Rehabilitation Curriculum Planning Process

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

Top Contributors - Stacy Schiurring, Jess Bell and Rishika Babburu

Introduction

A curricular plan is a guide that includes curricular design, the course plan, teaching strategies and learning experiences, and evaluation methods, all of which relate to the programme outcomes. The curriculum should be based on educational theory and influenced by both international standards and local context. The curricular plan is assessed by the curricular assessment plan to identify areas of improvement for the programme.  

Curricular Design

Curricular design is the intentional plan that informs course development and course sequence.

• Curricular designs are frequently organised by theoretical models.
• Frameworks for curricular design incorporate (1) practice standards, (2) clinical decision making tools, (3) classification systems, and (4) evidence based practice.
• More recently, competency-based frameworks have become a model for curricular design.  

Competency-based education

Competency-based education is an educational theory that emphasises content mastery, an outcomes based approach, and a continuum of learning. Competency domains are categories with similar characteristics that can be observed in the expert clinician and can be organised as knowledge, skills, and attributes.  

• Many international organisations have defined competency domains and competencies including the World Health Organization (WHO) and World Physiotherapy Association.
• Competency-based education is associated with (1) higher assessment scores, (2) faster pace of learning, (3) decreased variation in outcome, and (4) better learner preparedness.
• An element of competency-based education is workplace-based assessment. Workplace-based assessments are used to define behaviours and skills in the profession. Workplace-based assessment suggests that students are assessed in the clinical environment with the resources that are available on competency domains performed by a rehabilitation professional. This type of assessment is most commonly performed by clinical instructors in settings where clinical experiences take place.

The ReLAB Toolkit team compared international competencies, standards of practice, and standards of education for occupational therapy, physiotherapy, prosthetics and orthotics, and speech language pathology. The entry-level resources were compared and mapped to competency domains, competencies, and activities of the WHO Rehabilitation Competency Framework (RCF).

Seven common competency domains were identified: 

1. Expert (knowledge, skills, and attitudes)
2. Scholar
3. Communicator
4. Collaborator
5. Professional
6. Leader
7. Manager

These seven competency domains informed the programme outcomes for the ReLAB Toolkit. The intent is to use resources from the ReLAB Toolkit to achieve these outcomes. There are a variety of ways to organise courses to achieve the outcomes. A single standardised course plan is not required.  

Curricular models

Curricular models that promote clinical reasoning include (1) pattern recognition, (2) reflection, and (3) hypothesis generation.

• Pattern recognition is a technique to improve the rate of learning in a novice using scaffolding. Scaffolding is a technique where the learner is provided with a tool to utilise as a reference during the learning process. The learner uses the tool in progressively more challenging learning activities. These experiences reinforce the elements of the tool.  
• Reflective practice is a technique used to evaluate one’s performance for the purposes of learning. The Master Adaptive Learning Model utilises reflective practice into a quality improvement model of plan, learn, assess and adjust. In this model, the learner creates and implements a learning plan, assesses and reflects on the outcomes, and adjusts the reference of correctness in subsequent attempts. 
• The hypothesis oriented algorithm for clinicians is a clinical decision making model based on hypothesis generation. The learner utilises initial information in the form of the “patient identified problems” and “clinician-identified problems.” Then uses this information to formulate initial hypotheses for the clinical problems. As additional clinical information is gathered, often through assessment, the hypothesis is revised and updated.  

The curricular design may incorporate a model to promote communication amongst the learners and healthcare providers. Two of the more common organisational structures are the (1) WHO's International Classification of Functioning, Disability and Health (ICF) and (2) the Biopsychosocial model.  The goal is to improve communication amongst students, instructors, and healthcare providers through use of a common classification system. 

• The ICF model uses terms to describe different aspects of health and health related conditions including (1) participation in society, (2) capacity to perform activities, (3) impaired body functions and structures, and (4) contextual factors. 
• The biopsychosocial model organises health indicators into (1) biological, (2) psychological, and (3) social factors, and combines the complex interactions to understand health and illness.
• The use of  ICF framework or the biopsychosocial model throughout the curriculum is one way to organise student learning across course content and ultimately promote communication with practitioners in the clinical setting.  

World Health Organization's International Classification of Functioning, Disability and Health

Biopsychosocial Model

Curricular design may be informed by profession specific curricular models such as (1) the Movement System, (2) Canadian Model of Occupational Performance, and (3) Engagement, or (4) the Model of Human Occupation. 

Course Sequence 

An essential component in the curricular plan is the concept of curricular sequence. 

• Learning objectives should be developmental in nature where there is a progression in level of difficulty. The development can occur within a course or in a course series or both. 
• Some curricula include a course design where the highest level of taxonomy in the learning objective occurs at the end of the course, other curricula design course series to be developmental, where there is a progression and the higher taxonomy of learning objectives occur in the higher level courses. 
• There is no evidence on which method is superior, however a system should be selected and consistently applied through the curriculum.  

Course Plan

A course plan is a list of courses that are organised in a sequence according to the intended order in which the courses will be taken. 

• The course plan usually demonstrates courses that are taken concurrently, along with the number of credit hours allocated to the course. 
• The course plan outlines pre-requisite courses in a framework of “builds on” and “leads to”.  
• A course plan is a condensed map of the curriculum.

The course plan should organise courses into common themes based on (1) competency domain, (2) course type, or (3) course content. 

• An example using domains of competency is the rehabilitation competency framework’s domains of Research, Professionalism, and Practice. 
• Types of courses could use the organisation described in the world physiotherapist education framework’s example: biological and physical sciences, social and behavioral sciences, and clinical sciences.
• A final common example is the idea that courses could be organised into systems such as Cardiovascular, Pulmonary, or Neurology. 
• These three options are just three examples of organisational schemes. There are many ways to organise a curriculum.  

The alignment of the course plan with the programme outcomes should be demonstrated. 

• One way to organise the relationship between programme outcomes and courses is to map programme outcomes with course learning objectives. 
• One way to simplify this process is to identify sub-components of topics in programme outcomes. 
• Reviewing the alignment between the programme outcomes and course objectives ensures that the teaching and learning components of the curriculum are tied to the summative assessments assigned to the programme outcomes.  

If the course plan needs to be developed, it is useful to organise the course plan according to the programme outcomes at the initial stages. 

• The first step is to identify the sub-components of each programme outcome, then organise the sub-components sequentially.
• The sub-components are revised to become learning objectives. Similar learning objectives can be grouped together to create a course or course series. 
• Courses that require prerequisite knowledge should be identified such that the course plan reflects a progression. 
• Constraints on timing and logistics should be identified and considered, then ultimately the course plan is organised. 
• Once the course plan is created, the learning objectives can be refined based on the expected proficiency levels of the learner.

Teaching Strategies

• Teaching strategies that incorporate active learning have greater retention than direct instruction alone. Intentionally incorporating active learning strategies into the curriculum links courses together in a cohesive manner. 
• Active learning strategies can include (1) team-based learning, (2) problem-based learning, and (3) simulated practice.  
  • Team-based learning utilises a flipped classroom approach, followed by individual and team-based learning activities.  Initially, each student completes an individualised assessment readiness test, then completes the same test along with members of the team. 
  • Problem-based learning is a teaching strategy where the instructor serves as a facilitator of learning. The problem is clinically oriented and usually organised as a clinical case. A group of students discusses relevant information, applies current knowledge, identifies gaps in knowledge, and creates learning objectives to address the gaps in the learning. The students utilise evidence-based practice strategies to address the learning objectives. 
  • Standardised patient simulation is a teaching and learning technique where participants learn the role of a standardised patient. In this type of learning, the authentic experience of practising as a clinician is the goal.  

Team-based learning

Resources

Optional Additional Recommended Reading:

• Burgess A, van Diggele C, Roberts C, Mellis C. Team-based learning: design, facilitation and participation. BMC Medical education. 2020 Dec;20(2):1-7.
• Cutrer WB, Miller B, Pusic MV, Mejicano G, Mangrulkar RS, Gruppen LD, Hawkins RE, Skochelak SE, Moore Jr DE. Fostering the development of master adaptive learners: a conceptual model to guide skill acquisition in medical education. Academic medicine. 2017 Jan 1;92(1):70-5.
• Seibert SA. Problem-based learning: A strategy to foster generation Z's critical thinking and perseverance. Teaching and Learning in Nursing. 2021 Jan 1;16(1):85-8.

Online Resources:

• International Classification of Functioning, Disability and Health (ICF)

• Movement System Management
• The Canadian Model of Occupational Performance and Engagement (CMOP-E)
• The Model of Human Occupation