A Conceptual Framework for Analysing the Dental Curriculum
Introduction
In this chapter a theoretical framework that informs this study is presented. The framework draws on Bernstein’s (1977) conception of collection and integrated curriculum and the novice-expert continuum (NEC) model of skills acquisition (Benner 1984, 2004; Chambers 1994; Dreyfus 2001; Dreyfus and Dreyfus 1986; Dreyfus 2004; Dreyfus and Dreyfus 1980). The use of more than one theory to guide data analysis and interpretation is not uncommon in qualitative research. In their comparative study of the French schools’ success in mathematics, Fowler and Poetter (2004) have drawn on three theoretical frameworks, while Calgren and Kallos (1997), Cooper (1998) and Cooper and Dunne (1998) have employed two theoretical frameworks.
The chapter is divided into two sections. In the first section, Bernstein’s (1977) collection-integrated framework (CIF) and the five-stage NEC skills acquisition model (Benner 1984; Dreyfus and Dreyfus 1986) are discussed. The final section draws together the CIF and the NEC into a single analytical framework, which has informed this study.
The Need for a Broad-based Theoretical Framework for Analysing the Curriculum
Although a number of theoretical frameworks exist that can be used to “clarify a range of educational problems” (Walford 2002, p. 414) including dental curriculum planning, most literature on dental curriculum does not make explicit the theory underpinning it. Where education principles underpinning curriculum innovations have been explicated, two trends can be noted. The first is what has been noted about my informants at the WDS chapters 4 and 6. In their discussion of the rationale for curriculum restructuring, my informants drew on both abstractionist and pragmatistic repertoires. However, the importance of theory in guiding curriculum planning generally received low attention compared to the everyday practical realities of dental curriculum.
The second trend is what Morais (2002) has noted in education: the preponderance among science teachers to turn to education theories from the fields of psychology and cognitive sciences rather than from social sciences. She talks of a “general rejection of sociological approaches” among science teachers. She suggests science teachers are attracted to education theories from the fields of psychology and cognitive sciences because the strong grammar of psychology makes it more readily acceptable knowledge for grounding “the how to teach” science (Morais 2002, p. 565).
The observed rejection of education theories from the fields of social sciences by science teachers’ noted by Morais, can also be said about dental educators. A casual look at the literature on curriculum innovations in medical and dental education shows that, although it is recognised that the success of curriculum innovations such as PBL,
Dalrymple, Wuenschell, Rosenblum et al. 2007; Fincham and Shuler 2001; McLean and Van Wyk 2006), and power and control issues are well articulated by Bernstein, yet it is rare, if ever, that reference is made to Bernstein’s work in the literature on medical and dental curriculum. Instead extensive reference is made to the competency- based education (Chambers 1993, 1994; Hendricson and Kleffner 1998; Hendricson and Kleffner 2002), the PBL (Fincham and Shuler 2001) and the NEC model (UWCM Dental School 2001c) as guiding principles in curriculum restructuring in medical and dental education. The NEC, as noted by English (1993), has its roots in cognitive psychology.
Ignoring contributions from the field of education sociology simply means that an important resource has gone unnoticed and untapped. In the analytical framework I am presenting in this chapter, I have not only drawn on theories from the fields of sociology and cognitive psychology. But I have gone a step further and, drawing on the concept of abductive inference (Atkinson and Coffey 2004; Kelle 1995), I have reconceptualised the CIF and the NEC in a new and innovative way to produce an analytical model that also foreshadows the curriculum model developed in chapter 11.
Bernstein’s Contribution to Education: Classification and Framing and the Collection and Integrated Curriculum
The contribution of Basil Bernstein to the field of education is widely acknowledged and has been described as immense and inspiring (Aggleton, Brannen, Brown et al. 2001; Atkinson 1985; Atkinson , Davies and Delamont 1995; Sadovnik 1995). His work spans over a period of four decades and covers areas such as language (Bernstein 1977), curriculum and educational transmission (Bernstein 1975; Bernstein 1977). As
proof of the high esteem to which Bernstein was held, he has two festschrifts in his honour by Atkinson et al (1995) and Sadovnik (1995). When he died in September 2000, Aggleton et al. (2001) published a collection of eulogies to which several scholars from around the world contributed to celebrate his life. In addition, the editorial board of the British Journal o f Sociology o f Education published a special issue of the journal as “a mark of respect” (Amot, Apple, Beck et al. 2002, p. 525) in recognition of his immense contribution to the field of education and to render his work more accessible to readers unfamiliar with his writing.
I do not intend to engage in an extensive discussion of Bernstein’s work. Readers interested in exploring further this issue are referred to Atkinson (1985). The anthologies by Atkinson et al. (1995), Sadovnik (1995) and Morais et al. (2001) and the special edition of the British Journal o f Sociology o f Education, volume 23 number 4, are all highly informative and give a comprehensive picture of Bernstein’s contribution to education. What I have focused on is his work on curriculum. I have particularly paid attention on the concepts of classification and frame that he introduced to define collection and integrated curricula.
Classification and Framing
Bernstein's conceptualisation of the curriculum is based on two principles. The first is concerned with the structural relationship between the contents of a curriculum. That is, whether the contents of a curriculum stand in an open or closed relationship to each other and to the outside. The other principle addresses the nature of power and control social relationships between categories (Neves and Morais 2001a). To elucidate these two ideas, Bernstein introduced the concepts of classification and framing.
Classification
By classification, Bernstein referred to the structural relationship between the various contents of the curriculum—that is, whether the contents of a curriculum stood in complete isolation from each other or not. He used the terms ‘strong’ and ‘weak’ to describe the degree of boundary insulation between contents:
“Where classification is strong, contents are well insulated from each other by strong boundaries. Where classification is weak, there is reduced insulation between contents, for the boundaries between contents are weak or blurred.
Classification thus refers to the degree of boundary maintenance between contents. Classification focuses our attention upon boundary strength as the
critical distinguishing feature of the division of labour of educational knowledge” (Bernstein 1977, p. 88: emphasis in the original).
This definition highlights the fact that classification is not a fixed entity but exists as a continuum extending from weak to strong. Variations in classification strength give rise to two curricula types: collection and integrated. Bernstein differentiated between collection and integrated curricula as follows;
“Any organization of educational knowledge which involves strong classification gives rise to what is here called a collection code. Any organization of educational knowledge which involves marked attempt to reduce the strength of classification is here called an integrated code” (Bernstein 1977, p. 90).
From this formulation, a collection curriculum is marked by strong classification. This means that the contents of the curriculum stand in a “closed relationship” (Bernstein 1977, p. 87) to each other. In contrast, an integrated curriculum is marked by weak
classification, with contents standing in an “open relationship” with each other (Bernstein 1977, p. 87). Figure 5.1 presents classification as a continuum extending from strong to weak, with the ideal forms of collection and integrated curricula occupying the opposite ends on the continuum.
Figure 5.1: Variations in Classification and the Two Curricula Types
Strong classification gives rise to a collection curriculum, while weak classification gives rise to an integrated curriculum. In an integrated curriculum boundaries between subject areas are blurred. In a collection curriculum, in contrast, there is strong boundary maintenance between subiect areas.
In dental education strong classified curriculum is best illustrated by the pre-clinical component of a traditional undergraduate course, which is characterised by strong boundary maintenance between subject areas of physiology, biochemistry and anatomy. Weak classification occurs towards the end of the students’ clinical training, during the outreach and polyclinics.
Bernstein was not only concerned with the structural relationship between the content of a curriculum but also in the social context in which knowledge is transmitted and received. He was interested in the “pedagogical relationship” (Bernstein 1977, p. 88) between teachers and students and he introduced the concept of ‘frame’ to explore this relationship. He defined ‘frame’ as, “...the range of options available to teacher and
C O L L E C T I O N
C U R R IC U L U M * ^ S tr o n g * » ^ ^ Weak "")►
IN T E G R A T E D C U R R IC U L U M
taught in the control of what is transmitted and received in the context of the pedagogical relationship” (Bernstein 1977, p. 88 - 89. Emphasis in the original). Like classification, frame can be presented as a continuum extending from strong to weak as shown in Figure 5.2.
Figure 5.2: Variations in Frame Strength
S t r o n g Fram e W e a k
Frame refers to the degree of control over a pedagogical encounter between lecturers and students. In a strong framed pedagogical interaction, lecturers have increased and students’ have reduced control and vice versa.
Bernstein described what was implied by strong and weak framing as follows;
“Strong framing entails reduced options; weak framing entails a range of
options. Thus frame refers to the degree o f control teacher and pupil possess
over the selection, organization, pacing and timing o f the knowledge
transmitted and received in the pedagogical relationship” (Bernstein 1977, p.
89. Emphasis in the original).
Framing is not restricted to the teacher-student pedagogic relationships alone but can be extended to other encounters where there is differential allocation of power and control between agents (Hoadley 2003; Neves and Morais 2001c). Hoadley (2003) has coined the terms ‘internal’ and ‘external’ framing to distinguish between the pedagogic relationship between the teacher and pupils and the relationship between the teacher and external agents respectively.
In dental education, at the meso level, framing refers to the degree of control that dental schools possess over the selection, organisation, pacing and timing of the contents of the curriculum. In the UK, for example, under strong framing the dental schools would be expected to work within a highly prescriptive set of GDC curriculum guidelines. Under weak framing, dental schools would exercise greater control over the curriculum. That is, strongly framed curriculum guidelines would offer little choice to dental schools; while weakly framed curriculum guidelines would permit greater flexibility and variation in the curriculum (cf. Hoadley 2003). At the micro-level of subject transmission, strong framing means that lecturers exercise greater control, relative to students, over the selection, pacing, organisation and timing of knowledge in a pedagogic interaction. In a weak framed curriculum students’ have increased control over the pedagogic interaction. A lecture in paediatric dentistry or anatomy is an example of a strong framed pedagogic interaction, while a poster assignment or an authentic problem-based learning (PBL) are examples of relatively weak framed pedagogic interactions.
There is another aspect to framing. This relates to the degree of insulation between what Bernstein (1977, p. 89) terms as ‘non-school everyday community knowledge’ possessed by the teacher and the students and the ‘educational knowledge’ transmitted in a pedagogical relationship. He defines this aspect of framing as;
“...the strength of the boundary between what may be transmitted and what may not be transmitted, in the pedagogical relationship. Where framing is strong, there is a sharp boundary, where framing is weak, a blurred boundary, between what may and may not be transmitted” (1977, p. 88).
school. He differentiates between community knowledge and educational knowledge as follows;
“In a sense, educational knowledge is uncommonsense knowledge. It is knowledge freed from the particular, the local, through the various languages of the sciences or forms of reflexiveness of the arts which make possible either the creation or the discovery of new realities” (1977, p. 99).
It is the frame strength between educational knowledge and everyday knowledge that sets educational knowledge apart and makes it mysterious. The stronger the frame the more arcane educational knowledge becomes and therefore the more cherished and highly protected it is to those who possess it. Bernstein (1977, p. 99) observes that, “Such framing also makes of educational knowledge something not ordinary or mundane, but something esoteric, which gives a special significance to those who possess it.” This means the stronger the boundaries between everyday community knowledge and educational knowledge the more esoteric, ‘pure’ and ‘sacred’ (Atkinson 1985, p. 137) education knowledge is seen to be. Instances of weak framing between everyday community knowledge and educational knowledge are found in pre school education (Bernstein 1977; Tsatsaroni, Ravanis and Falaga 2003) as well as in the education of the ‘less able’ children in society. Bernstein (1977, p. 99) argued that frame strength was “relaxed to include everyday realities” in the education of less able children in order to establish some social control.
Although Bernstein had general education in mind in formulating this aspect of framing, the general principle may be applied to professional education. Within the dental profession two knowledge areas may be discerned: basic dental knowledge transmitted through the undergraduate dental curriculum and the specialist dental knowledge that is acquired through postgraduate professional training. Nearly all
specialist and sub-specialist disciplines of dentistry strive to have some control over the knowledge transmitted in the undergraduate curriculum and have formulated some guidelines for undergraduate education (See, for example, Dental Sedation Teachers Group 1999; Eaton, Adamidis, Mcdonald et al. 2000; European Society of Endodontology 2001; Odell, Farthing, High et al. 2004). Some disciplines even advocate strong framing between basic and specialist dental knowledge and suggest weakening of the frame strength only to some students as a way of rewarding excellence and a means of attracting them into the specialties once they qualify (cf. Eaton et al. 2000; O'Brien 1997). This is explored further in Chapter 8 in relation to the undergraduate orthodontic syllabus.
Collection and Integrated Curriculum
Variations in classification and frame strength give rise to a series of curriculum types. Bernstein (1977, p. 90) pointed out that;
“Any organisation of educational knowledge which involves strong classification gives rise to what is here called a collection code. Any organisation of educational knowledge which involves a marked attempt to reduce the strength of classification is here called an integrated code. Collection codes may give rise to a series of sub-types, each varying in the relative strength of their classification and frames. Integrated codes can also vary in terms of the strength of frames, as these refer to the teacher / pupil /
student control over the knowledge that is transmitted.”
When classification and frame are presented as vertical and horizontal continua respectively, they give rise to four main types of curricula as illustrated in Figure 5.3a and 5.3b. However, because classification and frame exist as continua, this can theoretically give rise to a range of curriculum varieties. But, Bernstein focused mainly
on the strong classified and framed collection and the weak classified and framed integrated curriculum types. Bernstein was attracted to the two curricula, to which he assigned the terms visible and invisible pedagogy respectively (Atkinson 1985; Bernstein 1977; Delamont 1989), to show how different models of pedagogic practice reproduced and produced the culture of the ‘old middle class’ and the ‘new middle class’ respectively (Amot 2002; Delamont 1989). In their application of the concept of collection and integrated curriculum to medicine, Armstrong (1977; 1980), Colditz and Sheehan (1982) and Jacobsen (1981) all appeared to have the two curricula in mind.
Figure 5.3a: Typology o f Bernstein’s Collection-Integrated Curriculum
C L A S S I F I C A T I O N W e a k W E A K C L A S S I F I E D - S T R O N G F R A M E D I N T E G R A T E D C U R R I C U L U M ■ S t r o n g ■ S T R O N G C L A S S I F I E D & F R A M E D C O L L E C T I O N C U R R I C U L U M W E A K C L A S S I F I E D & F R A M E D I N T E G R A T E D C U R R I C U L U M W e a k F R A M E S T R O N G C L A S S I F I E D - W E A K F R A M E D C O L L E C T I O N C U R R I C U L U M S t r o n g
I
When classification and frame strength are presented as vertical and horizontal continua, four curricula types are realisable: strong classified and framed (SC&F) collection; weak classified- strong framed (WC-SF) integrated; weak classified and framed (WC&F) integrated; and strong classified- weak framed (SC-WF) collection curricula. However, the most common discussed curricula in the literature are the two highlighted in the figure: the SC&F and the WC&Fcurricula, which are also simply referred to as the ‘traditional discipline-based' and the 'integrated' curriculum respectively.
Figure 5.3b: Three Dimention Typology ofBernstein ’s Collection-Integrated Curriculum
«--- C o llectio n C u rric u lu m --- * <--- In teg rated C u r r ic u lu m --->
Strong Classified and Framed W eak Classified and Framed Strong Classified weak Framed W eak Classified Strong Framed
The typology of Bernstein’s collection-integrated curriculum presented in three dimension as a continuum of vertical
landscapes. At one end of the continuum is the strong classified and fram ed collection curriculum and at the other end is the weak classified and framed integrated curriculum. In between are curricula with varying strength of classification and framing.
In the literature, integrated curriculum continuums comprising from three to as many as eleven have been presented eg (Harden 1998; Harden 2000; Kysilka 1998).
Fogarty (1991) has presented a curriculum continuum comprising 10 models of integration. At one end of this continuum is the teacher-centred, discipline-based ‘fragmented’ model and at the other end is the student-centred ‘networked model’ (p. 61). She describes her 10 models of curriculum integration as prototype ‘organizers’ which, “...a faculty can easily work with them over time to develop an integrated curriculum throughout the school.” Drake (1991) has reported a framework for curriculum planning which her grouped discovered when they were went through the process of developing an integrated curriculum. She introduces three terms: