There is much flexibility in how we design and revise curricula to meet program outcomes. That flexibility provides the opportunity for each school to have a curriculum that reflects its unique mission and characteristics and meets its students' and other stakeholders' needs. However, flexibility also makes it more difficult to decide what is best for the curriculum and students.
We cannot make informed decisions about curriculum revision without reviewing the literature and understanding where we are going with health care. I was reminded of this when reading Altmiller's1 article on integrating care bundles in the curriculum and the article by McDermott-Levy et al2 about why nursing students should learn about climate change. It is also important to search for studies to guide your curriculum decisions. For example, if you have a concept-based curriculum that needs revision, or if you are considering that model for your curriculum, read the article by Brussow et al.3 They report on a national study to develop a representative list of concepts and exemplars for a nursing curriculum. The authors provide a list of the final concepts with definitions and illustrate how exemplars can be leveled in a curriculum. This is a good example of a study that would be of value when revising a curriculum.
Second, curriculum or course revision cannot be viewed separate from the clinical environment. What is happening there should guide our decisions about courses and student learning activities. As the clinical practice environment changes, so should our nursing curricula.
As we gather evaluation data for curriculum change, feedback from the clinical environment is critical to our decisions. We need to know from new graduates, preceptors, and clinical agencies how well our graduates are prepared for their first position and where there are gaps. We need better strategies to gather this feedback, but this is important information for curriculum decisions. In one school of nursing, faculty asked preceptors to evaluate the degree to which their assigned senior nursing student was meeting expectations for readiness for nursing practice.4 The tool listed priority nursing knowledge areas, competencies, professional attributes, and general expectations for new graduates (aligned with the Quality and Safety Education for Nursing competencies). Students scored highest in professional attributes but lowest in time management, prioritization, management of multiple patients, and pharmacology knowledge. The results provided a basis for revising the curriculum.
Third, sometimes, a needed change can be made through a different approach to teaching-a pedagogical change rather than a curriculum change. Fewer lectures and more active learning methods, new learning activities and assignments that are planned across courses to build student knowledge and competencies, expansion of simulation, and different clinical sites may be all that is needed.
Lastly, schools need a process to make curriculum changes that are easy to do and do not require multiple levels of review and approval. We need to move quickly when we realize revisions are needed to improve student learning outcomes. In some schools, the process for curriculum revision is arduous. There may be a curriculum committee, but decisions about revisions (even minor adjustments) might then go through multiple levels of review, discussion, and approval. Although these may lead to some good ideas and new perspectives, they require more meetings and more time, lengthening the process and dampening enthusiasm. Curriculum decisions should be made by faculty who are most affected by them and who have the most knowledge and expertise to make those decisions. Give the curriculum committee the ability to make decisions and share (not revisit) them at other levels in your school.
Curriculum revision starts by recognizing the need for change. As faculty embrace new ideas and approaches, let us support them in the process and not set up barriers. We can move more quickly that way.
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