1

Educational Planning And Evaluation

=<M;9LAGF9D
HD9FFAF?
9F<
=N9DM9LAGFD
A
Y
O
N
E
 2
Educational Planning And Evaluation

EDUCATIONAL PLANNING
AND
EVALUATION
DAY ONE

Overview
Group Dynamics
Principles of learning
What is a curriculum: types and process
Structured Training Program
Clinical Protocols
Systems Approach
Writing objectives

D
A
Y
O
N
E
 2
Educational Planning And Evaluation

OVERVIEW
The Department of Medical Education, at the College of Physicians and
Surgeons of Pakistan, is interested in raising the standards of health
professions education. This is being done so that there is more relevant
and objective training of health professions in and outside Pakistan. We
hope that by doing so we would be able to increase the competence of
graduates and post graduates so that the delivery of health care improves
and we are able to achieve the goal of health for all. This workshop is
the first in a series. It lays the foundation for Assessment of Competence
and (we hope) will enable you to initiate academic activities in your own
settings with greater objectivity and relevance. It is being conducted on the
basis of experiential learning, whereby, the participants will learn by
completing various tasks and exercises individually and in groups.

This workshop is based on mutual group activity and it is important for its
smooth running that everyone participate fully. It is for this reason that you
are requested to attend all the sessions and avoid any other commitment
during these hours.

Note: No telephone calls or messages will be delivered during the

sessions. Please keep your mobiles and pagers switched off while the

D sessions are in progress.

OBJECTIVES OF THE WORKSHOP:

A By the end of the workshop, you will be able to:

Act as an effective group leader and a facilitator in achievement of group

tasks

Y Use the principles of learning in order to design learner- oriented units

of instruction
Improve your education plan, in your own settings, according to systems

approach and the latest cognitive philosophy

Write educational objectives for your own specialities

O Differentiate between curriculum and syllabus

Select a mode of instruction according to objectives

Provide feedback effectively to learners

N Deliver effective lectures and conduct small group discussions

Demonstrate ability to teach critical thinking

Demonstrate ability to teach procedural skills

E Discuss the steps in teaching affective domain

Differentiate between evaluaton and assessment

Enlist tools for objectively evaluating a training program

Discuss the uses of results of evaluation

 3
Educational Planning And Evaluation

GROUP DYNAMICS
STAGES OF GROUP BEHAVIOR
1. Getting acquainted
The associated behavior is that the people are polite and
indulge in superficial talk.

2. Why am I here and what am I here for?

In the second stage, people are slightly confused about what
they are going to learn and purpose of their presence. There
maybe confusion, frustration, anger, and the group may be a
little chaotic.

3. Bid for power and influence:

Some members attempt to create order out of the above. Norms
are established, commitment to membership begins, natural
resources and leadership begin to be identified.

4. What can I do to help?

Negotiations start; there is start of group cohesion and a sense
of order and direction begins to emerge. D
5. Sense of accomplishment:
There is collaboration around execution and completion of a
task.
A
6. Termination:
There is disengagement, withdrawing commitment to group,
Y
preparatory to separation and disbanding of group.

O
N
E
 4
Educational Planning And Evaluation

BEHAVIORS WHICH FACILITATE GROUP

INTERACTION
Checks out/ clarifies
Agrees with opinion
Responds to topics
Proposes solutions
Gives in
Summarizes
Speaks to all

BEHAVIORS WHICH HAMPER GROUP

INTERACTION
Interrupts
Changes subject
Defends
Attacks
Speaks to one or two
Speaks to ceiling
Disengages

D
A
Y
O
N
E
 5
Educational Planning And Evaluation

EDUCATIONAL STANDARDS
The core function of a body, which deals with educational standards, is to
determine and uphold the standards that define and govern competent
medical practice. These standards are defined by using the evidence from
international best practice and applying the experience of the institutions
own specialists. Two types of standards are considered for medical
education:

Educational Standards
Education Standards define the knowledge and skills doctors require to
practice safely and competently in the local environment, and are
organized according to Professional Development Standards.

Quality of Care Standards

Quality of Care Standards address the process and outcomes of care
provision and the structure in which the care is provided through
Practitioner Standards and Practice Standards, and are tailored to relevant
medical practice.
Practitioner Standards are determined for four domains of health care
provision:

1.
2.
Management of specific clinical conditions (clinical care)
Population health
D
3.
4.
Management of interpersonal skills
Coordination of care A
Practice Standards relate to the diversity of medical practices and the
communities in which they are located, and are flexible reflecting the
realities of local environment.
Y
O
N
E
 6
Educational Planning And Evaluation

Process of defining standards

The process must cover people, posts and practices.
It should be regionally based so that local knowledge, rural input and
professional linkages can be utilized to the full.
It should be based on educational excellence together with the highest
attainable standards of teaching and mentoring, maximizing available
resources, teaching situations, training versus service components and
qualifications for learners.
There has to be some regard to the amount of training and professional
development undertaken by teachers and mentors, and an assessment
of the administrative efficiency of the training or practice situations as
it impacts on learners.
There has to be a clear process of adjudication and appeals that is
understood by all parties from the outset.
Documentation should be easy to understand and put into practice, with
proformas that are not too time-consuming.
Finally, the criteria must have simplicity, relevance, lack of bias, speed
of execution and above all have the interests of the learner as the first
priority.

D Using the standards

For each standard there are several criteria, which are underpinned by
quality indicators. The criteria define the ideas or related concepts within

A each of the standards. The indicators provide a means of measuring the

evidence of the educational opportunities and processes offered by the

Y practice.

O
N
E
 7
Educational Planning And Evaluation

SYSTEMS APPROACH
Systems approach to education is a conceptual framework,
Which explain what the various components of an effective educational
plan are,
In what sequence they appear and

How they are inter-related.

It aids us in tackling problems that we experience in making our students
learn better and hence, be more competent.

OBJECTIVES :
Objectives are statements of what the educational process hopes to
achieve. For medical education in Pakistan, they are primarily laid down by
the PMDC, which draws upon the services of health officials and experts
in different fields in designing them. The needs of the nation, community,
profession, students etc. determine the objectives. Currently, the
educational worlds is focusing on outcomes of an educational program.
Hence, the term objective has been replaced by outcome. So, through
out this text we will refer to objectives as outcomes. Consequently, the first
major step in the systems apporach is the writing of learning outcomes.
Since these have to be written in specific and measureable terms, they are
called Specific Learning Outcomes or SLOs. SLOs inform the readers what
D
the learner will have accomplished after going through the course.

INSTRUCTIONAL STRATEGY :
A
This is the outline or plan of how the objectives should be met. In practical
terms, this is the timetable and schedule which each institution and
Y
department prepares in order to achieve the objectives. The strategy is
partly dependent upon the resources although it is possible to maximize
the available resources by fully using the principles of learning. We can
overcome our resource constraints a lot by this way. O
EVALUATION:
Evaluation is a general term, which incorporates a number of modalities.
N
For example, evaluation could be to find out the quality of a teaching
program, the teaching abilities of a faculty member, the strength of a
curriculum etc.
E
 8
Educational Planning And Evaluation

Assessment, on the other hand, is used specifically to mean evaluation of

students' knowledge, psychomotor competence and/or attitudes. Within
the same context, assessment is the process of determining whether the
objectives have been achieved or not. A properly designed assessment is
thus determined by including a sufficient number of SLOs in the test or
exam; this is called sufficient sampling. Student assessment is better if
the principles of evaluation are utilized in designing it.

This approach can be used in our lives also, i.e. first we make a plan
(objectives) to do some work and then we perform it and then we evaluate
what we did by thinking about how our work went. So usually we evaluate
our work mentally by matching what we did with what we had planned to
do. So the evaluation is always according to the initial plan. If things do not
go as per our plan (objectives) we review where we went wrong. This review
is not just of how we did our work (instructional strategy) but also of
whether we evaluated our plan correctly or not and whether our initial plan
was correct or not. So, review is ALWAYS of each and every aspect of the
systems approach.

REVIEW
It is imperative that once the whole circle has been followed, experts in the
subject hold a meeting in which they review the whole plan. They need to:

D 1. Go over the results of the test that they have administered and ask
themselves: does the test have indicators of high quality? If not, then

A the items in the test have to be reviewed and

2. Matched with the objectives (do the SLOs need to be changed also?).
3. Some changes in the instructional strategy may then be necessary

Y and/ or
4. Changes in the test that was
administered.
IS

O SLO
N
E EVALUATION
 9
Educational Planning And Evaluation

PRINCIPLES OF LEARNING
WHY IS IT NECESSARY FOR US TO KNOW ABOUT
LEARNING?
ince we are directly concerned with the acquisition of knowledge,

S whether that is theoretical or practical knowledge, it is only evident

that we know HOW knowledge is acquired, stored and recalled. This
would help us realize what the learner goes through while we are making
him learn and while he is independently trying to store information. It is
hoped that this text would help us become more aware of the positive and
negative aspects that are more prevalent in our teaching set up. By
becoming aware, we may be able to change and improve our working
strategy for our benefit and for our learners.

Storage in short or long term Retrieval or recall of

Registration of information memory (within a mental framework) information

WHAT ARE THE COMPONENTS OF LEARNING?

WHAT ASPECTS OF LEARNING DO WE NEED TO KNOW?
PRINCIPLES OF LEARNING
The current international emphasis regarding learning is on the "cognitive
philosophy". According to this philosophy: D
Learning is a constructive process and not a receptive one. That is,
knowledge is created, not simply acquired. The human mind stores
information in an organized form by storing it in mental frameworks. The
A
use of these frameworks is to:
1. direct attention
2. permit comprehension
Y
3. guide recall

MEMORY AND LEARNING

Memory is one of the most important concerns of cognitive psychology.
O
Memory is seen to comprise three major components:
N
Sensory memory: decays rapidly and spontaneously.
Short term or working memory: depends heavily on repetition and
rehearsal.
E
 10
Educational Planning And Evaluation

When students are helped to discover relationships, to group related

concepts and ideas and to see patterns, comprehension increases and
information overload decreases.

Long term memory: is the permanent storehouse for information and

seems to have unlimited capacity.

TEXT ORGANIZATION AND LEARNING:

Well- organized materials tend to be better remembered than poorly

organized one.
Complex materials are best encoded by using procedures that help

students relate new information to what they know already.

Skilled students possess knowledge that can be used to regulate their

learning.
If we want recall to be good we will have to put cues at the time of

learning.
Information should be accessible to students in a wide range of

contexts by helping them learn it in many ways with a broad range of

cues. This may be done by using various stimuli, i.e. visual, auditory and
tactile.
Rehearsal, mediation, and use of imagery are helpful for learning factual

D information. What students do while they learn determines the quality

of their memories. In general, activities that focus students on the
meaning of to be learned information result in better memory

A performance than activities that centre on superficial aspects of to be

learned materials.

Y HOW CAN WE APPLY THESE PRINCIPLES TO MAKE

LEARNING MORE EFFECTIVE ?

About learning

O 1. Recognize that the starting point of learning is what students already

know.
2. Help students activate their current knowledge.

N 3. Recognize the limitations of short-term memory. If you want to improve this,

have a number of useful rehearsals. Have students make links between
new and prior knowledge. Help them organize information in their minds

E instead of organizing it for them.

4. Help students in using their knowledge. This helps convert inert
knowledge to working knowledge.
 11
Educational Planning And Evaluation

5. Learning always occurs in a specific context that affects storage and

recall. Informing the students about the purpose of the learning task is
one excellent means for doing this. Another useful strategy is to activate
the students prior knowledge or to provide some information framework
prior to instruction.
6. Learning improves when students make rather than take meaning.

About strategies
7. Encourage the students to answer questions about to-be-learned
information or generate them. This clearly facilitates mental
processing of information.
8. Use instructional strategies that promote better understanding.
9. Make strategy instruction a priority. The teacher should be able to
guide students on how best to learn, retain and recall that information.
10. Memorizing and recall are linked. When information is learnt by using
strategies and by constructing meaning out of text, it is more easily
recalled than when no such methods are used at the time of learning.

About recall
11. Recall is state dependent. Our ability to remember information is
related to our mood and the conditions under which we learned that
information.
12. Memory is reconstructive. Students recall main ideas and use them to
construct a reasonable response.
13. Different types of tests have different recall patterns. Knowing what
D
kind of information will be included on the test also helps students
study more effectively. A
14. Recall can have errors. One of the main reasons for poor recall is that
information was not stored adequately in the first place. Errors occur
in reconstruction as well. Giving cues and providing context to the
learners may help this.
Y
O
N
E
 12
Educational Planning And Evaluation

CURRICULUM
he curriculum is not one document but a set of documents, which

T gives a clear written idea, and relevant description of the learning

means and outcomes of the entire educational program. A curriculum
consists of the following six aspects:
1. SCOPE AND SEQUENCE: The sequence section of a curriculum informs all
concerned in what order the objectives will appear for the learner. The
scope gives a clear idea (from the objectives) of how much depth of
information a student will be able to achieve at the end of a learning
period.

2. SYLLABUS: The syllabus is a plan for any one course. The plan typically
includes:
The goals and/ or rationale for the course,
Topics covered,
Resources used,
Learning objectives,
Learning activities,
Study questions,
Assignments to be given,

D Evaluation strategies,

Thus, the syllabus represents the plan for a course (and includes elements

A of both the ends and the means of the course).

3. CONTENT OUTLINE: This is a sub section of a syllabus. A syllabus

Y must contain at its outset a course outline which contains a list of

topics to be covered.

4. TEXTBOOKS: This is another sub section of syllabus and contains a list

of instructional materials used as a guide for instructions.

O 5. COURSE OF STUDY: This document contains a series of courses that

students must complete to attain completion of the course. For

N example, what courses must a student cover in order to complete the

first, second years of medical school?

E 6. PLANNED EXPERIENCES: This should contain all experiences that

learners have that are planned by the institution, whether academic,
athletic or social.
 13
Educational Planning And Evaluation

Every curriculum represents a choice as to how to approach the education

of students. The particular approach chosen by the curriculum developers
arises partly from how they formulate the problem to which they are
responding. It also depends on the developers philosophies and points of
view regarding life and learning.

Curriculum development has developed over the past few decades and is
still in a state of flux. Ideas and facts regarding the functioning of the
human brain and psyche have greatly influenced its metamorphosis.

Over time, we see five perspectives of curricula:

1. Traditional
2. Experiential
3. Structure of the disciplines
4. Behavioral
5. Cognitive

TRADITIONAL CURRICULUM
This was developed in the late nineteenth century. John Dewey (1938)
describes traditional education as:
"the subject matter of education consists of bodies of information and
skills that have been worked out in the past; therefore the main business
of the institution is to transmit them to the new generation"

EXPERIENTIAL CURRICULUM
D
The experiential perspective (developed in the early twentieth century) is
based on the assumption that everything that happens to learners
A
influences their lives. John Dewey was one of the main developers of this
philosophy. He suggested that an experiential curriculum should have a
three-pronged approach: development of the reasoning ability by
Y
emphasizing the academics, development of vocational abilities by
teaching the practical aspects of knowledge, and development or healthy
growth of individual experience by keeping the former two in balance.
O
It was greatly emphasized that high quality experiences must be a part of
the curriculum plan so that the individual became increasingly autonomous
and intelligent in guiding their own future educative experiences.
N
E
 14
Educational Planning And Evaluation

STRUCTURE OF THE DISCIPLINES

This philosophy evolved during the 1950s and gained momentum after
Russia launched Sputnik in 1957. One of the main supporters of this was
Jerrold Zacharias who believed that knowledge explosion had created too
much subject matter and that it was not possible to teach everything to
the learner. He emphasized that the institution needed to establish
priorities.
Zacharias gave two suggestions:
1. Teach only the most fundamental concepts and
2. Teach learners how to derive the rest of the knowledge from those
concepts.
He proposed that if a person understands the structure of a discipline (that
is, if he understood the main principles of a subject) he would then be able
to grasp the depths and complexities of that subject on his own.

BEHAVIORAL CURRICULUM
This philosophy gained momentum in mid 1950s and early 1960s. The
father of Behavioral psychology is considered to be Edward Thorndike.
Tyler and Bloom were active supporters of this philosophy. These
scientists proposed that curriculum development needed to focus mainly

D on what students should be able to do, i.e., the behaviors they learn as a
consequence of instruction.

A In 1956 Benjamin Bloom put forward a taxonomy of objectives. He

proposed that objectives are expressions of the behaviors that educators
want students to learn.

Y Thus behaviorists stress that instructors should decide what successful

graduates should be able to do in very specific measurable terms, analyze
those behaviors to identify their prerequisite skills, provide opportunities

O for students to practice each skill with feedback to the point of mastery,
and then evaluate the performance.

N
E
 15
Educational Planning And Evaluation

COGNITIVE CURRICULUM
Immanuel Kant in the nineteenth century established the foundation of the
Cognitive perspective. The various scientists supporting this view point
established the view that "the single most important determinant of
learning is what the learner actually knows; ascertain that and teach a
student accordingly".
This constructive and thinking curriculum asserts that:
"people are not recorders of information but builders of knowledge
structures.
To know something is not just to have received information but also to
have interpreted it and related it to other knowledge.
To be skilled is not just to know how to perform some action but also to
know when to perform it and to adapt the performance to varied
circumstances".

The cognitive school stresses that curricula need to allow students to

construct their own knowledge based on what they already know and to
use that knowledge in purposeful activities requiring decision making,
problem solving and judgement.

D
A
Y
O
N
E
 16
Educational Planning And Evaluation

OFFSHOOTS OF COGNITIVE PHILOSOPHY

EVIDENCE BASED MEDICINE (EBM)
This is a methodology for appraising clinical studies critically and
considering their applicability in clinical work. EBM was created during the
1980s and 1990s in the Anglo-Saxon medical community and has been
spreading all over the world. It is defined as "A just and explicit use of
current best evidence in making decisions about the care of individual
patients".

RATIONALE:
The turnover of knowledge is faster than ever. The last two decades have
seen many research articles coming up. New, powerful and effective
diagnostic tests and treatments nullify older ones ver y quickly.
Unfortunately this new information does not always reach us or it is not in
usable form for everyday practice. Standard textbooks do not contain the
latest information and journals are very disorganized and we do not always
have the time or finances to keep up with all of them. So, our knowledge
and performance as clinicians tend to deteriorate with time. An acute need
was felt to master knowledge. EBM provides a systematic approach to
obtaining information and appraise it critically at the point when it is

D needed. It also supports self-directed and lifelong learning. It is based on

the principle that instead of simply providing knowledge, the medical
curriculum should challenge medical students to strive for true expertise:

A critical scientific thinking, clinical hypothesis testing, solving medical and

ethical dilemmas and also communicating with patients. EBM is easily
combined with problem based Learning approach.

Y PROBLEM BASED LEARNING

This approach was started in the mid 1970s by a handful of medical schools
in the world.

O According to this method, students tackle problems that form the basis of
the study. The problems that form the basis of study are usually
descriptions of phenomena or events that can be observed in reality and

N that have to be analyzed by students by using their available prior

knowledge without consulting the literature first! The problem and the

E discussion are supposed to activate prior knowledge and arouse internal

curiosity about the topic. This initial session on problem discussion is
followed by a gap of a couple of days in which students get the chance to
study the relevant material and come up with logical solutions. When the
 17
Educational Planning And Evaluation

group meets again, the students will try and tackle the problem once more
in order to check whether the results of home study have enabled them to
comprehend the elements of the problem better.
Various medical institutions that have adopted PBL: McMaster (Canada),
University of Maastricht (the Netherlands), Al-Gezira University
(Sudan), Harvard medical School etc. In Pakistan, Ziauddin Medical
University and Agha Khan University Hospital are using PBL successfully.

COMMUNITY-ORIENTED MEDICAL EDUCATION (COME)

It is an education system, which is focused on population groups and
individual persons, taking into account the health needs of the community
concerned. (WHO 1987). Its aim is to produce doctors who are able and
willing to serve their communities and deal effectively with health
problems at primary, secondary and tertiary levels.

COMMUNITY BASED EDUCATION

It is a means of achieving educational relevance to community needs and
thus, of implementing a community-oriented educational program. A very
large number of learning activities use the community extensively as a
learning environment.

COME serves the purpose of a health-oriented physician education

(HOPE) rather than a disease-oriented physician education (DOPE).
D
A
Y
O
N
E
 18
Educational Planning And Evaluation

INTEGRATED CURRICULUM
WHAT IS IT ?
A curriculum which:
Cuts across subjects,

Makes meaningful associations

Helps learning and teaching in a holistic way

Reflects the real world, which is integrated"

(Fogarty R. The Mindful school: How to integrate the Curricula. Palatine, IL:
Skylight Publishing, Inc., 1991.)

WHY SHOULD WE INTEGRATE?

INTERNATIONAL & NATIONAL EXPECTATIONS FROM TODAYS GRADUATE
DOCTOR
Characteristics Of A Doctor
caring

holistic approach to management

critical thinker

patient and empathetic counselor

conscious of society needs

D self motivated, life long learner

CURRICULAR EXPECTATIONS FROM ACCREDITING AND

MONITORING ORGANIZATIONS
A PMDC advice for curriculum:

Y less than 1/3 time to lectures

maximum integration

assessment to match methodology

emphasis on practical training

deletion of excess information

O Expectations by GMC, UK
understanding of health and disease and of the prevention and

N management of the latter.

exploration rather than passive acquisition of knowledge .

Reduction of excessive burden of information.

E substantial component of PBL.

direct contact with patients and with the analysis of their problems

throughout the five years of the course.

An understanding of research methods.
 19
Educational Planning And Evaluation

Expectations by Council on Medical Education, USA

A broad general education in both clinical and basic sciences

Educational programs integrate the sciences of medical practice

throughout the entire course of study

Life long learning skills, values and attitudes should receive at least as

much emphasis as the acquisition of knowledge

Educational sites beyond tertiary care hospitals.

(Ref: Gastel B, Rogers DE, Mills JS, Rappleye W. Council on Medical Education, 1989.)

Current Situation
Content of curriculum is determined by Medical educators and health
professionals.

Health professionals expand curriculum based on advances in knowledge

and new technology. Hence there is, disparity between what is relevant to
society needs and what is taught.

(Schroeder, Evans, White, Connelly. World Federation for Medical Education. 1992).

Future needs
Changes outside the medical field will have a greater impact on medical
education. (Jolly B, Rees L. Medical Education in the new Millenium). D
The societys health needs will be a major factor in determining physicians
education. (Tarlov 1992) A
Health care systems can not be changed without changing how health care
providers are educated at all levels. (ONeil, Todd, 2000) Y
Qualities of the future practitioner

Assesses and improves quality of care

Makes optimal use of new technologies
Promotes healthy life styles by means of communication skills
O
Strikes a balance between patients expectation and those of society at
large.
Works efficiently in teams within health sector
N
E

 20
Educational Planning And Evaluation

WHO SHOULD INTEGRATE?

Basic scientists
Clinicians
Expert Curriculum designers
Health sector service providers
Students

STEPS FOR INTERGATING A CURRICULUM

1. Decide on commitment to the process

2. Make a multi-disciplinary team
3. View & review the competencies required of a graduate
4. Decide on the level of integration suitable for your institution
5. Group topics from various disciplines into common themes
6. Write the objectives of the themes
7. Decide on how assessment will be carried out:
= formative and summative
= format of assessments:
- essays, MCQs, skills

D 8. Develop a system of program evaluation

CURRENT DIVISION OF DISCIPLINES

A BASIC CLINICAL

Y SCIENCES SCIENCES

INTEGRATED DISCIPLINES

O CLINICAL
SCIENCES

N BASIC
SCIENCES

E
 21
Educational Planning And Evaluation

FORMATS WITHIN THE INTEGRATED CURRICULUM

1. Connected
Key concepts and topics within a discipline are connected.

For example first, embryology of Male reproductive system, then Gross

anatomy, finally histology. (Other disciplines may be doing totally different
topics)

2. Sequenced
Similar ideas are taught in concert, although disciplines are still separate.

For example first, embryology of Male reproductive system, then Gross

anatomy, Histology; Biochemistr y deals with steroidogenesis and
Physiology explains functions of various parts based on microscopic
structure and chemical structure.

3. Shared
Boundaries among disciplines are absent. Team planning and teaching
that involves two or more disciplines focusing on shared concepts, skills
and attitudes. A prime example is of a lecture in which 2 or 3 disciplines
are present dealing with one topic.

When the topic is infertility, Gynecology deals with infertility, Psychiatry

shares the concept of stress in couples who are infertile, communicating
D
and counseling such couples effectively are also taught.
A
4. Webbed
Webbed differs from Shared in that in this format, topics are not used.
Instead themes are used. A theme differs from a topic in that the former
is more general and usually based on symptoms or sign. For example, STIs
Y
is a topic and a related theme could be vaginal discharge.

Gynecology, Pathology and Dermatology deal with STI, Examination of such

patients, counseling are relevant skills. Re-visit of basic sciences will
O
enhance basic concepts and reasoning skills.

The teaching strategy used could be small group discussions preceded by

N
lectures and self-study opportunities.
E
 22
Educational Planning And Evaluation

TEN QUESTIONS TO ASK WHEN

PLANNING A CURRICULUM
By Ronald M. Harden
(Medical Education, 20,1986: 356-365)

1. What are the needs in relation to the product of this training program?
2. What are the objectives?
3. What content should be included?
4. How should content be organized?
5. What educational strategies should be adopted?
6. What teaching methods should be used?
7. How should assessment be carried out?
8. How should details of the curriculum be communicated?
9. What educational environment or climate should be fostered?
10. How should the process be managed?

D
A
Y
O
N
E
 23
Educational Planning And Evaluation

STRUCTURED TRAINING PROGRAM

The College of Physicians & Surgeons Pakistan, Specialist Faculties have
developed the curriculum guidelines, and entry and exit requirements for
each specialty. The Supervisor is responsible for implementing this
package at the institutional level in the form of a structured training
program.

Structured Training
Structured training implies a training period with defined entr y
requirements, predetermined objectives that follow a curriculum defined by
an authoritative body, with assessments and feedback to the trainee and
an exit from training certified by award of a qualification. For the successful
and smooth implementation of the structured training program a close
working relationship between the Supervisor and the trainee is crucial.

What is a Structured Training Program?

A training program is a combination of trainee post, which has staffing,
funding and is approved or accredited by an authoritative body, structured
learning experiences with protected study time, in which regular
assessments of trainees are incorporated and the whole program is
supervised by a Supervisor. The training program is organized by the
Supervisor on behalf of the CPSP and approved by the RTMC.
D
The Supervisor will ensure that the training arrangements are designed to
offer the maximum support to trainees, so that they can maintain good
progress and have the opportunity to complete their training as soon as
A
possible. Training also requires steady progress through the planned
programs, which are designed to meet the curricula requirements. The
process of reviewing trainees must be competency based, structured and
Y
interactive, with opportunity for discussion between the assessor and the
trainee. It demands a planned, managed and open approach. In practice a
Supervisor may provide, through constructive and regular dialogue,
feedback on performance. O
The purpose of assessment is to measure progress against defined
criteria based on the relevant curricula. Trainees have to meet these N
standards in order to proceed from year to year and to achieve a
Certification. E
 24
Educational Planning And Evaluation

Why Structured On-Job-Training?

Postgraduate trainees are service providers as well as trainees so they
need to be trained on job
Structured training has proven superior to other training methods,
especially for transfer of task based skills and knowledge
Results in immediate standardization and consistency in task
accomplishment
Provides opportunity for appraisal, remedial and re-training
Can be tailored to each individual's learning style and pace

How to develop a structured training program for your unit

1. Study the General Instructional Objectives (GIO) of the training program
given in the curricular document.
2. List the Specific Learning Objectives (SLO) of training program in terms
of what you want your trainee to achieve in the cognitive, psychomotor
and attitudinal domains relevant to the objective.
3. Specify the Instructional Strategy (IS) with timeline for achievement of
each objective.
4. Identify the resource requirements(e.g. skills laboratory, equipment,
model, teaching learning material)
5. Provide the learning environment (e.g. space, logistics, motivation)

D appropriate to foster achievement of learning objectives.

6. Build in learning experiences necessary for the attainment of
competencies.

A 7. Develop a system of appraisal (for feedback) and assessment for

monitoring of progression through the program.

Y
O
N
E
 25
Educational Planning And Evaluation

CLINICAL PROTOCOLS
What are Clinical Protocols
In medical profession, protocols refer to a set of guidelines to manage a
certain clinical or administrative problem. Protocols are practiced in
medical profession under various names like clinical guidelines, practice
guidelines.

These can be developed to deal with any aspect of patient management,

from waiting lists to infection control and role assignment to
medical/paramedical staff to the structured training of staff.

Why should we have Clinical Protocols

Using clinical protocol has the following advantages:

Produces workflow

Reduces discrepancies

Brings uniformity to patient management

Eradicates omissions

Reduces confusion of staff

Makes record amenable to audit

Makes record keeping easy

Optimal use of limited resources

D
How do we construct
1. Prioritization of area of interest A
Prioritization can be done on the basis of different criteria like
incidence of a condition, resources available, manpower involved
and mortality or morbidity associated with a disorder etc.
Y
2. Identification of subject area and refining of topic
Once a few common conditions are defined (e.g. diabetes,
hypertension) the subject has to be refined so that one specific
aspect (e.g. diagnosis, management) could be translated into
O
3.
protocol.

Formation of discussion group

N
This discussion group will comprise of content / subject specialists
in the content area. E
 26
Educational Planning And Evaluation

4. Defining objectives of the protocol

The discussion group will define the objectives of protocols after
holding discussions on various aspects of the subject.

5. Literature search, identification and analysis of evidence

Evidence is sought from published literature and an analysis done
6. Formulation of an initial draft
A draft of the protocol is prepared in the light of most recent
evidence in scientific practice.

7. Adaptation of the protocol to local conditions

The set of protocols are adapted according to the environment and
facilities available.

8. Preparation of workflow sheets and putting into practice

9. Nomination of supervisor to monitor implementation

A supervisory role has to be assigned to someone who can overlook
strict adherence to the guidelines and can evaluate the audit report.

10. Review by external peer

The last part of the process is an external review of the

D 11.
implementation as well as frequent audit of the practice.

Modification of protocol accordingly

A This process will help to eliminate the inconsistencies, identify the

problems in implementation and update the knowledge base of a

Y protocol.

O
N
E
 27
Educational Planning And Evaluation

TAXONOMY OF EDUCATIONAL
OBJECTIVES
INTRODUCTION
Educational development has been proceeding since the 19th century. The
beginning of the 20th century saw a rapid growth in work done in the field
of education. Educational psychologists evolved their ideas on the basis of
much research that kept pouring in from all over the world.

It was actually during the mid 50s that it was thought of classifying
knowledge and information. Bloom, in 1956, was amongst the pioneers in
presenting this classification to the world. We have tried to simplify the
extensive taxonomy or classification presented by Bloom. Following is its
description.

TAXONOMY OF EDUCATIONAL OBJECTIVES

The taxonomy of educational objectives is intended to provide for
classification of the goals of our educational system. Although the specific
learning outcomes resulting from a course of study may run into hundreds,
most of them can be classified under a small number of headings. Any
such classification serves several useful purposes. It:

Indicates the type of learning outcomes that should be considered.

Provides a framework for classifying those outcomes D

Directs attention towards changes in student performance in a variety

of areas
Forms the blueprint for forming your assessment tool
A
Provides common grounds and makes comparison of various teaching
programs easier. Y
The system proposed by Bloom first divides objectives into the following
three major areas:
Cognitive domain: Knowledge outcomes, intellectual abilities and thinking
skills. O
Psychomotor domain: Perceptual and motor skills.
Affective domain: Attitudes, interests, appreciation, and modes of N
adjustment.
E
 28
Educational Planning And Evaluation

Each of the three domains is subdivided into a number of sub-categories.

For the sake of convenience and based on literature from National Board
of Medical Education USA, we have simplified the original categories and
grouped them into three sub catagries the following:

Following are the levels of Cognitive skills:

Cognition 1 (C1): Recognition and recall: entails recall of facts and

figures
Cognition 2 (C2): Interpretation: involves recall, synthesis and
desisions about a single piece of information
Cognition 3 (C3): Problem Solving: consists of recall, synthesis,
analysis and judgement

C1: involves recall of facts, principles, processes, patterns and methods

necessary for efficient performance of a professional task.
C2: requires interpretation of one set of data. Laboratory data, X-rays,
ECGs or graphs are interpreted to determine whether they are normal or
abnormal in a given situation. Interpretation is not possible without the
knowledge of relevant facts and thus questions aimed at testing this level

D automatically test C1 as well.

C3: encompasses diagnoses, management, organization, clinical decision-
making, clinical reasoning. This, at best, includes finding solutions for a

A problem arising from new situations with very little or no precedence to

serve as a guide. Problem solving and clinical management start with

Y gathering data from all the available sources. This data is then interpreted,
analyzed and then synthesized to reach a diagnosis. This is the best
method for evaluation since it incorporates the previous two levels
automatically. The key step of C3 is synthesis. It occures when a person
has been given more than one than one piece of information and he has

O to reach to a conclusion ofter synthesizing the information.

N
E
 29
Educational Planning And Evaluation

Psychomotor 1 (P1): Imitation: Only small and simple tasks possible, one
at a time, many mistakes, high tress level, maximum
attention and heavy supervision required

Psychomotor 2 (P2): Control: Slightly complex tasks, fewer mistakes,

moderate or low stress/and less supervision
required, inability to deal with unique situations

Psychomotor 3 (P3): Automation: Complex multi-tasking, very few

mistakes, self analysis and correction, command
during unique situations, no supervision required

Following are the levels of Psychomotor skills:

P1) IMITATION:
This is the first level of competence of performing any skill. During this
stage the person has to devote all his attention to the work at hand and is
unable to perform complex tasks unless they are systematically broken in
to smaller tasks. He needs constant supervision and instant feedback
about his actions and mistakes, which are frequent. The stress level is
very high. A person has to devote all his attention to the task at hard.

P2) CONTROL:
The performer is slightly more adept at the skill. He still needs to pay attention
D
but the level of attention required is not as great as before. He is able to
perform complex tasks in bigger chunks and relatively more speed. At this A
stage he still needs supervision but to a much less degree. The number of
mistakes that he makes has reduced. He is able to judge when he makes a
mistake but has difficulty in making correction. He also has a lot of problems
in transferring his recently acquired skill to new and unique situations.
Y
P3) AUTOMATION:
The performer is fully skilled at the work and needs no supervision. He is
able to focus his attention on things other than the task while performing.
O
The frequency of his mistakes has reduced remarkably. He is able to self
analyze the mistakes he makes and correct them himself. He is also able to N
use his skill in new situations with relatively more ease. He is now able to
reflect on what he has done and how he can improve upon it. He can deal
with unique situations with ease and success. He can do multi - tasking
successfully.
E
 30
Educational Planning And Evaluation

Following are the levels of Affective domain:

Affective 1 (A1): Receptivity: Sensitivity to a phenomenon and willingness

to receive
Affective 2 (A2): Response: Action in response to a phenomenon due to
inherent interest
Affective 3 (A3): Internalization: Inclusion of the perception within the
personal value system

A1) RECEPTIVITY: This stage implies sensitivity to existence of a

certain phenomenon and includes willingness to receive. Example:
Noticing the anxiety of a patient awaiting the result of a laboratory test for
a disease that can have serious consequences.

A2) RESPONSE: This implies sufficient interest in the phenomenon

noticed to do something about it. Example: in the case described above in
the previous example, the response would be to say a few reassuring
words to that patient so that he does not feel alone.

A3) INTERNALIZATION: This level of affective domain implies that your

perception of a phenomenon has found a place in your scale of values and
has affected you long enough for you to adapt yourself to the value system
of the other person. This enables you to adapt your attitude to the other

D person as if you were experiencing the same phenomenon yourself.

Example: On the death of a child, your attitude to the members of his

A family will show them that you care about their grief and are ready to help
them get over it. This does not mean that you have internalized their grief
but that you have internalized the attitude that enables you to offer them

Y genuine, effective help.

O
N
E
 31
Educational Planning And Evaluation

GUIDELINES FOR WRITING SPECIFIC

LEARNING OUTCOMES
Objectives are statements of intentions. They have to be thought of and
documented in the initial phase of any educational activity (as per the
systems approach).
The whole of Behavioral philosophy of learning is based on stating
intentions of how or what the teacher expects the students to perform or
do as a result of instruction.
The technique of writing objectives has evolved over the decades. They
are now also called Specific Learning Outcomes (SLOs).
In the subsequent sections we will be dealing with the mechanics of
writing SLOs.

D
A
Y
O
N
E
 32
Educational Planning And Evaluation

STATE SLOs AS EXPECTED STUDENT PERFORMANCE

Start by writing a blanket statement, an example of which is as follows:
At the end of the session/ unit/ course, the learner will be able to:
Name the cells involved in acute inflammation

Enlist the drugs that block inflammation and are anti-pyretics.

Differentiate between a normal and an abnormal ECG.

Outline a management plan for a patient with a septic wound and

uncontrolled diabetes mellitus.

Justify investigations required to diagnose a case of high-grade fever in

children under one year of age.

Dont state them in terms of:

Teacher performance (e.g. teach inflammation)

Learning process (e.g. student learns the concept of immunization)

Course content (e.g. studies the management of enteric fever)

Two objectives (e.g. student knows and understands concepts in

peri-operative management)

USING OBSERVABLE VERBS

Each statement must begin with a verb. However, the verbs are specific

and indicate definite, observable responses; that is, responses that can
be seen and assessed by an observer.

D These verbs state learning objectives in terms of observable student

performance, e.g. describes, identifies, differentiates, plans.

Learning objectives should specify the types of reaction the students are

A supposed to make to the content and not identify the content itself. So,
do not go into too much detail. It is always beneficial to have objectives

Y that do not restrict the learning activities. Try and make them global.

OBJECTIVES SHOULD NEITHER BE TOO RESTRICTING

NOR TOO VAGUE
The following are too specific and restricting:

O Describes the phase of isovolumic contraction in a cardiac cycle.

Describes the phase of rapid ejection in a cardiac cycle.
The following is better:

N Describes how the heart functions in a normal adult human.

The following is too broad and vague:

E Deals with cases of endocrine disordes

The following is better:
Manages cases of Phaechromocytoma effectively
 33
Educational Planning And Evaluation

SUMMARY OF STEPS FOR STATING

OBJECTIVES
1. List a representative sample.
2. Write a blanket statement.
3. Begin each objective with an action verb that specifies
observable performance (e.g. identifies, manages).
4. Include enough objectives to describe adequately the
performance of students who have attained the objective.
5. Keep the objectives sufficiently comprehensive and global
and not too restricting.

D
A
Y
O
N
E
 34
Educational Planning And Evaluation

BEHAVIORAL OBJECTIVES
EXERCISE ONE
Please answer each statement by placing a tick mark () in the
appropriate box

Observable Non-observable

1. Knows the functions of thyroid gland.

2. Collects a sample of blood.
3. Recognizes the role of other members
of the health care.
4. Reports the results of a 4 day workshop
on educational planning and evaluation.
5. Assumes the responsibility of updating
his/ her professional competence.
6. Takes learning examinations to assess
his/her professional competence.

D 7. Differentiates observable from

non-observable objectives.

A 8. Requests psychiatric consultation for all

patients with anorexia.

Y 9. Realizes the significance of the influence

of emotions on physical well being.
10. Comprehends the anatomy of breast & axilla.




11. Insists on thoroughly washing hands before
examining newborns.

O Max marks : 11

N Score
9 -11: Good
7 - 9 : Fair
< 7 : Where was you attention:

E
 35
Educational Planning And Evaluation

BEHAVIORAL OBJECTIVES
EXERCISE TWO
Please answer each statement by placing a tick () mark in the
appropriate box

DOMAINS
Congitive Psychomotor Affective

1. Knows the functions of thyroid gland.

2. Collects a sample of blood.
3. Recognizes the role of other members
of the health care.
4. Reports the results of a 4 day workshop
on educational planning and evaluation.
5. Assumes the responsibility of updating
his/ her professional competence.
6. Takes learning examinations to assess
his/her professional competence.
7. Differentiates observable from
non-observable objectives. D
8. Requests psychiatric consultation for all
patients with anorexia. A
9. Realizes the significance of the influence
of emotions on physical well being.
10. Comprehends the anatomy of breast and axilla.






Y
11. Insists on thoroughly washing hands before
examining newborns.

Max marks : 11
O
Score
9 -11: Good
7 - 9 : Fair
< 7 : Where was you attention:
N
E
 36
Educational Planning And Evaluation

TAXONOMY OF EDUCATIONAL
OBJECTIVES
INTRODUCTION
Educational development has been proceeding since the 19th
century. The beginning of the 20th century saw a rapid growth in
work done in the field of education. Educational psychologists
evolved their ideas on the basis of much research that kept pouring
in from all over the world.

It was actually during the mid 50s that it was thought of classifying
knowledge and information. Bloom, in 1956, was amongst the
pioneers in presenting this classification to the world. We have tried
to simplify the extensive taxonomy or classification presented by
Bloom. Following is its description.

TAXONOMY OF EDUCATIONAL OBJECTIVES

The taxonomy of educational objectives is intended to provide for
classification of the goals of our educational system. Although the
specific learning outcomes resulting from a course of study may run

D into hundreds, most of them can be classified under a small number

of headings. Any such classification serves several useful purposes. It:
Indicates the type of learning outcomes that should be
A

considered.
Provides a framework for classifying those outcomes

Directs attention towards changes in student performance in a
variety of areas
Forms the blueprint for forming your assessment tool
Provides common grounds and makes comparison of various
teaching programs easier.

O The system proposed by Bloom first divides objectives into the

following three major areas:

N Cognitive domain: Knowledge outcomes, intellectual abilities and

thinking skills.

E Psychomotor domain: Perceptual and motor skills.

Affective domain: Attitudes, interests, appreciation, and modes of
adjustment.
 37
Educational Planning And Evaluation

TAXONOMY OF EDUCATIONAL
OBJECTIVES
INTRODUCTION
Educational development has been proceeding since the 19th century. The
beginning of the 20th century saw a rapid growth in work done in the
field of education. Educational psychologists evolved their ideas on the
basis of much research that kept pouring in from all over the world.

It was actually during the mid 50s that it was thought of classifying
knowledge and information. Bloom, in 1956, was amongst the pioneers in
presenting this classification to the world. We have tried to simplify the
extensive taxonomy or classification presented by Bloom. Following is its
description.

TAXONOMY OF EDUCATIONAL OBJECTIVES

The taxonomy of educational objectives is intended to provide for
classification of the goals of our educational system. Although the specific
learning outcomes resulting from a course of study may run into
hundreds, most of them can be classified under a small number of
headings. Any such classification serves several useful purposes. It:
Indicates the type of learning outcomes that should be considered.
Provides a framework for classifying those outcomes
D
Directs attention towards changes in student performance in a variety
A

of areas

Forms the blueprint for forming your assessment tool

Provides common grounds and makes comparison of various teaching

programs easier.
Y
The system proposed by Bloom first divides objectives into the following
three major areas:
C o g n i t i v e d o m a i n : Knowledge outcomes, intellectual abilities and
thinking skills.
O
P s y c h o m o t o r d o m a i n : Perceptual and motor skills.
A f f e c t i v e d o m a i n : Attitudes, interests, appreciation, and modes of
N
adjustment.
E