Theoretical Framing of the Curriculum

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

Top Contributors - Stacy Schiurring and Angeliki Chorti

Introduction[edit | edit source]

Curricula in healthcare programmes are influenced by a variety of factors that can be organised into four domains: [1]

  1. Future of healthcare workforce
  2. Capabilities of the graduate
  3. Teaching and learning approaches
  4. Local culture

These domains reference the why, who, how and where learning occurs.  A successful curriculum must need pace with and meet the needs of its learners, faculty, institutions, stockholders, future patients, and society.[2]

Use of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) can provide an international and holistic framework for designing healthcare curriculum. ICF provides language that can pull together human functioning across the lifespan and from the individual to a population level of health settings.[3] To learn more about how ICF can be used in the design of clinical and educational programmes, please read this article.


Future of Healthcare Workforce[edit | edit source]

The first domain references the reason healthcare programmes exist.  Healthcare education programmes are designed to train a healthcare workforce to address societal needs. 

  • To protect the public, standards are often created by regulatory bodies including licensing boards, educational programme accreditation bodies, professional associations, and higher education commissions.[1] [4]
  • These standards and requirements must guide the curriculum. The most common way to ensure alignment between the standards and the curriculum is by mapping the standards to course objectives. 
  • Creating standards of education or competencies has the benefit of fostering quality improvement of the profession by increasing standardisation of practice.[5]  This guidance can create conflict with the culture of academic freedom which is valued by most Universities.[5] 
  • In a curricular review or development of a new curriculum, the leaders should identify standards that inform the curriculum from national licensing boards, accreditation bodies, professional associations and higher education commissions.  

Capabilities of the Graduate[edit | edit source]

The second domain references the programme outcomes of the graduates in terms of knowledge, skills, and attitudes.[1] Programme outcomes should reflect diverse behaviours observed in the practicing clinician, considering the multiple roles, responsibilities of the profession and evolving roles of the advanced physiotherapy practice

  • The World Health Organization’s Rehabilitation Competency Framework identified five competencies for rehabilitation providers:  (1) clinical practice, (2) professionalism, (3) learning and development, (4) management and leadership, and (5) research. 
  • The World Physiotherapist Education Framework identifies eight domains of physiotherapy competence:  (1) assessment and intervention, (2) ethical and professional practice, (3) communication, (4) evidence-based practice, (5) interprofessional teamwork, (6) reflective practice and lifelong learning, (7) quality improvement, and (8) leadership and management.  
  • Defining expectations in graduates guide curriculum development including the conditions for the graduates to perform and opportunities for students to practice.[6][7]  The graduate outcomes can guide the selection of summative assessments, formative assessments, and learning theories and instruction.[7] 
  • In a curricular review or development of a new curriculum, the leaders should consider how each programme outcome will be developed and ultimately assessed.
  • Although frameworks that promote graduate competencies are highly desirable, implementation of competencies after an outcome-based graduate education has been shown to be problematic. [8] Models guiding curricular designs should also focus on building and reinforcing relationships between education and healthcare services. [9]

Teaching and Learning Approaches[edit | edit source]

The third domain references the teaching, learning and assessment approaches.[1]  The types of instruction, activities, and assessments are guided by the learning theories selected for the curriculum. 

The theories that will be described here are (1) objectivism (including behaviouralist and cognitivism), (2) constructivism, and (3) connectivism.[10][11]  The difference in these theories is primarily the level of teacher guidance relative to autonomy in the learner:

  • Objectivism relies on direct instruction
  • Constructivism emphasises inquiry-based learning with faculty guidance [12]
  • Connectivism is when knowledge is generated through discussion amongst learners without guidance.

The learning theory emphasised in the curriculum may subtly influence the culture of the programme.  Each learning theory has benefits and drawbacks, suggesting that incorporating different learning theories into a programme will ensure that learning is efficient and accurate, promotes critical thinking, and allows for personal growth in the affective domain.  Identifying content that best matches the learning theory, and ensuring course materials including instruction, learning activities, and assessments are aligned to the learning theory; will promote a well rounded curriculum.  

Objectivism[edit | edit source]

  • A course that emphasises direct instruction such as lecture or reading (using an objectivist approach) may promote a hierarchical structure where there is an authority who shares a specific correct answer with the learner.  
  • Programmes that utilise direct instruction (objectivism) emphasise a learning authority (instructor) and accuracy of the materials. 
  • For content that emphasises fact and recall of information, using lecture or reading as a way to transmit knowledge may be the most efficient way to teach content.[10]  The learning mechanism is primarily through receiving information (listening or reading). The assessment method is typically a multiple choice or short answer question, where there is an answer that is most correct.  The limitation with this theoretical approach is that the teaching and learning does not promote critical thinking or affective learning.  This type of instruction has been criticised for being superficial and not promoting long-term retention.  
  • In a similar way to direct instruction, experiential learning or apprentice learning can rely on observation of an expert, with an emphasis on learning by doing.  The difference is that the assessment method for experiential learning is usually in the psychomotor domain. 
  • In both examples, a reference of correctness is established.  This can lead to rote memorisation or practice of skills.  In circumstances which require rigid thinking and consistent performance, this is useful.  However, healthcare providers are often put into environments that are rapidly changing.  This suggests that a programme that only uses teaching and learning materials with direct instruction (using objectivism theory) are incomplete.  

Constructivism[edit | edit source]

  • A course that emphasises problem-based learning or case-based learning [13] may emphasise a process of discovery of knowledge, where there are several correct options rather than a single correct answer. This type of model uses a constructivist approach.[10]
  • Rather than observation or direct instruction, this type of learning relies on discovery learning and cultivation of thinking.[3]  In higher education, these types of courses may be referred to as interactive seminars or tutorial sessions.  There is often a small group of students paired with a course instructor.    

Haward Barrows defined problem-based learning in 1969 using these steps for students:

  1. Clarify concepts and define the problem
  2. Discuss the problem and identify solutions,
  3. Create learning objectives and research solutions
  4. Synthesize results and share the outcomes
  • This type of learning is useful for concepts that are multi-faceted with multiple solutions. 
  • This learning strategy has been criticised for being time consuming, but the depth of learning and the length of retention is greater than direct instruction. 
  • For courses with an emphasis on the attitudinal domain of learning, case-based learning might be particularly useful.  In case-based learning, the instructor selects a case to tell a story that creates empathy to the characters, provokes conflict and forces decisions.[14]  The role of the instructor is to guide decision making, model professional thinking, and provide feedback in a collaborative discussion.[13] 
  • The assessments used in a constructivist approach must allow for diversity of answers which might be best captured in a reflection, participation in discussion, or debate.  

Connectivism[edit | edit source]

  • Alternatively, for content that relies on subjective interpretation of information, an open forum may be the best learning environment using a connectivism approach.[10] 
  • In connectivism, groups share their experience, passion or concern through discussion.[15]  Knowledge is generated amongst group members through experiential learning and discussion. Communities of practice discussion forums use a connectivism approach to learning. Rather than allowing for a diversity of answers, in the connectivism approach – the answer changes based on group discussion.  

Local Culture[edit | edit source]

The fourth domain that influences the curriculum is the local culture within the university and community.[1]   This includes (1) cultural norms, (2) institutional values, and (3) expectations embedded in policies.[1] 

  • Institutional values can be identified in both the institution and programme’s philosophy,  mission, and vision statements.  
  • A philosophy statement defines the beliefs and values of a programme. 
  • Through a review of the mission and vision statement,  an institution’s priorities, [16] purpose, values, strategy, and standards [17][18] can be revealed. 
  • All of these elements reflect an institution’s culture.[18]   The local culture should influence the curriculum.  An institution that focuses on scholarly inquiry should emphasise performance of research in the curriculum.  Likewise, an institution that focuses on social justice should incorporate a project with a community partner.   Ensuring the local culture is embedded into the curriculum, will differentiate the programme and highlight the unique strengths inherent within the programme.[19]  

Resources[edit | edit source]

Optional Recommended Reading[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Lee A, Steketee C, Rogers G, Moran M. Towards a theoretical framework for curriculum development in health professional education. Focus on Health Professional Education. 2013 Jun;14(3):64-77.
  2. Thomas PA, Kern DE, Hughes MT, Tackett SA, Chen BY. (eds). Curriculum development for medical education: a six-step approach. 4th edition. Baltimore, Maryland: JHU Press, 2022.
  3. 3.0 3.1 Moran M, Bickford J, Barradell S, Scholten I. Embedding the international classification of functioning, disability and health in health professions curricula to enable interprofessional education and collaborative practice. J Med Educ Curr Dev. 2020 Aug;7:1-8.
  4. Forero DA, Adan A, Perry G, Majeed MH. Global perspectives and recommendations for curriculum design in academic programs in the health sciences. Educación Médica. 2022 Mar 1;23(2):100728.
  5. 5.0 5.1 Nieveen N, Kuiper W. Balancing curriculum freedom and regulation in the Netherlands. EERJ. 2012 Sep;11(3):357-68.
  6. Barrie SC. Understanding what we mean by the generic attributes of graduates. High Educ. 2006 Mar;51(2):215-41.
  7. 7.0 7.1 Premalatha K. Course and program outcomes assessment methods in outcome-based education: A review. J Educ. 2019 Oct;199(3):111-27.
  8. Holmboe E. Invited Commentaries. Competency-Based Medical Education and the Ghost of Kuhn: Reflections on the Messy and Meaningful Work of Transformation. Academic Medicine. 2018 March; 93(3):350-53.
  9. Khanna P, Roberts C, Stuart Lane A. Designing health professional education curricula using systems thinking perspectives. BMC Medical Education 2021; 21: 20.
  10. 10.0 10.1 10.2 10.3 Bates AW. Teaching in a digital age. Guidelines for designing teaching and learning for a digital age. Tony Bates Associates Ltd.
  11. Bovill C, Woolmer C. How conceptualisations of curriculum in higher education influence student-staff co-creation in and of the curriculum. High Educ. 2019 Sep 15;78(3):407-22.
  12. Mohajan D, Mohajan HK. Constructivist Grounded Theory: A New Research Approach in Social Science. Res Adv Educ. 2022 Oct 14;1(4):8-16.
  13. 13.0 13.1 Irby DM. Three exemplary models of case-based teaching. Acad Med. 1994 Dec 1;69(12):947-53.
  14. Herreid CF (ed). Start with a story: The case study method of teaching college science. Arlington, VA: NSTA press, 2007.
  15. Wenger E. Communities of practice: A brief introduction. 2011.
  16. Seeber M, Barberio V, Huisman J, Mampaey J. Factors affecting the content of universities’ mission statements: an analysis of the United Kingdom higher education system. Stud High Educ. 2019 Feb 1;44(2):230-44.
  17. Cortés-Sánchez J. Mission and vision statements of universities worldwide: A content analysis. Documentos De Investigación, Facultad de Administración, Universitad del Rosario. 2017.
  18. 18.0 18.1 Ozdem G. An analysis of the mission and vision statements on the strategic plans of higher education institutions. JESTP. 2011;11(4):1887-94.
  19. Melody R, Michele KF, Negar G, Beliard VR. A Systematic Review of Global Health Assessment for Education in Healthcare Professions. Ann Glob Health. 2022;88(1):1.