An Approach to

Curriculum Development
GME Lunch n Learn Series
Cuc Mai
September 2012
ACGME Program Requirements
• Common Program Requirements:
• Competency-based goals and objectives for each
assignment at each educational level

• Internal Medicine Specific Program Requirements:

• For each rotation or major learning experience, the
competency based goals and objectives (the written
curriculum) must contain the educational plan, goals
and objectives, educational methods, and the
evaluation tools that the program will use to assess the
resident’s competence.
Goals & Objectives

 Recognize key components of curriculum

development

 Demonstrate how each of these components can

be used to benefit learners and promote scholarly
activity

 Identify resources to improve curriculum

development skills
A Six Step Approach to Curriculum Development
Example Case
 Develop a curriculum to teach residents
about how to diagnose and treat
musculoskeletal diseases and increase
number of joint injections performed during
residency.
Step 1: Problem Identification &
General Needs Assessment

 Builds a rationale for the curriculum

 Focuses the curriculums’ goals and objectives
 Focuses the educational and evaluation

strategies
 Makes you an expert and scholar
Step 1. Problem Identification
Step 1. General Needs Assessment
Step 1. Problem Identification & General Needs
Assessment Example

 Musculoskeletal disorders are common and a

major cause of disability
 Patients want quick access
 Training increases confidence and decreases

referrals
 National organizations recommend training in

musculoskeletal exam; diagnosis; management

 Preferred training is in clinical practice with trained

preceptors

Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen
Intern Med 2004; 19: 524-529.
Step 2: Targeted Needs Assessment

 Assess the differences between your specific

learners and the general audience
 Assesses the environment to help tailor the

intervention
 Prevents duplication
 Identifies stakeholders and builds

relationships with stakeholders

Step 2. Targeted Needs Assessment
Example

 Methods for collecting information:

◦ Reviewed existing training
◦ Senior resident exit survey, Survey of current residents,
& Focus group of residents
 Findings:
◦ Strong desire for training
◦ Low levels of training and clinical experience and self
rated proficiency
◦ Wrong case mix in Rheumatology and Orthopedics
◦ Preferred direct supervision of patient care by
practitioners with expertise in musculoskeletal medicine
Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern Med
2004; 19: 524-529.
Step 3: Goals & Objectives

 Goal: broad educational goal

 Objective: specific measurable objective

Step 3. Goals & Objectives
 Helps prioritize
 Direct content
 Identify learning methods
 Enable and direct evaluation
 Provides clear communication to learners,

faculty, and stakeholders

 Required
Step 3. Objectives

 Types of Objectives
◦ Learner Objectives
 Cognitive, Affective, Psychomotor
◦ Process Objectives
 Curriculum Implementation Measures
◦ Patient/Healthcare Outcome Objectives
 Patient Outcomes: pt satisfaction
 Healthcare/System Outcomes: board pass rate
Step 3. Writing Objectives

 Who will do how much of what by when?

◦ Who (1)
◦ Will do (2)
◦ How much (3)
◦ Of What (4)
◦ By When (5)
Step 3. Writing Objectives & Bloomberg’s taxonomy
Step 3. Objectives Example
Step 4. Educational Strategies

 Maintain congruence between objectives and

methods
 Use multiple educational methods
 Choose methods that are feasible
Step 4. Educational Strategies
Table 5.2 Matching Educational Methods to Objectives*
Type of Objective
Cognitive: Cognitive: Affective: Psychomotor: Psychomotor:
Educational Method Knowledge Problem- Attitudinal Skills or Behavioral or
Solving Competence Performance
+++ + + +
Lectures +++ + + +
Programmed learning +++ ++ +
Discussion ++ ++ +++ + +
Reflection on experience +++ +++ +++
Feedback on performance + ++ ++ +++ +++

Small-group learning ++ ++ ++ + +
Problem-based learning ++ +++ + +
Team-based learning +++ +++ ++ + +
Learning projects +++ +++ + + +
Role models + ++ + ++
Demonstration + + + ++ ++
Role plays + + ++ +++ +
Artificial models and + ++ ++ +++ +
simulation
Standardized patients + ++ ++ +++ +
Real life experiences + ++ ++ +++ +++
Audio or video review of + +++ +
learner
Behavioral / environmental + + +++
interventions**
Step 4. Educational Strategies
Example

 Musculoskeletal Curriculum:
◦ Development of workshops and syllabus materials
on diagnosis and management for common
musculoskeletal disorders, including injection
therapy.
◦ Institution of a new primary care musculoskeletal
clinic supervised by Internal Medicine preceptors
with a special interest in musculoskeletal diseases.

Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen Intern
Med 2004; 19: 524-529.
Step 5. Implementation
 Identify Resources
◦ Personnel, Time, Facilities, Funding
 Obtain Support
◦ Internal vs. External
 Develop Administrative Mechanisms
 Anticipate and Address Barriers

◦ Competing Demands, Attitudes

 Develop a Plan for Introducing Curriculum
◦ Pilot, Phase In, Full Implementation
Step 5. Implementation Example

 Musculoskeletal clinic
◦ Financial analysis and feasibility analysis had to be
done
◦ Administrative support was obtained.
◦ Plan discussed with Rheumatology and Orthopedics

Houston TK et al. A primary care musculoskeletal clinic for residents: success and sustainability. J Gen
Intern Med 2004; 19: 524-529.
6. Evaluation & Feedback
 Need to determine if goals are met
 Provides information for improvement
 Documents accomplishments
 Specifics to Consider

◦ Evaluation Questions
 Address learner objectives
◦ Evaluation Design
 Consider internal and external validity
 Posttest, Pretest/Postest/Control Group
Conclusions
 Recognize and apply these 6 steps to
curriculum development
◦ Problem Identification & General Needs
Assessment, Targeted Needs Assessment, Goals &
Objectives, Educational Strategies, Implementation,
Evaluation & Feedback
 Define objectives in specific and measurable
language
◦ Who will do how much of what by when?
 Use references to help your faculty develop
curriculum for your learners
References
 Kern D, Thomas P, Hughes M, Barker L, Bass
E, Carrese J, Wolfe L. The Six-Step Approach
to Curriculum Development. SGIM Workshop.
5/2009.
 Kern D. Curriculum Development for Medical

Education. Second Edition.

 Thomas P, Kern D. Internet Resources for

Curriculum Development in Medical

Education. An Annotated Bibliography. J Gen
Intern Med. 2004; 19: 599-605.