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Glean pointers on teaching and learning as winners of the NUS Outstanding Educator Award share their teaching experiences and
views in this issue of CDTL Brief.

February 2003, Vol. 6 No. 2 Print Ready ArticlePrint-Ready
Teaching Tips: Developing the Curriculum for a Professional Clinical Course
Associate Professor Lim Lum Peng
Department of Preventive Dentistry

By three methods we may learn wisdom:
First by reflection, which is noblest;
Second by imitation which is easiest; and
Third by experience which is bitterest.

—Analects of Confucius

The explosion of knowledge arising from the recent proliferation of information technology has led educators in tertiary institutions to ask questions such as: How do we design a curriculum that will develop self-directed independent life-long learners? How successful have we been thus far in so doing? With regard to professional courses like Medicine, Dentistry and Pharmacy, educators not only have to achieve the goals of a broad-based education, but also face the challenge of designing a curriculum to help students attain certain desired and necessary professional skills so as to safeguard the interests of patients at large.

Thus to be an outstanding educator, one needs more than excellent presentation skills. The ability to design a good curriculum is also an integral component of good teaching. When designing a curriculum, one should consider the following key elements:

1. Learning objectives

As the basis designing curricula for a professional course in the medical and dental sciences (or in fact any other course), the learning objectives should be explicit, realistic and clinically relevant. In the three domains of learning (i.e. cognitive, affective, psychomotor) required for most courses, Bloom’s taxonomy of educational objectives could be applied as a useful guideline to establish the learning objectives of each course.

For example, in the cognitive domain, levels of knowledge could range from basic cognitive skills (essential knowledge) to higher order thinking skills (application and evaluation). The affective domain focuses on attitude and behaviour, which are essential in the working environment. In the psychomotor domain, development of psychomotor skills involves several stages from novice to expert. The level of the learner would therefore determine the learning objectives, particularly in the cognitive and psychomotor domains.

2. Sequence of learning

While it could be argued that learning should be open-ended and ill-defined, some sequencing of learning is necessary when developing the curriculum of a professional medical/dental course. Certain core skills need to be established first so as not to endanger the welfare of patients. Although there are increasing attempts to integrate the basic science course with the clinical course in medical education to allow students to appreciate the clinical relevance of learning basic sciences, some care and restraint should be exercised such that it is recognised that the training of a medical professional must proceed in the following stages of evolution:

novice --> advanced learner --> competent practitioner --> proficient practitioner --> expert

3. Deployment of appropriate learning strategies

Not only does a curriculum have various objectives, students too have different learning styles. Consequently, it may be useful to employ a combination of learning approaches such as problem-based learning, discovery learning, role-play, the use of simulation models, case studies/discussions, computer-based learning, multimedia presentations, collaborative learning, peer learning and direct instructional modes. The choice of learning approach is dependent on the discipline itself and to some extent on the individual teacher’s preferred teaching styles.

Although problem-based learning (which has proved useful in enhancing students’ self-directed learning) is increasingly being used, this does not mean that one should rigidly apply only one particular approach. There are circumstances when traditional modes of teaching may be highly effective and relevant. For example, when teaching a practical/clinical skill such as cardiopulmonary resuscitation or tooth-filling, direct instruction may be required to ensure students acquire the necessary basic skills and patients are ethically protected.

4. Independent learning vs. spoon-feeding

Despite the increasing focus on self-directed learning, students are ironically becoming more dependent on the lecturer’s PowerPoint notes and less engaged during lectures. This phenomenon raises the question: are lecturers in fact spoon-feeding students more than previously? Although a certain amount of spoon-feeding is inevitable to develop the students’ core knowledge, it is vital that the lecturer challenges the students’ thinking processes (instead of mass producing notes) by raising questions during lectures/seminars and following up the dialogue through emails, tutorials, take–home assignments, individual and small-group discussions.

5. Appropriate assessment strategies

How students are appraised should be an integral component of curriculum design. Not only should the learning outcome be assessed, but the process of learning must also be evaluated (an aspect that is often overlooked). A high achiever in terms of grades may not necessarily be the most successful in professional practice for the evaluation of life skills (e.g. interpersonal relationships, communication skills, ability to work with others and work under pressure) are often not reflected in traditional modes of assessment. Although outcome assessment is apparently easier and more straightforward as opposed to the evaluation of behavioural and attitudinal matters that is more difficult and subjective, it is crucial that we improve and refine our assessment methods to take the latter more into account.

To achieve a truly well-rounded education, it is essential to apply multiple assessment strategies besides the traditional written exams. This could involve project work, case presentations, open-book examinations, problem-solving tasks, objective-structured clinical examinations, take-home assignments, and competency-based tests (that assess practical and interpersonal skills). Assessment should include authentic tasks, be congruent to the learning objectives, reflect thinking skills, and not expect the mere regurgitation of information. Due credit should also be given to students who have demonstrated marked progress during the course.

6. Reflection

It is commonly accepted that reflection is one of the best avenues for evaluating the effectiveness of a course. Reflection could be carried out via self-reflection, students’ evaluation, peer review and employers’ feedback. While each mode has its advantages and limitations, a combination of different modes of reflection would help to reduce bias and could be used to evaluate the effectiveness of a programme from different perspectives.

In conclusion, it should be acknowledged that it is almost impossible to design a perfect curriculum. One must be prepared for change for what is considered good by today’s standards may be outmoded in tomorrow’s context. The curriculum must be modified after constant reflection and kept up-to-date in line with new knowledge and technology. One must be prepared to trim the curriculum or abandon certain aspects to make way for more effective learning tasks and not regard impending change as a threat to the success of one’s course.

Associate Professor Lim Lum Peng is a winner of the 2000/2001 Outstanding Educator Award.

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Learning Communities
Teaching Insights
Teaching Tips: Developing the Curriculum for a Professional Clinical Course
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