Complex perspectives on learning objectives: stakeholders' beliefs about core objectives based on focus group interviews

OBJECTIVE: To understand core curriculum design and involvement of stakeholders. METHODS: Twelve homogeneous focus group interviews with a total of 88 students, house officers, senior doctors and nurses concerning an undergraduate emergency medicine curriculum. Following content coding of transcripts, we analysed by condensation, categorisation and qualitative content analyses. RESULTS: The focus group participants gave a range of reasons for defining objectives or outcomes. They found their involvement in the process essential. Their argumentation and beliefs differed significantly, revealing 2 opposite perspectives: objectives as context-free theory-based rules versus objectives as personal practice-based guidelines. The students favoured theory-based objectives, which should be defined by experts conclusively as minimum levels and checklists. The senior doctors preferred practice-based objectives, which should be decided in a collaborative, local, continuous process, and should be expressed as ideals and expectations. The house officers held both perspectives. Adding to complexity, participants also interpreted competence inconsistently and mixed concepts such as knowledge, observation, supervision, experience and expertise. DISCUSSION: Participating novices' perspectives on objectives differed completely from expertise level participants. These differences in perspectives should not be underestimated, as they can lead easily to misunderstandings among stakeholders, or between stakeholders, educational leaders and curriculum designers. We recommend that concepts are discussed with stakeholders in order to reach a common understanding and point of departure for discussing outcomes. Differences in perspectives, in our opinion, need to be recognised, respected and incorporated into the curriculum design process.