Linking the RACGP Curriculum to Vocational Education
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PROFESSIONAL Linking the RACGP Lyn Clearihan curriculum to vocational Heather McGarry Melanie Cheng Peter Bratuskins education Mark Rowe the profession has two national curricula: Regional training providers face many challenges in delivering the RACGP curriculum10 and the vocational training to general practice registrars across Australia. They Australian College of Rural and Remote need to be able to respond to new learning theories and the ever Medicine (ACRRM) curriculum.11,12 The expanding volume of medical knowledge, as well as the changing 20 regional training providers (RTPs) who medical workforce. deliver vocational training nationally will In 2008, the Victorian Metropolitan Alliance (VMA) embarked use either one or both of these to underpin on a project to map the new Royal Australian College of General their educational programs. Practitioners curriculum to the VMA program. The aim of this article is to describe the processes through which the VMA created a curriculum While many RTPs have shown innovation and guide for peer learning workshops, supervisors and registrars, designed ingenuity in identifying the links between to be adaptable to various Australian curricula and to be flexible and robust, as well as accessible to the intended users. their individual programs and a professional curriculum,13,14 they have also expressed Keywords: vocational education/graduate education; education, that difficulties arise in identifying the gaps, medical; curriculum repetitions and redundancies in the curricula as they relate to the RTP programs. These factors can produce variability in the alignment of different RTP educational programs with the national curricula (Figure 1). This can be problematic The landscape of medical education is for medical educators in trying to ensure the changing in response to new approaches curriculum’s intentions are reflected in their to learning,1 the expanding nature programs.1,15,16 This makes it difficult for general and volume of knowledge2 and the practice registrars to track the extent to which changing structure and function of the their educational opportunities help them meet medical workforce.3–5 In response to the curriculum’s requirements, especially when these changes, modern day professional undertaking training in more than one RTP. curricula, such as those of The Royal This problem underpinned a recently Australian College of General Practitioners completed Victorian Metropolitan Alliance (RACGP), have absorbed new approaches (VMA) project, whose focus was to map the to learning and teaching6–8 in an attempt individual learning objectives of the RACGP to capture the breadth, depth and scope curriculum to find out where and when they of modern medical practice. From a would most suitably be implemented. This map vocational training perspective however, then formed the basis for revisions to the VMA there is a persisting challenge: ‘How educational program and the development of to meet growing expectations with a curriculum guides for both supervisors (to assist consistent approach across the nation them in their teaching sessions) and registrars while ensuring flexibility in pathways, (to enable them to track the proposed delivery of styles and approaches to learning?’9 This specific learning objectives). The full description question is especially relevant given that of the mapping project is available from the Reprinted from AUSTRALIAN FAMILY PHYSICIAN VOL. 39, NO. 11, NOVEMBER 2010 869 PROFESSIONAL Linking the RACGP curriculum to vocational education VMA. The purpose of this article is to provide others who are grappling with a way to adapt Designing the process an overview of the process and to describe the the RACGP (or ACRRM) curriculum for use in Although the RACGP national curriculum was format of the guides in the hope it will assist their individual settings. a consensus derived document and is well structured, it is not necessarily user friendly. Potential curriculum gaps Its size alone (the latest version has increased not covered in an RTP Individual components from 12 key topic areas to 34, with almost education program of an RTP education 600 individual learning objectives currently program unique to their in the public domain), while gratifying in its own framework acknowledgment of the complexity of general RTP educational practice, is daunting from an implementation program perspective. To address this problem, the VMA project design has drawn on two educational models. Curriculum The first was the Johns Hopkins University School of Medicine's six step approach to curriculum development.17 This model’s strength Figure 1. The relationship of an individual RTP’s education program to a national curriculum is its flexibility in the application of each step. It also defined curriculum as a ‘planned The square represents a specific curriculum, and the triangle represents an individual RTP. The degree of overlap of a triangle on the square will vary depending on the RTP. In addition, the educational experience’, which married with the shape of each triangle will vary, indicating the different focus or emphasis each RTP may give project outcome. to different components of their education and training program The second educational model was to employ Phase one Phase two Phase three Review, clarify and Commentary Collate material Development of Preparation document the VMA on blueprint from resource preliminary guides framework by registrars, material to Comment by all supervisors develop content stakeholders and medical educators Analysis of Analysis Conceptual mapping Develop learning Develop learning Process RACGP learning of RACGP of teaching and outcomes and outcomes and objectives by learning learning guides suggested teaching provisional workshop domain objectives by using crosslinks of and learning content to construct curriculum learning objectives options to construct workshop program statements to develop VMA supervisor guides curriculum topic Combine supervisor and workshop areas learning outcomes to construct registrar guides Development of Develop teaching Workshop program Supervisor Outcome VMA blueprint and learning guides guides for GPT guides for GPT from the VMA 1, 2, and 3 1, 2 and 3 blueprint Registrar guides for GPT 1, 2 and 3 Figure 2. Diagrammatic presentation of the process used to contextualise the RACGP curriculum for the VMA education and training program GPT = general practice terms 870 Reprinted from AUSTRALIAN FAMILY PHYSICIAN VOL. 39, NO. 11, NOVEMBER 2010 Linking the RACGP curriculum to vocational education PROFESSIONAL the concepts underpinning curriculum mapping. phases over a 2 year period (2008–2010), with blueprint). The three guides that evolved from The value of this method is that it allows the each phase starting with a preparatory stage, this (ie. the workshop program guide, the context of delivery to be considered while then progressing to a development stage that supervisor guide and the registrar guide) had ensuring the curriculum’s relevance for both its then produced an outcome, which fed into the clear links to each other. users and its recipients.18 It does this by making next phase (Figure 2). Relevance and transparency Key elements in the process the elements of the curriculum more transparent were built into the process by an iterative cycle and by demonstrating the links and relationships of feedback from VMA supervisors, registrars and Within the project design there are four key between the different components of the medical educators. elements that ensure the guides remain linked to curriculum, ensuring it remains consistent with The focus of the project design was to the blueprint. ‘current’ needs.19 produce a central document that incorporated • A three digit code specific for each RACGP specific predetermined attributes (Table 1) learning objective enabled easy tabulation Designing the project and brought together all the main elements while maintaining consistency of use across The project evolved through three interrelated of the curriculum (this is the VMA curriculum the guides (Table 2) • Each learning objective was prioritised using Table 1. Key attributes required of the blueprint and its associated guides a colour code to help target teaching and learning within a VMA perspective. Priorities Attributes Description were not based on importance, as all Adaptable The structure and format of the curriculum has to be sufficiently learning objectives are important, but rather adaptable to lend itself to both the national general practice curricula, the Fellowship of the RACGP and Fellowship of ACCRM on their appropriateness for teaching within Deliverable Ideally the VMA curriculum delivery would match the curriculum a VMA context. Some learning objectives intention. A ‘hidden’ curriculum undermines its potential strength and were allocated a priority three as it was can create confusion for registrars. Input was sought from all major felt they would best be acquired through stakeholders, ie. VMA medical educators, supervisors and registrars experience and exposure, rather than Flexible Medical education has changed dramatically over the past few years specific teaching with many different theoretical approaches currently in place. Program • The conceptual links between all the learning needs may also change even if the basic curriculum does not. This objectives were mapped, irrespective of format had to be able to accommodate that priority. This identified all the learning Robust The RACGP stated