Teaching and Learning Forum 2000 [ Proceedings Contents ] Fostering of self directed learning in the unit Medical Science 283 Julie Kendrick and Rosemary Johnston Department of Health Information Management Curtin University of Technology In depth knowledge of medical science is necessary for accurate clinical classification of diseases and associated procedures (Nosology). As the Nosology field is a main source of employment for the Bachelor of Science (Health Information Management) graduates in the field of clinical coding, a unit meeting specific professional needs had to be designed. The existing generic unit was too broadly based, consequently a relevant, medically current, and course linked unit was written for Semester 2, 1999. The new format to encourage independent learning was based on self directed principles and consisted of workbook completion, multimedia presentations and review seminars. Learning goals were set with a range of choice for student participation (group or individual), assessment and due dates. Self regulation was maintained by informal contracts; students were monitored and encouraged to seek help from staff throughout the semester. Structured evaluation of the students' understanding of information sources, research ability and presentation skills via various modes was carried out throughout the semester. The students' attitude to problem solving, group cohesion, workbook completion and response to self directed learning has been analysed, the results of which indicate a substantial increase in enjoyment of the unit, understanding of the material and relevance of this knowledge to the degree. It was rewarding for both staff and students to see a noticeable overall increase in the pass mark. Analysis also enabled reflection and further course revision. The formula of learning with guidance from a variety of self chosen, self regulated options will enable graduates to become self seeking and motivated in knowledge acquirement as they set and meet their personal and professional goals.

Introduction

The unit content, integral to other corequisite units, was divided into a series of teaching strategies, all suitable for self directed learning and catered for internal, distance and extension students. Based on the premise that medical knowledge, technology and terminology are dynamic, students need to learn and foster self regulation in information seeking so as graduates, the responsibility for learning is shifted from the institution to the individual.

End of semester unit evaluation questionnaires over a period of years had documented student desire for change of content and delivery. Through internal staff development, HIM lecturers were exposed to new teaching methods and approaches, including the University's move toward self directed learning (SDL). It was felt that the new unit would be ideally suited to this mode of teaching, enabling students to learn the required academic information, enhance generic skills and in particular, recognise the value of self regulated learning.

Staff then went on a steep learning curve to examine the ways and means of establishing a totally SDL unit. The goal was to provide students with the professional competencies and range of skills necessary to enable them to become self regulated learners and work effectively in groups.

Need for fostering of self directed learning

Current literature supports the view that graduates need to learn to effectively use a variety of information sources (Bruce, 1998) and develop self regulated learning strategies (Lindner and Harris, 1993; Grow, 1991; Hiemstra, 1994) if they are to be successful both within, and external to, the academic environment. Zimmerman (1998) supports this view when writing of the need for the development of a self regulated approach to learning where self monitoring can be an invaluable tool in the continued success in the university environment. Such skills will enhance learning in the dynamic field of medical science. This view is further supported by Zimmerman, Greenberg and Weinstein (1994) where time management skills in terms of self regulating academic study time is discussed. The authors write of students who have control of their time as having less tensions. In the field of medicine and clinical classification where deadlines must be met in order for hospitals to produce correct budgets, the skill of time management, ability to work as a team member and the skill to self assess and monitor is invaluable, particularly if tensions are reduced. To ensure that graduates do seek continuing education it is imperative they be given the skills to become self regulated learners and there is no return to the expectation of 'spoon feeding'.

The unit

The unit objectives and content are as follows:

Students will be able to:

• Comprehend the alteration in function of body systems to enable the accurate classification of diseases and procedures; outline the potential complications of diseases that would affect average length of stay; demonstrate the knowledge of clinical manifestations and differential diagnosis in the clinical setting for producing morbidity statistics.

• Define and describe pharmacological terminology, differentiating between drug groups, their use and action.

• Interpret and communicate the clinical content of health records to other health personnel; determine the correct casemix classification of diseases.

• Demonstrate an ability to utilise personal skills in the presentation and Synthesis of subject matter in the above areas.

• Plan and manage time and work effectively within a group.

Changes that took place

The new format of the unit provides information given in a workbook, similar to that used in first year medical terminology, with exercises and content used for exams. There is also a comprehensive choice of other assessment. Students have the opportunity to learn and develop skills in goal setting, group work and self regulation.

Having chosen research topics from a wide range, presentation mode choices are as follows:

• small group (2-3 students) presentation to class
• write, design and present a topic utilising a medium of their choice in a group or as an individual (eg: PowerPoint, poster, overheads, slides)
• write and produce an education package on video and worksheet
• write a research paper for a professional journal
• produce a short educational training package
• design a web page
• article critique

Staff and students negotiated the dates for workbook completion and review seminars. Presentation dates were set, but students chose the day on which they wished to present.

Teaching strategies included attendance at an introductory lecture to explain the format and expectations of the unit. The video 'Collaborative Learning' (Macbeth and MacCallum, 1996) was also viewed and discussed. Students divided into groups and entered into informal individual contracts with staff. The contract included personal goal setting, establishing dates for completion of the workbook and assessment options. It was continually impressed upon the students that academic help was always available.

Students were given the opportunity to self evaluate the effectiveness of working within groups in accordance with a materials package on this topic (Clarke, Wideman and Eadie, 1990). Students also had a further opportunity to self evaluate when they completed an eight self directed characteristics checklist (Radloff and de la Harpe, 1999) at the start of the unit, (Week 1), half way through (Week 6) and at the unit's completion (Week 14). This enabled the students to personally assess how they were going and whether the changes were working.

Outcomes

Highlights of project

• Obtaining the grant.
• The actual researching and writing the new unit.
• Seeking innovative and new methods of teaching a previously unpopular unit by building new pedagogy skills via literature searches, discussions with others already skilled in SDL practice and new technologies.
• Students' positive response to the unit at the end of the year.
• Clear long term advantages of fostering self directed and group learning.
• Promotion of self directed learning techniques into other units.

What we have learned about self directed learning through implementing the project

Lots! What self directed learning is, its value to modern teaching and future continuing education of professionals; a realistic curriculum was achieved.

The students enjoyed the independent nature of applying their own skills to a presentation topic and a style of their choice. The active students thrive in this environment and the more passive students struggle and prefer to be 'spoon fed'. These students actually started well, but as the semester went on they found it difficult to maintain their goals and panicked about the exam. However, there was positive feedback from all students as to the actual research skills employed and knowledge gained via a variety of information sources previously unused.

It would be beneficial if all units in the course had an SDL component as it is a positive skill and tool. This would allow the continual acceptance and development of SDL concepts throughout university and, as graduates, into their professional lives.

What we would do differently

• Formalise the contract process - this would be particularly relevant in terms of workbook completion and staying on track in terms of individual goal setting.
• Remove the 'self correct' answer section of the workbook and replace this with answers released at particular times when the unit is on the web in 2000.
• Provide more written information regarding the philosophy of SDL for goal setting, evaluation and reflection.
• Institute learning logs to provide revision and on going reflection.
• Encourage students to attend tutorials and ensure a mediator is available if group dynamics breakdown.
• Weight presentations in accordance to the degree of difficulty.
• Allow more time for presentations.
• Ensure each presentation has a summary sheet to be handed to the class and used as a learning tool.

What strategies worked to encourage the students to be self directed in their learning

• Choice of topics and presentation styles provided stimulation.
• Learning to design a web page.
• Realistic timelines.
• Students via reflection can realise their own strengths and weaknesses.
• For the majority, working within groups achieved better, comprehensive reports and results in terms of information sources utilised and depth of research accessed.
• Cooperation and negotiation to share workload
• Choice of group or individual presentations for the second research report allowed those students who preferred to work alone, to do so.

What is to be done next with the unit

• Make the changes as mentioned previously.
• Edit the workbook, taking into account suggestions from the students.
• Provide more time for choice of topics, allowing preliminary research to eliminate topics.
• Teach the students why and how to undertake honest reflection.
• Provide more time for feedback sessions to allow for reflection.
• Provide more flexibility with presentation dates.
• Put the unit on the web for distance education.

Conclusion

• Remember you will have both active and passive students and support for both groups is required.
• Be very clear in your initial introduction regarding assessment choices.
• Actively monitor student contracts to assist in maintaining timelines.
• As a beginner, do not be too ambitious as the process is very time consuming in planning and establishing a new unit; creating acceptance among students; review and analysis.

References

Clarke, J., Wideman, R and Eadie, S. (1990). Together we learn - cooperative small group learning. Prentice Hall Canada Inc, Toronto.

Grow, G.O. (1991). Teaching learners to be self-directed. Adult Education Quarterly, 41(3), 125-149.

Hiemstra, R. (1994). Helping learners take responsibility for self-directed activities. New Directions for Adult and Continuing Education, 64, 81-87.

Lindner, R.W. and Harris, B. (1993). Teaching self-regulated learning strategies: Proceedings of selected research and development presentations at the Convention of the Association for Educational Communications and Technology, held in January 1993.

Macbeth, J. and MacCallum, J. (1996). Collaborative learning: Working together in small groups. Murdoch University, Perth. (Videocasette). http://cleo.murdoch.edu.au/tlc/videos/learning/video_collab_learn.html

Radloff, A. and de la Harpe, B. (1999). Self directed characteristics checklist. Centre for Educational Advancement, Curtin University, Perth.

Stevens, S., Unwin, E. and Codde, J. (1997). A review of hospital medical record audits: Implications for funding and training. Proceedings of the Ninth Casemix Conference in Australia, held in Brisbane, September 1997. Canberra.

Zimmerman, B.J. (1998). Academic studying and the development of personal skill: a self regulatory perspective. Educational Psychologist, 33(2/3), 73-86.

Zimmerman, B.J., Greenberg, D. and Weinstein, C.E. (1994). Self-regulating academic study time: a strategic approach. In Schunk, D.H. and Zimmerman, B.J. (Eds.), Self-regulation of learning and performance: Issues and educational applications. Lawrence Erlbaum Associates, Hillsdale, New Jersey, pp. 181-199.