# Optimization of descriptors and cross-references across the different versions of the German National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM)

## TL;DR

This paper describes improvements made to a medical education framework by optimizing clinical descriptors and cross-references.

## Contribution

The study introduces structured interventions to refine clinical descriptors and cross-references in the NKLM framework.

## Key findings

- The number of clinical descriptors per disease was significantly reduced across diagnostics, therapy, emergency measures, and prevention/rehabilitation.
- The number of cross-references was also significantly reduced while closing all gaps in the network of clinical descriptors.
- The interventions led to a clearer and more precise network of learning objectives for medical education.

## Abstract

The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) has been developed as a curricular framework since 2009 and was published in version 1.0 in 2015. Refining the clinical disease descriptors and their associated cross-references (CR) is necessary to improve the clarity and usability of the NKLM. This study examines whether this optimization could be achieved through targeted interventions during the further development of the NKLM 1.0 via the intermediate versions NKLM 1.0 (neo) and NKLM 2.0 to NKLM 2.1..

The revision of the NKLM was supported by structured interventions such as the conversion of free text into CR, the introduction of essential and non-essential CR, and the linking of clinical descriptors exclusively to selected learning objective chapters. Subsequently, an analysis was performed to determine whether the number of descriptors and associated CR had been reduced and whether the clinical competencies were completely specified.

The number of clinical descriptors set per disease was significantly reduced (by 29% for diagnostics, 17% for therapy, 75% for emergency measures, and 66% for prevention/rehabilitation). The number of CR was also significantly reduced. At the same time, all existing gaps in the network (consisting of clinical descriptors and associated CR for learning objectives) were closed.

The interventions resulted in a clearer network of descriptors and CR, providing a more precise definition of the content to be learned. This means that the NKLM can presumably better fulfill its purpose with regard to the constructive alignment of learning, teaching, and assessment.