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A Model for Qualitative Research
Conceptual Framework and Purpose
Methods and Validity
Implicit vs. Explicit Curricula in General Pediatric Education: Is There a Convergence?
Dorene Balmer, Christina Master, Boyd Richards, and Angelo Giardino Pediatrics, 2008
Explicit Curriculum
• Medical knowledge• Patient care• Professionalism• Interpersonal communication
• Practice-based learning
• Systems-based practice
Background
Implicit Curriculum
Opportunities to learn when residents are doing their everyday work
Background (conceptual framework)Hidden vs Formal Curriculum ◦Rituals, beliefs, practices that function at the level of the organizational structure and culture
◦Single competency: Professionalism
Implicit vs Explicit curriculum ◦“Unadvertised”, informal and often ad hoc teaching
◦Spans the six competencies
Purpose (purpose)
• To study what pediatric residents have the opportunity to learn implicitly as they do their everyday work
• To understand how this learning maps on to goals and objectives in a competency-based explicit curriculum for a General Pediatrics rotation
Operational DefinitionsExplicit Curriculum ◦Competency based goals and objectives for one inpatient General Pediatric rotation
Implicit Curriculum: ◦Observed and reported events, activities and conversations that occurred as part of everyday life on a General Pediatric floor
Data Collection: ObservationObservation(Methods)(Methods)One General Pediatrics floor143 hours of observation ◦ 2/3s between 8:00 a.m. and Noon
◦ January to AugustMedical team:◦ Attendings, senior residents and interns
Observer-participant stance
Data Collection: Interviews((MethodsMethods))Overlapped with observation14/18 attendings, 16/22 interns and 9/11 senior residents
Audio-taped and transcribedGeneral questions◦What surprised you?◦What would you change?◦No competency specific probes
Data Analysis ((MethodsMethods)) Data source
interview transcripts and notes from observation
Inductive analysis • Inductively derived codes
• Codes: “labels” for key concepts
• Iterative revision of code list
Data Analysis
Final phase: Identification of themes pertaining to curricular convergence
Trustworthiness Trustworthiness (Validity)(Validity)Single observer and interviewer
Prolonged observation, allowing for check on preliminary findings
Independent coding of 30% of notes from observation
Created audit trail
Theme 1: Overall Curricular Convergence
• Residents had frequent opportunities to address 29/32 more granular objectives in the explicit curriculum
• Example: • [objective for Patient Care] Develop an appropriate diagnostic and therapeutic plan for patients requiring hospitalization
• [observation on rounds] “… so the plan for this 6 month old with retropharyngeal abscess is to continue the clinda …”
… but some divergence
Example ◦Converged around communication and teamwork
◦Diverged around systems-based practice and health care costs
Theme 2: Messiness of the Implicit Curriculum
Difficult to predict• Directed by patients illnesses and social situations
Difficult to compartmentalize• Lack of boundaries between competency domains
• Example: • Discharging patients: interconnection between patient care and systems based practice
Theme 2: Messiness of the Implicit CurriculumDifficult to balance
• Dominated by patient care• Learning by doing
Theme 3: Lack of formal recognition of the explicit curriculum• No direct reference to the explicit curriculum or the AGCME competencies throughout the study
Discussion
How the PARTS
Contribute to the WHOLE
Take away message:• Recognize competency-based education as inherent to the learning that occurs in today’s clinical context