Dr. James Nurse, general pediatric consultant at the University Hospital Southampton NHS Foundation Trust, and head of the Child Health module.

Providing Equitable Learning Experiences at Diverse Clinical Placements



Article originally published on E-Learn Magazine on Aug 23, 2018 – Click here for the Spanish version

Conducting blended courses can be an effective approach to improve learning, especially when students attend classes or placements at other institutions as part of a module. In clinical placements, specifically, each student experience is different, and faculty strive to ensure all learners receive the same opportunities to achieve module objectives. The virtual learning environment has an important role, and blended learning helps guarantee equal learning experiences for all students.

The Child Health module, within the Faculty of Medicine at the University of Southampton, is taught alongside student placements throughout a variety of hospitals in the United Kingdom and Germany. The module was one of the award-winning courses at the 2018 Blackboard & VLE Awards, which was put forward by students and chosen by a judging panel for its innovative features and use of visual resources to enhance the learning experience.

To accommodate the necessary placements, the module counts on the Southampton General Hospital and several other partner hospitals. Students in the same module and with similar goals are accompanied by clinicians at different locations and with diverse clinical opportunities available.

“From the start, it was clear to me that the curriculum provides the structure, but the body is given by the clinicians and the centers. So, I wanted to ensure there is a common level of teaching, which means that any material provided to some students must be available to all of them. It was a big concern that there wasn’t a sense of unfairness,” shares Dr. James Nurse, a general pediatric consultant at the University Hospital Southampton NHS Foundation Trust, and head of the Child Health module.

Dr. Nurse joined the University Hospital of Southampton in 2014 and was appointed the role of general pediatric consultant in the following year. When he was attending to his pediatric training and performing his initial clinical activities at Southampton, he divided his time between clinical care and teaching activities in an undergraduate module, which he believes gave him the chance to try different approaches in education.

“For me, it was an opportunity for learning educational theory. I had plenty of time to look at what we could deliver with the online course, working with Blackboard Learn, and seeing what we could create and put on there for the students. In my first year, we were trying many resources and approaches and seeing what worked. The time that I had allowed me to start developing materials.”

Simulation-based Learning

In a non-linear medical course module, professors can’t be aware of the types of clinical experiences students will have on a daily basisThusin order to provide equal learning opportunities to all students, regardless of location, an interactive compilation of symptoms provides access to a complete and standardized clinical activity, which includes from the patient interview and physical examination, to lab tests, diagnosis, and therapy. The simulations are computer-based and focused on activities with virtual patients that simulate real-life scenarios. These allow learners to practice as professionals in order to develop clinical skills such as analyzing patient history and making treatment decisions in a safe environment.

“It is challenging because this is not a classic course model and content is going to be delivered in different modes and in different places, but I think we found ways to complement them. In terms of tools and visual resources, one of the earliest things we put together was the virtual patient resources, a real-time system that the university settled on for delivering content and gathering cases designed to be read, so as to be sure that students later will be able to move on their own,” explains Dr. Nurse.

The faculty aims to re-create real-life situations in which students have to make decisions quickly, considering differential diagnosis and symptoms not described as they have previously learned them. He emphasizes that in this system, a clinician guides students through the clinical presentation of a case and encourages them, through the use of videos, questions, and pictures, to think what they would do in a similar situation.

“These virtual cases stimulate students to think about cases more broadly. We’ve used tools like CourseCast of the Panopto system to record videos and guarantee a system that allows students to revisit materials at their own pace. I’m particularly pleased with the cardiology videos. They are very popular with students and we know if they are viewing it on a regular basis.”

The virtual patient cases provided by the university allow students to see a variety of cases they might not have seen at their placements, such as a diagnosis of palsy or leukemia, for instance, if the hospital where they are placed doesn’t have these types of cases. Dr. Nurse mentions that it is essential to provide these resources in an efficient virtual learning environment so learners can quickly find what they need.

“If the site is easy to navigate, they’re not wasting their time when their time is already precious. It is also essential to make things that are bite-size so that students can use them in a short period of time and just pick up a quite focused piece of information.”

Lending a Hand with Assessments

According to Dr. Nurse, students tend to be assessment-focused, so providing them with past test examples supports them with exam preparation, which has been a popular initiative. He also mentions that using multiple means of representation stimulates students to go deeper into content and to leverage learning opportunities provided by their placements.

“We use the learning module in Blackboard Learn to provide materials that students can work with to help prepare them for assessment in the module — a writing assessment and then a presentation assignment — to give them a sense of what we could present in the exam. The combination of written materials, pictures and videos encourages students to think more deeply about something that they might otherwise treat in a superficial way,” says Dr. Nurse. 

Getting Feedback

Feedback, whether provided by learners or automatically generated, allows faculty to get an understanding of the most effective approaches to the virtual learning environment. Dr. Nurse points out that students may experience feedback fatigue when constantly asked for their thoughts on the learning activity, which should be avoided to ensure faculty will achieve high-quality priority information. 

“We need to be careful at how much we ask them as there are things that we definitely need to get feedback on, particularly on the course as a whole, because of the standards that we need to present to the General Medical Council, the regulatory authority that allows institutions to give out medical degrees. So, it is useful to know what to do, but also what not to do. One thing I appreciate in Blackboard Learn is that it allows us to track students’ activity. We can see who’s doing what and work out the things we should be investing more time in,” comments Dr. Nurse. 

Supporting Staff

Through the iSolutions Digital Learning team, the University of Southampton promotes technical expertise that supports professor initiatives aimed to provide students with an engaging and innovative learning experience. Faculty can count on a team of staff that includes videographers, graphic artists, and multimedia designers who collaborate to turn ideas into reality. The resources range from an infographic to a complete online course, and examples of innovation and good practice are shared through lectures, professional development sessions, and special interest groups.

“The university’s Digital Learning team provides training around Blackboard Learn, and they have been very supportive with that, providing technical support for us where we need it. There is a monthly e-coffee meeting handled by the iSolutions team, and it is good at bringing people together getting in sharing ideas and experiences. We had a recent VLE masterclass where they brought faculty together to share cases and what they were doing on their Blackboard Learn modules and on the VLE,” comments Dr. Nurse.

Future Challenges

Dr. Nurse sees winning the Blackboard and VLE Awards as a validation of the work developed for the Child Health module, and the certainty of having taken the right path when providing multiple resources to create the same experience for all learners. He says that the award stimulates him to search for new ideas when it comes to planning next year’s activities.

“There are new materials that I want to develop to support students where they’re working. I’m very keen on the idea of podcasting, that’s something that gives them the opportunity to learn even when they are busy. I think for us it’s not resting on our laurels; It’s continuing to innovate but also to maintain our old material, making sure that we’re not slipping behind in using flash websites they can’t access, and making sure it’s all mobile-phone-friendly,” concludes Dr. Nurse.

5 Best Practices to Create a Winning Course

  1. Helping with Exam Preparation – Students tend to be assessment-focused. Providing previous test examples helps them prepare for exams and is a popular initiative among learners. 
  2. Offering Staff Support – Supporting faculty with technical expertise to enhance initiatives and provide students with engaging learning experiences. The University of Southampton counts with a team that includes videographers, graphic artists and multimedia designers who collaborate to turn professors’ ideas into reality.  
  3. Getting Feedback – Receiving feedback, whether from learners or automatically-generated, allows faculty to understand the most effective approaches to the virtual learning environment. 
  4. Simulation-based learning – Providing computer-based simulations and multiple means of representation is an effective initiative to achieve equitable learning experiences. The Child Health module has used this resource alongside videos, questions, and pictures to create broader experiences and to help students develop skills. 
  5. Developing Critical Thinking – Encourage students to make decisions and deal with challenges. At the Child Health module, a clinician guides students through the clinical presentation of cases and the use of virtual resources, motivating them to consider the actions they would take in a similar situation.  

Photos: AFP Glyn Kirk