Investigation 7. Instrumental genesis in technology mediated learning : From double stimulation to expansive knowledge practices

The purpose of the present paper is to examine the sociocultural foundations of technology-mediated collaborative learning. Toward that end, we discuss the role of artifacts in knowledge-creating inquiry, relying on the theoretical ideas of Carl Bereiter, Merlin Donald, Pierre Rabardel, Keith Sawyer, and L. S. Vygotsky. We argue that epistemic mediation triggers expanded inquiry and plays a crucial role in knowledge creation; such mediation involves using CSCL technologies to create epistemic artifacts for crystallizing cognitive processes, remediating subsequent activity, and building an evolving body of knowledge. Productive integration of CSCL technologies as instruments of learning and instruction is a developmental process: it requires iterative efforts across extended periods of time. Going through such a process of instrumental genesis requires transforming a cognitive-cultural operating system of activity, thus “reformatting” the brain and the mind. Because of the required profound personal and social transformations, one sees that innovative knowledge-building practices emerge, socially, through extended expansive learning cycles.Peer reviewe

Feeling ready and always more to learn : students’ journeys towards becoming a professional nurse

Background: Well-educated competent professional nurses are needed to ensure sustainable healthcare systems and reduce health inequalities. Nursing is a global profession, and the requirements and competences vary between regions regarding both education and professional requirements. The Swedish nursing program contains both theoretical education and practical training, to prepare the students for working life. The learning process is affected by several factors, for example, learning environment, learning activities and feelings, so called academic emotions. Since students' experiences vary in relation to different learning activities and over time data was collected longitudinally to follow their development throughout the whole nursing program. Aim: The aim of this thesis was to contribute to a deeper knowledge and understanding about nursing students’ experiences of learning activities and the process of developing professional identity during higher education in the field of nursing. Methods: All students (n=459) starting the nursing program from August 2015 to January 2017 were invited to participate. The data collection started in August 2015 and was completed in January 2020. Data was collected via interviews at four occasions (n=286), and at 42 measurement (n=2,947) points using Contextual Activity Sampling System, CASS (Lachmann et al., 2012; Muukkonen et al., 2008). Study I was a mixed methods study including 126 semi-structured individual interviews and 158 CASS-questionnaires collected at the start of the program. The interviews were analysed using qualitative content analysis and the questionnaires with descriptive statistics. Study II was a longitudinal qualitative study using 136 semi-structured individual interviews performed at four stages, analysed using longitudinal content analysis. Study III was a longitudinal prospective study using 2,947 CASS-questionnaires collected throughout the program, analysed with descriptive statistics. In this study, the students’ academic positive emotions (determination; enthusiasm; interest), negative emotions (irritation; nervousness; anxiety) and their perceived challenge and competence related to their current learning activity were analysed. Study IV was a parallel mixed method study including 68 RIPLS questionnaires and 34 semi-structured individual interviews analysed with descriptive statistics, paired sample T-test, and qualitative content. Results: In Study I the findings from the interviews were summarized in the overarching theme: Making a difference if managing to become a professional nurse, from the seven main categories in the three domains Conceptions; Expectations; and Doubts. The selfrated questionnaires revealed emotions of high ambition and motivation. The ratings of negative emotions correlated with the fears and worries about uncertainty expressed in interviews. In Study II the overarching theme: Ready but not fully trained was summarized from the four main categories: Anticipation; Prepared for internship; Deepened understanding; and Insight. The students deemed that working as a professional nurse requires continuously learning and improvement and underlined in the final interview that there will always be more to learn. Study III revealed that the students experienced high positive academic emotions combined with low negative emotions when first entering clinical practice in the third semester, upon completion of clinical practice in the fourth semester and while writing their bachelor thesis in the fifth semester. Optimal experience during clinical practice was reported by 21 percent in semester three to five, and by 34 percent in semester six. The students’ reported low positive emotions and high negative emotions during theoretical courses in medical science and in research methodology preparing for writing their thesis. The negative emotions reported during the thesis preparation period shifted to more positive emotions during the time of writing it. While when writing the bachelor thesis, 29 percent experienced flow compared to 13 percent during the preparatory course. In Study IV the students’ reported learning styles and their attitudes to interprofessional collaboration were analysed. The findings indicated that 64.7 percent had a predominantly concrete learning style while 35.3 percent were predominantly reflective. No significant results were found regarding relationships between learning styles and attitudes to interprofessional learning. The theme Well-functioning teams improve patients’ outcome and working environment was summarized from the four main categories: Amazing when it’s functional; Deepened insight of care; Increased quality of care; and Understanding own profession. Conclusion: During the education, emotions experienced by students varied during the various learning activities. They started their education with a vision of making a difference. In the first academic year they developed a solid theoretical basis and were eager to enter internship to transform their knowledge into practice and to gain clinical experience. When entering clinical practice, students witnessed of a reality that did not always correspond with what they had been taught. At the time of graduation, students felt ready to join the workforce and stressed that there is always more to learn. These findings reveal a gap between theoretical and practical education that needs to be addressed

Workshop 08. Professional Delivery of Clinical Reasoning in Medicine

Objectives To consider the specific challenges for students in developing clinical reasoning skills in contemporary systems-based curricula. To consider case vignettes portraying specific student cognitive-processing difficulties in diagnostic reasoning and design a teaching approach to address these difficulties. To share best practice with colleagues. To watch and discuss one example of teaching and learning practice demonstrated in the authors’ DVD recording of an innovative teaching session .Workshop Summary A brief presentation will explore recent evidence in current literature regarding clinical teaching in this area. The delegates will work in small groups on real case vignettes bringing these specific student cognitive difficulties to life. This will enable delegates, in collaboration, to generate suitable teaching and learning approaches for consideration by the whole group. Watching the authors’ own demonstration DVD depicting an innovative teaching approach will stimulate further discussion and reflection on incorporating novel approaches in delegates` own teaching. There will be time for Questions/Answers and sharing best practice with other delegates

P06. Clinical Reasoning in Medicine: Developing Students' metacognitive skills

This poster outlines the introduction of formal Clinical Reasoning Skills sessions - initially a Student Selected Component (SSC) - as compulsory sessions in the core second year curriculum. Observations of 4th and 5th Year students’ performances in live examinations and student feedback indicated that, despite having excellent core communication skills, students struggled with the skills needed for effective analytical thinking when faced with complex diagnostic challenges.A three week SSC was designed around current research introducing students to the concepts underpinning the process of clinical reasoning. This SSC is founded on experiential practice where students analyse their thought processes and hypothetico-deductive reasoning governing the choices and conclusions reached whilst interviewing patients. All sessions are conducted in small interactive groups with experienced simulated patients and academic clinician tutors. Student feedback was extremely positive; all students felt these sessions must become part of the core undergraduate curriculum. The iterative processes required for developing higher order thinking skills in students are described

P33. Optimising student experience: an innovative and integrated tutor support and development programme

Background The curriculum of the five year MBBS course at HYMS is integrated and student–centred with regular clinical skills sessions throughout the first two years. The clinical skills tutors are practising clinicians who deliver their teaching role alongside everyday clinical practice. The essential features of our successful support system have evolved during our first eight years, creating a vibrant integrated and innovative Community of Practice. Our support system includes:• Peer observation • Regular online student-tutor feedback • Regular tutor training sessions • Regular Action Learning Sets • New tutor mentoring • Annual Performance Review 65 • Tutor commitment to completing a Postgraduate Certificate in Medical Education • Core staff in key roles facilitating inclusion of tutors in all aspects of the medical school. • Involvement in student assessment.Our tutors benefit and learn from each other’s experiences whilst developing professionally as educators embedded within medical school life. The Community of Practice ensures that tutors deliver consistently high quality student learning experience. The evaluation includes:• Students complete online, anonymous evaluation of tutors • We performed an evaluation of one session by observing all tutors • Informal evaluation that problems are now frequently managed by the tutor group rather than by faculty

Contextual activity sampling : a method to develop clinical interprofessional education

Higher health care education in interprofessional settings is evaluated and developed continuously. The aim of clinical interprofessional education is to provide healthcare students opportunities to develop their professional roles, and understanding of other professions, as well as to develop their teamwork and communication skills. However, there is still a need to improve understanding of how students experience their learning. Most often, post-course questionnaires and interviews are used to investigate students’ experiences of their learning activities. When using such approaches the respondents generalize about their experiences in retrospect instead of reporting on learning as it occurs. The Contextual Activity Sampling System (CASS) is a methodology inspired by ideas from the Experience Sampling Method (ESM). CASS was designed to collect frequent data from the participants’ ongoing learning activities by using mobile phones, which was the main methodology used in this thesis. The overall aim of this thesis was to investigate the potential of contextual activity sampling as an approach for studying students’ experiences connected to learning activities during clinical interprofessional education. Eighty-one students from six interprofessional training ward courses conducted during 2009 agreed to participate. For each course, students from two teams of three were randomly assigned to be included in an intervention group (using CASS, n=54) and from one team in a control group (not using CASS, n=27). The students’ learning experiences in the intervention group were collected via CASS and, for both groups, via interviews after the conducted courses and also RIPLS questionnaires both before and after the conducted courses. Study I was a study aiming at investigating the usability of CASS as a methodology in a clinical interprofessional context. Study II focused on the students’ experiences of clinical learning and Study III on the students’ experiences of collaboration. Study IV investigated whether students using CASS experienced their learning activities in different ways compared to students not using CASS. In Study I it was shown that the translated and cross-culturally adapted Swedish version of CASS was usable in a clinical learning environment and that it helped students to structure their study days and reflect on their learning activities. Study II demonstrated that students reported optimal experiences (flow) when they were engaged in knowledge creation activities and collaborated with their fellow students. A significant correlation was identified between positive emotions and how important the activities were considered to be. Study III showed that CASS provided possibilities to identify the student teams’ need of support to attain the intended learning outcomes and highlighted the importance of structure, interaction and insight in clinical interprofessional collaboration. In Study IV differences between the intervention and control groups were noted. The students who had used CASS rated their experience of ‘teamwork and collaboration’ significantly higher after the course than before the course, which was not the case for the control group. On the other hand, students in the control group rated stress higher than those who had used CASS. In conclusion, this thesis showed that the CASS methodology is suitable for collecting contextual data in clinical settings and can help students to structure their days and reflect on their learning activities. When interprofessional collaboration was working well it was associated with knowledge creation and an increased feeling of ‘flow’. CASS is an innovative methodology, which can be useful for stimulating reflection on clinical learning activities and development of clinical interprofessional education