Blocks by Body System, Concepts With Exemplars or Competencies With Evidence: Comparing Three Curriculum Designs for a BSN Program Drowning in Content, and Choosing a Hybrid
Student Name
American College of Education
NUR6043: Fostering Clinical Judgment Through Curriculum and Evaluation
Module 2 Assignment
Instructor Name
September 16, 2030
The Current Design and Its Problem
Our BSN curriculum is organized in the traditional way: after fundamentals and health assessment, medical-surgical content is taught by body system, cardiovascular, respiratory, renal and so on, with separate courses for pediatrics, obstetrics, mental health and community health. Each course has grown over the years as faculty added content to keep up with practice, and no course has ever removed a topic. The adult health courses now cover more than 140 conditions. Students report memorizing lists that they cannot connect, and third-semester faculty, as Module 1 described, find that students cannot interpret what they notice. The committee has been asked whether a different design would help.
The Concept-Based Alternative
Giddens and Brady (2007) described content saturation as a long-standing problem in nursing education, with several contributing factors, and proposed a conceptual approach to curriculum and teaching. In a concept-based curriculum, courses are organized around concepts such as perfusion, gas exchange, fluid and electrolyte balance, infection or mobility. Each concept is taught through a small number of exemplars, conditions chosen because they illustrate the concept well and are common in practice. A student who understands perfusion deeply, through exemplars such as heart failure and peripheral arterial disease, is expected to transfer that understanding to conditions not taught, rather than memorizing each.
The approach has been widely adopted, and the literature now addresses what happens after the launch. Guidance on implementation notes that the transition is a major undertaking and benefits from a structured plan for moving courses to the new design (Harrison, 2020). Writing from a school several years into its concept-based curriculum, Solheim et al. (2022) argue that sustaining it requires deliberate effort, since the curriculum is dynamic, and recommend strategies built around effective use of the curricular model, engagement of stakeholders and leadership. The practical warning is that a concept-based curriculum can drift back toward saturation if no one owns the exemplar list.
The Competency-Based Alternative
A competency-based curriculum is organized around what graduates must be able to do. In the definition reached by an international consensus group, competency-based education starts from outcomes, puts competencies at the center of design, holds programs accountable for results, attends closely to the learner and cares less about how long a learner has been enrolled (Frank et al., 2010). The AACN Essentials adopted this approach for nursing in 2021, defining domains and competencies for entry-level education (American Association of Colleges of Nursing [AACN], 2021). In a fully competency-based design, students progress when they demonstrate competencies, and assessment is continuous and developmental rather than confined to course examinations. The design aligns well with accreditation expectations and with the concern for practice readiness, but it is demanding: it needs assessments at many points, faculty trained to judge competence consistently and systems to track each student's progression.
Comparing the Three
I compared the designs on five criteria. On content saturation, the traditional design fails and the concept-based design is strongest, since it requires faculty to choose exemplars and leave other conditions out; the competency-based design addresses saturation only indirectly. On clinical judgment, the concept-based design supports interpreting, the aspect our students struggle with, because it teaches students to reason from underlying mechanisms; the competency-based design supports it through repeated assessment of performance. On alignment with the Essentials and accreditation, the competency-based design is strongest. On evidence, none of the three has strong comparative outcome evidence; the concept-based literature consists mostly of program descriptions and evaluations, and competency-based education in nursing is too new for long-term outcomes. On feasibility, the traditional design wins by default, the concept-based design requires rebuilding every course, and a full competency-based design requires assessment infrastructure we do not have. No design wins on every criterion, which is an argument for combining them rather than choosing one.
A Hybrid Recommendation
I recommend a hybrid. Courses after fundamentals will be organized around concepts, with exemplars chosen for frequency and teaching value, which addresses saturation and supports interpreting. Program outcomes and progression will be defined by the Essentials competencies, with the competency assessments from the alignment work already under way, which meets accreditation expectations without requiring a fully time-variable program. Specialty content, pediatrics, obstetrics and mental health, will become exemplars within concepts where they fit, such as fever in a toddler under thermoregulation, while each specialty keeps a short clinical rotation.
The hybrid addresses the concerns raised in the concept-based evaluation. Pharmacology and pathophysiology will be integrated into each concept rather than removed, and licensure preparation will be addressed through the case-based assessment items already being developed. Exemplars will be reviewed every three years against practice data, so that the list does not grow back into saturation.
What One Concept Would Look Like
An example makes the hybrid concrete. Perfusion is currently spread across three body-system units covering about 25 conditions, from hypertension and heart failure to deep vein thrombosis, shock and peripheral arterial disease. In the hybrid, perfusion becomes a four-week concept within the first adult health course. Exemplars are chosen on three criteria: how often the condition is seen by new graduates in our partners' units, how well it illustrates the concept's mechanisms and whether it carries high risk if missed. On those criteria, the exemplars are heart failure, for impaired pump function; hypertension, for resistance and chronic disease management; deep vein thrombosis and pulmonary embolism, for impaired flow; and hypovolemic shock, for acute perfusion failure. Conditions such as cardiomyopathy or aortic stenosis are not taught separately; students are expected to reason about them from the mechanisms learned through the exemplars, and a case in the concept's final week tests that transfer with a condition not yet taught.
Pharmacology and pathophysiology are taught within the concept: anticoagulants with the thrombosis exemplar, vasoactive drugs with shock, and the renin-angiotensin system with heart failure and hypertension. The Essentials competencies attached to the concept, such as recognizing deterioration and communicating it, are assessed through a simulation in the fourth week. The same pattern, a concept, four or five exemplars, integrated pharmacology and pathophysiology, a transfer case and a competency assessment, will be used for every concept.
What the Change Asks of Faculty and Students
The hybrid asks the most of faculty. Teaching from exemplars means accepting that some conditions will not be taught directly, which many faculty experience as a risk to students. The committee will address that concern with first-year results from the transfer cases, a direct test of whether students can reason about untaught conditions. Faculty will also need time to rebuild courses; the plan in Module 6 will propose a phased transition over two years. Students will need to learn differently, with less memorizing of lists and more explaining of mechanisms, and the first semester will include explicit teaching on how the concepts work and why the curriculum is built this way.
References
American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials
Frank, J. R., Snell, L. S., Cate, O. T., Holmboe, E. S., Carraccio, C., Swing, S. R., Harris, P., Glasgow, N. J., Campbell, C., Dath, D., Harden, R. M., Iobst, W., Long, D. M., Mungroo, R., Richardson, D. L., Sherbino, J., Silver, I., Taber, S., Talbot, M., & Harris, K. A. (2010). Competency-based medical education: Theory to practice. Medical Teacher, 32(8), 638-645. https://doi.org/10.3109/0142159X.2010.501190
Giddens, J. F., & Brady, D. P. (2007). Rescuing nursing education from content saturation: The case for a concept-based curriculum. Journal of Nursing Education, 46(2), 65-69. https://doi.org/10.3928/01484834-20070201-05
Harrison, C. V. (2020). Concept-based curriculum: Design and implementation strategies. International Journal of Nursing Education Scholarship, 17(1), Article 20190066. https://doi.org/10.1515/ijnes-2019-0066
Solheim, K., Mittelstadt, K., Muehrer, R., Pinekenstein, B., & Willis, D. (2022). Sustaining a concept-based curriculum: Beyond the launch. Nurse Educator, 47(1), 31-36. https://doi.org/10.1097/NNE.0000000000001016
How this NUR 6043 Module 2 example is structured
NUR 6043 Module 2 often compares traditional and concept-based or competency-based curriculum designs; your classroom's instructions decide which. This example describes the current design and its problem, explains each alternative from primary sources, compares all three on stated criteria, reports the evidence honestly and recommends a design with reasons.
NUR6043 Module 2 questions, answered
What does NUR6043 Module 2 usually ask for?
NUR6043 Module 2 often asks you to compare traditional curriculum designs with concept-based or competency-based designs and recommend one for a program. Your classroom's instructions decide which designs.
What is a concept-based curriculum?
A curriculum organized around concepts such as perfusion or infection, each taught through a few exemplar conditions, so that students learn to reason from mechanisms rather than memorize every condition.
Is there strong evidence that one design is better?
Not yet. Most literature describes implementations and evaluations rather than comparing outcomes, so a strong paper weighs designs on several criteria and says so.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.