Developing Online Asynchronous Materials – An Associate Lecturer’s Perspective

This year, FMS TEL assisted in the development of learning materials about unconscious bias in healthcare settings. This week we are sharing how we worked with Associate Lecturer Ann Johnson to design and create these materials.

As this was Ann’s first year as part of the module team, it was an exciting challenge to be involved in creating her first set of blended learning materials on Canvas. The process was highly collaborative, and the FMS TEL Team were able to contribute our knowledge of pedagogy – particularly online teaching – and the technical know-how to make the materials in Canvas and ensure they would work as needed.

To start the process, Ann outlined her goals for students, which we were able to shape into learning outcomes. She provided the final discussion topic exercise, and we discussed the issues to be considered as part of that discussion.

“How can I get people to challenge their own thinking?”

We discussed the learning outcomes and concepts, and this meant that I was able to suggest scaffolding activities for students to undertake in order to give students a solid foundation and build their confidence to answer the complex question at the end of the topic.

The design process was undertaken through a series of video calls during which we discussed the materials and reviewed how they worked on Canvas, finishing with a few action points for each of us. We discussed the learning journey in detail and stepped through content logically to ensure clarity. The development phase prompted questions and refinements – such as looking for specific resources or articles that could support the teaching.

“it improved my practice”

Activities added included short text and video input – written and sourced by Ann – which highlighted key concepts. A quiz was added so that students could test their knowledge of these important definitions and concepts. This allowed students to feel confident that they had a good grasp of the basics before applying them to their own contexts.

As an experienced facilitator, Ann identified where students might find the materials challenging, as the topic to be explored has a very personal dimension. We worked together to put in place alternative activities for students who preferred to reflect personally, discuss privately, or in an online seminar that Ann would facilitate.

At the end of the design process, the created materials were approved for inclusion in the module by module leader Fraser Birrell and will be part of MCR8032 in coming years. Working together with FMS TEL enabled the creation of high-quality and interactive online learning resources and allowed Ann to upskill in the area of asynchronous online teaching.

Associate Lecturer Profile

Ann Johnson has been a Patient and Public Involvement (PPI) Advocate, Lay tutor, and facilitator for twenty-five years, researching and creating a Patient Involvement Framework for Leicester University Medical School. She has conducted extensive community outreach in London, Leicester, and Florida USA with the goal of bridging communications between patients and practitioners. She is continuing her work as an Associate Lecturer and PPI Advocate at the School of Medicine.

Read more about the materials we developed.

Case Study – Unconscious Bias in Healthcare

This case study concerns a range of activities created for MCR8032 Clinical Research Delivery in Practice. The module leader, Fraser Birrell, put me in touch with his colleague, Associate Lecturer Ann Johnson, to assist in the development of a piece of learning about Unconscious Bias in Healthcare.

As part of this module, it was important to ensure that a patient-centred approach to healthcare was highlighted. As such, Ann’s experience in the field allowed her to challenge students to look at healthcare – and clinical trials in particular – from the patients’ points of view.

One particular topic inspired Ann to focus on the topic of unconscious bias in more detail. In cases of hypertension, GPs had been trained to prescribe different drugs and treatment plans to people based on ethnicity, even though there is no evidence to support this course of action (Gopal, D.P. et al., 2022). This is an example of taught bias – but at the same time, GPs were making assumptions about patients’ ethnicities which could also be erroneous. Naturally, this is an area of concern for patients.

Equality, Diversity and Inclusion and Bias

The difference between EDI concerns and bias is important to clarify at this stage. While EDI principles are focused on actively working to improve outcomes, unconscious bias is present in all of us as a survival instinct and extends beyond those ‘protected characteristics’ formalised in EDI policies. Unconscious bias allows us to make quick decisions based on assumptions – for example choosing to cross the road to avoid encountering someone walking along with an unleashed Pitbull Terrier.

As a clinician, it is especially important to recognise one’s own potential for unconscious bias as it can affect decision-making, resulting in poorer outcomes for some patients. When this bias extends to choosing who to include in clinical trials, it is easy to see how misconceptions or omissions could be compounded.

Discussion

You have been asked to become involved with the recruitment for the trial of Nosuchximab, a targeted therapy for Paediatric Lymphoma. The research target group is children aged between 02 and 14. There is a significant disparity in survival rates of the South Asian population and white European population. You have been asked to recruit children from the target age range. However, the NHS Foundation Trust site for the Nosuchximab trial is located within in a region where this population is under-represented – however, it is present (although in minimal number).

How might Unconscious Bias impact the outcomes of this trial?
Is it important to strategically recruit this cohort?
How might you put in place a strategy for recruiting those particular subjects?
What attempts should be made to minimalize barriers to their inclusion?

The above activity challenges students to consider a range of complex factors and is designed to explore the recruitment process for clinical trials, which can be affected by unconscious bias. As such, we designed a range of scaffolding activities to lead up to students exploring this topic in a more confident and informed manner.

The learning was divided into three stages, supported by Canvas’ tools.

An introduction to unconscious bias with a test-your-knowledge quiz. This built understanding of the basics, and used the quiz to instil confidence into the students that they had understood the basics. The introduction was also written in such a way to highlight that this was a supportive environment.
An opportunity to explore the effect of unconscious bias through a key reading, and a test that students could try to identify their own potential biases, followed by reflection in one of a few ways.
Attempt the activity in discussion with others. A webinar is also available for students to join and discuss the activity with Ann and the other students, as well as to explore the topic further if needed.

We understood that the topic of unconscious bias could be challenging for students to confront, as it is intensely personal and potentially triggering. To allow students to explore this area in a supportive way, we suggested a range of activities, from private reflection to group discussion, about the topic in general, to allow students to examine this in an environment where they felt comfortable. We felt that this was especially important as this meant students would not feel they may be judged or blamed for sharing their experiences and feelings about bias, and this would make the entire topic much more approachable, and the learning more effective.

Next Steps

The activities will soon be live for students to try out the materials and share feedback. Anything highlighted by the student feedback will be discussed, and appropriate changes made to the activities if necessary. These materials will then run as part of the module next year. Further distribution of this content can also be done via Canvas Commons, should other module leaders wish to incorporate them into their teaching.

References

Gopal, D.P., Okoli, G.N. & Rao, M. Re-thinking the inclusion of race in British hypertension guidance. J Hum Hypertens 36, 333–335 (2022). https://doi.org/10.1038/s41371-021-00601-9

Canvas Assessments from Start to Finish

We recently delivered a bespoke training session for the Graduate school about running assessments on Canvas. The session was aimed at Professional Services and Teaching staff, and covered the following:

Setting up assessments and enabling Turnitin
Creating Canvas rubrics
Monitoring submissions and managing different circumstances
Plagiarism checks and Marking
Moderation and release of grades

The resources are available on our Canvas Community to all Newcastle staff. You may need to enrol in the community if this is your first visit.

Conversations for Learning – Kay McAlinden

This case study concerns the current module Psychosocial Issues in Cancer and Palliative care (ONC8006) as it is taught in 2020-21 academic year. This module is part of the Cancer and Palliative care programme and as such deals with emotionally challenging topics, including breaking bad news, loss, responding with empathy, screening for distress, anxiety and depression, families and carers, body image issues, survivorship, and interventions such as Cognitive Behavioural Therapy and Mindfulness. It is currently a small module with less than 20 students.

Next year it will be merging with another module, Handling Loss Grief and Bereavement (ONC 8010) and will become Psychosocial issues in Advanced Disease (ONC8030). Several elements of professional development, including a session run by Manchester University, and the FMS TEL Humanising the Online Experience webinar, helped to inspire and implement a few new ways of working which will be carried forward.

Choosing Priorities

Clear themes emerged from the sessions attended, showing what students want from their online courses. Prompt feedback from tutors is clearly valued, as well as ease of access and clear information about assignments. Students want to feel the tutor’s presence in their course and want to be able to give feedback afterwards.

Given that the online environment can be stark and unemotional, and people do not always want to discuss these topics – even in classrooms, teaching this content online was always going to be a challenge. It was important to try and model the communication skills, behaviours and support that students would be learning about, allowing this to stand as an example of good practice.

Zoom Tutorials

The stress and emotional load on students this year has been particularly high both personally and professionally given the impact of COVID on service delivery and home life. Students often mentioned the difficulties of delivering bad news by phone and trying to support patients and families when there was minimal access to psychosocial services. This prompted the decision to offer Zoom appointments or phone calls to anyone who wanted them. These were offered rather than being compulsory, and not all students took up the offer. These were offered via Canvas announcements.

This year most chats only lasted 10-15 minutes but allowed students to consider how they would approach their essay. Spending this one-to-one time with students, even on the phone or via Zoom, has meant that getting to know them has been a lot easier, and students feel more supported. In some cases, a chat over email was enough, but sometimes it was much more time-effective just to call the student and have a quick chat, rather than spending time drafting and re-drafting a long or complex email.

Many of these chats took the form of one-to-one tutorials on assignments, explaining what was expected and how to do a good job of the assignment, as well as offering reassurance. Careful monitoring of the discussion boards has also allowed issues to be picked up and addressed.

Use of Discussion Boards

This module has always made good use of discussion boards. Participation in the discussion boards has been good, and regular and swift responses to students’ posts have helped further this. Questions such as ‘If you were diagnosed with cancer, who would be around to support you? What if they weren’t there?’ push students to think very deeply about their own personal situations, and to connect compassionately with what they are learning.

Some tasks had options which are less emotive, but most students chose to answer the most emotive task – naturally tutor feedback for this was very rich. This meant it was time-consuming, but also extremely valuable. Adding a simple ‘like’ or a quick remark would have been far too dispassionate for a module like this! Other students were also able to respond in a way that supported each other, thanking one another for their stories.

Further discussion board use included the choice for students to respond in their own private journal area rather than more publicly. This setup can help to engage students when topics are personal or reflective in nature.

Advice and Support from FMS TEL

The advice and support about what is possible, and how to implement things technically has been invaluable. This has allowed for modernisation, development and innovations in the methods used, as well as some experimentation within the module. When trying new things, make sure you set yourself up to succeed by starting small, and starting with what you’re comfortable with, adding more new elements as your confidence grows.

Feedback and Next Steps

This year the use of regular Canvas announcements has been a good way of keeping things on track. The participation in discussion boards and tutorials has been great, and students have said they feel supported. As the module will look very different next year, more adaptations will need to be made. For example, in future it might be useful to offer assignment guidance as a small group tutorial, especially if more students are taking the module. This way it can be scaled up and students can still feel supported.

Now it feels easier to interact with students online than it did at the beginning. Getting to know them as people beyond their studies has been very rewarding for everyone. Small things like being confident enough to use humour, or to share a funny cartoon about the subject, have become easier to judge as time has gone on. This can be tricky to judge if you can’t see faces or are worried about cultural faux pas, but once again, getting to know your class by building community really helps with this.

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)

Discussion Boards Webinar Materials (watch, listen or read) – including examples from this module

Discussion Boards Guides – how to implement different types of boards for different purposes in Canvas and Padlet (for MLE users)