Exposing the culture of professional practice

I often forget that learning is not only mediated by social relationships, but by cultural relationships as well. To a large degree we are the products of influence that emerge from interactions between thousands of variables within our families, groups of friends, communities, religions and countries. The process of becoming a physiotherapist is also embedded within a culture of the profession, and we forget that our system of values, social norms, belief systems and language is largely hidden to the student when they first arrive on campus. Not only is the world of academia a new culture for most of them, but then within that system is the sub-culture of physiotherapy education.

We spend a long time developing ways and means of teaching students the technical components of physiotherapy, but have very little in place to explicitly and intentionally induct them into the culture of the profession. We expect them to “pick it up” over time by a process of osmosis. Technical skills are relatively easy to teach: “Put your hands here, press this hard, so many times”. Knowing when to do that particular mobilisation, and why, is a lot harder to teach. Without knowing the when and the why, we’re little more than trained monkeys.

I believe that part of coming to know when and why to do certain techniques is partly related to the culture of the profession. Students must feel a sense of belonging to something that is more than the sum of a set of knowledge and techniques – a sense of becoming someone who is more than a trained monkey. I think that we can achieve this in some part by making explicit our social norms, values and belief systems, thereby exposing students to the culture of the profession.

The problem is that there isn’t much room in the curriculum for these aspects of professional practice, so we need a space for informal conversation in a way that the ideas and culture of the professional community can be shared in a normative way. We often make assumptions about what students (don’t) know and understand. As practitioners, we have developed a professional literacy over many years, but since our current state of knowing is tacit (it’s just part of who we are), we forget how we came to this point. We often forget that our students have not had the many years of experience that leads to the development of patterns of thinking and ways of being that we just know, and so we have expectations around performance that they cannot match.

I think that we can use online social spaces (i.e. social networks) to externalise and  make explicit the culture of the profession, exposing the hidden, tacit knowledge that students can use to orientate themselves to professional practice in a process of becoming a physiotherapist.

AMEE conference (day 2)

These are the notes I took on the second day of AMEE. One of the things I noticed is that in most of the presentations the speakers talk about “doctors”, and that little is said about “health professionals”. There seem to be few people here who understand that effective healthcare can only be delivered by teams. They may speak about multi-disciplinary teams but I doubt that they would accept that they are “on the same level” as others on the team. The traditional heirarchy is still very clear, even if it is only implicit. I’ve substituted “doctor” with “health professional” in my notes.

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

Twitter Weekly Updates for 2010-08-23

  • Cheating in online learning. Balanced viewpoint from Tony Bates http://bit.ly/adFoXT #
  • Went back 2 Thunderbird after using Kmail for a few years. Really impressed with how it’s developed, I’m actually enjoying managing my email #
  • RT @alastairotter: How the Internet is changing language http://bbc.in/95XmAo #
  • @nlafferty Used 2 use Zotero until I tried Mendeley, which supported PDF import at the time. I’d love 2 try it again, but no chromium plugin in reply to nlafferty #
  • Sadly, it looks like there’s no intention to port Zotero to #chromium & I’m not switching browsers just to get it http://ht.ly/2r9do #
  • Zotero Basics: Getting Stuff Into Zotero http://bit.ly/97IHMV. I’m always intrigued with Zotero, I just can’t get into using it #
  • Some simple points of advice on professional online behaviour for health professionals, from @rachaellowe http://ht.ly/2r8CZ #
  • Teaching Professor: Thinking constructively about teaching problems http://ht.ly/2r8BJ #
  • Beautiful drawings / paintings on the iPad. So much for the notion that it’s not a device for creation http://ht.ly/2r8sV #
  • Technology for 21st Century Learning: Part 2 (But is it a Literacy Machine?). Using the iPad in education http://bit.ly/cwIuEx #
  • @paulscott56 “Major design flaw upsets millions”. Could be a story about Facebook or twifficiency #
  • 17-Year Old Twitter Spammer Scores Facebook CEO as New Friend http://bit.ly/9pGmWA #
  • 08/9/10 PHD comic: ‘The Repulsor Field Explained’ http://bit.ly/cMmImF (humour) #
  • Dissertation Myth # 9: It Will Ruin Your Life. Great points to put your research into perspective http://ht.ly/2qELR #
  • RT @jamescun: OK. Twifficiency shouldn’t tweet your score automatically :/ Error on my behalf, I was just learning to use oAuth 🙁 #
  • RT @allankent: you know what would be awesome? If #twifficiency prompted me before sticking crap in my timeline. #fail #
  • @cristinacost I spent some time in Hay-on-Wye when I was in the UK a few years ago. Really beautiful walks in & around town in reply to cristinacost #
  • Sadly, Twifficiency is a trending topic on the home page, we can probably count on a lot more spam coming through 🙁 #
  • I don’t think I’ve ever seen an app (#Twifficiency in this case) generate so much bad feeling in such a short space of time #
  • RT @andrewspong: Deleted the Twifficiency tweet from my feed in case others see it later, & amplify the spam. You may wish to do the same. #
  • RT @cwcrawley: So all of you who did twiffiency – Go into profile & ‘revoke’ access to the app. That’ll stop it spamming in future #security #
  • Facebook, By the Numbers. Interesting infographic looking at the rise of Facebook over the past few years http://ht.ly/2qCvS #
  • I *hate* it when services / applications tweet on my behalf without asking me, as was the case a minute ago with #Twifficiency #
  • My Twifficiency score is 43%. Whats yours? http://twifficiency.com/ #
  • RT @wesleylynch:RT @shapshak: Africa’s tech start-ups break ground: iSigned (@garethochse) & Cognition (@patrickkayton) http://bit.ly/avauYZ #
  • Looking 4 Buddypress-Activity-stream-type threaded conversation tool. Must be hosted & not need registration. Suggestions? #
  • RT @sharingnicely: RT @myzt: The main idea of “Inception”: if you run a VM inside a VM inside a VM inside a VM, everything will be very slow #
  • @weblearning Just had a look now, thanks. Not sure if it “fits”. I already follow everyone I email. More likely to “find” people elsewhere in reply to weblearning #
  • @weblearning Installed #Rapportive a while ago & it has yet 2 return any info behind the email…maybe that says more about who emails me 🙂 in reply to weblearning #

Students’ languages and their associations

Our Directorate of Teaching and Learning has organised a series of seminars over the next few months, with invited speakers from a variety of institutions across the country. They’ll be presenting on a range of topics, including academic literacy, integrating technology into teaching, working with large classes, teaching practices, and educational theory. I’ll also be presenting a session on personal learning, which will be similar to the other talks I’ve give on the topic recently.

Today we had a presentation by Doctor Brenda Leibowitz, who spoke about the relationship between language and biography / identity and their impact on teaching and learning. Here are a few short notes I took during the session.

Language studies typically look at homogeneous groups, but few look at cross-institutional and cultural communities.

Language can be intimidating for students (“the words are so complicated”), which means that texts can take longer to read, result in more guessing and reduced coherence

“Too hard to find the words, so you just make simple sentences”

Students appreciated the focus groups where someone was paying attention to their difficulties (“This gathering is like rain in the desert”)

The ability to communicate effectively depends on genre. Context has implications for language

Attitude has implications for language, as does identity

Mastery of a second language is important, but is not the sole determinant of academic success

Role of language in teaching and learning:

  • Proficiency
  • Social – and isolation
  • Utility
  • Value (exposure)
  • Ideological associations

Language has an impact on social and organisational structure

Code switching

How can we introduce students to the genre of academic discourse?

Talking and writing students into the discipline”. How do you take your students with you to the conclusion, rather than leave them behind and create a gap that they cannot cross?

Blogging as a reflective tool

As part of their clinical placements (short term working placements in either hospitals or health clinics), the students in our department must write reflective pieces on their time at the placement where they look at things like their strengths, weaknesses, learning opportunities and clinical situations that raised issues for them.

This reflection is usually a typed page or two inserted into a file and submitted at the end of the placement.  Recently I’ve been wondering about the possibility of using blogging as a tool for our students to write their reflective journals, and encouraging other students on the same placements to to comment on each other’s work.

On one level I’m hoping that this will encourage further reflection based on feedback and discourse on both personal and clinical learning situations.  On another level, I’d like to use it to get students (and staff) to think about other concepts, such as the peer review process, the changing nature of academic publication and how knowledge is constructed through discourse.  I’m sure there’ll be plenty of other issues that are raised.

I also have anecdotal evidence that our students find it difficult to express themselves in clinical settings, for a variety of reasons, including not having English as a first language, which brings a subsequent lack of confidence when speaking in a group, as well as what seems to be an inferiority complex when confronted with students from other universities.  I’ve love for our students to be able to use this as an opportunity to find their own voices and tell their own stories in a semi-public space, which will still be a safe environment.

Here’s the article linked to in the post:
Academic blogging opens new world