Dr. Dorene Balmer PhD (Columbia University) is an expert on Qualitative Research methods and speaks through this webinar on Qualitative Methods, particularly through her own study on Resident Education.

1. A Model for Qualitative Research

2. Conceptual Framework and Purpose

3. Methods and Validity

4. Implicit vs. Explicit Curricula
in General Pediatric
Education:
Is There a Convergence?
Dorene Balmer, Christina Master, Boyd Richards,
and Angelo Giardino
Pediatrics, 2008

5. Explicit Curriculum
• Medical knowledge
• Patient care
• Professionalism
• Interpersonal
communication
• Practice-based learning
• Systems-based practice
Background
Implicit Curriculum
Opportunities to learn
when residents are
doing their everyday
work

6. Background (conceptual framework)
Hidden vs Formal Curriculum
◦ Rituals, beliefs, practices that function at the
level of the organizational structure and
culture
◦ Single competency: Professionalism
Implicit vs Explicit curriculum
◦ “Unadvertised”, informal and often ad hoc
teaching
◦ Spans the six competencies

7. Purpose (purpose)
• To study what pediatric residents have the
opportunity to learn implicitly as they do
their everyday work
• To understand how this learning maps on
to goals and objectives in a competency-
based explicit curriculum for a General
Pediatrics rotation

8. Operational Definitions
Explicit Curriculum
◦ Competency based goals and objectives for one
inpatient General Pediatric rotation
Implicit Curriculum:
◦ Observed and reported events, activities and
conversations that occurred as part of everyday life
on a General Pediatric floor

9. Data Collection: ObservationObservation
(Methods)(Methods)
One General Pediatrics floor
143 hours of observation
◦ 2/3s between 8:00 a.m. and Noon
◦ January to August
Medical team:
◦ Attendings, senior residents and interns
Observer-participant stance

10. Data Collection: Interviews
((MethodsMethods))
Overlapped with observation
14/18 attendings, 16/22 interns and 9/11
senior residents
Audio-taped and transcribed
General questions
◦ What surprised you?
◦ What would you change?
◦ No competency specific probes

11. Data Analysis ((MethodsMethods))
Data source
interview transcripts and notes from
observation
Inductive analysis
• Inductively derived codes
• Codes:“labels” for key concepts
• Iterative revision of code list

12. Data Analysis
Final phase: Identification of themes
pertaining to curricular convergence

13. TrustworthinessTrustworthiness (Validity)(Validity)
Single observer and interviewer
Prolonged observation, allowing for check
on preliminary findings
Independent coding of 30% of notes from
observation
Created audit trail

14. Theme 1: Overall Curricular
Convergence
• Residents had frequent opportunities to
address 29/32 more granular objectives in
the explicit curriculum
• Example:
• [objective for Patient Care] Develop an appropriate
diagnostic and therapeutic plan for patients requiring
hospitalization
• [observation on rounds] “… so the plan for this 6
month old with retropharyngeal abscess is to continue
the clinda …”

15. … but some divergence
Example
◦ Converged around communication and
teamwork
◦ Diverged around systems-based practice and
health care costs

16. Theme 2: Messiness of the Implicit
Curriculum
Difficult to predict
• Directed by patients illnesses and social
situations
Difficult to compartmentalize
• Lack of boundaries between competency
domains
• Example:
• Discharging patients: interconnection
between patient care and systems based
practice

17. Theme 2: Messiness of the
Implicit Curriculum
Difficult to balance
• Dominated by patient care
• Learning by doing

18. Theme 3: Lack of formal
recognition of the explicit
curriculum
• No direct reference to the explicit
curriculum or the AGCME competencies
throughout the study

19. Discussion
How the PARTS
Contribute to the WHOLE

20. Take away message:
• Recognize competency-based
education as inherent to the
learning that occurs in today’s
clinical context