it is difficult t o int roduce innovat ions.

We should check:
• That t he cont ent reflect s t he j ob t hat t he learners will be asked t o do aft er
t raining
• That t he cont ent relat es direct ly t o t he learning out com es
• That t he t ot al t im e given t o each elem ent of t he course is appropriat e and
t hat t he balance bet w een t heory and pract ice is appropriat e
• That t he cont ent is pit ched at an appropriat e level for t he learners

I deas about course cont ent can be gat hered from m any sources: previous courses
or exist ing curricula at one’s own organisat ion; nat ional professional or discipline
associat ions ( m any of t he m edical specialt ies produced core curricula in t heir own
t opics relat ing t o undergraduat e m edicine eg. ort hopaedics, disabilit y and
rehabilit at ion m edicine, renal m edicine and m edical et hics) ; t ext books; ot her
organisat ions’ courses, which can oft en be found on t he web and int ernat ional
bodies which have produced core curricula for t heir own subj ect eg. cancer
m edicine.

Once t he obj ect ives/ out com es and broad cont ent areas have been defined, t his
can t hen be developed int o a program m e of learning. Obviously t here will be
const raint s in t erm s of t im e allocat ion, t eachers’ availabilit y and access t o learning
resources, but it is im port ant for course planners t o plan out a t im et able for t he
course early on in t he planning process. This should include allocat ing t im e for
each elem ent of t he course and m apping out t he sequence of learning in a logical
m anner w hich enables st udent s t o progress t hroughout t he course. As we have
said, curriculum developm ent is an it erat ive process and t here will be m any
versions of t im et ables and ot her course docum ent s before t he program m e is
ready for im plem ent at ion.
I n m any curricula, t he choice of t e a ch in g a n d le a r n in g m e t h ods is not
st ipulat ed but it is left up t o t he t eacher t o select t he m et hod m ost appropriat e t o
t he subj ect and t he int ended learning. I n som e courses such as PBL curricula, t he
learning m et hod is explicit in curriculum design and guidelines will probably need
t o be produced t o support t eachers and st udent s during t he learning process. The
t eaching and learning m et hods or learning experiences should be derived from t he
cont ent and learning obj ect ives in a m eaningful way and t he m et hods or t he
organisat ion of experiences should facilit at e t he at t ainm ent of respect ive
obj ect ives in t he cognit ive, affect ive and psychom ot or dom ain

Point s t o keep in m ind are:

• How relevant are t he t eaching and learning m et hods t o t he cont ent and
learning out com es?
• How are pract ical skills going t o be t aught and supervised?
• How are st udent s support ed in independent learning and st udy ( eg self
direct ed learning) ?
• What resources are required and available t o ensure effect ive t eaching and
learning?
• Does t he t eaching prom ot e crit ical and logical t hinking at t he level of t he
learner?
• What are t he const raint s affect ing t he t eaching and learning process?
• Are t he t eaching and learning m et hods appropriat e for t he select ed
assessm ent m et hods?

Wit h developm ent s in new t echnology, and inform at ion t echnology in part icular,
t here are m any m ore opport unit ies for course developers t o int roduce innovat ive
t eaching and learning m et hods. This can enable learning t o be m ore flexible,
learners can st udy in t heir ow n t im e via t he I nt ernet or an I nt ranet , lect ures m ay
be given over t he I nt ernet or via videoconferencing reducing t he need for
st udent s or t rainees ( and t eachers) t o t ravel. Open learning m at erials can be
developed such as workbooks w hich can help t o encourage self- direct ed st udy and
reflect ive pract ice. Wit h careful planning, and careful m at ching of learning
out com es t o t eaching/ learning m et hods and assessm ent s, t echnology can help t o
facilit at e learning and use resources m ore effect ively and efficient ly.

Det ails of m any t eaching and learning m et hods can be found in ot her papers and
t here are m any excellent t ext books which cover t hese issues, see t he furt her
reading sect ion at t he end of t he paper.

I n designing t he a sse ssm e n t m et hods t hat m easure st udent s’ perform ance, t he

st art ing point should always be t he st at ed learning out com es. Assessm ent s m ust
check t hat st udent s have achieved t he learning out com es in various cont ext s and
t hus t hat t he cont ent has been covered. Teaching and learning m et hods m ust
support t he assessm ent st rat egy, if st udent s or t rainees are expect ed t o perfor m
well in MCQs for exam ple, t hen a PBL t ype course wit h a facilit at ive t eaching
approach will not be appropriat e. An assessm ent blueprint ( or m at rix) is a helpful
t ool t o m ap out coverage of core cont ent and learning out com es against t he
assessm ent m et hods ( see Teachers t oolbox) .

Teachers should check a num ber of aspect s relat ing t o assessm ent :
• Are t he assessm ent m et hods w hich relat e t o t he assessm ent of knowledge,
skills and at t it udes appropriat e?
 • Do t he t eaching and learning m et hods support t he assessm ent st rat egy?
• Are t he assessm ent m et hods reliable and valid?
• Are t he assessm ent m et hods designed so t hat learners can achieve t he
m inim um perform ance st andards set in t he curriculum and is t here capacit y
for learners t o dem onst rat e higher st andards of perform ance ( ie do t he
assessm ent s enable discrim inat ion bet w een candidat es) ?
• Are t he st udent s/ t rainees being assessed sufficient ly or are t hey being
over- assessed?
• Are t he regulat ions governing assessm ent procedures and awards clear and
easy t o follow and are t hey being applied appropriat ely and consist ent ly?

See t he Assessm ent paper for an in- dept h look at m edical and healt hcare
assessm ent s.

The im plem ent at ion of a new curriculum usually requires addit ional le a r n in g
r e sou r ce s or at least a ret hink of exist ing learning resources. Curriculum
planners who are developing whole program m es need t o t hink at a st rat egic level
about t he resources required and how t hese can be used effect ively and
efficient ly. As st udent num bers increase at t he sam e t im e as yet m ore
t echnological innovat ions becom e available, t here is a considerable t ension
bet ween different groups of t eachers and budget holders as t hey t ry t o m eet t heir
own and st udent s’ expect at ions. For exam ple, if t eachers are t rying t o int roduce
m ore self direct ed or flexible learning eit her t hrough PBL or ot her learning
st rat egies, t hen close liaison needs t o be carried out wit h library and I T st aff as
st udent s w ill require good access t o a wide range of t ext s, j ournals and web based
resources. The sam e applies t o t eachers who are developing sm aller part s of a
course or single sessions, t here are m any resources which m ay be available t o
you and it is helpful t o t hink about t hese as an int egral part of curriculum
developm ent .

Le a r n in g a ct ivit ie s a n d r e fle ct ion

Can you list som e of t he m ain resources w hich would be required t o deliver a new
curriculum ?
Le a r n in g r e sou r ce s r e qu ir e d t o de live r t h e cu r r icu lu m

• Teachers, t echnical and adm inist rat ive st aff – t here should be sufficient
st aff t o deliver and support t he delivery and assessm ent of t he course.
St aff should be appropriat ely skilled ( in pedagogical as well as t echnical
areas) and qualified and should be aware not only of t heir own areas of
t he course but also of t he course as a whole in order t hat t hey can
cont ext ualise t he learners’ learning experiences
• Equipm ent including I T and AV equipm ent , m odels and sim ulat ors,
laborat ory and clinical equipm ent , whit eboards, flip chart s
• Finances - t he course will require adequat e funding t o sust ain it s
act ivit ies
• Books, j ournals and m ult im edia resources – list s of core t ext books for
each part of t he course and ot her resources including reference t ext s
should be ident ified by t eachers and purchased for use by learners. These
should be support ed by ot her resources such as j ournals ( print ed and
online) and m ult im edia packages. The library will be t he m ain support
st ruct ure for t hese resources but addit ional resources m ay also be
delivered t hrough an I nt ranet or via depart m ent al ‘libraries’
• Teaching room s, office space, social and st udy space – t here should be
adequat e provision t o accom m odat e learners at all st ages of t he course as
well as social and st udy space for st udent s t o spend t im e out side t he
classroom . There should also be sufficient space for t eachers t o prepare
t eaching and m eet w it h st udent s.
• Requirem ent s for supervision and delivery of clinical t eaching/ placem ent s
– in courses for healt h professionals, t hese areas of t he course usually
com prise a large part of t he curriculum . Clinical t eaching is oft en delivered
by healt h professionals w orking in pract ice rat her t han linked t o t he
educat ional inst it ut ion and it is im port ant t o ensure t hat such st aff are
support ed and t rained t o deliver t he course. Ot her requirem ent s which
need t o be considered include t ravel and accom m odat ion arrangem ent s for
learners and t eachers.

I m ple m e n t in g t h e cu r r icu lu m

As we have seen in t he earlier sect ions, t here is no real clear dividing line
bet ween curriculum developm ent and im plem ent at ion. Once t he curriculum has
been developed and t est ed, and revised as necessary, t he curriculum is ready for
im plem ent at ion. I t is im port ant t hat t hose involved wit h im plem ent ing t he course
( usually t eachers and exam iners) as w ell as st udent s, int erpret t he curriculum
correct ly, because t he writ t en word is not always int erpret ed in t he sam e way by
different people. I deally, t he processes of developm ent and im plem ent at ion
should be seam less and involve m any of t he sam e t eachers and ot her st aff as well
as st udent represent at ives. This will help t o ensure ownership of t he new course
and m ore effect ive im plem ent at ion.

Pr e t e st in g a n d pilot in g
Before st art ing t o fully im plem ent t he curriculum it is preferable t o t ry t o pr e t e st
or pilot som e or t he whole of t he curriculum t hat has been developed. The m ain
obj ect ive of pre t est ing and pilot ing is t o t ry out t he draft curriculum in a sm all
num ber of t raining sit uat ions and in t he cont ext in which t he curriculum will be
used. This helps t o highlight t o t he curriculum developers whet her t he curriculum
is underst andable and relevant t o t he users and whet her it works in pract ice.
Based on t hese findings, t he curriculum can be m odified as appropriat e t o m eet
t he needs of t he pot ent ial st udent s. Som et im es t here is t he opport unit y t o fie ld
t e st t he developed course t o a larger num ber of users under real ‘field’
condit ions.

Pre t est ing and pilot ing can help t o creat e t he m ost appropriat e course as oft en
t he paper curriculum does not work as expect ed in pract ice because of unforeseen
sit uat ions or responses by st udent s or t eachers. For exam ple, if int roducing new
t eaching or learning m et hods or new t opics int o a curricula, it is easy t o
underest im at e t he am ount of preparat ion and som et im es addit ional t raining which
m ight be required of t eachers. Tools and m echanism s m ust be developed t o
ensure a syst em at ic evaluat ion of t he t est ing or pilot ing process.

M on it or in g a n d e va lu a t in g t h e cu r r icu lu m

M on it or in g can be defined as a cont inuous or periodic check and overseeing by

t hose responsible for t he course at every level. I t should focus at t ent ion on
processes and perform ance wit h t he obj ect ive of drawing at t ent ion t o part icular
feat ures t hat m ay require correct ive act ion. I t includes put t ing act ivit ies in place
t o ensure t hat input deliveries, work plans, expect ed out put and ot her act ions are
proceeding according t o plans. Monit oring should enable curriculum planners t o
det ect serious set backs or bot t lenecks of t he im plem ent at ion process t hat m ay
cause t he program m e not t o achieve expect ed learning out com es.
W h a t sh ou ld be m on it or e d?

• St udent recruit m ent and select ion processes

– do t he candidat es m eet t he select ion crit eria?
– do t he crit eria provide st udent s who are appropriat e for t he
course?
• Teaching st aff – are t he t eachers available, m ot ivat ed and capable
of t eaching t he new course?
• Have any t raining needs for t eachers been ident ified and addressed?
• The t eaching and learning process
– how is t he writ t en curriculum t ranslat ed int o pract ice?
– Are t he t eaching and learning m et hods appropriat e?
– I s t he balance bet w een different t ypes of learning m ode
appropriat e in achieving t he st at ed out com es?
• Assessm ent
– are t he assessm ent s appropriat e in t erm s of level, reliabilit y
and validit y and do t hey discrim inat e bet ween assessing
skills, knowledge and at t it udes?
– Are t he regulat ions and procedures appropriat e and are t hey
being followed?
• Learning resources
- are t he recom m ended books and j ournals and ot her t eaching
m at erials available?
- I s access t o t he library and ot her resources adequat e?
• Perform ance st andards – are t he m inim um perform ance st andards
being reflect ed and achieved?
M e t h ods of m on it or in g cur r icu lu m im ple m e n t a t ion

Obse r va t ion – t his is part icularly valuable in t he early st ages of im plem ent ing a
course but should be carried out separat ely from observat ions of t eacher
perform ance. The t eaching and learning process can be observed in a variet y of
set t ings and form s can be used t o record t he inform at ion in a st andardised way.
This is a t im e- consum ing m et hod of m onit oring and can be subj ect t o observer
bias.

Fe e dba ck qu e st ion n a ir e s – quest ionnaires can be used t o collect inform at ion

from st aff, st udent s and ext ernal people or groups involved w it h t he course.
I nform at ion ca be sought about all aspect s of a course. Quest ionnaires are useful
t o collect a large am ount of inform at ion and, if bot h open and close quest ions are
used, can be a rich source of dat a. Response rat es can be low and care m ust be
t aken not t o overload people w it h quest ionnaires and also t o seek out ways in
which responses can be encouraged eg. handing out quest ionnaires at t he end of
t eaching sessions and giving t im e for st udent s t o com plet e t hese. I t is usual
pract ice for quest ionnaires t o be com plet ed anonym ously.

Focu s gr ou ps/ m e e t in gs/ for a / in t e r vie w s – st ruct ured or sem i- st ruct ured
m eet ings ( wit h individuals or groups) and focus groups can be anot her useful
source of det ailed inform at ion about a program m e. These are t im e consum ing and
t herefore are best used t o probe int o areas of concern or t o follow up issues which
have been ident ified t hrough ot her m eans eg. quest ionnaires. I t is good pract ice
t o set up regular m eet ings wit h st udent and st aff represent at ives aim ed
specifically at reviewing t he course or elem ent s of it . Curriculum com m it t ees can
also be useful sources of inform at ion about t he course and help t o increase
ownership of t he curriculum . The result s from such m eet ings m ust be fed back
int o t he overall qualit y assurance m echanism s so t hat appropriat e act ion can be
t aken.

St u de n t a sse ssm e nt r e su lt s – Result s from bot h form at ive and sum m at ive
assessm ent s should be analysed regularly in order t o evaluat e w het her individual
assessm ent s are perform ing reliably and validly and also whet her m inim um set
st andards are being achieved. The report s from ext ernal exam iners are also a
very useful source of ext ernal inform at ion about t he course.

Re por t s – report s w hich t he inst it ut ion has t o provide for int ernal use ( eg.
absence st at ist ics) or ext ernal agencies can be useful sources of inform at ion
about t he program m e.

Eva lu a t ion is a syst em of feedback, providing inform at ion t o planners,

t eachers/ t rainers, st udent s, parent s and decision- m akers. Evaluat ion is a process
involving ongoing act ivit ies aim ed at gat hering t im ely inform at ion about t he
qualit y of a program m e.

W h y do w e n e e d t o e va lu a t e ou r cou r se s?
• To ident ify successes and failures of t he curriculum wit h a view t o
correct ing deficiencies
• To m easure if st at ed obj ect ives have been achieved
 • To assess if t he curriculum is m eet ing t he needs of learners, com m unit y et c
• To m easure t he cost effect iveness of t he curriculum

Som e qu e st ion s t o a sk w h e n e va lu a t in g a cou r se or pr ogr a m m e

• Whet her t he learning obj ect ives are realist ic and relevant
• Whet her t he different part s of t he course relat e t o each ot her m eaningfully
in t erm s of sequence and organisat ion
• Whet her t he subj ect m at t er and cont ent is relevant , accurat e and up t o
dat e
• Whet her t he learners’ ent ry requirem ent s are w ell defined and at t he right
level
• Whet her t he m at erials and delivery are pit ched at t he right level for t he
learners at different point s in t he course
• Whet her t he balance of t eaching and learning m et hods is appropriat e and
whet her t here is enough t im e t o ensure learning
• Whet her t eachers have t he knowledge and skills required t o deliver t he
curriculum
• Whet her t he learning resources t hat have been ident ified are adequat e,
appropriat e and available

See t he Evaluat ing t eaching and learning paper for a det ailed exam inat ion of
educat ional qualit y and course evaluat ion
Re fe r e n ce s

Becker, H.S., Geer, B., Hughes, E.C. and St rauss, A.L. ( 1961) Boys in Whit e:
st udent cult ure in m edical school, Universit y of Chicago Press, Chicago and
London

Brookfield, SD ( 1986) Underst anding and facilit at ing adult learning, Open
Universit y Press, Buckingham *

Forsyt h, I ., Jolliffe, A. and St evens, D. ( 1995) Planning a course: Pract ical

st rat egies for t eachers, lect urers and t rainers, Kogan Page, London *

Ham ilt on, J.D. ( 1999) Out com es in m edical educat ion m ust be wide, long and
deep, Medical Teacher, Vol.21, No 2, 1999

Harden, R.M., Crosby, J.R., Davis, M ( 1991) An int roduct ion t o out com es-
based educat ion, Educat ional leadership 4 9 ( 2) : 67- 72

McKim m , J. Case st udy 1: developing a new undergraduat e m edical course at

I m perial College School of Medicine in Robert s K. and Ludvigsen, C. ( 1998)
Proj ect m anagem ent for healt h professionals, But t erwort h Heinem ann, Oxford

Newble, D. and Cannon, R. ( 1989) A handbook for m edical t eachers, Kluwer

Academ ic Press, Lancast er *

Newble, D. and Cannon, R. ( 1994) A handbook for t eachers in universit ies and
colleges: a guide t o im proving t eaching m et hods, Kogan Page, London *

Peyt on JWR ( 1998) Teaching and Learning in Medical Pract ice, Mant icore
Europe Lt d, Rickm answort h *

Prideaux, D. ( 2000) The em peror’s new clot hes: from obj ect ives t o out com es,
Medical Educat ion, 2000; 3 4 : 168 – 169

Ram sden, P ( 1992) Learning t o t each in higher educat ion, Rout ledge, London
*

Sinclair, S ( 1997) Making doct ors: an inst it ut ional apprent iceship, Berg, Oxford

St enhouse, L ( 1975) An int roduct ion t o curriculum research and developm ent ,
Heinem ann, London, 1975: 52- 83

Willis, P. ( 1977) Learning t o labour, Saxon House, Farnborough

Fu r t h e r r e a din g

The books ast erisked above are useful for m any aspect s of curriculum
developm ent and t eaching and learning in general.

Anot her useful general educat ion book is:

Fry, H., Ket t eridge, S. and Marshall, S. ( 1999) A handbook for t eaching and
learning in Higher Educat ion: enhancing academ ic pract ice, Kogan Page,
London – t his book has lot s of useful inform at ion on general t eaching at
undergraduat e and post graduat e levels as well as a specific chapt er on m edical
and dent al educat ion. The chapt ers on underst anding st udent learning and
out com es based planning are especially appropriat e t o t hose int erest ed in
curriculum developm ent .
The 3 rd edit ion is due out in 2008.

For som e ‘t ips for t eaching’ rat her t han in- dept h t heory, t ry som e of t he Kogan
Page Teaching and learning in Higher Educat ion series, for exam ple:
Race, P. and Brown, S ( 1999) 500 Tips for t ut ors, Kogan Page, London – t his
book has lot s of helpful, pract ical suggest ions for helping learners t o learn.
Writ t en assum ing t hat learning should be an act ive process and t hat st udent s
should develop st udy and lifelong learning skills.

Specific t o clinical t eaching and learning:

Dacre, J. and Nicol, M. ( 1996) Clinical Skills: t he learning m at rix for st udent s
of m edicine and nursing, Radcliffe Medical Press, Oxon – t his handbook is a
useful list of all t he clinical and com m unicat ion skills considered necessary for
doct ors and nurses. The m at rix ident ifies t he skills t o be acquired, t he
necessary level of com pet ence and also areas where shared learning is
possible bet ween m edicine and nursing. Skills are list ed by body syst em s wit h
subdivisions int o assessm ent and diagnost ic skills; caring, com fort and safet y
skills and t herapeut ic and t echnical skills.

Moore, A., Hilt on, R., Morris, J., Caladine, L and Brist ow, H. ( 1997) The clinical
educat or – role developm ent : a self- direct ed learning t ext , Churchill
Livingst one, Edinburgh – t his is a package ( reader and t ext book) prim arily
writ t en for physiot herapist s. I t has som e int erest ing reading, exercises and a
deeper look int o som e of t he t heoret ical perspect ives relevant t o clinical
pract ice t han we have been able t o offer here.

You m ay also find it useful t o look at t he m edical educat ion j ournals ( eit her
online or print ed versions) for art icles about course planning and curriculum
developm ent at bot h undergraduat e and post graduat e levels. These include:

Medical Educat ion, t his is t he official j ournal of ASME ( t he Associat ion for t he
St udy of Medical Educat ion) at ht t p: / / w w w.m ededuc.com /
Academ ic Medicine at ht t p: / / w ww.academ icm edicine.org/
Medical t eacher at ht t p: / / www.m edicalt eacher.org/
Brit ish Medical Journal ( BMJ) at ht t p: / / bm j .com / cgi/ collect ion/ t eaching
Or have a look at t he Om ni gat eway on m edical educat ion at
ht t p: / / om ni.ac.uk/ browse/ m esh/ det ail/ C0013631L0013631.ht m l
This is a UK gat eway t o high qualit y int ernet resources in healt hcare educat ion.
An n e x 1
Cu r r iculu m de ve lopm e n t – im ple m e n t in g e qu a l oppor t u n it ie s

One of t he issues t o be addressed in curriculum design and delivery is t he issue of

equal opport unit ies. For exam ple, in aim ing t o achieve gender equalit y wit hin t he
educat ion syst em , t here are t w o m ain issues t o be addressed. The first is t he
recognit ion t hat despit e a general belief am ong t eachers t hat t hey do not
discrim inat e on t he grounds of gender, m ale and fem ale st udent s oft en leave
educat ion wit h different ial qualificat ions, career aspirat ions, and self percept ions
which reflect t radit ional assum pt ions and st ereot ypes.

I nst it ut ions should aim t o fost er a clim at e in which a posit ive at t it ude t o gender
equalit y is act ively prom ot ed. This includes t ackling t he problem s of different ial
expect at ions and t he long- t erm effect s of prej udice and st ereot yping. Research
int o t he posit ion of w om en in science and engineering has indicat ed t hat for m any
wom en t he educat ional clim at e is ‘chilly’ and com parably few wom en progress
int o senior posit ions. I n m edicine, t he posit ion is different . More wom en t han m en
ent er m edical school and qualify in sim ilar num bers. But , as in m any professions,
wom en are clust ered in lower career posit ions at t he bot t om of t he pyram id,
whereas t he m aj orit y of senior posit ions in clinical and in academ ic m edicine in
part icular are held by m en.

I t is im port ant t hat as t eachers, we do our best t o address t he needs of bot h

sexes whilst acknowledging t hat t here ar e ways in which w e develop and deliver
t he curriculum which m ay help perpet uat e wom en’s posit ion.

I n delivering t eaching, som e appropriat e m et hods are:

• Adopt ing part icular t eaching/ learning st yles eg. sm all group work w hich
m ay encourage less confident st udent s t o t ake a lead
• I ncorporat ing confidence building program m es int o t he curriculum
• I nt roduct ion t hrough t he curriculum of role m odels who w ork in non-
st ereot ypical areas
• The careful select ion of t eaching and display m at erials t o avoid bias. Where
resource m at erials cannot be replaced, at t ent ion can be drawn t o t he issue
of st ereot yping
• Considerat ion by st aff of any st ereot ypical reasons for regarding work as
accept able or ot herw ise eg. a fem ale has worked hard and t he work is neat
and well present ed, a m ale st udent is clever but unt idy

Above all, t eachers will need t o consider carefully and honest ly whet her t hey
prefer t eaching st udent s of one or ot her sex, and whet her as a result t here are
any ot her differences in t heir at t it udes or approach on grounds of gender. I t is
helpful t o be able t o discuss t hese issues wit h a colleague and t o enlist t hat
colleague’s help in observing pract ice in t eaching sit uat ions which m ay ident ify
unconscious variat ions in t he t reat m ent of st udent s/ t rainees. I t is im port ant
t herefore t hat st aff t ackle t hese issues as a group and lend support t o one
anot her, recognising t hat all can be involved in unconscious bias which m ay
reinforce t radit ional st ereot ypes prej udicial t o t he developm ent of t he individual
st udent .
Cu r r icu lu m pla n n in g
Teachers should ensure t hat in choosing t he cont ent of t heir courses, in designing
t heir schem es of work and in present ing t he m at erial t o be st udied, t he subj ect
m at t er is, as far as possible, equally appealing t o bot h m ale and fem ale st udent s
and t hat any st ereot yped view s of gender roles are not present ed unquest ioned.

Considerat ion should t herefore be given by t eachers t o:

1. choosing act ivit ies or exam ples t hat are as ‘neut ral’ as possible when
devising w ork t hat will help t each a skill, idea or concept . This is part icularly
im port ant in t he early st ages of learning a new subj ect when t he t radit ional
st ereot ypes about t he subj ect in t he m inds of st udent s are likely t o be at
t heir st rongest .
2. ensuring t hat where st udent s t hem selves opt for st ereot ypical roles t hey
are also encouraged t o consider ot her opt ions eg. in career choices or class
based act ivit ies
3. highlight ing t he achievem ent s and influence of fem ales doing
st ereot ypically m ale act ivit ies and m ales doing act ivit ies t radit ionally
associat ed wit h wom en’s roles, by way of illust rat ion, verbal exam ple,
writ t en account or choice of audio- visual m at erial. I n t his way t eachers can
also help t o count er som e of t he t radit ional st ereot ypes st ill found in
t ext books and ot her published m at erials.
4. providing support for st udent s/ t rainees who because of previous
st ereot yping have not had access t o t he experience required t o progress in
cert ain areas of t he curriculum
5. using t eaching m et hods designed t o involve st udent s/ t rainees of bot h
gender equally in discussion, quest ion and answ er and pract ical work

One of t he m ain difficult ies is t o decide t o what ext ent st ereot yped roles should be
used in order t o at t ract one sex int o an area of learning t hat has t radit ionally been
dom inat ed by t he ot her sex. Care needs t o be t aken t o ensure t hat such an
approach does not m erely reinforce t he st ereot ype, t his can be avoided by
st ressing t hose aspect s which are of com m on int erest t o all.

Acce ss t o cu r r icu lu m a r e a s
Male and fem ale st udent s and t rainees should have access t o all areas of t he
curriculum . Where choices are m ade, t hese should be present ed t o bot h sexes as
far as possible in an neut ral m anner. Where t here is a need t o com bat
t radit ionally sexist views, st udent s should be m ade aware in posit ive w ays of why
it is j ust as appropriat e for bot h sexes t o t ake up a part icular opt ion. The
t im et able should be as flexible as possible and t o provide opport unit ies for
st udent s t o opt for non- st ereot ypical areas. I t is essent ial t hat previous pract ice or
t ake- up of subj ect s should not be m ade t he basis for set t ing subj ect s against each
ot her.

When present ed w it h inform at ion about a specific subj ect or act ivit y st udent s
should be m ade aware of it s connect ions wit h a range of fut ure em ploym ent
opport unit ies open t o eit her sex.