Learning Sequence

Audiological Management of Clients with Tinnitus

Blended learning approach

Phase one

Front line managers, Manager Operations and Manager Professional Standards agree on the attendees and time line for the training program.  Time is reserved in the appointment book for the face to face training and Skype or web based conferencing (depending on number of learners).
Front line managers will discuss the proposed training informally with the learner.
 
Learners are contacted by Company email to outline the training program.

Learners are asked to select a client they have seen, who presented with concern about tinnitus.  There are no other restraints on case selection. They are to review the case so they can present a three minute summary at the face to face training day.

Learners complete pre-reading activity on elearning website - Read seminal article on the neurophysiological model of tinnitus and the role of the limbic and autonomic nervous systems.

            Completion of  online quiz.

Completion of reflective blog post addressing learner’s reflections on:                                  

 Their knowledge and skill base prior to completing this training

 The benefit their clients will obtain from them completing this raining.

 The benefit they will experience by completing this training

 The Company’s expectations of benefit from them completing the training

 What they anticipate is likely to be the greatest challenge to them in completing the training
What strategy they are going to use if they do experience that challenge and what support they would like from their front line manager

 Rate on a scale of 1-10 scale their current confidence level in working with clients with tinnitus 

 (Learners receive feedback on their reflective post from Manager Operations or Manager Professional Standards.  If any concerns have been raised that require specific support from the front line manager, the nature and timing of the support is agreed.  The Manager Operations or Manager Professional Standards
 
Completion of elearning modules on tinnitus assessment and tinnitus rehabilitation

            (15 minutes each)

Phase two

Face to face training day.
Each learner brings a case they have selected for discussion.  Each case is presented briefly and one selected to be the focus for the ongoing discussion.
 Drawing on any prior experience, pre-reading and informal learning (what they have observed in the clinic and the the cases that have been discussed informally in the open plan clinician's office), frame the question, what else do they need to know to manage this case?
This may include further audiological or medical investigations, further case history information from the client, identifying any other professionals who should be involved in the case.  What else do they need to know about tinnitus and the possible management options.
Final product for this phase is the production of a clinical report that would be sent to the referring doctor, which includes all relevant clinical pathway recommendations.

Notes are uploaded to the forum area on the Company server. 
Outline areas of investigation, assigned role of each learner, recommend create a schedule for touching base with each other and the trainer.


Phase three 

Face to face training day continues.
Discus the application of the neurophysiological model to the specific case under discussion.
Interpretation of the tinnitus reaction questionnaire.
Review the counselling tools and job aids available.

Hands on practise in activating the tinnitus settings within hearing aids.

Introduction to the Neuromonics Oasis sound device.

Phase three investigations and roles recapped and role four task introduced.

Phase four  

On returning to the clinic after the face to face training day
The use of illustrative stories or examples are very powerful in helping people to understand the concepts the scientific principles that underpin the neurophysiological model.  Identify or create two illustrative stories.  Take advantage of the resources available on the web and the experience of your colleagues, particularly the tinnitus specialists, in making your selections.

Then complete one of the following two activities:

a). Create an image that you feel visually illustrates one of your examples. Scan a copy of it and upload it to the tinnitus project site on the central server.

b).  Practise how you would present one of the illustrations to a client, then make an audio recording and upload it to the tinnitus project site on the central server.

Phase five

It is important that our clinical practice is evidence based. As a group, review the literature and compare and contrast the relative efficacy of counselling, hearing aids and the Neuromonics program in reducing distress.  The notes placed on the tinnitus project area of the central server by previous training groups may serve as a launching point.

Make a reflective blog post that summaises your findings and the clinical indicators that will shape your recommendations for each client.

Webconference/skype
Confer aboutdraft recommendations for the clinical report.  A timeline for completing the draft is negotiated.
The final report is uploaded to the tinnitus project area on the central server.

Phase six 
Timing of phase six is tied into the scheduling of the annual Neurosensory Clinical Conference.


Participate in the ‘Truly Terrible Tinnitus Treatment Challenge” as a member of your regional team.  
Health information is one of the most highly searched topics on the web.  While there is much scientifically sound information on the web from reputable sources there are also
Working as a group in your region, identify one tinnitus treatment advertised on the web which you regard to be 'Truly Terrible".

Create a presentation, three to five minutes in length, using any media of your choice, that highlights why the treatment qualifies as terrible.  Highlight the flaws in the evidence or absence of evidence for this treatment.
All entries will be presented at the Neuosensory clinical conference.
The winning region, as judged by our guest presenters, will be awarded a sum of Aron dollars (highly sought after 'Neurosensory money' used for bidding at the auction at the Gala dinner at the conference).

Portfolio and Reflective Synopsis

I think I’m learning to juggle!    That’s what came to mind for me when I first looked at the colourful venn diagram portraying the TPACK model developed by Mishra and Koehler (2006).  Learning that focuses only on content is like juggling with one ball,  It goes up and down but doesn’t travel very far and the only one who actively engages with it is probably the person throwing the ball up.  Adding a second ball, pedagogy, requires more purpose and direction but still limited movement and engagement for an audience accustomed to the constant sound and colour and motion of modern media.   It’s when you add the third ball, the technology, that exciting new possibilities emerge.  It takes effort to develop the skills to position the learner in the sweet spot where all three overlap. 

Mishra and Koehler (2006) note that “Developing theory for educational technology is difficult because it requires a detailed understanding of complex relationships that are contextually bound”.  It requires teachers to be creative and responsive.  “Underlying truly meaningful and deeply skilled teaching with technology (Mishra  and Koehler, 2009).

My natural point of focus is content, so the shift to focusing on how to make learning transformational under the SAMR model is still a conscious one.  I’m developing a checklist of questions.  

    How can I incorporate activities that wouldn’t be possible if technology didn’t exist?   
    How can I incorporate elements of choice and flexibility into the learning activities, when in my workplace learners have limited autonomy  over the topics that will be taught?
    How can I include ensure that my choice of learning activity is consistent with a constructivist learning    environment?
    How can I include reflection in this activity?
What other 221st century skills, or which of the 15 key capablities of a professional will this activity target (?
    How can I include activities where the learners create information and learning artefacts using multimodeal tools?
    How can I authentically share the artefacts the learners create?

Maybe I’m not learning to juggle, maybe I’m learning to drive a car….  At the moment I’m focused on letting out the clutch, pushing in the accelerator and turning on the indicator… so focused on the mechanisms of moving forward that I can’t yet focus down the road to my destination.     

Which I hope will involve IMPACT…

When I read about this model on the blogs of the teachers its' simplicity resonated with me.

            Inspire, Model, Practise, Apply, Connect, Transform


As i seek to develop my technological knowledge and in particular by technological pedagogical knowledge,
 I find Allan Carrington's Pedagogy Wheel v3.0 a powerful visual tool to shape my thinking.  I  like that it has, at it's core the attributes of the learner, or in my context the 15 key capabilities of professionals (Carrington, 2013) and that it incorporates the motivation aspects of autonomy, mastery and  purpose.  From that stmes the activities and various technological applications and tools.
i found Wendy's illustration of the way you could tell the story of your activity design as you work your way to the outer rim, very helpful.

www.unitynet.au

As a starting point I'm going to focus on including reflection in my activities, and building ways to choose a way of collaboratively create and publish media as part of my program.  As I continue to build my pedagogical and technological knowledge I will broaden my scope of activities.

Birden, H., Glass, N., Wilson, I., Harrison, M., Usherwood, T. & Nass, D.  (2011).  Teaching professionalism in medical education: a best evidence in medical education (BEME) systematic review.  www.bernecollaroation.org/downloads/1387/birden-SR-web.pdf
Carrington, A.  (2013). If you exercise these capabilities you will be employed.  www.unitynet.au, March 13, 2013.

Professionalism – role modelling and reflections

 Mishrak, P., & Koehler, M. J. (2006). Technological Pedagogical Content Knowledge: A framework for teacher knowledge. Teachers College Record, 108(6), 1017-1054. doi: 10.1111/j.1467-9620.2006.00684.x.
Koehler, M. J., & Mishra, P. (2009). What is technological pedagogical content knowledge? Contemporary Issues in Technology and Teacher Education, 9(1), 60-70.

The learning affordances of images

Images

Images may be used to convey meaning in a multitude of ways.

Maps and Google Earth.
While I wouldn't generally expect my workplace learners to use maps a great deal, they can serve to place the learner almost anywhere in the world.   This could help with studies of cultural appreciation, resource allocation, or the environmental impacts of climate change.

The primary use of maps in our workplace are to improve client access to our clinics. 
New staff could be asked to use online maps to plot the routes to our clinics from major roads in both directions, so they could better assist clients when making appointments.  This has greater relevance now that we have a centralised phone system, so appointments may be made for clinics that are hundreds of kilometers away. 

Sharing of personal images can be used to strengthen the links with our online community. While careful judgement should be exercised to ensure that the uploaded material is consistent with the intent of the communication space, it can create a sense of shared experience.  I found this to be true for my networks at the time of the Brisbane floods.  Many individuals stepped outside the normal topic rules to express concern for me, my family and the community as a whole.  These images were how I shared my experience, and the inclusion of the map provided a sense of perspective.

Used with permission

Charts and Graphs and Tables
Charts and graphs can be used to share statistical information in ways that make it meaningful to the viewer.  We use audiogram graphs to display information about hearing levels and tables to display clinical test results when communicating with clients and health professionals. 

Graphs and tables can also be used as tools for learners in analysing and creating meaning from data.  The chart/table function of Powerpoint or Excel allow the learner to explore the most effective ways of communicating the key aspect of their findings.

For instance in considering the importance of a multidisciplinary approach to managing health care, the learners could be asked to select a specific type of hearing or balance concern that our clients might present with, then conduct an analysis of the number and type of other professionals those clients have consulted.  Learners could collaborate to collect this data over a range of services and then report it back the whole Company via email or the Company intranet.
A follow up activity could be designed to focus on the importance of creating collaborative networks and communities of practice. Learners could select a particular category of professional and identify and establish  contact with two or three of those health professionals in their region.
The Company maintains a register of specialist service providers, and these contacts could be added to the register.

Learners could be asked to select two of the assistive devices we provide to clients and analyse their afforances. They could report their findings by creating tables of features that allow them to compare technologies when determining the best recommendation to make to a specific client. For example they could consider the affordance of a Bone anchored hearing aid and a Bonebridge aid.    In fact many similar tables have already been created to serve as job aids.

As a trainer i could structure a table in a wiki to serve as a framework for learners to report back their findings and interpretations.


Manuals and screenshots

The manuals for some of our assistive devices are not very accessible to clients with low literacy level as assessed by their reading grade.  As an exercise, learners could be asked to select a particular product and taking the viewpoint of the client, determine what information is most important for successful operation of the device.  They would then select or create visual illustrations and incorporate them into a new instruction sheet or manual.This project could incorporate an analysis of the efficacy of rich visual representations such as photos, versus lower fidelity portrayals such as line sketches.

Screenshots can demonstrate use of equipment and create job aids and performance support tools to aid in recall.  The visual cue aids in the recall of desired processes.

While video images are excellent at conveying a process - I'd be lost without YouTube - there are times when a still image allows you to focus more on a specific detail.  A series of pictures also allows you to progress through material at your preferred pace more easily than managing the pause, rewind or fast forward options for video.

Images to trigger an affective response.  
As noted in a previous blog post, the 'Don Quixote' effect of showing positive images of medical health care delivery, by image or video, can provide a short term burst of positive emotion that helps the learner reconnect with the reasons for choosing to work in this profession, and so better cope with a challenge they are facing at the time.

Wordle as a reporting tool, to quickly convey an overview of opinions and create a positive affect. 
This year we had a project at work to roll out a major change in process.  The government introduced a major change in the way that eligible pensioners access Government funded hearing and hearing aid services.  As a provider of the service we were required to implement the change, at the time stipulated by the goverment - which kept change as they experienced issues with the IT aspects of the program.  A key strategy for successful implementation was constant communication with staff about what would happen and when it was expected to happen.  Staff received updates from the CEO and the Manager Strategic Projects (we may be a small management team but we make up for that with the length of our job titles....).  

My role was firstly to create training materials and job aids, which would be used with the front line managers, who would then use the materials with their staff. These took the form of workbooks and clinical case scenarios.   Secondly I was to develop, conduct and report a pre and post -implementation poll to assess:

• the staff understanding of the Company's expectations of the process
• the individual staff member's expectations of the process
• their understanding of what the key changes were
• their understandingn of the benefits the change created for the the clients, the Company and each of them in their roles
• the impact they believed the change would have on their role
• their confidence in implementing the changes.

In reporting back to all the staff the findings of the pre-implementation survey, I used a wordle to convey the overall positive and optomistic nature of their responses.  This also helped to boost the confidence of the few staff members who did express some concern.
With wordle you can select the colour scheme and you can also submit the data multiple times to have a new arrangement created.  Using this process, on the fourteenth try I was able to get the word 'client' at the centre of the wordle.  This was important  to reflect the key message that the focus of the process was improved services for client.

The image below could be used to start a discussion on the stigma of hearing aids and how this may cause clients to delay help-seeking.

commons.wikimedia.org

Images can be manipulated to place empahsis on specific characteristics or aspects. In doing so they may create humour or sarcasm.    For example, cartoons, or photos modified with applications such as Pixlr-o-matic.  
Artwork, whatever the medium can also create a atmosphere or feeting, triggering different associations for each learner.   Applications such as Paper53 and Artrage allow direct creation of art images on tablets. 

Another factor not to be underestimated is that making images can be really fun.  Engendering emotion, of any kind helps in shifting memories from short term to long term memory.  Two benefits for the price of one! 


Images as a portrayal of objects in the real or imagined world

This is probably the most common way of creating a shared reference point. although in a constructivist learning environment it is acknowledge that as everyone constructs their meaning from the unique perspective of their prior history, we will all interpret visual images in a slightly different way.  Sharing these differences in perception can foster the skills of analysis and reflection.



Considerations in sourcing, storing and uploading of images

Copyright considerations 

Ensuring that neither I nor my learners breach copyright is a factor to be considered when including images in any materials we create and when creating photo or video images.  When taking protographs precautions should be taken all privacy requirments have been met.  Similiarly when uploading images of documents, work materials or elements of medical case notes, precautions must be taken that confidentiality is not breached.

Creating images in the workplace may often be an effective way of both ensuring they are relevant and overcoming copyright considerations.  However there are frequently images that would be impossible or impractical to create in house.  Images may be downloaded from commercial sites under licence, or from open image sharing sites.

Some sites offer images to use and modify without restriction or attribution, such as pixebay.com.  Others sites allow reuse but not modification, or reuse but not for commerical purposes.  When using a general search engine such as Google, using an image search and selecting the search tools to specify the appropriate level of usage rights removes uncertainty.  Alternatively, searches can be conducted on sites known to offer the relevant usage, such as creative commons which has relatively low restrictrions, although proper attribution is required.  Wellcomeimages.org is a particularly useful site for me as it specialises in medical images.
 

wellcoomeimages.org

Images may also be used with the consent of their creator, and the scientific community is usually generous in granting permission.  As I work for for a commercial organisation and have not purchased a limited licence, educational provisions for fair dealing do not apply.

Image storing sites
There are numerous image storage sites offering free or paid plans, such as Flickr or Picassa.   Many of these have the advantage that being cloud based they are accessible from any location and by mobile devices, both for uploading and downloading.  Increasing download speeds and decreasing costs of data storage make this an appealing option.   When privacy concerns apply a paid account or alternative storage must be sourced.

When uploading works that are the original creations of the learners, their consent must be obtained.

Image size and resolution
The primary consideration for image size and resolution is the storage size and download time needed to access it.  It has been my experience that learners generally prefer a low resolution image that loads quickly to a high resolution image that needs buffering.  Consideration should also be given as to whether the image will be displayed on the smaller screens of tablets and smartphones when determining the initial size.

File transferring options, such as dropbox, have overcome the previous limits of images as attachments to emails.


Developing technological and pedagogical skills in image creation.
The srong empahsis in transformational learning on the creation of learning objects and use of multimedia by learners for reporting and analysing has required me to markedly rethink my use of all media, including images.   I was aware that combining images and audio creates greater brain activation but I'd only applied that to materials that I created not to my expectations of learners.  Because this is still a conscious process for me, at this stage as soon as I start work on a topic area I  have to pause and consider how I will incorporate elements of creation into the project, and that usually leads back to what tools could I do that with.

I don't regard myself to be an artistic person, I'm a crafter not an artisan, but I've discovered there are a multitude of tools available to allow the alteration of existing works as well as creating new images that are a unique experssion of the learner. Fortunately, so far it's usually proven to be true that 'there's an ap for that'.  To date the greatest challenges have tended to be about transferring files from my ipad to the computer. 

It's interesting that for creating text materials I prefer a PC but when it comes to image creation and manipulation I'm a tablet person all the way.  I think it's about the ease of changing angle and perspective.

The affordances of technology in online spaces and media creation

Audio material

I played with some voice altering software.  I was considering the potential of using changed vocal quality to explore cultural biases. 
For example having a single speaker record statements or opinions or questions.  Using the voice altering software the timbre and pitch of the sound track could be changed to sound like a child, a young female adult, a young male adult, an old female or an old male etc.
The samples could be uploaded onto a wiki and learners could be asked to respond to the statement or question in a pre-structured form.  Only after the fact would it be revealed that there was only a single speaker.

This software could also be used as part of a lesson in online safety, introducing learners to voice altering software as a technique that can obscure the identity of the person they are interacting with, particularly as it can be used real time.  Or it could be used as a tool in online simulations.
I downloaded trial versions of Voice Changer Software Diamond and VOX Screaming Bee.
The free trial versions of both had only very limited features enabled, which meant I couldn't record a sample.  I wasn't sufficiently interested in them to take out a subscripton.  The link below is to a YouTube demonstration clip.

Voice changing software - how to sound like Darth Vader

Of more direct relevance to my field is the use of audio material to simulate the impact of hearing loss.  An example of this is a free application StarkeyHLS.  This hearing loss simulator has sixteen pre-loaded profiles of hearing.  The learner selects a profile of hearing loss and then can tap on icons to apply the effect of the hearing loss to everyday sounds such as a lawnmower, a tap, a mobile phone or the voice of a man, woman of child.
There isn't an option to download the audiofiles. 

A simpler version is accessible off the Starkey.com website.  It has only three profiles of hearing loss and pre-recorded samples of adult male, adult female, chile, outdoors sound and restaurant noise.  Again, the sound samples cannot be downloaded so screen capture software would be required to capture the output, and it appears that would be in breach of copyright.

The most common audio files are podcasts or music.  Podcasts serve as a personal radio station to the world.  Among my personal favourites is the ABC produced Conversations with Ricard Fidler.  The tagline "Spend an hour in someone else's life each weekday" captures the essence of the listening experience.  Listeners can subcribe to podcasts with notifications sent by Really Simple Syndication (RSS) or iTunes.

Podcasts can be a way of accessing information from reputable sources, but as in all media, the onus is on the learner to be a discerning consumer. iTunes U provides accessto expert opinion on a wealth of topics.

I've created a podcast on the use of insert earphones when recording vestibular evoked myogenic potentials.....   this could be used as a microlearning event. The sort of very short learning a clinician might fit in between clients, or access with a smart phone on the bus or train.  
This type of file can either be linked to a podcasting site:

The insertion of earphones in vemp testing

Or the podcast can be embedded in the blog. 

Or for a lengthier exposition, try this podcast from the American Tinnitus Associaton

11 Suggestions for conquering tinnitus and hyperacusis

Audio can also be used as a means of improving access.  As noted in the posting on blog affordances, I have embedded a text to audio converter to improve access for those with low literacy levels.  It does also allow visually impaired learners to access the material, provided someone else is present to click the 'Hear this post' icon at the end of each blog post.

In my context, the other use of music files would for learners to include them in shared or published learning artefacts.   Music can be a powerful tool to convey or affect emotion.   In schools the use of music creation programs, such as Garage Band could play a role in a creative arts.  
  

The learning affordances of blogs

Online spaces

I regard the primary affordance of blogs as serving as a communication tool between the author and a selected audience.  The author may be either the trainer or the learner.  In my context this affords the use of reflective writing.  Collaboration from the trainer or other learners can be provided in the form of Comments.  Like the postings themselves, the comments are listed in chronological order, allowing the development of a logic thread.  It also allows for the learner to display development of both thought and writing process.

The trainer's blog can be used for setting tasks while the learners post completed assignments on their personal blogs.   Alternatively, the learners could use the comment function on the trainer's blog to suggest future learning topics or to post questions on the current task.
  
An example of the collaborative affordane of Blogger is that multiple authors have access rights, for example co-teachers or even a whole class, as long as each author has a Google account.  
The blog is established by a single author who then invites other authors to join.  

Administrator rights can be assigned to as many of the authors as desired, which allows them to edit the posts created by other authors.  Those not assigned administrator rights can post to the blog and edit their own postings, but not material posted by other authors.  
Since authors can also be removed from the list, it allows the capacity to invite guest authors. For example if there was a theme on balance assessments, a vestibular physiotherapist could be invited as a guest blogger. 

The invitation is sent to them by email, and appears like this.
 

 

Polls can be uploaded as a gadget to the blog home page.  This could allow the collection of opinion that becomes the subject for a future blog post, or reader feedback which is used to modify aspects of the blog.   In an educational setting this could be a way of creating relevant data for a graphing lesson, with the resulting graph then published back on the blog as part of a post on the results.

There are literally hundreds of gadgets which can be added. I have included several the on side bar to this blog.  One way in which the gadgets can enhance access is the translator function.   I've also improved the access of my blog by uploadng a text to voice widget.  This functionality is accessed by clicking on the 'Hear this post' icon just above the comments area.  I haven't yet identified how to move this icon to a more prominent location as it would be easily overlooked in the current location.

Networking can be scaffolded by the inclusion of Blog lists. The display format can be customised - I've chose to display the topic of the most recent post.  

A different tool around 'technological access' is the Bandwidth Speed Test gadget.  This has a particular significance to me, as issues around bandwidth and the audio versus data versus video prioritisation settings on our central and site servers, while optimising our voice over internet phone system, seriously impacted video download capacity.   In effect this means that at some of our sites there are times that you cannot watch a YouTube clip online without the sound quality breaking up or waiting for buffering.  This varies from day to day and site to site but has seriously impacted on an attempt to employ a blended learning approach.  The first attempt to use recorded video lessons and quizes, as a prelude to a face to face session was less than a stellar success.  This gives me a tool that I could ask my learners to install on their blogs  as part of our exploration of the problem.  if the were experiencing difficulty accessing the 'flipped classroom' materials they could log onto their blog to report this and note the download speed at the time.


 

Design Rationale

Let's Connect for Success

What is my message?

Having a professional, engaged workforce is key to achieving the Company business plan.   

To promote professionalism we need to employ pedagogies supporting reflective practice and cognitive apprenticeships (role modelling).  Worker engagement is driven by autonomy, mastery and purpose.  Supporting our staff in their development of mastery should be the focus of our training program, using methods informed by adult learning principles.   

To position us for success in a globalised, twenty-first century marketplace, the balance of our training program should be adjusted to place greater emphasis on our clinicians achieving mastery in clinical work and displaying the key capabilities of a professional worker.  This includes their skills in constructing knowledge and support networks.    

Distributed learning is a key strategy for making our training effective.

Who is my audience?

Primarily the Neurosensory senior management team, but also the front line managers of our clinical staff, the clinicians-in-charge. 

While we are based in the health services sector, specifically dealing with the ear, hearing and balance, the key characteristics of our team generalise across many small to medium private enterprises. There will be variation in the degree to which each of these factors holds true across organisations.  The cohesion of our management team is something that we all value highly, and I acknowledge that not everyone in a position similar to mine will have that advantage when making a presentation such as this.

How do I persuade them?

Since we value evidence-based practice, my aim is to appeal to reason rather than emotion, to convince rather than to entertain.

The business plan is to serve as the driver and checkpoint for all our projects in the coming year, so I intend to use that as my starting point and core theme throughout the presentation.

Information drawn from our context and from research will be used to develop the case for why the affordances offered by eLearning are necessary to achieve our business plan.  Then constructivist pedagogy will be presented as the best solution to those needs.

The evidence that informs my presentation.

Learning is change in our cognitive structures that leads to the potential to exhibit new, desirable behaviours (Stolovich and Keeps, 2004).  

Much of workplace learning occurs informally.  That is, it is socially and cognitively constructed, by observation of and discussion with peers in the workplace environment, observation of how the workplace pedagogy of documents and forms is implemented and problem solving on the job (Choy, 2009).   This should be recognised and embedded in our learning strategy.  While the exact figures will vary according to the specific workplace, it is estimated that 70 per cent of learning occurs from on-the-job experience, tasks and problem solving, 20 per cent from observing and working with role models, and feedback received in the work place, with only ten per cent being due to formal courses and reading (Cross, 2012).

Learning programs that include problem based learning, cognitive apprenticeships and communities of practice meet the pedagogical goals of a constructivist learning environment and are in accord with adult learning principles (Bryan. Kreuter and Brownson, 2008).  Our company uses all of these to some extent, but my intention is that we should be more systematic in providing scaffolding within the learning experience. Our new key phrase in planning meetings is “mind the gap”, referring to Zygotsky’s zone of proximal development.

I work with adult learners in a medically aligned, professional services company.  Reflective practice and cognitive apprenticeships are the two most widely recognised ways of developing medical professionalism, ideally guided by an expert faculty ( Brennan & Monson, 2014., Birden et al, 2011, Somerville & Keeling, 2004, Irby, 2011).  Adding the use of reflective learning blogs, will strengthen the focus on reflective practice.   These blogs would have privacy settings to ensure no possible breach of privacy requirements around confidential medical records or business information, but a register of blog addresses on the Company server would allow access to all staff.  This also allows for interaction through use of comments.   As we are so heavily influenced by role modelling and our communities of practice, access to the learner’s reflective thinking is a key way of assessing the learning that is taking place.

Using pedagogical tools such as simulations to assess clinical decision making are also a way of ensuring that the role modelling has been effective (Motola et al, 2013).

An effective learning program identifies and acknowledges the most likely barriers to efficacy and takes steps to remove or ameliorate them. Understanding the role of social dynamics and brain function on how meaning and memories are created provides us with a framework to approach this (Rock, 2009).   In our company we refer to this as ‘removing the pain points’. Although as Maria Anderson points out, “Learning is hard.  Nothing will make it painless”.

Adopting distributed practice and microlearning strategies help overcome the ‘forgetting curve’, supporting the formation of long-term memories (Rock, 2009).  In my context I think of this as the ‘four Rs of remembering’ – relevance made obvious, repetition, re-engagement designed into learning activities and retrieval prompted.  The provision of job aids and performance support tools help support retrieval.   At work we refer to ‘drip feed’ learning – not as an aspersion on our learners - but as a reminder of the efficacy of microlearning.

The credits for images and references for specific slides are contained in my previous blog post, 
Video storyboard, design, credits and references.

if this video was embedded in a learning system a copy of the script would be linked, in accordance with accessibility guidelines.  

And so to the video....  
The technical tale (of woe). Converting from PowerPoint to iMovie, required using an intermediary converting software, which rereduced the quality of some of the figures.  Sharing from iMovie to YouTube resulted in further loss.  So I have chosen to upload the video to Vimeo as an alternative.

Since the video contains the mind map of the Company business plan for the coming year I have chosen not to make it viewable by the general public and have applied password protection.  While it cannot be viewed within this blog, clicking on the 'Watch on Vimeo' button will take you directly  to the presentation on Vimeo.
Alternatively it can be viewed by  searching for Vimeo number:  98111639     Password to view: antheaedel2014.





Let's Connect for Success from slides from Anthea Arkcoll on Vimeo.

Anderson, M. (2011, November 5). TEDx Muskegon.  Recipe for free range learning [Video file].  Retrieved from www.youtube.com/watch?v=mWdSz2nHQNY

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Video design, storyboard, credits and references

Let’s Connect for Success

Design considerations , Storyboard, credits and references.

Who is my audience?

Primarily the Neurosensory senior management team, but also the front line managers of our clinical staff, the clinicians-in-charge. 

While we are based in the health services sector, specifically dealing with the ear, hearing and balance, the key characteristics of our team generalise across many small to medium private enterprises. There will be variation in the degree to which each of these factors holds true across organisations.  The cohesion of our management team is something that we all value highly, and I acknowledge that not everyone in a position similar to mine will have that advantage when making a presentation such as this.

As a management team:

We hold a diversity of specialist knowledge.

We value evidence based practice.

We share a belief in the importance of continuous improvement.

We share a history of project implementation, and seek to learn from our failures and improve on our successes.

We were all involved in a recent review of the Company’s vision, mission statement, core values, goals and competitive advantage statement.

We were all involved in creating the first draft of the business plan for 2014-15.

We are united by a desire to see the Company succeed.

We believe in the value of the services we offer.

We are united by a desire to see each employee succeed.

We believe that each of our employees come to work wanting to do their job well.

We vary in how directly the proposed use of elearning will impact on our role and areas of responsibility.

We are generally relatively sophisticated consumers of media.   (The Gruen Transfer has often been a subject of ‘water cooler’ conversation.)

How do I persuade them?

Since we value evidence-based practice, my aim is to appeal to reason rather than emotion, to convince rather than to entertain.

The business plan is to serve as the driver and checkpoint for all our projects in the coming year, so I intend to use that as my starting point and core theme throughout the presentation.

Information drawn from our context and from research will be used to develop the case for why the affordances offered by eLearning are necessary to achieve our business plan.  Then constructivist pedagogy will be presented as the best solution to those needs.

Implications for presentation design.

Focus – On the narration

Pace -  Brisk and animated conversation – not fast and flashy like ‘Did you know’, enough time for the listener to feel they’ve connected with the argument, but faster than ‘lecture pace’. I want to keep the momentum up and I need to build my argument in a short time.

Music -  If any, subtle in the background to signal transitions, perhaps just for a few seconds at the introduction and to signal transitions in and out from the mind map.  Don’t want it to compete with the narration for attention. Might not use any at all.

Effects -  Very limited use, and only if they are attention getting in subservience to learning (eg. by highlighting or illustrating key concepts) not for their own sake.  

Could experiment with voice altering software for the introduction -  a twist on the familiar and expected that serves as an attention grabber. 

Visuals -  Simple and clean images.   Background a clean white or light tint.  Might use pale tint background, and change tints to signal topic changes.

Mind map of business plan 2014/15 will be the visual theme

·      The business plan has the highest relevance for every member of our team as our individual KPIs are all drawn directly from the business plan. 

·      The team all saw me drafting and working on the mind map over the course of our meetings, so it serves as a reminder of all those discussions.

·      The CEO is using it as a visual aid as she presents the business plan at each of the clinics.

·      Copies will be displayed in each clinic to help us maintain our focus on the core projects.

Images  -  Need to be in keeping with the style set by the mind map, so stylised, symbolic and cartoonish.  Use a cartoon style man whenever portraying people.  Cartoon figures used will all be licensed from Can Stock, and this type of presentation is covered by the terms of use so there are no copyright issues.
Images are intended to engage the viewer, but not to increase cognitive load to the point they distract from or compete with the message, instead of reinforcing it. Use the minimum visual detail required to convey the specific meaning.

Avoid mixing with photos of detail rich images.

Fonts -   Clean and simple.  Usually not more than two font styles or families on a slide at a time.  Probably no more than four or five fonts across whole presentation.  Consistency of use of font across ‘sublevels’ of presentation, eg Headers versus text information boxes 

I’m seeking to create a style and theme that I can use on an ongoing basis.   I’m optimistic that my presentation will be successful and that the management team will agree to begin implementing this approach to blended learning. If so, I want to be able to use this style in future pitches as I identify the specific investments required to enable implementation, eg engaging consultants to assist in design and personalisation of a learning system, such as Totara (a commercialised version of the Moodle platform), making changes to our existing IT capacity and processes.  I also want to be able to carry some of the visual images forward in documents related to the project.

Title slide

Text -  Let’s connect for success.

Introduction slide

Text:  Not that long ago, in a board room not very far away…..  ( homage to star wars opening titles).

Picture of actual mind map of business plan for 2014-15 –focus on the central cartoon figure of the client, standing on the core values and surrounded by the 8 projects identified in the business plan.

Transition to cartoon graphic of central figure with the 8 project bubbles.   Place question marks just out from each of the project bubbles that will be referred to in the presentation so audience can see what will be talking about.

Initially question mark connected by dot trail - once have discussed each project and return to image will replace with a key icon/image from the discussion. Serve as visual reminder of what have talked about as question marks are progressively replaced by symbols/images.

Colour of each of the project bubbles can be used as theme colour for related slides.

Script:

In March, the management team met at global headquarters to develop our next business plan.  We identified eight projects,  all focused on the client experience. How will we deliver them?

Project slides: 

How can our clinicians help you more?

Images:

Client cartoon figure beside client cartoon figure

Text:  Neurosensory # client experience

Script:

The focus of our business plan is the client experience, if we want our clients to engage with Neurosensory as their partner in the hearing health journey, we need our clinicians to be engaged with their work.

They must listen to the needs of our clients and those closest to them.  Then use their experience and knowledge shared by colleagues, make confident recommendations.  We need our clinicians to evaluate and compare device features, then to be creative in using and adapting those capabilities to meet our client’s needs.

What solutions do you need?

Images:

graphic representing connections between aid, remote, TV and phone.  

Script:

Hearing aids are complex, digitally programmable devices - that connect by bluetooth to remote controls and phones, and stream from TVs and sound systems.  They should help our clients become autonomous users of the constantly changing hearing technology - and remain calm under the pressure of troubleshooting.

How can we be where you need us?

Images:

Map of Australia, solid arrows going out from Brisbane indicating establishment of new physical clinics..  Dotted lines go out to represent services delivered remotely.

Script:

As our footprint grows over greater distances and multiple time zones, we face the challenge of maintaining consistency of standards, currency of knowledge, and our culture of care.

Emerging technologies will allow us to deliver our expert services in regions where we don’t even have a physical presence. But we’ll have to master the technology to deliver those services – using the network speed where our clients live.

How can we each be better at what we do?

Images:

Cartoon of client figure is on right of slide fades out and clinician figure fades in.

Text- names of 15 top capabilities each fly in over course of narration.

Script:

Before we talk about HOW we help our clinicians be better, let’s reflect for a minute on what we want them to become.  What capabilities do our ideal clinicians have?

International research has identified that across all disciplines the top 15 capabilities are very similar. 

The ideal clinician has energy, enthusiasm and passion  -  they think laterally and creatively.

They are true to their values and ethics, transparent and honest in their dealings and willing to give credit to others.

They have empathy, listening to different points of view and presenting effectively to different groups.

They have perseverance, learning from their experience and errors and understanding their personal strengths and limits.

They remain calm under pressure.

They are -  professional   and engaged.

How do we develop professionalism? 

Images:

Cartoon figure of professional is on right side of screen.  Text box on left side.

Text – role modelling,  personal reflection

Script:

It is widely agreed that role modelling and personal reflections are the most effective techniques, ideally guided by an experienced mentor.  We incorporate elements of this into our training – but we can do more.

Like most workplace learning, professionalism is

developed mostly through informal learning rather than being directly taught.  So we need to take steps to ensure the quality of that informal learning, for all clinical staff, whatever their location.

We can encourage our clinicians to develop connections with clinical champions, from within and outside the company.  We can foster collaboration, and the role of our clinical champions, through web based case conferences, clinical forums   -  and the sharing of success stories (and failures) in personal learning blogs.

We can develop the habit of reflective practice -  modelling this skill through the personal learning blogs of clinical champions -  and including an expectation of reflective practice into clinician’s personal development plans.

What’s engagement?

Images:

Cartoon figure of clinician on right side of screen.  Text box on left side of screen.

Text – definition:  Employee engagement is the extent to which employees feel passionate about their jobs, are committed to the organization, and put discretionary effort into their work.

Script:

Engagement is more than being satisfied at work, it’s the extent to which employees feel passionate about their jobs, are committed to the organization, and put discretionary effort into their work.  It impacts business profitability.

How do we develop engagement?

Images:

Cartoon figure of clinician on right side of screen.  Text box of left side of screen.

Text box:  Starts with equations   $ + $  / engagement.        $ + ? = engagement

Over course of narration? is replaced with text – autonomy, mastery, purpose

Change to slide with topic words ‘autonomy’, ‘mastery’ and ‘purpose’ listed down right side.

Mastery      -

Change to image of Ebbinghaus forgetting curve.             

Script:

It may surprise you that engagement isn’t just, or even mostly, about financial incentives.

For tasks that require at least some cognitive involvement or problem solving,

if you pay an adequate base salary, the secret to engagement is – autonomy, mastery and purpose.  Of these I’ll be focusing most on mastery. 

Mastery

It’s not our role to teach clinicians all they need to know to become master practitioners. – we couldn’t, knowledge is changing too fast.  We can make sure they have a sound understanding and application of the principles, and the skills to continually evaluate and update their knowledge. That they have good connections with technologies and social networks for learning and sharing, within and across disciplines.

Text box changes to:  Neuropsychology proves the brain acts to minimise danger  (away response) and maximise reward (toward response) 

The away response is stronger, faster and longer lasting than the toward response. (Rock, 2009)

Script:

Our desire to avoid feeling foolish in front of clients or workmates is far more powerful than our good intentions to implement what we’ve just learned.

So if clinicians don’t feel capable of delivering a service, or if they try to apply what they’ve learned, can’t remember exactly, and have no support, they’ll avoid the desired new behaviour and continue to do what they’ve always done.    

Retention

Image: 

Ebbinghaus forgetting curve.

Script:

This is the Ebbinghaus forgetting curve.  It shows that much of formal learning, out of context, is wasted.  Within an hour you’ll have forgotten over 55% of the information I’ve just shared.  But if I’ve been able to make it relevant to you, given the information in chunks, repeated it, and ask you to recall some of it….   then maybe you’ll be ahead of the curve.

The best way to improve recall is to repeatedly reengage with the information over time.   Or to present many short sessions over a long period of time.  We’re probably can’t do it face to face, but we can do it electronically.

(Text box appears:  Distributed learning – short sessions spread out over a long period of time.

Optimum schedule for reengagement:  Every sixth day for the first thirty days, and then every two months for the next six months.  McDaniel, M.  )  [not included in final presentation as judged to make the screen too busy]

Script:

Like most workplaces, our clinicians may not have discretion over which clinical skills and capabilities they develop, but we can provide multiple ways of supporting and scaffolding their learning – however, whenever and wherever it needs to happen. 

[We can blend their face-to-face apprenticeship of skills, with learning resources that can be accessed on a repeated basis.

We can provide links to additional explanations and examples, as a launching pad to independent inquiry, but avoid the paralysis of decision fatigue – that comes from having too much information.       Cut from final script to keep within 6 minute time limit]

We can provide case simulations that allow them to exercise critical thinking, experience consequences and receive feedback.   As we help them move from ‘how and what’ to ‘why and when’ we’ll share in the new knowledge they discover.

To borrow from a shampoo ad, it won’t happen overnight, but if we progressively include this as a deliberate strategy in our training, we can make it happen.

Images: 

Picture with symbols against all of project bubbles.

Changes back to mind map of business plan

Script:

When our clinicians are engaged in ensuring the highest quality of client experience, using optimum technologies, delivered by methods that best serve each client – wherever they may be…

Image:  Text box with company vision statement.

Script:

Then we’ll be set to be the largest and most respected ENT centric audiology company in Australia.

Are you ready?

Credits and References

Images: 

The silhouette figures of the client, the clinician and the questioning figure are all used under licence from CanStock.

Green check mark: By Nobbler 76 (Own work) [Public domain], via Wikimedia Commons.

Audio loop symbol, map of Australia, ruler,brain image and red cross in a black box were all sourced from Pixebay www.pixebay.com, and under their terms are free for reuse and modification without attribution, including commercial applications.

Mobile phone icon. Shmector.com/photo/3d_mobile_phone_icon/1-0-646

The Ebbinghaus forgetting curve.  Wikipedia  www.thefullwiki.org

Characteristics of the ideal clinician.

Carrington, A.  If you exercise these capabilities you will be employed.  www.unitynet.au, March 13, 2013.

Professionalism – role modelling and reflections

Birden, H., Glass, N., Wilson, I., Harrison, M., Usherwood, T. & Nass, D.  (2011).  Teaching professionalism in medical education: a best evidence in medical education (BEME) systematic review.  www.bernecollaroation.org/downloads/1387/birden-SR-web.pdf

Brennan, M. D. & Monson, V. (2014).  Professionalism: good for patients and health care organizations.  Mayo Clinical Proceedings, 89(5), 644-652.

Benefits of engagement slide:  

http://dop.bps.org.uk/organisations/insights-research/the-business-benefits-of-employee-engagement$.cfm

Towers Perrin ISR.  http://dop.bps.org.uk/organisations/insights-research/the-business-benefits-of-employee-engagement  -  Fifty international companies were followed over a period of 12 months.   The earnings per share of companies with a highly engaged workforce rose by 37.1%  Over the same 12 month period the there was an 11.2% decrease in earnings per share if the company had below average staff engagement.

Informal learning

70:20:10 model :  http://www.internettime.com/2012/03/is-702010-valid/

Ebbinghaus forgetting curve/distributed learning.

Distributed learning – short sessions spread out over a long period of time.

Optimum schedule for reengagement:  Every sixth day for the first thirty days, and then every two months for the next six months.  McDaniel, M.