The introduction of an online portfolio system in a medical school: what can activity theory tell us? The negative discourse of PPD in medical schools Analysis of PebblePad in the PPD curriculum with activity theory

In this paper we discuss innovations in the personal and professional development (PPD) curriculum that were introduced at a medical school in a major metropolitan university in Sydney, Australia. The review of the PPD curriculum involved the development of new content as well as the exploration of technologies that could be used to underpin the various collaborative, self-directed and reflective learning activities of the new course. An online portfolio system (PebblePad) was selected as the technological platform to deliver the new curriculum. Student feedback relating to the new technology has been critical and activity theory (AT) is used to broaden our understanding of the wider cultural forces -what we call the 'negative discourse of PPD' -that can potentially shape attitudes to technology and learning in the PPD component of a medical degree. Keywords: Activity theory, PebblePad, professional and personal development, curriculum, online portfolios, medical education. Setting the scene The University of Western Sydney School of Medicine (UWSSoM), established in 2007, is one of the newest Australian medical schools. The medical degree is a five year course with mostly domestic students ranging in age from 18 to the mid-40s although most of the students are recent high-school graduates. There is an equitable gender balance across all five years of the student cohort. During the first two years of the course, students engage in problem-based learning tutorials based at the university and are embedded in the clinical environment for the remainder of the course. As is the case with other medical schools in Australia, UWSSoM is required by the Australian Medical Council (AMC) to implement a PPD curriculum. The PPD theme is one of the UWSSoM's four major curricular pillars and aims to promote a bio-psychosocial model of medical care and to encourage students to reflect on, analyse and critically question how their professional identity is being shaped during medical school and beyond. However, despite the requirement and encouragement for curriculum reform from the regulatory bodies, we have found, similar to many other medical schools, that implementing a professionalism curriculum in the UWSSoM, has and continues to be, highly problematic. The negative discourse of PPD in medical schools The medical school curriculum is dominated by the scientific paradigm which exerts a powerful influence on students' conceptualisation of what medicine is and the formation of their professional identity The development of the new PPD curriculum Two years ago, the curriculum design team took over the stewardship of the PPD theme for the first and second years of the course. Aiming to overcome student negativity the team undertook significant curriculum reform based on feedback from both students and tutors. As a result of the redesign process, the curriculum is now delivered via fortnightly tutorials during which students are encouraged to engage in discussions about philosophical, ethical, legal and political issues relevant to the practice of medicine. The tutors' role is to facilitate student exploration and discussion of the topics rather than to act as content experts. The assessment takes a variety of formats including reflections, research essays, class presentations and creative responses. The new curriculum also reflects a change from a summative approach to assessment to semester-long progressive formative assessment. A key obstacle, however, to increasing the emphasis on formative assessment is the learning management system of the University of Western Sydney (UWS). The system does not expedite delivery of frequent and continuous feedback from tutors to students so that students' work can evolve. Nor does it facilitate the provision of peer feedback or provide students with effective tools to work collaboratively on a joint project. As a result, the curriculum was not able to provide students with the opportunity for integrating their self-directed, reflective and collaborative learning practices. The lack of this capacity prompted the search for a delivery platform that would be able to provide these feedback features. The team's interest in an online portfolio system (PebblePad) coincided with the university's interest in the evaluation of PebblePad and this system was subsequently adopted to deliver and implement the PPD curriculum. As part of the introduction of the new technology extensive staff development sessions were held before its introduction where tutors were introduced to PebblePad and the curriculum. The transition to the new delivery platform, however, was not a smooth one and several issues were encountered. These issues are identified below. Student feedback During the course of the first semester of its introduction feedback came in two forms. Anecdotal feedback was provided to us via the tutors and the required online survey for the university's evaluation of PebblePad, which included questions on its support and ease of use, reinforced the nature of the anecdotal feedback that we received. A summary of the survey and informal feedback is provided below. The interface was unintuitive and overly complex. Navigational steps to complete tasks such as getting templates were confusing -this confusion also created complexity for tutors. The value and utility of PebbePad were repeatedly questioned. The iPad was unable to render all features of PebblePad (all first year UWS students were given iPads). These issues, allied with the perception from students that PPD is a soft subject in the context of a medical degree, prompted us to explore theoretical frameworks that might help us to interpret this feedback. Activity theor

How do medical educators design a curriculum that facilitates student learning about professionalism?

Objectives: This study analyses the ways in which curriculum reform facilitated student learning about professionalism. Methods: Design-based research provided the structure for an iterative approach to curriculum change which we undertook over a 3 year period. The learning environment of the Personal and Professional Development Theme (PPD) was analysed through the sociocultural lens of Activity Theory. Lave and Wenger’s and Mezirow’s learning theories informed curriculum reform to support student development of a patient-centred and critically reflective professional identity. The renewed pedagogical outcomes were aligned with curriculum content, learning and teaching processes and assessment, and intense staff education was undertaken. We analysed qualitative data from tutor interviews and free-response student surveys to evaluate the impact of curriculum reform. Results: Students’ and tutors’ reflections on learning in PPD converged on two principle themes - ‘Developing a philosophy of medicine’ and ‘Becoming an ethical doctor’- which corresponded to the overarching PPD theme aims of communicative learning. Students and tutors emphasised the importance of the unique learning environment of PPD tutorials for nurturing personal development and the positive impact of the renewed assessment programme on learning. Conclusions: A theory-led approach to curriculum reform resulted in student engagement in the PPD curriculum and facilitated a change in student perspective about the epistemological foundation of medicine

'The game is in the tutorial' : an evaluation of the use of an e-portfolio for personal and professional development in a medical school

An e-portfolio system was introduced into the personal and professional development curriculum at the University of Western Sydney School of Medicine (UWSSoM) during 2011 and 2013. Adopting the methodology of Design-Based Research and an interpretive framework informed by Activity Theory we developed a set of educational design principles based on the analysis of the use of the e-portfolio system by students and tutors. These principles contain a range of insights applicable to the local context and may also be of interest to curriculum designers working in other domains

Student resistance to new technology

The content management system of the University of Western Sydney does not allow students to maintain a continuous record of their work from one year to another. Nor does it facilitate the provision of timely formative feedback as students work develops. Records of student learning are static finalised products to be uploaded for assessment, not dynamic documents which can be changed upon further reflection or in response to feedback provided by teachers and peers. At the School of Medicine we decided to introduce an electronic learning platform called Pebblepad to enable our first and second year medical students to develop a portfolio to record and reflect on their professional development across the 5 years of their undergraduate education

The introduction of an online portfolio system in a medical school : what can activity theory tell us?

In this paper we discuss innovations in the personal and professional development (PPD) curriculum that were introduced at a medical school in a major metropolitan university in Sydney, Australia. The review of the PPD curriculum involved the development of new content as well as the exploration of technologies that could be used to underpin the various collaborative, self-directed and reflective learning activities of the new course. An online portfolio system (PebblePad) was selected as the technological platform to deliver the new curriculum. Student feedback relating to the new technology has been critical and activity theory (AT) is used to broaden our understanding of the wider cultural forces - what we call the ‘negative discourse of PPD’ - that can potentially shape attitudes to technology and learning in the PPD component of a medical degree

Tottel's communications law : journal of computer, media and telecommunications law

Previous research has pointed to the role television can play in informing health practices and beliefs. Within the academic setting in particular, some educators have raised concerns about the influence of medical dramas on students. Less research, however, draws on the perspectives of students, and this study therefore explores medical students’ perceptions of medical practice and professionalism in popular medical television programmes. Qualitative data from surveys of Australian undergraduate medical students showed that students perceived professionalism in dichotomous ways, with three main themes: cure–care, where a doctor’s skill is either technical or interpersonal; work–leisure, where a doctor is either dedicated to work or personal life; and clinical–administration, where work is either direct patient care or administration. There continue to be imagined divisions between curing and caring for students, who express concerns about balancing work and leisure, and expectations that doctors should have little administrative work. Given students were able to identify these important contemporary issues around professionalism on television, there is pedagogical value in using popular images of the medical world in medical education

Medical student changes in self-regulated learning during the transition to the clinical environment

Background: Self-regulated learning (SRL), which is learners’ ability to proactively select and use different strategies to reach learning goals, is associated with academic and clinical success and life-long learning. SRL does not develop automatically in the clinical environment and its development during the preclinical to clinical learning transition has not been quantitatively studied. Our study aims to fill this gap by measuring SRL in medical students during the transitional period and examining its contributing factors. Methods: Medical students were invited to complete a questionnaire at the commencement of their first clinical year (T0), and 10 weeks later (T1). The questionnaire included the Motivated Strategies for Learning Questionnaire (MSLQ) and asked about previous clinical experience. Information about the student’s background, demographic characteristics and first clinical rotation were also gathered. Results: Of 118 students invited to participate, complete paired responses were obtained from 72 medical students (response rate 61%). At T1, extrinsic goal orientation increased and was associated with gender (males were more likely to increase extrinsic goal orientation) and type of first attachment (critical care and community based attachments, compared to hospital ward based attachments). Metacognitive self-regulation decreased at T1 and was negatively associated with previous clinical experience. Conclusions: Measurable changes in self-regulated learning occur during the transition from preclinical learning to clinical immersion, particularly in the domains of extrinsic goal orientation and metacognitive self–regulation. Self–determination theory offers possible explanations for this finding which have practical implications and point the way to future research. In addition, interventions to promote metacognition before the clinical immersion may assist in preserving SRL during the transition and thus promote life-long learning skills in preparation for real-world practice

Maske und Kothurn : internationale Beiträge zur Theater-, Film- und Medienwissenschaft

The transition of a medical student or a nursing student into a health care practitioner requires many changes. Among these is the development of an appropriate professional identity, which assists in the establishment of a sound base for professional practice and therefore should be a focus for health professions educators. There is evidence, however, that medical education and nursing education face challenges in guiding students' development of appropriate professional identities. In medicine, there is concern that medical education may contribute to the development of professional identities that alienate patients rather than identities that are patient centered. The nursing profession struggles with poor retention rates in the workforce, which have been attributed in part to discrepancies between the professional identities that students develop during nursing school and the realities of professional practice. In this Perspective, the authors explore the importance of and the pedagogical strategies used to facilitate professional identity formation for medical and nursing students. They argue that medical and nursing educators aim to instill in their students strong occupational identities which may perpetuate hierarchical disciplinary boundaries. They suggest that health professions educators should move beyond current disciplinary silos and create interprofessional education opportunities for medical students and nursing students to learn together to facilitate the development of the collaborative interprofessional identities necessary for the delivery of high-quality, patient-centered health care

Additional file 1: of Medical student changes in self-regulated learning during the transition to the clinical environment

Appendix 1 The Motivated Strategies for Learning Questionnaire (MSLQ). Description: The MSLQ, a validated instrument based upon the social cognitive theory of learning to measure SRL. (DOCX 52 kb