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Harden, R.,1986 - Ten Questions To Ask When Planning A Course or Curriculum
Harden, R.,1986 - Ten Questions To Ask When Planning A Course or Curriculum
Harden, R.,1986 - Ten Questions To Ask When Planning A Course or Curriculum
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Medical Education 1986,zo, 356365
R. M. HARDEN
Summary. This brief practical aid to course or qualification or formal training in educational
curriculum development cannot replace educa- theory and practice. If asked to plan a course,
tional qualifications o r experience, but it does they will depend on common sense plus three
examine ten basic questions, any of which may factors based on experience. These are their
be all too easily neglected. These are: (I) What perception of the subject which they are
are the needs in relation to the product of the teaching, the way in which they were educated
training programme? (2) What are the aims and themselves and current teaching practice else-
objectives? (3) What content should be in- where.
cluded? (4) How should the content be orga- This approach may suffice but it can be
nized? ( 5 ) What educational strategies should be improved by considering the ten questions
adopted? (6) What teaching methods should be discussed here. Whether the end product is an
used? (7) H o w should assessment be carried undergraduate degree course, a short post-
out? (8) H o w should details of the curriculum graduate course or a I-hour lecture, a systema-
be communicated? (9) What educational en- tic approach encourages timely decision-
vironment or climate should be fostered? (10) making. Bandaranayake (1985) has suggested
How should the process be managed? Each that a prerequisite to quality and relevance is a
aspect is illustrated through the analogy of car sound curriculum plan which follows a sequ-
manufacturing. ence of logical steps based on accepted educa-
The ten questions are relevant in all situa- tional principles. It is certainly easier to modify
tions where a course or curriculum is being a course while it is being planned than it is to
planned, including an undergraduate degree combat problems raised by an inadequately
course, a short postgraduate course or a I-hour considered one already in full swing.
lecture. The professional’s responsibility for course
development may vary in extent. This article is
Key words: * Curriculum; *Education, medi-
intended to be a practical aid for:
cal; Scotland; Teaching/methods; Educational
- heads of academic departments responsible
measurement; Education, medical, undergradu-
for the teaching of their own subject;
ate
- members of teaching staff who may teach
only one course;
Introduction - members of curriculum committees with
Though some professionals have attended short overall responsibility for overseeing and
in-service courses in education, most have no planning the work of students in an institu-
tion;
Correspondence: Professor R. M. Harden, Centre
for Medical Education, University of Dundee, - experienced workers with trainee attach-
Ninewells Hospital and Medical School, Dundee ments;
DDI 9SY, Scotland. - members of a national committee or board
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Questions for planning a course nv curriculum 3 57
charged with setting out policy for their (I) What are the needs in relation to the
own discipline. product of the training programme?
Before going into practical questions in de-
For cars, this is largely a matter of deciding
tail, it is worth examining the concept of
what type is necessary, e.g. a sports car, family
‘curriculum’. In the narrowest form this in-
saloon, executive model, or small low-budget
cludes only content and examinations; learning
utility vehicle. In other words, the market
is deemed to result from the assembly and
helps determine the product.
assimilation of a long list of facts (content),
Some would argue this aspect has been
confirmed by assessment in the form of an
neglected in medical education, and that doc-
examination. A more forward-looking view of
tors have been trained in a way inappropriate to
the curriculum puts emphasis on the aims, on
meeting community needs. The extent to
the learning methods and on the subject-matter
which the training of hospital-based physicians
sequencing. These five aspects of the wider
o r family practitioners better meets community
curriculum should all influence each other
needs is a matter of debate. Many graduates
(Fig. I ) .
choose to work in the rarified atmosphere of
hospitals-the ‘ivory towers’ of medicine-
rather than in general practice. That choice may
reflect conditions of service, job opportunities
and financial rewards hut it is also influenced
by attitudes acquired during training. Some
areas-the ‘Cinderella specialties’-have been
largely neglected in undergraduate education.
High-technology ‘star’ subjects such as cardiol-
ogy have been presented in a more attractive
light than other areas such as rheumatology,
psychiatry and the care of the elderly or the
terminally ill. There is some evidence that too
Figure I. The wider curriculum. little emphasis has been placed on ‘bedside
manners’, comprising attitudes and interper-
sonal skills.
The purpose of the curriculum is to bring The need to produce doctors to serve the
order, coherence and intellectual discipline to public accompanies t w o others in any medical
the transmission of stored human experience. school-the production of teachers and of re-
The following list of ten questions is not searchers. H o w should these three needs be
intended to be a step-by-step guide to the balanced? Do all doctors need to be trained in
development of a curriculum. However, the the skills required for carrying out research in
first t w o (needs and aims) must be examined their own area of practice? Where should future
before considering the other eight in an order priorities lie in relation to research? Political as
dictated by circumstances. Frequently, consid- well as medical answers must be sought to such
eration of one question may cause a revision of questions.
the response to a previous question. A number of approaches may be used to
Because a concrete example is sometimes identify needs as a step in curriculum planning
easier to grasp than abstract concepts, an (Dunn et a l . 1985).
analogy-car production-illustrates each ques-
tion. Just as the factory has an end product-
(a) T h e wisemen approach
the car-so the final result from course or
curriculum should be an educated or voca- In this traditional approach, professors or
tionally trained student. The products differ other senior teachers describe what they believe
but problems of design and production are are the needs. They may express these views
shared. jointly as members of a committee or panel or
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358 R. M . Harden
independently through textbooks and other be obtained by studying the syllabi from a
publications. The Delphi technique, a method sample of medical schools.
relying on the judgement of an expert panel of
‘wise men’, has been used in curriculum plan-
(h) Views of recent graduates
ning to obtain a consensus opinion (Miller
1974). Graduates may be asked to identify areas of
practice which were covered in the curriculum
and areas which were not adequately repre-
(b) A study of errors in practice
sented. Wright et al. (I979), for example,
A study of errors in practice suggests needs undertook a survey of 600 randomly selected
not met by existing curricula. Information can doctors on what should be taught to under-
be obtained from studies designed for this graduates.
purpose or from available data held by medical Where needs are examined in curriculum
defence societies. One study has shown that planning this is done most commonly using a
human error was a factor in from 65 to 87% of ‘wiseman’ approach. However, more attention
anaesthetic deaths and i t suggested that studies is now being placed on a multifaceted approach
of such errors can provide information for in which a number of the approaches are used.
designing and evaluating changes in training
methods (Cooper et al. 1978).
(2) What are the aims and objectives?
Meanwhile, back in the world of industry, the
(c) Critical incident studies
manufacturer has considered the needs for cars
In this technique qualified individuals are and must now choose the aims and objectives
asked to describe medical incidents that hap- for his own factory. He decides not to cater for
pened to them or that they observed which all market sectors. Some are better met by
reflected good or bad medical practice (Flana- more specialized plant. Some show insufficient
gan 1954). demand to justify a production run. Many
could be satisfied by post-production modifica-
tion of a standard car. He chooses, therefore, to
(d) Task analysis of established practitioners
produce a family saloon, designed to allow
Here, the work carried out by a doctor is subsequent changes in specification.
observed and the tasks carried out by him or In medical education this is akin to a standard
her are recorded. undergraduate curriculum which is to be fol-
lowed by postgraduate specialty training. A
medical school may decide that its major aim is
(e) Analysis of morbidity and mortality statistics
to produce doctors who are able and motivated
Information about the needs in the commun- on qualification to meet the community’s needs
ity can be obtained from a study of the while also being capable of continuing their
morbidity and mortality statistics. education. Alternatively, the decision might be
taken to produce basic doctors who are unable
to work in any branch of medicine without
cf) Study of star performers further formal vocational training as postgradu-
In this approach an analysis is made of the ates. The curriculum objectives will specify in
important skills and competencies needed in the detail what the student should be able to do
profession as delineated by doctors identified as after completing the course.
being star performers. Figure z illustrates the general relationship
between needs and objectives. Area A repre-
sents identified needs matched by course objec-
(g) Analysis of existing curricula including syllabi
and examinations tives. Needs which are identified but are not
met by objectives occupy area B, while area C
Evidence about what is currently raught can shows objectives which do not reflect identified
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Questionsfor planning a course or curriculum 3 s9
not be dealt with easily within the course
constraints and were more appropriate as sub-
jects for interdisciplinary workshops with other
health-care team members or in discussions
B A C
with colleagues. In some instances, the identi-
fied needs could not be translated into course
Figure 2. General relationship between needs and
objectives. objectives because insufficient answers or solu-
tions to the problems were available.
McAvoy (1985) has reviewed the choice and
needs. For a perfect course, the circles would use of educational objectives in medical educa-
overlap completely and only area A would be tion and Carter (1985) has suggested a tax-
visible. However, this is not always possible as onomy designed to meet the needs of profes-
one course or curriculum seldom meets all sional education. An example of the aims for an
needs. For example, in the development of a undergraduate medical programme are given in
distance-learning course for general practition- Table I (Engel 1980).
ers, the needs were clearly specified by groups
of general practitioners. Some of these could
(3) What content should be included?
In the case of a car, three wheels are .essential.
Table I . Examples from the Undergraduate Prog-
ramme Objectives, Faculty of Medicine, University Four are more usual. A spare wheel is expe-
of Newcastle, New South Wales (Engel 1980) dient. Front windscreen washers are manda-
tory, whereas a rear washer is useful. A radio is
It is proposed that the educational programme be
designed.to ensure that, at its conclusion, the gradu- now becoming a standard fitting, though the
ate demonstrates necessity is debatable.
( 5 ) that he accepts medical education in its full sense The choices are less clear-cut in medical
is a lifelong activity and that he is prepared to education. For example, what anatomical
invest time in the maintenance and further knowledge is required? Should the behavioural
development of his own knowledge and skills, sciences be studied? Is the topic of medical
over and above the pursuit of higher profession-
al qualifications ethics appropriate to an undergraduate curricu-
a critical appreciation of the techniques, proce- lum? Should all students have obstetric experi-
dures, goals- and results of biomedical research ence? New topics such as care of the terminally
including, in particular, an understanding of the ill, alcoholism, oncology and information tech-
scientific method, the reliability and validity of
observations and the testing of hypotheses nology compete in the medical curriculum with
the ability to adopt a problem-solving approach more traditional subjects such as anatomy,
to clinical situations pathology and surgery. Once the decision on
that he is willing and able to take responsibility, the inclusion of a subject is reached, the ques-
under supervision, for the management of a tion of extent or depth of coverage must then
defined range of common acute and chronic
clinical conditions be determined.
the ability to plan and interpret a programme of Content gains admission in a course by
investigations appropriate to the clinical prob- satisfying any of four criteria.
lem presented by the patient, with due regard (a) It directly contributes to the course objec-
for patient comfort and safety and for economic
factors tives. For example, students must learn during
that his approach to all patients reflects the the course how to use a sphygmomanometer if
attitude that the person who is ill is more as a doctor they have to be able on completion
important than the illness from which he suffers of the course to measure the patient’s blood
his awareness of the role of the physician in pressure.
healthiwelfare professional teams and his wil-
lingness to work co-operatively within such (b) It is a ‘building block’ which equips the
teams students with skill or knowledge needed to
his understanding of the importance of the tackle a later Dart of the course. For examole.1 ,
standing of the clinical features of patients with more efficient to complete the engine after,
heart disease, and knowledge of the pharmacol- rather than before, fitting the body shell.
ogy of the drugs which act on the nervous In medical education, should the basic scien-
sysem may help doctors in their choice of ces provide a foundation for the study of
analgesics. medical disciplines followed finally by dis-
(c) I t allows students to develop intellectual ordered function of the body? O r is it better to
abilities such as critical thinking. For example, work back from disordered function, explain-
cxperimental work in the biochemistry labora- ing it in terms of deviation from the normal?
tory may be designed to inculcate in students a Should subjects be covered in a particular
critical approach to facts and an acceptance of order? For example, should psychiatry be in-
the scientific model for clinical investigation. troduced before, during or after the study of
Project work might have as its objectives the general medicine?
development in students of skills of critical When can the minor specialties (such as
thinking and information retrieval. otolaryngology, ophthalmology and dermato-
(d) It aids the understanding of other subjects logy) be fitted in? Should they wait until the
on the course. For example, the introduction of final year, once students have mastered general
radiology as part of a course on anatomy might medicine and the other major specialties? O r
provide the doctor or student nurse with a should they come up earlier, with more time
better understanding of the applications of allowed to convert theory into practice? Should
anatomy to the functioning of the normal the teaching of a subject be arranged in a short
living body. intensive block or spread over a longer period
alongside other subjects?
Last but not least, which teachers or depart-
(4) How should the content be organized?
ments should be responsible for covering each
Once the car’s components are determined, the subject?
manufacturer must decide how to assemble the An example of t w o different sequences for
parts and in what order. Inclusion alone does subjects included in an undergraduate medical
not guarantee accessibility. For example, radio curriculum is shown in Table 2 . The same
controls would be of little use on the rear- content is contained in both curricula but the
window shelf and an underslung spare wheel is order in which the subjects are covered differs.
subject to corrosion and dirt. It may also be For example, in curriculum A students are not
/
Undergraduate
Committee
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IHCoUrse
Sub- committee
Early -years Committee HDepartments