I'm Alex Asian, the Cardiology Fellowship Director at the University of Illinois at Chicago. I'm going to be speaking about the basics of curriculum development through the lens of other fellowship program directors, associate program directors, chief fellows, and program coordinators. First, we have to ask, what is a curriculum? And the sibling's definition is listed on the second slide. It's a planned educational experience. And this can be scaled down as small as a short teaching session or a workshop all the way as large as a four-year College of Medicine curricular plan. For a fellowship director, the main resources that give us curricular structure are seen over on the right in the Venn diagram, and they include the Accreditation Council for Graduate Medical Education, or ACGME, core program requirements, the ABIM, or American Board of Internal Medicine blueprint for the board certification exam, and COCATS, or the Core Cardiology Training Symposium document created by the American College of Cardiology. These intersect and give us the planned experience that is a cardiology fellowship training curriculum. As a program director, you're responsible for the curricular management. That includes implementing and maintaining the fellowship curriculum, but you'll also be responsible for developing novel programs that need development from the start. To do so, you'll need a stepwise approach. Our next slide shows the six-step approach to curriculum development. We have a diagram on the left and a list of six steps on the right. At the top of the triangular and circular diagram is number one. Each circle clockwise provides us a step that corresponds to the list of six. At the top is problem identification and general needs assessment. If we move clockwise to the next, needs assessment for targeted learners. Number three, goals and objectives. Number four, educational strategies. Number five, implementation. Number six, evaluation and feedback. If you look closely in this diagram, you'll see that arrows will go between these six steps either clockwise or counterclockwise. There's also a relationship between the steps across the angles of the triangle that allows you to tell that while we have this in a stepwise approach, there clearly is an interrelated nature that will cause you to go back and revisit and adjust as you work on one or the other. The primary resource is located down in the bottom right. Step one, problem identification and general needs assessment. This is where you need to ask, what is the problem that is being addressed by your curriculum? So in this particular example, cardiology fellows have performed consistently below the mean on the acute coronary syndrome series of questions on the in-training exam. So secondary questions include, what is currently being done by the stakeholders for this problem? Stakeholders include faculty, administrators, fellowship director, associate program director, fellows themselves, program coordinators. What personal and environmental factors affect this problem? What ideally should be done by the stakeholders? And what separates the current approach from the ideal approach? To build on identification of the problem and understanding the general needs, you'll need a needs assessment specifically of your targeted learners. You need to identify them and the environment in which they work. So cardiology fellows on the wards, in the clinics, in the cath lab who are being exposed to knowledge and management of patients with acute coronary syndrome. What information about them is already known based on available data, either in their evaluation system, in-training exam, procedure logs, clinical performance assessment? Then you need to identify methods to obtain the most important unknown information. What are the gaps about what you need to know to work on this problem? Then you can conduct a more targeted needs assessment and review what you learn that's additive. The real key is to focus the problem. And the targeted needs assessment will help you do that and prepare you for the next step. Step three is goals and objectives. You need to write broad educational goals for the curriculum that you're planning. Objectives can be written considering the individual learner, objectives for the learners as an aggregate group, or for the fellowship educational program in general. And you need to decide which domain applies to the objectives that you're writing. Is this a cognitive problem, knowledge or problem solving? Is it an effective problem that considers fellow attitudes or values or beliefs? Is it a psychomotor problem where they need to learn a specific skill or a specific behavior? When goals and objectives are written, on our next slide we'll see an example. Each objective should have approximately five elements that are specific and measurable to the best way possible. I've highlighted each element in a different color. And down below, one objective for a specific educational session is tagged with the corresponding color. So we want your goals and objectives to say who will do how much or how well of what by when. In our example below, if we were to create a hypothetical educational workshop, at the completion of this workshop, by when, cardiology fellows who will be able to recognize the clinical presentation of acute coronary syndrome will do and enact guideline-based how well management of what. Step four is educational strategies. If you've spent time and invested well in your goals and objectives, the content of the curriculum you design will flow directly from those objectives. We need to consider content, which is the material, and the methods in which you present that content. You can see here those three domains are again repeated, cognitive, affective, and psychomotor, with some examples underneath of methods to communicate the content. So in our particular example, this is a cognitive or knowledge problem. So we can consider, for example, lectures, readings, problem-solving exercises, or case-based group discussion as a way to build our curriculum. Step five is implementation. We need to think about resources that are necessary for this curriculum to happen. Time, personnel, facilities, funding. You need to obtain support from the stakeholders that this is a necessary endeavor. Develop administrative mechanisms to support the curriculum. Anticipate and address barriers to implementation. And lastly, importantly, plan to introduce and pilot the curriculum, understanding that there may be revisions after the pilot. The last step is evaluation and feedback, step six. You need to encourage the planners and the curriculum itself to be guided by a cycle of improvement. The original diagram I showed you goes clockwise, but it really is never-ending and is also interrelated among the six steps. You want to choose a measurement method to evaluate your program and your curriculum and an instrument by which to measure, to evaluate both the individual performance and the program's performance. You need to collect and analyze that data, and you need to report the results transparently back to the stakeholders. A formative evaluation with feedback will help identify ways to improve, where a summative evaluation will allow you to report those results to continue to build support among stakeholders for sustained curricular growth. And an effective curriculum is always evolving, so this is a process that will often repeat. One particular model to utilize in the evaluation method is the logic model. This is an objective-based program evaluation method, one that is meant to find why a program is effective, not just whether or not it meets metrics. And it involves four specific steps. You need to think about inputs into the program, which include all relevant resources, what we listed before, personnel, time, facilities, funding, the activities of said program, so the strategies or teaching methods, the intervention outputs, the indicators that activities are underway or completed, so metrics that tell you about progress in the curriculum addressing its problem, and finally, outcomes. These can be short, medium, or long-term, tailored to the size and scope of the problem, and these are usually larger than your simple, straightforward outputs. So to review, three take-home points from our basics of curriculum development. One, consider the six-step approach to curriculum development to be a guide when considering the greater fellowship and smaller programs within it. Again, the six steps are not necessarily always one after the other, they are interrelated, and they repeat as you get evaluation and feedback and make changes. Next, educational goals and objectives are incredibly important and should be developed with care as the content and methods are directly derived from them. And lastly, a repeat of the message from slide 10, an effective curriculum is always evolving.

curriculum development

fellowship programs

cardiology

ACGME

ABIM