Running head: ASSESSMENT OF A CURRICULUM MODEL

Assessment of a Curriculum Development Model Kelly J. Thelen University of Idaho

ASSESSMENT OF A CURRICULUM MODEL

Assessment of a Curriculum Development Model Medical Assisting courses will combine cognitive learning and practice of psychomotor skills in classroom and laboratory settings. Clinical training through externships in local outpatient clinics and physician offices will allow students to observe and practice skills gained in the classroom and lab in actual healthcare settings. Medical Assistants are skilled professionals who perform administrative functions and basic clerical skills including medical insurance coding and processing, as well as clinical skills including vital signs, sterile technique, diagnostic testing, and laboratory procedures. Medical Assisting Program Goals 1. To prepare Walla Walla Community College (WWCC) Medical Assisting program graduates as competent entry level medical assistants having the knowledge base necessary for success in credentialing exams and professional practice. 2. To ensure that WWCC Medical Assisting program graduates are capable of performing the psychomotor skills expected of an entry level medical assistant in all the basic competencies of the profession. 3. WWCC Medical Assisting program graduates will model professional behaviors which are exemplar of the high standards required by industry, their profession, and the larger community of healthcare providers, ensuring success as entry level medical assistants (Galusha et al, 2008).

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Section 1: Governance of Curriculum Overview of the College: Walla Walla Community College has a present annual enrollment of over 13,000 students. Located on approximately 100 acres, WWCC serves as the educational center for Southeast Washington. WWCC also has a satellite campus located in Clarkston to serve residents of Asotin and Garfield County. WWCC also maintains a facility at Washington State Penitentiary. WWCC is accredited by the Northwest Commission on Colleges and Universities and is certified by the Washington State Board for Community and Technical Colleges. WWCC offers courses in Academic Transfer Education, Professional-Technical Education, Transitional Studies, and Academic courses. Most of these courses are then transferable to baccalaureate institutions in Washington and many schools in neighboring states. Walla Walla Community College (WWCC) has been previously audited by the accreditation body known as the Commission on Accreditation of Allied Health Education Programs (CAAHEP) for its Nursing Program. However, as the Medical Assisting Program was recently initiated in 2008, the first accreditation audit by CAAHEP is scheduled for December of 2010. The audit will consist of compiling information from three separate data sources: student documentation and sample work product, interviews with students and faculty, and site visits. All program faculty are required to maintain individual student portfolios demonstrating proficiency of the core competencies of the Medical Assisting program. These files must be kept for each student for three class years to be presented at time of the initial audit. Evaluation of

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students must be conducted on a recurrent basis to provide both the students and program faculty with valid and timely indications of the students progress toward and achievement of the competencies and learning domains stated in the curriculum. Documentation should include appropriate written, practical, and/or oral evaluations of student learning based on all components of the Core Curriculum for Medical Assisting. The Nursing Program undergoes a similar process under a different organization, (NLN). The only information that can be shared are the assessments of general college resources, institutional goals, and other broad information that applies to all programs of study offered at Walla Walla Community College. The purposes of CAAHEP are as follows: 1. Promote and support the education of competent and caring allied health professionals and the continued improvement of allied health education programs. 2. Inform the public of the status of the Commissions educational programs. 3. Establish standards of accreditation based on input from the profession and other communities of interest. 4. Maintain integrity and assure credibility of the process of accrediting allied health education programs. 5. Enhance and promote dialogue among all parties and accrediting agencies in the allied health field. 6. Compile, analyze, and disseminate information and data on allied health education and accreditation within the allied health education system.

ASSESSMENT OF A CURRICULUM MODEL 7. Promote the study of critical issues in allied health education and accreditation and respond to the changing health care needs of society by assisting institutions that respond to public policy initiatives (Jondahl, 2010). 3. The accreditation audit provides vast amounts of information to teachers including: Ways of aligning curriculum, instruction, and assessment with the American Academy of Medical Assistants (AAMA) and other Medical Assisting programs. Ways of implementing effective instruction and assessment strategies to meet students differentiated learning styles and needs. How to select standards based curriculum in all academic areas. Identifying strengths and weaknesses in the curriculum cycle. Sharing experience in planning and conducting future evaluations.

CAAHEP reports on any perceived deficiencies between the required curriculum content and the actual course content. Correcting any errors will ensure the curriculum is in compliance with accreditation standards. 4. Information that could prove to be problematic as discovered from the accreditation audit include: The curriculum does not meet accreditation standards set by CAAHEP. The learning objectives and scope of practice are not developed for each course. Administrators are not adequately monitoring curriculum implementation. If accreditation is not awarded upon the initial application and site review, the college will incur extra expense in repeating the process. Program graduates will also have an

ASSESSMENT OF A CURRICULUM MODEL extended waiting period before being eligible to participate in the AAMA CMA

credentialing exam or the AMT RMA credentialing exam. The curriculum would only be affected if there is a deficiency in the curriculum causing non-compliance, rather than program resources or procedures causing non-compliance. Initial accreditation is granted for a period of five years and expires at that time unless CAAHEP grants continuing accreditation to the program. If the program is granted continued accreditation, the next comprehensive review would be no later than five years after the continuation or ten years after the initial accreditation. WWCC has an active Curriculum Committee which oversees development of individual classes. The Workforce Education Division works extensively with the Washington State Board for Community and Technical Colleges to ensure that each program meets industry and SBCTC standards for each occupation through the new program application and review process. This process documents industry review of curriculum as it is developed and also ensures adequate contact hours and inclusion of required related instruction requirements. Additionally, all faculty positions are required to participate in the Professional Improvement process as part of their annual contract. Each faculty member may earn professional improvement units (PIU) by participating in workshops, seminars, conventions, and other instructional activities. Faculty members are formally evaluated by students, peers, and supervisors on a regular basis depending on their employment status: there are different evaluation schedules for adjunct, tenuretrack, and tenured faculty. Section 2: Content of Curriculum

ASSESSMENT OF A CURRICULUM MODEL 1. The approach to curriculum coordination that best fits my curriculum is the systems approach to curriculum coordination. In this model, goals, classroom objectives and activities, and measures of student performance are all aligned. Where my curriculum focuses on training students for a career, teachers are focusing their educational materials on the desired outcome of working as a Medical Assistant. At the end of the year, students are given a national examination and participate in an exit interview to help further plans for

improvement for future classes. Standards and performance objectives are clearly set by the AAMA and CAAHEP and these written performance standards are distributed to our students. Student achievement is monitored each quarter, and students are required to achieve a minimum of 72% to proceed to the next quarter in the program. 2. The systems method is the best approach for this type of curriculum. The Medical Assisting Program needs to be very structured and have specific learning objectives clearly outlined. Students need to have clear expectations set forth. Mandatory curriculum content based on accreditation is the result of extensive occupational analysis. Compliance with all accreditation mandated content in the Psychomotor, Cognitive, and Affective domains of learning will ensure that all WWCC Medical Assisting graduates are fully prepared to enter the Medical Assisting workforce. According to accreditation requirements the curriculum is driven by Standards and Guidelines. Textbooks are used as a secondary tool to aide in instruction of the required curriculum. Medical Assisting curriculum is largely competency based, which ensures orientation toward student learning.

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General, Clinical, and Administrative Skills* of the CMA (AAMA)

Communication l Recognize and respect cultural diversity l Adapt communications to individuals understanding l Employ professional telephone and interpersonal techniques l Recognize and respond effectively to verbal, nonverbal, and written communications l Utilize and apply medical terminology appropriately l Receive, organize, prioritize, store, and maintain transmittable information utilizing electronic technology l Serve as communication liaison between the physician and patient l Serve as patient advocate professional and health coach in a team approach in health care l Identify basics of office emergency preparedness t Legal Concepts l Perform within legal (including federal and state statutes, regulations, opinions, and rulings) and ethical boundaries l Document patient communication and clinical treatments accurately and appropriately l Maintain medical records

ASSESSMENT OF A CURRICULUM MODEL l Follow employers established policies dealing with the health care contract l Comply with established risk management and safety procedures l Recognize professional credentialing criteria l Identify and respond to issues of confidentiality t Instruction l Function as a health care advocate to meet individuals needs l Educate individuals in office policies and procedures l Educate the patient within the scope of practice and as directed by supervising physician in health maintenance, disease prevention, and compliance with patients treatment plan l Identify community resources for health maintenance and disease prevention to meet individual patient needs l Maintain current list of community resources, including those for emergency preparedness and other patient care needs l Collaborate with local community resources for emergency preparedness l Educate patients in their responsibilities relating to third-party reimbursements t Operational Functions l Perform inventory of supplies and equipment l Perform routine maintenance of administrative and clinical equipment l Apply computer and other electronic

ASSESSMENT OF A CURRICULUM MODEL equipment techniques to support office operations l Perform methods of quality control.
t Fundamental Principles

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l Identify the roles and responsibilities of the medical assistant in the clinical setting l Identify the roles and responsibilities of other team members in the medical office l Apply principles of aseptic technique and infection control l Practice Standard Precautions, including handwashing and disposal of biohazardous materials l Perform sterilization techniques l Comply with quality assurance practices t Diagnostic Procedures l Collect and process specimens l Perform CLIA-waived tests l Perform electrocardiography and respiratory testing l Perform phlebotomy, including venipuncture and capillary puncture l Utilize knowledge of principles of radiology t Patient Care l Perform initial-response screening following protocols approved by supervising physician l Obtain, evaluate, and record patient

ASSESSMENT OF A CURRICULUM MODEL history employing critical thinking skills l Obtain vital signs l Prepare and maintain examination and treatment areas l Prepare patient for examinations, procedures and treatments l Assist with examinations, procedures, and treatments l Maintain examination/treatment rooms, including inventory of supplies and equipment l Prepare and administer oral and parenteral (excluding IV) medications and immunizations (as directed by supervising physician and as permitted by state law) l Utilize knowledge of principles of IV therapy l Maintain medication and immunization records l Screen and follow up test results l Recognize and respond to emergencies.
Administrative Procedures
q

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Schedule, coordinate, and

monitor appointments l Schedule inpatient/ outpatient admissions and procedures

ASSESSMENT OF A CURRICULUM MODEL l Apply third-party and managed care policies, procedures, and guidelines l Establish, organize, and maintain patient medical record l File medical records appropriately t Practice Finances l Perform procedural and diagnostic coding for reimbursement l Perform billing and collection procedures l Perform administrative functions, including bookkeeping and financial procedures l Prepare submittable (clean) insurance forms.

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3. All students must complete an unpaid, supervised practicum of a minimum of 160 contact hours in an ambulatory healthcare setting. Prior to graduation, while there they will be demonstrating psychomotor and affective competencies. On site supervision must be provided by an individual who has knowledge of the Medical Assisting profession. 4. In developing a coherent curriculum in any school, the most important principles can be summarized in the following sentence. Consistency in course content across teachers in terms of texts, topics, assignments, and entrance and exit

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criteria is essential ( Hewitt, 2006). One of the most common complaints I hear from students is their frustration stemming from teacher inconsistencies. Students need clearly defined goals and objectives to follow. When teachers stray from an accepted pattern, it causes increased levels of student anxiety and uncertainty. I am training students for a career that expands across every state. I need to make sure that students in Washington know the same clinical skills as Medical Assisting students in Texas and New York. For accreditation standards, the entrance prerequisites and standard exit scores must remain consistent from state to state.

Course Listings for Medical Assisting

MEDA 105 Health Occupations Mathematics MEDA 110 Human Body Structure and Function in Health and Disease I MEDA 114 Therapeutic Relationships MEDA 120 Human Body Structure and Function in Health and Disease II MEDA 125 Clinical Procedures MEDA 140 Medical Law and Ethics MEDA 144 Medical Office Administrative Procedures MEDA 145 Office Emergencies for Medical Assistants MEDA 191 Medical Assisting Practicum MEDA 192 Medical Assisting Seminar

Year One
Fa W Sp Su

Year Two
Fa W Sp Su

X X X X X X

X X X X X X

Section 3: Process for Developing, Managing, and Improving Curriculum and Instruction 1. With regard to my curriculum, the model of evaluation that best fits is the consensus model consisting of both the traditional and technical evaluation components. I evaluate on a micro level. Both mastery (i.e. has the learner

ASSESSMENT OF A CURRICULUM MODEL acquired enough competency to succeed at the next level?) and diagnosis (i.e.

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what particular difficulties is this learner having?) are both central components in the Medical Assisting Program at WWCC. Our program applies several themes central to formative evaluation including: Identifying aspects of the courses where revisions are desirable. Collecting evidence midway through curriculum development, while the course is still ongoing. Examining how the course produces its effect and what factors influence its effectiveness. I do believe this model is currently being utilized in our Medical Assisting Program to date. 2. I am currently unaware of any technologies that could be considered problematic that are being used in the Medical Assisting curriculum today. 3. The types of assessment data currently being utilized include, classroom hands-on laboratory activities, online quizzes (both pre and posttest), and computerized tests generated at the national level for Medical Assistant student graduates to become nationally certified. The primary audience for the assessments is of course the Medical Assisting students, the Curriculum Committee, the Advisory Board, the Foundations Board of Directors, and Marilyn Galusha, the head of the Allied Health Department for the college. 4. The hazards of evaluation methods that would apply to my curriculum include: The lack of pre and posttest scores for each treatment participant. The use of pretest scores to select program participants.

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5. A possible learning activity that I could select for my students would be studying enzymes through kinetic activity. This is in the form of a laboratory experiment. Students will investigate the rate at which the enzyme catalase converts substrate to product by subjecting it to hydrogen peroxide (H2O2) under different pH and temperature conditions. Before beginning this laboratory activity, I will assess my students prior knowledge of enzyme activity and function, binding specificity, and factors that can influence enzymatic activity. After the experiment, students will be asked to provide their data to the rest of the class. All summative data will be written on the whiteboard for the class to copy into their lab notebooks and to serve as a guide in preparing their formal laboratory write-up. 6. Assessments: Students will calculate the rate of an enzymatic reaction by measuring the disappearance of substrate of the appearance of product. Students will then graph the rate of change of y/change of x. Students will also graph the rate of enzyme activity versus temperature and enzyme activity versus pH and compare individual data with class data. The results will be recorded in the students lab notebooks. Critical Thinking: At higher concentrations of H2O2, there is an increased probability that catalase will collide with H2O2. Design a series of experiments to investigate how differing the concentration of the substrate might affect the rate of enzyme activity. Section 4: Teachers and the Politics of Curriculum 1. People who influence my curriculum include:

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Teachers (choose what information to emphasize, instructional strategies, evaluation methods) Administrators (State Board of Education, PTTE programs) Students College Curriculum Committees Advisory Boards Testing Agencies (AAMA) Accrediting Bodies (CAAHEP) WWCC Education Foundation 2. In terms of curriculum design and planning, I favor a combination of the Needs Assessment model, the Rational Model, and the Vocational/Training Model. First, regarding the Needs Assessment Model of curriculum, I agree that teachers and administrators should give careful consideration in selecting relevant objectives for their students to attain. Reflecting back on the works of James Popham and his behavioral objectives, learner-centered curriculum places priority on desires of the students in the classroom setting. According to Popham, (Hewitt, 2006) in Step 1, educational goals are identified. In Step 2, guidelines are established for the mastery proportion, or the percentage of students that should achieve each objective. Step 3 identifies the current academic standing of the learner, and Step 4 helps to select new goals by contrasting the desired with the current status of the learner. In this model, the teacher sequentially orders specific ends for learners to attain. Follow-up activities are then carried out to reinforce learning each set objective. If the student does not achieve the first objective, a new teaching strategy needs to be implemented.

ASSESSMENT OF A CURRICULUM MODEL Sequential learning is followed by evaluation to ascertain if success in attainment is verifiable. The ends chosen by the teacher are selected based on the learner needs.

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These needs then become future objectives for students to obtain mastery. Kaufman stated, Needs assessment is a process of defining the desired end of a given sequence of curriculum development (Hewitt, 2006). This model makes sense to me because the learning is proceeding in a very logical, ordered fashion and the evaluation methods are directly linked to the objectives at hand. If one objective is not mastered by all students, the teacher incorporates new methods, rather than skipping over select objectives. Finally, vocational classes are designed for students who plan to enter the work force directly after high school. These courses and programs generally incorporate hands-on, practical approaches to learning with less focus on rigorous academics. Vocational curriculum focuses on subject matter concepts in real-world applications. My approach most closely resembles this model because my curriculum focuses on Anatomy and Physiology for the Medical Assisting Program. Vocational training is focusing on developing competence in one specific content area. Section 5: Content of Curriculum 1. My curriculum promotes an academic viewpoint of traditional thinking. This model focuses on categorization, conceptualization, and relating categories. The Medical Assisting students learn basic operations (Medical math), classifying (Medical Terminology), problem-solving strategies (Clinical Applications and Pharmacology courses) and domain-specific knowledge (Anatomy and Physiology).

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2. My curriculum promotes primarily procedural rather than conceptual knowledge. The Medical Assisting Program as well as the general health care field is very specific regarding the required knowledge. Much of the curriculum is based on sequential steps, memorization, and recitation of facts and numbers. For example, in Clinical Procedures the students are instructed in the necessary steps for giving a patient an injection. This procedure has to be completed in a precise manner with the steps occurring sequentially. In my curriculum, achievement is measured in terms of grades or percentages. Students are required to maintain at least a 72% average in each of their required courses to be eligible to advance to the next quarter. I do believe a 72% C- average is a very realistic expectation for students to achieve. Their laboratories and clinical practicums are skill based and must be passed with 100% proficiency given two tries. However, even with this attainable level of achievement, we still have a high level of attrition in the Medical Assisting Program. One reason for this may be a lack of prerequisites for admission into the program, low academic mindset of the students, and students who are ill prepared for college with a very low set of study skills. Section 6: Ideas for Continuous Improvement 1. In the future, the recommendation for science curriculum is focused more toward inquiry-based learning. Further, new materials are to be developed for use with new areas of modern science. Instructional activities would be directly linked to the students community with more emphasis being placed on the limitations of science. Science curriculum should be viewed as an essential component of

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knowledge for all students. Science content would be limited to fewer topics but taught with greater detail. 2. How will these new trends fit into my personal curriculum? I could start by answering this question in two ways. First, any career in the medical field will need to be flexible enough to change with basic technological advances. The health care field can never be viewed as static. However, the basics will likely remain relatively unchanged for a significant number of years. In summary, I am unable to provide a definitive statement. The program cannot be evaluated until three classes of graduates have completed the program. The faculty, administration, and Advisory Board have held many preparatory workshops and have filed our self-study with CAAHEP and the Medical Education Review Board. The third class will be matriculated in August of 2010 and the program administrators anticipate a formal audit in December 2010.

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References American Association of Medical Assistants. ( 2010). Retrieved from http://www.aamantl.org. Galusha, M. & Mason, B. (2008). WWCC Medical Assisting Program Webpage. Retrieved from http://www.wwcc.edu/Programs.com. Galusha, M. & Mason, B. (2008). WWCC Medical Assisting Student Handbook. Retrieved from http://www.wwcc.edu/MedicalAssisting.com. Hewitt, T. (2006). Understanding and shaping curriculum of what we teach and why. New York, NY: Sage Publications. Jondahl, J. (2010). Medical Assistant Education Review Board. Retrieved from http://www.maerb.org/GeneralReference/tabid/64/Default.aspx.