Dr. Dorene Balmer PhD (Columbia University) is an expert on Qualitative Research methods and speaks through this webinar on Qualitative Methods, particularly through her own study on Resident Education.
4. Implicit vs. Explicit Curricula
in General Pediatric
Education:
Is There a Convergence?
Dorene Balmer, Christina Master, Boyd Richards,
and Angelo Giardino
Pediatrics, 2008
5. 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
6. 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
7. 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
8. Operational Definitions
Explicit 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
9. Data Collection: ObservationObservation
(Methods)(Methods)
One General Pediatrics floor
143 hours of observation
◦ 2/3s between 8:00 a.m. and Noon
◦ January to August
Medical team:
◦ Attendings, senior residents and interns
Observer-participant stance
10. Data Collection: Interviews
((MethodsMethods))
Overlapped with observation
14/18 attendings, 16/22 interns and 9/11
senior residents
Audio-taped and transcribed
General questions
◦ What surprised you?
◦ What would you change?
◦ No competency specific probes
11. 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
14. 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 …”
15. … but some divergence
Example
◦ Converged around communication and
teamwork
◦ Diverged around systems-based practice and
health care costs
16. 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
17. Theme 2: Messiness of the
Implicit Curriculum
Difficult to balance
• Dominated by patient care
• Learning by doing
18. Theme 3: Lack of formal
recognition of the explicit
curriculum
• No direct reference to the explicit
curriculum or the AGCME competencies
throughout the study