Alternative ways of sharing my PhD output

“Online journals are paper journals delivered by faster horses”

– Beyond the PDF 2

I’ve started a process of creating a case study of my PhD project, using my blog as an alternative means of presenting and sharing my results. Most of the chapters have already either been published or are under review with peer-reviewed journals, so I’ve played my part in the publishing game and jumped through the hoops of my institution. The full-length thesis has also been lodged with the institutional repository, so it is available, but in all honesty it’s a big, unwieldy thing, difficult to navigate and work through for all but the most invested reader.

Initially I thought that the case study would simply be a summary of the entire project but quickly realised that this would defeat the object of using the format. If people want the “academic” version, with the full citations, reference lists, standard headings (Background, Method, Results, etc.) then they’d still be able to download the published paper or even just read the abstract as a summary. The online case study should be more blog / wiki, than peer-reviewed paper. I’m starting to realise that one of the great things about the PhD-by-publication approach is that with the papers already peer-reviewed and published, I’m freed from having to continue playing the game. I get to do whatever I want to with the case study, because the “serious, academic” stuff is done.

After exploring a few other options (see list below), I decided that HTML was the best way to share the process in a format that would be more flexible and engaging than a PDF. HTML is a text-based format that degrades well (i.e. old browsers, mobile browsers and slow internet connections can all deal reasonably well with text files) while at the same time allowing for advanced features like embedded video and presentations. Also, being an open standard, HTML is unlikely to suffer from the problems of software updates that disable functionality available in previous versions. Think how many people were (and continue to be) inconvenienced by Microsoft’s move from the .doc to the .docx format.

Here are some of the features I thought were important for whatever platform I chose to disseminate my research. It should:

  • Be based on an open standard so that it would always be readable or backwards compatible with older software
  • Have the ability to embed multimedia (video, audio, images, slideshows)
  • Enable some form of interaction with the reader
  • Have a responsive user interface that adapts to different devices and screen sizes i.e. it should be device independent
  • Allow the content to be presented in a visually attrative format (“Pretty” is a feature“)
  • Be able to be adapted and maintained easily over time
  • Be able to export the content in multiple formats (e.g. Word, ODT, PDF)

Before deciding on using HTML and this blog, here is a list of the alternative diseemination methods I considered, and the reasons I decided not to go with them:

  • ePub is an open standard and can potentially be presented nicely, but not all ePud readers are created equal and I didn’t want anyone to have to jump through hoops to read my stuff. For example, an ebook published to the Kindle may not display in iBooks.
  • PDF is simple, open standard, easy to create but too rigid in the sense that it conforms to “digital paper” paradigm. It wouldn’t allow me to be flexible in how content is displayed or shared.
  • Google+ is visually pleasing but it is not open (the API is still read-only) and I have no idea if it will be around in a few years time.
  • Github was probably never a real option, but I like the idea of a collaborative version control system that allows me (and potentially others) to update the data over time, capturing all the changes made. However, it is simply too technical for what I wanted to do.
  • Tiddlywiki actually seemed like it might win out, since it’s incredibly simple to use, and is visually appealing with a clean user interface. I even began writing a few notes using it. The problem was that once I decided that HTML was the way to go, there wasn’t a strong enough reason to use anything other than my own blog.

If you’re interested in exploring this idea further, check out the Force11 White Paper: Improving The Future of Research Communications and e-Scholarship as a manifesto for alternative methods of sharing research.

Design principles for clinical reasoning

graphic_design smallerClinical reasoning is hard to do, and even harder to facilitate in novice practitioners who lack the experience and patterns of thinking that enable them to establish conceptual relationships that are often non-trivial. Experienced clinicians have developed, over many years and many patients, a set of thinking patterns that influence the clinical decisions they make, and which they are often unaware of. The development of tacit knowledge and its application in the clinical context is largely done unconsciously, which is why experienced clinicians often feel like they “just know” what to do.

Developing clinical reasoning is included as part of clinical education, yet it is usually implicit. Students are expected to “do” clinical reasoning, yet we find it difficult to explain just what we mean by that. How do you model a way of thinking?

One of the starting points is to ask what we mean when we talk about clinical education. Traditionally, clinical education describes the teaching and learning experiences that happen in a clinical context, maybe a hospital, outpatient or clinic setting. However, if we redefine “clinical education” to mean activities that stimulate the patterns of thinking needed to think and behave in the real world, then “clinical education” is something that can happen anywhere, at any time.

My PhD was about exploring the possibilities for change that are made available through the integration of technology into clinical education. The main outcome of the project was the development of a set of draft design principles that emerged through a series of research projects that included students, clinicians and clinical educators. These principles can be used to design online and physical learning spaces that create opportunities for students to develop critical thinking as part of clinical reasoning. Each top-level principle is associated with a number of “facets” that further describe the application of the principles.

Here are the draft design principles (note that the supporting evidence and additional discussion are not included here):

1. Facilitate interaction through enhanced communication

  • Interaction can be between people and content
  • Communication is iterative and aims to improve understanding through structured dialogue that is conducted over time
  • Digital content is not inert, and can transform interactions by responding and changing over time
  • Content is a framework around which a process of interaction can take place – it is a means to an end, not an end in itself
  • When content is distributed over networks, the “learning environment” becomes all possible spaces where learning can happen
  • Interaction is possible in a range of contexts, and not exclusively during scheduled times

2. Require articulation

  • Articulation gives form and substance to abstract ideas, thereby exposing understanding
  • Articulation is about committing to a statement based on personal experience, that is supported by evidence
  • Articulation is public, making students accountable for what they believe
  • Articulation allows students’ thinking to be challenged or reinforced
  • Incomplete understanding is not a point of failure, but a normal part of moving towards understanding

3. Build relationships

  • Knowledge can be developed through the interaction between people, content and objects, through networks
  • Relationships can be built around collaborative activity where the responsibility for learning is shared
  • Facilitators are part of the process, and students are partners in teaching and learning
  • Facilitators are not gatekeepers – they are locksmiths
  • Create a safe space where “not knowing” is as important as “knowing”
  • Teaching and learning is a dynamic, symbiotic relationship between people
  • Building relationships takes into account both personal and professional development
  • Building relationships means balancing out power so that students also have a say in when and how learning happens

4. Embrace complexity

  • Develop learning spaces that are more, not less, complex
  • Change variables within the learning space, to replicate the dynamic context of the real world
  • Create problems that have poorly defined boundaries and which defy simple solutions

5. Encourage creativity

  • Students must identify gaps in their own understanding, and engage in a process of knowledge creation to fill those gaps
  • These products of learning are created through an iterative activity that includes interaction through discussion and feedback
  • Learning materials created should be shared with others throughout the process, to enable interaction around both process and product
  • Processes of content development should be structured according to the ability of the students

6. Stimulate reflection

  • Learning activities should have reflection built in
  • Completing the reflection should have a real consequence for the student
  • Reflection should be modelled for students
  • Reflections should be shared with others
  • Feedback on reflections should be provided as soon after the experience as possible
  • Students need to determine the value of reflection for themselves, it cannot be told to them

7. Acknowledge emotion

  • Create a safe, non­judgemental space for students to share their personal experiences and thoughts, as well as their emotional responses to those experiences
  • Facilitators should validate students’ emotional responses
  • These shared experiences can inform valuable teaching moments
  • Facilitators are encouraged to share personal values and their own emotional responses to clinical encounters, normalising and scaffolding the process
  • Sensitive topics should be covered in face­to­face sessions
  • Facilitators’ emotional responses to teaching and learning should be acknowledged, as well their emotional responses to the clinical context

8. Flexibility

  • The learning environment should be flexible enough to adapt to the changing needs of students, but structured enough to scaffold their progress
  • The components of the curriculum (i.e. the teaching strategies, assessment tasks and content) should be flexible and should change when necessary
  • Facilitators should be flexible, changing schedules and approaches to better serve students’ learning

9. Immersion

  • Tasks and activities should be “cognitively real”, enabling students to immerse themselves to the extent that they think and behave as they would be expected to in the real world
  • Tasks and activities should use the “tools” of the profession to expose students to the culture of the profession
  • Technology should be transparent, adding to, and not distracting from the immersive experience

We have implemented these draft design principles as part of a blended module that made significant use of technology to fundamentally change teaching and learning practices in our physiotherapy department. We’re currently seeing very positive changes in students’ learning behaviours, and clinical reasoning while on placements, although the real benefits of this approach will only really emerge in the next year or so. I will continue to update these principles as I continue my research.

Note: The thesis is still under examination, and these design principles are still very much in draft. They have not been tested in any context other than in our department and will be undergoing refinement as I continue doing postdoctoral work in this area.

PhD project using design research

I’m supposed to be submitting my thesis in about 3 weeks time, so obviously I’m getting distracted by anything that means I can avoid that nightmare. Which is why I spent about an hour this morning making this nice flowchart. Putting complex things into pictures makes them easier for me to understand, so making this graphic was just a way for me to make sure that I actually do understand what I’m supposed to be doing. If you see anything fundamentally flawed with this process, please make sure that you keep it to yourself. Seriously.

Note: the major phases of the project are on the left, key aspects of each phase in the middle, and outcomes of the phase that lead to the next one on the right. Numbers in brackets highlight the chapter in which the item is described. All chapters except 1, 9 & 11 are written as articles for publication.

Twitter Weekly Updates for 2012-07-16

Blended learning in clinical education

Later today I’m presenting a progress report on my PhD, at the UWC “Innovations in Teaching and Learning” colloquium. Here is the presentation:

Blogging taking a back seat for now

I’m in the process of writing up the final parts of my PhD and am hoping to submit a first full draft in August, in preparation for a final submission in November. I’m doing it by publication and so am focusing my attention on the last 2 articles I need to complete. I’ve published two, submitted one, have one almost ready for submission and a final paper that I haven’t begun yet. Together with the bridging pieces that connect the articles, I still have a lot of work to do, which is why I haven’t been blogging with any regularity lately. I’ll definitely pick up on this when my work has been submitted.

Twitter Weekly Updates for 2012-02-20

Workshop on facilitation techniques using the Conversational Framework

How do we get students to think more deeply about learning in an academic context?

I’m giving a workshop later today. The idea is that we’ll get all of the facilitators who’ll be working on the module we’re designing (and which I’m evaluating for my PhD) and help them get a grip on the approach to facilitation that we’d like them to use. The objective of the workshop is to help them get an understanding of the conceptual basis for facilitation in this module. We’re going to use Laurillard’s “Conversational Framework” as a structure to guide how the facilitators should try and engage with their groups, both in the classroom and in the clinical context. The following notes have been taken from Laurillard’s “Rethinking University Teaching“.

Learning needs to be situated within a context and we can’t separate the knowledge to be learned from the context in which it has to be applied. Conceptual knowledge is not an abstract, intangible thing. It is a tool that can be used as part of an authentic learning activity. There is a unity between the problem, context and solution when the problem is experienced, that is absent when an answer is merely given.

Teaching is essentially an activity that tries to help students change the way the see the world by interpreting the insights of others.

  • “Everyday learning” = a result of our experiences in the world i.e. we develop an implicit awareness of gravity by falling
  • “Academic learning” = a result of our reflections on others’ descriptions of the world i.e. we develop an understanding of a theory of gravity by reading about experiments conducted by other people

Academic learning is different to everyday learning in the sense that it is the student learning through interpreting the symbols (i.e. language, images, diagrams) of someone else’s view of the world

The knowledge that students bring with them will impact on how they integrate the new knowledge that they learn. Remember the ZPD and how the MKO guides the student to higher cognitive levels by building on what they already know.

It makes no sense to correct a faulty procedure without also correcting the faulty conceptualisation that supported it (knowledge is situated in action, and action manifests knowledge). Correcting fundamental misconceptions automatically corrects all of the faulty procedures associated with it. Correcting the procedure corrects only one way of doing it incorrectly. This is one problem with merely demonstrating a technique. The student is forced to conceive a rationale for the technique, which may be incorrect. By taking them through an experience of solving a problem, the rationale for the technique is implicitly tied to its performance.

Before we can challenge the students’ fundamental misconceptions, we need to know what those misconceptions are. Again, this links back to the ZPD. Without knowing where the student is, we cannot help them get to where they want to be.

Researching the learning process (which is essentially what a facilitator is…a dynamic researcher into student learning) should include an observation of student performance on a task e.g. worked problems or written explanations, with a retrospective interview of the student looking back at the task and describing how they experienced it. The interviewer uses the task to provide cues to the student.

The learning process includes 5 interdependent aspects:

  • Apprehending structure. Students often fail to apprehend the structure of a discourse (e.g. a body of text), and there is often meaning that is implicit in structure (e.g. headings, paragraphs, etc.). When students take a surface approach to studying a text they lose the structure of the arguments and end with a series of statements that are not related to each other. When they take a deep approach they preserve the structure was well as the original meaning.
  • Integrating parts. Students must learn how to interpret the discipline-specific representations if they are to make sense of them. The way that information is presented can lend itself to deep or surface approaches, as well as create potential “distractors” for the student. The idea is not to ensure that data representation is “easy” for the student to interpret but rather to prepare the student to handle the different representations. Complex scenarios provide opportunities to determine students’ ability to interpret the representations. For example, consider how students are confused when different clinicians advocate different management approaches for the same patient. The student who only comprehends the superficial structure of the interaction is stuck because they cannot perceive that interpretations can be different.
  • Acting on the world. Learning is an activity (classroom-based problem-solving), an imitation of practice (practical sessions in the classroom), or actual practice (seeing patients). The student must engage with the world (i.e. solving problems in the classroom, or treating patients) by performing an action that is based on their understanding of how the world works.
  • Using feedback. As we learn about the world by acting on it, we receive direct feedback and adjust the action in relation to the feedback. The feedback must be perceived as useful to the student (i.e. it must be meaningful). It must be given immediately (or soon) after the students’ action in order for the student to relate the feedback to the action. Helpful feedback also provides the student with specific information on how to adapt their performance.
  • Reflecting on goals. Reflection is about establishing conceptual links between the action, feedback, and integration of the two as they relate to the achievement of a goal (e.g. solving a problem). Students often interpret goals as being something required by the teacher and go through the steps necessary to reproduce an outcome, with little intention of understanding the task or the goal (i.e. the tasks are a series of hoops that they have to jump through). The same task is therefore perceived differently by the students and teacher, and therefore operationalised in different ways. For many students, what it means to achieve the objective / goal is different to what the teacher is trying to do.

Using the above steps, we can see how learning something deeply is complex and difficult to facilitate. In short, the facilitator should try to conduct an interactive dialogue that supports the learning process. The following points describe the components of a teacher-student dialogue that promotes deep learning of a topic.

Apprehending structure

  • Students role: look for structure, discern topic goal (if the goal isn’t explicitly identified, the student lacks the structure to guide their thinking), relate goal to structure of discourse
  • Facilitators role: explain phenomena, clarify structure, negotiate topic goal, ask about internal relations (explain phenomena, make predictions, compare analogous situations)

Interpreting forms of representation

  • Students role: model events / systems in terms of forms of representation, interpret forms of representation to model systems / events
  • Facilitators role: set mapping tasks between forms of representation and systems / events, relate forms of representation to students’ view

Acting on descriptions

  • Students role: derive implications, solve problems, and test hypotheses to produce descriptions
  • Facilitators role: elicit descriptions, compare descriptions, highlight inconsistencies

Using feedback

  • Students role: link teachers redescription to relation between action and goal, to produce new action on description (student gives a description of something, teacher responds with a different viewpoint that demonstrates inconsistency, student must therefore reframe / describe it again)
  • Facilitators role: provide redescription, elicit new description, support linking process

Reflecting on goal-action-feedback cycle

  • Students role: engage with goal, relate to actions and feedback (this is why the goal of the dialogue must be explicit, to allow students to reflect its relationship to the action / description and feedback)
  • Facilitators role: prompt reflection, support reflection on goal-action-feedback cycle

There should be a continuing, iterative dialogue between teacher and student, that reveals both parties conceptions and differences between the conceptions, which then determines the focus for continuing dialogue. However, it’s not just the process of conducting the dialogue that matters but HOW it is conducted e.g there must be an opportunity for the student to interpret forms of representation other than language.

A teaching strategy should be:

  • Discursive – the teachers and students conceptions should be continually accessible to each other; teacher and student must agree on the learning goals for the topic; the teacher must provide an environment for the discussion, within which the student can generate and receive feedback on descriptions appropriate to the topic goal; the teachers description must be meaningful to the student
  • Adaptive – the relationship between the teacher’s and student’s conceptions must serve as the focus for the continuing dialogue; it is the student’s responsibility to use the feedback from their work on the task and relate it to their conception
  • Interactive – the teacher must provide an environment in which the student can act on, generate and receive intrinsic feedback on actions appropriate to the task goal; the student must act to achieve the task goal; the teacher must provide meaningful feedback on their actions that relates to the nature of the task goal
  • Reflective – the teacher must support the process in which students link the feedback on their actions to the topic goal for every level of description within the topic structure; the student must reflect on the task goal, their action on it, and the intrinsic feedback they receive, and link this to their description of their conception to the topic goal

Challenging students’ conceptual relationships in clinical education

I just wanted to share a thought while preparing our case notes for the Applied Physiotherapy module we’re developing. One of the designers made a note of the “guideline answers” for facilitators to some of the questions that we might use to trigger students’ thinking. I wrote the following as a comment and didn’t want to lose it when the document is finalised, so I’m putting it here.

“I think we should make sure that, in addition to the ‘answers’, we should identify the main concepts we want students to understand. Remember that we’re using our paper patient (i.e. the case) as a framework for students to learn about concepts. Then, they apply those concepts in the real world to patients. They reflect on those real-world interactions and identify dissonance between their experienced reality (the patient contact) and their abstract conceptions of reality (how they originally conceived of the patient contact). After the patient contact, they feed back to their small groups and facilitators, who together help students create new relationships between concepts. So, in short, the clinical concepts are learned initially through the paper patient, tested in the real world with an actual patient, discussed online (maybe) and then brought back to the classroom for further reflection and refinement. The next week they are exposed to new concepts that build on their previous experiences, and then they get to test those abstractions in the real world again.”

I’m trying to take an intentional approach to using Laurillard’s conception of academic learning that I’m exploring in “Rethinking University Teaching”

From “designing teaching” to “evaluating learning”

Later this month we’ll be implementing a blended approach to teaching and learning in one module in our physiotherapy department. This was to form the main part of my research project, looking at the use of technology enhanced teaching and learning in clinical education. The idea was that I’d look at the process of developing and implementing a blended teaching strategy that integrated an online component, and which would be based on a series of smaller research projects I’ve been working on.

I was quite happy with this until I had a conversation with a colleague, who asked how I planned on determining whether or not the new teaching strategy had actually worked. This threw me a little bit. I thought that I had it figured out…do small research projects to develop understanding of the students and the teaching / learning environment, use those results to inform the development of an intervention, implement the intervention and evaluate the process. Simple, right?

Then why haven’t I been able to shake the feeling that something was missing? I thought that I’d use a combination of outputs or “products of learning” (e.g. student reflective diaries, concept mapping assignments, semi-structured interviews, test results, focus groups, etc.) to evaluate my process and make a recommendation about whether others should consider taking a blended approach to clinical education. I’ve since begun to wonder if that method goes far enough in making a contribution to the field, and if there isn’t something more that I should be doing (my supervisor is convinced that I’ve got enough without having to change my plan at this late stage, and she may be right).

However, when I finally got around to reading Laurillard’s “Rethinking University Teaching”, I was quite taken with her suggested approach. It’s been quite an eye opener, not only in terms of articulating some of the problems that I see in clinical practice with our students, but also helping me to realize the difference between designing teaching activities (which is what I’ve been concentrating on), and evaluating learning (which I’ve ignored because this is hard to do). I also realized that, contrary to a good scientific approach, I didn’t have a working hypothesis, and was essentially just going to describe something without any idea of what would happen. Incidentally, there’s nothing wrong with descriptive research to evaluate a process, but if I can’t also describe the change in learning, isn’t that limiting the study?

I’m now wondering if, in addition to what I’d already planned, I need to conduct interviews with students using the phenomenological approach suggested by Laurillard i.e. the Conversational Framework. I don’t yet have a great understanding of it but I’m starting to see how merely aligning a curriculum can’t in itself make any assertions about changes in student learning. I need to be able to say that a blended approach does / does not appear to fundamentally change how students’ construct meaning and in order to do so I’m thinking of doing the following:

  • Interview 2nd year and 3rd students at the very beginning of the module (January, 2012), before they’ve been introduced to case-based learning. My hypothesis is that they’ll display quite superficial mental constructs in terms of their clinical problem-solving ability as neither group has had much experience with patient contact
  • Interview both groups again in 6 months and evaluate whether or not there constructs have changed. At this point, the 2nd years will have been through 6 months of a blended approach, while the 3rd years will have had one full term of clinical contact with patients. My hypothesis is that the 2nd years will be better able to reason their way through problems, even though the 3rd years will have had more time on clinical rotation

I hope that this will allow me to make a stronger statement about the impact of a blended approach to teaching and learning in clinical education, and to be able to demonstrate that it fundamentally changes students constructs from superficial to deep understanding. I’m just not sure if the Conversational Framework is the most appropriate model to evaluate students’ problem-solving ability, as it was initially designed to evaluate multimedia tools.