Art of the “How Health Professions Education Goes Virtual” mini-series

By Sarrah Lal (@SarrahML) & Sharon Bal (@SharonBal8)
Originally Published, April 6, 2020

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As we transition from in-person to online PBL education, we must consider how this impacts PBL learning environments for UGME. Indeed, while the role of the tutor (to facilitate the group learning process, guide learners to develop frameworks for knowledge construction, support in content acquisition) does not change (1) when transitioning to virtual PBL, this new learning environment does require a few extra considerations. This piece focuses on establishing both synchronous and asynchronous communication channels, empowering learners to succeed in online learning environments, and building trusting tutor-learner relationships in a virtual setting.

1. Create both synchronous and asynchronous communication channels.

The learning environment extends beyond the traditional classroom (2) and it is especially important to recognize this when a program is fully online. Conversations that once took place in the hallway or before a lecture began are no longer happening – this lack of meaningful social interaction can be “the largest single barrier to student success online.” (3).

• Use a video-conferencing platform to support tutorials – options include Zoom, Google Hangouts and Webex. This will be “where” synchronous online discussions will occur during tutorials.
• Use another communications platform to support asynchronous dialogue before, during and after tutorials. Learners can use this to communicate directly with the tutor(s) and peers, post relevant resources for tutorials and ask clarifying questions. Slack, WhatsApp and Microsoft Teams are all good platforms for this.

2. Expect declining engagement over time and build strategies to intentionally counteract this. 

Success in online learning environments is highly dependent on learner self-regulation, self-efficacy and self-directedness (4). Learner engagement and active participation in sessions is generally linked to high concentration. Consider that the average learner has an attention span of 10-15 minutes (5) and the number of demands which present remotely far exceed those in a traditional classroom. How might you, as a tutor, structure the environment for the learner to ensure their undivided attention for a three-hour period?

• Intentionally engage and ask questions that require group brainstorming and higher-level problem solving. Encourage learners to ask questions of their peers to challenge thinking.
• Use additional functions of video-conferencing platforms (e.g. polling and breakout rooms on Zoom) to enrich the learning environment. Encourage learners to ‘submit’ questions to you in advance of the tutorial and then provide this ‘quiz’ before content dialogue. Discuss discrepancies in their answers.
• After objective-setting, encourage learners to each take the ‘lead’ on different topics. Spontaneous remarks are challenging online – certain behaviours (e.g. quiet learners, outspoken learners) may be amplified.
• Online whiteboarding tools (available through video-conferencing platforms) are helpful when wi-fi is reliable for all learners. In the absence of such, encourage learners to use Google Docs as a ‘whiteboard’ to create knowledge-building frameworks (e.g. tables, charts and diagrams). NB: These resources may also be shared through asynchronous communication platforms. Encourage short ‘side conversations’ on these channels for quick clarifications without disrupting the flow of discussion.
• Offer shorter and more frequent breaks to ensure maximum attention.
• Collect ongoing feedback on tutorial engagement. Establish practices that are helpful to both tutor(s) and learners – this is an opportunity to co-create an engaging learning environment.

3. Build positive relationships with learners to improve their self-reported learning effectiveness. 

Trust between learners and educators is particularly important in medical education (6) and its presence is critical for effective knowledge acquisition in both clinical and classroom settings. Factors typically assessed for such trust between learner and tutor (i.e. perceived ability, benevolence and integrity) are challenged by the lack of non-verbal cues in online learning settings. Consistent with the Community of Inquiry model (7), an educational experience requires a cognitive, social and teaching (structure/process) presence. Focusing on the social element, two closely related concepts, self-disclosure and social presence (8), can help tutors promote online relationship building in the absence of non-verbal cues.

• Self-disclose (e.g. information about role, previous PBL experiences). This is an important immediacy behaviour to communicate warmth, availability for communication and positive affect. ‘Checking-in’ and ‘checking-out’ at the beginning and end of tutorials, respectively, are especially useful to build rapport.
• Ensure that as a tutor you establish social presence. This means you are available to communicate synchronously during tutorial and one-on-one feedback sessions, as well as asynchronously via email or other communication platforms. Using a personal tone, addressing learners by name and sharing relevant personal experiences also contributes to social presence. It is worth noting that social presence fully mediates the impact of self-disclosure on building positive tutor-learner relationships and, by extension, improves self-reported learning effectiveness.

We hope you feel empowered to take these strategies and maximize the online PBL experience in UGME. If you are interested in suggesting additional topics for support during this transition to online PBL please get in touch.

References

1. Jong, N., Verstegen, D., Konings, K. (2017). The role of the e-tutor in synchronous online problem-based learning: A study in a Master Public Health Programme. British Journal of Educational Technology. 49(3), 385-397. doi:10.1111/bjet.12554
2. Roddy, C., Amiet, D., Chung, J., Holt, C., Shaw, L., McKenzie, S., Garivaldis, F., Lodge, J., Mundy, M. (2017). Applying best practice online learning, teaching and support to intensive online environments: an integrative review. Front. Educ. doi:10.3389/feduc.2017.00059
3. Muilenburg, L. Y., and Berge, Z. L. (2005). Student barriers to online learning: a factor analytic study. Distance Educ. 26, 29–48. doi:10.1080/01587910500081269
4. Stephen, J. (2020). Persistence model of non-traditional online learners: self-efficacy, self-regulation, and self-direction. American Journal of Distance Education. Doi: 10.1080/08923647.2020.1745619
5. Bradbury, N. (2016). Attention span during lectures: 8 seconds, 10 minutes or more? Advances in Physiology Education. 40(4), 509-513. doi:10.1152/advan.00109.2016
6. Abruzzo, D., Sklar, D., McMahon, G. (2019). Improving trust between learners and teachers in medicine. Academic Medicine. 94(2), 147-150. doi:10.1097/ACM.0000000000002514
7. Garrison, D., Arbaugh, J. (2007). Researching the community of inquiry framework: review, issues, and future directions. The Internet and Higher Education. 10(3), 157-172. doi:10.1016/j.iheduc.2007.04.001
8. Song, H., Kim, J., Park, N. (2018). I know my professor: teacher self-disclosure in online education and a mediating role of social presence. International Journal of Human-Computer Interaction. 448-455. doi:10.1080/10447318.2018.1455126

About the author:

Dr. Sharon Bal (@sharonbal8) is a clinical assistant professor in the Department of Family Medicine at McMaster University. She is a prominent educator at McMaster’s Waterloo Regional Campus and the lead of our Social Media team in the McMaster Faculty of Health Sciences Program for Faculty Development (@MacPFD). She is also a Mom, family physician, educator, student.

Sarrah Lal, MBA is an assistant professor in the Division of Education & Innovation (DEI) within the Department of Medicine. She is a entrepreneurship and innovation expert and directs various educational efforts within the Michael G. DeGroote Initiative for Innovation in Healthcare. Currently she is also the lead of the Leadership & Management team in the McMaster Faculty of Health Sciences Program for Faculty Development (@MacPFD).