Conceptual guidelines for developing and maintaining curriculum and examination objectives: the experience of the Medical Council of Canada

In an era of increasing professional accountability, there is a need for both medical educators and licensing bodies to identify attributes expected of medical graduates. Once these attributes are identified, educators must translate them into meaningful learning objectives. Because educators in many countries are in the process of defining (or have defined) attributes and competencies expected of their graduates, a review of the conceptual basis for writing curricular and examination objectives is relevant and constructive. The authors compare the principles of a conceptual model for identifying educational objectives and those used in the creation of the second (and most current) edition of the Objectives for the Qualifying Examination of the Medical Council of Canada (MCC). In developing these objectives, extensive and careful collaboration between licensing bodies, medical schools, the practicing profession, learners, and the MCC was critical. The process illustrates that the goals for the education of medical students can be consistent whether they are elaborated by medical schools or licensing bodies. The authors present the method and principles used by the MCC, including the clinical presentation model. The basic steps in the process are described: identifying the attributes, identifying the basic educational philosophy, assigning priority to problem-solving principles, and deducing learning objectives from desirable practice-related behaviors. The authors conclude with a consideration of the need and feasibility of defining the scientific underpinnings of competency-based learning objectives.