The need for an outcome-based approach

Published on 01/06/2015 by admin

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6 The need for an outcome-based approach

An important trend is the move from an emphasis on the process of teaching and learning to the product and what is achieved.

What is outcome-based education (OBE)?

The most important responsibility teachers have is to identify the learning outcomes or competencies expected of their students or trainees and to ensure that these can be achieved in the education programme.

Traditionally medical education has focused on teaching methods such as the lecture and small group work, on the design of the curriculum and whether, for example, it was community-based or integrated, and on the assessment of the learner and the different approaches adopted. What has been described as the most important trend in medical education in the past decade is the move towards an outcome-based approach where the emphasis is on the product of the learning rather than on the process. Outcome-based education (OBE) is a performance-based approach at the cutting edge of curriculum development and offers a powerful way of changing and managing medical education.

OBE requires:

• The learning outcomes expected at the end of training and at the end of each phase of training to be clearly stated, explicit and communicated to all concerned including teachers, students and other stakeholders such as employers in the health service.

• Decisions about the curriculum, including the content, the educational strategies, the teaching methods and the assessment, to be based on the agreed learning outcomes. The learning outcomes define the process of what is taught, how it is taught and how it is assessed (Fig. 6.1).

• A collectively endorsed vision that reflects a commitment that students will succeed and that their achievement of the exit outcomes will be demonstrated before they leave the programme of training.

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Fig 6.1 Curriculum decisions are based on the learning outcomes.

The concept of OBE was promoted by Spady (1994). He defined OBE as ‘a way of designing, developing, delivering and documenting instruction in terms of its intended goals and outcomes’. Spady suggested that ‘Exit outcomes are a critical factor in designing the curriculum. You develop the curriculum from the outcomes you want students to demonstrate, rather than writing objectives for the curriculum you already have’. OBE can be summed up as ‘results-orientated thinking’. This shift towards OBE is at least in part analogous to the total quality movement in business and manufacturing.

Why OBE has been adopted

OBE offers major advantages, some of which are obvious:

• OBE highlights the competencies to be achieved. What matters are the competencies and abilities achieved by doctors, including their knowledge, skills and attitudes, rather than how they were trained or how they acquired these competencies. This has been described as ‘education for capability’. In the analogy of buying a car, the customer is more interested in how the car performs, in its features and petrol consumption and in how easily it can be maintained rather than in the details of the car manufacturing process. As Thomas Fuller noted ‘A good archer is not known by his arrows but by his aim’.

• OBE is necessary given the rapid advances in medicine. Knowledge in the biomedical field is doubling every 18 months. It is no longer feasible, given this information explosion, to cover in the curriculum all aspects of a subject. While the amount of knowledge has greatly increased, the length of the undergraduate curriculum has remained the same at 4, 5 or 6 years’ duration. It is now more important than ever that we agree as teachers and advise our students about the core competencies and knowledge we expect them to master.

• OBE ensures consideration is given to important topics that otherwise might be neglected. Potentially important topics in the curriculum such as attitudes and professionalism, communication skills, health promotion, team working, patient safety and management of errors have in the past been neglected. OBE helps to ensure that careful consideration is given to these and other key topics.

• OBE emphasises accountability and transparency in medical education.

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