Activity Six B, more planning...

...so I guess thinking about this new idea, and a Blended Learning Template approach:

Overall Strategy: the development of a blended learning strategy for second year midwifery students to cover course content related to antenatal screning options.

Strategy for Content: there will be a variety of content components, ranging from a video I will make of a role-play between a midwife and a woman, where the midwife discusses the screening options, with an emphasis on informed choice and decision-making. There will links to external websites eg National Screening Unit where theoretical content about screening programmes is offered, and where students are able to enrol in an online series of workbooks with formative quizzes included to assess their learning as they go. There will also be a Moodle exe package with relevant information about related professional frameworks, legislation, and screening pathway information.

Strategy for Communication: there will be facilitator:student communication via Adobe Connect tutorials, discussion fora where students can share their experiences of both hearing midwives in clinical practice discuss screening, and also their own discussions in practice with their follow-through women. Forum posts can facilitate student:student communication, alongside Adobe sessions.

Strategy for Activities: in addition to what has already been covered in content, as an activity students can be directed to select one aspect of screening (eg initial antenatal blood test, combined first trimester screening, gestational diabetes screening, family violence screening etc) and prepare a short teaching session for their SPF group. This peer-to-peer teaching opportunity means each student will learn about all the screening strategies but will only be doing a fraction of the 'work' of learning by themselves, and there will be a tutor on hand to clarify any misperceptions/misinformation. Each student can prepare a summary sheet for their colleagues with main points and relevant references.

Strategy for Assessment: assessment for this learning package willbe formative only, as this is just one small aspect of a much larger paper (Midwifery Scope of Practice) which has its own summative assessment. Formative assessments might include the online quizzes in the NSU resources, and participation in the peer-teaching component within the student's own SPF group.

Activity Six: Planning...

One of the things I've become aware of as I work my way through the Course material is that I haven't consistently landed on a 'thing' which I want to address as a thread throughout the course. I have meandered through both postgraduate and undergraduate aspects of my teaching, using examples from each to highlight different aspects of my musings about flexible learning. It is time to settle down!

I've been thinking alot about one particular aspect of learning that the students become acquainted with more specifically in the beginning of the second year of undergraduate midwifery education. This is the area of antenatal screening, which is an area that students need to have sound knowledge about, but also a level of sensitivity in relation to the way that this discussion occurs with pregnant women. It used to be that the first visit with a pregnant woman was a great opportunity to latch onto her excitement and thrill about her pregnancy, congratulate her warmly and begin the journey of learning about her aspirations and hopes for her pregnancy, birth and beyond.

With the advent of earlier and earlier opportunities for screening, the first visit has beome one of "congratulations - fantastic - you're pregnant BUT..." and the need to have a frank and somewhat sobering conversation about how things might not be perfect and what technologies are available to assist us to uncover the possibilites of imperfection. This is tricky ground, and an area that students identify as being something that makes them nervous. So I think my plan is shaping up into thinking of an inclusive, thoughtful and thorough preparation for the students to tackle this aspect of care, by piecing together a variety of strategies to cover this complex content.

There is plenty of theory and research to introduce to them about the screening options on offer, but at present they don't have so much available to them about how to communicate effectively with women about this, how women feel about being offered this level of scrutiny of their pregnancies, what women of diffferent ethnicity or cultural/religious affiliations think about this information etc. I think a more complete package of learning that encompasses these additional apsects (besides the 'facts' about the screening offerred) would make for better-prepared students, and therefore ultimately a better service to women in the community who might consider that more of their own needs are being met.

So perhaps I will plan to create a learning package that covers more ground, and in ways that will expand student thinking beyond 'the facts' and give them additional tools to work with when discussing this important aspect of care.

Activity 5

Flexible Learning Strategies in my Context.

cdn5.wn.com

For this activity I am going to describe one learning area for our first year midwifery students, and demonstrate how we can use several approaches to teach, reinforce, and develop both competence and confidence in this area of skill development.

VENEPUNCTURE describes the skill of obtaining a blood sample from a consenting person. This skill is introduced in the first year of our midwifery degree, and is considered a basic midwifery skill. At first many students feel very nervous about the idea of puncturing someone’s vein to obtain a sample. They worry about: hurting the person, missing the vein (and therefore not getting the sample), and holding the needle steady once in, to be able to change blood tubes. Usually students have mastered the giving of injections by the time venepuncture comes along, and we find this helps to decrease their anxiety around actually putting a needle in someone else!

The acquisition of this skill is dependent on applying several layers of learning. Students begin by completing an online theoretical learning package (on Moodle) which covers all the theory they need to know, eg anatomy, where the vessels are which might be used, where the nerves are which need to be avoided etc. They learn about the equipment used. They learn about the appropriate sequence to completing the skill, including aspects of informed consent, safe handling of equipment, site selection for inserting the needle etc.

http://www.livewirelearning.com/

When they come together at an Intensive block (face-to-face, large class situation) we revise the theory, and the students all have opportunities to practice the skill on a ‘dummy arm’. This allows them to use repetition as a learning tool, and they talk each other through the ‘skill sheet’ which is the ‘sequential step’ sheet for successfully completing the skill, including the informed consent, the taking of the sample, the documentation, and all the safety aspects. Their ultimate goal is to have this skill sheet signed off by a lecturer or midwife in practice, upon successful demonstration of the skill, which will usually occur in practice at a later date, when the students themselves deem they are confident to complete the assessment.

Once students feel confident on the dummy arm, many of them choose to practice the skill on one another, under the supervision of a lecturer. This is reinforced and practiced in our weekly small group sessions (SPF groups – six to eight students in each group with one lecturer). Then students attend a local laboratory where they complete a four hour clinical placement, taking blood samples from consenting members of the community, under the supervision of the phlebotomy staff at the lab.

Template for Blended Learning Strategy:

Overall Strategy: a blended learning strategy for learning the skill of venepuncture.

Strategy for Content: Moodle package for theoretical learning related to the skill, includes formative quiz to allow student to assess own learning as they progress through the package. Theoretical components includes related anatomy and physiology, site selection, equipment, informed consent, safe handling/universal precautions etc.

Strategy for Activities: sequential opportunities for skill acquisition as confidence develops: use of ‘dummy’ arm, practice on peers/lecturer with instant feedback, practice on ‘real people’ in the community.

Strategy for Communication: interaction between lecturer/student (Moodle, forum posts), interaction between students (forum posts, practice on one another/feedback), interaction between students and community (in safe environment and under supervision) – very ‘hands on’ communication!

Strategy for Assessment: skill sheet sign off – most importantly, this occurs when the student says they are ready to be assessed, not when the lecturer determines they are ready.

This strategy is both resonant of Heinz & Proctor’s (2004) claim that blended learning is “the effective combination of different modes of delivery, models of teaching and styles of learning” (p.1) but also covers the five elements described in Salmon’s model, which encourage students to engage with both each other and the facilitator ie access and motivation, online socialization, information exchange, knowledge construction and development (Salmon, 2002, cited Heinz & Proctor, 2006). Another model, described by Mayes & Frietas (2004, cited in Kitson-Reynolds, 2009) ensures that varying learning styles are included, as is evident in the venepuncture skill acquisition process; Models of Constructivism (Kitson-Reynolds, 2009, p.119)

Model	Explanation
Associative	Learning achieved by completing an activity through structured tasks (learning by doing)
Cognitive	Learning attained through understanding
Situative	Learning realized through social practice and cultural settings

References

Heinze, A. & C. Procter (2004). Reflections on the use of blended learning]. Education in a Changing Environment. University of Salford, Salford, Education Development Unit. Retrieved from http://www.ece.salford.ac.uk/proceedings/papers/ah_04.rtf

Kitson-Reynolds, E. (2009). Energising enquiry based learning through technology advances. British Journal of Midwifery,17 (2) 118-122.

Activity Four - on a roll!

Activity Four: Access and Equity, Diversity, and Inclusivity.

Access in education is about many things, but essentially it is about enabling anyone, irrespective of their characteristics, to engage in the learning opportunities they wish to. This requires the removal of barriers to their engagement, which could relate to affordability, being a particular gender or having personal attributes considered inappropriate. Ideas about access may well be socially constructed, as on the one hand, open access is an honourable aspiration, but there may sometimes be sound reasons why access might be limited. For example, most people would embrace the possibility of a child with a physical disability being a member of a mainstream classroom, but those same people might baulk at the idea of a convicted paedophile having the opportunity to be educated as a primary school teacher.

Zondiros & Dimitris (2008) identify a number of potential barriers in access to education. These include income, gender, race, power, status, age, religion and physical or mental disability. I believe there are additional barriers once access has been secured, which might prevent successful progress in people’s learning pathways. These might include learning strategies that are incompatible with learner styles, inflexible assessment arrangements, negative or prejudicial attitudes within some aspect of the student’s required learning environments (eg in a clinical placement context) or language difficulty.

Equity sits alongside access, and relates to learners having equal opportunity to participate and be successful. It includes the structures that are in place to increase one’s ability to take part, for example distance and online education. Rhode (2009) found that learners participating in distance online learning highly valued the interactions they had with both the lecturer and the content of their course, but found learner-to-learner interaction harder to prioritise. The flexibility that online learning allows might have its cost in less interaction between learners, because students are not engaging at the same time and in the same ways. This seems to be similar in our midwifery course; students say they love being able to engage with the theoretical content at their own pace and in their own time, but this often results in less interaction with one another about specific content areas.

Diversity is humanity, in all its various forms! No two learners are the same, despite that they will share attributes which brought them to their place of study. They may be an eclectic mix of cultures, ages, genders, sexual orientations and learning proclivities, with physical, social, political and spiritual differences and uniqueness. This enables a rich and vibrant learning environment in which people can share experiences and gain valuable insights into each other’s worlds, as they move through their learning journey together.

Inclusivity sits alongside diversity as it is the tool used to ensure that diverse elements have the opportunity to give to and receive from one another. The shared learning in an inclusive context is an important process, as strategies that work for some don’t work for others, but through discussion of the differences new strategies can be found that are workable. A recent example in my context is the learning of Procal – or professional calculations – this is maths-based content which student midwives learn to be able to calculate and administer drug dosages correctly. Some students have learned this content best by using real-life scenarios, picking up a syringe and an ampoule of medication, figuring out what would be a correct volume with the maths and then practicing drawing up etc. They have found the practical application helpful. Others have found the exercises in the Moodle modules adequate for their learning, some have found the Adobe session where a lecturer worked through some examples most useful, and yet others have only learned it through peer –tutoring, and using different strategies with the maths to arrive at the correct result.

Universal Design in Learning: I have really enjoyed looking into this topic, and ended up looking at several of the ‘related’ slideshare offerings alongside the UDL: Framework for Access and Equity. The UDL concept suggests that we conceptualise learning content “from scratch” as incorporating a variety of tools to enable all learners to pick and choose how they will learn the topic. The principles include having multiple means of representation, action and expression, and engagement. This allows learners to have a range of options for acquiring knowledge, for demonstrating what they know, and “taps into [their] interests, offers appropriate challenges, and increases [their] motivation” (Universal Design for Learning, n.d.). I was stimulated into thinking about designing a learning resource that would be about learning a specific skill, for example abdominal palpation, in which I could incorporate an number of different options to accommodate our students’ diverse learning styles. On more than one occasion I have had Maori midwifery students lament the fact that if only they could ‘sing’ an assessment, or weave a mat while they talked to a lecturer about a theoretical concept, this would be much better for them. An idea is taking shape in my head about a learning resource which might include both visual and audio components, maybe even a song to help remember a concept…

Which brings me to issues of access and equity within my learning context: the Bachelor of Midwifery is a four year degree delivered in three years. This means a very long academic year of 45 weeks (end January to mid-Dec each year). This limits student’s chances of being able to work to support their studies, so most have student loans which will continue to burden them once their studies are completed. The cost of the course is also a significant barrier to many prospective students. There are strict entry criteria including a moderately high level of prior academic achievement (NCEA Level 3). Students must be able to afford significant ongoing additional costs over and above course costs, as they are required to travel to weekly face-to-face tutorials, attend visits in women’s homes and clinical placements. In their third year they are required to do a six week placement outside their usual area of residence and therefore have to meet accommodation and travel costs for this. The blended model of course design requires them to have a computer, secure and reliable internet connection, and the requisite digital literacy skills to engage in the learning opportunities provided. Students are required to be on-call, so need to have very flexible and reliable arrangements for childcare, as there exists the possibility of ‘drop everything and go’ at all times. This is made difficult for women who are parenting alone, or whose partners have little flexibility in their workplaces.

Strategies to mitigate these issues: include limited opportunities for scholarships, and the availability of a Certificate Level Course which enables prospective students who do not meet the academic entry criteria to up-skill in the areas they need to demonstrate proficiency in. The Learning Centre is available to support students who have ongoing learning difficulty once they are accepted into the course. Age and gender restrictions are not applied, although it is unusual to receive applications from men for the midwifery course. Learning pedagogy within the school sees great variety being offered in terms of course content delivery, with online modules, synchronous online tutorials, face-to-face learning, clinical placements to develop skill proficiency and regular opportunities to debrief practice experiences. Assessment strategies are varied too, with presentations, exams, quizzes, video assessment, essays and case studies all being employed to assess learning. Different learner styles are hopefully accommodated within this matrix, but I can definitely see a place for inclusion of assessments that ‘work’ for students who find these ones stressful and difficult. Perhaps this is where I will focus my attention…

Rhode. (2009). Interaction equivalency in self-paced online learning environments: An exploration of learner preferences. Retrieved from The International Review of Research in Open and Distance Learning 10 (1) http://www.irrodl.org/index.php/irrodl/article/view/603

Universal Design for Learning: Meeting the Needs of Learners. Retrieved from http://www.slideshare.net/mlmitchellpe/udl-presentation-updated

Zondiros, D. (2008). Online, distance education and globalisation: Its impact on educational access, inequality and exclusion. Retrieved from The European Journal of Open and Distance Learning website:  http://www.eurodl.org/material/special/2008/DimitrisZondiros.htm

The tortoise is edging over the startline

Activity Three: Investigate and describe an example of flexible learning in your organization.

Because I am so far behind in the course, and the option to talk to two colleagues may have escaped me, I am going to reflect on two teaching sessions I have recently observed, and then go on to explore the five dimensions of flexibility within a postgraduate paper that I facilitate. The first session I observed was a colleague running a session on blood loss estimation for a group of ten second year midwifery students. The session was run during a scheduled weekly face-to-face tutorial session, and began with a discussion of the theory and evidence-base for when and how midwives estimate blood loss. Students contributed a number of stories from their clinical experience and the learning was very reciprocal between students and lecturer. There followed a practical exercise where the lecturer had pre-prepared some blood loss scenarios (using fake blood from an internet-sourced recipe!) and the students moved through the ‘stations’ estimating the volume of blood observed on inco sheets, maternity pads and, in one case, the floor – following a simulation of what may happen when a woman gets up to have a shower after giving birth. They were enabled to see how the evidence relating to blood loss estimation was resonant of their own efforts, i.e. that health professionals are typically quite accurate when estimating lower volume losses, with increasing inaccuracy as blood loss volumes rise (Buckland & Homer, 2007).

Ketewestcoast from peoplesnetworknz.info

The second observation was of a face-to-face session about sustainability for third year student midwives. The session ran over a whole day, and was the final day in a two-week Intensive block which had been very dense and full-on for the students. After a couple of hours of discussion and structured learning using Powerpoints and general discussion about what sustainability means in midwifery – the lecturer invited all the students to participate in a weaving activity. After observing tikanga (North Islanders here!) we all sat on the floor and spent three hours weaving flax, storytelling and drawing together the threads of the learning that had taken place over the previous two weeks.  We observed and reflected on how we learn, how (or even whether) we seek assistance when we need it, how we persevere when we think we can’t do it, how we help others learn, all from this practical creative venture of creating a putiputi and an ipu whenua. The thread about how as midwives we need to take time to remember to nourish our spirits, to be still and thoughtful in our busyness so we can replenish our own energies for our important work with women and families, was woven throughout the session, and it was a beautiful way to wind up (or down!) the last day of our intensive.    

Reflecting on these two sessions in relation to flexible learning, I discerned that in both sessions although the time element and the entry requirements were unable to be flexible, in each session other opportunities were there for offering flexibility. Because the BM programme is offered in a blended learning environment, this was a rare opportunity to observe two face-to-face components of the course. As such the ‘class’ was at a scheduled time, on a scheduled day. The students for both sessions have met the entry requirements for the BM programme, and additionally have passed the preceding years’ papers in order to have progressed.

FlexibIe aspects of both sessions included that the student’s differing learning styles were accommodated as instructional approaches included both ‘hands on’ and ‘minds on’ learning. The content in the first session was less flexible in terms of there being a primary focus about what would be covered, but because the students were very participatory and storied a great deal from their own clinical experiences, tangential learning opportunities arose because of this (McDrury & Alterio, 2003). In the second session additional flexibility was offered because tikanga suggests that women who were menstruating may choose to either not participate in the activity, or to  participate in a gentle way, as the work of flax weaving was traditionally ceased during menstruation to allow the women to rest and re-energise.  The combination of weaving and storytelling is a powerful way to share knowledge, and my observation was that students who are normally a bit hesitant to contribute to a discussion seemed more relaxed and happier to speak in this environment. As a critical incident (Hegarty, 2011), whilst undramatic in the normal sense, this session particularly enabled me to appreciate how the blend of ‘hands-busy’ and a relaxed atmosphere created a vibrant learning environment I had not anticipated. The principles of andragogy (Knowles, 1989) were alive and well as students were motivated to be engaged, their participation was enthusiastic because of the relevancy of the content, they shared their own knowledge and experiences, and they were collaborative about ‘leading’ the direction of the talk.

The postgraduate paper I facilitate – Evidence-Informed Practice – also has both less and more flexible aspects to its delivery. The students are registered midwives who are on a pathway to Postgraduate Certificate, Diploma or Master of Midwifery, so the entry requirements reflect their midwifery registration. The paper runs over 14 weeks at a pre-scheduled time, but within this timeframe the students are free to engage with the learning material at their own pace.  The structured parts of the course are the Adobe Connect web-conferences which are timetabled, but I do offer the class the opportunity to reschedule these at will, as long as the times and days suit everyone in the class. Other structured parts of the course are the assessments, one of which involves three separate discussion forum postings, and one is an essay- these do have due dates, but  extension requests are possible for both the assessments. 

The first time I ran this course, I opened up the modular content at regular intervals through the duration of the course. This time, I decided to open the whole course at the beginning, so that students who wished to forge ahead could do so, and also so that students could choose which order they covered the content. It also means they can get started on the big assessment as early as they wish, because they have access to the course material that they will utilize to complete the assessment.

Although the paper is only ‘two-pronged’ blended delivery (combination of face-to-face via Adobe and Moodle online modules), within the modules  the learning strategies are quite varied, including straight text, quizzes, an interactive statistics tutorial available at an external website address, YouTube clips, cloze activities etc . This addresses individual students’ learning propensities, and hopefully mixing it up keeps the paper fresh and interesting for the students.  Adobe sessions see the students contributing their own ideas and experiences about the course content and they have assisted one another with refining their essay topics.  So hopefully I have illustrated how flexibility has been introduced into the course by addressing the five dimensions of time, content, entry requirements, instructional approaches and resources, and delivery and logistics (Collis &  Moonen, 2001).

References

Buckland, J. & Homer, C. (2007). Estimating blood loss after birth: using simulated clinical examples. Women and Birth 20(2) 85-88.

Collis, B & Moonen, J. (2001). Flexible learning in a digital world. Open and Distance Learning Series. London: Kogan Page Ltd.

Hegarty, B. (2011). Three-step reflective framework. Retrieved from http://wikieducator.org/Hegarty_Reflective_Framework_and_Template

Knowles, M. (1980). The modern practice of adult education .New York: Adult Education Company.

McDrury, J. and Alterio, M. (2003). Learning through storytelling in higher education: using reflection

                and experience to improve learning. London, Sterling VA: Kogan Page.

             

Back on that horse, again

Well, despite my good intentions I fell off the wagon and didn't manage to complete the course in 2011 due to busy-ness. So I'm back again and feeling resolved! In my third year of lecturing now, and I feel like this year I have hit the ground running, and that even though its as busy as ever, I have my head around what I'm doing. A few new things on our horizon this year, as we are moving to some new forms of assessment with the midwifery students, using video recorders as an assessment tool for the students' practice assessments. In the past we have completed a Midwifery Practice Skills Assessment by having the student meet a 'woman' and after information-sharing, discussion and gaining informed consent, the students have performed practice skills (eg blood pressure recording, postnatal check etc) in front of a lecturer who is assessing their performance against a set of skill sheets. These assessments are quite stressful for students, and we are trialling a video assessment where the student uploads a video of themselves performing skills in mock-up situations which can be assessed and moderated by lecturers. The benefits to the students include being able to repeat the 'take' as many times as is necessary for them to perfect the skill (learning by repetition) as well as being able to reflect on how they 'come across' in terms of their communication with the 'woman'. Seeing oneself in this context is always illuminating, as watching your own demeanour and body language etc can give good insights into how you are perceived by the recipient of your attention! So I look forward to thinking and learning about the different dimensions of this new form of assessment and whether it will assist or hinder the goal of successful skill development for the students.

Flexible Statistics

I have been reflecting on the teaching session I recently did with our second year students on research statistics. I mentioned that I used Fruit Bursts and balloons... so I thought I would explain a bit about what I did, and relate it to some adult learning theory. At the beginning of the day I outlined the content I was hoping to present, and gave the students the option to choose the order of events for the day. They decided they wanted to do the statistics first, while they still felt fresh and more open to complex ideas. We began by discussing 'levels of measurement', which is one of the more basic things to understand. Where possible I used examples from midwifery, so that the students could relate to the concepts more easily. Then I divided the group of 28 students into three groups, and gave each group an unopened large bag of Fruit Bursts. I suggested Group 1 could describe their 'data' using a histogram, Group 2 a pie-chart and Group 3 a horizontal bar graph. They rose to the challenge superbly,and we soon had three colourful charts to explore which we discussed in relation to frequencies, and looked at some of the differences between groups. Then I asked them to tell me the 'average' colour, (not the average of the number of sweets of a particular colour), and thus introduced the concepts around how only certain statistical tests can be used with certain 'kinds' of data (= levels of measurement).
Next I distributed balloons so that every student had one. I asked them all to blow three breaths into their balloon, knot it, then measure it's circumference in cms. Each group then listed their group circumferences, and we played with those numbers, learning concepts relating to statistical tests appropriate to this different level of measurement, normal distribution curves etc.
We went on to look at p-values, Odds Ratios, Confidence Intervals etc and worked through some examples from some interesting midwifery research articles about third stage care (for birthing the placenta) and an RCT about waterbirth, where we calculated Numbers Needed to Treat, using the actual data from the studies etc.

I believe the session worked because it was relevant to their interests. I got to expand their thinking about waterbirth and physiological management of the placental birth, which not only enabled them to gain mastery of the statistics but in a 'by stealth' way also educated them further about these important midwifery concepts.
Adult learning theory supports this method of instruction. The students were actively involved, by firstly telling me which order they wanted to cover all that day's content, and determining their pace - saying we would move onto the next concept only after checking in that everyone had grasped the last one. This reflects Westberg and Jason's (1993) ideas about Collaborative vs Authoritarian learning and teaching. The class assisted to 'set the agenda' rather than me telling them which way round we would do things, though admittedly this was still in the context of particular content that I was required to cover. Knowles (1980) describes adult learners as practical, relevancy and goal-oriented, internally motivated, bringing their own knowledge and experience, and reminds us that adult learners like to be respected (and fed, I discovered - they were quick to ask if they culd eat their "sample"!). I aimed to meet these needs in my students, and while possibly not getting it right for everyone, several students did speak to me at the end of the day about how refreshing they had found it, and how much less difficult the statistical concepts were than what they had expected.

Knowles, M. (1980). The modern practice of adult education .New York: Adult Education Company.

Westbury, J. and Jason, H. (1993). Collaborative clinical education: the foundation of effective health

                care. New York: Springer Publishing Company.