F.A. Davis Moving to a Concept-Based Curriculum

Moving to a Concept-Based Curriculum + Next Steps

Susan Sportsman, PhD, RN, ANEF, FAAN Managing Director Collaborative Momentum Consulting

The Problem “The faculty organization has made the decision. We will be moving from a traditional curriculum for our undergraduate nursing program to a Concept-Based Curriculum. Now, what do we do?” This question is top of mind for most nursing faculty as they make the decision to move to a Concept-Based Curriculum (CBC). The decision to embrace a concept-based approach to organizing the nursing curriculum is typically based upon concerns that the volume of material nursing students must translate into caring for patients makes application in various clinical contexts difficult. Many faculty feel that preparing students for this daunting task by using the “traditional approach of transmitting large amount of material to passive students with minimal time to practice problem solving” is not working (Baron, 2017). Transitioning to a CBC provides an opportunity to change from an instruction paradigm to one focused on student learning. Rather than focusing on what the teacher needs, ( “I must tell the students everything they will need to practice!” ) faculty must make the classroom a place where students have the opportunity to think and develop clinical judgment skills. Baron (2017) suggests that a Concept-Based Curriculum focuses on understanding concepts by applying them through the use of examples (exemplars). Active learning on the part of the students is required: Students must be able to apply concepts in a variety of unfamiliar clinical situations (Baron, 2017). As Benner, et al . (2007) suggests in Educating Nurses: A Call for Radical Transformation (http://archive.carnegiefoundation.org/ publications/elibrary/educating-nurses-highlights.html) faculty must bring clinical into the classroom. The Concept-Based Curriculum provides a framework for such integration.

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Advantages of a Concept-Based Curriculum

Barriers Associated with Implementing a Concept-Based Curriculum 2. A Concept-Based Curriculum provides a number of benefits to the preparation of nursing students. In a review of the literature regarding the use of a conceptual approach in nursing education, Repsha et al . (2020) identified several positive outcomes of a CBC. For example, students’ critical-thinking scores trended upward as graduation drew closer and students described feeling empowered and having a sense of increased autonomy after completing their education with a CBC. Although NCLEX-RN® pass rates initially dropped for several schools implementing a CBC, the pass rates surpassed the national average in subsequent years. Despite the advantages associated with a Concept-Based Curriculum, barriers to implementation do exist. Table A outlines the prevalent barriers, because planning for implementation of a CBC requires these barriers be addressed. Typical barriers include:

Table A: Barriers to Implementing a Concept-Based Curriculum

During the Decision to Move to a CBC

When Developing and Implementing a CBC

Planning the Evaluation of a CBC

Fear of the unknown and lack of knowledge about conceptual learning

Amount of time and administrative work to develop a CBC

Difficulty in determining evidence-based markers that effectively measure the impact of a CBC

Dread of change

Disagreement regarding what concepts to include in the curriculum, what the definitions should be, and what the exemplars (examples) of each concept should be

Fear of not being the “expert”

Lack of knowledge regarding conceptual learning

Resistance to changing beliefs regarding the role of faculty and what students need to know

Adapting clinical experiences to a CBC approach

Fear of first-time pass rate dropping if a CBC is implemented

Concern that textbooks built on the systems approach to nursing may not be sufficient

(Adapted from Giddens, et al . 2021; Patterson, et al . 2016; Deane, 2017; Duncan & Schulz, 2014; Sportsman & Pleasant, 2017; Hendricks, and Wangerin, 2017; Decker, et al . 2017; Hensel, 2017)

Overcoming Barriers

Identifying barriers can be frightening, particularly when a prospective change is considered to be a “high-risk” endeavor. A framework designed to provide direction for planning a change can be helpful in dealing with barriers to the implementation of a concept-based curriculum. The VCST™ Framework below is particularly helpful in overcoming barriers when developing a CBC because of its specific focus on removing (or minimizing) the barriers to implementation.

Vision | Challenges | Strategies | Tactics (VCST™) Framework

AN EFFECTIVE APPROACH TO MANAGE CHANGE § Define the VISION (or outcomes) you would like to achieve. § Identify the CHALLENGES/barriers that stand in the way of accomplishing the vision. § Develop STRATEGIES to overcome the challenges. § Develop TACTICS to implement the strategies that are developed. http://collaborativemomentum.com

Example of Using the VCST™ Framework in Developing a CBC

The following tables are an outline of the application of the VCST Framework during a curricular change from a systems-based approach to a CBC. The Vision To develop a nursing curriculum which emphasizes the application of concepts important to nursing practice in a variety of clinical scenarios, thus encouraging student engagement in all aspects of their educational process. The Challenges/Barriers and Strategies Both the Challenges/Barriers and Strategies to overcome them are identified in Table B (Making the Decision to Move to a CBC), Table C (Developing the CBC) and Table D (Evaluating the Curriculum).

Table B. Making the Decision to Move to a CBC

Challenges/Barriers

Strategies to Overcome Challenges/Barriers

Fear of the unknown, lack of knowledge about conceptual learning

§ Provide external support for entire faculty through seminars, reading, and faculty discussions. § All faculty must be involved in this process, not just the committee assigned to the organization of the curriculum. § Focus on team building. § Hold faculty forums to explore the perceived outcomes of implementing a CBC using open and honest communication. § Provide adequate time for making the decision to change. § Moving to a CBC requires a change in focus from “teacher- centered” to “student-centered” teaching–learning. § Support for faculty as they move through this change is important. § Review current literature regarding NCLEX® pass rates for programs using a CBC. § Given the 2023 change to the NGN NCLEX, review the ways that this approach coincides with the requirement for active learning in a CBC.

Dread of change

Resistance to change beliefs regarding the role of faculty and what students need to know

Fear of first-time pass rate dropping

Table C: Developing the Concept-Based Curriculum

Challenges/Barriers

Strategies to Overcome Challenges/Barriers

Amount of time and administrative work to develop a CBC

§ Be realistic about the time required to develop and begin implementation of the CBC. (Programs report taking 1-2 years for the development process.) § Develop a timeline for steps in the process, but be flexible; life happens! § Suggest that faculty begin by converting a few lessons at a time and make peer review of the work expected and comfortable. § Develop an evidence-based process for determining which concepts and exemplars will be chosen, i.e., literature review, comparison with other programs, vote by faculty. § Provide templates. § Give faculty with special nursing expertise an opportunity to weigh in on decisions regarding their specialty.

Disagreement regarding what concepts to include in the curriculum, what the definitions should be, and what the exemplars (examples) of each concept should be

Challenges/Barriers

Strategies to Overcome Challenges/Barriers

Lack of knowledge regarding conceptual learning

§ Even if faculty have the opportunity to study conceptual learning as part of making the decision to move to a CBC, as the curriculum is being developed, faculty may find they really do not know how to structure classes and clinicals. Further education (reading the literature, presentations, etc.) may be necessary to connect the theory with practical application. § Engage faculty in experiences that demonstrate the power of CBC coupled with active learning. § Show faculty how the understanding of deep conceptual principles leads to application across situations. § Use CBC champions (faculty who understand the process) to help those who have less experience in this approach. § Emphasize continuous improvement; do not blame if a new learning episode is not successful during the first implementation. § Review literature and presentations and interact with experienced colleagues. § Provide an opportunity for clinical partners to be introduced to the principles of conceptual learning. § Ask selected clinical partners to assist in the development of clinical experiences. § While textbooks and related learning activities play a crucial role in students’ education, faculty have the flexibility to assign specialized content designed to align with specific concepts and exemplars being presented. It is not mandatory for students to read the material in the order presented in the text.

Adapting clinical experiences to a CBC approach

Concern that textbooks built on the systems approach to nursing may not be sufficient

Table D: Evaluating the Curriculum

Challenges/Barriers

Strategies to Overcome Challenges/Barriers

Difficulty in determining evidence- based markers that effectively measure the impact of a CBC

§ Continue to review the literature and talk to colleagues to determine what markers they are using. § Use the continuous quality improvement process to focus on evaluation markers that 1) are required by regulators AND 2) add areas in which students as an aggregate demonstrate difficulty.

Tactics 5. The last step in the VCST™ Framework is to develop actions that are specific to individual programs. The size of the faculty, the number of students in each cohort, support of the administration, the availability of resources (time and financial) all matter when determining the specific tactics. For example, the strategies above include learning about the CBC approach. Specific tactics might include sending selected faculty to conferences, inviting expert consultants to come to campus, or internal reading groups. The key point is to identify and implement those actions that work best for the program and to track the effectiveness of the strategies chosen.

About the author Susan Sportsman, PhD, RN, ANEF, FAAN , is a nationally recognized speaker and consultant with over 10 years of consulting experience, providing program development and other consultation services to nursing and health professions programs throughout the United States and Canada. Previously, she served as Dean of the College of Health Sciences and Human Services at Midwestern State University in Wichita Falls, Texas.

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References Baron, K. (2017) Changing to Concept-Based Curricula: The Process for Nurse Education. Open Nursing Journal , 11 : 277-287. Benner, P., Sutphen, M., Leonard, V., Day, Lisa. (2023) Book Highlights from Educating Nurses: A Call for Radical Transformation . Carnegie Foundation e-Library. (http://archive.carnegiefoundation.org/publications/elibrary/educating-nurses-highlights.html ). Accessed 2023. Brussow, J. A., Roberts, K., Scaruto, M., Sommer, S., & Mills, C. (2019). Concept-Based Curricula: A National Study of Critical Concepts. Nurse Educator , 44 (1), 15-19. Deane W, Asselin M. (2015) Transitioning to concept-based teaching: A Discussion of Strategies and the Use of Bridges Change Model. Journal of Nursing Education Practice , 5 (10):52-59. Decker, K. A., Hensel, D., Kuhn, T. M., & Priest, C. (2017). Innovative Implementation of Social Determinants of Health in a new Concept-Based Curriculum. Nurse Educato r, 42 (3), 115-116. Duncan, K., Shultz, P. (2015). Impact of Change to a Concept-Based Baccalaureate Nursing Curriculum on Student and Program Outcomes. Journal of Nursing Education , 54 (3). Giddens J, Brady D. (2007) Rescuing Nursing Education from Content Saturation: The Case for a Concept-Based Curriculum. Journal of Nursing Educator, 46 (2):65-69 Hendricks, S., Wangerin, V. Concept-Based Curriculum Changing Attitudes and Overcoming Barriers. Nurse Educator, 42 (3), 138-142. Hensel, D. (2017). Using Q Methodology to Assess Learning Outcomes Following the Implementation of a Concept-Based Curriculum. Nurse Educator , 42 (5), 250-254. Patterson, L. D., Crager, J. M., Farmer, A., Epps, C. D., & Schuessler, J. B. (2016). A Strategy to Ensure Faculty Engagement When Assessing a Concept- Based Curriculum. Journal of Nursing Education , 55 (8), 467-470. Repsha, C., Quinn, B., Peters, AB (2020) Implementing a Concept-Based Nursing Curriculum: A Review of the Literature. Teaching and Learning in Nursing, 15 (1) 66-71. January. Sportsman, S., & Pleasant, T. (2017). Concept-Based Curricula: State of the Innovation. Teaching and Learning in Nursing , 12 (3), 195-200.

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