The curriculum has no universal definition. Curriculum theory describes the basis of its development. Its four main components are aims, contents, methods of delivery teaching and evaluation(1).This theory defines the basic structure of curriculum but with more research in education, anatomy of curriculum has expanded Learning theories or paradigms have shaped the perspectives or model of curriculum from the beginning of last century. Behaviourist learning theories are based on response to a stimulus; cognitivist paradigms explain the mind-memory phenomena whereas constructivist theory explains the buildup of knowledge on the previous knowledge(2). Based on Skinners Behaviourist theory, Tyler in 1949 gave the prescriptive model of curricular development that comprises of educational purposes and experiences, structure and evaluation of the curriculum(3). Hilda Taba in 1962 modified Tyler’s model by producing an ‘Interactive model, which comprised of more or less of the same components, however more emphasis was laid on learning and teaching and all components (objectives, contents, learning experiences, teaching strategies and evaluative measures) interacted with each other(4). Walker in 1971 gave the process or descriptive model of curriculum development, which is also called naturalistic model. It was based on (i) Platform (beliefs that guide curriculum developer), (ii) Deliberation (process of making decisions) and (iii) Design (organisation and structure of the curriculum)(5).In 1986 for undergraduate medical curricula, Harden devised ten questions, which guided the practical development of a curriculum(6).Almost during the same time Mager stressed on the needs of defining the instructional objectives used in the curricula(7).Gagne however had stressed in 1965 on ‘conditions of learning’ and ADDIE model in early 1980’s emphasized the instructional design based on Analysis, Design, Develop, interaction and Evaluation(8). J G van Merrienboer gave the 4C ID model explaining the learning of a task, based on learning and training phase with reflection and feedback as the corner stones (9).
With evolution of Curriculum, it can be viewed as a sophisticated blend of educational strategies, course content, learning outcomes, educational experiences, assessment, the educational environment, timetable and programme of work (10,11). It becomes outdated or riddled with problems if not regularly reviewed and renewed (12). Being a dynamic entity, the curriculum can be considered alive and, in its ideal state, healthy. In humans, the standard values for being non-diabetic are less than 125 mg/dl (13), which is one of the standards to be achieved to remain healthy. If such standard is not achieved, the person will become unhealthy (diabetic). Some factors may act as inhibitors to the healthy state in humans and contribute to diabetes such as: eating unhealthy food and lack of exercise. Continuing in this metaphorical vein, curricula are like humans. There are curricular inhibitors that may deter them to achieve certain expectations (standards). Relevant literature in curriculum evaluation and accreditation have more emphasis on two aspects, either on setting standards (14) and seeking evidence to confirm their fulfillments or on describing clinical pictures of some curricular diseases (15). There is a need to explore the curricular dynamics and interplay of their elements and most importantly indicate the inhibitors that contribute to the morbidity of curricula.
The traditional approach to determine a curriculum’s health condition is to evaluate its quality. Curriculum evaluation aims to determine the curriculum’s quality by comparing it against different national or global accreditation quality standards (16). These quality standards in medical education curricula, for example, serve as expectations and may include, but are not limited to, the World Federation of Medical Education (WFME) global standards for quality improvement; Liaison Committee for Medical Education (LCME) accreditation standards; and General Medical Council’s (GMC) ‘Tomorrow’s doctor’ standards (17–20).
In this approach, quality is synonymous with the attainment of standards (21), whether they are basic minimum standards or standards of excellence (22). Consequently, the main emphasis is on defining quality, setting quality standards, comparing them with the outcomes, and on determining the extent to which standards have been met (23,24). The quality of curricula can be assessed in areas of mission and objectives, educational program, assessment, students, faculty, educational resources, program evaluation, governance and administration and continuous renewal (17). Such quality assessment, however, does not aim to detect the inhibitors that potentially interfere with the attainment of quality standards, but only serves as a checklist of what is in order and what is not. Even if a school or agency does identify the inhibitors that impede the achievement of standards, it is not a structured process that has been described in the literature.
As such, insight into the degree to which quality standards have been met may not give a true reflection of a curriculum’s health status. The curriculum may be meeting certain quality standards, but still be fraught with problems (inhibitors) that remain unnoticed without a purposeful effort to detect them (15).
That said, we can identify two approaches in curriculum evaluation, namely: the reviewers’ approach, which aims to provide a report on the current status of the curriculum against certain standards in a judgmental perspective, and the interpreters’ approach, which investigates why standards have (or have not) been met in a more analytical stance. Reviewers need only standards and evidence from practice to decide, while interpreters need to study the underlying variables that contribute to the current state of the curriculum. Interpreters are like doctors of the curriculum; they gather information to diagnose the condition from different sources.
Curriculum evaluation is done by reviewers, while we would like to introduce a new term that best suit the job of the interpreters: Curriculum viability, which is the current state of a curriculum determined by the degree to which particular quality standards have or have not been met, and inhibitors affecting the attainment of those standards. Hence, measures of viability will yield added information that is more valuable for renewal and improvement than quality measures alone. Figure 1 shows the difference in approach and outcome of curriculum evaluation and curriculum viability.
The allusion to these inhibitors is not completely new as Abrahamson in 1978 had already identified ‘Diseases of the Curriculum’ and the problems (inhibitors) responsible for them. He described nine diseases in total, along with the underlying problems in some diseases. While revisiting this iconic article, we can clearly identify some inhibitors that would help curriculum interpreters. For instance, curriculo-sclerosis is extreme departmentalization due to extreme ownership of the subject and fighting for the hours of the discipline. Curriculum carcinoma is curriculum imbalance due to overgrowth of a particular curriculum segment by the disparity in the powerbase of one or more disciplines. Curriculo-arthritis is the miscommunication between disciplines due to limited opportunities for faculty members to meet and interact. Iatrogenic curriculitis is the excessive tampering with the curriculum due to abrupt and unplanned response to adjust or modify changes according to meet societal demands and expectations.
The above inhibitors clearly affect a curriculum’s viability or well-being, yet they are not considered as part of regular curriculum evaluations based on specific standards (16,17,25). Sometimes the effect of inhibitors on the curriculum viability is not linear or straightforward. For instance, when faculty members resist change, this may not directly compromise curriculum quality now, but it could hinder the implementation of new ideas, thereby indirectly affecting future curriculum reforms. Adding more sophistication, one inhibitor (e.g., ineffective communication among faculty members) may compromise different aspects of curriculum viability and contribute to different manifestations simultaneously.
In summary, we postulate that curriculum viability provides a better foundation for evaluation and improvement than do traditional quality measures and also provides a basis for preventive measures. In the current study, we planned to conduct a scoping review to provide a quick overview to identify not only standards, but also inhibitors of curriculum quality, thereby allowing for a more comprehensive assessment of curriculum viability. The study aims to address two research questions: (1) What, according to the literature, are standards of curriculum quality? (2) What inhibitors of curriculum quality, have been reported in the literature?