Health Sciences and Practice Subject Centre

1. Health Sciences and Practice Subject Centre Problem Based Learning Special Interest Group 26th March 2009 Bernadette Burns (Senior Lecturer) Moira McLoughlin (Senior Lecturer)

2. Bernadette Burns (Senior Lecturer) Moira McLoughlin (Senior Lecturer) March 2009 A GREATER MANCHESTER UNIVERSITY

3. Bernadette Burns Introduction and Evaluation of Problem Based Learning using the triple jump approach within an undergraduate children’s nursing curriculum A GREATER MANCHESTER UNIVERSITY

4. North west of England 5 minutes from Manchester centre 2hrs 50 mins from London Direct flights toManchester Home of the Commonwealth Games Where is Salford?

5. Aim of presentation • To demonstrate how the triple jump assessment strategy was used as a summative assessment strategy to develop knowledge and skills acquisition using a problem based learning approach.

6. Outcomes • Understand how curriculum changes facilitated the introduction of the triple jump strategy as an effective summative group assessment tool. • Discuss how cased based resources were developed • Present an overview of the preparation of students and facilitators to engage in this change process • Identify how knowledge gaps were identified and resolved by accessing quality resources, working effectively with peers and work to a timescale. • Present findings from the evaluation of the first cohort

7. Curriculum Changes • Institutional Audit (2006) identified an over reliance on written assignment as a form of summative assessment strategy. • Colleagues returned from McMaster University where triple jump used by a variety of healthcare professionals and used as vehicle to promote change. • New Curriculum (changes in structure) - module lost 4 weeks of taught time - moved from year 3 to year 2 - increased numbers of students requiring assessment supervision - decreased availability of lecturers

8. Curriculum Outline Year 1 semester 1 Semester 2/3 short module 2 long modules run concurrently Year 2 semester 1/2 Semester 3 2 long modules run concurrently short module (complex care needs) Year 3 Semester1 Semester 2/3 short module 2 long modules run concurrently

9. 2nd year student nurses on diploma training programme leading to RN Child Curriculum underpinned by Problem Solving Philosophy (Glen & Wilkie 2000) Key skills incorporated into curriculum Literacy Numeracy Information technology Communication Problem Solving Working with others Oakey& Doyle(2000) A Strategic Approach to Undergraduate Key Skills Development The students

10. Developing of the module facilitators: assessment strategy • Introduction to rationale for change • PBL and Triple Jump (PBL sig group • Development of cased based scenarios • Development grade descriptors • Development of facilitator packs with clear information and strategy to direct student learning • Preparation and peer review of grade descriptors by module team and school QAEG (based on McMaster grade descriptors) • Ratification Journey school teaching and learning committee • Faculty approvals final ratification for ready for September 2008

11. Developing the assessment strategy • Assessment strategy had to be common to adult and mental health branches of nursing • Clinical cases studies developed in year 3 partnership modules amended and enhanced by module team and practitioners • Ratification Journey school teaching and learning committee • School Programme Approvals Committee • Faculty approvals final ratification for ready for March 2008

12. The assessment • 5 Case Based scenarios developed with practitioners - neonate with liver disease - child with leukaemia - child with cystic fibrosis - child with epilepsy - child with long term renal condition - child with autism spectrum disorder ( new)

13. Example of case based scenarios linked to module outcomes • Module Outcomes to support summative case based presentations: • Displays knowledge and skills required for effective partnerships and collaboration in children’s nursing (1) • Defends ethical decision making in clinical practice (2) • Critically debate the provision of services for children and families with complex health and social needs. (3) • Analyse evidence on which children’s nursing is based (4) • Defends problem solving and decision making in children’s nursing (5)

14. Example of case based scenarios linked to module outcomes PBL Case Study 1 Molly is the second child of Dan and Sarah She was born at the local district General Hospital following a full term normal delivery. Her birth weight was 3.5Kg. She was noted to have mild jaundice and was discharged home within 24 hours post delivery. Sarah had chosen to breast feed Molly unlike her first child who was formula fed.. On Day 4 it was reported by Sarah to the midwife that Molly’s umbilical cord tended to bleed during nappy changes but following reassurance from the midwife Sarah was encouraged to cleanse the area more thoroughly as no signs of infection were evident.. The Health Visitor visited the family when Molly was 3 weeks old. When Sarah was asked about Molly’s progress Sarah identified that Molly did not appear to be gaining weight as compared to her first child and her stools were now becoming pale. Her nappies were also noted to be very yellow. Sarah had continued to breast feed Molly and had been reassured that the symptoms she was describing were associated with breast feeding jaundice and the Health Visitor felt this was an over anxious mother but agreed to revisit in 1 weeks time. One week later when the Health Visitor called on the family Molly’s jaundice was unresolved and her abdomen appeared swollen. Molly was then referred to the GP for further investigations.

15. Assessment continued • Assessment • Students in groups of 4 will undertake a presentation surrounding the care issues arising from the clinical case scenario they have been allocated. Forty minutes will be allowed for the group presentation with 15 minutes allocated for questions. These answers need to demonstrate some depth of knowledge pertaining to the clinical case scenario. The group take joint responsibility for the knowledge presented and any member of the group may be asked questions on any aspect of the content. Students will be informed of their problem based learning group and the date and time of their group presentation on day one of the module. 100%

16. Assessment continued • Guidance • The triple jump is a three-staged process which culminates in a summative, presentation by a pre designated group of students. Each presentation is based on a clinical scenario given out in week 1 of the module. • On the day of the presentation present an abstract which contains a summary of the way the presentation is to be organized and sequenced, please include clearly structured objectives and a brief overview of the content. This abstract will not be marked. The copy of the abstract will be kept by the markers. • The triple jump uses a problem-based learning format which takes place within a defined and compressed, time frame. • Students with an identified disability will be allowed an extra 5 minutes for their presentation.

17. Onion Model: Personal and Professional development • Using the model identified knowledge deficit using NMC four domains and link to family centred care and care planning.

18. The Onion Model (Darvill and McLoughlin 2000)

19. STUDENT GUIDELINES: PRESENTATION : CLINICAL CASE SCENARIO ASSIGNMENT • Stage 1 Timetabled session • Step I, Introduction to the clinical case scenarios. facilitated by a member of the module team • Step 2students’ mind map their groups learning issues, developing and prioritizing learning objectives, and outlining a shared learning plan in relation to the clinical case scenario ( wikki used a repository) • Step 3 students advised to delegate the development of the knowledge content pertaining to the clinical case between the group members. Students then negotiate ground rules between themselves (appoint chair person) Group Learning Outcomes agreed and verified by facilitator Marking criteria developed and adapted from Evaluation of Students in BSc ( Occupational Therapy (Sue Baptiste 2000) McMaster Conference

20. STUDENT GUIDELINES: PRESENTATION : CLINICAL CASE SCENARIO ASSIGNMENT • Stage 2 • Occurs at a pre-arranged time negotiated between the students and the learning facilitator • Opportunity to discuss the resources they will use to support their presentation and the learning facilitator will offer any extra guidance and support required at this time • Stage 3 Student group presentation: 40 minutes with an extra 15 minutes for questioning. Presentation of the evidence based knowledge generated pertaining to the learning objectives and the clinical case scenario. Each student expected to present an equal amount of content and all students share joint responsibility for the content delivered.

21. Problem Solving • Encourages student to challenge practice • Allows student to identify knowledge deficit • Utilises key skills to solve problems • Evidence based practice • Develops a practitioner fir for purpose fit for practice (Glen& Wilkie 2000)

22. Virtual Learning Environment • Facilitators set up group discussion boards • Students set up a file exchange • Students developed group outcomes/ reviewed by facilitators and amended if required • Content accessible to whole group • Once content developed trial run in university using power point

23. Student Evaluations ( trialled PBL evaluation tool (25 students) On a scale of 1-10 (1 = poor, 10 = excellent) • What was your perception of using problem based learning as a summative assessment strategy • Was the assessment strategy clearly articulated in the module handbook and on introduction to the module by the module leader? • Was sufficient time allocated to facilitation? • Was sufficient time allocated to researching materials to underpin the case presentation? • How well do you feel the group members have participated and worked effectively as a team member on this presentation? • Please identify factors that negatively impacted on the groups overall presentation and how these could be overcome? • How relevant was the taught content of the module?

24. Student Evaluations ( trialed PBL evaluation tool (25 students) 8. Was the information placed on your groups? blackboard pages 9. How well do you feel group members used the available resources pertinent to this presentation 10. Did you group have a chairperson? 11. How effective do you feel the role of the chair was in relation to this summative presentation? 12. Chair person only to answer this question Please list any difficulties associated with this role 13. What was the standard of references and reading used to support the presentation? 14. How well do you feel the group presentation went? 15. What was the standard of discussion in relation to this presentation? 16. What have you learned about yourself from participating in this group presentation?

25. Student Evaluations ( trialed PBL evaluation tool (25 students) 17. How well do you feel that the working on this presentation has helped YOU enhance the following key skills IT, communication, working with others, managing own learning, working with numbers? 18. Are there nay other comments you would like to add? See attached summary of answers

26. Grade Descriptors Electronic feedback template • Presentation and development • Accuracy and relevance including references sources • Knowledge and understanding of specified topic underpinned by relevant reading. • Applicationof theory to clinical practice • Analysisand demonstrationof reflection • Demonstration of key skills • ( see module handbook) • Grade descriptors used as a template for electronic feedback

27. Success criteria • 26 students enrolled on the module • 24 passed • 1 non submission due to sickness (re-learner) • 1 failed poor content failed to reach academic standard • Marks ranges from 78 to 35 • Failed student was a re-learner with two other assignments to resubmit • Improved median mark • Successful assessment strategy adopted by all 3 branches

28. Benefits to lecturers • Allowed students to take responsibility for own learning • Clear guidance on facilitation and development of content, • Timetabled group facilitation • Reduced time spent on assignment supervision • Reduced marking time • Reduced number of failures • Students ready to access year 3 without having to resubmit assignments • Feedback given electronically

29. Conclusion • Summative assessment using the PBL triple jump was successful • Achieved an improved pass rate at first attempt • Introduced a new and successful assessment strategy • Minor amendments to be made e.g. increase time allocation to 15 mins per student.

30. References • Brown, S. and Glasner, A. (Eds.). (1999) Assessment matters in higher education—choosing and using diverse approaches. Buckingham: Open University Press • Baptiste S (2000) Marking criteria developed and adapted from Evaluation of Students in BSc Occupational Therapy McMaster Conference • Burns B (2005)Utilising information technology and problem-based learning strategies to resolve practice dilemmas in a children’s orthopaedic setting Journal of Orthopaedic NursingVolume 9, Issue 3, Pages 127-133 Glen and Wilkie 2000 Cited in Roberts, D Ousey K ( 2003) Problem based learning: developing the triggers. Experiences from a first wave site Nurse Education in PracticeVolume 4, Issue 3,Pages 154-158 • Mcloughlin M , Darvill, A ( 2007) Peeling back the layers: a classroom model for problem based learning Nurse Education Today • McTiernan et.al. (2007) The triple jump in problem based learning: an evaluative method used in the appraisal of both knowledge acquisition and problem solving AISHE Reading No 1 http://www.aishe.org/readings/2007-1/No-19.html • Oakey, D., Doyle, M., (2000) A Strategic Approach to Undergraduate Key Skills Development: Salford Key Skills Project, Final Report,

31. Contact Us Health Sciences and Practice Subject Centre http://www.health.heacademy.ac.uk info-hsap@kcl.ac.uk Higher Education Academy http://www.heacademy.ac.uk