STATEMENTS Backward Course Design: Making the End the Beginning

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1 STATEMENTS Backwar Course Design: Making the En the Beginning Kimberly K. Daugherty, PharmD College of Pharmacy, Ferris State University Submitte April 4, 2006; accepte April 28, 2006; publishe December 15, Pharmacy eucation is in a state of flux as we eal with teaching more stuents with a shortage of faculty members. We, as pharmacy eucators, also have to eal with our lack of formal training in the area of course an lecture esign. Backwar course esign is one metho that can guie iniviual instructors as they struggle with esigning their own courses or even an iniviual lecture. The steps in backwar course esign inclue: (1) ientify the esire results, (2) etermine the acceptable evience, an (3) plan learning experiences an instruction. By focusing on the en results first, we can help stuents to see the importance of what they are learning an make our activities more meaningful an base less on what we have seen others o or how we were taught. This type of course esign can also help us teach stuents to become lifelong learners. Consier these 2 classroom vignettes from a traitional classroom setting. The first focuses on a common problem seen among our stuents an the secon on a problem face by many teachers. A National Assessment of Eucational Progress mathematics assessment aske the following question: How many buses oes the army nee to transport 1,128 soliers if each bus hols 36 soliers? Many of the eighth grae stuents answering this question gave the answer 31 with a remainer of In other wors, the stuents were able to construct the mathematical equation to etermine the answer, but they faile to apply their results to the context of the question, ie, a 32 n bus woul be require to transport all of the soliers. An example of a common problem teachers face can be seen in the following scenario. A worl history teacher realizes late in the year that he is not going to finish presenting the information in the textbook to his class unless he covers 40 pages a ay in a lecture-base format. Because of this he eliminates all of his active-learning activities an instea covers the leftover textbook material Corresponing Author: Kimberly K. Daugherty, PharmD. Aress: 2301 Rosewoo Ave SE, Gran Rapis, MI Tel: Fax: augherk@ferris.eu 1 in a fast-forwar lecture moe. 1 In this example, the teacher forgoes the activities that may help the stuents remember an relate the material being presente to the worl aroun them in favor of covering all of the facts necessary to pass the examination. Many pharmacy eucators can ientify with one or both of these vignettes. Many of us have been given answers to examination questions like that in the first example when we aske for the number of tablets or particular oses. We have all been face as well with the ilemma of realizing that we have more lecture material to cover than time in the class perio or semester allows. Why is this? It is because we are caught in the twin sins 1 of typical instructional esign. These sins are activityfocuse teaching an coverage-focuse teaching where we either teach to cover the material require for an examination or we give stuents activities to complete without making sure they unerstan the concepts we want them to learn (eg, for a problem such as calculate the ose of warfarin neee to bring the patient s INR to the therapeutic range, we get answers like 5.65 mg aily). 1 Eucators shoul keep the following question in min: How o we make it more likely by our esign that more stuents really unerstan what they are aske to learn? 1 To o this, we nee to train teachers to be able to emonstrate knowlege of their course content an ifferent methos of peagogy, knowlege of their stuents, knowlege of selecting suitable instructional goals, knowlege of the resources available to help in their teaching, the ability to esign coherent instruction, an the ability to assess stuent learning. 2 Traitional moels of curriculum, course, an lecture construction have the following steps: (1) efine the goals, purposes, an objectives of your lecture/moule; (2) efine experiences or activities relate to the goals; (3) organize the experiences an activities, an (4) evaluate the goals. This metho of teaching leas to coverage-oriente teaching where topics are checke off as they are covere. It also leas to conucting assessments at the en of a lesson or moule because it has to be one, not because the teacher wants to see if the stuents unerstoo the material. 2

2 Backwar course esign changes the orer of the steps: (1) ientify the esire results, (2) etermine the acceptable evience, an (3) plan learning experiences an instruction. This moel of esign is stanar-oriente instea of activity- or coverage-oriente because the teacher starts with what he/she wants the stuents to be able to o when the lesson has been complete rather than what material nees to be covere. This esign also makes assessment part of the learning process an not just something to o at the en of a chapter or section because the stuent nees agrae. 1,2 The purpose of this paper is to efine backwar course esign, outline the steps for this process, provie an example of this process, an explain where this type of course esign can be use in pharmacy eucation. BACKWARD COURSE DESIGN Theory an Definition One way to think of course esign is to compare it to software esign. Software is esigne to increase the prouctivity of its users just as course esign shoul help to make learners more prouctive. Our stuents are our clients an the effectiveness of our lectures, curriculums, an assessments is etermine by their ability to learn the material we present. 1 Just as a computer software esigner is given a set of stanars to follow when eveloping a new program, we as pharmacy eucators are given a set of stanars to follow when eveloping our curriculum an even iniviual lectures. These stanars shoul guie our choices of what we teach, the activities we choose to have stuents complete, an the assessments we conuct. 1 Backwar course esign is evelope on the premise that the teacher nees to state with clarity what the stuents shoul learn, unerstan, an be able to o at the en of the curriculum or lecture in orer to know what material shoul be covere an what activities an assessments shoul be complete. Backwar course esign forces eucators to shift the focus from content-focuse esign to result-focuse esign. This type of course esign helps eucators answer the age-ol stuent questions of why are we oing this assignment, what is its purpose, an will I ever use this in real life? 1 Backwar course esign by efinition is where the teacher teaches for stuents to be able to use the unerstanings that are presente to them as oppose to just giving them the unerstanings an then hoping they can apply them to ifferent situations. 1 There are 3 questions that backwar course esign asks: (1) What shoul stuents walk out the oor able to unerstan, regarless of what activities or texts we use? 2 (2) What is evience of such ability, an (3) What texts, activities, an methos will best enable such a result? 1 Steps in Backwar Course Design In orer to esign a lecture, course, or curriculum using backwar course esign, it is important to unerstan the 3 main steps: ientifying the esire results, etermining acceptable evience, an planning learning experiences an instructions. 1 The first step of the backwar esign process is to ientify the esire results. In orer to accomplish this step, a teacher must ask him/herself the following question: What o I want stuents to be able to o or unerstan at the en of my course or lecture? One way to answer this question is to review the course goals an objectives for which the lecture is given or examine national accreitation stanars to see what is require for the course. By completing this first step, the teacher clarifies the goals of the lecture or course, making it easier to etermine what content is important. 1 In this step, the teacher first establishes the large goals that stuents shoul obtain by the en of the course or lecture. 1 From this list of goals, the teacher then asks the following: What are the big ieas? What specific unerstanings about these ieas are esire? What stuent misunerstanings are preictable? What provocative questions will foster inquiry, unerstaning, an transfer of learning? What key knowlege an skills will stuents acquire as a result of this lecture/course? What shoul the stuent eventually be able to o as a result of such knowlege an skills? 1 In orer to see how the first step may be accomplishe, consier a traitional ambulatory care clinical clerkship. In orer to begin step 1, the teacher must first etermine what the large goals of the rotation are. I use the goals given by both our College of Pharmacy an the Center for Avancement of Pharmaceutical Eucation (CAPE) to etermine the goals for the rotation. A couple of examples of these goals inclue: (1) Using the principles of pharmaceutical care, be able to esign, implement, monitor, evaluate, an ajust care plans that are patient specific an evience base. This inclues the ability to obtain an analyze a complete meication history. (2) Communicate an collaborate with prescribers, patients, caregivers, an proviers to engener a team approach to efficient, cost-effective care. This inclues making the correct choice of written versus oral communication an use of appropriate language an terminology. 3

3 Once these goals were etermine, the next step was to etermine from these goals what unerstanings stuents neee to have when they left the rotation, what questions they shoul be able to answer, an what knowlege an skills they shoul have obtaine. From the above goals, here are some examples of the unerstanings, questions, an knowlege/skills that I expect stuents to obtain from my rotation: Unerstanings. Pharmaceutical care is a complex process that involves knowlege about the pathophysiology of isease, pharmacology of rugs, an social, ethical, an legal issues. Patient-specific information (social, economic, meical) is neee to implement evience-base treatment plans. The choice of written versus oral communication can effect how a recommenation is perceive as well as the quality of that communication. Questions. How o we use pharmaceutical care in the ambulatory care setting? What is eviencebase meicine an how an why shoul it be use to generate a patient s treatment plans? How shoul rug-relate questions be communicate to other health care proviers versus patients? Knowlege/skills. Definition of pharmaceutical care an evience-base meicine, pathophysiology of isease, conucting meication histories, esigning evience-base treatment plans. The secon step of backwar esign involves etermining acceptable evience to conclue whether stuents have met the goals etermine in step one. This section helps a teacher think about what assessments an activities will prove the stuents have met the esire goals an objectives instea of planning on assessments an activities an hoping at the en, the stuent has learne what was esire. By planning the assessment activities before a teacher plans the content of the lecture, it makes it easier to know what content shoul be taught. 1 Assessment evience can be ivie into 2 components: performance tasks an other evience. 1 For performance tasks, teachers shoul ask themselves: Through what authentic performance tasks will stuents emonstrate the esire unerstanings an by what criteria will performances of unerstaning be juge? 1 Other evience covers the more traitional activities such as quizzes, tests, an homework. In this section, teachers shoul have stuents o self-assessments of their learning when appropriate. 1 I first etermine what performance tasks, other evience, an self-assessment activities shoul be use 3 to help me etermine if the stuents obtaine the unerstanings an knowlege/skills that I etermine in step 1. Some of the performance tasks I came up with were: conucting meication histories, writing in-epth care plans that are evience-base, an writing SOAP notes to physicians. Other evience that I will use to show the stuents meet the state goals are: pathophysiology quizzes uring our morning iscussions an an initial/final assessment test on a large array of internal meicine topics. Lastly, the stuent self-assessments that I create are to have the stuents answer questions on what they think pharmaceutical care is, what evience-base meicine is, an where they woul fin evience-base meicine. Stuents will answer these questions at both the beginning of the rotation an again at the en to see if their answers have change base on our iscussions throughout the rotation. Once I etermine what assessments I woul be using for the rotation I then evelope graing rubrics an irections for each activity to make sure that the activity truly i assess the goal I was trying to achieve. The thir step in this process is planning the learning experiences an instruction. 1 Just like in the other steps, there are several key questions that teachers nee to think about: What enabling knowlege (facts, concepts, principles) an skills (processes, proceures, strategies) will stuents nee in orer to perform effectively an achieve the esire results? What activities will equip stuents with the neee knowlege an skills? What will nee to be taught an coache, an how shoul it best be taught, in light of the performance goals? What materials an resources are best suite to accomplish these goals? 1 The following acronym can be use when esigning a lesson plan: WHERETO. 1 The W stans for Where is the unit going an what is expecte? 1 In this section the teacher thoroughly explains to the stuents before each lecture or activity what is expecte of them an what goal this activity will achieve. 1 The H stans for Holing the stuents interest. 1 Again, by explaining to the stuents why they are completing this activity or listening to a particular lecture will help the stuents see the relevance an be more engage. 1 The first E stans for Explore, experience, enable, an equip. 1 Here the teacher must go back an look at the activities an assessments that were planne in stage 2 an the goals in stage 1 to etermine what lecture content an activities will help the stuents be able to o well in these final assessments an what type of activities will help the stuents to better unerstan the questions evelope. 1 TheRis for Reflect, rethink, an revise. 1 Here the teacher nees to plan time for the stuents to reflect on the big ieas for the lecture an to be able to self-assess their own

4 learning an activities. 1 The secon E stans for evaluate work an progress. 1 In this section the teacher shoul place time in each lecture or course for the stuent to again self-evaluate items that they may have not learne as well as those they woul have like to learn or unerstan better. 1 The T stans for Tailor an personalize the work. 1 In this section the teacher nees to look at the lesson plan an assessments an make sure they inclue activities that cover all stuent learning styles, levels of prior knowlege, an interests. 1 The O stans for Organize for optimal effectiveness. 1 The teacher nees to think about the best organization for the course/lecture to maximize stuent engagement an learning. 1 The last step shoul flow from the previous 2. Here is an example of how I use the acronym for my rotation: W: Go over rotation objectives an syllabus an explain to the stuent why they woul be oing each of the require activities uring the rotation (tie the activities to the larger goals for the rotation). H: When the stuent is oing a specific activity (such as a meication history), remin them why they are oing that activity an what they are expecte to learn from that activity. I will also explain to the stuent how the skills/ knowlege from the activity they are completing may be use in real life no matter what career path they choose to follow. E: I will emonstrate a proper meication history prior to asking the stuent to complete one. Demonstrate how to complete a patient care plan using evience-base meicine before having the stuents complete one. We will also complete a number of morning iscussions on an array of internal meicine topics to ensure the stuent gains the require rug an isease state knowlege neee to complete the rotation tasks. R an E: These two sections of the acronym go together an will be accomplishe in numerous ways uring the rotation. The last ay of the rotation I will have the stuents pick one thing they learne on the rotation that they coul use in their future career. The stuents also complete an initial multiple-choice examination the first ay of the rotation. I give this examination back an give the stuent s time to see what topics they nee to work on uring the rotation. The stuents then repeat this examination the last ay of the rotation to see if they improve an to help them see what areas they still nee to work on uring future rotations. T: The whole rotation has a mixture of activities for all learning styles (written assessments, iscussions, written an oral examinations). Stuents also have the opportunity to help tailor the rotation to what they want to learn as they complete their own goals for the rotation an they get to pick many of the morning iscussion topics. 4 O: The first week of the rotation is set-up for orientation an each new activity is introuce in general in the first ay orientation but then is iscusse in etail when it is time to complete that task. Many of the large ambulatory care topics that come up on a aily basis uring the rotation are iscusse uring the first week or so of the rotation to make sure the stuents have the neee knowlege to care for patients. The rest of the rotation is then flexible epening on what learning activities arise uring the rotation. Stuies on Backwar Course Design At first glance this process may seem overwhelming an ifficult to complete, but the results are worth the time an effort. Also, step one oes not have to be complete before going on to the next step. It is just important to think through all of the steps before completing the course or lecture esign. There is little evience in the literature that compares backwar course esign to traitional course esign an no evience to this author s knowlege of this type of course esign in the meical literature. Kelting-Gibson an colleagues 2 conucte a stuy comparing backwar course esign to a more traitional classroom esign metho in elementary school teachers involve in a teaching training program. This stuy foun that teachers esigning coursework using the backwar course esign metho outperforme teachers using the more traitional approach. Teachers using the backwar course esign metho showe better content knowlege, mae better connections between the content an other isciplines, an evelope plans that reflecte research on peagogical practices better than teachers using a more traitional metho of esign. Backwar esign teachers also set clearer an more suitable goals for their stuents, evelope better plans that linke learning activities an teaching resources to instructional goals, an better recognize stuents skill levels an approaches to learning. Despite the better results seen with the backwar course esign approach to course evelopment this stuy i fin that both groups neee work in the areas of emonstrating the knowlege level of the stuents an assessing stuent learning. 2 Pharmacy School Uses for Backwar Course Design Backwar course esign coul be useful for the iniviual pharmacy professor as well as colleges an schools of pharmacy as a whole. The concept of backwar course esign can be use not only to help pharmacy professors prepare their iniviual lectures, courses, an rotation coursework but also to esign whole curriculums. Pharmacy is in a great position to use this approach because the curriculums are base on a core set of

5 stanars hane own from the American Council of Pharmaceutical Eucation. These stanars can be use to guie not only whole curricular esign but also iniviual lectures an course esign. SUMMARY Backwar course esign is one metho to guie colleges an schools of pharmacy in formulating or revising whole curriculums, an help the iniviual instructor as he/she struggles with esigning his/her own course or lecture. By focusing on the en results first, we can help stuents to see the importance of what they are learning an make our activities more meaningful an less base on what we have seen others o or how we were taught. This type of course esign can help us teach stuents to become lifelong learners as we focus on teaching larger concepts that stuents can apply in many professional situations rather than on isolate pieces of information that they may rarely or never encounter. REFERENCES 1. Wiggins G, McTighe J. Unerstaning by Design. 2n e. Alexanria, Va: Association for Supervision an Curriculum Development; 2005: Kelting-Gibson LM. Comparison of Curriculum Development Practices. Eucational Research Quarterly. 2005;29: CAPE Avisory Panel on Eucation Outcomes. American Association of Colleges of Pharmacy Center for the Avancement of Pharmaceutical Eucation Eucational Outcomes Available at: _CAPE2004.pf#search5 CAPE%20outcomes. Accesse April 23,