Outcome-Based Education: from Curriculum to

Instructional PlanningErlyn A. Sana, PhD

NTTCHP Interuniversity Workshop

Cherry Blossoms Hotel, May 7, 2014

Background of OBE (Davis, 2003)

In the US, OBE had its roots in pre-university education. Reports were

appreciated that it was inappropriate to fix the time for study and

expect variable learning results from students. What was needed was

a uniform standard that all students would be expected to achieve

and that all would be given time to achieve.

The State Board of Education, Pennsylvania shifted to OBE in 1992.

Pioneer OBE Schools

1. English National Board of Nursing, Midwifery and Health Visiting, 1991

2. Brown University, Rhode Island, 1996

3. Dundee Medical School, University of Dundee, Scotland, United

Kingdom, 1997

4. Association of American Medical Colleges, 1998

5. Accreditation Council for Graduate Medical Education, US, 1998

Major references

World Health Organization, 2010; TransformativeScale up of Health Professional Education, 2011

Frenk, Chen, et al., 2010. Health Professionals for a new century. The Lancet, Vol. 376, pp.1923-58

Other References

1. Harden, Crosby, and Davis. (1999). AMEE Guide No. 14: Outcome-based education: Part I. an introduction. Medical Teacher. Vol. 21, No. 1, pp. 7-14.

2. Smith & Dollase. (1999). AMEE Guide No. 14: Outcome-based education: Part 2: Planning, implementing, and evaluating a competency-based curriculum. Medical Teacher. Vol. 21, No. 1, pp. 15-21.

Other References

3. Harden, Crosby, Davis, & Friedman. (1999). AMEE Guide No. 14: Outcome-based education. Part 5: From competency to meta-competency: a model for the specification of learning outcomes. Medical Teacher. Vol 21, No. 1, pp. 546-552.

4. Malan. (2000). The new paradigm of outcome-based education in perspective. Journal of Family Ecology and Consumer Sciences. Vol. 28, pp. 22-28.

Other References

5. Davis. (2003). Outcome-based education. JVME. 30 (3). Pp 227-232.

6. Commission on Higher Education. CHED Memorandum Order No. 46, series of 2012.

7. CHED OBE Framework Implementing Guidelines, 2014.

8. Sana, Atienza, Abarquez, et al. (2010; 2013). Teaching and learning in the health sciences. Quezon City: UP Press.

Session Objectives

1. Differentiate outcome-based education (OBE) from other curriculum tracks in health sciences education,

2. Explain the basic features, strengths, weaknesses, and organizational implications of OBE in the context of transformative learning,

3. Explain OBE framework in ones own curricular setting.

General Steps in Curriculum Planning & Development (Sana, editor, 2010, 2013)

Educational Questions

1. Where are we now?

2. Where are we going?

3. How do we get there?

4. How do we know we

have arrived?

Educational Decisions1. Needs assessment

2. Formulation of curricular vision, goals, objectives

3. Selection of content, teaching-learning strategies, instructional resources

4. Evaluation

Educational Decisions in Instructional Design Context

1. Needs assessment

2. Formulation of curricular vision, goals, objectives

3. Selection of content, teaching-learning strategies, instructional resources

4. Evaluation

Instructional Context1. Situational analysis: Curricular

goals, characteristics of teachers, leaners, resources, constraints

2. Session objectives for students to acquire

3. Topics, activities, instructional media

4. Assessment: blueprint, tests, measurement

Educational Decisions

Comparison of the different curricula in the Health Sciences

Educational decisions Science-based curriculum(Frenk. Chen, et al, 2010)

Problem based(Gallagher & Gallagher, 2013)

Competency-based curriculum

(Peralta, 2013)

Needs assessment Purely based on the traditional sciences, disciplines

Based on common cases and problems encountered in professional practice

What society needs not only from one profession and HRH but also in terms of structures

Curricular objectives Science-based Identifying and solving problems, decision making

Competencies required by the professions

Content, teaching-learning activities, resources, etc

Theoretical, in large groups, teacher-centered

Integrated basic & clinical sciences, learning in small groups, student-led, problem-centered

Content based on institutional VMG, eclectic, systems approach, integrated

Evaluation Mainly by summative written examinations

Formative & summative, variety of ways

Formative & summative, varied but sometimes process-centered

Statement of the problem

1. Glaring gaps & striking inequities in health persist between and

within countries,

2. Poor people in developing countries continue to have common

infections, malnutrition, and maternity-related health risks, which

have long been controlled in more affluent populations,

3. Mismatch of professional competencies to patient and population

priorities because of fragmentary, outdated, and static curricula

producing ill-equipped graduates from underfinanced institutions

Social

accountability

Transformative Scale up of the Education of Health Professionals (WHO, 2011)

Driven and informed by population health needs,

transformative scale up means delivering

educational reforms that address not only the

quantity, but also the quality and relevance of

health care providers in order to achieve

improvements in population health outcomes.

Key components of the educational system (Frenk, Chen, et al., 2010)

Institutional DesignSystemic levelStewardship & governanceFinancingResource generationService provision

Organizational levelOwnershipAffiliationInternal structure

Global levelStewardshipNetworks & partnerships

Structure

Instructional Design

Criteria for admissionCompetenciesChannelsCareer pathways

Process

ContextGlobal-Local

Institutional Reforms1. Nurture a culture of critical

inquiry2. Establish joint planning

mechanisms3. Expand from academic

centers to academic systems

4. Link through networks, alliances, and consortia

Structure

Instructional Reforms1. Adopt a CBC (Lancet)

OBE (WHO)2. Promote inter-

professional & trans-professional education

3. Exploit the power of IT4. Harness global

resources and adapt locally

5. Strengthen educational resources

6. Promote new professionalism

Process

Reforms to transformative scale up of HPEd(GCSA, 2010, WHO, 2011, Frenk, Chen, et al., 2010)

Interdependence

in EducationTransformative

Learning

Proposed

outcomes

ContextGlobal-Local

Refers to clearly focusing and organizing everything in the education system around what is essential for all students to be able to do successfully at the end of their learning experiences. This means starting with a clear picture of what is important for students to be able to do, then organising the curriculum, instruction and assessment to make sure that learning ultimately happens (Spady, 1994).

What is outcome-based education (OBE)?

1. An approach to education in which decisions about the

curriculum are driven by the outcomes the students

should display by the end of the course.

2. The educational outcomes are clearly specified and serve

as bases in deciding on all other curricular elements.

OBE defined(Harden, Crosby, & Davis 1999)

What is outcome-based education?

Educational decisions OBE

Needs assessment Multi-stakeholder consultations on what society, various industries, professions, and institutions require from their

personnel; transforming these into learning outcomes

Curricular objectives Conversion of LOs into competency standards, then reformulated as learning objectives

Content, teaching-learningactivities, resources, etc

Breakdown of these LOs, competency standards into specific subjects per year levels with own learning objectives; intensive use of simulations, practicum, on the job training, application of knowledge , skills, attitudes (KSA) to particular workplace contexts

Evaluation of achievement Formative & Summative assessments for students; regular monitoring and performance evaluation of teachers and schools, dissemination of results to stakeholders

Basic differences between input- and outcome-based education paradigms

(CHED OBE Guidelines, 2014)

Dimension Input-Based (Instruction)

Paradigm

Learning (outcome-based)

paradigm

Vision and

purposes

Deliver instruction Produce learning

Criteria for

success

Quality of entering students

Quality & quantity of resources

Enrolment & revenue growth

Quality of exiting students Quantity & quality of

outcomes

Aggregate learning growth, efficiency

Basic differences between input- and outcome-based education paradigms

Dimension Input-Based (Instruction)

Paradigm

Learning (outcome-based)

paradigm

Teaching-learning

structure

Classes start, end at same time

Per department/discipline End of course assessment Degree=accumulated credits

Learning held constant, time varies

Cross disciplines Pre-, during, post-course

assessment

Degree=demonstrated KSA

Learning theory Knowledge exists out there, comes in chunks

Learning is teacher-controlled

Knowlege exists in each persons mind & experience

Learner-centered

Steps in developing OBE programs (Davis, 2003)

1. Identification of the type of health professional that the country needs

2. Identification of the outcomes of the educational process

3. Identification of curriculum content

4. Organization and sequencing of content

5. Identification of appropriate educational strategies

6. Identification of teaching methods

Higher Order Thinking Skills

(HOTS)=Culture of critical inquiry

Steps in developing OBE programs (Davis, 2003)

7. Decisions on how the students will be assessed and the curriculum evaluated

8. The educational environment

9. Management and administration of the curriculum

10. Communication of the curriculum to all stakeholders.

Levels 1-4 (Kirkpatricks) Assessment &

Evaluation

Framework of Outcome-Based Learning (CHED Implementation Handbook, 2014)

Institutional Vision, Mission, & Goals

Program Outcomes (Curriculum map)

Institutional Outcomes (Competencies of ideal graduates)

Course Outcomes

Assessment & evaluationLearning environment:

content & methodology

Teaching-learning systems

CourseDesign

Stan

dar

ds

and

De

man

ds

Social, e

nviro

nm

en

tal con

textDriven and informed by population health needs,

transformative scale up means delivering educational reforms that address not only the quantity, but also the

quality and relevance of health care providers in order to achieve improvements in population health outcomes.

(WHO, 2011)

Framework of Outcome-Based Learning, CHED Implementation Guidebook, 2014

How pioneer schools developed their learning outcomes

English National Board of Nursing, Midwifery and Health Visiting, 1991

Brown University, Rhode Island, 1996

University of Dundee Medical School, United Kingdom, 1997

Association of American Medical Colleges, 1998

Accreditation Council for Graduate Medical Education, US, 1998

Multi-stakeholders consultation

Technical Working Groups, multi-stakeholders consultation and Delphi Technique

Recommended by the ACGME

Nominal group technique

Criteria for specification of outcomes (Harden, Crosby, Davis, & Friedman, 1999)

1. Reflect the VMG of the institution

2. Are clear and unambiguous

3. Are specific and addressed defined areas of competence

4. Are manageable in terms of the number of outcomes

5. Are defined at an appropriate level of generality

6. Assist with development of enabling outcomes

7. Indicate the relationship between different outcomes

Brown University(Smith & Dollase, 1999)

A. Type of doctor: Care provider, decision-maker, communicator, manager, community-minded

B. Learning outcomes:

1. Effective communication

2. Basic clinical skills

3. Using basic science in the practice of medicine

4. Diagnosis, management, and prevention

5. Lifelong learning

6. Self-awareness, self-care and personal growth

7. The social and community contexts of health care

8. Moral reasoning and clinical ethics

9. Problem solving

Status of LOs in various health sciences (Technical Committees in HPEd)

1. Nursing: through the help of Dean Edna O. Imperial (ADPCN)

2. Pharmacy: through Dean Imelda G. Pena (PACOP)

3. Allied Medical Fields (OT, PT, SP): through Dean Cecille D. Licuan(DLSHSI)

4. Other fields: still in progress

TCME Accomplishments (As of October 2013)

Type of doctor

1. General medical practitioner

2. Leader/manager

3. Researcher

4. Educator

5. Social advocate/mobilizer

Learning Outcomes1. Clinical competence

2. Communication skills

3. Management of research findings

4. Inter professionalism

5. Appreciation of systems approach to health care

6. Personal and continuing professional development

7. Adherence to professional and ethical practice

Sample curriculum map of aCollege of Medicine

Vision:

Mission:

Goals:

Year level and courses

LO1 LO2 LO3 LO4 LO5 LO6 LO7

YL1 GE

YL1 Basic Sciences

YL1 Others

LO1:Clinical competence; LO2: Communication skills; LO3: Management of research findings; LO4: Inter

professionalism; LO5: Appreciation of the systems approach to health care; LO6: Personal & continuing

professional development; LO7: Adherence to professional & ethical practice

Scale: I: introduced; P: Practiced; D: Demonstrated

Sample decision matrix of curriculum map of the College of Medicine (YL4)

Learning outcomes Introduced in

the course (I)

Practiced with

supervision (P)

Demonstrated without

supervision (D)

Decision

1. Clinical competence 2 10

2. Communication skills General: 10 General: 2 To patients: 12

3. Management of research

findings

10 2

4. Inter professionalism 1 2 9

5. Appreciation of systems

approach to health care

9 2 1

6. Personal & continuing professional development

3 9

7. Adherence to professional & ethical practice

12

Philippine Qualification Standards

Level ofeducational qualification

Basic Education Technical/Vocational Education

Higher Education

8 Doctoral (PhD)

7 Post-baccalaureate

6 Bachelors

5 Diploma

4 NC IV

3 NC III

2 Grades 11-12 NC II

1 Grades 1-10 NC I

ASEAN 2015: ASEAN Economic Community

Objectives: Build ASEAN as a:

1. Single market production base

2. Highly competitive economic region

3. Region of equitable economic development

4. Region fully integrated into the global economy

www.business-in-asia.com/asia/asean_economic_community.html

Selected Professions that will be pilot tested in 2015 (ILO 2006)

Professional Expectations

Engineering Accountancy Medicine Dentistry Nursing Architecture

Autonomy

Responsibility & accountability

Complexity

Workplace environment

Choice and range of contingencies

Discretion and judgment

Special Competencies that are expected in the 21st century education of the health

professionals

1. Evidence-based practice of the profession

2. Cultural competence (minimum of 6 units of foreign language and cultural studies in the new curriculum)

3. Information and communication technology

Framework of Outcome-Based Learning (CHED Implementation Handbook, 2014)

Institutional Vision, Mission, & Goals

Program Outcomes (Curriculum map)

Institutional Outcomes (Competencies of ideal graduates)

Course Outcomes

Assessment & evaluationLearning environment:

content & methodology

Teaching-learning systems

CourseDesign

Stan

dar

ds

and

De

man

ds

Social, e

nviro

nm

en

tal con

text

Learner-centered

Experiential learning

Teacher as facilitator

Holistic Work based Quality standard

Framework of Outcome-Based Learning, CHED Implementation Guidebook, 2014

Sample of outcome-based Lesson Plan (From Flexnerian Physiology Curriculum)

Cognitive (Knowledge) Domain

Psychomotor (Skills) Domain

Affective (Attitudinal) Domain

Synthesis Origination Characterization

Evaluation Complex overt response Organization

Analysis Mechanism Valuing

Application Guided response

Comprehension Set Responding

Recall Perception Receiving

Institutional Reform

1. Nurture a culture of critical inquiry

Higher Order Thinking Skills (HOTS)

Transformational Learning Theory (Mezirow, 1996)

1. A uniquely adult, abstract, idealized, and grounded in the nature of human communication.

2. It explains that learning is a process of using a prior interpretation to construe a new or revised interpretation of the meaning of ones experience in order to guide future action.

Institutional Reform

Common themes of Transformational Learning Theory (Mezirow, 1996)

1. Centrality of experience

2. Critical reflection

3. Critical reflection of assumptions

Institutional Reform

Common themes of Transformational Learning Theory (Mezirow, 1996)

1. Centrality of experience

2. Critical reflection

3. Critical reflection of

assumptions

Experience must be socially constructed to be deconstructed and acted upon.

Teachers may consciously disrupt the learners world view

Institutional Reform

1. Centrality of experience

2. Critical reflection

3. Critical reflection of

assumptions

Distinguishing characteristic of adult learning

Reflection is the apperceptiveprocess by which we change our minds literally and figuratively.

Institutional Reform

Common themes of Transformational Learning Theory (Mezirow, 1996)

1. Centrality of experience

2. Critical reflection

3. Critical reflection of

assumptions

Critical reflections of assumptions (CRAs) are critique of habits of the mind based on logical, ethical, ideological, social, economic, political, ecological, or spiritual aspects of experience underlying a problem defined by a learner.

Institutional Reform

Common themes of Transformational Learning Theory (Mezirow, 1996)

1. Centrality of experience

2. Critical reflection

3. Critical reflection of

assumptions

Critical self-reflection of assumptions (CSRAs), are subjective reframing of a given view, and essential in developing perspective transformation.

Institutional Reform

Institutional Reform

Common themes of Transformational Learning

Theory (Mezirow, 1996)

Learning Quadrants in Transformational Learning (Mezirow, 1978 cited by Atienza, 2013)

Disorienting Experience

Critical Reflection

ActionRational Dialogue

Common themes of Transformational Learning Theory & Experiential Learning Cycle (Mezirow, 1996; Kolb, 1984)

Transformational learning Experiential learning cycle

Disorienting Experience

Critical Reflection

ActionRational Dialogue

Reflections of students on their Community Drugstore and Hospital Pharmacy Internship Program

Written by Shiela Marie J. Nacabu-an, Faculty of UP College of Pharmacy

Thesis completed for the degree of Master of Health Professions Education, NTTCHP, UP Manila, 2014

Respondents: 36 3rd year BSPh students in Community Drugstore internship and 33 4th year BSPh students in Hospital Pharmacy rotation

Transformative Learning Experiences of BSPhstudents during their Community Drugstore Internship

New constitution of common drugs like antibiotics

Dealing with Senior citizens Different roles of

pharmacists , eg, seldom counselling of patients

Reinforcement given by the preceptor

Continuous reflection as encouraged by logbooks and diaries

Exposure to all facets of community drugstores

Transformative Learning Experiences of BSPhstudents during their Hospital Pharmacy Internship

Different roles of pharmacists in the hospital, eg conducive to patient counselling

Appreciating pharmacy as science with leadership role

Reconciling pharmacy in the classroom with hospital practice

Promotion of HOTS

2. Establishment of joint planning mechanisms, (WHO, 2011; Frenk, et al., 2010)

Institutional Reform

2. Establishment of joint planning mechanisms: The School of Health Sciences

Institutional Reform

2. Establishment of joint planning mechanisms: The School of Health Sciences

Institutional Reform

Source: Destura, S. SHS Updates as of April 4, 2014

3. Shift from academic centers to an academic system (WHO, 2011; Frenk, et al., 2010)

Institutional Reform

3. Expansion from Academic Centres to Academic Systems

A new structure where products of the culture of critical inquiry are not just produced repeatedly, but also disseminated, enriched, and further shared with the public

Nurturing a culture of critical inquiry

Production of new knowledge, services,

technology, etc

TeachingResearchService

Intellectual PropertyResource Sharing

Institutional Reform

4. Linkage through networks, alliances, & consortia

1. Partnerships among governments, civil society organizations, business, and media groups.

2. Activate the power of ICT to reach to the far flung areasTE

Govern-ments

Civil society

Business

Media

Other partners

Schools

Institutional Reform

Vision for a new era of professional education (Frenk, Chen, et al., 2010)

Transformative

LearningInterdependence

in Education

Equity in Health

Individuals Population

Patient- based

centered