Knowledge Construction in the Online Classroom

by Jacqueline Clark, PharmD, PGY1 Pharmacy Practice Resident, University of Maryland Medical Center

Knowledge construction is the step-wise process of learning through which we build upon pre-existing experiences and prior understanding. It is based on the premise that our current knowledge influences not only what we learn, but the way in which we learn. Although learners have different styles and preferences, knowledge construction is thought to be a common process for all learners.

Knowledge construction begins by connecting. During this step, learners are provided with resources such as textbooks and validated online references, and are prompted to complete assignments to build upon existing knowledge. The next step, communicating, is achieved by the sharing or elaborating on the material. This may be achieved through any type of informational presentation, such as student-led presentations, topic discussions, and group assignments. Next, collaborating is achieved when teachers and learners review the assignments, contrast interpretations, and compare them to structured content, such as a textbook chapter. Finally, learning (or acting) collectively is achieved through the further synthesis and interpretation of all aspects of the process, in order to achieve an understanding for application to future situations.¹

Researchers have put great effort into examining the knowledge construction process. In a study focused on problem-based learning, researchers looked for an association of student questions and knowledge construction drive.² Results suggest that student learning is driven by questions. More specifically, learning is closely related to the ability to ask the "right" questions. The extent by which the students’ "right" questions could be answered was associated with a continued quest for knowledge – thus stimulating their motivation.²

In an era of recorded lectures and online student forums, do the same opportunities for asking the "right" questions, receiving appropriate responses, and sustaining interest still exist? In this course [Educational Theory and Practice PHMY 545], we witness firsthand the process of knowledge construction in the setting of an asynchronous online discussion. We are instructed to first, read and analyze literature on the topic, such as books and articles. We then read and analyze our classmates' interpretations of the topic by reviewing the responses posted on the discussion board. Next, we are encouraged to post our own thoughts on the topic in response to the instructor's prompts. After reading comments from our colleagues, both in response to our own posts and to others, we are encouraged to draw conclusions. Although we may not have realized it, we are participating in the knowledge construction process!  Also, in addition to encouraging high-level thinking, we are grounded by the instructor's comments. The instructor provides us with answers to our questions. If we happen to stray away from the purpose of the discussion, we are re-directed and are led back to asking the "right" questions.

There appears to be three cognitive phases of the knowledge construction process.  These phases are prompted by "questions or tasks."

Applying these concepts to the discussion board assignment in this course, the pre-construction phase includes gathering the information required to answer the questions. This includes information from experts (e.g. the literature), information from colleagues, and integrating these sources with our pre-existing understanding of the topic. The stage of cognitive imbalance occurs when we are writing about our own interpretation in response to another's interpretation. High-level thinking occurs when we evaluate our own interpretation — comparing and contrasting to another’s interpretation. This step provides a chance to re-consider our original conceptual understand and thus collaborating with others to build upon our knowledge.³  The re-construction phase makes us aware of how our original understand differs from our newly acquired knowledge. This may include disregarding a previous assumption or going forward with a stronger understanding and increased confidence in future situations.⁴

Knowledge construction does not end when the discussion board is over. In one study, the researchers found that learners continued to construct their knowledge outside of the online class through interpretation and application to daily life.⁴ Our discussion board engenders application outside the class too. So, in an era of online instruction, do we have the same opportunities for optimal knowledge construction?  The answer is yes! Technology and modern forms of communication do not hinder us – but they must be used and applied wisely based an understanding of how learners learn.

References

1. Olson, R. Collective Knowledge Construction. Ideas Lab. Available at: http://www.ideaslab.edu/wp-content/uploads/2011/07/Understanding-Virtual-Pedagogies_CKC_ideasLAB. Accessed September 22, 2015.
2. Chin C. and Chia L.G. Problem-based learning: Using students' questions to drive knowledge construction. Sci. Ed. 2004; 88: 707–727. doi: 10.1002/sce.10144
3. Rahman S, Yasin RM, Jusoff K, et al. Knowledge Construction Process in Online Learning. Middle-East Journal of Scientific Research 2011; 8: 488-492.
4. Kanyka, H and Anderson, T. Online Social Interchange, Discord, and Knowledge Construction. International Journal of E-Learning & Distance Education. 1998; 13: 57-74.

The Interprofessional Classroom

by Kathy Tang, PharmD, PGY1 Pharmacy Practice Resident, University of Maryland Medical Center

For health care professionals, collaborative practice is the basis for providing patient-centered, comprehensive care. However, health care professional students often only experience interprofessional collaboration on their first advanced practice experience in the hospital.

What medications was the patient actually taking at home? Which medications are appropriate now, can the patient afford them, and does the patient understand how to take them? What is the discharge plan? Does the patient have access to primary care services? How can we safely transport the patient home? These are the kinds of questions that students (pharmacy, nursing, social workers, and medical students alike) must ask when they first encounter patients.  But are they sufficiently prepared to work together to address and answer them?

I first become interested in interprofessional education in the classroom setting when I attended the University of Maryland Interprofessional Education Day (IPE Day) activities as a first year pharmacy student. One day on the University’s academic calendar was blocked off and students from all professional programs were encouraged to attend a series of seminars.  In the afternoon, they worked together on a patient case. That was the day that I learned that nurses often ask patients about the medications taken at home. That was the day that I learned that social workers assist in arranging patient transportation and finding the necessary equipment to continue treatments at home. That was the day I realized that interprofessional education was needed in the classroom and that it was sorely lacking in our curriculum.

Why hasn’t interprofessional education been assimilated into every healthcare professionals’ curriculum? The answer is multifactorial. In a survey of academic deans of U.S. and Canadian dental schools, several challenges were cited.¹ Cost and coordinating a common curriculum between different professional schools has been difficult to overcome.  It requires years of planning and collaboration between the academic dean of each school. Classes must be synchronously scheduled, professors/instructors must be available to teach classes, staff must be trained, and so on. While these barriers are daunting enough for large universities with multiple health professional programs on a single campus, it’s nearly impossible for stand alone schools to pair up, let alone coordinate between 3 or 4 different programs on separate campuses.

Another barrier – and perhaps the most difficult one to surmount — is profession-centrism. This occurs when a professional group “nourishes its own pride and vanity, boasts itself superior, exalts its own divinities and looks with contempt on outsiders.”² Profession-centrism promotes competition and prevents health care professionals from acknowledging each other’s skills and roles. I have experienced this many times, in the hospital and community settings alike. As a fourth year pharmacy student at an independent community pharmacy, I identified an opportunity to optimize a patient’s medication regimen. When I contacted the physician to express my concerns, he stated that he had been practicing for more than 20 years and that pharmacists had no role in helping make therapeutic decisions for patients. Physicians aren’t the only one’s who harbor profession-centric beliefs. Frankly every health professional is prone to thinking that they are intrinsically better than others.  Its OK to have pride in one’s profession, but we must overcome this kind of mentality if we truly want to teach students about and model interprofessional collaboration.

Exposing health professional students to the respective roles and responsibilities of team members is certainly one way to counter profession-centrism. For example, during the annual Interprofessional Education (IPE) Day, the realistic cases highlighted the complex social, nursing, diagnostic, and medication needs of patients. The overall response was extremely positive.  One medical student noted that she did not know how much pharmacists knew about therapeutic decision-making or could do follow-up monitoring. The social work student addressed many of the social barriers that the medical and pharmacy students simply overlooked. While the IPE day activities at the University of Maryland were very helpful, others have take it one step further. For example, the University of Pittsburgh uses standardized colleague encounters to improve pharmacy students’ ability to communicate evidence-based recommendations. Not only did this help build communication skills but it also improved student confidence.³

Other studies have examined the effect of interprofessional course work on students’ understanding and respect for the professional roles on a team. Faculty at the University of Toronto developed a 5-week interprofessional program where student initially (week 1) discussed areas of common professional knowledge and experience and then worked together through patient cases as a team (weeks 2-5).⁴ A survey of the student participants found that there was a significant increase in students’ appreciation of each profession’s scopes, roles, and values.  Moreover, participants had a stronger belief that collaboration was important to achieve the best patient care outcomes. Another study involved a yearlong structured program with nursing and PhD psychology students. Qualitative data revealed that participants had increased clarity of each others’ roles, approaches, and resources as well as how to collaborate in practice.⁵

So how can we make interprofessional education throughout the curriculum a reality? The first step is to create a common vision of interprofessional development. On campuses where there are multiple health care professional schools, representatives from each school must meet and create a shared vision as part of their respective schools’ goals. Then, formation of an interprofessional education committee is necessary to turn ideas into action. Committee members should consist of members of each of the health professional schools and led by a dedicated full-time champion (most often a professor who cares deeply about interprofessional collaboration). The committee should meet at regular intervals for continuous program improvement. The next step, and perhaps the most time intensive, is curriculum development, requiring the interprofessional education committee to work with the individual schools to align the curriculums. Last, but certainly not least, is teaching professors how to deliver instruction in a interprofessional manner. To achieve this, an active learning approach should be used. For example, East Carolina University’s Rural Health Training Program has an interprofessional preceptor development course that consists of several meetings and cases taught over multiple, highly interactive sessions.⁶

Interprofessional education in the classroom will never be a reality unless we make an effort to address professional-centrism, create a shared vision, and develop a plan.  There’s lots of work that needs to be done.  Let’s get started … now.

References

1. Formicola AJ, Andrieu SC, Buchanan JA, et al. Interprofessional education in U.S. and Canadian dental schools: an ADEA Team Study Group report. J Dent Educ. 2012 Sep;76(9):1250-68.
2. Pecukonis E. Interprofessional education: a theoretical orientation incorporating profession-centrism and social identity theory. J Law Med Ethics. 2014 Dec;42 Suppl 2:60-4.
3. Davies ML, Schonder KS, Meyer SM, et al. Changes in Student Performance and Confidence with a Standardized Patient and Standardized Colleague Interprofessional Activity. Am J Pharm Educ. 2015 Jun 25;79(5):69.
4. Pinto A, Lee S, Lombardo S, et al. The Impact of Structured Inter-professional Education on Health Care Professional Students' Perceptions of Collaboration in a Clinical Setting. Physiother Can. 2012 Spring; 64(2): 145–156.
5. Priest HM, Roberts P, Dent H, et al. Interprofessional education and working in mental health: in search of the evidence base.  J Nurs Manag. 2008 May;16(4):474-85.
6. World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice. Health Professions Network Nursing and Midwifery Office. 2010: 9-41.

Professional Education in < 140 Characters: A Tweetorial

by Emily Wiener, PharmD, PGY1 Pharmacy Practice Resident, Sinai Hospital

The internet has changed nearly every aspect of our lives. The way we communicate, shop, and learn has fundamentally changed. Websites abound with information which can be accessed nearly instantaneously. Social networking sites and instant messaging applications allow us to connect with people worldwide with a simple click of the mouse or tap on the screen. Although many social media tools were originally developed for, well, socializing, many of them can be used for professional and educational purposes as well. I was first introduced to the idea of Twitter for professional education during my first advanced pharmacy practice experience (APPE). My preceptor (@PharmERToxGuy) along with a number of the medical residents and attending physicians actively sent and received messages on Twitter. They used Twitter as a means of sharing clinical pearls, staying up to date on literature, and connecting to others in their specialty worldwide. I, in jest, joined Twitter as my "final project.” Since then I have been surprised by what I’ve learned. But the use of social media sites is not risk free, especially in educational settings. It can compromise the authority of the teacher-learner relationship and blur the lines between professional and personal life. In health professional education, there’s the added risk of compromising patient anonymity. Twitter use, as with most things, is all about the risk/benefit ratio. How does one minimize these risks and maximize the quality learning opportunities available through Twitter?

Twitter has been adopted in various educational settings as a means to dialogue with and engage learners as well as a forum for sharing knowledge.  This practice has been slowly adopted in health professional education. The first paper regarding Twitter’s use in health professional education was published in 2009.¹  Several reports have been published since. Most are descriptive in nature. They address a variety of uses including "Tweeting the Meeting", evidence based tweeting, learner engagement, blog dissemination, and networking.^1-6

With the increased use of social media, many journals have added social media editors to their editorial team in an attempt to increase readership. The Journal of Continuing Education in the Health Professions appointed Alexander M. Djuricich, MD to this position in 2014. In an article he wrote describing his position, he explained that one goals is "to connect with the continuing education and continuous professional development community beyond the traditional peer-reviewed publication format."² Other well-known journals including the Journal of the American Medical Association (JAMA) and the British Medical Journal (BMJ) regularly send evidence-based tweets (EBT) to their followers.² These tweets generally contain a brief description or pearl along with a link to the original source. The link provides followers direct access to primary literature from an array of journals which are relevant to practice. Learning who the right people, organizations, and journals to follow is key to finding quality Tweets.  Strategically employing hashtags is another tactic to maximize learning.

“Tweeting the meeting” has increased substantially over the past few years at national conferences. Many medically related conferences now have their own hashtag(s) including the largest pharmacy conference, the ASHP Midyear Clinical meeting (MCM). Audience members can interact with speakers, ask questions, make comments, and archive information for retrieval after the meeting. At the ASHP MCM in 2013, 31% of postings were related to specific educational sessions.³

The use of Twitter in conferences isn't limited to large, national gatherings. Local conferences such as grand rounds and weekly resident conferences have also created hashtags and taken to tweeting the meeting.⁶ This allows clinicians with similar interests in different geographic locations to share experiences and improve their practice. In March 2012, a hospital in Indiana started tweeting grand rounds. There were 613 tweets sent from 17 consecutive grand rounds presentations.⁴ Tweets came from users physically attending as well as those following asynchronously. This breakdown of geographical barriers engages learners and maximize learning opportunities.

There are a few simple tips to maximize your Twitter experience. The quality of your Twitter feed is directly related to who you follow. Be selective!  Identifying experts in your specialty area is key to increasing the quality of the Tweets you read. Even when following the “right” people (the so called twitterati), it’s important to maintain a skeptical eye. Remember, Tweets are not always evidence based and they certainly aren’t peer reviewed literature. They are often opinions or über brief summaries of primary literature or anecdotal reports. It is important to read the literature and draw your own conclusions. If you disagree with the Tweeter, respectfully respond and engage in a discussion. Just like face-to-face dialog, the best learning often comes from professional differences of opinion. But it’s important to remain professional.  Don’t be a TrashTweeter! And don’t use your professional title or credentials without first checking your institution’s policies regarding social media use. Recently, the Royal Pharmacuetical Society published a guidance document.⁷ Once you’ve built your Twitter network and start meeting people at conferences, it can be difficult to keep use strictly professional. If you want to use Twitter for social purposes too, consider creating a separate personal account. This helps to keep a clearer division between the two.

Twitter can be a great resource for connecting with experts in your field, staying up to date on primary literature, and engaging at conferences. If you are a twewbie, learning twettiquette can help you navigate the Twitosphere. Getting started is easy. Fly on over, create an account, and start reading what people have to say. You might be surprised by what you learn.

[Editor's note:  For more detailed instructions on how to create a Twitter account and some recommended twitter feeds for health professionals, visit Using Twitter for Professional Development on the iForumRx.org website. Follow us at @iforumrx.]

References

1. Williams, SA Terras, M Warwick, C. How Twitter is studied in the medical professions: A classification of Twitter papers indexed in PubMed. Med 2.0. 2013;2(2):e2 DOI: 10.2196/med20.2269.
2. Djuricich, AM. Social Media, Evidence-Based Tweeting, and JCEHP. JCEHP 2014; 34(4): 202-4.
3. Awad, NI Cocchio, C. Use of Twitter at a major national pharmacy conference. Am J Hosp Pharm. 2015;72:65-9.
4. Djuricich, AM Zee-Cheng, JE. Live Tweeting in medicine: 'Tweeting the meeting.' International Review of Psychiatry. 2015;27(2):133-9.
5. Jalali, A. "Why do you Tweet, Anyway?" A glance into medical education tweeting. [Internet] AM Rounds: Beyond the pages of academic medicine. 2015 June - [Cited 2015 Sept 20].
6. Joshi, N. Introducing #EMConf Twitter hashtag. [Internet]. Academic Life in Emergency Medicine. 2013 Aug - [cited 2015 Sept 20].
7. Royal Pharmaceutical Society. Social media guidance for pharmacists. [Internet]. Royal Pharmaceutical Society. Accessed 2015 Sept 27.