Outcome-Based Learning and TeachingYeu-Jhy Chang, MDDepartment of NeurologyChang Gung Memorial Hospital, Linkou

OutlineIntroduction of models of medical educationWhat is outcome-based learning?How to establish the learning outcomes?General principles of teaching and assessment for outcome-based learningTake home message

A story frequently told by educators concerns a young lad and his dog, Fido.I taught Fido how to whistle, the boy proudly tells his father.When asked to demonstrate this remarkable achievement, the boy commands, Fido, whistle! Fido wags his tail vigorously but not whistle.I thought you said you taught Fido how to whistle. I didnt hear him whistle, the father says to his son who replies. I said I taught him how to whistle, I didnt say he learned it!

The Flexnerian Model (Planning Forwards) 1. Define Fundamental knowledge2. Teach the fundamentals3. Test for knowledge of fundamentals4. Hope for the best?What is Fundamental knowledge(1) (2) (3) (4)?

Competency-Based Model (Planning Backwards)1. Define the successful graduate2. Design measures and standards of performance3. Develop learning experiences

Outcome-Based EducationAll too often, we, as teachers, focus too much on what we teach rather than on what our students learn.Outcome-based education emphasizes what we expect students will have achieved when they complete their course.These learning achievements go beyond just knowing; rather, they describe what learners can actually do with what they know.

Definition of Outcome-Based EducationWhat we expect of our graduates and holds us accountable to provide an education that achieves those endpoints. Its not only good education, it is good public policy.

Three features of outcome-based educationThe (1) development of clearly defined and published learning outcomes that must be achieved before the end of a course.The (2) design of a curriculum with educational strategies and learning opportunities to ensure the achievement of the learning outcomes.An (3) assessment process matched to the learning outcomes with the assessment of individual students to ensure that they achieve the outcomes.The Scottish Doctor 3, 2008

Working Definition of Learning outcomes are: Statements of what a student should know, understand and/or be able to demonstrate after completion of a process of learning.The learning activity could be, for example, a lecture, a module or an entire program.Learning outcomes must not simply be a wish list of what a student is capable of doing on completion of the learning activity.Learning outcomes must be simply and clearly described.Learning outcomes must be capable of being validly assessed.

From the definitions we see:Emphasis on the learner.Emphasis on the learners ability to do something.Focus on teaching aims and objectives and use of terms like know, understand, be familiar with.Aims: Give broad purpose or general intention of the module.Objectives: Information about what the teaching of the module hopes to achieve.Outcomes: Focus on what we want the student to be able to do - use of terms like define, list, name, recall, analyze, calculate, design, etc.Learning outcomes are not designed to replace the traditional way of describing teaching and learning but to supplement it.

Good DoctorsThe expectation of populationPatients need good doctors. Good doctors make the care of their patients their first concern: they are competent,keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues,are honest and trustworthy, and act with integrity.Good Medical Practice, General Medical Council (GMC), UK 2006

The Social ContractR. Cruess & S. Cruess. Perspectives in Biology and Medicine 2008;51(4):57998.

EXPECTATIONS: THE PUBLIC AND THE MEDICAL PROFESSIONR. Cruess & S. Cruess. Perspectives in Biology and Medicine 2008;51(4):57998.

Patients/publics expectations of medicineMedicines expectations of patients/publicFulfill role of healerAssured competence of physiciansTimely access to competent careAltruistic serviceMorality, integrity, honestyTrustworthiness (codes of ethics)Accountability/transparencyRespect for patient autonomySource of objective advicePromotion of the public goodTrust sufficient to meet patients needsAutonomy sufficient to exercise judgmentRole in public policy in healthShared responsibility for healthBalanced lifestyleRewards: nonfinancial (respect, status), financial

Roles and Attributes of a PhysicianR. Cruess & S. Cruess (The Healer)

Roles and Attributes of a PhysicianR. Cruess & S. Cruess (The Healer)(The Professional)

KnowledgeComprehensionApplicationAnalysisSynthesisEvaluationEvidence and dataCollectionAnalysisSynthesisEvaluationPerformanceDiagnosisTreatmentJudgment & data managementValue, Cost-BenefitExperience, Intuition, BiasBy: Paul PL ChangReasoningEvidenceThe OutcomeA Good Doctor

Outcome-Based EducationKnowledgeSkillCompetencePerformanceCapability (The power or ability to generate an outcome)

Advantages of Choosing Established OutcomesThe easier way for a medical school to create an outcome-based curriculum is to adopt outcomes that others have defined.Using an already established list of outcomes has the advantages of ease, simplicity, comparability and established credibility.

Disadvantages of Choosing Established OutcomesSimply adopting someone elses list has its own drawbacks. The faculty and students may not feel the same sense of ownership, unique characteristics of the school may not be represented or sufficiently emphasized, and the outcomes may be interpreted differently from what was originally intended.

(ACGME) (Medical knowledge) (Interpersonal and communication skills) (System-based practice) (Patient care & clinical skill) (Professionalism) (Practice-based learning and improvement)2001Mnemonics: MIS 3P

BROWN'S NINE ABILITIES1. Effective Communication (C)2. Basic Clinical Skills (P1)3. Using Basic Science in the Practice of Medicine (P1&P3)4. Diagnosis, Management, and Prevention (K, P1&P3)5. Lifelong Learning (P3)6. Self-awareness, Self-care, and Personal Growth (P2)7. The Social and Community Contexts of Health Care (P2)8. Moral Reasoning and Ethical Judgment (P2)9. Problem Solving (P1)

Good Medical Practice1. Good clinical care2. Maintaining good medical practice3. Teaching and training, appraising and assessing 4. Relationships with patients5. Working with colleagues6. Probity7. HealthGeneral Medical Council, UK, 2006

THE SCOTTISH DOCTOR learning outcomesThe 12 domains and the three circle outcomes modelTHE SCOTTISH DOCTOR 3rd Edition Scottish Deans Medical Education Group April 2008

1. 2. 3. 4. 5. 6.

(1)1. (Patient Care) 2. (Medical Knowledge)3. (Practice-Based Learning and Improvement)4. (Interpersonal and Communication Skills)

(2)5. (Professionalism)6. (System-Based Practice)7. (Biomedical Research Ability):

KASH makes cash. K Knowledge A Attitude S Skills H Habit = + x +

*5%Within 2 weeks:&Immediate useAuditory

Visual

Kinestheticafter24 hoursActive Passive

MethodsCognitiveAffectivePsychomotorStudent centeredSelf-directedTeamworkLecture+++++Discussion+++++++PBL++++++++++++++++Role play++++++++++++Video+++++++Hand-on+++++++++++Simulation+++++++++++++Brain storm+++++++++Case+++++++++++

Overview of Assessment of Learning Outcomes MCQ Multiple Choice Question; EMI Extended Matching Items; MEQ Modified Essay Question; CRQ Constructed Response Question.

KASHO makes much more cash. K Knowledge A Attitude S Skills H Habit O Organization culture (Decided by the Leaders will)

(Learning) = (Emotion) + (Motivation)

Take Home MessageLearner-Centered and Outcome-based TeachingTo define the outcomes before your teaching.To design the curriculumto establish the learning environment to encourage the motivation of learners for teaching.To assess the achievement of learnersto reflect yourself.

Learning has to be done by the learner, not for the learner.* Teaching as engineering effective learning environments.Thank You for Your Attention!

The traditional model of medical education (planning forwards) begins with the delineation of the knowledge fundamental to medicine, teaching that knowledge, then testing whether students have learned that information, typically by some form of closed-book examination.The hope is that acquisition of this knowledge base will lead to students becoming good doctors.Goes in the opposite direction, starting with the good doctor and working backwards.The faculty designing the curriculum begins by defining the attributes of the successful graduate, then they figure out how they would know whether students had attained those outcomes, then they create learning opportunities that would enable the students to achieve them.