blended learningin clinical education

michael rowedepartment of physiotherapyuniversity of the western cape

background: blended learning

a systematic combination of face-to-face and technology mediated interactions between students, teachers and learning resources (bliuc, goodyear & ellis, 2007)

allows for greater flexibility and responsiveness in teaching and learning (lewin, singh, bateman & glover, 2009)

background: blended learning (2)true potential is in enhancing

communication and promoting reflection

blended learning is highly context dependent, so it cannot be generalised from other domains (harris, connolly & feeney, 2009)

the medium is less important than the way in which learning is approached (laurillard; cited in ennew & fernandez-young, 2005)

background: reflection

reflection and reasoning both emphasise the connection between action and thinking (aars, 2008)

focused reflection is a significant factor in developing clinical practice through clinical reasoning (murphy, 2004)

making meaning through reflection is more important than memorising content

1 establish global context

aim: how have others used blended learning in clinical education?

method: systematic literature review

outcomes:

- few well designed studies evaluating blended learning

- some studies demonstrate positive clinical outcomes

Rowe, M., Frantz, J. & Bozalek, V. (2012). The role of blended learning in the clinical education of healthcare students: A systematic review. Medical Teacher, 34:e216-221

2 establish local context

aim: what are students' experiences and perceptions of emerging technology in learning?

method: survey of students

outcomes:

- students use technology, but don't understand it

- studying is not part of social

- internet access is a concern

Rowe, M., Frantz, J. & Bozalek, V. (2012). Physiotherapy students’ use of online technology as part of their learning practices: a case study. South African Journal of

Physiotherapy, 68(1): 29-34

3(a) pilot interventionaim: how can we use wikis effectively for

collaborative content creation?

method: wiki-based assignment and survey

outcomes:

- students are able to collaboratively develop content

- groupwork is more of a problem than technology

- wikis are difficult to facilitate

Rowe, M., Frantz, J. & Bozalek, V. (2012). The use of a wiki to facilitate collaborative learning in a South African physiotherapy department. South

African Journal of Physiotherapy (accepted for publication)

3(b) pilot intervention

aim: how can we use a social network for reflection in clinical education?

method: reflective blogging around clinical experiences

outcomes:

- students need significant facilitation

- social networks provide useful platforms

Rowe, M., Frantz, J. & Bozalek, V. (2012). The use of assisted performance within an online social network to develop reflective reasoning in undergraduate

physiotherapy students. Medical Teacher, e1-e7

4 intervention design

aim: how will we integrate technology into teaching in order to develop personal & professional attributes?

method: delphi study with 3 different panels

outcomes:

- values and attributes are essential for clinical practice

- process is more important than product

- technology affordances before platforms & services

Rowe, M., Frantz, J. & Bozalek, V. Beyond knowledge and skills: The use of a Delphi study to develop innovative teaching practices in a blended learning module. BMC Medical Education

(submitted and under review)

5 explore theoretical perspectivesaim: what theories of learning and instructional

frameworks are appropriate?

method: review of relevant theory

outcomes:

- socio-cultural theories fit clinical education

- instructional frameworks are rarely used

- authentic learning tasks model the clinical context

Rowe, M., Bozalek, V. & Frantz, J. A theoretical approach to technology-mediated teaching and learning in medical education. Medical Education (submitted and under review)

6 implementation

classroom context:

- case-based learning in small groups

- collaborative content development with facilitation

- online environment for support

clinical context:

- integrated with classroom context

- emphasis on solving problems, not knowing facts

7 evaluation

aim: how are we evaluating and adapting the module?

method: developmental evaluation & focus groups

outcomes:

- frequent changes based on feedback

- students want the certainty of knowing the answer

- initially resistant, but moving towards appreciation

- acknowledgement of benefits e.g. enhanced reasoning

- technology is grudgingly accepted

conclusionsthis approach is resource intensive (time,

energy, facilitators)

technology is good for moving content out of the classroom

case-based learning (i.e. classroom context) must be integrated with practice (i.e. clinical context)

students demonstrating enhanced:

- clinical reasoning

- reflective skills

- evidence-based practice

moving forward

introduce teaching approach from 1st year, emphasising:

- authentic learning tasks for students

- technology integration early and throughout

- understanding concepts, not memorising facts

- move conceptually between modules

- develop modules that are flexible and adaptable

- iterate rapidly based on feedback

thank you