Reflections on SAAHE 2010

The SAAHE conference has come and gone for the 3rd year running. It’s been an interesting and engaging 3 days, and since I’ve already posted all my notes, these are just a few thoughts on what it’s like having a conference in South Africa. And it’s the last post, I promise.

To get the negative stuff out of the way, there were two things that really disappointed me, and which I’ve mentioned at every conference I’ve been to (in South Africa), and they are:

  • A lack of dedicated wireless access, even though internet access is not an issue at tertiary educational issue
  • No video or audio coverage of any of the tracks, not even of the keynote speakers (I’m sorry, but uploading presentations just doesn’t cut it)

As a collection of South African health educators who say they to participate in a global, regional and national conversation on these issues, how can you possibly do it if you have no voice? I can’t think of any reason not to provide dedicated access in all conference venues.

Piggy backing on this idea of what we could do with access, I had an interesting conversation with a colleague when we were trying to decide which presentations to attend. We realised that we were trying to situate our own work within the broader context of what was happening at the conference. Where does my work fit in with all the other work that’s being done in my own (or a similar) domain?

It seems to make sense that if all attendees (or a significant proportion) were tweeting, blogging, waving or otherwise engaged in providing their own personal experiences, perceptions, insights, etc., we would have multiple streams within which we would be able to situate our own work. Not that we would necessarily watch the streams while presenting (although that would be an option), but it would be nice to reference the work of others that you’d already seen in the stream. These referrals could be aggregated after the conference to see who’s working on similar ideas (or who should be working on similar ideas) and make it easier to build national networks for collaboration. What topics are most common? Who seems to be involved in the most conversations? Who are the “qualitative” people who can give me the insight I need for my own work?

Unfortunately, this won’t happen anytime soon. It’s not a technical problem (all the infrastructure and technology is there), but rather the complex human component. Besides a resistance to learn new things (“I’m a busy person, I don’t have the time”), most health educators aren’t technically savvy.

Finally, during the last half of the last day, we had a power outage across the campus and we had to continue outside. Interestingly, most people seemed quite amused with the experience. We got to sit outside and enjoy the beautiful weather and have a more informal (if a bit rushed) discussion. It was also refreshing for me having to present my work without a presentation on a computer. I felt a bit more connected with the audience, although being in such close proximity could also be a bit daunting. See below for our “conference venue”.

All in all, it was a great conference, I learned a lot and the organisers should be proud of what they achieved.

SAAHE conference, 2010 – day 3

How can teachers improve their teaching using concepts that matter? (Prof. Joke Denekens)

We have to reduce the context, content and noise when moving from a clinical setting to an educational setting. In an educational setting, we have to create context and content

There are, in principle, similarities between South health system and the Belgium health system. Different scales and context, but problems exist nonetheless

Development of competencies is an ongoing process, because the health system, science and society is changing all the time

Millers pyramid is a simple model of competence

Students work for what you inspect, not what you expect

 

Drowning in words (Athol Kent)

Teachers don’t know what student’s don’t know, so we might use language / concepts that students aren’t familiar with. Relates to Bechers’ notion of tribes

knowledge is gained by understanding, but before you can understand concepts, you must understand language

Developed a self-teaching concept that is computer based i.e. a dictionary of terms (what do students need to know to converse in this “tribe”

Students self-test when they think they are ready and they need 80% to pass

Interesting discussion following presentation. Will be great to extend the platform to include not only definitions, but deeper concepts. Athol suggested they are moving towards offering multiple levels of access i.e. superficial for quick review, more in-depth content for further though, and also adding links to more material. I suggested making an open wiki for the project, which would allow faculty to scaffold / structure it, but students could also participate in the direction it goes.

 

Knowledge and attitudes of Wits medical students concerning the role of nurses in the healthcare team (O Oyedele)

When doctors and patients work together, patient care is improved

Negative stereotypes hinder effective collaboration

When groups from different disciplines do work together, they end up having higher levels of respect for each other

Study looked students perceptions following an interdisciplinary module where medical students are taught by nurses during a “nursing block”

Nurses should have an equal “social” status as doctors? That’s a perception determined by society, not doctors. Wouldn’t it be more relevant to find out if nurses should enjoy the same “professional” status as doctors?

Some stereotypes about nurses persist among medical students at Wits

But there were also clear benefits to nurses teaching medical students on nurse-orientated blocks.

 

Reflection sucks – Avoiding the black hole: medical student responses to formal reflection during an academic service learning module (D Cameron)

Students have weekly, facilitated reflection sessions, as well as written reflections before, during and after the sessions – during a 4 week academic service learning module in a Primary Healthcare Clinic

Reflective learning:

  • What happened? What did I do? How did you feel?
  • Why did this happen? (various points of view) → reviewing concepts
  • Does this make sense in relation to what I know? → theorising and forming new ideas
  • Planning for the future, how will this influence practice

Do students grasp the concepts of reflection?

Asked students what has happened during the past week to influence students opinions of reflection, and then convince a colleague why they believed that

Perceived benefits:

  • Personal growth
  • Self-insight
  • Camaraderie
  • Self-confidence
  • Changed attitude to service

“Nobody can take my reflections away from me”

Some students dislike written reflection, but are OK with verbal reflection

Students have had negative experiences where they write reflections but don’t receive feedback, this frustrates students

Students are briefly introduced to Kolb’s cycle to provide some context to the students

 

The differences in perceptions in GEMP III and GEMP IV students in the exposure to expected case competencies of internal medicine at the 3 Wits academic hospitals (F Indeviri)

Reclassification of one of the hospitals led to a reduction in the number of common conditions seen at that hospital

Few students are satisfied with the level of exposure to competencies they receive

Students felt that the block rotation was too short to adequately cover the core competencies

Students also preferred to go to hospitals where they would see a greater variety of common conditions that would allow them to gain greater exposure to core competencies

 

The scholarship of pedagogy in the health sciences: On teaching, learning and qualitative variation (Shirley Booth)

Scholarship is a hallmark of academic professions

Teaching and research should be placed on an equal footing, and promotion strategeies should take it into account

Scholarships of discovery, application, integration and teaching (Boyer, 1990)

It’s important to reflect on your own practices, as well as the practices of colleagues

Scholarship of teaching (Kreber, 2002)

  • Excellent teachers – full participation and approval of colleagues and students
  • Expert teachers – making full use of resources
  • Scholarly teachers – all of the above, but also sharing outcomes / results as local and global knowledge

Academics conceptions of the SoT&L (Trigwell, Martin, Benjamin & Prosser, 2000, pg. 160)

  • Scholarship (discovery, application, integration, teaching)
  • Scholarship of teaching (making teaching insights public)
  • Scholarship of teaching and learning (as above, with learning brought into focus)

How do we bring learning into focus? Do we give students the essence of what they need to know, or do we open it up to allow them to identify what they need to know?

Methodologies for SoTL

  • Ad hoc approaches
  • Informed by disciplinary research
  • Educational theory (often from sociology or psychology)
  • Educational research approaches (quantitative, qualitative, and mixed methods)
  • Phenomenography – a purely educational (or pedagogical) research approach: an analysis of qualitative variation which brings learning into focus

SAAHE keynote – Improving health professions education to improve health (Bill Burdick)

I’m going to split my blog posts up according to the different sessions, just for ease of reference i.e. a few posts, rather than one very long one. Here are my notes from the first keynote of the day, from Professor Bill Burdick.

If you don’t continue the momentum for change, you’re going to be left behind

We need to start system capacity building at the undergraduate level

Presentation made good use of Gapminder (started by Hans Rosling to track human development trends)

It turns out that GDP isn’t the most important factor in determining life expectancy, nor is the number of doctors / 1000 population, nor is sanitation and literacy, although there is an increasing trend for each of these variables. Health spending as a % of GDP also isn’t the major factor. Changing each of these independent variables isn’t going to necessarily enhance life expectancy, but changing all of them will.

Fewer children per woman = greater life expectancy, also the younger a woman is at marriage, the earlier she dies

Taking these factors into account, what must we as health educators do to have an impact on improving health?

Academics have the skills to pull in, analyse and interpret data, and to disseminate the resultant new knowledge, which clinicians need to make evidence based decisions to enhance clinical care.

It is important for academics / health educators to integrate with the public sector by engaging with the community, training other health workers, incorporate health professionals in the management sector, and to engage with public policy makers

Ruth Levine – Case studies in global health: millions saved (freely available report):

  • Health interventions have worked even in poor countries
  • Donor funding saves lives
  • Saving lives saves money
  • Partnership is powerful
  • National governments can get the job done
  • Health behaviours can be changed\
  • Successful programmes can take many forms

Health education by itself cannot improve health

Is our curriculum aligned with any of the following factors?

  • Water
  • Sanitation
  • Fertility
  • Literacy
  • Social integration
  • Access to healthcare
  • Nutrition

Discussion of the above can easily be integrated into any case study but faculty may need support during the change

Start system capacity building with undergraduates

  • Teach leadership and management skills → students can be better at facilitating community change with these skills
  • Add interdisciplinary education to improve subsequent team work
  • Integrate rural practitioners into the faculty role
  • Create systems for knowledge sharing (academia ↔ community)

Positive deviance inquiry – technique to introduce behavioural change in communities

Lessons to learn from the Brazilian health education system

  • Curriculum guidelines should emphasise local needs
  • Government and medical school leaders attend educational meetings together (integration of ministry of health and ministry of education)

If any of this is to make an impact in health outcomes, institutions must have institutional goals that reflect a desire to improve health → then faculty promotion can be linked to institutional goals

SAAHE conference, 2010 – day 1

I had made notes for the presentations I attended during the first half of the day using the Scribefire plugin for Chromium, when it crashed and I lost all my notes 🙁 I knew that there wasn’t a save button in the plugin (I didn’t have an internet connection so couldn’t publish as a draft) and was relying on the Lazarus plugin to auto-save everything in the text box. Sadly, I only realised afterwards that Lazarus doesn’t work on pages that don’t have a URL. Oh well, we live and learn.

Here are some notes from the afternoon’s workshop.

How to best teach research skills to clinicians (Dr. Alison Bentley)

The problem is:

  • Few clinicians have higher degrees → “research is an imposition”, and there’s been a reduction in research intensive environments

  • Few qualified supervisors

  • Few experienced internal examiners

  • Students can move through entire departments and never discuss research

  • Research is perceived to be hard, a different field, and not relevant to clinical practice

Attitudes vs. skills: If they don’t want to do it, they won’t get the skills. If they don’t have the skills, they won’t go through the process

Research is important because knowledge isn’t a passive substance but is constantly created and reformulated

Students won’t be able to think for themselves if they can’t query the world around them

We need to generate more South African based, contextually relevant statistics and knowledge, to better situate our patient care

Important for clinicians to model the concept that they don’t know everything

Is there a relationship between clinical reasoning and research methods?

Split into groups to discuss clinical reasoning vs. research methods

What is the research process (for a researcher)?

Before identifying a problem, you need a certain level of experience, as well as a context in which to frame the problem. When the experience, knowledge and context are missing, it’s hard to even find a problem.

How do you find a problem?

  • You can search the literature, but this might be hard in cases where the volume of literature is massive

  • You can observe phenomena

How can you be sure that no-one else has already solved the problem? → literature review

Design the study, then run it

Collection, analysis and interpretation of data

Go back to the literature to situate your results in the broader context

Have you answered the question / solved the problem? Either way is acceptable.

On the other hand, clinicians begin with data collection, but they must first have the right background (skills, knowledge, context), then you interpret the data and come up with a differential, which has to be confirmed by gathering more data

A researcher begins with a problem that will determine data collection. A clinician will begin with data collection and end with identifying a problem (the assessment component…the treatment component might be more similar to the research approach).

Students don’t like the PBL approach because it requires thinking, and the high school system doesn’t set them up to think. They learn that they have to memorise content and get high marks, which isn’t the best way to learn. Then they get to higher education and too often continue in departments that don’t encourage them to think critically.

One of the problems may be that we’re not linking research to teaching. We also need to get clinicians to link research to practice.

Research skills:

  • Searching for literature

  • Some basic statistical knowledge

  • Using literature

  • Writing

  • Research process

  • Time management

  • Project management

  • Collaboration

  • Digital and information literacy

  • Referencing

  • Information management

  • Budgeting

  • Available resources / access

  • Research ethics

  • Critical thinking

  • Data collection skills

  • There were others, but we stopped counting…

Came to the conclusion that many of the above are really hard to teach, and if they are, it’s often not taught at an undergraduate level, which makes it hard to introduce to postgraduates.

One of the problems seems to be that these skills shouldn’t be taught as part of a separate subject, but should be integrated into all other modules

There is value in clinicians having research skills

Thoughts on SAAHE 2009

Another SAAHE has come and gone and once again, it was an absolute pleasure to attend. The conference was well organised, the presentations were interesting and informative and I think everyone was able to go home having received something of value. I’ll try and share some of my notes and reflections over the course of the next week or so (although I’m going on a faculty academic writing retreat on Monday and will be caught up with that for 3 days).

I have a few suggestions for next years conference organisers (being held at Wits):

Record all the presentations (audio only, to make it less complex), collect all the presentation slides, and together with the accepted abstracts, zip all three and make them available for download as soon as possible after the conference ends. I’m constantly amazed that we aren’t doing everything we can to make sure that all the experiences and innovative practices can’t be accessed by anyone who didn’t attend. Make all delegates aware that their content will be shared in this way, but give them the opportunity to opt out if they prefer not to share.

If possible, provide all attendees with temporary access to the internet. It’s frustrating when you want to tell the world about what’s happening in your little corner and you can’t.

Register a Twitter account (how about “saahe”?) and provide regular updates about how the planning process is going. Use the conference home page to inform visitors on how to follow your updates. You could use it to alert people about abstract submission, which ones have been accepted, dates, etc. This way you’ll regularly keep us informed and hopefully get us excited when the time comes.

These are just a few simple things that might help to raise the profile of the conference and of South African health education in general.