Abstract
COVID-19 has had a significant impact on teaching and learning in postgraduate education. In particular, work integrated learning, in health care settings, has been disrupted in many ways negatively impacting student learning. Our Clinical Redesign courses are designed to deliver work-integrated learning in partnership with healthcare organisations to deliver workplace projects in real time, which has been complicated by COVID-19. This reflection examines the challenges that arose in the healthcare redesign teaching and learning space during the COVID-19 pandemic. We explore the experiences of our work-integrated learning students using Johns’ reflection model.1 Our students faced disruption to their education, workplaces and personal lives, and the experiences of our teaching team whose teaching philosophies were challenged. In response to the ongoing challenges, we developed strategies for supporting our students including the development of virtual projects for students who no longer had access to their workplaces or project appropriate resources.
Introduction
This reflective piece discusses the challenges we, as an academic teaching team, faced in delivering a postgraduate, work-integrated learning course during the COVID-19 pandemic and how we have responded to the specific needs of our students in this unprecedented time. This reflection is underpinned by Johns’ model of reflection, 1 which describes 5 stages of reflection: description, reflection, influencing factors, alternative strategies and learning. We begin by providing some background information about our course, work-integrated learning as a pedagogical practice, its importance in healthcare and how our course contributes to health systems improvement in Australia. We explore a number of key issues that have emerged through our students’ experiences during COVID-19 in relation to the course and discuss how we have responded to challenges to our teaching philosophy and pedagogical approach posed by COVID-19.
Graduate certificate and Professional Honours (Clinical redesign)
The University of Tasmania delivers 2 postgraduate healthcare redesign, work-integrated learning (WIL) courses (Graduate Certificate in Clinical Redesign and Professional Honours (Clinical Redesign)) in which students undertake a health service improvement project in their own workplace. The courses have a combined intake of 200 to 300 students a year. Our students are largely experienced healthcare professionals working across many disciplines in both major and regional hospitals and health services. In semester 1, 2020, our student cohort (
Workplace-based projects undertaken during the courses are fully supported by our healthcare redesign academic staff, whose experience in healthcare includes nursing, midwifery, pathology, quality improvement and quality and safety as well as academic and organisational research. WIL is an educational approach whereby students apply academic theory in the real world via an experiential learning model, which accurately reflects the learning outcomes and aims of our course.
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The benefits of WIL have been demonstrated in many disciplines,
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including health,
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globally and within the Australian health system.
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Graduates from our course have demonstrated this through the achievement of successful, sustainable changes to health service delivery.
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For example, a medication management project for elective surgery patients in Victoria won a regional Quality and Safety Award. The graduates involved in this project improved accuracy and timeliness of charting regular medications, leading to a reduction of both repetitive tasks and adverse drug reactions. The graduates’ reflection on this work highlighted that ‘
The courses are designed around the expectation that our students will undertake a number of project activities within their workplace. In line with the views of Parmelee, 7 active learning strategies in health education enhance the learning environment through more meaningful educational experiences. Our learning activities are often role-specific and require direct interaction with the student’s organisation and colleagues in accordance with the theory of work-integrated learning. 2 For example, students are required to develop governance structures, engage with stakeholders, collect and analyse data and design health service interventions as part of their assessment tasks providing a foundation for sustainable change. 8 Our courses are designed to support these activities through partnerships with healthcare organisations, who provide organisational oversight of projects and support, such as access to service and administrative data sets, provides a constructive educational culture.9,10 In addition, we deliver a number of face-to-face masterclass days which align with units around project planning and intervention design.
Description of the experience: COVID-19 disruption to learning and teaching
The COVID-19 pandemic first affected the way we deliver our courses in March 2020, when the number of new COVID-19 cases began to grow exponentially across Australia. Most of our students live and work in the states of Queensland, New South Wales, Victoria and Tasmania, where strict measures were rapidly implemented to reduce the spread of COVID-19 and increase capacity within the health system. 11 This meant that our students faced many changes to their workplaces, organisational structures and their own roles as well as major changes in their home and personal lives. It has been suggested in the literature that universities and higher education facilities should move to online learning throughout COVID-19 with students being encouraged to maintain social and professional connections fully online. 12 This approach, however, is not a practical solution for work integrated learning models, including our courses, where students undertake workplace projects in healthcare settings.
Student experience of clinical redesign WIL during COVID-19
Through a student focussed-lens we identified 5 key issues 1 through data derived from students’ emails and formal assessment task extension requests, and phone calls from distressed students. Notes were kept from the conversations with students and there were several issues that repeated in these communications which highlighted the main concerns that our students faced as the broad impact of the COVID-19 pandemic grew.
Reflection on supporting our students
With a focus on student experience, we share our reflections of teaching and learning in a WIL, healthcare space during Semester 1, 2020 in the midst of the COVID-19 pandemic and some strategies for overcoming challenges.
It became increasingly apparent that our teaching team needed strategies to assist students during this time to continue their studies while not adding further pressure to their work or personal lives. First, we reached out to our partner organisations and students, as well as internal channels, to develop and implement solutions to ensure that our students felt academically, and personally, supported throughout the COVID-19 pandemic. These strategies were in line with broader university support provided to students, including the provision of an automatic extra 5 working days from the due date to submit an assignment and extending the date for withdrawal without academic penalty until the end of Semester 1 where unit results are published before 8 July 2020. The university also introduced a procedure to ensure students maintain a strong Grade Point Average (GPA) (average results of all grades achieved throughout a course) in which students are able to ask for their results to be converted to an Ungraded Pass (UP) if their GPA was negatively impacted by COVID-19 during Semester 1. An UP is a grade that shows a student has successfully completed a unit of study within their course but their grade does not count toward their GPA. This allows usually high performing students who achieved lower than expected results due to the effects of COVID-19 to have these results removed from their GPA calculation (provided they have passed the unit). 13
Further strategies were based on the direct needs of our students. Flexibility around timing was requested by our students most often, allowing them extra time to complete their assessment tasks, including project deliverables, and reading through the unit(s) content. In particular, students in the 2 fully online, theory units found it difficult to meet the deadlines for the assessment tasks as they had not had time to engage with the learning material. This was evidenced through the number of formal extension requests received in these units. In addition, we provided further options for students allowing due dates to extend into Semester 2. As we were unable to provide our face-to-face masterclass days due to COVID-19 restrictions, there were also changes made to the order in which our students completed their units, to maximise the chances of students being able to attend masterclass sessions. Ongoing communication with students about their enrolment in individual units has been essential to ensure that we are providing equal opportunity for social learning outside of the workplace as well as experiential, workplace learning. Further to this, we recognised that a number of students no longer had a workplace in which to complete their project or had been seconded into a role that was not consistent with their initial project idea(s). We needed to develop a longer-term strategy for supporting these students both professionally and academically.
In line with suggestions from other medical educators, we considered adaptive strategies for learning and how to innovate in this new COVID-19 environment. 14 After much team discussion, we decided to develop a suite of virtual projects for students unable to undertake a workplace project to complete the course requirements. The projects are set in a virtual ‘made-up’ health service, designed to reflect current Australian health service provision, and provide a context in which students can develop problem-solving skills through data gathering and analysis exercises and planning implementation of appropriate interventions. The characteristics of a problem-based learning approach, using problems as a stimulus and focus for student activity, 15 will enable our students to meet the course learning outcomes through real-world scenarios with data adapted from previous redesign projects. The virtual projects aim to be sufficiently flexible so that students can tailor them to their own needs, experiences and interests with the teaching team facilitating this individualised learning approach. This will provide an environment that encourages creativity and critical reflection, which can be adapted to a wide variety of learning styles. 16 However, we will need to ensure that learner collaboration and interactivity are maintained as they are key enablers of learning in online environments.17-19
Students appeared to appreciate the efforts made by the teaching team to respond to learning challenges caused by the COVID-19 pandemic. Feedback from students throughout the semester indicating that the personal support from each member of our teaching team and the consideration shown to students by the University as a whole created a positive learning environment that made students feel valued and understood: ‘
Influencing factors: Our teaching approach
As a teaching team we embrace constructivism as our teaching and learning paradigm and this approach continued to influence the way we responded to our students’ challenges due to the COVID-19 pandemic. Constructivism proposes that students learn by observation, processing and interpretation, and that they filter information into knowledge. 20 In our teaching and learning experience, constructivism essentially provides an intellectual framework for experiential learning through contextualised meaning making. Learning is increased when students can contextualise and situate what they learn for immediate dissemination. 21 Learning is therefore regarded as an active process through engagement with real-world problems which aligns with the experiential learning theory and our pedagogical approach. 22
As educators, we play an important role in linking students’ previous experience to current learning content, enabling students to experiment with our learning material and provide feedback, in real-time, as a quality assurance approach. Similarly, consistent with pedagogical research around social learning theory 23 there are several factors that influence teaching and learning per social learning perspectives: context, culture and community. Our students’ learning occurs as a combination of each of these concepts through observation and collaboration within the workplace (collegial connection) and directly through online interaction with learning materials and human interaction with lecturers. From a social learning theory perspective, knowledge is constructed while students engage in activities, receive feedback and participate in other forms of human interaction in a social context. 23 We aim to provide this social environment by supporting our students through projects that they plan, develop and implement as part of a shared goal or outcome for their organisation. This concept has been recognised in the field of medical teaching, as an approach whereby students learn to problem solve, contributing to improved clinical care and health systems. 24
We recognise that healthcare is a diverse field with many disciplines and areas of expertise and that a virtual project may appear to be a ‘one-size-fits-all’ approach. Our students include nurses, pharmacists, medical officers, paramedics, allied health and administrative staff who conduct projects across all areas of healthcare. The virtual project curriculum is not based on 1 discipline but provides students with a choice of redesign projects covering a range of fields. These currently include acute medical inpatient journey, mental health, specialist outpatient clinics, pathology services, ambulance services and community healthcare. By providing a more individualised approach to virtual projects, we aim to continue to support our students as individual healthcare professionals through the development of contextually-relevant problem-solving and critical-thinking skills. Virtual project-based learning then becomes a pedagogy that essentially integrates theory with the simulated practice of work within a purposely-designed curriculum.
Alternative strategies
The creation of virtual projects was at first challenging, as we believe that the most important way to learn how to improve health services is by doing, consistent with the constructivist approach. Health service improvement involves knowledge mobilisation based on previous tacit knowledge gained in practice. 25 For many practical skills, especially ‘soft skills’ centring on engagement of health workers; the only way to learn and hone these skills is to practice. Our teaching is therefore centred on practice, utilising experiential learning, problem solving and the analysis of practice within theoretical concepts. Through our team discussions we came to the conclusion that this strategy could be applied to the virtual projects by retaining and emphasising the reflective elements in assessment tasks, whilst still retaining a student-centred approach to teaching and learning. We considered alternative strategies by delaying the WIL units. However, a prolonged delay may mean that students are unable to finish the degree within the maximum timeframe stipulated by the course rules.
We felt that the creation of virtual projects was the right choice but that they had potential limitations that required addressing. Participation in virtual projects as an educational model reduces the opportunity for learning in a social context. Students who choose this pathway will not interact with workplace colleagues as part of their projects. Previous research, however, suggests that students perceive greater social interaction in an online learning space when creating and sharing in-depth online messages. 26 Therefore, it will be important for us, as a teaching team, to ensure that our students remain socially connected to other students undertaking the virtual project curriculum and in the broader course.
Learning: Changed ways of knowing in practice
Our response to the challenges posed by COVID-19 has been informed by a constructivist paradigm. While we hope our courses will make a positive contribution to students’ future professional careers, our ultimate goal is for our students to become safe, competent and reflective practitioners. We feel a sense of pride by offering our students alternative strategies to allow them to keep studying and we have done this by being open and responsive. We were able to create a positive learning environment were students feel comfortable to think critically. Critical thinking assists students to become capable, autonomous practitioners needed to deliver services in a health care environment, that is rapidly increasing in complexity. Similarly, as we have all practiced in various healthcare roles, we have a level of empathy for our students in that we understand the constraints that are often faced during project work in healthcare organisations. This empathy extends to include COVID-19 as we have endured many challenges with our own healthcare redesign project work within local and national organizations. The COVID-19 pandemic has led us to critically reflect on our roles as educators in the fields of health and medicine. We now have a clearer understanding of our position within the learning and teaching space, leading to enhanced methods of support and teaching strategies, for our students’ benefit. It is not unusual that a major event such as COVID-19 leads to changes in thinking and practice. 27
Conclusion
The COVID -19 pandemic has caused disruptions in teaching and learning in our WIL course. Four key issues have emerged:
Footnotes
Acknowledgements
We would like to acknowledge our students and the challenging times they have faced during the COVID-19 pandemic. In particular, we thank the students who allowed us to use direct quotes from our conversations to demonstrate the impact that COVID-19 had on teaching and learning.
Funding:
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests:
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
