Planning activities

Higgins, Reading and Taylor (1996, p120) listed four dimensions that constitute a learning environment. Firstly, they referred to a cognitive apprenticeship which is learning in the context of future practice which relates to CBE as discussed.

The second dimension was that of the pedagogical methods of modelling, scaffolding and coaching, where the student moves from observation of a teacher-performed task, through teacher-supported to teacher-observed independent execution of the task by the student depth (Higgins, Reading & Taylor, 1996, pp120-121). Articulation involves the student’s reasoning while executing the task. Once the student is able to reflect on their own performance they will be able to explore solutions to improve performance. For example, in the medical field this would include assessment, diagnostic and management skills as well as rehabilitation essential skills such as interpersonal communication and team work skills. These methods need to be applied according the stage of knowledge acquisition as described by Bloom (Leinster, 2005) and will determine assessment methods at the various stages of the programme as tabled below.

Table 2.5: Application of learning theories to teaching and assessment methods Bloom’s

taxonomy

Description of ability Pedagogical

method

Appropriate assessment

Progression

Remember Recall of information from

long-term memory Modelling, Scaffolding Recognise, recall Early Phase

Understand Being able to interpret the meaning of instructions

Explain, classify, compare, interpret

Apply Using the information in a

defined context Coaching, articulation Execute or implement Mid Phase/Theory Block

Analyse Dissecting the bigger picture

into smaller parts and understanding the

interrelationship of these parts

Organise, differentiate

Evaluate Being able to judge

according to criteria

Reflect Pass critique

Create Putting it all together to

create a new product

Explore Plan Late Phase

Activities should thus be graded so that students begin with more teacher-supported activities in the earlier phases of the programme, through to more independent student- driven activities in the late phase. This can be achieved by exposure of the students to progressively complex cases in a spiral manner through the curriculum. Assessment methods also need to be graded through the programme as indicated by the arrow in the above table (Leinster, 2005; Friedman Ben-David, 2005).

Thirdly learning activities should be sequenced so that students first acquire a global understanding of the subject, for example as the ICF has been used in this chapter, before understanding specific aspects which should then be sequentially developed to the appropriate depth (Higgins, Reading & Taylor, 1996, p121).

Lastly students interact with their physical and human environment, in a socialisation process involving both co-operation and competition. To a certain extent this environment is controlled through planning of activities however each student’s experience of these environments may be different. There is also a relative lack of control over the interpersonal interaction with the various staff that students come into contact with which was referred to as the influence of the hidden curriculum (Lempp & Seale, 2004). Students should learn to apply their knowledge, skills and attitudes in a variety of contexts and also be able to achieve outcomes by different means for example using a transdiciplinary approach when resources are limited. Understanding of subject matter at this deeper cognitive level instils motivation for further learning beyond that of the set outcomes and promotes long-term retention and continuing professional development (Higgins, Reading & Taylor, 1996, pp121-122).

When reviewing appropriate methods to teach disability and rehabilitation, the following PM&R activities were described: lectures, literature readings, shadowing a patient attending therapy sessions, evaluating patients in an outpatient setting, visiting this same or another patient in their home environment, observing an interdisciplinary meeting, case discussions, visiting and gaining information from community resources, and personal experience of simulated impairment (Jones, Sinaki & McPhee, 1984; Marshall & Haines, 1990; Ward, 1992; Claxton, 1994; Fiedler & Marshall, 1994; Kahtan, Inman, Haines & Holland, 1994; Crotty, Fiucane & Ahern, 2000; Laskowski, Moutvic, Smith, et al, 2000; Saketkoo, Anderson, Rice, et al, 2004; Raissi, Vahdatpour, Ashraf & Mansouri, 2006; Jones & Donald, 2007). Experience of a simulated disability may facilitate students’ understanding of life as a disabled person (Grayson & Marini, 1996) however Crotty, Finucane and Ahren (2000) warned that such activities may be perceived to be demeaning. Contact with tutors was spent on feedback, presentation of projects, discussion, reflection on and analysis of experiences and emotional reactions to disability (Jones, Sinaki & McPhee, 1984; Marshall & Haines, 1990; Khatan, Inman, Haines & Holland, 1994; Claxton, 1994; Field & Marshall, 1994; Crotty, Finucane & Ahern, 2000; Saketkoo, Anderson, Rice, et al, 2004).

Only two learning opportunities within the SA context were described, both being from the UCT in the WC, neither being part of a rehabilitation training programme. During the fifth year paediatrics rotation all students visit a child they have initially seen in the wards or outpatient clinic, in the family’s home environment. The purpose is to evaluate the impact

of chronic disease on the child and the family (Henley, 1999). Students reported this to be an extremely worthwhile exposure. The second activity described was a four week elective or special study module (SSM) that was introduced in 2003 when the MBChB curriculum was reformed. The UCT Physiotherapy Department offered an ‘Images of Disability’ module as one of the 76 SSMs available for the 186 medical students in 2004. Although there were only two students who signed up for the module that year, there were five SSMs that were not utilised at all. The rehabilitation module intended to develop positive attitudes towards people with disabilities. The two students spent five days in a wheelchair after which they reflected on their experience (Amosun, Volmink & Rosin, 2005).

Higgins, Reading and Taylor (1996, p89) described how students learn through developing educational programmes themselves. This called to mind the saying ‘watch one, do one, teach one’ which the researcher recalls from her student days. Imparting knowledge to other students during interdisciplinary sessions and to patients can provide reinforcement. Allowing students to devise assessments for work learnt is another teaching strategy and provides feedback to students on their assimilation of knowledge (Race & Brown, 1994, pp85-106).

However before any of these activities is embarked on, students need to be adequately prepared (Kahtan, Inman, Haines & Holland, 1994; Crotty, Fiucane & Ahern, 2000). This should be more than the sequential outline of activities but rather an understanding of how the programme builds on previous knowledge especially that acquired in other specialities, which can be used as anchor points for new learning. Pre-tests can identify prior knowledge to tailor teaching sessions and when compared to post-tests can provide a measure of gained knowledge, skills and attitudes (Kahtan, Inman, Haines & Holland, 1994; Laskowski, Moutvic, Smith, et al, 2000). They can also alert the student to the most important aspects of the programme and reduce anxiety for the end of programme assessments.

In order for students to participate in CBE and PBL, a certain level of competency and maturity are required, thus timing of such activities within the curriculum needs to be considered. Timing is also important when it comes to the subject of attitudes.