TRAINING Outcome-based education: Principles and practice S. MUKHOPADHYAY & S. SMITH Department of Obstetrics and Gynaecology, Chesterfield Royal Hospital NHS Foundation Trust, UK Summary Outcome-based education is a recent development in modern curriculum planning. The attributes of a good trainee are defined first and the ways to achieve them are suggested next. Outcome-based educational models have been used successfully. This paper deals with the application of 12 learning outcomes to a very relevant educational intervention from the Royal College of Obstetricians and Gynaecologists (RCOG): the Labour Ward Advanced Training Skills Module (ATSM, relating to advanced labour ward practice) and assessing their suitability for the same. The second part of the paper deals with principles and methods of assessment. Assessment is important in an outcome-based model, as it allows us to decide whether trainees have learnt what was expected to be learnt. The assessment tools in the labour ward ATSM have been critically appraised. It has been stressed that a good doctor’s practice is a congruous blend of knowledge, skills and attitudes, rather than executing these domains in isolation. Keywords ATSM, Bloom’s taxonomical objectives, Miller’s pyramid and assessment tools, outcome-based medical education Introduction An educational outcome refers to what a student or a trainee should be able to perform at the end of a course (Spady 1993). On the other hand, an educational objective refers to what a student should have learnt by the end of a course. In outcome-based education, one plans backwards: the attributes of a successful trainee are defined first and the ways to achieve them are suggested next. Therefore, in such a model, ‘product defines the process’ (Harden et al. 1999). Models of outcome-based education were first developed in the USA in a bid to develop high quality student performance. Bloom (1968) developed the concept of ‘mastery learning’, in which a fixed level of performance was to be achieved in a variable length of time and space. The General Medical Council (GMC 1993) in the UK voiced the same in its document, ‘Tomorrow’s Doctors’. Thus began the search for viable outcomes in medical educa- tion. The model has since been adopted in medical schools worldwide (Simpson et al. 2002; Smith et al. 2003). The Brown medical school (Rhode Island, USA) model utilises nine learning outcomes that incorporate the use of basic sciences, diagnosis, management and prevention of disease, life-long learning, moral aspects and ethics, to name a few. Harden et al. (1999) summarised the essence of this and several similar models in a three circle concept. In three concentric circles, the author mentions tasks (doing the right thing), attitudes (doing the thing right) and finally, professionalism (the right person doing it). Criticisms of objective-based education included the artificial separation of knowledge and skills, and the constraints of time needed to gather the same. However, given the current educational climate, an outcome-based model seems entirely appropriate: it delineates the roadmap of ‘fitness to practice’ and suggests ways to achieve the same. The Scottish doctor model has 12 outcomes categorised in three broad sections (Simpson et al. 2002). In short, this model utilises outcomes relevant to each of the three circles (Harden 1986). These outcomes (the Dundee 12 out- comes) are divided into three major categories as men- tioned above. What the doctor is able to do: (1) Clinical skills (2) Practical procedures (3) Patient investigations (4) Patient management (5) Health promotion and disease prevention (6) Communication (7) Medical informatics How the doctor approaches his/her practice: (8) Basic, social and clinical sciences (9) Attitudes, legal responsibilities and legal under- standing (10) Clinical reasoning processes Correspondence: S. Mukhopadhyay, 15 Sycamore Drive, Calow, Chesterfield S44 5DX, UK. E-mail: drsujitmuk@yahoo.co.in Journal of Obstetrics and Gynaecology, November 2010; 30(8): 790–794 ISSN 0144-3615 print/ISSN 1364-6893 online Ó 2010 Informa UK, Ltd. DOI: 10.3109/01443615.2010.505305 J Obstet Gynaecol Downloaded from informahealthcare.com by University of the West of England on 01/27/14 For personal use only.