Dasar-dasarPengembangan KurikulumPendidikan Dokter

Titi Savitri Prihatiningsih

Bagian Pendidikan Kedokteran

Fakultas Kedokteran Universitas Gadjah Mada

Definisi Kurikulum

Kurikulum pendidikan tinggi adalah seperangkat rencana dan pengaturan mengenai isi, bahan kajian maupun bahan pelajaran serta cara penyampaian dan penilaian yang digunakan sebagai pedoman penyelenggaraan kegiatan belajar-mengajar di perguruan tinggi

Definisi Kurikulum

The curriculum is all the experiences that students have under the guidance of the university

Asas Pengembangan Kurikulum

Asas Filosofis Asas Sosiologis Asas Psikologis Asas Pengorganisasian Asas yuridis

Komponen Kurikulum

Tujuan

Materi

Proses BelajarMengajar

Penilaian

Langkah-langkah Pengembangan Kurikulum

Model Tyler (1949)

Tentukan tujuan pendidikan yang akan dicapai

Pengalaman belajar apa yang dapat diberikan agar tujuan tersebut tercapai

Model Warwick (1975)

Susun kurikulum yang paling ideal Pertimbangkan segala sumber yang ada Identifikasi hambatan atau kendala Modifikasi kurikulum ideal dengan

mempertimbangkan hambatan Disain cetak biru kurikulum dan perhatikan

struktur, ruang lingkup, urutan dan keseimbangan

Model Warwick (1975)

Persiapkan materi pembelajaran Disain proses belajar-mengajar yang efektif

dengan memperhatikan cetak biru kurikulum

Model Hilda Taba (1962)

1. Menentukan tujuan pendidikan: Merumuskan tujuan umum Mengklasifikasi tujuan Merinci tujuan (mis. Pengetahuan, ketrampilan,

dll) Merumuskan tujuan dalam bentuk spesifik

Model Hilda Taba (1962)2. Menseleksi pengalaman belajar

Relevansi dengan kenyataan sosial Keseimbangan ruang lingkup dan kedalaman Variasi pengalaman belajar Penyesuaian dengan minat dan kebutuhan

mahasiswa

Model Hilda Taba (1962)

3. Pengorganisasian materi dan kegiatan belajar mengajar Menentukan pengorganisasian kurikulum Menentukan urutan atau sequence Menentukan integrasi Menentukan fokus pembelajaran

Model Hilda Taba (1962)4. Evaluasi hasil kurikulum

Menentukan kriteria penilaian Menyusun program evaluasi yang komprehensif Menentukan teknik pengumpulan data Menentukan penafsiran data evaluasi Menterjemahkan evaluasi ke dalam kurikulum

Harden (2000) 1. Identifying the need 2. Establishing the learning outcome 3. Agreeing the content 4. Organizing the content 5. Deciding the educational strategy

Harden (2000)

6. Deciding the delivery methods 7. Preparing the assessment 8. Communication about the curriculum 9. Preparing the educational environment 10. Managing the study programme

Kurikulum baru HARUS diujicoba

Langkah ujicoba kurikulum

1. Menyusun bahan ujicoba

2. Melakukan ujicoba kurikulum

3. Revisi dan konsolidasi

4. Review kurikulum yang telah disusun

5. Pelaksanaan

Competency-based Medical Education

Competency is an action performed to a specific standard under specific condition

Competencies(a cognitive perspective)

““Competence embraces the structure of Competence embraces the structure of knowledge and abilities” knowledge and abilities” (Messick, 1984)(Messick, 1984)

““Competence rests on an integrated deep Competence rests on an integrated deep structure (understanding) and on the structure (understanding) and on the general ability to coordinate appropriate general ability to coordinate appropriate internal cognitive, affective and other internal cognitive, affective and other resources necessary for successful resources necessary for successful adaptation” adaptation” (Wood & Powers, 1987)(Wood & Powers, 1987)

There are enabling factors for competenceThere are enabling factors for competence

Competencies(a cognitive perspective)

Competence derives from possession of a Competence derives from possession of a set of relevant attributes such as knowledge, set of relevant attributes such as knowledge, skills and attitudes, called skills and attitudes, called competenciescompetencies

a a competencycompetency is a combination of attributes is a combination of attributes underlying some aspect of successful underlying some aspect of successful professional performanceprofessional performance

(Gonczi et al, 1993)(Gonczi et al, 1993)Competence in an area therefore requires a Competence in an area therefore requires a specific set of prerequisite competenciesspecific set of prerequisite competencies

Competency is …

A complex set of behaviour built on the components of knowledge, skills and attitudes

Differences between Content-based/Structure/Process-based and Competency-based

Educational Programme

Structure/Content-based

Competency-based

Driving factorCurriculum

Content-knowledge acquisition

Outcome-knowledge application

Driving force for process

Teacher Learner

Path of learning Hierarchical Non-hierarchical

Differences between Content-based/Structure/Process-based and Competency-based

Educational Programme

Structure/Content-based

Competency-based

Responsibility for content

Teacher Student and teacher

Goal of educational encounter

Knowledge acquisition Knowledge application

Typical assessment tool Single subjective measure

Multiple objective measures

Differences between Content-based/Structure/Process-based and Competency-based

Educational Programme

Structure/Content-based

Competency-based

Assessment tool Proxy Authentic (mimic real task of professional)

Setting for evaluation Removed Direct observation

Evaluation Non-referenced Criterion-referenced

Differences between Content-based/Structure/Process-based and Competency-based

Educational Programme

Structure/Content-based

Competency-based

Timing of assessment Emphasis on summative Emphasis on formative

Program completion Fixed time Variable time

Curricular Design for CBE1. Competency identification

2. Determination of competency components and performance levels

3. Competency evaluation

4. Overall assessment of the process

Examples of performance levels1. Novice

2. Beginner

3. Competent

4. Proficiency

5. Expert

1. Beginning level

2. Intermediate level

3. Advanced level

1. Melihat/tahu

2. Melakukan di bawah supervisi

3. Melakukan mandiri

OutcomesOutcomes(areas of competence)(areas of competence)

CompetenciesCompetencies

Knowledge, Skills, AttitudesKnowledge, Skills, Attitudes

CurriculumDevelopment

EducatingDoctor

Roles and Functions of Health ProfessionalRoles and Functions of Health Professional

Competencies required for performance of roles/functionsCompetencies required for performance of roles/functions

Knowledge, skills, attitudes for acquisition of competenciesKnowledge, skills, attitudes for acquisition of competencies

Competencies required for performance of roles/functionsCompetencies required for performance of roles/functions

Roles and Functions of Health ProfessionalRoles and Functions of Health Professional

Knowledge, skills, attitudes for acquisition of competenciesKnowledge, skills, attitudes for acquisition of competencies

AssessAssess

AssessAssess

AssessAssess

Elements of CBME (1)1. Competencies to be achieved are carefully

identified, verified and made public in advance

2. Criteria to be used in assessing achievement and the conditions under which achievement will be assessed are explicitly stated and made public in advance

Elements of CBME (2)

3. The instructional program provides for the individual development and evaluation of each of the competencies specified

4. Assessment of competency takes the participant’s knowledge and attitudes into account but requires actual performance of the competency as the primary source of evidence

Elements of CBME (3)

5. Participants progress through the instructional program at their own rate by demonstrated the attainment of the specified competencies

Characteristics of CBME (1)

1. Competencies are carefully selected2. Supporting theory is integrated with skill

practice. Essential knowledge is learned to support the performance of skills

3. Detailed training materials are keyed to the competencies to be achieved and are designed to support the acquisition of knowledge and skills

Characteristics of CBME (1)

1. Competencies are carefully selected 2. Supporting theory is integrated with skill

practice. Essential knowledge is learned to support the performance of skills

3. Detailed training materials are keyed to the competencies to be achieved and are designed to support the acquisition of knowledge and skills

Characteristics of CBME (2) 4. Methods of instruction involve mastery

learning, the premise that all participants can master the required knowledge or skill provided sufficient time and appropriate training methods are used

Characteristics of CBME (3) 5. Participants’ knowledge and skills are

assessed as they enter the program and those with satisfactory knowledge and skills may bypass training or competencies already attained.

6. Learning should be self-paced

Characteristics of CBME (4) 7. Flexible training approaches including

large group methods, small group activities and individual study are essential components

8. A variety of support materials including print, audiovisual, and simulations keyed to the skills being mastered are used

9. Satisfactory completion of training is based on achievement of all specified competencies.

Characteristics of CBME (5) Evaluation is focused on the measurement of

the mastery of information and skills. Criterion-referenced should be used

Implications for using CBME (1) 1. Organizations must be committed to

providing adequate resources and training materials

2. Audiovisual materials need to be directly related to the written materials

3. Training activities need to match the objectives

Implications for using CBME (2) 4. Continuous participant interaction and

feedback must take place 5. Trainers must be trained to conduct

competency-based training courses 6. Individuals attending training must be

prepared for CBT as this approach is likely to be very different.

Design activities for CBME (1) 1. Identification of specific clinical

performance or clinical skills (e.g. CPR, etc) 2. Identification of the conditions under which

the clinical performance or clinical skills must be demonstrated (e.g. using simulators, role plays, etc)

3. Development of the criteria or standards to which the skills must be performed

Design activities for CBME (2) 4. Development of the competency-based

learning guides and checklists which list each of the steps and sequence required to perform each skills or activity

5. Development of the reference manuals which contain the essential, need-to-know information related to the performance or skills to be developed

Design activities for CBME (3) 6. Development of the models to be used

during training 7. Development of training objectives which

outline what the participant must do in order to master the clinical performance or clinical skills

8. Development of course outlines which match a variety of training methods and supporting media to course objectives

Design activities for CBME (4) 9. Development of course syllabi and

schedules which contain information about the course and which can be sent to participants in advance so they are aware of details concerning the course.

Delivery and Evaluation Activities for CBME using a clinical skill as an example

1. Administration of a precourse questionnaire to assess the participants’ knowledge and attitudes about course content

2. Administration of precourse skill assessments using model to ensure participants possess the entry level skills to complete the course successfully and role plays to determine the level of their communication skills

3. Delivery of the course by a trainer/facilitator using an interactive and participatory approach

4. Transfer of skills from the instructor to the students through clinical counselling skill demonstrations using slide set, videotapes, models, role plays and finally clients

5. Development of the students’ skills using a humanistic approach, which means participants acquire the skills and then practice until competent using anatomic models and role plays

6. Practice of the skills following the steps in the learning guide until the participant becomes competent at performing the skills

During this time, the trainer functions as a coach providing continous feedback and reinforcement to participants. Only when participants are assessed and determined to be competent on a model do they work with clients

7. Presentation of supporting information and theory through interactive and participatory classroom session using a variety of methods and audivisuals

8. Administration of midcourse test to determine if the participants have mastered the new knowledge associated with clinical skills

9. Guided practice in providing all components of the clinical performance

10. Evaluation f each participant’s performance (i.e. knowledge, attitudes, practice and clinical skills) with clients. The evaluation by the trainer using performance-based test. The participant is either qualified or not qualified as a result of knowledge, attitude and skills assessments.

11. Presentation of a statement of qualification which identifies the specific clinical performance the individual is qualified to provide

Learning principles underlying CBME (1)

1. Learning is most productive when the student is ready to learn. The Clinical teacher should create a climate that will nurture motivation

2. Learning is most effective when it builds on what the students already knows or has experienced

Learning principles underlying CBME (2)

3. Learning is most effective when students are aware of what they need to learn

4. Learning is made easier by using a variety of training methods and techniques

5. Opportunities to practice skills initially is in controlled or simulated situations are essential for skill acquisition and for develoment of skill competency

Learning principles underlying CBME (3)

6. Repetition is necessary to become competent or proficient in a skill

7. The more realistic the learning situation, the more effective the learning

8. To be effective, feedback should be immediate, positive and nonjudgemental.

Key Words Relevant- task oriented – participatory –

friendly – varied – built on past experience Faculty members must be genuinely

interested in teaching and must be trained in interactive method

From teacher-oriented to learner oriented, including self-paced learning and assessment

Key Words Changing from narrow-discipline oriented

teaching to a problem-solving approach Moving from lecture-oriented teaching to

experiential and interactive learning Changing the medical teacher’s role to a

coach of student learning

Thank You