Using E learning in Advanced Practice Education: A demonstration of the Stilwell Project

1. Using E learning in Advanced Practice Education: A demonstration of the Stilwell Project Kathy Haigh Senior Lecturer Programme Leader Msc Advanced Practice in Health and Social Care University of Cumbria

2. Presentation Overview • Educational overview • What is a virtual community? • Working with an example from Stilwell • Student Responses and Thematic analysis • Interprofessional learning • Evaluation of Stilwell

3. Educational Approaches for Health and Social Care Students Conventional pedagogy can cover the content of a curriculum and the competencies required, but can it....... • Support interprofessional education? • Engage students with the meanings, emotions and experiences of patients / clients? • Question conventional orthodoxy? • Place facts and skills in a human context and reveal the patient’s perspective (one of the 3 sources of EBP) Combining narrative pedagogy with conventional approaches can make practice come to life in a much more realistic way and better prepare students for the reality of life after they qualify.

4. Educational Theory: Narrative Pedagogy • Based on Diekelmanns Narrative Pedagogy (2001) 1: Learning from story and interpreting the meaning of the story. 2: Multiple Perspectives. 3: Discussion leading to the sharing of understanding and challenging assumptions and conventional wisdom. 4: Insights into emotions such as guilt, pain, anguish and dilemma of choice.

5. What is a Virtual Community? • Multimedia extension of technology-enhanced learning • Telling individuals’ stories in the context of community setting –impact of problems on individual, family and community- ‘soap opera’ • Narrative pedagogy is the theoretical underpinning. • Virtual practicum for interprofessional learning (IPL) • Examples: • Stillwell (UK) • Stillwell (Ontario) • The Neighborhood (USA)

6. Stilwell Virtual Community Elements An online site containing: • Medical case notes and social histories for residents • A video tour of Stilwell and Brigstow, map and description • Photogallery of Stilwell/Brigstow • Professionally made videos of critical incidents in patients’ lives • Podcasts and other audio files relating to staff and patients • Front page of the local paper The Brigstow Herald • Blogs kept by health care professionals (nurses, paramedic etc). Also features a blog from a citizen’s advice bureau worker. • Blog kept by Annie, a Stilwell teenager. • Police records and files on key individuals (Westland County Constabulary) These resources create realistic context & are narrative devices to tell stories

7. Using Stilwell with Advanced Practice Students • Video clips and Podcasts • Setting tasks related to the module content • Students are in groups of 5-6 • Groups are mixed, so representation from HPC’s primary, acute, community and mental health are represented. • Total of 29 students

8. The unseen story of Maureen Black • We all engage and discuss issues with friends, but is the information / advice we receive always helpful, knowledgeable, relevant or can it lead to misinformation and cause worry. • The following clip is the first in a series of Maureen Black and her quest for knowledge into her newly diagnosed condition

9. Maureen Black-Student engagement • Theme of the task : Advanced communication, information gathering (history taking) from patients and the subsequent educative aspects of these clinical encounters. • Task: Watch the first of Maureen’s 3 videos and critically evaluate the conversation between Maureen and her friend.

10. Selection of Student responses from all groups • ‘The dialogue with Maureen and her friend demonstrates the importance of recognising influence of peers and family in people’s health beliefs’. (Holt & Kumar, 2010). (Every group had this quoted within their responses). • A key point is that much of the health education material available requires a year 10 reading ability, but the average reading age in the UK is estimated to be at year 4 level (roughly nine years of age). Thus there was a considerable gap in the readability of existing healthcare publications and the reading ability of the general population when this research was undertaken (Wilson et al 1997).

11. Continued • Noticeable signs of anxiety from Maureen, facial expression, hands, seems to be seeking reassurance • Feel empathy for Maureen, newly diagnosed, confused, overwhelmed by information already given, seems to be searching for answers.

12. Continued • What was discussed in the previous consultation. The notion that diabetes is mild or borderline needs to be challenged in clinical practice. Who told her this? • Did the previous practitoner ‘chunk and check’ with Maureen? • How many information leaflets was she actually given

13. Thematic Analysis of Student responses • All responses have been analysed and the following themes are present within all groups • Previous healthcare encounters • Use of leaflets (multiple perspectives, language, type, childs, adults) • Patient attitudes towards own health • Level of disease knowledge within the general population • Peer support and influence

14. Themes from extended critical evaluation • Language barriers, use of language line etc • Understanding the patients knowledge base and ability and tailoring education to patient needs and expectations (New 2010, SIGN 2010) • Patient education programmes such as Xpert and DESMOND • The complexity of the patient and the challenge of consultations

15. Themes for future consultations • Ensuring the patient is a partner in care. • Ensuring that the next consultation explores the ideas, concerns and expectations (ice) of the patient as a priority. • Utilising frameworks to ensure a therapeutic helping relationship is established • Challenging own knowledge base and our own abilities to communicate in plain English with no medical jargon • Educational aspects of consultations

16. Interprofessional learning • Immersion of the person watching the video creates a picture of the people in the case • Dialogue allows students to actually discover, understand, appreciate and learn from the care provided by other HPC’s within their groups. • The videos have multiple perspectives that the students discuss (we do have academic level and can be used for different learning outcomes)

17. IPL • Every student has a voice and opinion and therefore increases student engagement. • Demonstrates a clear use of narrative pedagogy

18. Evaluation of Stilwell • Externally conducted focus group evaluative research, key findings: 1: Bridges theory practice gap 2: Engages with patients, start to care for them 3: Different way of learning and knowing 4: Challenging, makes student think differently 5: Shows connections between health problems and the social context 6: Allows exploration of difficult and challenging situations 7: Some stories are very harrowing (child sex abuse), intensive student support needed

19. Conclusion • Only had a 2 minute glimpse into the Stilwell community. • Students have evaluated the use of Stilwell into their last module and have been very positive regarding its use. • Has given students insight into the usually unseen social aspects of the patients lives. • Is now being used in collaboration in North America partners and with 5 Australian Universities

20. References • Diekelman N (2003) Teaching the practitioners of care: new pedagogies for the health professions. Madison, University of Winconsin Press. • Holt, T. Kumar, S (2010) ABC of Diabetes. Oxford; Wiley-Blackwell. • New N (2010) ‘Teaching so they hear: using a co-created diabetes self-management education approach’.  Journal of the American Academy of Nurse Practitioners, 22, pp316-325. • SIGN(2010) Management of Diabetes. A national clinical guideline.[Online] Available at: http://www.sign.ac.uk • Wilson, R. Kenny, T. Clark, G. Moseley, D.Newton, L. Newton, D. Purves, E (1997) Ensuring the readability and understandability and efficacy of Patient Information leaflets. Prodigy Publication 31.[Online] Available at: http://www.ecls.cl.ac.uk/publications