Describing and communicating the learning outcomes

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8 Describing and communicating the learning outcomes

Different frameworks or models can be used to categorise and communicate learning outcomes.

Learning frameworks

Learning outcomes are structured round a number of domains – usually no more than 12. Each domain represents a category of learning outcomes, for example clinical skills. Learning outcomes are then specified for each of the domains.

Several frameworks or models for grouping learning outcomes have been described. Not surprisingly the different frameworks, while having significant differences, have much in common. Some of the most widely used frameworks are described below.

The dundee three-circle outcome model and ‘the scottish doctor’ framework

This framework is based on 12 domains. It is different from other frameworks in that the domains are incorporated in a three-circle model that emphasises the relationship between the different domains (Fig. 8.1). We have looked in Chapter 5 at a similar model for describing the good teacher.

image

Fig 8.1 The three-circle model for learning outcomes incorporating 12 domains.

The inner circle represents the technical skills of the doctor or what the doctor is able to do – ‘doing the right thing’. It includes seven domains:

1. clinical skills

2. practical procedures

3. patient investigations

4. patient management

5. health promotion and disease prevention

6. communication

7. information handling skills.

The middle circle represents the way the doctor approaches the tasks in the inner circle –‘doing the thing right’:

8. understanding of social, basic and clinical sciences

9. appropriate attitudes and ethical understanding

10. decision making skills and clinical judgement.

The outer circle represents the development of the personal attributes of the individual – ‘the right person doing it’:

11. the role of the doctor.

12. personal development.

This model is described in more detail in Appendix 6.

The three-circle model with the 12 outcome domains has been adopted in ‘The Scottish Doctor’ as a description of the abilities of medical graduates from the five Scottish Medical Schools. The approach has also been used in other countries.

The canmeds physician competency framework

The Royal College of Physicians and Surgeons of Canada developed a framework built round seven physician roles. These make explicit the abilities of the highly skilled physician. The roles are:

1. Medical expert: applying knowledge skills and attitudes to patient care.

2. Communicator: communicating effectively with patients, families, colleagues and other professionals.

3. Collaborator: working effectively within a healthcare team.

4. Health advocate: advancing the health and well-being of patients and populations.

5. Manager: participating effectively in the organisation of the healthcare system.

6. Scholar: committing to reflective learning as well as to the creation, dissemination and application of medical knowledge.

7. Professional: committing to ethical practice and high personal standard of behaviour.

Figure 8.2 illustrates the elements and the interconnections of the roles.

image

Fig 8.2 The CanMEDS Roles Framework.

Adapted from the CanMEDS Physician Competency Diagram with permission of the Royal College of Physicians and Surgeons of Canada. Copyright ©2009.

The CanMEDS competency framework has been used in postgraduate and continuing education in Canada and worldwide and has also been adopted for use in undergraduate education.

The accreditation council for graduate medical education (ACGME)

The Accreditation Council for Graduate Medical Education in the USA developed a model based on six competency domains closely aligned with healthcare quality aims. These were:

1. patient care

2. medical knowledge

3. practice-based learning and improvement

4. inter-personal and communication skills

5. professionalism

6. systems-based practice.

The ACGME competencies are used both internationally and in US postgraduate medical education programmes to foster and assess resident physicians’ development in the six domains. They have also been adopted in undergraduate education.

The brown abilities

Brown University in the USA was one of the first medical schools to adopt an outcome-based approach to education. A series of nine abilities was developed from the tasks that are expected of physicians practising in the twenty-first century and the attributes needed to perform the tasks competently. The Brown description of learning outcomes is of interest in that it describes for each of the nine abilities observable behaviours that students must demonstrate at the beginning, intermediate and advanced levels of their training.

The nine abilities identified to describe a successful doctor are:

1. effective communication

2. basic clinical skills

3. using basic science in the practice of medicine

4. diagnosis, management and prevention of disease

5. lifelong learning

6. self-awareness, self-care and personal growth

7. the social and community context of health care

8. moral reasoning and clinical ethics

9. problem solving.

Global minimum essential requirements (GMER)

The Institute for International Medical Education of the China Medical Board in New York, working with an international network of experts in medical education, developed the global minimum essential requirements (GMER) as a set of learning outcomes that highlight the competencies expected of graduates from medical schools in countries throughout the world.

The seven domains are:

1. professional values, attitudes, behaviour and ethics

2. scientific foundation of medicine

3. clinical skills

4. communication skills

5. population health and health systems

6. management of information

7. critical thinking and research.

Criteria for a learning outcome framework

A learning outcome framework should meet the following criteria:

• The key domains should reflect the vision and mission of the institution as perceived by the various stakeholders including the public. They should reflect clearly, with an appropriate sense of values, what is expected of a doctor.

• The domains should be defined at an appropriate level of generality. The number of domains should be small enough to be manageable but large enough to distinguish the different aspects of competence.

• The framework should provide a holistic and integrated view of medical practice and indicate the relationship between the different outcome domains.

• The framework should assist with the development of ‘enabling’ outcomes for each of the key domains specified.

• The framework should be clear and unambiguous. It should be user-friendly, intuitive and easy to use.

Reflect and react

1. Agreement may already have been reached regarding the outcome framework that is used in your situation. If not, you can develop your own framework or select and adapt an existing framework. The latter approach has obvious advantages.

2. Are teachers and students familiar with the details of the framework and how the elements of the education programme for which you have a responsibility relate to the overall outcome framework?

Exploring further

If you have a few hours

Med. Teach.. 2007;29;7.

This issue of the journal has as its theme outcome-based education. It includes a series of articles describing the different OBE frameworks.

If you have more time

The CanMEDS. Physician Competency Framework. Better Standards. Better Physicians. Better Care. Frank J.R., Ottawa: The Royal College of Physicians and Surgeons of Canada. 2005.

An introduction to the CanMeds framework with a more detailed description of the CanMeds roles.

Scottish Deans’ Medical Education Group. The Scottish Doctor. Learning outcomes for the Medical Undergraduate in Scotland; A Foundation for Competent and Reflective Practitioners. Dundee: The Association for Medical Education in Europe (AMEE); 2008.

A description of the 12 outcome domains subdivided into a more detailed set of learning outcomes.

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