Formal faculty development programs in family medi-cine and other clinical disciplines are the result of awareness that educational expertise and clinical knowl-edge do not necessarily go hand in hand. Successful teachers of medicine have mastered a specific set of educational skills, knowledge, and attitudes that can be taught and learned.
Since the 1970s, medical education specialists and physicians have collaborated in the development of training programs that teach clinical teaching methods.1
The early emphasis of family medicine on faculty
development programs to improve clinical teaching skills and enhance academic careers quickly expanded to include the teaching of research and administrative skills. Early on, the need for faculty with curriculum design skills also became apparent.2
Recent innovations in the curricula of many medical schools, including the advent of problem-based learn-ing, case-based learnlearn-ing, and the use of standardized patients,3 are producing medical students and residents
who are increasingly sophisticated learners.4 To design
effective educational experiences that will meet the needs and expectations of this new group of learners, family medicine faculty require a solid knowledge of educational principles. Emerging diseases, changing health care systems,5,6 new priorities set by funding
agencies and policy-makers,7 and public criticism of
A Program to Teach Curriculum
Development to Junior Faculty
Susan Snyder, MD
From the Department of Family Medicine, Harbor-UCLA Medical Center.
Background and Objectives: Even though curriculum skills are widely acknowledged to be an
impor-tant part of faculty development in family medicine, reports of outcomes of programs that teach those skills are rarely found in the medical education literature. The Curriculum Workshop Series, one part of a 1-year faculty development fellowship for recent residency graduates, was designed to teach curricu-lum skills to junior faculty. The Program: Developed as part of the Harbor-UCLA Family Medicine Faculty Development Fellowship, the Curriculum Workshop Series consisted of monthly or twice-monthly group sessions, readings, discussion, and individual projects with feedback from colleagues and the instructor. Objectives included developing an understanding of six fundamental steps of curriculum development, completion of an individual project, and giving and receiving feedback regarding projects. Outcome measures included number of projects implemented, the quality of projects, and participant satisfaction. Outcomes: Eight fellows participated in the Curriculum Workshop Series and completed projects. Six of eight were implemented, providing three new curricular opportunities and three en-hancements to existing curricula for three family practice residency programs. Review of projects by outside experts showed that a majority of the six steps were addressed by most fellows but that more emphasis needed to be placed on the clarity of the written curriculum, the link between teaching strat-egies and specific learning objectives, and evaluation of learners and projects. Participants endorsed the relevance of curriculum skills, the practical step-by-step approach to curriculum develop-ment, and the opportunity to produce and implement an individual project. Conclusions: The Cur-riculum Workshop Series provides a straightforward format for teaching curCur-riculum skills to junior faculty and demonstrates that recent graduates have the ability to make a contribution in the area of curriculum development. The format presented here could readily be adapted to other faculty develop-ment settings. Long-term outcomes of this type of faculty developdevelop-ment remain to be studied.
(Fam Med 2001;33(5):382-7.)
physicians8 provide additional impetus for continued
evolution of medical curricula.
Faculty development programs in the area of cur-riculum planning, particularly those that describe how to design the educational structure within which learn-ing will occur, are rarely described in the published lit-erature. In the April 1997 issue of Family Medicine, dedicated to faculty development, Simpson and Ullian wrote that there is a “paucity of literature about faculty development activities in the area of curriculum design and evaluation,” even though a number of faculty de-velopment programs require “that participants design, implement, and evaluate an educational project.”9
Simpson and Ullian challenged “those who are provid-ing strong faculty development programs in curricu-lum and evaluation to submit descriptions of their pro-grams and their outcomes to peer-reviewed journals.” Despite this, our MEDLINE search identified no ar-ticles describing faculty development in the area of cur-riculum skills.
The workshop series described in this article was recently implemented to teach basic principles of cur-riculum development to fellows participating in a 1-year family medicine faculty development fellow-ship. Although only a small number of graduates have completed this program, we report on our experience with the intention of stimulating others to teach cur-riculum skills to faculty.
Program Development
The Harbor-UCLA Family Medicine Faculty Devel-opment Fellowship is based in the family practice resi-dency program at Harbor-UCLA Medical Center, a public hospital in Los Angeles County. There are 36 residents and 4 full-time fellows in the Department of Family Medicine. Residents and fellows gain clinical experience working with a medically underserved,
urban population at two clinical training sites. In 1998, we received Health Resources and Services Adminis-tration grant funding to implement a formal faculty development program.
The mission of the 1-year fellowship is to provide recent residency graduates with basic academic skills needed to make the transition from residency to fac-ulty. These skills include teaching in a variety of for-mats, leadership skills,10 curriculum development, and
administrative skills. Enrichment sessions in family systems and health care delivery systems are also part of the fellowship curriculum. The program includes a series of workshops devoted to curriculum skills. These workshops are the subject of this report. Eight full-time and four part-time fellows have completed the fellow-ship to date. Nine out of the 12 fellows elected to par-ticipate in the curriculum workshop series. In addition, four full-time and three part-time fellows are enrolled in the fellowship for the current academic year.
Curriculum Workshop
The Curriculum Workshop Series was designed, implemented, and taught by the author, who received training in curriculum development through a medical education fellowship sponsored by the Center for Edu-cational Development and Research at the University of California, Los Angeles (UCLA).11 The faculty of
the UCLA Medical Education Fellowship provide sup-port and input into our faculty development fellowship at Harbor-UCLA Medical Center.
The Curriculum Workshop Series is embedded in the year-long fellowship. The goal of the Curriculum Work-shop Series is to train fellows to develop, monitor, im-prove, and enhance curriculum. The specific objectives, corresponding educational strategies, and outcome measures are outlined in Table 1.
Table 1
Educational Components of the Curriculum Workshop Series
Objectives Teaching Strategies Evaluation Outcomes
Participants should be able to:
• Participate in group discussions devoted to • Readings, group discussion • Active participation and satisfaction principles of curriculum development • Frequent short oral and written of participants
presentations during workshop
• Apply six steps of curriculum development • Individual curriculum projects with • Quality of written projects as judged by to an individual project. step-by-step guidance and feedback outside experts
• Design and implement* a new curriculum • Individual curriculum projects • Number of new curricular opportunities or enhance an existing one. or enhancements
Participants in the Curriculum Workshop met for 3 hours a month for 10 months, initially in a once-monthly session and later in twice-monthly sessions lasting 1.5 hours each. The program consisted of assigned read-ings about curriculum development, short lectures, group discussion, participant presentations, and step-by-step guidance in the completion of a curriculum project by each member of the group. At the introduc-tory session, participants select a project in an area of interest that will also meet an educational need of the family practice residency.
Initially, the process of curriculum development was broken down into the following five steps. These steps were adapted with permission from materials developed by Wilkerson12 and Quirk13 for other faculty
develop-ment settings. One or two workshop sessions specifi-cally addressed each of these steps. The five steps are (1) Needs Assessment—deciding what needs to be cov-ered, what learners need to learn, and identifying what they already know, (2) Developing Goals and Objec-tives—defining the broad aim of an educational activ-ity and the specific skills, knowledge, and attitudes that learners will be expected to gain, (3) Selecting Teach-ing Strategies—choosTeach-ing educational methods appro-priate to the objectives of the curriculum, (4) Imple-mentation—developing resources and negotiating ob-stacles, and (5) Evaluation and Feedback—developing measures of the educational effectiveness of the cur-riculum. A sixth step of problem identification was added to the Workshop Series as an additional session during the 1999–2000 academic year, following the re-cently published text by Kern et al, Curriculum
Devel-opment for Medical Education, a Six-Step Approach,14
which was adopted as the principal text for the Work-shop Series early in 1999. Supplementary reading ma-terials were gleaned from the family medicine and medical education literature.
Each session begins with a short description of one of the steps of the curriculum development process, followed by a group discussion of the readings. Fel-lows then report their progress in applying steps learned in previous sessions to their own projects. The remain-der of the session was spent discussing individual projects. This gave ample opportunity for feedback from the group and the instructor. At the end of the session, an assignment was given that required fellows to apply the step learned during the session to their projects. Each fellow was expected to prepare a brief verbal and writ-ten summary of the status of his or her project for each session.
Evaluation Methods
Studies of faculty development programs have gen-erally examined outcomes such as participant satisftion, knowledge and skills acquired, and scholarly ac-tivities following completion.15 Participant self-efficacy
is another outcome measure that has been used.16 The
small number of program completers would limit the value of many of these types of measures in determin-ing the effectiveness of the Curriculum Workshop. We therefore chose to focus our attention primarily on the quality and importance of the work produced, rather than on characteristics of the learners themselves.
Three principal outcome measures were examined to determine the effectiveness of the Curriculum Work-shop Series. The first was fellows’ satisfaction with the quality of the educational experience and its relevance to their professional needs. The second was fellows’ ability to produce well-planned curriculum projects that incorporated the six steps described above. The third was the number of new curricula developed or enhance-ments to existing curricula that the fellows produced.
Participant Satisfaction
Data regarding participant satisfaction with the Workshop Series was gathered informally at a mid-year session attended by all participants and in writing dur-ing the last session. At both times, fellows were asked to describe either verbally or in writing what worked well about the workshop series and to comment on how it could be improved. Because of the small size of the group, open-ended questions were chosen rather than a structured survey.
Quality of Projects
Two medical education specialists from the UCLA School of Medicine’s Center for Educational Develop-ment and Research (CEDR) developed evaluation cri-teria based on the curriculum design model used in the Workshop Series (Appendix A). They reviewed the written documentation of eight projects to determine whether (1) a description of each of the six steps of curriculum development outlined above was included and (2) the description of each step reflected an under-standing of reasonable educational practice, based on their expert opinion. The CEDR review addressed only the written curriculum. Its purpose was solely to evalu-ate the effectiveness of the workshop series and had no bearing on whether or not the participants were con-sidered to have successfully completed the program.
New Curricular Opportunities
The development of new curricular opportunities is the outcome measure that best reflects the actual effect of the Curriculum Workshop on the family practice resi-dency. During the first year of the project, we encour-aged, but did not require, the implementation of projects. During the second year, it was expected that fellows would implement their curricula and develop a plan for evaluation.
Results
Nine fellows participated in the Curriculum Work-shop during the 1998–1999 and 1999–2000 fellowship programs; six of the fellows were full-time, and three were part-time. Eight of the nine fellows completed projects. The ninth participant joined the group on an elective basis and was not required to do a project.
Projects are summarized in Table 2. In addition to submitting a written curriculum, participants presented their projects to an assembly of faculty members, resi-dents, and guests at fellowship culmination events.
Participant Satisfaction
All fellows felt that skills learned in the Curriculum Workshop were either very or somewhat relevant to their future professional tasks. Six out of nine fellows spe-cifically endorsed the step-by-step method of teaching curriculum development. Regular feedback from col-leagues was mentioned specifically by six fellows as a strength of the program.
The first group reported that they would have liked more opportunity to implement projects. Three fellows with projects that were more complex experienced dif-ficulty defining and prioritizing their curriculum ob-jectives. Shorter, more-frequent sessions were
imple-mented in the second half of the 1999–2000 academic year to help these fellows track their projects more closely. Four out of five fellows in the group at that time felt that this improved their learning. A lack of adequate protected time to work on projects was an is-sue for one part-time fellow with many clinical and teaching responsibilities. One fellow suggested limit-ing the scope of projects so that all could be imple-mented and evaluated during the fellowship year.
Quality of Projects
Out of eight projects reviewed by the CEDR, seven had a needs assessment and goal statement. All eight projects had learning objectives, with seven correctly formulated in terms of learner outcomes. Six of eight projects had clearly stated teaching strategies that were appropriate for the learning objectives, in the opinion of the reviewers. The descriptions of the teaching strat-egies in two of the projects were considered too vague by one or both reviewers. Only one of eight linked the teaching strategies to specific learning objectives. Five out of eight projects included an appropriate plan to evaluate both the learning and the curriculum. Overall, the written curricula met between six and eight of the nine criteria set by reviewers.
Table 2
Summary of Projects by Curriculum Workshop Series Participants
Topic Type of Experience Taught By Location Trainee Level
IMPLEMENTED
Adolescent medicine elective* Block rotation Residency faculty School-based clinic Third-year residents and fellow
Adolescent psychosocial Workshop series Fellow and staff High school Adolescent boys intervention of high school
ECG reading Small-group sessions Fellow Family practice residency First-, second-, and third-year residents
Adolescent high-risk Group training for residents Behavioral science Junior high school Third-year residents and behaviors who gave classes to junior director, fellow, junior high school students
high students and residents
Maternity care Lecture series Fellow and residency Family practice residency First-, second-, and third-faculty year residents
NOT IMPLEMENTED
Alternative medicine elective Block rotation Residency faculty Physicians’ offices Second- and third-year residents
Community medicine elective Block rotation Residency faculty Multiple community sites Second- and third-year residents
ECG—electrocardiogram
New Curricular Opportunities
Six out of eight projects, including all four done by the 1999–2000 fellows, have been implemented, result-ing in three new curricular opportunities and providresult-ing enhancements to three additional existing curricular components in a total of three residency programs. Two projects from the first year were not implemented be-cause of insufficient time during the fellowship year and for other logistical reasons. As previously stated, we did not require implementation during the first year of the program.
Discussion
The evaluation of the workshop series described in this article yielded several useful pieces of information about the process of teaching curriculum skills to jun-ior faculty in a fellowship setting. First, participants were generally satisfied with the educational strategy employed, namely a small-group workshop with group discussion of readings and plenty of opportunity for feedback from the group on an individual curriculum project. The scope or complexity of the curriculum project and the need to juggle competing priorities were concerns for some participants.
Second, based on the written curricula, all projects fulfilled between six and eight of the criteria set by ex-pert reviewers. The overall goal of the curriculum, needs assessment of targeted learners, learning objectives, and teaching strategies were well documented in almost all cases. Areas needing improvement included linking teaching strategies to specific learning objectives, the evaluation of the curriculum, and the completeness and clarity of the written curriculum.
Third, and most important, projects implemented by fellows provided a significant number of new or im-proved curricular opportunities to a large number of learners in several residency programs. Two projects went beyond the confines of the residency program and addressed the needs of adolescents in the community. This demonstrates that fellows with limited teaching experience can successfully acquire enough skill in designing curriculum within a 1-year fellowship to have a meaningful influence on a residency program or other educational setting.
Although the program presented here was one part of a comprehensive fellowship program, the educational format, a series of workshops on curriculum develop-ment, could readily be adapted to other faculty devel-opment settings as an independent activity. The educa-tional strategy described above has the advantage that fellows or faculty are actually creating new curricula while they are developing skills. The availability of a clear, concise, and yet thorough text that outlines the steps in curriculum development14 provides a guide for
anyone seeking to implement this type of faculty de-velopment activity.
Limitations
The limitations of the data reported in this article include the small size of the group and the fact that the Curriculum Workshop Series was taught by a single, highly motivated faculty member who had completed a fellowship in medical education. Thus, the outcomes we experienced may not occur in other projects with other faculty members.
We also did not formally evaluate the effect of par-ticipants’ projects on their targeted learners. A future goal would be to ensure that all projects include some form of evaluation of what learners learn and their sat-isfaction with the educational experience that results from the implementation of the fellows’ curricula.
We also did not assess the long-term influence of the curricular opportunities created on the residency pro-grams. Were the new additions one-time offerings, or were they accepted as permanent modifications to the residency program?
Finally, the evaluation of the written curricula was based on the presence or absence of specified elements. It did not attempt to judge those elements in a detailed fashion but, rather, relied on expert opinion as to whether they were adequately addressed.
Conclusions
Recent residency graduates in a year-long faculty development fellowship produced a significant num-ber of new curricula or enhancements to existing cur-ricula of acceptable quality as a result of participation in the Curriculum Workshop Series. This type of fac-ulty development activity can be readily implemented with easily available resources and allows for the cre-ation of new curricular opportunities while participants gain skills in curriculum design.
Acknowledgments: The activities described in this article were supported
by Health Resources and Services Administration Grant 1 D45 PE50168 for Faculty Development in Family Medicine.
I thank LuAnn Wilkerson, EdD, senior associate dean for medical educa-tion, and Kim Crooks, PhD, of the Center for Educational Development and Research at UCLA, for reviewing the manuscript and Dr Wilkerson and Carol Hodgson, PhD, formerly director of the Center for Educational Development and Research at UCLA and currently on the faculty of the University of California, San Francisco, for reviewing the participants’ writ-ten curricula.
Correspondence: Address correspondence to Dr Snyder, Harbor-UCLA
Medical Center, Department of Family Medicine, 1403 West Lomita Blvd., 2nd Floor, Harbor City, CA 90710. 310-222-5654. Fax: 310-326-7205. [email protected].
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Appendix 1
Criteria for Review of Curricula
1. Did the curriculum plan include some form of needs assessment? If yes, indicate which form by circling the appropriate letter(s):
(a) Original data collected by the designer (b) Data from the literature
(c) Recommendations from a professional organization 2. Is there an overall goal statement for the curriculum?
3. Are there stated learning objectives? if yes, indicate which form by circling the appropriate letter:
(a) Stated in terms of learner outcomes (b) Stated incorrectly as instructor goals (c) Stated as a list of topics
4. Are specific methods of learning described? 5. Is the choice of learning method(s) appropriate? 6. Is each method linked to a learning objective? 7. Is there a plan for evaluating the learning? 8. Is there a plan for evaluating the program?