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, 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. The curricular designs are frequently organized by theoretical models. Frameworks for curricular design incorporate practice standards, clinical decision making tools, classification systems, and evidence based practice, more recently, however competency based frameworks have become a model for curricular design.  

Competency based education is an educational theory that emphasizes content mastery, an outcomes based approach, and a continuum of learning. Workplace based assessments are used to define behaviors and skills in the profession. Competency domains are categories with similar characteristics that can be observed in the expert clinician, and can be organized as knowledge, skills, and attributes.  Many international organizations have defined competency domains and competencies including World Health Organization and World Physiotherapy Association. Competency based education is associated with higher assessment scores, faster pace of learning, decreased variation in outcome, and better learner preparedness. An element of competency based education is workplace based assessment.  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:  Expert, (Knowledge, Skills, and Attitudes), Scholar, Communicator, Collaborator, Professional, Leader and Manager.   These 7 competency domains informed the program 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 organize courses to achieve the outcomes.  A single standardized course plan is not required.  

Curricular models that promote clinical reasoning include pattern recognition, [McAllister, 2000] reflection, [Plack, 2004] and hypothesis generation.[Rothstien, 2003][Rothstein, 1986}  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 utilize as a reference during the learning process.  The learner uses the tool in progressively more challenging learning activities, and the 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 utilizes 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 utilizes initial information in the form of the “patient identified problems” and “clinician-identified problems”, and uses this information to formulate initial hypotheses for the clinical problems.  As additional clinical information is gathered (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 organizational structures are the World Health Organization's International Classification of Functioning, Disability and Health and the Biopsychosocial model (Engel, 1977) (Borrell-Carrió, 2004).  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 participation in society, capacity to perform activities, impaired body functions and structures, and contextual factors.  The biopsychosocial model organizes health indicators into biological, psychological, and 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 organize student learning across course content and ultimately promote communication with practitioners in the clinical setting.  

Curricular design may be informed by profession specific curricular models such as the Movement System,[Sahrmann, 2014] Canadian Model of Occupational Performance,[Ashby, 2010] and Engagement, or the Model of Human Occupation.[Ashby, 2010].  

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 with 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 organized 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 organize courses into common themes based on competency domain, course type, or 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 organization 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 organized into systems such as Cardiovascular, Pulmonary, or Neurology.  These three options are just three examples of organizational schemes.  There are many ways to organize a curriculum.  

The alignment of the course plan with the program outcomes should be demonstrated.  One way to organize the relationship between program outcomes and courses is to map program outcomes with course learning objectives.  One way to simplify this process is to identify sub-components of topics in program outcomes.  Reviewing the alignment between the program outcomes and course objectives ensures that the teaching and learning components of the curriculum are tied to the summative assessments assigned to the program outcomes.  

If the course plan needs to be developed, it is useful to organize the course plan according to the program outcomes at the initial stages.  The first step is to identify the sub-components of each program outcome, then organize 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 organized.  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 team-based learning, problem based learning, and simulated practice.   Team based learning utilizes a flipped classroom approach, followed by individual and team-based learning activities.  Initially, each student completes an individualized assessment readiness test, then completes the same test along with members of the team (Burgess, 2020).  Problem based learning is a teaching strategy where the instructor serves as a facilitator of learning (Seibert, 2021).  The problem is clinically oriented and usually organized 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 utilize evidence-based practice strategies to address the learning objectives (Seibert, 2021).  Standardized patient simulation is a teaching and learning technique where acts learn the role of a standardized patient.  In this type of learning, the authentic experience of practicing as a clinician is the goal.  

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