This paper examines foundational instructional design models — ADDIE, ASSURE, and Criterion Referenced Instruction (CRI) — analyzing how each structures the learning process and encourages learner involvement. It compares the stages of each model, noting their relative strengths and limitations regarding student feedback and formative assessment. The paper then applies these models to a practical scenario: teaching phlebotomy techniques requiring both anatomical knowledge and hands-on blood-drawing skills. It argues that CRI is the most appropriate model for this context due to its competency-based, performance-oriented approach, and discusses the advantages and disadvantages of that selection.
Instructional design models provide structured frameworks for developing effective educational experiences. Each model organizes the learning process differently, with varying degrees of emphasis on learner involvement, feedback, and assessment. Two of the most widely used models are ADDIE and ASSURE, both of which incorporate formative and summative assessment strategies, though they differ in specificity and the timing of learner feedback.
The foundational instructional design model is called the ADDIE model, an acronym for Analysis, Design, Development, Implementation, and Evaluation. During the analysis (planning) phase, the designer identifies the "learning problem, the goals and objectives, the audience's needs, existing knowledge, and any other relevant characteristics. Analysis also considers the learning environment, any constraints, the delivery options, and the timeline for the project" (ADDIE Model, 2012, Learning Theories). During the design phase, learning objectives are further specified as the instructional plan takes shape. The development phase involves the actual creation of the content. The implementation phase is the execution of the instructional plan, during which input is solicited from both learners and instructors about its efficacy. Finally, and equally critically, the evaluation phase assesses the instructional process as a whole and gathers feedback from users.
Built into the ADDIE model are both formative and summative techniques of assessment. Learners provide feedback during the implementation phase — either by taking quizzes or by being asked for their opinions — representing the formative component. A general summative evaluation follows in the final phase. However, one of the more common criticisms of the ADDIE model is that meaningful feedback comes too late in the process.
Another model commonly used in instructional design is the ASSURE model. The acronym stands for the following steps: Analyze learners; State objectives; Select media and materials; Utilize media and materials; Require learner performance; and Evaluate and revise. The first stage is similar to that of ADDIE in that it involves analyzing the audience of the lesson. The subsequent stages are more specific in nature, however. The second stage involves setting objectives, followed by selecting media and materials, and then utilizing those materials while preparing the learning environment. During the "require learner performance" phase, "there should be activities included in the lesson that allow learners to respond and receive feedback before any type of evaluation is administered" (Smaldino, Lowther, & Russell, 2012). Finally, during the evaluative phase, the designer, teacher, and students assess the entire instructional process in a summative fashion.
The ASSURE model has the advantage of providing more specific steps in terms of content design than ADDIE. However, like ADDIE, emphasis on student feedback occurs primarily during the final phases — first in a formative fashion and then in a summative one. Neither model systematically solicits student feedback throughout the design process, except in the form of audience analysis.
Given that the learning objective for a phlebotomy course is that students will be able to draw blood and possess sufficient knowledge to make independent decisions when doing so, a Criterion Referenced Instruction (CRI) model is likely to be the most useful method for creating an effective curriculum. CRI methods, like Instructional Systems Design (ISD) methods, are first and foremost "competency-based (job-related)" (Clark, 2010). This means that "learners are required to master a Knowledge, Skill, or Attitude (KSA). The training focuses on the job by having the learners achieve the criteria or standards necessary for proper task performance" — in this case, drawing blood (Clark, 2010). CRI methods are best deployed within sequential learning structures, which makes process-type activities like phlebotomy particularly well-suited to this approach.
CRI is especially appropriate because it is essential for learners to satisfy specific criteria in order for the learning to be considered effective. Grading students on a curve relative to the performance of others in the class is meaningless if those students are not competent phlebotomists at the end of the course. Using CRI involves the steps of: (1) goal and task analysis — identifying what needs to be learned; (2) performance objectives — exact specification of the outcomes to be accomplished and how they are to be evaluated; (3) criterion-referenced testing — evaluation of learning in terms of the knowledge and skills specified in the objectives; and (4) development of learning modules tied to specific objectives (Criterion-referenced instruction, 2012, Instructional Design).
"CRI elements, tracking, and continuous improvement"
One potential weakness of CRI is that it was originally designed more for self-instruction than for processes involving a traditional classroom environment. Nevertheless, its emphasis on self-mastery and the ability of the learner to operate autonomously outside the classroom seems well-suited to instruction in the medical field. Graduates of a phlebotomy program must ultimately be able to perform their tasks to a defined standard with minimal supervision. They must also possess the necessary knowledge of anatomy and physiology of the vascular system so that they can make decisions quickly when unexpected events arise, or simply when they need to explain a procedure to a patient.
A strong "performance orientation" makes CRI a good fit for phlebotomy training (Criterion-referenced instruction, 2012, Instructional Design). While ADDIE and ASSURE offer valuable frameworks for general instructional design, CRI's competency-based structure, sequential learning approach, and focus on measurable performance outcomes align more closely with the demands of clinical medical education. Its emphasis on mastery rather than relative performance ensures that students are genuinely prepared for the responsibilities they will face in professional practice.
ADDIE Model. (2012). Learning theories. Retrieved from http://www.learning-theories.com/addie-model.html
Clark, D. (2010). Why instructional system design? Retrieved from http://www.nwlink.com/~donclark/hrd/sat1.html
Criterion-referenced instruction. (2012). Instructional Design. Retrieved from http://www.instructionaldesign.org/theories/criterion-referenced.html
Smaldino, S. E., Lowther, D. L., & Russell, J. D. (2012). Instructional technology and media for learning (10th ed.). Upper Saddle River, NJ: Prentice Hall.
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