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The constructive alignment theory has been used to underpin the development of curriculum in medical education for some time Biggs and Tang 2007. A constructivist teacher designs learning experiences which are active and interactive and works at the interface between the curriculum and the learner, which creates a new knowledge. Â A constructivist learner will create or construct their own knowledge and understanding with what they already know. The constructive alignment theory has been shown to equip medical students with the required knowledge and skills that is required to practice medicine successfully. There are two broad orientations in teaching; the content cantered or teacher-centered conceptions and student or learner-centered conception. Â In the learner-centered conception the knowledge is constructed by the learner and the teachers a facilitator of learning than a mere presenter of knowledge. The student centeredness includes the idea that the learner has a choice what to study, when to study and how to study. Here the learner is placed at the center of the entire learning process there is increased responsibility and accountability on the part of the learner.
An emerging trend in all the medical schools in Australia is to have an integrated medical curriculum where there is an increased emphasis on self-directed or learner centered learning, and active participation of the learning process. JCU integrated medical curriculum follows the guidelines for effective university teaching which says " effective university teachers provide students with opportunities to be involved in the structuring of their own learning experiences, and encourage them to take control of their own learning" and "effective university teachers select from a range of teaching approaches and media those which will help students meet subjects and their own aims effectively".
Today's medical students represent a broad spectrum in terms of age, experience, culture, ethnicity and level of preparedness as well as learning styles and preferences.so there is a huge challenge for instructors to meet the educational needs of all students. When instruction is adopted to learners learning styles there will be increased student motivation and performance. Because there are students with different educational backgrounds and different learning styles, it is the responsibility of the instructor to address this diversity of learning styles among students and develop appropriate teaching learning activities.
The challenge of providing quality learning experience for the students has prompted many educators to look towards learning technologies. Increased interest in flexible learning opportunities in tertiary education has risen in recent years in response to increased student diversity and the emergence of new technologies. Technologies allow educators to personalize and humanize learning by including rich media components in courses that endeavor to engage students in active, meaningful learning (Lee, Tan & Goh 2004). Australia has a strong tradition of distance education and a shift towards online learning in Universities in the recent years has been seen as a natural extension of the more traditional form of distance education (Bell et al, 2002). In today's learning environments, the effective use of instructional technologies provide the learner with flexible, immediate and on demand access to course content. Flexible learning has emerged recently to describe the changing phase of distance education, brought about by the growing adoption of different learning technologies to support increasingly diverse student population.
Flexible learning is a range of learning approaches in terms of time, pace, place, content and mode, which are applied in varying degrees. Flexible learning incorporates computer technology into learning aiding students in developing the cognitive processes needed for the use of information technology effectively. A scaffold of learning activities is created in flexible learning. The most important aim of flexible learning is to provide greater control to the learner in the learning process and to provide opportunities and options through a variety of teaching -learning modes. The learner will have greater choice, autonomy and control in flexible learning (Geroge and Luke 1995). This type of learning provides the learner with choices about where, when and how learning takes place (Shurville et al., 2008).
Pedagogical approach in flexible learning is sound and here the teacher becomes the facilitator in the learning process and the learner gets greater control in the learning process. This pedagogy is a departure from the traditional teacher-centered methods of teaching, favoring the facilitation of the collaborative construction of knowledge and skills. It increases the efficiencies in the delivery of education and caters to different groups of learner. Present day net generation learner is multitasking nature and they demand for greater flexibility related in the mode of study, place and pace. Flexible learning caters for these diverse groups of student body (Casey and Wilson, 2005).
The exponential growth of computer power and rapid expansion of the broadband speeds in recent years has changed the expectation of these net generation students and the learning opportunities offered to these learners. In order to meet this growing demand, Universities are turning to flexible learning and e-learning as a convenient way to provide flexible access to learning (Buleen and Janes 2007). James cook Universities commitment to the development of flexible learning is embedded in the teaching learning assessment policy, that is dedicated in providing students from different backgrounds with the top quality learning environment and enhance student's learning experience. One of the Core principles of the JCU teaching learning assessment policy addresses this diversity of students and their different learning styles. "Course design will endeavor to respond to the rich diversity of student backgrounds and pathways, including Aboriginal, Torres Strait Islander, international, inter cultural, low socioeconomic backgrounds, rural or remote, first family member attending a university, return to study and people with accessibility issues". "In all subjects a variety of resources, teaching methods and approaches to learning will be considered and adopted, in recognition of the diversity of the student body".Â Overall objective here is to give students many choices in learning and control over the timing, structure and sequencing of their learning.
One of the key hallmarks of flexibility in learning is the recognition of the differences; differences in what the students want to learn and when he/she wants to learn. It also allows for serving students with special needs and accommodating the increasingly varied cultural dimension in learning. Educators recognize that the learners have individual needs and require varying degrees of flexibility to meet their needs. Learner centered instruction is the core principle underlying this flexible learning. Here the emphasis is on the choice of the learner. Facilitation of learning is another core principle of flexible learning where the instructor takes more of a facilitator role in the process of learning than a commanding or information transporter role. Facilitators provide opportunities for presenting content in a new and innovative role using a combination of media and delivery modes. Here the content is drawn from a variety of sources including video, web sites, multimedia, graphics, audios, animations etc.
Today's medical educators are facing challenges than their predecessors in teaching tomorrows doctors. Changing in health care delivery and advances in medical education and clinical medicine have increased demands on the medical faculty, resulting in decreased time for teaching. Flexible learning can be used in undergraduate medical education to improve the efficiency and effectiveness of educational interventions in the face of scientific and pedagogical challenges. Use of flexible learning is highly variable in medical schools and it is more common in basic science courses than in clinical sciences. Flexible learning has a characteristic that presupposes a great emphasis on self-teaching in undergraduate medical education. Students are encouraged to study and research independently. Collaborative learning and information exchange is intensified as to consolidate learning through group activities. The virtual group activities can be performed in synchronous or asynchronous meeting in student home groups that permits collaborative and deep learning.
Year 2 Medical program has 190 students of which more than 50% of the students are between 21 to 25 years and the group also has about 35 % of students who are above 30 years. Students joining six year undergraduate medical program at JCU are school leavers, graduates (with a degree not related to the medical course) or graduates with degrees in biological and health sciences. But there are students in this group who are not from the biological background and had the difficulty in settling into the Medical curriculum in their early months in the Medical School. The biggest challenge faced by the School of Medicine at JCU is to accommodate the learners who have come from different backgrounds. Being a rural medical school this challenge is heightened at JCU due to lack of resources and isolation. Because the student group has learners from different backgrounds, the curriculum or the individual module must be more creative and flexible to meet the needs of individual learners. Larger class (190 students) means more about lecture centered - learning and minimal student engagement and this will create a barrier to access learning. The class size works against the intellectual development, learning and success in a medical school.
Year 2 medical program has two pathophysiology courses - Integrated system pathophysiology 1 and 2. Different body system modules are taught with emphasis on Anatomy, Physiology and Pathophysiology in these courses which is spread across two study periods (SP1 and 2). Hematology and Renal Medicine is the module under Integrated System Pathophysiology 1 during study period 1, which runs for 13 weeks. This module has two sections - hematology and Renal Medicine. During the last 5 weeks of HRM module students learn about Renal Physiology and Pathophysiology.
Physiology and Pathophysiology topics in this module are complex and in the previous feedback students have raised few concerns about the lecture topics in the module and about lack of time and opportunities available for the study of complex physiology topics in this module. Feedback suggested that face to face and synthesizing sessions in the module were inadequate to conceptualize the dynamic processes and complex physiology mechanisms in the renal physiology topic. Also when complex topics were presented in classroom lectures, students either retained a simplistic view of the topic or were confused when introduced to a new topic based on an understanding of sequential processes. Hence, I have planned to introduce flexible learning module, which supports face-to-face delivery, to specifically address the problems identified by the students in the Renal Medicine Course.
Face-to-face learning for this module is in the form of one hour lecture at the beginning of the week and another hour of synthesizing session on Fridays. There is a three hour guided learning session in the form of active learning that supports these face-to-face deliveries during the week.
The contents of the renal medicine modules are carefully chosen to develop flexible learning activities spread across a 4 week period.
Table 1: Different segments chosen to deliver in the flexible learning module for this course
Histology of kidneys and the urinary system
Physiology of renal system
Role of kidneys in water balance
Role of kidneys in blood pressure regulation
Control of urinary bladder and micturition
Diuretics and their mechanisms of action
Every segment has different teaching learning activities which are developed using Blackboard, the open source course management system.
Different teaching learning activities for these flexible learning modules are
Podcasting and Camtasia recordings; face-to-face lecture will be recorded using Camtasia/Doceri and will be uploaded online.
Lecture podcasting is also uploaded in MP3 format
A 20 minutes i-lecture which will cover the topics (as per the segments mentioned above) is recorded and uploaded
Home group wiki discussion board for mini case discussion related to the weekly topic.
Open discussion board for discussion about the questions asked in the workbook in the GLS sessions, using blackboard discussion tools
YouTube video links - Anatomy, Physiology and Pathophysiology videos
E-book chapters, textbook pages, and review articles related to the topics are uploaded to the learning resources folder
Home groups [20 students in a group] have the opportunity for 30 minutes blackboard collaborate chat session with the lecturer
Links to the specific topic pages of Medical Revision Community and Pod medics
Online quizzes at the end of the week - which will have MCQ's and key feature paper questions.
Online reflective journals will be used for feedback on a weekly basis for this module.
Contexts and Settings for Flexible Learning:
Our learners: Undergraduate, adult, domestic and international students
The kind of learning we are trying to achieve: Knowledge, skills and attitudes
Delivery of the content: Online lectures and case discussions.
The other learning activities that can be organized to meet the learning outcomes: Question-answer sessions, videos, online quizzes
Available Resources: handouts, worksheets, workbooks, visual, power points, videos
Table 2: Summary of the Comprehensive Teaching Strategies used for Flexible Learning in this module
Linking to theory
Mini Case Discussion
Providing multiple perspectives
Key Feature Paper questions (case based)
Apply basic sciences to clinical medicine
As with face to face teaching, these online, blended classes is constructively aligned to achieve maximum learning benefits and outcomes. All aspects of the flexible delivery, from aims, learning outcomes, lectures and other activities are all and directly related to each other, and support a progressive system of learning throughout the 5 weeks duration of the course.
Year 2 hematology and renal medicine course are currently using face-to-face teaching which treats all students as identical learners. This ignores the fact that students have different levels of learning styles, motivation, attention span and ability to learn [ref 5]. Traditional large lecture presentations [first day introduction session and synthesizing session in this module] have problems engaging the students and in meeting their individual learning styles. With flexible teaching-learning activities in this module, the learning and teaching can occur at times that are more convenient and productive for students. Students can work at their own pace within a given framework. Online learning provides options to access and share information more readily and this also provides greater depth of resources and information. Open discussion and mini case discussion sessions in this module offer opportunities to interact and learn in ways that the traditional teaching in the module can't offer. Thus, there is a shift of focus in the module from a teacher-centered model to learner centered model offering stronger learning motivation and interactivity. The module is designed to value the diversity of experience and practice taking into the consideration of the Internationalization of University curriculum and this flexible teaching will always support both local and international students' who have come from different educational backgrounds and have diverse learning styles.
Learning management system, social software application like Wiki, discussion forum and web based lecture technologies are the different learning technologies used in this flexible learning module that will provide communication and collaboration opportunities. The university teaching and learning policy emphasizes that the teacher should try to enhance student engagement in learning by connecting various components in a subject. The core learning principle also underlines the need of innovation in teaching and learning and the use of learning technologies to reinforce and enhance the student learning experience. The different learning technologies will give the students flexibility to choose when and where to access lectures and other learning resources. Students with weaker learning skills will get more time and options for interaction and to accelerate their learning independently. Medical education is a dynamic entity that is evolving quickly and taking advantage of the flexible, web based teaching methods allow more face-to-face teaching time to be used for teaching other complex topics during this basic science module.
The lecture podcasting, Camtasia/Doceri and i-lecture formats offer students the increased flexibility of being able to access the learning materials as often as required, 24 hrs. a day, 7 days a week. This online lecture will be very effective for this module as there are a large number of students in class (more than 180 students). These online lectures engage the students more effectively than the face-to-face lectures and students can refer to this lecture several times over the course of the module. During the online discussion forums (mini case discussions and open discussions in this module), students are given basic information about the new concepts and are encouraged to work together on clinical problems and questions which helps them to understand key physiology and pathophysiological concepts for themselves. Students in the traditional face-to-face learning do not possess the key critical analytical skills hence they are finding it difficult to understand the key basic physiological concepts. Flexible learning enables students to extend their learning experience beyond the borders of a classroom and a variety of web resources and web links to medical podcast, podmedics and medical revision community pages in this module to improve student's learning capabilities and also their critical thinking skills.
Renal Medicine module in year 2 includes complex topics in Physiology (renal regulation of electrolyte balance, water balance, blood pressure regulation etc.). Some of the aspects of physiology that make it difficult include the large volume of information typically covered and its integrative nature. Most common complaints from students in their feedback is that there is too much to study and remember and too many didactic sessions on basic physiology. The planned flexible learning sessions address these aspects and introduce active learning tools to organize structure and represent information and knowledge in a more meaningful format. During the flexible learning, students are able to choose a content delivery method that matched their learning style to understand the complex topics in physiology. Students can work through the different segments in the module at their own speed and develop a more meaningful understanding of the topics.
Thus the overall objective of this flexible learning module is to give the learner more choice and control over the timing, sequence and the structure of learning activities, and to reduce the barrier to access learning. This online module is likely to enhance students' motivation in learning Renal Medicine physiology. The interactivities and communication tools will motivate the students and help them increase perception and retention of this topic. Present day net-generation medical students want learning 'options', 'choices' and 'personalization'. By providing learners with the freedom of choice, this flexible learning can set the stage for student success in this course.