Faculty Research-Led Education Federation (FREF)

It is crucial that all academic staff including researchers, are involved in teaching at the university. To this end, we hope to make information about what educational opportunities are out there available, as well as signposting where to find information on best practices and educational research. FREF, or the Faculty Research-Led Education Federation, part of the Good to Great Project, has been formed to address those needs.

In particular, we have at FMS-TEL been developing the FREF website which should provide a one-stop shop of sorts for institute-based researchers and others interested in finding information about teaching and research project opportunities. Those who are maybe just starting out and would like an overview of the structure of the schools and institutes in the Faculty of Medical Sciences can find this information on the website. We hope to help them identify which programmes are available that they might teach on or otherwise contribute to, for example by supervising undergraduate research projects. We are currently working to locate the website for FREF under the Learning and Teaching section of the FMS Sharepoint site and will also encourage colleagues to take advantage of professional development opportunities to build on the quality of their teaching.

Zoom and MBBS at NUMed with Fiona Clarke

This case study concerns the MBBS programme at NUMed, and the different ways interactive tools and humanising teaching techniques on Zoom has helped facilitate learning during lockdowns. Zoom tools have been used in many different ways, and tools and tips from colleagues, internet searches, and the FMS TEL Humanising the Online Experience webinar have helped enhance these sessions.

From Beginner to Teacher

The prospect of teaching online can be quite daunting, especially if you don’t already have a lot of interest in or experience with the technology. Initially Paul Hubbard offered a help session for Zoom, which was a great help and provided inspiration on how to use the different tools in teaching. With practice, a lot of skills were developed and put into practice with students. After hearing about how Zoom is used in these MBBS sessions, colleagues now come to ask for advice based on the techniques and tools that have been used, and it’s great to be able to provide that for them now.

Humanising the Online Experience in Practice

Turn off Self-View

Some students are very shy, and a range of techniques can help them build their confidence. One among these is turning off self-view in Zoom, which only takes a couple of clicks. This is useful when teaching as well, as your own image can get a little distracting. At first you might worry that you are fidgeting without being aware, but it soon becomes easy to remember that you are still on camera. Students who had initially struggled with presentations or speaking in front of others did become more confident after these interventions, and after getting more comfortable with the Zoom environment.

Encouragement to Switch on Cameras

One thing that has worked very well is giving a lot of deliberate positive feedback to students about switching on their cameras. At the start of sessions students are greeted warmly and the benefits of having the camera on are shared. More importantly, efforts are made to share how lovely it is to see their faces when they do turn the camera on. Even saying something like ‘it’s so nice to see you’ or ‘I’ve missed seeing you all’ as cameras come on encourages others. Since making this deliberate extra effort, a lot more students turn on their cameras during sessions, which helps lift the atmosphere.

Teaching Ethics

Teaching concepts like ethics can be tricky, as they don’t lend themselves to a practical format. To help bring the subject material to life, the ethics segment of the Medicine, Acute Care and Surgery course was previously presented in a very interactive format in person. Students used flipcharts to collate information, moved around the room, worked in groups, did card sorting activities… initially this seemed difficult to replicate online, but it was possible to adapt the sessions using Zoom tools like polling, breakout rooms for group work, and interactive whiteboards.

Approximating In-Hospital Experience

One thing that has been a challenge for the programme is the lack of access to hospitals due to the pandemic, especially for The Hospital-Based Practice course. This is normally case-based, interacting with real patients. The decision was made to create staged patient interactions. These sessions work a bit like branching scenarios in that what the student chooses to do guides the rest of the interaction. A ‘patient’ acts from a script on the Zoom call, and the lecturer can coach the student through the interaction and offer feedback. If the student chooses to, for example, listen to a patient’s breathing, the lecturer provides a sound file of what the student hears when they do so. While this can’t perfectly replicate what it’s like on a ward (patients don’t follow a script!), students still get the chance to practice skills like decision-making and explaining diagnoses.

Advice

The best advice is to try things out and experiment in a Zoom meeting on your own, or with colleagues. Even if you have used a tool before, if it has been a while, just start up an empty Zoom meeting and refresh your memory before it’s time to go live. Google has also been invaluable – it’s possible to fix common issues or refresh your memory by finding software instructions online. Finally, don’t be afraid to try out new tools with students. The interactivity tools such as polls and whiteboards can help bridge the gap and make sessions more engaging.

“Don’t be afraid, just try it out! It’s so worth it, it makes such a difference.”
Fiona Clarke

Resources

Newcastle University Digital Learning – Technology Guides
Enrol in the FMS TEL Canvas Community for access to materials and Canvas notifications of new resources and blog posts.
Humanising the Online Experience Webinar Materials (watch, listen or read)
Zoom Documentation
Turn off Self View in Zoom

Contact

Dr Fiona Clarke, Associate Professor and Senior Lecturer in Medicine, NUMed

Fiona.clarke1@nhs.net

Humanising the Online Experience – Guide

A new guide has been created in the Humanising the Online Experience area on the FMS TEL Canvas Community, and can be accessed directly. You can download this document to keep a summary of the webinar tips handy, or read it below. If you can’t access the FMS TEL Canvas community, please enrol yourself before retrying the direct link.

Humanising the Online Experience

This document summarises the tips from the FMS TEL Humanising the Online Experience webinar. The full set of resources can be found on the FMS Community, including rationale, research, and links to resources. This should be read in conjunction with the University guidance and the guidance available within your school. Not all tips will be useful for all situation or all students – you know your students and can select appropriate strategies.

Objectives

know how to set expectations and maintain these
have strategies to make synchronous sessions more like PiP interaction
have strategies to be more present in non-synchronous aspects of a course

Summary

Humanise your teaching by being compassionate to your students and yourself.
Set clear and reasonable expectations, and be predictable.
Know your student (‘s names)!
Ensure student contributions are easy to make and clearly valued.
Be authentic rather than perfect – acknowledge the awkwardness and tech troubles.
Create opportunities for regular quality authentic interactions with students.
Appreciate the strength of video and live interaction in terms of richness of interaction, while noting that this makes it more intense to participate in.
Recognise the benefits of non-synchronous activities in reducing pace and intensity, allowing for more reflection and considered responses, and bridging time zones.

Expectations

Learning online is a change of culture and this needs to be recognised. Students and staff are still negotiating how the classroom works in an online context and sometimes there is a misalignment between staff and student expectations.

Expectations and Assumptions

Remember that your session may not be the only session that students are attending that day. Acknowledge the challenges of the online way of working and work with students to adapt to these. Consider:

A poll or survey to check what is going on with students.
Reach out to learners who are not engaged or are not progressing.
Discuss how to adapt to the online environment.
Draft a Group Learning Agreement together and share your expectations clearly.

Make it easy for students to access your session by being predictable. Repeat similar task/session structures and activities to cut down on instruction time.

Maintaining Expectations

Consider using a holding slide at the start of each session with session expectations on it. Repeating these helps remind students of the required standards. Include/be mindful of caveats. For example, instead of ‘Students must have cameras on at all times’ try ‘Students should keep cameras on where possible’. Encourage through gentle nudges – thanking students for complying rather than taking an ‘enforcer’ stance. Lead by example wherever possible.

Synchronous Strategies

Camera Off

You can use these camera breaks for any type of task, such as considering an answer to a question or looking at a new resource and responding. Make sure that you use clear start and end points, stay silent for some time yourself, and warn students before feedback or further input starts. If students don’t have to worry about how they appear on the camera, they can more effectively concentrate on the task. Camera-off time allows for moments away from the emotional stress of being ‘under scrutiny’, and it eases screen fatigue if the student has had other classes prior to yours.

Explain that camera-off time will be included in your session introduction and expectations. This mitigates the problem of people thinking they need to choose on or off at the beginning of the session and then stick to it, making ‘camera on’ a much less intimidating choice and allowing an easy way in for shy students.

Hide Self View

If you find your own image distracting, click on your image in Zoom and choose ‘hide self’. Note students do need to be warned that this doesn’t hide others from seeing them! This feature is not yet available in Teams, but you can always stick a post-it on your screen!

Chat

Asking students to drop their responses in the chat box allows shy students to participate more easily and allows those who prefer to learn through discussion to do that without taking over the session. Students can go back and review the chat if it is saved for them too. This is quicker than setting up a shared document.

Authenticity

Acknowledge the awkwardness of video teaching and that you understand their awkwardness too – we’re all in it together and may need to push out of comfort zones. Be animated and show your personality/humour a little – it’s OK to smile or make jokes. People always come across ‘flatter’ on screen than in person, so the extra effort is worth it. Admit if things are a little tricky or go wrong and take a moment to fix them before moving on smoothly. Suggest a five-minute break if the whole session has been halted for tech reasons so that you can fix the problem and regroup your thoughts. Have a question or little task for students in your back pocket in case of difficulties.

Icebreaking

Icebreakers almost always feel contrived but still work – acknowledge this and be encouraging as you try these activities out. Try these in small groups in breakout rooms first. You will likely need to visit the rooms and push the energy levels up initially. Whole group icebreakers can include things like asking everyone to send a reaction emoji or give you a thumbs up/down on camera in response to questions.

Wait Time

Teachers are often guilty of not waiting long enough for an answer – usually overestimating the time they have waited. This wait time feels worse in the online environment. You need to wait longer than normal online because it takes time for students to type a response or switch on their microphones. Give a long wait time for your questions and use a timer (either on screen or silently on your phone/another screen) to make sure you are giving students enough time to respond. Lengthen your wait time if students haven’t responded, and state that you are giving them more time.

Acknowledge Individuals

Start the room early and greet students as they arrive in the room – a simple hello and using the students’ names is a lovely start! Ask students to set profile pictures on Zoom (not necessarily of themselves) to help differentiate them visually if they don’t put their cameras on. This makes them more memorable individually than a sea of names in text. Explain why you are doing this. Make effort to learn and use students’ names as you would in PiP. That doesn’t necessarily mean picking on students for questions, it can be thanking them for contributions and greeting them too. Suggest students do a video/audio introduction either privately or in a shared discussion space.

Have we started? Are we done?

Normally this is done non-verbally or with body language like standing up and coming to the front or packing away notes. Clearly announce the start and end of the class time. Consider leaving the room open for a little while after class for less formal chat.

Breakout Room Strategies

Set expectations: What do they need to achieve? By when? When will you check in with them? Warn students if/how you will do this and be consistent.

Use monitoring strategies as in PiP. Visit each breakout room quickly at the start to check everything is understood, say when you will visit again and follow up. You do not always have to contribute ‘in person’ by dropping into the room – you can also drop comments and annotations on the page. Some tasks can be monitored by a Sharepoint folder in tile view to watch multiple documents being updated simultaneously. You can’t read text, but you can set up documents with visually distinctive features such as empty boxes to be filled, or items to be sorted/moved around on the page. You can also monitor web tools and documents for each group by opening each group’s document or page in a new tab in your browser and clicking between, or even tiling them in separate windows if you have enough screen space.

Non-Synchronous Strategies

In addition to the above strategies, some of which apply in a non-synchronous setting, the tips below are unique to the non-synchronous environment.

Presence

Maintain an online presence by regularly participating in discussions and giving feedback. Show students that their discussion board posts etc. are being read by someone. This doesn’t mean always being available; it just means setting aside some time to connect. Consider running an ‘office hour’ drop-in via Teams, Zoom, or Canvas chat.

Text-based interactions

Bear in mind that tone is more difficult to convey in writing than in person. Supplement your text with emojis where appropriate or if you think there is a chance of misinterpretation. If a message seems impolite consider differences in culture and language usage – English has a tendency to be full of pleases and thank yous in a way that other languages aren’t.

Scheduling, planning, linking

Ensure that non-synchronous tasks are part of the flow of learning and that the knowledge gained is referred to in synchronous sessions. Create clear learning objectives with completion linked to synchronous events or certain dates, and make sure you feed back on them. This gives the learning more value. Set time aside to clear up issues arising from non-synchronous teaching if needed.

Download The Guide

Visit the Community

Planning Learning

As part of my own research to pass on to colleagues, I recently attended a Future Learn course “How to Teach Online” where this planning tool was demonstrated. I thought colleagues may find it to be of interest.

Learning Designer helps you plan different types of activities for your students. It allows you to organise a blend of online and face to face activity. These are called TLAs, or Teaching and Learning Activities. There are 6 different types to choose from

Read, watch, listen
Collaborate
Discuss
Investigate
Practice
Produce

You can add resources such as links to videos and websites.

It produces a helpful pie chart showing the proportion of activities the students will experience.

You can download your plan as a word document or share it with a link.

Have a go with the Learning Designer Tool yourself at https://www.ucl.ac.uk/learning-designer/designer.php (Links to an external site.) The video below talks you through how to use it.

More information is available on the Learning Designer Website https://www.ucl.ac.uk/learning-designer/index.php (Links to an external site.)

A User Guide is also available at https://www.ucl.ac.uk/learning-designer/guide/

Digital Code for Teaching Anatomy Online – Joanna Matthan

Jo Matthan (Director of Academic Studies, School of Dental Sciences) talks about the teaching of Head and Neck Anatomy (DEN1101) within the School of Dental Sciences (SDS) at the Faculty of Medical Sciences (FMS), and how the move to online teaching necessitated the development of a specialised Digital Code around the use of cadaveric imagery.

Background

In Present-in-Person (PiP) teaching, students attending this foundational head and neck anatomy course would typically have access to the Dissecting Room for their learning. This would be delivered over a six-month period in their first year on either the Dental Surgery (BDS) or the BSc Oral and Dental Health Sciences degrees. This face-to-face time has been reduced to 12 hours from the approximately 50 hours of hands-on anatomy teaching delivered, which left a considerable amount of content to be covered in the digital format. In normal times, a code of conduct is signed by every student the first time they enter the restricted Anatomy and Clinical Skills Centre teaching facility. This was utilised in a digital format during the pandemic but, due to the major overhaul in teaching delivery, there was no way of reinforcing the messages contained within the code of conduct on a regular basis. It felt like a tall order to expect students to remember and understand a list of statements that is seemingly far-removed from them at the start of their anatomy learning journey, and to retain this volume of information in the digital era.

Due to the highly sensitive nature of working with donated cadaveric material and the associated professional standards and ethical considerations linked to this usage, it was necessary to develop a set of guidance to protect the dignity of donors, whilst simultaneously guiding educators, students and institutions on the manifold issues to consider when transitioning to online cadaveric teaching. The sensitive material (i.e., cadaveric images) would not normally be available to students on an ad hoc basis on their own devices. As this content still needed to be covered to ensure the healthcare professionals received all of the necessary training they needed to practice their profession safely and keep patients safe, questions arose around the potential for covert screen-capture, unauthorised viewing and wider sharing of cadaveric content. Such breaches of professionalism have widespread implications, not merely for the course and programme but potentially for the institution. It became clear that it was necessary to collate clear guidance for staff and students to steer through the digital landscape.

Developing an In-house Digital Code

An in-house digital code was developed as part of the SDS Digital Delivery Working Group – a student-staff collaboration that convened over summer 2020 to specifically mitigate for any anticipated issues that could arise from the shift to online delivery for both students and educators within the School. Three different digital codes were created, each in the form of a holding slide that could be utilised in (1) Cadaveric Anatomy Teaching, (2) Clinical Teaching and (3) Seminar or Lecture-based teaching situations. These slides were circulated to the FMS TEL Group and then circulated for feedback from the other Schools that grapple with similar concerns around donor dignity and patient confidentiality. A basic confidentiality agreement was later put in place institutionally, but this was not specific to anatomy or teaching involving potential breaches of patient information. It was felt that, in the new era of digital delivery, it would be more beneficial to reinforce the message of a common digital code at every learning encounter to clearly communicate to students the expectations and behaviours appropriate for this form of teaching. For this purpose, the Digital Code for anatomy was developed, with the aim of utilising it as a holding slide for every synchronous encounter, and as a recorded slide at the start of each non-synchronous session that included cadaveric content.

Digital Code in Practice

The Digital Code slide is displayed at the beginning of every teaching session, whether synchronous or non-synchronous. In synchronous sessions, it is used as the ‘holding slide’ displayed as students enter the video call. When teaching begins, the slide is also reinforced verbally to signal the start of the learning and shared professionalism code of conduct. In practice, it may feel that the points around ethical standards and professionalism are somewhat overemphasised but, given how important they are, the Digital Code does bear repeating. In non-synchronous sessions, a pre-recorded initial slide is added to every lecture recording to reinforce the message not to view the recording in public and to adhere to the digital code. This is added to all recordings from all contributors.

The slide shows 10 dos and don'ts. Do find a quiet place for viewing, switch off from other devices and social media, be mindful many are working from home and disruptions may occur, focus on the session at hand, mute yourself when not speaking and unmute yourself when speaking, raise your hand if you want to ask a question, switch your camera on if possible when speaking. DO NOT view this material/session in a public place, breach confidentiality, take screenshots, use and screen-recording or recording devices to capture these sessions, share material from the sessions, post or discuss sensitive material on social media — The Digital Code slide (download .ppt slide at the end of the post)

The Digital Code slide gives a simple overview of both the required professional behaviours for healthcare professionals and unacceptable behaviours, bringing the more abstract guidance document into clear actionable focus. As a result, students are very clearly aware of the professional expectations expected of them in their chosen field of study, and these regular reminders serve to reinforce this. This is much more effective than simply citing a document which may have only been seen once at the beginning of the course. The existence of this Code is beneficial not only for students who, it is hoped, develop a sense of responsibility with the access to sensitive content, but also for donors, teachers and institutions who can rely on clear guidance but also appreciate that institutions have pre-defined consequences for any breaches – of which none have been reported thus far. Students have displayed high levels of professional conduct throughout the anatomy teaching in SDS and have adopted the digital code without any apparent reluctance or challenges. It is highly likely that, once students return to physical classrooms, this practice will be continued and developed.

Taking it a step further: Developing National Guidance for Online Cadaveric Imaging

Due to manifold misunderstandings on the legislation and guidance around the use of cadaveric images, it became clear at an informal National Designated Individual (DI) / Head of Anatomy Forum (convened to improve communication during the pandemic and consisting of heads of anatomy units and DIs from across the UK, as well as representatives of the regulatory bodies from each country) that educators could benefit from a unified front with regards to digital cadaveric education. A small group from within this informal forum (consisting of representatives from Brighton Sussex Medical School, Newcastle University and University of Nottingham) collated anecdotal and professional experiences with patient confidentiality and social media guidance documentation and developed a three-pronged approach to using cadaveric content online. The first step was to search for guidance from the relevant professional bodies. The Human Tissue Authority (HTA), the national body who regulate teaching related to cadaveric specimens in England, is virtually silent on the use of images of a cadaveric nature, and decisions relating to how images can be used are made by the local HTA DI within institutions. There is also a paucity of guidance on image usage in this context from the devolved nations’ regulatory bodies/inspectors. Some institutions do have some guidance around social media and images, but there is no unified and unambiguous guidance on cadaveric teaching in the online era.

The draft guidance document was circulated to the DI Forum and to the HTA for comments and the final document amended with suggested changes. The current version, along with a suggested PowerPoint slide, is already utilised at SDS for teaching purposes. It has recently been presented at the March 2021 meeting of the Trans-European Pedagogic Anatomical Research Group (TEPARG), at which it proved very popular across the European countries represented, and has been widely lauded for its clarity and utility during this period of intense change. The guidance document, with the digital code appended to it, is now in use across many institutions nationally and internationally and is being reviewed for formal dissemination.