Considerations for Curriculum Design
Educational values held by academic and clinical faculties subtly but strongly influence curriculum design in physical therapy education. Five major value orientations, Curriculum as the Development of Cognitive Processes, Curriculum as Technology, Curriculum as Self-Actualization, Curriculum as Social Reconstruction-Relevance, and Curriculum as Academic Rationalism, are presented. The suggestion is made that these underlying value-orientations influence the choice of curriculum design more than do "available resources." A second component of curriculum design, i.e., evaluation of student performance, also influences and is influenced by the direction and development of physical therapy curricula. A plea is made for expressive objectives and outcome objectives to be considered along with instructional or behavioral objectives to yield more comprehensive and creative appraisals of student growth.
Each year academic and clinical faculties sit around long paper-laden tables and review curricu lum plans: "Should we add two more hours of functional activities related to total hip proce dures?" "Should we add four hours on an introduc tion to manipulation?" "Can we put a short section on the use, of community resources in the ethics course?" And, from the clinicians, come, "Are you teaching anything on working with mastectomy pa tients?" "Your students are very weak in orthotics." "We can't teach much in four weeks. Students are just feeling comfortable after the third week. Could they be assigned to us for six weeks . . . ?" And the students present their lists, too: "We need material on pharmacology." "What about more (or less) on PNF?" "Why can't we have our own lectures in physiology instead of sitting in with the medical students?" As always, too much has to be learned in too short a time and the increasing information explosion leaves students, clinicians, and faculties confused and frustrated. Theoretically at least, much of this confusion and frustration can be elimi nated by sound curriculum planning. The purpose of this paper is to identify and briefly discuss two components of curriculum planning —the values which influence basic curriculum design and objec tives which are established for student performance.
Ms. Shepard is currently a lecturer in the Division of Physical Therapy, Stanford University, Stanford, CA 94305. She is a candidate for the Doctor of Philosophy Degree in Sociology of Education at Stanford University.
Volume 57 / Number 12, December 1977
CURRICULUM DECISION-MAKING
Downloaded from https://academic.oup.com/ptj/article-abstract/57/12/1389/4558767 by University of Texas at Dallas user on 16 February 2019
KATHERINE F. SHEPARD, MA
A limited number of strategies are used by aca demic faculties in physical therapy to guide their decision-making in curriculum development. The most apparent universal strategy is to look at the APTA-approved "Standards for Basic Education in Physical Therapy" 1 and attempt to respond to these standards with currently available resources. Aca demic levels of students, clinical facilities used, academic strengths of classroom instructors, extensiveness of interdepartmental relations and commit ments, and money available are often listed as prime influencing factors. As a result, the solution to the problem of what to teach apparently revolves around what learning experiences can be provided within the confines of existing resources to fulfill which specific competency as stated in the Stan dards.
CURRICULUM DESIGN: FOUR FUNDAMENTAL QUESTIONS
In 1949, at the University of Chicago, Tyler published his famous and enduring rationale on curriculum. 2 The four fundamental questions he posed as prerequisite to developing a course of instruction include the following: 1. What educational purposes should the school seek to attain? 2. What educational experiences can be provided that are likely to attain these purposes?
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opt for increased time spent in clinical settings for both students and academicians. 2. Curriculum as Technology.
FIVE CURRICULUM VALUE ORIENTATIONS
The underlying learning theory of this orientation is essentially a stimulus-response reinforcement model; that is, a specific stimulus is given to the student who responds with a specific response. This reply is followed by immediate feedback (reinforce ment) to the student as to whether he has given a correct answer. Course content, eg, anatomy or biostatistics, which utilizes objective short-answer evaluation methods operates under this strategy. "Curriculum as Technology" is derived from the premise that such stimulus-response curriculum ma terials lend themselves to computer-aided instruc tion (CAI) and other prepackaged learning mod ules. The advantages of CAI are easy to visualize — self-paced learning, an interactive immediate feed back medium, availability at numerous locations for day and night use, and increased standardization of group outcomes. The disadvantages, however, considerably slow the implementation of this strat egy—substantial time, money, effort and special skills are required to produce good CAI material and to keep such materials updated. 5
1. Curriculum as the Development of Cognitive Processes.
3. Curriculum as Self-Actualization.
With this value orientation, the educator's con cern is with the development and refinement of intellectual processes— the how rather than the what. Emphasis is on providing students with opportuni ties to develop problem-solving skills which can be applied to any subject matter. Thus, for example, course content related to cryotherapy or clinical practice related to care of the patient who has sustained a burn would stress student learning ex periences in data gathering and sifting, the use of speculation and deduction, and effecting intellectual compromises. Little emphasis is placed on acquiring a multitude of facts —which are often lost, and, once lost, can be retrieved simply by using correct reference sources. Learning under this orientation, the physical therapy student would, for example, trade off memorizing collateral circulation of the knee for time spent in reading, conceptually digest ing, and discussing the question, "Given this patient information, what two different treatment regimens might you establish?" Exercising such basic cogni tive processes as analyzing, abstracting, and gener alizing has a natural laboratory in the clinical set ting. 4 Curriculum planners holding this view may
Appearing in this country with the forceful and enduring writings of Dewey 6 and coming of age in the humanist movement of the late 60s was a type of education advocated by Rogers, 7 Nyberg, 8 and others. Their premise is that schooling should be a total experience responsive to the unique needs of the individual. Personal self-fulfillment is the central curriculum theme, and the design is an open-ended value-saturated content which leads one on a jour ney of search to discover self. The ultimate outcome is existential in nature-a consummate experience to which the learner is guided by dramatic, dynamic, liberal teachers. The end product predicted is a creative, enthusiastic, emotionally stable adult. Of the five curriculum orientations, this one appears least likely to appear as a guiding strategy in health care curricula. Following medicine's example, allied health educators have often allowed science to become the only cornerstone and allowed art to become something the practitioner salvages from his preprofessional educational experiences. 9 With an increasing interest in the integrated mind-body of Eastern religion and medicine as well as increas ing "scientific discoveries" of the impact of the
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PHYSICAL THERAPY
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3. How can these educational experiences be effec tively organized? 4. How can we determine whether these purposes are being attained? We are most familiar with the second and third questions and an inordinate proportion of curricu lum discussions focus on them. The reason is simple: deciding what experiences to provide and how to teach them comes to us quite easily out of the familiarity of our own history in the classroom and in clinical practice. Return for the moment to Ty ler's first question. What purposes should we seek to attain? This weathervane question seems explicit enough in "The Standards for Basic Education in Physical Therapy," yet in utilizing resources to implement these purposes, it becomes obvious that the choice of resources goes beyond simple availa bility. Our choice is strongly imbedded with our values —values which lead us to seek certain imme diately available resources and to overlook finding or initiating others. These tenaciously held values of curriculum planners are the key to forecasting curriculum decisions. Eisner and Vallance have delineated five major value orientations which have an impact on curriculum planning. 3
psyche on illness behavior, this orientation may find increasing acceptance. 4. Curriculum as Social Reconstruction-Relevance.
At the one end is the narrow practice under the prescription, supervision, and direction of the physi cian and at the other is the broad practice as an independent practitioner. The values, knowledge and skills that are desirable for practice in the one future vary markedly from those required for the other. 11
5. Curriculum as Academic Rationalism. This strategy is the most tradition-bound with its advocates identifying the educated person as one who has had access to the great ideas in science and the arts. " . . . Educated man should be able to continue the Great Conversation that began in the dawn of history, that goes on at the present day, and that is best exemplified by the Socratic dia logue." 12 This approach relishes history and exalts the slow, careful inquiry which has supposedly led to the formulation of universal principles and con cepts upon which unique bodies of scientific and artistic theory are built. With this orientation in mind, curriculum planners in physical therapy would advocate that less time be spent both in the class room and in the clinic on application of, for exam ple, principles of kinesiology, and more time on research devoted to discovering, synthesizing, and refining knowledge related to motor behavior. The lack of, and the current desperate need for, this orientation to be considered as a guide to curriculum Volume 57 / Number 12, December 1977
We must produce scholars in human pathokinesiology. Not every therapist can become a scholar in the true sense, but every therapist can be imbued with an understanding of science as it is applied to physical therapy. If the capacity for logical thought and scien tific values is not acquired early, there is little hope such qualities will surface later. 13
PRACTICAL USE OF VALUE ORIENTATIONS
Downloaded from https://academic.oup.com/ptj/article-abstract/57/12/1389/4558767 by University of Texas at Dallas user on 16 February 2019
This is a two-pronged orientation which places importance of the society above importance of the individual. One prong is the adaptive or conserva tive value strategy which depicts education as pro viding the student with tools necessary for survival in "real life." This line of thinking is supported by, for example, Illich, who advocates abolishing the schoolroom altogether and returning to an appren ticeship type of education. 10 The other prong is "reformist." This tenet holds that the school is the major vehicle for social change and students should be provided with visions of a better world and with political leadership skills with which to implement social change. In a physical therapy curriculum under the social relevance philosophy, for example, designers would be reluctant to trade hours cur rently allotted to modality practice for hours de voted to the yet-to-be-fully valued area of preven tive medicine. Faculties holding a social reconstruc tion philosophy would lean toward the opposite decision. As Johnson states,
planning was expressed by Helen Hislop in her eloquent address, the Tenth Mary McMillan lecture:
Of course, none of these orientations is likely to be found in any physical therapy curriculum in a "pure" form because they are not mutually exclu sive. For example, think about how Curriculum as Academic Rationalism might enhance Curriculum as the Development of Cognitive Processes, or how Curriculum as Self-Actualization could seep into Curriculum as Social Reconstruction. Using these five orientations as surveying instruments, faculties, clinical instructors, and students together could dis cover the extent to which each of these orientations is currently operating as a base for decision-making related to curriculum change (or lack of change). After the value orientations become clear, the next step is to accept or alter the degree to which these value orientations are operating. For example, con sider possible answers to the following questions: With standardized licensure examinations, can cur riculum designers "risk" less emphasis on technol ogy and more emphasis on self-actualization? Will clinicians philosophically and behaviorally support the research of academic rationalism so severely needed by our profession; or must research be practiced only in university settings and leak out only through conventions and journals supported by other scientific disciplines? Is it our function in the intensive one- or two-year physical therapy taskoriented curricula to develop a student's basic cog nitive processes? Will a clearer view of our value orientations point to a possible answer to clinicianfaculty-student conflicts? Will a clearer view alter or solidify lock-step programs, bring more clinicians into the classroom and educators into the clinics, or change the questions asked in admissions inter views? The questions tumble out. Only after we have defined our value orientations can we respond coherently to Tyler's second and third questions. EVALUATION OF STUDENT PERFORMANCE We now turn to the fourth question of Tyler: "How can we determine whether these purposes are being attained?" The student evaluation process
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EXPRESSIVE AND OUTCOME OBJECTIVES Eisner and others have suggested two other types of objectives which we might consider as evaluation tools . 20 ~ 22
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1. Expressive Objective. This type of objective, instead of specifying a particular behavior the student is to demonstrate, describes a task in which the student is to engage. What is desired is not a homogeneous student response but responses as unique as the students themselves. The methods involved are evocative, not prescriptive. This notion is derived from the arts and humanities in which a student may be asked to read and interpret a poem or to create a "feeling" out of pieces of black and white paper and a bottle of glue. In such situations the educa tional outcomes are appraised after they emerge, and the evaluator plays a role similar to that of an art critic. Such an objective might be particularly useful in formative evaluation, that is, evaluation interspersed in a course of study for the purpose of determining what deficiencies students have which need to be remedied. For example, suppose a student is to fulfill an expressive objective such as "Observe and appraise a clinician measuring ROM of a frozen shoulder." And suppose the student reports instructions given to the patient, placement of the patient on the plinth, placement of the goniometer, stabilization applied, and motions and degrees of motion recorded. With such an appraisal the student is well on his way to fulfilling a behav ioral objective related to the use of a goniometer. But, obviously, educators would hope the student would see and be responsive to much more. Was the patient in pain and if so, how did the therapist respond? How did the therapist use her hands differently for guidance, reassurance, and stabiliza tion? Did the therapist talk with the patient on eyelevel or standing above the patient? Was the patient relaxed or apprehensive? What impact did this have on the measurement? Did the therapist convey assurance, or warmth, or boredom? The list is endless. The point is that if expressive objectives are used we would be in a better position to capture the essence of patient care.
2. Outcome Objective. In using this format for evaluating student per formance, the outcome to be achieved by the stu dent is highly delineated but the opportunity for solution is left open. This type of objective, which takes into account a number of specific standardized task behaviors and yet allows for individual skills and sensitivities to be used, fits particularly well into a health-care format. The end product in most cases is already well delineated in terms of "maximal PHYSICAL THERAPY
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is currently a much-discussed issue in professional education. With faculties now required by accredi tation protocol to have explicit behavioral objectives as evaluation guidelines for each course, we are witnessing the culmination of a tradition initiated by Bobbit 14 in 1924 in his scientific system of curriculum construction, formally explicated by Bloom 15 and his associates, and enticingly portrayed in Mager's bestseller Preparing Instructional Objec tives. 16 The process of defining curricular goals in terms of behavioral objectives appears to be the answer to a longed-for rationality and explicitness in the complex, muddied world of education. Who can argue with the idea that educational outcomes should be stated in terms of a change in the behavior of the student? Or, for that matter, that change should be observable, pertain to a given circum stance and attain a certain competence standard? 17 Thus, for example, one encounters behavioral ob jectives such as, "Given a list of 25 true-false questions on the structure and function of the synovial joint the student should be able to respond with 90 percent accuracy," or "Given a patient with patella tendon-bearing prosthesis, the student should be able correctly to perform a prosthetic checkout." Advocates of the instructional or behav ioral objective laud its observability, objectivity, standardization, and transferability. Why then is it that educators, clinicians, and even students are struggling with the design and implementation of behavioral objectives? The edu cator is overheard to say, "I have written 32 behav ioral objectives for this course and they don't begin to cover the material." The clinician exclaims, "Pa tients and disease processes are unpredictable. Six patients with rheumatoid arthritis are all treated somewhat differently. Students may have great technical skills in prescriptive formats but you can't use rubber stamps in the clinics." And the students may be heard mumbling, "Is that all there is?" These academicians, clinicians, and students are all correct. Behavioral objectives may quickly number into the unmanageable hundreds. Much more than can be objectified into behavioral objectives must be taught in the classroom and the clinic, and bright, young, creative students do not want to be "standardized." Indeed, much more is essential for the education of our students than the narrow confines of a behavioral objective. 18,19
CONCLUSION All three of these objectives, the behavioral ob jective, the expressive objective and the outcome
objective, have a place in our curricula. The expres sive objective, with its open solution and open end, may lend itself to seminars exploring health-care team dynamics or the development of research endeavors. The outcome objective, with its open solution and closed end, might be found in a course on neuromuscular disabilities. The behavioral or instructional objective, with a closed solution and closed end, is more applicable to lectures in anat omy or biomechanics. Certainly, knowledge ob tained by meeting all three of these objectives is used daily in all clinical settings. Those who are strong advocates of the behavioral objective may well ask, "How can expressive and outcome objectives be measured objectively?" The answer is, "They can't." Ideas for measurement are still in the early discussion stage and objective measures may never be formulated. If health care professions such as physical therapy combine ele ments of an objective science and a subjective art, modes of instruction and evaluation must be found which lend themselves both to the growth of science and the growth of the art. Let us be clear in the values which guide our curriculum planning and be flexible in the use of our outcome objectives so that our future practition ers have an expanding future.
REFERENCES 1. Standards for basic education in physical therapy. Phys Ther 52:521-525, 1972 2. Tyler R: Basic Principles of Curriculum and Instruction. Chicago, University of Chicago Press, 1949 3. Eisner E, Vallance E (eds): Conflicting Conceptions of Curric ulum. Berkeley, CA, McCutchan Publishing Corp, 1974 4. Pinkston D, Hochhouser S, Gardiner-O'Laughlin K: Stan dards for basic education in physical therapy: A tool for planning clinical education. Phys Ther 55:841-849, 1975 5. Hoffer E: CAI: While it has many advantages, let's not forget that it has problems. AAMC Ed News 3: 6-7, 1975 6. Dewey J: Experience and Education. New York, Macmillan, Inc, 1938 7. Rogers C: Freedom to Learn. Columbus, OH, Charles E. Merrill Pub Co, 1969 8. Nyberg D: Tough and Tender Learning. Palo Alto, CA, National Press Books, 1971 9. Rezler A: Attitude changes during medical school: A review of the literature, J Med Ed 49: 1023-1030, 1974 10. Illich I: Deschooling Society. New York, Harper and Row, Publishers, 1970 11. Johnson G: Curriculum design: A process in creative planning. Phys Ther 54: 384-386, 1974 12. Hutchins R: The Conflict in Education in a Democratic Society. Westport, CT, Greenwood Press, Inc, 1972
Volume 57 / Number 12, December 1977
13. Hislop H: The not-so-impossible dream. Phys Ther 55: 10691080,1975 14. Bobbit F: How to Make a Curriculum. Boston, Riverside Press, Div of Houghton Mifflin Co, 1924 15. Bloom B (ed): Taxonomy of educational objectives, Hand book I, Cognitive domain. David McKay Co, New York, 1956 16. Mager, R: Preparing Instructional Objectives. Fearon Publish ers, Belmont, CA, 1962 17. Miles D, Robinson R: Behavioral Objectives: An even closer look. Ed Tech: 39-44, June 1971 18. Eisner E: Educational Objectives Help or Hindrance. Read at the 50th Annual Meeting of the American Education Research Association, Chicago, 1966 19. MacDonald-Ross M: Behavioral objectives - a critical review. Instruc Sci 2: 1-52, 1973 20. Eisner E: Instructional and expressive objectives: Their for mulation and use in curriculum. In Popham W (ed): Instruc tional Objectives. Chicago, Rand McNally and Co, 1969, pp 1-29 21. Eisner E: Emerging models for educational evaluation. Sch Rev 80:573-590,1972 22. Stake R: To evaluate an arts program. In Stake R (ed): Evaluating the Arts in Education. Columbus, OH, Charles E. Merrill Publishing Co, 1975, pp 13-31
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functional behavior." As professional relationships with physicians become less prescriptive and more referral-oriented, physical therapy students in the future will be more likely to encounter directives in terms of, for example, DX: Chronic Low Back Pain (etiology unknown) RX: Evaluate and treat rather than DX: Chronic Low Back Pain (etiology unknown) RX: Hot packs, massage and Williams Flexion Exercises 3X week/4 weeks Now, if a student had been exposed only to behav ioral objectives he might, upon receiving the first order, proceed to evaluate and treat using a pre packaged treatment format much like the one delin eated in the second order. If, however, the student had been exposed to outcome objectives he might proceed to evaluate with a number of options in mind: Use of ice? Instructions in proper body mechanics in the patient's vocational setting? Sug gest use of manipulation or biofeedback techniques? Is the family reinforcing pain behavior?
Educational values held by academic and clinical faculties subtly but strongly influence curriculum design in physical therapy education. Five major value orientations, Curriculum as the Development of Cognitive Processes, Curriculum as Technology, Curriculum as Self-Actualization, Curriculum as Social Reconstruction-Relevance, and Curriculum as Academic Rationalism, are presented. The suggestion is made that these underlying value-orientations influence the choice of curriculum design more than do "available resources." A second component of curriculum design, i.e., evaluation of student performance, also influences and is influenced by the direction and development of physical therapy curricula. A plea is made for expressive objectives and outcome objectives to be considered along with instructional or behavioral objectives to yield more comprehensive and creative appraisals of student growth.
Each year academic and clinical faculties sit around long paper-laden tables and review curricu lum plans: "Should we add two more hours of functional activities related to total hip proce dures?" "Should we add four hours on an introduc tion to manipulation?" "Can we put a short section on the use, of community resources in the ethics course?" And, from the clinicians, come, "Are you teaching anything on working with mastectomy pa tients?" "Your students are very weak in orthotics." "We can't teach much in four weeks. Students are just feeling comfortable after the third week. Could they be assigned to us for six weeks . . . ?" And the students present their lists, too: "We need material on pharmacology." "What about more (or less) on PNF?" "Why can't we have our own lectures in physiology instead of sitting in with the medical students?" As always, too much has to be learned in too short a time and the increasing information explosion leaves students, clinicians, and faculties confused and frustrated. Theoretically at least, much of this confusion and frustration can be elimi nated by sound curriculum planning. The purpose of this paper is to identify and briefly discuss two components of curriculum planning —the values which influence basic curriculum design and objec tives which are established for student performance.
Ms. Shepard is currently a lecturer in the Division of Physical Therapy, Stanford University, Stanford, CA 94305. She is a candidate for the Doctor of Philosophy Degree in Sociology of Education at Stanford University.
Volume 57 / Number 12, December 1977
CURRICULUM DECISION-MAKING
Downloaded from https://academic.oup.com/ptj/article-abstract/57/12/1389/4558767 by University of Texas at Dallas user on 16 February 2019
KATHERINE F. SHEPARD, MA
A limited number of strategies are used by aca demic faculties in physical therapy to guide their decision-making in curriculum development. The most apparent universal strategy is to look at the APTA-approved "Standards for Basic Education in Physical Therapy" 1 and attempt to respond to these standards with currently available resources. Aca demic levels of students, clinical facilities used, academic strengths of classroom instructors, extensiveness of interdepartmental relations and commit ments, and money available are often listed as prime influencing factors. As a result, the solution to the problem of what to teach apparently revolves around what learning experiences can be provided within the confines of existing resources to fulfill which specific competency as stated in the Stan dards.
CURRICULUM DESIGN: FOUR FUNDAMENTAL QUESTIONS
In 1949, at the University of Chicago, Tyler published his famous and enduring rationale on curriculum. 2 The four fundamental questions he posed as prerequisite to developing a course of instruction include the following: 1. What educational purposes should the school seek to attain? 2. What educational experiences can be provided that are likely to attain these purposes?
1389
opt for increased time spent in clinical settings for both students and academicians. 2. Curriculum as Technology.
FIVE CURRICULUM VALUE ORIENTATIONS
The underlying learning theory of this orientation is essentially a stimulus-response reinforcement model; that is, a specific stimulus is given to the student who responds with a specific response. This reply is followed by immediate feedback (reinforce ment) to the student as to whether he has given a correct answer. Course content, eg, anatomy or biostatistics, which utilizes objective short-answer evaluation methods operates under this strategy. "Curriculum as Technology" is derived from the premise that such stimulus-response curriculum ma terials lend themselves to computer-aided instruc tion (CAI) and other prepackaged learning mod ules. The advantages of CAI are easy to visualize — self-paced learning, an interactive immediate feed back medium, availability at numerous locations for day and night use, and increased standardization of group outcomes. The disadvantages, however, considerably slow the implementation of this strat egy—substantial time, money, effort and special skills are required to produce good CAI material and to keep such materials updated. 5
1. Curriculum as the Development of Cognitive Processes.
3. Curriculum as Self-Actualization.
With this value orientation, the educator's con cern is with the development and refinement of intellectual processes— the how rather than the what. Emphasis is on providing students with opportuni ties to develop problem-solving skills which can be applied to any subject matter. Thus, for example, course content related to cryotherapy or clinical practice related to care of the patient who has sustained a burn would stress student learning ex periences in data gathering and sifting, the use of speculation and deduction, and effecting intellectual compromises. Little emphasis is placed on acquiring a multitude of facts —which are often lost, and, once lost, can be retrieved simply by using correct reference sources. Learning under this orientation, the physical therapy student would, for example, trade off memorizing collateral circulation of the knee for time spent in reading, conceptually digest ing, and discussing the question, "Given this patient information, what two different treatment regimens might you establish?" Exercising such basic cogni tive processes as analyzing, abstracting, and gener alizing has a natural laboratory in the clinical set ting. 4 Curriculum planners holding this view may
Appearing in this country with the forceful and enduring writings of Dewey 6 and coming of age in the humanist movement of the late 60s was a type of education advocated by Rogers, 7 Nyberg, 8 and others. Their premise is that schooling should be a total experience responsive to the unique needs of the individual. Personal self-fulfillment is the central curriculum theme, and the design is an open-ended value-saturated content which leads one on a jour ney of search to discover self. The ultimate outcome is existential in nature-a consummate experience to which the learner is guided by dramatic, dynamic, liberal teachers. The end product predicted is a creative, enthusiastic, emotionally stable adult. Of the five curriculum orientations, this one appears least likely to appear as a guiding strategy in health care curricula. Following medicine's example, allied health educators have often allowed science to become the only cornerstone and allowed art to become something the practitioner salvages from his preprofessional educational experiences. 9 With an increasing interest in the integrated mind-body of Eastern religion and medicine as well as increas ing "scientific discoveries" of the impact of the
1390
PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/57/12/1389/4558767 by University of Texas at Dallas user on 16 February 2019
3. How can these educational experiences be effec tively organized? 4. How can we determine whether these purposes are being attained? We are most familiar with the second and third questions and an inordinate proportion of curricu lum discussions focus on them. The reason is simple: deciding what experiences to provide and how to teach them comes to us quite easily out of the familiarity of our own history in the classroom and in clinical practice. Return for the moment to Ty ler's first question. What purposes should we seek to attain? This weathervane question seems explicit enough in "The Standards for Basic Education in Physical Therapy," yet in utilizing resources to implement these purposes, it becomes obvious that the choice of resources goes beyond simple availa bility. Our choice is strongly imbedded with our values —values which lead us to seek certain imme diately available resources and to overlook finding or initiating others. These tenaciously held values of curriculum planners are the key to forecasting curriculum decisions. Eisner and Vallance have delineated five major value orientations which have an impact on curriculum planning. 3
psyche on illness behavior, this orientation may find increasing acceptance. 4. Curriculum as Social Reconstruction-Relevance.
At the one end is the narrow practice under the prescription, supervision, and direction of the physi cian and at the other is the broad practice as an independent practitioner. The values, knowledge and skills that are desirable for practice in the one future vary markedly from those required for the other. 11
5. Curriculum as Academic Rationalism. This strategy is the most tradition-bound with its advocates identifying the educated person as one who has had access to the great ideas in science and the arts. " . . . Educated man should be able to continue the Great Conversation that began in the dawn of history, that goes on at the present day, and that is best exemplified by the Socratic dia logue." 12 This approach relishes history and exalts the slow, careful inquiry which has supposedly led to the formulation of universal principles and con cepts upon which unique bodies of scientific and artistic theory are built. With this orientation in mind, curriculum planners in physical therapy would advocate that less time be spent both in the class room and in the clinic on application of, for exam ple, principles of kinesiology, and more time on research devoted to discovering, synthesizing, and refining knowledge related to motor behavior. The lack of, and the current desperate need for, this orientation to be considered as a guide to curriculum Volume 57 / Number 12, December 1977
We must produce scholars in human pathokinesiology. Not every therapist can become a scholar in the true sense, but every therapist can be imbued with an understanding of science as it is applied to physical therapy. If the capacity for logical thought and scien tific values is not acquired early, there is little hope such qualities will surface later. 13
PRACTICAL USE OF VALUE ORIENTATIONS
Downloaded from https://academic.oup.com/ptj/article-abstract/57/12/1389/4558767 by University of Texas at Dallas user on 16 February 2019
This is a two-pronged orientation which places importance of the society above importance of the individual. One prong is the adaptive or conserva tive value strategy which depicts education as pro viding the student with tools necessary for survival in "real life." This line of thinking is supported by, for example, Illich, who advocates abolishing the schoolroom altogether and returning to an appren ticeship type of education. 10 The other prong is "reformist." This tenet holds that the school is the major vehicle for social change and students should be provided with visions of a better world and with political leadership skills with which to implement social change. In a physical therapy curriculum under the social relevance philosophy, for example, designers would be reluctant to trade hours cur rently allotted to modality practice for hours de voted to the yet-to-be-fully valued area of preven tive medicine. Faculties holding a social reconstruc tion philosophy would lean toward the opposite decision. As Johnson states,
planning was expressed by Helen Hislop in her eloquent address, the Tenth Mary McMillan lecture:
Of course, none of these orientations is likely to be found in any physical therapy curriculum in a "pure" form because they are not mutually exclu sive. For example, think about how Curriculum as Academic Rationalism might enhance Curriculum as the Development of Cognitive Processes, or how Curriculum as Self-Actualization could seep into Curriculum as Social Reconstruction. Using these five orientations as surveying instruments, faculties, clinical instructors, and students together could dis cover the extent to which each of these orientations is currently operating as a base for decision-making related to curriculum change (or lack of change). After the value orientations become clear, the next step is to accept or alter the degree to which these value orientations are operating. For example, con sider possible answers to the following questions: With standardized licensure examinations, can cur riculum designers "risk" less emphasis on technol ogy and more emphasis on self-actualization? Will clinicians philosophically and behaviorally support the research of academic rationalism so severely needed by our profession; or must research be practiced only in university settings and leak out only through conventions and journals supported by other scientific disciplines? Is it our function in the intensive one- or two-year physical therapy taskoriented curricula to develop a student's basic cog nitive processes? Will a clearer view of our value orientations point to a possible answer to clinicianfaculty-student conflicts? Will a clearer view alter or solidify lock-step programs, bring more clinicians into the classroom and educators into the clinics, or change the questions asked in admissions inter views? The questions tumble out. Only after we have defined our value orientations can we respond coherently to Tyler's second and third questions. EVALUATION OF STUDENT PERFORMANCE We now turn to the fourth question of Tyler: "How can we determine whether these purposes are being attained?" The student evaluation process
1391
EXPRESSIVE AND OUTCOME OBJECTIVES Eisner and others have suggested two other types of objectives which we might consider as evaluation tools . 20 ~ 22
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1. Expressive Objective. This type of objective, instead of specifying a particular behavior the student is to demonstrate, describes a task in which the student is to engage. What is desired is not a homogeneous student response but responses as unique as the students themselves. The methods involved are evocative, not prescriptive. This notion is derived from the arts and humanities in which a student may be asked to read and interpret a poem or to create a "feeling" out of pieces of black and white paper and a bottle of glue. In such situations the educa tional outcomes are appraised after they emerge, and the evaluator plays a role similar to that of an art critic. Such an objective might be particularly useful in formative evaluation, that is, evaluation interspersed in a course of study for the purpose of determining what deficiencies students have which need to be remedied. For example, suppose a student is to fulfill an expressive objective such as "Observe and appraise a clinician measuring ROM of a frozen shoulder." And suppose the student reports instructions given to the patient, placement of the patient on the plinth, placement of the goniometer, stabilization applied, and motions and degrees of motion recorded. With such an appraisal the student is well on his way to fulfilling a behav ioral objective related to the use of a goniometer. But, obviously, educators would hope the student would see and be responsive to much more. Was the patient in pain and if so, how did the therapist respond? How did the therapist use her hands differently for guidance, reassurance, and stabiliza tion? Did the therapist talk with the patient on eyelevel or standing above the patient? Was the patient relaxed or apprehensive? What impact did this have on the measurement? Did the therapist convey assurance, or warmth, or boredom? The list is endless. The point is that if expressive objectives are used we would be in a better position to capture the essence of patient care.
2. Outcome Objective. In using this format for evaluating student per formance, the outcome to be achieved by the stu dent is highly delineated but the opportunity for solution is left open. This type of objective, which takes into account a number of specific standardized task behaviors and yet allows for individual skills and sensitivities to be used, fits particularly well into a health-care format. The end product in most cases is already well delineated in terms of "maximal PHYSICAL THERAPY
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is currently a much-discussed issue in professional education. With faculties now required by accredi tation protocol to have explicit behavioral objectives as evaluation guidelines for each course, we are witnessing the culmination of a tradition initiated by Bobbit 14 in 1924 in his scientific system of curriculum construction, formally explicated by Bloom 15 and his associates, and enticingly portrayed in Mager's bestseller Preparing Instructional Objec tives. 16 The process of defining curricular goals in terms of behavioral objectives appears to be the answer to a longed-for rationality and explicitness in the complex, muddied world of education. Who can argue with the idea that educational outcomes should be stated in terms of a change in the behavior of the student? Or, for that matter, that change should be observable, pertain to a given circum stance and attain a certain competence standard? 17 Thus, for example, one encounters behavioral ob jectives such as, "Given a list of 25 true-false questions on the structure and function of the synovial joint the student should be able to respond with 90 percent accuracy," or "Given a patient with patella tendon-bearing prosthesis, the student should be able correctly to perform a prosthetic checkout." Advocates of the instructional or behav ioral objective laud its observability, objectivity, standardization, and transferability. Why then is it that educators, clinicians, and even students are struggling with the design and implementation of behavioral objectives? The edu cator is overheard to say, "I have written 32 behav ioral objectives for this course and they don't begin to cover the material." The clinician exclaims, "Pa tients and disease processes are unpredictable. Six patients with rheumatoid arthritis are all treated somewhat differently. Students may have great technical skills in prescriptive formats but you can't use rubber stamps in the clinics." And the students may be heard mumbling, "Is that all there is?" These academicians, clinicians, and students are all correct. Behavioral objectives may quickly number into the unmanageable hundreds. Much more than can be objectified into behavioral objectives must be taught in the classroom and the clinic, and bright, young, creative students do not want to be "standardized." Indeed, much more is essential for the education of our students than the narrow confines of a behavioral objective. 18,19
CONCLUSION All three of these objectives, the behavioral ob jective, the expressive objective and the outcome
objective, have a place in our curricula. The expres sive objective, with its open solution and open end, may lend itself to seminars exploring health-care team dynamics or the development of research endeavors. The outcome objective, with its open solution and closed end, might be found in a course on neuromuscular disabilities. The behavioral or instructional objective, with a closed solution and closed end, is more applicable to lectures in anat omy or biomechanics. Certainly, knowledge ob tained by meeting all three of these objectives is used daily in all clinical settings. Those who are strong advocates of the behavioral objective may well ask, "How can expressive and outcome objectives be measured objectively?" The answer is, "They can't." Ideas for measurement are still in the early discussion stage and objective measures may never be formulated. If health care professions such as physical therapy combine ele ments of an objective science and a subjective art, modes of instruction and evaluation must be found which lend themselves both to the growth of science and the growth of the art. Let us be clear in the values which guide our curriculum planning and be flexible in the use of our outcome objectives so that our future practition ers have an expanding future.
REFERENCES 1. Standards for basic education in physical therapy. Phys Ther 52:521-525, 1972 2. Tyler R: Basic Principles of Curriculum and Instruction. Chicago, University of Chicago Press, 1949 3. Eisner E, Vallance E (eds): Conflicting Conceptions of Curric ulum. Berkeley, CA, McCutchan Publishing Corp, 1974 4. Pinkston D, Hochhouser S, Gardiner-O'Laughlin K: Stan dards for basic education in physical therapy: A tool for planning clinical education. Phys Ther 55:841-849, 1975 5. Hoffer E: CAI: While it has many advantages, let's not forget that it has problems. AAMC Ed News 3: 6-7, 1975 6. Dewey J: Experience and Education. New York, Macmillan, Inc, 1938 7. Rogers C: Freedom to Learn. Columbus, OH, Charles E. Merrill Pub Co, 1969 8. Nyberg D: Tough and Tender Learning. Palo Alto, CA, National Press Books, 1971 9. Rezler A: Attitude changes during medical school: A review of the literature, J Med Ed 49: 1023-1030, 1974 10. Illich I: Deschooling Society. New York, Harper and Row, Publishers, 1970 11. Johnson G: Curriculum design: A process in creative planning. Phys Ther 54: 384-386, 1974 12. Hutchins R: The Conflict in Education in a Democratic Society. Westport, CT, Greenwood Press, Inc, 1972
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13. Hislop H: The not-so-impossible dream. Phys Ther 55: 10691080,1975 14. Bobbit F: How to Make a Curriculum. Boston, Riverside Press, Div of Houghton Mifflin Co, 1924 15. Bloom B (ed): Taxonomy of educational objectives, Hand book I, Cognitive domain. David McKay Co, New York, 1956 16. Mager, R: Preparing Instructional Objectives. Fearon Publish ers, Belmont, CA, 1962 17. Miles D, Robinson R: Behavioral Objectives: An even closer look. Ed Tech: 39-44, June 1971 18. Eisner E: Educational Objectives Help or Hindrance. Read at the 50th Annual Meeting of the American Education Research Association, Chicago, 1966 19. MacDonald-Ross M: Behavioral objectives - a critical review. Instruc Sci 2: 1-52, 1973 20. Eisner E: Instructional and expressive objectives: Their for mulation and use in curriculum. In Popham W (ed): Instruc tional Objectives. Chicago, Rand McNally and Co, 1969, pp 1-29 21. Eisner E: Emerging models for educational evaluation. Sch Rev 80:573-590,1972 22. Stake R: To evaluate an arts program. In Stake R (ed): Evaluating the Arts in Education. Columbus, OH, Charles E. Merrill Publishing Co, 1975, pp 13-31
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functional behavior." As professional relationships with physicians become less prescriptive and more referral-oriented, physical therapy students in the future will be more likely to encounter directives in terms of, for example, DX: Chronic Low Back Pain (etiology unknown) RX: Evaluate and treat rather than DX: Chronic Low Back Pain (etiology unknown) RX: Hot packs, massage and Williams Flexion Exercises 3X week/4 weeks Now, if a student had been exposed only to behav ioral objectives he might, upon receiving the first order, proceed to evaluate and treat using a pre packaged treatment format much like the one delin eated in the second order. If, however, the student had been exposed to outcome objectives he might proceed to evaluate with a number of options in mind: Use of ice? Instructions in proper body mechanics in the patient's vocational setting? Sug gest use of manipulation or biofeedback techniques? Is the family reinforcing pain behavior?
