Faculty Curriculum Retreat 6 September 2008. Key points to be covered 1.UGC and University’s OBA initiative 2.SLO framework - what is it and why do we

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Faculty Curriculum Retreat

6 September 2008



Key points to be covered

1. UGC and University’s OBA initiative

2. SLO framework - what is it and why do we need it

3. SLO from the teacher’s perspective

4. Evaluation of SLO’s and teaching

5. Student Views

6. What we need to do next



University Grants Councilis promoting Outcome-based approached to teaching and learning

and has set up a task force with 2 members from each UGC-

funded institution.

CUHK’s OBA plan was submitted to the UGC in April 2007 and noted by the senate committee on teaching and learning in June

2007

Outcome Based Approaches in

Tertiary Education

UGC initiative on OBA in higher education

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decompressorare needed to see this picture.

The OBA Road-MapThe OBA Road-Map

1. Program Level descriptors of Outcomes

2. Analysis of the strengths and challenges faced in implementing

3. How the OBA has built into the 3-3-4 plan

4. Details of specific strategies

5. Prioritization of these strategies

6. Detailed proposal of the work

7. Clearly defined and described monitoring mechanisms

8. Plans for addressing the 2012 University entrance

Senate Committee on Teaching and Learning, CUHK

Each program/faculty is required to submit a “road-map”

UGC initiative on OBA in higher education



The OBA Road-MapThe OBA Road-Map

A Teaching Development Grant was awarded to each

Program/Faculty to support the development of the OBA -

road map and to facilitate its implementation

Kevin MoShekhar Kumta

Teaching and Learning Resource CentreUGC initiative on OBA in higher education

SLO Task Force was set up -

1. Develop or adopt a generic outcomes framework

2. Generate,define,refine outcomes and their evaluation

A Learning Outcome Framework

• A mechanism upon which to attach further information, which might include “where and how” learning outcomes are delivered in a curriculum,

• together with descriptors of resources, including materials that might be shared.

• A mechanism for curriculum analysis and development.

Medical education is constantly evolving in response to developments in medicine and healthcare.

Curriculum managers and developers can establish pathways for responding to such changes, which may be important for a single school, or mutually

important for many schools.

Tomorrow’s DoctorsGMC 1999

Tomorrow’s DoctorsGMC 1999

Recommendations and principles

about teaching,

learning and assessment,

together with reference to the

statutory framework and

responsibilities that UK schools

have in respect to delivering

medical education

The “Scottish Doctor” sets out to establish a consensus about the learning

outcomes for undergraduate medical education

in the five Scottish Schools, and to agree a common framework or cataloguing

process.

The Scottish Doctor

Consensus Statement - from 5 Scottish Medical

Schools

Medical Educational Reform

Required Knowledge Understanding & Clinical Skills

Required Professional Skills& Personal Development

Understanding Professional Attitudes & Responsibility

D1

D2

D3

D4

D5

D6

D7T1-10

T11-14

T15-20

T21-38

T39-40

T42-47

I II III

D8

D9

D10

D11

D12

D13

T48-51

T52-59

T60-65

T66-68

T69-74

PillarsD

omai

ns

T 75-77

T 78-80



Required Knowledge Understanding & Clinical Skills

Required Professional Skills& Personal Development

Understanding Professional Attitudes & Responsibility

D1. Understanding processes in Basic,

Social and Clinical Science

D2. Demonstrating Clinical Skills

D3.Undertaking Patient Investigations

D4. Patient Management

D5. Practical Procedures

D6. Health Promotion & Disease Prevention

D7. Medical Informatics

I II III

D8. Decision Making Skills,

Clinical Reasoning & Judgment

D9. Communication Skills

D10.Management Skills

D11. The Role of the

Doctor within Society

D12. Meeting Theoretical

and Legal Determinants

D13. Personal Determinants

PillarsD

omai

ns

Pillar 1: Required Knowledge, Understanding and Clinical Skills

(Domain 1 Theme 1)

D1 P1D1 Domain 1

Understanding Underlying Procedures in Basic, Social and Clinical Science

T1 P1D1T1 Theme 1 Normal structure and function of the individual as an intact organism and of each of its major organ systems

T1i P1D1T1i i Cardiovascular-respiratory

T1ii P1D1T1ii ii Foundation studies

T1iii P1D1T1iii iii Gastroenterology and Nutrition

T1iv P1D1T1iv iv Haematology

T1ix P1D1T1ix ix Reproduction

T1v P1D1T1v v Homeostasis

T1vi P1D1T1vi vi Human Structure

T1vii P1D1T1vii vii Musculo-skeletal

T1viii P1D1T1viii

viii Neuroscience

Outcomes - A Teacher’s PerspectiveOutcomes - A Teacher’s Perspective

Expectations

Opportunity

Performance

Expectations

Opportunity

PerformanceAre they meeting specified targets ?

What capabilities you want your students to acquire?

Does the environment facilitate this goal ?

Learning OutcomesLearning Outcomes

Outcomes should be expressed in a form which enables learners to know at the commencement of a course what is it they are expected to achieve in relation to

• Subject content

• Skills

• To what degree of proficiency

Outcomes should be expressed in a form which enables learners to know at the commencement of a course what is it they are expected to achieve in relation to

• Subject content

• Skills

• To what degree of proficiency

Expressing these in terms of student behaviors makes it easier for students and teachers to

understand

Capability

Knowledge

The standard

Think Core !

Reviewed byTeachers

Reviewed byTeachers

Refined SLO’s

SLO FrameworkWeb-site

Student feedback

SLO Evaluation

Review of TeachingDraft SLO’s

Written MaterialHandbookOutlines

Input from TeachersCoordinators

Reference Texts

How is our work-flow





Contextual statements of expected student behaviors in terms of knowledge, skills and attitudes, following the

completion of a given clinical module

•Orthopaedics

•Surgery

Colorectal, CT-Surgery, PRS & Burns

•A&E Medicine

•Family Medicine

•Anesthesia

•Intensive Care

Competence in Musculoskeletal Examination

}At graduation students are

expected to be competent in musculoskeletal examination

1. assess joint movements accuratelyaccurately**,

2. identify effusions and synovial hypertrophy,

3. detect joint instability*,

4. identify deformity and limb length discrepancy

5. evaluate the functional status of the extremity including gait in a given patient……….

** Identify 5 degree loss of movement * Grade II or more



I II III IV V

IntegratedBasic and

clinical sciences

IntegratedBasic and

clinical sciences

SurgerySurgery

MedicineMedicine

Course, module, panel, Year-wise outcomes

Course, module, panel, Year-wise outcomes

Generic statements

of knowledge, skills and qualities expected in a graduate from the

MBChB programme

Clinical modulesClinical

modules

I II III IV V

IntegratedBasic and clinical sciences

IntegratedBasic and clinical sciences

SurgerySurgery

MedicineMedicine

Clinical modulesClinical modules

I II III

D1

D2

D3

D4

D5

D6

Pillars

Themes

Themes

Themes

Specify Outcomes at point of curriculum delivery Curricular mapping

Pillar 3: Understanding Professional Attitudes and Responsibilities

(Domain 12 Theme 75-77 / Domain 13 Theme 78-80)

D12 P3D12Domain 12 Meeting Theoretical and Legal Determinants

T75 P3D12T75 Theme 75 Basic ethical principles and standards

T76 P3D12T76 Theme 76 Legal responsibilities

T77 P3D12T77 Theme 77 Ethical aspects of medical research

D13 P3D13Domain 13 Personal Determinants

T78 P3D13T78 Theme 78 General attitudes and responsibilities

T79 P3D13T79 Theme 79 Attitudes and responsibilities related to cultural, social & psychological diversity

T80 P3D13T80 Theme 80 Attitudes and responsibilities related to economic and financial issues

SLO web-siteSearch

P3D12T-76

Contextual Outcomes Generic Framework

Sincere Thanks to Jenny Fang, Raymond Chu and the MIT teamAlex Yung of the Learning Resource Centre.


(Domain 4 Theme 21 - 38)

D4 P1D4 Domain 4 Patient ManagementT21 P1D4T21 Theme 21 Providing continuity of care by multi-disciplinary approach

T22 P1D4T22 Theme 22 Administering drugs

T23 P1D4T23 Theme 23 Surgery

T24 P1D4T24 Theme 24 Psychosocial support

T25 P1D4T25 Theme 25 Providing radiotherapy

T26 P1D4T26 Theme 26 Working with Allied health services

T27 P1D4T27 Theme 27 Nutrition

T28 P1D4T28 Theme 28 Providing emergency medicine

T29 P1D4T29 Theme 29 Acute care

T30 P1D4T30 Theme 30 Chronic care

T31 P1D4T31 Theme 31 Intensive care

T32 P1D4T32 Theme 32 Palliative care

T33 P1D4T33 Theme 33 Pain control

T34 P1D4T34 Theme 34 Rehabilitation

T35 P1D4T35 Theme 35 Complementary therapies

T36 P1D4T36 Theme 36 Patient referral

T37 P1D4T37 Theme 37 Blood Transfusion Services

T38 P1D4T38 Theme 38 Management of Death


(Domain 5 Theme 39-41 / Domain 6 Theme 42-47)

D5 P1D5 Domain 5 Practical Procedures

T39 P1D5T39 Theme 39 Measuring and recording

T40 P1D5T40 Theme 40 Administering and doing

T41 P1D5T41 Theme 41 Treatment

D6 P1D6 Domain 6 Health Promotion & Disease Prevention

T42 P1D6T42 Theme 42 Doctor as patient educator

T43 P1D6T43 Theme 43 Understand the determinants of health

T44 P1D6T44 Theme 44 To be able to implement, where appropriate, risk reduction strategies for individual patients & population

T45 P1D6T45 Theme 45 Understand the concept of multi-disciplinary and multi-sectoral collaborations in health promotion and disease prevention

T46 P1D6T46 Theme 46 Plan health promotion taking into account barriers to preventing disease and promoting health both in the individual and the population

T47 P1D6T47 Theme 47 Screening: understanding the principles and rationale including personal and cost effectiveness for screening

Search P1D5

Pillar Domain ThemePillar Domain Theme P1 P2 P3

D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11 D12 D13

Orthopaedics 82 33 63 4 2 3 0 24 0 0 0 0 0

Anaesthesia 24 3 24 53 29 0 0 0 0 4 4 2 0

82

33

63

4 2 3 0

24

0 0 0 0 0

24

3

24

53

29

0 0 0 04 4 2 0

0

10

20

30

40

50

60

70

80

90

D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11 D12 D13

Orthopaedics Domain Total

Anaesthesia Domain Total

Practical procedures Clinical reasoning



Examples of OBA in other medical schoolsExamples of OBA in other medical schools

To evaluate basic cognitive, reasoning skills, and clinical aptitudes required of physicians entering medical practice in Canada



Objectives expressed in behavioral terms and reflect the council’s expectations ofa competent physician in the supervised practice of medicine

• Obtain pertinent information• Perform necessary physical examination• Order appropriate investigations• Arrive at a reasonable diagnosis• Formulate short and long term management plans

Patient Presentation Model

Rationale ÷ objectives ÷ communication skills÷ history ÷ examination ÷ investigations ÷

clinical decision making ÷ management skills ÷ health maintenance ÷ critical appraisal ÷ health economics ÷

law and ethics



ITUCritical care

History

Examination

Investigations

SeriouslyIll patient

COAD management

Airway management & Obstruction

Respiratory failure

Pnuemonia

History

Examination

Investigations

Management

Knowledge

OSCEShort Cases

}

Sample MCQ’s



We can assist teachers!We can assist teachers!

Help you express or refine outcome statements

Help with a review of existing teaching outlines and stated objectives

Help tie-in assessments to outcomes

Enable you to gather evidence whether

outcome expectations are indeed being met !

Examples of how assessments may be planned to evaluate SLO

Blue Print Matrix for the MBChB Examination in Surgery - 2008General

1Vascular

2Urology

3Plastic

4Neurosurgery

5Endocrine

6GI7

Breast +wound 8

Thoracic9

Orthopaedic10

Trauma11

0 2 0 2 0 1 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 1tory/symptoms

A

0 3 1 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0Exam/features

B

1 2 1 0 1 1 0 0 1 1 0 1 4 4 3 2 1 1 4 1 0 0Investigation

C

3 11 0 0 1 3 1 2 1 2 1 0 3 10 3 1 0 1 2 4 0 12Diagnosis

D

7 5 2 3 1 1 1 1 1 0 0 3 8 1 2 0 2 0 7 0 9 1Management

E

2 3 1 0 2 0 0 0 0 0 0 0 8 1 1 0 0 0 0 0 1 0S/concepts etc

F

0 1 0 2 0 2 0 1 0 0 0 1 0 4 0 1 0 0 1 4 1 0ses and others

G

TOTALS13 27

405 7

125 8

133 4

73 3

62 5

723 22

459 5

143 2

5 15 10

25 11 14

25

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Hands

Rheumatology

SpineTumoursTraumaSportsGeneral

Foot

PaediatricsInfection

SLO-Assessment linkageOrthopaedic (25)

Spinal conditions

1. Low Back Pain, diagnosis B-K22. Diagnosis Osteoporosis, Primary, or secondary G-K23. PID L4/5 C-K2

Arthritis

4. Osteoarthritis, knee or hip E-K15. Rheumatoid arthritis, lab values, diagnosis G-K26. Monoarthritis, diagnosis G-K2

Hand Problems

7. Carpal Tunnel Syndrome diagnosis B-K18. Re-implantation of a digit E-K19. Median nerve palsy D-K2

MS Tumours

10. Osteosarcoma C-K111. Secondary bone malignancy/hypercal C-K212. Myeloma, case with lab values and diagnosis G-K2

Infections

13. Microbiology for penetrating soft tissue injuries C-K114. Typical Osteomyelitis, management E-K115. Suppurative tenosynovitis D-K216. Septic arthritis, management E-K1

Sports Medicine

17. Knee, investigation C-K118. Drug abuse, detection D-K119. Ankle sprain, management E-K1

Special Diagnoses

20. Hypercalcaemia, Lab Values G-K221. Perthe’s disease, management E-K122. Gout, diagnosis D-K223. Mallet finger, management E-K124. Flat foot, diagnosis D-K2

Item ID: 191 A type: 3-5 options

A 42-year-old unmarried woman has received a mastectomy for breast carcinoma.She has complained of bone pain two months ago & Tc-99MDP scan showed multiplehotspots on the thoracic and lumbar the ribs and pelvis. Plain radiographsshowed multiple osteolytic lesions in the skeleton. She now complains of severefatigue since 2 days appears to be confused. The family confirms that she hashad a poor appetite and has not opened bowels for 2 days. She also has hadseveral episodes of generalized abdominal pain. The abdomen is soft, pulse is102 BPM, temperature is 37.8. An ECG showed a short QT interval.

What is most diagnostic of this clinical situation?

A. Elevated Alkaline phosphatase > 1000 I.U./ml.B. Elevated Serum Calcium > 3.1mMols/l.C. Elevated LDH > 600 I.U./ml.D. Presence of the BRC1 & 2 Gene in Breast tumor tissue.E. Elevated Parathyroid Hormone Related peptide (PTH-rP).

Answer:B

Last Use Statistics: Examination Year: 2007/JanExamination used for Level: 5-5Difficulty Level: 63 Discrimination Index: 50 Pt.Biserial: 50Number in Group: 19 Test #: Med5 Gp 3 Question #: 10Percentage Of Group Selecting Options: <A>11% 63% <C>0% <D>0% <E>26% <F>0% <G>0% <H>0% 0% <J>0% <K>0% <L>0%<M>0% <N>0% <O>0% 0% <Q>0% <R>0% <S>0% <T>0% 0% <V>0% <W>0% <X>0% <Y>0%<Z>0%

Second Last Use Statistics: Examination Year: 2005/MarDifficulty Level: 69 Discrimination Index: 50 Pt.Biserial: 28Examination used for Level: 5-5Number in Group: 16 Test #: M5 Gp10 Question #: 19Percentage Of Group Selecting Options: <A>19% 69% <C>0% <D>0% <E>13% <F>0% <G>0% <H>0% 0% <J>0% <K>0% <L>0%

Background Info.:Author: Prof S M Kumta [Orthopaedics & Traumatology, CUHK]Item entered the bank on 4 February 2005 for Med 5 Group 2 Examination.

SLO-Assessment linkage

Rheumatoid Arthritis

Given the history and presenting clinical features, of a typical patient with RA, students should be able to interpret radiographs to the extent that they can explain the underlying pathological process that results in joint destruction……



The next phase……….

• I need your support• Will help you define & refine outcome statements• Will facilitate input onto the SLO framework• Outcome expectations must be communicated to

students• We must solicit feedback - from S&T’s• Eventually outcomes need to be integrated into

the teaching cycle - – teaching- outcome evaluation - realignment

• Concerns regarding student performance in Final Year exams – (2006-2007)

• ECG interpretation skills• Radiographic interpretation skills

– Particularly skeletal radiographs– Special investigations (CT, MRI)

New Outcome Based Initiatives

Interpretation = Reading (a skill) + Reasoning

Pattern Recognition

• Distinguishes the expert from the novice

• RPD enables intuitive decision making through the recognition of critical features.

• Transition from competence to expertise may be hastened by training that targets the “recognition”

aspect.

• Recognition may be facilitated through the development of a systematic approach to the reading of

radiographs, and ECG tracings

• Decision making must be supported by clinical reasoning

Recognition primed decision making (RPD)

Novice Competent

Training & deliberate practice

ExpertExperience

Arrythmias and Life threatening Cardiac problems

Students are expected to recognize STEMI and Non-STEMI on a 12-lead ECG

& formulate an appropriate management plan

Outcome Expectations :

But we do not want students to guess.

Instead we want to encourage a systematic

approach

Weekly ECG reading Quiz Med-3 and Med-5 students in Medicine-Cardiology

FACS based Web-site

Login is monitored

Students to select appropriate items from a standard Checklist covers the essential components required for a proper reading of an ECG tracing

Select the appropriate clinical management for that given clinical presentation

306 Students 4480 logins - 20 cases

January 1 , 2008 to September 1, 2008

Pre-test Post-test

Mean Score

52.01 73.13

SD 13.2 9.81

52.01%

73.13%

47.99%

26.87%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Overall 20 Cases on the first access Overall 20 Cases after first access

Correct %

Wrong %



Skeletal radiology

2 Training CD’s

1 Tutorial - 3 hours

Pre-test

Post-test

Pre Post

Y-3 (n=33 )

3.5 19.28

Y-5(n=29 )

19.70 19.00

Year 3/5 students are expected to interpret radiographs of patients presenting with common musculoskeletal complaints to a degree that are able to

……..Identify key anatomical landmarks

Identify and describe the location and displacement of fractures

Distinguish aggressive and non aggressive lesions………

Pre/Post Tutorial Correctness %

53.01%

65.34%

46.99%

34.66%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Before Tutorial After Tutorial

Correct Score %

Wrong Score %

Student feedback

Outcome Evaluation

Review of TeachingTeaching

Expected outcomes

Year -3

Pre/Post Tutorial Correctness %

65.95%63.27%

34.05%36.73%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Before Tutorial After Tutorial

Correct Score %

Wrong Score %

Year -5

Documents

Faculty Curriculum Retreat 6 September 2008. Key points to be covered 1.UGC and University’s OBA initiative 2.SLO framework - what is it and why do we