1. Developing Goals, Objectives, and Competencies
Clark Denniston, MD
Executive Assoc Dean for GME
DIO UNC Hospitals
thanks for coming today
I consider it a privilege to be able to talk to you today – our greatest institutional resources, the TEACHERS
Know your audience: Basic scientists? Clinicians? Neither – educators, admin?
How many have been teaching 10 yrs or longer?

2. Apples and Oranges, or…

3. Goals and Objectives are not the same
Competencies are also different, but linked to G and O
Outcome-Oriented educational principles are critical to understanding Competencies
Use “backwards design” concept to frame the process of developing G, O, C
Bloom’s Taxonomy for Objectives
SMART pneumonic for Outcomes

4. Definitions

5. Goals
Broad and overarching statements about what you desire to achieve with your curriculum
May include:
Background
Rationale
Philosophy
Performance expectations

6. Objectives
Clear, brief, action-verb framed specific knowledge, skills, and attitudes that are intended results of education
Differ from Goals in terms of specificity
Often a number of Objectives are defined for each Goal
Bloom’s Taxonomy gives a cognitive framework to write objectives

7. Bloom’s Taxonomy (Revised)
Create
Evaluate
Analyze
Apply
Understand
Remember
Higher Order Cognitive Process
Anderson, L.W. & Krathwohl, D.R. (Eds.). (2001). A taxonomy for learning, teaching and assessing: A revision of Bloom's taxonomy of educational objectives. Boston, MA: Allyn & Bacon.

8. Bloom’s Taxonomy (revised): Cognitive Process Action Verbs
Remember
Define, Describe, Identify, List, Locate, Name, Recognize, Select, State
Understand
Associate, Classify, Demonstrate, Discuss, Distinguish, Explain, Generalize, Illustrate, Interpret, Summarize
Apply
Apply, Choose, Classify, Explain, Implement, Organize, Prepare, Select, Use
Analyze
Analyze, Attribute, Diagram, Differentiate, Discriminate, Distinguish, Organize, Structure
Evaluate
Appraise, Assess, Compare, Contrast, Critique, Defend, Determine, Estimate, Evaluate, Justify, Rate, Support
Create
Compile, Create, Design, Devise, Formulate, Generate, Hypothesize, Integrate, Plan, Propose, Summarize

9. Competencies Measurable endpoints of actual achievement of learning
Discrete “musts”
Action words describing what knowledge, skill or attitude is to be demonstrated
Include the criterion for acceptable performance (rubric)

10. Competency-based Education
Competency-based education has taken hold in medical education, and is a reflection of the recognized need for accountability, measurement of educational impact. To understand the model requires us to completely reframe how we think - it is no longer acceptable to see medical education as a process of opening up the minds of medical students and residents and pouring in content. Educational processes can no longer be defined periods of exposure with enough repetition of that exposure to make it likely that the content sticks!
To develop effective Goals, Objectives, and Competencies we really need to understand well the paradigm shift that is now being referred to as “Outcome-Oriented Education”

11. Outcome-Oriented Education
Passive
Process
Oriented
Receive Instruction...
Outcome
Demonstrate Competence...
Active
The Old Model (Process Oriented)
time/exposure specified; proxy for achievement of desired objectives
global rating forms (summative evaluations) used at end of each rotation or activity to determine successful completion
successful completion of the process implied competence (which evolved to include the 6 core competencies)
procedurally-based specialty requirements depended on achievement of required numbers
at the end of the process (i.e. end of residency), ready to go out and practice
Board certification (implied expertise) based on demonstration of medical knowledge and documentation of case/procedure logs
The New Model (Outcome Oriented)
educational milestones – ”developmentally based, specialty specific achievements that residents are expected to demonstrate at established intervals as they progress through training) will be the basis for assessing and reporting educational outcomes”
these milestones are educational targets that both resident and program alike will know are “must” outcomes, and each program will be reporting their milestones data on each resident every 6 months through the ADS system
time spent in educational activity becomes less important, because until a resident achieves a particular milestone, they cannot advance in the program (one month rotations may not be enough in some cases)
direct observation will play much larger role
assessments “along the way”, i.e. formative evaluations, will play a much larger role
faculty development will be necessary to get people to shift from the old paradigm
Clinical Competency Committees (CCC) will be necessary within each program to document that there is a standardized assessment that milestones have actually been reached and demonstrated in a reproducible fashion
Ultimate “competence” will be reached once a resident has met all required milestones at each level of training
If a resident can’t reach all milestones, their training will need to be extended until they do, or until they are deemed unable to do so (at which point they would be dismissed from the program without completion)

12. “You have to know where you are going before you can decide how to get there”
This is a part of my “Roadmap Model”, which has become my Mantra…
I was thrilled to learn that there is a research based educational model that serves as the backbone of my conceptualization of the Roadmap and this short sentence serves as a reliable way for me to remember the basic tenets of outcomes-based education and educational program planning

13. This book pulled everything together for me, and the model I’m about to present to you comes from this work

14. Backwards Design
This model, articulated in great detail in the Wiggins and McTighe book, has transformed education and educational planning in the K-12 world since 1998
It’s time for us in medical education to catch on to this model

15. Identify Desired Results
Determine Acceptable Evidence
Plan
Learning
This graphic sums up the model of “backwards design”

16. Identify Desired Results
What do you want your learners to look like when you are done with them?

17. Determine Acceptable Evidence
How will you know that your learners “got there”
think about assessment before deciding what and how you will teach

18. What content, activities and methods will enable the desired results
In the roadmap model of thinking; once you know your destination, then you plan your route!
Deciding on content and activities prematurely, and we risk having to take educational detours in order to reach our desired outcomes.
Plan
Learning

19. Define Outcomes Choose/Develop Assessment Tool(s)
Choose Content & Methods
Adapt “Competency-based” to backwards design model

20. Competency = Outcome

21. How do the three pieces – Goals, Objectives, Competencies – fit together?

22. Order of Development
First step  Goals Second step  Competencies(Outcomes) Third step  Objectives

23. Why?
First step  Goals  provide general direction for competencies Second step  Competencies/Outcomes establish final destination “backwards design” Third step  Objectives define actions necessary to reach the Outcomes
Further explanation for Objectives is that they define the turn-by-turn directions and actions on the journey to the final destination…

24. SMART
Specific
Measureable
Attainable
Relevant
Time-Sensitive

25. Non-medical SMART outcome
Cooking Class 101 – Knife Skills By the end of a one- hour workshop, all participants will be able to demonstrate 4 core knife skills with a 9 inch chef’s knife: honing of the blade with a sharpening steel, correct hand position to protect fingers of the non-dominant hand, “tip-to-tang” slicing technique to julienne green peppers, and double hand “rocking chop” to finely chop Italian parsley.

26. You have to know where you are going before you can decide how to get there

27. Desired Results
Competencies
Outcomes
My cognitive framework for this…

28. 3 Steps to Educational Success
Understand that Competencies = Outcomes
Understand the different purposes of “Goals” vs. “Objectives” in defining the path toward Outcomes
Employ “backwards design” using the SMART pneumonic to define Outcomes and Bloom’s taxonomy to define Objectives