The Inner-workings of Conceptual Learning in Competency-based Education

Male nurse talking with two female nurses

Q. What is conceptual learning and how long has it been in existence?

Suz Wilhelm: First, it is important to recognize that concept-based learning and curriculum design is not specific to nursing education. In fact, it is a well-documented consideration in educational theory in curriculum and instructional design.

Educational Psychologist William M. Stinson, defines conceptual learning in this way: 

Conceptual learning is a process by which students learn how to organize information in logical mental structures, thus challenging students to become increasingly skilled at thinking (Timpson & Bendel-Simso, 1996).


It may help to think about conceptual learning in the following manner, outlined by Erickson:

  • It is a process by which students learn how to organize information in logical mental structures;
  • It focuses on learning organizing principles that are threaded throughout learning environments;
  • It includes;
    • Classroom learning
    • Clinical experiences
    • Simulated experiences
  • It provides context for concepts/exemplars.

Kim Rodehorst: Concept-based curricula are not new to ​nursing either. Many nurse educators may recall a similar curricular movement more than 20 years ago. It just seems that in the last 6-8 years there has seen a resurgence of interest in concept-based curricular design in an effort to respond to the need to move away from content over-saturation in nursing education that continued unabated for years. 

The focus of concept based curriculum in nursing 20 years ago was on concepts from nursing theories and now it is on concepts that are unifying classifications of information in the physiological, psychological, nursing and health care domains.

Q. Tell us about conceptual teaching.

Wilhelm: Teaching conceptually requires a teaching approach that may be quite different from what many faculty are accustomed to. Rather than relying on covering mass amounts of content and textbook readings, the focus of teaching conceptually is guiding students to truly understand core concepts through the focus on generalizations or central ideas and patterns that assist the learner to apply the concept to high incidence and prevalent examples – or exemplars. The exemplars also help students develop an understanding of the inter-relatedness of multiple concepts.

​Conceptual teaching/learning is not the same as active lear​ning, but they are great complements to one another.

Q. What are some of the pros and cons of conceptual learning?

Rodehorst: I would not necessarily describe them as “cons” but there are obstacles or “speed bumps” as we often call them. The biggest obstacle to moving to a concept-based approach to teaching and learning is that change is hard! Change can be difficult, whether ​it’s about a concept-based approach or not. Some other common obstacles or concerns are:

  •   Some faculty and students may be resistant to the changes implemented (Celebrate ending of old curriculum. What is the purpose of CBC?)
  • Faculty concern over key content being left out of the curriculum (What is the picture of how it will look and feel)
  • Uncertainty over how specialty-area content will be handled (What is their part in the new curriculum)
  • Requires a different level of organization and collaboration (What is the step-by-step detailed plan including team building)
  • Lack of an abundance of literature detailing specific steps and outcomes/results (Dissertation study ongoing on faculty’s experience with moving to a CBC.
  • Concern over potential impact on NCLEX® pass rates

​There has been very promising ​data now that many programs have begun evaluating their curricula like the case study out of Forsyth Tech on their NCLEX scores pre and post implementation of their concept-based curriculum.

The “pros” often cited by programs include:

  • A more unified, organized approach to presentation of content
  • Decrease in content overload
  • Student’s ability to apply the content vs. just knowing the information.

Q. What are the primary motivational factors for schools to move to a concept-based curriculum?

Rodehorst: The most common motivation that we hear from nursing programs​ is the desire to streamline their curriculum and a concept-based approach is a great way to streamline content coverage. Also, many nursing programs have not updated their curricula in a long time and are due for a curriculum update – and a concept-based model is a popular curriculum approach right now.  We also commonly hear that nursing programs are looking to:

  • Focus on problems
  • Foster systematic observations
  • Foster understanding of relationships
  • Focus on nursing actions and interdisciplinary efforts
  • Create a catalyst for challenging students

​Another motivation that we are hearing more and more frequently is the desire to improve articulation between ADN and BSN nursing programs by creating a shared, concept-based curriculum. This was given as a driving factor in concept-based curriculum consortia in places like Texas and Hawaii. ​

Q. How many schools/programs are expected to move to a concept-based curriculum in the coming years?

Wilhelm: Pearson ​conducted a “concepts landscape survey” this past spring and got some great insight into the growing interest in moving to a concept-based program. There were nearly 200 nursing programs that responded that they were considering or had made the decision to move to a concept-based curriculum in the next 24-36 months. And from what we’ve seen as we travel across the country consulting with nursing programs, the interest certainly isn’t waning. Just this year alone, we’ve personally spoken to nursing programs in places as far-spread as Florida and Wyoming that are making the decision to move concept-based. 

Q. What advice do you have for those who are interested in moving to a concept-based curriculum?

Wilhelm: My first piece of advice is…give yourself an appropriate length of time to make the move! As with any curriculum update, it can be time consuming, so it’s better for all faculty if the decision, planning and implementation are not rushed. 
Rodehorst: I also commonly recommend that nursing programs work on obtaining a broad base of support among the faculty and administrators. While it may not ever be possible to get 100% buy-in (especially in departments with larger faculty), to the extent that the change agents can garner their colleagues support, they should. People tend to resist even more adamantly when they feel like the change is happening to them. It requires a fine balance of helping the change-averse understand and support the changes being made and pressing forward – but it’s important. The concept-based implementation guide that the Pearson Faculty Consultants authored this summer has great, “tried and true” best practices for supporting and coaching colleagues throughout the planning and implementation phases of concept-based curriculum redesign.


About the Authors
Suz Wilhelm, RN, Ph.D.

Suz Wilhelm, RN, Ph.D.

Suz Wilhelm, RN, Ph.D. is an assistant professor and assistant dean in the University of Nebraska Medical Center College of Nursing, West Nebraska Division, where she has been a faculty member since 1990. She received her bachelor’s degree in nursing from the University of Northern Colorado and her master’s and doctoral degrees from the University of Wyoming. Dr. Wilhelm’s clinical background includes all areas of obstetrics. She has held nursing positions in several states in the mid-western region, and she conducts breastfeeding research in rural areas. Dr. Wilhelm has taught the under-graduate Maternal-Newborn and Women’s Health course. She has taught in a concept based curriculum for the last 4 years. In addition, she has developed inter-disciplinary simulations for Maternity-Pediatrics. A strong advocate for concept-based learning, Dr. Wilhelm lent her considerable Maternity-Child Nursing and inter-disciplinary expertise to ensure that the second edition of Nursing: A Concept-based Approach to Learning effectively threaded these themes throughout its content.

T. Kim Rodehorst, Ph.D.

T. Kim Rodehorst, Ph.D.

Dr. T. Kim Rodehorst is an associate professor at University of Nebraska Medical Center College of Nursing, West Nebraska Division, where she has been a faculty member since 1988. Kim received her bachelor’s degree from Loretto Heights College in Denver, CO and her master’s degree is in Parent-Child Health and from the University of Colorado. After working as a pediatric nursing instructor for many years, Kim returned to school to receive her Ph.D. in Adult Education and Technology from the University of Wyoming. Kim has developed numerous pediatric simulations over the past 20 years and often includes simulation learning in the classroom. Additionally, she has used a variety of innovative teaching strategies to engage students in their learning. Her interest in helping others learn more about concept based curricula began four years ago when UNMC adopted a concept based curriculum. Dr. Rodehorst has been involved in review and development of both editions of the textbook: Nursing: A Concept-based Approach to Learning.