Division of Rehabilitation

 

Promoting the Patient Perspective in Pre-Practice Education through Blended Learning

 

 

Authors: Jane Priestley, Michael Hellawell, Judith Hinton and Bryan Walkden

 

 

A blended learning approach was developed to increase student's awareness of a social model of care and facilitate clinical reasoning skills prior to practice . E-learning provided the medium for the delivery of case based scenarios based on actual service user experiences, enriched with podcasts, film clips, associated digital stories and external links. Associated learning tasks facilitated the development of problem solving skills and the opportunity to apply theory to practice in a 'safe' environment

 

1. Why did you use the e-learning approach?

Through the course review process the following factors were identified: A need to enhance the student learning experience especially in the delivery of the behavioural science, the increased emphasis on contextualised professional learning particulary in relation to the increasing emphasis on primary and intermediate care, and a need to enhance the perspective of the service user in professional education. In addition there was acknowledgement of the need to engage students in autonomous learning and to address the institutional strategy on elearning.The learner group was a cohort of approximately 48 level 1 physiotherapy students.

 

A blended learning approach was identified as an appropriate strategy to address these issues, as it permitted retention of successful teaching and learning strategies previously utilised, with a concurrent increase in the use of e-learning. All elements of the approach had a practice based, person-centred focus.

 

2. What was the context in which you used this e-learning approach?

Specific features of the undergraduate physiotherapy programme were considered in the design of the e-learning element of the overall blended learning approach. Students do not experience practice based learning until level 2 of the programme thus there is a particular need to develop clinical reasoning/ problem solving skills in the academic setting . In practice there is an increased contextual application of physiotherapy practice which could be simulated through e-learning, facilitating development of the reasoning processes that will be required in professional practice and allows the student to reflect, replay and revisit that process. In addition there is an increased use of technology as a learning approach by students in previous studies. Use of the virtual learning environment (VLE) allows the incorporation of service user and carer experiences without necessarily requiring face to face contact, and can provide representation for those who may not wish to be invloved in face to face contact.

Prior to the e-learning approach the biomedical model was utilised consisting of traditional teaching, paper-based scenarios & external experts

 

There were some challenges to developing the e-learning approach, principally the time and funding involved in establishing an ethically sound framework for collaboration with service users and carers in the development of case based materials.

 

3. What technologies and/or e-tools were available to you?

Blackboard VLE was used to host the scenarios, which were produced from Microsoft Word Documents using Course Genie to develop multimedia rich e-learning materials. Podcasting was carried out using Audacity on PC and Quicktime on Apple MacBook with Video Vodcasts using Camcorder & Moviemaker on PC, iMovie and Quicktime on Apple MacBook. Permission was already in place to use and link to other multimedia clips or to link to open access materials available online, such as 'Patient Voices' from Pilgrim Projects.

 

The rationale for using these resources was based on several factors.

 

• The University subscribed to Blackboard and Course Genie, these allowed the creation of easy to produce accessible electronic scenarios
• Case based scenarios authenticated the service user experience with easy to produce media clips
• The e-approach allowed students to access such materials revisiting and augmenting previously taught face to face sessions
• An Apple Mac and software were used personally by a member of the team .

 

4. What was the design?

Action planning though the course review process led to initial identification of the learning out comes for a new module 'Physiotherapy Intervention in Context'. A teaching and learning approach was required that would develop problem solving and clinical reasoning skills and promote insight into the psycho-social context of the patient outside the practice setting. The e-learning was part of an overall blended learning approach designed to enhance and not replace the face to face contact that students experienced, through the production of media rich case based scenarios with directed learning activities with associated face to face tutorials. To authenticate the patient experience, service user and carer views were used to inform the on-lone materials. Service colleagueswere involved from the outset in the curriculum review process and had been highly influential in raising awareness of the need for students to develop apprecaiton of a more social model of care. In developing the e-materials there was a recognised need for accessible materials that would run alongside existing technologies that the students and staff were already familiar with.

 

Promotion of the collaborative approach was reinforced by action planning formulated at a two phase developmental workshop facilitated by the Health Science and Practice subject centre of the Higher Education Academy. Subsequent developments involved service users, carers, students and service colleagues with a lead from the academic team.

 

5. How did you implement and embed this e-learning approach?

The approach was implemented and embedded through Blackboard VLE training, which was delivered as part of student's induction to the programme, it was revisited in the introduction to the module and e-learning was co-ordinated and integrated from a thematic approach to mirror the focus of face to face contact. Verbal and written reminders were given to students and duplicated on-line in the VLE to maximise student participation in the e-approach. Materials were presented via Course Genie and a range of formats to increase accessibility. Staff were supported in the use of technology through peer support, and by school and institutional training for the use of e-learning. Students gave informal favourable feedback on the practice focus promoted by the case based materials and the level of organisation provided though the e-administration. There were some disadvantages; not all students acccessed the materials,although this was a very small number and the time to develop materials in a truly collaborative fashion was challenging. Other issues relating to accessibility, finance and accessibility were pre-empted and dealt with during the planning stage.

 

 

 

6. What tangible benefits did this e-learning approach produce?

 

Student evaluation demonstrated a high level of satisfaction with the teaching and learning strategy, especially for the perceived degree of relevance to future practice. Course statistics taken from our VLE show a significantly higher usage in this module compared to an equivalent 20 credit module. 6539 “hits” as against 3990 in the 15 week period leading up to assessment.

Use of the VLE has exposed students to a wider range of issues and broadened the range of learning activities. It has catered for a wider range of learning styles and has facilitated the application of theory to practice.

A significant improvement in student satisfaction with the learning process has been evidenced in module and on-line evaluation:

“I enjoyed the session which for me reminded me of the importance of clear concise communication and reinforced the need to involve the patient/family in the discussion to avoid taking to much control and not allowing for their voices/opinions/concerns to be heard which could be the discussion less effective. The actors were great and made the scenario very realistic.”

“I thought it was really useful, really liked talking to the family about their thoughts. i think it will be really helpful in the future.”

“I thought the session was really excellent. It really opened my eyes to different communities and changed my perspective on some issues. Listening to Julie & Kevin's stories was depressing, but I think they are important for everyone to hear. I'd definatly ask them to speek to the student's next year.”

There has been a noticeable improvement in staff satisfaction with, and enthusiasm for, e-learning. This has also been noted within the department and across the School of Health. Staff have disseminated examples of innovative use of elearning and shared practice within the department, the wider institution and with colleagues elsewhere.

An increase in service user involvement and community engagement has provided a means of increasing collaborative activity with external partners and enhancing patient and public involvement in course delivery through the medium of elearning.

The project has enabled us to obtain more funding to develop the programme further.

Whilst no resource savings have yet been identified this is certainly anticipated once the approach is repeated and the learning materials re-used .

 

 

7. Did implementation of this e-learning approach have any disadvantages or drawbacks?

approx. 250 words

 

The implementation of this e-learning approach did have a few disadvantages. Despite the devlopments taking place as a consequence of the curriculum develeopment and planning process, the time required to develop the approach was not fully appreciated. As a consequence it was not been fully factored in to the workload planning of staff and therfore relied on the staff teams ongoing motivation to push ahead with the developments. Another drawback identified was that not all students engaged with the material and some did not access it at all. It is acknowledged that this is something that is not just limited to these resources and engagement with e-learning is being discussed in the wider community. With the time invested, it was disappointing nonetheless.

 

Another drawback contributing to the previous point regarding time was the choice and integration of all the software and media options available to us. Accessiblity was of paramount importance to us and as a consequence this influenced some of the decisions regarding software such as Course Genie. This gave us accessible web based resources that worked seamlessly with the University's VLE. Additional benefits in using Course Genie was the use of MS Word based documents as a template, a programme all staff were familiar with. As a dedicated IT development team was not available staff with varying technical expertise were all able contribute in the production of the web based tremplates. When producing the media clips many otions in terms of software and format were available. The materials were produced in a variety of different formats and file sizes to increase accessiblity but this was time intensive. This approach has proved expensive particulalrly in terms of time and this could be a drawback to rolling it out within the wider curriculum.

 

 

 

8. How did this e-learning approach accord with or differ from any relevant departmental and/or institutional strategies?

approx. 250 words

 

This approach clearly accorded with the governments strategy for engaging service users within healthcare education. In doing so it preempted the University's strategy but has since aligned well with it. In addition to the engagement of service users it also clearly met the University e-learning strategy and has been highlighted as an area of good practice within the institution. That said at times the institutional strategy was not always explicit in the amount of time that should be allocated to such projects. In this respect the amount of time required to implement the project was potentially problematic and only possible through the good will of the staff team. The approach is now embedded within the module and has generated interest within the staff team and beyond. It is the intention that this should be rolled out to approriate areas within the wider curriculum.

 

 

9. Summary and Reflection

approx. 200 words

 

 

We believe that this has been a successful pedagogical strategy as means of promoting students' insight into the 'patient experience', developing clinical reasoning skills and providing an opportunity to test the application of theory to practice in the academic setting. This approach provides a 'safe' environment for service users and carers to share their experiences and a safe environment for students to consider the context in which they will encounter patients.

The e-learning approach is coherent with the Learning,Teaching and Assessment strategy and the strategic objectives of the institution relating to effective communication in an information age, innovation and partnership.

 

A great deal has been learned from the development of this approach; the power of working as a team, the huge benefits of collaborating with others and the endless possibilities that are emerging and evolving with technology. Developing an action plan through the HEA workshop scheme enabled us to focus on opportunities to develop rather than limitations such as time and resources. There is still great potential for improvement in the integration of the approach within the overall module delivery and more sensitive evaluation of the process.

 

The approach is now being developed through a funded collaborative project that aims to develop a virtual community, this involves working with a service user and carer group in Bradford, the COMENSUS project at the University of Central Lancashire and Advocacy in Action in Nottingham .

Example Material

 

An extract from a video clip of two simulated patients