Moving Pathophysiology: A Curriculum Change Under Constraints
You chair the assessment committee at a 4-year BSN program with 22 full-time faculty, 6 of whom teach primarily in the prelicensure track. Three-year program data show first-time NCLEX pass rates fell from 94 to 82 percent. The steepest drop is among students who earned a C in pathophysiology, which is currently in semester 3. The curriculum committee proposes moving pathophysiology to semester 2 and adding a 1-credit application lab. Constraints: the science department controls the prerequisite sequence; four faculty say the change dilutes the liberal arts mission; the registrar says the only available room on Tuesdays is a 24-seat lab; the change needs curriculum committee, dean, and state board approval within 8 months to affect the next cohort; faculty governance requires a 30-day comment period.
1. Build a change strategy. Name the stakeholders, the sequence of steps, and how you would use data and address the four faculty who oppose the change.
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Stakeholders. Faculty governance body, curriculum committee, dean, registrar, science department chair, state board, clinical partners, and students. The four opposing faculty are stakeholders, not obstacles; their concern about the liberal arts mission is legitimate and should be engaged early.
Sequence.
- Weeks 1 to 2: convene a small design group with one opposing faculty member, the science chair, and a prelicensure faculty member. Frame the problem as a shared outcome (first-time pass rate and student success), not as a pet reform.
- Weeks 2 to 4: present the three-year data, including the C in pathophysiology pattern, and ask the group to generate options, including options that do not move the course. This avoids a false binary.
- Weeks 4 to 6: draft the proposal with a resource plan: room constraints (24-seat lab means two sections or a hybrid), faculty load, and a plan for the 30-day comment period.
- Weeks 6 to 10: run the 30-day comment period with two open forums and a written response to every substantive comment.
- Weeks 10 to 16: curriculum committee vote, dean approval, and state board submission. Build in a 4-week buffer for the board.
- Before the next cohort: registrar update, catalog change, and advisor training.
Using data. Show the trend, not just the last year. Disaggregate by course grade, not by demographic group in a way that stigmatizes students. Pair pass-rate data with course outcome data and student feedback.
Addressing the four faculty. Meet individually before the first forum. Ask what evidence would change their mind. Offer a concrete protection for the liberal arts mission: the application lab uses case-based writing and ethics content, not just test prep. If they still oppose, document their concerns and proceed through governance; do not isolate them or label them resistant.
2. Identify two risks to this effort and how you would mitigate them, including what you would do if the science department refuses to move the course.
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Risk 1: The science department refuses to move pathophysiology. Mitigation: do not make the move the only lever. Propose a co-requisite model, a summer bridge course, or a pathophysiology review embedded in the semester 3 clinical course. If the department refuses, escalate to the dean with data and a resource offer (for example, a joint appointment or stipend). If that fails, implement the application lab without the move and evaluate it as a partial intervention. Do not promise the board a change you cannot deliver.
Risk 2: The 24-seat Tuesday lab cannot accommodate the cohort. Mitigation: model the enrollment and section count before the vote. Options include two lab sections, a hybrid format with simulation, or a different room on another day. If the registrar cannot solve it, scale the lab to a pilot section and compare outcomes. Do not approve a design that is undeliverable; faculty and students lose trust when a plan collapses in the first term.
Other risk: timeline. The 8-month approval window with a 30-day comment period is tight. Build a Gantt chart with the board deadline as a hard stop and a decision point at week 6. If the comment period produces major objections, delay the cohort start rather than rush a flawed plan.
3. What outcome and process measures would tell you in 18 months whether the change worked, and what would you do if pass rates did not improve?
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Outcome measures. First-time NCLEX pass rate for the first cohort exposed to the change, compared with the prior three cohorts. Pathophysiology course grade distribution. Application lab pass rate and clinical judgment scores. Graduation rate and time to degree. Disaggregate to check whether any group is differentially affected.
Process measures. Percentage of students who complete pathophysiology before semester 3. Lab attendance and section utilization. Faculty fidelity to the case-based design. Student perception of relevance and workload. Number of advising exceptions.
If pass rates do not improve in 18 months. Do not abandon the change reflexively; check implementation first. If fidelity was low (for example, the lab became a study hall), fix implementation. If fidelity was high and outcomes did not move, examine the theory of action: maybe pathophysiology timing was not the active ingredient. Test a different intervention, such as a standardized exit exam with remediation or a clinical judgment coaching model. Report the null result to faculty; it is useful evidence, not a failure. Avoid changing multiple variables at once so you can attribute effects.