A curriculum is nothing more, but nothing less, than a planned education experience. Traditionally within chiropractic education new instructors who took over a course simply used pre-existing materials as a basis for putting their own stamp on the content of the course, and given that most of those who teach in health care education were not actually trained as educators but as either clinicians or academic scientists, little thought was given to how best to develop a curriculum. This was true whether writ small (such as single course or lecture) or large (such as a full curriculum or course series). A superb text by Kern et all provides a reasoned mechanism for developing the curriculum in medical education (1). I provide a short summary here of a text we should all have and read.
Kern starts with several underlying assumptions, including (1) educational programs have aims or goals, whether these are stated or not; (2) educators have an obligation to meet the needs of learners, patients and society; (3) educators need to be accountable for the outcomes of their interventions; and (4) a logical approach to curriculum development will help achieve these ends. They therefore offer a six-step approach to curriculum development. Much of the following will be recognizable in one form or another from efforts accomplished here at Palmer College.
Step 1: Problem identification and general needs assessment. The process begins with recognition and analysis of a health care problem or need. Perhaps it might be a need to increase coverage of public health issues in response to new requirements from the Council on Chiropractic Education, or a need to enhance evidence-based practice (EBP) arising from R25 grant funding. In order to properly analyze the issue, we need to look at what our current approach is; thus, needs assessment and analysis. We can then develop an ideal approach to the challenge, to address the need. Kern et al note that the difference between the ideal approach and the current approach is the general need assessment.
Step 2: Needs assessment of targeted learners. Here we assess the needs of our targeted group of learners, as distinct from the general needs of all learners or of all health care (chiropractic) institutions. We may find that we lack discrete coverage of evidence-based practice in our curriculum, but that some instructors do touch on various aspects of the discipline in their specific courses.
Step 3. Goals and objectives. After we identify the needs of our learners, we can begin writing goals and objectives. Kern recommends beginning with board or general goals and then moving toward specific and measurable objectives. We have all engaged in this activity. These goals and objectives are critical for determining content. They also communicate what our curriculum is about to the outside, including accrediting bodies.
Step 4. Educational strategies. At this point, we have goals, objectives and content. The next issue to be addressed regards which educational strategies we should use to achieve those objectives. Perhaps in the case of EBP, we should look at case-driven approaches, given the emphasis on placing context around individual patient cases, as noted by the use of a PICO question (Patient-Intervention-Comparison-Outcome). In clinic,, we might rely on small-group teaching or individual teaching.
Step 5. Implementation. Kern notes several important components necessary for implementation: administrative support for the curriculum; identification of resources; identification of barriers to implementation; introduction and piloting of the curriculum (roll-out); administration of the curriculum; assessment and refinement.
Step 6. Evaluation and feedback. Noted in the last step directly above is assessment. This occurs at both the individual and institutional (program) level, and it can be both formative and summative.
This is an ongoing process, and it is not one that is accomplished sequentially and step-by-step, even though the above would seem to suggest it is. Each step has affects on, and influences, each other step, in a cycle of continual assessment, refinement and improvement. We have seen significant change here as a result, and we can be equally sure that we will see more as time goes on.
1. Kern DE, Thomas PA, Howard DM, Bass EB. Curriculum development for medical education: a six-step approach. Baltimore, MD; Johns Hopkins Press, 1998