I was first exposed to Biggs and Tang’s constructive alignment concept a couple of years ago and have personally found it, and parallel processes quite transformative in my thinking not only about education, but also my practice of medicine and life in general. Central to many aspects of life is having goals (intended learning outcomes). You then need to work out how you will achieve these goals (teaching and learning activities) and finally, you need to know whether or not you met the goals (assessment).
Rehabilitation Medicine practice: I run an day rehab program for people with diabilities at a major teaching hospital in Sydney. I now more explicitly think about the ‘intended learning outcomes’ (patient centred goals which are established between the patient, their doctor and their treating team which are SMART goals (specific, measurable, achievable, realistic and time-contingent). We then design ‘teaching and learning activities’ (therapeutic interventions in which the client participates eg medical treatment of spasticity with injections of botulinum toxin and / or oral medications, plus physiotherapy), and an ‘assessment’ (clinical review) is undertaken at the end of the therapy program to determine whether the goals were met. (Incidentally, something I am very interested in exploring further at some point is how principles of education can be applied to learning new skills in a rehabilitaiton setting…..maybe one for the future!)
Post Graduate Medical Education: in our four year post graduate vocational specialist medical training program, there is an assessment which is currently conducted during the first year of training. Historically, this exam was an “entry exam” into the training program to ensure that trainees had the requisite foundational knowledge and skills for the program: it was not part of the teaching and learning program itself, but an entry barrier. As it was not part of the training program, it did not have associated intended learning outcomes and associated teaching and learning activities. Due to an evolution of the training program, this exam morphed from being a barrier entry exam to being situated within and as an element of the training program. The problem was that as this exam became an embedded assessment, no intended learning outcomes (curriculum) and teaching and learning activities were developed in parallel. I explored some of these issues further in a review of our training program I was employed to undertake (Parker, 2015).
This has caused angst for:
- Trainees who, rightly so, have voiced concerns such as: “how am I meant to prepare for an exam that is a component of a training program when I don’t know what the intended learning outcomes are (there is no curriculum) and there are no associated teaching and learning activities.
- Examiners: how can an assessment be set with confidence and authenticity when there is no curriculum against which it can be blueprinted? Although I personally am not responsible for this exam, it comes under the auspices of the Faculty Assessment Committee of which I am a member and I have an ethical issue with this assessment how it is currently situated and have advocated strongly for change.
- The accreditation body: the Australian Medical Council (AMC) is responsible for accrediting specialit training programs in Australia. While the misalignment, or more accurately the non-alignment of this examination with intended learning outcomes and teaching and learning activities has not been identified by the accreditation body (yet), this is a potential stumbling block for future accreditation of the training program and needs to be addressed.
Where to from here? The faculty and College are currently undertaking a review of entry to training standards. The fortunate timing of this process offers a natural opportunity to revise how this ‘entry exam’ is defined within the program, so that can be not only seen to be serving its proported purpose, but actually doing what it needs to be!
So, to sum up, constructive alignment is central to many aspects of life from my perspective….and while the contexts may change, the underlying principles of: what am I trying to learn? How am I going to learn it? And how will I know that I have learnt it? Apply. Such fundamental principles are almost universal and ubiquitous.
Biggs, J. B. (2011). Teaching for quality learning at university: What the student does. McGraw-Hill Education (UK).
Parker, S. (2015). The Rehabilitation Medicine Trainee of the Future. Retrieved from https://www.racp.edu.au/docs/default-source/default-document-library/the-rehabilitation-medicine-trainee-of-the-future-report801e52afbbb261c2b08bff00001c3177.pdf?sfvrsn=0