I just finished giving feedback to my students on the concept mapping assignment they’re busy with. It’s the first time I’ve used concept mapping in an assignment and in addition to the students’ learning, I’m also trying to see if it helps me figure out what they really understand about applying the theory we cover in class to clinical contexts. They’re really struggling with what seem to be basic ideas, highlighting the fact that maybe the ideas aren’t so basic after all. I have to remind myself that clinical reasoning is a skill that takes many years to develop through reflection and isn’t really something I can “teach”. Or is it?
For this assignment I wanted the the students to set a learning objective for themselves (I gave examples of how to do this, including using SMART principles of goal setting). They also needed to highlight a particular clinical problem that they wanted to explore and how they would use concepts from the Movement Science module to do this. They needed to describe a clinical scenario / patient presentation and use it to identify the problem they wanted to explore. From that short presentation, they should derive a list of keywords that would become the main concepts for the concept map.
Here’s a list of the most common problems I found after reviewing their initial drafts:
- Many of them lacked alignment between the patient presentation, the learning objective, keyword / propositions and the final concept map
- Many of the learning objectives were vague. They really found it hard to design appropriate learning objectives, which meant that their whole assignment was muddled
- There were two processes going on in the students’ minds: patient management, and their own learning. This assignment was about student learning, but most of the students were focused on patient management. This was especially clear in the learning objective and actual maps they created, which all had a clinical focus on the interventions they would use to treat the patient, rather than the learning concepts they would apply
- Most of the students created hierarchical maps which failed to identify complex relationships between concepts
After going through their initial drafts, I had another session with them to go through the feedback I’d given and providing more examples of what I expected from them. This assignment is proving far more difficult for the students than I’d expected. However, I’m not sure if it’s because they can’t apply theoretical concepts to clinical scenarios, or if they just don’t have a good understanding of how to create concept maps. I think that they’re having difficulty thinking in terms of relationships between concepts. The maps they’ve been drawing are appropriate in terms of the interventions they’d choose to manage their patients, but the students can’t seem to transfer the concepts from the classroom into clinical contexts.
They’re used to memorising the content because that’s how we assess them i.e. our assessments are knowledge-based. Then they go into clinical contexts and almost have to re-learn the theory again in the clinical environment. There doesn’t seem to be much transfer going on, in terms of moving knowledge from the classroom context to the clinical one. I haven’t researched this yet, but I wonder what sort of graduate we’d get if we scrapped classroom teaching altogether and just did everything on the wards and in the clinics? I understand the logistical issues of an apprentice-based approach to teaching large groups but if we didn’t have classroom time at all, maybe it’d be possible?
“Clinical reasoning is a process in which the therapist, interacting with the patient and significant others (e.g. family and other health-care team members), structures meaning, goals and health management strategies based on clinical data, client choices and professional judgment and knowledge (Higgs & Jones, 2000).
Clinical reasoning is difficult, if not impossible to “teach” (if anything is actually possible to teach [Game & Metcalfe, 2009]) but can be developed indirectly through careful course design. I’m trying to move my teaching from helping students to answer the simple Who, What, Where and When questions, to answering the more complex How and Why questions. Instead of memorising content, which is how most of my students prefer to study, I’m trying to help them see the value in developing a deeper understanding of the topic. To use the content as a framework around which we can use critical thinking to apply our understanding of theory, to practice. In other words, to develop clinical reasoning.
I’ve started to change the types of assignments I give to my students, to try and integrate some form of critical thinking. I’ve uploaded and shared the last assignment handout on Google Docs (unfortunately I only have the PDF…seem to have deleted to ODT version), and would love suggestions or feedback on the process. The feedback from students has been great and the quality of the work they produce has been of a very high standard. I’ve found that the feedback from the drafting process (a requirement of the assignment) really helps to give direction to the students, and although they are initially resistant to the idea (they want to submit work that is perfect), they see the value when they get their scripts back and have the opportunity to refine their arguments.
The research and evidence-based practice component is something that we’re trying to incorporate into all of our modules, but which currently is covered only superficially. Students don’t understand how to extract relevant information from academic publications, probably because they lack the specific academic literacies required in higher education. Once we establish that they need only identify the main conclusion of the study (this is at a second year undergraduate level), and use that conclusion to construct an argument, they manage just fine.
Game, A., & Metcalfe, A. (2009). Dialogue and team teaching. Higher Education Research & Development, 28(1), 45-57. doi: 10.1080/07294360802444354
Higgs, J. & Jones, M. (2000). Clinical reasoning in the health professions. In Clinical Reasoning in the Health Professions, 2nd edition (J. Higgs & M. Jones, eds), pg. 3-14
I’m busy reading Dan Ariely’s Predictably Irrational: The Hidden Forces that Shape Our Decisions, and wanted to share some of the takeaway points that made me think about how I could change my own teaching practice. I haven’t finished the book yet, so I may update this post when I do.
The premise of the book is that we aren’t always the rational beings we believe we are, and that there are powerful emotional factors that cause us to make decisions that are often counterintuitive. If we understand how these factors predictably make us less rational, we might be able to affect greater self-control over our lives, and be better off for it.
One of the ideas that really got my attention was how we respond to social and market norms in our everyday interactions with other people. When you think about it, a lot of what we do as teachers has nothing to do with market norms i.e. we don’t work the hours we do because we’re paid appropriately. Social norms mean that we go above and beyond what is required of us possibly because we have a sense of shared purpose or a belief that we’re contributing to something more important than money. In other words, people are motivated to work harder when they believe they’re in a socially-orientated relationship, rather than one in which market values dominate. Ariely also conducted experiments showing that when market and social norms collide, relationships that were based on the social norms are disrupted and can take years to rebuild. This has implications when we start thinking about building communities of practice in our professional domains, and it seems that we would do well to base our interactions on a shared sense of purpose, rather than financial reward. I know from recent conversations with students with whom I have a good relationship, that they try harder to impress me with their work, and worry less about the mark they receive, than they do with other lecturers who don’t engage with them at all. For me, this is a powerful incentive to engage with students not only on a cognitive level, but on a social level as well.
Ariely also shows clearly how emotionally heightened states cause us to make bad decisions for ourselves and for those around us. How many times have we made a bad decision when we’re angry? When I think about it (and if I’m honest with myself), I know that I’ve been guilty of being a stricter assessor when I’m in a bad mood, than when I’m having a good day. I know that my marking isn’t as objective as I’d like it to be, but to be shown the evidence of how much it influences my behaviour has made me commit to avoid marking students’ work when I’m upset.
When discussing procrastination, Ariely makes the observation that when students are given absolute submission dates for assignments that are appropriately spaced, they do better than students who are given flexibility in determining their own submission dates. I know that recently I’ve started including draft deadlines into assignments to “encourage” students to begin work their on assignments early, and to continue improving their work up until the final submission date. Last year I saw students who participated in the drafting process score significantly higher marks than those who chose to submit only one, final version of the assignment. Students will procrastinate if left to themselves, and I guess we need to decide if we’re OK with that, or to rather try and figure out how to more effectively guide them through the process of making regular improvement through regular feedback.
The final point I wanted to highlight is from a TED presentation that Ariely gave (although it might be in the book too), where he finds that students are less likely to cheat after thinking about the 10 commandments. It turns out that signing an honour code might not be as pointless as I’d previously thought.
You can also see Ariely discuss some of his ideas at these 2 TED talks:
I’ve started a few projects in my department, one of which revolves around the use of wikis to create environments for students to engage more dynamically with both the content and each other. The rationale is that deeper learning occurs when there is an understanding of the content that goes beyond the ability to recite tracts of it back to the teacher. Another component incorporates the idea of social constructivism, which asserts that knowledge is created through social interactions, where groups build knowledge for themselves and for each other.
It seems that a wiki is an appropriate platform that fits well with this concept. It allows collaboration from many students, separated in geography and time, to build on each others’ contributions leading towards the completion of a shared goal, all the while encouraging discussion around the content and structure of the content. In my Applied Physiotherapy class, I’ve put aside a small section of the OpenPhysio website in order to evaluate the process. Each group must complete an article on an appropriate topic assigned to them, as well as provide a critical review of another group’s topic. They are also encouraged to make small grammatical and spelling corrections on any other topic they read.
I’m hoping that the process will highlight the benefits of truly working together as a group, as well as of the peer review and drafting processes. Students should be more aware of how to structure documents with regular feedback, not only from the facilitator but also from each other. The ability of the wiki to track changes over time will provide valuable information about how the document grows, who makes contributions, the challenges of group dynamics and a host of other data that might be useful in forming a more academic picture of the use of new technology in education.