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

Abstract

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