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
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.
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.