Learning Objects

It's strange concentrating now on learning objects. The last task involved reflection on assessment and the idea of, assessment-centred learning' became to be quite important in my thinking (Race, P. 2003; Anderson, T. 2004). It seems interesting to me today then- with the knowledge that assessment is quite possibly the single most important factor in driving learning- that with the new focus of learning objects and the discovery of a whole industry of commercial learning-products, there is very little available in the area of assessment objects.

I think this is probably worth considering at an undergraduate level of assessment, given the medical council requirements for standardisation of learning outcomes- since assessment drives learning, than wouldn't standardisation of assessment modules converge learning outcomes (e.g. USMLE - United States Medical Licensing Examination - http://www.usmle.org/)? But then I suppose the logistics of high quality, reliable, valid and transparent assessments (Race, P. 2003) become compromised with the scale on which this assessments must be made (~300 medical students per year, for six levels, throughout New Zealand each year).

Much of what is easily found on e-learning throughout the Internet seems to be on learning objects. I think there are a few reasons for this. Firstly, the Internet is a technological beast, and as such the techies (computer scientists and engineers) tend to have a lot more of a presence then other professionals- thus, the focus on e-learning standards, organisations etc. is on largely in respect to the technological factors, rather than on content or pedagogy.

Secondly, as alluded to in one of my previous posts, whether many of these learning objects recognise good pedagogy or not is overridden by the commercial forces driving uptake- both reduced cost for educational institutes and generation of profits by e-learning companies.

However, now onto my actual search.

Learning object search strategy and tips

1A. Which repositories did you visit, and what process/strategy did you use to locate an appropriate learning object?

I started off using the resources listed in the course guide. Following this, I searched using Google. I had originally written this reflection with the exact process, but on revision I think it's suffice to say that there just isn't the availability of resources for this course. Indeed, of the private/commercial learning objects such as IVIMEDS, they do not appear to have gone further than the pre-clinical sciences in an organ systems-based approach.

However, one of the learning objects I did find which was of note, was a learning object on paediatrics asthma, which gave license and author details and was actually pretty good, although it was largely didactic disease-based followed by case-based instruction. There appeared to be no standardised meta-data by which to search for the object within a repository. I found this object by searching for "pediatric (I used both pe- and pae-) learning objects" in google (http://www.google.com/search?q=pediatrics+learning+objects&rls=com.microsoft:en-nz:IE-SearchBox&ie=UTF-8&oe=UTF-8&sourceid=ie7), followed the first link (http://www.gwumc.edu/healthsci/faculty_resources/health_science_learning_objects.cfm), and despite my previous comments, found this conveniently half-way down the page (http://learn.gwumc.edu/hscidist/LearningObjects/PediatricAsthma/index.htm).

But:

If you are unable to locate a satisfactory learning object, specify in detail your 'ideal' learning object for the learning task you had in mind.

So, my ideal learning object.

Taking the content of an 'Approach to...' topic (e.g. approach to fever in a child), I would use a narrative-based approach with a non-linear interface (storyteller approach), in order to create a PBL exercise. The technology would need to be cross-platform, web-browser based, light on resources, and amenable to visual niceties.

Therefore, the tool I would use to produce such a learning object would be:
The Flash Based RPG Game Engine (https://eduforge.org/projects/gameflashobjs/). This uses the Adobe Flash environment (http://en.wikipedia.org/wiki/Macromedia_Flash), the built-in Actionscript programming/scripting language (http://en.wikipedia.org/wiki/ActionScript), a simple XML back-end file (http://en.wikipedia.org/wiki/XML), is quite simple to use and meets the aforementioned tech requirements.

Ideally, I would like to collate the story selection choices (i.e. MCQ results), and collate them for the class and tutor to see. The tutor would then be able to focus discussion on areas in which students' incorrect answers tended to cluster- I think this is where SCORM (http://en.wikipedia.org/wiki/SCORM) would come in, but this is beyond my technological understanding and skill- and I imagine would add considerable time and effort onto the production timetable.

I would also like to integrate a free-text box, so that descriptive answers could be submitted within the learning object environment and posted on the class discussion forum. The purpose of this would be to generate further discussion outside of the learning object environment, and thereby generate discussion around the differences in answers and the reasons underlying the differences (where they are significant).

1B. What tips would you offer to somebody else undertaking their own search?

I would advise them to prepare for a long and difficult search. I would advise them to start by searching for repositories, then searching within repositories. I would also advise them to search outside repositories, using google etc. There seems to be a lot of good learning objects which do not fit into a particular course or strategy, and do not comply with the learning object standards, but could reduce the time take in producing standards-based resources and could be ported relatively easily.

Linking learning object to learning objective(s)

2. What learning objective(s) will the learning object help your students achieve? How?

These learning objects will help satisfy the third learning outcome, as part of the professional, clinical and research skills domain:

Formulate logical problem lists for a range of paediatric patients.

• Develop a differential diagnosis list for a patient;
• Determine the most likely working diagnosis;
• Select appropriate tests that will confirm or alter the working diagnosis;

The problem-based learning exercises will specifically focus on diagnostic formulation, rather than on management issues- thereby satisfying the learning outcomes. 

Access and copyright

3. If you did not locate an appropriate learning object, what were the access/re-use terms and conditions for one of the repositories you visited that you found notable?

For the pediatric asthma management learning object cited above the license was clearly linked to at the bottom. It used one of the Creative Commons licenses, "Attribution-NonCommercial-NoDerivs 2.0".

I find the creative commons format of presenting licenses exceptional, especially given how often I stroll past EULAs/Copyright agreements/GPLs etc. without really taking any notice- simply because there has been almost no attempt made to make the license easily and quickly comprehendible by non-solicitors.

To quickly re-present what it says:

 

You are free:

• to Share — to copy, distribute and transmit the work

Under the following conditions:

• Attribution. You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work).

• Noncommercial. You may not use this work for commercial purposes.

• No Derivative Works. You may not alter, transform, or build upon this work.

For any reuse or distribution, you must make clear to others the license terms of this work. The best way to do this is with a link to this web page.

Any of the above conditions can be waived if you get permission from the copyright holder.

Nothing in this license impairs or restricts the author's moral rights.

Full code

And proper attribution means:

...the proper way of accrediting your use of a work when you're making a verbatim use is: (1) to keep intact any copyright notices for the Work; (2) credit the author, licensor and/or other parties (such as a wiki or journal) in the manner they specify; (3) the title of the Work; and (4) the Uniform Resource Identifier for the work if specified by the author and/or licensor.

This means that my idea of deriving my own learning objects from the content in this learning object is technically out of the question. Having said that, once the object is broken down into its separate parts (i.e. content and presentation), I think it's difficult to establish that this work would be significantly original to justify it's licensing- having said that I'm not a lawyer, I don't have a clue about IP/copyright law, and the last thing I'd want to get involved in is a copyright dispute.

I have a couple of difficulties with the creative commons license- it is new, so the quirks in applying the license in practice may not be entirely worked out (perhaps as evidenced by the development of a replacement for this license- http://creativecommons.org/licenses/by-nc-nd/3.0/. The changes are solely in the legal code section, i.e 2.0 cf 3.0, which probably just proves the saying, the devil's in the detail... For a summary of the changes between 2.0 and 3.0 see here: http://creativecommons.org/weblog/entry/7249. For more detail see: http://wiki.creativecommons.org/Version_3. Finally, for a good overview (in my opinion) of the whole CC affair, see: http://en.wikipedia.org/wiki/Creative_Commons_License- which is kind of fitting given that most (?all) wikipedia content is open-licensed, in some way, shape, or form: http://en.wikipedia.org/wiki/Wikipedia:Copyrights, largely on the GNU Free Documentation License (GFDL).

Also, that although there is an adaptation for the license for Australia, there does not appear to be any work in progress to develop the license for official use in New Zealand. I find that kind of strange because there is extensive discussion about the document, including citation in New Zealand government discussion documents.

Finally, in my search through CC, I came across the discussion of an educational-specific license creation project which might be of interest: http://creativecommons.org/weblog/entry/3633.

Learning object integration/adaptation

4. How will you integrate the learning object into your course design? Can it be used exactly as is, or does it (or your course) require changes? Are changes permissible/realistic?

The learning object which I described previously would be integrated into the Clinical knowledge in paediatrics module.

The module as I described, would ideally be integrated as a unit within the LMS.

I think as discussed above that some of the changes are likely to be logistically difficult but nor unrealistic. However, it is likely that the changes would not be fully implemented.

Anticipation of positives and negatives

5. What knowledge, experience and attitudes of your particular student group do you anticipate might help or hinder the integration of your learning object? How can you best harness or overcome these factors?

These students are fairly tech savy. They are also fairly used to being spoon-fed with rote-based materials, with a focus on memorising details immediately prior to examinations. Thus, I think that it's reasonable to expect that some students may face difficulties with motivation and with milestones.

These students are also used to almost exclusively independent learning. The idea of being required to discuss the issues in a democratic way, may be challenging in this respect.

Finally, I think that students attitudes of e-learning will be fairly damaged. The reason I say this is that most of the existing use of learning technologies may appear to have been for the advantages to teachers and administrators, rather than for the pedagogical benefits.

I'm not really sure how these can be taken advantage of. I think the best way to overcome these factors is to design a clear, efficient and high quality learning environment, and thereby the reputation of the course be anticipated in a positive way. That sounds a bit idealistic on revision, but I think that other ways might help. I've found that during this course, that despite my difficulties with certain technicalities, the milestones have forced me to simply move-on (although I've submitted most of the assessments considerably late).

In terms of the knowledge of the students, I think this will be a positive feature. This students will have had at least 14 months of clinical exposure at this stage. They will understand some of the conventions of clinical practice, and diagnostic process. Thus, the narrative of the learning object will be intuitive. If it is not intuitive to all students- which would be surprising- then the environment itself would serve to further immerse them in this narrative process.

References

Anderson, T. (2004). Toward a theory of online learning. In T. Anderson & F. Falloumi (Eds.), Theory and practice of online learning (pp. 273-294). Athabasca (AB): Athabasca University.

Race, P. (2003). Why fix Assessment? – a discussion paper [Electronic Version], 9. Retrieved 14 May 2007 from http://www.scu.edu.au/services/tl/why_fix_assess.pdf.

Reflective Commentary: Course Development Document - Assessment & Feedback (Part 3; Column 7)

Just going back a little to reflecting on the learning tasks, I've only just realised that my CDD draft has presented the learning design in a content/domain centred way, rather than in the Learning Task centred way as requested. I would plan to change this for the final as in reading over it I realise that the tasks that I've envisaged are certainly not crystal clear.

Now onto assessment.

On reading Phil Race's (Race, P. 2003) article on assessment, several things have resonated with me. I've read it several times, that good education emphasises assessment-centred learning (Including: Anderson, T. 2004). I'm not sure of all of the arguments for this, but I know that with the volume of information needing to be memorised- usually with little processing going on- the challenge and the strategy of med school became 'how to learn about what we were tested on'; there was little desire to 'learn for the sakes of learning'; peer discussion was centred on 'what you need to learn', rather than on 'what does this mean' and 'why is this important. The aforementioned article quotes the following:

“Assessment is the engine which drives student learning” (John Cowan). “And our feedback is the oil which can lubricate this engine”

To me, this simply reiterates the importance of aligning learning outcomes with assessment. There seem a myriad of other reasons for 'assessment-centred learning', but I'm yet to figure out their place amongst 'student-centred learning' and the like.

1.  The form of assessment I have chosen for each learning activity is consistent with its learning objectives, and is integrated into the learning activity.

The assessment tasks are somewhat of a compromise. As such, I haven't integrated all learning tasks with assessment. In fact, I'm not too sure whether I have changed the course in this respect at all.

In module 1, it's displayed quite ambiguously but the learning tasks are self-directed PBLs (problem based learning exercises), combined with peer-assisted mini-CEX ('mini' clinical examinations). The assessment in this later module is the peer-submitted evaluations- i.e. the task is also the assessment. I'm not quite sure how to explain how this will be assessed, perhaps because I'm not quite certain myself- I think this needs to be finalised as part of the discussions with the committee, i.e. NOT finalised as part of the proposal.

This task is most definitely consistent with the learning outcomes (Pinnock, R. 2007):

Domain: Professional, Clinical and Research Skills
Evaluate paediatric patients presenting with a range of clinical problems...

I think both the task and this kind of assessment are a key aspect missing from the existing course, and that the teaching perspectives of development and nurturance are thoroughly expressed in this task. I think that students will receive formative feedback from each other on not only clinical skills but also wider professional skills and communication. I think it will also contribute to an environment where students feel that peer-feedback is part of professional development rather than a 'summative' criticism.

As far as the PBLs go, these are not assessed as part of the module. This was probably because as part of my original conception of the course, transmission would be through didactic and linear materials. As this idea has evolved toward active learning tasks, the assessment aspect has lingered. I'm still not sure how I could assess this part of the course without increasing the tutor workload too heavily. I also don't know how you could mark for completion, without having it as part of the LMS- also a considerable undertaking. Although if we were to integrate the PBLs into the LMS, I think we could probably mark on a grade-based system, given that if you take the time to collaborate, this doesn't necessarily mean that you've "cheated", perhaps this could even be considered part of the task. I'm not sure if the PBLs could be submitted collaboratively? Going in circles now, I'm also not certain what, other than the logistical benefits, the benefit of LMS submission would be unless the PBL answers were in a MCQ form and instantly analysed by the LMS.

The second form of summative assessment mentioned in my CDD is the end-of-course OSCE (Objective Structured Clinical Examination). This is the ?'main-stay' of the current assessment. The OSCE seem to have developed an air of absoluteness about them; that they are valid, reliable, transparent and authentic (Race, P. 2003):

Valid. Assessment should measure what it purports to measure, namely the intended and published learning outcomes for a given module or course.

Reliable. Assessment should be objective, and consistent across students and assessors.

Transparent. Students (and assessors) should know exactly which aspects of a task will be assessed, and what will constitute a satisfactory or a poor performance.

Authentic. Assessment should measure a student's own, non- plagiarised work.

I've not read extensively on the literature around the OSCE, although I'm planning on enrolling in Jennefer Weller and Alison Jone's Assessment Course next semester (ClinEd 704). My understanding is that the OSCE becomes ?more reliable with an increased number of stations.

To me the existing OSCE suffers from several issues: The reliability suffers because the station numbers are restricted by the available staff. It is also affected by inter-rate differences, and by the subjective nature of some of the questions- it's odd how despite a complete jungle of opinions surrounding many clinical questions in practice, that many of these questions are expected to be answered in a binary way.

The OSCE suffers from issues of validity, in that many of the tasks are abstractions. It suffers from decreased transparency, because for some reason there is a fear that if students know what they will be assessed on, this will not distinguish between levels of 'ability'. As a result of the reduced transparency it suffers from issues of authenticy, since students from previous groups compile lists of 'remembered questions'- I was forwarded a copy (Anon. 2005) as a student of the same course, but unfortunately gadn't checked my emailprior to sitting, however my disappointment with the OSCE was not with the issues of validity or reliaiblity, but with the fact that other students had been prior to what I see as a basic requirement of any assessment- i.e. being told what you're going to be assessed on.

Thirdly, the logbooks/vignettes. To me the task should be that the student takes a history, examines a patient, then attempts a formulation, then compares that formulation with what the patient's team thought and reflects on the differences and similarities. In reality there will likely be a difference in order- the team will say, 'go see that you boy with x', but the essence is the same- practice of the 'hypothetico-deductive' method of formulation, filling gaps in knowledge, comparing ideas with peers and superiors.

Thus, ideally these aspects would be reported in fluent language (potentially preceeded by rough, hand-written notes), and assessed/reflected on by the students, their peers and tutors- throughout the course. Note that the students themselves would have fairly specific instructions on how to formulate the reflection/instruction. The final grade would consist of a combination of cumulative assessments, and global grading.

To me, this is different from the existing 'case-history' style of assessment. These are long, and somewhat detached from clinical practice; they allow the student to avoid any responsibility for combining the information in the paper in any way other than in print presentation, ordered in the recognisable, "presenting complaint, history of presenting complaint...".

Furthermore, I think the assessment relates to the learning outcomes in the sense that it not only serves as an exercise in developing the cognitive skill of formulation- But that it develops the skill of fluent and efficient presentation (given a maximum word count).

Finally, the community and Hauora Maori collaborative tasks. I think that formulated and presented in the optimum way, these problem-based learning tasks could prove to be quite useful and innovative. The existing tasks are centred on the individuals reflections on aspects of community health. But to me, the task is rather abstract and therefore not engaging. I think that these tasks could improve on this state-of-affairs by testing the students assumptions around their ability to effectively and efficiently problem-solve 'social' issues.

The assessment is intertwined with the learning task, and I feel is quite successful in its consistency with the learning outcomes (Pinnock, R. 2007):

Domain: Hauora Maori
Identify key health issues for Maori children and adolescents and explain the approaches to addressing the issues;

Domain: Population and Community Based Practice
Summarise the roles, responsibilities and collaborative processes of child health professionals.

2. Students will have opportunities to undertake self-assessment and peer critique as well as receiving instructor feedback.

I think it's become quite evident, my attempt to involve peer-assessment wherever possible. I recently read a quote from J. M. Coeztee's Disgrace (Coetzee, J. M. (2000), which sounded a note with me:

The irony does not escape him: that the one who comes to teach learns the keenest lessons, while those who come to learn learn nothing.

To me the main reason for wanting students to assess each other is not for the increased learning as it relates to the subject content, but to develop awareness of the skill of communicating clinical information between each other- i.e. fluid presentation.

I think that there are several areas that would particularly benefit in terms of 'increased learning'. Clinical examination skills and patient communication, are areas which peer supervision could help not only to evaluate and feedback, but also to socialise into this 'routine'.

3. The strategy underlying the assessment approaches 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 assessment and e-learning.

Development and nurturance were the original two key perspectives I felt I held. However, following my recent reflection on teacher role, I realised the significance of what was originally an equivalent 'score' for apprenticeship in the Teaching Perspectives Index (TPI).

To me, the underlying strategies of my assessment approaches, are to assist in development in key cognitive skills, to do this in a way which is nurturing and socialises peers into the requirements of the task rather than the (often mis-aligned) expectations of the (often absent and/or disinterested and/or overcommited) clinical supervisor.

Thus, the way the student interacts with the teacher is to clarify issues which cannot be easily dealt with by suitable alternatives- i.e. text-book or peers.

I think these definitely reflect insights I have gained into assessement and learning, but not necessarily e-learning. What I am quite confident of it that e-learning provides the excuse to implement many of these advantageous course changes.

References

Anderson, T. (2004). Toward a theory of online learning. In T. Anderson & F. Falloumi (Eds.), Theory and practice of online learning (pp. 273-294). Athabasca (AB): Athabasca University.

Anonymous. (2005). Paediatric OSCE Cheat Sheet.

Coetzee, J. M. (2000). Disgrace. London: Vintage.

Pinnock, R. (2007). 5th Year Book: University of Auckland Department of Paediatrics Undergraduate Curriculum Committee.

Pratt, D. D., & Collins, J. B. Teaching Perspectives Inventory. Retrieved 14 March, 2007, from http://teachingperspectives.com/

Race, P. (2003). Why fix Assessment? – a discussion paper [Electronic Version], 9. Retrieved 14 May 2007 from http://www.scu.edu.au/services/tl/why_fix_assess.pdf.

Reflective Commentary: Course Development Document - The Role of the Teacher (Part 2; Columns 5-6)

Unfortunately I had read the resources for this module quite some weeks prior to completing this reflection, thus I'm not entirely sure whether my ideas have incorporated the reading or whether I merely 'validated' my existing ideas against the reading.

The following link to the other 'role of the teacher' task which Leah and I worked on (rather asynchronously to begin with) together- Principles: The role of the teacher in clinical education(http://dylanandleah.pbwiki.com/ and http://bubbl.us/view.php?sid=14398&pw=ya.8QMLbhmKbUMTEyLjBacjQxQnQ0WQ).

Our principles, and the following embedded diagram, drew heavily from "The good teacher is more than a lecturer- the twelve roles of the teacher" (Harden & Crosby, 2000

 

1. The teaching presence I intend to enact to enable my students to achieve the learning outcomes specified in the Needs Analysis Document will acknowledge the importance of my students' prior knowledge, and encourage them to take ownership of their own learning.

The role of the teacher I would like to maintain is that of a master and apprentice, in which the apprentice is encouraged to tackle a problem, and seek validation of a proposed solution to that problem, or to seek advice in order to solve a problem.

Moreover, as a manager of the team the master has a responsibility to ensure efficiency, productivity, morale, and that the team is up-to-date. Thus, the teaching presence should include reminders about deadlines, with support and flexibility when there are difficulties due to workload and deadlines.

This model seems ideal- students begin learning from where they left off; they seek advice when new questions arise, and continually reinforce that learning with repeated experiences - i.e. experiencial learning (Kolb, 1984) - see infed.com for a good summary, especially the weaknesses of the theory!!! (http://www.infed.org/biblio/b-explrn.htm)

Experiential Learning Diagram (above)

Although it would be nice to leave it at this apprenticeship analogy, the issue of quality of teaching seems to be of concern when the implementation of teaching activites are left to 'teachers intuition' (Herrington, Herrington, Oliver, Stoney, & Willis, 2001). Indeed, the continuing erosion of quality master-apprenticeship interaction in the health sector, has lead to claims of the apprenticeship model being 'abandoned' in certain aspects of clinical practice such as surgical procedures, for stategies such as simulation-based training (e.g. www.vrmedical.com)- I can't help but feel like a salesman for putting this link in, although I do acknowledge my confusion and indeed skepticism over some of the simulation rhetoric that exists. As recently discussed, the commerical imperitive of high-end simulation can be seen as somewhat self-pepetuating, irrespective of need.

2. The supports (e.g. strategies, templates, announcements) I intend to build into the course materials and contribute during the course will model critical thinking and reflection appropriate to clinical practice.

Problem-based learning is the closest description to the process of learning in hospital clinical practice. The materials and learning activities focus on this style of learning. What I haven't made explicit, is the role of the teacher in characterising this model of learning.

Therefore, I need to develop a well-defined role for teacher in this process, without overwhelming the tutors.

Thus, the idea of having students work with other students to develop solutions to these PBLs has this implicitly built-in. I think that it's a reasonable expectation that if the students are appropriately inducted into this method of problem-solving, that there will be relatively few instances in which they will need to consult about the problems with the tutors.

Thus, what I need is a way in which the tutors can observe the problem-solving process. Small-group online discussion groups seem like a good way to do this, and by including individuals from different geographical areas (Starship, KidsFirst, Northland, Wai ato), it would encourage (or essentially force) students to rely-on the online interaction in order to complete these tasks.

These peer-peer and peer-tutor (/master) interations are very close to what happens in the hospital. The online learning environment simply allowsfor an interaction which is not hospital specific, and thereby allows discussion to occur over the differences between 'taught', text-book, and hospital-specific practice, and also encourages discussion between the differences in practices and the factors which influence the differences- i.e. resources, expertise, patient population etc.

3. The strategy underlying the teaching presence I intend to enact reflects the view of teaching and learning evidenced by my Teaching Perspectives Inventory results, but also reflects new insights I have gained into the role of the teacher and e-learning.

In my original post about the Teaching Perspectives Inventory (Pratt & Collins), I struggled to explain the meaning of the apprenticeship perspective in my results (see below). Indeed, my discussion focused on development and nurturance and how they related to my own perception of my teaching perspectives- this conveniently explained the transmission and social reform perspectives not registering.

Transmission total: (Tr)   25.00
  B=8; I=7; A=10
Apprenticeship total: (Ap)  32.00
  B=10; I=11; A=11
Developmental total: (Dv)  32.00
  B=10; I=11; A=11
Nurturance total: (Nu)  33.00
  B=13; I=11; A=9
Social Reform total: (SR)  21.00
  B=8; I=6; A=7
----------------------
Beliefs total: (B)  49.00
Intention total: (I)  46.00
Action total: (A)  48.00
----------------------
Mean: (M)  28.60
Standard Deviation: (SD)    4.76
HiT: (HiT)   33.00
LoT: (LoT)   24.00
----------------------
Overall Total: (T) 143.00

However, on reflection I feel that I have neglected to define the place of the apprenticeship perspective throughout the subsequent discussions. In some respects, I now find it difficult to distinguish completely between these perspectives. Somehow, I must have thought that the apprenticeship perspective could be avoided (and certainly the transmission perspective).

What I have found myself leading to in this course development document is a modelling the teaching perspective on the apprenticeship model, given that this is essentially how learning occurs in clinical practice- in that a problem is recognised, information is learned about that problem, and expertise is developed experientially.

Furthermore, the information that is learned can be presented (taught) in such a way so as not to question the validity (or evidence), or in such a way that the best possible and most up-to-date information is used to develop a solution to the problem- i.e. social reform.

Thus, the CDD reflects my new focus on apprenticeship, whilst retaining the focus on developmentalism. The learning activities are designed in such a way (peer assisted), so as to nurture a less-threatening learning environment than tutor-focused learning. I've also begun to recognise the importance of the social reform perspective, and although the tasks in community paediatrics have some of this perspective built-in, this perspective has not been widely included elsewhere.

The position of transmission in my CDD seems slightly uncertain now- I've included 'information' learning tasks via problem-based learning exercises, which have tried to avoid traditional case-based or rote learning exercises. I think the ability to include learning activities like this is advantageous, however there seem to be two difficulties with this strategy:

1. Problem-based learning exercises are time-consuming and challenging to develop
2. Students may rote-learn the examples, relying on their understanding of these examples to help with assessment, rather than on their understanding of the broader principles, skills and underlying knowledge.
   

References

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.

Herrington, A., Herrington, J., Oliver, R., Stoney, S., & Willis, J. (2001). Quality guidelines for online courses: The development of an instrument to audit online units [Electronic Version]. Meeting at the crossroads: Proceedings of the 18th Annual Conference of the Australasian Society for Computers in Learning in Tertiary Education (ASCILITE). , 263-270. Retrieved September 6, 2006, from from http://elrond.scam.ecu.edu.au/oliver/2001/qowg.pdf.

Kolb, D. A. (1984). Experiential learning : experience as the source of learning and development. Englewood Cliffs, N.J.: Prentice-Hall

Pratt, D. D., & Collins, J. B. Teaching Perspectives Inventory. Retrieved 14 March, 2007, from http://teachingperspectives.com/