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Outcome-Based Learning and Teaching

Outcome-Based Learning and Teaching. Yeu-Jhy Chang, MD Department of Neurology Chang Gung Memorial Hospital, Linkou. Outline. Introduction of models of medical education What is outcome-based learning? How to establish the learning outcomes?

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Outcome-Based Learning and Teaching

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  1. Outcome-Based Learning and Teaching Yeu-Jhy Chang, MD Department of Neurology Chang Gung Memorial Hospital, Linkou

  2. Outline • Introduction of models of medical education • What is outcome-based learning? • How to establish the learning outcomes? • General principles of teaching and assessment for outcome-based learning • Take home message

  3. A story frequently told by educators concerns a young lad and his dog, Fido. • ‘I taught Fido how to whistle,’ the boy proudly tells his father. • When asked to demonstrate this remarkable achievement, the boy commands, ‘Fido, whistle!’ Fido wags his tail vigorously but not whistle. • ‘I thought you said you taught Fido how to whistle. I didn’t hear him whistle,’ the father says to his son who replies. ‘I said I taught him how to whistle, I didn’t say he learned it!’

  4. The Flexnerian Model (‘Planning Forwards’) • 1. Define “Fundamental knowledge” • 2. Teach the fundamentals • 3. Test for knowledge of fundamentals • 4. Hope for the best? ? ＝ What is “Fundamental knowledge” (1) (2) (3) (4)

  5. Competency-Based Model (‘Planning Backwards’) • 1. Define the successful graduate • 2. Design measures and standards of performance • 3. Develop learning experiences

  6. Outcome-Based Education • All too often, we, as teachers, focus too much on what we teachrather than on what our students learn. • Outcome-based education emphasizes what we expect students will have achieved when they complete their course. • These learning achievements go beyond just knowing; rather, they describe what learners can actually do with what they know.

  7. Definition of Outcome-Based Education • What we expect of our graduates and holds us accountable to provide an education that achieves those endpoints. • It’s not only good education, it is good public policy.

  8. Three features of outcome-based education • The (1) development of clearly defined and published learningoutcomesthat must be achieved before the end of a course. • The (2) design of a curriculum with educational strategies and learning opportunities to ensure the achievement of the learning outcomes. • An (3) assessment process matched to the learning outcomes with the assessment of individual students to ensure that they achieve the outcomes. The Scottish Doctor 3, 2008

  9. Working Definitionof Learning outcomes are: • Statements of what astudent should know, understand and/or beable to demonstrate after completion of aprocess of learning. • The learning activity could be, for example, a lecture, amodule or an entire program. • Learning outcomes must not simply be a “wish list” ofwhat a student is capable of doing on completion of thelearning activity. • Learning outcomes must besimply and clearlydescribed. • Learning outcomes must be capable of being validlyassessed.

  10. From the definitions we see: • Emphasis on the learner. • Emphasis on the learner’s ability to do something. • Focus on teaching – aims and objectives and use of terms like know, understand, be familiar with. • Aims: Give broad purpose or general intention of the module. • Objectives: Information about what the teaching of the module hopes to achieve. • Outcomes: Focus on what we want the student to be able to do - use of terms like define, list, name, recall, analyze, calculate, design, etc. • Learning outcomes are not designed to replace the traditional way of describing teaching and learning but to supplement it.

  11. Good DoctorsThe expectation of population • Patients need good doctors. • Good doctors make the care of their patientstheir first concern: they • are competent, • keep their knowledge and skills up to date, • establish and maintain good relationshipswith patients and colleagues, • are honest and trustworthy, and • act with integrity. Good Medical Practice, General Medical Council (GMC), UK 2006

  12. The Social Contract R. Cruess & S. Cruess.Perspectives in Biology and Medicine 2008;51(4):579–98.

  13. EXPECTATIONS: THE PUBLIC AND THE MEDICAL PROFESSION R. Cruess & S. Cruess.Perspectives in Biology and Medicine 2008;51(4):579–98.

  14. 醫師的角色與特質（Roles and Attributes of a Physician） 治療者(The Healer) 傾聽 能力 承諾 保密 洞察力 利他主義 值得信任 心胸開放 廉正與誠實 關懷與熱情 全心照顧與陪伴 倫理與道德行為 對職業的責任感 尊重病人治癒的潛能 尊重病人的尊嚴與自主權 R. Cruess & S. Cruess 修改自賴其萬教授提供檔案

  15. 醫師的角色與特質（Roles and Attributes of a Physician） 專業人員 (The Professional) 治療者(The Healer) 自律 自主性 團隊合作 對社會的責任感 廉正與誠實 關懷與熱情 全心照顧與陪伴 倫理與道德行為 對職業的責任感 尊重病人治癒的潛能 尊重病人的尊嚴與自主權 傾聽 能力 承諾 保密 洞察力 利他主義 值得信任 心胸開放 專業的素養(Professionalism) R. Cruess & S. Cruess 修改自賴其萬教授提供檔案

  16. KnowledgeComprehensionApplicationAnalysisSynthesisEvaluation Performance Diagnosis Treatment Reasoning Evidence Judgment & data management Value, Cost-Benefit Experience, Intuition, Bias Evidence and data Collection Analysis Synthesis Evaluation The Outcome A Good Doctor By: Paul PL Chang

  17. Outcome-Based Education 知識Knowledge 技術Skill 能力Competence 執行力Performance 完成力Capability (The power or ability to generate an outcome)

  18. Advantages of Choosing Established Outcomes • The easier way for a medical school to create an outcome-based curriculum is to adopt outcomes that others have defined. • Using an already established list of outcomes has the advantages of ease, simplicity, comparability and established credibility.

  19. Disadvantages of Choosing Established Outcomes • Simply adopting someone else’s list has its own drawbacks. • The faculty and students may not feel the same sense of ownership, unique characteristics of the school may not be represented or sufficiently emphasized, and the outcomes may be interpreted differently from what was originally intended.

  20. 2001 美國畢業後醫學教育評鑑委員會(ACGME)之六大臨床核心能力 • 醫學知識 (Medical knowledge) • 人際與溝通技巧 (Interpersonal and communication skills) • 系統為基礎的醫療 (System-based practice) • 病人照顧與臨床技能 (Patient care & clinical skill) • 專業素養 (Professionalism) • 執業中學習與改進 (Practice-based learning and improvement) Mnemonics:MIS 3P

  21. BROWN'S NINE ABILITIES • 1. Effective Communication (C) • 2. Basic Clinical Skills (P1) • 3. Using Basic Science in the Practice of Medicine (P1&P3) • 4. Diagnosis, Management, and Prevention (K, P1&P3) • 5. Lifelong Learning (P3) • 6. Self-awareness, Self-care, and Personal Growth (P2) • 7. The Social and Community Contexts of Health Care (P2) • 8. Moral Reasoning and Ethical Judgment (P2) • 9. Problem Solving (P1)

  22. Good Medical Practice • 1. Good clinical care • 2. Maintaining good medical practice • 3. Teaching and training, appraising and assessing • 4. Relationships with patients • 5. Working with colleagues • 6. Probity • 7. Health General Medical Council, UK, 2006

  23. THE SCOTTISH DOCTORlearning outcomesThe 12 domains and the three circle outcomes model THE SCOTTISH DOCTOR 3rd Edition Scottish Deans’ Medical Education Group April 2008

  24. 長庚醫學系的願景 • 1. 培養更具人文素養及良醫氣質的醫學生 • 2. 建立更完善與不斷進步的課程規劃及授課 品質 • 3. 培養術德兼備及具研究理想的良醫 • 4. 鼓勵師生參與偏遠地區及社區的醫療服務 • 5. 加強和國際知名醫學院的交流及學生交換 • 6. 追求卓越以達國內及國際一流醫學院醫學 系

  25. 長庚醫學系畢業生應具備的七大核心能力(1) • 1.臨床照護病人能力 (Patient Care)：能展現愛心、關懷與同理心，提供病人適切有效的照護，以解決其健康問題。 • 2.完整與優質的專業醫學知識 (Medical Knowledge)：能理解與應用生物、心理、社會、種族、文化等與健康相關知識，並懂得運用專業相關的基礎與臨床醫學知識處理、分析與研究病人問題。 • 3.實作為基礎之終身、自我學習與改進 (Practice-Based Learning and Improvement)：能具備評估現行醫療照護內容，經過終身、自我學習，吸收科學實證資料並評判資料之可靠性與在病人的適用性，從而改善病患照護；追求醫療品質改善。 • 4.人際關係及溝通技巧 (Interpersonal and Communication Skills)：能有良好的人際關係與溝通技能以便與病人、家屬、同儕及醫療團隊進行資訊交換與溝通，建立團隊合作及良好的傾聽、表達與同理心。

  26. 長庚醫學系畢業生應具備的七大核心能力(2) • 5.專業精神及倫理 (Professionalism)：能展現負責任、尊重、紀律、與愛心之專業態度，堅守醫學倫理原則及對各種病人能包容跨文化間差異；對病人年齡、性別、種族、宗教差異具一定的理解與敏感度及以病人為優先之利他主義觀念。 • 6.制度與體系下之醫療工作 (System-Based Practice)：能夠認知健康照護制度與體系之運作及緣由；有效整合所有資源以提供適切醫療照護；著重病患安全並避免系統性錯誤，檢討各項醫療決策及操作內容，評估系統資源內容減少系統性錯誤。 • 7.生物醫學研究能力 (Biomedical Research Ability):具備文獻評析、彙整能力及研究構思、設計與執行之基本能力。

  27. KASH makes cash. K Knowledge 專業的知識 A Attitude 正確的態度 S Skills 圓融的技巧 H Habit 良好的習慣 工作成就 = 工作能力（知識 + 技巧） x 工作態度（態度 + 習慣）

  28. Within 2 weeks: Auditory Visual Kinesthetic 5% after 24 hours Active Passive & Immediate use 28

  29. Overview of Assessment of Learning Outcomes MCQ Multiple Choice Question; EMI Extended Matching Items; MEQ Modified Essay Question; CRQ Constructed Response Question.

  30. KASHO makes much more cash. K Knowledge 專業的知識 A Attitude 正確的態度 S Skills 圓融的技巧 H Habit 良好的習慣 O Organization culture 機構的文化 (Decided by the Leader’s will) 學習 (Learning) = 情緒(Emotion) + 動機(Motivation)  

  31. Take Home MessageLearner-Centered and Outcome-based Teaching • To define the outcomes before your teaching. • To design the curriculum • to establish the learning environment • to encourage the motivation of learners for teaching. • To assess the achievement of learners • to reflect yourself.

  32. Learning has to be done by the learner, not for the learner.* Teaching as engineering effective learning environments. Thank You for Your Attention!

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