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Year : 2015  |  Volume : 28  |  Issue : 2  |  Page : 138-141

Application of Kern's Six-step approach to curriculum development by global health residents

Department of Pediatrics; Section of Infectious Diseases, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA

Date of Web Publication21-Nov-2015

Correspondence Address:
Leigh R Sweet
Texas Children's Hospital, Feigin Center, 1102 Bates Street, Suite 1102, Houston, Texas 77030
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1357-6283.170124

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Background: Global health practitioners have a responsibility to deliver appropriate and effective health education to patients and families. We demonstrate how residents in a global health elective can utilize Kern's six-step approach to develop educational products for patients and their families. Methods: Residents completed a pre-curricular survey of knowledge, skills and attitudes regarding curriculum development. Kern's six-steps were introduced through a series of lectures; workshop exercises highlighted the application of each step: (i) Problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation and (vi) evaluation and feedback. Residents used the six-steps to develop health education projects they subsequently implemented locally and abroad. Reflective exercises were conducted after utilization of each of the six steps. Residents also completed a post-curricular assessment of knowledge, skills and attitudes regarding curriculum development. Results: Mean scores on pre- and post-curricular self-assessment of knowledge were 18 and 26.5 (out of 28); skills 19.8 and 33.5 (out of 35); and attitudes 13.3 and 19.8 (out of 21), respectively. Reflective exercises highlighted resident sentiment that the six steps enabled them to be more thoughtful of the interventions they were undertaking in communities locally and abroad. They were impressed how the model allowed them to ensure their goals were aligned with those of patients and their families, fully engage their audience and effectively implement the curricula. Discussion: Kern's six-step approach to curriculum development is an effective method for global health residents to develop educational products for patients and families.

Keywords: Child health, curriculum, international health, medical education, pediatrics

How to cite this article:
Sweet LR, Palazzi DL. Application of Kern's Six-step approach to curriculum development by global health residents. Educ Health 2015;28:138-41

How to cite this URL:
Sweet LR, Palazzi DL. Application of Kern's Six-step approach to curriculum development by global health residents. Educ Health [serial online] 2015 [cited 2023 Mar 28];28:138-41. Available from:

  Background Top

Globalization has resulted in the diversification of populations and a heightened awareness of health disparities in the world. Medical trainee interest in pursuing global health education and international experiences is on the rise,[1],[2],[3],[4],[5],[6],[7],[8],[9] and many training programs have responded to this increase in demand by developing or expanding global health curricula at their institutions.[2],[7],[8],[9]

Global health practitioners have a responsibility to provide patient-centered care that is culturally sensitive, and to deliver appropriate health education to patients and their families. However, few trainees in the health professions receive formal instruction or practice in developing planned educational experiences.[10] Kern et al. developed a six-step approach to curriculum development in order to provide "a practical, theoretically sound approach to developing, implementing, evaluating and continually improving educational experiences in medicine".[10] The six steps are (i) problem identification and general needs assessment, (ii) targeted needs assessment, (iii) goals and objectives, (iv) educational strategies, (v) implementation and (vi) feedback and evaluation.[10] We demonstrate how residents in a global health elective can utilize Kern's six-step approach to develop educational products for patients and their families.

  Methods Top

Setting and participants

In 2011, one of the authors started a Global Child Health Elective at the University of Connecticut Pediatric Residency Program in Hartford, Connecticut, USA. The residency program is three years in duration, with 20 residents in each class. The program's primary teaching hospital is a 187-bed not-for-profit children's hospital. The Global Child Health Elective is a month-long experience designed to provide interns interested in pursuing careers in global child health with a basic foundation of global health knowledge and skills. The elective is offered once annually to four interns who apply for a position in the elective. The month-long curriculum consists of lectures, skill-building workshops and experiences in local and international community settings, which highlight some of the major inequalities encountered in global child health.

In 2013, we augmented the Global Child Health Elective curriculum by introducing residents to Kern's six-step approach to curriculum development. We hypothesized that introduction to Kern's approach would increase global health resident knowledge of curriculum development, and that learner application of the approach would lead to increased skills and confidence in the development of educational products for patients and their families. The study met requirements for exemption by the Institutional Review Board.

Educational intervention

Residents were introduced to Kern's six steps for curriculum development through a series of lectures and workshop exercises. The first lecture was a 30-min overview designed to briefly introduce residents to the six steps, and provide a roadmap for subsequent in-depth sessions in which each step would be explored in more detail. Each in-depth session was one and a half hours in length, and began with a 30-min lecture that provided a more detailed description of the components of the step, described the importance of the step in curriculum development and illustrated how the residents could implement the step in their practice. Following the 30-min lecture, the residents participated in a 1-h workshop, where they utilized the components of the step to develop a health education curriculum they would subsequently implement.

In the first workshop, residents identified a health care problem in the community and began performing a general needs assessment. During the second workshop, they defined which learners they would target with the educational intervention and performed a targeted needs assessment. The third workshop involved the development of goals and specific objectives for their educational activities. Workshop four focused on identification of the most appropriate and effective educational strategies for delivery of the curricular content. During the fifth workshop they developed their plan for implementation. And finally, workshop six was where they planned how they would approach the feedback and evaluation process. The entire curriculum, including the introductory lecture and the six in-depth sessions, was 9.5 h in length and was delivered over a 3-day period.

Application in the local context

During the Global Child Health Elective residents visited Catholic Charities Migration, Refugee and Immigration Services in Hartford, Connecticut to learn about the process of refugee resettlement in the area, and met some of the local refugees and their families. After meeting with leaders at the organization and hearing from members of the local refugee community, hygiene was identified as a problem area and topic of interest. Residents utilized Kern's six steps to develop a 1-h long curriculum on the relationship between hygiene and health. They subsequently implemented the curriculum with the assistance of interpreters for the languages (Burmese, Nepali, Somali and Spanish) spoken by the local refugee attendees.

Application in the international context

The Global Child Health Elective also includes a 1-week cultural immersion experience in Guatemala. The experience includes participation in health-screening clinics offered in collaboration with Niños de Guatemala, a Dutch-Guatemalan non-profit organization, at elementary schools developed by the organization for underserved children. Residents utilized information gathered from encounters with these children and their families to work through Kern's six steps and develop two educational sessions, one on nutrition and health, the other on hygiene and health. They subsequently delivered these curricula to patients and their families during two afternoon sessions with the assistance of a local Spanish interpreter.

Data collection and analysis

Prior to the curricular intervention, residents completed a survey of knowledge, skills and attitudes regarding curriculum development [Table 1]. Reflective exercises were conducted after the introduction and utilization of each of the six steps to encourage residents to critically analyze their experiences and newly acquired knowledge. Inspirational quotes were utilized as prompts for these reflective exercises. For example, for Step 4: Educational Strategies, reflection was prompted by the quote "Tell me and I'll forget; show me and I may remember; involve me and I'll understand" (Chinese proverb). Residents reflected on the utility of the associated step in an open-ended free text format. Residents also completed a post-curricular assessment of knowledge, skills and attitudes regarding curriculum development at the end of the educational experience [Table 1].
Table 1: Self-assessment survey questions by topic

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  Results Top

Mean scores on pre- and post-curricular self-assessment of knowledge, skills and attitudes regarding curriculum development [Table 1] were 18 and 26.5 for knowledge (out of 28); 19.8 and 33.5 for skills (out of 35); and 13.3 and 19.8 for attitudes (out of 21), respectively. Reflective exercises highlighted resident sentiment that utilization of the six steps better enabled them to develop effective health curricula and projects [Table 2]. All resident participants reported significant increases in their knowledge, skills and confidence following the lecture, workshop and real-time application sessions. Multiple residents reflected that the steps allowed them to be more thoughtful of the interventions they were undertaking in communities locally and abroad. They acknowledged that although their intentions were altruistic it was important for them to ensure that their goals were culturally sensitive and aligned with those of the patients and their families; they felt as though the six-steps, especially the targeted needs assessment, provided them with a framework that allowed them to achieve these goals. Residents also reflected that application of the steps to the development and delivery of their curricula allowed them to stay focused and provide effective educational content that could encourage change. They were impressed how the use of multiple educational modalities allowed them to fully engage their audience, and felt as though they were able to effectively implement the curricula with ease secondary to utilization of the six-step process.
Table 2: Intern reflections on utility of the six steps

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Feedback from attendees at the educational sessions residents conducted locally and internationally was positive. The participants were engaged with the sessions, asked questions, and thanked the residents for the presentations. Participants were overheard sharing learning points with other community members who had been unable to attend the sessions, and both groups invited the residents back to provide further educational sessions in the future.

  Discussion Top

This study demonstrates the utility of Kern's six-step approach to curriculum development in the setting of a Global Child Health Elective. Limitations of the study include small sample size and a specific sub-population of medical trainees, that is, four pediatric interns interested in pursuing a career in global health. It is possible that our positive outcomes are dependent on the small, self-selecting group. Further study is therefore necessary to confirm utility of the six-step approach for medical trainees at different levels of training, in other specialties, and in other settings. Another limitation is that we have only assessed short-term outcomes such as knowledge gained and change of attitudes during the course to date.

Lessons we learned about implementing Kern's Six-step Approach with residents include the importance of having a motivated group of learners. The six-step process takes time and its effectiveness as a curriculum development tool is dependent on the user fully working through each of the steps. We feel as though the success of this approach in our group was highly dependent on the interns' motivation to fully engage in each step of the process. Another lesson we learned was that although reflective exercises are helpful for processing experiences and newly acquired knowledge, many learners do not regularly reflect and may be uncomfortable with how to proceed. Integrating reflective exercises on general global health topics early on in the elective allowed our learners to work through these initial feelings of discomfort and uncertainty prior to engaging in and reflecting on the six-step curriculum, which in turn made these exercises more beneficial.

  Conclusion Top

Kern's six-step approach to curriculum development can be an effective method for global health residents to use in developing educational products for patients and families.

  References Top

Eneriz-Wiemer M, Nelson BD, Bruce J, Chamberlain LJ. Global health training in pediatric residency: A qualitative analysis of faculty director insights. Acad Pediatr 2012;12:238-44.  Back to cited text no. 1
Anspacher M, Frintner MP, Denno D, Pak-Gorstein S, Olness K, Spector J, et al. Global health education for pediatric residents: A national survey. Pediatrics 2011;128:e959-65.  Back to cited text no. 2
Castillo J, Goldenhar LM, Baker RC, Kahn RS, Dewitt TG. Reflective practice and competencies in global health training: Lesson for serving diverse patient populations. J Grad Med Educ 2010;2:449-55.  Back to cited text no. 3
Bozorgmehr K, Schubert K, Menzel-Severing J, Tinnemann P. Global Health Education: A cross-sectional study among German medical students to identify needs, deficits and potential benefits (Part 1 of 2: Mobility patterns and educational needs and demands). BMC Med Educ 2010;10:66.  Back to cited text no. 4
Drain PK, Holmes KK, Skeff KM, Hall TL, Gardner P. Global health training and international clinical rotations during residency: Current status, needs and opportunities. Acad Med 2009;84:320-5.  Back to cited text no. 5
Izadnegahdar R, Correia S, Ohata B, Kittler A, ter Kuile S, Vaillancourt S, et al. Global health in Canadian medical education: Current practices and opportunities. Acad Med 2008;83:192-8.  Back to cited text no. 6
Nelson BD, Herlihy JM, Burke TF. Proposal for fellowship training in pediatric global health. Pediatrics 2008;121:1261-2.  Back to cited text no. 7
Fox GJ, Thompson JE, Bourke VC, Moloney G. Medical students, medical schools and international health. Med J Aust 2007;187:536-9.  Back to cited text no. 8
Miranda JJ, Yudkin JS, Willott C. International Health Electives: Four years of experience. Travel Med Infect Dis 2005;3:133-41.  Back to cited text no. 9
Kern DE, Thomas PA, Hughes MT. Curriculum Development for Medical Education: A Six-Step Approach. 2nd ed. Baltimore, MD: The John's Hopkins University Press; 2009.  Back to cited text no. 10


  [Table 1], [Table 2]

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