Rehabilitation Curricular Assessment

Original Editor - Stacy Schiurring based on the course by Larisa Hoffman

Top Contributors - Stacy Schiurring and Rishika Babburu

Introduction[edit | edit source]

Curricular revision is necessary to ensure the curriculum is responsive to innovation and societal needs[1][2].  It is more likely to be successful if it is intentional and based on a thoughtfully designed plan that incorporates quality improvement processes[3].  Implementation of a curriculum assessment plan ensures a curriculum is progressive and adapting to current and future healthcare workforce needs.  

Curriculum Assessment Plan[edit | edit source]

  • The curriculum assessment plan organises data to evaluate the curriculum. 
  • The purpose is to identify strengths and opportunities for curricular enhancement using reflection and feedback from multiple sources of information. 


Several models of curriculum review have been proposed[4] and most incorporate the quality improvement model: (1) Plan, (2) Do, (3) Study, (4) Act as a process model. 

Applied to curricular review, this process can be modified to the following steps:[1] [4][5]

  1. Plan: includes critical appraisal of the course objectives
  2. Teach: involves selection and creation of pedagogical approaches
  3. Assess: requires reflection on feedback
  4. Adjust: comprises reimaging and creating new teaching strategies. 

Course objective appraisal[edit | edit source]

The first step in the review process is the critical appraisal of the course objectives in terms of (1) format, (2) content, and (3) curricular sequence. 

  • The course objectives should be clearly stated[1] in a format that includes an observable behaviour, the conditions or environment in which the behaviour will be assessed, and the level at which the student is expected to perform. 
  • Objectives should address a variety of learning domains including cognitive, psychomotor, and attitudinal domains[6]
  • The content in the course objectives should be consistent with the programme outcomes[4] [6].  The programme outcomes should be written to reflect the local healthcare needs and workforce requirements, as they relate to the graduate. 
  • The course objectives are also informed by international standards[4][6].   International standards help to identify and elevate the standard of care for a profession. 
  • The relationship between course objectives, programme outcomes, regional healthcare needs, and international standards should be clearly communicated through a curricular mapping process[4][6]
  • Curricular mapping can help identify omissions and redundancy across the curriculum[6].  


Critical appraisal of the content in course objectives can promote the integration of curricular content. 

  • Courses with similar objectives, that are concurrently taught, can utilise intentional reinforcement of learning[6]
  • Courses that are sequential should be differentiated in the objectives through the use of higher learning taxonomy or degree of complexity. 
  • Reflecting on the format, content, and sequence of course objectives frames the review process in terms of educational needs such that there is intentional reinforcement and greater expectations in higher-level coursework[4].  

Educational approach reflection[edit | edit source]

The next step is to reflect on the use of the selected educational approaches[1][4].  

  • Several theoretical models and pedagogical strategies should be intentionally selected to be consistently used throughout the curriculum[7]
  • The theoretical models should be easily recognisable in the learning activities and resources.  For example, if the International Classification of Functioning, Disability and Health (ICF) model has been adopted as a classification system, the terms from the ICF model should be consistently utilised. 
  • In a similar way, a variety of pedagogical strategies should be selected and consistently applied in multiple courses.  Active learning strategies such as problem-based learning and team-based learning have been shown to have longer retention than direct instruction[8].  Intentionally selecting and consistently using effective educational approaches, ties the series of courses into a cohesive curriculum.  

Curricular outcomes assessment[edit | edit source]

The assessment phase of curricular review involves reflection on data from the learning process and outcomes.  

  • Evaluating the learning process relies on formative assessment while evaluating learning outcomes involves summative data[9].  
  • Feedback on the learning process can include surveying the experience of the learners, observing student performance in the classroom, and assessing student’s didactic knowledge[1]
  • The learner’s experience can be assessed using end-of-course surveys.  Surveys are useful to identify themes in course organisation, clarity of expectations and assessment measures, and topics requiring more or less emphasis[6].  
  • Student performance can be evaluated using simulations, practical examination presentations, objective structured clinical examinations, self and peer assessment, and reflection (World Physiotherapist Education Framework).  Assessment of a student's knowledge can be ascertained from reflections, assignments, and examinations.  The quality of the assessment method should be considered.  Assessment methods should be evaluated in terms of correlation between questions and learning objectives, level tested, item difficulty, item discriminative values, grade distribution and quality of questions[6].   Formative assessment can guide changes to teaching strategies.  


Learning outcomes should emphasise the graduate’s competency in working in their community'[1]

  • Assessment of graduate outcomes could include the graduate’s confidence in performing professional activities and the feedback from clinical instructors on the graduate performance[1][4].  An example of a graduate exit survey has been published by Shields in 2018.  In this graduate exit survey, the items measure graduate perception of level of preparedness for entry level practice[10].  Examples of several items on this survey require the participant to rate their level of agreement with statements such as:
    • “I believe I am adequately prepared to care for patients from different backgrounds”
    • “I understand ethical and professional values that are expected of the profession”
    • “I have basic skills in clinical decision-making and the application of evidence-based practice information for clinical practice”
    • “I have the communication skills necessary to interact with patients and health professionals”
    • “I am confident that I have acquired the clinical skills required to begin practice”
  • Another approach to the assessment of outcomes utilises student clinical performance in the final clinical experience.  There are a variety of assessments used for clinical performance[11] including the Clinical Performance Instrument[12], Canadian Physiotherapy Assessment of Clinical Performance[13], and Assessment of Physical Therapy Practice[14].  However, it has been suggested that healthcare education should develop and utilise similar assessment methods across specialities[15].  
  • An alternative to profession-specific measures of clinical performance is the use of rubrics that include entrustable professional activities[16].  The biggest draw to entrustable professional activities is the alignment with competencies[16]
    • An example of a scale of entrustment includes the following levels:  (1) has knowledge, (2)  may act under full supervision,  (3) may act under moderate supervision, (4) may act with supervision from a distance, and (5) may supervisor others[17]
    • The medical profession has developed a list of entrustable professional activities, which could serve as a model for other healthcare professions[16]
    • Similarly, the rehabilitation competency framework lists activities along with levels of proficiency that a preceptor could utilize.  Examples of activities include managing rehabilitation service delivery, participating in team forums, and designing and implementing research.  Each of these activities has defined proficiency levels which are described in terms of observational tasks, which could be used as an outcome of performance (Rehabilitation Competency Framework).  

An entrustable professional activity is an activity performed by a clinician (an essential component of practice) that reflects one or more competencies[18] and can be entrusted to a learner based on the individual’s proficiency[17]

Curriculum evaluation committee[edit | edit source]

The process of assessing the curriculum can be overwhelming.  To mitigate the stress of curriculum assessment several authors have recommended the creation of a curriculum evaluation committee[6][19].  

  • The role of the committee is to evaluate the performance and outcomes of the curriculum, judge the value of instructional methods, and work with instructors and committees to improve the curriculum[6]
  • Creating a scheduled course review process throughout the year makes the process more manageable[6]
  • Further inviting the course instructor to compile the review data and share their reflection on the course with committee members minimises the disconnect between those involved in the change[20]
  • During the course review process, committee members discuss the positive and negative aspects of the course and create actionable recommendations for instructors to enhance their course.[6]

Resources[edit | edit source]

Optional Reading on Clinical Performance Assessment Tools:

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Supriani Y, Meliani F, Supriyadi A, Supiana S, Zaqiah QY. The Process of Curriculum Innovation: Dimensions, Models, Stages, and Affecting Factors. Nazhruna: Jurnal Pendidikan Islam. 2022 May 18;5(2):485-500.
  2. Timmerberg JF, Chesbro SB, Jensen GM, Dole RL, Jette DU. Competency-Based Education and Practice in Physical Therapy: It’s Time to Act!. Physical Therapy. 2022 May;102(5):pzac018.
  3. Brown JF, Marshall BL. Continuous quality improvement: An effective strategy for improvement of program outcomes in a higher education setting. Nursing Education Perspectives. 2008 Jul 1;29(4):205-11.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Frye AW, Hemmer PA. Program evaluation models and related theories: AMEE guide no. 67. Medical teacher. 2012 May 1;34(5):e288-99.
  5. Haji F, Morin MP, Parker K. Rethinking programme evaluation in health professions education: beyond ‘did it work?’. Medical education. 2013 Apr;47(4):342-51.
  6. 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 Karpa K, Abendroth CS. How we conduct ongoing programmatic evaluation of our medical education curriculum. Medical teacher. 2012 Oct 1;34(10):783-6.
  7. Darrah J, Loomis J, Manns P, Norton B, May L. Role of conceptual models in a physical therapy curriculum: application of an integrated model of theory, research, and clinical practice. Physiotherapy Theory and Practice. 2006 Jan 1;22(5):239-50.
  8. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The lancet. 2010 Dec 4;376(9756):1923-58.
  9. Bhat BA, Bhat GJ. Formative and summative evaluation techniques for improvement of learning process. European Journal of Business & Social Sciences. 2019 May;7(5):776-85.
  10. Shields RK, Dudley-Javoroski S, Sass KJ, Becker M. Benchmarking the physical therapist academic environment to understand the student experience. Physical therapy. 2018 Aug 1;98(8):658-69.
  11. O’Connor A, McGarr O, Cantillon P, McCurtin A, Clifford A. Clinical performance assessment tools in physiotherapy practice education: a systematic review. Physiotherapy. 2018 Mar 1;104(1):46-53.
  12. Roach KE, Frost JS, Francis NJ, Giles S, Nordrum JT, Delitto A. Validation of the revised physical therapist clinical performance instrument (PT CPI): Version 2006. Physical therapy. 2012 Mar 1;92(3):416-28.
  13. Mori B, Norman KE, Brooks D, Herold J, Beaton DE. Canadian Physiotherapy Assessment of Clinical Performance: face and content validity. Physiotherapy Canada. 2016;68(1):64-72.
  14. Reubenson A, Ng L, Gucciardi DF. The Assessment of Physiotherapy Practice tool provides informative assessments of clinical and professional dimensions of student performance in undergraduate placements: a longitudinal validity and reliability study. Journal of Physiotherapy. 2020 Apr 1;66(2):113-9.
  15. Swing SR, Clyman SG, Holmboe ES, Williams RG. Advancing resident assessment in graduate medical education. Journal of graduate medical education. 2009 Dec;1(2):278-86.
  16. 16.0 16.1 16.2 Chesbro SB, Jensen GM, Boissonnault WG. Entrustable professional activities as a framework for continued professional competence: is now the time?. Physical therapy. 2018 Jan 1;98(1):3-7.
  17. 17.0 17.1 El‐Haddad C, Damodaran A, McNeil HP, Hu W. The ABCs of entrustable professional activities: an overview of ‘entrustable professional activities’ in medical education. Internal medicine journal. 2016 Sep;46(9):1006-10.
  18. Ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice?. Academic medicine. 2007 Jun 1;82(6):542-7.
  19. Lypson ML, Prince ME, Kasten SJ, Osborne NH, Cohan RH, Kowalenko T, Dougherty PJ, Reynolds RK, Spires MC, Kozlow JH, Gitlin SD. Optimizing the post-graduate institutional program evaluation process. BMC Medical Education. 2016 Dec;16(1):1-6.
  20. McKimm J, Jones PK. Twelve tips for applying change models to curriculum design, development and delivery. Medical teacher. 2018 May 4;40(5):520-6.