The major findings of the study are presented as responses to the overarching question that informed the previous round. However, only summaries of the first two rounds are presented here, in order to contextualise the findings of the third round. Responses from the third round are presented here in aggregate, as a narrative of the themes that arose during the analysis, and supporting quotes are presented.
Panelists in the first round were asked to identify what they thought capable students should “be”, as opposed to what they were expected “to do”. They strongly emphasised a process of active engagement with people and concepts when it came to the characteristics of “being” a professional. They spoke of students needing to engage with and be willing to be part of a developmental process, in addition to “having” knowledge, skills, understanding and attitudes, which were seen as products or final outcomes of a competent student. They also emphasised the personal, affective components of students’ approaches to practice, taking into account the challenges that they often face, and giving voice to the complexity of the clinical context. Panelists identified the challenges of authentic engagement with ethical contexts in healthcare, again highlighting the complexity of the situations that students face and the emotional context in which healthcare is practised.
In the second round, clinical educators were asked how they would go about facilitating a developmental learning process rather than focusing on the products of learning. Many panelists reported combinations of teaching strategies instead of only one approach. Teachers should provide a safe space for students to explore the domain independently, rather than telling students what they need to know. For this, appropriate role modeling is important, in which teachers demonstrate to students not only what to do and to know, but how to be. Using paper patients in small group sessions with guided discussion was a common suggestion, especially around the development of clinical reasoning and critical thinking. Educators should encourage the sharing of personal values and experiences among students and clinicians, as well as the impact of those experiences on themselves. They should build reflective components into the curriculum, asking students how they deal with stress and emotion, and then how they feel about, and deal with, those responses. Students should be encouraged to provide evidence of engagement with their own emotional responses through reflective self-report, which should include a feedback component from peers and more experienced clinicians, who each provide alternative viewpoints. They should also be encouraged to develop agency and active engagement with each other, rather than being passive recipients of information.
In the third round, which will now be focused on in detail, educational technologists and clinical educators were asked about the use of technology in teaching and learning contexts that supported continuing professional development, knowledge and skills acquisition, and emotional responses to clinical practice. Participants described a range of technology-mediated teaching practices that were interactive, integrative and reflective in nature, and which made use of technological features that enhanced student-centred and self-directed learning. In terms of using technology-mediated teaching practices to facilitate the development of lifelong learning and continuing professional development, participants reported that ICTs (Information and Communication Technology) offered a more flexible approach to learning. However, participants also suggested that underlying personal motivation and attitudes were more important than specific technological tools.
“[technology] can be exploited to encourage sharing, debate, questioning and thought provocation. Experts can role model the behaviours by posting links to recent research, plus corresponding questions to encourage further discovery and discussion.”
“The promotion of self-regulation is important in health-professionals education because it underpins the principles of PPDa or lifelong learning, as well as non-technical skills development. ICT may be used to develop self-regulation skills as long as the technology is designed around the teaching and not the other way around.”
“Personal and professional development, i.e. lifelong learning is dependent on the personal attitudes and behaviour of an individual. No ICT per se has the ability to develop the attitudes and values which underpin the principles of lifelong learning. Nevertheless, ICTs may help facilitate PPD as certain professional…organisations have shown. [However], the role of ICT in PPD is secondary to the greater problem of self-assessment and self-regulation amongst healthcare professionals.”
In terms of using ICTs to develop knowledge and skills in the clinical context, participants suggested a range of strategies that promoted interaction, reflection and self-directed learning. In addition, participants advocated the use of ICTs to create more integrated learning experiences that went beyond merely learning facts. The following quotes are presented in support of these ideas:
“Communities of practice are groups of people who share a concern or a passion for something do and learn how to do it better as they interact regularly. ICTs offer greater opportunities for people to create such communities and engage in a ‘process of collective learning in a shared domain of human endeavour’.”
“Reflection can be personal or interpersonal activity, therefore ICTs which foster learning alone or with others may be suited for this purpose. Blogs or even forms of social media which require learners to analyse, evaluate or create knowledge may facilitate reflection-in-action or on-action…[Virtual patients] may allow learners to analyse, evaluate and create new knowledge, whereas learners may be limited as to how much knowledge they can reliably demonstrate using paper-based activities.”
“ICT can be used to promote engagement and interactivity. Audience response systems (ARS) come to mind as a method for facilitating this aim. The same may be true in the context of practical demonstrations. Learners can give feedback about performance during a practical demonstration.”
One of the main themes that emerged was the use of technology to displace content in time and place, moving it out of the classroom in order to create space for discussion and engagement. One common suggestion was for teachers and students to make use of technology to record practical demonstrations and lectures, thereby shifting the content to be available anywhere, anytime.
“Lectures can be provided as audio/video for the student to consume prior to meeting face-to-face (ie flipped classroom).b The face-to-face component can then be devoted to rich learning experiences such as demonstrations, role plays and Q&A’s.”
“ICTs should be considered the foundation stone of clinical study. Relevant tools and resources empower the students to direct their own learning, according to a predefined program or curriculum. Face-to-face sessions can then be focused on enriching and extending the learning experience and making it authentic.”
“Lectures could be recorded and made available to students via a virtual learning environment (VLE) or other institutional platform to view online or for download to student devices. Videos/podcasts of procedures of clinical skills could also be made for students to download and support just-in-time learning either via VLE or iTunes-U.”
In terms of using technology to help support students’ emotional responses to complex clinical situations, participants’ suggested that it be used to create both synchronous and asynchronous supportive environments in which students could share difficult clinical encounters, and discuss those situations in a safe space. The sharing of experience should come from both teachers and students, as appropriate responses to ethical challenges could therefore be modelled to students.
“Creating a space where students can share their experiences and feelings without feeling threatened or judged: a simple example: the inbox message space of [social networks] allows students to share their experience with someone they trust and with whom they can be honest and open without feeling judged.”
“Supporting students’ values and emotional responses may be facilitated by ICTs, especially through the use of blogs or discussion forums.”
“drawings, poems, music to reflect moods and feelings with discussion on blogs and/forums to unpack the ‘art work/drama’.”
While the use of technology to support the sharing and discussion of students’ emotional responses to clinical situations was encouraged, several participants cautioned against the idea that technology is the best way to engage with students around sensitive topics. They suggested that working with students face-to-face at the moment of (or soon after) the clinical encounter is generally more appropriate.
“…this is one area where I think that personal contact with a senior doctor is essential. This is particularly true after traumatic incidents such as when the student participates in a resuscitation and the patient dies, or when they have a needle stick injury from an HIV + patient.”
“I think that f2fc is definitely the safest way to get this kind of feedback. Usually ICT makes it harder for us to get cues that we normally use when giving or getting feedback. So with sensitive areas then we need to be especially careful.”
“I would prefer discussion to occur synchronously alongside or immediately after a learning encounter, however ICT may facilitate discussion to continue asynchronously after the learning activity is completed.”
Finally, while participants described the role of technology in teaching practices as being positive, they also suggested caution, in the sense that “the teaching should drive the technology, and not the other way around”. The following quotes are suggestive of a considered approach to the integration of technology into the curriculum.
“…the role of ICT is secondary to the environment in which the learning or reflection occurs.”
“Print, broadcast media, computers and diffused networks have introduced at least 4 new layers of mediation. It is often the affordances of these mediation layers that capture the attention of teachers and not their students pedagogical needs. When this happens, teaching suffers. When learning, however is foregrounded, and demands of pedagogy & subject matter come before bells and whistles, then technology can indeed enhance and enrich the teaching and learning process.”
“ICTs can be extremely effective at bringing together learning from across a curriculum. This requires skilled instructional design, rather than technology per se.”
