Educational Perspectives: A Systematic Approach to ......atic approach to curriculum develop-ment and standardizing teaching practices, clinician educators can en-sure that their learners

DOI: 10.1542/neo.12-1-e2 2011;12;e2-e7 NeoReviews

Dara Brodsky and Lori R. Newman Educational Perspectives: A Systematic Approach to Curriculum Development

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A Systematic Approach to CurriculumDevelopmentDara Brodsky, MD,* Lori R. Newman, MEd†

AbstractThis review presents a systematic approach to curriculum development,divided into five steps: 1) perform a needs assessment, 2) define the goalsand learning objectives, 3) identify resources, 4) develop educationalstrategies and implement the curriculum, and 5) evaluate and modify thecurriculum. Although the curriculum developmental stages are presentedin five ordered steps, curriculum development is actually a dynamic,interactive process, in which development of one step naturally affectsother steps. Learners are central to this process, and with each step, theinstructor needs to be mindful of the learners’ needs and prior experiences,using a variety of educational strategies to reach trainees with differentlearning styles.

Objectives After completing this article, readers should be able to:

1. Identify key steps in developing a curriculum.2. Distinguish between goals and learning objectives.3. Select learner-centered teaching strategies.4. Recognize the importance of evaluating a curriculum.

IntroductionMedical school curricula receive sub-stantial attention and are largely stan-dardized across the country, butpostgraduate curricula in most hos-pitals are inconsistent, depending onthe ability, interest level, and avail-ability of faculty. By using a system-atic approach to curriculum develop-ment and standardizing teachingpractices, clinician educators can en-sure that their learners master theknowledge and skills necessary to at-tain the next level of training. Thisarticle describes one such systematicapproach: a five-step, easy-to-use

framework for curriculum develop-ment (modified from Kern and asso-ciates). The learner is central to thisprocess, and with each step, the in-structor should be mindful of thelearner’s needs and prior experiences,using a variety of educational strate-gies to reach trainees with differentlearning styles.

Definition of CurriculumA curriculum is any planned educa-tional experience. Clinicians tend tothink of curricula as teaching guide-lines for clinical rotations or entiretraining programs, but the term alsoincorporates planned teaching ses-sions at the bedside or in an outpa-tient clinic. Using this broader defi-nition, most neonatology fellows andneonatologists have experience withcurriculum development activities.

Within this definition of curricu-

*Assistant Professor in Pediatrics, Harvard MedicalSchool, Beth Israel Deaconess Medical Center,Boston, MA.†Director, Office of Faculty Education, Center forEducation, Shapiro Institute for Education atHarvard Medical School and Beth Israel DeaconessMedical Center, Boston, MA.

educational perspectives

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lum are four categories. The officialcurriculum is generally a written setof information and skills that learnersmust master by the end of their train-ing experience. The operational cur-riculum is that portion of the officialcurriculum and any additional con-tent that actually is taught. The nullcurriculum category describes theknowledge and skills that are ne-glected or intentionally not taught.Finally, the hidden curriculum cate-gory is the set of values, attitudes,and beliefs embedded in the trainingprogram’s cultural milieu, which isconveyed through verbal and non-verbal cues.

Step 1: Needs AssessmentThe first step in curriculum develop-ment is for the instructor to assess thelearners’ educational needs, whichwill help determine the breadth anddepth of the curriculum. A needs as-sessment is critical for effective cur-riculum development, and althoughit is a simple concept to understand,it can be challenging to execute. Cur-riculum developers must determinewhat the learners already know, whatthey need to know to move to thenext training level, and what infor-mation and skills need to be taughtto fill knowledge gaps and meet edu-cational benchmarks. Methods forassessing the learners’ current knowl-edge and determining their prior ex-periences range from formal writtentests to informal surveys. Curriculumdevelopers should consider the localand national expectations of theirtraining programs to help determinethe educational standards for theirtrainees. Once curriculum develop-ers have identified what the traineesknow and need to learn, they canfocus on the information they needto teach.

Developers should select a needsassessment method based on the typeof curriculum they are planning and

the amount of face-to-face contacttime they will have with the learners.For example, a clinician educatordeveloping a yearlong curriculummight need to use multiple assess-ment methods, such as a knowledgepretest, focus group input, and awritten survey. On the other hand, ifa clinician is planning a single bedsideteaching session, one method, suchas informally asking the trainees whatthey want to learn, should suffice.

To demonstrate how this curricu-lar design process works, we use aclinical scenario throughout this re-view:

An attending in the neonatal in-tensive care unit will be working withthree pediatric residents for a 2-weekrotation. A few weeks before the rota-tion, the Department Chair tells theattending that she has heard a lot ofcriticism from the residents about thecurriculum this year. The traineeshave complained that they are notlearning anything they really need toknow. The Chair asks the attending todesign a new curriculum for the resi-dents.

The attending is already familiarwith the Accreditation Council forGraduate Medical Education’s pedi-atric residency program requirements.Because the rotation is fast approach-ing and there is no time for formaltesting, the attending meets with thechief resident, a group of pediatric res-idents, and other neonatologists to de-termine what the residents typicallyknow at baseline. Based on this infor-mation, the attending determines thatan important subject that the residentsneed to know, but do not consistentlylearn, is how to manage a hospitalizedinfant with respiratory distress.

Step 2: Goals and LearningObjectivesThe second step of curriculum devel-opment is to define the learning goalsand objectives. A learning goal com-

municates the educational aim andpurpose of the instruction. It alsoidentifies the learner group and thescope of the curricular content. Us-ing the scenario, the attending de-cides that his primary learning goalis: To have the residents develop theknowledge and skills necessary to carefor a hospitalized infant with respira-tory distress. In this example, “resi-dents” encompass the learner group,“develop the knowledge and skillsnecessary” is the purpose of the in-struction, and the “hospitalized in-fant with respiratory distress” definesthe scope.

After defining the learning goal,the attending needs to determinethe learning objectives. The learningobjectives describe what the learnerswill be able to know, show, or doat the end of the teaching ses-sion(s). The objectives can be cog-nitive (knowledge-based), psycho-motor (skill and performance-based), and affective (attitudinal).Objectives answer five questions:

● Who?● Will do?● How much?● Of what?● By when?

Thus, a learning objective for thescenario might be: The pediatric resi-dents will intubate five infants whohave respiratory distress by the end oftheir 2-week rotation. This statementanswers the five questions:

● Who?�The pediatric residents● Will do?�will intubate● How much?�five● Of what?�infants who have respi-

ratory distress● By when?�by the end of the 2-week

rotation

Ideally, the learning objectivesshould incorporate the acronym“SMART”: Specific, Measurable,Attainable, Relevant, and Targeted


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to the learner. The example learningobjective fits these criteria. The fol-lowing two learning objectives, onthe other hand, are flawed:

1. The pediatric residents will un-derstand the causes of respiratory dis-tress in an infant by the end of therotation. This learning objective isnot measurable because there is noobservable indication of how to mea-sure the residents’ understanding.Because there are many causes of re-spiratory distress in infants, this ob-jective needs to be more specific anddemonstrable. The objective mightbe changed to: The pediatric residentswill summarize the five most commoncauses of respiratory distress in a hospi-talized infant by the end of the rota-tion. This is measurable and demon-strable; at the end of the rotation, theinstructor can assess the residents’acquired knowledge by having themprovide a written or verbal summaryof the causes of respiratory distress.This objective is also specific, aimedat describing the five most commoncauses of respiratory distress in a hos-pitalized infant.

2. The pediatric residents will suc-cessfully intubate an infant with alarge neck mass obstructing the airwayby the end of the rotation. Althoughthis objective is measurable (the res-ident will be able to do it or not) andspecific, it is neither realistic norlikely attainable. An improved objec-tive would be: The pediatric residentswill successfully intubate three infantsby the end of the rotation.

To ensure that the learners areactively engaged with the curricu-lum, find the content meaningful,and can apply and retain new knowl-edge and skills, curriculum designersshould use Bloom’s taxonomy as aguide when creating learning objec-tives. This multi-tiered model classi-fies educational objectives accordingto six cognitive levels of increasingcomplexity: knowledge, comprehen-

sion, application, analysis, synthesis,and evaluation. To engage the learn-ers in higher-order thinking anddeep understanding of concepts,mastery of the lower levels is re-quired. Figure 1 provides examplesof learning objectives for the scenariothat target each cognitive domain.

Step 3: ResourceIdentificationWhen developing a curriculum, in-structors need to identify the people,time, facilities, materials, and fund-ing necessary to build, implement,and sustain the curriculum. Al-though this seems obvious, if curric-ulum designers do not focus on thisstep in advance, they may find thattheir curriculum is complete butlacks the critical resources to imple-ment it. For example, to teach resi-dents how to intubate effectively,the curriculum should involve sometype of simulation-based training.Depending on the resources avail-able, intubation training can rangefrom use of a mannequin head to ahigh-fidelity mannequin that has acardiovascular monitor.

To obtain the necessary resources,curriculum developers need to iden-

tify stakeholders and gain their sup-port. Stakeholders are directly af-fected by a curriculum, such as theDepartment Chair in the scenario.Additional stakeholders include cli-nicians who need to commit theirown time to help teach the curricu-lum. Before approaching the stake-holder, the instructor should knowhow to respond to the often unspo-ken question, “What’s in it for me?”In response, the curriculum devel-oper can reveal a well-developedneeds assessment, well-crafted edu-cational objectives, and possibly anevaluation plan to show how the cur-riculum will be an excellent return onthe stakeholder’s investment.

Step 4: Development ofEducational Strategies andImplementation of theCurriculumEducational strategies are the teach-ing methods and activities used toengage learners actively and enablethem to meet the learning objectives.These methods include:

● Readings from textbooks or jour-nal articles

● Lectures

Figure 1. Bloom’s taxonomy. This multi-tiered model classifies educational objectivesaccording to six cognitive levels of increasing complexity: knowledge, comprehension,application, analysis, synthesis, and evaluation. To the right of the model are examplesof learning objectives that target each cognitive domain.




● Small group or case-based discus-sions

● Simulations with patient-actor,family member-actor, or manne-quins

● Bedside teaching sessions

In addition to connecting theteaching method with the specificcurricular content, curriculum de-signers also must think about thelearner when selecting educationalstrategies. Some trainees prefer tolearn by reading; others may learnbest through discussions or activepractice. To appeal to all types oflearners, curricula should include avariety of teaching methods. In thescenario, the attending might usereadings and small group discussionsto help the learners summarize thefive most common causes of respiratorydistress in a hospitalized infant anduse simulation and bedside teachingto have the residents apply knowledgeof pharyngeal anatomy and intubatean infant.

Each type of educational strategyhas its own strengths and weak-nesses. For example, readings are lowcost, but learners need to be self-motivated to complete their assign-ments. Although lectures offer agreat opportunity to teach to a largenumber of learners simultaneously,this approach can be passive, withminimal interaction between thelearners and teachers. Small-groupdiscussions are ideal for problem-solving and teaching clinicaldecision-making, but success de-pends on the learners’ interest, expe-rience, and knowledge. Realism is atremendous benefit of simulation,but the more realistic the simulation,the higher the cost. Finally, bedsideteaching fosters learner motivationand responsibility but requires inten-sive faculty supervision.

After determining the educationalstrategies and curriculum content,

the instructor can implement thecurriculum. During this step, it iseasy to fall into a teacher-centeredapproach with an overly rigid adher-ence to the preplanned curriculum.It is essential at this point for thecurriculum designer to maintain hisor her commitment to learner-centered learning. Teachers need toguide or facilitate learning andshould consider the following tech-niques:

● Avoid information overload and al-low time for group discussion

● Ask higher-order questions, com-pelling learners to analyze and eval-uate information

● Encourage learner-to-learner dia-logue

● Be flexible and allow the learners’interests, experiences, and needs toguide the direction of teaching

Step 5: Evaluation andModificationEvaluation and modification com-pletes the curriculum developmentmodel. The process of evaluation al-lows the teacher to ask and answerthe critical question, “Was the curric-ulum successful in achieving thelearning goals and objectives?” Eval-uation of a curriculum consists oftwo interconnected domains: learner

evaluation and program evaluation(Fig. 2). Learner evaluation asks thequestion, “Did the learners get it?”and determines whether learners canprovide evidence that they under-stand what they were taught, candemonstrate new skills, and will beable to apply new learning when car-ing for their next patient. Programevaluation asks the question, “Doesthe curriculum work?” This is an-swered by quantitatively measuringthe achievements of all learners, col-lecting feedback about the quality ofthe teaching, and assessing the im-pact of the curriculum on future clin-ical care.

There are many methods to eval-uate the learner. Some examples in-clude:

● Knows: Written examinations, pre-and posttesting

● Shows: Observation by a supervisor,simulation, objective structuredclinical examination, standardizedpatients

● Does: Medical record audit, multi-source feedback, learner portfolio,clinical evaluation exercise

In the scenario, if a learning ob-jective is to have the resident summa-rize the five most common causes ofrespiratory distress in a hospitalized

Figure 2. The questions that encompass the two interconnected domains of curricu-lum evaluation: learner evaluation and program evaluation. Adapted from Tess AV.Introduction to curriculum development and instructional design. In: Principles ofMedical Education. Boston, MA: Beth Israel Deaconess Medical Center; 2009.




infant, the evaluation might includea written or verbal knowledge-basedexamination. If another learning ob-jective is to have the resident applyknowledge of pharyngeal anatomy andintubate an infant, the use of simu-lation or observation of a resident’sintubation procedure is an excellentmethod of learner evaluation.

Program evaluation measures thesuccess of the curriculum by analyz-ing the quantity, quality, and impactof the curriculum. Quantitative eval-uation of the curriculum can includeresults of knowledge-based tests orthe number of learning objectivesthat each resident attained. For ex-ample, in the scenario, measuring theresident’s success rate of intubationbefore and after the curriculum willhelp evaluate the program’s effec-tiveness. Feedback from learners, at-tendings, and clinical team memberson the structure and content of thecurriculum can help to assess the pro-gram qualitatively. In the scenario,improved quality of the program may

be shown by an increase in positiveresident evaluations about the curric-ulum meeting their learning needscompared with precurriculum evalu-ations. To determine if the curricu-lum had an impact on clinical care,the attending in the scenario can col-lect data to see if there are fewerresident-associated complicationsfrom intubation after the curriculumwas introduced.

After compiling the findings fromlearner and program evaluations, theattending can modify and improvethe curriculum. By analyzing thestrengths and weaknesses of the cur-riculum and determining the needsof the next set of learners, curriculumdevelopers can engage in continuousquality improvement as they recon-sider and recalibrate each step of themodel for the next clinical rotation.

ConclusionThe diagram in Figure 3 depicts thesystematic approach to curriculumdevelopment discussed in this article.

The learner is central to this process,reflected within the star model. Dur-ing each step of curriculum develop-ment, clinical teachers need to bemindful of their learners’ needs andprior experiences and the educationalstrategies to engage them. Curricu-lum development is a dynamic, inter-active process, in which developmentof one step naturally affects othersteps. As clinicians move forward intheir own curriculum developmentprocess, we encourage them to in-corporate learner-centered instruc-tion into their everyday interactionswith trainees, to reflect on what as-pects of a curriculum works well andwhat needs to be improved, to bewilling to modify the curriculum tomeet the needs of the learners, and tohave fun teaching.

Suggested ReadingBillings D, Halstead JA. Teaching in Nurs-

ing: A Guide for Faculty. St. Louis, MO:Saunders, Elsevier Science Health Sci-ence; 1998

Bloom B. Taxonomy of Educational Objec-tives. Handbook I: Cognitive Domain.New York, NY: David McKay Com-pany, Inc; 1956

Figure 3. Systematic approach to curriculum development.

American Board of PediatricsNeonatal-Perinatal MedicineContent Specifications• Understand the

strengths andweaknesses ofvarious teachingmethods (eg,lecture, small group discussion,bedside teaching, simulation).

• Understand that individuals may learnmore effectively with certain teachingmethods (eg, reading, hearing, doing)than with others.

• Understand the role of needsassessment in educational planning.

• Distinguish between goals andlearning objectives.

• Identify components of well-formulated learning objectives.




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DOI: 10.1542/neo.12-1-e2 2011;12;e2-e7 NeoReviews

Dara Brodsky and Lori R. Newman Educational Perspectives: A Systematic Approach to Curriculum Development

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