Cracks in the curriculum: an appreciation

We recognize that undergraduate medical training (as distinct from education) is very much driven by learning objectives and outcomes (e.g., CanMEDS, LCME, CACMS, MCC). There is a requirement to insert such measures in a professional curriculum to ensure that teaching is in alignment with the dictates of accrediting and licensing bodies. Yet, there may be unintended consequences if objectives and outcomes are followed unthinkingly or too slavishly in the classroom. A recent British critique that has been widely circulated in Canadian academic circles entitled Learning Outcomes are Corrosive1 declaims the demerits of learning outcomes as they "threaten to disrupt the conduct of the academic relationship between teacher and student," "foster a climate that inhibits the capacity of students and teachers to deal with uncertainty," "devalue the art of teaching" and finally that the "regime of learning outcomes ... breeds a culture of cynicism and irresponsibility." Undeipinning these criticisms is the notion that such "utilitarian education" reduces the intrinsic meaning of learning at the university level and tends to oversimplify material, while rewarding "those who have internalized template-speak." Worse yet, it may promote among academics a "calculating and instrumental attitude where responsibility becomes equated with box-ticking" because the emphasis switches more to achieving outcomes without actually gauging what students have learned.