Representing integrated clerkships
Integrated clerkships are ones where content “cuts across subject-matter lines, bringing together various aspects of the curriculum into meaningful association to focus upon broad areas of study” (Shoemaker, 1989). In a medical school context, integrated clerkships are ones that include content across disciplines. For example, an integrated clerkship experience for students might include following a panel of diverse patients over a period of time from internal medicine, family medicine, and pediatrics, where students act as patient advocates and navigators. In this example, the integrated clerkship includes content from several clinical disciplines: internal medicine, family medicine, and pediatrics.
From a MedBiquitous Curriculum Inventory (CI) specifications standpoint, a clerkship can be either rotational OR integrated; clerkships are not able to be documented as both rotational and integrated. The concepts of “rotational” and “integrated” can only be applied to sequence blocks which are clerkships; they cannot be applied to non-clerkship sequence blocks.
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Consider if integrated clerkships need to be modeled in your CI.
Representing elective and selective courses
Elective courses typically mean that students can opt-in to taking a course or may choose not to take a course. Elective courses would therefore be designated as “optional.”
One way to think about electives is to consider a course that is optional, where there is no academic penalty if a student chooses not to take the elective. As an example, perhaps a global health trip to Central America is offered during winter break of the first year of medical school. Students are offered the optional elective trip, but they could also choose to do something else with their winter break time (e.g., have a part-time job, study, go home to visit family) without academic penalty. The only consequence would be not acquiring any credit hours offered for that course.
Elective courses, like the example described above, are designated “optional” (rather than “required”) in your CI to model them accurately.
With “selective” courses, it typically means that students have some flexibility in choice but there are limitations and requirements on which and how many students choose.
For example, perhaps students are required to complete one intensive care unit (ICU) rotation. Students can choose from an ICU rotation in medicine (MICU), surgery (SICU), or pediatrics (PICU). Students therefore must choose one ICU rotation of the three. There is some degree of choice (e.g., which ICU rotation is available when a student wants to take it and will best prepare the student for their future career?). There are also limitations on that choice – students must choose one of these three ICU options. Another common example are sub-internships (sub-I’s). Perhaps all students at your school are required to complete a sub-internship, but there are multiple sub-internship options students can choose from (e.g., medicine, surgery, pediatrics, etc.).
How will you model these types of selective courses in your CI? Recall that the goal is to model what any typical, hypothetical student may experience in the curriculum (e.g, must take 1 ICU rotation), and model your complete and accurate curriculum (e.g., can choose from 3 ICU selective options). The MedBiquitous Curriculum Inventory Implementation Guidelines, from pages 10-13, may be a helpful resource here.
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It may be that the definitions and examples of electives and selectives above do not line up perfectly with your school’s application of the word “elective.” Whether optional courses are referred to as electives or selectives at your school, the vernacular per school is not so critical for the AAMC CI – what is important is that the electives, selectives, and optional courses at your school are modeled accurately.
With our selective ICU course described above, here is how it could be modeled, using the “nested sequence block” concept discussed in Building a Curriculum Inventory: Determining Your CI Organizational Strategy.
List all courses, modules, clerkships, etc., which are optional (e.g., electives, selectives), and determine how to model them accurately in your CI, considering the examples above.
Course-level learning objectives
Each of the course/modules and clerkships in your list will have learning objectives, and there are many questions to consider before finalizing the course-level learning objectives for inclusion in your CI.
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Are there documented learning objectives for each course/module, or are any missing? Do the learning objectives reflect the content of the course/module? Do the objectives reflect relevant and up to date medical and other literature? Are the learning objectives written in descriptive, specific, outcomes-based language?
It is also important to confirm that the learning objectives at the course-level collectively meet your school’s goals, i.e., the program objectives.
For example, perhaps for your pre-clerkship courses, a collective goal is that all the course-level learning objectives add up to preparedness for the clerkship experience. Or perhaps course learning objectives collectively need to prepare learners for a licensing exam. Whatever your curriculum goals are, your course-level learning objectives should collectively meet your curriculum goals.
It is useful to engage content experts both to review the content of the learning objectives, and to judge the relatedness of the learning objectives to each other and to your school’s program objectives, and goals. For example, if one of your goals for the pre-clerkship learning objectives is to collectively prepare students for clerkships, perhaps clerkship directors should be consulted in reviewing the learning objectives.
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Gather draft learning objectives for each course, module, clerkship, etc. you need to include in your CI.
Once you have drafted learning objectives for each course/module, there are additional questions to ask. Are these learning objectives the appropriate degree of difficulty, and do they build upon each other over time?
Consider alignment of your learning objectives within courses and modules, across and between courses and modules, and across time. In this simplified, limited example, the colored arrows represent how vertical and horizontal alignment and integration of content (in this case, learning objectives) could be considered.
At this stage, you can check to make sure that learning objectives are not too easy or too challenging for where the students will be at a given phase of the curriculum. If the learning objectives relate to each other across courses and over time, there will be limited duplication of content presented to students and fewer gaps in content coverage.
It will be helpful to establish institutional guidelines on writing learning objectives so that faculty take a consistent approach across courses when editing their learning objectives. Offering faculty development in writing effective learning objectives using your school’s guidelines is another way to support faculty through this process. If you have multiple authors contributing to your learning objectives, you may also want to establish a centralized clearinghouse to review learning objectives to ensure quality.
Again, program-level learning objectives drive curriculum. Any learning-objectives at the course/module level should be driven by your program objectives. However, there are likely some commonalities in the wording/content of learning objectives schools need, and there may be sources you can refer to for sample learning objectives.
Some professional societies for clinical areas have recommended learning objectives. For example, the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) have a “Clinical Learning Objectives Guide for Psychiatry Education of Medical Students” organized by unit (e.g., “clinical skills”), topic (e.g., “history-taking, examination, and medical interviewing”), and learning objective (e.g., “elicit and accurately document a complete psychiatric history, including the identifying data, chief complaint, etc.”). If the sources are up to date, evidence-based, informed by content experts, and well-written, it may be more efficient to use these examples as inspiration rather than start from scratch.
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As you choose which resources or samples to use or consult, keep a written record per course/module – this may be helpful for your curriculum committee (or similar oversight body) when conducting curriculum evaluation and course reviews.
Finalize your course-level learning objectives after additional considerations.
Once edits to the learning objectives are finalized, it is time to link course objectives to program objectives. This applies to all courses, clerkships, modules, whatever you have included in your CI using the “sequence block” concept from the MedBiquitious CI specifications.
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If a very broad approach is taken in linking learning objectives, such that every course objective is linked to many program objectives, it can be difficult to identify your curriculum content in reports. It may be helpful to establish thresholds for what warrants a link between a course objective and a program objective. At least one link between each course-level learning objective up to a program objective should be documented.
Before further CI content is developed, as a school’s program objectives and related learning objectives drive content, you should evaluate if any gaps are identified at this point. Are there course-level learning objectives that do not relate to a program objective? Are there any program objectives with little or no course-level learning objectives to link to?
Keep in mind that number of learning objectives is not necessarily equal to amount of exposure; what matters at the end is not the amount of objectives but the overarching representation of their content at the program-level that fits with the school’s mission and vision.
Create links between course-level and program-level learning objectives, and address any gaps identified.
If you nested your program objectives into domains (e.g., patient care, knowledge for practice, etc.), it may be helpful to monitor all the course objectives linked up to each domain for breadth and depth. The goal is not to have an equivalent amount of content in each program objective domain, but to make sure the spread of content is intentional.
This also is the time to choose whether you will assign ID codes to each course learning objective.
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Analyze how your course-level learning objectives are linking up to your program objective domains (if you have them) and consider assigning ID codes to each course-level learning objective.
Chapter 5 key questions
- Do each of our courses, clerkships, modules, threads have a title? Have we documented whether they are required or optional? Have we documented their start dates, end dates, and durations?
- Have we created a “typical” course, or some other approach that will accurately and completely model our curriculum, for our rotational clerkships? Do we have any integrated clerkships to model in our CI?
- Do we have a list of all our optional courses, modules, clerkships, etc., including optional electives? Do we have any for which the selective model (some choice in what students can choose, but limitations on those choices) applies, such as sub-I’s? What modeling strategy will we use to completely and accurately represent the breadth of what our curriculum offered, and the experience of any typical, hypothetical student?
- For our course/module level learning objectives,
- Are there documented learning objectives for each course/module?
- Do the learning objectives reflect the content of the course/module?
- Do the objectives reflect relevant and up to date medical and other literature?
- Are the learning objectives written in descriptive, specific, outcomes-based language?
- Have we consulted our content experts for their input on the learning objectives?
- Do these learning objectives add up to meeting our school’s program objectives?
- Are these learning objectives the right degree of difficulty?
- Do these learning objectives build upon each other over time?
- Are these learning objectives aligned across our courses/modules?
- What are our school’s standards and guidelines for writing learning objectives, and how are we disseminating that information to our faculty?
- How are we ensuring consistency in the quality of our learning objectives across courses/modules, across multiple authors?
- Have we consulted any sample or model learning objectives, such as those from clinical professional societies?
- Does each course/module learning objective have at least one link to a program objective? Have we identified any gaps based on these links which need to be addressed?
- If your program objectives are nested in domains, does our coverage of content for breadth and depth play out as expected?
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