NURS 619 Week 2 Reflection Paper 2 on Concept-Based Curriculum and the Educator's Role Example

Reflection Paper 2: Teaching Fewer Diseases and More Concepts, a Reflection on Concept-Based Curriculum and the Educator Who Designs It

Introduction

I learned nursing one disease at a time, in the order the textbook chapters ran. In my medical-surgical courses, heart failure, myocardial infarction, peripheral arterial disease and deep vein thrombosis each had their own lecture, their own list of signs and symptoms, and their own set of nursing interventions to memorize. I passed every exam, and the licensure examination on my first attempt, and then, in my first year of practice, I struggled whenever a patient did not look like the textbook. This term, my practicum placed me in a program that teaches medical-surgical nursing through concepts. Watching a class learn perfusion instead of four separate diseases made me reflect on how I was taught, what concept-based curriculum promises, and what it asks of the educators who design it.

How I Learned and How These Students Learn

In the concept-based course I observed, the unit on perfusion began not with a disease but with the concept: how blood flow delivers oxygen to tissues, what interrupts it, and what nurses assess and do when it is impaired. Students then studied two exemplars, heart failure and peripheral arterial disease, chosen because together they illustrate central and peripheral perfusion problems. The instructor repeatedly asked students to explain how the same concept explained different findings, such as crackles in one patient and cool, pale legs in the other. Later in the term, when the class met a patient with a pulmonary embolism, students worked out the nursing priorities by reasoning from the concept rather than recalling a list.

In their discussion of curriculum design, Billings and Halstead (2016) describe curricular frameworks as the organizing structures that determine how content is selected and sequenced, and they note that concept-based approaches respond to the explosion of nursing knowledge by focusing on transferable ideas rather than exhaustive coverage. I realized that my own education had tried to cover everything and had therefore taught me to recognize lists, while these students were being taught to recognize patterns.

What the Evidence Says

I wanted to know whether the concept-based approach actually produces better nurses, and the honest answer is that we do not yet know. Buckner et al. (2024) conducted an integrative review of outcomes of concept-based curricula compared with traditional curricula and organized the findings around four themes: critical thinking and clinical judgment, licensure examination pass rates, graduation rates and student satisfaction. They concluded that the evidence base is not robust and called for a valid and reliable tool to measure clinical judgment. That conclusion tempered my enthusiasm. A model can be logical and appealing and still lack strong evidence, and educators should say so when they advocate for it.

Students' own accounts add something that outcome data cannot. In conversational interviews with eight final-year students in a concept-based program, Bolianatz et al. (2026) described becoming a nurse as a process driven by reciprocal care and personal transformation, shaped by experiences of being evaluated, belonging to a cohort, making educational choices, experiencing nursing and seeing how nursing is presented. Their central point was that pedagogical care, the way educators care for students as they learn, is central to professional formation in a concept-based curriculum. That finding suggests that the curricular model alone does not form nurses; the relationships within it matter as much.

What the Model Asks of Educators

Watching the concept-based course, I noticed how much work the model demands of faculty. Choosing exemplars that illustrate a concept well, deciding where each concept appears across the program and at what level, and writing cases that require reasoning rather than recall all take more planning than updating a lecture on a single disease. Reekie et al. (2023) described faculty in one BSN program developing learning pathways, curriculum planning tools that map how specific concepts are leveled and scaffolded across courses, so that students build deeper understanding in line with constructivist theory and the curriculum keeps its integrity. Seeing their model made me realize that a concept-based curriculum is not a set of courses but a carefully sequenced map, and someone has to draw and maintain it.

Concept-based design also asks educators to think about outcomes in a new way. Chitwood et al. (2026) described a tiered model for structuring competency-based assessments in a nurse practitioner program, linking assignments to end outcomes required by the 2021 AACN Essentials. Although their program is at a different level, their approach showed me that concepts and competencies fit together: concepts organize what students learn, and competencies describe what they must be able to do with it.

What I Saw Go Wrong

The concept-based course was not without problems, and an honest reflection should name them. In the second week of the perfusion unit, several students told the instructor that they felt lost because they did not know which diseases would be on the exam. They had been trained by earlier courses to study lists, and the shift to concepts unsettled them. The instructor responded by giving students a short map showing the concept, its exemplars and the related conditions they should be able to reason about, which seemed to ease the anxiety. I also noticed that one exemplar, peripheral arterial disease, received far less class time than heart failure, so students' understanding of peripheral perfusion was thinner than the design intended. These problems were not failures of the model so much as signs of how carefully it must be implemented. Students need explicit help to change how they study, and faculty need to protect time for every exemplar.

The experience also showed me how important consistency across faculty is. When one clinical instructor asked students to recite the signs of heart failure from a list, the students who had learned to reason from the concept were confused about what was expected. A concept-based curriculum works only if classroom and clinical faculty share the same approach, which requires orientation and ongoing conversation among faculty, not only a new syllabus.

Faith and Curriculum Design

I was encouraged to find that a concept-based approach can carry a program's faith commitments as well as its clinical content. Bell (2025) proposed a biblically based concept curriculum that emphasizes deep learning, critical thinking and student-centered learning, gave examples of how faith can be integrated into curricula, teaching methods and assessments, and reported that students' perceptions of faith integration in nursing courses increased after it was implemented. For a Christian school of nursing, concepts such as caring, dignity and stewardship could be taught with the same rigor as perfusion. Colossians 2:3 speaks of Christ, "in whom are hidden all the treasures of wisdom and knowledge" (English Standard Version Bible, 2001/2016), and a curriculum that connects nursing concepts to that larger wisdom can help students see their work as part of a coherent whole.

What I Will Carry Into My Curriculum Plan

These reflections will shape the curriculum plan I begin next week in three ways. First, I will organize the plan around a small number of concepts and exemplars, with a map showing where each concept is introduced, reinforced and mastered. Second, I will connect each concept to competencies that can be assessed, so the plan is both concept-based and competency-based. Third, I will include faith-related concepts, such as caring and stewardship, as genuine curricular concepts rather than as statements in the philosophy alone. I will also be careful in how I describe the model's benefits, presenting it as a promising approach whose outcomes are still being studied. Finally, I will plan for the transition students experience, including a short orientation to concept-based learning in the first course, so that students who have learned to study lists are not left feeling lost as the students in my practicum site were.

Conclusion

I learned nursing as a list of diseases and spent my first years learning to see patterns on my own. Observing a concept-based course showed me a curriculum designed to teach those patterns from the start. The evidence for concept-based curricula is promising but not yet strong, and the model demands careful mapping, thoughtful exemplars and attentive teaching from educators. As I begin my own curriculum plan, I want to build a structure that teaches patterns, measures competence and cares for students as they become nurses, and I want to describe it to colleagues with the same honesty about its limits that I have tried to bring to this reflection.

References

Bell, A. (2025). Integrating faith and learning using a biblical concept-based curriculum. Journal of Christian Nursing, 42(1), 22-27. https://doi.org/10.1097/CNJ.0000000000001226

Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). Elsevier.

Bolianatz, J. D., Chernomas, W. M., & McMillan, D. E. (2026). Becoming a nurse: Pedagogical care and professional formation in a concept-based curriculum. International Journal of Nursing Education Scholarship, 23(1). https://doi.org/10.1515/ijnes-2025-0091

Buckner, M., Camp, S., & Murabito, S. (2024). Outcomes of concept-based curricula: An integrative review. The Journal of Nursing Education, 63(11), 725-729. https://doi.org/10.3928/01484834-20240711-02

Chitwood, H. R., Hampton, D., Falls, C., Ewen, J. Z., Scott, L., Tovar, E., Stith, H., Makowski, A., Grubbs, A. B., Clemmons, J. M., & Melander, S. D. (2026). Model for structuring competency-based education assessments for nurse practitioner students in a Doctor of Nursing Practice program. Journal of the American Association of Nurse Practitioners. Advance online publication. https://doi.org/10.1097/JXX.0000000000001342

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Reekie, M., de Bosch Kemper, N., Epp, S., Denison, J., Willson, M., & Moralejo, L. (2023). Learning pathways: Levelling, scaffolding & mapping curriculum. Journal of Professional Nursing, 46, 163-167. https://doi.org/10.1016/j.profnurs.2023.03.006