IPE course project update

This post is cross-posted from the International Ethics Project site.

My 4th year students have recently completed the first writing task in the IEP course pilot project. I thought I’d post a quick update on the process using screenshots to illustrate how the course is being run. We’re using a free version of WordPress which has certain limitations. For example it’s hard to manage different cohorts of students, but there are many more advantages, which I’ll write about in another post.

My students will keep writing for their portfolios using the course website, which I’ll keep updating and refining based on our experiences. The idea is that by the end of the year we’ll have figured out how to use the site most effectively for students to work through the course for the project.

PHT402: What is the value of a human life?

This is my fourth contribution to a series of weekly posts related to the #pht402 Professional Ethics course. This week’s topic is specifically about torture, but the general principle concerns the rights of the individual vs the rights of society, as well as asking about the relative value of a human life.

free-humanityI’m going to begin by answering the question in the title: “It depends on who’s life you’re talking about”.

When preparing this course I thought that the topic of torture could be used to move a conversation beyond the specific example of torture and look at the broad principle, which concerns the rights of an individual human being weighed against the rights of society. Or, to put it another way, how do we ascribe value to human life? I hadn’t really considered the possibility of a physiotherapist being asked about a patient’s physical condition in order to determine whether or not they could be hurt by someone else. It shouldn’t have surprised me though, since in South Africa we have a long history of our medical profession being complicit in human rights abuses that include torture (as highlighted in one of the readings for this week).

Even though the topic of torture has been questioned as part of this course, I think that the principles that emerged from the week’s discussions are relevant to other areas of our practice. For example, how many lives is one life worth? What value do we place on human lives? Are all human lives valued the same? These questions bring us back to the idea of equality and morality. Are we all equal? In what ways are we equal? How different are our boundaries of what is “right” and “wrong”? Is torture ever the “right” thing to do? The United Nations says it never is. But, there are times when your personal morality might say that torture absolutely is necessary. Wendy expressed this nicely when she asked about actions that may be morally wrong but which are morally justifiable.

I think that these are interesting questions that don’t need to be answered, but talking about them may help us to figure out some things about ourselves.

Naom makes two good points in her post, which are that your thinking around this topic is influenced by how you value human life, and whether the value of lives from those within your group is higher than those outside of it. As noble as we like to think we are, we do inherently place more value on certain lives than on others and this is where the importance of context comes in. My daughter’s life is more valuable to me than any other child in the world because she is my  daughter. She doesn’t need to have any special skills, knowledge or potential in order for me to value her more. As much as I like to think that we’re all equal, I have to acknowledge that we don’t all have the same value.

Um’r makes the point that for thousands of years, human beings have consistently looked for more and more ingenious ways to inflict pain and suffering on each other. He also links this week’s topic back to the questions of equality and morality, and then goes on to day that as much as each of us may abhor violence towards others, he asks how far he would go in order to protect those closest to him. This is challenge, to live the life we believe is right, even when faced with difficult choices. If every life is equal (Janine has a simple exercise that explores this), then torture can never be OK.

In the comments on Janine’s post there’s a question about how age could be a deciding factor in determining if a life could be sacrificed to save others.  In one context, age may be an appropriate reason to sacrifice a life but not in every context. For me, this is one of the most difficult skills that we need as health care professionals…the ability to modify our decision making processes depending on the unique context we find ourselves in. There are no universally correct answers to morally ambiguous situations.

Everyone I’ve read so far has focused on the military use of torture, but what about the other reading that briefly looked at the use of torture (or at least complicity in it’s application and cover up) by medical professionals? Tony has explored this by asking how medical professionals can be involved in torture.

I think that one of the most interesting aspects of Week 4s topic has been the emergence of side topics…conversations that were peripherally associated with torture but which became something else. Discussions about the value of life, morality, equality, moral boundaries, etc. all began happening in the comment threads, which was great to read. I think it really highlighted one of the benefits of a course with weak or flexible boundaries and participant-led discussion.

Finally, I’m going to point you to Chantelle’s blog, where she did a great job in relating the week’s broad topic to the South African context, as well as providing a reflective overview of the posts from Week 4. She opened her first post with this quote and I’m going to end with it:

The argument cannot be that we should not torture because it does not work. The argument must be that we should not torture because it is wrong.

Short notes on concept mapping

In preparation for a concept mapping assignment I ran during the course of this year, I did some reading on concept mapping, during which I made some short notes. Here they are…

Concept mapping is useful to establish relationships between ideas and has been linked to 30 % improvement in student understanding

Ausubel’s assimilation theory: Meaningful learning involves changing ones current knowledge as a result of the comprehension of new knowledge

Concept: anything that can be named / perceived regularities or patterns

Proposition: an expression of the relationship between concepts

Maps: represents knowledge using diagrams that express concepts and relationships

Linking phrases: without the relations, knowledge would not “cohere”

The most important single factor influencing learning, is what the learner already knows (Ausubel, 1968)

In the process of meaningful learning, people construct meanings for concepts and propositions based on experiences, building up their knowledge structure

Meaningful learning involves changing ones current knowledge as a result of the comprehension of new knowledge

There needs to be:

  • Differentiation of concepts
  • Superordination of concepts under more general, more inclusive concepts
  • Subsumption of new concepts into existing, more general concepts and propositions
  • Integrative reconciliation to achieve coherence and consistency

Drawing a map:

  • Helps the designer understand the problem
  • Is a creative process (new discoveries are made as the map is drawn)
  • Helps establish credibility within the team
  • The map itself offers the first chance to interject the user as a guiding concept for the product

Progressive cognition (3 levels): review at a glance → readable with some attention → deeper, richer understanding can be layered in

Drawing a map:

  1. Identify main concept
  2. List related concepts (don’t worry about organisation, importance, completeness)
  3. Draw a rough map
  4. Interview team members and domain experts
  5. Identify synonyms and instances (remove redundancy, cluster related concepts)
  6. Redraw, redraw, redraw (each time you’ll discover new connections)
  7. Get feedback from the team
  8. Repeat 4-7

Maps can be redrawn and rearranged to highlight different concepts

Choose a dominant position, use a hierarchy, different colours, etc.

Problem based learning: transitioning to an online / hybrid learning environment

A few weeks ago I attended a short presentation by Prof. Meena Iyer from Missouri University. Prof. Iyer spoke about how she moved her PBL module from using a traditional, mainly face-to-face approach, to an online / hybrid approach. Here are my notes.

—————————-

“All life is problem solving” – Karl Popper

How do we get students to think like professionals in the field?
How do we foster group interaction in online spaces?
How do I assess learning in online spaces?

PBL addresses the content issue, as well as enhancing critical thinking through the collaborative solving of authentic, real-world problems

Mismatch:

  • PBL → solving problems is the tool, learning is the goal
  • Traditional → content is the tool, problem solving is the goal

PBL is all unstructured (but it can be scaffolded), and there’s not necessarily a right/wrong answer

Six steps to problem solving (IDEALS):

  • Identify the problem (What is the real question we are facing?)
  • Define the context (What are the facts that frame this problem?)
  • Enumerate the choices (What are the plausible actions?)
  • Analyse the options (What is the best course of action?)
  • List reasons explicitly (why is this the best course of action?)
  • Self-correct (What did we miss?)

The problem should be authentic and appealing (a mystery to solve)
Clearly outline expectations for each step of the process

Why move from face-to-face to online?

  • In F2F, you can only move forward at the speed of the slowest learner
  • Significant time requirements for F2F
  • Identify…can be anonymous online → fewer preconceived biases among students

Challenges:

  • How do you transition F2F to online
  • What tools are appropriate / feasible / viable / affordable?
  • How do you do collaborative work when everyone is online at different times?

Format:

  • Cases are presented in multiple formats / media
  • Introductory week to familiarise students with online environment. In addition to learning the content and critical thinking, students also have to learn about PBL
  • Scenarios are released in 2 stages over a 2 week period
  • Scenarios are accompanied by a set of probing questions to stimulate discussion
  • Teacher provides support during the discussions
  • Students must also design their own case
  • Assessment is based on content and depth
  • Wiki used for question / answer. Each student must answer each of the questions, each answer must be different i.e. must add to what has already been added (this means that the question can’t just be a knowledge question)
  • Discussion boards are used for students to dissect the cases (All and Group)
  • Each group assesses their own knowledge base, and define what the gaps are, and therefore what they need to find out (who provides the links to the resources, or can students use any resources?)
  • At least 3 posts per student, including: Summarise and question one citation; Answer another students’ question; Follow up any discussion on their own posts
  • Reading assignment: written, critial appraisal of a published article relevant to the case study. This summary must be posted online.

Important for students to learn how to share information in supportive environments

Assessment:

  • What parts of the process need to be assessed?
  • What parts can be graded as a group?
  • What needs to be submitted for individual assessment?
  • What are the time constraints for the grading?
  • How do you balance grading workload with the need to externally motivate student performance?
  • There is also a syllabus quiz to ensure the students actually know the content

Design:

  • Make the problem compelling
  • Outline expectations
  • The problem analysis should relate to the professoinal field
  • As student proficiency develops, withdraw support
  • Use learning issues to encourage EBP
  • Ensure that solution development is based on critical appraisal

Resources

  • Barrows, HS (1996). Problem based learning in medicine and beyond: a brief overview. New directions for teaching and learning
  • Barrows HS & Tamblyn, RM (1980). Problem based learning: an approach to medicla education. New York, Springer Pub. Co.
  • Hmelo-Silver, C (2004). Problem based learning: what and how do students learn? Educational Psychology Review, 16(3)
  • www.criticalthinking.org

 

Applying theoretical concepts to clinical practice

Concept map about concept mapping taken from IHMC website

I just finished giving feedback to my students on the concept mapping assignment they’re busy with. It’s the first time I’ve used concept mapping in an assignment and in addition to the students’ learning, I’m also  trying to see if it helps me figure out what they really understand about applying the theory we cover in class to clinical contexts. They’re really struggling with what seem to be basic ideas, highlighting the fact that maybe the ideas aren’t so basic after all. I have to remind myself that clinical reasoning is a skill that takes many years to develop through reflection and isn’t really something I can “teach”. Or is it?

For this assignment I wanted the the students to set a learning objective for themselves (I gave examples of how to do this, including using SMART principles of goal setting). They also needed to highlight a particular clinical problem that they wanted to explore and how they would use concepts from the Movement Science module to do this. They needed to describe a clinical scenario / patient presentation and use it to identify the problem they wanted to explore. From that short presentation, they should derive a list of keywords that would become the main concepts for the concept map.

Here’s a list of the most common problems I found after reviewing their initial drafts:

  • Many of them lacked alignment between the patient presentation, the learning objective, keyword / propositions and the final concept map
  • Many of the learning objectives were vague. They really found it hard to design appropriate learning objectives, which meant that their whole assignment was muddled
  • There were two processes going on in the students’ minds: patient management, and their own learning. This assignment was about student learning, but most of the students were focused on patient management. This was especially clear in the learning objective and actual maps they created, which all had a clinical focus on the interventions they would use to treat the patient, rather than the learning concepts they would apply
  • Most of the students created hierarchical maps which failed to identify complex relationships between concepts

After going through their initial drafts, I had another session with them to go through the feedback I’d given and providing more examples of what I expected from them. This assignment is proving far more difficult for the students than I’d expected. However, I’m not sure if it’s because they can’t apply theoretical concepts to clinical scenarios, or if they just don’t have a good understanding of how to create concept maps. I think that they’re having difficulty thinking in terms of relationships between concepts. The maps they’ve been drawing are appropriate in terms of the interventions they’d choose to manage their patients, but the students can’t seem to transfer the concepts from the classroom into clinical contexts.

They’re used to memorising the content because that’s how we assess them i.e. our assessments are knowledge-based. Then they go into clinical contexts and almost have to re-learn the theory again in the clinical environment. There doesn’t seem to be much transfer going on, in terms of moving knowledge from the classroom context to the clinical one. I haven’t researched this yet, but I wonder what sort of graduate we’d get if we scrapped classroom teaching altogether and just did everything on the wards and in the clinics? I understand the logistical issues of an apprentice-based approach to teaching large groups but if we didn’t have classroom time at all, maybe it’d be possible?

CHEC short course: teaching and learning

Today was the first day of a short course looking at teaching and learning and is pretty innovative in that it is co-ordinated by, and open to, academics from several higher educational institutions in the Western Cape. It’s being organised by the Cape Higher Education Consortium (CHEC). The course runs for the next month, during which we attend a session a week, and includes an assignment component. In this case, the assignment is to develop and evaluate a teaching activity using principles from the course.

The content of the course is aimed at new lecturers or those with experience who’d like to explore new ideas in their teaching practices. I thought it’d be interesting to engage with people from other institutions and see what I could learn from them. The sessions are really short so there isn’t much time to cover a lot of ground. However, the interaction seemed pretty good today. Most of the notes below were thoughts I had that were inspired by what was said, and not really content from the session.

What do teachers and students do to create learning spaces?

Students’ learning behaviour is a response to the education system they’re a part of

Perceived relevance influences participation (it’s not necessarily about actual relevance)

Challenging boundaries can develop critical thinking

Definitions of learning are context dependent i.e. it’s hard to pin down a definition of what it means “to learn”. Remembering a fact is different to more efficiently performing a task, but both are “learning”

Bloom’s taxonomy implies that certain “types” of learning are more developed than others, but “Evaluation” can be done at a basic level, and “Remembering” can be complex

How do you enable self-expression as a means of developing creativity / engagement?

When we mediate teaching and learning experiences with technology, are we producing a fundamentally different thinking process? If we are, then “e-learning” isn’t just about using technology…then it really is something different that should stand alone

How does “what students do” impact on how they think? How can I make better use of our learning spaces to change students’ thinking?

How do you get students to prepare for class, engage during class, and follow up (reflect) after class, in order to reach specific learning objectives?

If you give homework, do you need to make sure that students do it? If the homework task is designed to develop thinking, and then you assess the students’ ability to think, doing the homework task stops being work for the sake of work. Completing the homework then has a real positive outcome in terms of facilitating deeper understanding, which increases the probability of the student being deemed “competent”, which makes them more likely to do the homework.

Concept mapping assignment in Movement Science

Fora while I’ve been toying with the idea of using concept mapping for an assignment in the Movement Science module that I teach and I finally took the plunge. See below for the assignment I gave the students using CmapTools to explore relationships between the concepts in the module and clinical practice. It’s my first attempt at using concept mapping so would love any suggestions or ideas. Have you used concept maps? How did it work out?

Concept Mapping in a Movement Science physiotherapy module

Social networks and clinical education: presentation at SAAHE

My presentation at the SAAHE conference is a more in-depth look at the same project that I presented at the conference in 2010. The key points I wanted to make were that:

  • Students struggle to develop practice knowledge because it is hidden from them i.e. they can’t “see” our thinking process as we reason our way through clinical issues
  • One way to externalise practice knowledge is by sharing experiences and outcomes as colleagues or peers
  • Social networks facilitate that sharing
  • Reflection needs to be facilitated and structured, otherwise students feel lost
  • Pedagogically sound teaching principles must be integrated no matter what tools you’re using

Here is the presentation that I gave earlier today:

SAAHE conference, 2011 – day 1

Introduction by Dr. Lionel Green-Thompson

A country whose health is fragile

The future of health science education: 2020 vision by Prof. Athol Kent

“After an introduction like that I can’t wait to hear myself speak”

It’s not the strongest or fittest who survive but the ones who are most adaptable to change

  • Who will our students be?
  • How many of them will we need?
  • Who will their teachers be?
  • What will we teach them?
  • How will we teach them?

They will be smarter, better prepared, more IT literate, more women, more black students

We need far more than are currently graduated, more from rural areas, more mid-level workers, clinical assistants

“Innovation through diversity”

Why do health professionals leave? Political, security, working conditions, financial reasons

Makes reference to Freni, et al, Health Professionals for a new century, The Lancet

30% of all posts are unfilled

Need to increase intake & satellite campuses must evolve

All service posts should have a teaching component

Doctors who want part-time work (e.g. mothers) can be integrated as clinical teachers

Generalists who teach as opposed to specialists

Peer teaching should become a core, significant component of clinical teaching (“the mark you get will be the same mark your students get”)

Syllabus will change from curative to preventative → PHC, lifelong learning, less factual, more core and process orientated (“we can’t possibly teach all the facts”, “teach how to learn”)

“The world is flat” → information is everywhere

Move from university → centres → health/education system-based

Teach students HOW to learn

Move from assessment of learning → assessment for learning

“A lecture without a story is like an operation without an anaesthetic”

800 specialised language forms in O&G alone ← imagine what this must look like to a new clinical student

Is the gap between secondary education and health science education going to increase?

The content we give students today is based on work that was done 5 years ago. In 10 years time that content will be less valuable even than today. For all intents and purposes, the content is irrelevant. We need to give students the tools to identify gaps in their own knowledge, and the skills to find the answers to the questions that will help fill those gaps.


Evidence-based practice: how can we facilitate student learning? by Prof. Robin Watts

Practice = EBP is nothing if concepts are not implemented in clinical practice

Evidence-informed practice? More inclusive in that it implies that evidence isn’t the only factor in clinical decision-making, and that practice knowledge is an important component to take into account

Different language roots have an impact on how EBP is understood by people from different parts of the world

EBP steps:

  • Asking (Population, phenomenon of Interest, Context, Outcome)
  • Acquiring
  • Appraising (levels of evidence – hard for students to conduct appraisals of online sources)
  • Applying
  • Assessing

Is evidence derived from medical research directly generalisable to other health disciplines? Should be be modified? Avoid making assumptions of transferability

Springer, “7 pillars of information literacy”

Discrete subject (EBP separate from other modules), or integrated throughout and within other modules? Standalone courses appear to be less effective than integrated. Discrete modules found improvement in basic knowledge, but no impact on appraisal ability. It integrated into clinical practice, improvements occur throughout. Integration should be well-designed.

Content in EBP module should be sequenced, building on previous content / components

Benefits of EBP enhanced when modelled by clinicians

Integrating EBP into the curriculum requires a culture and mindset change

 

Morning POEMs (Patient Oriented Evidence that Matters) – Teaching Point-of-care, patient centred, evidence-based medicine by Dr. Eamon C. Armstrong

Patient presentation followed by real-time internet search for best available evidence → discussion of patient management using those sources

EBM triad:

  • good clinical expertise
  • best external evidence
  • patient values and expectations

POEM = valid:

  • information that patient will care about i.e. has positive patient outcomes
  • addresses a common problem
  • should require a change in practice

How do you brindge the growing knowledge “chasm”

Change the paradigm from “just-in-case” (learn everything in case it comes up) to “just-in-time” (learn what you need, when you need it)

Negotiate common ground around medical decision-making

Prior to the introduction of POEMs, use of electronic sources was scant (study done in US hospital)

Led to fundamental change in prevailing teaching and learning practice

 

The use of reflective journaling in the training of play therapy students by Isabella Jacobs

Reflection used to raise personal awareness, and integrate theory into practice

Students find that ideas become clearer when they write them down, they have to declare concepts in concrete form

Existential dialogue = ways of being, reflective journal may help to implement

Students must receive guidance regarding expectations for jounnaling i.e. must be structured

Role of the self in patient encounters

Journals not assessed, although a random selection of journals were analysed

Students not informed prior to journaling that the journals would be researched, so as not to influence their responses. Informed consent obtained from students after assignments were completed

Students initially reluctant to participate in journaling, but awareness of self began to emerge over time

“as we write conscious thoughts, useful associations and new ideas begin to emerge” (Miller, in Moon, 2006)

“regain my balance by losing my mind” (student quote)

“I do not want to be in unawareness anymore” (student quote)

Some students referred to the process as “a life changing experience”

 

Selective alignment as an applied education and research tool by Sophia Fourie

Assingment which served as an educational tool and research project

Students gained research experience, improved knowledge, and encountered principles of rational drug prescription

 

Do emergency medical care student’s perceptions of their educational environment predict academic performance? by Benjamin van Nugteren

Role of the academic environment in student success?

Identify areas of student dissatisfaction / satisfaction

Used the DREEM questionnaire: 50 statements based on 5 point Likert scale

Looked at:

  • perceptions of learning
  • perceptions of teachers
  • academic self-perception
  • atmosphere
  • social self-perception

Associated above outcomes with academic performance

Noticed a trend of decreasing satisfaction in all of the above components from 1st – 4th year medical students, even though overall satisfaction was reasonably high. What are the implications considering these students are going straight into clinical practice? Is burnout beginning already?

When the data is connected relative to final exams / other stressors might make a difference to student perceptions

 

Workshop: Concept maps and cognition by Dr. Stephen Walsh

Here’s the basic concept map I made during the short workshop:

 

Why open licensing benefits everyone

In 2009 I started an online physiotherapy encyclopaedia called OpenPhysio. It was a space for me to run a few assignments with my 4th year students at the time, as well as a bit of an experiment to see what would happen i.e. would physiotherapists and physiotherapy students automatically create and edit an online physiotherapy encyclopaedia. At the time I was unaware of the excellent Physiopedia that had been started a few months before by a physiotherapist in the UK (@rachaellowe).

Looking back, I think that the two projects had different goals (I stand under correction here. Rachael, feel free to set me straight in the comments). OpenPhysio was always meant to be a bit chaotic and informal, while Physiopedia was more structured and rigorous in who was allowed to edit the content. I was thinking “interesting playground”, while Rachael was probably thinking “evidence-based resource”. Here’s an excerpt from the OpenPhysio About page:

“OpenPhysio is an attempt to create a database of high-quality, physiotherapy specific content that is free for clinicians, students and educators to use, modify and improve……Hopefully, in time, OpenPhysio will become a useful resource, not only for accessing free, high quality content, but also as a teaching tool. For example, by giving students feedback on each contribution they make. The usual concerns about the quality of the content (issues around references and credibility) and plagiarism apply but these obstacles should not be prohibitive and in fact could also be seen as teaching opportunities to educate students with regards improving their academic writing skills.”

A few weeks ago Rachael contacted me to let me know that OpenPhysio was getting heavily spammed and it dawned on me that I haven’t really paid much attention to the wiki over the past few years, besides writing up the experience for publication and as a conference presentation. By coincidence, the domain name renewal came up a few days later and I decided to pull the plug on the project. We’re doing some things with social networks and clinical learning right now and I can always embed a wiki there if we need one. When I told Rachael that I was going to let the domain expire, she asked if she could port some of the content from OpenPhysio to Physiopedia, which I thought was a wonderful offer from her. And, because all content on OpenPhysio was licensed with a creative commons license, I didn’t have to get permission from contributors to “give away” their content.

OpenPhysio will go offline at the end of June, 2011 when the domain name expires but happily the content that has been contributed during the past few years has found a home at Physiopedia. Which is why I think that when we make use of IP licenses that allow and promote openness, we get to more easily share and build on what we know and understand about the world.