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Program Evaluation Models and Related Theories: AMEE Guide No. 67 2012; 34: e288–e299 WEB PAPER AMEE GUIDE Program evaluation models and related theories: AMEE Guide No. 67 ANN W. FRYE1 & PAUL A. HEMMER2 1Office of Educational Development, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0408, USA, 2Department of Medicine, Uniformed Services, University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD, USA Abstract This Guide reviews theories of science that have influenced the development of common educational evaluation models. Educators can be more confident when choosing an appropriate evaluation model if they first consider the model’s theoretical basis against their program’s complexity and their own evaluation needs. Reductionism, system theory, and (most recently) complexity theory have inspired the development of models commonly applied in evaluation studies today. This Guide describes experimental and quasi-experimental models, Kirkpatrick’s four-level model, the Logic Model, and the CIPP (Context/Input/ Process/Product) model in the context of the theories that influenced their development and that limit or support their ability to do what educators need. The goal of this Guide is for educators to become more competent and confident in being able to design educational program evaluations that support intentional program improvement while adequately documenting or describing the changes and outcomes—intended and unintended—associated with their programs. Introduction Practice points Program evaluation is an essential responsibility for anyone overseeing a medical education program. A ‘‘program’’ may be . Educational programs are fundamentally about change; as small as an individual class session, a course, or a clerkship program evaluation should be designed to determine rotation in medical school or it may be as large as the whole of whether change has occurred. For personal use only. an educational program. The ‘‘program’’ might be situated in a . Change can be intended or unintended; program medical school, during postgraduate training, or throughout evaluation should examine for both. continuing professional development. All such programs . Program evaluation studies have been strongly influ- deserve a strong evaluation plan. Several detailed and enced by reductionist theory, which attempts to isolate well written articles, guides, and textbooks about educational individual program components to determine associa- program evaluation provide overviews and focus on the tions with outcomes. Educational programs are complex, with multiple inter- ‘‘how to’’ of program evaluation (Woodward 2002; actions among participants and the environment, such Goldie 2006; Musick 2006; Durning et al. 2007; Frechtling that system theory or complexity theory may be better 2007; Stufflebeam & Shinkfield 2007; Hawkins & Med Teach Downloaded from informahealthcare.com by 134.174.140.216 on 06/19/14 suited to informing program evaluation. Holmboe 2008; Cook 2010; Durning & Hemmer 2010; . The association between program elements and out- Patton 2011). Medical educators should be familiar with comes may be non-linear—small changes in program these and have some of them available as resources. elements may lead to large changes in outcomes and This Guide will be most helpful for medical educators who vice-versa. wish to familiarize themselves with the theoretical bases for . Alwayskeepanopenmind—ifyoubelieveyoucanpredict common program evaluation approaches so that they can the outcome of an educational program, you may be make informed evaluation choices. Educators engaged in limiting yourself to an incomplete view of your program. program development or examining an existing educational . Choose a program evaluation model that allows you to program will find that understanding theoretical principles examine for change in your program and one that related to common evaluation models will help them be more embraces the complexity of the educational process. creative and effective evaluators. Similar gains will apply when an education manager engages an external evaluator or is helping to evaluate someone else’s program. Our hope is that this Guide’s focus on several key educational evaluation models Correspondence: Ann W. Frye, Office of Educational Development, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0408, USA. Tel: 409-772-2791; fax: 409-772-6339; email: [email protected] 288 ISSN 0142–159X print/ISSN 1466–187X online/12/050288–12 ß 2012 Informa UK Ltd. DOI: 10.3109/0142159X.2012.668637 Program evaluation models and related theories in the context of their related theories will enrich all educators’ information related to the design, implementation, and work. outcomes of a program, for the purpose of monitoring and improving the quality and effectiveness of the program.’’ (ACGME 2010a). As is clear in this definition, program A focus on change evaluation is about understanding the program through a We believe that educational programs are fundamentally about routine, systematic, deliberate gathering of information to change. Most persons participating in educational programs— uncover and/or identify what contributes to the ‘‘success’’ of including learners, teachers, administrators, other health pro- the program and what actions need to be taken in order to fessionals, and a variety of internal and external stake- address the findings of the evaluation process (Durning & holders—do so because they are interested in change. While Hemmer 2010). In other words, program evaluation tries to a program’s focus on change is perhaps most evident for identify the sources of variation in program outcomes both learners, everyone else involved with that program also from within and outside the program, while determining participates in change. Therefore, effective program evaluation whether these sources of variation or even the outcome itself should focus, at least in part, on change: Is change occurring? are desirable or undesirable. The model used to define the What is the nature of the change? Is the change deemed evaluation process shapes that work. ‘‘successful’’? This focus directs that program evaluation should Information necessary for program evaluation is typically look for both intended and unintended changes associated gathered through measurement processes. Choices of specific with the program. An educational program itself is rarely static, measurement tools, strategies, or assessments for program so an evaluation plan must be designed to feed information evaluation processes are guided by many factors, including the back to guide the program’s continuing development. In that specific evaluation questions that define the desired under- way, the program evaluation becomes an integral part of the standing of the program’s success or shortcomings. In this educational change process. Guide, we define ‘‘assessments’’ as measurements (assess- In the past, educational program evaluation practices often ment ¼ assay) or the strategies chosen to gather information assumed a simple linear (cause-effect) perspective when needed to make a judgment. In many medical education assessing program elements and outcomes. More recent programs data from trainee assessments are important to the evaluation scholarship describes educational programs as program evaluation process. There are, however, many more complex systems with nonlinear relationships between their assessments (measurements) that may be necessary for the elements and program-related changes. Program evaluation evaluation process, and they may come from a variety of practices now being advocated account for that complexity. sources in addition to trainee performance data. Evaluation,as We hope that this Guide will help readers: (1) become aware noted earlier, is about reviewing, analyzing, and judging the of how best to study the complex change processes inherent in importance or value of the information gathered by all these any educational program, and (2) understand how appreciat- assessments. For personal use only. ing program complexity and focusing on change-related outcomes in their evaluation processes will strengthen their Reasons for program evaluation work. In this Guide, we first briefly define program evaluation, Educators often have both internal and external reasons for discuss reasons for conducting educational program evalua- evaluating their programs. Primary external reasons are often tion, and outline some theoretical bases for evaluation models. found in requirements of medical education accreditation We then focus on several commonly used program evaluation organizations (ACGME 2010b; LCME 2010), funding sources models in the context of those theoretical bases. In doing so, that support educational innovation, and other groups or Med Teach Downloaded from informahealthcare.com by 134.174.140.216 on 06/19/14 we describe each selected model, provide sample evaluation persons to whom educators are accountable. A strong program questions typically associated with the model, and then discuss evaluation process supports accountability while allowing what that model can and cannot do for those who use it. We educators to gain useful knowledge about their program and recommend that educators first identify the theories they find sustain ongoing program development. (Goldie 2006). most relevant to their situation and, with that in mind, then Evaluation models have not always supported such a range choose the evaluation model that best
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