Video on Blogging, Peer Assisted Learning and Professional Development

The link below will take you to a video on how I view blogging as an excellent medium to promote clinical reasoning and professional development. The focus on peer assisted learning in as part of the blogging experience can be a very powerful way to increase learning and dialogue regarding professional practice. I hope you enjoy the video.

http://dbs.ilectures.curtin.edu.au/lectopia/lectopia.lasso?ut=952&id=19836

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.

Blogging - Views of Students on Practicum

Here are some views of students who have been experiencing Blogging as part of their clinical fieldwork experience. Some interesting outcomes to further develop the Blogging experience.

Benefits of Blogging as a Clinical Practice Reflective Tool.

Blogging is simple. When something was relevant you could ‘blog’ it immediately. was not time consuming. Its easy to access if at home or on practicum if you have web access.
It was non-threatening because there is no evaluation pressure when the sharing is done with your peers.
You can relax about your entries…they don’t have to be perfect because its not an assignment. You don’t have to worry about conciseness.
One could learn a lot from each other. For example, there are areas where you do not get clinical experience but you can still learn some unique things about areas that you do not experience as a student.
You discover that many of your own doubts are similar to those of others. You are not alone. It is great to get feedback that others are feeling the same, trying the same things.
Because of the random allocation of students to Blog groups you move outside your typical circle of ‘friends’ for support and learning.
You also don’t feel isolated because you can keep in contact with your peers about your placement – especially if you are on a solo placement.
You can prepare for future placements that you may be assigned to because you can ask questions and read about the experiences your peers are having on those placements. You can build from there.
You can also edit your entries, go back and read them gain later. If you remember things you can put them in as additional facts.

Challenges and Disadvantages of Blogs as a Clinical Practice Reflective Tool.

There were some challenges associated with the initial set up of the Blog and inviting members.
Some comments which were entered did not appear in the blog and were subsequently lost – saving them in word and the cutting and pasting was a better idea.
Few problems access and setting up and the logging in and invites
Key board skills for some were difficult but they could go back and edit their mistakes.
The orientation in class was quite different from actually sitting down and doing it live.
If you don’t have high speed internet access it is very slow.
In a smaller group of 4 individuals (instead of the normal 5 allotment), a couple of students had access problems, so only two individuals really did most of the blogging. The collective input of the group to support learning was vastly minimised.
Other participants in the Blog had to be diligent about their entries and timeliness to keep the learning active and moving. Otherwise it could stall.
Feedback from the academic staff person who was monitoring the blog room could be higher to help participants know that they were on track (especially in the initial phases).
There was also not a lot of information on how much one should enter into the blog. Some were brief so at times one could feel they were putting too much effort into the Blog. A standard might have been helpful.
Blogging on Evidence Based Practice was okay, but it was harder to reflect on that information because its factual. One often found that they ended up writing the blog on EBP like an assignment as a result. Further, if you could find no evidence to support your claims about EBP this made it even harder.
It would have been good to read other Blog groups contributions to see what they were experiencing, and perhaps contribute as well.
Computer access was difficult for some individuals at their practicum because they could not access the institutional computer system to get on to the WWW. If you didn’t have a computer at home or high speed internet access this was also a limitation.

What would you change about the Blog process?

Introduce it earlier in the curriculum, for example, rather than in 4th year, it could have been used in year 3 in preparation for fieldwork.
While the orientation workshop was good, it would have been better for everyone to set up their Blog in the computer lab at university so everyone had a practical experience with some support.
It would have been good to expand the focus of the Blog and not just keep it to clinical issues. It would have been good to look at professional issues, how to deal with difficult supervisors, arrogant doctors etc…open the scope of blogging more.
People used nicknames so it became hard to know who you were talking to initially in the Blog until they identified themselves. Using a first name or some kind of abbreviation with one’s name would help.

How did the BLOG provide support to students in clinical placement?

Blogs that were relevant (they weren’t all) provided some good extra ideas, provided information for trying things different.
At times you may be in a situation and remember that it was discussed in the blog so you have some ideas to implement.
It could be useful for future reference, for example, after you graduate. You could go and refer back to the site for information.
One example was about group classes and strategies for challenging participants at different levels.
I could see maintaining the blog group after graduation. For example, I need help does anyone have any ideas about……..

Other Dimensions about the Blogging Experience

The non-threatening environment made it easier to share ideas and stupid questions which you would never ask your supervisor.
If you don’t get along with the student you are placed with you have other options to get information.
If your on a placement by yourself you have ways of maintaining contact with other students.
Some students only contributed the minimum or caught up at the very end of the placement so there was not time to build a discussion. If they did contribute their comments were very superficial and not deep. Some students just shared what they were doing – reported successes only.
Other groups engaged well and were able to generate discussion.
Some students were very task focussed in the Blog.
Evenn if just asking question - - - just generated discussion
5 was a good number. If you had less you may find that there are things being raised that you can’t contribute towards. With 5 options increased and you had more scope to make comments and contributions.


The Building of Trust and Self-Disclosure in the Blog.

Some individuals felt uncomfortable about self-disclosure regarding learning deficiencies.
If you don’t have the confidence in something it is easy to be apprehensive about opening up. However, if people start to share and are prepared to be vulnerable and open about their learning, it was much easier to self disclose.
The presence of an academic supervisor monitoring the Blog still had some impact on disclosure. If you put something wrong on the Blog you might get caught out – what will the supervisor and your peers think of you. However, once you see students putting up things that they are uncertain about, or incorrect, and they are not upset about it, and you see people supporting one another it is easier to share things and you don’t get so stressed.

Progress on Blogs in Clinical Placements: Actual Stuff!

Academic Monitors Meeting (1)

It was noted that the point of engaging learners to reflective practice is to help them transfer academic knowledge to the clinical setting and to test practice with input from peers. All this leads to professional competency. It is a great skill to equip them for professional practice. The UK for example, sees reflective practice skills an integral part of the continuing professional development experience.

Students were randomly allocated to the Blog group (38), with a few minor alterations to compensate for web access etc.)

It was considered that this Blog experience has enormous potential to impace on different aspects of professional practice – eg. Clinical skills, ethics, professional practice, etc… Some of the topics that have been raised in the Blogs to date:

1. Conflict with supervisor
2. Patient education
3. Working with clients whose first language is not English
4. Time management in outpatients
5. Compliance issues with respect to treatment****
6. Grieving processes
7. Death and dying – aged care
8. Models of supervision – learning styles and differences in supervision style
9. Goal setting with children and the influence of parents in managmenet
10. Questions about practice = what works, what doesn’t work with specific cases
11. Managing classes.
12. Family centered care – paediatrics…how to engage family
13. Difference in practice between facilities eg. ACL?
14. Pain and paediatric treatment…
15. Communication strategies and patient compliance – communication difficulties
16. How decisions are made about use of specific equipment how much EBP drives practice.

• General feeling that the Blog is much better than the Patient Clinical Written Examinaation
• Would be useful to introduce blogging and more expanded opportunities for students to develop reflective practice skills earlier in the curriculum. This would make engagement at fourth year during clinical placements potentially easier. There is some space for this in the second year but it really needs to be examined more broadly across the curriculum.
• It is still difficult to ascertain how fully engaged participants are in the Blog environment because of required elements and the presence of an academic monitor.
• Some participants clearly are better at reflective engagement whereas others need coaching to move from describing events to more reflective practice.
• Moderators find they must refrain themselves from providing too much expert opinion. Need to encourage students to engage in a dialogue and reflection about shared practice. Otherwise students may shift dependence to moderator.

Some greater clarity about the staff role is needed. Some guidelines that were discussed include:

• Encourage learners to apply more of the Experiential Learning Framework to their journaling: Write about their experience, discuss their reflections such as how they felt, what they understood to have happened…make some conclusions based on this thinking and consider how to apply learning in the future….
• Vulnerability - encourage students to self disclose, be more vulnerable, shift away from ‘looking good’ and share questions as this is how professional practice develops.
• Give feedback to others to reduce their blind spots and move out of hidden windows so that others can help with questions.
• Challenge them to make contributions, generate questions to make them think and consider more deeply issues that are raised in the blog
• Dates for placements should be provided by organisers so know when students rotate and whether they are in the first, second, third etc.. week.
• Tracking of student contributions can be made on a simple template.
• Provide positive feedback for good contributions.
• Monitor the quality of contributions as well.
  

There are some great potential research outcomes that will flow from this project. They largely will be qualitiative in nature by examining and coding the documents. Will need student consent and ethics approval. However some outcomes will be to look at the sorts of issues students generate and need help with. Will be great information for curriculum planners and problem based learning cases. Can also look at differences in blogging by gender. Reflective practice and clinical reasoning analysis can also be carried out. Questions on evidence based practice that frequently appear may also be used for curriculum innovations.

Blogs in Practice ...

Well the Blogging project is underway. Interesting. Aside from a few technological hiccups getting started with invitations.....people seem to be using the technology to bring peers together to discuss professional practice issues. One thing that seems to be hitting me is to what extent are people working to the minimum standard given that we have set some guidelines. Another question I have is to what extent are people hiding behind hidden windows. The Johari Window is really relevant here in its connection to developing clinical practice. Here are a couple of sites explaining it in more detail for those that are unfamiliar.....

http://en.wikipedia.org/wiki/Johari_window

http://www.noogenesis.com/game_theory/johari/johari_window.html

Luft in the 50s talks about the hidden window and how we often keep things hidden from others in order to 'look good', 'appear in control', 'competent' etc... and in other cases, refrain from sharing insights with others because of 'fears', 'nerves', 'role confusion' and thus leaving them in performance blind spots. To really maximise the utility of using peers to coach us through difficult professional practice issues, we really need to be in the 'open window', according to Luft. This means through self - disclosure, and a bit of humility recognising that we can't possibly know everything, we can actually accelerate our clinical competency. After all, what is factual when it comes to professional practice decisions? So much of this is art, situated in the context that we are experiencing, so is there ever a correct answer or approach. The only way to validate this is by asking others (supervisors usually arent' asked because of evaluation tension), in particular our peers cause they are not in evaluative roles. So I wonder if students really grasp the opportunity they have to Blog. That is, taking all this theory they have learned, and then using a Blog group (community of practice) to help them with the transfer of theory to clinical practice...which is quite different.

Evaluating the Impact of Blogging on Reflective Practice

The orientation to students was held the other day. Surprisingly none of the students except for one had heard of or used Blogs, hence, it will be interesting to see how this technology takes hold for the students. The students were accepting of the split between blogging group and journal (manual group). Once students are aligned to their groups then the orientation to the technology can take place. I had an idea that we can run the focus groups as part of the action research through the Graduate School of Business' StratCom Laboratory. Students in the Blog and Journal group can answer a series of questions around a table with 12 terminals. Each terminal is connected to a central screen where people can type in their answers. It is confidential so no one knows who has said what. This may provide for more anonmymous and forthcoming results from the groups. It will be good to also have instructors undergo a session too to capture their feedback on the process. We will need to identify the questions we want to ask the focus groups to gain a sense of the two models. What will be interesting is to see if the journalling group naturally move beyond independent journalling to include peers to expand their understanding....

The Impact of Blogs on Reflective Practice: A Pilot Project

What is the impact of blogging on reflective practice? Is it better than journalling? Journalling is highly personal and private unless shared with others. Does a community of practice, that journals publically within this group gain more with respect to professional development? These questions are explored in this pilot project involving final year physiotherapy students. The attached power point provides some detail on the project.
Two groups will engage in reflective practice during the course of some clinical fieldwork. One group will use standard journalling processes. The other group will use Blogging in pods of 5 learners who can see and contribute to individual and/or group reflections. Focus groups will determine qualitatively, differences in learning, practice and performance. To guide the learning process, students will reflect on clinical practice ethics, evidence based practice and professional practice (eg. clinical reasoning, peer support, and general questions/answers) Other measures may also be taken to look at differences between the two groups.