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altphysio curriculum physiotherapy

altPhysio | Creating value

This is the second post in a series of exploring what a next-generation physiotherapy school might look like. Many of the ideas are not fully formed and some have very little evidence to support them. This is OK. Push back is welcome. Here’s the second interview.

Q: Now that you’ve provided the background and context for why the school was necessary, tell us what the first step was. Where did you begin?

As with all things in learning we knew we had to start with the students and their perceptions of the curriculum. The curriculum is a series of signals we send students about what we value but how those signals are mis/interpreted is important. We know that people’s beliefs inform their behaviour so we asked our students what they believed was important. Lecturers believe everything they do has value but students make their own judgements about about what is valuable independently of what lecturers say. The conventional wisdom in the past was that everything a lecturer said was valuable and it was valuable simply because they had said it.

However, if the student doesn’t see the value proposition of what you’re saying or asking them to do then its utility is limited. When we tell students to pay attention because what we’re saying will be important one day (e.g. in clinical practice in the third year) the message we’re actually sending is that they don’t need to pay attention now. If the information is only useful later then that’s when they’ll look it up. Why waste resources in the present if the benefits are only useful at some future, undetermined time?

Like it or not, students are doing a cost-benefit analysis for every task you set them. They evaluate the cost of the task in terms of time and effort, against the perceived benefits of doing the task. For example, what is the cost of attending a lecture versus the benefit? If the cost (time and effort) is perceived to be higher than the benefit, they might skip the lecture. And in many cases they are probably right to do so. If classroom time is spent sharing content then the student is making a strategic decision about better allocation of their limited resources (i.e. time and effort) because they can get content anywhere at any time.

Q: So what did you do about that? How did you correct the students’ reasoning?

We didn’t try to correct it. We tried to understand it and work with it. Now we’re always asking, “How is this task going to help to change our students’ thinking and behaviour in ways that are useful for them today?” In the case of a lecture we make sure that attendance has real world value today and don’t simply offer the promise of future value or threat of immediate punishment.

What would happen if there was no requirement to attend class and no negative consequence for being absent? Would students attend? If the answer is no, then you should think carefully about the value you think you provide.

At altPhysio we don’t take roll call and there is no attendance requirement in any part of the programme. Once we had taken that decision the pressure was on us to make sure that the time we spend with students has  measurable value for them. We begin by assuming that students come to altPhysio with ambition and the capacity to achieve great things. Then we help guide them to open up their thinking and give them space to take responsibility for their learning. Everything we do in the curriculum is about empowering students and developing their agency to act in the world. We give them challenging tasks that force them to go beyond what they believed they were capable of and in doing so, set up conditions that show them how far they can go.

Students don’t hate working hard; they hate being bored. It turns out that they really do care about learning, it’s just that we force them to care about marks instead.

Q: How do we get students to care about their learning, as opposed to caring about marks?

Learning happens in the mind of the student and only in the mind of the student. A learning environment is therefore just a series of contexts to try and get students to value their learning. An intrinsically motivated student could probably get through our exams with nothing but a curriculum outline and an internet connection. So we asked how to get our students intrinsically motivated rather than satisfy a set of external conditions that were not always tied to outcomes that they valued. The problem was that most of our curricular interactions sent very strong signals that 1) we were in charge, and 2) what we valued was all that mattered.

The locus of control for (almost) all students sits outside themselves. We tell them where to go, when to get there, what to read, what would happen if they pushed back, etc. In the past our students had no control over their learning and it was clear in every aspect of the curriculum that lecturers had all the power. It’s hard to be internally motivated when you have no power. For example, if classroom attendance is compulsory (i.e. there is a mandatory cost) and students perceive that it has little value, but they have no option to make a choice about attending, then you’re sending a signal that they have no power in the domain of their learning.

Q: What is wrong with students being externally motivated? Does it really matter, as long as they get the work done? Pass the exams?

The problem with an external locus of control is that it sets up a context where students are responding to a system of reward and punishment that is determined by others, rather than responding to what they value. “Success” in that system is determined by how well you learn the rules for gaining rewards and avoiding punishment. It has nothing to do with what students believe is important for their own learning. Our old curriculum – as the expression of what lecturers value – only required that students passed a series of assessment tasks. Their own beliefs about what was important were not integrated into the system. In effect, it didn’t matter what was important to them.

Q: OK, so you realised that the curriculum was “telling” students to think and behave in ways that were not consistent with what you valued. What next? How did you get students’ values to align with lecturers’ values?

We asked ourselves what conditions would help students think and behave in ways that would most likely approximate the patterns of thinking and behaviour we expected to see in qualified professionals. In other words, how do you get students to think and behave like professionals? To come to class; to show up on time; to put maximum effort into their assignments; to do extra reading?

Once we had a better idea of students’ strategic thinking about the curriculum and how they assigned value to tasks, it gave us insight into how we designed those tasks. Our curriculum therefore had to describe a learning environment where thinking and behaving like a professional had a higher value for students who aligned with it, than for those who didn’t. For example, if we said that attending class was important, then there had to be something that happened in that class that gave a strategic advantage to those who attended compared with those who did not.

Q: What is the take home message here about providing value for students?

We used to look at students’ learning needs as a series of physical, social, financial and psychological factors that would positively influence their learning. And those things are obviously important. But we realised that a missing piece in our framework for understanding students was their rationalisation for compliance (or non-compliance) with the curriculum requirements. What were the underlying beliefs they had with respect to the inherent value of the tasks we were asking them to complete?

We needed figure out how to design our curricular interactions in order to maximise the utility of that time for students. We could no longer expect them to comply with our instructions simply because we told them that they should. The curriculum does not have any inherent value simply because we say it does. We need to intentionally design activities so that the value proposition for students outweighs the costs.

We want students to do what we ask them but we want them to do it because it has real value for their current and future practice, not because of a system of reward and punishment that we control. We can no longer afford to take students’ presence and attention for granted.

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diigo

Posted to Diigo 04/12/2012

    • : It’s not just what you know. It’s what you know about what you kno
    • To put it in more straightforward terms, anytime a student learns, he or she has to bring in two kinds of prior knowledge: knowledge about the subject at hand (say, mathematics or history) and knowledge about how learning works
    • the guidance we offer on the act of learning itself—the “metacognitive” aspects of learning—is more hit-or-miss
    • Research has found that students vary widely in what they know about how to learn
    • low-achieving students show “substantial deficits” in their awareness of the cognitive and metacognitive strategies that lead to effective learning
    • Teaching students good learning strategies would ensure that they know how to acquire new knowledge, which leads to improved learning outcomes
    • Students can assess their own awareness by asking themselves which of the following learning strategies they regularly use (the response to each item is ideally “yes”):

      • I draw pictures or diagrams to help me understand this subject.
      • I make up questions that I try to answer about this subject.
      • When I am learning something new in this subject, I think back to what I already know about it.
      • I discuss what I am doing in this subject with others.
      • I practice things over and over until I know them well in this subject,
      • I think about my thinking, to check if I understand the ideas in this subject.
      • When I don’t understand something in this subject I go back over it again.
      • I make a note of things that I don’t understand very well in this subject, so that I can follow them up.
      • When I have finished an activity in this subject I look back to see how well I did.
      • I organize my time to manage my learning in this subject.
      • I make plans for how to do the activities in this subject.
  • students who used fewer of these strategies reported more difficulty coping with their schoolwork
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