Instructional Design in Outcome

Based Education Format

Erlyn A. Sana, PhD

erlynsana@yahoo.com.ph
ADPCN, May 7, 2013
 Breakthrough References
1. Commission on Higher Education Memorandum
Order Number 46, series of 2012
2. Frenk, Chen, et al. (2010). Health professionals for a
new century: transforming education to strengthen
health systems in an interdependent world. The
Lancet, vol. 376, pp.1923-58.
3. WHO. (December 2010). Global consensus for social
accountability of medical schools.
http://healthsocialaccountability.org/
4. Domingo, EO. (2010). Reforms in the Health Human
Sector in the Context of Universal Health Care. Acta
Medica Philippina. Vol. 44, No. 4, pp. 43-55.
 Statement of the problem
The Flexnerian Curriculum turned 100 years
old in 2010,
Report paved way to the science-based (now
the traditional) curriculum,
From 1910 to early 2000s, curricula in the
health sciences evolved from science based to
problem based to system based.
 Same problems persist:
1. Glaring gaps & striking inequities in health persist
between and within countries,
2. Poor people in developing countries continue to have
common infections, malnutrition, and maternity-related
health risks, which have long been controlled in more
affluent populations,Social
accountability
3. Mismatch of professional competencies to patient and
population priorities because of fragmentary, outdated,
and static curricula producing ill-equipped graduates
from underfinanced institutions
Transformative Scale up of the Education of
Health Professionals (WHO, 2011)

Driven and informed by population

health needs, transformative scale up
means delivering educational reforms
that address not only the quantity, but
also the quality and relevance of health
care providers in order to achieve
improvements in population health
outcomes.
 Transformative Scale up of the Education of
Health Professionals (WHO, 2011)

Population Transformative Educational

health needs Education Reforms
 Key components of the educational
system (Frenk, Chen, et al., 2010)
Structure Process
Institutional Design
Instructional Design
Systemic level
Stewardship & Context Criteria for admission
governance Global- Competencies
Financing Local Channels
Resource generation
Career pathways
Service provision
Organizational level
Ownership
Affiliation
Internal structure
Global level
Stewardship
Networks & partnerships
Institutional and instructional reforms towards
transformative education (Frenk, Chen, et al, 2010)
Structure Process
Institutional Reforms Instructional Reforms
1. Adopt CBC
1. Nurture a culture of Context 2. Promote inter-
critical inquiry Global- professional & trans-
2. Establish joint planning Local professional education
mechanisms 3. Exploit the power of IT
3. Expand from academic 4. Harness global resources
centers to academic and adapt locally
systems Proposed 5. Strengthen educational
4. Link through networks, resources
alliances, and consortia outcomes 6. Promote new
professionalism

Interdependence in Transformative
Education Learning
Areas where medical schools can
respond to social accountability
1. Anticipating societys health
needs
2. Partnering with the health system
and other stakeholders
3. Adapting to the evolving roles of
doctors and other health
professionals
4. Fostering outcome based
education
5. Creating responsive and
responsible governance of the
medical school
Areas where medical schools can
respond to social accountability
6. Refining the scope of
standards for education,
research, & service delivery
7. Supporting continuous
quality improvement in
education, research & service
delivery
8. Establishing mandated
mechanisms for accreditation
9. Balancing global principles
with context specificity
10. Defining the role of society
 Background of OBE (Davis, 2003)
In the US, OBE had its roots in pre-university
education. Reports were appreciated that it
was inappropriate to fix the time for study and
expect variable learning results from students.
What was needed was a uniform standard
that all students would be expected to achieve
and that all would be given time to achieve.
The State Board of Education, Pennsylvania
shifted to OBE in 1992.
 Background of OBE (Davis, 2003)
OBE gave way to schools teaching a set of
performance capabilities that students had to
achieve.
This impacted on health professions education
after the General Professional Education of
the Physician (GPEP) report called on all
medical schools to give each student the KSVA
that all physicians should have.
 Schools that have shifted to OBE
English National Board of Nursing, Midwifery
and Health Visiting, 1991
Brown University, Rhode Island, 1996
Dundee Medical School, University of Dundee,
Scotland, United Kingdom, 1997
Association of American Medical Colleges,
1998
Accreditation Council for Graduate Medical
Education, US, 1998
 OBE defined
(Harden, Crosby, & Davis 1999)
1. An approach to education in which decisions
about the curriculum are driven by the
outcomes the students should display by the
end of the course.
2. The educational outcomes are clearly
specified and serve as bases in deciding on all
other curricular elements.
 OBE as a curriculum design

Content

Learning Teaching
& learning
outcomes activities

Assessment
How schools developed their learning
outcomes
English National Board of Multi-stakeholders
Nursing, Midwifery and consultation
Health Visiting, 1991
Brown University, Rhode Technical Working Groups,
Island, 1996 multi-stakeholders
University of Dundee consultation and Delphi
Medical School, United Technique
Kingdom, 1997
Recommended by the
Association of American
Medical Colleges, 1998 ACGME
Accreditation Council for Nominal group technique
Graduate Medical
Education, US, 1998
 Steps in developing OBE programs
(Davis, 2003)
1. Identification of the type of doctor that the
country needs
2. Identification of the outcomes of the
educational process
3. Identification of curriculum content
4. Organization and sequencing of content
5. Identification of appropriate educational
strategies
 Steps in developing OBE programs
(Davis, 2003)
6. Identification of teaching methods
7. Decisions on how the students will be
assessed and the curriculum evaluated
8. The educational environment
9. Management and administration of the
curriculum
10. Communication of the curriculum to all
stakeholders.
 Educational decisions in curriculum
planning (Sana, et al., 2010)
1. Where are we now? (Needs assessment)
2. Where are we going? (Formulation of
objectives and organization of content)
3. How do we get there? (Selection of teaching-
learning strategies)
4. How do we know we have arrived?
(Assessment of student competence)
The three-circle outcome model
(Davis, 2003)

Professionalism

Attitudes

Tasks
Tasks: what the doctor is able to do-doing
the right thing (the technical intelligence)

1. Competence in clinical skills

2. Competence to perform practical procedures
3. Competence to investigate a patient
4. Competence to manage a patient
5. Competence in health promotion and disease
prevention
6. Competence in skills of communication
7. Competence to retrieve and handle information
Attitudes: how the doctor approaches
practice: doing the thing right
8. With an understanding of basic, clinical, and
social science
9. With appropriate attitudes, ethical
understanding, understanding of legal
responsibilities
10.With appropriate decision making skills,
clinical reasoning and judgment
 Professionalism: the doctor as a professional:
the right person doing it (personal intelligence)

11. Appreciation of the role of the doctor within

the health service
12.Appraisal for personal development
 Brown Universitys Nine LOs
(Smith & Dollase, 1999)
1. Effective communication
2. Basic clinical skills
3. Using basic science in the practice of medicine
4. Diagnosis, management, and prevention
5. Lifelong learning
6. Self-awareness, self-care and personal growth
7. The social and community contexts of health
care
8. Moral reasoning and clinical ethics
9. Problem solving
Criteria for specification of outcomes
(Harden, Crosby, Davis, & Friedman, 1999)
1. Reflect the VMG of the institution
2. Are clear and unambiguous
3. Are specific and addressed defined areas of
competence
4. Are manageable in terms of the number of outcomes
5. Are defined at an appropriate level of generality
6. Assist with development of enabling outcomes
7. Indicate the relationship between different outcomes
 OBE as a curriculum design

Content

Learning Teaching
& learning
outcomes activities

Assessment
 Other peculiar features of OBE
Makes use of active learning, student-
centered, interactive teaching strategies
Promotes life-long and independent learning
Criterion reference in testing and grading
With built-in program improvement including
the staff, to check for accountability, and
effective leadership
 Suggested Types of Performance
Assessment (Norcini & Burch, 2007)
Bases of Diagnostic Formative Summative
comparison

Timing Before instruction During After

Frequency Usually once Frequent Once at the end of

@ term
Usual Role playing, oral Mini-CEX, CEC, OSCE, DOPS,
instruments examination, CWS, BPE, Mini-CEX, Oral
OSCE DOPS, CbD, Examination
MSF
Purpose for To determine To monitor To determine final
students readiness progress grade
Purpose for To guide teaching To improve To test
teachers teaching effectiveness
 Instructional design in a nutshell

Goal: Learning

Formulate
Organizinglearning
subject Assessment of
Teaching
objectives
matter student achievement
 Basic Questions in Designing Instruction
(Mager, 1984)

Where are we going?

How do we get there?

How do we know
we have arrived?
Where are we going?

What should trainees be able to learn?

Lesson objectives
and selection of topics
Where objectives come from

Professional roles

Professional responsibilities

Tasks: KSA

Student competencies
 Competencies

Skills performed to specific standards

under specific conditions. They are
also explicit responsibilities expected
of individuals in their professional
practice (McGaghie, et. al., 1978)
 The value of Competencies

Content

Learning Teaching
Competencies & learning
Objectives activities

Assessment
 What is a learning objective?

Statement of what learners should be able to do when

they have completed a segment of instruction (Smith &
Ragan, 2001)

Learner-oriented, learning-based, explicit, assessable

statement of intended learning outcomes (Anderson,
Krathwohl, et al., 2001)
 Continuum of educational statements
(Anderson, et al, 2001)

Dimensions Global Educational Instructional /

objectives objectives Training objectives

Scope Broad Moderate Narrow

Time needed One or more Weeks or Hours or days

yrs months
Purpose Terminal
Provide vision Intermediate
Design a Specific
Prepare lesson
objectives objectives
curriculum Objectives
plans
Example Plan a multi Plan units of Plan daily
year instruction activities,
curriculum experiences
 Outcomes & Domains of Learning

Knowledge Cognitive Domain

Skills Psychomotor

Attitudes Affective Domain

Taxonomy of the Cognitive Domain of Learning
(Anderson, 2001)

Synthesis

Evaluation

Analysis

Application

Comprehension
Recall
The Psychomotor Domain of Learning
(Henson, 1995)

Origination

Adaptation

Complex Overt Response

Mechanism
Guided Response
Set
Perception
The Affective Domain of Learning
(Krathwohl, et. Al., 1960)

Characterization

Organization

Valuing

Responding

Receiving
The process of behavior change

Advocating

Practicing

Intending

Approving

Knowledge

Pre knowledge
 Relationship of cognitive & affective domains of
learning with the process of behavioural change

Cognitive Affective Behaviour change

Recall Receiving Pre-knowledge

Comprehension Responding Knowledge
Application Valuing Approving
Analysis Organization Intending
Evaluation Higher Order Thinking Skills Practicing
(HOTS)
Synthesis Characterization Advocating
 Sample ID of Communication Skills
(Smith & Dollase LO6, Davis LO1)
Learning Content Teaching- Resources Assessment
objectives Learning
Activities
At the end of 1.Diagnosis and 1. Ward work 1. All clinical A. Formative
clinical rotation management of 2. Case settings 1.Bedside
in Pediatrics, common pediatric discussion 2. Access to assessment
YL4 nursing diseases 3. Conferences library and 2.Video-recorded
students should 2.Principles of 4. Bedside on-line wardwork
be able to communication rounds collections 3.Self-assessment
explain to the with different 5. Journal 3. Preceptors (reflection
patients & their pediatric age report 4. Video camera paper)
family, the groups
condition, 3.Basic principles of B. Summative
diagnostic and teaching 1.OSCE
management 4.Professional ethics 2.Written
options, and 5.Social examination
prognosis determinants of 3.Journal reports
health 4.Case
6.Levels of presentation
prevention
 Sample ID of Communication Skills
(Smith & Dollase LO6, Davis LO1)
Learning Content Teaching-Learning Resources Assessment
objectives Activities
At the end of the 1. Community 1. Community 1. Community A. Summative
community diagnosis medicine 2. Preceptors 1. 360-degree
rotation, YL4 2. Health care system rotation 3. Transportation assessment
students should delivery 2. Meetings with services (multiple
be able to explain community 4. Meeting room stakeholders
health issues health workers, feedback)
relevant to a leaders, 2. Written
group in a residents examination
community 3. Public health 3. End-of-rotation
lectures report
4. Action- B. Formative
reflection 1. Reflection session
sessions feedback