Wednesday, December 06, 2006

Implications for Blogging in Professional Development Programs

The positive benefits gained from this blogging experience in a health care setting demonstrate that information communication technologies (ICT), in combination with peer coaching, can build the capacity of health professionals. While this study focussed on the novice practitioner (NP), the authors see applications for post-graduate specialisation, rural and remote practitioners and the everyday clinician.

The blogging experience was able to support students through the range of clinical reasoning approaches, as well as creating opportunities to explore evidence based practices in the clinical setting. Many of the same issues noted by Watrall & Ellison (2006) were echoed in the comments of the students, for example, the neutrality and informality of blogging and the value of learning about how others see the same question.

The social constructivist discourse that took place enhanced students’ and academic moderators’ understanding of professional practice dilemmas and issues. Students could focus on the propositional, professional and personal aspects of their clinical competency. The operational aspects of the blog facilitated this discourse and was an effective medium for creating a community of practice among the students as noted by Allen (1999) and Hiler (2002).

The need for reflection as part of the experiential learning cycle and for the development of clinical competence was also reinforced by the use of blogging. Similarly the five metaspaces noted by Green (2005) were also evident with students taking charge of learning issues, exploring critical elements of practice and sharing examples of professional skills. Spaces of trust also was quite resounding, and the value of having a neutral group of individuals, aside from those in authority, was highly valued by the students.

Similarly the five categories of learning noted by Gunawardena et al., (1998) as sharing and comparing information; discovering and exploring dissonance and inconsistencies among ideas; negotiating meaning and co-construction of knowledge; testing and modifying proposed syntheses and co-constructions; and specifying agreement regarding statements and the application of newly constructed meaning were all factors that emerged in the feedback and blogs.

The fact some students were poor at reflection or did not engage as fully as other students should not be a measure of learning effectiveness. Nonnecke (2001) notes that lurkers, individuals who read but do not necessarily participate in the online discussion, may still be learning through their passive or vicarious participation.

In terms of implementation practicalities, it was clear that students and academic moderators need clearer guidelines to support them in the blogging environment and to optimise value. For moderators guidelines on how to be facilitators, for students example blogs, deadlines for original and return comments. Introduction earlier into the curriculum is important to develop competency in using blogs, blog administration, and in reflective writing and practice. Group size should be larger than 5 but less than 10 to maximise social constructivist discourse and to compensate for lurkers and those who reflect poorly or contribute little. Clinical facilities should also consider providing students with internet access while at their facilities to increase the timeliness of reflective writing and group feedback. The idea of having a blog that is designated towards a clinical specialty area was excellent as it focuses issues and feedback within that area. However, the rotation of individuals in and out of the blog could interfere with the space of trust and the concomitant self-disclosure that is critical for deep reflection.

Student Views of Blogging to Support Professional Development

Over 30 Students provided feedback on their experience using Blogging as a professional development tool. Their comments are summarised below....

Students were asked a range of questions to focus data collection. The results of these responses are reported by question. The first question asked was , “what did you like about the BLOG?” Students reported that they enjoyed the simplicity of the blogging experience. It could be done wherever there was internet access and one could go back and edit things as necessary. It did not take a lot of time, it was non-threatening and did not create the pressure that the examination caused. The pacing of the required work across the semester was beneficial and further reduced assessment pressure and anxiety. It also helped them to consider and practice reflection across the entirety of their fieldwork program.

The students also liked the informality of the entry standards as they did not have to comply with conventional academic writing standards. They learned a lot from each other and also gained access to information about other placements. This was particularly helpful for future placement planning and for learning about areas where they were not going to have any direct experience. For example, there was one discussion about a patient who had suffered burns and was being treated by one of the physiotherapy students. Students who were going to that placement in future rotations could prepare themselves more readily for the nature of work they were going to face.

The students also appreciated knowing that they were not alone in their struggles, fears and uncertainties. Individuals would write about challenges and doubts that many of them were experiencing and this openness helped to reduce fears and anxieties. The social connection to classmates, particularly if you were alone on a placement was particularly valuable and reduced the sense of isolation. Students also felt that they could disclose some things that they would not normally discuss with their supervisors, and appreciated the relatively quick feedback.
The whole idea of getting peer feedback was unique for some students and they found this very beneficial. However, the role of the moderator was also important, particularly where a group went off track, or where there were concerns that ideas of the student(s) may be questionable.
The second question was also asked of the students, “what did you not like about the blogging experience?” The typical computing issues emerged such as problems with access, low bandwidth, problems setting up accounts, keyboard literacy, the odd blog entry going missing, misinterpretation of written comments because of a lack of nonverbal cues, and having to learn a new software program.

One group only had four members and this turned out to be too small, particularly when one member did not participate fully. This reduced opportunities for social co-construction to develop. Another difficulty was that some bloggers only entered their blogs towards the end of their placement, which meant there was a flurry of activity at the end. This again diminished the learning value because there was not enough time to build up a stream of ideas, get feedback and implement suggestions.

Participants also felt some example blogs would have been helpful at the start of the program to get a sense of what is a ‘standard’ entry. Whilst they liked the informality of the experience, initially they were unsure of how ‘academic’ the entries needed to be, particularly with respect to writing in third person, referencing, and formatting.

Discussions on evidence based practice were also less conducive to reflection as they were rather factual. Professional practice issues were much more conducive to reflection as clear cut answers were far more ambiguous and uncertain.

Most students also did not have access to the internet at their placements because of site restrictions. This meant they had to do their blogging on their own time whereas it could have been beneficial to do this at the placement site if time was available and staff understood why they were sitting at a computer.

The students also would have liked to have read other blogs and to make contributions to them as well. While some did, because they got log in addresses from friends, or searched the blog web directory, it appeared that they were reluctant to do this as it was not within the framework of the guidelines.

The fact that the blog was open access caused some withholding of information and discussion because people could identify parties or institutions if the discussion went any deeper. Similarly, some supervisors in the placements were also blog moderators so again, some students felt stifled about what they could write because individuals and agencies could still be identified.
The third question asked of students was “how could the blogging experience be improved?” Students suggested that blogging be introduced earlier into the curriculum and to perhaps have a workshop at University in the computer laboratories where the blogs and accounts are actually set up. Participants could then experiment and practice using the blogs before departing for their placements.

Students also recommended that deadlines and penalties be applied for blog entries so that they were not left to the last minute, thus reducing the benefit of the experience. Some participants would have also preferred more open ended blogging so that they could discuss things beyond professional practice and evidence based practice topics. Another suggestion was to have open blogs which were specifically oriented around a particular professional practice area. For example, have a cardio-respiratory blog and all students on a rotation in that area could read and add comments and ideas to that particular blog.

The fourth question asked of participants was, “how did the blog help you in your clinical placement”? For some students, some of the blogs did not have relevance, whereas others were very useful and provided very good information for use in their placements, either currently or in the future. For example, there was one blog on managing group classes and how to work with individuals at different ability levels which bloggers found very helpful. For other students, having already completed a rotation in a clinical area, they could coach and provide support to their peers who were now having a placement in that clinical area.

The blog also required students to reflect on their practice which they found beneficial as it made them ‘have to stop and think about what you were doing’. The input from peers, as well as the academic moderator, also expanded the network of people the blogger could gain assistance from, although sometimes, if you needed some help quickly you didn’t get the turn around time needed.

The fifth question asked was “given other resources available to you at your placement (such as peers, supervisors, other clinicians), how helpful was the blog? What emerged that was of value was that non-threatening and safe space which the blog provided to ask, ‘stupid’ questions. The neutrality of the blogging group provided another option for discussion.

The remaining questions that were asked of the students were, “how did you feel about blogging in a group’? and ‘how did you build trust?’ Participants stated they were able to build trust in the group although there were still students who would avoid making ‘deep’ comments and kept things very superficial. There was a sense that everyone was in the same boat so it was easy to share, although there was some apprehension in the early stages of the blog about how much do you self-disclose. As one person expanded the scope of their self-disclosure, this encouraged others to self-disclose more readily. Some students elected to set up their name for the blog as a nickname. This caused some uncertainty at the beginning because the bloggers were unsure of which class mates were behind the nickname. They would have liked to have known who was in their group from the start, as this made building trust and considering feedback easier. Lastly the importance of acknowledging each other for their contributions was also an important aspect of building the blog community.

More views on Blogs - Academic Moderators

Based on our pilot project and feedback from 8 Academic Moderators.....the following results emerged from our blogging project.

The academic moderators felt that the blog was an improvement over the final clinical written examination held at the end of the academic year. Students were more engaged in discussions about their clinical practice and provided insights into some of the challenges students face during fieldwork. They felt however, that blogging should be introduced earlier into the curriculum. This would enable students to develop their reflective writing and practice skills so that when they entered fourth year they were well prepared as it was clear some students were more competent at reflection than others.

Moderators also found they had to refrain from taking too ‘active’ a role as this would have shifted dependence on to the moderator and reduced the benefits of co-constructive knowledge development amongst peers. This observation was also made by students who felt that moderators sometimes came in too early with their concluding comments which stifled dialogue amongst the peers. In light of this, moderators felt that guidelines would have been useful to help them understand their role more deeply. For example guidelines encouraging learners to frame their discussions using experiential learning frameworks (eg describe experience, discuss reflections, summarise conclusions and then consider re-application); and encouraging students to self-disclose, be vulnerable, and share issues. Moderators also found that they had to challenge some bloggers to make contributions and to get them to think more laterally. Hence, the moderator took on a ‘coaching’ or ‘facilitator’ role versus that of expert, and needed to provide positive reinforcement for high quality entries.