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Outcome based education enacted: teachers’ tensions in balancing between student learning and bureaucracy

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Abstract

This paper reports on how teachers within health sciences education translate outcome-based education (OBE) into practice when they design courses. The study is an empirical contribution to the debate about outcome- and competency-based approaches in health sciences education. A qualitative method was used to study how teachers from 14 different study programmes designed courses before and after OBE was implemented. Using an interpretative approach, analysis of documents and interviews was carried out. The findings show that teachers enacted OBE either to design for more competency-oriented teaching–learning, or to further detail knowledge and thus move towards reductionism. Teachers mainly understood the outcome-based framework as useful to support students’ learning, although the demand for accountability created tension and became a bureaucratic hindrance to design for development of professional competence. The paper shows variations of how teachers enacted the same outcome-based framework for instructional design. These differences can add a richer understanding of how outcome- or competency-based approaches relate to teaching–learning at a course level.

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References

  • Biggs, J. B. (1996). Enhancing teaching through constructive alignment. Higher Education, 32, 1–18.

    Article  Google Scholar 

  • Biggs, J. (2003). Teaching for quality learning at University. (Phialdelphia: The Society for Research into Higher Education & Open University Press (Second Edition)).

  • Bolander, K., Josephson, A., Mann, S., et al. (2006). Teachers promoting expertise in medical education: Understanding the role of the core curriculum. Quality in Higher Education, 12(1), 41–55.

    Article  Google Scholar 

  • Bruner, J. (1990). Acts of meaning. Cambridge: Harvard University Press.

    Google Scholar 

  • Creswell, J. W. (2007). Qualitative inquiry and research design. Choosing among five approaches. London: Sage.

    Google Scholar 

  • Davis, M. H., Amin, Z., Grande, J. P., et al. (2007). Case studies in outcome-based education. Medical Teacher, 29(7), 717–722.

    Article  Google Scholar 

  • Denzin, N. K., & Lincoln, Y. S. (2003). The landscape of qualitative research. London: Sage.

    Google Scholar 

  • Elizondo-Montemayor, L., Cid-Garcia, A., Perez-Rodriguez, B. A., et al. (2007). Outcome-based national profile of Mexico’s medical graduates. Medical Teacher, 29(7), 691–698.

    Article  Google Scholar 

  • Frank, J. R., Mungroo, R., Ahmad, Y., et al. (2010a). Toward a definition of competency-based education in medicine: a systematic review of published definitions. Medical Teacher, 32(8), 631–637.

    Article  Google Scholar 

  • Frank, J. R., Snell, L. S., Cate, O. T., et al. (2010b). Competency-based medical education: Theory to practice. Medical Teacher, 32(8), 638–645.

    Article  Google Scholar 

  • Frenk, J., Chen, L., Bhutta, Z. A., et al. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), 1923–1958.

    Article  Google Scholar 

  • Gadamer, H.-G. (1976). Philosophical hermeneutics. Los Angeles: University of California Press.

    Google Scholar 

  • Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105–112.

    Article  Google Scholar 

  • Grant, J. (1999). The incapacitating effects of competence: a critique. Advances in Health Sciences Education, 4(3), 271–277.

    Article  Google Scholar 

  • Harden, R. M. (2007). Outcome-based education: The ostrich, the peacock and the beaver. Medical Teacher, 29(7), 666–671.

    Article  Google Scholar 

  • Harden, R. M., Crosby, J. R., & Davis, M. H. (1999b). AMEE Guide No 14: Outcome-based education: Part 1-An introduction to outcome-based education. Medical Teacher, 1(21), 7–14.

    Article  Google Scholar 

  • Harden, R. M., Crosby, J. R., Davis, M. H., & Friedman, M. (1999a). AMEE Guide No. 14: Outcome-based education: Part 5-From competency to meta-competency: a model for the specification of learning outcomes. Medical Teacher 21(6), 546-552.

  • Hodges, B. D. (2010). A tea-steeping or i-Doc model for medical education? Academic medicine : journal of the Association of American Medical Colleges, 85(9 Suppl), S34–S44.

    Article  Google Scholar 

  • Lindblom-Ylänne, S., & Hämäläinen, K. (2004). The Bologna Declaration as a Tool to Enhance Learning and Instruction at the University of Helsinki. International Journal for Academic Development, 9(2), 153–165.

    Article  Google Scholar 

  • McNeil, H. P., Hughes, C. S., Toohey, S. M., et al. (2006). An innovative outcomes-based medical education program built on adult learning principles. Medical Teacher, 28(6), 527–534.

    Article  Google Scholar 

  • Morcke, A., Dornan, T., & Eika, B. (2013) Outcome (competency) based education: An exploration of its origins, theoretical basis, and empirical evidence. Advances in Health Sciences Education. 18(4), 851–863.

    Google Scholar 

  • Morcke, A. M., & Eika, B. (2009). Medical faculty and curriculum design? ‘No, no, it’s like this: You give your lectures…’. Medical Teacher, 31(7), 642–648.

    Article  Google Scholar 

  • Murphy, M. J., De, A. S. R., Remers, O. J., et al. (2009). Student selected components: Student-designed modules are associated with closer alignment of planned and learnt outcomes. Medical Teacher, 31(10), e489–e493.

    Article  Google Scholar 

  • Murphy, M. J., Seneviratne, R. D. A., Mcaleer, S. P., et al. (2008). Student selected components: Do students learn what teachers think they teach? Medical Teacher, 30(9–10), e175–e179.

    Article  Google Scholar 

  • Newble, D., Stark, P., Bax, N., et al. (2005). Developing an outcome-focused core curriculum. Medical Education, 39(7), 680–687.

    Article  Google Scholar 

  • Norman, G. (2006). Editorial-outcomes, objectives, and the seductive appeal of simple solutions. Advances in Health Sciences Education : Theory and Practice, 11(3), 217–220.

    Article  Google Scholar 

  • Patton, M. Q. (2001). Qualitative research and evaluation methods. London: Sage.

    Google Scholar 

  • Ricoeur, P. (1976). Interpretation theory: discourse and the surplus of meaning. Fort Worth: Texas Christian University Press.

    Google Scholar 

  • Ross, M. T. (2012). Learning about teaching as part of the undergraduate medical curricula: Perspectives and learning outcomes. The Centre for Medical Education. Edinburgh, University of Edinburgh. Doctor of Education.

  • SFS. (2006:1053). Förordning om ändring i högskoleförordningen 1993:100. Swedish Higher Education Ordinance. Ministry of Education and Research, Government offices of Sweden, Stockholm.

  • Širca, N. T., Nastav, B., Lesjak, D., et al. (2006). The labour market, graduate competences and study programme development: A case study. Higher Education in Europe, 31(1), 53–64.

    Article  Google Scholar 

  • Taber, S., Frank, J. R., Harris, K. A., et al. (2010). Identifying the policy implications of competency-based education. Medical Teacher, 32(8), 687–691.

    Article  Google Scholar 

  • Talbot, M. (2004). Monkey see, monkey do: A critique of the competency model in graduate medical education. Medical Education, 38(6), 587–592.

    Article  Google Scholar 

  • Whitehead, C. R., Austin, Z., & Hodges, B. D. (2013). Continuing the competency debate: Reflections on definitions and discourses. Advances in Health Sciences Education 18(1), 123–127.

    Google Scholar 

Download references

Acknowledgments

The authors wish to thank all teachers that contributed to the study and Helene Wallsten, Maria Westerståhl, Maria Weurlander and Professor Håkan Hult, for their initial involvement in the project.

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Correspondence to Linda Barman.

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Barman, L., Silén, C. & Bolander Laksov, K. Outcome based education enacted: teachers’ tensions in balancing between student learning and bureaucracy. Adv in Health Sci Educ 19, 629–643 (2014). https://doi.org/10.1007/s10459-013-9491-3

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  • DOI: https://doi.org/10.1007/s10459-013-9491-3

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