Online Approaches to Reflective Learning initial studies

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Online Approaches to Reflective Learning
initial studies

• Isobel Braidman, Maria Regan, Simon Wallis,
  Caroline Boggis and Tim Dornan
• University of Manchester Medical School

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Manchester Medical School Teaching and Learning

• PBL driven from years 1 - 5
• Emphasises participant led learning
• Introduced contact with patients at both
  community and hospital level, clinical and
  communication skills to years 1 and 2 (Phase 1)
• Issues of professional identity and development
  raised earlier

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Phase 1 Personal and Professional Development
Portfolios
PHASE 1 Years 1 and 2
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Students are familiar with..

• Group facilitation techniques
• Face to face discussion of professional issues
• Framework of reflective learning for personal and
  professional development

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Challenges to portfolios inYears 3 - 5
gt450 students per year
Located in hospital sites spread over North West
England
Each has its own specific timetable
But a common University of Manchester portfolio
had to be delivered
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Overview of portfolio in years 3 - 5
PHASE 1
PHASE 2 Work place learning
Phase 1 Extra sections (research, governance)
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Phase 2 Personal and Professional Development
Portfolio

Supported by peer facilitators from same year as
students
On line discussions through WebCT
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Online reflective learning discussions

• Text based discussion encourages more reflection
• Interchanges are asynchronous - allows time to
  assimilate arguments of others and relate them to
  learners own experiences
• Important in the context of work place clinical
  learning
• Contrast with face to face which promotes more
  new ideas/thought showering
• Newman et al (1997). Journal of the American
  Society for Information Science 48484 - 496.
  Garrison (1997). Open Learning 123 - 11.

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Online reflective learning communities

• How to turn groups of individuals exchanging
  information into communities of reflective
  learners?
• Require framework for the groups activities, so
  that the group can focus their interactions
• Necessitates understanding how such groups
  develop
• Community of Enquiry Model

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Community of Enquiry Model
Supports discourse
LEARNING EXPERIENCE
Defines milieu of discourse
Defines content
Establishes structure and process
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Importance of student facilitators

• Volunteering to take responsibility for the
  learning of their peers
• Taking responsibility is important marker for
  professional development
• Important group to follow as a cohort

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On line reflective discussions
Advertised for student facilitators in Year 3
gt60 responded received training in facilitation
techniques
Year 3 divided into 63 groups of 8 students, each
with facilitator
Web CT page established
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Web Page
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Discussions
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Prompts and Links

• Should there be a common health professional
  code? (Nursing and Midwifery Code of Conduct and
  Ethics http//www.nmc-uk.org/aFramedisplay.aspx?do
  cumentID201 )
• Should medical students make a declaration or
  take an oath?
• When do you think medical students should adopt a
  professional code?
• Should this apply in your private life?
• How will you protect yourself and your colleagues
  from the hidden curriculum? http//bmj.bmjjourna
  ls.com/cgi/reprint/329/7469/770
• How do doctors maintain professional behaviours
  when society is unsympathetic? http//www.webster.
  edu/woolflm/nazidocsandothers.html

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What happened?
First reflective exercise What is appropriate
professional behaviour for Year 3 medical
students
Prompts for discussion, web links and resources
to stimulate thinking accessed through Web page
Facilitator calls first face to face meeting of
group, to decide balance of on line and face to
face meetings and other ground rules
End point of exercise each group reaches
consensus over code of conduct and these are
pooled students show evidence of participation
by downloading contributions
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Research Questions

• What was the extent of Web page usage?
• How did group members interact online with each
  other and with student facilitators?
• Did these discussion exhibit critical thinking?
• What was the content of the interactions?
• Did the student facilitators fulfil their role?

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Methods

• Mixed Method approach used
• Web postings for quality of interactions analysed
  by Community of Enquiry Model (Garrison et al)
  for cognitive, social and tutor presence
• 5 groups randomly sampled from each hospital
  sector (n20)
• Focus groups both students and facilitators
• Individual semi-structured interviews
• Completion of questionnaire

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Community of Enquiry Template 1
Resolution
Integration
Exploration
No of triggers
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Community of Enquiry Template 2
Group Cohesiveness
Open
Emotional
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Community of Enquiry Template 3
Discourse, consensus, sharing
Clarification
Organisational (management)
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Results Use of web page

• Online discussions used vigorously from November
  June
• All 63 groups have participated
• gt3,300 messages posted

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Analysis of message interactions
Cognitive Presence in Messages
CTE (No of triggers)
3
CE (Exploration)
37
CI (Integration)
37
51
CR (Resolution)
51
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Analysis of message interactions
Social Presence in Messages
SEE (Emotional)
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35
SOC (Open)
SGC (Group cohesiveness)
39
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Analysis of message interactions
Tutor Presence in messages
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Organisational (Management)
48
Clarification
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Discourse, consensus, sharing
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Example of facilitator interaction with group - 1
Message no. 1737Branch from no. 1660 Posted by
(MMMP3EJS) on Thursday, March 1, 2007
556pm Subject Re Relationships with
patients Hi everyone! I think the points you have
been discussing are all very true and very
important to remember each time we speak with a
patient. I too have noticed how patients will
speak openly and in long detail about their
illnesses and current problems with us as medical
students and then as you mentioned, decide not to
tell the Dr in order not to "waste their time" or
bother them too much. A good point was made when
X mentioned the importance of our role in passing
this information on to the Dr in charge of the
patient's care. I once spoke to a patient at my
GP practice ready to present her history to the
Dr, she gave her consent to speak with me and
went on to explain that her husband was seriously
ill and had been transferred to a hospital in
another part of the country. I explained that I
would be able to go in to the consultation with
her and help to explain her situation if she
liked. I think the fact that I could transfer
this information to the GP and accompany her was
a comfort. It is also interesting that X
mentioned the importance of avoiding giving false
reassurance to patients. Sometimes, if not
careful, this could be an easy way out of a
difficult conversation. How has everyone else
dealt with some of the situations come across
when patients are looking for reassurance in your
answers?
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Reflective Content

• Has anyone ever considered just how much of a
  difference we can make to a patient just by
  sitting and talking to them? I can appreciate
  that the doctors and nurses are generally too
  busy to have time just to sit and chat with
  patients, so I think that since we have this
  opportunity as medical students then we should
  make the most of it.
• This incident touched me quite a lot
  personally, because I'd just had first hand
  experience in my personal life with people
  suffering from HIV/AIDS.

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Student Reaction
From preliminary analysis of structured interviews
I think is good and anything that encourages
people to write more I think is good, and I think
that you can use it anytime, anywhere is
definitely a benefit, and especially if youve
got a busy timetable, its much easier to fit in
fifteen minutes of an evening to write a reply to
someone than it is to try and meet up with
someone and so, yeah, I think it should continue.
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Summary and Conclusions

• Initial observations indicate that the online
  discussion facility used by almost all Year 3
  students, despite being widely dispersed
• It is possible to support this with student
  facilitators, drawn from the same year.
• We also provided reflective learning by this
  means
• Community of Enquiry Analysis showed interactions
  in some groups became more sophisticated over time

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Challenges

• Role of student facilitator requires
  clarification for the students
• Does downloading evidence of participation in
  online discussions for the purposes of portfolio
  review/appraisal, influence the nature of these
  discussions?
• Student Facilitators felt that discussions
  required a focus and requested further exercises
• Further activity provided How to become a safe
  prescriber?
• On line reflective discussions facilitated by
  students is now being rolled out to Year 4