SES09: Teaching the Competencies:

Thinking Outside-of-the-Box
2010 ACGME Annual Education Conference

Bardia Behravesh, MA &

Alice Edler, MD, MA, MPH
Department of Graduate Medical Education

Session Objectives
Identify

innovative teaching methods used by

your residency programs and share them
across programs.
Leverage existing resources within your
institution to teach the ACGME General
Competencies.
Use a systematic curriculum design
approach to develop curriculum.

Background
In

2008, Stanford GME conducted a needs

assessment with the goal of identifying ways
in which it could better serve its residency
programs.
63 of 75 Program Directors responded to an
online survey.
Following the survey, 69 of 75 Program
Directors were interviewed.

Findings
46%

of respondents requested centralized

teaching of the competencies (i.e. delivered
by the Dept of GME).
23% of respondents requested more
information about educational techniques and
resources.
19% of respondents requested web-based
learning modules that teach the
competencies.

Goals
1.
2.

Identify educational techniques and

resources to share across programs.
Identify avenues for centrally teaching the
competencies (including the utilization of
web-based learning modules).

Goal 1: Techniques & Resources

Initial approach: Searched the web for teaching and

evaluation methods (best practices) to post to the
Dept of GME web site.
Challenges:

Limited resources available online

Cost

Thinking Outside-of-the-Box: Which programs are

currently using innovative methods to teach the core
competencies (i.e. what ideas can we borrow from
our own programs and share across all programs)?

Program Innovations
Solicited

voluntary submission of innovative

teaching strategies by Program Directors.
Flagged innovative teaching strategies
during internal program reviews.
Collected strategies into a spreadsheet and
posted to the Dept of GME web site.

Exercise 1
1.
2.

Review the learning activities described in

the handout.
Using the blank fields, describe an
innovative activity developed by your own
program that you could potentially share
with other programs within your institution.

Goal 2: Centralized Education

Initial approach: Looked at developing and/or

purchasing web-based learning modules.
Challenges:

In-house development is costly.

Off-the-shelf solutions do not fit needs exactly.
Customization of off-the-shelf solutions difficult/costly.

Thinking Outside-of-the-Box: What existing content

(already available at our institution) can we leverage
to teach the competencies?

Regulatory Compliance Training

Stanford satisfies various regulatory requirements

through the use of online training.
Topics include:

Patient Rights
HIPPA
Emergency Codes
Quality Management
Cultural Diversity

Residents are required to complete the modules on

a yearly basis.

Mapping Content to Competencies

Determined

what web-based learning

modules were available.
Used a spreadsheet to map the modules to
the competencies.
Posted spreadsheet to the Dept of GME web
site.

Mapping Content to Competencies

ACGME Competency
Module

Length (min)

Frequency

Patient Rights (PA)

30

Yearly

Rapid Regulatory

60

Bi-Annual

LIFE Curriculum: Fatigue

30

Bi-Annual

Code of Conduct

20

Yearly

Cultural Diversity

20

Bi-Annual

Emergency Codes

1x

HIPAA

30

Yearly

Quality Improvement

20

Yearly

Respiratory Precautions

25

Bi-Annual

Restraints/Seclusion

20

1x

MK

PC

PBLI

CIS

Prof

SBP

X
X

X
X

X
X

E-learning as a springboard
A web-based

learning module should not be

thought of as PRIMARY and SUFFICIENT
for competency education.
Pre-existing curriculum can act as a
springboard for additional learning.
Partner the goals and objectives of the preexisting curriculum with those of additional
learning activities.

Systematic Curriculum Development

Two

commonly used curriculum design

approaches in medical education:

Tylers principles for curriculum and instruction

Tyler R, Basic Principles of Curriculum and instruction

Chicago, University of Chicago Press, 1949

Kerns six step approach to curriculum

development
Kern

D, Thomas P, Howard D, Bass E, Curriculum

Development for Medical Education, Baltimore, Johns
Hopkins University Press 1998

Pros of Tyler Rationale

Simple

and straight forward

Starts with Goals and Objectives
Good for institutional curriculum
development
Good for modification of pre-existing
curriculum
Teacher-oriented

Tylers Four Questions

What

educational purposes should the

curriculum seek to attain?
What learning experiences should be selected
to achieve these goals and objectives?
How should these learning experiences be
organized?
How can the effectiveness of these
experiences be evaluated?

Goals and Objectives

Goals:

Overall outcomes
Objectives: Criteria by which the educational
materials are selected and the content is
outlined. Based on:

Values
Needs
Learner
Society

Objectives = The Desired Educational Ends

The

changes in learner behavior/attitudes

Not what the teacher does

Not a content list
Not a vague abstraction but concrete change

Behavioral and Attitudinal Aspects of

Objectives
Understanding

of the important facts and

principles
Familiarity with the sources of information
Ability to interpret data
Ability to apply principles
Ability to interpret results of investigation
Broad and mature interests

Selecting Educational Experiences

Real

and attainable
Satisfying to the learner
Multiple and reinforcing

Organization of Educational
Experiences
Sequencing

Increasing complexity, if needed (graduated

responsibility)
Reinforcing

Implementation
Political

support for program

Procurement of resources (room,
standardized patients, etc)
Piloting, if possible
Introduction
Barriers to implementation

Evaluation of the Curriculum

Multi-source

evaluation of the

Written Curriculum
Educational Milieu
Administration of the Curriculum
Faculty
Learner

Exercise 2

Review the sample e-learning module and consider

the following questions:
1.
2.

3.
4.

What competency-based goals and objectives could this

module address?
If we were to use this module as a springboard, what
additional learning experiences could we combine with
this module to develop a competency-based curriculum?
How would you sequence the learning experiences,
including the use of this module?
How would you evaluate the effectiveness of your new
curriculum in teaching the desired competencies?

Summary
Resident

learning need not be bounded by

program-specific curricula.
Rather than develop completely from
scratch, look for pre-existing practices and
content that can be leveraged.
Look across programs for best practices.
Look at the institutional level for resources.

Questions?
Feel

free to contact us:

Bardia Behravesh, MA bbehrave@stanford.edu

Alice Edler, MD, MA, MPH aedler@stanford.edu