To begin with, there are 9 elements of authentic learning (I believe that in designing our blended module we’ve managed to cover most of these elements. I’ll write that process up another time):

1. Provide authentic contexts that reflect the way the knowledge will be used in real life
2. Provide authentic tasks and activities
3. Provide access to expert performances and the modelling of processes
4. Provide multiple roles and perspectives
5. Support collaborative construction of knowledge
6. Promote reflection to enable abstractions to be formed
7. Promote articulation to enable tacit knowledge to be made explicit
8. Provide coaching and scaffolding by the teacher at critical times
9. Provide for authentic assessment of learning within the tasks

The above elements are non-sequential.

“Authentic activities” don’t necessarily mean “real”, as in constructed in the real-world (e.g. internship), only that they are realistic tasks that enable students to behave as they would in the real-world.

Here are 10 characteristics of authentic activities (Reeves, Herrington & Oliver, 2002). Again, I believe that we’ve designed learning activities and tasks that conform – in general – to these principles. It’s affirming to see that our design choices are being validated as we move forward. In short, authentic tasks:

1. Have real-world relevance i.e. they match real-world tasks
2. Are ill-defined (students must define tasks and sub-tasks in order to complete the activity) i.e. there are multiple interpretations of both the problem and the solution
3. Are complex and must be explored over a sustained period of time i.e. days, weeks and months, rather than minutes or hours
4. Provide opportunities to examine the task from different perspectives, using a variety of resources i.e. there isn’t a single answer that is the “best” one. Multiple resources requires that students differentiate between relevant / irrelevant information
5. Provide opportunities to collaborate should be inherent i.e. are integral to the task
6. Provide opportunities to reflect i.e. students must be able to make choices and reflect on those choices
7. Must be integrated and applied across different subject areas and lead beyond domain-specific outcomes i.e. they encourage interdisciplinary perspectives and enable diverse roles and expertise
8. Seamlessly integrated with assessment i.e. the assessment tasks reflect real-world assessment, rather than separate assessment removed from the task
9. Result in a finished product, rather than as preparation for something else
10. Allow for competing solutions and diversity of outcome i.e. the outcomes can have multiple solutions that are original, rather than a single “correct” response

Design principles for authentic e-learning (Herrington, 2006)

“Authentic learning” places the task as the central focus for authentic activity, and is grounded in part in the situated cognition model (Brown et al, 1989) i.e. meaningful learning will only occur when it happens in the social and physical context in which it is to be used.

“How can situated theories be operationalized?” (Brown & Duguid, 1993, 10). Herrington (2006) suggests that the “9 elements” framework can be used to design online, technology-based learning environments based on theories of situated learning.

The most successful online learning environments:

• Emphasised education as a process, rather than a product
• Did not seek to provide real experiences but to provide a “cognitive realism”
• Accept the need to assist students to develop in a completely new way

There is a tendency when using online learning environments to focus on the information processing features of computers and the internet. There is rarely an understanding of the complex nature of learning in unfamiliar contexts in which tasks are “ill-defined”.

The “physical fidelity” (how real it is) of the material is less important than the extent to which the activity promotes “realistic problem-solving processes” i.e. it’s cognitive realism. “The physical reality of the learning situation is of less importance that the characteristics of the task design, and the engagement of students in the learning environment” (Herrington, Oliver, & Reeves, 2003a).

Learners may need to be assisted in coming to terms with the fact that the simulated reality of their task is in fact, an authentic learning environment. It may call for their “willing suspension of disbelief” (Herrington, 2006).

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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”)

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

Social, cognitive 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.

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Supporting Scottish dental education through collaborative development and sharing of digital teaching and learning resources
D Dewhurst

Scottish dentail students had little engagement with mainstream e-learning

Low level of e-learning experience or readiness (among students or staff?)

3 year project to:

• Provide support
• Develop digital resources
• Empower learners and teachers:
• Effective engagement with academics / clinicians
• Create resources
• Maintain a community and encourage participation
• Share resources in a wider community

People developing resources were not concerned with taking 3rd party content off the web, included personally identifiable information

An electronic lexicon in obstetrics
Athol Kent

For deep learning to occur, students must make meaning from the information we give them. But, we make assumptions about what students understand about our professional culture, which includes an entirely new language.

The project is to create an online electronic lexicon of common O&G common terms and phrases

When the student feels ready, they are assessed on their knowledge of 100 of the 800 words in the lexicon

Students enjoy being seen as “intelligent but uninformed”

Students are able to add their own content to the lexicon

Would you consider making this valuable resource available to the global community? Yes, the database can be made available to other institutions on request

The literature as a means of distance learning in a PG course of family health
A Dahmer

Why does Brazil need large-scale training? Enormous population spread out over an area more than half the size of South America

One of the biggest problems in DE is maintaining motivation among students

Created a fictional city that accurately reflects the kind of places that medical students are expected to work in, down to the political structure of the city, Neighbourhood descriptions

Used virtual teams with individual characteristics

Used comic books, newspapers, podcasts and blogs

Using Moodle to create the learning environment, fits into the university infrastructure

Mimic social problems as well, which the students have to deal with

Humanises the work for students, approximated reality using distance learning

Did you consider using something like Second Life for creating the city? Yes, decided against it because infrastructure is a problem, as well as internet access for students

Virtual clinical encounters for developing and assessing interpersonal and transcultural competence with traumatised patients
Solvig Ekblad

Medical competence:

• Clinical
• Interprofessional
• Cultural

Cultural compentence is the ability of the clinician to overcome cultural difference to build effective relationships with patients, exploring the patient’s values and beliefs

Virtual clinical encounter = an interactive computer simulation of real-life scenarios for the purpose of healthcare and medical training, education or assessment (Ellaway et al, 2008)

Patient information in the VCE is very comprehensive

The intervention is scalable, generalisable, the assessment tool can be summative or formative, works as a controlled environment where medical students can work safely

Implementing the future of medical education in Canada
G Moineau

Recommendations:

• Address individual and community needs (speaks to social accountability)
• Enhance admissions processes (cognitive and non-cognitive considerations, interviews, autobiography)
• Build on the scientific basis of medicine
• Promote prevention and public health
• Address the hidden curriculum (learning environment must explicitly promote appropriate professional attributes)
• Diversity learning contexts (community based, preceptor programme, rural environments mandatory rotation)
• Value generalism (value primary care specialities / family medicine)
• Advance inter- and intra-professional practice (participate as part of a team)
• Adopt a competency-based approach (used CANMeds framework)
• The physician is a clinician, communicator, collaborator, professional, advocate, scholar, person, manager
• Electornic portfolio on core competencies → reflective practive, longitudinal over duration of course, pass / fail assessment
• Foster medical leadership (integrated into curriculum)

An anatomy course on “Human evolution: the fossil evidence”
Netta Notzer

About 130 students attend annually, a 3rd of them non-medical

Information for the course came from lecturers (e.g. their teaching philosophy), other faculty members’ opinions, observations in the class, the curriculum and syllabus, students’ web-sites

Scientific theory can be contradicted by new evidence and be argued. There is no superior authority in science, it is governed by factual evidence

Course is different from traditional anatomy courses, in that it is:

• Conceptually complex
• Intelllectually demanding
• Scientifically dynamic

Course presented in lecture hall, but instructor uses analogy, open discussion and explanation rather than memorisation

Course demonstrates that students from different faculties can learn together

GIMMICS: an educational game for final year pharmacy students and GPs in family practice
Pascale Petit

GIMMICS = teaching game in a controlled academic setting, focus on communication skills

First introduced in 2001, operational in 2003

Teaching goals:

• prepare for tasks as pharmacists
• improve quality of care
• address heterogeneity
• help student reflect and error-correct

Game is web-based, consists of a virtual pharmacy, is open for others to follow, covers all aspects of the profession

University remodels actual rooms to mimic game interface

Also makes use of reflective journals

Activities within the game are scored

Also used for communication between students and pharmacists

Game is a structured mix of all kinds of activities e.g. consultations, interruptions, home visits, prescription

No evaluation, focus is on learning

Can take a long time to introduce minor concepts to students

See Bertram (Chip) Bruce – University of Illinois

The impact of PDAs on the millenial medical student
Monica Hoy

We need to move the conversation away from the idea that a certain generation of students is more “technologically savvy” by virtue of the fact that they were born during a certain period of time

To determine if the stage of training plays a role in attitudes towards the use of newer technologies for learning

Determine baseline prevalence of PDA use among medical studnets

To determine preference among students towards more traditional adjuncts to learning

Students feel that PDAs are more useful as they progress through the curriculum, and derive more value from them when they’re actually practicing, rather than when they’re in the pre-clinical stages

Students are NOT doing it for themselves: the use of m-learning in a minimally supported environment
K Masters

“Use of handheld devices is crucial for modern healthcare delivery” ← really?

Should be encouraging self-learning activities

Students purchase own hardware and software, no advice from staff, no encouragement, no expectation, etc. i.e. no support at all

Second presenter in this session giving information on what type of mobile device (e.g. iPhone, etc.) that students are using…is this important?

Uses deviced for taking notes, accessing medical websites, emails, reference tools, lecture notes, research, videos

Drop in use as sophistication of use increases

Many of the activities that are important for medical education are not accessed by students on mobile devices

Students talk about anywhere, anytime access, and ease of use. However, they also complain of small screen sizes, cost, technical difficulties and lack of support (14% saw this as a problem → but students only use devices for simple activities e.g. email, so high levels of support not necessary)

International medical education
Plenary (David Wilkinson, Madalena Patricio, Stefan Lindgren, Pablo Pulido, Emmanuel G Cassimatis)

Is the globalisation / internationalisation of medical education just another form of colonialism?

What are the:
Models
Opportunities
Challenges

Higher education is a global industry, a globally traded commodity as demand soars

“Constantly inspired by students”

What is the difference between globalisation and internationalisation?

Global medicine:

• Medicine and disease are global e.g. HIV. Influeza, TB
• Medical professionals are highly mobile
• Medical tourism as an emerging industry
• Medical migration (in some countries, more than half of professionals were trained in other countries)
• Expansion of agencies and institutions

The international / visiting teacher is becoming less common, but the virtual teacher is increasing (is this happening fast enough?)

Models of international medical education:

• Outbound / inbound student mobility e.g. electives
• Staff mobility and sabbatical e.g. conferences, formal exchange
• Academic partnering
• Offshore campus
• “Franchised” curriculum
• International schools
• Institutional partnerships

Shift from student numbers to a global strategy for recruiting, supporting students

International students are one of Australia’s biggest earners

Transnational medical education:

• Global faculty and curriculum (recruit offshore whenever possible)
• Global students → diversity
• Global student exchange
• Key partnerships
• Global projects
• Global presence

Huge opportunity for the virutal international teacher

In a global medical programme how would you manage:

• Accreditation?
• Registration?
• Cost-effectiveness?

In 2001: will medicine and medical education escape the impact of globalisation…no

Medical students should be involved in global endeavours? Most salient reason in moral obligation, students want to “help others”

Students the skills to work in an international context, and an understanding of the values of the global citizen

“To grow is to understand that we are very small…”

Understanding difference is part of being a competent health professional

“Different…but not indifferent”

Quality standards:

• Degrees
• Licensure
• Accreditation
• …and others

Transition from process-based to outcomes-based education

Increasing emphasis on life-long education and regulation for health care professionals

Should look at harmonising quality of education, rather than standardisation

Accreditation must be local, but should be based on an awareness of a global context

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