2 X-rays – 2 very different patient experiences

I’ve been exploring the patient perspective recently – not at all voluntarily but with great interest. I’ve had 2 x-rays done in the past months and I can’t help comparing them.

First experience
Got a referral to a large hospital for an x-ray of my sinuses since I’ve had so much trouble with them lately. Made it to the hospital on the day of my appointment and after some waiting I was strapped in the x-ray-machine by the “x-ray nurse” (no-one had so far asked me why I was there, I assumed they new “all” about me from the referral…). Pictures where taken, and while I was still strapped in the machine, a man enters the room, gives me a not very friendly look, stares at the screen for a few seconds, says something to the nurse and then leaves. I ask the nurse who that was, and he explains that it was the physician who will analyse my pictures later. Ok… so, I was done, but I couldn’t help myself and before leaving I asked if the x-ray shows anything? I’m thinking that the nurse must have seen many x-rays and should be able to say something… but no – I have to wait for the answer to the referral to be sent back to my referring physician and then she will contact me. So I leave without having any clue as to whether something is actually wrong with my sinuses or if I’m just going insane.

Second experience
3 weeks later my physician calls me and says that I need to visit my dentist to exclude that there’s anything wrong with my teeth causing the problems with my sinuses. I call my dentist and get an appointment the following day (!). I still haven’t got the papers my physician sent me, but after a second phone call I feel confident I can explain the issue to my dentist. When I arrive, everyone introduces themselves, they ask about my problem and I get to tell the whole story (which to me feels good even though I would have liked them to have seen the x-rays from earlier…). My dentist takes the time to explain exactly why my physician wanted me to get the dentist to look at my teeth. She then proceeds to take the pictures. All the time, I can see the same screen she’s looking at with my dental record and the x-ray images. She’s not content with the first pictures, and explains to her assistant (and me!) why not, so a second set is taken. She then explains in detail to me what we are seeing on the screen, how she interprets it and why she concludes there is no problem with my teeth! She also explains what she can see relating to the problems with my sinuses – so I now have a much greater understanding of what the problem actually is. She also does her best to answer all my questions regarding this. The whole time, I feel as if I’m the most important person in the room, as if I’m competent to understand basic information about my own health, and as if it’s actually important that I do understand. Great feeling – and completely the opposite to the first experience.

Perhaps this was just a bad day at the hospital, perhaps my dentist is exceptionally good at patient participation, or perhaps it’s something more. Would it be possible for the experience of getting an X-ray at the hospital to be similar to the one at the dentist? What are the barriers? Is it a technical problem (the pictures takes longer to process? can’t have the screen in the same room as the patient?)? Or a lack of time (the physician not having the time to do the interpretation while the patient is still in the room?)? A matter of distributed responsibilities (the x-ray physician is not responsible for talking to the patient, this should be done by the referring physician)? Or simply a cultural difference? Either way – having the experiences so close to each other I couldn’t help compare. Anyone else with similar experiences?

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Opening up my practice

We have now reached unit 6 in the course flexible, distance and open learning  and the topic for this unit is “Open educational practices”. I will here reflect on my current practice and identify I can provide opportunities to my students to connect with individuals, groups and resources beyond the course, module, programme boundaries.

An idea that I have already written about is to use blogging as a tool for my students to interact more openly. I will revise some of the content here, and also add some reflections based on the insights I’ve gained so far in the course.

In one of the courses in health informatics I teach, the students work in smaller groups (5-6 students with mixed backgrounds, some clinicians and some developers/engineers) throughout the course to analyze needs and requirements for a health informatics system of their choosing. It is very difficult to gain access to real stakeholders/end users during the 6 weeks the course is running and so the course (albeit being hands-on in the use of different analysis and modeling tools) becomes quite abstract and disconnected from reality. The students are very creative in their work, but have complained about not really knowing whether their ideas are really relevant or not (despite getting feedback from me, they want to hear from the real end-users which is exactly what I teach them is important). An idea I’ve gotten was that if the students were to describe their proposed systems and progress continuously on blogs, would it then be possible to get feedback from real stakeholders? By making the blogs public perhaps we could actually get healthcare professionals, patients and other stakeholders to access and comment on the proposed solutions.

Hilton et al describe three different types of learner interaction that is important to support; learner – content, learner – learner, and learner – teacher. The blogs I suggest could be a means to support interaction within the course, but my goal is rather to create opportunities for learners to interact outside the course. I’m not entirely certain what this interaction might be called, perhaps learner – public interaction? Either way, it would be interesting to explore how useful such interactions could be.

I see two main challenges to get this idea working, (1) to get others to feedback/comment on the students blogs, and (2) to get all students to feel comfortable opening up their learning like this.

Here’s my plan to address these issues.

1. FEEDBACK FROM OUTSIDE I think that there are a lot of people out there who are interested in health IT and who are eager to comment and give feedback. If I were to organize f2f sessions with such people it would however be costly and time consuming. BUT, reading someones blog posts and writing a few lines back is much less resource consuming. And since I have a growing network in Sweden and internationally of people (both technical and clinical) who are interested in health IT, why not make use of it? So, today I asked on twitter (making use of the fact that it’s an IT in healthcare conference going on in Stockholm today with the hashtag #ITivardendagen) for volunteers to read and give feedback on my students blog. In a matter of minutes 5 persons expressed their interest, and I haven’t really started trying yet. So, I’ve got high hopes for this, and I’ve decided to at least give it a try when my course starts in January – and even if the feedback from outside does not work, we’ll  use traditional peer feedback which will be an additional learning experience for the students.

2. DIGITAL LITERACY AND OPENNESS – one concern I have is that not all students may feel comfortable sharing their work online. My plan is to let them choose; since we have the opportunity to create closed blogs within the learning platform we use at Karolinska Institutet it would be possible for students to reflect and receive feedback within the course. I will however clearly describe the rationale for using open blogging, and provide an introduction to the tools, to support and motivate those students who are uncertain. Simpson also focus on motivation as a key aspect of online learning [2], and I believe that both peer feedback and (perhaps even more so) feedback from the public could increase student motivation and creativity.

I have other ideas for opening up my teaching practice, some I have described previously here. Providing my courses as completely online courses is not relevant right now, but I think it could be a step-wise development – by using more open, online resources in our campus-based teaching the effort required to offer the course fully online is decreased. Finally, I do find the idea of open courses appealing and hopefully in the future more of the health informatics courses we teach at KI can reach a wider audience!

[1] John L. Hilton III, Charles Graham, Peter Rich and David Wiley, Using Online Technologies to Extend a Classroom to Learners at a Distance

[2] Ormond Simpson. Motivating learners in open and distance learning: Do we need a theory of  learner support?

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How I support my students and opportunities for further improvement

Today, I’m reflecting on how I support my students’ learning today and opportunities for improvement using online tools. I teach two courses at the International master program in health informatics in at KI. The student group is very heterogeneous with varied experiences and expertise; roughly half have a clinical background (physicians, nurses etc), whereas the other half have a technical background (software engineers, computer scientists etc). The entire program is campus based, and most interactions are f2f. However, in my courses I use the learning platform pingpong to guide the students through the course. There I post information about the different parts of the course, clear instructions for assignments and deadlines (the students also upload their assignments there and get feedback on them), all literature and lecture notes are posted there, and we use pingpong for communication. One of the courses is based largely on collaborative group work, where the students are divided into smaller groups and work together to produce a requirements specification for a health information system of their own choice.

Coomey and Stephenson identify dialogue, involvement, support and control as four key elements in designing online courses [1]. Of course, my courses are not exclusively online, rather blended, but I still consider online tools great for improving the all four aspects in my teaching practice.

Support: When I first started teaching my courses, I gave the students their assignments and told them to contact me whenever they needed support. Needless to say, it didn’t work. The students that did contact me were the ones that were doing really well, the groups in trouble didn’t contact me at all. When I realized they were not on track, half the course had passed and they had no time to catch up. So, after this experience, I’ve changed my teaching practice to a more pro-active approach, and now we have scheduled check-up points ones a week where the students present their work so far and we discuss any difficulties they’ve run into. Works much better! Still, for me to able to give really useful formative feedback (something stressed in the literature) I would have to monitor their work more more closely than I do currently, and I simply don’t have the time to do so. Therefore, I have considered using online tools to help the students engage in more peer feedback (which is also very useful for learning). For example, by making the students share work in progress between groups, they can (with clear instructions) also feedback on other students work on a regular basis.

Dialogue: I’ve also showed the students all the discussion boards and tools for online collaboration that are available within our learning to platform, but without any clear structure for when and how to use these tools. Again – discussion does not occur spontaneously, quite in line with the results described in [1]. Now, the two courses I teach are very different in structure – the first is very much based on group work (face-2-face) and we meet on campus several times/week, whereas the second course stretches the entire semester and we only meet every 3 weeks for a seminar, in between the students are expected to work individually analyzing different cases. In the second course I intend to add more structured discussion forums next year. The students will be divided into smaller study groups, and each group will have a discussion forum online where I (and hopefully some teaching assistants) will post questions on a regular basis for them to discuss. This way, I hope to support their learning through more proactive dialogue.

Involvement: according to Coomey and Stephenson this relates to learner motivation and having relevant tasks which can engage learners in the activities. This is something I’ve spent a lot of time struggling with, and I have some ideas for how I can use online tools to both increase motivation and opening up the learning practices. In a previous blog post I discussed using blogging as a tool to motive learners and engage with a broader audience. I plan to experiment with this next year – I’ll keep you posted!
Simpson also focus on motivation as a key aspect of online learning [2], and I believe that both peer feedback and meaningful activities can increase student motivation.

Control: relates to how much the learners can control e.g. their time, managing their activities and their collaboration. I must say, the FDOL course I’m taking now really gives most of the control to the learners, and I’ve appreciated that quite a lot (although it is quite challenging). I try my best to relinquish control to the learners in my courses, but I believe it’s important to keep a balance between control and support. As discussed in [1], learners with little experience of self-directed learning can struggle if they are not given too much control without enough structure. In my experience, teaching at a global master program, students experience with this varies greatly. Many expect the teacher to have the control, and get frustrated if they are asked to act more independently, finding their own literature and setting their own goals. Therefore, I try to provide structure and clear instructions to keep all students on the right track – but at the same time encourage learner control by e.g. letting them choose the topics of their own group work.

As much as I would like to say that my teaching practice is of the learner managed type, I have to admit that I still keep a lot of control. I suppose it is a process one has to go through as a teacher as well, to give up control to the students.

[1] Marion Coomey and John Stephenson. Online learning: it is all about dialogue, involvement, support and control

[2] Ormond Simpson. Motivating learners in open and distance learning: Do we need a theory of  learner support?

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World Usability Day 2013

World Usability Day is an international event taking place on the second Thursday in November every year. It is a day with focus on usability, user experience and accessibility. This year’s theme is “Healthcare: Collaborating for Better Systems” and of course we want to acknowledge this at the Health Informatics Centre (HIC).

Therefore, we are organizing poster sessions and lectures together with among others STIMDI – the Swedish Organization for Human-Computer Interaction. We hope that in doing so, we create a forum where the worlds of healthcare and usability experts/designers can meet – as this is always needed.

Details

What:                 Interactive poster session (in English)
When:               Thursday 14th of November, 13.30-14.30
Where:              Karolinska Institutet, Berzelius väg 3 in Solna
– outside lecture hall Andreas Vesalius

What:                Presentations (in Swedish) see program
When:               Thursday 14th of November, 15.00-18.30
Where:              Karolinska Institutet, Berzelius väg 3 in Solna
– lecture hall Andreas Vesalius

To attend the lectures 15.00-18.30 (free of charge), you need to sign up at the STIMDI web page, if you are only interested in the poster session – just show up!

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Extending collaborative learning using digital technologies

I’m continuing the course “Flexible, distance and online learning” (FDOL) and the past weeks we have been discussion collaborative learning and how it can be extended using digital technologies. In this blog post I will discuss some of the aspects I have learned and how these are applicable in my own teaching practice.

Definition of collaborative learning

Dillenbourg gives a broad (and admittedly unsatisfactory) definition of ‘collaborative learning’ stating that “it is a situation in which two or more people learn or attempt to learn something together” [1]. He continues to identify different aspects of the definition that gives room for interpretation; (1) the number of students, which can range from a pair, to a small group (3-5 subjects), a class (20-30 subjects) all the way to a community (a few hundreds or thousands of people) or a society (several thousands or millions of people), (2) the learning situation could be to follow a course, study course material, perform learning activities such as problem solving, or learning from lifelong work practice, and finally (3) the means of interaction which can be face-to-face or online/computer-mediated, synchronous or not, frequent or not, etc. So, collaborative learning can vary greatly in scope and scale – the common denominator being that unlike in individual learning people capitalize on one another’s resources and skills (asking for information, evaluating one another’s ideas, monitoring each other’s work etc.). Siemens suggest another scale to discuss collaborative learning, describing how learner-learner interactions in an e-learning course can be viewed as a four stage continuum [2]:

  1. Communication (people talking, discussing)
  2. Collaboration (sharing ideas and working together, occasionally sharing resources, in a loose environment)
  3. Cooperation (doing things together, but each with his or her own purpose)
  4. Community (striving for a common purpose)

Siemens argues that most collaborative learning in a course takes place between the 1st and 3rd levels, whereas the 4th level is difficult to achieve within one course [2]. I am inclined to agree – even getting past the communication level can be difficult depending on the factors identified by Dillenbourg above. In the Health Informatics Masters program, one way we strive to use online tools to create a sense of community within the student group is to give them opportunity to build up an online platform, including blog, calender etc, which is entirely run by the master students and in which they create content together. In addition, of course the learners’ motivations and external factors affect the collaborative activities, e.g. in the online Problem Based Learning (PBL) group I’m currently involved in myself where all learners are taking the course while working more or less full time in parallel.

 Benefits and challenges of collaborative learning

There are many benefits of collaborative learning. In a review by Laal & Ghodsi [3] the benefits are divided into four major areas;

  1. Social benefits – creates a social support system for learners, build diversity understanding among students and staff, establish a positive atmosphere for modeling and practicing cooperation, and develops learning communities
  2. Psychological benefits – student centered instruction increases students’ self-esteem, cooperation reduces anxiety, and develops positive attitudes towards teachers
  3. Academic benefits – promotes critical thinking skills, involves students actively in the learning process,
  4. Assessment benefits – collaborative teaching techniques utilize a variety of assessments where peer assessment can be a key ingredient.

In the courses I teach, I definitely use collaborative learning activities to increase both social and academic benefits. I have not yet utilized the assessment benefits, this has remained more traditionally teacher assessment, but I plan to include collaborative peer assessment both between groups (one collaborative group giving feedback on another groups work), and between individuals to increase collaborative learning in a course that is very much based on individual work. However, despite the many benefits, it is not uncommon that learners experience frustration with collaborative learning [4]. The main problem described by learners in this study was commitment imbalance, i.e. some learners take on the role of “free rider”, contributing very little or not at all to the work, whereas others may take on too much responsibility doing the majority of work (which does not support the goals of collaborative learning). The study focuses on online learners’ frustration, but my experience of participating in both online and offline group work myself, and using face-2-face group work for my students, is that this problem is not exclusive to the online world.

Using digital technologies

So, how can we use digital technologies to extend collaborative learning? One of the strategies deemed important by Brindley et al is to “monitor group activities actively and closely” [5]. I believe that this can be a benefit of online learning – especially when it comes to the problem of commitment imbalance described above. By using online tools such as discussion forums, collaborative writing tools (e.g. shared documents or wikis) it can actually be possible to monitor (and perhaps assess?) the collaborative processes, not just the output of them. For example, in traditional collaborative learning it may be difficult for an instructor to actually be available and monitor group discussions and see who is present and participate (unless such discussions are scheduled on campus with the facilitator present which is rarely possible or desirable). If assigned tools are used for such online discussions instead, the input and contribution of individual students becomes more visible – both to the group and to a more or less intervening facilitator. A tricky part in my teaching is that it is blended, so students meet face-to-face but have access to online tools. So, how can I insist they use the online tools for their group work? One incentive may be that a facilitator can then help them and give continuous feedback – but this of course requires a lot of time. Another may be that they themselves give each other feedback – for example between groups. Yet another would be that the end-results should be presented online, and that part of the outcome is to describe the process of reaching the end-results, e.g. in a blog where each student is responsible for writing a reflective post about the collaborative work done during the week. Regardless of the approach we finally take in the course, I have a lot of new ideas for how I can use digital technologies to extend collaborative learning.

[1] Dillenbourg P. (1999) What do you mean by collaborative learning?. In P. Dillenbourg (Ed) Collaborative-learning: Cognitive and Computational Approaches. (pp.1-19). Oxford: Elsevier

[2] Siemens, G. (2002).  Interaction. E-Learning Course. October 8, 2002. http://www.elearnspace.org/Articles/Interaction.htm

[3] M Laal, SM Ghodsi (2012) Benefits of collaborative learning, Procedia-Social and Behavioral Sciences, 2012 – Elsevier

[4] Neus Capdeferro and Margarida Romero, Are online learners frustrated with collaborative learning experiences?

[5] Jane E. Brindley et al. Creating effective collaborative learning groups in an online envrionment

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Flipping the classroom – making my teaching more fun!

This blog post is part of the examination for the course IT in education I’m taking at Karolinska Institutet (KI). The course has introduced a number of different tools and techniques to help us as teachers in higher education to explore the benefits of using online tools in our teaching/learning activities. This examination assignment focuses on describing our current teaching practices, identifying a pedagogical problem that can be solved using ICT, writing a plan for how I will use ICT to solve this problem (and any support I might need in doing so), and finally to describe the results I hope to achieve.

Background – my current teaching scenario

I teach at the International master program in health informatics in at KI. The student group is very homogeneous with varied experiences and expertise; roughly half have a clinical background (physicians, nurses etc), whereas the other half have a technical background (software engineers, computer scientists etc). The scenario I have chosen for this assignment is quite narrow – one theme in one of my courses: prototyping. The learning outcomes are that the students should gain both theoretical and practical knowledge about prototyping in health informatics. Today I give a traditional lecture introducing the concepts, with shorter interactive parts, but with a lot of focus on transferring information to the students. Then the students work in smaller groups to develop their own prototypes, and at the end of the module they present their work and get feedback.

The pedagogical problem

As a teacher, I never have as much time as I would like to spend together with the students, and so I need to spend the time with them as best I can. Right now, I am active most of the time when I meet the students, whereas they are passively receiving information. It is not until they actually start to work in their groups that the questions occur – and then I’m not there! In addition, since the students have such varied level of experience and knowledge before, some students are already very familiar with prototyping methods and for them the lecture becomes very repetitive.

The plan

I have found a number of really good, short lectures from Stanford University on youtube that introduce the concept of prototyping. My plan is to use such learning objects to flip my classroom – to enable the students to prepare before we meet. That way the “passive” part of listening to a lecture is done before, alone. Of course I also want my students to be more active – so I will also try to activate their preparation time. Then the traditional lecture will be transformed into a prototyping workshop where we can work practically together – that’s usually when the important questions arise!

  1. Identify the learning objects (online movies/short lectures) that can replace important parts of my lecture.
  2. Formulate good questions the students can answer after having watched each short film.
  3. Identify important parts of my lecture material that are NOT covered by the learning objects I have found. This will probably include examples from healthcare, specific issues in health informatics etc. Then decide how to deal with these aspects – either make them part of the introduction to the workshop, or use Screencast-o-Matic to make movies of my own.
  4. Plan the workshop well to complement the information provided through the lecture films.

Expected results

I hope that the students will find the course more fun, more flexible, and more interactive – that they will learn more from having access to me as they work on developing their prototypes! For my own sake, I also hope that the course will be more fun to teach – I have enjoyed using the tools in this course so much!

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Using open learning resources – could it be for me?

So, anyone reading my blog lately will have noticed that I’m focusing a lot on online learning and the use of information and communication technology (ICT) to improve my teaching practice. And here’s yet another post on this subject.

Today’s reflection is on the topic of using so-called “learning objects” in my courses. The first thing to ponder is of course “what is a learning object”? As usual, there seem to be a number of definitions out there; but I quite like this page by Robert J. Beck which provides an overview of the topic. During the course I’m taking right not (IT i undervisningen – a course for teachers at Karolinska Institutet) we talked about learning objects as anything from the powerpoint presentations I upload for the students to access after class to recordings of lectures and presentations, quizzes and any other online resource that could be reused in a Teaching/Learning Activity (TLA). So, how could I use such learning objects in my courses? Well, one thing I’ve been considering for quite a while is reducing the amount of lecturing I do by providing the students with the same information online. There are two reasons for this:

  1. The amount of time available for me to teach is very limited, and I want to use the time I have with the students as best I can. Lecturing to them doesn’t appear to be the most efficient way. I already provide materials for them to read beforehand, but to summarize and give them focus a presentation seems much more efficient. Then we could quickly review the content when we meet and spend the rest of the time doing practical things in more of a workshop TLA.
  2. The students I teach have very varying backgrounds – some are very familiar with some of the topics we address in the course, whereas others are novices. By providing online access to learning objects the students who are already familiar with those topics can skip them and focus on other parts of the course.

My main concerns right now, coming from a usability background, is ensuring that the learning objects I reuse are well-suited to the purpose. ISO defines usability as “The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use.” Translating this to my teaching practice I need to ask myself;

  • Who are the students who will use the learning objects (specified users)? What are their previous knowledge and interest in using such tools?
  • What are the students supposed to learn (specified goals)? How does this map towards the learning outcomes of the course?
  • And in what course will the learning object be used (specified context-of-use)? What other learning objects and activities are there? Will this learning object overlap with other parts? Do I risk overloading the students with information?

Probably there are many more questions to ask. Yet, I will do my best to overcome this irrational feeling of cheating or stealing and instead embrace this wonderful world of shared, and reusable learning objects. After all, my PhD thesis was called “Sharing is Caring”. The next step would of course be to start producing my own learning objects and perhaps sharing those with the world. This is somewhat more intimidating (and appears very time consuming!). Today, I have used ScreenCast-o-Matic for the first time to record a presentation, and it was fun! Already have plenty of ideas for how this could be useful in both education and research activities. So, perhaps you will get to see and hear (rather than just read) more of me  online in the future…

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