CM 2 - Principles of Curriculum Development and Evaluation- Assignment

1. Describe a course which you have been/is involved, using the framework of Hardens 10
questions (1000 words)

The course that Im going to elaborate using the Hardens 10 questions is the MBBS
undergraduate course which I have been engaged in. Harden listed his ten questions as
following(R. M. Harden, 1986);

What are the needs in relation to the product of the training programme? What are the aims and
objectives? What content should be included? How should the content be organized? What
educational strategies should be adopted? What teaching methods should be used? How should
assessment be carried out? How should details of the curriculum be communicated? What
educational environment or climate should be fostered? How should the process be managed?

When considering the first question, the needs in relation to the product of the training
programme, the final need was to produce quality undergraduates who can function as an intern
medical officer in a hospital set up. For that purpose there are various methodologies like the
Wiseman approach, a study of errors in practice, critical incidence studies, task analysis of
established practitioners, analysis of morbidity and mortality studies, studying the star
performers, analysis of the current curricula by various means and interviewing the recent
graduates. However, the need for the course was established from the commencement of the
faculty to our era of study.

The second question comes as the aims and objectives of the programme. Our facultys main aim
was to produce qualified medical practitioners who can cater the needs of the patients at the
hospital set up and continue their professional education and be competent in the ever changing
field of medicine. The aims and objectives were quite focused on this need. Although the
problem based approach was limited, the clinical skill development, encouragement on research,
ethics, and guidance on continuous professional education activities and team work with other
professionals were included in the objectives with reference to the need in producing a good
clinician.
Harden explains that content gain access to the content of a subject by four criteria(R. M.
Harden, 1986). That is, based on objectives, if its a building block which helps to students to
tackle problems in the latter part of the course, if it helps students to develop critical thinking and
if it aids the other subjects on the course. In our faculty, the course content was planned on the
objectives as well as thinking about the other subjects and the latter part of the course. It included
an orientation programme and subjects unlike the module system which was adopted later on.
The organization of the content was the Hardens fourth question. In that case, part one basic
subjects gave a foundation to build on for the clinical appointments which were planned at the
latter part of the course. Part two subjects addressed several disciplines which are needed in
multi-disciplinary approach in patient care. Third and fourth year clinical appointments covered
few weeks in major specialties and few weeks at minor specialties as a preparation for the final
year professorial appointments. Final year professorial appointments were the pinnacle point
where we could use our knowledge in the real day to day clinical scenarios and gather hands on
experience.

The educational strategies used according to the fifth question of Harden, were more teacher
centered. Lectures were the main method of providing knowledge in the first year. However this
trend was more towards the student side in the latter part with the professorial clinical
appointments. Problem solving techniques were only utilized in the tutorials or ward classes.
However there were some appointments where we were instructed on writing a portfolio on case
scenarios we were involved in the appointment. The systems were not taught in an integrated
manner, but for the new batches our faculty adopted the body system modules later on. In the
final year and third year there were few opportunities in community based learning. No elective
subjects/appointments were included in the course. It was a systematic approach and no traces of
apprenticeship were seen as all the students were taught by each and every teacher and not by
specific teachers.

The teaching methods used as per the sixth question, were mainly lectures, practical sessions,
tutorial sessions, dissecting sessions, ward classes and observation ward rounds. One or two
subjects like behavioural sciences and family medicine had small group discussions occasionally.

The assessment techniques as per the seventh question of Harden were basically MCQ, SEQ,
OSPE and OSCE tests and viva voce examinations. Short case examinations and long case
examinations were included in the final year examinations. The assessors were a mix of internal
and external teachers. And the examinations were according to the standards. For second MBBS
examination at the end of the second year and the third MBBS examination at the end of the third
year, there were no carried marks from the in course assessments. However there were quite a
few in-course assessments in the first, second and third years. In the final years there were some
activities like, case books and portfolios as well as end of the appointment assessments which
carries marks for the final MBBS examination. Nevertheless, the examinations results were not
transparent and questionable.

To communicate the curriculum details to the involved parties they used various methods. The
prospectus was available and before beginning of subjects the objectives were distributed. In the
professorial appointments, we were given separate hand books with the specific objectives and
plans. The staff meetings were held to update teachers, as we were told. Subject wise, term time
tables were distributed among students.

When considering the ninth question, we had a good teaching learning environment. Teachers
were helpful and facilitated scholarly activities. There were mentorship programmes organized
by teachers and senior student collaboration. Scholasticism, social harmony and cooperation
among students were promoted.

I think we had good managers at the top decision making positions, because in a short time
compared to the other faculties, our faculty is making its mark. It is reflecting as the many
students who are the products of our faculty are good doctors in many ways. Planning and
implementation of new strategies took place and innovations of medical education were
promoted. Different approaches were adopted to address certain shortcoming of the course.
Responsibilities were given to most suitable and capable managers and processes were
established for the good of the faculty. I think it was a good opportunity for me to be among such
breed of doctors.
Evaluate the selected curriculum for:

a) Constructive alignment (500 words)

Constructivism believes as the student as the constructor of his own knowledge. It explains that
different people have different interpretations and based on their own experiences, construct
knowledge. It simply means that even listening to a lecture involves active attempts to construct
knowledge.(Constructivism, 2015)

Constructive alignment as John Biggs explains is starting with the outcomes we intend students
to learn, and align teaching and assessment to those outcomes.(Constructive Alignment, n.d.)
This can be better explained by looking at the following diagram.

Figure 1: Aligning teaching learning activities and assessment tasks and curriculum objectives
(Biggs, 2003)
The process involves four aspects; describing the intended learning outcomes (ILOs); then
identifying teaching/learning activities that facilitate ILOs; then assess the students' real learning
outcomes to compare them with the intended objectives and finally arriving at a final grade at the
assessment. (Biggs, 2003)

In our curriculum, the most learning objectives were depending on the content of the knowledge
which was expected from the students. Actually in basic subjects like anatomy, physiology and
biochemistry, the intended learning outcomes were quite straight forward. However, in clinical
subjects like Medicine, Surgery, Paediatrics and Gynaecology and Obstetrics, making of
intended learning objectives might have been quite beneficial as the content that one could learn
was not quite quantifiable.

Our teachers could have looked at the two ends. Good students could seize the knowledge the
teachers gave into functioning knowledge later on, but most of the average and bad students
might not be able to do the same if they are not prompted to do so. So the teachers could have
stated the objectives in terms that require students to demonstrate their understanding, so the
objective making could have been done to be specific about what levels of understanding they
wanted from in what topics, and what performances of accepting the knowledge would give us
the comprehension we were expected to have. I think our teachers tried to do that but it would
have been better if we had more clear ILOs.

Teaching/learning activities were mainly lectures and tutorials as I stated before. But our teachers
could have planned them to elicit higher levels of Blooms taxonomy (Objectives) we could have
gained more. We were happy to listen passively and memorize whatever was said without
actively involving. There might have been various other activities to enhance the active
participation. However some subjects like Behavioural studies module tried to implement some
new methods of TLAs.

When considering the assessments, for the teacher, assessment is at the end but to the student it is
at the commencement of teaching learning activities. If the ILOs revealed the assessment more
specifically, the teaching actions of the teacher and the learning actions of the students could
have been towards the same goal. But we were totally blind on the assessment objectives which
were planned at the end.
So as I see, our teachers were trying to include more specific ILOs to plan the teaching learning
activities but they failed to convey the extent of expertise we were expected at the assessments so
some of even with the knowledge failed at certain exams.
b) Educational strategies, i.e. SPICES (500 words)

Six education strategies have been recognized with regard to medical curriculum. Each strategy
can be represented as a spectrum as follows(Ronald M. Harden, Sowden, & Dunn, 1984);

Student-centred / teacher-centred

Problem-based / information-gathering

Integrated / discipline-based

Community-based / hospital-based

Elective / uniform

Systematic / apprenticeship based

Our curriculum at the faculty was mainly teacher centered activities. Lectures were the main
mode of information provision and even tutorials contained a bit of teacher centered approach. In
the first few years the spectrum was totally in the teacher side but towards the end and at
professorial appointments the spectrum shifted towards the students a bit. There were some
activities in ward classes where students were expected to present and the others could critically
analyze the presentations. There were few small group discussions in some subjects and in
clinical groups.

Also in the first few years, the trend was towards feeding information to the students via various
methods of teaching. Its believed that it is not the best way to prepare students to their career
goals where they meet various kinds of patients at different scenarios(Ronald M. Harden et al.,
1984). Aims of this approach can be via two ways

To use problem-based learning as a vehicle to develop a usable body of integrated

knowledge
To develop problem-solving skills
However we were given opportunities in ward classes and in the professorial appointments to
present and critically evaluate patient presentations, histories, examinations and finally the
management plans which are suited to individual patients. I think this could have been since
beginning and a module (System based) method might have helped better to establish this
approach.

We were taught subject wise (discipline based) in our era. It was not integrated. But now the
module system is established in our faculty. However I personally think that we would have
gained more skills and knowledge if there had been the integrated system was there in our time.
This might have helped to reduce the fragmentation, to motivate the students and shape our
attitudes (patient care from beginning), to improve the effectiveness, to facilitate higher level
objectives and to promote collaboration even between departments in the faculty.

Most of our clinical activities were hospital based. But some components in the Family Medicine
and Community Medicine involved community attachments where we were encouraged to go to
the community and tackle the real world scenarios from the grass root level. Although the
opportunities were there, I believe there should be community attachments from the beginning of
the curriculum so that we can relate to the real scenarios and learn to cater the community from
the beginning.

There were no electives whatsoever. But if there was a chance it would have been better even for
a short period, because it could give us the chance to feel responsible for our own choices, it
could facilitate career choices, and it could inspire students at times.

Our system was systematic and not apprenticeship based. It was better because students need
variety of patients and disciplines to learn the core, it was a rational way of dividing
competencies and time of the teachers among everyone but not one student.

So it is an ever changing spectrum and we should always allow it to be, because the position of
our curriculum at each spectrum depends on individual needs of the different faculties.
C) Extent of integration (500 words)

Need of integration of subjects in medical curriculum, has been discussed in many reports and
emphasized by many researchers. GPEP report, `Educating Medical Students', the report of the
ACMETRI project and Tomorrow's Doctors and the recommendations of the General Medical
Council in the UK similarly discuss about this topic(Ronald M. Harden, 2000). Integrated
teaching has many benefits and can make a curriculum delivered more effectively. However
there has been debate over integration. In SPICES model(Ronald M. Harden et al., 1984) the
integration is described as a continuum between full integration and discipline based teaching.
However, Harden in his article of integration ladder, defines eleven points on a continuum
concerning these two extremes namely, Isolation, Awareness, Harmonization, Nesting, Temporal
co-ordination, Sharing, Correlation, Complementary , Multi-disciplinary, Inter-disciplinary,
Trans-disciplinary.

When describing the integration ladder, Step one that is Isolation is teaching subjects in isolated
departments where they consolidate their teaching in isolation where they select their own
content, organization of delivering the content and timing with no thought about any other
subject or discipline. Awareness is basically different subject professionals are aware of what is
being done by others departments but they still prefer to go by their subject. In the next step, in
Harmonization the professionals (teachers) of different disciplines communicate and are aware of
what is being taught by other departments and they can refer to areas that the others are doing
and help to make connections for students. (Common documents can be available for from
planning stages) In the next step (Nesting) a teacher takes in the knowledge and skills related to
other subjects within a subject based course. (Example: Basic sciences include sessions on
different case scenarios to show the connection) In temporal coordination the horizontal
integration of subjects takes place.(Example: In the first year , Anatomy, Biochemistry and
Physiology departments teach aspects related to CVS to understand normal structure and
function of the Cardio Vascular System) In the next step in the ladder, the common topics get
shared by departments (Example: Parasitology and Microbiology developing a course on
Defenses of the body) In the Step seven, correlation emphasis is on subject based teaching and
also include sessions at the end to help the students to incorporate (Example: discussion of a
common patient presentation at the end of a module) In the next step, that is Step eight,
(Complementary)more integrated sessions are taking place. It includes incorporation of subject
based teaching. In the next step, multidisciplinary inputs from different departments come under
a common theme and it helps the student to make learning more meaningful. In the Step 10-
Interdisciplinary teachers from other disciplines cross over to teach related aspects in other
subjects. At that stage, the subjects begin to lose their subject identity. In the final step,
disciplines disappear like in Problem based learning. Real world problems are used as a starting
point of learning Focus.

Looking at our curriculum I can say that the first year subjects were mostly at step 1 and 2. But
towards the second year it became step 3 and 4. And towards the final year appointments, at
some instances, the teaching learning activities were at a much higher place in the integration
ladder. (Only at some instances, not the whole curriculum)
d) Meeting the standards of SLQF (250 words)

Sri Lanka Qualifications Framework classifies qualifications into 12 levels based on the learning
achieved by the learner, at the time of completing a given qualification(Sri Lanka Qualifications
Framework (SLQF), n.d.). Quantity and Quality of learning achieved by a learner is measured
by volume of learning and learning outcomes and level descriptors respectively. Volume of
learning is calculated measuring the hours involved in teaching time, learning time and
assessment time. The time is then converted to credits. In the medical undergraduate degree, the
SLQF level is 6 which include 120 credits after SLQL 2.

When we consider the learning outcomes and level descriptors, the following points are
considered

Subject / Theoretical Knowledge, Practical Knowledge and application , Communication,

Teamwork & Leadership, Creativity & Problem Solving, Managerial and Entrepreneurship,
Information Usage & Management, Networking and Social Skills, Adaptability and flexibility,
Attitudes, Values & Professionalism , Vision for Life , Updating self.

When considering our curriculum I personally feel that even if we were placed at the level 6, we
possess even higher standards, volume wise and outcome wise. Its because we dedicate
ourselves to the curriculum and are involved in more ward work the volume is definitely high.
And the knowledge, skills communication skills and attitudes are shaped because of the ward
procedures and patient handling at the clinical appointments. Social skills, adaptability and
flexibility, Attitudes, Values and professionalism, Vision for Life automatically comes with the
routine ward work and shadow on-calls and community attachments. IT skills and self-updating
ability has been provided from the orientation and till the end of the curriculum.
e) Meeting the basic requirements of QA (250 words)

Quality assurance is the positive assertion of the degree of excellence. This assertion can be on
several criterions. Within a criterion, there are several standards. To show the achievement of
each standard, evidence should be provided. The evidence is in terms of Performance Indicators.
(Joshi, 2012)

According to the University Grants Commission Manual, Sri Lanka (graduate Study
Programmes of Sri Lankan Universities and Higher Education Institutions, 2015) its been said
that the Academic Programmes of study should reflect Universitys mission, goals and
objectives. Curriculum should be outcome based and should equip the students with knowledge,
skills and attitudes to succeed in the world of work and for lifelong learning. Programme design
should be initiated by describing the graduate outcomes of the programme followed by a clear
mapping of course/module outcomes to the programme outcomes. Learning outcomes should be
developed and described with reference to a particular level of study based on (in compliance
with) the Sri Lanka Qualification Framework (SLQF). All programmes outcomes should be
clearly aligned with course outcomes, content, teaching / learning and assessment strategies
(constructive alignment). Programmes should seek to engage students in a variety of learning
activities that would encourage diversity, flexibility, accessibility and autonomy of learning, and
produce compatibility between curriculum, student-centered teaching methods, and assessment
procedures. Essentially the final curriculum is an interaction between learning outcomes,
methods of assessment, teaching methods and content. There should be an effective process for
regular monitoring and review of design, development and approval of programmes.(graduate
Study Programmes of Sri Lankan Universities and Higher Education Institutions, 2015)

According to the document, I think our curriculum was compatible with most of the said
criterions. However, to analyze the evidence one by one I think I need more exposure as how the
curriculum has been formulated and aligned at the beginning and how it evolved throughout the
years.
2. Propose appropriate evaluation methods/tools to evaluate the selected course (500 words)

Evaluation is an important part of the educational process. The aim of evaluation is on quality
enhancement and is equal to clinical audit. Evaluation is a part of the quality assurance
procedure, but the value of it is much higher in terms of providing evidence in how well
students learning objectives are being accomplished and whether teaching principles are being
sustained. It also allows the curriculum to develop. A curriculum should constantly develop in
response to the needs of its stakeholders. Evaluation can compare that it has been directed in that
pathway. It should be viewed positively because it helps the academic staff to come to decisions
and it helps students to effectively plan their work.

Theres a famous model on which to focus evaluation(Programme outcomes) by Kirkpatrick as

follows (Cantillon, 2005);

Level 1Learners reactions

Level 2aModification of attitudes and perceptions

Level 2bAcquisition of knowledge and skills

Level 3Change in behaviour

Level 4aChange in organizational practice

Level 4bBenefits to patients or clients

I suggest that we stick the same model and principles when formulating questionnaires and
designing ways for evaluating our curriculum. We should maintain reliability, validity,
acceptability but it should be inexpensive as well. Also, we should remember that it is a
continuous cycle which contains steps from engaging the stakeholders to sharing the lessons
learned. The outcomes to be evaluated should be properly identified beforehand. Outcomes are
conceptual and often imperceptible.

We should plan on a good sample number. We can involve students in evaluation; they are a
valid and reliable source of gathering information. Also emphasizing the need of data and the
purpose may give them a sense of ownership and it can result in better sampling. Anonymity
should be maintained. Also they should know that their ideas are being considered and valued.
The teachers should also be involved. That should be involved in both self-evaluation and peer-
evaluation. In self- evaluation it is self-reflective and will provide motivation to change. We can
utilize and train them on using log book, portfolios and even utilize video tapes which have been
recorded during teaching sessions. In peer-evaluation, direct observation can be used as well as
mutual classroom exchange visits by several teachers.

The methods that can be utilized are questionnaire surveys, information from student assessment
and interviews. Interviews could be individual or in groups. Individual interviews can result in
descriptive and detailed views. Questionnaires are useful because it can gather information from
a large cohort. However the quality may be poorer than the individual interviews. The data from
the assessments can be utilized to find out whether the Intended learning outcomes have been
achieved. Also, we can analyze the tasks which are successfully completed in OSCE stations.
This kind of analysis can give us an idea of the competency of the skills and attitude that are
been taught. We can gather information and finally provide integrated recommendations.

We should remember that the main purpose of evaluation is curriculum development. And we
should always respect the cyclical tendency in curriculum evaluation and feedback and reforms.
References

Biggs, J. (2003). Aligning teaching for constructing learning. Higher Education Academy, 14.

Constructive Alignment. (n.d.). Retrieved February 18, 2017, from

http://www.johnbiggs.com.au/academic/constructive-alignment/

Constructivism. (2015, June 20). Retrieved from https://www.learning-

theories.com/constructivism.html

Cantillon, P. (2005). ABC of learning and teaching in medicine. London: BMJ Books.

Graduate Study Programmes of Sri Lankan Universities and Higher Education Institutions.
(2015). Retrieved February 16, 2017, from https://www.pdn.ac.lk/centers/iqau/upload/PR-
manual.pdf

Harden, R. M. (1986). Ten questions to ask when planning a course or curriculum. Medical
Education, 20(4), 356365.

Harden, Ronald M. (2000). The integration ladder: a tool for curriculum planning and evaluation.
MEDICAL EDUCATION-OXFORD-, 34(7), 551557.

Harden, Ronald M., Sowden, S., & Dunn, W. R. (1984). Educational strategies in curriculum
development: the SPICES model. Medical Education, 18(4), 284297.

Joshi, M. A. (2012). Quality assurance in medical education. Indian Journal of Pharmacology,

44(3), 285287. https://doi.org/10.4103/0253-7613.96295

Sri Lanka Qualifications Framework (SLQF). (n.d.). Retrieved February 17, 2017, from
http://www.ugc.ac.lk/en/all-notices/1156-sri-lanka-qualifications-framework.html