A Review of Reviewing Itself: Improvements on DID-ACT’s Learning Unit Review Process

The DID-ACT project’s in-person September meeting in Bern, Switzerland, brought forward many interesting insights and opportunities for streamlining tasks. Aspects of effective project management in our development of a clinical reasoning curriculum were brought up a few times. Some key takeaways were small, like how to more clearly manage our folders using the feedback from the interim report. Larger topics, like tools for effectively writing blog posts and reports, were also brought up. These tools help to ensure the language of posts are at an appropriate audience level. One of our largest takeaways was how to streamline the review process for our learning units (LU) in a way that was more time-efficient and thorough.

Streamlining the curriculum review process

Our previous process for reviewing the learning units developed was to set up a small working group. Groups would be given a week or two for review, then come together to discuss our thoughts using a standardized review template. The team who developed the learning unit would then implement the necessary implementations based on feedback. Following this, there was a final review opened to the group.  We noticed a few downfalls to this method: 

  1. It took many weeks to get the review done due to requiring a sync between the entire team;
  2. Things slipped through the cracks upon the more scrutinized review that the Moodle implementation required; 
  3. By not being as high a stakeholder as, for example, someone who was testing the learning unit themselves, reviewers were not as engaged as needed for proper scrutiny.

This third point was the experience of one of the EDU teammates when preparing to implement the Person-Centred Care learning unit for trainers.

New review process for clinical reasoning learning units

omething many of us know about preparing anything is that running through it in detail, as close to how it will be used in real life, is a key part of ensuring you are producing a quality item. This is exactly the circumstance Jennifer and Daniel found themselves in when preparing their PCC learning unit pilot. Despite having made it through the pre-described learning unit review process, tiny errors slipped through. Ideas around how to more effectively use time, adequate prep for an activity, and Moodle implementation itself were all aspects of the curriculum we could streamline before the actual pilot. The EDU team brought this experience forward to the consortium at the Bern meeting and from this fruitful discussion came the following modified review process: 

  1. LU’s are to be completed in batches
  2. When a working group has their LU prepared for review, they email the consortium and a review group of 2-3 people, including 2 of the authors, is formed using a Google doc sign up sheet
  3. A review date is agreed on
  4. At this point, the team is to review the learning unit asynchronously
  5. Upon meeting synchronously, one of the authors is to proceed to run through the learning unit as if they were piloting it. The second is to take notes of their own as well as marking the reflections of the ‘learners’
  6. Amendments are to be made and when completed go through a final review before being added to Moodle. 

This modified review process helps to ensure that there is a stronger stakeholder in the review, the person who has to actually teach it to their teammates. We will keep you posted on how it goes!

For any questions regarding this process, please contact us!

How to teach synchronously in a virtual setting

  • You need a reliable camera, microphone, and virtual platform and be familiar with its features, such as whiteboard, chat, polling, breakout rooms, etc.
  • At the beginning establish communication rules, e.g. whether participants should raise their (virtual) hand, use the chat, and/or just speak. Also, we recommend asking participants to turn on their camera
  • For small group work break out rooms work very well, just be clear about the tasks the groups should work on prior to dividing them into the groups.
  • For collaboration the use of integrated virtual whiteboards or other platforms such as Padlet are very useful. Just make sure prior to the session that you have everything setup and the links at hand, e.g. to post them in the chat.
  • Allow a bit more time for starting the session and the group works as there might be participants who are not familiar with the platform or technical problems might occur.

How to motivate unprepared participants

  • Make clear that the asynchronous assignments are a core part of the course and that its content will not be repeated. Even if it is difficult, stick to that when starting the synchronous teaching session.
  • If you expect unprepared participants, you can start the session with a student-centered group exercise mixing prepared and unprepared students to increase peer-pressure and make them realize that being unprepared does not feel good.  
  • Use the introductory or closing quizzes / tests so that participants can self- assess whether they have the required knowledge and you as a facilitator can see the level of knowledge and preparation of your participants.

Further recommended reading:

How to involve participants with different levels of experience

  • To account for such different levels, we recommend making use of the asynchronous preparatory phases which also include introductory quizzes in which participants can self-assess their prior knowledge and you as a facilitator can assess the differences within your group. Participants with less prior experience can also be guided to additional preparatory resources.
  • Encourage participants to work in pairs or small groups when preparing so that they can help and learn from each other. You could even facilitate this by dividing them into groups with different levels of experience.
  • Similarly, during the synchronous phases, we recommend forming groups with participants different levels of experience and emphasize the peer support aspects of such group activities.
  • We also recommend starting with rather smaller groups and allow more time than stated in the course outlines, if you expect a heterogenous level of experience. This way you can better manage this challenge.
  • Encourage your participants to ask questions, emphasizing that nobody knows everything and that it is important for learning to ask questions.  
  • Especially in the train-the-trainer course you might have to deal with over-confident participants, who especially in an interprofessional setting can dominate the group. This is a complex cultural challenge, but you could try to establish (and follow) communication rules at the beginning of a session.  

How to address potential overlaps or redundancies

  • Identify what is already included and what is missing in your curriculum related to clinical reasoning outcomes and compare it to the DID-ACT blueprint. Prioritize learning outcomes that are not yet covered but regarded as important.
  • Identify activities, resources, or teaching sessions with similar learning outcomes that might be in need for change anyway because of low evaluation results, teachers or students struggle with it. These could be suitable for adding or replacing parts with DID-ACT activities.
  • Ask teachers and students about overlaps and gaps they see in their teaching / learning of clinical reasoning and where they struggle. This could also be done by a reflection round after related teaching activities in the curriculum
  • Although ideally a longitudinal integration is aimed at, we recommend to starting small with a pilot implementation to gain experience and develop a show case.

How to teach in an interprofessional setting

  • Allow for enough time prior to the teaching for the organization and motivation / encouragement of stakeholders and participants
  • Allow for enough time and guidance during the course so that the participants from the different professions can get to know each other and their professions and discuss their different perspectives. This might mean that you need to calculate some extra time in addition to the suggested duration of the learning unit.
  • There may be a different understanding of clinical reasoning in the different health professions, so we recommend making participants aware of this. You could for example use and adapt activities from the learning units on the health profession roles to facilitate this.
  • Courses in an interprofessional setting should not come too early in the curriculum (not before professions have formed their own professional identity - however, this also depends on the aim of the course). 
  • Make sure you have enough participants from different professions. If possible, the facilitator could divide the participants in smaller groups with an equal distribution of professions. 
  • Similarly, you need an equal distribution of facilitators / facilitators from different professions.
  • Develop customized learning materials considering the different professions. If needed you can adapt the material and activities provided in the DID-ACT curriculum.

Further recommended reading:

van Diggele, C., Roberts, C., Burgess, A. et al. Interprofessional education: tips for design and implementation. BMC Med Educ 20, 455 (2020). (Link)

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