Illusions

What we believe we are isn’t always what others think we are. Do we all live in an illusion of the reality? Unfortunately, I don´t think I have the capacity to go further into this question. I do know that it is important to listen to others and I do think it is important to actively work with improvement.

Earlier this year I wrote a blog post about feedback . I am not finished with that thought so I will try to write something more about the topic. It´s not always nice to get feedback from others, thus sometimes it hurts and sometimes its a joy. When teaching and learning, feedback can be given on different levels both for students and teachers. These six different feedback options is what I´ve come up with.

To students

  • 1. From the teacher – That’s ought to be me
  • 2. From a peer – A fellow partner in crime
  • 3. From themselves – It is important to practice and to put improvement into words

To me as a teacher

  • 4. From the students – The students experience are always interesting
  • 5. From a colleague – I would love to have a critical friend
  • 6. From myself – It is hard to be objective but important to strive for improvement

Feedback can be like a flower bouquet. Some are beautiful and some in colors we don´t prefer. All different comments are useful, however feedback is not a monologue. It´s occurs through interaction and dialogue so it is important to have a strategy for it. Multiple sources for feedback is always a good thing given the different perspective (Svinicki & McKeachie, 2014).

Tiny_flowers_by_Cecile_Vazquez_CCBY_NC_ND_2.0
Photo: Tiny flowers by Cécile Vázquez (CC BY-NC-ND 2.0)

When teaching nursing students how to administer and handle central venous catheters in a way that is patientsafe I will use these six different feedback options. Here´s how I plan to do it.

  1. I move around and meanwhile the students are training practical skill procedures, in our clinical training center, I give them individual feedback, both direct on their performance and e.g. questioning why they chose to do some tasks in a specific order. I will try to balance the negative comments carefully with the positive once (Ramsden, 2003) and tailor them into their needs (Svinicki & McKeachie, 2014).
  2. Feedback given from a peer is sometimes more valuable then from the teacher (Svinicki & McKeachie, 2014). So I will ask them to observe, by using a checklist on the correct steps in the procedure they are training, ready to give feedback when finished.
  3. In long-term the goal and purpose of feedback is to foster the student to manage to given themselves feedback in the future. The students ability to evaluate their own performance is a key to life-long learning (Svinicki & McKeachie, 2014). According to, the Swedish Bachelor Programme in Nursing a nursing student are supposed to evaluate their ability to identify their need of further knowledge and continuously develop their skills (Högskoleförordningen, 1993). Before leaving the training I will ask them to write down on a paper what they think went well and what they think they need to know more about. As an offer they can put the paper in a box, like a letter to themselves and the future.
  4. I can have my feedback from two different sources, the students evaluation and the result of the assessment. (Ramsden, 2003). Don´t want to live in an illusion! I will ask the students to evaluate the training after their participation. As a new teacher it is extremely important for me to know if I succeeded to motivate them and if the students believes that they have learn about how to administer and handle central venous catheters in a way that is patientsafe. I will use Google docs for that purpose.
  5. In the world of academics we are used to give constructive criticism to each other aiming to improve research. Having a critical friend is kind of the same thing. A skilled colleague how gives you constructive criticism with the aim to improve your teaching (Handal, 1997; Lauvås et al., 1997). If you can´t find a personal critical friend, a collegian learning communities can be a good thing. Exploring and learning together meanwhile given each other feedback can enhance your own learning (Stuck et al., 2013).
  6. Self-knowledge is absolutely a good thing for a teacher. After I´ve had my classes in the training center I will give myself time to think it over and reflect on how to improve. I am very well aware of that feedback and reflection isn´t the same thing and in the future I will try to learn more about the topic and how to enhance students learning using reflection.

When I started to write this blog post I thought that feedback is feedback…is feedback and there is nothing more the feedback. It is extremely frustrating to realize , now, hours later, that each bullet point on my list could generate a whole assignment. Undoubtedly I will write about feedback again, but this will do for now.

References
Handal G, (1999) Consultation Using Critical Friends. New directions for teaching and learning, Issue 79.

Högskoleförordningen (1993:100) Sjuksköterskeexamen – Bachelor Programme in Nursing. (In Swedish)

Lauvås P, Hofgaard Lycke K, Handal G, (1997) Kollega-handledning i skolan. Studentlitteratur, Lund. (In Swedish)

Ramsden, P (2003) Learning to teach in higher education. 2nd edition. RoutledgeFalmer, London & New York.

Stuck S, Aubussona P,  Kearneya M, Burdenb K, (2013) Mobilising teacher education: a study of a professional learning community. Teacher Development, Vol. 17, No. 1, 1–18.

Svinicki M, McKeachie WJ (2014) McKeachie´s teaching tips. Strategies, research, and theory for college and university teachers. 14th edition. Wadsworth.

Photo: Illusion by Mark Heath (CC BY-NC 2.0)

 

 

Learning by doing

Is it Dewey who coined the phrase “Learning by doing”?

Dewey claims that there is a relationship between knowledge and active inquiry. He also advocated that action, reflection, emotion and theory is prerequisite for continues life-long learning. The teachers role is to facilitate learning by assisting creation of a cooperative learning exercise. The teachers leadership includes e.g. being aware of past experiences, needs and capacities. To be prepared and have the ability to suggest further learning activities based on the class experiences and by this achieve continued growth (Jarvis, 2010).

I found a quote about learning and doing on the internet, from the book “The Cardturner: A novel about a king, a queen and a joker” written by Louis Sachar. It goes like this:

“I hope I remember everything,” said Toni.
“You won’t,” said Trapp. “That’s how you learn. But after you make the same mistake one, or two, or five times, you’ll eventually get it. And then you’ll make new mistakes.”  

I would like to use these insights in my work as a teacher with nursing students. To know and “feel” their needs and to let them fail, and fail again and just encourage them to keep on trying until they get it right. The diversity of different students and their needs are just as big as they are numbered. I believe that diversity is so much more that cultural and ethnically differences. We are all different human beings with different experiences and my job as a teacher is to greet these differences and to facilitate their learning experiences. Some are introvert and maybe they need the courage to speak up, while the opposite to this is them who often say what they think and sometimes in the need of listening. As a teacher I have to pay attention to this diversities so that I can facilitate the learning experience in a correct way.

Chemo_treatment_by_Jenny_Mealing_CCBY_SA_2.0
Chemo treatment by Jenny Mealing (CC BY-SA 2.0)

One concrete example of how I try to work with facilitation and diversity is when I see my nursing students at our clinical training center. In the introduction, I usually start out with asking them of their experiences of administer and handle central venous catheters. You could say that I use this as a baseline for the rest of the class. As often as I can, without being to excessive, I connect and refer back to what they told me. I try to ask questions like, -What if this…? and -What if that…? to students that I have identified in need for it. It has not always been a delightful and easy way to go cause some of them have had tough experiences of those damn catheters. Often relatives in connection with cancer treatment (some alive and some dead). Even themselves who sometimes have been through the cancer treatment – and yes, we have had tears and both physically and mentally reactions but in the end I am confident in my decision to use the students own experiences since I can see that it enhances their motivation to learn.

I strive to be student-centered and one key to that is to motivate. In 2013 The Swedish Federation of Student (not sure of the correct translation) released a report (SFS, 2013). When it came out it got lots of attention and still… we really need to work with these issues. The report argued for the lack of pedagogical and teaching skills of Swedish teacher in higher education. One thing to make it more student-centered is, as I mentioned, to motivate the students while facilitating a learning activity. The students are also eager, if motivated, and requesting activity. I take along this thought and will try to design some student-centered learning activities with hands-on training.

OM152A_Centrala_infarter_Design_HT16

I am, obviously not a graphic designer but I have tried to do a simple sketch of how the workflow of the training cessions are supposed to look like. We have a common introduction and then I divide the students into two smaller groups. One group will work with wound dressing and the other one with injections. After a coffee break, fika as we say in Swedish, the groups are swapping subject to the other. You can´t have too many fika so we go for that one more time and after that we have a common discussion around cases. At the end of the session we summarize. When they are training wound dressing and injections the students are doing it hands-on. In our training center we have dolls for simulation. The students are prepared theoretical by flipped classroom pedagogy and they will also get a film of how the procedure can be done. The task they are supposed to achieve is to train the procedure. Meanwhile a peer is observing using a checklist on the correct procedure, ready to give feedback when finished. So the students are active both by doing and observing. The students will be like critical friends to one another. I cross my fingers that this will work out!

References
Jarvis P (2010) Adult education and lifelong learning. Theory and practice. 4th edition. New York, Routledge.

SFS (2013) Studenternas läranade i centrum. Stockholm (In Swedish)

Photo: Aniversário do Henrique by Tony Cavalcanti (CC BY-NC-ND 2.0)

Totally not right

Hopefully, we all have visions of a brighter future and then there is the harsh reality…

In his own words, John Biggs tells us how it suddenly stuck him of how irrelevant it was to ask students to tell, in a final exam, of how he had told them about how psychology could be applied into teaching. Instead, he asked the students (in accordance to the intended learning outcome) to do a portfolio in where they themselves described how they knew psychology could be applied to improve their teaching decisions. Biggs describes this event as one of his peak regarding to teacher ratings and luckily for us the constructive alignment was born. Constructive alignment is a concept of how to use outcome-based education (Biggs & Tang, 2011). It all starts with the intended learning outcome and in my case, in this particular course, it is:

“To administer and handle central venous catheters in a way that is patientsafe”.

The active verb is to administer and handle and that is what my students are intended to learn. According to, my institutions own educational platform (MAH, 2016), all teaching and assessment are supposed to harmonize with each other as well as to the intended learning outcome. The students are expected to participate in an active way and the design of the course should be in accordance with this alignment.

So, I have a dilemma – what I am doing now is totally not right.

The ultimate assessment to administer and handle should be something practical. As I see it the student should be tested in how they administer and handle instead they are asked to answer a web-based multiple choice quiz about how they are supposed to administer and handle. I tried to think about this when I constructed the questions. Most of them are about how different skills in action can avoid or prevent complications…but still, now actually action only words about it. As you see, the reality isn´t always inline with the intentions. But I think I have a good position for negotiation with my employer.

References
Biggs, J. B. & Tang, C. (2011) Teaching for quality learning at university. (Fourth edition). Maidenhead, Open University Press.

MAH, Pedagogisk plattform för institutionen för vårdvetenskap (2016) Fakulteten för hälsa och samhälle, Malmö högskola. (In Swedish)

Photo:Wrong by Kerry Lannart (CC BY-NC-ND 2.0)

Clinical training center

This summer I went on a vacation to Italy. Me and my family stayed in a house for rent, somewhere in the middle of nowhere, at the Italian countryside. The weather was fine, it was hot and sticky, so we mostly choose to hang around the pool… or at least nearby. For two days we visited Rome and then again back to the cooling water.

Guardea_2016 (2)

The vacation lasted for two weeks and we all had a great time. Italy gave me a taste for more since it showed itself from its best side. Next time I would love to see other regions of Italy. One region to visit could be Emilia-Romagna and the city of Bologna. Speaking of Bologna… In 1999 there were 29 European countries how choose to sign a declaration about the standards and quality of higher education qualifications. Nowadays it is more then 45 countries that are connected. The main focus is:

  • the introduction of the three cycle system (bachelor/master/doctorate)
  • strengthened quality assurance and
  • easier recognition of qualifications and periods of study

Did you know that the town of Bologna hosts the oldest university in the world, founded in 1088, the University of Bologna? One of the most important buildings at the university, Archiginnasio, situates the Anatomical Theatre, used at the medical school for anatomy lecturers.

Anatomy_theatre_Palazzo_del_Archiginnasio_by_Terry_Clinton_CCBY_NC2.0
Photo: Anatomy theatre, Palazzo del Archiginnasio by Terry Clinton (CC BY-NC 2.0)

Nowadays, when we teach our students we don´t do the whole “theatre thing”, we invite them to our clinical training center and sometimes I´m a teacher there. The center gives the nursing students a chance to practice their skills in a safe environments before they meet patients. Generally, both students and teachers are enjoying the skill training since we all  have a feeling of finally doing it “for real”. I think it is extremely important that we take advantage of the opportunity to do workshops based on “hands-on” activities. I would like to leave the theory lecturing outside of the training center. The course I teach in has, for the moment, a course design of teaching/learning activities that starts out with a theoretical lecture for approximately 45-60 minutes. Only after the lecture the students are allowed to actually get their hands on the different training scenarios which sometimes can be utterly frustrating for all of us. I would like to change this into a flipped classroom design, but first things first… Let´s start with the learning outcome.

Biggs & Tang (2011) describe different stages of how to design constructively aligned teaching and assessment. First of all, the intended learning outcome, shall be described. The active verb of the learning activity is “administer and handle“. Second, its object or the content is “central venous catheters” and last the standard the students are to attain is “in a way that is patientsafe“. In fact, as it is now, the learning outcome consists of the verb and the content. I would like to add the last part about the patientsafety since the whole core in administer and handle is about how to prevent complications.

Back to the design of teaching/learning activities. To be able to administer and handle something I believe that you have to use your hands and mind together. By flipping it around and letting the students work with the theoretical background of the topic before they come into the training center, they can get most out of their skill training. For me this is a question of quality and efficiency. Therefore, my intention is to record my theoretical lecture in short film clips which the students get access to minimum a week before they´re scheduled to the skill training.

Flip_by_Oscar_Rohena_CCBY_NC_ND2.0

Photo: Flip by Oscar Rohena (CC BY-NC-ND 2.0)

Recently, two of the major journals for nursing education have published a respective review articles about flipped classroom approaches in nursing education (Betihavas et al, 2016; Presti, 2016). Both articles refers to a book by Benner et al in their introductions. The book title says it all: Educating nurses: A call for radical transformation. The authors argues for BIG changes in how we educate nursing students and that we teachers have to acclimatize into the 21th century. We have to embrace student centered methods in our pedagogy. Flipped classroom can be one example of how to meet our students in other ways then we nursing teachers by tradition are used to. Presti (2016) claims that flipped classroom enhance active learning but asks for further research since evidence of learning outcomes are missing. Even Betihavas et al (2016) argues for more evidence but the authors conclude that the flipped classroom has a potential to reform nursing education. Although, fully evidence to the method flipped classroom is lacking I feel confident that optimizing the time in the clinical training center is a good thing thus the learning outcome is to administer och handle. Of course I have to evaluate the flipped method and if it doesn´t work out I would like to give a theoretical pre-lecture face-to-face before entering the training center.

References
Betihavas, V. Bridgman, H. Kornhaber, R. & Cross, M. (2016) The evidence for “flipping out”: a systematic review of the flipped classroom in nursing education. Nurse Educ Today, Mar(38), 15-21.

Biggs, J. B. & Tang, C. (2011) Teaching for quality learning at university. (Fourth edition). Maidenhead, Open University Press.

Bologna process (2016) European higher education area. Official website.

Bolognaprocessen (2016) Bolognaprocessen/det europeiska området för högre utbildning. Universitets- och högskolerådet, Stockholm. (In Swedish)

Presti, CR. (2016) The flipped learning approach in nursing education: a literature review. J Nurs Educ, 55(5), 252-257.

Diversity

Earlier today at the course “Academic teaching” (which I participate) we were discussion diversity. The learning outcome for me regarding to this topic is:

“Develop different strategies for equal treatment in the meeting with students / participants in heterogeneous groups.”

So, I´ve been thinking of how to embed this in my teaching to nursing students. The topic I teach is about how to administer and handle central venous catheters. One of the learning outcomes is that the students are expected to reflect over risks and how to avoid them.

The university I work in has a strategic platform (Strategy 2020) and Malmö University wants to base its work on four core values; diversity, creativity, quality and commitment to the community. I came up with the idea of using cases to reflect diversity.

In Sweden (were I live and work) we of course have a law for higher education (SFS 1992:1434). For instance, the students are expected to develop their ability to critical thinking and problem solving.

Lynn (1999) writes about the differences between case teaching and research cases. Lynn argues that when teachers use cases from research as an example or illustration the whole idea of case as a method fails thus the thinking has already been done and the conclusion is already made. The research case is more like a lecture where there is “a true” solution to the problem. Therefor, when using case as a method for develop skills in critical thinking the cases have to contain questions to raise. There should be no right answer and the students should be exposed to different problems, issues and choices. Lynn means that the students are supposed to come up with a solution and proposed action regarding to the present dilemma to succeed and develop their critical thinking.

When writing the cases I have to keep this in mind! I don´t want them to have only one right answer. Back to diversity. I will use name, age and gender as a base and they will all represent a diversity of people. Each case will have a picture of the “patient” and I will choose the pictures carefully so that they shows my intended diversity. I will give you one example of a case.

Muslim woman
Photo: Muslim woman by Peter Dahlgren (CC BY-NC 2.0)

Aisha, a female patient, is treated with total parenteral nutrition (TPN). She has a central venous catheters on her neck (it´s like been given “food” straight in to your blood). Aisha is wearing veil. The veil is “hiding” her central venous catheter so you can´t see the venous access or it´s connections.
-What should you, as a nurse, do?

It is very important to be able to observe the venous access and it´s connections on a daily bases. When having a ongoing infusion (TPN) it´s even more required.

I can think of some different paths to go in the discussion. The students can choose to talk about the ethic part of wearing a veil (the patients religious need vs. patients safety need). I will try to provoke the students a bit if they “chicken out” on the dilemma and I want them to give me an answer of how they think and why. I would also like them to talk about hygiene. The right answer is that the veil has to be change every day… but how will they make this happen? As I see it, they can choose different solutions to the problems.

I’m eager to try this out and I think (and hope) that we can talk to each other and have really constructive discussions of how to solve the different dilemmas. I am aware of that this is an example of how to work with diversity in teaching material. A further challenge would be to describe and have a well founded intention to work with diversity in the group of students, but that´s another blog post.

References
Lynn, L (1999). Teaching and learning with cases. A guidebook. Seven bridges press, New York.

SFS 1992:1434 (2016) Högskolelagen. Utbildningsdepartementet, Stockholm. (In Swedish)

Strategy 2020 (2016) Strategic Platform. Malmö University.

Photo: Diversity by Meena Kadri (CC BY-NC-ND 2.0)

Intended learning outcome

 

This summer I participate in a course about “Academic Teaching” where I am expected to learn how to support the learning of others. The course is given by Malmö university and is an educational part of my personal development plan. The main learning outcome is to describe and justify the academic teaching on a scientific basis and proven experience.
In the assessment I will make a presentation of a design and a plan for teaching. I am expected to describe and justify my choices concerning learning outcomes, assessment and teaching and learning activities in relation to relevant research and proven experience.
The intended learning outcomes for the course are:
  • use teaching and learning activities that are tailored to course content and learning outcomes
  • describe and justify the academic teaching on a scientific basis and proven experience
  • develop different strategies for equal treatment in the meeting with students / participants in heterogeneous groups
  • compile a curriculum that relate to the concept of “constructive alignment”
  • relate their own teaching to national policy documents and the internationalization of higher education

According to my teachers, Mikael and Kristina, I am free to do my presentation just the way I want as long as I can demonstrate and show that I´ve achieved the intended learning outcomes. So, here´s an idea – I will do several blog posts on the different topics.

I think it´s scary to do this – so that is why I do it!

I’m keeping the fearsome spider in the cage and while I am floating away in some kind of weightlessness with only the intended learning outcomes as my navigator I will try to master this task.

References
Malmö university (2016) Academic teaching. Malmö >http://edu.mah.se/sv/Course/HP601A< 2016-08-22.

Photo: Somewhere in a dream by stu mayhew (CC BY-NC-ND 2.0)