Implementing an outcome-based approach in practice

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9 Implementing an outcome-based approach in practice

Outcome-based education requires two things. The learning outcomes need to be identified and specified. Decisions about the curriculum must be based on the specified outcomes.

The ostriches, the peacocks and the beavers

Outcome-based education, as discussed in Chapter 6, is about more than defining and publishing a set of learning outcomes that must be achieved before the end of the course. OBE is characterised by a curriculum with the learning strategies and learning opportunities designed to ensure that students achieve the learning outcomes specified and with an assessment process matched to the learning outcomes. Individual students are assessed to ensure that they achieve the outcomes. Remediation and enrichment for students is provided as appropriate.

Teachers react differently when it comes to implementing OBE. Some consider OBE to be a passing fad and make no effort to either prepare learning outcomes or incorporate them into their teaching. They bury their heads in the sand and can be likened to ostriches (Harden 2007). Then there are teachers who work hard producing a set or list of learning outcomes that is prominently displayed for visitors or programme assessors – the peacocks. Unfortunately they do not make use of the learning outcomes in their teaching, so their efforts are to no avail. The teachers who do successfully implement an OBE approach are those who believe that OBE is the way to design, deliver and document instruction and work hard to make this happen – the beavers.

Planning an OBE programme

An OBE curriculum starts with the question – what are the expected learning outcomes to be achieved by the end of the programme and what capabilities should the graduate have as a practising doctor? An outcome framework is used, as described in Chapter 8, to describe the broad performance capabilities. These in turn are specified in more detail. For example, in the broad domain of patient management a more detailed set of learning outcomes includes surgery, drugs, physiotherapy, social dimensions and alternative therapies.

After the exit learning outcomes are defined, working backwards, outcomes are specified for each of the courses or attachments in the curriculum. These will identify how the course contributes overall to the school’s exit learning outcomes. For example the learning outcomes achieved in an anatomy course may go beyond the mastery and understanding of anatomy and, as identified by Pawlina in the Mayo Clinic, can include communication skills and teamwork. The outcomes are specified further for each of the learning experiences in a course or attachment, for example a lecture, a clinical session or a practical experience. It is helpful to produce a grid or blueprint that relates each of the learning experiences to the learning outcomes for the course. A similar grid should be produced that relates the assessment to the learning outcomes. The clearer the definition of learning outcomes, the more effectively can student assessment be planned. The appropriate tools are selected according to the outcomes to be assessed. An assessment profile can be produced for each student that highlights the outcomes that have been achieved and those that have not.

Student progression in an OBE curriculum

It is recognised that there are legitimate differences as to the manner and rate at which students progress to the exit learning outcomes. Some students, for example, may acquire the necessary communication skills more quickly than others. Students’ achievements of the learning outcomes can be used to monitor and plan for their progression through the curriculum. Mastery of an outcome to a specified standard may be a requirement before the student is allowed to progress from one part of the medical course to the next. A student may be required to have a certain mastery not only of basic sciences but of communication skills before proceeding to clinical studies in the later years of the course. Progression can also be charted across the continuum of education from undergraduate through postgraduate to continuing education.

Four dimensions can be considered with regard to students’ achievements of learning outcomes and their progression through the course and these are described in Chapter 12.

An OBE implementation inventory

An OBE implementation inventory can be used to describe a school’s or postgraduate body’s level of adoption of an OBE approach in their education programme. This can be rated on a five-point scale in each of nine dimensions as shown in Figure 9.1:

1. The extent to which there is a clear and unambiguous statement of the learning outcomes expected.

2. Whether staff and students in an institution are made aware of and are familiar with the outcome statements.

3. The extent to which the educational strategies adopted, such as problem-based learning, community-based learning or inter-professional learning, reflect the learning outcomes. The ability to work as a member of a team alongside other healthcare professionals, for example, can be facilitated through inter-professional learning experiences.

4. The matching of the learning opportunities selected with the learning outcomes. Almost certainly this will require the use of a range of teaching and learning methods.

5. A significant problem facing medical education is the rapid expansion of knowledge with the associated danger of information overload and curriculum congestion. Consideration of the learning outcomes can help to determine what content should be covered in the curriculum.

6. The students’ achievements of the learning outcomes can be used to assess their progression through the curriculum and to determine whether they are able to proceed to the next stage.

7. The learning outcomes are important in relation to assessment. Serious problems arise when there is a mismatch between the learning outcomes, the learning experiences and the student assessment.

8. In planning an education programme, increased attention is being paid to the educational environment. This is described in Chapter 18. In OBE, the learning outcomes specified can indicate what should be a desirable learning environment. For example, a learning outcome addressing teamwork skills should suggest the need for an educational environment that supports collaborative working rather than the more typical environment where competition is rewarded.

9. The final dimension in the inventory relates to the selection of students. It can be argued that with an OBE approach, the exit learning outcomes should be reflected in the admission criteria for students. Students should be assessed on the entry-level requirements for each of the outcome domains such as communication skills, problem solving and attitudes.