The Affective Domain
I recently read an article concerning the consequence of bias in emergency medical care. An ambulance crew made a faulty assumption about a particular patient that ultimately ended with the patient later dying.
How often do we make judgments about people based upon characteristics other than those found during the assessment? How do you feel about treating people who are rich, can’t speak English, live on the street, or are in some way different from you?
Now change gears and consider this: How willing are you to participate in continuing education sessions, take on a student as a preceptor, mentor new hires, stay late for one of your co-workers, or do that little “something extra?”
You might wonder what this has to do with learning objectives, but all of these questions actually relate to the affective domain of learning and affective domain competencies. The affective domain is related to attitude, motivation, values, feelings and emotional responses.
Affective domain competencies are arguably as important as cognitive and psychomotor domain competencies, and for EMS providers, they are at times even more important than medical knowledge or skills. After all, EMS — at its heart — is about attitude, compassion, caring and service.
The problem we face when writing affective domain performance or learning objectives is that it is hard to quantify things such as attitude, motivation, values, feelings and emotional responses. It is difficult to identify objective, observable and measurable behaviors that indicate competency when attempting to evaluate learning. Yet, no matter how difficult, instructors and supervisors have an obligation to ensure practitioners are competent in all three domains.
The Affective Domain Hierarchy
Like those within the other domains, affective domain learning objectives are organized in a hierarchy that was described in “Taxonomy of Educational Objectives: Volume 2” (Krathwohl). Each level is built upon competencies in the levels below and the behaviors grow more complex as you ascend the hierarchy. The five levels in the hierarchy, from lowest to highest, are: Receiving, Responding, Valuing, Organization, and Characterization.
| Level | Definition | Verbs |
| 1. Receiving | The lowest level. Involves willingness to pay attention, openness to new experience, developing awareness, and selective attention. | Asks, attends to, captures, chooses, feels, follows, gives, holds, identifies, listens, locates, names, obeys, perceives, points to, pursues, replies, selects, senses, sit erect, uses |
| 2. Responding | Refers to active participation and reaction, willingness to respond, showing interest, feeling satisfaction. | Answers, acclaims, approves, assists, attempts, complies, conforms, continues, discusses, follows along, greets, helps, presents, performs, practices, recites, reports, selects, volunteers, writes |
| 3. Valuing | Involves the worth a student attributes to an object, behavior, or phenomenon. Valuing also relates to acceptance of, preference for, or commitment to a particular value. | Appreciates, accepts, argues, believes, challenges, chooses, completes, criticizes, describes, explains, follows, forms, initiates, invites, joins, justifies, prefers, proposes, respects, searches, persuades, prioritizes, reads, reconciles, refutes, reports, seeks, selects, shares, studies, writes |
| 4. Organization | Is concerned with resolving conflicts between different values, developing a value system, making judgments, and deciding when faced with alternatives, and comparing, relating and synthesizing values. | Adheres, alters, arranges, builds, combines, compares, completes, defends, develops, explains, formulates, generalizes, identifies, integrates, judges, modifies, orders, organizes, prepares, relates, synthesizes |
| 5. Characterization | Student has a long standing value system that has controlled behavior for a time long enough to develop a “life-style.” Behavior is consistent and predictable. Values have been internalized and integrated beliefs, ideas and attitudes form a philosophy of life. | Acts, concludes, discriminates, displays, influences, internalizes, judges, listens, modifies, performs, practices, proposes, qualifies, questions, resolves, reviews, revises, serves, solves, uses, verifies |
| *The table was compiled using Krathwohl, et. al., and various related sources. | ||
Affective Domain Objectives
The structural components of learning objectives in the affective domain are the same as those of the cognitive or psychomotor domains: you must identify the audience, the condition under which the audience must perform, the behavior you will observe and measure, and the degree of performance that indicates the student has met the objective as compared to a standard.
By recognizing that affective domain components are also a component of most cognitive and psychomotor competencies, we can then use those objectives as guides to affective domain objectives within a particular topic or lesson.
Identifying the audience is the easiest piece of the puzzle, so easy that often the explicit identification is omitted. I would recommend that you get into the habit of specifying your audience. It helps you to remember who you will be teaching, evaluating or supervising when you are developing your learning objectives, your performance objectives, and lesson plans. For a continuing education class, this can be as easy as using, “The student will…"
It is important for your students to clearly understand the conditions for performance and any constraints they must perform under. As the condition, you may use a statement like, “Given a role-play scenario of a patient complaining of difficulty breathing, you find that the family members are angry about the length of time it took for you to respond.”
As with other objectives, the behavioral component is represented by a verb. The table above lists examples of verbs for use at the various levels of the affective domain hierarchy. What verb might be appropriate to use for the objective that includes the angry family in the condition statement? Perhaps you would use “respects” from the valuing level. How could you incorporate “respects” into the objective using the angry family? What other verb could you use?
The final piece of the objective is the degree of performance that must be demonstrated to meet the objective. This is the hardest part of writing affective domain objectives. How can you create a standard for “respects?” How do you measure respect? How do you indicate the degree?
These judgments are unfortunately more subjective than in the cognitive and psychomotor domain objectives. It takes deep thought, consideration and practice to get it right. In the “angry family” objective, how could we measure respect? Perhaps the paramedic maintains an even tone and volume in his voice. Maybe the paramedic gives a truthful explanation and an apology for the delayed response. Or the paramedic maintains appropriate distance and doesn’t encroach on the family’s personal space. Maybe the paramedic calmly explains that he cannot complete his assessment with all of the noise and distraction. Maybe he requests that the family gather the patient’s medications. As you can see, there are numerous factors and behaviors to consider when determining the performance degree that meets the objective.
Conclusion
Over the years I have heard many EMTs and paramedics described like, “She’s a good EMT, but...” In my experience, that “but” usually means that although the person is technically proficient and knowledgeable, they may be less competent in the affective domain. The EMT may be rude, mean, condescending or a “know-it-all” — attributes that are difficult to quantify. This would be my follow-up question, “Is she really a ‘good EMT’ if she is mean while on the job?”
As EMS practitioners, we all must be aware of our attitude, motivation, values, feelings and emotional responses. As educators and supervisors, we have an obligation to help our students and subordinates develop their affective domain competencies.
Educators use learning objectives to guide the development of educational programs and lesson plans. Supervisors use performance objectives to facilitate growth and development of their subordinates. Whether you’re an instructor or a supervisor (or both), it is important to include objectives in the affective domain in your lessons and in your performance improvement plans.
References
- Krathwohl, D.R., Bloom,B.S. and Masia, B. B. (1964).Taxonomy of educational objectives, Book II. Affective domain. New York, NY. David McKay Company, Inc.
