1. SES09: Teaching the Competencies: Thinking Outside-of-the-Box
2010 ACGME Annual Education Conference
Bardia Behravesh, MA &
Alice Edler, MD, MA, MPH
Department of Graduate Medical Education

2. Session Objectives
Identify innovative teaching methods used by your residency programs and share them across programs.
Leverage existing resources within your institution to teach the ACGME General Competencies.
Use a systematic curriculum design approach to develop curriculum.

3. Background
In 2008, Stanford GME conducted a needs assessment with the goal of identifying ways in which it could better serve its residency programs.
63 of 75 Program Directors responded to an online survey.
Following the survey, 69 of 75 Program Directors were interviewed.

4. Findings
46% of respondents requested centralized teaching of the competencies (i.e. delivered by the Dept of GME).
23% of respondents requested more information about educational techniques and resources.
19% of respondents requested web-based learning modules that teach the competencies.

5. Goals
Identify educational techniques and resources to share across programs.
Identify avenues for centrally teaching the competencies (including the utilization of web-based learning modules).

6. Goal 1: Techniques & Resources
Initial approach: Searched the web for teaching and evaluation methods (best practices) to post to the Dept of GME web site.
Challenges:
Limited resources available online
Cost
Thinking Outside-of-the-Box: Which programs are currently using innovative methods to teach the core competencies (i.e. what ideas can we borrow from our own programs and share across all programs)?

7. Program Innovations
Solicited voluntary submission of innovative teaching strategies by Program Directors.
Flagged innovative teaching strategies during internal program reviews.
Collected strategies into a spreadsheet and posted to the Dept of GME web site.

11. Exercise 1 Review the learning activities described in the handout.
Using the blank fields, describe an innovative activity developed by your own program that you could potentially share with other programs within your institution.

12. Goal 2: Centralized Education
Initial approach: Looked at developing and/or purchasing web-based learning modules.
Challenges:
In-house development is costly.
Off-the-shelf solutions do not fit needs exactly.
Customization of off-the-shelf solutions difficult/costly.
Thinking Outside-of-the-Box: What existing content (already available at our institution) can we leverage to teach the competencies?

13. Regulatory Compliance Training
Stanford satisfies various regulatory requirements through the use of online training.
Topics include:
Patient Rights
HIPPA
Emergency Codes
Quality Management
Cultural Diversity
Residents are required to complete the modules on a yearly basis.

14. Mapping Content to Competencies
Determined what web-based learning modules were available.
Used a spreadsheet to map the modules to the competencies.
Posted spreadsheet to the Dept of GME web site.

15. Mapping Content to Competencies
Module
Length (min)
Frequency
ACGME Competency MK PC
PBLI
CIS
Prof
SBP
Patient Rights (PA) 30
Yearly X
Rapid Regulatory 60
Bi-Annual
LIFE Curriculum: Fatigue
Code of Conduct 20
Cultural Diversity
Emergency Codes 5 1x
HIPAA
Quality Improvement
Respiratory Precautions 25
Restraints/Seclusion

16. E-learning as a “springboard”
A web-based learning module should not be thought of as PRIMARY and SUFFICIENT for competency education.
Pre-existing curriculum can act as a springboard for additional learning.
Partner the goals and objectives of the pre-existing curriculum with those of additional learning activities.

17. Systematic Curriculum Development
Two commonly used curriculum design approaches in medical education:
Tyler’s principles for curriculum and instruction
Tyler R, “ Basic Principles of Curriculum and instruction” Chicago, University of Chicago Press, 1949
Kern’s six step approach to curriculum development
Kern D, Thomas P, Howard D, Bass E, “Curriculum Development for Medical Education”, Baltimore, Johns Hopkins University Press 1998

18. Pro’s of Tyler Rationale
Simple and straight forward
Starts with Goals and Objectives
Good for institutional curriculum development
Good for modification of pre-existing curriculum
Teacher-oriented

19. Tyler’s Four Questions
What educational purposes should the curriculum seek to attain?
What learning experiences should be selected to achieve these goals and objectives?
How should these learning experiences be organized?
How can the effectiveness of these experiences be evaluated?

20. Goals and Objectives Goals: Overall outcomes
Objectives: Criteria by which the educational materials are selected and the content is outlined. Based on:
Values
Needs
Learner
Society

21. Objectives = The Desired Educational Ends
The changes in learner behavior/attitudes
Not what the teacher does
Not a content list
Not a vague abstraction but concrete change

22. Behavioral and Attitudinal Aspects of Objectives
Understanding of the important facts and principles
Familiarity with the sources of information
Ability to interpret data
Ability to apply principles
Ability to interpret results of investigation
Broad and mature interests

23. Selecting Educational Experiences
Real and attainable
Satisfying to the learner
Multiple and reinforcing

24. Organization of Educational Experiences
Sequencing
Increasing complexity, if needed (graduated responsibility)
Reinforcing

25. Implementation Political support for program
Procurement of resources (room, standardized patients, etc)
Piloting, if possible
Introduction
Barriers to implementation

26. Evaluation of the Curriculum
Multi-source evaluation of the
Written Curriculum
Educational Milieu
Administration of the Curriculum
Faculty
Learner

27. Exercise 2
Review the sample e-learning module and consider the following questions:
What competency-based goals and objectives could this module address?
If we were to use this module as a springboard, what additional learning experiences could we combine with this module to develop a competency-based curriculum?
How would you sequence the learning experiences, including the use of this module?
How would you evaluate the effectiveness of your new curriculum in teaching the desired competencies?

28. Summary
Resident learning need not be bounded by program-specific curricula.
Rather than develop completely from scratch, look for pre-existing practices and content that can be leveraged.
Look across programs for best practices.
Look at the institutional level for resources.

29. Questions? Feel free to contact us:
Bardia Behravesh, MA –
Alice Edler, MD, MA, MPH –

30. Basics of Kern Iterative, Action Research Approach
Assumes that you are starting denovo with needs assessment
Multi-directional Interactions
Good for denovo curriculum planning at the program level

31. Kern Six Step Curriculum Model

32. Example Problem Identification: Needs of Targeted Learners
provision of care to HIV-AIDS positive patients
Needs of Targeted Learners
For Family Practice residents
Preventative care for HIV infected patients
Avoidance of HIV-AIDS, homosexual and substance abuse patients in general
Development of Goals and Objectives

33. Example (continued) Educational Strategies Content Methods
Use of ARV drugs
Cultural competency with substance abuse patients
Methods
Use of ARV drugs: didactics followed by test for learning and comprehension
Cultural competency with substance abuse patients: role play, Standardized patients

34. Pro’s
Can start from nothing
Best used with homogenous set of learners