A Model for Qualitative Research

Conceptual Framework and Purpose

Methods and Validity

Implicit vs. Explicit Curricula in General Pediatric Education: Is There a Convergence?

Dorene Balmer, Christina Master, Boyd Richards, and Angelo Giardino Pediatrics, 2008

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

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

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

Operational DefinitionsExplicit 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

Data Collection: ObservationObservation(Methods)(Methods)One General Pediatrics floor143 hours of observation ◦ 2/3s between 8:00 a.m. and Noon

◦ January to AugustMedical team:◦ Attendings, senior residents and interns

Observer-participant stance

Data Collection: Interviews((MethodsMethods))Overlapped with observation14/18 attendings, 16/22 interns and 9/11 senior residents

Audio-taped and transcribedGeneral questions◦What surprised you?◦What would you change?◦No competency specific probes

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

Data Analysis

Final phase: Identification of themes pertaining to curricular convergence

Trustworthiness Trustworthiness (Validity)(Validity)Single observer and interviewer

Prolonged observation, allowing for check on preliminary findings

Independent coding of 30% of notes from observation

Created audit trail

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 …”

… but some divergence

Example ◦Converged around communication and teamwork

◦Diverged around systems-based practice and health care costs

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

Theme 2: Messiness of the Implicit CurriculumDifficult to balance

• Dominated by patient care• Learning by doing

Theme 3: Lack of formal recognition of the explicit curriculum• No direct reference to the explicit curriculum or the AGCME competencies throughout the study

Discussion

How the PARTS

Contribute to the WHOLE

Take away message:• Recognize competency-based education as inherent to the learning that occurs in today’s clinical context