A few final words to end another semester, and wow that means I'm half done! Even better, that means I still have half to go! I've thoroughly enjoyed and and begun to see how these courses build off each other, and all carry a practical association back to my own context. Through this blog activity, I found a host of resources that have helped further my thoughts on many current learning needs, and have fostered many thoughts of change. I'm a paramedic by training, and am finishing my second year of full-time teaching, after about five years of part-time teaching, and with a change in program leadership, find myself in a position where evidence based change is encouraged. There really hadn't been any significant changes in the past decade, the former coordinator had largely built the program, arguably one of if not the most successful in the province, and based on those results it had always worked, so changes were not seen as a good thing. As student cohorts changed, and educational views changed, all current faculty recognize that we are not here to teach the content and administer the tests, allowing students to pass or fail on their own, but we're here to teach the students, and provide them with both the best education and the best opportunity to succeed that we can.
Through these reflections I've come up with many ideas that are exciting to think about, and that my program colleagues are intrigued by. Classroom delivery will be a work in progress for a while, but my lecture based theory classes are going to change to better incorporate full participation, and my method of stand-alone high-stakes evaluation will be changing. For my thoughts on various multiple choice scoring systems, although very intriguing, I still fear that it may produce an atmosphere of gambling, of spending too much time on debate between options. I am however encouraged by the notion of utilizing an evaluation system that scores the best possible outcome, weighting tests in 3-5 different schemes as discussed in a previous post. The only difficulty will be my school's eGrades used for tracking marks, as it relies on a given outline, however I may just change this to a final grade value, and track all marks separately, it will just involve clear structure within the course outline. I'll take this chance to thank everyone for sharing your views and comments throughout the course, I genuinely enjoyed both courses I took this semester (801 was the other), and move on to some of the Classroom Specialist courses, with an elective in Assessment, as clearly that seems to have become a large component of my thoughts throughout this blog. Thanks for reading, and good luck going forward!
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I've focused a lot during this blog on the current evaluation and teaching methods used within my program, and what changes might be made to improve upon these. There is another component in discussion currently, which is adjusting our entry requirements. Currently we require a collection of college stream high-school courses, typical of any program, and upon a conditional offer of acceptance, we require these applicants to attend a June/July information session where we ensure these students understand the rigors of our program, including the fitness component. To do this, we put the students through the Beep Test and Obstacle Run; we demonstrate but avoid doing the lifting tests as it requires certain safety apparel and lifting techniques taught once within the program.
Our information session fitness component is participation only, we do not hold any requirements, however there are other colleges that do. To demonstrate the relevance of this, last year we lost fifteen students to fitness in first semester. This is the high end of a normal range. We view this number as unacceptable, particularly since we let the students know they need to start training in June, for a test that occurs in December. I'll reiterate that the levels we ask for barely meet what most sources would call below average, and even unhealthy. Our proposal is that we implement a fitness requirement. Based upon Canadian Military evidence, there is research to clearly show the progression one can make and improve; for example, if you can only run to level 2 in June, there is evidence that this applicant will not be able to obtain a passing level of 5 by December. This applicant would then be denied admission, sent home with their results and a worksheet on how to improve, should they desire. Judging from last year, this would have denied six applicants entry into our program. These six were ultimately unsuccessful, and we could have used these seats in our limited enrollment program for students with a higher chance of success. We make it clear in June of the hard work necessary and the statistics of success, however students and parents always believe they'll be able to do it. I do believe statistics can be beat, but it requires such a drastic lifestyle change for these applicants that I have yet to see it happen. Our initial proposal to administration was met with hesitation, with thoughts of human rights being questioned. I admit I need to investigate this further, and within the context of my college policies, however is it any better to set students up for failure? Perhaps after another couple of years of tracking these initial results with eventual class grades we will have sufficient internal evidence to approach this again. Our program's biggest issue from an administrative point of view is retention, and we believe this is a valid method to improve upon this - we implemented the information sessions to attempt to improve retention and inform applicants about the fitness requirements, however it does not seem to dissuade anyone. Many teachers I know take attendance, mostly as a fallback when students are unsuccessful, as only rare courses in my school give marks for attendance. This fallback typically demonstrates a student's lack of class attendance, and thus provides additional evidence beyond an unsuccessful grade.
I do happen to teach one such rare class where attendance is still given a mark - Physical Fitness and Wellness. The major part of this course is physical preparation for their fitness and lifting evaluations and job competitions. I started to wonder this semester though, why am I giving away free marks to those that can roll out of bed and arrive in the gym on time, to then participate with a complete lack of effort, barely going through the motions. It's the participation that matters, not the attendance. So this thought rolled around a bit more in my brain, would this not apply to my theory classes too? Currently, there are no attendance or participation marks, but should there be? If I want students to care more than just about a number at the end of the course, should I not demonstrate what I preach by praising active participation and preparation? I want the focus to be on the material and its application, and promoting the metacognitive skills to become better learners, but a final grade based completely on tests seems contrary to this philosophy. As the teacher I have the freedom and control to change my course outline and evaluation scheme, and I think change is in the wind. I enter my third year of full-time teaching next fall, and though I have made minor changes in both content and evaluation, it's time to stop doing what was done previously, just because it was already in place and worked. Below is an example of a rubric I found that is an example of how one might evaluate participation, and this can be done by both the teacher, and the student. Some comments on the rubric stated that it was too complex and unnecessary to track participation this way, just put a plus or minus next to a students name each day. I however like this rubric, or something based off of this concept, as the other important aspect is the self-evaluation and reflection, promoting that metacognition and self-regulated learning I want my students to develop. http://www.facultyfocus.com/articles/effective-teaching-strategies/participation-points-making-student-engagement-visible/ I write this post following a recent conversation with an EMS service, who questioned what our paramedic program does to instill our graduates with a healthy physical fitness outlook. "Sure you prepare them for their fitness evaluations to get hired, but what do you do, if anything, to ensure they continue with their fitness once they graduate?"
The Background: Our students take three semesters of fitness courses, the last being an online and self directed course. The ultimate goal is to help the students train to pass the physical evaluations that must be passed to obtain employment. This consists of a beep test, an obstacle course, and two strenuous patient extrication/lifting tests. After discussing how our students progress to the self-directed class, I then posed what I think are bigger questions. If services value this attitude, and require such testing prior to hiring, then why do they not do annual tests to ensure medics are still able to this? Cognitive abilities are tested yearly, why not fitness? We've all seen the large proportion of out of shape medics out there, what incentive do they have when other life pressures start to take their time? Having a staff of physically fit paramedics certainly reduces injury time, and is well established as one of the most effective coping mechanisms for stress, yet services offer very little if any incentive here. Would the savings in decreased injury and stress leave not be enough to offer greatly reduced or even free gym memberships? Paramedics are encouraged to enter various athletic events, however there is no support from the employer, even at events where medics are entering under their service name. At the extreme, those medics who actively pursue great athletic achievements on a national and international scale are only seen as those with limited availability to work, and have that time held against them. I have been happy to hear these same questions from some of my students. I applauded their critical thought and scrutiny, for their questions are legitimate. "Why do we have to do all this, when it's obvious from looking at working paramedics that fitness isn't as big a deal once you're hired?" There is certainly validity in ensuring a base-line level of fitness to enter the workforce, you do need to be able to lift people, work around difficult terrain and accident scenes, but employers need to do more to continue this. They provide continuing medical education, why not continuing fitness opportunities? All I can do is keep pursuing the development of a fitness curriculum that inspires students to continue physical activity for life, they don't need to be "athletes", I just want them to have the skills to be healthy and well. And who knows, maybe once enough get out there with these attitude, and these questions, employer attitudes may change. As I was searching for more evidence to support the team teaching concept I discussed in my last post, I came across this, Team-Based Learning. In this instruction model, a focus is put on pre-class preparation and group work. Fundamentally, students are assigned pre-class material, upon arrival in class students are tested individually on this material, then move into their assigned groups where the test is taken again as a group, following these assessments groups then move to working together on problems and discussion to further the learning. This would be an interesting shift in how my theory class operates. I picked up teaching my theory classes in the traditional lecture style that has always been used, which utilizes three tests worth 20% and one final worth 40%. This team-based approach increases the accountability of the students to keep up with their daily work. Our classes are extremely content heavy and progress rapidly, so we rarely have attendance issues, however this increased emphasis on pre-class preparation would add to the flow of the class, as well as help students develop better learning skills. A portion of the final grade then comes from the individual and team taken in-class tests, which would take some of the stress off of the current high-stakes exams. Paramedicine is a high-stakes profession, but I don't believe education must follow this, we should be preparing them for it, not expecting it from them. The focus on team test taking would foster discussion, and the ability to use resources to verify information. There are often discussions they'll face in the workplace about how best to treat a patient, and this could provide valuable experience in listening to others, critically analyzing options, and justifying decisions. I will certainly consider a lesson plan like this, not just for change, but as there are relevant skills fostered within this method. With a lot going on, I may incorporate it into one class, or even just a unit or two within one class to see how effective I find it, and how the students do with it. http://www.teambasedlearning.org/ One of my colleagues presented an interesting idea a few weeks ago, that came back to discussion today. His idea: that we consider team teaching. The premise is that among the three of us that are full-time faculty, we each teach similar content at different levels and scopes of practice throughout the three years of our program, and that we consider each teaching our favourite units throughout the program at each level. For example, Brad teaches the advanced care theory class in third year, I teach theory in the second year, however we both cover similar topics. In this method I might teach toxicology to my second year class, while Brad is teaching obstetrics to his third year class, then we would switch; I would take my toxicology unit with additions to the third year class, and Brad would move into the second year classroom.
Advantages would include each of us having more focused prep time, and we would be that much more up to date and read on our individual modules. It may also prove more interesting for the students, as each teacher brings their own methods and enthusiasm. Disadvantages would be the obvious difficulty in coordinating these modules and our teaching time, as we all have busy semesters, and teach our content in an organized flow that may have to be altered. There would also be less familiarity with the students in each class, and therefore less emphasis on understanding students on an individual basis. I am intrigued by the idea, however at this time the task of coordinating teaching efforts seems very large in light of the workload we currently have, as we are in a program accreditation year. Additionally, as I am just finishing my second year of full-time teaching, I would be happy to have at least a third year to continue working on my current courses and teaching methods. Our dean has no issue with the sharing of teaching assignments like this, so if it is something we decide to try we have the support to do so. My fellow program faculty are also very excellent to work with, and we will only go ahead once all three of us feel ready or have desire to do so. So at this point, I personally would like to hold off for another year. Has anyone else taught in a similar context as this? I'd be keen to hear some first hand thoughts about the experience! This article I recently came across brought up an interesting thought, why do I teach medical skills in the manner I do? Typically, I teach these skills in the manner that I was taught, and continue to be educated through continuing medical education (CME) to maintain my working paramedic certification. As this article points out, most of these skills are taught in a manner that is not based on any evidence or research, we simply do what's always been done. We usually present the theory behind the intervention (as pre-reading for more advanced skills), then demonstrate in class, discuss evaluation, and break into smaller groups for simulated practice. Based on this recent research, I'm not doing a bad job, but improvements could be made. Ideally, pre-reading should be given, along with an emphasis on a pre-class instructional video, including access to the evaluative criteria that will be used. Then in class, review the material, demonstrate, followed by simulated practice. Students should then perform ten repetitions of the skill within the next ten days. Skill competence levels were retained much longer and with better evaluation scores when all these components were in place. This is an important process to consider, for as the article also states, often students learn medical interventions and skills months before actual live practice, and our instruction must be evidence based to ensure we are utilizing the most effective methods. It is also mentioned that when possible, spaced reinforcement promotes further success than a single long duration lesson and practice session. For my context, to use IV's as an example, it would be better to teach the basic initiation on a perfect patient presentation, and in subsequent shorter sessions introduce variations in technique for difficult patient populations, over attempting to teach this all at once. Overall this will be a simple and relatively small change in my teaching practice, but one that will now be evidence based and promote better long term competence, which is important to my personal philosophy. Routt, E., Mansouri, Y., de Moll, E. H., Bernstein, D. M., Bernardo, S. G., & Levitt, J. (2015). Teaching the simple suture to medical students for long-term retention of skill. JAMA Dermatology, 151(7), 761-765. doi:10.1001/jamadermatol.2015.118 After another meeting today, the idea of Ontario's Primary level paramedic programs progressing from a two to three year course is likely becoming an official proposal to the Ministry. Paramedicine, like education, is an ever evolving and growing profession. A job that was once driving an ambulance is becoming ever more complex, as yearly new medications and emergency procedures are added to the primary level of practice. The catch is that the program duration has not changed in decades. Even comparing to ten years ago, the scope of practice has advanced so much, that primary care medics are practicing at near the level advanced care medics were just a few years ago. Obviously with this, the amount of increased training and education added to the curriculum has increased, yet where does this time come from? Well, it hasn't. We're just asked to teach more. Our students are already in credit overload as it is, and now carry arguably the most demanding course load and steepest learning curve in the college. Is this responsible for our 60% attrition rate? Partially. Mostly this is from a complete lack of a robust entry process, but that's a whole other post / blog in itself.
This made me think of the teaching of the history of education, and how important it was we determined that teachers should know where they came from, in best order to understand where they're at, and where they may go. Likewise, I think it is equally important to continue to impart to paramedic students the history of their profession, as it also helps develop the skills they'll need to adapt to the changing industry and standards. So with all these factors at play, the college heads are proposing the paramedic program become a three year advanced diploma. This is also aligned with the terminology change that paramedics are not to be considered technicians, but clinicians - a term also that defines other three year medical programs. As an educator, this move makes sense. As a college it makes sense. It should help reduce the acute stress and workload, and retain more students. And it should also help the employers as they will be getting a more mature graduate who has had another year of personal growth via more clinical hours, more residency hours, and an overall year of life, which can mean so very much for an eighteen year old. So once the official proposal is submitted, we will wait on the Ministry's decision, which currently depending on who you know, and who you ask, is about a 50/50 split on thoughts of approval. Could there be an alternative? Services could implement a much more rigorous new employee training and mentorship program, solidifying their education and promoting a safe environment of trust and development. Unfortunately, as good as that sounds, that is not our current industry, nor do employers seem to want to spend any time, money or resources implementing this, they simply want employees to show up job ready on day one, fed to the wolves, sink or swim. A harsh reality, and one that would require a culture shift to successfully accomplish. Within the program I teach, our practical lab and theory courses share content yet are independently evaluated. Some colleges have elected to put them together, more typical of anatomy or science classes that carry attached labs, but our school has always kept them separate.
As I think about going forward and envision changes I'd like to implement, the concepts of collaborative inquiry and increased student participation keep coming up, even for theory classrooms. These classes for the past many decades have been your typical lecture based room, sure the teachers use constant real-world examples to ensure relevance, but the student role is passive. Evaluation is done strictly by examinations. The argument for this has been that we ensure the students have a basic grasp of fundamental concepts, then later that week it is applied in lab and practiced. The students that typically excel here are those that come from a university background, those that have become "professional students", and are typically those that do well in a lecture hall and have the ability to synthesize spoken word into practice. This student is the minority in a college classroom, where more and more our cohorts are coming straight from college-stream high-school. Would this type of student, and all students really, not benefit from a more engaging classroom setting? Unfortunately, appealing to students to come better prepared to class to actively discuss our way through new concepts and apply them to case studies isn't enough, inevitably many are not motivated by this intrinsic appeal. They are often results driven, so how to externally motivate these reluctant numbers? I've been looking at a few class participation rubrics that may help remedy this. It is a quick way to scale quality of participation, and would provide the motivation to come to class ready to actively engage. The argument against this would be the question of watering down the course with such participation marks, but ultimately I think this does the opposite, strengthening not only the knowledge of content, but also imparting valuable good learning habits. The following link is to one such rubric, a simple 0-4 scale, which after an adjustment period I'm sure I could reflect after each class and apply to my 25-30 students. http://cte.virginia.edu/resources/grading-class-participation-2/ I found an interesting article by Starling, that describes his semester as returning to the classroom as a student. In his college setting, for professional development, one teacher each semester is selected to suspend their teaching and enroll in a full-time semester as a student. The premise is to have the teacher view other classrooms and teachers from the student perspective, instead of just attending as a peer reviewer. The teacher is to assume the role of a "master-learner" and assist newer students, in addition to doing all assignments and tests themselves.
One of the driving forces is to increase the amount of self-reflection, as so often our feedback is derived from anonymous student surveys and very rare and brief supervisor visits. Some of Starling's take-aways include focusing the first day on content and assignment relevance, employing increased journal activity and group discussion over exams and lectures, and having increased empathy for student concerns and questions. I don't foresee this being an activity my school would endorse, primarily because many of our programs have a small faculty, such as three full-time teachers in my program, so the resources to cover the classes simply aren't there. However, I could envision a few hours set aside for teachers to visit a handful of classes, it would just take a shift to move away from being there to critique, to being there to absorb and reflect. In another course during a group discussion, colleagues who teach in Korea and Vietnam discussed how this type of PD is already being done, where teacher visits to other classrooms are the norm. Here in North America, this would most often be viewed as an intrusion, we've got work to do! Starling, R. (1990). The impact of alcoholism: The writer, the story, the student. College Teaching, 38(3), 88-92. doi:10.1080/87567555.1990.10532200 |
AuthorI teach Paramedicine at Cambrian College, in Sudbury, Ontario. I also continue to work as a paramedic, and ride bikes. This is my third semester in the PME program, and I look forward to learning with everyone! Archives
March 2017
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