09. Curriculum mapping: helping you through the pain

Introduction

This chapter is meant to help you as a program director in organizing both your thinking around and documentation of the learning experiences and assessment opportunities that your program provides to ensure resident success. Curriculum mapping is a planning and communication tool that can be thought of as a road map to your curriculum. Most of us feel a little reluctant to sit down and tackle this task, and the prospect can even feel overwhelming. However, a small time investment and a little planning here will pay off, as your curriculum map will help guide your learners, clinical teachers and program team to success. Using this tool they will be able to see how your program’s learning and assessment opportunities fit together and promote resident progression. Curriculum maps should be living documents that are flexible and can be revised over time as the requirements of your educational context evolve. For example, new initiatives such as Competence by Design (CBD) will require changes to your curriculum map.

How a curriculum map can help your program

The main job of a curriculum map is to serve as a tool to align your program’s goals, training experiences and assessments. It links the program expectations at each stage to the learning opportunities and associated assessments. It helps you to plan learning activities along training stages in a logical sequence of progression (i.e., along the Competence by Design [CBD] Competence Continuum). It provides transparency about the learner’s expected educational journey for all stakeholders (learners, teachers, appraisers, administrators, etc.). It can help to highlight what is working well and diagnose program challenges such as unintended redundancies, gaps or sequencing issues in the curriculum (e.g., if a specific activity is at the wrong stage).

How to create a curriculum map

By following these straightforward steps, you can create a map that links your program’s competencies with educational strategies and assessment tools including entrustable professional activities (EPAs) and other forms of assessment.

1. Assemble a dynamic team: This should not be a lonely activity. Gather your team (your curriculum committee) by identifying and recruiting individuals who are passionate and committed. These may include members of the residency program committee, clinician educators, resident representatives, program administrators and others.

2. Keep the momentum going: Once you have assembled your team, plan a series of closely spaced meetings. Ensure that your team understands what CBD is, the rationale behind it and the changes that are needed. Consider selecting some key resources from the Royal College CBD resource directory and adapting them to your local context. Your postgraduate medical education office may also have resources available.

3. Revisit your program’s mission and/or goals: Whether you are just starting to design your CBD program, are in the thick of the design and implementation work, are responding to updates in your traditional or CBD curriculum or are taking over a program and reviewing the existing curriculum, you can perform this step.

• What competencies do you expect of your current graduates and future colleagues? Think about how your specialty may have evolved since the current curricular objectives were set.
• Review your current program goals to prioritize the most important ones.
• What strengths of your program do you want to ensure are maintained after the curriculum is changed? Think of how you like to “sell” your program to prospective residents during the Canadian Resident Matching Service (CaRMS) process and what you are proud of in your program.

4. Review your existing curriculum: Itemize your program’s rotations and teaching and assessment opportunities. If you don’t have a map of your current curriculum, create a diagram, map or spreadsheet so you can visualize your curriculum in one place. Although there are many ways to do this, here are a few curriculum examples. CanEra (Canadian Excellence in Residency Accreditation) provides a template based on CanMEDS key and enabling competencies for accreditation purposes. However, for the purposes of communication and planning with regard to your curriculum, you will probably need a template that directly links learning experiences and assessment. For example, as you progress through CBD implementation, these elements may change and you will need flexibility to ensure that your curriculum map does not become obsolete.

5. Match and map your new teaching and assessment activities: Seeing how all the different parts of your program fit together is an important step; don’t skip this one! For example, if you are making curricular changes as you move toward CBD, match your CBD curriculum’s required training experiences (RTEs) and other learning experiences to your EPAs and other assessments, and ask yourself the following questions:

• Are there any gaps (e.g., EPAs without learning experiences, or learning experiences without assessments)? Remember to go back to the CanMEDS framework to identify potential missing elements of intrinsic competencies. For CBD programs, your specialty’s pathway to competence document can help with this exercise as it shows the links between EPAs and the CanMEDS framework.
• Are there training experiences that are no longer required? If so, what will be the impact of removing each of these experiences?
• If there are current training experiences that do not map to particular EPAs, do they serve other learning needs? Could they be assessed in other ways?
• Are there competencies/learning needs that you cannot map to existing training experiences? If so, you may need to work with your curriculum committee to create new teaching, learning and assessment opportunities.
• Are there any concerns regarding equity, diversity, and inclusion that may be reflected in the mapping exercise? Does your curriculum specifically provide training and exposure in issues of systemic discrimination/racism within the practice of your specialty?

6. Ensure logical progression and even distribution of your curriculum: Remember that a resident should achieve all EPAs at a stage of training before progressing to the next stage of training. Distribute the EPAs, RTEs and other teaching and assessment opportunities across the stages of the program. Consider these questions:

• Have you ensured there are opportunities for learners to complete less complex EPAs before they complete more complex related EPAs?
• Confirm that the EPAs follow a logical progression of learning and comply with accreditation standards.
• Is it realistic for EPAs and assessments to be done within the curricular time allotted? Keep in mind that residents will often need a few tries at an EPA with targeted feedback before they achieve competence in it.
• Ensure that the EPAs are distributed “evenly” so that some rotations don’t end up with many more EPAs than other rotations.
• If an EPA can be mapped to several different rotations, ensure that you indicate which rotation is responsible for the EPA, for example by assigning required versus optional EPA expectations. This helps safeguard against a scenario in which multiple rotations all select the same EPAS out of a possible set of EPAs and one or more of the EPAs in the set remain unselected by any rotation. Often the same EPAs can be achieved in many rotations — the trick is to have a system in place to ensure that all are assessed without gaps.

7. Refine your map in light of practical realities: You may need to rearrange the EPAs and assessments in relation to the availability and timing constraints of training experiences and rotations. This is a complex step, but focusing some attention here will ensure that it is possible for your residents to achieve the EPA observations they need during their rotation schedule (i.e., there may be no opportunity for residents to manage an emergency-related EPA in their Transition to Discipline stage if they are only scheduled for ambulatory clinics). If the rotations can’t be altered, the program may need to delay progress to the next stage until that opportunity becomes available or consider whether a simulation experience would be a reasonable alternative. Another consideration would be contextualizing your map related to equity, diversity, and inclusion (EDI) Should it be specified About First Nations?) and anti-racism/anti-discrimination.

8. Ensure your program complies with accreditation standards: After you complete your new map, check the accreditation standards again to ensure that your program remains compliant. Don’t forget that accreditation requires that your curriculum map include mapping to the CanMEDS Roles down to the level of enabling competencies, EPAs, stage of residency training, required training experiences (how learned and taught) and assessment methods. Remember to check CanMEDS to ensure you have incorporated all the key and enabling competencies. Ensure you refer to the CanEra proposed template that is specific to accreditation-related mapping needs. Remember that your specialty’s pathway to competence document can help with this exercise as it shows the links between EPAs and the CanMEDS framework.

9. Prepare to implement your newly mapped curriculum: Once you have a good draft of your new curriculum, discuss the new curriculum map with your department or division members and chair or chief. When preparing to launch your new curriculum, consult the more extensive implementation resources on the Royal College website, but don’t forget the following:

• Allow time for faculty development for teachers, to engender culture change.
• Take the time to create a communication plan so that all stakeholders can understand what is expected of them on the basis of your curriculum map.
• Review your curriculum map with your residency program committee and competence committee members.
• Engage your residents in reviewing the curriculum map. Ask them to provide feedback on it, and let them know what the expectations are for them. Take care to include senior residents whose training has been based on the previous curriculum map, as they will provide a valuable perspective on the new map and can serve as role models for your more junior residents.
• If service changes are required, give the key stakeholders lots of advance notice to ensure they have the time they need to make the necessary changes. Be sure to explain the rationale for the changes.
• Try piloting elements of your new curriculum with your program’s existing training or teaching experiences.

10. Evaluate your program regularly: The goal of a curriculum mapping process is to promote open communication and continuous improvement. Accept that curriculum mapping is a transparent, dynamic and iterative process. Regularly evaluating what is working well and what needs improvement engages colleagues and residents. It helps to validate your curriculum and will assist you in adapting your program to improve the logical progression of training to ensure residents become competent.

Don’t forget to review your curriculum map regularly, especially when new versions of your EPA documents come out, or if there are other changes to your specialty that affect training. These changes very often will affect your map and you don’t want it to be seen as obsolete. Fortunately these reviews will usually be more about refreshing than starting from scratch.

Conclusion

The common saying “no pain, no gain” holds true for curriculum mapping. As with many things that program directors encounter, an investment of time and effort in curriculum mapping will definitely pay off, as it will make it easier for your faculty and residents to understand and adopt your program’s new expectations. Although there are many ways to create a curriculum map, we hope these principles will get you off to a good start.