Outcome-based Education: AMEE Guide No. 14

For a complete list of AMEE Medical Education Guides, see this page.

I often get asked for the AMEE [Association for Medical Education in Europe] Guides that have been published in Medical Teacher, particularly the outcome-based education articles. Below are the citations and abstracts for Parts 1-5 [full text by subscription].  [Read a summary of AMEE Guide #14.]

Harden RM, Cosby JR, Davis MH. AMEE Guide No. 14: Outcome-based education: Part 1 – An introduction to outcome-based education. Medical Teacher 1999; 21(1):7-14.
Outcome-based education, a performance-based approach at the cutting edge of curriculum development, offers a powerful and appealing way of reforming and managing medical education. The emphasis is on the product-what sort of doctor will be produced-rather than on the educational process. In outcome-based education the educational outcomes are clearly and unambiguously specified. These determine the curriculum content and its organisation, the teaching methods and strategies, the courses offered, the assessment process, the educational environment and the curriculum timetable.They also provide a framework for curriculum evaluation. A doctor is a unique combination of different kinds of abilities. A three-circle model can be used to present the learning outcomes in medical education, with the tasks to be performed by the doctor in the inner core, the approaches to the performance of the tasks in the middle area, and the growth of the individual and his or her role in the practice of medicine in the outer area. Medical schools need to prepare young doctors to practise in an increasingly complex healthcare scene with changing patient and public expectations, and increasing demands from employing authorities. Outcome-based education offers many advantages as a way of achieving this. It emphasises relevance in the curriculum and accountability, and can provide a clear and unambiguous framework for curriculum planning which has an intuitive appeal. It encourages the teacher and the student to share responsibility for learning and it can guide student assessment and course evaluation. What sort of outcomes should be covered in a curriculum, how should they be assessed and how should outcome-based education be implemented are issues that need to be addressed. 

Smith SR, Stephen R, Dollase Rd. AMEE Guide No. 14: Outcome-based education: Part 2 – Planning, implementing and evaluating a competency-based curriculum. Medical Teacher 1999; 21(1):15-22.
Abstract: In September, 1996, Brown University School of Medicine inaugurated a new competency-based curriculum, known as MD2000, which defines a comprehensive set of competency requirements that all graduates are expected to attain. The medical students entering in 1996 and thereafter are required to demonstrate mastery in nine abilities as well as a comprehensive knowledge base as a requirement for graduation. Faculty use performance-based methods to determine if students have attained competence. We describe in this article the reasons why we developed the new curriculum, how we planned and structured it, and the significance we anticipate the curricular innovation will have on medical education.

Friedman B, David M. AMEE Guide No. 14: Outcome-based education: Part 3 – Assessment in outcome-based education. Medical Teacher 1999; 21(1):23-25.
Abstract: The role of performance assessment in outcomebased education is discussed emphasizing the relationship and interplay between these two related paradigms. Issues of the relevancy of assessment to student learning are highlighted in the context of outcome-based education.The importance of defining assessment premises and the role of institutions in defining their educational philosophy as it pertains to student learning and assessment is also presented. A brief description of implementation guidelines of assessment programs in outcome-based education are presented indicating the key features of such programs.

Ross N, Davies D. AMEE Guide No. 14: Outcome-based education: Part 4 – Outcome-based learning and the electronic curriculum at Birmingham Medical School. Medical Teacher 1999; 21(1):26-31.
Abstract: Outcome-led curricula are increasingly relevant to medical education as Universities seek means to make explicit the criteria against which the success of both the course and the students should be judged. This paper outlines some of the main factors which led the University of Birmingham School of Medicine to develop an outcome-led curriculum for the new undergraduate medical course. Having set the general context, it then describes how the specific structure used by the school for organising integrative learning outcomes both influenced and was influenced by the parallel decision to develop an ‘electronic curriculum’database.The advantages of the electronic curriculum database developed by the School are discussed and examples are given to demonstrate the flexibility with which information can be accessed by students, clinicians and other teachers.

Harden RM, Crosby JR, Davis MH, Friedman M. AMEE Guide No. 14: Outcome-based education: Part 5 – From competency to meta-competency: a model for the specification of learning outcomes. Medical Teacher 1999; 21(6):546-552.
Abstract: Increased attention is being paid to the specification of learning outcomes.This paper provides a framework based on the three-circle model: what the doctor should be able to do (‘doing the right thing’), the approaches to doing it (‘doing the thing right’) and the development of the individual as a professional (‘the right person doing it’).Twelve learning outcomes are specified, and these are further subdivided.The different outcomes have been defined at an appropriate level of generality to allow adaptability to the phases of the curriculum, to the subject matter, to the instructional methodology and to the students’ learning needs. Outcomes in each of the three areas have distinct underlying characteristics.They move from technical competences or intelligences to meta-competences including academic, emotional, analytical, creative and personal intelligences. The Dundee outcome model offers an intuitive, user-friendly and transparent approach to communicating learning outcomes. It encourages a holistic and integrated approach to medical education and helps to avoid tension between vocational and academic perspectives.The framework can be easily adapted to local needs. It emphasizes the relevance and validity of outcomes to medical practice.The model is relevant to all phases of education and can facilitate the continuum between the different phases. It has the potential of facilitating a comparison between different training programmes in medicine and between different professions engaged in health care delivery.

Here is a list of AMEE publications; these are the Education Guides. You can also search for these in MEDLINE, although Medical Teacher has not been fully indexed there.

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