Photo from paukrus on Flickr

On Saturday I attended a workshop at Groote Schuur hospital that had the aim of providing “…clinicians with the opportunity to improve their ability to facilitate learning in clinical practice”. Objectives included improving the understanding of theories of learning, methods of enhancing learning and assessment practices and the role of assessment in learning. I was impressed with the number of clinical educators and supervisors (about 40) who gave up their Saturdays to attend. Here are my notes:

Learning in clinical practice

Brainstorming:

• How do I learn? Immersive, pulling in additional material, alternative ideas, I need to see the big picture
• How do I learn best? Personal, vested interest, answering a question of relevance, application to a relevant problem, can be associated with different sensory modalities
• How did I develop “expertise”? Socially, conversation, discussion, sharing, questioning, choosing to “own” something, pushed out of your comfort zone
• How does learning happen? Reducing to basic principles, commitment, dedication
• When last did you learn something new?

Students feel lost and disorientated when first arriving on a placement, no matter how much they prepare, they still feel unprepared

Theory is linear, it’s neat and “tight”, whereas practicals are messy and untidy. So, theory doesn’t prepare you for practice, only practice does

Students should be allowed to make mistakes, but when a patients health and well-being are at risk, mistakes are problematic. Students want to be “right” (maybe because we stress how important it is that they get it “right”). Clinical skills labs are useful to address the problem of practising and being allowed to make mistakes. But clinical skills labs are expensive

“Learning” is the process of turning information into knowledge through engagement

Learning is about making meaning

Students struggle with theoretical concepts until they have the opportunity see / feel the concept in the real world e.g. low tone, ataxia

Learning happens by linking new ideas to older, established ideas, which is why our perceptions of the world are highly individual

What do we do to develop student, as well as professional identity. The notion that students are “socialised” into the profession

Once students cross a “threshold”, the learning experience opens up to them

Students sometimes know the words, but not what they mean

Many students have trouble navigating between different professional contexts

Reducing power differentials helps students feel at ease and more comfortable with the idea of sharing ideas / themselves, you “humanise” the interaction

Students often don’t have a framework for self-evaluation i.e. they don’t know what a 3rd year should be able to do relative to a qualified practitioner. Their frame of reference is limited to themselves and a few teachers whose thinking process exists inside a black box

Correct errors gently, create a space of emotional safety, learning doesn’t happen in an emotional / financial / social / personal vacuum (in another workshop that I attended the other day, the presenter mentioned the “kind teacher”, an idea that I’ve been thinking about a lot)

Predicting the future by understanding the past allows us to look back at our practice and make long term plans for patient management

Enhancing learning in clinical situations

Why is the clinical learning situation so unique? Good place to apply theory, real world scenarios, BUT also a place that can inspire levels of fear that are not present in a classroom

We can ask students to assess their fears i.e. what are they afraid of and why. Then create an environment in which they can confront their fears and see the outcomes of their fears realised e.g. take off the cardio leads and hear the alarm go off, but also see that the patient continues breathing

Educational theories and frameworks can give students a structure for thinking, can help guide their thought processes, but do they necessarily need a deep understanding of the theory e.g. social constructivism?

Creating relationships between pathology and “normal” helps students understand dysfunction. However, this does little to help them develop a management protocol i.e. relate dysfunction to intervention

Facilitating ethical reasoning in student clinical practice. The relationship between ethical principles should be analysed in the light of their impact on the patient

In the early stages of their training, students don’t yet have the language to articulate ethical dilemmas

Feedback to students around ethical dilemmas should acknowledge the experience, but not pass judgement on any of the parties involved

Students often don’t emphasise the moral and ethical components of their practice, as they believe that technical ability is what they will be assessed on (which is true)

Assessment isn’t perfect

Use rubrics to prepare students in terms of providing a framework for their learning

Students won’t expose their weaknesses if they believe that they will be judged on them

Students must be able to act on the feedback given, which means that it must be timeous in order to be relevant

Students need to “learn how to know”

Share

I wanted to step out of the linear, bullet point style of presenting that Powerpoint defaults to, so decided to try Prezi for a change. I’d played around with it a few years ago but struggled with the interface. This time I found it more agreeable and enjoyed playing around with it. It is a bit all over the place and the spacing doesn’t always work but anyway, here’s the presentation:

Share

• It’d be an invasion of their privacy
• They may feel an obligation to accept, even if they didn’t want to
• I didn’t feel comfortable hearing and seeing what they were doing in their private lives
• I wasn’t sure that I’d be able to remain objective if I grew closer to the students I shared interests with
• I was trying to keep my professional and private lives separate

Last year I ran a social networking research project in our department, which had students completing assignments within a private social network that I set up using WordPress and Buddypress. I learned a lot through the experience, including the following:

• Facilitating engagement around professional issues in a social environment is hard
• Students use (or don’t use) the tools in the way you expect / want them to
• Most of them only participated in the network for the duration of the assignment, and didn’t go back when it was completed
• Students shared personal experiences (with me and with each other) in ways that helped me to see more clearly who they really are

The last point was perhaps the lesson that touched me most. Most of our students have a tendency to see us as “just lecturers” and feel that there’s a huge chasm between us and them. To get around this, I often share some of my personal experiences to show that I also struggle to get through the challenges I’m presented with. I try to highlight the fact that as they find some things difficult to overcome, so do I and that the only real differentiator between us is our levels of experience in the various domains of our lives. This has happened most often with students on one of the rural community placements that I supervise. I often spend hours talking to them about some of the issues they’re experiencing, not only on the placement, but also in their personal lives. This has had a profound impact on some of them, as they’ve come to me after graduating and told me how much those social interactions helped shape who they’ve become.

I’m beginning to think that it’s impossible to keep my personal life out of the classroom and in addition, whether that’s something I should even strive for. The end of last year saw me going through an emotional upheaval that was devastating. I was incapable of thinking clearly, let alone teach (thankfully, classes were over for the year) and it was clear that my personal experiences very much affected my professional behaviour. This got me thinking about what our students bring with them into the classroom that we have no idea of, and which has a profound impact on how they’re able to participate in the class. What I’ve learned through this is that my social and professional personas are not only connected, but deeply integrated and to ignore that is to miss out on really understanding myself and my students.

I’ve also been more active on Facebook recently. Over the past month or so, I’ve been friending last years graduates as they prepare for their year of community service in different parts of the country. Not only do I enjoy keeping in touch with them, I try to provide an additional level of support as they’re trying to find their way in their professional lives. This has been an interest of mine since my Masters research looked at how emerging technology could be used to help support students and new graduates, especially in the more rural placements. This is the second year that I’ve been adding our past students to my Facebook friend list, and I often have opportunities to catch up with how they’re getting on, which is great.

This, together with my social networking project, has had me reflecting on whether or not maintaining the “friend barrier” with students on Facebook is actually a good thing. My understanding of what is “personal” and what is “professional” is that they’re blurring together, and I wonder if exploring different aspects of engaging with students on Facebook might be a positive experience for us all. A simple example would be the many opportunities for modeling behaviour. Instead of having a “No Facebook-friending” policy, wouldn’t it be better to tell them that I’m available on Facebook if they’d like to connect? I could tell them that there’d be no pressure to ask or accept and that they wouldn’t be disadvantaged by choosing not to do it (for example, I won’t be giving exam tips on Facebook). I’d also make it clear that for good or bad, I’d be able to see their social activities (as they’d be able to see mine), which may impact on our classroom interactions.

Our 4th year students spend most of the year off campus on clinical placements, and often feel that they’re isolated from social and professional support. I’m thinking of letting them know that if they send me a friend request, I’ll accept it, having first run through the implications of what it’d mean. If you have any thoughts or suggestions, I’d love to hear from you.

Share

@RachaelLowe Nothing sophisticated, it was a workshop with colleagues from institutions around the country in reply to RachaelLowe #

Share

• Naming things is important. It’s easier to say “web 2.0″ than “participative, fragmented content, conversation-driven web”. Unfortunately, names give shape to concepts that are often imprecise. Sometimes words hurt more than they help.
• xWeb is the utilization of smart, structured data drawn from our physical and virtual interactions and identities to extend our capacity to be known by others and by systems. This is an imprecise definition, but it’s a start

• It involves a negotiation of two key questions that I continue to grapple with:

  1. What does technology do better than people?

  2. What do people do better than technology?

With xWeb, we are rethinking what we have to do as people and starting to rely on what technology does better than we possibly could. Over the last few years, I’ve been trying to capture the nature of the change around technology. Some of the recurring themes:

• The eXtended Web and the Personal Learning Environment « Plearn Blog – Annotated

  • Web 1.0 mainly seemed to consist of semantics, Web 2.0 of connections, communications, multi-media, virtual worlds and the introduction of mobile devices through the emergence of wireless and higher Internet connection speeds; while Web 3.0 connects data streams in a supposedly intelligent way. The combination of all four would lead to Web X.0 (Steve) or Web X (Stephen)
  • Why would anybody need some researchers and developers to work on a PLE for them?
  • 1. Intelligent data connections are one exciting option for PLE development and networked learning. Recommender systems of information, resources, critical friends and experts could form part of the access options for learners in a PLE that they would not likely be finding in a self-directed fashion
  • 2. That brings me to the challenges of an open online networked environment for learning. Not all adult learners are able to critically assess what they find online and might prefer to receive guidance from knowledgeable others
  • educators have highlighted that there is a real need for critical literacies while learning informally on networks
  • people might not necessarily have the critical literacies required to learn and search independently
  • Learning in my view is not synonymous with accessing information, and requires a level of reflection, analysis, perhaps also of problem solving, creativity and interaction with people to be able to get the best out of the structures and sub-structures of the Internet
  • the majority of people in the northern hemisphere should now have access to technology (so happy to see Rita qualify the statement with “…in the northern hemisphere…”)

  • The people least likely to use the Internet are also the least likely to participate in adult education
  • And I haven’t even spoken about the people on the southern half of the globe, where the access and participation rate to technology and learning is even lower and the group of vulnerable people greater. Should we just leave these people behind?
  • The components that were formulated in Stephen Downes’ vision for a PLE at the start of the PLE project of the National Research Council of Canada are the following: 1. A personal profiler that would collect and store personal information. 2. An information and resource aggregator to collect information and resources. 3. Editors and publishers enabling people to produce and publish artifacts to aid the learning and interest of others. 4. Helper applications that would provide the pedagogical backbone of the PLE and make connections with other internet services to help the learner make sense of information, applications and resources. 5. Services of the learners choice. 6. Recommenders of information and resources.

• So-Called “Digital Natives” Not Media Savvy, New Study Shows – Annotated

  • Having been born into a world where personal computers were not a revolution, but merely existed alongside air conditioning, microwaves and other appliances, there has been (a perhaps misguided) perception that the young are more digitally in-tune with the ways of the Web than others
  • Apparently, the students favor search engine rankings above all other factors. The only thing that matters is that something is the top search result, not that it’s legit.
  • many students trusted in rankings above all else
  • researchers found that even in this supposedly savvy minority, none actually followed through to verify the identification or qualifications of the site’s authors
  • students are not always turning to the most relevant clues to determine the credibility of online content

• 1008. Displaying a Personal Interest in Students and Their learning « Tomorrow’s Professor Blog – Annotated

  • Several strands of research demonstrate that displaying a personal interest in students is not only effective as a way to encourage participation and engagement, but necessary for real learning negative emotions such as fear and shame, all too common in the college classroom, retard learning, due to “choking,” the shutting down of higher-order thinking, and the activation of more primitive areas of the brain associated with the fight-or-flight syndrome

    undergraduate students repeatedly mention the importance of one-to-one interaction with instructors. Displaying a personal interest in students is the first step toward demonstrating that community exists within the classroom and across the campus

  • Be available to students in ways that you judge are not too invasive of your personal boundaries

    Encourage and respond to email

    Solicit and respond to student feedback

  • Mid-semester evaluations that you create and use to fine-tune instruction midstream also convey to students that you care what they think and about their learning

    During discussions and other interactions with students, really listen to them, striving to hear what students are really saying; not what we want to hear and/or assume students are saying

  • making connections between academic material and students’ personal experience also conveys an interest in students and their learning.

Share