Margery H. Davis

AMEE Guide No. 14: Outcome-based education: Part 1-An introduction to outcome-based education

SUMMARY Outcome-based education, a performance-based approach at the cutting edge of curriculum development, offers a powerful and appealing way of reforming and managing medical education.The emphasis is on the product‐ what sort of doctor will be produced‐ rather than on the educational process. In outcome-based education the educational outcomes are clearly and unambiguously speci® ed. These determine the curriculum content and its organisation, the teaching methods and strategies, the courses offered, the assessment process, the educational environment and the curriculum timetable.They also provide a framework for curriculum evaluation. A doctor is a unique combination of different kinds of abilities. A three-circle model can be used to present the learning outcomes in medical education, with the tasks to be performed by the doctor in the inner core, the approaches to the performance of the tasks in the middle area, and the growth of the individual and his or her role in the practice of medicine in the outer area. Medical schools need to prepare young doctors to practise in an increasingly complex healthcare scene with changing patient and public expectations, and increasing demands from employing authorities.Outcome-based education offers many advantages as a way of achieving this.It emphasises relevance in the curriculum and accountability, and can provide a clear and unambiguous framework for curriculum planning which has an intuitive appeal. It encourages the teacher and the student to share responsibility for learning and it can guide student assessment and course evaluation. What sort of outcomes should be covered in a curriculum, how should they be assessed and how should outcome-based education be implemented are issues that need to be addressed.

Task-based learning: the answer to integration and problem- based learning in the clinical years

Integrated teaching and problem‐based learning (PBL) are powerful educational strategies. Difficulties arise, however, in their application in the later years of the undergraduate medical curriculum, particularly in clinical attachments. Two solutions have been proposed – the use of integrated clinical teaching teams and time allocated during the week for PBL separate from the clinical work. Both approaches have significant disadvantages. Task‐based learning (TBL) is a preferred strategy. In TBL, a range of tasks undertaken by a doctor are identified, e.g. management of a patient with abdominal pain, and these are used as the focus for learning. Students have responsibility for integrating their learning round the tasks as they move through a range of clinical attachments in different disciplines. They are assisted in this process by study guides.

Planning and implementing an undergraduate medical curriculum: the lessons learned

In 1995 Dundee medical school introduced an integrated, systems-based spiral curriculum with a number of innovative features. The medical school has now had eight years’ experience of the curriculum. This paper describes the changes that have taken place in the curriculum over the eight years. Evidence from internal and external reviews and student examination data are used to identify the lessons learned from implementing the curriculum. The Dundee experience, the approaches to the curriculum described and the conclusions reached are relevant to all with an interest in medical education.

The continuum of problem-based learning

Problem-based learning (PBL) has been recognized as an important educational strategy and has been adopted in many medical schools. There is confusion, however, about what constitutes PBL. In the SPICES model for educational strategies PBL is presented as a continuum. This paper describes 11 steps in the continuum between problem-based learning and information-orientated learning. Task-based learning is viewed as the final step at the problem-based end of the spectrum. The continuum presented recognizes the two key variables-the problem and the information or principles derived from a study of the problem. It builds on the rul-eg/eg-rul approaches introduced in programme learning in the 1960s. The continuum offers a useful taxonomy to describe PBL. It emphasizes the range of options and in so doing helps to avoid a polarization of viewpoints between enthusiasts and traditionalists. The continuum can be used as a tool for curriculum evaluation and development.

AMEE Medical Education Guide No. 5. The core curriculum with options or special study modules

A core curriculum with options, or special study modules, is a response to the major problem of content overload. Mastery of the core, which may cover knowledge, skills and attitudes, ensures the maintenance of standards: the options or SSMs (special study modules) allow in-depth work and the achievement of higher-level competences, such as critical thinking. Students, encouraged to take more responsibility for their own learning, can choose the subjects they study. The core curriculum can be specified in various ways. This is the responsibility of teachers, of subject specialists, the medical profession more generally, and of the public. An SSM may entail a more detailed study of part of the core, where the student has already acquired prerequisite basic knowledge or skills. An SSM may cover a medically or clinically related topic, such as sports medicine and the locomotor system. SSMs can be completely unrelated to the core and indeed to medicine, e.g. studying a foreign language. Options or special stu...

AMEE Education Guide no. 28: The development and role of departments of medical education

A department of medical education is becoming an essential requirement for a medical school. This publication is intended for those wishing to establish or develop a medical education department. It may also prove useful to teachers in medicine by providing information on how such a department can support their activities. This will vary with the local context but the principles are generalizable. Medical education departments are established in response to increased public expectations relating to healthcare, societal trends towards increased accountability, educational developments, increased interest in what to teach and how to educate doctors and the need to train more doctors. The functions of a department of medical education include research, teaching, service provision and career development of the staff. The scope of its activities includes undergraduate and postgraduate education, continuing professional development and continuing medical education. These activities may be extended to other healthcare professions. Flexibility is the key to staffing a department of medical education. Various contractual arrangements, affiliations and support from non-affiliated personnel are needed to provide a multi-professional team with a range of expertise. The precise structure of the department will depend on the individual institution. The name of the department may suggest its position within the university structure. The director provides academic leadership for the department and his/her responsibilities include promotion of staff collaboration, fostering career development of the staff and establishing local, regional and international links. Financial support may come from external funding agencies, government or university sources. Some departments of medical education are financially self-supporting. The department should be closely integrated with the medical school. Support for the department from the dean is an essential factor for sustainability. Several case studies of medical education departments throughout the world are included as examples of the different roles and functions of a department of medical education.

Student perceptions of a portfolio assessment process

Objectives  The objectives of this study were to identify and analyse students’ attitudes to the portfolio assessment process over time.

The place of the oral examination in today's assessment systems

(2005). The place of the oral examination in todays assessment systems. Medical Teacher: Vol. 27, No. 4, pp. 294-297.

EditorialCompetency-based assessment: making it a reality

This quotation is the introduction to the 2003 report from the Institute of Medicine of the National Academies in the USA (Greiner & Knebel, 2003). Health Professions Education: A Bridge to Quality makes the case that reform of health professions’ education is critical to enhancing the quality of healthcare in the United States. The report focuses on integrating a core set of competences—patient-centred care, interdisciplinary teams, evidence-based practice, quality improvement and informatics—into health professions’ education. All health clinicians, it is argued, should possess these core competences regardless of their discipline if they are to meet the needs of the twenty-first-century healthcare system. The goal is an outcome-based education approach that better prepares clinicians to meet both the needs of patients and the requirements of a changing health system. This move in the training of doctors from an emphasis on process to one on product and from input-based education to results-orientated thinking has been highlighted in recent years (Harden, 2002). The Association of American Medical Colleges (AAMC, 1998) in the USA identified four goals for medical education: the physician must be altruistic, knowledgeable, skilful and dutiful. The World Health Organization rolled out the notion of the five-star doctor for the twenty-first century (Boelen, 1992)—she would be a care provider, decision maker, communicator, manager and community-minded. Smith & Dollase (1999) identified nine abilities for graduates of their MD 2000 medical programme at Brown University in Rhode Island. In Canada, the CanMeds 2000 project presented their essential roles and key competences of specialist physicians: medical expert, communicator, collaborator, manager, health advocate, scholar and professional. The Accreditation Council for Graduate Medical Education (ACGME, 1999) in the USA identified the outcomes for graduate medical education. Bloch & Burgi (2002) presented their Swiss catalogue of learning objectives. In the UK the General Medical Council (GMC, 2002a; Rubin & Franchi-Christopher, 2002) announced its move to an outcome-based approach and the Institute for International Medical Education (IIME) identified the global minimum essential requirements in medical education (Schwarz & Wojtczak, 2002). Harden et al. (1999a) identified 12 learning outcomes for an effective doctor and represented the outcomes in a three-circle model (Harden et al., 1999b), derived from the concept of multiple intelligences provided by Gardner (1983). In March 2000, the Scottish Deans’ Medical Curriculum Working Group recommended this model and the 12 learning outcomes for all five Scottish medical schools (Simpson et al., 2002). Prompted by UK Government reports such as Unfinished Business (Donaldson, 2002), the Medical Royal Colleges set about identifying outcome-based curricula for postgraduate training in a range of specialities. The Joint Committee on Higher Medical Training (2003) published a higher medical training generic curriculum and a higher medical training curriculum for general (internal) medicine. Both were based on the General Medical Council (GMC) outcomes identified in Good Medical Practice (GMC, 2002). The components of surgical competence were identified by Rowley et al. (2002) on behalf of the Joint Committee on Higher Surgical Training. A logical and essential aspect of this competence-based approach to education is the assessment of students’ achievements of the necessary competences or outcomes. The learning outcomes must be clearly specified, but so also must be the methods of assessment whereby the students’ achievements are judged. Fletcher (1997) surveyed competence-based assessment techniques outwith the health professions and Gonczi (1994) provided information about the development of competence-based standards and assessment in 19 professions in Australia. In medicine, Stern et al. (2003), working with the IIME task force for assessment, have identified the assessment tools currently used in medicine and categorized them according to their appropriateness for assessing the outcomes or global minimum essential requirements. In another paper in this issue of Medical Teacher, Shumway & Harden (2003) have reviewed five categories of assessment instruments for outcome-based assessment: written assessments, clinical or practical assessments, observations, portfolios and other records of performance, and peer and self-assessment. They emphasize the importance of developing an assessment system for outcome-based assessment using an assessment toolkit that profiles the learner in terms of the learning outcomes. The Scottish Deans’ Curriculum Working Group (2001) have progressed from a statement of the learning outcomes for the medical undergraduate to a report on their assessment. An assessment manual for postgraduate education has been produced by Holmboe & Hawkins (2001).

Case studies in outcome-based education

Outcome-based education is one of the most significant global developments in medical education in recent years. This paper presents four case studies of outcome-based education from medical schools in different parts of the world; Scotland; USA; Pakistan; and Singapore. The outcome-based curricula have either been in place for some time, are evolving or are at the planning proposal stage. The outcomes, change process and implementation of the outcome-based approach are described. Variation in the extent to which each medical school has implemented outcome-based education is discussed and key points for successful implementation are highlighted. This paper is based on the pre-conference symposium “outcome-based curricula: global perspectives” presented by the authors at the 4th Asia Pacific Medical Education Conference (APMEC) in Singapore, 8–11 February, 2007.