This week I have been reflecting on the online course design we have been tasked to do for #EDUC90970. Specifically it has got me wondering whether we apply principles of learning design well in any course. Having been involved in at least one major course design during my time there was a lot of discussion of learning objectives and learning activities but little around learning theories or frameworks. I (and I know many others) have reflected before that medical students seem to want information in certain ways, that reflect more traditional formats, but perhaps we are driving this behaviour through our expectations of knowledge and approaches to assessment. Could we take a step back? Redesign with purpose? As easy as ABC, right?

…sorry wrong ABC. This one.

If I have this right, Professor Diana Laurillard’s Conversational Framework, incorporating 6 learning types – Acquisition, Collaboration, Discussion, Investigation, Practice and Production – was incorporated into the ABC Learning Design approach developed by Clive Young and Nataša Perović at UCL. The original ABC approach was a 90 minute workshop which took participants from a module/course concept, to a “spider diagram” reflecting the amount of “learning types” they want wanted in their course, followed by sequencing these along with specified activities.

• Acquisition – well there are always lectures. But I think these should be chunked and curated with other materials the students already lean to…podcasts, videos, online websites with medical information and resources.
• Collaboration – this is probably where a problem based learning approach comes in. Students given a case that they work on and solve together. But ideally I would add an interprofessional element to better reflect what happens in the clinical world.
• Discussion – a case reflection, beyond the medical where the challenges of the clinical environment, the interprofessional relationships and identities and personal reflections. Or maybe this should just be reflections on anything that has occurred that week in the clinical placement – so students have a chance to take time out and process with peers and an expert.
• Investigation – looking for the evidence of what to do with a clinical problem they are presented with.
• Practice – seeing and presenting patients to the team, participating in the ward round and clinics, writing notes. The usual business of a clinical placement but perhaps better prepared when scaffolded on the rest.
• Production – Doctors produce lots of things (notes, referrals, investigation requests) but we rarely deliberately practice. A virtual or simulated WR give students a chance to produce these in a safe environment with feedback OR COVID saw many students producing evidence syntheses to support busy clinicians, while learning themselves how to navigate and interpret literature. Could we not do this routinely for paediatric evidence?

None of this is particularly new, but somehow helpful to reframe…and think about deliberately.

References

Laurillard, D. (2012) Rethinking University Teaching: A conversational framework for the effective use of learning technologies. London: Routledge Falmer.

Evers, K. (2018) Breaking Barriers with Building Blocks: Attitudes towards Learning Technologies and Curriculum Design in the ABC Curriculum Design Workshop. Erudito. Volume 2. Issue 4 http://eruditio.worldacademy.org/volume-2/issue-4

Let’s start with a definition given this concept is new to me, and I imagine many others. Here’s one. There are many more.

Heutagogy is the study of self-determined learning and applies a holistic approach to developing learner capabilities with the learner serving as,“the major agent in their own learning, which occurs, as a result of personal experience”

Blaschke, L. M., & Hase, S. (2019). Heutagogy and digital media networks: Setting students on the path to lifelong learning. Pacific Journal of Technology Enhanced Learning, 1(1), 1-14. https://doi.org/10.24135/pjtel.v1i1.1 (Links to an external site.) 

I figure heutagogical could be an adjective. My ponderings come from my chosen learning and reading this week and reflections on this idea in my own context. In particular I want to consider it in relation to my field of medicine.

I very much believe in the idea of learner agency. As @StewardHase said in his talk at #SoTELNZ2020 Symposium https://www.youtube.com/watch?v=6MKDIPCacY0 “learners will find a way not matter what you do” as a teacher. He also challenges us to consider if we have incorporated heutagogy formally in our curricula. But I have sometimes frustrated at conversations which feel to me as though highly competent, highly intelligent, adult learners in medicine who feel that many things must be covered in lecture – and largely I am talking about content knowledge for high stakes exams (both under-graduate and post-graduate). Now, one could argue this is the learner, telling us, the teacher how they want the learning to occur and we should listen and deliver.

In the talk above by Stewart Hase, this comes up at the end in a question posed by the audience – when you apply heutagogy, and give learners agency, some student seem uncomfortable and want a safety net, or structure. Stewart responds to this by saying you may need to recognise those learners as a group – and give structure. I suspect in medicine there is a lot of learned behaviour – after all getting into medicine involves a lot of exams (high school, undergrad degrees, post grad) and remembered content from (largely) a lot of lectures. It’s a hard act to halt.

So I looked for examples of what others had done. Eachempati et al applied heutagogy used closed Facebook forums for dental students to discuss a case, and then shared their discussions with a facilitator in a shared forum (also closed)(see below). This in many ways reflects traditional problem-based learning approaches but uses social media, rather than face to face and synchronous communication.

It is also not dissimilar to how our post-graduates learn, in groups, solving problems from previous exams, often face to face. We provide lectures as one source of curated material but we know there are others which are learner driven – old exam notes, websites. And yet, when a lecture is missed on one topic it is a seen a major failing. I wonder if it is simply we have the emphasis wrong. That we need to orientate them to the simple fact that in our post-grad world our lecturers (largely) don’t right our exams and so they “answer” may be anywhere – and they can and should draw on whatever material they find most useful and most accessible for them. Debunk the myth of the lecture. I will ponder some more.

References

1. Blaschke, L. M., & Hase, S. (2019). Heutagogy and digital media networks: Setting students on the path to lifelong learning. Pacific Journal of Technology Enhanced Learning, 1(1), 1-14. https://doi.org/10.24135/pjtel.v1i1.1 (Links to an external site.) 
2. Eachempati P, KS K, Komattil R, , et al. 2017, ‘Heutagogy through Facebook for the Millennial learners ‘, MedEdPublish, 6, [4], 25, https://doi.org/10.15694/mep.2017.000194

The COVID 19 pandemic has made mobile learning an unavoidable alternative (Naciri et al, 2016 https://www.aquademia-journal.com/download/mobile-learning-in-higher-education-unavoidable-alternative-during-covid-19-8227.pdf).

Or has it? There are many contexts in which mobile learning can and has been applied. But there are others it has not quite reached been embedded in. Despite the pandemic. I am fortunate to work in Laos. But as our paper in 2019 described it faces far reaching issues with medical education capacity (https://pubmed.ncbi.nlm.nih.gov/30707856/). To put it in clear context, during my PhD between 2009 and 2013 we translated and implemented one of the first Lao language guidelines for paediatric care in the country. At the time, this was one of the first medical texts. That was a book. At the same time we know where students are learning now – mostly it is on phones and social media – and internet which is unreliable but relatively expensive. However, what they see and the quality of what they learn is hard to gauge (https://core.ac.uk/display/200957037). To put it simply…if there are few Lao language resources online, and few Lao students have capacity to fully learn in English or Thai, French, or other languages…what is the quality and nature of the content they access.

To go from there to a world of mobile, online learning in around a decade is a large leap. But let’s take it…

• Prior to the coronavirus pandemic I argued that countries like Laos need to leap frog. In a relatively colonial approach to education development they often aimed to develop, adopt or adapt curricula from well meaning foreign partners. But universities take years to develop and implement curricula and by the time countries like Laos have replicated them, the other countries have moved on…and therefore will always remain ahead. To make any gains, they need to leap frog – to jump to where the other countries want to be in 2 to 3 years time.
• If we take a visitor and resident view (http://daveowhite.com/vandr/) of Laos, pre-pandemic, the technologies used were very much smart-phone based, drawing on social media platforms. So ideally this is the technology we would use as a starting point. Learning platforms were trialed and found it hard to find traction, not the least because of language barriers and the ensuant difficulties of using passwords!!!
• If we draw on Social Constructivism (https://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/social-constructivism/) Laos has much to gain. It’s culture naturally supports a community of learning, discussions among groups but converting this online does not require a “More Knowledgeable Other” in technical medical expertise, it requires one in online learning approaches…which (at my last check) few and far between locally. There have been enough challenges developing traditional education capacities, let alone online ones. I have seen Lao colleagues drawing on Zoom meetings and webinars, but little beyond this and I wonder how this translates at an institutional level.
• If we take an equity lens, although most students have smart phones and most (>90%) can access the internet daily (despite expense and slow speeds), what about those who cannot? They are not on the first rung.
• And finally there is cognitive load theory (https://faculty.washington.edu/farkas/WDFR/MayerMoreno9WaysToReduceCognitiveLoad.pdf). I have watched senior Lao colleagues navigate online modules and there is no doubt there is an extra, extraneous load which may impact on learning. So keep it simple.

So how do we leap frog? How do we get from here to here?

Perhaps if we draw on a known current ecology of resources (Whatsapp, Zoom, Facebook) we can insert and drive knowledge via websites with basic information in Lao language (as this is a missing link). Providing a scaffold on which students can stand to get their first foot on the ladder.

Perhaps podcasts and videos offer a way in (https://melbourne-cshe.unimelb.edu.au/__data/assets/pdf_file/0008/3398201/designing-authentic-mobile-learning_final.pdf), in a country without a strong written tradition? All are actually quite resource intensive in a country not accustomed to publishing academic content in this way. And bandwith is limited making videos difficult. So perhaps podcasts, which may be difficult to find a foothold, offer a way forward.

Perhaps later we add social interaction via posts and discussion to build on notions of Social Constructivism and “meaning making” from conversations with colleagues? But these are social tools, not used well in education yet, nor recognised as necessarily “valid” by local educational institutions.

Suggestions welcome!

Whichever way we look at it, over the last year we have seen a revolution in technology enhanced learning. No matter the context or content we had to switch to stop. Adapt or await. Await, that is, a return to normal, whatever that looks like. Globally and locally some contexts some managed this change, others did not.

One of my contexts is Laos (Lao PDR and for those who do not know it, the most delightful country wedged between its bigger neighbours – China, Vietnam, Cambodia, Thailand and Myanmar) from which I have been removed physically this past year, but not technically. I have consulted, zoomed, trouble-shooted and tried to understand how to help a country such as Laos, barely on the first (comparative) rung of access to technology make the leap that so many well-resourced settings have done. It is difficult. As Luckin et al stated…”There is nothing new about the suggestion that one should explore the educational context in which learning takes place in order to understand more about learning.’ But do we truly explore these contexts, different to our own? They have not been set up for success. But more on this in posts to come…

Closer to home, I am privileged to work in education across both University-based courses and post-graduate or workplace learning environments. Much switching to online has been an “urgency.” However, in the University context I am struck by the thought, incorporation of learning design or learning frameworks, consideration of synchronous vs asynchronous approaches which have gone into the planning or rethinking of what to do. How to educate? This, after all, is the role of academia – to inform, to provide evidence and under-pinning theory for our actions. But often in the medicine in the work place, the role of academia in education can be minimised. See one. Do one. Teach one?

I think it is time to pay attention.

I have been busy. We all have, reinventing ourselves. But in hospitals we are often grateful just to have kept education alive during the past year. Taking a tutorial, making it available by a video-conferencing tool and then available later for those who could not attend is a good start. But, perhaps it is time to help education thrive. So, the questions I ask myself:

Do the needs of doctors and training doctors actually lend themselves to asynchronous modes, a Community of Inquiry, with support and direction? A platform we can turn to when we have time? After all, scheduling education may not be achievable simply because the care of patients comes first. Yet, this what EBAs and other contextual structures demand.

If this is what is needed, how do we change a culture which is so entrenched? We in medicine are not always nimble. We are slow to move past apprentice models of ward rounds or teaching and learning. How do we suggest, or engage our community in a relatively novel idea which requires a rethink, even from our educators?

Would it ever succeed? In June 2020, as education clearly needed to turn online, our hospital education team discussed that the best way to teach junior doctors was not through lectures online (zoom-based doom) but via a flipped classroom approach via Teams which was new at the time – online material, followed by a forum for questions and an online Q&A . The response from trainees….none. Zoom tutorials with recordings became the norm….

So where to now?

I have began to reflect on our Ecology of Resources for a learner-centric view (http://learnergeneratedcontexts.pbworks.com/f/Ecology%2Bof%2BResources%2B08.pdf). What tools did our learner use then both for learning and for sharing? Did we push a technology tool which was unfamiliar? Perhaps we needed to spend more time acclimatizing our learners to both the tool and why we were taking that approach. What (if anything new) do our learners use now? We are thinking about using VandR mapping to understand this and integrate this knowledge in our own design or plan for learning. To be continued…