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What activities might support learning for your subject?

Video shows a variety of learning activities in practice
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We have seen how activity helps embed learning. In fact, it’s essential that some form of exertion takes place on the part of the learner in order for it to be stored in long-term memory. Here are some different training methods which incorporate activities. Perhaps you’ve experienced some of these yourself? And perhaps you could use some of these in the subjects you teach. Here we see nursing staff learning how to insert a cannula into a patient’s arm. They’re practising the skill whilst receiving feedback from a trainer. Mental connections are being made and correct actions are reinforced by the trainer.
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Here junior doctors are learning how to run a cardiac arrest, even though they are using a manikin, the simulation makes it feel real, and as well as learning the techniques, they are being prepared for making decisions under pressure. Here we see administration staff learning to how to accurately enter personal details into a patient record system. They are going through the process in an online training environment where they can experience making mistakes but with no consequence. The trainer is able to support them and steer them toward a correct action. Group work is a common feature in classroom-based learning. Notice that learners don’t necessarily need to be sitting at a table. Here a trainer poses questions.
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Learners quickly move to which ever they think is the correct answer. This injects some fun to the activity, and ensures everyone contributes. Here learners share ideas at tables, they are encouraged to discuss and debate questions instead of passively accepting facts. This ensures they engage with the material fully, and aids retention of key concepts. In this exercise, they are asked to find and hold up the correct page when they have found the answer. In this instance, learners are participating in a child protection scenario while their colleagues watch in another room via a video link. Later, the participants are reunited with the group and everyone discusses what took place in a safe and supportive environment.
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Here learners at a psychiatric hospital practice safe restraint techniques with coaching from instructors who provide feedback. Here we see learners all answering questions with an online voting system.
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Here learners are developing a new skill, actually practicing and feeling the needle helps to create a lasting mental model; in this case, the model has a physical, ‘feeling’ element. When learners have performed a new skill several times, it starts to become becomes easier, and more natural. This is often called developing ‘muscle memory’ because it seems as though the muscles remember how to carry out the task. It’s a bit like changing gear in a car – it’s as though your arm remembers how to change from second to third gear without being directed. Muscle memory is actually a false name, as the skill is retained in the brain. But it’s a good description, as we don’t consciously control these movements.

In the video we saw learners actively engaging with a variety of topics by means of discussion and participation in set exercises. Learning in small groups is enriched by the sharing of experiences and ideas. It encourages everyone to participate, and is particularly relevant in healthcare where everyone works together to deliver the best care.

To ensure colleagues learn effectively, it is important to select methods that suit the topic and which will create strong mental connections. The most appropriate learning method is selected first. Once this has been decided, a delivery route is chosen.

For example, if we require learners to be able to site a cannula in a patient’s arm, learners need to know the veins in the forearm and the key parts and function of a cannula (Knows that). There may be differences in the level of existing knowledge and some learners may require more time than others. So, the method chosen is self-study and practised recall of knowledge. Two delivery routes may be considered; it can be undertaken in a classroom but could also be completed online. As there are likley to be different knowledge levels in a given group, online learning allows everyone to reach the required level at their own pace.

They also need to be able to site a cannula correctly (Knows how). This physical skill requires hands-on practice with pracice arms supported by formative feedback from a trainer. So the choice is made to undertake this section in a classroom.

Competence needs to be assessed in order that patient safety is maintained so they can prepare and perform the procedure unaided (Shows how). Finally, their performance with real patients is assessed at the bedside by an appointed mentor (Does). The table below shows the learning outcomes and associated methods.

Learning Outcome Learning Method
Name the main veins of the forearm Retrieval. Learn vein names. Label blank diagram later from memory. Practice after 1 day, 2 days, then 4. Also practise drawing and labelling veins on blank picture of arm.
Insert cannula correctly Realistic practice with formative feedback. Prepare equipment and insert cannula into training arm. Tutor asks questions and provides supportive feedback.
Cannulate a patient Real practice with formative feedback. Cannulate patients under observation from mentor. Mentor provides feedback following successful siting.

Retrieval practice after time has elapsed is a powerful learning method. It makes the memory stronger and easier to access in the future. Spacing practice out over a period of time further strengthens this.

In the example provided above there are three assessments; one after each part. It is not always necessary to have an assessment after each section of training. However, in this instance each section requires competence in the preceding part before progression to the next.

In this course we differentiate between ‘learning methods’ and ‘learning delivery routes’. This is because at the planning stage, we don’t wish to exclude any options. The method is the way the knowledge or skill is absorbed by the learner and turned into a lasting mental model. Once we have decided this, then we can consider the best delivery option.

For new knowledge such as the names and location of veins in the arm, the chosen learning method may be self-study followed by retrieval practice. This method could be delivered by either of these routes:

  • Reading and practiced recall by writing and labelling sketches.
  • Online reading, and ‘fill in the blanks’ labelling of veins.
  • Classroom lecture with individual recall tested via a phone app.

Inserting a cannula requires the learner to experience tactile feedback through their fingers. They also need to be able to recognise a visual flashback of blood into the cannula chamber. This can only be realistically undertaken well using the delivery route of a classroom.
(Note: the ever-increasing sophistication of Virtual Reality (VR) and Augmented Reality (AR) training may soon offer valid alternatives).

Examples of active learning experiences

Classroom:

  • Skills practice
  • Small group discussion and feedback
  • Group problem solving
  • Group practice of interpersonal skills
  • Group exercises designed to develop teamwork skills
  • Quizzes with group or individual responses via smartphone apps, skills simulation.

Online (non-live):

  • Real-time decision making (scenario-based training)
  • Branched video scenarios
  • Online forums
  • eLearning tests with free text answers
  • practice tests

Online Live:

  • Video conferencing based learning which provides group discussion and practice
  • Online group tasks in breakout rooms, with whole group feedback.

Active learning and social distancing

We know that learning is more likely to last and be transferred to everyday work practice if learners ‘have a go’ and receive feedback. However, social distancing requirements mean we need to keep face to face meetings to a minimum, and this presents a challenge. For practical clinical skills which need to be personally observed and assessed by a trainer, the necessary personal protective equipment (PPE) is worn.

However, there is much we can do to minimise the need for contact by teaching online instead. This can be undertaken live with videoconferencing apps, or non-live by using engaging online learning. For example, the use of free text answers marked by a trainer provides insight into learners’ understanding and allows individualised feedback. Assessments and forums which allow such commmunication are readily available on eLearning platforms such as Moodle.

It is important that we keep testing and evaluating learning methods which allow us to maintain engaging training whilst observing virus-safe processes.

Talking point

Look at the following questions and consider sharing your thoughts with other learners:

  • How much practice and feedback is included in the training you are involved with?

  • Would any of your courses or modules benefit from a more active approach?

  • How much practice and feedback is provided in the courses you design and/or deliver?

If your answers indicate your training is currently active, consider sharing what you believe makes them so. If you answered that they would benefit from a move towards a more active approach, share what you think might make them more so. Comment on others’ posts regarding how active their courses are.

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Train the Healthcare Trainer

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