Specifying learning outcomes and competences

Published on 01/06/2015 by admin

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7 Specifying learning outcomes and competences

A range of approaches can be used to identify and define the expected learning outcomes.

Specification of learning outcomes

The previous chapter highlighted the benefits to be gained from the adoption in education of an outcome-based approach. The first step in implementing OBE is to define the learning outcomes required by the end of the training programme. This process is often initiated at a national level. In the UK the General Medical Council has set out in Tomorrow’s Doctors their expectations for the learning outcomes of a graduate in a UK medical school. There are similar initiatives by the regulatory or accrediting bodies in the USA, Canada, Australia, the Netherlands, Saudi Arabia and many other countries. National examinations where they exist may also be viewed indirectly as statements of the expected learning outcomes.

While the learning outcomes will be to some extent specific to the context of a country, there are learning outcomes relating to what constitutes a good doctor that can be shared across geographical borders. In Europe, through a consultation process, generic and subject-specific competences expected of students at set points in the education programme are being identified. The International Institute for Medical Education in New York defined in terms of learning outcomes what they considered to be the ‘global minimum essential requirements’ for a doctor, whether in China or the USA.

The specification of learning outcomes is both a top-down and a bottom-up activity. A medical school can build on a national statement of learning outcomes with an expanded version reflecting the particular mission of the school. A community-oriented medical school or a school with the aim of qualifying the future researchers or leaders in medicine will reflect these orientations in its statement of learning outcomes. The Scottish medical schools, in ‘The Scottish Doctor’ report, specified the learning outcome domains subscribed to by all five Scottish schools. While the domains were agreed by all schools, more detailed learning outcome statements varied from school to school, mirroring the differences in the curriculum of the five schools.

Within each institution, detailed learning outcomes will be specified for each course and for each lecture or clinical training session within a course. These identify how each specific learning experience contributes to the exit learning outcomes for the school’s education programme.

Just as with basic medical education programmes, OBE and the specification of learning outcomes are now features of training programmes for many specialties in medicine with the learning outcomes or competences agreed by the postgraduate training body or authority. In the USA the Accrediting Committee for Graduate Medical Education and, in Canada, the Royal College of Physicians and Surgeons have led the field.

Learning outcomes and the continuum of education

For the most part, undergraduate, postgraduate and the continuing phases of education have been organised in separate silos each specifying independently their learning outcomes and the design of their learning programme. For almost 100 years there has been strong criticism of this separation or segregation. In 1932, the Final Report of the Commission of Medical Education in New York stated ‘Artificial segregation of the basic medical course, the internship, the training of the specialist, or the continuation education of the general practitioner is very likely to create serious gaps in the education of physicians which should be avoided’. More recently, Cook, Irby and O’Brien, in Educating Physicians, a Carnegie follow-up to the 1910 Flexner Report in the USA, expressed concern that ‘there is no single agency responsible for regulating and financing medical education; multiple agencies participate in this process and often hold conflicting expectations of programs and learners’. They highlighted the need for learning outcomes to bridge the continuum.

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