This module explores some key educational concepts and applies them to clinical teaching and learning situations. Education uses a range of terms – aims, learning outcomes, learning objectives, competencies – to describe what learners should achieve as a result of educational interventions. This can be confusing, but it is often important that end points are clearly defined before the learning takes place. It is like planning a journey, if you don't know where you intend to go before you start, you may end up where you don't want to be
The term aim is usually used to define what the programme or teacher is trying to achieve overall. It tells participants what the programme or session is about. For example:
‘the aim of this session is to revise the principles of resuscitation and test your learning with a quiz’.
Distinctions between the terms ‘learning objectives’ and ‘learning outcomes’ have been under debate in medical education for more than 20 years. Learning objectives state the observable and measurable behaviours that learners should exhibit as a result of participating in a learning programme. An example of a learning (or instructional objective) would be:
‘on completion of this course, the learner should be able to describe the common causes of a unilateral headache in an adult’;
‘by the end of this teaching session the trainee should be able to aspirate a knee joint without undue discomfort to the patient’.
Latterly, there has been a shift from defining such specific instructional objectives to providing more broad-based learning outcomes that are intended to arise as a result of the programme. Harden suggests that learning outcomes (which underpin the ‘outcome-based education’ model) are essentially more ‘intuitive and user-friendly’ than objectives, that they are ‘broad statements… that recognise the authentic interaction and integration in clinical practice of knowledge, skills and attitudes and the artificiality of separating these’ (2002, p. 151). We can think of outcomes as ‘learner goals’.
‘Graduates must know about biological variation, and have an understanding of scientific methods, including both the technical and ethical principles used when designing experiments’ (GMC, 2003, p. 6).
Increasingly, at postgraduate level, learners are required to demoonstrate specific competencies. An example around history-taking at F1 level might be that the doctor:
‘routinely undertakes structured interviews ensuring that the patient’s concerns, expectations and understanding are identified and addressed’
‘demonstrates clear history taking and communication with patients’ (Foundation Curriculum, 2005).
In practice, the terms ‘objectives’, ‘outcomes’ and ‘competences’ are often used interchangeably.
Grant notes that:
‘what is important is fitness for purpose, and the main purposes of stating the intended learning achievements of the curriculum are to:
- inform learners of what they should achieve
- inform teachers about what they should help learners to achieve
- form the basis of the assessment system, so that everyone knows what will be assessed
- reflect accurately the nature of the profession into which the learner is being inducted and the professional characteristics that must be acquired’ (2007, p. 21).
Defining outcomes also helps us achive what Biggs (1996) calls ‘constructive alignment’, where objectives, teaching methods and assessments are aimed at delivering the same thing. It is not just in face-to-face teaching where learning outcomes need to be aligned; learning materials, library and online support all have to be constructed to help the learner achieve the specified outcomes of the training programme.