Niall Winters, Caroline Pelletier, Catherine O’Keeffe & Sara Price{n.winters, c.pelletier, c.okeffee, s.price}@ioe.ac.uk

@nwin | @eastriviera | @CatherineOKeef1

http://www.lkl.ac.uk | http://www.ioe.ac.uk | http://www.londondeanery.ac.uk

June 26 2013

Technology Enhanced Clinical Education

#tece #meded

Aim

• You will work with educational experts and technologists to design a learning support tool that addresses the needs of clinical educators/trainers and trainees

Programme Dates• 14.00-17.00, June 26th 2013 Introduction

– Outline problem spaces, generate initial ideas• 10.00-13.00, July 22nd 2013 Development

– Develop the initial ideas into concrete learning support tools – Pilot intervention

• 14.00-17.00, Sept 26th 2013 Tool refinement – Pilot analysis resulting in extended development of the learning support tool

• October 2013 – April 2014 Feedback and iterative development (in-situ)– Educational experts from the IOE will come to your workplace in October, December,

February and April to help further develop and evaluate the learning support tool • 14.00-17.00, May 22nd 2014 Reflection

– Reflection on the iterative extension of learning support tools resulting form pragmatic use

• 14.00-17.00, June 26th 2014 Consolidation– Drawing together and final outputs– Best learning support tool Award

Agenda

• 14.00-14.15: Welcome and Introduction• 14.15-14.45: The role of technology in clinical

training and education• 14.45-15.15: Discussion of selected submitted

cases (and examples from the literature)• 15.15-15.30: Coffee break• 15.30-16.15: Group work on initial design ideas• 16.15-16.45: Discussion• 16.45-17.00: Next steps

Developing people for health and healthcare

working on behalf of

Faculty Development ….

in the new world

Why is TECE important?

National picture

• HEE’s Better Training Better Care (BTBC)– Number of pilots funded

• Limited innovative uses of technology

• A Framework for Technology Enhanced Learning (report from Dept. of Health)

1. Local implementation and pilots

2. Role of the trainee

3. Role of trainers

4. Workforce planning

5. Improving careers guidance and availability

6. Integrated technology enhanced learning1. Casebook for simulation, elearning, mobile learning (focus on

apps), with a showcase in early 2014

7. Broadening the Foundation Programme

8. Regulatory approach to supporting Better Training Better Care

9. Funding and education quality metrics

What do we mean by education?

What do we mean by technology?

As Jerome Bruner (1996, p. 146) put it, learning ‘is not simply a technical business of well managed information processing’. Instead, learning can be seen to involve an individual having to make sense of who they are and develop an understanding of the world in which they live. From this perspective learning can be seen as a continuing process of ‘participation’ rather than a discrete instance of ‘acquisition’ (Sfard 1998).

From Sfard (1998)

Technologies are not ‘neutral’ tools but instead structure human activity (Winner, 1986). How do they do this?

Lievrouw and Livingstone’s (2002) description of three distinct – but interconnected – aspects of what ‘technology’ is:• Devices: the technology itself and

how it is designed and made• Activities and practices: what

people do with technologies (including issues of human interaction, organizing, identity, cultural practices)

• Context: social arrangements and organizational forms that surround the use of technologies (including institutions, social structures and cultures)

If education is a process of participation and technologies structure learning activities, what does this mean for designing and using technology in clinical training?

A direct focus on practice is crucial

“The use of a practice lens to study technology use in organizations focuses attention on what people actually do with particular technologies in their ongoing and situated activity.” (Orlikowski, 2000)

Examples

Example 1 (from submissions)

• An interactive website and webapp for post-graduate trainees and nurses on the neonatal unit that allows them (as a group) to keep a record of their learning activity whilst on the neonatal unit - including the outcomes of formal and informal learning, practical procedures etc. This record may be in the form of written posts, photo, audio or video. It should also give the ability to have interaction between seniors and trainees - asking questions and leaving comments which can be answered on the site. It should give the trainees an easily accessible record of their learning journey, and allow interaction amongst peers and with seniors.

Example 1 (from submissions)

• An interactive website and webapp for post-graduate trainees and nurses on the neonatal unit that allows them (as a group) to keep a record of their learning activity whilst on the neonatal unit - including the outcomes of formal and informal learning, practical procedures etc. This record may be in the form of written posts, photo, audio or video. It should also give the ability to have interaction between seniors and trainees - asking questions and leaving comments which can be answered on the site. It should give the trainees an easily accessible record of their learning journey, and allow interaction amongst peers and with seniors.

Questions

• What is the problem in your practice being addressed?– [Fill in]

• What is the technology in use?– [Fill in]

• What activities will participants engage in?– [Fill in]

• How will the technology support participation (a) in practice and (b) between practitioners?– [Fill in]

Example 2: Judgment• Smartphone and web-based app for enhancing learning of prescribing

and therapeutics.

• Dual theme– A virtual logbook of personal drug choices (known as p-drugs) that

students become familiar with for common medical conditions. As they learn more about the drugs, they enter the info into specified tabs (ie indication, dose, route, side effects, interactions) in a cumulative way over months/years to build a personal formulary, based on current medical school top 100 drugs

– within same portal is the ability to work through example patient-based clinical scenarios that lead the user to therapeutic dilemmas, problems and decisions to enact accurate and safe prescriptions on virtual drug charts, to enhance the practical application of drug prescribing as well as the theory as per 1 above.

Example 2: Judgment• Smartphone and web-based app for enhancing learning of prescribing

and therapeutics.

• Dual theme– A virtual logbook of personal drug choices (known as p-drugs) that students

become familiar with for common medical conditions. As they learn more about the drugs, they enter the info into specified tabs (ie indication, dose, route, side effects, interactions) in a cumulative way over months/years to build a personal formulary, based on current medical school top 100 drugs

– within same portal is the ability to work through example patient-based clinical scenarios that lead the user to therapeutic dilemmas, problems and decisions to enact accurate and safe prescriptions on virtual drug charts, to enhance the practical application of drug prescribing as well as the theory as per 1 above.

• Our view: explore the tension between evidence and practice around decision making

Question

• What is the problem in your practice being addressed?– [Fill in]

• What is the technology in use?– [Fill in]

• What activities will participants engage in?– [Fill in]

• How will the technology support participation (a) in practice and (b) between practitioners?– [Fill in]

Pre-CbD Reflective Tool

Pre-CbD Reflective Tool

Themed GroupsReflectionCaroline FertlemanGloria EsegbonaChatenya ChauhanSiobhan Cooke

Professional development of supervisorsHelen Burgess

Group learning Hammad Khan

Videos of practiceTara RentonRoberta BrumClaudia SalazarHelen O' TooleJane NeerkinDeen MirzaDavid SayerRekha Bhalla

Portfolio contentClare EtheringtonAndrew PerriamVikas KapilAllan Andy

Next steps

• Moodle– Logins to be sent within a week– Groups– Papers and discussion groups

Next steps• The project pro-forma, for presentation at the next workshop• Writing a scenario – an example:Informal mentoring of GP traineesAs an educational supervisor of GPs, Paula is allocated her trainees in year 1 but does not deal with them on a daily basis until year 3. During years 1 and 2, she is working in practice while her trainees are based in secondary care. Some of her trainees have requested that she explore opportunities for forms of unstructured sharing of experience to support building up of the relationship at a geographical distance. The trainees are interested in informal mentoring that moves away from reflective logs and e-portfolios. Paula is not a keen user of technology in her work (other than her PC) but she does have a smartphone. She is of the opinion that technology could interfere with the quality of supervisory relationships, rather than supporting it. Nevertheless, she is convinced by the enthusiasm of her trainees and is intrigued when one of them sets up a private twitter group where she and her trainees can share interesting links, and comments on each other’s daily practices.