Manage the patient suffering marine envenomation - The Teacher's Narrative

Manage the patient suffering marine envenomation.

The how, what, when, where, why of a lecturer’s experience

Authentic learning

This learning event involves student paramedics within their third (final) year undertaking Objective Structured Clinical Examinations (OSCEs) or practical patient management scenarios in the field of marine envenomation.  See posts below for example OSCE.

Students work in self-selected groups of four, simulating two paramedic crews.  The primary crew (two people) undertakes the OSCE whilst the secondary crew observes, critiques, reports and provides discussion and feedback.  Mechanisms for feedback are discussed further within this post.

OSCEs are all conducted under high fidelity simulation conditions and are based on authentic case reports from qualified people within the industry.  To aid assessment and feedback, and to engender reflective practice in our students all OSCEs are video recorded.

Design and the guide at the side

Ask any Paramedic about conducting Objective Structured Clinical Examinations (OSCEs) or practical patient management scenarios for students and they will tell you “it’s easy”, we do this all day every day.  This is true at a superficial level, but when exposing the ‘normal’ or every day process to the rigors of assessment at a higher education level the cracks start to show.

The all-seeing, all-knowing Educator goes from the senior ranking officer who is ‘always right’ to the role of guide at the side or at least this is a portion of the role.

The major role for the educator in this learning event is purposeful design of the experience to achieve a particular outcome.  In this case, at the end of the process the student should be able to manage a patient suffering marine envenomation.

It should also be noted the above goal was the starting point for this process and the principles of backward design were utilised to formulate the learning experience.

Within my design process is the purposeful use of technology which considers both Mishra and Koehler’s TPACK framework and SAMR to determine what technology we use and how we use it.

The Technology

Within this experience we utilised I pads with interactive PDF app which synced through google drive.  This technology is utilised in formative and summative assessment.  Click here to see example of rubric. 

Students receive a number of completed practice or formative rubrics from their peers and the lecturer after having completed each OSCE.  This is written feedback within a marking rubric which outlines areas they completed well and points for improvement.  These documents reinforce verbal feedback provided by peers and the lecturer during post simulation group discussion.

I pads with an interactive PDF were chosen for a number of reasons including:

·         Robust format.

·         Ease of design.

·         Ease of use for both students and lecturers (repurposing familiar technology).

·         Institutional preference and availability of device.

It is worthy of note any smart phone or android device could also be substituted for I pads.  Wireless connectivity whilst desirable at the time of the scenario is not essential.  Once back in an area with connectivity the marking rubric files can be synced. 

Syncing via google drive also allows data correlation at a central point remote from where the learning is occurring. 

Video is the second major technology utilised in this learning event.  Video was chosen for the ability to record visual and audio feeds from the OSCE.  This mode was chosen for the purposes of:

·         Encouraging reflective practice in students.

·         Moderation of complex assessments (OSCEs) conducted live.  Due to the fast paced nature of the OSCE Lecturers can miss key points or interactions.

Devices used for videoing were varied due to equipment not being available at the time the OSCE was conducted.  The preferred method of videoing was via a camcorder style camera device with a large hard drive capacity but I pads were utilised as a substitute for them as well at other locations.

Results

As expected there was a range in the level of mastery for students undertaking this learning event and but five of the 66 students involved showed improvement from formative feedback.  The five students who did not show, or had minimal improvement entered the learning event with a high level of mastery due to prior knowledge and experience (qualified Lifesavers).

Their contributions were invaluable during group discussion and feedback (see reflections below).

The management of marine cases involves not only the technical aspects of medical procedures but history taking, patient assessment and psychological support (empathetic or reassuring management) during treatment.

As students practiced in the formative assessment phase of this learning event and gained better mastery of technical, history taking and assessment skills there was also an unexpected improvement in the psychological support provided to their patients. 

Reflections

Using a social constructivist style of learning with small group feedback has like many learning activities produced a bell curve of grade, participation and student comfort.  Students liked and felt more comfortable in small self-selected groups but a minority were still reluctant to provide feedback seeing this as an instructor/lecturer role.

Moderation by a qualified paramedic generally worked well for but some lecturers had difficulty encouraging and allowing students to provide the majority of feedback to their peers and rather than being the guide at the side were more the Sage.  This led to students who had mastery being underutilised and frustrated with the experience.

Technology Reflections

During this learning experience both live and delayed syncing of marking rubrics were undertake with equal effectiveness.  As a Coordinator I would have liked to review the data for commonalities in both what was done well and points for improvement, allowing modifications to teaching and ‘just in time learning’.

This wasn’t completed live due to the coordinator not having time to correlate and would have worked better with another person completing this task or other tasks which would have freed me to focus on commonalities in the experience.

Whilst video recording generally worked well device capacity let us down with I pads sometimes running out of space during the OSCEs.  Cameras worked well but in general footage was underutilised. 

Disappointingly only two of the 66 students wanted to view the footage as an exercise in reflective practice and the main use for it ended up as grading challenges.  The number of challenges was limited to three students.

Conclusion

I believe the design process for this learning event is robust and with minor modifications such as better briefings on role of lecturers and technology substitution it can be utilised throughout the Paramedic Program for the majority of OSCE assessments (formative and summative).