CHAPTER 5: Curriculum design

Figure

This chapter describes how the results of the situation analysis and task analysis can be used in planning and evaluating the curriculum.

5.1 What is a curriculum?

The word curriculum can be used in two different ways. It can be used to mean what actually happens during the course - the lectures, the work with patients and so on. The other meaning is the written description of what happens. This chapter will use "curriculum" to mean the written curriculum.

What should a curriculum include?

A written curriculum is needed to help teachers to organize the course. It should contain the necessary information to keep the course well run, such as:

1. The objective of the course - i.e. the tasks and sub-tasks that the students must learn.
2. The general methods that should be used to teach the students the various objectives.
3. The time and place where the students will learn - i.e. a time table.
4. The methods used to assess the students.

5.2 Lesson plans and the curriculum

The written curriculum is needed to keep the course as a whole well organized. In the same way a lesson plan is necessary to organize a shorter period of teaching. It will need the same kind of information about the objectives, teaching methods, timetable, and possibly some note about the assessment methods.

It is essential to write down the curriculum for a course. On the other hand, many good teachers do not need to write down their lesson plans. There are many good reasons why teachers should record a lesson plan. In practice, time is usually limited and experienced teachers can often manage without a written plan or with just very brief notes.

A lesson plan is a small curriculum.

Suggestions for ways in which teachers can plan teaching sessions (i.e. make lesson plans) are given in Chapter 10.

5.3 When should teachers be involved in planning curricula?

Teachers are often involved in planning the curriculum. They may be involved as a member of a team planning a completely new course or planning improvements in existing courses. Alternatively, they may be asked to comment on a curriculum planned by other people.

They must be involved when they are teaching a curriculum, because they should be trying to find ways to improve it.

5.4 Planning the course outline

Courses for health workers require a great deal of planning. The first stage should be to plan a course outline. This breaks the course down into smaller parts which can be analysed more easily.

It is obviously very important to make sure that this outline will make it as easy as possible for the students to learn. Look at the example below where learning is made difficult.

An example of a poor course outline
Course for community health nurses

This course outline has a number of poor features:

· The basic science courses probably give much more detail than is necessary for the job. This means that students waste time learning unnecessary facts.

· The basic facts (e.g. sociology, nutrition) are taught quite separately from their application (community health nursing).

· The separate courses - microbiology, psychology, sociology, etc. - mean that the timetable is probably based on short fixed teaching periods.

A better way of planning the curriculum would be to base it on the tasks of the community health nurse.

Example - A course outline based on tasks

Community health - water supply, food storage and waste disposal
Family health - nutrition and health education
Maternal and child health care
Midwifery
Prevention and control of communicable diseases
First aid and emergency medical care
Training village health workers
Promotion of community development

This outline is designed to train students to do exactly the same job as the previous example, but it has a number of important differences.

· The whole course is designed to give the students the necessary skills to do the job.

· The underlying theory is learned at the same time as the practical applications. This is likely to lead to faster and more thorough learning because the students can understand exactly why the theory is needed.

· The timetable can be much more flexible. This makes it easier to arrange longer periods of work such as project work or supervised practical work in the community. It gets away from the rigid pattern of one-hour lectures.

Base the curriculum on the tasks that the students need to learn.

5.5 What kinds of teaching methods will be used?

Many courses for health workers include too much classroom teaching and concentrate too much on teaching facts.

If you prepare a list of tasks for any category of health worker you will find that most of the tasks involve:

· using the hands (e.g. giving an injection)
· making decisions (e.g. deciding whether a cough is a symptom of pneumonia)
· communication (e.g. explaining to a mother the need for protein in the diet).

You must give students opportunities to practice these skills during the course. Unfortunately this practice often takes a lot of time and effort to organize. It may be quicker and easier to give a lot of lectures, but the students will not learn the necessary skills.

The curriculum should include enough time for students to practice the tasks they need to learn. Sometimes this will involve them in working in the community, for example, in a hospital or nearby health centre. Sometimes they can practice on each other in the classroom. Specific suggestions for teaching methods are given in Part 2. In planning the curriculum, teachers must allow enough time for this practice.

It is impossible to specify how much time is required for every course. However, most courses should allow much more time for practicing skills than for theoretical teaching.

More time for practice Less time for theory

5.6 What kind of assessment methods should be used?

It is important that the course should be based on the job that the students are learning to do. Therefore the assessment must test whether they can do the job. This approach is called performance testing. It means that assessment methods such as those based on multiple-choice questionnaires and essays are used less often. Such methods usually only test the students' knowledge. Other assessment methods such as those based on case-studies and casebooks are used more frequently. These methods test the important skills and attitudes.

More details on methods of assessment are given in Part 3.

5.7 Evaluating the curriculum

The students should be assessed to see whether they have learned the necessary skills and facts. In the same way, the curriculum should also be examined to find out whether any changes are needed. This process is called curriculum evaluation.

The aim of curriculum evaluation is to find out how successful the curriculum is and to find out ways in which it can be made better. The basis for the evaluation is to see whether the students learn how to do their job satisfactorily.

The curriculum can be evaluated by testing the students at the end of the course. If they complete their examinations satisfactorily, this suggests that the course has been good enough. However, the examinations must be relevant and based on the job that the students are being trained to do. Also, the course may help the students to reach a satisfactory standard, but it may take much more time than necessary.

The curriculum can also be evaluated by finding out how well the students are doing after they have left the school or college and started work.

Example - On-the-job evaluation

In one district a group of health workers were trained to do a number of tasks. One of the tasks was to conduct an immunization programme. After a few months it was found that a lot of the mothers brought their children for the first vaccination. Only a few came back for the necessary second injection

Comments

Clearly this part of the training programme had not been successful.

There are many reasons why the programme may not have succeeded, for example:

· the health workers may have had too many other responsibilities and so did not have enough time to talk to the mothers about the need for the second injection.

· the programme may not have trained the workers how to communicate.

· the programme may have failed to teach them suitable attitudes.

5.8 Methods of evaluating the curriculum

Analysis of health needs

In the example above, the weakness of the training programme - or the curriculum - was shown by an analysis of the health statistics for the district. This is the best way to evaluate a curriculum, although it may not always be possible. It is the best way because the purpose of the curriculum is to train people to solve health problems. If the health workers can solve the problems, the curriculum is probably satisfactory. If not, it may need to be improved.

Health statistics are usually available for details such as:

- the number of children immunized,
- the number of live births,
- the number of infant deaths, and
- the number of cases of disease.

If the statistics are available, they can help the teacher to decide which parts of the curriculum need improvement.

But remember that some of the things health workers are trained to do cannot be easily shown in statistics. Also, in many areas the information collected may not be very reliable or complete. For example, the number of reported cases of diphtheria may go up because the system of reporting the disease has improved - not because more people are suffering from diphtheria.

Critical incident studies

Critical incident studies are a fairly simple method of finding out from the health workers themselves how successful a curriculum is. The teacher asks an experienced health worker to describe five or six recent events that he or she has not felt able to handle. These situations are the critical incidents. This kind of questioning is then repeated among a sample of recently trained health workers. Using this approach, the teacher can build up a picture of the situations that have caused problems for health workers.

Some of the critical incidents may be very unusual or rare. In some cases it may not be necessary to change the curriculum. Again, if only one worker finds that a particular situation causes problems, while all the others report that they can deal with it, then probably no action needs to be taken. However, if several workers report difficulty with similar situations, then clearly the curriculum should be looked at.

Supervisors' reports

In many countries the work done by the health workers is supervised. In some cases this supervision is carried out almost continuously - as in hospital wards. In other cases the supervision is very restricted - for example when health workers work alone in remote villages. Therefore the value of supervisors' reports will vary from one situation to another.

However, all of these reports can be more useful if the supervisors are asked to comment on specific points. For example, you may have tried teaching part of the curriculum differently, so ask the supervisors whether they notice any differences in the way the new health workers do that particular job. Supervisors can also help if they identify the tasks that the students do well or badly at the end of the course.

They may also be able to point out the tasks that are taught wrongly. For example, students may not have been taught about local traditions or how to cooperate with village councils.

If the teacher asks for advice from supervisors and acts on that advice, the curriculum will be made more effective.

5 9 Evaluating lessons

Lessons can and should be evaluated. This is just as important as evaluating the curriculum.

Broadly the same methods should be used. After a lesson (or possibly a group of lessons), the teacher should find out how much the students have learned. This evaluation should be based on performance testing. The teacher should find out whether the students can do the tasks that they have been taught to do.

If the students cannot do the tasks, then the teacher must change the content of the lessons or the teaching methods.

5.10 Summary

1. The aim of a curriculum or a lesson should be to give the students the skills and the knowledge needed to do the job.

2. The content should be organized on a "task" basis.

3. The curriculum must include a high proportion of time for practicing the skills of communication, thinking, and using equipment.

4. Evaluation may lead to changes in the content or the teaching methods.