Using E learning in Advanced Practice Education: A demonstration

of the Stilwell Project

Kathy HaighSenior Lecturer

Programme LeaderMsc Advanced Practice in Health and Social Care

University of Cumbria

Presentation Overview

• Educational overview• What is a virtual community?• Working with an example from Stilwell• Student Responses and Thematic analysis• Interprofessional learning• Evaluation of Stilwell

Educational Approaches for Health and Social Care Students

Conventional pedagogy can cover the content of a curriculum and the competencies required, but can it....... Support interprofessional education? Engage students with the meanings, emotions and

experiences of patients / clients? Question conventional orthodoxy? Place facts and skills in a human context and reveal the

patient’s perspective (one of the 3 sources of EBP)

Combining narrative pedagogy with conventional approaches can make practice come to life in a much more realistic way and better prepare students for the reality of life after they qualify.

Educational Theory: Narrative Pedagogy• Based on Diekelmanns Narrative Pedagogy (2001)

1: Learning from story and interpreting the meaning of the story.

2: Multiple Perspectives.3: Discussion leading to the sharing of

understanding and challenging assumptions and conventional wisdom.

4: Insights into emotions such as guilt, pain, anguish and dilemma of choice.

What is a Virtual Community?• Multimedia extension of technology-enhanced learning• Telling individuals’ stories in the context of community

setting –impact of problems on individual, family and community- ‘soap opera’

• Narrative pedagogy is the theoretical underpinning.• Virtual practicum for interprofessional learning (IPL)• Examples:

• Stillwell (UK) • Stillwell (Ontario) • The Neighborhood (USA)

Stilwell Virtual Community Elements

An online site containing:• Medical case notes and social histories for residents• A video tour of Stilwell and Brigstow, map and description• Photogallery of Stilwell/Brigstow • Professionally made videos of critical incidents in patients’ lives• Podcasts and other audio files relating to staff and patients• Front page of the local paper The Brigstow Herald• Blogs kept by health care professionals (nurses, paramedic etc). Also

features a blog from a citizen’s advice bureau worker.• Blog kept by Annie, a Stilwell teenager.• Police records and files on key individuals (Westland County Constabulary)These resources create realistic context & are narrative devices to tell stories

Using Stilwell with Advanced Practice Students

• Video clips and Podcasts• Setting tasks related to the module content• Students are in groups of 5-6• Groups are mixed, so representation from

HPC’s primary, acute, community and mental health are represented.

• Total of 29 students

The unseen story of Maureen Black

• We all engage and discuss issues with friends, but is the information / advice we receive always helpful, knowledgeable, relevant or can it lead to misinformation and cause worry.

• The following clip is the first in a series of Maureen Black and her quest for knowledge into her newly diagnosed condition

Maureen Black-Student engagement

• Theme of the task : Advanced communication, information gathering (history taking) from patients and the subsequent educative aspects of these clinical encounters.

• Task: Watch the first of Maureen’s 3 videos and critically evaluate the conversation between Maureen and her friend.

Selection of Student responses from all groups

• ‘The dialogue with Maureen and her friend demonstrates the importance of recognising influence of peers and family in people’s health beliefs’. (Holt & Kumar, 2010). (Every group had this quoted within their responses).

• A key point is that much of the health education material available requires a year 10 reading ability, but the average reading age in the UK is estimated to be at year 4 level (roughly nine years of age). Thus there was a considerable gap in the readability of existing healthcare publications and the reading ability of the general population when this research was undertaken (Wilson et al 1997).

•

Continued

• Noticeable signs of anxiety from Maureen, facial expression, hands, seems to be seeking reassurance

• Feel empathy for Maureen, newly diagnosed, confused, overwhelmed by information already given, seems to be searching for answers.

Continued

• What was discussed in the previous consultation. The notion that diabetes is mild or borderline needs to be challenged in clinical practice. Who told her this?

• Did the previous practitoner ‘chunk and check’ with Maureen?

• How many information leaflets was she actually given

Thematic Analysis of Student responses

• All responses have been analysed and the following themes are present within all groups

• Previous healthcare encounters• Use of leaflets (multiple perspectives,

language, type, childs, adults)• Patient attitudes towards own health• Level of disease knowledge within the general

population• Peer support and influence

Themes from extended critical evaluation

• Language barriers, use of language line etc• Understanding the patients knowledge base

and ability and tailoring education to patient needs and expectations (New 2010, SIGN 2010)

• Patient education programmes such as Xpert and DESMOND

• The complexity of the patient and the challenge of consultations

Themes for future consultations• Ensuring the patient is a partner in care.• Ensuring that the next consultation explores

the ideas, concerns and expectations (ice) of the patient as a priority.

• Utilising frameworks to ensure a therapeutic helping relationship is established

• Challenging own knowledge base and our own abilities to communicate in plain English with no medical jargon

• Educational aspects of consultations

Interprofessional learning

• Immersion of the person watching the video creates a picture of the people in the case

• Dialogue allows students to actually discover, understand, appreciate and learn from the care provided by other HPC’s within their groups.

• The videos have multiple perspectives that the students discuss (we do have academic level and can be used for different learning outcomes)

IPL

• Every student has a voice and opinion and therefore increases student engagement.

• Demonstrates a clear use of narrative pedagogy

Evaluation of Stilwell• Externally conducted focus group evaluative research, key

findings:

1: Bridges theory practice gap2: Engages with patients, start to care for them3: Different way of learning and knowing4: Challenging, makes student think differently5: Shows connections between health problems and the

social context6: Allows exploration of difficult and challenging situations7: Some stories are very harrowing (child sex abuse),

intensive student support needed

• Only had a 2 minute glimpse into the Stilwell community.

• Students have evaluated the use of Stilwell into their last module and have been very positive regarding its use.

• Has given students insight into the usually unseen social aspects of the patients lives.

• Is now being used in collaboration in North America partners and with 5 Australian Universities

Conclusion

References• Diekelman N (2003) Teaching the practitioners of care: new pedagogies for the health professions.

Madison, University of Winconsin Press.

• Holt, T. Kumar, S (2010) ABC of Diabetes. Oxford; Wiley-Blackwell.

• New N (2010) ‘Teaching so they hear: using a co-created diabetes self-management education approach’. Journal of the American Academy of Nurse Practitioners, 22, pp316-325.

• SIGN(2010) Management of Diabetes. A national clinical guideline.[Online] Available at: http://www.sign.ac.uk

• Wilson, R. Kenny, T. Clark, G. Moseley, D.Newton, L. Newton, D. Purves, E (1997) Ensuring the readability and understandability and efficacy of Patient Information leaflets. Prodigy Publication 31.[Online] Available at: http://www.ecls.cl.ac.uk/publications