More from my round-up of articles on clickers in the health professions.  This time, another article that doesn’t add much to the literature, but raises an interesting idea.  Again, your comments are invited…

Reference: Williams, B., & Boyle M. (2008). The use of interactive wireless keypads for interprofessional learning experiences by undergraduate emergency health students. International Journal of Education and Development Using ICT, 4(1).

Notes: This article has features results from a survey of students using clickers in a “foundations of health” course taken by emergency health students as well as students majoring in “nursing, physiotherapy, occupational therapy, midwifery, health science, and social work.”  The authors refer to this as interprofessional education, “learning that represents a way of fostering collaborative and seamless, integrated patient-care education.”  I first heard about this approach from my POD Network colleague Marilla Svinicki, who is involved in interprofessional education at the Clinical Education Center affiliated with the University of Texas-Austin.  The CEC is an impressive initiative.

I was interested to hear how clickers would play out in this setting, one featuring students with a diverse set of backgrounds and career goals.  However, the course is a first-year course, so the students weren’t likely to have differentiated themselves yet.  Moreover, there’s no attention paid to these different majors in the survey results that are reported here.  (The survey results are very positive, however, and are in keeping with other surveys I’ve mentioned here on the blog before.)

Have you used clickers in a course that included groups of students from different majors?  I can imagine forming heterogeneous student groups, then giving each group a single clicker as part of small-group activities during class.  How would you teach a course like this?

Update: Just a couple of days after posting this, I learned that Vanderbilt University has an interprofessional program something like the one at UT-Austin.  The Vanderbilt program involves medical and nursing students from Vanderbilt and social work students from Tennessee State University.  The students work together (with mentors) in clinical settings half a day per week and participate in classroom-based learning (using reflective exercises and case study activities) half a day a week, as well.  The rest of the week they participate in their respective programs as normal.  Given the complex nature of health care today, this seems like an incredibly sensible approach to health professions education.

Image: “Colourful Army” by Flickr user maistora / Creative Commons licensed

More from my round-up of articles on clickers in the health professions.  A short, but interesting post today.  Your comments are invited…

Reference: Zurmehly, J., & Leadingham, C. (2008). Exploring student response systems in nursing education. CIN: Computers, Informatics, Nursing, 26(5), 265-270.

Notes: This short article is another introduction to teaching with clickers, although I found it a little too prescriptive for my tastes.  There’s nothing here you won’t find in other articles with one very interesting exception:

To date, there has been no evidence of hacking or compromise to the SRS systems that were evaluated.  As a safeguard against tampering, a computer printout of responses can be generated and saved, to be used as a record for future references and to check for any attempted manipulation of grades.

Wow!  I’ve never heard this worry before.  Have you had to worry about students hacking into their clicker grades?

Image: “Me on Computer” by Flickr user Brian Lane Winfield Moore / Creative Commons licensed

More from my round-up of articles on clickers in the health professions…

Reference: Kenwright, K. (2009). Clickers in the classroom. TechTrends, 53(1), 74-77.

Notes: This short paper from Kathy Kenwright (University of Tennessee Health Science Center) serves as a concise introduction to teaching with clickers, complete with a brief review of the literature.  As with Cain and Robinson (2008), the lit review isn’t comprehensive, but Kenwright does a good job of discussing the major benefits of clickers in the context of reported studies.  Most of her observations are not specific to any one discipline.  For example, she notes that clickers facilitate formative assessment of student learning, as well as agile teaching.  She mentions the importance of the display of results of a clicker question and the use of clickers to facilitate in-class quizzes on pre-class readings.

I have concerns about a couple of Kenwright’s recommendations, however.  She notes that many students in the health professions must pass national board exams, and uses this to support her claim that one shouldn’t ask too many clicker questions during class.

Asking too many questions during the lecture leaves less time to convey important content.  In a curriculum such as the Clinical Laboratory Science program, there is a defined body of knowledge that must be delivered to the students.

She’s speaking of a coverage model of education here, which is problematic, as I’ve mentioned here before.  I would argue that since students will be required to excel at the multiple-choice questions seen on these national board exams, they should spend plenty of class time practicing these kinds of questions.  Clicker questions based on these exam questions work well for that.

Kenwright also notes that asking clicker questions “on the fly” during class can take too much class time:

If they are added during class the class will be kept waiting while the instructor is typing in the question and answer choices… There is nothing wrong with reverting to an old-fashioned show of hands, or calling on a particular student for an answer.

Asking “on the fly” questions doesn’t require you to type questions into your clicker system–asking them verbally usually does the trick.  Moreover, if there was nothing wrong with a show of hands, there wouldn’t be any reason to use clickers to begin with.  Why are clickers better than a show of hands?  Because students don’t answer questions independently when you go with a show of hands (Stowell and Nelson, 2007).

What’s your view on the coverage issue?  Is a lot of active learning possible in health professions education?

Image: “Stethoscope” by Flickr user vitualis / Creative Commons licensed

Back in January I gave a keynote talk at the Health Professionals Education Research Symposium hosted by Nova Southeastern University.  Part of my preparation for that talk included reading some of the articles from related disciplines in my clickers bibliography.  Shortly after the conference, I blogged about one great article about using clickers to promote critical thinking in nursing (Debourgh, 2008), and I’ve been meaning to post some notes about the other articles I read.  Let’s get started…

Reference: Cain, J., & Robinson, E. (2008). A primer on audience response systems: Current applications and future considerations. American Journal of Pharmaceutical Education, 72(4), 77.

Notes: The literature review is the highlight of this article.  It’s not as comprehensive as other lit reviews, but it does a great job of describing a few studies of the use of clickers in the health professions with particularly positive results.  For example, Slain et al. (2004) report that students in clicker sections of two pharmacy courses scored significantly higher on exams than students in non-clickers sections.  Similar results were found by Schackow et al. (2004) in classes for family medicine residents and by Pradhan, Sparano, and Ananth (2005) in classes for obstetrics and gynecology residents.  These references are listed in my bibliography.  Hopefully, I’ll find some time to read and blog about them soon.

Cain and Robinson also include a useful exploration of some of the logistical aspects of teaching with clickers.  Instead of making recommendations, they describe the various choices a department might make and their pros and cons.  They note that any clickers initiative should make sense given an institutions teaching philosophy and technology plan.

For example, a pharmacy school with a mandatory laptop program may highly value an ARS that can utilize laptops as response devices, rather than basing the decision on other features.

They also recommend purchasing a set of clickers available to faculty and staff to check out for one-shot events, like continuing education programs and faculty meetings.

The section on recommendations for future research is a strong one.  Cain and Robinson write, “Any effects from using an instructional medium do not come from the use of the media itself, but from the instructional methods employed.”  That’s something I’ve argued here before.  Cain and Robinson call for research that explores the effects of very particular instructional strategies involving clickers, including strategies useful for facilitating discussion about matters of ethics and morality.  While ethical issues are present in every discipline, they are often particularly important in professional education.

Cain and Robinson make an interesting statement in their section on student considerations: “Finally, appropriate application of the ARS in the curriculum should be defined and encouraged.”  I understand the interest in encouraging instructors to use clickers in appropriate ways.  It’s the “defining” piece that makes me wonder if pharmacy education is a bit more top-down than the kinds of programs you find in, say, colleges of arts and science.  I find that faculty members in undergraduate liberal arts departments tend to have a high degree of autonomy when it comes to their teaching decisions.  They might not be comfortable having appropriate uses of clickers “defined” for them.  Am I reading too much into this word choice?  Does your department (whatever your discipline) set policy on educational technology use?

Image: “Rx, San Antonio, TX” by Flickr user Tadson / Creative Commons licensed

Reference: DeBourgh, G. A. (2008). Use of classroom “clickers” to promote acquisition of advanced reasoning skills. Nurse Education in Practice, 8(2), 76-87.

Summary: Gregory DeBourgh provides a useful introduction to using clickers in nursing education, focusing on pedagogical strategies that use clickers to promote critical thinking.  His exploration of critical thinking in the context of nursing education is particularly interesting.  Here’s a sample:

“Reasoning is about using intellectual power to draw conclusions, form judgments, and make inferences based on evidence, education, and experience… The practical significance of acquiring skill in advanced reasoning is to move to the level of predictive clinical reasoning which enables one to anticipate both ideal and likely outcomes given a set of data.”

DeBourgh argues that using classroom response systems to engage students in high-level questions is an effective strategy for developing their critical thinking skills.  He supports this assertion by drawing on the literature on the roles of feedback and questioning in learning and by sharing concrete examples of clicker uses in nursing education.

Included are three sample questions, including a “one-best-answer” question that asks students to identify the likely cause of a particular symptom shown by a patient in a case study.  DeBourgh endorses the use of such questions since they better represent situations students are likely to encounter in clinical settings where they must deal with ambiguity.  He also suggests asking question sequences based around patient cases that “change the focus to add new variables,” noting that doing so also reduces the cognitive load students experience when familiarizing themselves with a new case.

DeBourgh makes a good argument for using clicker questions to model critical thinking skills for students:

“Anticipate likely incorrect responses and prepare ‘talking points’ for discussion as this facilitates ‘thinking on your feet’ and makes more visible to students how an expert uses heuristics, reasoning, and refined problem-solving skills to gain command of a clinical situation.”

Asking questions designed to provide an opportunity for the instructor to model critical thinking is one instance of many DeBourgh describes of crafting questions to meet particular teaching and learning objectives.  In doing so, DeBourgh draws on articles by Ian Beatty on good question design, transferring Ian’s advice to the context of nursing education.

DeBourgh also points out that clicker questions embedded in PowerPoint can be particularly useful in nursing, a field which frequently uses pictures, diagrams, sound clips, and video–media that can also be embedded in PowerPoint.  He also notes that nursing courses often involve discussion of nursing ethics and student opinions about ethical decisions, topics that lend themselves well to clicker questions.

The article also includes results from a study survey about clicker use.  Student responses to rating questions are summarized, and student responses to open-ended questions are presented, as well.

DeBourgh ends with a few challenges involved in teaching with clickers, two of which are particularly significant.  He notes that since instructors can track student performance in a class on a daily basis, expectations for students are raised, which is not popular with all students.  DeBourgh also speaks to the increased expectations for instructors:

“The greatest challenge is the new role for faculty to plan the curriculum and instruction around ‘deep comprehension’ rather than ‘covering content’ using a traditional lecture format.”

Comments: I read this article in advance of my presentation at the Health Professional Educational Research Symposium earlier in the month, and I was particularly impressed with Gregory DeBourgh’s eloquence in describing critical thinking in the context of nursing education and in describing ways that clicker pedagogies can foster those critical thinking skills.

As I’ve tried to capture above, DeBourgh describes a variety of ways of using clickers in nursing education, and he included one approach that was entirely new to me, one inspired by the 50-50 option in the television game show Who Wants to Be a Millionaire? DeBourgh suggests that before the correct answer to a clicker question is revealed to students, an instructor might ask the students which answer choices should be eliminated.  It’s a little unclear how DeBourgh implements this, but I can even imagine setting up a multiple-mark question with four answer choices, then asking students not to select the one correct answer but to select two incorrect answers.  This would offer a nice change of pace in question format and would help students focus on more than just the correct answer.  It’s often useful for students to consider why some answer choices are plausible on the surface but actually incorrect.

Hopefully it’s also above that DeBourgh puts an emphasis on teaching with case studies (multimedia case studies, at that) in his article.  I understand that case study methods are perhaps more common in nursing than they are in other disciplines, and I appreciated reading this article as a way to better understand why that was the case.  DeBourgh’s comments about using clickers for discussing ethics also helped me better understand the disciplinary context here.

If you’re a nursing educator, please share a thought or two about using clickers in your field in the comments section!

Update: Greg DeBourgh emailed me and clarified his 50-50 technique.  Here’s what he said:

I display the potential four-answers to a given question, then before the students “vote” with their clickers, I ask for a volunteer or select a student at random (my clicker system has this feature) and ask the student to eliminate 2 of the 4 potential answers and to explain why they are eliminating these two. This speaking out loud of their rationale for eliminating two of the potential answers that are not related to the question strengthens the students’ reasoning skills. They actually get quite good at it. If the student I called upon to answer hesitates or is reluctant to speak, I invite them to choose a “consultant” in the room to help them out. I hope this clarifies a bit for you.

I asked Greg what he does if the student eliminates the correct answer.  Here’s his response:

If the student eliminates one of the correct answers, it is still learning, and so I ask “does everyone agree with the 50/50 elimination?” If someone objects, I ask for their rationale. If no one objects, I just let the process go and during the “reveal and rationale” we talk about why each answer is incorrect or correct.

Thanks, Greg, for this clarification, and for this great use of clickers.

Last weekend I was honored to give the opening keynote at Nova Southeastern University’s Health Professions Education Research Symposium (HPERS) in Ft. Lauderdale, Florida.  (And, yes, Ft. Lauderdale is a great place to be in mid-January!)  Below you’ll find the slides from my presentation.  Many of my slides are designed to visually complement my verbal presentation, so they might not make too much sense on their own.  Still, I think they’ll give you a sense of what I talked about.  There are also some sample clicker questions in the slidedeck appropriate for the health professions.

And speaking of backchannel, I live-tweeting during several of the presentations later in the day at HPERS.  Here are the highlights of the conference for me, according to my Twitterstream.

In a recent blog post, Dave Foord, an education consultant in the UK, describes his use of clickers in a sports science course.  The course included a leadership component and so he had each of his students lead part of a class session.  He then had the other students provide feedback, but he found that the students were hesitant to publicly criticize their peers, leaving him to be the bad guy.

One year, however, he had his students provide feedback using clickers, which allowed them to provide anonymous and thus more-honest feedback.

This had a much better effect on the learner who had lead, than me just ploughing in with critiscisms – instead I was able to pick up on the feedback from their peers, and pick out the reasons why, and what to do next time to better effect.

The use of clickers to have students assess their peers’ work (presentations, papers, works of art, performances) seems to have a lot of promise, primarily for the reason Dave points out.  A couple of months ago, I met Ray Miller, a theater and dance instructor, and he said that in the performing arts, peer critique is an important learning activity, one that could be enhanced with the use of clickers in this fashion.

Have you had students assess their peers’ work using clickers?  If so, how did it go?

I just ran across an interesting interview with Linda Hancock, director of the Wellness Resource Center at Virginia Commonwealth University.  In the interview, she describes her use of clickers during sessions for incoming first-year undergraduates.  For example…

So I can take a group of 300 freshmen and say “How many people do you think smoke daily?” and they think everybody’s smoking cigarettes because smokers are always standing out front of the buildings. “How many of you are daily smokers?” It’s like seven to eight percent.

This is a great combination of a student experience question (“Are you a daily smoker?”) with a prediction question (“How many of your peers are daily smokers?”).  The student experience question alone would have some impact, but that impact is magnified by the prediction question.  This technique is also used by Resa Walch and Amanda Tapler, two Elon University health sciences instructors I interviewed for my book.

In the interview, Linda Hancock goes on to provide another example and to note that the immediacy of the data collected via clickers helps it have more impact.