After exploring the literature and narrowing down my
intended outcomes for this case study, I now consider what has been the
established practice for students’ reflective commentaries in fourth year Obstetrics teaching, and I follow
on with an examination of the possibilities that technology provides for
shifting practices.
Established
practice in terms of students’ reflective curricular tasks
[T]eaching
at universities is changing towards student-centred learning-by-doing with high
student activity, where teachers as tutors have different roles, and formal
skills have to be supplemented with reflection-in-action (Walkington, Christensen, & Kock 2001).
While reflective tasks are strongly recognized as an
important curricular component in medical education, the process is changing. Reflective
journals were first introduced into the fourth year MBChB Primary Health Care community-based
block in 1996. In email correspondence (2012) Melanie Alpenstein in her
role as Faculty curriculum developer explained that “reflective practice
was encouraged to assist students understand issues affecting communities
and themselves personally, as they were sometimes in very unfamiliar
environments”. She added “traumatic issues related to their Obstetrics block
were raised in these journals. Consequently Dr George Draper, an Obstetrician
with a particular interest in student learning, then introduced a student
reflective commentary as a tool for improving Obstetrics care. His
Masters thesis researched
students’ developing roles, identities and relationships that emerge as they
are introduced into a Community of Practice (CoP) through their debut
experience of their first delivery (Wenger 2006). He noted the shift
“from
involvement to detachment and from care to cure” (Draper 2006:75).
From 2006 till 2013 students
were asked to hand in a hard copy of their reflective commentary following
instructions in their course booklet (2010:23) that clarified the task as one not
for assessment but rather intended to “make [students] stop and think about
[their] experience in the knowledge that this facilitates learning”. The
objective was to facilitate students’ insights as they entered the Obstetric
community of practice. Students were requested to keep their commentary simple
and brief – to about one page. Informality was suggested in the genre of the
instruction – “More is OK if you feel what you have to say is important”.
Instruction in the booklet indicated that students needed to draw on their
practical experience, reflect on it, and discuss how their early delivery
experiences “had:
- Affected
[each student] as a person
- Shaped
[each student’s] understanding of the role of the midwives and medical
colleagues as teachers and models, and
- Given [each
student] insight into the needs of mothers in labour”.
In 2012 an extra commentary
was requested from the students in which they had to post online their
reflections and interpretations of a particular event that occurred in their
learning block of 8 weeks in which they rotate between several Maternal
Obstetric Units (MOUs). This task was facilitated by referring students to an
online visual a six step framework, called the Six Step Spiral for Critical
Reflection (SSS4CR) which guided students thinking through probing questions.
Because the uptake was below
half the class, the course convenors and facilitator decided to drop the
original reflective task in favour of the latest one in which a structured
approach to critical inquiry was required. Initially very few students
responded online however with encouragement and acknowledgement of the
difficulty in sharing reflections online, more students have engaged in the
task. Scaffolding the task was noted as a key factor to improve participation.
At the initial introductory session, students were introduced to the Probing
Professionalism towards Positive Practice website on the Learning Management
System (LMS). They were also encouraged to post a comment on the Chatroom
relating to their prior knowledge about the Obstetrics block. This has
developed a cluster of insights, adding energy to the group towards cultivating
an electronic CoP (Wenger 2006). Further participation in the online space then
happens asynchronously.
Self-organized activity
following the introductory session encouraged students to use the six separate
threads on the LMS Forum space for their future posts. However alternative
suggestions were offered as an acknowledgment of the difficulty in sharing
personal experiences. These were mailing the facilitator directly or using the
anonymous Question&Answer option, as described in my previous reflective
blog post.
Affordances of technology
[C]ontemporary educational
design needs to focus on the selection of technologies which are complex
combinations of media that do not fall into simple categories (Bower 2008:3)
Recent advances in technology offer many more
opportunities to enhance reflective practice in medical education. Beyond the
single text Word document written by each individual student and signed off in
a register as the task completed, are flexible and collaborative tools that can
enhance the individual and collective inquiry process as well as offering a
product available for sharing with others.
While looking back on an experience is important,
Donald Schon (1983) reminds us of the value of considering reflection in three
phases described as reflection to action in preparation for a process,
reflection in action which is more difficult for a novice practitioner than an
expert, and the more commonly used
simpler process of reflection on an experience. (Butler 1996). As an educator
interested in developing democratic teaching practices I also identify the
opportunities available to shift the classroom power and control towards more
student ownership for developing knowledge and valuing the collective
contributions of their peers. A collaborative approach to learning is another
of the key features for Authentic Learning as described by Herrrington, Reeves
& Oliver (2010), and demonstrated by recent research with Physiotherapy
students (Rowe,
Bozalek & Frantz 2013).
My role as an educational designer
(as well as the student facilitator) is important to acknowledge. By choosing a
new tool for reflective practices I recognize the need to continually assess
and adapt it in a creative manner to reach my desired educational outcomes.
Tools
of technology considered
The success of educational
technology implementations is dependent on the educational developer’s ability
to appreciate the requirements within the learning context and subsequently
select and utilize technologies in a way that meets those needs.” (Bower 2008:14).
From my understanding, a flexible
approach that can provide scaffolding through the process is an important
factor that will determine my choice of technology tools. Over this past year I
have offered students the vehicles of Forum posts, Question&Answer or
emails to me.
Exploring alternatives has led me to
consider several options based on the affordances of technology which is
understood as the possibilities available through the tools of technology.
Bower (2008) suggests a form of classification to assist educators to design
e-learning tasks with available technology indicating the social and
educational affordances. He separates affordances into the degree of
interaction naming those that are static and instructive as compared to those
that are collaborative and productive (2008:7). Because the latter is more
appropriate for my case study, I identify particularly relevant affordances in
the table below with suggested reasons.
Functional affordance
|
Reason
|
Usefulness for my context
|
Ability that is enhanced
|
Access-control
|
Choice of
access with one or many others.
Choice about
the level of participation offered to others.
|
Students are
sharing personal experiences where safety in sharing is important. The sharing
can be scaffolded by first encouraging them to share just with a partner and
myself, then with others.
|
Permission-ability
Share-ability
|
Media
affordances
|
Providing a
vehicle to expose products of individuals by sharing experiences.
|
Students
value the opportunity to write about their experiences, recognizing that they
have something to contribute to the furthering of maternal health. They
appreciate their colleagues experiences too.
|
View-ability
Speak-ability
(through text or multimodal pedagogies
|
Temporal
affordances
|
The written
narrative offers a window into the students’ experiences, thoughts and
perspectives – a valuable feedback tool for Faculty and peers.
|
Students
narratives provide a text to act as evidence for good and poor practices in
the clinics. This has led to further actions from the Department.
|
Record-ability
|
Resource
affordances
|
Linking to
related resources can be valuable.
Experts in
the field could be offered access to add relevant comments to deepen the
learning.
|
Adding readings
and images can foster a broader learning experience.
Bringing
experts into the online space develops the learning beyond the classroom and
single facilitator
|
Link-ability
Expert-ability
|
Timing
affordance
|
Asynchronous
sharing is possible
Synchronous editing
offers the ability to write on the same document together
|
Students can
choose when they work on the documents.
This can
create a new shared experience for students.
For the
educator it offers a view into the written dialogue
|
Synch-ability
|
Motivational
affordance
|
Student
buy-in to this curricular task is important.
|
If students
can recognize the wider benefit to themselves it will be beneficial
|
Use-ability
|
Mobile
affordance
|
To promote
engagement anytime anywhere it is valuable to include the use of mobile
devices
|
Students can
access the documents through the free Google Drive app on their Smartphones
or similar devices by downloading it for future use. It can be used to edit
text (not to create)
|
App-ability
|
Collective
affordance
|
To accumulate
all students’ experiences to view their practical learning as a collective
departmental experience, thereby becoming a user-friendly type of wiki.
|
Isolated
experiences can be useful however a pattern of systemic behaviours can
indicate where intervention is needed. It can also act as a normalizing
feature for students.
|
Group-ability
|
Clouding
affordance
|
Available
24/7 where internet is accessible.
|
Cloud
computing beyond the Faculty LMS is welcomed by the student group.
|
Avail-ability
|
Organizing
affordance
|
The ability
to set up folders in Google Drive offers an organized platform for working.
|
Medical
students tend to be logical and structured as they cope with high quantities
of information and heavy workloads.
|
Structure-ability
|
Reviewing
affordance
|
By using the
insert function added benefits can be gained such as the dictionary and
thesaurus. Footnotes are possible.
A revision
history enables readers to refer to previous contributions
Small groups
with peer editting
|
Students’
writing ability can benefit by using the extra options available on Google
docs. For instance in their partners they may choose to explore the meaning
of certain terms.
A record of
the document history can encourage students to take risks as they make
changes because an older version can always be brought back.
|
Research-ability
|
Long-lasting
affordance
|
By Google
docs staying in coud without limitations on folder size (as is the case with
other applications such as Dropbox), the text can remain accessible for a
long time
|
The lasting
nature of the document enables students to relook at their writing and their
peers at a later stage
|
Last-ability
|
Further considerations are the
timing affordance and the ease of access. Using an asynchronous medium will be
most useful to our students who work and learn at different hours in this block
which weaves practical shifts with theoretical input. Furthermore cloud
computing offers students easier access to information wherever and whenever
they wish particularly as our students access the internet through their
Smartphones and laptop computers. Anecdotal reports indicate that many students
avoid using the Faculty LMS as they find it cumbersome and boring. Perhaps it
doesn’t offer them the ownership and freedom that they value through the
internet.
Social media could be a possibility
in which for instance a closed Facebook group is set up. However the sensitive
nature of the student reflections and the higher order thinking required for
this task seems to indicate that the conversational nature of Facebook is not
the appropriate online space for posting deeply meaningful and sensitive
insights. Once posts are made on Facebook there is no option available for
editing as a result of deeper understanding of the concepts or responding to
feedback received from others. Furthermore the shifting nature of this medium
that acts primarily as a social virtual interactive space, makes it challenging
to actually follow through on a meaningful dialogue when many posting intervene.
Privacy laws by Facebook may also interfere with the dissemination of
information.
Common
collaborative tools mentioned by Brodahl.
Hadjrrrouit & Hansen (2011) include blogs and wikis.
Blogs: Each student could
create a blog offering them a sequential space for their comments. This is
unlikely to be welcomed by our student group as time is an extremely limiting
factor in their programme. This
affordance enables removing documents and adding new ones through the editing
option however it does not provide for changing documents or openly responding
to feedback on the original text.
Wikis: Although used in
some places in the undergraduate curriculum, this option appears to not
necessarily encourage the deep personal introspection that I am hoping to
achieve from each student. The feature of editing to produce a polished
finished product is tangential to my desired outcomes. The process of
reflecting critically to offer an opportunity for transformative learning is
more important for me as the teacher than the product.
Google docs:
Engaging in Google Drive may
facilitate more interaction and collaboration with the students. By using a
sharing platform through Google docs, students can collectively co-construct
their knowledge while unpacking their experiences towards mutual learning and
interpretation of their personal events in their practical block.
Students can choose with whom they
wish to share their documents. For instance the
concept of critical friends has been welcomed by the students. They may choose
to only share their document with their friend and the facilitator rather than
all their colleagues in the small group of 40 students. In our online
discussion it was suggested that I create subgroups of students to enable them
to share just with a few colleagues thus providing a less threatening
environment and developing the scaffolding further.
Google docs may provide an avenue to enable students to comment and
assess each other’s reflections leading to a deeper peer-to-peer engagement
beyond the articulation and conversation that has occurred to this stage. It
may even offer the opportunity for outside experts to review the students’ work
and perhaps assess it too.
Rowe, Bozalek & Frantz (2013) used Google docs
as “a collaborative authoring platform to implement authentic learning tasks”.
Advantages cited by the authors included the facility to modify content at any
stage of the process, and that text and images can be added and edited by
multiple group members. The automatic saving is a helpful time saver. It offers
reassurance to students that their work will not be lost through not saving it
in time thus possibly reducing their anxiety. The products can be shared with
others chosen by the group adding to the sense of ownership of the students. It
could also be downloadable. Therefore if permissionis granted, it can be mailed
to other people. Collaboration becomes possible and visible. Further advantages
that may be useful for the future are that Google Drive can enable feedback
comments, instant messaging and notifications via email when changes are made. As
students move to satellite compuses such as Vredenberg, this can mean that
physical distance becomes irrelevant in their group work.
Task feedback from students
Since initiating the online reflective dialogue by
students on their personal experiences at the MOUs, there have been mixed
responses. Just when I felt that there was buy-in on the Forum of the LMS with
half the student group posting their comments, the next group mostly chose to
mail me their commentaries with 10% posting on Vula. After querying this with a
few students at our face-to-face session, reasons offered were that:
- It is quicker
to just mail to Word document to the facilitator rather than posting each of
the six stages into the relevant Forum thread. As mentioned in my earlier
reflection, time is a big issue with these students
- It is
uncomfortable sharing experiences with others
- There is a
sense of vulnerability; it would seem that students feel more supported by
sending their document straight to me their facilitator
However there is a strong
consensus that hearing about one another’s experiences is hugely beneficial
which leads me to recognize the value of developing a collaborative approach.
Although one student has now chosen the anonymous option of Q/A on Vula, the
coded format seems bulky and not particularly user friendly. He has given me
permission to use his post as a example to other student groups thereby
providing me with a form of scaffolding.
Challenges
Students’ digital competence and comfort is an
important consideration and may be a limiting factor. I recognize the value in
beginning the collaborative process in class to enable some students to draw on
the expertise of others and the educator so that they become more comfortable
to then progress in their different places and spaces.
When students are motivated to develop a
collaborative skills on line, they are more inclined to engage in the process
(Brodahl, Hadjrrrouit & Hansen 2011). Some students may not own a Gmail address,
This could exclude them from the process unless they are willing to initiate a
new email identity. However I note from a Facebook posting in our group area
that access is now possible through Google Accounts offering a different type
of functionality.
Initial resistance to a collaborative online
approach is reported by Rowe, Bozalek & Frantz’s research (2013). Yet the
acquisition of new relevant skills and a shared process that contributes
towards “empowering students to take control of their learning …[and a] move
towards thinking about learning” appeared to be later welcomed when students
recognized their personal and professional growth.
As suggested by Brodahl,
Hadjrrrouit & Hansen (2011) there are arguments towards keeping to
traditional teaching practices with students who prefer working on their own,
and that the affordances of technology may not be a gain for the students
themselves.
Conclusion
To successfully implement
innovative tools into our teaching, more is needed than merely setting up a
structure. Veletsianos (2011) points
out that the educator may provide the opportunities for deep learning and
transformation through the affordances of technology, however it is up to the
learners to fully engage with the process. I find the infographic below useful
as it encompasses the complexity of online teaching indicating how teachers and
students need “personal
tools to orchestrate the inquiry process” (http://www.teachthought.com/learning/what-are-the-habits-of-mind/).
.
.
References
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Personal e-mail communication 15 May 2012.
Bower, M. 2008. Affordance
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Butler, J. 1996. Professional
development: Practice as text, reflection as process, and self as locus.
Australian Journal of Education. 40:3:265-283.
Draper, G. 2006. A
classroom of life. A qualitative analysis of the reflections of medical
students on their entry into an obstetric community of practice. Masters of Philosophy thesis. (Unpublished).
Herrington, J., Reeves, T. &
Oliver, R. 2010. A guide to authentic e-learning. Routledge. London.
Rowe, M., Bozalek, V.
& Frantz, J. 2013. Using Google Drive to facilitate a blended approach to
authentic learning. British Journal of
Educational Technology.
Schön, D. 1983. The
reflective practitioner: How professionals think in action. New York. Basic Books.
Veletsianos, G. 2011.
Designing Opportunities for Transformation with Emerging Technologies. Educational Technology. 51:2:41-46.
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