1/18/2013

1

Jane H. Brice MD, MPH

January 9, 2013

Research Contractso EMS for Children – ongoingo National Highway Traffic Safety Administration – recently completed

Organizationso Secretary-Treasurer - NAEMSP

1/18/2013

2

What is a curriculum? Why do I need a curriculum? What are the elements of the curriculum? How do I use a curriculum?

Curriculum (Perina)o Operationalizes core content for trainingo Provides standardization between programso Ensures core content covered

Pratt (1980): a written document that systematically describes

1. goals2. objectives3. content4. learning activities5. evaluation procedures

1/18/2013

3

A functional curriculum is one that takes the entire body of knowledge necessary to appropriately practice in the identified area and codifies it into a training blueprint to ensure that the totality of items are covered in a prescribed time period.

In other words, curriculum turns this………………

1/18/2013

4

Into this……………Time/Life Critical Events

Goals and Objectives: At the completion of fellowship training, the EMS physician will be competent to:

1. Recognize prehospital patients with time/life critical events2. Perform procedures necessary for patient stabilization and treatment3. Assess and manage the airway in the prehospital environment4. Assess and manage breathing through physical examination,

measurement of oxygen saturation and end-tidal CO2 monitoring5. Assess and manage circulation and delivery of medication 6. Assess and manage the differential diagnosis to find and treat reversible

causes of time/life critical events Evaluation and Assessment Methods:

1. Direct observation of patient assessment and treatment skills in the prehospital setting by program director or faculty supervisor

2. Structured patient simulations 3. 360° feedback from faculty, allied health personnel, patient

Can be as granular as you like with respect to core content

Typically major headings and subheadings are included in curriculum

1/18/2013

5

‘Curriculum' derived from Latino ‘Curers' which means to runo So 'curriculum' is a course or path which one runs to reach a goal.

Curriculum includes the subject matter and all learning experiences for a particular content area

1/18/2013

6

Curriculum can never be statico It must be a dynamic, living document. o Content selected according to the changing needs of society in

general and the subject in particular

As the core content is revised and changed, so, too, must the curriculum change and grow

Between teacher and student

Enables the students to know the subject matter they are responsible for

Makes clear to teacher the material they have to teach

1/18/2013

7

For the learnero Defines subject matter and educational content of fellowship

For the teachero Defines the depth and breadth of the material to be taught

Should visited and reviewed at regular intervals throughout the fellowship

Allows learner and teacher to mark growth (or deficiencies)

Plan for remediation

1/18/2013

8

Enables leaner and teacher to evaluate o Mastery of contento Readiness for independent practice

1/18/2013

9

Overall Educational Goal Module Goal Objectives Explicit Content Implementation Methods Evaluative Methods

Example:

The primary purpose of the EMS fellowship curriculum is to prepare the fellow to both provide and manage competent, patient-centered medical care in the out-of-hospital environment.

1/18/2013

10

The educational goal is the “end toward which an effort is directed” and it embodies the ideal training scenario for core competency.

The objectives are specific and include tasks, discussions, and exercises that are designed to fulfill the competency.o Should be specific to a competencyo Should utilize an action verbo Should be measureableo Should be concrete

Goals (expansive, broad)o To prepare board certified physicians to competently deliver and

administer care to patients in the prehospital environment

Objectives (narrow, focused, measurable)o Explain the prehospital interventions in the early treatment and

management of hypovolemic, obstructive, cardiogenic and distributive shock

o Identify prehospital patients who meet criteria for systemic inflammatory response syndrome and who would benefit from early intervention

o Identify and manage prehospital patients experiencing hypotension and shock from anaphylaxis

o Acquire working knowledge of the role of prehospital ultrasound in the assessment and care of the patient with shock

1/18/2013

11

Three major categories (plus one)o Learnero Processo Outcome

o Plus – System

Lies in three areas

Cognitive objectives = “medical knowledge” component

Affective objectives = attitudes or beliefs that may affect learning or performance (think – professionalism)

Psychomotor objectives = specific skills or behaviors

1/18/2013

12

Knowledge

Most curriculum planners write objectives at the highest level of cognitive functioning expected, recognizing that there are many steps in the path to mastery

Recitation of Facts

Complex Problem-Solving

Clinical Decision-Making

Values, Beliefs, Emotions Reflected in ACGME core competencies – Professionalism,

Interpersonal Skills Example: At the end of

the fellowship, an EMS fellow will be able to identify their attitudes and beliefs regarding safety in the EMS environment and have discussed with the fellowshipfaculty how to incorporate thesevalues into their EMS practice.

1/18/2013

13

Skills or Behavioral Objectives Important to distinguish between the two Skill objectives measure whether or not a learner can

perform a skill correctly. Behavioral objectives measure whether or not a learner

incorporates the skill into continuing practice and uses it appropriately.

Implementation of the curriculum into practice Two kinds

o Fellowo The fellow will participate in at least one root cause analysis of

either a reported near-miss or an actual medication error committed in the prehospital environment.

o Programo All fellows will participate in a critical incident stress debriefing

prior to completion of the fellowship

1/18/2013

14

Describe the impact of the curriculum on the practice of EMSo Health, Health care, Patient

Example: All patients resuscitated from ventricular fibrillation arrest will be cooled prior to hospital arrival.

May also focus on career objectives of the fellow Example: 90% of fellowship gradates will practice in the out-

of-hospital environment five years after successful completion of the fellowship.

Not always part of a curriculum Critical to the EMS curriculum (IMHO)

Leader

Developer

Manager

Apprentice

1/18/2013

15

Should be harmony between the objectives you define and the methods of delivering this contento Sim lab or supervised practice for psychomotor

skill

Use multiple education strategieso Allows learner to utilize fullest complement of

learning strategieso Every learner has a preferred learning styleo EMS fellows may be over-prone to kinesthetic

learning

Choose delivery methods that are feasible within the constraints of resources o Cost, faculty time, learner time, clinical

availability, physical space

There is no one size fits all here.

Didactic lectures Online courses Journals Textbooks Podacsts (NAEMSP) NAEMSP Medical Directors Course Apprentice-style learning in the field Simulation Center Teaching files (web-based or self-created) Mentored project One-on-one discussions with faculty

1/18/2013

16

Must be based on the criteria you established in your objectiveso Both the fellow and the faculty must know what is being evaluated

Should be frequent – most advocate monthly to allow for improvement and growtho Some use a monthly checklist

Should include self-evaluation by the fellowo Habits of self-evaluation will enhance life-long learning

May be a useful tool Agreed upon list of objectives to accomplish in a pre-

defined time period Presented and discussed with the fellow at the start of

each month Expectations are communicated clearly Opportunities for learning created At end of month allows for evaluation and

planning for next month

1/18/2013

17

Provide a useful framework for planning evaluation

Medical Knowledge Written testingInteractive discussionTeaching product of fellows

Interpersonal and Communication Skills 360 feedbackDirect observation

Patient Care Direct observationOutcome review

Professionalism Direct observation360 feedback

Practice-based learning and improvement

Self-evaluationFormat improvement plans

System-based practice Direct observationWork product

Direct observation of patient assessment and treatment skills in the prehospital setting by program director or faculty supervisor

Structured patient simulations 360° feedback from faculty, allied health personnel,

patient Retrospective chart review Review of fellow work products

1/18/2013

18

All faculty members with whom fellow has had interaction EMS Administration EMS field personnel 9-1-1 personnel Nursing Education partners Patients with whom

fellow has interacted

Critically important Fellow must have an opportunity to provide structured,

meaningful, and consequence-free feedback to the fellowship director about the program.

Honest evaluation is the only way we improve and get better.

1/18/2013

19

Curriculum useso Recruitmento Justification for funding (or existence)o Blueprint for planningo Measurement of learning and masteryo Evaluation of program productivity

1/18/2013

20

Sample curriculum available on NAEMSP website

Designed to be aresource documentfor use by fellowships

Each fellowship willcreate their own curriculum specificto their needs and environment.