Proposal abstract: Case-based learning in undergraduate physiotherapy education

Abstract for a project I submitted earlier this week for ethics clearance. During 2012 – 2014 we converted one of our modules that runs in the 2nd, 3rd and 4th year levels from a lecture-based format to a case-based learning format. We are now hoping to have a closer look at whether or not the CBL approach led to any changes in teaching and learning behaviours in staff and students.

Case-based learning (CBL) is a teaching method that makes use of clinical narratives to create an authentic learning activity in which students navigate their way through complex patient scenarios. The use of CBL in a health professions undergraduate curriculum attempts to convey a multidimensional representation of the context, participants and reality of a clinical situation, allowing students to explore these concepts in the classroom. While the implementation of CBL has a sound theoretical basis, as well as a strong evidence base for use in health professions education, there are challenges in its effective use that are not easily resolved. However, if it can be shown that the approach leads to changes in teaching and learning practice, which enhance student learning, providing additional resources to resolve the challenges can be more strongly justified. This project therefore aims to determine staff members’ and students’ perceptions of CBL as a teaching method, and to find out how it influenced their teaching and learning behaviours.

This study will make use of a mixed method research design in which the experiences and perceptions of student and staff members are used to determine whether or not there was a change in their teaching and learning practice. Qualitative and quantitative data will be gathered using a survey of all students in the population, focus group discussions of students and in-depth interviews of all staff in the department. The survey will determine if the design of the CBL approach led to a change in what the students did. The focus group discussions will gather data on the nature of the changes and the underlying rationale for those changes. The interviews with lecturers will be conducted in order to delve more deeply into whether or not lecturers’ teaching behaviours changed, and again, to explore the underlying rationale of those changes.

The survey will make use of a self-developed questionnaire that will gather quantitative data using Likert scales and other closed-ended questions. The survey will be sent to all 3rd and 4th year students in the 2015 academic year. The same students will be invited to participate in the focus groups, and the researchers will make use of purposive sampling to allocate volunteers into two focus groups in each year level. All lecturers in the department (n=10) will be invited to participate in the in-depth interviews, including those who were not directly involved in the implementation of CBL. In addition, we will also invite ex-staff members who were involved in the process, as well as postgraduate students who assisted with student facilitation.

Qualitative data will be gathered during the focus groups and interviews. This data will be interpreted via the theoretical frameworks used in the design of the CBL cases. The focus group discussions and interviews will be conducted in English and recorded using a digital audio recorder. The audio files will be sent for verbatim transcription and the anonymised, transcribed documents will then be sent to participants for verification. The transcripts will be analysed thematically, coding the data into categories of emerging themes. Trustworthiness of the analysis will be determined through member checking and peer debriefing and participants will be given the opportunity to comment on whether or not the data was interpreted according to what they meant. The transcribed verbatim draft will be given to colleagues who were not involved in the study for comment.

Understanding vs knowing

Final exams vs. projects – nope, false dichotomy: a practical start to the blog year (by Grant Wiggins)

Students who know can:

  • Recall facts
  • Repeat what they’ve been told
  • Perform skills as practiced
  • Plug in missing information
  • Recognize or identify something that they’ve been shown before

Whereas students who understand can:

  • Justify a claim
  • Connect discrete facts on their own
  • Apply their learning in new contexts
  • Adapt to new circumstances, purposes or audiences
  • Criticize arguments made by others
  • Explain how and why something is the case

IF understanding is our aim, THEN the majority of the assessments (or the weighting of questions in one big assessment) must reflect one or more of the phrases above.

In the Applied Physiotherapy module that we teach using a case-based learning approach, we’re trying to structure our feedback to students in terms that help them to construct their work in ways that explicitly address the items listed above. We use Google Drive to give feedback to students as they develop their own notes, and try to ensure that the students are expressing their understanding by creating relationships between concepts.

One of the major challenges has been to shift mindsets (both students’ and facilitators’) away from the idea that knowing facts is the same as understanding. As much as we try to emphasise that one can know many facts and still not understand, it’s still clear that this distinction does not come easily to everyone. Both students and some colleagues believe that knowing as many facts as possible is the key to being a strong practitioner, even though the evidence shows that decontextualised knowledge is not helpful in practice situations.

The list above, describing what students understanding “looks like”, is helpful in getting our facilitators and students who struggle with the shift in thinking, to better grasp what we’re aiming for.

Case-based learning

Introduction

It is useful to think of case-based learning (CBL) as a teaching method that uses a set of events unfolding over time to stimulate an activity (Shulman, 1992). In clinical education cases make use of clinical narratives to create an authentic learning activity. CBL represents an approach to unstructured learning that can nonetheless be scaffolded in the sense that students choose the details of what they want to explore, while the case designer chooses the broad themes that must be covered. It is therefore an attempt to convey a balanced, multidimensional representation of the context, participants and reality of a clinical situation.

Cases are based on complex clinical situations or problems that should aim to stimulate discussion and collaborative groupwork among students (Flynn & Klein, 2001). They usually involve the interactive, student-centred exploration of those problems while being guided by facilitators. Since the cases are complex, students must analyse them as they try to resolve problems and answer questions that have no single, or simple, correct answer.

Case-based learning reduces the likelihood of students constructing inert knowledge that is decontextualised from how that knowledge will be used in the real world. If the case is an accurate representation of what can be expected in the real world, then the knowledge produced is more likely to be of use when they encounter similar events in the clinical context.

Benefits of CBL

CBL offers the following advantages (David, 1954; Flynn & Klein, 2001; Herreid, 1997; Lombardi, 2007):

  • It provides students with authentic situations in which to explore and apply a range of behaviors and information that can strengthen the learning of knowledge that transfers between different situations.
  • When students participate in the analysis and discussion of alternative solutions they come to better understand difficult or complicated issues and analyse them more effectively.
  • The emphasis on the process of decision making requires students to synthesise information from a variety of disciplines and subject areas.
  • Students can use the case as a base from which to launch their own, personally meaningful investigations into a topic or theme.
  • New technologies and resources can be integrated in order to solve problems. The use of images, video, audio and collaborative writing platforms can enhance the case, increasing the authentic context that promotes deep learning.
  • Cases can help students develop multiple perspectives, as opposed to hearing about patient management from only one point of view (usually the lecturer’s). Cases emphasise the value of interdisciplinary and collaborative approaches, skills that are increasingly important in health care systems.
  • In the process of finding solutions and making decisions through collaborative group work, students must sort out factual data, apply analytic tools, discuss issues, reflect on their experiences, and draw conclusions that can be related to new situations. Through this, they develop analytic, collaborative, and communication skills that are essential for the clinical context.
  • Cases provide students with the opportunity to see how to apply theory in practice. This can lead to graduating students who are more engaged, interested, and involved in the clinical environment.
  • CBL develops students’ skills in group learning, public speaking, and critical thinking.
  • Cases can be used effectively with both large and small classes or groups.

In summary, the benefits of using CBL in the classroom can lead to the development of knowledge that is not decontextualised, as well as skills that are relevant for working as part of multidisciplinary clinical teams.

Theoretical foundations of CBL

Collins (1988, pg. 2) described the idea of “learning knowledge and skills in contexts that reflect the way they will be used in real life”, as situated learning and cognition. When decontextualised material is presented to students (as it is during a lecture), they have difficulty deciding how to integrate that knowledge into their practice i.e. to bridge the gap between the classroom and clinical spaces. Being able to use information effectively requires that students learn it in the same, or similar, contexts as those in which they will be expected to use it. When knowledge and context are separated, knowledge is seen by learners as a product of education, rather than a tool to be used within dynamic, real-world situations. Authentic learning positions the task as the central focus for authentic activity, and is grounded in the situated cognition model (Brown et al, 1989; Herrington, Oliver & Reeves, 2003). In other words, meaningful learning will only take place when it happens in the same social and physical context in which it is to be used.

In addition, to situated learning and authentic learning, CBL also draws on elements of constructivism, in which students actively work to construct their own meaning from the learning opportunities presented to them. No matter what the intention of the teacher is, if students do not engage with the learning experience, they will have difficulty integrating the concepts that the teacher is presenting (Prideux, 2005). Social constructivism builds on this concept still further, and suggests that meaningful knowledge is only developed through discourse with a more knowledgeable other (Vygotsky, 1978). The teacher (or more experienced peer) helps guide the student through the zone of proximal development, the conceptual distance between what the student can do alone and what they can only do with the assistance of another (Vygotsky, 1978).

It is clear then, that CBL as a teaching and learning method has significant theoretical support, offering more than a practical framework for the design of classroom activities. It is an approach that helps students develop the ability to apply abstract concepts and ideas to clinical situations, in an authentic context that leads to personally meaningful learning.

Common characteristics of cases

While cases can cover a broad range of topics, patients, conditions and environments, most effective cases have the following generic characteristics (adapted from Dolmans et al., 2009; Flynn & Klein, 2001; Herried, 1997; Wasserman, 1994):

  • Content should be closely aligned with one or more of the overall learning objectives for the course or module.
  • They tell a story and focus on a current issue that arouses interest. It should draw the reader into the story and enhance interest in the subject matter, helping to sustain discussion about possible solutions and encourage students to explore alternatives. The ending of the narrative could be open-ended, allowing students to develop their own conclusions.
  • It should be well-written and appropriate for the level of the students and could include direct quotes, using the characters’ dialogue to tell the story. It should be compelling and create empathy with characters, aiming not only to make it more engaging but because the attributes of the characters can influence the decisions that students make.
  • Include situations that students know about or are likely to face, therefore making it worth their while to complete. The content should adapt well to their prior knowledge and contain cues that stimulate them to use that knowledge.
  • Stimulate self-directed learning by encouraging students to generate their own learning outcomes and conduct literature searches in order to answer research questions that they come up with themselves.
  • Should provoke conflict and force decision-making, clearly presenting the dilemma but not resolving it. Include conflict or ambiguity so that students do not agree on the outcome, encouraging compromise and decision-making.
  • Collaboration and cooperation should be encouraged, rather than competition.
  • The case should be short. It is easier to hold someone’s attention for brief periods than long ones.

Designing effective cases

Before beginning to design the case, it’s important to determine what the objectives of the case will be. Begin by explicitly stating the purpose of the case and what specific knowledge and skills you’re trying to develop in the students (Dent & Harden, 2005). Provide some background for the case by inserting it into a larger health system context, which serves to inform students why they are going to be working on this particular case and why it is appropriate for them as part of their training. By making it more relevant, they are more likely to actively engage with it. Learning outcomes might need to be changed in order to reflect the idea that the knowledge gained should be used as a tool as part of a process, rather than an end in itself. In other words, it’s not enough to know a series of facts, but rather how those facts can be applied to solve real-world clinical problems. Designing authentic tasks is challenging, and readers are encouraged to review Authentic Learning as a framework to guide this process (Herrington, Oliver & Reeves, 2003).

It is useful to design cases that based on actual patients, which serves to increase its authenticity, as well as leaving less room for error (Marks & Humphrey-Murto, 2005). Place less emphasis on the volume of content to be covered and spend more time designing cases that facilitate the development of critical thinking and clinical reasoning. Pay attention to preparing resources for the case, including artefacts like policy documents, X-rays, referral letters, research papers, readings from textbooks, images of real patients, and videos. The range of materials is enormous and depends on the level of the students, complexity of the case, the creativity of the case designer and objectives of the module. These resources should be as authentic as possible in order to reduce the cognitive dissonance experienced by students when the classroom context is logically inconsistent with reality.

It should be noted that the key to success is the quality of the small group discussion, which is an integral aspect of CBL (Christensen 1987; Flynn & Klein, 2001; Wetley, 1989). Without the discourse associated with exploring new territory, students will not have the opportunity to analyse, generate and evaluate solutions, solve problems, or make decisions. These are the types of learning activities that give students an active role in the learning process, thereby helping them to develop and improve their higher-order thinking abilities. The content of cases and the process of discussion are therefore inseparable in CBL and designers should ensure that reasonable time is allocated for this activity.

Generic content, or content that is relevant across a wide range of contexts, should be included in multiple cases in order to show students the different ways it can be used. For example, hypertension is a concept that is relevant for a range of cases that could involve heart disease, amputation, stroke and maternal health. The same is true of professional ethics, which can be explored across a diverse range of cases. In this way, the student is introduced to the idea that information can be used in many different ways, and that knowing the facts is less important than knowing how those facts can be used to solve problems in different contexts.

Finally, a multi-disciplinary team approach is recommended when designing cases. This has several advantages, including the increased likelihood of catching errors, more creativity, better resources, the inclusion of domain-specific expertise and ultimately, a more authentic case.

Preparing students for CBL

If this is the first time students are faced with CBL they will most likely have a few concerns. These can include the fact that they will be more responsible for their learning, the realisation that they are covering less content than friends from other classes or institutions (who are not using CBL), and general anxiety because the approach is new to them. These concerns can be addressed by discussing with them (as many times as necessary) the benefits of using CBL. You can also use one session to guide them through the process of completing a case, possibly with a topic that isn’t formally included in the course, to take the pressure off of getting the “right” answer.

While we may like to think that our students are capable of working collaboratively in groups, we often find that they work cooperatively as individuals. They split the work into smaller chunks and then assign those chunks to people in the group with one person taking responsibility for combining all the pieces at the end. The problem with this is that no single member of the group actively works on the project as a whole. Even the person who combines it all is only acting as an editor, giving a consistent aesthetic and voice to the content. Without actively engaging with all of it throughout the process, this form of cooperative groupwork has little value in CBL. Therefore, students will have to be taught and guided through a process of collaborative groupwork, including how to allocate roles, what those roles should be, how to negotiate group norms, setting consequences for failure to comply with group norms, resolving conflict, reporting what is learned back to the group and a host of other skills necessary for effective groupwork.

Designers should aim to create a space in the module for students to share and discuss their concerns, helping them to resolve any issues that arise. As they become more experienced with working in groups students will begin resolving their own problems.

Working through a case

Working through a case usually involves the following problem-based approach, although the specific steps used will likely be an adaptation of this. The following structure (or some variation of it) is usually used by groups when working through a case.

  1. One person reads the case out loud for the group.
  2. The group members identify words and phrases they don’t understand.
  3. They confirm what they do understand, and ensure that they all have the same understanding.
  4. Identify the clinical or functional problems (depending on the objectives of the case) that may arise as a result of the information presented.
  5. Brainstorm possible causes of the problems, taking on board every suggestion no matter how unlikely. This needs to be a safe space for students to be OK with sharing openly and without judgment.
  6. Structuring and hypothesis: students begin to systematically and logically explore relationships between concepts, narrowing down possible causes of the problems identified. They should create a list of statements that look something like “We believe that….because of….”
  7. Generate research questions in order to fill in the gaps in understanding and to “prove” the statements that they have made.
  8. Conduct research in order to find evidence to support (or refute) the statements.
  9. Finish with a set of notes that: i) Define words and phrases relevant to the case. ii) Present problems the patient is likely to have, possibly using the International Classification of Function (ICF), or another outcome measure that they would be expected to use in the clinical context. iii) Highlight relationships between clinical presentation and functional problems, supported by evidence. iv) Document the appropriate assessment and management of the patient. v) Note that the items presented above would vary significantly depending on the type of case, and the learning outcomes described at the outset.
  10. At the next session, each member of the small groups present to each other within the small groups. The purpose of this is to consolidate what has been learned, clarify important concepts and identify how the group is going to move forward (if the case is still not complete).
  11. At the end of each week each small group presents to the larger group. This gives them the opportunity to evaluate their own work in relation to the work of others, to make sure that all of the major concepts are included in their case notes, and the opportunity to learn and practice their presentation skills. Students could also be expected to evaluate other groups’ work.
  12. Note that students may begin moving between steps as they develop their clinical reasoning skills, which is only a problem if the process becomes one of unthinking, rote behaviour, in which case completing the activity will not have the desired impact on critical thinking.

In addition to the more detailed steps listed above, students could also use a simpler, six step IDEALS approach when working through a case:

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

Using the questions above, they begin to get a sense of the case and what it is about as well as situating themselves and their prior knowledge within that context. They identify the basic concepts and questions that will serve as a basis for progressing through the rest of the case. This approach helps to create a broad outline for the case before delving into the more complex aspects. For very simple cases students can also be guided by the following questions:

  • What do I know that will help me to solve this problem?
  • What do I think I know that I’m uncertain of?
  • What don’t I know that I need to learn more about?

A typical case is designed to be integrated with small group learning. However, it is also possible to create shorter, less complex cases that can be resolved independently as part of self-study. Note that students will need to be quite motivated to work through cases alone and the facilitator should still be available for short discussion and guidance. Remember that cases are a type of formative learning experience, where the process of working through the case is more important than the final product i.e the completed case.

Cases can also be distributed to students before or after a lecture, so that they can prepare for the work ahead, or to consolidate what has been covered. In these situations, the case would more likely contain more information, and leave fewer gaps because the objective is less about stimulating critical thinking, and more about revising content in an authentic, clinical context.

The role of the facilitator

Different facilitators take on different roles during the CBL process. They are, at various stages students, listeners, analysts, questioners, paraphrasers and lecturers, and it is important to recognise that this can have a significant impact on the students’ experience. Try to avoid having the facilitator take on the “teacher” role too often, providing students with the answers to all of their questions. The “all-knowing” facilitator who is the inquisitor, judge and jury can be seen as trying to extract wisdom from the student “victim”. In its worst form it can be a version of “I’ve got a secret, and you have to guess it.” But, in its best form it can bring about an intellectual awakening as insights emerge from a complex case.

The facilitator should aim to stay on the sidelines as the students take over the analysis but can begin the discussion by simply saying, “Well, what do you think about the case?” From then on, they may simply ensure that some semblance of order is kept and that all students in the group get to voice their views. They should also try to avoid being too far on the periphery and not providing students with the structure they need to not feel lost. Highlight the fact that they don’t have all the answers and that they are co-learners in the classroom.

The facilitator should aim to guide the discussion but not control it, which requires the confidence to give up control. This is the only way to get students to actively construct their own learning experiences by asking questions, gathering information, testing hypotheses, and convincing others of their findings. During this process, facilitators should work with the groups in order to make sure that students have not left out important concepts as they progress through the case.

It is important that the facilitator withholds personal or professional judgments and opinions during discussions. They need to guide the discussion in a way that generates as many different issues, perceptions and solutions as possible, which will be limited if they project their own opinions into the discussion. Using the basic questions, “who, what, why, when and where” helps to engage the students in the activity. Facilitators must also summarise the main concepts and ask questions that help students identify issues and stay on track, but that also do not lead them to a specific conclusion. Facilitating student discussion may appear to be simple but in reality it requires skill in helping students explore and discuss the case in ways that maximises their learning opportunities.

The facilitator’s work can be divided into two broad general categories: setting up the learning environment and facilitating discussion and exploration (Blackmon, Hong & Choi, 2007). They should provide the context for the class and the depth to which students should explore questions. They can also decide which questions are prioritised and which ones can be answered via different methods e.g. lectures, essays, or assignments. It is worth noting that CBL may not be appropriate for every aspect of the curriculum.

Finally, the facilitator needs to add additional information and be able to direct students to resources that are appropriate to the topic (Blackmon, Hong & Choi, 2007). Most practitioners of the discussion method prefer a middle ground, with the facilitator providing an introduction, directed but not dominating questioning, highlighting the essential issues, and an appropriate summary (Welty, 1989).

The role of the student

Although some teachers will assign cases as the basis for individual work, many would argue that discussion in groups is at the core of the CBL approach. The group discussion in CBL can be an effective and motivating method of learning if students are well-prepared and given time for both individual preparation and group discussion (Flynn & Klein, 2001). You might even say that the student’s role is as important as that of the facilitator. Students who take their “jobs” seriously in CBL will prepare in advance by reading through the cases and describing the issues, perceptions, and possible courses of action. They could also review relevant materials in advance if the case is presented early enough.

In addition to preparation the successful student will continually evaluate the proposed solutions and reflect on what is learned and what still needs to be learned. In this process of evaluating and reflecting, they are able to take more responsibility for, and control of, their own learning. Finally, the student must commit to working collaboratively with their peers. Even students who reported disliking groupwork were more satisfied with their learning experience than those who worked alone (Flynn & Klein, 2001). While working through cases, students should aim to:

  • Engage with the characters and circumstances of the story
  • Identify and define the problems as they perceive them
  • Connect the meaning of the story to the clinical and professional context
  • Bring their own prior knowledge and principles to bear on the problem
  • Highlight relevant points and questions, and defend their positions
  • Formulate strategies to analyse the data and to generate possible solutions
  • Work with others to develop a collaborative solution to the problem

Case-based assessment

Initially, assessment and performance evaluation in CBL may seem daunting, as it can be more subjective than other methods and some teachers may be uncomfortable with that. However, with careful planning and preparation, assessment in CBL can be done efficiently, effectively and fairly. Students might also be uncomfortable with assessment, especially those who are accustomed to multiple choice or other forms of assessment that have clear right and wrong answers. This is one reason why the learning objectives need to be established at the beginning, and referred to regularly. Once those are clear and students understand what is expected of them, they should be able to keep track of their own progress and play a greater role in regulating their learning (Wasserman,1994).

The following questions should be considered when deciding how to evaluate a case (Schneider, 2010):

  • What parts of the process need to be assessed?
  • What parts can be graded as a group?
  • What can 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?
  • How will you ensure that the students actually know the content?

Assessing a student who has used a CBL approach can make use of something called key-feature approach questioning (Schuwirth & van der Vleuten, 2005). In this context, the assessor can use short cases that are followed by a limited number of questions aimed at addressing specific decisions that the student must make. Ensure that all of the information necessary to answer the question is presented in the case; not only medical information, but contextual information as well. Ensure that the questions are directly linked to the case, so that the correct answer is based on the students’ ability to integrate all of the relevant information in the case i.e. students should not be able to answer the question without comprehending the case. Ensure the question elicits important decisions where an incorrect decision would lead to incorrect management of the patient.

Teachers and students may both find scoring rubrics helpful, as these can help to establish a clear picture of successful behaviour or work quality, removing subjectivity and some of the ambiguity inherent in using CBL. Cases and group performance can also be assessed with case presentations, which are conducted at the completion of a case. Facilitators and other students can challenge the approaches and outcomes of the case, using a rubric that is distributed to students well before the presentations.

Conclusion

Case-based learning provides opportunities for the richer, deeper exploration of concepts and ideas in clinically-orientated teaching and learning. Students are able to develop experience in analysing ideas and applying concepts to solve problems, rather than simply acquiring abstract knowledge. It also requires students to engage with one another and their environment and facilitate the development of a wide range of social and cognitive skills. Case-based learning requires careful preparation and skilled facilitation on the part of teachers, as they aim to guide students towards personal learning, as opposed to providing them with content. Assessing student learning and evaluating their performance requires more than the traditional multiple choice or short-answer tests. Clear learning objectives, performance standards and relevant criteria can help enable teachers use a more holistic approach in order to better tailor the learning activities to students’ needs. Case-based learning is a valuable teaching and learning method that aims to develop contextualised knowledge and skills that will help students succeed in the clinical context.

References and Resources

  • Association of American Medical Colleges (1984). Physicians for the 21st century: Report of the project panel on the general professional education of the physicians and college preparation for medicine. Journal of Medical Education, 59, part 2:1-208.
  • Blackmon, M., Hong, Y., & Choi, I.. (2007). Case-based learning. In M. Orey (Ed.), Emerging perspectives on learning, teaching, and technology.
  • Christensen, C. R. (1987). Teaching and the case method. Boston: Harvard Business School Press.
  • Collins, A. (1988). Cognitive apprenticeship and instructional technology. Technical Report No. 6899. BBN Labs Inc., Cambridge, MA.
  • David, D.K. (1954). Forward In McNair, M.P. (Ed.), The case method at the Harvard business school. New York: McGraw-Hill (p.viii).
  • Dolmans, D., Snellen-Balendong, H., Wolfhagen, I., & van der Vleuten, C.P.M. (2009). Seven principles of effective case design for a problem-based curriculum. Medical Teacher, 19(3), 185-189.
  • Flynn, A & Klein J, (2001). The influence of discussion groups in a case-based learning environment. Educational Technology Research & Development, 49(3), 71-86.
  • Herreid, C.F. (1997). What makes a good case? Some basic rules of good storytelling help teachers generate excitement in the classroom.
  • Herrington, J., Oliver, R. & Reeves, T.C. (2003). Patterns of engagement in authentic online learning environments. Australian Journal of Educational Technology, 19(1), 59-71.
  • Lombardi, M.M. (2007). Authentic learning for the 21st century: An overview. Educause learning initiative, Diana G. Oblinger (Ed.).
  • Marks, M & Humphrey-Murto, S. (2005). Performance assessment. In Dent, J.A. & Harden, R.M. (Eds). A practical guide for medical teachers. Elsevier.
  • Prideux, D. (2005). Integrated learning. In Dent, J.A. & Harden, R.M. (Eds). A practical guide for medical teachers. Elsevier.
  • Regehr, G. & Norman, G.R. (1996). Issues in cognitive psychology: Implications for professional education. Academic Medicine, 71(9), 988-1001.
  • Schneider, D.K. (2010). Case-based learning. Edutech wiki. Schuwirth, L.W.T., Blackmore, D.B. Mom, E.M.A., van den Wildenberg, F., Stoffers, H.E.J.H., van der Vleuten, C.P.M. (1999). How to write short cases for assessing problem-solving skills. Medical Teacher, 21, 144-150.
  • Schuwirth, L.W.T. & van der Vleuten, C.P.M. (2005). Written assessments. In Dent, J.A. & Harden, R.M. (Eds). A practical guide for medical teachers. Elsevier.
  • Seely-Brown, J., Collins, A., & Duguid, P. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32-42.
  • Shulman, J. (1992). Case methods in teacher education. New York: Teachers College Press.
  • Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.
  • Washington University in St. Louis (n.d.). Teaching with discussions. The Teaching Center, accessed 11 January, 2013 at http://teachingcenter.wustl.edu/teaching-discussions.
  • Washington University in St. Louis (n.d.). Asking questions to improve learning. The Teaching Center, accessed 11 January, 2013 at http://teachingcenter.wustl.edu/asking-questions-improve-learning.
  • Wenger, E. (1998). Communities of practice. Cambridge University Press, New York.
  • Weltey, W. (1989). Discussion method teaching: A practical guide. Change, July/August, 40-49.

Content isn’t important, relative to thinking

I just had a brief conversation with a colleague on the nature of the teaching method we’re using in my department. Earlier this year we shifted from a methodology premised on lectures, to the use of case-based learning. I’ve been saying for a while that content is not important, but I’ve realised that I haven’t been adding the most important part, which is that content is not important, relative to thinking.

Of course content is important, but we often forget why it’s important. Content doesn’t help students to manage patients (not much anyway). The example I often use is that a student can know many facts about TB, including, for example, its pathology. But, that won’t necessarily help them to manage a patient who has decreased air entry because of the TB.

What will help the student is the ability to link data obtained from the medical folder, patient interview and physical exam, with the patients signs and symptoms. By establishing relationships between those variables, the student develops an understanding of how to proceed with the patient management process, which includes treatment. There is very little content that the student needs in order to establish those relationships. In those situations, what the content does focus on is a recipe list of commonly used assessment and treatment interventions, which the student can memorise and apply to a patient who presents in a certain way. This is NOT what we want though. This approach doesn’t help students’ adapt and respond to changing conditions.

Knowing the pathology of TB may tell the student WHY there is decreased air entry to the basal aspect of the lungs, but not WHAT TO DO about it (unless you want students to follow recipes). Clinical reasoning is the important part, not content. This is what I’ve been missing when I tell people that content isn’t important. It’s not, but only relative to thinking.

Posted to Diigo 03/23/2012

    • I also told students why we were doing this (something that isn’t done often enough in classrooms, in my opinion–why do some still insist on keeping what they want students to learn a big secret, making students stumble around trying to figure it out all in the name of “it’s good for them?”) by writing some “I can” statements for problem-solving
    • I can solve problems by:

      • analyzing given information to determine what you need to know
      • doing research and collecting resources using technology
      • stating the problem in clear language
      • mapping out the problem to arrive at a solution
      • proposing a logical solution to the problem based on evidence gathered during your research, and supporting that solution by citing evidence from your research
  • However, I must still focus on my content area objectives
  • after a few days of processing the initial information given to them in the case report and letter, I sent them another letter from the good doctor which stated the specific “science stuff” they needed to include in their presentation
  • We then added more questions to their “Need to Know” list, and continued the research
  • Our next steps are to plan out their presentations (which is the solution to their problem) and practice them in class before giving them in class
  • Don’t use a case that is easily find-able on the internet
  • Make your problem more than just about finding a “right” answer
  •  Also, the inherent real-world “messiness” of my problem  lies not in the solution itself but in making the connections between the science concepts and the little girl’s symptoms in order to form a coherent and concise explanation
  • Have students practice making connections between concepts
  • students are used to the “memorize, repeat, forget” model of schooling and need practice with upper-level thinking skills
  •  Bottom line–if your students don’t know how to think the way you want them to, you have to have them practice that thinking
  • Just throwing them out into the thinking pool without any training (or even any floaties to help them) is setting yourself and your students up for frustration rather than learning
  • Provide students with activities to help them learn your curricular goals.
  • in order to guide them and help them focus their research, I wrote some learning activities
  • But don’t let students get so lost in the content forest that the content trees are all they see
  • review the problem statement every day
  • Don’t let them get so deep into the memorizing content zone that they lose sight of the problem they’re supposed to be solving
  • Unlearn talking at students and learn to ask them question after question
  • I am also driving my students nuts with my questions, because now I am not the supreme answer-giver and master science-explainer
  • it puts the burden of thinking back on the student

From “designing teaching” to “evaluating learning”

Later this month we’ll be implementing a blended approach to teaching and learning in one module in our physiotherapy department. This was to form the main part of my research project, looking at the use of technology enhanced teaching and learning in clinical education. The idea was that I’d look at the process of developing and implementing a blended teaching strategy that integrated an online component, and which would be based on a series of smaller research projects I’ve been working on.

I was quite happy with this until I had a conversation with a colleague, who asked how I planned on determining whether or not the new teaching strategy had actually worked. This threw me a little bit. I thought that I had it figured out…do small research projects to develop understanding of the students and the teaching / learning environment, use those results to inform the development of an intervention, implement the intervention and evaluate the process. Simple, right?

Then why haven’t I been able to shake the feeling that something was missing? I thought that I’d use a combination of outputs or “products of learning” (e.g. student reflective diaries, concept mapping assignments, semi-structured interviews, test results, focus groups, etc.) to evaluate my process and make a recommendation about whether others should consider taking a blended approach to clinical education. I’ve since begun to wonder if that method goes far enough in making a contribution to the field, and if there isn’t something more that I should be doing (my supervisor is convinced that I’ve got enough without having to change my plan at this late stage, and she may be right).

However, when I finally got around to reading Laurillard’s “Rethinking University Teaching”, I was quite taken with her suggested approach. It’s been quite an eye opener, not only in terms of articulating some of the problems that I see in clinical practice with our students, but also helping me to realize the difference between designing teaching activities (which is what I’ve been concentrating on), and evaluating learning (which I’ve ignored because this is hard to do). I also realized that, contrary to a good scientific approach, I didn’t have a working hypothesis, and was essentially just going to describe something without any idea of what would happen. Incidentally, there’s nothing wrong with descriptive research to evaluate a process, but if I can’t also describe the change in learning, isn’t that limiting the study?

I’m now wondering if, in addition to what I’d already planned, I need to conduct interviews with students using the phenomenological approach suggested by Laurillard i.e. the Conversational Framework. I don’t yet have a great understanding of it but I’m starting to see how merely aligning a curriculum can’t in itself make any assertions about changes in student learning. I need to be able to say that a blended approach does / does not appear to fundamentally change how students’ construct meaning and in order to do so I’m thinking of doing the following:

  • Interview 2nd year and 3rd students at the very beginning of the module (January, 2012), before they’ve been introduced to case-based learning. My hypothesis is that they’ll display quite superficial mental constructs in terms of their clinical problem-solving ability as neither group has had much experience with patient contact
  • Interview both groups again in 6 months and evaluate whether or not there constructs have changed. At this point, the 2nd years will have been through 6 months of a blended approach, while the 3rd years will have had one full term of clinical contact with patients. My hypothesis is that the 2nd years will be better able to reason their way through problems, even though the 3rd years will have had more time on clinical rotation

I hope that this will allow me to make a stronger statement about the impact of a blended approach to teaching and learning in clinical education, and to be able to demonstrate that it fundamentally changes students constructs from superficial to deep understanding. I’m just not sure if the Conversational Framework is the most appropriate model to evaluate students’ problem-solving ability, as it was initially designed to evaluate multimedia tools.

HELTASA conference, 2011 – day 2

 

Explaining, naming and crossing border in Southern African higher education
Prof Piet Naude

This was one of the most challenging presentations I’ve ever listened to. I didn’t agree with a lot of what Prof Naude said, but he made me question my own beliefs and biases.

Ontology: language is the house of reality (language shapes reality)
In political discourse, language precedes actual violent acts. In Rwanda, people called each other “cockroaches”, and it’s much easier to kill a cockroach than to kill a human being.

Crossing interpretive borders in higher education:

  • Utilitarianism: views universities as vehicles for the promotion of sectarian interests e.g. religious, political, economic → doctrines dictate the boundaries of science and denies the search for truth without fear nor favour (religious language abundant in university e.g. professor, sabatical, rector). University as a vehicle to continue the doctrine or belief e.g. when universities in South Africa advanced the notion of Apartheid in different fields (biology, politics, religion, etc.). “Truth” would be based on doctrine.
  • Scientism: views “real knowledge” on the basis of empiricist, quantitative assumptions and a correspondent theory of truth. Science is the future, Humanities is the past. Some scientists are blind to the social construction of scientific paradigms. Blind to the link between science and the power or use of science. Blind to the complexity of personal and societal development.
  • Liberalism: rests on presumed a-contextual and unversalist assumptions about the human person, rationality and knowledge whist actually reflecting post-Enlightenment, Western thinking. “Professional training is vicious”. I think therefore I am vs. ubuntu = I am who I am because of who we all are. “Vicious ideological nature of Western scientific thinking”. Are there non-empirical forms of validation that are equally valid as scientific ones? Are all forms of non-Western knowledge subject to verfication by Western evaluation practices?

If universities don’t exist for the public good, they become playgrounds for the rich. Commercial language can change the direction of education e.g. when a “vice chancellor” becomes a “CEO”

Crossing 5 metaphorical boundaries

  • Centre – periphery: where you are born will determine your ability to succeed in the world / geographical (in)justice
  • Conceptual – technical / applied (epistemic justice). People who work with their hands are not as “smart” as people who can “think”. In South Africa, we need a greater emphasis on technical / applied knowledge. More colleges, fewer universities.
  • Uniformity (globalism) – plurarility (glo-cality) (cultural justice): where everyone wears jeans, watches BBC and speaks English. Emphasise a system where I can function at a global level but remain true to my local context. What is the impact on language / culture of the homogenising effect of university?
  • Anthropocentrism – cosmocentric thinking (ecological justice): it’s a problem when science and technology seeks only to improve the lot of human beings at the expense of everything else.
  • Past / present – future (noogenic justice): the world is in a mess, we need to prepare students to improve the future. Challenge students to imagine a future that does not exist, and give them the knowledge and skills to create it.

 

Perceptions of PBL group effectiveness in a diverse pharmacy student population
Lindi Mabope

Study set out to evaluate student perceptions of differences in plenary vs small group work in a PBL context

4th years have better experiences with groups than 3rd years

Some students prepare only what THEY need to present in plenary sessions, whereas small groups mean that students must prepare better and more broadly

Students generally feel that the plenary sessions aren’t a “good way of learning”

Most students agree that working in small groups helps develop tolerance for language and cultural difference

Most students agreed that small group working helped them to work effectively

Cases in small groups helped students to clarify areas of difficulty

PBL seemed to work well across a diverse student group, perceptions were generally positive

Confusing / difficult conceptual work required the development of certain attributes e.g. communication, self-directed learning, tolerance

Some students found the small groupwork sessions frustrating and challening

Groups demand a large investment in time and energy, from students and staff

Problems must be resolved very early on

Continuous monitoring and evaluation of the PBL process is essential

Facilitators must pay regular attention of the changing needs of the students (students change and develop as part of the process, as do their needs, so facilitators must be aware of the changes and change the programme accordingly)

Use the positive benefits of diversity, rather than merely work around it (how can student diversity actually feed into the programme, encourage students to bring themselves into the cases, share their own life experiences in order to enrich the module)

Supporting and enabling PG success: building strategies for empowerment, emotional resilience and conceptual critical work
Gina Wisker

What are the links between students’ development and experiences: ontology (their sense of being in the world) and epistemology (how they construct knowledge)
Why do students undertake doctorates and what happens during their studies to help / hinder them?

Conceptual threshold crossing (Meyer & Land): the moments when you know that you’re being cleverer than you thought you were 🙂

What can staff do to enhance and safeguard research student wellbeing and nudge conceptual threshold crossing?

Building emotional resilience and wellbeing

Students kept learning journals for a duration of 3 years and included interviews during that period

“Troublesome encounters” (Morris & Wisker, 2011)

Doctoral learning journeys are multi-dimensional:

  • Meeting course requirements (instrumental)
  • Professional dimension
  • Intellectual / cognitive development
  • Ontological (how does it change the person?)
  • Personal / emotional

How do doctoral students signify their awareness of working conceptually?

How do supervisors recognise students’ conceptual grasp of research (this applies equally well to UGs conceptual grasp of the discipline)

Conceptual crossing is evidenced by:

  • Troublesome knowledge
  • Movements on from stuck places through liminal spaces into new understanding
  • Transformations (Meyer & Land)

Ontological change: seeing the self and the world differently and you can’t go back
Epistemological contribution: making new contributions to understanding and meaning

You have to find your own way, otherwise it’s a mechanistic process

Threshold concepts are:

  • Transformative: developing an academic identity
  • Irreversible: when you change how you perceive the world, you can’t go back
  • Integrative: forming relationships between what seemed previously to be disparate ideas
  • Troublesome knowledge: dealing with complexity

Learning moments that may indicate threshold crossings:

  • Coming up with research questions
  • Determining relationships between existing theory and own work
  • Device methods and engage with methods
  • Deal with surprises and mistakes
  • Analsyse and interpret data

There needs to be a number of conceptual leaps, otherwise the thesis is a box-ticking exercise

Make sure that the doctoral project has boundaries. The work is part of a greater whole, and the more focused the work, the easier it is to define the boundaries

Research is a journey (risks, surprises, deviations, even though it looks mapped), but a thesis is a building (ordered, coherent, organised, linked)

Constructive, intellectually challenging relationships

Student wellbeing is essential for postgraduate success:

  • Academic
  • Personal
  • Financial

There are factors in the learning environment that pose challenges to student wellbeing

What are the wellbeing issues for our research students?

Negative impacts cripples creativity and encourages you to take the path of least resistance, where the project is more about a qualification and less about innovation

Important to switch off from the process and engage in the world in different ways, as a coping strategy when experiencing difficulty

 

Crossing borders between face-to-face and online learning: the evaluation of an online tutoring initiative
Sanet Snoer

Collaborative learning has as its main feature a structure that encourages students to talk

Created an online module because student numbers increased, shortages of venues and tutors, timetable clashes, changing student profile and needs

Blended approach could help with logistical problems, expose students to a new way of learning, more challenging activities, develop wide variety of skills

Uses Gilly Salmon’s model for teaching and learning online as a point of departure, provides scaffolding to take students through a process of familiarising students with the environment

Students’ perceptions of online components were generally positive. However, students reported challenges with effective textual communication and typing, time management (which seems odd, since blended learning seeks to help with time issues), self-expression, understanding of concepts that are read rather than heard, poor familiarity with computers and the internet → disadvantage, feedback is immediate with face-to-face, relationships → face-to-face is a more personal interaction

Used Community of Inquiry framework to develop good online teaching practices (see Kleimola & Leppisaari, 2008 for breakdown of different “presences”)

Recommendations:

  • Needs to be agreement about turnaround time for feedback from facilitators
  • Purpose of each activity should be clear
  • Understand the benefits of the activities
  • Must model effective online behaviour
  • Communicate expecations clearly
  • Promote the mind shift that needs to take place
  • Create a non-threatening environment
  • Don’t assume students are familiar with the environment
  • Explain the role of face-to-face and online activities

Was there integration of online and offline activities? Used real-world examples to develop conversation around activities

 

Students’ learning satisfaction from a blended learning environment for physiology
Saramarie Eagleton

What aspects of technology provide benefits / advantages to the learning process. NOT whether technology is inherently good or bad

 

How collaborative groupwork affects students’ writing
Shena Lamb-du Plessis, Laetitia Radder

Aim was to get the students to write in as many different ways, and as regularly as possible during the course

Used group journal reflections and group progress reports

Peer feedback is valuable when students know from the start that they will be sharing their work with others

Developing a writing identity means pushing students to think for themselves and to imagine themselves as writers

A process of developing and clarifying thoughts by sharing them with an audience

Groupwork can shape the meaning of the work

Group dialogue helped to define / outline the writing requirements

Students felt that personal expression validated their viewpoints

Helped to develop self-confidence when they realised that others shared their experiences

Must introduce conflict management strategies, orient students to role allocation, discuss writing tasks to restructure meaning

 

Exploring the tension between institutional learning management systems and emergent technologies: staff perspectives at the Cape Peninsula University of Technology
Daniela Gachago, Eunice Ivala, Agne Chigona

What are “emerging technologies” and can they disrupt teaching practice?

The impact of technologies in education falls short of the rhetoric:

  • They are used to support and improve current teaching practices
  • Teachers and students use a limited range of technologies
  • Used to reproduce existing practice, as opposed to transforming practice
  • Supports passive, teacher-centred and didactic instruction

Need to redefine e-learning: “can no longer be viewed as a purely institutionally based or narrowly defined set of activities” (HEFCE paper, 2009, 5). Difficult because institutions are reluctant to give up their power and control

There is a shift of the locus on control:

  • Control moves to students and lecturers
  • Transfer of authority of knowledge and ownership of technology

Type I technologies replicate existing practices, Type II technologies allow students and lecturers to do things that they couldn’t do before

In complex-adaptive domains, knowledge doesn’t provide prospective predictability but rather, retrospective coherence. Learning should be self-organised and collaborative (Williams, Karousou, Macness, 2011)

“Hard” technologies: constraining and limiting, stifles creativity e.g. LMS
“Soft” technologies: freedom to play

Soft technologies require skill and artistry. It’s not just what you do but how you do it.

Qualities of disruptive technologies (Meyer, 2010):

  • Student-centred
  • Designed to offer options, motivate students, provide connections to the lives, jobs and communities of students
  • Capitalise on willingness of students to experiment and fail, to improve, and to keep at problems until solutions are crafted

Laurillard (2002, 141): We’re playing with digital tools but with an approach still born in the transmission model. There is no progress therefore, in how we teach, despite what is possible with the new technology

Laurillard’s conversational framework: there’s no escape from the need for dialogue, there is a constant exchange between teacher and student:

  • Discursive
  • Interactive
  • Adaptive
  • Reflective

Laurillard (2002). Rethinking university teaching.

No one approach is better than the other. We need to have a mix of approaches to get the maximum benefit of using different tools

“It’s a way of doing life. It’s not about computers. It’s not about mobile learning. It’s just learning – it’s just life”

 

Analysing teaching and learning at five comprehensive universities
Sioux McKenna

What are the mechanisms in the world that exist in order for us to have the experiences that we do?

Move beyond the statistics of higher education, and ask what must the institution be like in order for this to be (im)possible?

What is the role of Culture (ideas), Structure (process), and Agency (people)?

Most institutions continue to reflect their individual histories as rural/urban, disadvantaged/advantaged, traditional/university of technology. There seemed to be little cohesion in terms of what it means to be a comprehensive university.

Comprehensive universities emphasise the management discourse that focuses on the “complexity to be managed” rather than a “knowledge discourse” i.e. what is knowledge / research, etc.

There are implications for academic identify and research output

“Powerful ways of knowing”

Often students are constructed as deficits i.e. they are deficit in language, life skills, motivation, etc.

Developing case studies for holistic clinical education

This is quite a long post. Basically I’ve been trying to situate my current research into a larger curriculum development project and this post is just a reflection of my progress so far. It’s probably going to have big gaps and be unclear in sections. I’m OK with that.

Earlier this week our department had a short workshop on developing the cases that we’re going to use next year in one of our modules. We’re going to try and use cases to develop a set of skills and attitudes that are lacking in our students. These include challenges with (text in brackets are stereotypical student perspectives):

  • Problem solving and clinical reasoning (Tell me what the answer is so that I can memorise it)
  • Critical analysis (Everything I read has the same value)
  • Empathy (The patient is an object I use to develop technical skills)
  • Communication (The use of appropriate professional terminology isn’t important)
  • Groupwork (Assessment is a zero sum game…if you score more than me it bumps me down the ranking in the class, therefore I don’t help you)
  • Knowing vs Understanding (It’s more important for me to know the answer than to understand the problem)
  • Integration of knowledge into practice (What I learn in class is separate to what I do with patients)
  • Integration of knowledge from different domains (I can’t examine a patient with a respiratory problem because I’m on an orthopaedic rotation)
  • Poor understanding of the use of technology to facilitate learning (social networks are for socialising, not learning)

I know it might seem like a bit much to think that merely moving to case-based learning is going to address all of the above, but we think it’ll help to develop these areas in which the students are struggling. The results of my ongoing PhD research project will be helping in the development of this module in the following ways:

  • The survey I began with in 2009 has given us an idea of digital literacy skills of this population, as well as some of the ways in which they learn.
  • The systematic review has helped us to understand some of the benefits and challenges of a blended approach to clinical education.
  • The Delphi study (currently in the second round) has already identified many of the difficulties that our clinicians and clinical supervisors experience in terms of developing the professional and personal attributes of capable and competent students. This study will attempt to highlight teaching strategies that could help to develop the above mentioned problems.
  • I’ve also just finished developing and testing the data capture sheet that I’ll be using for a document analysis of the curriculum in order to determine alignment.
  • Later next year I’ll be conducting an evaluation of the new module, using a variety of methods.

All of the above information is being fed into the curriculum development process that we’re using to shift our teaching strategy from a top-down, didactic approach to a blended approach to teaching and learning. Development of the cases is one of the first major steps we’re taking as part of this curriculum development process. I’ll try to summarise how the cases are being developed and how they’ll be used in the module. This module is called “Applied Physiotherapy” and it’s basically where students learn about the physiotherapy management of common conditions.

In the past, these conditions were divided into systems and taught within those categories e.g. all orthopaedic conditions were covered together. The problem is that this effectively silo’s the information and students see little crossover. In fact, reality is very rarely so conveniently categorised. Patients with orthopaedic conditions may develop respiratory complications as a result of prolonged bed rest. Patients with TB often also present with peripheral neuropathy, as a result of the association of TB with HIV. So, the purpose of the cases is also to integrate different conditions to help students understand the complexity of real-world cases.

In the first term we’ll use 2 very simple cases that each run for 3 weeks. The reason that the cases are simple is that we’re also going to be introducing many new ideas that the students may have little experience with and which are important for participation in the cases e.g. computer workshops for the online environment, concept mapping, group dynamics, presentation skills, etc. The cases will increase in complexity over time as the students feel more comfortable with the process.

Each case will have an overview that highlights the main concepts, learning outcomes, teaching activities, assessment tasks and evaluation components that the case encompasses. The case will be broken up into parts, the number of which will depend on the duration and complexity of the case. After the presentation of each part, the students (in their small groups) will go through this process:

  • What do I know that will help me to solve this problem?
  • What do I think I know that I’m uncertain of?
  • What don’t I know that I need to learn more about?

These questions should help the students develop a coherent understanding of the knowledge they already have that they can build on, as well as the gaps in understanding that they need to fill before they can move on with the case. Each part will involve students allocating tasks that need to be completed before the next session and role allocation is done by each group prior to the introduction of the case. During this process, facilitators will be present within the groups in order to make sure that students have not left out important concepts e.g. precautions and contraindications of conditions.

At the next session, each member of the small groups present to each other within the small groups. The purpose of this is to consolidate what has been learned, clarify important concepts and identify how they’re going to move forward. At the end of each week each small group presents to the larger group. This gives them the opportunity to evaluate their own work in relation to the work of others, make sure that all of the major concepts are included in their case notes, as well as opportunities to learn and practice presentation skills. Students will also be expected to evaluate other groups’ work.

There will be a significant online component to the cases in the form of a social network built on WordPress and Buddypress. We will begin by providing students with appropriate sources that they can consult at each stage of the process. Over time we’ll help them develop skills in the critical analysis of sources so that they begin to identify credibility and authority and choose their own sources. They will also use the social network for collaborative groupwork, communication, and the sharing of resources.

Finally, here are some of the tasks we’re going to include as part of the cases, as well as the outcomes they’re going to measure (I’ve left out citations because this has been a long post and I’m tired, but all of these are backed by research):

  • Concept mapping – determine students’ understanding of the relationships between complex concepts
  • Poetry analysis – development of personal and professional values e.g. compassion, empathy
  • Reflective blogging – development of self-awareness, critical evaluation of their own understanding, behaviours and professional practices
  • Peer evaluation – critical analysis of own and others’ work
  • Case notes – development of documentation skills
  • Presentations – ability to choose important ideas and convey them concisely using appropriate language

This is about where we are at the moment. During the next few months we’ll refine these ideas, as well as the cases, and begin with implementation next year. During my evaluation of the module, I’ll be using the results of the student tasks listed above, as well as interviews and focus groups with students and staff. We’ll review the process in June and make changes based on the results of my, and 2 other, research projects that will be running. We want the curriculum to be responsive to student needs and so we need to build in the flexibility that this requires.

After reading through this post, I think that what I’m saying is that this forms a basic outline of how we’re defining “blended learning” for this particular module. If you’ve managed to make it this far and can see any gaping holes, I’d love to hear your suggestions on how we can improve our approach.