Effective lectures

This is the first draft of an article that was eventually published in the Clinical Teacher mobile app.

Introduction

“The successful teacher is no longer on a height, pumping knowledge at high pressures into passive receptacles. He is a senior student anxious to help his juniors” (William Osler, 1849-1919)

In medical education, the word “lecture” is fast becoming a term of derision. Advances in our understanding of how people learn have demonstrated that passive approaches to teaching and learning is ineffective in developing advanced cognitive skills. However, traditional lectures where students are expected to sit and listen are still one of the most common methods of teaching in health sciences education (Graffam, 2007; Sandhu et al., 2012). When interactive lectures are used instead of didactic lectures, we know that student satisfaction, learning outcomes, and knowledge retention is better. However, rather than suggest that the lecture is dead, as many would have you believe, this article presents a range of methods that clinical teachers can use to enhance lectures by making them more interactive.

What is a lecture?

“…a great lecture is not a rote mechanical reading of notes, but a kind of dance, in which lecturer and listeners watch, respond to, and draw energy and inspiration from each other. One of the greatest pleasures of lecturing occurs when learners pose insightful questions that the lecturer did not — perhaps even could not — foresee..” (Gunderman, 2013)

A good lecture tells a story, as simple as that. It poses problems that are eventually resolved, and it keeps learners in suspense, waiting to see how the problem can be worked out. Great lecturers find ways to share the responsibility for solving these problems with learners, working with them to find a solution. In these kinds of classrooms, students are not merely sitting and listening. Instead, they are challenged and engaged, actively thinking and imagining along with the lecturer as both struggle toward new insights (Gunderman, 2013).

Lectures are often thought of as a mechanism for sharing facts, rather than for sharing personal experiences and insights. When thought of in this way, a lecture can be used to give a human face to a topic, or to paint a bigger picture for a course. They can stimulate interest, explain concepts, provide core knowledge and direct learning (Cantillon, 2003). Outlines of lectures can provide a structure where they can be seen in the context of the whole programme, with concepts shown in relation to each other. In this respect, it is clear that the purpose of a lecture need not be primarily to transmit information, since other techniques like assigning a reading or distributing an electronic copy of the notes, can be equally effective. Lectures should therefore not be used simply as a method of spoon feeding students with predigested facts (Harden & Dent, 2005).

“The real purpose of a lecture is to show the mind and heart of the lecturer at work, and to engage the minds and hearts of learners” (Gunderman, 2013)

It is important to note that lectures in themselves are not bad but that they, like any teaching method, can be used badly. A good lecturer tells a story that inspires and motivates students, so we should use caution when speaking poorly of lectures. When the lecture fails as a teaching medium, it is often the lecturer who is at fault.

Content vs Learning

One of the key challenges faced by lecturers is the tension between covering a range of discipline-specific content and ensuring that deep and meaningful learning happens. This tension is often exacerbated by the limited time in the curriculum allocated to each section of work. The movement of facts from lecturer to the class is pretty much how most people think of learning. However, knowing what to do with facts should rightfully be the centre of the learning process. That doesn’t mean that we shouldn’t stand in front of students and speak, but that our “speech should be to evangelise, to inspire, and to demonstrate”, rather than simply being a mechanism to impart knowledge (Chester, 2013).

“A great lecture is not a rote mechanical reading of notes, but a kind of dance, in which lecturer and listeners watch, respond to, and draw energy and inspiration from each other.” (Gunderman, 2013)

One of the enormous challenges with lectures is the attempt to incorporate students into the process, as part of an interactive exchange. The problem is that one-way lectures are difficult to make interactive because students are generally presented with answers rather than having to find answers for themselves (Dalsgaard & Godsk, 2007). However, a problem-based approach to teaching and learning that is supported by social constructivist principles (Vygotsky, 1978) is not feasible with a lecture. It requires a different approach to learning than what is available in the traditional lecture format, which is why lectures should not be thought of as an effective means of developing skills, higher order thinking, or changing attitudes (Cantillon, 2003). It is therefore worthwhile to consider that multiple teaching approaches have value, and that no single method can be used to cover the range of learning that much happen during clinical education.

“In the world of Google, facts can be accessed quickly and efficiently at any time, from any place, and with any device – so rote mastery of facts is no longer the core of learning” (Chester, 2013)

Types of lecture

Before you begin creating a lecture, it is useful to spend some time thinking about what kind of lecture you’re going to present. Or, to put it another way, what is the overall objective of the lecture? What will it be used for, in the context of the programme? Consider the following different types of lecture (Dent & Harden, 2005):

  • Overview – an overview of the module as an introduction to establish the context, before beginning with other teaching and learning methods.
  • Core – a series of lectures that presents the major concepts of a module.
  • Non-core – using lectures occasionally to elaborate on complex ideas, or to present aspects of the topic that are peripheral to the core curriculum.
  • Assessment material – demonstration of worked examples of assessment methods in the module.
  • Patient presentations – using a lecture to “walk students through” a case study, which can be more interactive than the one-way transmission of facts
  • Shared lectures – when several lecturers provide multiple points of view or perspectives on the same topic e.g. a physician and nurse provide different approaches to the management of the same patient (see also “Team teaching”).

Structuring a lecture

Most lectures are able to follow the simple outline of a beginning, a middle and an end. “Tell them what you are going to tell them, tell them, then tell them what you told them.”

Introduction

The introduction to the lecture is used to attract the attention of the students and set the mood for the session. One was to “captivate” students from the start is to use an exciting or controversial proposition, question or statement (Sandhu et al., 2012). It can be used to inspire them to concentrate, or to establish pre-existing knowledge. During this early part of the session, make sure you establish context by explaining how this lecture fits into the broader picture. Identify the usefulness of the content, identifying it’s perceived value for the students and thereby giving them a sense of place and direction (Cantillon, 2003). The Introduction should also be used to set the aims and objectives for the lecture. If the lecture is part of a series, it is always useful to use the Introduction to briefly review what was presented during the previous lecture. If this is the first lecture with a new group, this would be a good time to go over the “ground rules” e.g turning off cell phones, late arrivals, questioning periods, etc.

Main body

The main part of the lecture can be structured in a variety of ways:

  • Sections: Lecture is divided into sections, which is easy to plan and for students to make notes, but can be perceived as boring. This approach may be more useful for topics that are naturally categorised in hierarchies e.g. health or body systems, or classifications of injuries or disease.
  • Problems: State a problem and then produce arguments and counterarguments for solutions to the problem. This approach can help students develop critical thinking around clinical problems.
  • Sequence: A series of linked statements, each leading logically from one to the other, towards a conclusion. This approach could be used to take students through a patient examination process.

In order to prevent students’ minds from wandering, the Body of the lecture should be broken up into shorter sections, either by alternating the presentation format or by having students engage in relevant activities (Sandhu et al., 2012). After presenting the content, lecturers can have students work individually, in pairs or in small groups. You could even ask them to present short summaries of the key points of the lecture, during the end of the session.

Conclusion

The lecture should finish with a review of the objectives and key points that were covered. The lecturer might highlight ways in which students could extend the lecture by presenting routes for self-study and further independent learning. The Conclusion should avoid the introduction of new ideas.

Duration

Keep the time that students are sitting passively to a minimum. Thirty to forty minutes can be considered a maximum period of time without a proper break, since this is about the longest that people can concentrate. This time period can be broken up into ten or twenty minute sections, during which lecturers can have students engage in activities. For example, present them with a new idea or high-level concept (10 minutes), have them engage with the idea by discussing with a neighbour (2-5 minutes), clarify the idea with further examples (10 minutes), before finally moving on to the next idea. After that, give the students a 5-10 minute break before continuing.

The lecturer as a performer

“There are good lectures and bad lectures, just as there are good lecturers and bad lecturers. Rather than disposing entirely of the lecture as a means of learning, we should attempt to understand better the features that distinguish effective, engaging lectures from those that leave learners limp. Good lecturing is an art, and like other arts such as painting, musicianship, and writing, it takes real dedication and many hours of practice to excel at. Some may be more gifted at lecturing than others, but through study and practice, nearly everyone can improve” (Gunderman, 2013).

While it can be useful to think of the lecturer as a performer, they are not entertainers. The lecturer should aim to inspire and captivate students, but not to entertain them. There are a range of verbal and nonverbal skills that can be employed to keep the students captivated and engaged. These include using direct eye contact, changes in body language, gesturing, changing volume and tone for emphasis and exaggeration, projecting a sense of enthusiasm and excitement, and having a sense of humour (Sandhu et al., 2012). Digressions in the form of a personal story or contemporary reference can alter the tone and style of the lecture and can recapture flagging student attention. Students are almost always excited to hear about clinical experiences, especially those that demonstrate that the lecturer is human and fallible.

Maintain eye contact with students, moving your attention around the room. Focus on individuals when making a relevant point, as if you are speaking directly to that person. While this is a good way of maintaining a connection with them, avoid focusing on the same person too often, as this may make them feel targeted. Speak clearly and fluently. You may need to practice enunciating your words if you’re not comfortable speaking to groups. Make sure that you adjust your pace of delivery if you expect students to take notes, and adjust your tone of voice to avoid a monotonous session. Whether you prefer to lecture while seated, standing still or walking around the room, make sure that wherever you are, you are visible and audible to everyone in the room.

The last lecture is a good example of the lecturer as a performer.

It is worth noting that the lecturer may need to change their personal perspective of their role in the classroom, moving from being a “fount of knowledge” towards becoming a more experienced peer, a guide who knows the terrain and who can help students learn how to navigate it independently. If the lecturer sees themselves as the source of the “correct” information, students will also have that perception, which gives them little incentive to actively work through the course (Dalsgaard & Godsk, 2007).

Slideshow presentations

Many lecturers use slideshow presentations as a way of highlighting the major points of the session but many more use presentations in ways that end up distracting students while adding little to the lecture. For example, fancy animated transitions between slides add nothing to what students should learn, and comes across as cheap and gimmicky. In the same way, multimedia integration as part of a slideshow can add significant value to what you want students to learn but can also distract from the main point of lecture. Therefore, avoid adding images and video simply for the sake of it. Try to decide how adding different media will add to the presentation, rather than simply take attention away from the main concepts you’re trying to convey.

When developing a slideshow presentation, lecturers often focus on the bullet points that convey the facts, and pay attention to little else. But slideshow design is important. There’s nothing worse than trying to make sense of too much cramped text forced onto a single slide, or to feel like you’ve been slapped in the face by an ugly presentation. Even if you don’t believe that you can design anything good looking, then a simple black font on a white background is perfectly adequate. Better that than cheap clip art and flashing animated transitions.

For those who are a bit more adventurous and would like to learn more, Presentation Zen is a great site for learning about good design principles for presentations. Here are some example posts from the site that I enjoyed:

Presentation tools

If you’re considering (or are already using) slideshows as part of your lectures, you should familiarise yourself with the following tools:

Using images in a slideshow

There’s nothing more boring than reading a long list of bullet points. Consider using pictures embedded in the slide that will help you to make a point more strongly, or that add the kind of detail that is difficult to illustrate with text. Presentation Zen is an amazing resource that has many examples of how images can make or break a presentation.

Always try to find high quality images, preferably from sources that use open licenses (see the section on “Copyright” later). The quality of a digital image is determined chiefly by its resolution. The higher the resolution, the better the quality of the image. However, note that as resolution increases so does the file size, which may be a problem if you need to keep your presentations small. The table below presents examples of an image at different resolutions.

Normal resolution

Low resolution

* *

Also, make sure that you maintain the correct aspect ratio when using images in your lecture slides. It’s jarring for the viewer to see images that are stretched or compressed into areas that they were not designed to fill.

Correct aspect ratio

Incorrect aspect ratio

* *

Another common problem is when lecturers take a small image and expand it to take up more screen space. When this happens, the image on display looks pixelated. You can avoid this by using images at their actual size, rather than enlarging them. Note that you can take a large image and make it smaller with no discernable problems. The issue arises when you try to make a small image larger.

Using video

Video can be a great way to appeal to students on an emotional level, since it often brings out the human element of a story. However, if you do include a video as part of your lecture, make sure that it’s short, since passively watching a video is no different to passively watching a lecturer. If you do include video, it should go beyond simply telling the students something that you could tell them yourself. If all it does is convey more facts, then it would be better to have them learn those facts in another way. Also, after watching the video, the lecturer should set aside time for the students to engage with the ideas that were presented. If you’d like for students to watch a long video because it’s an essential aspect of the module, rather have them watch it at home, make notes, create questions, and then bring those questions to class for discussion.

It is possible to record lectures in a way that the lecture can be made available for students to watch later. The benefits of this include being able to pause, rewind and re-listen more complex sections of work. In addition, some software programmes allow a slideshow presentation (if one was used) to be synchronised and shown alongside the video of the lecturer. Recorded lectures can be made available on the university intranet along with additional resources, copies of the presentation slides, handouts, etc. for students to access after the lecture. Note however, that watching videos of lectures is not a replacement for attending lectures, especially if the lecturer has created space and time in the lecture for interaction.

Handouts

A lesson plan is always useful as a guide for students to situate themselves within the context of the lecture, and can be made available to them in print or online. The can be created in advance and given to students either before the lecture to help them prepare, or afterwards as a summary.

The point of a handout is to scaffold students’ independent exploration of a topic, not to provide them with the content of the lecture. Use the handout to identify the aims and objectives of the session, to make connections to other lectures or subjects, summarise the main concepts, provide self-assessment questions for independent study and direct them to additional reading and resources.

More comprehensive handouts avoid the need for students to take extensive notes but this may also encourage them to stop concentrating during the lecture. Notes that provide less detail may encourage students to pay more attention and to engage with the topic independently, since the handouts in themselves do not provide everything that is necessary to know. For this reason, handouts should provide a scaffold for students to build a better understanding of a topic by summarising the major themes of the lecture, while at the same time avoiding exhaustive coverage. They should aim to inform self-directed learning, and should therefore include exercises and questions with reading lists (Cantillon, 2003).

Let students know if they are expected to take notes during the lecture or if the handouts will provide everything they need. Note-taking is a form of engagement during the lecture but can also help students to structure their thoughts during follow up homework. You can teach them how to effectively take notes during class, for example by using the Cornell method (see below for a guide on using this method, from the Cornell Learning Strategies Center).

Facilitating interaction

While most students have had several years of experience attending lectures by the time they reach you, almost all of them view lectures as an opportunity to sit back and soak up the learning, or as one student told me, to “sit back and switch off”. It’s important for students to understand that actively engaging with the lecture will help them to derive maximum benefit from it.

One of the easiest ways to encourage interaction during a lecture is “Think. Pair. Share”. The lecturer presents an idea, then gives the students a short period of time to think about it individually, possibly giving them a question as a stimulus or asking them to write something down. Then, they pair up with the person sitting next to them and discuss the ideas and questions that each of them just came up with. Finally, some of the pairs are asked to share what they discussed with the larger group, with the lecturer providing input at various stages in the form of clarification, reinforcement and challenges.

Another useful option is to get the students to ask the lecturer questions during the session. However, instead of asking them to do it as individuals, try having them work on a question in small groups of two or three. This way they can avoid the perceived embarrassment of asking a “silly” question and will gain confidence to ask questions in public. Then, instead of the lecturer answering the question, give other groups the opportunity to try first. This will not only hold everyones attention but will also give the lecturer a few different ideas to work with during the discussion.

Having students work in small groups is an effective way for them to engage with the content of the lecture. By discussing the concept with others, they not only remain focused during the lecture, but they have an opportunity to reinforce it in their own minds. In this way misunderstanding can be identified early on, with students having the opportunity to ask clarifying questions. In addition, seeing different answers to the same question can demonstrate to students the different ways of understanding something.

Students can also be given short, formative assessments after a significant piece of work has been covered. They can be informed in advance that the assessment will happen at the end of the lecture, thereby prompting them to pay more attention than they would usually. By making it a formative assessment there is less pressure on them to worry about passing, and more attention can be paid to identifying areas of their misunderstanding. The timing of the assessment is important, since doing one at the beginning of the lecture would be more appropriate to determine prior learning, while one at the end would be better for evaluating the work just covered. Having students assess each other’s work using a rubric prepared in advance will not only relieve the lecturer from marking the work but will introduce students to evaluating the work of others. Completing the assessment before the end of the lecture period also allows time for students to ask questions to clarify their misunderstanding.

Questions of copyright

This is a common challenge that lecturers often face. What content you can use and what you can use it for is determined by copyright. How much text can you photocopy and give to students? What pictures can you include in my slides? Are YouTube videos off limits? These are just a few questions that arise when considering the issue of intellectual property and which pieces of content you can include. Note that even if you’re properly referencing the content, it doesn’t matter. This is a problem of how much content you can distribute without paying for it.

It’s always a good idea to try and find content that is licensed with Creative Commons licenses. This is a way of knowing exactly what the content creator will allow you to do. When someone creates a piece of content, even if there is no copyright notice, by default they own all rights to use that content exclusively. This has implications for when lecturers use content they did not create, and share it with students without paying the author. Most university libraries have intellectual property policies and agreements, and specify exactly how much content lecturers can share with students.

Getting feedback

It is always useful to get feedback after a lecture as this will allow you to make changes to future lectures based on the students’ experiences. The feedback should not only aim to identify areas that could be improved but should also provide constructive advice on how the lecturer can actually improve. Sources of feedback can include:

  • Students, whose opinions are possibly the most valuable
  • Colleagues, as part of a more formal peer review
  • Personal reflection, as part of developing a teaching portfolio

If mini-assessments are conducted at the end of the lecture they also be kept as part of an informal evaluation of teaching practice, since student performance is a useful indicator of teaching efficacy. In addition, students’ notes can also be reviewed (with their permission) in order for the lecturer to see if the session was clear to them (Cantillon, 2003).

A simple form can be used for either peer or student review of a lecture:

The lecturer was:

Strongly agree

Slightly agree

Slightly disagree

Strongly disagree

Enthusiastic

Punctual

Confident

Clear and concise

Challenges

Lecturers will often need to deal with several challenges that may arise during the lecture, including:

  • Students arriving late
  • Questions that aim to distract
  • Cell phones ringing
  • Students falling asleep
  • Students talking to each other
  • Technical failures

While these challenges are outside of the direct control of the lecturer, being well-prepared and engaging the students’ attention will help prevent many of these problems arising. In addition, ensuring that students know the rules of the classroom may also address some of these issues.

Conclusion

Lectures can be an incredible effective, powerful form of communicating important and difficult concepts and ideas to students. Lectures can be used to present core material and to provide an overview of the course. It should be structured, have clearly defined objectives and a lesson plan. Lecturers should pay attention to their own presentation skills and to the preparation of their handouts and other materials. Lectures can be made more effective by capturing and maintaining the attention of students, requiring them to be active participants in the session, leading them in questioning and discussion. In addition, formative assessment with immediate feedback can also be used to enhance traditional lectures.

References

Legal stuff

To the best of my knowledge, all sources used in the creation of this work are freely available and not encumbered by licensing issues. The image in the article header was taken from the Wikipedia page on Meerkats.

I enjoyed reading (February)

landscape-nature-reading-Favim.com-586095

Is the lecture dead?

The real purpose of a lecture is to show the mind and heart of the lecturer at work, and to engage the minds and hearts of learners.

It’s important to understand that lectures in themselves are not bad but that they, like any teaching medium can be used badly. A good lecturer tells a story that inspires and motivates students, so we should use caution when speaking poorly of lectures. When the lecture fails as a teaching medium, it is the lecturer who is at fault.

I was asked (Stephen Downes)

…focus your work on serving others, not enriching yourself, because your work will have no value to you otherwise. Write from the heart; don’t be a slave to academic form, but don’t ignore it. Back up your reasoning with evidence, and reason soundly from what you know and what you have experienced, not what you have been told. Understand that argument rarely convinces anyone of anything, that an understanding of principles of reasoning is to protect yourself from error, not to correct other people in theirs, that time spent explaining what you are doing and why will often pay off, but not everyone will support you, and often nobody will, but if you are true to these principles, that won’t matter. And, at the end of life, the only thing that will matter to you will be what you gave to the world, not what you took from it. Share.

 

I used to think (Shelley Wright).

I used to think marks were important. Now I think they’re arbitrary at best. What does 82% really mean? I’ve asked my students that question. They don’t know, and the truth is, most often, neither do I. I would like to get rid of all marks, and move solely to feedback, and the more often this feedback can be verbal dialogue the better. When my students receive lots of formative feedback they know where they stand as learners. Then it’s about learning, not marks and grades.

 

Freedom to connect (Eben Moglen): Eben makes the argument that in a digital and networked world, open source software and hardware are essential if citizens are going to maintain control of their civil liberties. When governments and corporations control our devices and the code that runs on them, we will find ourselves with fewer and fewer private places to go.

So here we are, asking ourselves what the educational systems of the 21st century will be like, and how they will socially distribute knowledge across the human race. I have a question for you. How many of the Einsteins who ever lived were allowed to learn physics? A couple. How many of the Shakespeares who ever lived, lived and died without learning to read and write? Almost all of them. With 7 billion people in the world right now, 3 billion of them are children; how many Einsteins do you want to throw away today? The universalization of access to education, to knowledge, is the single-most important force available for increasing innovation and human welfare on the planet. Nobody should be afraid to advocate for it because somebody might shout “copyright”.

Twitter Weekly Updates for 2012-07-16

Posted to Diigo 07/14/2012

    • Today’s standard lecture, as a knowledge delivery model, is a legacy of our pre-digital past. We already have decades of research behind us which says that, as far as learning goes, having one person stand up in front of lots of people and talking non-stop is about as ineffective as it gets.
    • There is no reason to believe the roller coaster ride for universities will be any less bumpy than it has been for the media, the music industry or book and magazine publishers.
    • the global demand for mass higher education is outstripping the capacity and infrastructure of traditional on-campus universities. In Australia, the federal government is actively pushing university enrolments towards new higher education attainment targets; potentially cramming more students into already crowded lecture halls
    • Universities could take the first step towards the future by shifting the classroom, with its human scale interaction, to the top of the on-campus education agenda. Much of the common “content” for particular disciplines can be effectively delivered online.
    • We could turn back to Confucius for a way forward. He said: “I hear and I forget, I see and I remember, I do and I understand.” Hearing and seeing is what we call “lean back learning”. But doing- via problem solving – is “lean forward learning”

      We should be using precious face time in classrooms for these lean forward types of teaching — to ask hard questions, to take part in interactive tasks, for guided problem solving, for working in groups and for engaging with directly and productively with teachers or tutors. Not for “talking at” students en masse.

    • universities could concentrate on higher level learning and inquiry and research in class? That is, the future of universities may lie in shifting away from dispensing knowledge on campus towards interpreting and applying knowledge, with consequent gains for innovation.

AMEE conference, 2011 (day 1)

Today was the first day of AMEE 2011, and a great start to my first international conference. Here are the notes I took.

Donald Clark – 21st century medical learning

“Death of the compliant learner” – almost all of my students are compliant, I hope Clark doesn’t buy into the idea that all of today’s students are somehow different? Even Prensky has moved on from the Digital Native debate

When the cost of education goes up, and the deliverable stays the same, you have the characteristics of a bubble → is higher education / medical education in a bubble (Malcolm Gladwell)?

Clark shows excerpt from Ferris Bueller’s day off to demonstrate poor lecturing style, gets a laugh but is caricaturing the format useful in terms of solving the actual problem?

Psychology of learning:

  • Spaced practice
  • Attention
  • Assessment
  • Learn by doing
  • Collaboration

“The internet is shaping pedagogy”, this is the wrong way around. Effective teaching practice should make effective use of the internet.

“Lectures are ineffective for teaching”

  • don’t inspire or motivate
  • no critical thinking
  • doesn’t emphasise values
  • no social adjustment
  • or behavioural skills
  • only useful for transmitting information

Student and lecturer’s attention begins to fall off after 25 minutes, yet lectures often continue for much longer. Clark’s solution → record lectures! OR…change teaching practice to make use of that time more effectively

Cultural reasons for not changing teaching practice

Assessment is skewed towards favouring cramming

Is technology supporting assessment?

Surgeons who play video games perform better with laparoscopic procedures than those who don’t

I think Clark’s emphasis on technology misses the point. This isn’t the right audience to make assumptions about what technology should be used with what teaching approach. The message he’s sending is that we should use digital tools because they’re better. But he hasn’t spent enough time explaining what it’s better for and how.

 

The future of online continuing medical education: towards more effective approaches
Panel discussion (John Sandars, Pat Kokotailo, Gurmit Singh)

How do we get the new evidence base to change behaviour in health professionals? By delivering content and hoping → behavioural change

Online CME is about transmitting content from an “expert” to the person at home, and competing with their social lives. Does this have the intended impact of actually changing clinician’s behaviour? Sandars says “No”

How can the intended impact be achieved?

CME vs CPD
CME process whereby people keep updated regarding medical information
CPD includes CME but is more broad

e-learning implies that technology is used to enhance T&L but no definition of what technology is. I wish people would stop talking about e-learning until we demonstrate that it’s fundamentally different in terms of changing learning behaviour

List of digital tools and blending them with f2f spaces

Issues in obtaining evidence of effective CPD:

  • Differing content in med ed → differing ways of delivering / teaching
  • Traditional curriculum vs no curriculum
  • Rare comparison between e-learning intervention and traditional intervention
  • Difficulty with educational RCTs (very “medical” to think that RCTs are an important evaluative tool in education)

Kirkpatricks model to categorise the level of evaluative outcomes

Majority of research looks at participant satisfaction, but limited research demonstrating performance change in practice, no studies demonstrated that web-based CME had any effect on clinical practice

Internet learning associated with large positive effects compared with no intervention, but the effects were heterogeneous and small (internet learning interventions were broad in terms of content)

Comparison of different virtual patient desings suggest repetition, advance organisers, enhanced feedback and explicitly contrasting cases can improve learning outcomes (Cook at al, Academic Medicine, 2010)

Which “e-learning” techniques enhanced learning experiences?

  • Peer communication
  • Flexibility
  • Support of a tutor who was also a moderator
  • Knowledge validation
  • Course presentation
  • Course design

Effectiveness of the online course is mediated by the learning experience

Cost effectiveness of online CPD is mainly based on self-report, so data not robust (Walsh et al, Education for primary care, 2010)

Most to least effective approaches (Bloom, International Journal of Technology Assessment in Health Care, 2005):

  • Interactive techniques (audit / feedback, academic detailing / outreach, reminders)
  • Clinical practice guidelines and opinion leaders less effective
  • Didactic presentations and distributed print material have little to no effect

Therefore, not much evidence for the use of online learning, and the effects that do exist, are small (smaller than traditional), course design is important, and interactivity appears to be key

Improving knowledge and skills without an associated change in behaviour, is useless

Discussion:

  • Isolated, invidualised online CME is focused on delivering content more efficiently but that misses the point
  • We need to integrate social components into the learning experience
  • We evaluate episodic events and expect to find behavioural change
  • It’s not about one approach or the other, we need to blend different teaching methods
  • We need to stop talking about e-learning, we don’t talk about overhead projector learning

Problems with CME (currently)

  • Exisiting models do not improve patient care
  • Current models are incomplete, and are used for different reasons
  • Use is unco-ordinated
  • Participation is low
  • Much research names existing models as “largely irrelevant”

Moving from knowledge and skills to changing behaviour. What is the / a new model?

The outcome must be: improving patient care. This comes about through supporting information exchange, opinion and advice to make sense of the complexity of practice

Technology used must be useful and relevant

Technology + pedagogy = outcome (is it this simple?)

Should move psychological learning theory to sociological theory

Professionals learns as they go about doing things, sharing tacit knowledge, discussing and interacting with others in social networks. As people interact they share ways of thinking, feeling and acting in daly life, which influences their behaviours and habits. We are living, learning and changing in practice. They are reflexive. Learning, behaviour and change are all dynamically connected in networks and make practice complex.

Learning practive should be embodied and emergent

Reflexive networks used in teaching and learning

We should be more strategic in collaboration, rather than having collaboration forced.

How do you evaluate outcomes?

  • CME credits
  • Self-report: was it relevant and useful?
  • Patient care audit: do patients have improved outcomes?

Tacit knowledge = useful knowledge

Practice and learning are inseparable

If individual practice is only part of the team approach, is it reasonable to expect that changing an invidual’s approach will actually impact on patient outcomes?

Interprofessional workplace-based learning using social networks
JM Wagter

Difference between in/formal learning

80% of learning is outside the formal context. How do we make the informal learning explicit?

Between whom is learning taking place i.e. identifying actors within the network by mapping relationships between teams, professions, etc.

Look at density and information and communication flows

Everybody is involved in informal learning within networks, but the relationships are assymetrical and not collaborative or reciprocal

Network analysis is a useful method to identify relationships between professionals, but what do you do with the information i.e. how do you change the relationships?

Patient attitude to medical students experience in General Practice
H Cheshire

Patients lack confidence to ask students to leave when receiving a personal physical examination by a GP

Female patients are less likely to have positive attitudes with regards a medical student conducting an assessment, although the numbers are quite high nonetheless

The context of the examination changes whether or not patients are happy to have students present e.g. sexual health, etc.

Learning at a clinical education ward: first and final year nursing students’ perceptions
K Manninen

Final year students have an emphasis on supervisor relationships and are more dependant on feedback and affirmation but don’t experience internal authenticity, which is what drives the understanding of the nursing role.

First year students focus on patient relationships with concomittant feedback

Creating a student ER
A O’Neill

Highly integrated, student-centred, emphasis on PBL → creation of a student ER

Organisation based on teams, rather than a hierarchy. Team sees the patient concurrently, rather than consecutively

Approach allows the student to manage the patient with a focus on structured feedback. Tried to avoid students managing those with obvious serious pathology, cognitive dysfunction, etc.

Supervisor behind the student, not the other way around

Received positive feedback from students, in addition to significant improvement in student note-taking ability, among other clinical skills

Evaluating medical grand rounds – 10 years later
Mary J Bell

High numbers of repeated evaluations in order to determine reliability

We tend to give colleagues higher evaluator ratings

Highest scores had less to do with knowledge and presentation of objectives, and more to do with presenter style, level of presentation and enthusiasm → edutainment

When grand rounds were done using digital video, overal presenter ratings went down, seeming to concur with social learning theories i.e. we want to be in the same room as those we’re learning from (but is social just about physical presence?)

Applying theoretical concepts to clinical practice

Concept map about concept mapping taken from IHMC website

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?

Twitter Weekly Updates for 2010-09-13

  • More on online learning & the visually impaired. Useful links 4 anyone working with learners who have visual impairments http://ow.ly/1qQGws #
  • Gilly Salmon’s 5 stage model http://ow.ly/1qQGsw #
  • Social Learning in the Positivist Paradigm http://ow.ly/2D2kT #
  • Presentation: A few minutes with John Cleese on creativity http://ow.ly/1qQDg5 #
  • Multitasking Lowers Academic Performance http://ow.ly/1qQDfL #
  • Dear Baby Boomers, Gen Xers, Gen Yers … Can We Please Move On? http://ow.ly/1qQDfa #
  • Documents and Data… http://ow.ly/1qQy7b #
  • As clinicians we tend 2 focus on results that are easy to measure e.g. ROM, & ignore ones that are hard e.g. learning, hope, quality of life #
  • Strange how some people’s first intuition re. open learning practices is that their colleagues will “steal from them”? #
  • Presentation on blended learning in clinical education for SASP went well, good discussion afterwards, some resistance from academics #
  • Reading Social Networks and Practice Knowlege (WCPT abstract) on Scribd http://scr.bi/cxhwWm #readcast #
  • Published Social Networks and Practice Knowlege (WCPT abstract) on Scribd http://scr.bi/cxhwWm #readcast #
  • RT @francesbell: 3 ALT Learning Technologisits of the Year 😉 http://flic.kr/p/8zx9ip #
  • @cristinacost Your colleagues…sure it’s them 🙂 in reply to cristinacost #
  • Reflections on Blogging | Virtual Canuck http://bit.ly/awblvh #
  • Is the Lecture Dead? http://ow.ly/1qQ0oP #
  • Can MOOCs make learning scale? Dont assume that learning comes from the teacher http://ow.ly/1qQ0nY #
  • IBM Helps Tennis Fans “See Through Walls” with Augmented Reality http://ow.ly/1qQ0hf #
  • ResearchGATE Offers Social Networking for Scholars and Scientists http://ow.ly/1qQ0gf #
  • RT @SalfordPGRs: Huge congratulations to Cristinacost on ALTC Learning Technologis award!! #
  • Was away the whole of last week planning for next year, making 2 big curricular changes, combining some theory subjects, and moving to OSCEs #
  • Just finished a week of assisting with clinical exams for #Stellenbosch good learning experience, one learns so much from colleagues #

Posted to Diigo 08/18/2010

    • Gregory A. Moses, a professor of engineering physics at the University of Wisconsin at Madison, has tried to reverse the “lecture-homework paradigm” in a computational science course. Instead of watching a lecture and doing homework later, outside the classroom, students study the lectures on their own time online. Class is a lab, with students solving problems under the supervision of faculty. Mr. Moses went from “not knowing the names of the students in his huge lectures to knowing which ones smoked and which ones didn’t”
    • In scholarship and research, having a ‘problem’ is at the heart of the investigative process; it is the compound of the generative questions around which all creative and productive activity revolves
    • But in one’s teaching, a ‘problem’ is something you don’t want to have, and if you have one, you probably want to fix it
    • Changing the status of the problem in teaching from terminal remediation to ongoing investigation is precisely what the movement for a scholarship of teaching is all about
    • many of us struggle to find the objectivity necessary to reflect and analyze the problem
    • Teaching problems are best solved intellectually, not emotionally
    • You can solve the problem on your own in the privacy of your classroom and be proud of the solution. But your colleague across the hall may have a better solution or may have figured out how that solution can be applied to other problems

Twitter Weekly Updates for 2010-08-02

Posted to Diigo 05/02/2010

    • You can’t force students to pay attention if they don’t want to. And even if you forbid all electronic gadgets, students will still daydream, whisper, and pass notes.
    • You can’t force students to pay attention if they don’t want to.
    • If you permit mobile devices, establish rules of etiquette.
    • Share research findings on task switching that show multitasking students learn significantly less and perform on tests more poorly than students who focus solely on classwork.
    • Survey results indicate that the majority of college students prefer courses that offer podcasts over those that do not. Students cite convenience, flexibility, and positive impact on learning as the main reasons to have recorded lectures (Nagel, 2008; Fernandez, Simo, & Sallan, 2009).
    • Lecture capture
    • archived lectures
    • allows students to review material at their own pace and convenience (Coghlan et al., 2007)
    • offers students more flexibility in note-taking
    • makes time for active learning during class by having the lecture available for viewing before the class meetings (Lund, 2008)
    • allows students to catch up with a missed lecture
    • No noticeable impact on students’ class attendance
    • In surveys, students report gaining a better understanding of class material in courses that used the technology
    • Undergraduate students have reported in focus groups and surveys that podcasts helped them stay focused on the course, made learning more fun and informal, supported independent learning, and enabled deep engagement with course material (Edirisingha & Salmon, 2007; Duke University, 2005)

    • Some students have reported that, because they had access to this learning tool outside of class, they took fewer notes during class and were able to pay closer attention to the lecture (Brotherton & Abowd, 2004)
    • Students report that they appreciate the flexibility of accessing podcasts anywhere and anytime (Fernandez, Simo, & Sallan, 2009; Winterbottom, 2007), and they like resources that are presented in a video or audio format, since this allows for self-paced learning and multitasking

    • students usually view podcasts shortly after a lecture has occurred and in the few days before an exam (Copley, 2007)
    • When considering the use of lecture capture technology, faculty should also understand students’ technological competencies. It is important not to assume that all students possess the same technology skills and have had equal exposure and access to technology (e.g., computers and MP3 players)

    • Given the potential differences in levels of access and technological skills, instructors may want to consider administering a short survey at the beginning of the term to determine students’ comfort with and access to technology required for using lecture capture (Zhu & Kaplan, 2011)

    • Since students take fewer or summary style notes in courses using lecture capture (Brotherton & Abowd, 2004), they have more time to process course material on the spot, which may lead them to ask more questions and want more interactivity during lecture

    • Make podcasts available as soon as possible after a lecture, since most students download podcasts within a few days of a given lecture
    • When appropriate, make reference to podcasts during lectures or when responding to students’ questions
    • Provide students with a clear explanation of instructional goals and technical requirements if podcasts are used for student projects or assignments.
    • the digital divide in education goes beyond the issue of access to technology.  A second digital divide separates those with the competencies and skills to benefit from computer use from those without.”
    • the digital divide is as much about access to reliable power as it is about access to ICT.
    • ICT use holds very real promise for facilitating greater inclusion of such groups into existing educational practices and environments as well — but such inclusion is by no means automatic, despite what countless pictures of happy children with computers from all walks of life might imply.
    • But do we really need to repeat the mistakes of others? If adopting ‘best practice’ is fraught with difficulties, and ‘good practice’ often noted but ignored, perhaps it is useful instead to look at ‘worst practice’.
    • 1. Dump hardware in schools, hope for magic to happen
    • 2. Design for OECD learning environments, implement elsewhere. Sometimes this works, but unfortunately many places roll out programs and products that have at their core sets of assumptions (reliable electricity and connectivity, well-trained teachers, sufficient available time-on-task, highly literate students, space to implement student-centric pedagogies, relevant content, a variety of cultural norms, etc.) that do not correspond with local realities.
    • 3. Think about educational content only after you have rolled out your hardware. It is a fact that, in many places, only once computers are in place and a certain level of basic ICT literacy is imparted to teachers and students is the rather basic question asked: What are we going to do with all of this stuff?
    • 4. Assume you can just import content from somewhere else. Much effort typically needs to be expended to map this content to explicit objectives and activities in the local curricula.
    • 5. Don’t monitor, don’t evaluate. What is the impact of ICT use in education? If we don’t evaluate potential answers to this question, rigorously and credibly, all we are left with is well-intentioned guesswork and marketing dross.
    • 6. Make a big bet on an unproven technology (especially one based on a  closed/proprietary standard) or single vendor, don’t plan for how to avoid ‘lock-in
    • 7. Don’t think about (or acknowledge) total cost of ownership/operation issues or calculations. We know that “total cost of ownership or operation” (TCO) is often underestimated, sometimes grossly, when calculating costs of ICT in education initiatives in developing countries.
    • 8. Assume away equity issues. Introduction of ICT in schools often exacerbates various entrenched inequities in education systems (urban-rural, rich-poor, boy-girl, linguistic and cultural divides, special needs students — the list is long)
    • 9. Don’t train your teachers (nor your school headmasters, for that matter). Teacher training is critical to the success of such initiatives.
    • Many of the lessons, or ‘worst’ practices that you describe can also be easily transferred over to the use of ICT in the health sector, so all nine points are applicable to us too.
    • technology can empower people, but not if their most basic needs are not met (i.e., safe water, sanitation, security).