Curriculum Development in Medical Education - Part I - Laying the Foundation with Kern’s Framework
Federico Puerta Martinez, MD, Dario Winterton, MD
Published January 23, 2025 | Clinics in Medical Education
Issue 5 | Volume 1 | January 2025
In Medical Education, the development of a robust curriculum—a pathway or roadmap—is essential to ensure that learners achieve the competency to provide skilled patient care. A systematic approach, such as Kern’s Curriculum Development Framework, is paramount when designing medical education programs.
This article will explore the first two crucial steps of this framework: (1) Problem identification and general needs assessment and (2) Targeted needs assessment, providing insights and practical examples to guide educators in the field, particularly those in anesthesiology.
Step 1: Problem Identification and General Needs Assessment
The initial step in curriculum development involves identifying a problem and conducting a general needs assessment. This is a critical stage because it is easier to design appropriate curricula to address a problem that is well defined and understood. This step sets the direction for the entire curriculum development process by addressing real-world issues.
The problem identification phase requires a critical analysis of the educational gap or problem that the curriculum intends to address. This includes understanding the epidemiology of the problem and its impact on patients, health professionals, medical educators, and society since the ultimate purpose of health professions education is to improve public health.
Once a problem is identified, a General Needs Assessment (GNA) is performed to thoroughly understand the gaps between current practices and the desired outcomes. This process is crucial because it not only clarifies the scope of the problem but also provides the foundation for designing an effective and targeted curriculum. The GNA involves a structured, three-part process:
1. Analyze the Current Approach to the Problem: This step requires a detailed examination of how the problem is currently addressed within the existing educational framework (i.e. What methods, strategies, or tools are currently in place? What works well in the current system, and where are the shortcomings?
2. Define the Ideal Approach: This involves envisioning the optimal way to address the identified problem, guided by best practices, evidence-based recommendations, and theoretical frameworks (Competency-based approaches, diverse learning modalities, standards and guidelines)
3. Identify the General Need: The difference between the ideal and current approach represents the general need. This is often expressed as actionable objectives that the curriculum aims to address.
General Needs Assessment Formula:
General Need = Ideal Approach - Current Approach
The GNA should be informed by evidence-based sources such as literature reviews, accreditation requirements, and competency frameworks (e.g., ACGME competencies and milestones). Additionally, previously published curriculum models, expert opinions, and best practices from thought leaders can provide valuable insights.
Step 2: Targeted Needs Assessment
While the general needs assessment provides a broad overview, the second step focuses on the needs of a targeted group of learners and their specific learning environment. This step tailors the curriculum to address environment-specific challenges, creating an effective learning experience. The targeted needs assessment involves assessing the differences between the ideal and actual characteristics of both the learners and the learning environment. It encourages curriculum developers to shift their focus from the health problem to the specific learners.
This assessment includes gathering information from various sources:
- Surveys help gather broad insights and identify common barriers in training.
- Interviews and focus groups provide an in-depth understanding and group dynamics.
- Direct observation—if feasible—is valuable to understanding real perioperative interactions.
Stakeholder input is also crucial:
- Residents, faculty, and specific team members should all have input.
- Performance data from existing rotations is essential.
- Feedback from clinical supervisors provides valuable insights.
Furthermore, an assessment of the institution itself is necessary:
- Institutional resources, opportunities, and constraints must be identified. In our example, institution-specific clinical exposure to various regional anesthesia procedures should be considered.
- Faculty expertise and availability also play a role.
Analyzing the data collected helps identify recurring themes, like case mix, and prioritize areas for improvement. This step leads to clear priorities for the curriculum’s content.
Challenges and Conclusion
Both Step 1 and Step 2 may present challenges:
- Stakeholder engagement is critical to ensure that all voices are heard and considered. It can be challenging to involve a diverse range of stakeholders early in the process.
Overcoming institutional inertia and resistance to change is also important; therefore, clearly communicating the purpose and benefits of the curriculum development is essential.
It is crucial to clearly define the healthcare or educational issue, determining the current approach and the ideal approach.
Using robust data collection methods informs a more complete understanding.
In conclusion, the initial steps of curriculum development using Kern’s Framework are essential for creating effective medical education programs. The process begins with identifying and assessing the problem in a general sense, and then looking at the specific needs of the learners and their environment. This ensures educators can create a curriculum that is both relevant and impactful, ultimately leading to better-prepared physicians. One last tip: be mindful of the challenges and try to overcome them from the very beginning—early involvement of stakeholders can make the process much easier.
In the next issue, we will be covering the next 2 steps (Steps 3 & 4) of Kern’s Curriculum Development Framework.