Practice Education for Placements

____________________________________

The Robert Gordon University

January 2017

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INTRODUCTION

Welcome to the Health and Social Care Practice Education short course. We hope you

will enjoy learning and sharing your experiences of Practice Education with the other

course participants.

Format and Accreditation

Many participants join this course as their first introduction to practice education or for

consolidation of their experiences as a student supervisor. We would encourage

participants to continue their studies of Practice Education demonstrating their

knowledge, skills and experiences as a Practice Educator.

RGU’s Practice Education for Placements course is also approved by the Institute of

Biomedical Science, allowing you to become Registration Training Portfolio verifier,

providing that you meet all the other mandatory requirements.

Pre-reading material

Please read the following material in preparation for the course. There are activities

that will be incorporated into the day that you will need to prepare for by using this

workbook.

There are questions and reflections throughout this workbook that need to be

completed before attending the course. Please bring your work with you as it

will facilitate your experience on the day.

You will gain more from the course, activities and discussions if you take time to read

and engage with the material.

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Learning Styles

LEARNING STYLES

The education literature suggests that students who are actively engaged in the learning process will be more likely to achieve success (Dewar 1995; Hartman 1995, Leadership Project 1995). Once students are actively engaged in their own learning

process they begin to feel empowered and their personal achievement and self-direction levels rise.

A key to getting (and keeping) students actively involved in learning lies in understanding learning style preferences, which can positively or negatively influence a student's performance (Birkey & Rodman 1995; Dewar 1995; Hartman 1995). It has

also been shown that adjusting teaching materials to meet the needs of a variety of learning styles benefits all students (Agogino & Hsi 1995; Kramer-Koehler, Tooney & Beke 1995).

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ADULT LEARNING STYLES

What makes adult learners different from kids? Knowles’ theory of andragogy (adult learning) is an attempt to differentiate the way adults learn from the way children

learn. A number of assumptions are made based on this theory as outlined by Cantor (1992, 36-37) and Cranton (1992, 13-14, 49):

Adults are autonomous and self-directed

Adults are goal oriented

Adults are relevancy oriented (problem centred)--they need to know why they are learning something

Adults are practical and problem-solvers

Adults have accumulated life experiences

Kearsley (1996) summarises what this means to instructors in practical terms: "andragogy means that instruction for adults needs to focus more on the process and less on the content being taught. Strategies such as case studies, role playing, simulations and self-evaluations are most useful. Instructors adopt a role of facilitator

or resource rather than lecturer or grader."

What Motivates Adult Learners?

Adults typically, have different motivations for learning than children such as those pointed out by Cantor (1992, 37-38):

To make or maintain social relationships

To meet external expectations--the boss says you have to upgrade skill X to keep your job

Learn to better serve others -- managers often learn basic First Aid to protect their employees

Professional advancement

Escape or stimulation

Pure interest

Instructors should be aware of the possible motivations behind their students' learning.

So they can better shape the instructional materials.

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Differences between Men's and Women's Learning Styles

Not only do adults have different learning styles than children, but men and women do not approach the world of "thinking" in quite the same way either! In 1968, William

Perry did a study of undergraduate New England college students (male). From this study he determined that young men pass through a developmental sequence in their thinking modes. Perry isolated nine stages in the sequence, but in outline the stages

form this pattern (Bodi 1988; Cranton 1992, 47; McNeer 1991):

Perry's "Developmental Process"

1. Male students see the world as black/white, right/wrong--they are convinced there IS one right answer

2. Male students see there is diversity of opinion, but feel that authorities that describe diversity are poorly qualified, or just "exercising students" so students will be forced to find the "right answer" themselves

3. Male students begin to feel that diversity is temporary. They feel that maybe the "right" answer just hasn't been found yet

4. Male students understand that diversity is a legitimate state, but they would still prefer to know what is "right"

5. Male students see that everyone has a right to his or her own opinion

6. Finally the male student develops a personal commitment to the real world...

Belenky et al.(1986) discovered that women have different "ways of knowing".

Belenky et al. "Women's Ways of Knowing"

Received knowledge: women students feel they can receive knowledge, but not create it

Subjective knowledge: truth and knowledge are private and subjectively known or intuitive

Procedural knowledge: women students are invested in learning and applying objective procedures for obtaining and communicating knowledge

Constructed knowledge: women students view knowledge as contextual and can create knowledge found objectively or subjectively

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STYLES OF LEARNING

This section is designed to help you to identify your style of learning and how that relates to our student on placement.

This suggests that there are four stages which follow from each other: Concrete Experience is followed by Reflection on that experience on a personal basis. This

may then be followed by the derivation of general rules describing the experience, or the application of known theories to it (Abstract Conceptualisation), and hence to

the construction of ways of modifying the next occurrence of the experience (Active Experimentation), leading in turn to the next Concrete Experience. All this may happen in a flash, or over days, weeks or months, depending on the topic, and there

may be a "wheels within wheels" process at the same time.

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Experiential Learning Styles

Honey and Mumford (1982) have built a typology of Learning Styles around this sequence, identifying individual preferences for each stage (Activist, Reflector,

Theorist, Pragmatist respectively), Kolb also has a test instrument (the Learning Style Inventory) but has carried it further by relating the process also to forms of knowledge.

Learning styles mean that: At a minor level there is a need for adjustment between learner and teacher: sometimes their preferences are complementary, sometimes

antagonistic, and of course sometimes collusive if they both tend to go for the same stages in the cycle. At a major level, neglect of some stages can prove to be a major obstacle to learning.

Elaborations of the Experiential Learning Cycle

Not all forms of skill and knowledge emphasise all the stages of the Cycle to the same extent, and Kolb has carried the argument further by relating topics and subject areas

to the cycle in the following ways:

Concrete Experience corresponds to "knowledge by acquaintance", direct practical experience (or "Apprehension" in Kolb's terms), as opposed to "knowledge about" something, which is theoretical, but perhaps more comprehensive, (hence

"Comprehension") and represented by Abstract Conceptualisation. Reflective Observation concentrates on what the experience means to the

experiencer, (it is transformed by "Intention") or its connotations, while Active Experimentation transforms the theory of Abstract Conceptualisation by testing it in

practice (by "Extension") and relates to its denotations.

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The Kolb Model

Kolb and colleagues have undertaken extensive empirical work using the Learning Styles Inventory to relate different subject disciplines to the quadrants of the learning

cycle and hence to different forms of knowledge. The latest version of the LSI can be downloaded or taken on-line at http://www.learningfromexperience.com (for a fee).

Popular thinking has identified four different main styles of learning. By thinking about

your preferred style, you can try and apply this to learning new things. If you're able to use your natural style, you're likely to find learning much easier and quicker.

Activists like to leap on a bike and have a go. They learn by doing. Reflectors like to think about things before having a go and to learn by

watching other people try to ride bikes. Theorists like to understand the theory and to have a clear grasp of the

concept before having a go. Pragmatists like to have some practical tips and techniques from someone with

experience before having a go.

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Activists

Activists like to be involved in new experiences. They are open minded and enthusiastic about new ideas but get bored with implementation. They enjoy doing things and tend

to act first and consider the implications afterwards. They like working with others but tend to hog the limelight.

Activists learn best when: Activists learn less when

Involved in new experiences, problems and opportunities

Listening to lectures or long explanations

Working with others in business games, team tasks, role-playing

Reading, writing or thinking on their own

Being thrown in the deep end with a difficult task

Absorbing and understanding data

Chairing meetings, leading discussions Following precise instruction to the letter

Reflectors

Reflectors like to stand back and look at a situation from different perspectives. They

like to collect data and think about it carefully before coming to any conclusions. They enjoy observing others and will listen to their views before offering their own.

Reflectors learn best when: Reflectors learn less when

Observing individuals or groups at work Acting as leader or role-playing in front of others

They have the opportunity to review what has happened and thing about what they have learned

Doing things with no time to prepare

Producing analyses and reports doing tasks without tight deadlines

Being thrown in at the deep end

Being rushed or worried by deadlines

Theorists

Theorists adapt and integrate observations into complex and logically sound theories. They think problems through in a step by step way. They tend to be perfectionists who

like to fit things into a rational scheme. They tend to be detached and analytical rather than subjective or emotive in their thinking.

Theorists learn best when: Theorists learn less when

They are put in complex situations where they have to use their skills and knowledge

They have to participate in situations which emphasise emotion and feelings

They are in structured situations with clear purpose

The activity is unstructured or briefing is poor

They are offered interesting ideas or concepts even though they are not

immediately relevant

They have to do things without knowing the principles or concepts

involved

They have the chance to question and

probe ideas behind things

They feel they're out of tune with the

other participants e.g. with people of very different learning styles

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Pragmatists

Pragmatists are keen to try things out. They want concepts that can be applied to their job. They tend to be impatient with lengthy discussions and are practical and down to

earth.

Pragmatists learn best when: Pragmatists learn less when

There is an obvious link between

the topic and job

There is no obvious or immediate

benefit that they can recognise

They have the chance to try out

techniques with feedback e.g. role-playing

There is no practice or guidelines on

how to do it

They are shown techniques with obvious advantages e.g. saving time

There is no apparent pay back to the learning e.g. shorter meetings

They are shown a model they can copy e.g. a film or a respected boss

The event or learning is 'all theory'

Most of us have elements of more than one learning style. To identify your own learning style go to one of the following web pages:

http://www.engr.ncsu.edu/learningstyles/ilsweb.html http://www.ldpride.net/learning_style.html http://webster.commnet.edu/faculty/~simonds/styles/styles.htm

While none of the above models or the many others in common uses are perfect, they

should give you an opportunity to learn your preferred learning style. Now you can decide to try to alter how you learn, become even more proficient in your preferred style, or adapt learning that is presented to you so that it more closely matches your

preferred style.

Activity one

Identify three key pieces of learning that you want to gain from undertaking the

Practice Educators Course.

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Teaching Styles

Our individual teaching styles help determine how much information is retained and

understood by the student. Just as each of us uses our own personal style of professional-patient interaction, we also use many unique teaching styles with the

students and residents in our offices. However, some general categories of teaching styles can help us look at our own strengths and weaknesses and allow us to expand the variety of teaching styles we use. Table 1, adapted from Quirkb(1994) describes

four basic teaching styles. The characteristics of each style range from a teacher-centred approach on the left to a student-centred approach on the right. The further to

the right we go, the more the students are required to think and problem- solve and the more information they will retain.

Assertive Suggestive Collaborative Facilitative

Gives direction Suggests alternatives

Elicits student ideas

Elicits student feelings

Asks direct questions

Offers opinions Explores student ideas

Offers feelings

Gives information

Relates personal experiences

Invites personal experiences

Encourages/ Uses silence

TEACHER CENTERED

LEARNER CENTERED

Activity two

How would you define the key attributes of an effective Practice Educator?

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Assessment is the Heart of Learning

‘Assessment’ or ‘evaluation’?

These two words have different meanings for different people. In the UK people ‘assess’ students to find out if they have learnt, and they ‘evaluate’ programmes, to

see if they are effective. In the United States the two words are often used the other way around - they ‘evaluate’ students and ‘assess’ programmes. It doesn’t matter

which word you use, as long as you tell other people what you mean.

ASSESSMENT DRIVES LEARNING!

What does this mean, practically? It means we have to plan our assessment very carefully, in such a way that our students will learn what we want them to learn. If we

want students to learn how to manage patients, our exam questions must be patient case studies in which we ask students what their management will be.

Why do we Assess Students?

The main reason is obvious: we want to see if they have learnt what we have taught

them. This kind of assessment, which is done at the end of a period of teaching, is called summative - it is a ‘summary’ of what the students have learnt. To protect society, we should only send out students who are safe - who know their work well

enough not to harm anybody.

In the table below you will find examples of how we should assess the learning of our students, for each domain. If you follow the guidelines in this table, your assessment is likely to be valid - it will test what it is supposed to test.

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Skill/enabling factor to be

examined Suitable assessment method

Manual skill

Performing an X-ray of the forearm

The student has to perform the x-ray on a patient with

fractured forearm, while the teacher watches and marks her/ his performance with a checklist.

Communication skill

Educating an older person on how to prevent falls

The student has to educate the older person on the

prevention of falls, while the teacher watches and gives marks with a checklist.

Decision making skill

Diagnosing and treating an individual with a stroke

The student is presented with a patient following from stroke.

S/he has to examine the patient and make an initial

assessment and draw up a treatment plan, while the teacher

watches.

The teacher can also give the students a written case study,

which gives the history and examination findings, and ask

them how they would manage the patient.

Knowledge

Knowledge of symptoms, signs,

stages, the organism, medication,

anatomy, spread, prevention, etc.

Written examination with short questions, Multi-choice

Questions, essay questions.

Oral examination.

Attitude

An attitude of concern and caring

The teacher observes the student as s/he works in the

department. After a week or so the teacher uses a checklist to make a final assessment of the student’s attitude.

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Writing Learning Outcomes

WHAT ARE LEARNING OUTCOMES?

Learning outcomes specify what a learner is expected to know, understand or be able to do as a result of a learning process.

Why are learning outcomes important?

1. Communicate expectations to learners

2. Review curriculum and content

3. Design appropriate assessment

4. Evaluate the effectiveness of learning

How to write learning outcomes?

Three components:

1. Behaviour – skill or knowledge to be gained. Use an action verb, such as define,

count, list, to describe what a learner will be doing. Choose from Bloom's Taxonomy

according to levels of learning

2. Conditions of performance – under what circumstances will the learning take

place

3. Measurable performance criteria – how the learning will be evaluated

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Example 1 In an oral presentation, student will paraphrase Dr. Martin

conditions of performance behaviour

Luther King’s I Have A Dream address, mentioning at least 3 of the 5 major points discussed in class. measurable performance criteria

Example 2

Given a diagram of…, without consulting a reference sources, conditions of performance

student will be able to identify the…and…and write the Behaviour

correct terms for the process with 100% accuracy.

measurable performance criteria

What is Bloom’s Taxonomy?

Bloom and his colleagues (1956) proposed that knowing is actually composed of six

successive levels arranged in a hierarchy: Knowledge, Comprehension, Application, Analysis, Synthesis and Evaluation. Research has generally confirmed that the first four levels are indeed a true hierarchy. However, research is mixed on the

relationship of Synthesis and Evaluation; it is possible that these two are reversed or they could be two separate activities (Seddon, 1978).

What is its purpose? Bloom’s Taxonomy attempts to divide cognitive objectives into subdivisions ranging from the simplest behaviour to the most complex.

What are the six levels of Bloom’s Taxonomy?

1. Knowledge is defined as the remembering of previously learned material. It requires the bringing to mind of the appropriate information. Example of Learning objectives: know common terms, know specific facts, know methods and procedures, know basic concepts and know principles.

2. Comprehension is defined as the ability to grasp the meaning of material. This

may involve translating material from one form to another (words to numbers), interpreting material (explaining or summarising), and estimating future trends (predicting consequences or effects).

Example of learning objectives: understand facts and principles, interpret verbal

material, interpret charts and graphs, translate verbal material to mathematical formulae, justify methods and procedures.

3. Application refers to the ability to use learned material in new and concrete situations. This may include the application of such things as rules, methods, concepts, principles, laws and theories.

Example of learning objectives: apply concepts and principles to new situations, apply

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laws and theories to practical situations, solve mathematical problems, construct graphs and charts and demonstrate the correct usage of a method or procedure.

4. Analysis refers to the ability to break down material into its component parts so

that its organisational structure may be understood. This may include the identification of parts, analysis of the relationship between parts and recognition of the organisational principles involved.

Example of learning objectives: recognise unstated assumptions, recognise logical fallacies in reasoning, distinguish between facts and inferences, analyse the organisational structure of a work, such as art, music, writing.

5. Synthesis refers to the ability to put parts together to form a new whole. This may involve the production of a unique communication (theme or speech), a plan of

operations (research proposal), or a set of abstract relations (scheme for classifying information).

Example of learning objectives: write a well organised theme, give a well organised

speech, propose a plan for an experiment, and formulate a new scheme for classifying objects.

6. Evaluation refers to the ability to judge the value of material (statement, novel, poem, research report). The judgments are to be based on definite criteria, which can

be internal criteria (organisation) or external criteria (relevance to the purpose).

Example of learning objectives: judge the logical consistency of written material, judge the adequacy with which conclusions are supported by data, judge the value of a work.

Checklist for writing learning outcomes

(√) Focus on outcomes, not processes.

(√) Use an action verb.

(√) Avoid vague verbs such as know and understand.

(√) Use only one action verb per learning outcome. (√) Action verbs should reflect the level of learning required.

(√) Include no more than three outcomes per major topic.

(√) Outcomes are observable and measurable.

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Activity three Identify an everyday task e.g. making a cup of tea. Using Blooms Taxonomy as a guide identify a student stage of learning (1-4) and write a learning outcome for the task.

Activity four

In what ways would you expect students to demonstrate their learning? Consider skills, behaviours, knowledge etc.

Activity five

How would you develop a teaching and learning plan to engage the student as a co-partner in their learning?

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Approaches to Learning

Deep and Surface Approaches

Deep and surface approaches to learning are words that most academics will have

heard. In fact the idea that students can and do take a deep or surface approach to their learning is probably one of the most used bits of educational research in higher education. It is a very powerful and useful principle that we should apply most of the

time to the way we teach. It is particularly applicable in health, and failure to apply it and apply it properly explains how an awful lot goes wrong with the learning processes.

Simply stated, deep learning involves the critical analysis of new ideas, linking them to already known concepts and principles, and leads to understanding and long-term

retention of concepts so that they can be used for problem solving in unfamiliar contexts. Deep learning promotes understanding and application for life. In contrast,

surface learning is the tacit acceptance of information and memorisation as isolated and unlinked facts. It leads to superficial retention of material for examinations and

does not promote understanding or long-term retention of knowledge and information. Critical to our understanding of this principle is that we should not identify the student

with a fixed approach to learning, but it is the design of learning opportunity that encourages students to adopt a particular approach.

Designing for Deep Learning

Very crudely: deep is good, surface is bad, and we should teach in a way that encourages students to adopt a deep approach; although achieving this is not so easy.

Basic Principles and the Approaches to Learning

Medical sciences is a hierarchical subject. There is little point in trying to comprehend peripheral vascular disease without first developing at least a working comprehension

of blood supply, anatomy, clotting etc. This is not to say that understanding of the subject proceeds in a simple linear fashion (the naive bricks in the wall model of learning). Attempting to work with more complex principles without a good grasp of

the more basic principles from which they are built can only lead to frustration and a surface learning approach in which students attempt to memorise solutions to complex

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problems they cannot understand. Encouraging students to practice the application of basic principles will not force them to adopt a deep approach to learning, but it at least

makes it possible.

Putting theory into practice The following table compiled from the work of Biggs (1999), Entwistle (1988) and

Ramsden (1992) provides some very valuable characteristics of the approaches and illustrates the importance of how we manage the curriculum impacts on the learning

process.

Deep Learning Surface Learning

Definition:

Examining new facts and ideas

critically, and tying them into existing

cognitive structures and making

numerous links between ideas.

Accepting new facts and ideas

uncritically and attempting to

store them as isolated,

unconnected, items.

Characteristics

Looking for meaning.

Focusing on the central argument or

concepts needed to solve a problem.

Interacting actively.

Distinguishing between argument and

evidence.

Making connections between different

modules.

Relating new and previous knowledge.

Linking course content to real life.

Relying on rote learning.

Focusing on outwards signs and the

formulae needed to solve a problem.

Receiving information passively. Failing

to distinguish principles from examples.

Treating parts of modules and

programmes as separate.

Not recognising new material as building

on previous work.

Seeing course content simply as

material to be learnt for the exam.

Encouraged by

Students'

Having an intrinsic curiosity in the

subject.

Being determined to do well and

mentally engaging when doing

academic work.

Having the appropriate background

knowledge for a sound foundation.

Having time to pursue interests,

through good time management.

Positive experience of education

leading to confidence in ability to

understand and succeed.

Studying a degree for the qualification

and not being interested in the subject.

Not focusing on academic areas, but

emphasising others (e.g. social, sport).

Lacking background knowledge and

understanding necessary to understand

material.

Not enough time / too high a workload.

Cynical view of education, believing that

factual recall is what is required.

High anxiety.

Encouraged by

Teachers'

Showing personal interest in the

subject.

Bringing out the structure of the

subject.

Conveying disinterest or even a negative

attitude to the material.

Presenting material so that it can be

perceived as a series of unrelated facts

and ideas.

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Concentrating on and ensuring plenty

of time for key concepts.

Confronting students' misconceptions.

Engaging students in active learning.

Using assessments that require

thought, and requires ideas to be used

together.

Relating new material to what students

already know and understand.

Allowing students to make mistakes

without penalty and rewarding effort.

Being consistent and fair in assessing

declared intended learning outcomes,

and hence establishing trust (see

constructive alignment).

Allowing students to be passive.

Assessing for independent facts (short

answer questions).

Rushing to cover too much material.

Emphasising coverage at the expense of

depth.

Creating undue anxiety or low

expectations of success by discouraging

statements or excessive workload.

Having a short assessment cycle.

Table 1 Compares the characteristics and factors that encourage Deep and Surface Approaches to learning. (Compiled from Biggs (1999), Entwistle (1988) and Ramsden (1992))

Activity six

Choose something that you have recently learnt and identify:-

What it was you learnt?

How you learnt it

What learning style was used?

Your views on how you learnt

How you felt about learning it

Activity seven Select a task, either practice related or other. Consider how you would adapt the teaching of the task to meet the needs of each of the four learning styles.

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Learning Agreements and Health Education Academy (HEA) Framework

The Higher Education Academy (HEA) is the national body which champions teaching excellence. THE HEA work with governments, ministries, universities and individual

academics in the UK, and around the globe to provide value to the HE sector by focusing on the contribution of teaching as part of the wider student learning experience (https://www.heacademy.ac.uk/about-us)

The HEA’s Framework for partnership in learning and teaching in higher education has been developed to provide greater clarity and focus in broader discussions of student engagement and partnership. The framework provides a set of partnership values to

offer support for the development and enhancement of partnerships between students, staff and higher education institutions.

(https://www.heacademy.ac.uk/system/files/resources/hea_framework_for_partnership_in_learning_and_teaching.pdf) Figure: A conceptual model for students as partners in learning and teaching in higher education

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The HEA Partnership Principles

There are many different individual and collective motivations for engaging in partnership in learning and teaching for example to design and deliver engaging

student learning experience. A review of the literature on successful partnership and engaged student learning, core

values which underpin successful partnership in learning and teaching are sugeested:

• authenticity – all parties have a meaningful rationale for investing in partnership, and are honest about what they can contribute

• inclusivity – partnership embraces the different talents, perspectives and

experiences that all parties bring, and there are no barriers • reciprocity – all parties have an interest in, and stand to benefit from working

and/or learning in partnership; • empowerment – power is distributed appropriately; all parties are encouraged

to constructively challenge ways of learning that reinforce existing inequalities;

• trust – all parties take time to get to know each other, engage in open and honest dialogue and are confident they will be treated with respect and fairness;

• challenge – all parties are encouraged to constructively critique and challenge practices, structures and approaches that undermine partnership

• community – all parties feel a sense of belonging and are valued fully for the unique contribution they make;

• responsibility – all parties share collective responsibility

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Providing Feedback

Stengelhofen (1993) points out that the clinical teacher / educator is in the unique

position of being able to give the student precise and specific feedback on all aspects of professional development to: 1. Encourage the student to reflect on the work they are doing.

2. Lead the student towards independent practice, including evaluating practice. 3. Build the student's competence across the full range of professional

competencies. 4. Build the student's confidence in their own skills. 5. Provide the opportunity for the student to try out knowledge in the reality of

practice. 6. Identify strengths and weaknesses.

7. Identify precisely what needs to be worked on, to facilitate behavioural change. 8. Ascertain if there are discrepancies between the clinician and student's

expectations and perceptions. 9. Ensure that students are given help and guidance in areas where they feel a

need.

10. Ensure that students do not miss out because they feel unable to ask for feedback, Stengelhofen states that clinicians should be the initiators here.

11. Help students arrive at a complete view of the professional role, as well as the detail within it. (Stengelhofen, 1993, pg. 173.)

Research indicates that the most effective feedback is:

Immediate, i.e. immediately after or even during the session / event.

Constructive and focused

Ideally verbal, followed up by written notes

Discussed directly with the student

Effective if student is invited to give own evaluation first

Providing constructive feedback to students is probably one of the most useful things

for student learning you can do – and most likely to be appreciated by students. Feedback is an integral part of all teaching not just assessment. Feedback is

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constructive observations and suggestions on work done, skills acquired, emerging capabilities and ideas for directing further learning.

Feedback is a starting point for learning – not just confirmation for the students

that they were right or wrong. In particular, students will appreciate advice which helps them discover and address their weaknesses. It is best seen as a trigger for active learning and therefore feedback can be challenging, questioning, widening.

In summary, feedback is about students learning to self-evaluate, helping them to take

greater ownership of their learning and increasing the likelihood that they will come to direct their own learning.

Feedback Guidelines The use of guidelines for giving and receiving feedback can be helpful in facilitating

constructive exchanges. Be aware that these are not hard and fast rules, but merely guidelines.

1. Make sure the other person is ready to listen, otherwise the feedback will be

ignored or misinterpreted.

2. Feedback should be a clear report of the facts based on observation. Make sure it is descriptive and not interpretative. Start with, "I noticed..."; "I saw..."; "I observed..."; "I wonder..."

3. Be specific. Use quotes and give examples of what you are referring to.

4. There is less chance of confusion and misunderstanding when feedback is given immediately after the event. If this is not convenient, set up an appointment to meet as soon as possible.

5. The focus should be on behaviours which can be changed and not on personality

issues.

6. Do not overload the other person with too much information. Keep it simple and to the point. Ask the other person to paraphrase what s/he heard. Too much information can be confusing and leave the other person wondering where to start. Also be cognisant of the other person's self esteem.

7. The goal of feedback should be to offer helpful input. Consider your reasons for giving your comments and ask yourself, "Am I being helpful?"

8. Have the other person share reactions to the feedback. Find out what is helpful and what part is not helpful.

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Activity eight Reflect on a time that you were given feedback. Consider – Where it was given? How it was given? What was said? Was it useful? Did you understand what was said? How did it make you feel? Did it aid your learning? How you would provide the same feedback to another individual?

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Reflection and Learning needs

Reflection and Learning needs

The concept of reflection and using it as a technique to learn is not new. As far back

as 1933 Dewey wrote a highly influential piece of work and defined reflection as: “an active persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusion to which it tends.”

(Dewey 1933)

Many others have developed the concepts and reflection is now accepted as being integral to the process of learning. In his cycle of experiential learning Kolb refers to reflection as occurring after the concrete experience and before conceptualisation. It is

the link between the actual experience and developing an understanding or making sense of it (Kolb 1984).

As well as forming one aspect of experiential learning, reflection helps individuals

identify areas for development or learning needs. Successful reflection is a skill that can be practiced by all professionals whether learners (students) or those with many years experience behind them who are teaching the learners. It empowers everyone

to learn from experience. It enables self-awareness, personal & professional growth and improved practice.

Although everyone can learn from experience, more experience does not necessarily guarantee more learning. 10 years professional practice may not equate to 10 years of

learning about professional issues, it could be only one year repeated 10 times. There may be many times when situations happen and for various reasons there is little or no

reflection. In such instances opportunities to learn from the experience are lost. Practitioners should actively seek ways to ensure that reflection becomes a habit. This helps ensure continuing development as a student, as a professional and as an

educator for students (http://www.ukcle.ac.uk/resources/reflection/you.html).

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As reflection is considered an integral part of practice an educator must make time for reflection so that it becomes part of the student's way of working. Students need time

to develop this skill and it is not a process that can be rushed, but neither is it a process that has to occur at a particular time. The student can reflect on their journey

to and from placement, or between activities or during their lunch break. They could be encouraged to sum up each day with a reflective comment.

With facilitation, students will develop reflective abilities during the course of their learning on placement but it is sometimes a gradual process. Reflection should initially

be developed in a safe environment where mistakes can be tolerated. Then discussions regarding decisions that they made can be discussed and reflected on in a non threatening way.

(http://www.practicebasedlearning.org/resources/materials/docs/Reflection)

Models of Reflection

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Another way of facilitating reflection is the DATA approach. DATA is a problem-solving approach which stands for Describe, Analyse, Theorise and Act. The stages are as

follows:

Describe - the area of practice which you feel needs improvement or change.

Analyse - the factors contributing to the problem area of practice. You should dig deep here and consider the assumptions or underlying beliefs and motives involved.

Theorise - possible ways to improve the practice and suggest ways forward.

Act - on your theory by trying out the new practice to see how it works.

(Hillier 2002) http://www.itslifejimbutnotasweknowit.org.uk/RefPractice.htm

As reflection involves revisiting a situation that has often been a less than positive experience, it can be quite emotive and students will sometimes relive feelings felt at the time of an earlier incident/situation. Any negative emotions should be eliminated

as far as possible during discussions and analysis of the relevant situations to allow the student to go forward and learn from their experiences (Atherton 2005). Reflection

should not be forced upon a student; it can be encouraged and facilitated with careful explanations and positive reinforcement of the benefits.

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One major advantage of successful reflection is the effectiveness with which it helps

identify personal and professional areas for development, or gaps in skills and knowledge. This in turn indicates the individual’s learning needs. As well as studying professional issues, students (and often experienced practitioners) are still learning

how to learn.

Rowntree (1988) says reflection is studying one's own study methods as seriously as one studies the subject and thinking about a learning task after you have done it. Unless you do this, the task will almost certainly be wasted. In any learning situation,

he says, you should prepare for it beforehand, participate actively during it, and reflect on it afterwards.

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As well as discussions to aid reflection, other methods of helping students identify their learning needs are varied and can include:

Keeping diaries, journals, log books, weekly reviews

This is an extension of reflection that involves keeping a diary or other written account of experiences. This is a very useful way of providing evidence for assessment or CPD

purposes that ongoing learning and development has occurred.

Gap or discrepancy analysis This formal method involves comparing performance with stated intended

competencies by self-assessment, peer assessment, or objective testing then planning further education accordingly. This is what happens at the midway and final visits when

the university tutor is present and the student’s performance is compared against the specified criterion referenced learning outcomes in the assessment forms. This can also be done in between tutor visits on a more informal basis.

Self or Peer review

This involves practitioners assessing their own and each other's practice, giving

feedback and perhaps advice about possible education, training, or skills acquisition to improve performance. Students can be encouraged to work together on this where there is more than one on a placement.

Observation

In more formal settings students can be observed performing specific tasks that can be rated by an observer, either according to known criteria or more informally. The results

are discussed, and from that learning needs identified. The observer can be an educator, university tutor or another member of the multidisciplinary work place team.

Critical incident review and significant event auditing

The method involves individuals identifying and recording incidents in which they feel they should have performed better, analysing the incident by its setting, exactly what

occurred, and the outcome and why it was ineffective. Practice review

A routine review of patients’ notes, learning needs forms from the university, reflective

diaries or log etc. can identify learning needs, especially if the format of looking at what is satisfactory and what leaves room for improvement is followed. The main purpose of a learning needs assessment is to help plan future development.

Learning in a medically related profession is unlike any other kind of learning. The search for the one right answer or one best way of learning is a hopeless task,

especially if this is combined with an attempt to objectively measure learning. Any learning needs identified should be very individual to the student identifying them but as with reflection, students will need time and facilitation to achieve this.

Below is a list of some potential learning opportunities which may influence students’

reflection and learning needs.

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Learning by doing

Experience of seeing patients Building up personal knowledge and experience

Discussing patients Managing patients Having errors corrected

Making teaching points during service Listening to experts' explanations

"Picking things up" Charismatic influences Learning clinical methods from practice

Being questioned about thought and actions about patients Teaching by doing

Using knowledge and skill Bite-size learning from "bits and pieces" Retrieving and applying knowledge stored in memory

Learning from supervision Receiving feedback

Presentation and summarising Observing experts working

Learning from role models Learning from team interactions Hearing consultants/experts thinking aloud

Thinking about practice and patients (http://www.bmj.com/cgi/content/full/324/7330/156)

This list is not intended to be exhaustive, individual placement sites and educators will probably develop other ways to encourage students’ learning.

Activity nine

Select the reflective tool that you feel most comfortable with and use it to reflect on

the attributes you identified for an effective practice educator and how these apply to

you. As a guide considering the following may assist you, why you want to be an

educator, importance and value of the attributes and your teaching and learning

philosophy.

Activity ten

Reflecting on your reflection, how can you support and facilitate students’ reflection?

That’s a lot of reflection!

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References ATHERTON J S (2005) Learning and Teaching: Reflection and Reflective Practice [On-

line] UK: Available:http://www.learningandteaching.info/learning/reflecti.htm Accessed: 30 September 2008

Biggs, J. (1999). Teaching for Quality Learning at University, SHRE and Open University Press.

Bloom, B., Englehart, M., Furst, E., Hill, W., & Krathwolhl, D. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive

Domain. New York: Longmans Green.

Boud D, Keough R and Walker D (1985) Reflection: Turning experience into learning.

Kogan Page.

Dewey, J. (1933) How We Think. New York: D. C. Heath.

Entwistle , N. (1988). Styles of Learning and Teaching, David Fulton.

Hillier Y. (2002) Reflective Teaching in Further and Adult Education (Continuum Studies in Lifelong Learning). Continuum International Publishing Group Ltd. http://www.itslifejimbutnotasweknowit.org.uk/RefPractice.htm. Accessed 30

September 2008.

Kolb D A (1984) Experiential Learning: Experience as the source of learning and development. Prentice-Hall. http://www.practicebasedlearning.org/resources/materials/docs/Reflection. Accessed

30 September 2008.

Rowntree D (1988) Exploring Open and Distance Learning. Routledge.

Quirk M.E. (1994) How to learn and teach in medical school: a learner-centered approach. New York: Charles C. Thomas Publishers.

Ramsden, P. (1992). Learning to Teach in Higher Education, Routledge.