17literature. Secondary data provides the advantage of immediate availability for use;
most is readily accessible and inexpensive and reduces collection time. However,
secondary data may fail to address the specific needs of the program and its target
population and thus may not be generalizable to all academic situations.
Many academicians in graduate medical education (GME) fail to begin curricu-
lum planning with a needs assessment for a number of reasons, with the most com-
mon a lack of confidence in what way to proceed. Although the reasons for a needs
assessment are recognized, hesitation exists because of uncertainty in the process,
limited resources, financial constraints, and lack of time to dedicate to the effort.
Occasionally, a sense that the needs of the program and the individual learners are
already clear to the planners may preclude the developers from taking the time to
perform the needs assessment. This paternalistic misperception is a significant pit-
fall to be wary of, as effective educators cannot presume to understand the perspec-
tive and needs of the target population without their input. Additionally, changes to
the curriculum that are implemented without the benefit of a needs assessment are
subject to great scrutiny if there are problems identified after the changes are
applied. It is difficult to defend actions taken without careful and thoughtful plan-
ning. Furthermore, it is difficult to define success or failure of curriculum changes
if outcome measures have not been clearly defined through the process of conduct-
ing the needs assessment.
Specific to a urologic surgical residency, some areas of needs assessment content
targeted to the recent graduates of the program include their perception of prepared-
ness for practice in all core areas of the urologic residency curriculum, proficiency
of surgical skills, readiness to engage in practice management, professional devel-
opment, interpersonal communication, and adaptation to their new practice environ-
ment post-graduation [ 1 ]. When targeting the current residents of the program, a
well-designed focus group setting led by a curriculum planner may be a very time-
efficient way to evaluate this cohort as all parties are proximately located on numer-
ous occasions during the educational period of residency. The content can be similar
to that sought from the recent graduate cohort, keeping in mind that at different
levels of training, the feedback will vary from inexperience. Currently practicing
physicians should also be surveyed for their perspective. Other considerations to
consider in curriculum development include the requirements of the residency
review committee (RRC) and in-service exam results. Communication with other
program directors who have gone through the same process can be invaluable in
planning and implementing changes.
Once the needs assessment is completed, reviewed, and analyzed, the assessment
should be validated for accuracy to make sure identified needs are the actual needs.
If the needs assessment was well designed and carried out, validation is a cursory
exercise, and the gaps are sound and clearly identified, which leads to the next step
in the process: constructing precise in-depth program goals and objectives. The
composition of a concise mission statement can help define the program and help
planners prepare to write thoughtful goals and objectives. A well-written mission
statement defines the focus of the program and the educational philosophy behind
it. Goals and objectives are not synonymous [ 2 ]. Program goals are global phrases
2 Surgical Curriculum Development