The Accreditation Council for Graduate Medical Education (ACGME) requires programs to develop goals and objectives for each educational level and distribute them to residents and faculty in written or electronic form,1 and specifies that these learning objectives “must be accomplished through an appropriate blend of supervised patient care responsibilities, clinical teaching, and didactic educational events.”1 These requirements reflect an understanding that explicit goals and objectives contribute to the planning, conduct, and evaluation of programs that prepare residents able to practice independently at the completion of training. The purpose of this article is to provide program directors with operational definitions, medical education examples, and features contributing to the quality of educational goals and objectives.
What Is Known
Goals, objectives, and competencies are terms with specific meanings used to communicate expectations for educational programs. The ACGME directs programs to communicate effectively about each of these components, such that learning expectations are transparent, explicit, and predictable to residents, faculty, and accrediting agencies. A classic format for behavioral objectives is Bloom's taxonomy.2,3 More recently, entrustable professional activities4 and intended learning outcomes5 have been added for communicating desired expectations to learners. Definitions and examples are provided in table 1.
What Can You Start Today?
Have faculty and residents review the written curriculum to guarantee that the goals and objectives make sense and are attainable within the constraints of the program.
Discuss with faculty and residents how often and in what way your objectives are actually used. What would make them more practical or useful?
Post pertinent objectives for residents at different training levels where the residents easily can review them: on the wards, procedural areas, or outpatient settings.
Revise learning objectives by using action verbs (table 2).
Elicit from faculty a list of their top 5 expectations for trainees. These expectations should specify what trainees should be able to know and do at the end of a period of learning. Frame these within the 6 general ACGME competencies.
Elicit from faculty major professional care responsibilities that, when demonstrated by residents, are evidence that trainees are ready to practice independently (“entrustable professional activities”).
Review assessment tools in terms of how they reflect your goals and learning objectives.
What Can You Do Long-Term?
Before a Residency Review Committee visit, the internal review process should examine your curriculum in detail.
Make your curriculum a living document that you refer to and update continuously.
At least once annually, obtain trainee feedback about the accuracy and utility of the learning objectives.
Schedule faculty development workshops for core faculty that focus on learning objectives and behavioral change, as well as new concepts in curriculum implementation.
Evaluate your current objectives. Where do they lie in the context of the cognitive taxonomy (level of acting on knowledge, shown in table 2)? Are higher-order category objectives used for more advanced trainees? Would some of them serve better as entrustable professional activities?4
Contact your specialty organization for national curriculum guidelines.
Develop relationships with local education specialists, for assistance in reviewing your curriculum.
Program directors must
Distribute program goals to residents and faculty annually
Ensure goals are reviewed during the annual program evaluation
Ensure goals and objectives make sense to residents and faculty
Develop “Goals & Objectives” for each level of training (by year, experience, or rotation)
Writing Clear Goals and Objectives
Do these broad statements of what the program is intended to achieve align with the program's mission, board certification performance, and alumni careers?
Do these statements of what trainees will learn …
Use action verbs that specify observable behavior? Identify when the learning should be achieved?
For example, “understand quality improvement” does not communicate an observable behavior, whereas “identify predictable barriers to quality improvement on an inpatient ward by the end of the second year of the program” does.8
In addition, this objective's inclusion of a specific time point satisfies the ACGME's expectation that objectives identify time-specific milestones and progressive levels of responsibility for trainees.
Link the objectives to expected competencies?
For example, “perform chart audits using national benchmarks to identify possible explanations for deficiencies associated with physician, patient, or system factors”8 is an objective linked to the ACGME's practice-based learning competency.
University of Michigan Advisory Committee
Séan Smith, MD, Resident Physical Medicine & Rehabilitation; Richard Cohan, MD, Faculty Radiology; Scott Gitlin, MD, Faculty Internal Medicine/Hematology/Oncology; Steven Kasten, MD, Faculty Plastic Surgery; Terry Kowalenko, MD, Faculty Emergency Medicine and Medical Education; Monica Lypson, MD, MHPE, Faculty Internal Medicine and Medical Education/Graduate Medical Education; Mark Prince, MD, Faculty Otolaryngology; Kevin Reynolds, MD, Faculty Obstetrics Gynecology – Gynecology Oncology; Catherine Spires, MS, MD, Faculty Physical Medicine & Rehabilitation; and Paul Dougherty, MD, Faculty Orthopedics.
Patricia B. Mullan, PhD, is Professor, Department of Medical Education at University of Michigan School of Medicine; Monica L. Lypson, MD, MHPE, is Associate Professor, Departments of Internal Medicine and Medical Education at University of Michigan School of Medicine.