Learning to Teach in Higher Education - Research Proposal Example

Learning to Teach in Higher Education 1. Introduction In the context of emergency medicine, training and learning of the obligatory expertise and understanding to attain excellence in cardiopulmonary resuscitation (CPR) techniques must be the main concern with a precise goal: the management of real-life medical conditions. The advantages of imparting training and guidance in the field of cardiopulmonary resuscitation techniques were established decades ago (Curry et al, 1987; Camp et al, 1997) by both medical as well as nursing professionals (Dane 2000, Hamilton 2005) in urban and rural surroundings (Sanders 1994). Aspects such as teaching, learning and continuing education have always been one of the most innate characteristics in the field of medicine and healthcare. Considering its growing popularity and importance, the implications of training and education with respect to CPR and basic life support techniques, has increased significantly in the recent decades, ranging from the appropriate teaching strategies involved to the range of subjects and its learning outcomes. Learning and teaching in clinical education holds immense significance and hence go hand in hand. In recent years, the functions and responsibilities of the “student” as well as the “teachers” have become increasingly compatible, where both are provided with the opportunity for learning and teaching at the same time. The dawn of the new millennium which witnessed large scale destruction through terrorism as well as natural disasters, has caused an increased responsiveness to such natural as well as man made phenomenon, and at the same time has generated a dire need for a new improved CPR training program, which encourages the development of core skills among the lay public as well as medical professionals so as to train them to confront such challenges in the future. Hence a comprehensive understanding on Basic Live Support Training as well as CPR is crucial. It not only equips people with life saving knowledge but helps them in saving lives of people around them in critical times. According to the Center for Disease Control and Prevention, the number of deaths caused by cardiac arrest in the U.S is far more than deaths caused by any other reason (CDC 2009). A majority of such deaths occur on account of prompt first aid support prior to provision of professional medical assistance. Although statistics regarding the exact number of such “sudden deaths” is not available, according to estimates, approximately 310,000 people are reported to have succumbed to death on account of sudden or unexpected cardiac arrest. The American Heart Association claims that: “Cardiac arrest can be reversed in most victims if it's treated with immediate CPR” (AHA 2009). However research suggests that caregivers rarely succeed in providing best possible CPR or offer basic live support to patients in need (Abella 2005). It further states that CPR is performed in only 1 out of 3 cases of witnessed arrests (AHA 2005) and that the quality of CPR can be improved significantly through timely feedback and appropriate training (Kramer et al, 2006). 2. Literature Review: “Good teaching means that faculty, as scholars, are also learners” – (Boyer, 1990 Pp. 24) Learners undertaking clinical education include, by definition, adult learners who are enrolled to undertake an academic, professional or vocational program of clinical education which includes theoretical as well as practical knowledge, behaviors and attitudes and the facility as well as skill to execute such learned skills in their everyday lives and / or in random situations requiring urgent medical attention. Various theories and models have been developed by researchers and academicians alike, which provide valuable insights into the means and ways of providing adequate knowledge and imparting training in the field of CPR and Basic life support. Some of them are discussed hereunder: 2.1. Theories Kaufman et al have effectively reviewed and summed up the educational strategies and theories which can sustain practice in the education of health professionals. These include social cognitive theory, reflective learning, transformative learning, self-directed learning and experimental learning. There is an intersection and mutual agreement between these theories each of which implements the principles of adult learning such as a safe learning environment whereby confrontations are balanced by support; learners are engaged in determining and influencing learning processes and in the context of formal educational interventions; they are encouraged to recognize their own learning needs and objectives; and are provided with adequate assistance in assessing and appraising their own learning etc. The significance of different theoretical perspectives lies in the manner in which valuable information associated with the intricate educational task of producing a fully rounded practitioner is imparted1. Social Learning: The basic underlying notion in this theory is the prevailing impact of communication between the learner and the entirety of the surroundings or educational settings in ascertaining learning outcomes. The former acquaintance, inspiration, morals and outlooks possessed by the learner interrelate with unknown as well as the unambiguous and recognized constituents of an educational programme. Reflective Learning: It is among the most captivating theories of all, for medical practitioners who tend to feel at ease within the rational favorableness of the life sciences. Elevated eminence and superiority was associated with individuals who persistently challenge their own performance and who use the unanticipated to investigate, examine and adapt their constructs of sickness prototypes and therapeutics. Encouraging such professional behaviors is perceived as a fundamental aspect of training according to this theoretical perspective. Transformative Learning Theory: This theory has a striking resemblance to the theory of social learning with regard to the definition of learning which describes learning as a social process of creating and internalizing innovative connotations of one's familiarity as a guide to action. On the other hand, it does not revolve around the incremental amplification of current constructs but instead, looks at what is essential for drastically modifying them. For such a reformist didactic outline, the educator needs to be a co-learner as well as a stimulator. This is one of the strongest speculative arguments offered in support of small-group learning. Peers can confront the pre existing beliefs and behaviors of one another in an accommodating environment, with a view to trigger far-reaching change. Self directed Learning: This is more of an objective involving ethical implications rather than a learning theory which builds on humanist traditions of personal development as well as the technological substantiation to organize their own education. This theory exemplifies the crucial beliefs and attitudes associated with adult learning. Experimental Learning: This theory highlights the criticality of learning in an environment which tends to connect tangible know-how with abstract models. Learning is perceived to be augmented by engaging in all four modalities. 2.2. Models and Principles of Teaching and Learning Instructional Videodiscs is one of the most modern and intriguing means of imparting CPR training. Developed by the American Heart Association, this system provides psychomotor skills required to govern CPR using an instrumented mannequin and a two-monitor system with light pen input. The system offers various facilities to the learner such as comprehensive advise and / criticism with regard to aspects such as appropriate hand placement method, pressure rhythm etc which are essential for the learner. Since CPR skills are complicated and requires proper guidance, this system is regarded as most favorable in eliminating teaching problems encountered during imparting training to learners (N.A., 1989). Another exceptional mode of imparting clinical education is through simulations. It helps the learners in practicing such intricate skills as providing basic life support to victims of sudden death. Courses offering CPR training, hence, must involve various simulation techniques with models. However, care must be taken that such training is offered in an environment where the patients are exposed to least harm. In order to avoid mishaps during training and to ensure the safety and well being of the patients the staff providing such training may consider applying peer-exemplars as an aid for learning (Marx, Misceli, 2008). Training involving the use of an object or a model ensures active participation of the learner and encourages them to apply their learned skills promptly whenever required. The learners may monitor, handle, maneuver, exhibit, argue, accumulate, and disassemble objects and / models used for training and receive valuable feedback or criticisms from the teacher (Rankin, Stallings, 2005). 3. Plan and Implementation I adopted and implemented the adult learning theory in classroom because the principles of adult learning offer guidance to the students which helped them in the development of their clinical reasoning skills. My basic aim was to facilitate the creation of a supportive and collegial learning environment which promotes adult learning. This involved acknowledging and building upon the learners' clinical experiences and creating opportunities for learners to reflect on their learning, share their experiences with peers and to engage in critical discussions and debate on clinical reasoning in practice (Higgs, Jones, 2000, Pp.276). I used the some of the most commonly used teaching strategies such as lectures – which were mostly instructor led teaching sessions, and have been historically proven to be largely informative in nature; followed by provision of appropriate tutorials which can be used by the students as guidance materials. The teaching strategies were designed keeping in mind, the number of students per class. For enabling the students to rehearse their theoretical skills, practice sessions were organized in the form of practicals, which were held in a non clinical environment as well as clinical environment. The students were offered training through simulations and were encouraged to participate in discussions, debates and role play. Existing and Novel Pedagogies Used in Clinical Education “Pedagogies evolve from and are a reflection of philosophies, educational frameworks, learning theories and theories derived from other fields. It is more than simply the art and science of teaching. It encompasses what we teach and how we teach, as well as why we do it in the way we do” (Emerson, 2007, Pp.25). Conventional CPR courses were typically instructor led programs which initiated with an introduction of theoretical aspects, followed by a live demonstration using models and concluding with practice using instrumented manikins. However, this model of training was subsequently proved to be ineffective during 1985 and hence was succeeded by a more advanced and developed method of training which involved video based skill instruction i.e. “watch and then practice” method. In this method of training the learners were offered regulated, precise and on-message information from an instructional video, wherein the instructor assumed the role of a catalyst. Video self instruction or VSI is another such method of providing CPR training which involves interactive technology. Other CPR programs which developed during the 1990s include the use of video television, CD-software, as well as web based programs2. Currently, simulation technologies have gained widespread recognition and acceptance as a credible mode of imparting training in the field of clinical education, since simulation based experimental programs are regarded as a crucial source of providing exceptional training particularly in health care (Gaba, Howard, Fish, et al, 2001)3. 4. Recommendations for improving teaching strategies: The teaching strategies which I implemented were faced with certain setbacks, based on which I have listed the following recommendations for improvement. Firstly, I failed to ascertain and hence allot adequate time for each lecture session. The lectures should neither be too long nor too brief, a limitation that I shall try to overcome in the future. I did not focus on rapport building among the learners and hence failed to keep up their motivation and interest in the class schedules. I intend to include special rapport building exercises in the future, to avoid such a setback. Goldhammer and his colleagues' (1980) in their pervious studies in the field of clinical education developed a model which incorporated the fundamental stages of a pre-observation meeting, whereby the educator and the student establish rapport and evaluate teaching plans, as well as discuss and review changes, wherever need be. Knowles believed that adults need to know the reason behind learning a particular fact. Hence the teachers must help the learners in understanding the significance of the information being taught as well as how the learner can implement the same in a non clinical or out of hospital environment (McEwen, Wills, 2007, Pp. 399). According to Decleva (1994), integrated and holistic understanding on the part of the student is aided by the clinical educator's authenticity, mutual understanding, as well as a mutually trusting relationship, compassion for the student's perspectives and absolute and unreserved recognition (Rose, Best, 2005, Pp. 31 - 32). References: Abella, et al. JAMA 2005 Vol.293, No.3, Pp. 305 - 310 American Heart Association (2009). About Sudden Death and Cardiac Arrest, viewed: October 12, 2009 from: American Heart Association, (2005). American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. Circulation 2005: 1 12: Pp. IV -16 American Heart Association. Heartsaver AED student workbook. Dallas: American Heart Association; 2006. Backer, H. D., Paton, B. C., (2005). Wilderness First Aid: Emergency Care for Remote Locations, Jones & Bartlett Publishers, Pp.291 Brennan RT, Braslow A. Are we training the right people yet? A survey of participants in public cardiopulmonary resuscitation classes. Resuscitation 1998; 37:21–25. Curry L, Gass D. Effects of training in cardiopulmonary resuscitation on competence and patient outcomes. CMAJ 1987; 137:491-6. Camp BN, Parish DC, Andrews RH. Effect of advanced cardiac life support traiing on resuscitation efforts and survival in a rural hospital. Ann Emerg Med 1997;29:529-33. CDC (2009). Leading Causes of Death, viewed: October 12, 2009 from: Chickering, A., Gamson, Z., (1987). Seven Principles for Good Practice in Undergraduate Education, American Association of Higher Education Bulletin, March Cummins RO, Ornato JP, Thies WH, Pepe PH. Improving survival from sudden cardiac-arrest - the chain of survival concept - a statement for health-professionals from the Advanced Cardiac Life-Support Subcommittee and the Emergency Cardiac Care Committee, American-Heart-Association. Circulation 1991; 83:1832–1847. Dane FC, Russell-Lindgren KS, Parish DC, Durham MD, Brown TD. Inhospital resuscitation: association betwen ACLS training and survival to discharge. Resuscitation 2000;47:83-7. Doyle, D., Hanks, G., Cherny, N. I., Calman, K., (2005). Oxford Textbook of Palliative Medicine, Oxford University Press, Pp.66 - 67 Eisenberg M, Bergner L, Hallstrom A. Paramedic programs and out-of-hospital cardiac arrest: part I. Factors associated with successful resuscitation. Am J Public Health 1979; 69:30–38. Flint LS Jr, Billi JE, Kelly K, et al. Education in adult basic life support training programs. Ann Emerg Med 1993; 22:468–474. Gallagher EJ, Lombardi G, Gennis P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA 1995; 274:1922–1925. Gaba, D.M., Howard, S.K., Fish, K.J., Smith, B.E., & Sowb, Y.A. (2001). Simulation-based training in anesthesia crisis resource management (ACRM): A decade of experience. Simulation & Gaming, 32, 175-193. Hamilton R. Nurses knowelledge and skill retention following cardiopulmonary resuscitation training: a review of the literature. J Adv Nurs 2005;51:288-97. Jevon, P., Soane, K., Berry, K., Pearson, G. A., (2004). Paediatric Advanced Life Support: A Practical Guide, Elsevier Health Sciences, Pp. 156 Kaye W, Mancini ME. Teaching adult resuscitation in the United States–time for a rethink. Resuscitation 1998; 37:177–187. Kramer, J et al.,(2006).Resuscitation, Vol.71, Pp. 283 - 292 Litwin PE, Eisenberg MS, Hallstrom AP, Cummins RO. The location of collapse and its effect on survival from cardiac-arrest. Ann Emerg Med 1987; 16:787–791. Marx, E. S., Miceli, D. G., (2008). Leadership and Management Skills for Long-Term Care, Springer PUblishing Company, Pp.178 Paradis, N. A, Halperin, H. R., Kern, K., (2007). Cardiac Arrest: The Science and Practice of Resuscitation Medicine, Cambridge University Press, Pp.1259 Platz E, Scheatzle MD, Pepe PE, Dearwater S. Attitudes towards CPR training in family members of patients with heart disease. Resuscitation 2000; 47:273–280. Rankin, S. H., Stallings, K. D., London, F., (2005). Patient Education in Health and Illness, Lippincott Williams & Wilkins, Pp. 236 Rose, M., Best, D., (2005). Transforming Practice Through Clinical Education, Professional Supervision, and Mentoring, Elseivier Health Sciences, Pp. 31 - 32 Sanders AB, Berg RA, Burress M, Genova RT, Kern KB, Ewy GA. The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community. Ann Emerg Med 1994;23:56-9. Swansburg, R. C., (1995). Nursing Staff Development: A Component of Human Resource Development, Jones & Bartlett Publishers, Pp.111 Timmermans, S., Berg, M., (2003). The Gold Standard: The Challenge of Evidence- Based Medicine and Standardization in Health Care, Temple University Press, Pp.1 Wyatt, L. H., (2005). Handbook of Clinical Chiropractic Care, Jones and Bartlett Publishers,Pp. 252 White RD, Hankins DG, Bugliosi TF. Seven years’ experience with early defibrillation by police paramedics in an emergency medical services system. Resuscitation 1998; 39:145–151. No Author, (1989). Interactive Video, Vol.1, Educational Technology Publications, p. 79 Ramsden, P. (1992).Learning to Teach in Higher Education, London: Routledge Davis, B., (1993). Tools for Teaching, CA: Jossey-Bass Gaberson, K., Oermann, M., (1999). Clinical Teaching Strategies in Nursing, Springer Laurent, T., Weidner, T., (2001)00. Clinical Instructor's and Students Athletic Trainers Perceptions of Helpful Clinical Instructor Characteristics, Journal of Athletic Training, 36(1), Pp. 58-61 Wagner, S., Ash, K., (1998). Creating a Teachable Moment, Journal of Nursing Education, 37(6), Pp. 278-281 Boyer, E. L., (1990). Scholarship Reconsidered: Priorities of the Professoriate, Carnegie Foundation for the Advancement of Teaching, Pp. 24 Higgs, J., Jones, M. A., (2000). Clinical Reasoning in the Health Professions, Elsevier Health Sciences, Pp. 276 Emerson, R. J., (2007). Nursing Education in the Clinical Setting, Elsevier Health Sciences, Pp. 24 McEwen, M., Wills, E. M., (2007). Theoretical Basis for Nursing, Lippincott Williams & Wilkins, Pp. 399 Read More