Curricular Coherence and Global Health

Particularly in the United States, policy makers, parents, and the public are increasingly calling for higher education to meet workforce development needs and make connections between formal academic programming and careers. Some US states have considered tying financial allocations for public institutions to their graduates’ starting salaries. In response, institutions are revisiting their curricula to match workforce needs. As a young area of study, the global health field can respond to these types of concerns as educators develop new programs. The programs must be guided by clearly identified programmatic and learning outcomes with strong connections to theoretical and practical dimensions of global health.

As institutions construct new global health programs and reconsider existing ones, it is critical that they guide these programs using the principles of curricular coherence: intentional curricula that promote pathways for success. Instead of a cafeteria model, where students select courses from a list and take them at any point over their educational experience, curricular coherence provides students with a logical sequence of courses that build on each other (Leskes and Miller 2006). Since faculty are responsible for the curriculum, they must lead this comprehensive intellectual endeavor (Bordoloi Pazich 2017) and examine how the courses and experiences connect to create a pathway toward sequential learning (Leskes and Miller 2006). During curricular reflection, faculty must identify course learning outcomes that build upon students’ prior knowledge and skills, sequence classes accordingly, and explore activities that give students opportunities to adapt, integrate, and apply skills in different settings, including their future professions (Leskes and Miller 2006). These pathways present students with goals and learning outcomes to direct their learning. In addition, they make students aware of what to expect across their educational experiences (Green 2018) and the reasoning behind the program structure. This intentionality increases the likelihood of student success.

Within the growing field of under­graduate global health, the Cycle of Intentional Learning (Leskes and Miller 2006) is an excellent model for conversa­tions about curricular coherence and transparency (see figure 1). It starts with student learning goals and outcomes, which connect to curricular design and coherence, where faculty engage in critical dialogue about what students should be able to do at each level of their educational experiences, from skill devel­opment to content knowledge. Faculty must thoughtfully consider when and where to offer specific experiences and the types of pedagogies that will improve student learning and ensure students learn what their programs deem important. Students should also have opportunities to shadow profes­sionals in the field and reflect on these experiences. Finally, faculty must assess whether the curricular design and pedagogy were successful. Did students learn what was expected and demonstrate the appropriate level of learning? If not, what adjustments need to be made (Leskes and Miller 2006)?

Figure 1. The Cycle of Intentional Learning. (Click to enlarge image.)

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Image adapted from Purposeful Pathways: Helping Students Achieve Key Learning Outcomes by Andrea Leskes and Ross Miller (Association of American Colleges and Universities 2006).

When faculty apply principles of curricular coherence and intentionality, they pursue a shared vision for an integrative, holistic curriculum where students can make connections among all of their courses. Clearly identified and designed course sequences steer students toward higher levels of learning, more systematic development of intellectual skills, and deeper connections to practical knowledge that prepare them for their careers (Leskes and Miller 2006).

To encourage student success, institutional or program leaders who are creating and revising global health programs should examine the following considerations: a shared vision of global health, curriculum mapping, integrative learning frameworks, pedagogy and high-impact practices, and assessment.

A Shared Vision of Global Health

To facilitate the success of global health programs, it is essential to articulate the vision and meaning of global health and identify what students should be able to do, so that students, faculty, and professional staff are all on the same page. This shared vision contributes to the process of attaining curricular coherence when it is based on agreed-upon, measurable learning outcomes (Bordoloi Pazich 2017). The challenge of defining a shared vision of global health may be rooted in its circuitous history as a field. Global health has origins in public health and international health and has inherited some of the legacies of those fields, both of which have gone through periods where they were not clearly defined (Kiviniemi and Mackenzie 2017; Koplan et al. 2009). Global health has emerged as its own field that is more global in nature, transcending boundaries and examining global and local challenges. It is also increasingly interdisciplinary and goes beyond the health sciences (Koplan et al. 2009). These distinctions also affirm the need for a definition and a common approach for undergraduate global health.

We must create a unified, comprehensive, cross-institutional definition of global health that meets the needs of undergraduate global health programs. While there are many definitions of global health, some are more deeply rooted in the health sciences, such as medical or nursing education. Undergraduate global health students may go on to a variety of professions linked to global health, but they will still need integrative and interdisciplinary global learning centered around global health and health systems.

Faculty leaders must develop shared student learning outcomes and communicate them to all constituents. Effective design and pedagogy can yield specific global health student learning outcomes, and the emphasis should be on implementing practices that advance the identified learning goals and outcomes. Faculty in global health programs should work together to cultivate the desired qualities, goals, and outcomes for global health graduates (Leskes and Miller 2006).

The interdisciplinary nature of global health is an added challenge and benefit to this process. Faculty may be grounded in their own disciplines, but they must come together to align the curriculum with the shared framing of global health to prepare students for the range of global health experiences they may pursue. This takes time, but these conversations are essential to create a meaningful global health program guided by institutional goals, mission, and context.

The goals and outcomes should also give students insight into the ways diverse scholars in global health think and go about their work. Global health professionals draw on skills and knowledge from across the disciplines, so global health faculty must find agreement on the shared skills and knowledge necessary for professionals in the field, and they must also consult the literature on global learning. The AAC&U Global Learning VALUE Rubric (2014), with its six interdisciplinary dimensions of global learning, is an excellent resource to start the conversation among faculty about elements of global learning that should be embedded into global health student learning goals and outcomes.

Curriculum Mapping

To ensure their effectiveness and relevance, the curricula of global health programs must be aligned with learning outcomes from start to finish, and curriculum mapping is an excellent strategy to accomplish this (Green 2018). Curriculum mapping goes beyond adding or removing courses, which does not necessarily result in transformation (Bordoloi Pazich 2017).

In this process, faculty identify the connections among courses, field experiences, cocurricular activities, and careers, and then map the courses based on agreed-upon learning outcomes. This puts courses in developmental order based on the knowledge, theory, and skills students need to build over the course of the program (Green 2018; Leskes and Miller 2006). Faculty leaders should have conversations to identify courses for introduction, proficiency, and mastery levels and establish the right course sequence (Leskes and Miller 2006). These types of conversations facilitate faculty awareness of and agreement on knowledge and skills students should attain, as well as faculty ownership of their courses and their roles in the entire program, not just their individual courses.

Integrative Learning Frameworks

Global health epitomizes integrative and applied learning, which is “an understanding and a disposition that a student builds across the curriculum and cocurriculum, from making simple connections among ideas and experiences to synthesizing and transferring learning to new, complex situations” (Association of American Colleges and Universities 2009). Global health students must use problem-solving skills to address complex, unscripted issues; make connections across the curriculum and cocurriculum and with communities where they live, work, and study; and apply their learning to new situations (Ferren and Paris 2015). To prepare students to meet these challenges, faculty must coordinate and work together to identify curricular and cocurricular experiences that contribute to students’ learning (Green 2018).

This is where the interdisciplinary nature of global health is an asset, because faculty are used to applying diverse approaches to solve problems. Furthermore, students are challenged to use diverse frameworks and strategies as they engage in a variety of topics, such as disease prevention and treatment, access to clean water, or food security. With faculty support, students are able to see connections across course content, community developments, and experiences around global health topics (Green 2018). By building an integrative learning framework into a global health program, faculty prepare students to make these connections between their learning and their future work.

Pedagogy and High-Impact Practices

Faculty must thoughtfully consider active learning, collaborative learning, and field-based experiences that put students in direct contact with the realities of global health professionals. These pedagogies, when intentionally integrated, contribute to greater coherence and ensure that students have experiences in the fields where they will work once they complete their programs (Green 2018). Global health students should have opportunities to apply their skills and knowledge in a variety of field settings that mirror the broad field of global health to prepare them to blend theory and practice. Students also need to have multiple experiences at appropriate levels to practice these skills prior to completing the program. These experiences should be scaffolded over the course of the program (Green 2018), and students should see increasing skills and activities in each progressive experience.

Since experiential learning is an integral part of global health programs, faculty should consider embedding high-impact practices (HIPs) such as service learning, community-based learning, internships, and capstone courses and projects into their global health curricula. HIPs are “teaching and learning practices [that] have been widely tested and have been shown to be beneficial for college students from many backgrounds, especially historically underserved students, who often do not have equitable access to high-impact learning” (Kuh 2008). Kuh and O’Donnell (2013) have outlined quality dimensions that make HIPs high-impact. For example, students should invest significant time and effort over an extended period. For global health, this would mean engagement with the content, culture, or health topic over the course of a semester or an academic year, well beyond the timing of the field experience. Students also need periodic and structured opportunities to reflect on their learning (Kuh and O’Donnell 2013). Global health faculty should build this reflection into the course design and give students structured opportunities to connect their course-based readings, activities, and assignments with their field experiences. Faculty should ask critical guiding questions that require students to apply the practical and theoretical learning they are gaining inside and outside the classroom.

Assessment

Assessment of both the curricular design and pedagogy is essential to ensure student success in global health programs (Leskes and Miller 2006). With an interdisciplinary program, there may be questions about how to determine what is expected from students. While global health programs with a clinical component, such as nursing, medicine, or dentistry, may require an emphasis on the clinical experience according to their accreditation requirements, all programs must include assessment of global health skills and knowledge. Tools such as AAC&U’s VALUE rubrics, Iowa State University’s Global Perspective Inventory, and the Intercultural Development Inventory provide pathways to meet the aspirational goals of undergraduate global health programs. Faculty may also consider creating their own instruments to assess what their program deems important. Without strong assessment, it will be unclear how well students are learning and how to identify areas of improvement in curricular design and pedagogy.

Conclusion

Global health is a powerful example of liberal education. It is essential that emerging and existing global health programs coalesce around unified definitions and approaches for global learning to meet the needs of students and prepare them for diverse global health experiences. This unified approach will guide curriculum mapping, an integrated framework, and the types of pedagogy, practice, and assessment that empower students to succeed in their courses and after they graduate. With curricular coherence and intentionality, students should understand where they are headed in their educational experience and the connections between their courses and their future education and work.

References

Association of American Colleges and Universities. 2009. “Integrative and Applied Learning VALUE Rubric.” https://www.aacu.org/value/rubrics/integrative-learning.

———. 2014. “Global Learning VALUE Rubric.” https://www.aacu.org/value/rubrics/global-learning.

Bordoloi Pazich, Loni. 2017. “A Call for Curricular Coherence.” Inside Higher Ed, September 18, 2017. https://www.insidehighered.com/views/2017/09/18/overcoming-obstacles-curricular-coherence-essay.

Ferren, Ann S., and David C. Paris. 2015. Faculty Leadership for Integrative Liberal Learning. Washington, DC: Association of American Colleges and Universities.

Green, Madeleine F. 2018. In Search of Curricular Coherence. New York: The Teagle Foundation. http://www.teaglefoundation.org/Impacts-Outcomes/Evaluator/Reports/In-Search-of-Curricular-Coherence-(2018).

Kiviniemi, Marc T., and Sara L. C. Mackenzie. 2017. “Framing Undergraduate Public Health Education as Liberal Education: Who Are We Training Our Students to Be and How Do We Do That?” Frontiers in Public Health, 5 (9). https://www.frontiersin.org/articles/10.3389/fpubh.2017.00009/full.

Koplan, Jeffrey P., T. Christopher Bond, Michael H. Merson, K. Srinath Reddy, Mario Henry Rodriguez, Nelson K. Sewankambo, and Judith N. Wasserheit. 2009. “Towards a Common Definition of Global Health.” The Lancet 373 (9679): 1993–95.

Kuh, George D. 2008. High-Impact Educational Practices: What They Are, Who Has Access to Them, and Why They Matter. Washington, DC: Association of American Colleges and Universities.

Kuh, George D., and Ken O’Donnell. 2013. Ensuring Quality and Taking High-Impact Practices to Scale. Washington, DC: Association of American Colleges and Universities.

Leskes, Andrea, and Ross Miller. 2006. Purposeful Pathways: Helping Students Achieve Key Learning Outcomes. Washington, DC: Association of American Colleges and Universities.


Dawn Michele Whitehead is Vice President, Office of Global Citizenship for Campus, Community, and Careers, at the Association of American Colleges and Universities.

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