Using the Community of Inquiry in online learning environments

I’m in the process of putting together a workshop for the  facilitators of one of our modules that we’re restructuring in order to use a blended learning approach. Here are the notes that I’ve been putting together on the Community of Inquiry (CoI) for the workshop. Bear in mind that these notes are my attempt to get a better understanding of the CoI, and so lack academic rigor (i.e. there are no references). Finally, I apologise in advance for any errors or misinterpretation of the model, especially where I’ve given my own examples for our participants. Feedback, as always, is welcome.

The Community of Inquiry is a framework developed by Garrison and Archer (2001) as a way of describing favourable conditions to stimulate learning in online environments. Since a lot of the Applied Physiotherapy module will be conducted online, the CoI is a useful framework to guide our understanding of interactions in the social network we’ll be using. The CoI suggests that in order for meaningful learning to take place in online spaces, there needs to be evidence of 3 types of “presence”:

  • Social presence
  • Cognitive presence
  • Teaching presence

Social presence is about encouraging purposeful communication in a trusted setting, and developing interpersonal relationships by projecting personality. There are 3 categories of social presence;

  • Affective response: humour, emotional expression (e.g. emoticons, “lol”)
  • Open communication: recognition, interaction, reflection
  • Group cohesion: use names, greet students, use inclusive pronouns (e.g. “Hi Sue. This is a good question that we can all learn from”)
Social presence is an essential component in online learning, in that students who perceive that it is lacking (i.e. they don’t feel welcome and safe) demonstrate low levels of cognitive presence. Some of the ways in which social presence can be enhanced is by communicating in ways that are perceived by students to be “warm” (think; a caring attitude). Participate regularly, respond quickly, use chat when possible. In other words, create a sense of “being there”.

Cognitive presence refers to an ability to construct meaning through sustained communication. There are 4 practical components to developing a sense of cognitive presence, which are similar to Kolb’s cycle of experiential learning:

  1. Provide a triggering event or problem that is indicated by a sense of puzzlement. The idea is to create a conflict between a students perceived understanding of reality (“This is how I believe the world to be”) and a realisation that the evidence doesn’t support their perception (“The world is not how I believed it to be”).
  2. Opportunities for exploration of the problem. This is achieved by creating an opportunity for students to understand the nature of the problem (“How or why isn’t the world the same as my mental construct of it?”), find relevant information (“What evidence can I find that will help me to understand this problem better?”), propose explanations (“If this is true, then it means that…”), and exchange information (“Hey guys, here’s some information that will help us understand this better”). You can see from these examples that this is similar to the process we want to stimulate in our cases.
  3. Students must try to integrate the new information through a focused construction of new meaning based on the new evidence. They do this by connecting new ideas and concepts to old knowledge that they already have. An understanding of the Zone of Proximal Development would be useful here.
  4. There must be a final resolution of the problem i.e. it must be solved.

There are 6 practical suggestions for how cognitive presence can be facilitated in online spaces. I’ve tried to explain each of these suggestions in terms of how we might implement them because it turns out the when facilitators model the behaviour we want to see in students e.g. critical discourse with each other and constructive critique, students tend to do similar things. The idea is that if we succeed in doing things like what is outlined below, we create the favourable conditions for cognitive presence in the online space:

  1. Discourse. We should aim to be active guides by posing questions that are relevant to emerging topics of discussion. Be aware of entering a discussion and “breaking it” by being an authority figure and / or using “academic” language that students may not be familiar with. There’s little point in students’ continuing a discussion when one of us comes in and provides a definitive resolution (i.e. an “answer”) to whatever problem they’re discussing, or when we say things that they don’t understand. Remember that we want to stimulate a conversation for them, not end one they’re already having.
  2. Collaboration. Groupwork should aim to involve generating, sharing, critiquing and prioritising solutions. There are 2 key elements; availability of the facilitator and the intellectual engagement of the student with the content.
  3. Management. Students begin to take increasing control of the learning activities e.g. suggesting and developing their own projects, with feedback from the larger group guiding their implementation.
  4. Reflection. Students tend to spend more time deliberating on their reflections when they know that what they write will be read and commented on by others. This is why we will use “public” reflections online and students will be expected to read and comment on each others’ reflections. Reflection, simply, is forming relationships between your abstract view of the world (i.e. how you believe the world to be) and how the world actually is (i.e. the congruence between your belief and what actually happens in the world). Try to use language to help students make connections between the cases and personal experiences.
  5. Monitoring (self-assessment). Rubrics can be used to help students grade their own progress and understanding. They take responsibility for making judgements about their work, which is what self-directed learning is. In the professional world, it is rare that we have someone else telling us what we don’t know. It’s up to us as professionals to evaluate our skillset and make decisions about where we’re lacking and what we need to do to fill gaps in our knowledge and skills. We need to enable students to make judgements about what they know and don’t know. Peer- and self-assessment is one way of doing this.
  6. Knowledge construction. Students must make personal meaning (i.e. “sense”) of the information they gather. They must identify the problem (“The patient can’t weightbear on the ankle”), collect data related to the problem (ROM, history of the incident, functional ability, etc.), create an hypothesis (“I believe that the lateral ankle ligament has a grade 2 sprain”), test the hypothesis (send patient for stress test under X-ray), confirm hypothesis or collect more data if necessary, make a conclusion. This process is more effective in terms of “deep learning” than memorising the signs and symptoms of a sprained ankle.

Teaching presence is about directing the social and cognitive processes (see above) to develop personally meaningful and worthwhile outcomes. There are 3 categories of teaching presence:

  • Design and organisation i.e. developing and structuring the learning experience and activities
  • Facilitating discourse by maintaining student and facilitator interest, motivation and engagement
  • Direct instruction through “injecting knowledge”, dealing with issues around content and summarising discussions
There is a significant relationship between teaching presence and perceived learning / satisfaction with online courses. In the absence of synchronous, moment by moment negotiation of meaning available in the classroom, high levels of teaching presence in the online space is even more important, as it has a greater relative impact on cognitive presence when compared to students in a physical interaction.

Socialcognitive and teaching presence all interact / are dependent on each other. Studies have found that “teaching and social presence play a major role in predicting online students’ ratings of cognitive presence, and that teaching presence is strongly correlated with students’ satisfaction with the online learning experience and their sense of community. Furthermore, comfort in online discussion was the most significant factor in students’ perceptions of cognitive presence i.e. in order to develop higher order critical thinking, students need to feel comfortable with online discussion. It may be useful to ask students to reflect on their levels of comfort with online discussion. If they report low levels of comfort, further reflection on their part might identify why they feel this way and what might be done to improve their comfort levels, allowing facilitators to modify their approaches and / or the environment.

AMEE conference, 2011 (day 1)

Today was the first day of AMEE 2011, and a great start to my first international conference. Here are the notes I took.

Donald Clark – 21st century medical learning

“Death of the compliant learner” – almost all of my students are compliant, I hope Clark doesn’t buy into the idea that all of today’s students are somehow different? Even Prensky has moved on from the Digital Native debate

When the cost of education goes up, and the deliverable stays the same, you have the characteristics of a bubble → is higher education / medical education in a bubble (Malcolm Gladwell)?

Clark shows excerpt from Ferris Bueller’s day off to demonstrate poor lecturing style, gets a laugh but is caricaturing the format useful in terms of solving the actual problem?

Psychology of learning:

  • Spaced practice
  • Attention
  • Assessment
  • Learn by doing
  • Collaboration

“The internet is shaping pedagogy”, this is the wrong way around. Effective teaching practice should make effective use of the internet.

“Lectures are ineffective for teaching”

  • don’t inspire or motivate
  • no critical thinking
  • doesn’t emphasise values
  • no social adjustment
  • or behavioural skills
  • only useful for transmitting information

Student and lecturer’s attention begins to fall off after 25 minutes, yet lectures often continue for much longer. Clark’s solution → record lectures! OR…change teaching practice to make use of that time more effectively

Cultural reasons for not changing teaching practice

Assessment is skewed towards favouring cramming

Is technology supporting assessment?

Surgeons who play video games perform better with laparoscopic procedures than those who don’t

I think Clark’s emphasis on technology misses the point. This isn’t the right audience to make assumptions about what technology should be used with what teaching approach. The message he’s sending is that we should use digital tools because they’re better. But he hasn’t spent enough time explaining what it’s better for and how.

 

The future of online continuing medical education: towards more effective approaches
Panel discussion (John Sandars, Pat Kokotailo, Gurmit Singh)

How do we get the new evidence base to change behaviour in health professionals? By delivering content and hoping → behavioural change

Online CME is about transmitting content from an “expert” to the person at home, and competing with their social lives. Does this have the intended impact of actually changing clinician’s behaviour? Sandars says “No”

How can the intended impact be achieved?

CME vs CPD
CME process whereby people keep updated regarding medical information
CPD includes CME but is more broad

e-learning implies that technology is used to enhance T&L but no definition of what technology is. I wish people would stop talking about e-learning until we demonstrate that it’s fundamentally different in terms of changing learning behaviour

List of digital tools and blending them with f2f spaces

Issues in obtaining evidence of effective CPD:

  • Differing content in med ed → differing ways of delivering / teaching
  • Traditional curriculum vs no curriculum
  • Rare comparison between e-learning intervention and traditional intervention
  • Difficulty with educational RCTs (very “medical” to think that RCTs are an important evaluative tool in education)

Kirkpatricks model to categorise the level of evaluative outcomes

Majority of research looks at participant satisfaction, but limited research demonstrating performance change in practice, no studies demonstrated that web-based CME had any effect on clinical practice

Internet learning associated with large positive effects compared with no intervention, but the effects were heterogeneous and small (internet learning interventions were broad in terms of content)

Comparison of different virtual patient desings suggest repetition, advance organisers, enhanced feedback and explicitly contrasting cases can improve learning outcomes (Cook at al, Academic Medicine, 2010)

Which “e-learning” techniques enhanced learning experiences?

  • Peer communication
  • Flexibility
  • Support of a tutor who was also a moderator
  • Knowledge validation
  • Course presentation
  • Course design

Effectiveness of the online course is mediated by the learning experience

Cost effectiveness of online CPD is mainly based on self-report, so data not robust (Walsh et al, Education for primary care, 2010)

Most to least effective approaches (Bloom, International Journal of Technology Assessment in Health Care, 2005):

  • Interactive techniques (audit / feedback, academic detailing / outreach, reminders)
  • Clinical practice guidelines and opinion leaders less effective
  • Didactic presentations and distributed print material have little to no effect

Therefore, not much evidence for the use of online learning, and the effects that do exist, are small (smaller than traditional), course design is important, and interactivity appears to be key

Improving knowledge and skills without an associated change in behaviour, is useless

Discussion:

  • Isolated, invidualised online CME is focused on delivering content more efficiently but that misses the point
  • We need to integrate social components into the learning experience
  • We evaluate episodic events and expect to find behavioural change
  • It’s not about one approach or the other, we need to blend different teaching methods
  • We need to stop talking about e-learning, we don’t talk about overhead projector learning

Problems with CME (currently)

  • Exisiting models do not improve patient care
  • Current models are incomplete, and are used for different reasons
  • Use is unco-ordinated
  • Participation is low
  • Much research names existing models as “largely irrelevant”

Moving from knowledge and skills to changing behaviour. What is the / a new model?

The outcome must be: improving patient care. This comes about through supporting information exchange, opinion and advice to make sense of the complexity of practice

Technology used must be useful and relevant

Technology + pedagogy = outcome (is it this simple?)

Should move psychological learning theory to sociological theory

Professionals learns as they go about doing things, sharing tacit knowledge, discussing and interacting with others in social networks. As people interact they share ways of thinking, feeling and acting in daly life, which influences their behaviours and habits. We are living, learning and changing in practice. They are reflexive. Learning, behaviour and change are all dynamically connected in networks and make practice complex.

Learning practive should be embodied and emergent

Reflexive networks used in teaching and learning

We should be more strategic in collaboration, rather than having collaboration forced.

How do you evaluate outcomes?

  • CME credits
  • Self-report: was it relevant and useful?
  • Patient care audit: do patients have improved outcomes?

Tacit knowledge = useful knowledge

Practice and learning are inseparable

If individual practice is only part of the team approach, is it reasonable to expect that changing an invidual’s approach will actually impact on patient outcomes?

Interprofessional workplace-based learning using social networks
JM Wagter

Difference between in/formal learning

80% of learning is outside the formal context. How do we make the informal learning explicit?

Between whom is learning taking place i.e. identifying actors within the network by mapping relationships between teams, professions, etc.

Look at density and information and communication flows

Everybody is involved in informal learning within networks, but the relationships are assymetrical and not collaborative or reciprocal

Network analysis is a useful method to identify relationships between professionals, but what do you do with the information i.e. how do you change the relationships?

Patient attitude to medical students experience in General Practice
H Cheshire

Patients lack confidence to ask students to leave when receiving a personal physical examination by a GP

Female patients are less likely to have positive attitudes with regards a medical student conducting an assessment, although the numbers are quite high nonetheless

The context of the examination changes whether or not patients are happy to have students present e.g. sexual health, etc.

Learning at a clinical education ward: first and final year nursing students’ perceptions
K Manninen

Final year students have an emphasis on supervisor relationships and are more dependant on feedback and affirmation but don’t experience internal authenticity, which is what drives the understanding of the nursing role.

First year students focus on patient relationships with concomittant feedback

Creating a student ER
A O’Neill

Highly integrated, student-centred, emphasis on PBL → creation of a student ER

Organisation based on teams, rather than a hierarchy. Team sees the patient concurrently, rather than consecutively

Approach allows the student to manage the patient with a focus on structured feedback. Tried to avoid students managing those with obvious serious pathology, cognitive dysfunction, etc.

Supervisor behind the student, not the other way around

Received positive feedback from students, in addition to significant improvement in student note-taking ability, among other clinical skills

Evaluating medical grand rounds – 10 years later
Mary J Bell

High numbers of repeated evaluations in order to determine reliability

We tend to give colleagues higher evaluator ratings

Highest scores had less to do with knowledge and presentation of objectives, and more to do with presenter style, level of presentation and enthusiasm → edutainment

When grand rounds were done using digital video, overal presenter ratings went down, seeming to concur with social learning theories i.e. we want to be in the same room as those we’re learning from (but is social just about physical presence?)