I have to be honest, this project is very challenging in the respect of all the relationships that are entailed between different aspects which and people who will need to be involved.
Although I’ve certainly moved from my original conception of an e-learning project- which was focused on the mere replication/updating/inprovement of the pre-existing digital lecture series- I have certainly found it difficult to construct an e-learning course which can challenge the multifaceted learning environment that is undergraduate clinical paediatrics.
Indeed, there is a definite knowledge (transmission) component directly relating to the first learning outcome:
Determine the essential knowledge base for paediatrics.
Apply knowledge of basic physiology and pathology to the management of paediatric patients.
Use knowledge of growth and development in children and adolescents to interpret manifestations of disease.
But, creating resources to satisfy this outcome, seems relatively easy to accomplish in a simple way and certainly open to more interesting interpretations than simple digital lectures. What I have found difficult is integrating in my mind is the combined needs of a module which involves a clinical placement (development of skills), information transmission (Pratt et al., 2001), and assessment. Indeed, the existing assessment of the knowledge component of the undergraduate clinical paediatrics component seems set in stone for a few reasons, which are unlikely to be overcome.
However, now onto the main reflection...
1. The learning activities I intend to use to enable my students to achieve the learning outcomes specified in the Needs Analysis Document will actively engage them in problem-solving, and reflect the way that the learning outcomes will be applied in real world settings
The learning activities specifically address each of the seven learning outcomes, with the a large focus remaining within the knowledge domain. Despite this, several aspects of the design refocus on the areas not related to mere information-content, there are the case-history and related formulation exercises, the collaborative community paediatrics project, and the peer-tutor formative assessment of mini clinical examinations- the core changes to the existing course.
Thus, the difference between the proposed modules and the existing modules is the move away from information transmission as the primary focus, and toward skills development- both clinical and cognitive (i.e. formulation and reasoning) (Pratt et al., 2001).
The first of these mentioned above is the case-history. Interestingly, the description of the expected learning outcomes associated with the case history (in the paediatrics course handbook- Pinnock, 2007) is as follows-
"The discussion should be relevant to the patient you have seen with emphasis on either diagnosis or management pertaining to the patient rather than the text-book regurgitation"
This made me wonder what exactly the proposed learning outcomes were in detail. A quick literature search on Pubmed and google certainly didn't elucidate anything worthwhile either- I think this relates to the ubiquity of the term case history, and perhaps the meaninglessness of the term in respect to learning outcomes. From my perspective, the educational value of the case history relates to the direction in which the author takes- that having been said, the most strong influence in directing case history discussion is usually a tutor (either consultant, registrar, or occasionally house officer). This is certainly an area I'd like to search more in detail (given time).
However, one of the advantages of the case-history is that when done well, they clearly summarise the real-world process (although often very much absent of any concept of time- tests on paper seem very easily obtained as a student, but when you have to negotiate with a radiologist for a scan...). The case-history in the context of this project would be to specifically direct the discussion of the case history around articulating the basis for the diagnosis that was made and or management that was undertaken. Students would be asked to causally relate clinical findings, and relate the findings to the underlying processes (anatomy, physiology, pathology); they would be asked to explain why a medication would be expected to be efficacious in a certain situation, rather than simply regurgitate the epidemiological/trial evidence for its use.
Secondly, the collaborative community paediatrics project would move the existing, individually completed project to a more real-world platform, where unilateral decisions about care and welfare are fiction. The idea would be to present a clinical problem where the focus is 'non-medical', and where a solution needed to be arrived at with discussion and input from several people. Group members would assign each other to investigate the available services for the particular problem, and construct (Pratt et al., 2001) a solution that would be best-fit, to a problem which would have no perfect solution, and would come together dynamically (i.e. with tutor input- Chickering & Ehrmann, 1996-7).
The point of this task is to actively engage students in solving a community/social problem, not merely by constructing hypothetical solutions, but by investigating the availability and suitability of the services. The task would allow for a much greater scope of learning than the individual project due to the collaborative process, but would also develop reciprocity and cooperation amongst students.
Finally, the mini clinical examinations would focus time on task (Chickering & Ehrmann, 1996-7), introduce collaboration in the learning of clinical skills, and provide a level of peer-mentoring and feedback not previously encouraged, nor indeed present- feedback being a key catalyst to focused learning and motivation.
2. The learning activities I intend to use will require my students to articulate and justify their understandings, and to collaborate to create meaningful products.
It seems to be strongly held that ‘peer-to-peer’ (p2p) and ‘peer-to-tutor’ (p2t) interaction in an e-learning context (Chickering & Ehrmann, 1996-7; Anderson, 2004) is a strong catalyst to a constructive learning experience. Given that many clinical decisions are not an individual process, but an activity of collective reasoning- even if one individual is deemed to hold more information that another, and especially in a multi-disciplinary setting where content experts somehow agree on a generalised solution- seems an important activity. Thus, a (small-group) p2p project would combine data collection- individual transmission (‘banking’- (Freire, 1970)) of information- with a collective clinical reasoning activity- the rubric focusing not merely on the accuracy of the information or the appropriateness of the decision, but on the quality of the reasoning behind the clinical decision, and democracy or appropriateness of the input from each individual.
Indeed, the p2p strategy will also be used in both the community paediatrics project and in the peer-tutor formative feedback mini clinical examinations (mini-CEX).
I feel that the major problem is going to be moderation of a discussion forum, and that there will be difficulty in determining an appropriate tutor. I certainly think there does need to be some tutor input into the process, in order to enhance the learning experience (Anderson, 2004; Harden & Crosby, 2000). Fundamentally though, I think the optimun learning will occur with prompt and dynamic feedback and discussion from the tutor (Chickering & Ehrmann, 1996-7).
3. The resources I intend to offer my students to help them complete the learning activities represent a variety of perspectives and use a medium that is engaging and well-suited to their message.
The resources I intend to offer are formulated to present the most important information in the simplest and most efficient way possible, whilst remaining non-linear and interactive. Thus, the perspectives recognised are information transmission (because one simply can't compute or formulate without data), apprenticeship, development, nurturance and social reform.
I find it difficult to separate these in some respects, although previously I hadn't recognised some of the aspects as being distinct. Indeed, previously I had perhaps shunned social reform as a necessary perspective in teaching. Having said that, I did recognise that social reform had an important role to play in more socially focused specialties such as public health. Thus, I think the collaborative learning project would be ideal to introduce a social reform perspective. Students would be asked to evaluate the level of suitability or satisfaction with their solution and what could be done to improve to the delivery of the solution or the services used. Indeed, this would introduce the idea of limited resources, of organisational politics, and more wide priniciples of public health funding.
Further perspectives are development, nurturance and apprenticeship. I find these hard to distinguish completely from one another. To me, apprenticeship is part of the behavioural model of learning/psychology in the respect that it encourages replication of behaviour- in the same way that transmission encourages the replication/assimilation of information. Thus, in the same way that formulation cannot occur without data, data cannot be obtained without it first being collected- in particular the collection of clinical histories and examinations. Thus, replication of behavior to the extent that students understand what the process is, is important.
However, the apprenticeship perspective does also relate to the cognitive skill of formulation. However, it seems to me that formulation is a developed skill rather than a replicated skill, and thus fits into the contstructivism epistemology.
In combining all this discussion then, these tasks are designed to hold a perspective of learning that best suits the knowledge that is aimed to be developed. Clinical skills are to be practiced, and peer feedback given on the correctness of the order, thoroughness and quality of the examination (replication of skills- apprenticeship). The information is then processed, with the transparency of logic and the quality of the formulation being emphasised (development of skill- formulation). However, the information is not merely examined in a 'sink or float' examination environment; practice/replication, and formulation are nurtured by the process of peer mentoring and feedback, and by collaborative learning (nurturance).
4. The technologies I intend to use to facilitate my students' learning activities are appropriate when considered in light of the Bates & Poole (2003) SECTIONS model and the technology principles I helped to formulate during Module 3.
Students:
The intended audience of this course is the fifth year class of the undergraduate medical program at the University of Auckland. In background, these students will have studied at least two years of pre-clinical sciences (some students obtain alternative entry, waving the first year), followed by at least a year of clinical studies in their fourth year as medical students. The students at this stage have minimal time together in lecture theatres or tutorials; the year is roughly nine months long, with roughly four weeks of "lecture time". They will be used to being in small groups and to some degree of self-directed learning. There is minimal use of learning management systems, and minimal requirements for using computers- other than performing literature searches and writing assignments.
The above is taken from my course development document. The key point is that med students are intelligent and highly adaptive, but non currently immersed in any significant e-learning environment. Thus, whilst they will likely learn quickly, the course medium will still be a challenge. Having said that, it is my belief that the proposed environment will be more familiar to them than the existing digital lectures, and independent-individual learning activities.
Ease of use and reliability: this will be a significant challenge. The platform will likely need to be CECIL (cecil.auckland.ac.nz), which certainly has its challenges. One of the 'saving graces' will be that this should be a reasonably familiar interface for students, that is a reliable enterprise application, and that future developments of the interface will benefit students.
Costs: Students will need to have no more existing resources than are currently required, and will likely have less computing demands. The main difference between this e-learning strategy and the existing 'm-learning' strategy is that internet access will be required to access the content at home.
In terms of the demands on faculty, the project would not require significantly more input than at present, but would require that content specialists participate in the initial development of resources. This could be challenging to coordinate, but should not put a significant burden on faculty, given the relative simplicity of the content and the continuing reduction of ongoing lecturing requirements initiated with the original digital lecture concept.
Teaching and Learning: I won't spell them all out here partly because of potential copyright implications (believe it or not!), but the learning outcomes fall generally in the following categories: Professional, Clinical and Research Skills, Acquisition and Application of Medical Knowledge, and Population and Community Based Practice.
The current approach to these learning outcomes tends to be either entirely assessment focused, or focused on the linear transmission of information. My approach is to refocus the learning perspectives more toward construction of knowledge and cognitive frameworks, through a variety of methods including collaboration, peer mentoring, and dynamic (non-linear) resources, aswell as being focused on assessment.
Technologies which associated collaborative learning seem to fit within their own category of e-learning. Perhaps the most traditional would be the forum or the wiki, but others might include concept mapping and document workflow environments.
Technologies which support peer mentoring in truth could be in person given the personal requirement of supervision, but electronically submitted feedback would be available for reflection by the student at a future date, for verification of completion by the tutor for assessment, and for tutor input/reflection. These technologies would include a private messaging or journaling system.
Finally, technologies which encourage dynamic learning involve streamin audio and visual content, non-linear text structures such as hyperlinks, images and information visualisation techniques such as concept mapping. Technologies which build these are many, but frameworks on which these are based are relatively few and include flash, AJAX, and silverstream. In particular flash is a widely accepted technology, particularly for streaming audio and video. One particular concern with the flash medium is accessibility (particularly visual), but this will not be a concern with this population.
Interaction: This is discussed above. There are many frameworks and specific applications. The particular stategy I plan on using for collaboration is the wiki, given the ubiquity and relative simplicity. Journalling is conveniently built into CECIL. Flash is a presentation framework which is ideal for producing dynamic, multimedia, interactive presentations.
Organisational Issues: Integration with the CECIL LMS will be the key limiting factor.
Novelty: As far as web technologies go, these are well tested- except for the CECIL environment which is quirky at best and could definitely be improved and standardised.
Speed: These are relatively simple technologies. The content specialists will likely not know how to use flash for development, but this is a one-off and relatively simple. It is likely that the learning technology unit would need to be involved.
5. The strategy underlying the learning activities I have chosen reflects the view of teaching and learning evidenced by my Teaching Perspectives Inventory results, but also reflects new insights I have gained into learning theory and e-learning
I think what Leah has been saying about the TPI is correct to a certain extent. However I do think that the TPI was useful in both teaching the principles of the teaching perspective constructs, and in thereby helping me identify with what I think is important in a given situation. I have reflected on this extensively in the previous paragraphs, but have retraced this below.
http://bubbl.us/view.php?sid=17402&pw=ya.8QMLbhmKbUMTF6bmgxeThyL2IwVQ
My feeling is that information is required in which to act on. Thus, students require information transmission to allow them to function in the most basic way possible- as a walking textbook. Following this, and a similarly behaviourist way, is the apprenticeship model where certain skills, activities (and behaviours) are replicated in order to function properly as a clinician- independent of clinical decision making, formulation, or any functioning greater than the level of mimicking activity.
Then, and what I feel are the most important, are the development of cognitive skills which enable appropriate use of information and ability (knowledge). Nurturance, to me, is merely a strategy to catalyse the transmission, apprenticeship and development aspects- the perspective encourages optimisation of the learning environment and of motivation. Certainly social reform fits into the higher functioning, in the sense that once some of the higher skills have been taught some of the previously transmitted information and abilities can be critically evaluated. More particularly though, social reform is a perspective which encourages the evaluation of the environment both in which the learning occurs, and of which the learning is about.
My strategy is thus to build a layer of information on which to develop the higher skills of formulation, clinical decision making, self- and peer- critical evaluation, and on psychosocial/multidisciplinary interaction/formulation/consideration.
Apologies for the referencing quirks- I’ve given up on figuring out end-note’s quirky cite-as-you-write.
References
Anderson, T. (2004). Teaching in an online learning context. In T. Anderson & F. Falloumi (Eds.), Theory and practice of online learning (pp. 273-294). Athabasca (AB): Athabasca University.
Bates, A.W. & Poole, G. (2003). Effective teaching with technology in higher education. San Francisco: Jossey-Bass.
Chickering, A. W., & Ehrmann, S. C. (1996-7). Implementing the seven principles: Technology as lever [Electronic Version]. AAHE Bulletin, 49, 3-6 from http://www.tltgroup.org/programs/seven.html.
Freire, P. (1970). Pedagogy of the oppressed. [New York]: Herder and Herder.
Harden, R., & Crosby, J. (2000). AMEE Guide no. 20: The good teacher is more than a lecturer - the twelve roles of the teacher [Electronic version]. Medical Teacher, 22(4), 334-347
Pinnock, R. (2007). 5th Year Book: University of Auckland Department of Paediatrics Undergraduate Curriculum Committee.
Pratt, D., Arseneau, R., & Collins, J. (2001). Reconsidering "good teaching" across the continuum of medical education. Journal of Continuing Education in the Health Professions, 21(2), 70-81.
