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 Table of Contents  
BRIEF COMMUNICATION
Year : 2017  |  Volume : 30  |  Issue : 3  |  Page : 236-239

Curriculum development for a module on noncommunicable diseases for the master of public health program


1 Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Physiology, Medical Education Unit, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Biochemistry, Medical Education Unit, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication18-Apr-2018

Correspondence Address:
Anu Mary Oommen
Department of Community Health, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/efh.EfH_148_15

  Abstract 

Background: As the burden of noncommunicable diseases (NCDs) has been rising globally, various educational programs have introduced chronic disease epidemiology teaching, which is now a component of most of the Master of Public Health (MPH) programs. However, the process of curriculum development for these courses has not been adequately documented for use by educators planning such courses. Methods: A detailed process of curriculum development based on David Kern's six-step approach was undertaken for a 2-week course on NCDs, as part of the MPH program of a tertiary institution in South India. The processes were documented so that the method of curriculum development for such a course could be made available for educators across this field. Results: The course on NCDs was carried out over 73 learning hours (2 weeks) for a group of MPH students including medical, dental, allied health, and nursing graduates. Evaluation of the revised curriculum at the end of the 2 weeks revealed that mean scores for knowledge and confidence in skills increased by 50% (11.1–16.6, t-test, P < 0.001) and 79% (3.3–5.9, t-test, P = 0.002), respectively, from baseline scores. Discussion: The revised curriculum was effective in improving knowledge and confidence in epidemiological skills. The documented process of curricular development using standard methods if made publicly available can be of use to those involved in planning similar educational programs for students of public health.

Keywords: Curriculum, design, Master of Public Health, noncommunicable diseases


How to cite this article:
Oommen AM, Vyas R, Faith M, Selvakumar D, George K. Curriculum development for a module on noncommunicable diseases for the master of public health program. Educ Health 2017;30:236-9

How to cite this URL:
Oommen AM, Vyas R, Faith M, Selvakumar D, George K. Curriculum development for a module on noncommunicable diseases for the master of public health program. Educ Health [serial online] 2017 [cited 2019 May 20];30:236-9. Available from: http://www.educationforhealth.net/text.asp?2017/30/3/236/229504


  Background Top


Master of Public Health (MPH) programs include a component on noncommunicable diseases (NCDs) which are now the major causes of deaths worldwide.[1] Training regarding NCDs is necessary as public health professionals are expected to implement prevention and control programs. Although curricula used in these courses are often published, descriptions of the processes of curriculum design are not available in the public domain. Availability of the curriculum along with documented processes of curriculum design would be of use to medical educators to design such curricula and also apply these processes for other curricula.

An educational project was undertaken to develop a curriculum for NCDs for the MPH program of a medical college in South India. This was part of educational reforms planned for the entire program, 4 years after its implementation, based on student and faculty feedback. This article details the process of curriculum development of the 2-week module on NCDs for the MPH program.


  Methods Top


The curriculum development process followed the six steps recommended by Kern et al.[2] This practical guideline for medical educators describes analysis of learning needs, designing, and executing appropriate learning strategies and evaluation. Since this MPH program accepts mainly students with a medical background (e.g., doctors, nurses, and occupational therapists), a medical education model for curriculum development was chosen. Permission for data collection was obtained from the Institutional Review Board of the program's institution.

Step 1: Problem identification and general needs assessment

The health problem for which the curriculum was to be developed was described (magnitude, risk factors, and approaches to the problem) through interviews with experts and literature review.[2] Disease burden, lacunae in research, preventive efforts, and other MPH curricula were reviewed.

The problem

The rising incidence and mortality due to NCDs in developing countries has led to increasing research and control programs.[1],[3],[4] High-income countries have shown a decline in diseases such as coronary heart disease, attributable to better prevention, detection, management, and public awareness.[5] In this context, public health experts need to be competent in managing control programs and conducting research regarding unanswered questions regarding etiology, health-care delivery, and prevention.

Current approach

According to Kern's model, current efforts to control the problem (NCDs) were analyzed by asking what different groups were doing currently. Knowledge regarding what these groups are doing to solve or exacerbate the problem can influence curricular content.[2] This can be explained as follows: patients: awareness regarding prevention and screening is low, leading to late detection of diseases, with widespread increase in lifestyle-related risk factors;[4],[6],[7] society: with increased urbanization, work and home environments are not conducive to healthy lifestyles, although the urban elite are recognizing the need for lifestyle changes; health-care providers: while there is an increasing interest in NCDs, the emphasis in India appears to be on screening, with fewer efforts on primary prevention;[3] and medical educators: NCDs are often taught piecemeal to undergraduates, emphasizing diagnosis, complications, and treatment more than prevention. Lifestyle medicine taught as a separate discipline is rare although chronic diseases are covered in MPH programs.

Ideal approach

The ideal approach has been described as follows: patients: ideally, the whole population (healthy or affected) would be aware of preventive measures, take collective steps to modify unhealthy habits, and avail of opportunities for screening and treatment; society: every individual would have access to “healthy settings,”[8] enabling environments at home, work, schools, and neighborhoods; health-care providers: the health sector should be involved in primary prevention using an intersectoral approach, while simultaneously increasing screening services; and medical educators: teaching regarding prevention of NCDs should be a part of undergraduate and postgraduate education of health-care professionals.

Step 2: Targeted needs assessment

The specific needs of learners were identified from the current and former students. Previous assignments revealed an inadequate understanding of principles of research and an inability to comprehensively describe disease burden. Feedback showed the need for more practical experiences, avoiding duplication of course content and greater exposure to public health activities.

The long-term impact of previous teaching on NCDs was evaluated by examining work done by former students. Eight out of 19 (42%) students had chosen NCDs for their theses, while only two (11%) were involved in NCD related service programs. This indicated that the course should focus on the need for public health professionals to be involved in both control programs and research. Confidence in epidemiological skills (e.g., critical review of journal articles and planning research studies) was assessed using a rating scale, with options 1 (no confidence at all) to 5 (extremely confident). The mean score was 4.6 and standard deviation (SD) was 1.7 (out of a maximum of 7, indicating confidence in all the seven skills assessed), implying that skills training needs to be addressed.

A structured questionnaire was administered to the current group of 16 students assessing knowledge, attitudes, and confidence in skills. Knowledge regarding disease burden, causation, surveillance, and screening and attitudes toward prevention, causation, chronic diseases in the elderly, and importance of lifestyle change for whole populations were tested. The mean knowledge score was 11.1 (SD: 2.2) out of 22, attitude score was 4.5 (SD: 0.7) out of 5, and confidence in skills was 3.3 (SD: 1.9) out of 7.

Step 3: Goals and specific measurable objectives

Based on the needs assessment, the goal was “creation of public health professionals equipped to take measures for the promotion of health and prevention of NCDs.”

The expected outcomes were that the students should be able to do the following:

  1. Plan, implement, and evaluate prevention and control programs
  2. Design and implement research studies regarding NCDs.


Specific learning objectives were framed for knowledge, attitudes, and skills covering burden, causation, surveillance, research, prevention, screening, treatment, and intersectoral coordination for NCD control [Table 1].
Table 1: Objectives, teaching–learning methods, and assessment of the noncommunicable disease module for Master of Public Health

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Process objectives were also defined corresponding to the six steps of curriculum development.[2]

Step 4: Educational strategies

Educational strategies were aligned to objectives [Table 1], keeping the course 50% student based using problem-solving assignments. A multidisciplinary team from medicine, cardiology, radiotherapy, endocrinology, respiratory medicine, geriatrics, psychiatry, and community medicine, as well as a lay leader, covered diabetes, heart disease, respiratory diseases, cancer, mental illness, and geriatrics. Teaching methods included lectures, epidemiological exercises, journal article discussions, a research study, case workup, and observational visits (psychiatry, lifestyle clinic, diabetic clinic, and community-based screening clinics for cervical cancer).

Step 5: Implementation

The course was implemented for 2 weeks in April 2014, over 73 learning hours, with formative and summative assessments, after ensuring the presence of appropriate faculty, materials, and administrative approval. The institutional learning management system was used to upload course objectives, assignments, schedule, and reading material [Table 1].

Step 6: Evaluation and feedback

Process evaluation included asking questions such as “was a needs assessment done”? corresponding to the six steps, to evaluate if the curriculum was developed scientifically.

Evaluation showed that while two-thirds of the students rated the course at least 8 out of 10, there was a 50% improvement in knowledge and 79% increase in confidence in skills [Table 2]. Although the current evaluation was based on short-term outcomes, long-term outcomes were identified for future evaluation, for example, proportion of students choosing an NCD as their thesis as an indirect outcome indicator of the success of the module in triggering interest.
Table 2: Results of subjective and objective evaluation of learner outcomes

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  Discussion Top


Given the need for public health professionals to be involved in the prevention and control of NCDs, this 2-week course for MPH students was intended to equip them for this purpose. The six-step process of curriculum development recommended by Kern et al.[2] was used with the help of medical educators to scientifically redesign an existing curriculum. As the students were from a medical background, this medical education model was considered appropriate. The results of this project showed good student satisfaction with the revised course, and both improvement in knowledge and self-confidence in skills. Such curriculum enhancement projects have shown to have a positive effect on student outcomes.[9],[10]

The evaluation was limited by sample size and a lack of advance planning, being undertaken only 4 years after the course was started. Only confidence in skills could be assessed as it was not feasible to formally assess all skills learned. Evaluation for long-term outcomes such as impact of the course on students' choices for theses and career will be carried out later, by contacting students who have attended the revised course.

This development of a course curriculum is an excellent method to ensure that an educational course is designed to achieve its objectives, providing a platform to assess achievements. While detailed curricula are published often, curriculum development processes are rarely explained. Therefore, when required to develop new curricula, course coordinators may not follow comprehensive standard processes. If course coordinators of various educational courses follow recommended processes for curriculum development and publicize these along with the curricula, it would serve as a guide to others. This would enhance the quality of education and finally lead to appropriate solutions for health problems.[2] This documented example of curriculum development for a course on NCDs, an important part of public health programs worldwide, could serve such a purpose.

Acknowledgments

The authors thank the MPH students and staff of the Medical Education Unit of the Christian Medical College, Vellore, for their support in carrying out this educational project.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Non Communicable Diseases Country Profile. Available from: http://www.who.int/nmh/countries/en/. [Last retrieved on 2017 Dec 17].  Back to cited text no. 1
    
2.
Kern DE, Thomas PA, Hughes MT. Curriculum Development for Medical Education: A Six-Step Approach. Baltimore: Johns Hopkins University Press; 2009.  Back to cited text no. 2
    
3.
Directorate General of Health Services. National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke. Operational Guidelines. Ministry of Health & Family Welfare. Government of India. Available from: http://dghs.gov.in/content/1363_3_NationalProgrammePreventionControl. [Last retrieved on 2017 Dec 17].  Back to cited text no. 3
    
4.
Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217-30.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA 1999;281:1291-7.  Back to cited text no. 5
[PUBMED]    
6.
Tripathi N, Kadam YR, Dhobale RV, Gore AD. Barriers for early detection of cancer amongst Indian rural women. South Asian J Cancer 2014;3:122-7.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res 2010;131:53-63.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
World Health Organization. Sundsvall Statement on Supportive Environments for Health. Report from the International Conference on Health Promotion, Sundsvall. Copenhagen: WHO; June, 1991. Available from: http://www.who.int/healthpromotion/conferences/previous/sundsvall/en/. [Last retrieved on 2015 May 18].  Back to cited text no. 8
    
9.
Ives-Kennedy B, Kennedy WC, Southard DR. A medical education model for collaborative chronic disease management. J Physician Assist Educ 2008;19:18-29.  Back to cited text no. 9
    
10.
Strayhorn G. Effect of a major curriculum revision on students' perceptions of well-being. Acad Med 1989;64:25-9.  Back to cited text no. 10
    



 
 
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