Tuesday, 22 April 2014

To Copy or Not to Copy?




Scenario: 


Pre-existing training materials are being incorporated into a corporate elearning module.  The subject matter expert (SME) wants to include an anatomical drawing of the neck muscles.  There is no attribution or permission relating to the drawing in the material supplied.


Considerations: 


Whole works should only be included if they are: in the open public domain, provided under a suitable creative commons license or with permission for commercial use, or if permission has been obtained from the copyright holder.


The scenario unfolds:


Examination of the illustration shows the name “F. Netter”.  A quick online search identifies the signature as that of Frank Netter, a famous  American surgeon and medical illustrator, also known as the Michelangelo of medicine. 

While Netter died in 1991, individual illustrations, including the one of the neck muscles, are available for purchase over the internet (thus in a timely manner) and at what would be regarded as an ordinary commercial price.  Unfortunately this still places the illustration well outside the modest budget for your project.

You advise that the illustration cannot be included.  The SME is dismayed and argues that the material will only be seen by a small number of people, all employees, as access to the learning site hosting the module is password protected.  No revenue is collected from the learning modules and they are for the sole purpose of staff education.

You maintain this does not abrogate the responsibility to comply with copyright requirements regarding a whole work, where the material (in the form intended for use) is available for purchase in a timely manner and at an ordinary commercial price.  Begrudgingly the SME agrees to source a different illustration.  



Gray, H. (1918). Anatomy of the Human Body.   Philadelphia: Lea and Febiger



The resolution:



An illustration was sourced from the 20th edition of Henry Gray’s classic textbook,  Anatomy of the Human Body.  While more recent editions are still copyright protected, the 1918 publication is now in the open library.    

This image was supplemented with a photo of the neck of a staff member, with consent obtained from both the staff member and the photographer.







 

Wednesday, 2 April 2014

Filling the bucket or lighting a fire?




While I may use a behaviouralist approach to teaching physical procedures, I’m more likely to use a cognitivist approach to teaching processes.    The processes may incorporate the procedures which were taught behaviourally, but greater emphasis is placed on the information processing that occurs mentally, the stimulus evaluation and decision making that leads to a response.  An example would be learning how to structure a balance assessment for a client.  This would make use of skill in applying electrodes, which has been taught previously using a behaviourist approach.

On reading the citation from Harasim1 “The learning sequence is led by the teacher as a didactic approach to individualized learning” I was reminded of another quote, credited to Edwin Slosson2,  College is a place where a professor’s lecture notes go straight to the students’ lecture notes, without passing through the brains of either.”

This resonates with me, as one of my first year lecturers in speech pathology spent every lecture dictating his notes to us.   Consultation with fellow speech pathology students in the second year of the course quickly established that this had been his practice for many years, with course material varying little from year to year.  Had the class size not been so small that regular absences would have been obvious and acted on, our learning would have been just as effective if we had all copied the lecture notes from a previous year and designated one student each lecture to attend and scribe any variation in the material.    Fortunately for current learners, this lecturer has long since retired and didactic lectures have been supplemented with problem based learning, often in groups.

While I have always sought not to emulate this example, in truth there have been multiple times when expediency has led me to adopt a didactic cognitivist approach, when a constructivist approach would have provided a richer learning experience.  This has usually related to time pressure, the time available to develop the learning materials or the amount of learner time allocated.  This will be an ongoing consideration for me, working in a professional services business, where the value placed on staff development must be weighed against the lost opportunity cost of time not spent in client contact.  This is where I currently see great potential in eLearning as part of a blended learning approach,  providing tools that will enable me to systematically, over time, design learning activities that are truly learner centred.  Materials that can be accessed asynchronously and opportunistically, supporting the learner in venturing (or leaping) away from the learning system and then returning to reflect and share.    Doing this requires more frequently moving away from the cognitivist approach, with the limitation this places on the learner’s ability to work independently and self-determine the focus of study.

This will also require me to broaden the focus from being predominantly on content to including learning skills and technology literacy.  In doing so I must remember the range of learners I work with, from Mitch who blithely reminds me that he is a digital native – expecting that you should be able to swipe, touch, or press and have everything work as expected – to Denise who feels apprehensive each time she is faced with a new software program and needs to be reminded that shutting down and rebooting the computer is a key step in any troubleshooting process.   Enrolling in this course is part of my personal journey to develop technology literacy.

Digital, asynchronous learning also provides a means to support staff in the development of other skills which are not directly related to their position descriptions.  For example, a benefit of working in the private sector is that changes can be implemented quickly in response to alterations in the business environment.  A corollary of that is that constant change can be stressful to some employees. Digital learning has the potential to provide access to resources that will help them understand and manage their reaction to change.

I experienced this on a small scale when I introduced the use of a cloud based learning system (Edubrite) as a way of delivering a limited number of electronic modules.  The modules followed many of Gagne’s design aspects – but differed from a strictly cognitive design in that learners weren’t constrained in the order they could take modules.  Enhanced transfer opportunities were limited in the module, referring mostly to practical in-clinic sessions.

I was very interested to read on Suzy Romanelli’s blog about Cathy Moore’s Action Mapping process, which she describes as “reflective of Gagne’s approach sequenced differently by giving the learner the opportunity to attempt activities and/or assessment first and provide information secondly.”
This model seems more flexible to meet the variation in preferred individual learning styles, and I hadn’t heard of it previously.

This segues to a second important factor about my historical teaching style.   I haven’t, until very
(very) recently used a specific andragogy as the basis for learning design.  That isn’t to say that there hasn’t been delivery of quality learning experiences, but it has been as much by instinct and experience as by conscious design.  There has been a strong element of apprenticeship or experiential learning, which is relatively aligned to Miller’s Pyramid or Dreyfus’s model of skill acquisition 4.  In Dreyfus’s approach the learner progresses through the stages of novice, advanced beginner, competent, proficient to expert.  As they progress along  the continuum there is a decreasing reliance on rules and greater reliance on intuition, increased ability to identify and focus on relevant information and enhanced metacognitive ability.  In my workplace, historically  staff have tended to be compliance and rule focused.  A current aim of our training program is to facilitate the transition from operating at a technician or competent level, to becoming clinicians who develop proficiency and expertise.

However the absence of an adragogical base means that, looking back I can identify many activities that were teacher focused rather than learner focused, and tasks that either failed to achieve the intended learning outcome or were inefficient in delivering the outcome. 

A perpetual problem has been scheduling clinical caseloads so a ‘more knowledgeable other’ is available  to model and mentor desired clinical skills.  Invariably clients would reschedule or cancel, either the mentor or learner would be away on sick leave, or the mentor would be called on to fit in an urgent case compromising the time allocated for the mentoring experience.  This resulted in a gap between the theoretical and practical sessions which markedly reduced the efficacy of the theory sessions.

An advantage of electronic materials is that they can be revisited, web case conferences can be recorded and recordings of modelled interactions could be used to supplement hands on experience.   High fidelity simulations are not readily available in the field of audiology and the cost is prohibitive to a company of our size, with little probability the investment could be shared with other audiology providers.

1  Harasim, L. (2011) Learning theory and online technology:  How new technologies are transforming learning opportunities.  New York: Routledge Press.  Cited in CQUniveristy e-courses EDEL20001: Learning theory in the digital age,  http://moodle.cqu.edu.au.
2.  Retrieved from http://quoteinvestigator.com/2012/08/17/lecture-minds/ on March 12, 2014.
3.  Romanelli, S.  (2014, March 15). Knowledge and Learning: Objectivists Approaches [Web log post]. Retrieved March 16, 2014, from http://suzy-e-learning.blogspot.com.au
4.  Dent, JA and Harden, RM. (Ed)  (2013)  A Practical Guide for Medical Teachers 3rd edition.  Churchill Livingstone. Elsevier.

Behaviourism

Learning theory as applied in my workplace...


Classical Conditioning
I regard classical conditioning as a suitable tool only when you’re seeking to elicit specific or limited behaviours; where there isn’t necessarily an expectation that the learner will generalize that behavior across multiple or divergent settings, or to stimuli that vary notably from the conditioning stimulus.  It is of use when the learner is not required to comprehend the task or apply insight, but merely reacts in a pre-determined way.

 
For example, in my clinical practice I use classical conditioning when assessing hearing with children between 9 and 24 months of age.  Loud sounds are presented into the room and a brightly coloured puppet is shown in a lighted puppet window.  The desired behavior is that the child will associate hearing the sound with seeing the puppet, and will be motivated to look for the puppet whenever they hear the sound, even as the intensity of sound is decreased.

It’s not a technique that I consciously employ when working with adult clinicians, who I expect to apply clinical judgment in decision making, to reflect on the success of the process and develop and apply refinements or alternative processes when the initial approach is unsuccessful.  


Operant conditioning

In our workplace we adopt a behaviouralist approach to ensuring  compliance with many regulatory requirements,  for example Workplace Health and Safety or  HR requirements.  These are areas where there are high volumes of material, which are generally highly proscribed, with low frequency of use by individual staff.  There are generally a limited number of ways a situation may present and limited room for discretion in determining acceptable outcomes. However breaches may potentially have high consequences.   Consequently, there is an identified workplace officer to assist staff when any uncertainty of interpretation arises.  Time constraints are the primary reason for adopting this approach. 

My approach in training with these materials is, wherever possible, to have a pre-training quiz.  Those employees who can demonstrate familiarity with and comprehension of the material are not required to complete any further training.  It also allows targeted training for those staff who have knowledge or performance gaps.   This acknowledgment of prior learning saves the company time and helps avoid staff disgruntlement.

However within the broad scope of material, specific areas may be selected for further activities.  They are generally chosen for having a higher probability of occurrence or for having catastrophic consequences even if the probability of occurrence is low.   For example, I employ a more social constructivist approach to addressing the topics of workplace bullying and harassment.  In contrast, emergency evacuation procedures are considered situated learning, specific to the context in which they  occur.   For this reason evacuation drills are conducted at each office rather than at centralized training days.  Feedback is immediate and specific to that environment.   The activity is directed by an authority figure, as we are aiming for competence to carry out that activity in that environment rather than a generalized capability or what, in the military, would be regarded as ‘situational appreciation’.



I may use a behavioural approach to training procedural elements of clinical service, for example  in learning how to apply electrodes,  determining if masking is required in audiometric testing and learning how to operate clinical equipment.   I also employ a behaviouralist approach to some simple manual tasks within the workplace, where the focus is purely that the task be completed, for example loading and unloading the dishwasher in the staffroom.

Another key area where I incorporate operant conditioning principles is when providing feedback,  both at an individual and group level.  For example, after a session supervising an inexperienced clinician,in addition to asking them to reflect on how they felt the session went, I provide explicit feedback, which includes positive reinforcement of the aspects they delivered well  and any improvement in emergent skills.  “ It was great that you  invited  the client to identify which symptom was most important to them. Did you notice how their body language relaxed after that? ”



Behavioural approaches, as exemplified in Bloom’s taxonomy and subsequent revisions, support a hierarchical structure of learning progression, requiring mastery of each level before progressing to subsequent levels.


Image:  File:Bloom's Rose.png - Wikimedia Commons                                        
                   https://www.flickr.com/photos/21847073@N05/5857112597/in/photostream/

I agree with those who challenge the hierarchical structure, as I believe there is the potential to be developing  competency in multiple   areas simultaneously.   I like the concept of a ‘learning spiral’,  with the implication that you are moving through different areas but aiming to perform at a higher level on each pass through the area, or of a learner oscillating between levels of learning and mastery.

I don’t think the behaviouralist approach is as successful for ‘big picture learners’ who want to grasp the context and higher level interactions  before focusing on specific details.

While observed behaviours can provide clues, when it comes to mentoring clinicians  on developing  and exercising  clinical judgment I don’t just want to see what they did,  I want to know:

  • Why they did it.
  • What they think and feel about what they did. 
  • What if anything they will do differently the next time.
Despite the inclusion of the affective domain in the taxonomy , I generally find the behavioural approach  less effective in areas such as assessing whether a clinician is developing a sense of professionalism.   I find that when I try to write learning goals in the affective domain they can feel artificial or contrived. They tend to evolve  into either very sweeping statements that probably don’t really help the learner, or specific constrained goals that don’t really cover the scope of desired outcomes.