Using Online Digital Tools and Video to Support International Problem-based Learning

Cindy E. Hmelo-Silver, Rutgers Cheshta Khurana, RutgersSusanne P. Lajoie, McGill Jingyan Lu, HKU Jeffrey Wiseman, McGill Lap-ki Chan, HKU Ilian Cruz-Panesso, McGill

Overview

Why PBL?Why connect across cultures?Communities of inquiry frameworkDesign of PBLTechnology toolsInternational PBL studyImplications

The Problem:

Need for cultural competence in communication by physiciansProposed Solution:

Problem-based learning (PBL) connecting medical students across continents

Problem-based Learning(Hmelo-Silver, 2004, Hmelo-Silver & Barrows, 2006)

Learning through solving ill structured problemsCollaborative groupsChanged roles

Teacher as facilitatorStudent agency

SupportsKnowledge constructionCritical analysisProblem solving

Problem Scenario

Identify Facts

Generate Hypotheses

Identify Knowledge Gaps (Learning Issues)

Engage in Self-directed Learning

Apply New Knowledge to

Problem

Evaluate

Reflect

Connecting across Cultures

Technology to create communities of learnersVideo to provide:

ContextCommunication space

Supports collaborative engagementResearch question:

Can this potential be realized?

Community of Inquiry Framework(Garrison, Anderson, & Archer, 2000)

Students responsible for:Generating Supporting Building understanding in small group activities

Social presencee.g., open communication, group cohesion

Cognitive presencee.g., triggering event, integration

Teaching presencee.g., instructional design, facilitating discourse

Instructional Goals for PBL

1. List difficulties in communicating bad news to a patient with strategies for addressing these issues.

2. Describe one way of approaching a bad news communication session (SPIKES).

3. Use the SPIKES model to analyze a video of a bad news communication session.

4. Discuss and reflect on how the use of the SPIKES model may have to be changed in response to context, culture and language barriers.

PBL Design

Context Two video-based problemsConnecting medical students from Canada and Hong Kong University using AdobeConnect

Phase ITwo PBL sessionsSession 1, Canadian Case, facilitatorSession 2, Hong Kong case, facilitator

Phase IIPractice on stnadardized pation

Technology Tools

AdobeConnect: off the shelf video conferencing tool

Using Video Triggers for PBL

Technology-rich environment for PBL (Lajoie et al, 2011)

Delivering bad news to patientsExploring role of affect and culture

Methods

Participants2 Canadian medical students2 Hong Kong medical students

Data SourcesVideo transcriptsChat logsFocus group transcripts

AnalysisInductive—facilitation, cultureDeductive– community of Inquiry

Inductive Analysis

Transcripts examined for emergent themesCultureFacilitationTechnology

Students highly engagedDay 1: 234 turns Day 2: 266 turns

Initially, technology discussion focus (47 turns)

Comparing Practices

• I am just wondering, the video I guess is taking [place] in Canada, what are the procedures like are about testing like for HIV. Is.. throughout the video, my thoughts in thinking cuz in Hong Kong what happens is we have to get consents from the patient when we test for HIV viruses. And so in that sense um so, so that the patient would already given consent for HIV to be tested, that means they would have some sort of expectation already, so I am not sure ar is this the case in Canada? …

Facilitating the FacilitatorExpert facilitator provided advice on PBL process and group dynamics through chat box:

Perhaps ask students to go over the whiteboard and remind them that they need to get ideas down. Maybe get suggestions for how to organize ideas-- can what they learned from SPIKES framework…”

HKPE then suggested to the students:Looking at the white board, so we have um quite a number of facts…from the video. Okay, can we also start to think about …the ideas that we have about the performance of the doctor in the video how he should or should not have… communicating the bad news to the patient. Can we also …jot down some of these ideas, …start organizing our you know our thoughts about what gone really well in the video or not to mention too many ar, and what are the improvements we would suggest…

Facilitating Conversation about Cultures

HKPE: ...Supposed we are just making an assumption that this is a typical patient …would react to that kind of bad news to Hong Kong, and you was thinking … in a different country the patient would react in a different way. Right?C2: Very likely but … I would just say that, there are yes in Canada probably because of the history with … people people coming from a lot of different places. We can end up with a lot of different variability in terms of the type of responses you might get from the patient because of their background and so it’ll be a little bit hard harder to make to say what a typical response might be.

Living in a Global Village

I think the whole international theme that went on the for … PBL really reminded me of being in Australia. Where you get a group of Caucasian people sitting with Asian people in the rooms chatting about the patients and trying to critique on how things can be improved.

What I am trying get here is that different colors, different cultures, different language experience or even knowledge experience I think it really just really shows that we are living in a global village where we could acknowledge common themes, acknowledge common facts, and ideas that are very much comparable.

Deductive Analysis Coding: Communities of Inquiry

Teaching presenceDescribes role of online facilitator

Social presencePresenting as real people

Cognitive presenceCritical thinkingPhases of inquiry

Triggering eventsExplorationIntegration Resolution

Discussion

Proof-of-conceptSynchronous video conference allowed engagement DESPITE technology glitchesVideo triggers serve as boundary objects across cultures for affective and cognitive issueExpert facilitator can provide just-in-time coaching

Culture was explicit focusDifferencesCommon culture of medicine

Technology, context and human facilitation support the teaching, social, and cognitive presences

Conclusions

Fruitful demonstration but need to test at larger scaleChallenges of:

Coordinating time, technology, bandwidthsConstructing cases to promote meaningful discussions

ImplicationsStudents develop awareness of similarities and differencesTraining PBL facilitators in cross-cultural PBL