Category: Case Study

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

Contact

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

Fiona.clarke1@nhs.net

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.

Resources

Human Tissue Authority

TEPARG – Trans-European Pedagogic Anatomical Research Group

Newcastle University Digital Etiquette Guide

Newcastle University Staff – Join our Canvas Community for access to all resources

Download the Slide and Guidance from our Canvas Community

Chameleon Programme – Blended Working

The Project Beginning

In September 2019, I started a Chameleon Programme that was tasked with reviewing how the university could support colleagues to work more flexibly. A particularly relevant topic as it turned out!

The Chameleon Programme is a year long business improvement programme that involves colleagues from across the university working together, in multi-functional teams, on specific projects set by Senior Officers Group . I was teamed with three other university colleagues, who work in different areas of the university and with different roles.  Our project sponsor was John Hogan and we had to set about devising plan and understanding our project scope.

We began by gathering information from sources at the forefront of flexible working, such as CIPD and ACAS, as well as reviewing existing university policies . Interviews with various colleagues across the university, such as School and services managers gave us a better understanding of what ​Flexible working meant in the context of our university. Consensus was that there was support for increased flexible working practices but there was a need for greater guidance to ensure fairness . 

We also had the opportunity to visit an external company, called The Thirteen Group, who are a social housing provider located in Middlesbrough.  Their belief is based on staff being in control of their working patterns with productivity measured by outputs rather than presenteeism. They invested heavily in infrastructure and technology as well as providing guiding principles, with endorsement from senior leadership, which was key to driving the changes. ​It had showcased what was possible.

Desk availability system and The Thirteen Group

We decided to try to mirror some of the Thirteen Group principle through an initiative called ‘Flexible Fortnight’ – the principle was to remove existing boundaries to working times and allow teams to manage working hours accordingly, and we were to capture staff response via a survey.

We had a plan.  We had teams ready to take part in the Flexible Fortnight and had generated recommendations that could be put forward and arranging events to present our findings.

Then, it all changed

Then COVID came along! 

COVID has been responsible in changing working patterns, for most employees, across the university; how we work, where we work and when we work. 

In March 2020, everything changed.  The majority of us were asked to work from home.   It was potentially the best Chameleon project ever! Or it might be the worst ever!

What did that mean for our project?  Well, it meant change too.  We could no longer pursue the initiatives that we had arranged.  So, we created a questionnaire to incorporate feedback about working for home.  We combined the survey results with the findings from our research and submitted a report in June 2020 to our sponsor.  We were also invited to be part of some of the Executive Board lunch meetings that touched on the new way of remote working and listened to feedback from staff across the wider University.    

Its flexible; its informal; its team specific; its build on trust.

This culminated, in December 2020, with an invitation to join a task and finishing group for blended working. The group includes representation from the Faculties, People Services, NUIT, Estates and Trade Unions with the focus on discussing how the university workforce could mix campus-based working and working remotely, post pandemic. Consultations are still ongoing, papers have been submitted to various committees, and webinars have been arranged to give colleagues the opportunity to hear plans first hand. Hopefully, this will be the start of clearer vision going forward.

The Future of working patterns

What have we learnt? A lot! One thing is certain, there is a consensus that we do not want to go back to the way we operated before. Why would we look back when we have come so far? Though the past year has been challenging on many different levels, it has also allowed many of us to gain first-hand experience of working in more flexible ways. There is an opportunity to embrace change from the lessons learnt and build a more modern approach to our working culture and behaviours. To make a change like this before COVID was hard to imagine.

As a project team, we have achieved far more than we ever envisaged; having helped give guidance and findings to potentially changes in University working patterns and policies.  The Chameleon programme lasts for 12 months and this is where it comes to an end for or team. However, we hand over the baton now and the story continues. Only time will show what the university does to progress and evolve the changes it needs to our working patterns.

We have been fortunate in terms of the timing of our project and I feel that we have taken advantage of the situation to allow us to leave a legacy from Chameleon project on the university.

From a Chameleon Project, For the University

From Blackboard and Ngage to Canvas

In the summer of 2020 Newcastle University switched from Blackboard to Canvas. In truth, some online modules had been hosted on Canvas months before the official launch, but from August 1st 2020 Canvas was the exclusive Virtual Learning Environment (VLE). The content that had previously been in Blackboard was transferred over to Canvas, creating three years’ worth of archives. For the majority of courses this was fine, as Blackboard was only ever a repository for course materials. For the e-learning courses offered in the FMS Graduate School and the School of Medical Education, there was an additional challenge.

In addition to Blackboard, e-learning courses also used Ngage, a bespoke VLE used widely throughout FMS. Quizzes, assignments and discussion boards could all be found on Blackboard, but Ngage was home to the actual content, typically released weekly to students. Where Blackboard content could be migrated en masse, anything on Ngage had to be migrated over manually. Page by page, course by course, for all three semesters.

The Ngage user interface.
The Ngage user interface. (Click the image to see a full size version – opens in a new tab)


Once the content was copied over, we had to adapt it to fit the new platform. Discussion boards and assignments were like for like, but certain Blackboard features such as blogs and eJournals had no direct equivalent on Canvas. This required creative problem solving to adapt Canvas to our specific needs, and with help from the Canvas Community we were able to find solutions. For example to create an eJournal, a staple of many of our modules, we had to assign every student to their own private group, and then set up a regular discussion board as a ‘group discussion’ and selecting the pre-prepared eJournal groups, thereby creating a private area for students to make notes on the different topics and have the module leader’s check over them.

The same page on the new Canvas VLE. A less clutter page with a built-in discussion board and a crisper overall presentation. (Click the image to see a full size version – opens in a new tab)


A lot of visual features and formatting were also lost during the copying and pasting process, meaning pages previously adorned with images and embedded materials had to be reworked. We utilised the web design skills of the FMS TEL Team and with a bit of creativity were able to create interactive features such as click and reveal, and visual aspects, such as shadowboxes, to help emphasise particular pieces of text.

As well as the migration of content, a huge effort was made to train University staff in the run up to the 2020/21 academic year. Training sessions that had originally been scheduled in-person were instead delivered via Zoom, covering areas such as Canvas essentials, assignments and quizzes. To supplement the training, a Canvas orientation module was created to help ease staff into the transition. Additionally, every member of University staff was assigned their own sandbox course allowing them to experiment with the new platform and test out features that could be replicated in real courses.

The Canvas orientation home page. (Click the image to see a full size version – opens in a new tab)

Now that we are exclusively using Canvas, the feedback has been overwhelmingly positive. Despite some initial challenges with the practicalities of using a new VLE – and some trial and error – new Canvas features such as Zoom integration, built in calendars and Speedgrader have enhanced the user experience.

Dealing with extra sensitive data in the Medical Learning Environment (MLE)

Most FMS sites run by the unit contain and maintain personal data that needs to be kept private. Techniques such as securely certified websites and authentication/authorisation portals are usually sufficient in keeping this data safe.

The Challenge

With the introduction of the new year 4 in the MBBS curriculum and the move to more blended learning, a higher degree of sensitive data was required to be stored on the Medical Learning Environment (VLE for MBBS). Year 4 students are now asked to keep electronic records of patients and interactions as part of the Advanced Clinical Experience module. This data contained personal contact details such as address, telephone and email of patients the students would follow on the clinical journey, and let them reflect upon this experience throughout year 4.

So before the start of Year 4, in the summer of 2020, we investigated and implemented an enhanced way of storing this patient information in the MLE.

The Solutions

First we investigated how the data was stored in the backend database. Most information is stored in databases as unencrypted data due to the lack of sensitive nature of the data.

This new data required something else. It was decided that parts of the data that could contain personal patient information should be encrypted, both in transit and at rest.

For parts of the ACE model (the data structure we use for the ACE section of MLE) we replaced the open text fields with this new encrypted field. This now meant that when data was entered and saved, before it was added to the database, the system would replace the open text with a encrypted data set using a secure key. To read the data again it would need the use of the decrypt method, that only the MLE could do by using the secure key.

The second part we investigated was to detach any personal patient information from the student’s reflections. Once the student had completed the recording of the patient’s details, the direct link in the website was removed and generic patient information used from that point onwards to identify the individual records. This kept the sensitive information separate from the day to day recording of patient interactions.

The students also uploaded consent forms signed by patients who agreed to take part in the ACE module. Final versions of consent forms highlighted that these would also contained sensitive information.

After further investigation the development team included these static files in the encryption methods used to support ACE. In order to allow students to verify the uploaded consent forms, the MLE allows a short window before encryption and archiving of consent forms takes place. Once this process completes the consent forms are no longer accessible via the website (MLE) and recovery if required is performed by a limited number of staff in FMS TEL.

These methods used may be a little extreme for the day to day data stored on most FMS sites, but the investigations and lessons learned from the ACE data has provided us with options for other sites in the future.

If you are interested in this topic and wish to learn more, please contact:

Dan Plummer, Learning Technologies Developer, dan.plummer@newcastle.ac.uk

John Moss, Technology Enhanced Learning Manager, john.moss@newcastle.ac.uk

Case Study: Adapting a course for a larger cohort

Guest post by Sue Campbell from the FMS Graduate School, Module Leader for ONC8024: Chemotherapy Nurse Training.

The Challenge

In December 2020, we were informed that Lancashire Health would be sending their Nursing students to study our course, which was due to start in February 2021. We had already seen an increase in our own numbers so with these additional students we were going to be expecting a much larger cohort than usual. The increase was in part due to the COVID situation and study leave cancellation in the NHS. We needed to investigate if the course structure would be suitable for 50 students instead of the usual 10-15 we had taught in previous years.

What did you do?

We reviewed each activity and imagined how it would work with 50 students. Activities that students completed on their own such as crosswords and quizzes were fine. 

Our main concern were the collaborative wiki tasks – these are pages within Canvas, usually involving a table, that students completed together to create a resource. We wanted to keep these tasks as they encouraged teamwork, but the tasks were not suitable for 50 students to be able to contribute. After discussing the problem with others who have experience of working with larger cohorts we came up with a solution. 

With help from the FMS TEL Team we were able to separate the students into groups of 10-15 students and provide each group with their own collaborative wiki task to complete. Once the course began we experienced registration issues so students were all starting at different times. We decided to adjust the groups so the late starting students would be in the same group and would not feel left behind.

“It’s about finding solutions you are not aware of; groups was a really quick and effective fix for what I envisioned to be a much larger problem.”

We wanted to keep the discussion tasks as they worked well in the past but would they work with large numbers? We went through each discussion task and made changes. 

Where we had previously asked students to discuss three points, we changed so students could choose one discussion they could take part in but were able to view all discussions. 

Modified Discussion Board: Before and After

We decided to change the scenario discussions into branching activities instead. The questions asked in these discussions had only one right answer and were more of a fact checking exercise than something the students discussed. Students could complete the branching activities independently, so cohort size did not matter, but the objective of the task was still achieved. We also added a presentation to summarise the learning from the scenarios which replaced the interaction from the Module Leader that would have usually occurred on the discussion board at the end of the week.

Branching Activity

Tips

  • Ask for advice – I spoke with the FMS TEL and Programme Teams and they provided several solutions I wasn’t aware of. I also spoke with our DPD, Victoria Hewitt for marking help
  • Consider running the module twice a year if numbers/demand remains too high to sustain within one cohort
  • Branching activities will work regardless of numbers so we can easily roll those over year after year now
  • Groups in Canvas is easy to turn on/off and adjust depending on numbers

What might you do differently next time?

We shall wait and see the student feedback but we are currently in week 5 of the course and so far it is going well and the group work is successful. Some things we are thinking about are:

  • We have a lot of activities, but they are now largely peer to peer or independent tasks so to bring back the teacher presence I would like to include more videos and presentations
  • We do provide a general Q&A discussion board, and for the rest of the course we are also introducing fortnightly, 10 minute 1:1 Q&A bookable slots via zoom for any students preferring a one-to-one discussion with the tutor.

Resources:

The versatility of quizzes

Over the past couple of months I have been talking to a lot of teaching colleagues about how they use quizzes. A quick summary of some uses for quizzes can be found below. There are two quiz tools available in Canvas (old and new quizzes), as well as a lot of web services that offer quiz functionality.

Using quizzes before synchronous seminars allows students to check their knowledge and make sure they have understood things correctly before entering into a discussion. This boosts confidence and allows them to participate more effectively in the session, knowing they have definitely grasped the concepts. This is especially useful with topics that are very abstract or contain a lot of new concepts or terminology. The case study with Rosalind Beaumont and Lydia Wysocki can be found on the LTDS case studies site.

Quizzes can also be used in the sense of providing test-enhanced learning opportunities for students. Regular short quizzes encourage students to retrieve the information they have remembered and put it into practice, boosting knowledge retention. The case study with Nick Riches can be found on the LTDS case studies site.

Another use for quizzes is to use them to replicate a workbook – something that might be used in Present in Person (PiP) teaching to guide students through a series of problems as teachers monitor the room. Here the quizzes are instructive and challenge students to find the information they need, practicing the skills they are learning. Detailed feedback and extra information allows the students to step through the processes they are learning and approximates the monitoring that may be done in the classroom by anticipating difficulties that may need clarifying. Teachers can then look at analytics or ask students to send questions to identify anything that needs further explanation. More information can be seen in the case study with the Library Liaison team.

When testing higher-order thinking skills such as evaluation, automatically-marked quizzes may not spring to mind, as evaluation is often done in prose. The case studies mentioned above include examples of higher-order thinking questions. This can be done through careful question construction with high-quality distractors, for testing, as shown here, or as a learning activity, asking students to apply skills and enter a rating at each stage as modelled by the Drop Bear activity in the Library Liaison team’s case study.

How do you use quizzes?

360° Images

Prompted by the need to show students FMS teaching labs, we have added some information around 360° images to the FMS Community, including example images and how these images are captured, processed and made ready for viewing. This work results in images which can be viewed on screen or using a VR headset.

360 pan of lab showing navigation through the tour
This is a low-quality preview of the real output.

These images have a variety of uses, including:

  • allowing students to view places they may otherwise never see in person
  • allowing students to see facilities such as labs before they arrive on campus
  • students can familiarise themselves with the layout of a room or building
  • taking activities in a safe controlled realistic environment, for example identifying hazards without putting themselves at risk
  • helping students learning at a distance to feel like they are part of the institution

As well as single images, it is possible to connect a series of images to create tours. Users can then click one place to the next in a series of linked 360 images – like in Google Map Street View. Video tours can also be created.

Recently we used these images to provide a virtual induction to FMS labs as part of a health and safety course. To see the full case study, visit the FMS Community.