Scaffolding Clinical Problem Based Learning Within an Online Collaborative Environment

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University of Wollongong

Research Online

Faculty of Education - Papers (Archive)

Faculty of Arts, Social Sciences & Humanities

2005

Scaffolding Clinical Problem Based Learning Within an Online Collaborative

Environment

Lori Lockyer

University of Wollongong, [email protected]

John W. Patterson

University of Wollongong, [email protected]

Follow this and additional works at:

https://ro.uow.edu.au/edupapers

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Education Commons

Recommended Citation

Lockyer, Lori and Patterson, John W.: Scaffolding Clinical Problem Based Learning Within an Online

Collaborative Environment 2005, 236-241.

https://ro.uow.edu.au/edupapers/382

Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected]

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Proceedings o f the IASTED International Conference EDUCATION AND TECHNOLOGY

July 4-6, 2005, Calgary, Alberta, Canada

SCAFFOLDING CLINICAL PROBLEM BASED LEARNING WITHIN AN

ONLINE COLLABORATIVE ENVIRONMENT

Lori Lockyer John Patterson U niversity o f W ollongong

W ollongong, N SW A ustralia lori_lockyer@ uow .edu.au j ohn_patterson@ uow .edu. au

A BSTR A C T

W ith a specific focus on addressing the health care needs o f regional, rural and rem ote com m unities, the new m edical school at the U niversity o f W ollongong w ill open the doors to its first cohort o f students in January 2007. Clinical placem ents will see students spend substantial periods o f tim e in general practices located in these target com m unities - w hich may be as far as 1200km from campus. Problem based learning (PBL) is the underpinning educational strategy used to facilitate students’ integration o f m edical science know ledge and clinical com petencies. Educational technology has m ade a significant im pact on the quality o f the resources used to facilitate PBL in medical education through the developm ent o f m ultim edia clinical cases and online delivery o f curriculum m aterials, readings, and literature. H ow ever, the learning interactions rem ain largely face-to- face. The unique context o f this m edical school requires the design o f solutions that utilize com m unication technologies to connect learning groups but th at do so in a way that scaffolds the learning process that is so em bedded in the traditional face-to-face setting. This paper outlines the PBL process currently im plem ented in m edical education and proposes a fram ew ork to structure the process w hen learners engage in w eb-based environments.

KEY W O R D S

W eb-based education, m edical education, problem based learning, case based learning, collaboration

1. Introduction

In order to tackle the grow ing challenge o f shortages in the m edical w orkforce, the A ustralian federal governm ent is increasing support for m edical education through, am ong other initiatives, the establishm ent o f new m edical schools. W ith a specific focus on addressing the health care needs o f regional, rural and rem ote com m unities, the U niversity o f W ollongong (U O W ) plans to open the doors to its first cohort o f students in January 2007.

Its regional, rural and rem ote m edicine focus m eans that the school w ill rely upon significant involvem ent from com m unity based clinicians located as far as 1200km from campus. Clinical placem ents will see all students spend substantial periods o f tim e in general practices in these areas.

The m edical school curriculum is based on the U niversity o f S heffield’s outcom es-focused approach w hich draw s from a set o f presenting clinical problem s as the basis o f its core curriculum . Problem based learning (PBL), in Sheffield delivered through Integrated Learning A ctivities, underpins the core curriculum . The purpose is to support students’ integration o f know ledge and skill developm ent associated w ith m edical sciences (i.e., basic, clinical, behavioural and population health sciences) and clinical com petencies (i.e., clinical, practical, and interpersonal skills and professional behaviours) that are defined by these presenting clinical problem s [1], An online core curriculum database is used to define the specific clinical com petencies and medical sciences know ledge thus guides teachers and students in designing and undertaking teaching, learning and assessm ent activities.

In m ost m edical schools, students engage in PBL activities face-to-face on cam pus or in hospital or health care settings w hen they are on clinical placem ent. The unique context o f U O W ’s m edical school will m ean students, at times, w ill be unable to be co-located for their PB L experiences. Thus, during the school’s developm ent process, it is necessary to design solutions that utilize com m unication technologies to connect PBL groups in a way that scaffolds the learning process th at is so em bedded in the traditional face-to-face setting. This paper outlines the PBL process currently im plem ented in m edical education and proposes a fram ew ork to structure that process w hen learners interact through w eb-based environm ents. This fram ew ork is derived from the experiences o f online collaborative learning across disciplines and from the research and design team ’s

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specific im plem entations o f w eb-based collaborative learning in teacher education.

2. PBL in Medical Education

W hile academ ic debate continues to rage am ong m edical educators regarding the efficacy o f PBL, this approach to teaching and learning is a feature o f m any m edical schools’ curriculum strategy. Problem based learning may be considered an ‘um brella’ pedagogical approach that can be im plem ented through a variety o f m ethods [2, 3] w hich are often adapted to suit the range o f disciplines - particularly th e variety o f professional education disciplines - th at have adopted such strategies. For exam ple, PBL may incorporate aspects o f case based, project based, and/or group based activities.

In m edical education, problem based learning is characterised by the use o f clinical case scenarios or triggers (i.e., case based) w hich focus student group discussion (i.e., group based) to identify learning objectives and engagem ent in individual student inquiry (i.e., independent learning) and subsequent group refinem ent and consolidation o f outcom es [4],

It is well recognised that PBL realises constructivist notions o f learning. This is indicated by:

• clinical case triggers providing authentic learning objects;

• student-centred w ith learners draw ing upon prior know ledge and defining their ow n objectives; • w ith the teacher (or PBL tutor) acting as

facilitator;

• independent inquiry supporting deep learning; and,

• group discussion exploring m ultiple representations and social construction o f know ledge.

W hile specific im plem entations o f the PB L process have slight variations across m edical schools [6] they all have sim ilar intent. A s defined by Barrow s [2], the ultim ate objectives o f the use o f PBL approaches are organising know ledge for use in clinical settings; developing clinical reasoning skills; developing self-direct learning skills; and, increasing m otivation to learn.

U sing O liver’s concept o f learning tasks, resources and supports as a learning design [7, 8], the general PBL process can be illustrated to define the sequence o f activities in w hich student engage independently and as a group. W ithin this fram ew ork, tasks are the assessable and non-assessable learning activities in w hich students engage. R esources are those (m ostly) static inform ation and/or curriculum m aterials that are used by students w hile engaged in those tasks in order to develop their know ledge and skills base. R esources m ight include clinical case scenarios, textbooks and textbook chapters,

journal articles, w eb sites, and past student work. Supports are those scaffolds and tools designed and/or im planted by the curriculum designer and/or teacher to facilitate student engagem ent in the learning tasks. Supports m ight include schedules, instructions, prom pts, and tem plates.

This fram ew ork o f the learning design has em erged as a m ethod o f describing both contextualised and generic instructional approaches. Further, learning designs are suggested as a way to m eaningfully incorporate digital learning objects (i.e., discrete m ultim edia educational resources) [9, 10]. R e so u rc e s Tasks Student's r e a d s oroDIerr scenario Students , identifies. + ; clarifies ! / urtfamhar I / \ / terms or 1 concepts I Clinica* Students | suggest merim c o n o -sio n s ; Students j define learning i goals + objectives zx ~ r..z:: Student engages in ! indeoendnt inquiry i Students share iaammg, apffy lo scenanc - other situations !

Figure 1. PBL learning design defined by a sequence o f learning resources, tasks and supports.

Specific to this context, the fram ew ork provides a form alism w ith w hich to illustrate the learning resources tasks and supports o f PB L w ith resources represented as triangles, tasks as squares and supports as circles, Figure 1 depicts the sequential flow o f PBL learning tasks, resources and supports.

The key resource is the problem itself com m unicated through the clinical case scenario. C reation and/or selection o f an appropriate scenario is a vital responsibility o f any school’s curriculum design team. Factors for selection include the potential o f the case to: relate to students’ prior know ledge; elicit student elaboration; dem onstrate clinical relevance; connect w ith a particular stage in the school’s curriculum and potential

Supports PBL Tuto' P BL \ O O JD Discussion Case Trigger Textcooks, Curriculum matenais, L t l t - 'c 'S . Literature, Other resources

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to facilitate integration o f know ledge; encourage self directed inquiry; engender interest in the subject matter; and, link to course objectives [6 ,1 1 ].

O ther resources facilitate the self-directed aspect o f the PBL process as students engage in inquiry related to learning goals developed from the case scenario. Some PBL im plem entations may leave identification and selection o f inform ation resources com pletely to the individual student’s discretion w hile others provide a subset o f resources from among w hich students m ay m ake appropriate selections depending on their learning objectives.

It is in the developm ent o f resources - case scenarios and curriculum m aterials - w here educational technology has had its greatest im pact in facilitating PB L w ithin m edical education. M edical schools, professional associations and educational publishers have m ade significant investm ent in developing clinical cases in m ultim edia formats. Over the years, these m ultim edia cases have developed in scope reflecting the state o f m ultim edia learning resource developm ent in general. This has included collections o f com prehensive cases w hich utilise a range o f rich m edia elem ents such as video and anim ation to more discrete learning objects technically structured for w eb-based delivery.

Educational technology has further enhanced the independent inquiry stage o f the PBL process. Increasingly students have access to a vast range o f CD and w eb-based resources, digital library collections, course notes, video lectures, and m ultim edia resources for specific content dom ains. For example, anatom y is one area in w hich the developm ent o f rich m ultim edia educational m aterials has led som e m edical schools to com pletely rem ove lab-based dissection or pro-section from the curriculum . H ow ever, it is the im plem entation o f the PBL learning tasks and associated supports in w hich educational technology has had variable attention.

3. Supporting PBL Collaboration Online

Engagem ent in PBL learning tasks traditionally takes place in face-to-face m ode w ith tutorial groups m eeting to receive case triggers (w hether they be on paper, online or on CD, or through structured interaction w ith real or actor patients). Independent research tasks w ould occur betw een subsequent face-to-face m eetings o f the PBL group. D epending on the structure o f the m edical school curriculum and the stage in w hich the students are enrolled in their program , these face-to-face PBL groups may occur on cam pus or in a hospital setting w hile students are on clinical placem ent. In m edical education to date, there has been lim ited exploration o f extending the PBL group collaborative process w hen students are, by necessity o f the curriculum , disparately located.

This w ill becom e a particular challenge for U O W students enrolled in the third phase o f the m edical school program. D uring the entire academ ic year, students w ill be placed in general practitioner offices located throughout regional, rural and rem ote com m unities in A ustralia. In many instances, individual students m ay be located several kilom etres from their closest peer(s). Thus, travel to a m utually convenient PBL group location during the clinical day w ill be near im possible. A s such, it is im perative to explore how com m unication technologies m ight be best utilised to continue and extend the rich PBL face-to-face interaction th at these students w ill have experienced on cam pus and during local hospital placem ent at earlier phases in their course o f study. The sim ple solution to this problem w ould be to suggest these students engage in their PBL activities through the learning supports o f synchronous chat spaces and w hiteboards and/or asynchronous discussion bulletin boards available through any com m ercial learning m anagem ent system. H ow ever, the com m unication tools in them selves are akin to the PB L tutorial room, tables, chairs, and w hiteboard. It is the process o f facilitation that is the key to the learning experience. So the solution to the problem really m ust focus on w hat structures (or scaffolds) and system s can be put in place to support the process w hen students are at a distance and the facilitator m ay or may not be present online. C ertainly lessons can be learnt from initial investigations in m edical education as w ell as other disciplines that utilised technologies to support collaborative PBL distance and/or blended experiences. W e w ould not be the first to postulate the need for tailored tools to support PBL interaction. T echnologies have been designed to support the collaborative learning process in general - som e have specifically focused on PBL structures. W hile system s that support collaborative learning are often com prehensive incorporating a num ber o f tools, many focus on providing scaffolding in selected areas (e.g., structuring group discussion or creating collaborative w riting spaces). T he enhancem ent o f a solution to support online PB L collaboration in medical education m ight draw upon the ideas and experiences from across the disciplines w ithin a fram ew ork o f the PBL activities them selves. A s such, from the perspective o f the tasks, the learning design fram ew ork can be used to develop a storyboard (see Figure 2) o f how PBL m ight be scaffolded w ithin the online environm ent w ith the specification o f resources and supports.

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Student's reads problem scenario C o ectea ■» Wwtimeca student Case identified Triggers online — resources ♦ learning research oc^ects 9 -C e s

Figure 2: Storyboard o f online environm ent w ith supports and resources based on PBL tasks

Task 1: Student/s read the clinical case/problem scenario

W ith an em phasis on m ultim edia and hyperm edia educational resources w ithin the field o f educational technology for m ore than a decade, a focus for problem based learning in m edical education (and health education more generally) has been the developm ent o f clinical case scenarios. In som e instances, online PB L system s have been designed w ith em bedded cases (see for exam ple STEP as described in [12]). H ow ever, the em erging em phasis over the past five years on reusable learning objects suggests a m ove away from m edical schools investing in and sole reliance on in-house created case resources that are locked into a static online environm ent. Further, the availability o f case m aterial from a range o f sources, including the developm ent o f learning object repositories tailored specifically for m edical education (for exam ple IV IM ED S), and the need to adapt cases over time suggest online collaborative PBL environm ents link to, rather than em bed, clinical case resources.

The key support usually provided by the PB L tutor during this task is in helping the students make the link betw een the case and the overall curriculum . W ithin a w eb-based environm ent, the curriculum coordinator could construct a descriptive textual link as they select a particular case trigger learning object for each PBL cycle. In the UOW context this w ould include a link to the online core curriculum database. This may replace the need for a tutor to provide the facilitation at this early stage o f the process and assum es self-directed initiation o f the problem.

Task 2: Students identify and clarify the unfamiliar Task 3: Students suggest interim solutions/conclusions

The im portant facilitation support provided by the PBL tutor in the face-to-face environm ent is creating a sense o f ease and equality such that each student will identify the concepts or term s w ithin the case trigger w ith w hich they are unfam iliar. The danger in m oving this task online - particularly w hen students engage asynchronously - is the potential for the less confident or m otivated students to delay their response or not respond at all. Im plem entations o f collaborative task-based online learning have provided students w ith a structure to input initial responses to th e task prior to engaging in group discussion and collaboration [13]. Thus, for the medical PBL environm ent students can individually com plete a form that scaffolds their identification o f unfam iliar term s and initial suggestions for a solution to the problem o f the case. Individual responses can be collected on a separate page for all group mem bers to view prior to discussion.

Task 4: Students define learning goals

The definition o f learning goals helps direct students for their independent inquiry. Thus, the support o f group interaction through a structured discussion space carries the benefit o f collaboration from the face-to-face environm ent online w hen students are not co-located. The question for practice in any particular context is w hether this task can be facilitated by the group alone or if a tutor is necessary to support the direction tow ard definition o f learning goals. In the particular context o f U O W ’s online PBL im plem entation, students will have

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previously engaged in tw o years o f face-to-face experience w ith goal-setting. Thus, it is plausible to expect online PBL groups to be self-facilitating. W hat will be im portant is for students w ithin th e groups to continue to carry out necessary PBL ‘ro les’ - that is, group elected ‘ch air’ and ‘scribe’ [4]. In self-facilitated online PBL interactions. To support the group m oving tow ard conclusion o f the discussion on goal setting the online environm ent could have scaffold w ithin w hich the scribe can input the agreed learning goals. This sets a guide and a point o f reference for students to engage in their self-directed inquiry.

Task 5: Student engages in independent inquiry

W eb delivered resources aide students’ im m ersion in the self-directed inquiry task. Some m edical schools leave this stage o f the process com pletely to the individual student’s discretion to search, access, evaluate and incorporate the resources and literature relevant to their defined learning objectives. O thers provide students w ith m ore direction w ith links to specific w ebsites, journal articles, and/or textbook chapters organised per curriculum m odule or per case. Regardless the particular school’s approach, within the face-to-face learning environm ent, students often use the PBL tutorial session (and/or inform al on-cam pus study m eetings) to share and discuss the appropriateness o f the resources they identify and use during this task. To support distance study, the online environm ent can include a support tool that provides a place for students to input links to the sources they have identified. Such a tool needs to provide a structure that guides students to annotate these links such that they can adequately describe the source to their group m ates and thus link the relevance to the particular case and/or aspect o f the curriculum in general. The tool then acts as a group-defined repository o f resources.

Task 6: Students share and apply learning to this and other scenarios

As students re-convene their groups to share their independent findings a structured discussion tool can again be o f support. A t this stage w e can replicate the interaction m echanism s and tools used in the goal-setting stage. Im portantly the scaffold for the scribe to sum m arise the group findings w ill provide closure to the particular PB L activity.

4. Conclusion

The learning design fram ew ork o f tasks, resources and supports provides a m ethod o f describing the PBL learning process in general and helps to design how the pedagogical m odel m ight be enhanced through technology tools.

In the context o f the U niversity o f W ollongong’s m edical school, the com plem ent o f technology tools w ill be progressively introduced to facilitate the PBL process during face-to-face sessions and as students m ove to rural and rem ote clinical placem ents. The focus w ill not be to attem pt to reduce face-to-face collaboration w hen students are co-located but to investigate how the technologies can enhance the PBL process in both environments.

W ithin this medical education research context, as the academ ic debate regarding the efficacy o f PBL continues, it will be critical to docum ent the learning outcom es realised for students engaged in the pedagogical strategy w ithin all contexts.

References

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[3] Lloyd-Jones, M argetson, & Bligh, Problem -based learning: a coat o f m any colours. M edical E ducation 32 (5), 1998, 492-494.

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[9] S. Bennett, L. Lockyer & S. A gostinho, Investigating how learning designs can be used as a fram ew ork to incorporate learning objects. In R. A tkinson, C. M cB eath, D. Jonas-D w yer & R. Phillips (Eds), Beyond the com fort zone: Proceedings o f the 21st A SC ILITE Conference, Perth, A ustralia, 2004, 116-122 A vailable online at http://w w w .ascilite.org.au/conferences/perth04/procs/ben nett.html.

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