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assessment curriculum education PhD physiotherapy research teaching technology workshop

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.

Categories
assessment curriculum physiotherapy research teaching technology

Graphically representing a curriculum

Schematic map of the Milky Way

I’ve been a bit quiet on the blog lately, owing to the fact that I’ve been putting a lot of time into the next phase of my PhD. This post is in part an attempt to summarise and try to make sense of what’s going on there, as well as to assuage my feeling of guilt at not having posted for a while.

In terms of my research progress I’m currently running a Delphi study among clinicians and clinical educators, as well as a document analysis of the curriculum. The Delphi is trying to identify the personal and professional attributes that clinicians believe are important in terms of positively impacting patient outcomes, the relevant teaching activities that could be used to develop and assess these attributes, and any appropriate technologies that might facilitate the above teaching and learning activities.

I’m busy with the second round of the Delphi study (I’ll post the main results of the first shortly) and will begin analysing the curriculum documentation soon. The combination of these two projects will (hopefully) give me enough data to determine how we need to change the curriculum in order to better develop the attributes we’ve identified.

As part of that process I’m starting to look at curriculum mapping. What I’m struggling with at the moment is to figure out how best to represent what I’m learning as far as what the curriculum looks currently like, and how we need to change it. These are the difficulties I’ve come up with:

  • The learning process isn’t linear, which cuts out a narrative representation
  • A curriculum is organised by many things e.g. outcomes, content, teaching approach, assessment tasks, time, space, etc. How do you emphasise all of these (and their relationships) while keeping some measure of sanity?
  • There are many interrelated concepts i.e. multiple connections, nested connections, linear and non-linear components, etc. all of which makes a mindmap difficult to work with (mindmaps are usually hierarchical, and a curriculum presented as a hierarchy would be necessarily simplistic)
  • A Gantt chart might be useful to show how activities or projects progress over time, but it doesn’t have much scope for depth
  • Tabular representation doesn’t allow you to expand / collapse sections, or add detailed notes. It also allows only very simple, one-to-one connections e.g. content over time but not time, content and outcomes.
  • At the moment I seem to have settled on CmapTools for concept mapping. It’s not the ideal solution but it seems to be the one that enables most of what I need (see list below)

As much as I’ve read around curriculum mapping I haven’t yet found a solution that helps me to address everything that I think I need. I know that I probably won’t be able to find a tool that enables all of the following, but this is what I’d like to be able to do:

  • Create relationships between concepts e.g. outcomes, teaching activity, assessment task, etc.
  • Emphasise the nature of the relationships
  • Annotate concepts and relationships
  • Expand and collapse sections i.e. see the big picture (e.g. national exit level outcomes) as well as drill-down into the details (e.g. lesson plans)
  • I should be able to show a process over time i.e. workflow should be built in
  • I’d like the ability to input more data over time, and delete outdated content
  • I’d like to be able to detect redundancy, inconsistency and omissions (of content, tasks, outcomes, etc.)
  • It’d be great if it was collaborative
  • Must be able to review vertical (subjects between years) and horizontal (between subjects in the same year) alignment, as well as the sequencing of activities
  • Define a shared vocabulary for use in our department (we often use different terms for the same thing, creating confusion)

I’ve also been also looking into other domains for ideas that will help me to get a better understanding of graphical modelling to represent complex information. One example is Unified Modelling Language (UML), a general purpose modelling language that is used to represent the various facets of objects and systems in computer science. It is used to “…specify, visualize, modify, construct and document the artefacts of…a system”. It also offers a standard way to visualise the different elements of that system e.g. activities, actors, processes, components, etc. I’m still holding out for a modelling tool from another domain (besides education) that might serve my purposes.

During the above-mentioned process, I also had fun looking at a curriculum as a computer platform. A computer platform includes:

  • The operating system (OS), which is basically a set of instructions for what to do in certain situations, including task scheduling and resource allocation. I think that this is a useful way to think about the structure of a curriculum i.e. what should happen, when it should happen, who is responsible for it, etc.
  • Architecture (hardware) that includes the CPU, data bus, chipsets, graphics cards, motherboard, sound card. CPU is concerned with how programmes access memory. The physical structures that enable the manifestation of the curriculum.
  • Frameworks are collections of software libraries that contain generic functionality that can be modified by within certain constraints. Frameworks allow developers to spend time working on useful features rather than having to write code for low level functionality. Within the curriculum there are modules that share generic features e.g. problem solving. A way of assessing whether or not a student can solve problems is a generic “framework” that can be modified slightly to be used in other modules. Why should every lecturer have to re-create the same libraries of tools in order to assess the same thing in a different context?
  • Programming languages that use a standardised set of vocabulary and grammar to create a set of instructions that the OS will understand.
  • The user interface (UI) that allows a user to interact with the computer and its peripherals. This is the most visible part of the platform, and often the part that draws the most attention. This is the part of the curriculum that everyone can see. The handouts, the lecture, the assessment tasks i.e. this is what the students and lecturers  use to interact with the curriculum. Is is also the part that people will love or hate. No matter how “good” the underlying structure is, the student engages with the UI and most people in higher education haven’t caught onto the idea that “pretty is a feature“.

Schematic transit maps and Venn diagrams might also be useful in terms of thinking about curriculum mapping in a different way. I’m inclined to think that a combination of all of the above will be an interesting experiment.

I guess the biggest issue I’m having is trying to figure out a way to show how we can go from what we have to what we want, from a very high to very low level. It’s harder than I thought it’d be…

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research

Curriculum development and PhD

Earlier this week we had our second curriculum development meeting in our department. It’s something we’ve recently implemented after realising that we need to pay more attention to teaching and learning, especially now that the university’s released it’s implementation plan for the next 5 years.

After going through one of the modules, we quickly realised that in order to really understand the relationships between modules, we’d need to look at them in 2 different ways:

  • Horizontally – how do concepts in different “groups” relate to each other in the same year of study? E.g. what are students learning in anatomy and how does that relate to their applied subjects?
  • Vertically – how do concepts in the same “groups” relate to each other over time? E.g. how does what students learn in PHT203 relate to what they learn in PHT303?
  • It’s hard to visualise how these different “tracks” relate to each other. I’m thinking that a concept mapping tool (e.g. Cmap, Xmind) would be the best way to do it.

We’ve split the curriculum into “groups” of related modules e.g. Movement Science (human movement and movement disorders), Applied physiotherapy (clinical theory), Clinical practice (application of theory). Staff members were then assigned to groups to look at the following over the next few weeks:

  • Curriculum alignment. We’ll need to make sure that our learning outcomes are aligned with content, and assessment
  • Practical assessment. We’re looking at moving to our practical assessments to an OSCE-type format
  • Integration of teaching and learning practices in alignment with university policy
  • Determine how we’re going to integrate the institutional graduate attributes (scholarship, lifelong learning, etc.) into our modules and teaching practice

During the meeting we noted other issues that arose. We realised that we have no naming convention for our digital files, which means they all have different names. I’d like to see a convention adopted during this process e.g. module code-description-version-increment. I also think we should consider having a Notes section at the end of each module descriptor, where we can document minor editorial corrections that happen during the year, as opposed to creating a new version for major changes and archiving the old one.

I’ll be sitting in on each group to document the process we’re going through. Part of my PhD will be how I track the changes that are happening in the department, both as a result of my own work, but also as we fall in line with institutional changes in teaching and learning. I don’t see this becoming part of my publications, but will rather form bridging documents that establish relationships between research objectives. I’ll need to evaluate the process of the project, and these meetings will form an important part of the process. I’m starting to realise that the curriculum we had when this project began will be quite different from the one that exists when it ends.