From Where We Sit – The Importance of Measurable Objectives

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“From Where We Sit” is a twice a year feature authored by NAACLS Review Committee Chairs, Laura Ahonen (PARC), Brenda Barnes (DRC) and Andrea Gordon (RCAP). For the previous “From Where We Sit” posts, please visit this link.

To keep program directors up to date and informed, NAACLS has a variety of resources available, such as The NAACLS NEWS, podcasts, workshops, coffee hours and the NAACLS website. One topic that has not been covered recently is the importance of meaningful and measurable objectives. Dr. Kathy Waller penned an article, “Writing Instructional Objectives” that was available on the NAACLS’ website for many years. While we could not find a date for this article, her resources included publications by Benjamin Bloom ^[1]Bloom, Benjamin S., (ed.) Taxonomy of Education Objectives: Handbook I: Cognitive Domain, N.Y., David McKay Company, Inc. 1956. in 1956 through Karen Karni ^[2]Karni, Karen, Writing Great Objectives and Exam Questions. Presented at the Clinical Laboratory Educators Conference, Salt Lake City, UT, 2000. from 2000.  Since the original publication of … Continue reading revised the original work creating A Taxonomy for Teaching, Learning, and Assessment. ^[3]Anderson, L.W. (Ed.), Krathwohl, D.R. (Ed.), Airasian, P.W., Cruikshank, K.A., Mayer, R.E., Pintrich, P.R., Raths, J., & Wittrock, M.C. (2001). A taxonomy for learning, teaching, and assessing: A … Continue reading The purpose of this article is not to get into the details of the revisions, or why they were developed, but instead how we can use these models in the development of our classes and programs.

Every academic accrediting agency will, in some form, require statements that clearly describe what the students should know, be able to do, and how to behave upon completion of courses and the program. The NAACLS’ Standards includes an introduction for each program type that specifies required Entry Level Competencies with further breakdown within Standard VIII.A.2. In addition, Standard IV.A.1.b. requires that current and prospective students have access to program goals and graduate competencies. We have found that different programs and institutions may use different terms for these statements that define what the student or graduate will know upon completion of a course or program. Competencies, objectives, outcomes, goals and even objective competencies are some terms that have been used. It is easy to get bogged down on the label, but regardless of the terms being used by a particular program the intent of these statements is to ensure that prospective and current students know what is expected of them upon completion of specific courses and the program. There may be general statements and others may be more specific and detail driven, including objectives within course units and hands-on activities. The approval and accreditation processes are not to judge the terms used to label the objectives, but to ensure that through those objectives students know what is expected of them.

Objective statements provide structure to the curriculum and inform faculty and students what students should know, be able to do, and the expected professional behaviors.  These statements must be measurable so they may be objectively evaluated.  Measurable objectives “provide enough information to measure student outcomes while also offering instructors sufficient freedom to adjust assessment methods according to the student population and the instructor’s strength….” ^[4]Shaw, A. (2018). 3 Tips for writing measurable objectives, Center for Teaching and Learning, Wiley Education Services. Posted October 12, 2017, … Continue reading (Shaw, 2017) Per NAACLS Standards they must include “pre-analytical, analytical and post-analytical components of the laboratory field” ^[5]NAACLS Standards for Accredited and Approved Programs, May 2021, Standard VII.B.. (Standard VIII.A.2) As such, it is essential that there are components integrated into each course that verify the degree to which a student has met an objective through assessment tools. Examples of such tools might include quizzes and examinations, homework and assignments, and observations evaluated through rubrics.

In our professions students must have the required knowledge base of the discipline and level (cognitive domain), and they must also possess technical skills (psychomotor domain) and behavioral skills (affective domain) expected of an entry level practitioner. As we write objectives, we must keep in mind that they represent all three domains as well as pre-analytical, analytical, and post-analytical components of the field. This does not mean that every single course will include objectives from all three domains. For example, a lecture only course may not have a psychomotor objectives. Nor does it mean that each course will include pre-analytic, analytic, and post-analytic variables. However, per NAACLS standards, they must be present within the program.

During an approval or accreditation process, it is not uncommon for programs to have concerns identified because clear and measurable objectives are not present to represent all areas mentioned above. Or perhaps an objective is written but there is no evidence of a process for evaluating that the objective is met.  VIII.C states “Evaluation systems must relate to course content and support program competencies. If there is no evidence found that competencies are adequately achieved (through feedback mechanisms as described in Standard II.B) then course objectives will be examined in detail to assure that the objectives are behavioral, including all domains and related directly to the evaluations used.” ^[6]NAACLS Standards for Accredited and Approved Programs, May 2021, Standard VII.C. Therefore, regardless of whether a program has stellar outcome measures for graduation rates, placement rates and certification rates, they must still have clear and measurable goals and objectives in place with a applicable evaluation process.

The original publication by Dr. Waller was comprehensive and provided many program directors at that time, and for many years, a wonderful source of key terms that could and should be used to describe the cognitive, psychomotor, and affective domains of learning to make them “specific, observable and measurable”.

She first explained that these statements consist of four components: an action verb, the conditions of which the objectives are to be met, the standard to which the performance is compared, and the intended audience.

For example, a clear and measurable objective can be dissected as follows:

Upon completion of this course, the student will be able to list the four components of a well-written objective

In this statement, the action is “to list”, the conditions are “upon completion of the course”, the standard is to “list the four components of a well-written objective”, and the audience is “the student”. This would be an example of a cognitive objective in that it is measuring what the student has learned. Let’s look more specifically at examples of objectives for each of the required domains.

Cognitive Domain

The 2001 Bloom’s Taxonomy revisions updated the cognitive dimension, from lower order thinking skills to higher order thinking skill. This model also identifies the order of thinking from concrete knowledge to abstract. ^[7]A Model of Learning Objectives–based on A Taxonomy for Learning, Teaching, and Assessing: A Revision of Bloom’s Taxonomy of Educational Objectives by Rex Heer, Center for Excellence in Learning … Continue reading

The verbs we use in a statement help to identify the level of thinking required for the concept. First semester courses rely on essential knowledge of concepts that can be built upon so that more advanced courses can expect students to think in the more abstract. It is important to note that the headings that are found above, particularly in the older model are not strong verbs to use in writing objectives. We often see statements like “the student will demonstrate knowledge of the white blood cell”. This general statement would be difficult to evaluate. What exactly should they know? That statement alone could mean anything from expecting the student to know the five types of normal white blood cells in the peripheral blood, to the construct of the DNA found in a mature neutrophil.  As such a better objective would state exactly what is expected, “the student will list the names of the five types of normal white blood cells found in human peripheral blood”.

In Defining, writing, and applying learning outcomes, A European Handbook (Cedefop, 2017)^[8]Defining, writing and applying learning outcomes: a European handbook. Luxembourg: Publications Office. Retrieved February 24, 2022.http://dx.doi.org/10.2801/566770 Cedefop tells us the importance of using precise verbs. For example, terms like know, understand, appreciate, and comprehend are vague and difficult to define. Using terms such as identify, list, compare, contrast, solve and differentiate provide more context for the specific objective. (p.49, Table 7, 2017)

Consider the difference between the following statements:

• Students will understand the importance of the immune system.
• Students will be able to list and describe five ways the immune system provides protection against gram negative bacteria.

While the first of these two statements may be somewhat useful to introduce a course, the second provides more information regarding specific student learning that can lead to greater understanding by breaking down the specific elements of the immune system that are important to the learner.

Table 1 Examples of verbs with statements used in writing cognitive objectives. ^[9]Shabatura, J. (2013). Using Bloom’s taxonomy to write effective learning objectives. University of Arkansas Tips Assignments & Measuring Student Learning. Posted Sep 7, 2013, … Continue reading (Shabatura, 2013)

Bloom’s taxonomy has also provided us with language for identifying the psychomotor and affective domains from lower order skills to higher level order skills. ^[10]Shabatura, J. (2013). Using Bloom’s taxonomy to write effective learning objectives. University of Arkansas Tips Assignments & Measuring Student Learning. Posted Sep 7, 2013, … Continue reading (Cedefop, p. 34, Figure 3, 2017)

Psychomotor Domain

Terms associated with psychomotor domain skills can be further defined:

• Imitation: Student can copy a demonstration.
• Manipulation: Student can perform a skill following an explanation or written instructions.
• Precision: Student can perform a skill to a defined standard.
• Articulation: Student can “multitask” or perform several skills together.
• Naturalisation: Student can perform a technique without conscious thought.

Upon completion of this laboratory activity, the student will be able to accurately measure 5 mL of distilled water using a serologic pipet.

Here we are measuring several things: the ability to properly use a serologic pipet, the ability to measure using a pipet, and the ability to do so accurately. One might argue that it is also measuring the student’s ability to discern distilled water from another available solution.

The condition of the skill  is “upon completion of this laboratory activity”, the standard is to “accurately measure 5 mL using a serologic pipet”, and the audience is the student. This is easily measurable by the laboratory instructor through accuracy of test results, remeasuring volumes, obtaining the density for example and would represent both manipulation and precision.

Affective Domain

The affective domain “categorizes the ways in which we think and reason” ^[11]Brouse, K. (2021). Understanding the affective domain of learning. Posted May 13, 2021. Graduate Programs for Educators. … Continue reading (Brouse, 2021). Within career programs this is often the mechanism we use to determine if a student is able to conduct professional behaviors that demonstrate characteristics such as motivation, ethics, integrity; and how we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations and attitudes. These are often things that are much more difficult to measure. Terms associated with the affective domains can be more clearly defined:

• Receiving: Student demonstrates good listening skills and a willingness to listen.
• Responding: Student is able to engage in active communication, asking questions, interacting with others freely and able to present information.
• Valuing: Students are able to take information and internalize it so it informs their way of thinking. This can be measured through the student’s ability to appreciate, justify or demonstrate how the information is important.
• Organization: The student can receive conflicting information and organize it to create their own point of view.
• Characterization: The student can take their point of view or beliefs and change behaviors accordingly.

Example of verbs that may be used when writing affective domain objectives:

Internalizing Values	Acts, influences, performs, qualifies, questions, revises, verifies, discriminates (e.g., shows self-reliance when working independently; cooperates in group activities; revises judgments.
Organizing Values	Adheres, alters, compares, defends, explains, formulates, generalizes, prepares, synthesizes (e.g., accepts professional ethical standards; accepts responsibility for behavior)
Valuing	Completes, demonstrates, differentiates, explains, initiates, invites, justifies, proposes, reports, shares, studies (e.g., is sensitive to cultural differences; values diversity; shows ability to solve problems.
Responding to phenomena	Answers, assists, conforms, discusses, performs, practices, presents, reads, recites, selects, tells, writes (e.g., participates in class discussion; questions new concepts; knows & practices safety rules)
Receiving phenomena	Asks, chooses, describes, follows, gives, holds, identifies, locates, names, replies (e.g., listens to others with respect)

Upon completion of this course the student will share why s/he believes it is important to comply with HIPAA regulations.

Here we are measuring the student’s ability to incorporate the rules and regulations associated with patients’ rights to confidentiality and express why they are important. This may be measured through a carefully crafted rubric that rates a student’s ability to explain and justify their opinion.

Assessment Tools

As mentioned earlier, writing good quality measurable objectives in the three domains is a requirement of the NAACLS Standards. They help to develop a solid curriculum that informs all stake holders. But to really do their job, the program must also have developed evaluation techniques that can be related directly back to the objectives as they are written. While there may

be times that we incorporate information beyond what is included in the program outcomes and objectives, assessment tools must directly relate to those objectives and not stray into alternate or extraneous content.

For example, in a hematology course we have just finished a unit on hemoglobinopathies. This unit has objectives specific to the analysis of hemoglobin S. But to supplement the course I have introduced the news that through gene editing there are new treatments for sickle cell disease.   This is certainly exciting news! I then add a question on the exam that says “Describe the CRISPR technique being used in gene therapy for sickle cell anemia.” Is this fair? The student has gone back to the unit as advised, read through all the objectives in preparation for the exam and studied hard. But it would be difficult for them to answer this question correctly. It is not in the textbook, nor in the list of things to know. It can be easy to introduce evaluation items into an assessment tool just because we find them interesting, or because we recall discussing them in a class. However, much like we refer the student to the syllabus and written objectives, we must also do our due diligence to use those statements in the development of our assessment tools, keeping in mind the level of thinking that is required.

Once faculty understand the purpose of measurable objective statements with related assessment methods, they can see how the process provides a foundation for student learning. Once implemented, courses progress more smoothly with clear expectations and result in satisfied students.  And in the end, the accreditation and approval Standard will be met.