a tool for transparent and authentic teaching and learning

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This AMEE Education Guide was first published in Medical Teacher: Harden R M (2000) AMEE GuideNo 21: Curriculum mapping: a tool for transparent and authentic teaching and learning. Medical Teacher23(2), pp 123-137.

�� R M Harden is Director of the Centre for Medical Education and Teaching Dean in the Faculty of Medicine,Dentistry and Nursing at the University of Dundee. He is also Director of the Education Development Unit(Scottish Council for Postgraduate Medical & Dental Education), Dundee, UK

Guide Series Editor: Pat Lilley

Desktop Publishing: Lynn Bell

Copyright: © AMEE 2001

ISBN: 1 903934 01 X

Published by: Association for Medical Education in EuropeCentre for Medical Education � �� University of Dundee484 Perth Road � Dundee DD2 1LR �� Scotland UK

Tel: +44 (0)1382 631953 �� Fax: +44 (0)1382 645748E-mail: [email protected] � http://www.amee.org

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��The curriculum is a sophisticated blend ofeducational strategies, course content, learningoutcomes, educational experiences, assessment, theeducational environment and the individual students’learning style, personal timetable and programmeof work.

Curriculum mapping can help both staff and studentsby displaying these key elements of the curriculum,and the relationships between them. Students canidentify what, when, where and how they can learn.Staff can be clear about their role in the big picture.The scope and sequence of student learning is madeexplicit, links with assessment are clarif ied andcurriculum planning becomes more effective andeff icient. In this way the curriculum is moretransparent to all the stakeholders including theteachers, the students, the curriculum developer, themanager, the public and the researcher.

The windows through which the curriculum map canbe explored may include:

1 The expected learning outcomes

2 Curriculum content or areas of expertise covered

3 Student assessment

4 Learning opportunities

5 Learning location

6 Learning resources

7 Timetable

8 Staff

9 Curriculum management

10 Students.

Nine steps are described in the development of acurriculum map and practical suggestions are madeas to how curriculum maps can be introduced inpractice to the benefit of all concerned.

The key to a really effective integrated curriculumis to get teachers to exchange information about whatis being taught and to co-ordinate this so that itreflects the overall goals of the school. This can beachieved through curriculum mapping which hasbecome an essential tool for the implementation anddevelopment of a curriculum. Faced with curriculawhich are becoming more centralised and lessdepartmentally based, and with curricula includingboth core and optional elements, the teacher mayfind that the curriculum map is the glue which holdsthe curriculum together.

�� In medical education, much attention has been paidto curriculum development (Harden 1986). Emphasishas been placed on educational strategies such asstudent-centred learning, problem-based learning,integrated teaching and community-based teaching(Harden et al 1984). The use of new learningtechnologies and new approaches to assessmenthave also attracted interest (Harden 2000a). Changeshave been made too in the content areas to be studiedand new subjects have been added to the educationalprogramme with less emphasis placed on sometraditional areas of study (General Medical Council1993).

In contrast, an aspect of curriculum developmentwhich has been relatively neglected iscommunication about the curriculum. How doteachers and students know what is covered in thecurriculum and where it is addressed? How dostudents know what learning opportunities areavailable to assist them to master each of theexpected learning outcomes? How does assessmentrelate to the teaching programme? What resourcesare needed to mount each part of the programme?Curriculum mapping helps to provide answers to

these and other related questions. Curriculummapping is concerned with what is taught (thecontent, the areas of expertise addressed, and thelearning outcomes), how it is taught (the learningresources, the learning opportunities), when it istaught (the timetable, the curriculum sequence) andthe measures used to determine whether the studenthas achieved the expected learning outcomes(assessment).

As suggested by English (1984), when he introducedthe concept of curriculum mapping, “The real geniusof mapping is to give a broad picture of the taughtcurriculum” (p50). Curriculum mapping providescurriculum developers, teachers, students andmanagers with a handle on the curriculum whichthey may not have had. It is a powerful tool formanaging the curriculum. This guide illustrates howcurriculum maps achieve this by making thecurriculum more transparent and by linking thedifferent aspects of the curriculum – learningoutcomes to learning opportunities, different learningoutcomes to each other, assessment to teaching andso on.

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Curriculum mapping is about representing spatiallythe different components of the curriculum so thatthe whole picture and the relationships andconnections between the parts of the map are easilyseen. A curriculum is a programme of study wherethe whole is greater than the sum of the individualparts (Harden et al 1997). The curriculum mapsupports this through assembling the different piecesof the curriculum jigsaw together. This completepicture is more meaningful to the teacher, the studentor the manager than the picture presented by therandom collection of pieces which is often what theyhave.

This guide explains why curriculum mapping is animportant tool in education, facilitating as it does,many of the trends such as integrated teaching(Harden 2000b), outcome-based education (Hardenet al 1999a), the core curriculum (Harden and Davis

1995) and multi-professional education (Harden1998). The guide explains the concept of curriculummapping and suggests how, if used properly,curriculum mapping can lead to more effective andefficient education. It builds on previous work onthe subject including that of English (1984) oncurriculum mapping, Novak and Gowin (1984) onconcept mapping and Du Bois and Kiewra (1989)on matrix representation systems. The guide suggestshow medical teachers can use curriculum mappingto improve their own teaching. It has to berecognised, however, that experience of curriculummapping in education is limited. It is hoped thatreaders of this guide find that the suggestions andinformation contained in it will give them anunderstanding of the subject, encourage them toexplore the technique and assist them to formulatean approach appropriate to their own setting.

��Before we consider the concept of curriculummapping in more detail, we will look at why thetechnique has been introduced and how it can assistthe medical teacher.

Curriculum maps, like road maps, serve two keyfunctions.

❑ The curriculum map makes the curriculum moretransparent to all the stake holders – the teacher,the student, the curriculum developers, themanager, the profession and the public.

❑ The curriculum map demonstrates the linksbetween the different elements of the curriculum,e.g. between learning outcomes and learningopportunities and between the parts within oneelement, e.g. between different learning outcomes.

�� Road maps of the UK highlight major towns andindicate their relation one to another, as shown inFigure 1. Such maps are useful in the planning of anitinerary for visitors who intend to spend some timein the country. The visitors can decide which townsthey will visit, to which they will make only a briefexcursion and which they will explore in more depthon this or a future occasion. Special features, suchas gardens, castles or other sites of historical interestmarked on the map may assist them to plan theirvisit. So also are routes of transport – the roads,railways and airports. Using such maps, travellerscan plan their own itinerary, or agents or tour guidescan assist the visitors to plan an itinerary,

recommending towns and other sites to be includedin the itinerary and the most appropriate forms oftransport.

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In the same way, curriculum maps make transparentthe area of study and what is expected of the studentduring their course, in terms of the areas to bemastered as prescribed in the curriculum. The mapmakes explicit the essential core areas to be coveredand how students can achieve this.

The curriculum map, by making explicit what it isthat the students should learn offers a number ofobvious advantages. English (1978 p 15) describedthe ‘f ictional curriculum’. This is the declaredcurriculum – what it is assumed the student islearning. This may differ from the ‘real’ or taughtcurriculum – that is the curriculum as it is deliveredto the student (Figure 2). It may also be differentfrom the ‘tested’ curriculum - what students actuallylearn. The curriculum map makes explicit the implicitcurriculum and helps to ensure that what is assessedis in line with the declared curriculum.

The curriculum map, by making what is coveredexplicit, helps the curriculum developer and teacherto ensure that there are no gaps in the curriculumand that the same area is not unwittingly visited twicewith unnecessary repetition. Students and teacherscan use the map to discuss which areas should bevisited as part of the students’ programme of studiesand also the depth into which each area should beexplored at the different stages of the curriculum.

�� The user of a road map can see how near or far aparttowns are situated from each other and whether theyare connected directly by road or whether water, hillsor other obstacles intervene. Travellers can look atthe map from a specific perspective or area of specialinterest. If they are interested in sites of historicinterest, they will wish to find out how such sites are

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related to the towns, to the road systems, railwaysand airports.

The curriculum map, like a road map, shows thedifferent aspects of the curriculum and therelationships and the nature of the connectionsbetween them. With the curriculum map the user canlook at how the different content areas relate to eachother and how the course content relates to thelearning opportunities available, the learningoutcomes, and the assessment.

The expected learning outcomes for the curriculummay include an understanding of the pathogenesisof disease, skills in practical procedures andacquisition of appropriate attitudes. In the curriculummap, how the different learning outcomes are relatedto each other is made explicit, e.g. acquisition ofappropriate attitudes may be related to themanagement of patients. The curriculum mapencourages a holistic approach to medical care bydemonstrating the relationships and links betweendifferent learning outcomes – appropriate attitudesas well as technical proficiency, health promotionas well as disease management, and communicationskills as well as skills in physical examination. Themap also encourages the application of theory topractice by relating an understanding of basicmedical sciences to the mastery of clinical skills, thusemphasising the relationship between ‘knowing’ and‘doing’.

In outcome-based education, the importance ofrelating the different learning outcomes is madeexplicit in the three circle model (Harden et al 1999b).Wager (1976) used curriculum maps to examine thefunctional relationships between the differentlearning outcomes. “Diagramming theserelationships (between objectives from differentdomains) provides a visual analytic tool for theteacher in instructional sequencing and makesevident the need for instructional strategy decisionsbased upon the functions being served by theperformance objectives” (p4). Concept mapping canserve as a blueprint for developing curricular goalsand learning objectives, suggested Weiss andLevison (2000) and “might be used to transformmedical education by making it more integrated andinterdisciplinary”.

The introduction of integrated teaching has beenwidely advocated (Harden 2000b). Bydemonstrating the relationship between the differentelements of the course content, the curriculum mapoffers powerful support for this strategy. Thecurriculum map illustrates how the curriculum maybe focussed round different themes including thebody systems or topics such as chest pain.

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The curriculum map makes possible a level offamiliarity with the curriculum, on the part of bothstudents and teachers, which is important for thesuccessful implementation of an integratedapproach. In the traditional curriculum, teachers areused to looking at the curriculum from theperspective of their own discipline or content area.In an integrated curriculum, teachers are faced withnew boundaries. “The problem our faculty faces”suggests Edmondson (1993) “is how to

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reconceptualise the subject matter in a way thateliminates redundancy, creates a smooth transitionbetween courses, and demonstrates the conceptualinterrelationships the faculty hope students willdevelop as a result of integrated, meaningfullearning” (p1). She described mapping as a usefultool for the development of an integrated curriculumand how a map can be used to ensure coherenceacross the integrated curriculum.

In the previous section, a curriculum map is likenedto a road map with the main towns and how they arerelated and linked to each other identified. In thesame way, a curriculum map can be viewed as adiagrammatic representation of the curriculumdisplaying the different elements of the curriculumand the inter-relationships between these differentelements. These may include the learning outcomes,the course content, the learning experiences, thelearning resources and the staff. The map can alsoinclude the students’ programme of study, i.e. howthey interact with the learning opportunities indifferent phases of the education programme.

This section of the guide describes the points ornodes identif ied in a curriculum map and thecategories into which these can be grouped - the‘windows’ into the curriculum. It also looks at howthe nodes within one window or in different windowsare linked.

�� Four key areas covered in a curriculum map areillustrated in Figure 3.

In this representation, the learning opportunities areplaced at the centre. These may be a single or courseof lectures, a session in the community or anexperience in a clinical skills laboratory. Related tothe learning opportunities are the learning outcomesto which the learning opportunities contribute, thecontent or what is covered in the sessions and howthe development of the students’ competencies towhich the sessions contribute are assessed. In thisway, the curriculum map provides a broad multi-dimensional overview of the curriculum and itsdifferent components. The map may be looked atfrom the perspective of any of these four differentwindows. The different windows highlight what hasto be learned, how it can be learned and how thelearning is to be assessed. The emphasis placed oneach of the four windows characterises differenteducational approaches or philosophies as shownin Table 1.

A more extensive map is illustrated in Figure 4. Inthis paper representation of the map, students aredisplayed in the centre of the map. Ten windows areshown (Table 2).

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The expected learning outcomes which the studentwill achieve in the course or curriculum representan important window in the curriculum map. Thethree circle model with the twelve categories oflearning outcomes (Harden et al 1999b), provides a

useful framework for this window (Table 3). The sub-divisions of each of the twelve outcomes can berepresented in the map. The learning outcomes arelinked to other areas in the map, e.g. to the learningopportunities - what does the learning opportunitycontribute to the course learning outcomes; to thestudent - what learning outcomes the student hasachieved, and the evidence for this included in his/her portfolio; and to assessment - the learningoutcomes an assessment is designed to test.

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Curriculum content can be defined in terms of areasof expertise to be mastered. We have describedpreviously the use of task-based learning in planningand developing a curriculum with 100 or so tasksidentif ied as a focus for the students’ learning(Harden et al 2000). Tasks such as the managementof hypertension or a patient with a seizure can beconsidered as areas of expertise, to be mastered by

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1 The expected learning outcomes2 Curriculum content or areas of expertise covered3 Student assessment4 Learning Opportunities5 Learning location6 Learning resources7 Timetable8 Staff9 Curriculum management10 Students

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the student and these can be used as a statement ofcourse content. ‘Areas of expertise’ are equivalent,in knowledge management terms, to ‘communitiesof practice’.

Each area of expertise is made up of a series of nodes– ‘units of expertise’ – as illustrated in Figure 5. Thearea of expertise ‘hypertension’ includes units ofexpertise such as ‘measurement of BP’ and‘�-blockers’. These small discrete units of learningare equivalent to what has been described ine-learning as ‘reusable learning objects’ – smalldiscrete units which contribute to the course learningoutcomes and can be assessed. These units can beregarded as the Lego pieces or the building blocksfor larger learning units or courses. The ‘areas ofexpertise’ can be grouped in clusters, relating to thebody systems – ‘expertise clusters’. Hypertensionis part of the cardiovascular system cluster’ of areasof expertise.

The term ‘expertise mapping’ is used here to describethis area of the curriculum map in preference to theterm ‘concept mapping’ as used by Novak and Gowin(1984). The term represents the move to acompetency based model for education and the needto include skills and attitudes as well as the cognitivedomain.

Representing content in this way in a curriculum maphelps to improve understanding through theprovision of a structure. According to Mandler(1983), “meaning does not exist until some structureor organisation is achieved” (p4). Good teachersprovide such a structure as they communicate withtheir students about a subject. Poor teachers, incontrast, present students with what appears asapparently unconnected pieces of information.Kiewra (1997) describes how “structural knowledgecan be represented spatially so that theinterrelationships among ideas – the entire skeleton,the assembled puzzle – are apparent. Spatialrepresentations present ideas two-dimensionally sowhat relates within and across topics are easily seen”(p115). He suggests that this contrasts with standardtext which presents information linearly, one idea ata time.

Du Bois and Kiewra (1989) describe the underlyingstructure of information as hierarchical or sequential.Descriptors such as “types, part, components,characteristics and kinds signal a hierarchicalrepresentation”, suggests Kiewra (1997, p119). Anexample of such a hierarchical representation ofnodes or ‘units of expertise’ relating to the area ofexpertise, ‘lumps in the neck’, is shown in Figure 6.

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The sequential component in a map, Kiewrasuggests, is represented by words such as ‘steps,phases, next and before.’ Nodes or units of expertiseare related sequentially in the map where, forexample, a pathogenesis, a prognosis orcomplications of a condition or treatment aredescribed as shown in Figure 7.

In the ‘expertise’ area of the curriculum map, nodescan be represented not only hierarchically andsequentially but also as a matrix. The matrixrepresentation system described by Du Bois andKiewra (1989) displays structural knowledge spatiallyusing three simple patterns: hierarchy, sequence andmatrix. The matrix is the cornerstone as it developsfrom the hierarchy or sequencing representations.Musgrave and Cohen (1971) believe that allinformation has an underlying repeatable categorystructure and that the matrix is developed from this.In the expertise map, the repeatable categorystructure for the matrix is provided by the links tothe learning outcomes window. Each node or unitof expertise in the map is linked to as many of theoutcomes as are relevant. An example is given inFigure 8.

Another dimension to the matrix is ‘the patient’ asshown in Figure 7. This includes:

❑ age – child, adult, elderly.

❑ geographical, ethnic or cultural considerations

❑ stage of illness, e.g. acute or chronic

❑ special categories of patient, e.g. pregnant ordiabetic.

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Student assessment is a key factor in curriculumdevelopment – it influences what students learn andwhat teachers teach. The assessment area of the

curriculum map identifies the range of assessmenttools used in the curriculum, and the components ofeach approach. It may include, for example, an MCQpaper with 100 multiple true/false items and an OSCEwith 25 five minute stations.

Assessment is linked to the other areas of the mapincluding the learning outcomes. The map identifiesthe learning outcomes assessed in each of the stationsin the OSCE and each of the questions in the MCQpaper. The map relates the assessment to the learningopportunities and identif ies how the learningassociated with the students’ learning experiencesis assessed. The map also identif ies which staffmembers are responsible for the assessment, whichcan be useful for administrative purposes.

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An important area of the map represents the learningopportunities available to the student. These caninclude formal presentations and whole classteaching sessions, small group work and individual

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independent learning. The learning opportunitiesmay be classified into those available in each phaseof the curriculum and in the different courses in eachphase. In the example in Figure 4, it is assumed thatthe curriculum has three phases and that the emphasisis on system-based courses in the first two phasesand on clinical attachments in phase 3.

The learning opportunities may be linked to the‘learning location’ window to ensure appropriateaccommodation has been booked, to ‘students’ toidentify which students are scheduled to participatein a teaching session and to ‘learning outcomes’ toidentify how the learning opportunity addresses thecourse learning outcomes.

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An additional window shown in Figure 4, but notincluded in the shorter version of the curriculum map(Figure 3), is the ‘learning locations’. This windowincludes all sites where learning may take place.Typically this includes:

❑ Lecture theatres

❑ Small group rooms

❑ Library

❑ Learning resource area

❑ Computer suite

❑ Hospital wards in ‘teaching hospital’

❑ Outpatient and ambulatory care areas

❑ Other hospitals

❑ Community.

Each of these can be sub-divided, e.g. named lecturetheatres, different wards in the hospital and a rangeof sites in the community.

The ‘location’ window is linked to other windowsincluding the ‘learning opportunity’ window toidentify scheduled sessions, and the ‘timetable’window to identify their timing. The window maybe linked for administration purposes to the bookingarrangements for each site and to the equipmentrequirements at the site. This may be linked also tothe ‘staff ’ window which includes the technical staffresponsible for maintaining the equipment.

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A catalogue can be kept of all learning resourcesavailable to support the students’ learning and theseare recorded in a ‘learning resource’ window. Suchresources may include:

❑ books

❑ articles from journals

❑ computer programmes

❑ videotapes

❑ displays

❑ printed notes

❑ models and simulators

❑ simulated patients.

The resources may be linked to other windowsincluding the ‘learning outcomes’ and ‘content’windows.

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The curriculum timetable is an important andtraditional view of the curriculum. A ‘timetable’window shows chronologically the scheduling of thelearning opportunities in each phase of thecurriculum. The window can be linked to otherwindows including the ‘students’ window - thestudents who should participate in a scheduledteaching session, the ‘staff ’ window - the memberof staff who is responsible for the session, and the‘learning location’ window – where the session isscheduled.

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The staff window identif ies the professional,technical and administrative staff responsible for thecurriculum. It may include information about theteaching load of the members of staff, their areas of

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educational expertise, their appraisal and theirpersonal development programme. The window canbe linked usefully to other windows, including the‘learning opportunities’, ‘timetable’, ‘assessment’and ‘curriculum responsibility’ windows.

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A useful window to the curriculum relates to themanagement of the curriculum. This includes thestaff who serve on the curriculum committees, thestaff responsible as convenors for courses, e.g.system-based courses and the staff responsible forassessment. Information contained in this windowmay be used to inform teaching activity exercisesand the allocation of funds which is made relatingto teaching.

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Information recorded about students may include:personal details such as stage of study, previous levelof achievement and progression through thecurriculum, and participation in or attendance atscheduled learning opportunities. This area may bedeveloped to include a portfolio of the student’swork. The window can link to the other windowsincluding links to ‘assessment’ (the student’s progressrecord) to ‘learning outcomes’ (the student’s personallearning plan) and to ‘learning opportunities’ and‘timetable’ (the student’s personal programme ofwork).

Strictly speaking, the inclusion of ‘students’, ‘staff ’and ‘curriculum management’ windows as part ofthe curriculum map goes beyond what one wouldnormally expect to find in a curriculum map. Theyhave been included, however, to demonstrate howthey are closely linked in curriculum planning inpractice and how a curriculum map can beconsidered as part of a learning management system(LMS).

�� Reference has been made to the two components ofthe curriculum map. The first is the windows andthe content or nodes within a window. The second isthe links between the nodes within a window andbetween the nodes in different windows. Theserelationships or links, while difficult to represent ona paper version of a curriculum map in a form thatallows the nodes with their associated link to beidentified, can be displayed on a computer versionof the map. It is this combination of nodes and linksthat is the very essence of a curriculum map. At itssimplest level, a curriculum map can be viewed asthe combined stories of sets of two nodes and theirlinks. This is illustrated in Figure 8 where such linksor stories are illustrated for a node – ‘goitre’. Thelinks show for the unit of expertise, ‘goitre’:

a) the learning resource available, e.g. a videotapedemonstration of how to examine the neck;

b) the assessment of the students’ competence in thearea – a station in an OSCE designed to assessthe students’ mastery of examination of the neck;

c) the relevance of health promotion, e.g. dietaryiodide supplementation to prevent iodinedeficiency goitre, one of the commonest diseasesworld-wide;

d) the available learning opportunities in thecurriculum, e.g. the subject of goitre and itsmanagement covered in a lecture on the topic inweek three of the endocrine system course inphase 2 of the curriculum;

e) the sites where students can acquire experiencein the area, e.g. the endocrine clinic in one of thehospitals where they may get the opportunity toexamine a patient with a goitre;

f) the learning outcomes relevant to the topic‘goitre’, e.g. students should know when to orderbiochemical tests of thyroid function as part ofthe investigation of a patient with goitre.

�� The curriculum map offers a number of facilities.

❑ It can provide a day-by-day account of studentactivities (the course timetable covering theorganisation of content and the learningopportunities available).

❑ It can communicate what is expected of students– (the learning outcomes).

❑ It can provide a clear picture of what is coveredby students in each phase of the curriculum orstage of study (the course content).

It has to be emphasised, however, that a curriculummap is more than just a timetable, a list of contents,a syllabus or even a map of what is to be learned. Itincludes all of these and more. A curriculum mapprovides a multi-dimensional view of the curriculum

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and allows the user to look at the curriculum withdifferent lenses or through the different windowsdescribed. The user, whether course planner, teacheror student, may look at the curriculum, at one time,from the perspective of the timetabling andscheduling, at another time from the perspective oflearning outcomes and at another from theperspective of subjects or themes running throughthe curriculum.

It is not surprising that workers in the f ield ofcurriculum mapping have placed their own emphaseson what they see as the key role for the curriculummap. English (1979), in his early description ofcurriculum mapping, emphasised the curriculummap as a record of how students’ time is currentlyspent, and referred to the curriculum map as “adescriptive portrait of what tasks and how much timewere spent on any given set of items, concepts, skillsor attitudes” (p8-9). He saw the curriculum map asreflecting the ‘real’ curriculum and developed theconcept of a curriculum map as a method of

��The first step in preparing a curriculum map is toinvestigate the potential users of the map, their needsand the questions they are likely to ask. Is the mapintended for use by students, teachers, curriculumplanners, examiners or administrators? Table 4summarises the possible needs of different usergroups and gives examples of the types of questionsthey are likely to ask.

It is important to decide if what is needed principallyis a curriculum database emphasising curriculumcontent or a learning management system whichtakes a broader view of how students interact withthe curriculum and which tracks their progressthrough it.

�� The task of preparing a curriculum map may seemoverwhelming. The rewards of delivering such amap, however, are high and the potential benefitsare both compelling and tantalising. A map of thecurriculum is now an essential tool: every curriculumneeds a map if it is to be delivered effectively andefficiently. A decision has to be taken, however,about the complexity of the map and the level ofcurriculum detail displayed, for example, the numberof windows in the map and the amount of detail ornumber of nodes in each window. This decision

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describing the status quo and the actual schoolcurriculum as it existed. “A map is not a lessonplanned” suggested English (1979 p8) “a map is taskorientated, a recording of what was taught”. Otherworkers share this emphasis on the timetable ofcontent in curriculum mapping but with respect toplanning for the future rather that monitoring whathas happened in the past. Jacobs (1997) argued theneed for curriculum mapping and suggested theschool calendar as the focus of the map. The calendarwas used as the basis for collecting information aboutthe curriculum plans. This proved convenient andacceptable to teachers.

An alternative emphasis is on the content area ofthe map. Indeed, Eisenberg (1984) has suggestedthat concept mapping has some of its origins incontent analysis. Other writers have emphasised thelinks or relationships in the map. Wager (1976)focussed the curriculum map on “diagramming theinterrelationships among objectives from differentdomains of learning” (p2).

determines the amount of work required to developa curriculum map. In the simple version of a map,as shown in Figure 3:

❑ only a few windows are used;

❑ the learning opportunities are defined only ingeneral terms as they relate to each of the majorcourses in the curriculum, omitting a detaileddescription of each learning opportunity;

❑ the outcomes are specified at the broad level ofthe 12 main outcomes;

❑ the assessment is recorded at the level of the maincomponents of the end of phase examinations anddetails are not included relating to the individualquestions or stations in an examination;

❑ the content is def ined as a set of previouslydefined areas of expertise or tasks (Harden et al2000) and a detailed specif ication of contentrelating to each area is not included;

❑ Links between the different windows and nodesare restricted.

The curriculum map illustrated in Figure 4 is morecomplex with a greater number of windows. Itincludes ten different windows with additionalinformation noted in each window. Learningopportunities, instead of being defined at the levelof courses, are def ined at the level of majorcomponents of courses such as lectures, clinical

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experiences, and the use of textbooks or multimediapackages. Other windows are also defined in moredetail.

A feature of a curriculum map is that the map andthe windows in it can be presented at different levelsor depths. Road maps may be consulted whichindicate only the main towns, while others includesmaller towns and villages, and still more detailedmaps show the layout of the streets in an individualtown. In the same way, the level of detail in thewindows in the curriculum map may vary. The‘outcomes’ window of a map, for example, may beat the level of the 12 key learning outcomes requiredfor a good doctor - clinical skills, practicalprocedures, patient management etc, (Harden et al1999b). Alternatively, each of the twelve outcomescan be subdivided and represented in the map inmore detail with their subdivisions. Assessment maybe mapped also at different levels – at the level ofthe individual examination, the components of the

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examination e.g. written, OSCE or portfoliocomponents or the questions or stations within eachcomponent. Learning opportunities can be mappedat the course level, or at the level of the learningopportunities scheduled within a course, e.g. lectures,clinical ward based experience, computer assistedlearning etc.

Finally, a curriculum map can be static or dynamic.The latter is preferable with the map developed as aliving structure with which the student interacts andwhich changes with time. In this way the map canmirror the curriculum as it evolves. Teachers maybe encouraged to add to the map further information,relating to the learning opportunities for which theyhave responsibility. The curriculum map may bedesigned in such a way that it highlights the latestnews or developments in a f ield. It may displayinformation about new learning resources and howthey relate to the curriculum including the learningoutcomes. The map may also show changes to

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scheduled learning opportunities including lectures.Students can plot their own progress on the map andthis record, including the students’ reflections ontheir learning, can be the basis for a student portfolioused for the purposes of assessment.

In summary, decide:

❑ the number and nature of the windows in the map

❑ the level of detail to be included

❑ the extent to which the map is static or dynamic.

��The key links between the different windows andsections of the windows need to be developed. Ithas been emphasised that the essence of a curriculummap is not the nodes but the links or relationsbetween the nodes. It is the links which provide thereal power to the map. The logistics of the mappingexercise, however, means that there is a need torestrict what could otherwise be an almost infinitenumber of links. It is in recording and presentingthe links that computers come into their own. Allenet al (1993) described the impossible pattern of linesand connections that can result in presenting linkson a paper version of a map. Links may be set up ona computer so that data entered in one windowautomatically affect other windows in the map andallow cross-checking of the data included. Inconstructing the links it is helpful to think of thecurriculum map as a series of matrices. While thestrength of a map lies in its multi-dimensionality, itmay be helpful to think of the map in its preparationas a series of two-dimensional matrixes. For eachspecific area of content or expertise, e.g. a patientwith a goitre, the learning opportunities can bedescribed against each of the 12 learning outcomes.A second matrix may relate the 12 outcomes to the

assessment instruments, including writtenconstructed response questions, extended matchingitems, OSCE stations and the portfolio assessment.

� �� After the content of each window and the links havebeen decided, the next step is to decide:

❑ the sources of the information necessary topopulate each window

❑ the person or persons who will be charged withcarrying out the necessary inputting work and

❑ the person who will take responsibility for theprocess and for verifying the data.

Much of the information needed to populate acurriculum map may be contained in curriculumtimetables, student study guides, lecture handoutsand in statements of expected learning outcomes.

A pro-forma which summarises the requireddecisions about the map is given in Table 5.

�� The fifth step is to decide and prepare the format forthe map. Curriculum mapping was limited in the pastby the problems associated with storing,manipulating and updating the large amounts of datanecessary and by the inability to view easily theinformation from different perspectives (Eisenberg1984). The storage and display of the nodes and thelinks manually is unwieldy when the amount ofinformation contained in the window in a curriculummap is of the order illustrated in Figure 4. The amountof detail that can be presented on paper even in onewindow of a map is limited (Figure 9). With theexception of the simplest maps, the use of paper-based maps is too limiting.

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The ready availability and developments incomputing have given the concept of curriculummapping a new impetus. Eisenberg (1984) f irstpiloted a computer-based system using a mainframeIBM machine. The system, however, suffered fromnot being readily accessible to a wide range of usersand could not be modified to meet individual needs.Eisenberg went on to explore, by adapting existingmicrocomputer f ile management software, thedevelopment of a microcomputer system as a toolfor overcoming the difficulties of manual curriculummapping. Almost all maps will now be presented inelectronic form, usually on the internet. This has anumber of advantages. It allows the maps to be madeavailable widely to students wherever they arelocated, whether this is in the main teaching hospital,in the community or on a peripheral hospitalattachment. The presentation of the curriculum mapon the internet also allows the map to be readilyupdated.

Ross and Davies (1999) have described theirexperience in Birmingham with an electroniccurriculum map driven by a series of relatedFilemaker Pro databases and delivered to studentsand staff via the web. The map consists of a matrixof three types of data – learning outcomes, taught

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content and key terms. The key terms, based onmodified MeSH terms, provide a navigational toolworking within and between the outcome and thecontent data.

A digital presentation of the entire medicalcur riculum in the Faculty of Medicine at theUniversity of Oslo was described by Aabakken andBach-Gansmo (2000) with dynamic links to theavailable electronic resources. Lee (2000) describedthe development, in Tufts University School ofMedicine, of a computer-based curriculum databasewhich had a tremendous impact on the students andteachers and which offered the potential ofcontributing through the internet to a national corecurriculum and standards.

Whatever format is chosen, it is essential that themap is presented in a way that is user-friendly andmeets the specific needs of the different potentialusers. Some users may need a broad overview ofthe complete curriculum map, while others want anin-depth access to particular parts of the map. Theunderlying structure which underpins the map maybe complex, but this should be simplif ied andpresented to each user from the perspective of theuser. It is important to make it easy for the user to

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ask a question of the map and receive in return theanswer to the specific question asked. Examples oftypical questions of interest to different classes ofusers are given in Table 4.

�� !�� In designing a curriculum map, it is important todecide the extent to which the map should reflectthe past, the present and the future curriculum. Thecurrent curriculum map represents a snapshot of thecurriculum at that point in time and describes thecurriculum for each year of the students in the currentacademic year. Some change from the curriculumas it existed in previous years is likely. The result isthat the current curriculum map, which reflects thecurriculum as it exists at that point in time for eachyear, will not reflect the curriculum as experiencedby the students during their earlier years. The firstyear curriculum experienced by the current fifth yearstudents, for example, is likely to have been differentfrom the first year programme as shown on the mapof the current curriculum. What matters, when thefifth year class of students is considered, is the firstyear curriculum which they experienced and not theprogramme which is now available. It is importanttherefore to record on the curriculum map, not justthe current first year curriculum, but the first yearprogrammes as they existed for each of the years ofmedical students currently enrolled in the medicalschool. It follows that for a 5 year course there shouldbe 15 years not 5 years on record.

A curriculum map can also look to the future. Byreflecting proposed future changes to theprogramme, the curriculum map can assist withcurriculum planning and development. Such ‘future’maps, however, must be clearly distinguished from‘present’ and ‘past’ maps.

�� A decision needs to be taken as to who has accessto the map. In general, access to the map should beopen to all potential users within the institution.Access to specif ic sections of some windows,however, may need to be restricted. This may includesections where there is detailed information aboutthe content of the student’s assessment, personalinformation about individual students, and staffappraisal. A decision also needs to be taken as tothe extent to which the curriculum map should bemade available outside the institution e.g. on theinternet.

"�� It is important that the best use is made of the mapand all appropriate information is captured correctlyfor inclusion in the map. To this end, it is essential togive teaching staff, administrators and students someownership of the map, to provide them with thenecessary background information and to familiarisethem with how the map can be used. The importanceof a staff development initiative relating to thecurriculum map should not be under-emphasised.Maps, by their very nature, may seem impossiblycomplex and their use forbidding. The wholecurriculum mapping process needs to be demystifiedand the simplicity of access by potential usersemphasised.

�� #��$It is unlikely that you will get the curriculum mapright first time. It is important to plan to evaluate theuse made of the map and to collect the response ofstaff and students to the map once it is in action.

Moreover, inevitably there will be changes in thecurriculum and it is essential that arrangementsshould be in place to update the maps as necessary.This updating should be institutionalised as part ofthe accepted curriculum planning and revisionprocess.

� �� $� ��The production of the curriculum map will almostcertainly be a team effort with the tasks of producingthe specification for the map, developing appropriatecomputer tools and populating the map undertakenby different individuals or groups of individuals. Allthe major stakeholders should have an input into thedesign and production of the map.

It is important that the use of the map is part of theteaching strategy for the institution and has the fullsupport of teaching staff including the dean. It isadvisable to allocate the overall responsibility forco-ordinating the work required to develop thecurriculum map to one member of staff who is ableto give the map the necessary time and priority.

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��Curriculum maps offer a powerful tool which canbe used by all stakeholders in the curriculum. Thedifferent potential users, their particular needs andexamples of the questions they typically might askare given in Table 4.

%��The curriculum map is an essential tool for curriculumplanners or developers. It helps them to plan changesbased on a full understanding of the present position,and helps them to study the possible implications ofany changes made. It is particularly valuable in thecontext of an integrated curriculum or where one ishoping for a seamless interface between the differentphases of medical education.

Curriculum mapping offers the potential of applyingan artif icial intelligence approach where thecurriculum mapping process itself identifies furtherpossible changes in the curriculum.

��The curriculum map can help teachers in a numberof ways. It can help the teacher to match the part ofthe course or teaching slot for which the teacher isresponsible, to the students’ level of understandingand to the curriculum learning outcomes.

The map can provide also a vehicle in which teacherscan provide additional information about the areasin the curriculum for which he/she are responsible.This may be, for example, in the form of additionalinformation relating to a lecture, further referenceson a topic, or questions on a topic with associatedfeedback to allow the student to assess their owncompetence in the area.

The curriculum map provides the teacher with aframework on which he/she can chart the progressof students towards the exit learning outcomes. Thismay include an increase in the scope of the students’learning, both in depth and in breadth, an increasein the application to clinical practice and an increasein the students’ proficiency.

��A curriculum map makes more accessible to thestudent the areas to be studied and the learningopportunities available. With the move to student-centred learning, the challenge, suggestedO’Loughlin (1992), is “to define a pedagogy that istruly empowering rather than one that merely givesthe illusion of power”. Curriculum maps offer the

potential of doing just that. The maps indicate to thestudent what, of all the things that they might learn,are the things they must learn and identify for themthe most appropriate learning opportunities availableto achieve this. Lee (2000) found that, at TuftsUniversity Medical School, a curriculum map couldtransform students’ learning and make a majorcontribution to students’ knowledge management.Edmondson (1993) has pointed out that it isparadoxical that the design of a curriculum that aimsto be student-centred requires extensive facultyplanning and that faculty need to delineate theinformation that students will discover on their own.This is a role for curriculum mapping.

Just as a travel itinerary is planned and agreed bythe traveller and travel agent or tour guide, so thecurriculum map can be the basis for the developmentof a learning contract between the student and theteacher. Students can plan their trail or path throughthe map helped by the signposts at the intersections.For example, if they are on the learning outcomestrail they may be led to the most appropriate learningresources or to self-assessment questions.

�&��The curriculum map, if used appropriately byteachers and examiners, can help to correct themismatch that often exists between the teaching andthe assessment process (see Figure 2). The map canhelp the examiners to construct a valid examination- one that assesses what should be assessed. The mapmay also be used more directly as an assessmenttool. It may be used as a framework on which thestudents submit personal electronic portfolios. Thesecan be used to provide the evidence that the studentshave achieved the expected learning outcomes.

�� The curriculum map provides a valuable tool foradministrators. It helps them to meet theirresponsibilities in administering the curriculum andprovides them with a useful management aid. Usingthe map, they can identify who is responsible forthe different teaching-related activities, and they canassess the accommodation and resourcerequirements. Where funds are allocated todepartments or units in relation to their contributionsto the teaching programme, the curriculum map canprovide the necessary information which allows theteaching activity to be measured.

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��The key to an effective curriculum is to get teachersto exchange information about what is being taughtand to co-ordinate this so that it reflects the overallgoals of the school. This has become more difficult,however, with the increasing complexity of curricula.A number of factors have contributed to this. Theseinclude increased vertical and horizontal integration,the provision of a wide range of learningopportunities in different sites and settings includingthe hospital, the community, and other settings suchas the clinical skills learning area, and theimplementation of core curricula with options orspecial study modules.

Curriculum mapping can help to improvecommunication about the curriculum. Indeed, onecould argue that curriculum mapping is an essentialtool for the implementation and development of a

��'�� The curriculum map can be a valuable resource whenit comes to monitoring the curriculum andundertaking an internal or external audit. Ifappropriately designed, the map can be customisedto meet the needs of the auditors, so that the requiredinformation is provided.

� ��The map may be used to provide for the public atlarge and for potential students an overview of thecurriculum and a flavour of the types of learningexperiences on offer.

�� The question has to be asked as to the extent to whichthe use of a curriculum map is likely to help students.In the development of a new veterinary curriculumat Cornell, concept maps of the curriculum contentwere used for planning purposes only and were notdistributed to students. The intention was to protectthe students’ role in constructing their ownunderstanding of the material (Edmondson 1993).There is little direct experimental evidence to supportthe value of maps in enhancing student learning.There is however a theoretical and conceptualunderpinning for curriculum mapping includingevidence that advance organisers can lead to moreeffective learning by the student (Ausubel 1960). Itis likely that curriculum mapping will be provedeffective as a tool to enhance students’ learning asinvestigators devise measurement procedures that are

sensitive to the strengths of the approach. Curriculummapping offers a rich area for research in medicaleducation.

Increased attention is being paid to best evidencemedical education (BEME) where decisions aboutteaching and learning are based on the bestevidence available (Harden et al 1999c,www.bemecollaboration.org). A key factor ineducational research is the context or situation inwhich the research is conducted. The curriculummap assists the educational researcher by providingthis background and information about theeducational context in which the intervention is beingstudied. The map may also help to plan how theapproach or area studied can be evaluated by relatingit to the expected learning outcomes. The curriculummap may itself even open up new lines of enquiry.

A possibility for the future is that the curriculum mapcould be developed in such a way that evidenceavailable about educational practice and teachingeffectiveness is integrated into the map. The evidenceavailable about the effectiveness of the differentlearning opportunities may be linked to the learningopportunity nodes. For example, the evidencerelating to the use of simulated patients to teachcommunication skills may be related to the linkbetween simulation as a learning opportunity andthe communications learning outcome. Analysingand relating the available evidence to all aspects ofthe map, however, is an ambitious undertaking andone which is beyond the capabilities of any onemedical school.

curriculum in postgraduate as well as undergraduateeducation. Mapping not only assists with planningand implementation of the curriculum butimportantly helps to raise the level of discussion andreflection about the curriculum and resourceallocation.

If curriculum planning is to be effective, however,there are a number of requirements:

1 The curriculum mapping initiative must have fullinstitutional support and must be recognised as amainstream curriculum planning andimplementation activity.

2 Sufficient time from medical, educational andcomputer experts must be assigned to the task ofcreating the map. Appropriate carrots need to beidentified to encourage staff to take part in the

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8 An element of interaction should be incorporatedinto the map. Students can record their progresson the map or use it as the basis for their personalportfolios. Staff may annotate their owncontributions to the curriculum.

Faced with curricula which are becoming morecentralised and less departmentally based, and withcore and optional elements, the teacher may findthat the curriculum map is the glue which holds thecurriculum together. The curriculum map can helpto ensure that the best use is made of the teacher’sand the student’s time and to make sure what wewant to happen, happens. The map can help toensure that the student chooses the most appropriatelearning opportunities from those identif ied andmake the best use of the opportunities chosen. At atime of financial stringency the curriculum map mayfacilitate the prioritising of the use of resourcesincluding staff. Finding one’s way round a strangecountry or town without a map may be wasteful oftime and indeed the travellers may never reach theirintended destination. The use of a map can preventthis. The curriculum map helps to manage thelearning process by making the roles of the studentand of the teacher more explicit.

The curriculum map is a method of operationalisingoutcome-based education. In an age of qualityassurance and academic standards, the curriculummap has a role in determining whether thecurriculum meets specified standards and whetherthe school’s curriculum is congruent with theexpected learning outcomes.

Developing and implementing a curriculum map isnot an easy task. However, time and effort spentdeveloping and maintaining the curriculum map willprove to be rewarding. No good curriculum canafford to be without one.

exercise. For example only teaching activitiesrecorded in the map are counted in the estimateof teaching activity of individual members of staffand work on the curriculum map is itselfrecognised as a teaching activity which attractscredits.

3 One member of staff should be identified whowill provide the academic leadership. It isimportant that protected time is allocated for co-ordinating the curriculum mapping activities.

4 The map must meet the needs of all stakeholdersand must be user-friendly. No matter how complexits underlying structure and how comprehensivethe information contained in it, the map must besimple to use at the point of access by the widerange of users. It has to be recognised that userswill wish to consult the map at different levels ofdetail.

5 It has to be recognised that some teachers willfind the map threatening because of its perceivedcomplexity, and because of its reliance ontechnology. It may be seen as a threat to the staffmember’s autonomy with regard to his or herteaching. Why the map was introduced, the valueof using the map and how to gain maximumbenefit from it must be made clear to students,teaching staff and administrators. The opportunity,using the curriculum map, to take a multi-dimensional look at the curriculum using differentlenses or through different windows should beemphasised as an attractive feature.

6 The map must be flexible so that, as the needarises, it can be added to or changed in terms ofwhat is recorded in the windows or the links. Themap should be a living tool, evolving with thecurriculum.

7 The map must be able to record the pastcurriculum, in so far as it is relevant to the currentcohorts of students, the present curriculum andthe curriculum being planned for the future.

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Du Bois NF and Kiewra KA (1989). Promotingcompetent study skills: some new directions. Paperpresented at the National Conference on theFreshman Year Experience, Columbia SC.

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Edmondson KM (1993). Concept Mapping for theDevelopment of medical curricula. Paper presentedat the Annual Meeting of the American EducationalResearch Association, Atlanta, Georgia.

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