|Year : 2011 | Volume
| Issue : 2 | Page : 468
Feeling Connected: Technology and the Support of Clinical Teachers in Distant Locations
P Gallagher, M Newman
University of Otago, Wellington, NewZealand
|Date of Submission||30-Mar-2010|
|Date of Acceptance||25-Jan-2011|
|Date of Web Publication||10-Aug-2011|
Medical Education Unit, University of Otago Wellington, PO Box 7343, Wellington 6242
Source of Support: None, Conflict of Interest: None
Context: This paper discusses a key finding arising from a qualitative research project which explored the provision of educational support to clinical teachers who were at least 100 kilometres distant from a university medical school.
Objectives: We examined the preferences of clinical teachers in relation to the preferred use of technology as a medium for educational support.
Methods: A qualitative approach was used for which 19 participants were interviewed using structured interviews consisting of prepared open-ended questions.
Findings: All participants reported that they had a very positive association with the university. However, they overwhelmingly expressed a need to feel more strongly connected to the university and with each other.
Discussion: Although a trial of the videoconferencing technology had problems, there was still great potential to connect clinical teachers in a 'Community of Practice'.
Keywords: Educational support, Keywords: clinical teachers, videoconferencing
|How to cite this article:|
Gallagher P, Newman M. Feeling Connected: Technology and the Support of Clinical Teachers in Distant Locations. Educ Health 2011;24:468
At the University of Otago, Wellington, New Zealand, medical students are increasingly being placed on clinical attachments at a distance from the three campuses and the tertiary hospitals in Dunedin, Christchurch and Wellington. Most often, educational support is provided by face-to-face small group tutorials facilitated by a member of the university’s staff. However, the competing demands made of clinicians’ time and New Zealand’s challenging topography make it difficult for many to attend face-to-face meetings. The logistical challenges of gathering clinical teachers together for face-to-face workshops have been commonly reported1,2. Further, providing educational support, or faculty development, to clinical teachers off-site, or distant from a medical school campus, presents unique challenges2-4.
Increasingly, the literature reports a demand for electronic support including websites, web-based e-learning modules, videoconferencing, discussion boards and compact disks2,4,5. There are numerous web-based support programmes and materials or programmes using a blended approach; that is, offering online support as follow-up or in combination with face-to-face training sessions3,4,6,7. Persuaded by the argument that information technology (IT) would prove an effective educational medium for clinical teachers in distant locations, the intention of this project was to establish and then develop specific technologies based upon clinicians’ preferences.
We conducted a qualitative study using interviews with open-ended questions which were audio-recorded. Ethical approval was granted by the University of Otago. Clinical teachers, who were located at least 100 kilometres from each campus, were identified. The clinicians were drawn from the following groups: General Practitioners (GPs); clinicians in a range of specialities in regional hospitals; and those teaching in the Rural Medical Immersion Programme.
Participants: Potential participants were recruited from 12 of the 18 geographic regions served by the medical school. A total of 118 invitations were sent to clinical teachers by either email or letter and followed up with a second invitation to participate. The following medical specialisations, drawn from rural, urban, hospital and community settings were included in the invitations: Paediatrics; Obstetrics and Gynaecology; Psychiatry; Surgery; General Medicine; and General Practice.
Interviews: Each interview was conducted on the telephone or face-to-face by one or both of the investigators and lasted between 15 to 30 minutes. Table 1 presents the structured interview questions.
Table 1: Structured interview questions of clinical teachers at distant locations
Data Analysis: Within one week of each interview the two investigators sat together and listened to each interview. At the same time, each investigator made separate notes identifying key words or phrases that could be used to form the initial coding labels. The notes were compared and agreement was reached on those labels before determining categories which were then grouped into a smaller number of recurrent themes. The transcriptions of the audio-recordings were also read by each investigator and a similar analytical process was employed.
Twenty-three clinicians volunteered, and eventually 19 (14 men and 5 women) were interviewed. There were eight General Practitioners, three Psychiatrists, one Paediatrician, two Surgeons and five Hospital Physicians. Of this number, the majority (n=16) worked in urban areas of New Zealand. The clinicians who participated were very experienced, all having taught medical students for 10 years or more which was reflected in both their age and seniority within their respective organisations.
The following five broad themes were identified from the interviews:
- The need to feel connected;
- The need for regular feedback on performance;
- A general level of comfort with information technology;
- The desire for clarity in the role of clinical teacher; and
- A high level of self-motivation and problem-solving.
The need to be connected was the predominant theme to emerge regularly in the data analysis. It was a more important theme than any clear preferences for the method of delivery of educational support or any specific educational topic. We will focus on this theme in the following presentation of study findings.
Some participants (n=9) were explicit about the challenge for the university to keep in contact with and support its clinical teachers as medical education moves away from the clinical schools. For example, one respondent stated:
I guess if you look in a crystal ball in ten years time an awful lot of medical school, clinical work is going to be out of the teaching hospital. And I think just the way of keeping people connected is very important.
Working at a distance meant that contact with the university was limited for many participants but, even so, they (n=8) reported very positive associations with the university. One teacher reported:
I think it's just good to feel connected to the university. I think that the further away you are, sometimes the more remote you may feel.
Generally, however, having little or no contact with the university creates very real feelings of isolation and disconnection. Some participants (n=9) openly stated their lack of connectedness or isolation; others alluded to it in the way in which they spoke about their relationship with the university. For instance:
If you're in on the loop and … if you have contact with the other tutors and within the department … for me I just feel as if I'm teaching in a vacuum.
During their interviews, a number of participants (n=7) actually provided the name of course convenors or departmental administrators whom they contacted, particularly if there were problems with a student. However, this was not universal; one participant responded:
….. I sometimes wonder if we're just a little bit isolated and we should be communicating more but I'm never quite sure how or with whom or what about sort of thing….
The desire for opportunities to learn from their peers, to network and to share resources was expressed by many (n=10), including the more experienced clinical teachers. This is reflected in the following comment:
I'm sure lots of teachers have really good things they do; it would be nice for them to share them [their ideas].
Some participants (n=6) were prepared to travel to face-to-face workshops to learn more about teaching as well as to reflect and network. However, distance and weather were disincentives for attending meetings or workshops. Participants who had attended workshops spoke of their value, as in the following comment:
The thing I got most from it [face-to-face meeting] was just the networking with the other GPs.
It was interesting to note that only two participants raised videoconferencing as one method of keeping connected with other teachers and as one participant stated:
I think as medical education becomes more community-based that [videoconferencing] is going to be a more and more useful facility to have.
The feedback loop from the university reporting students’ progress and results back to the clinical teachers varied from informal corridor conversations to regular and comprehensive feedback from course convenors. One suggestion was that the feedback system from students and the university needs to be formalised.
Knowing the curriculum content helps teachers feel confident they are addressing student learning adequately and know where their teaching fits in. This was noted by eight participants. However, knowledge of the current medical curriculum was variable. One teacher responded:
Being away from the Medical School, I'm not very sure what the students know when they come here… what they're supposed to know, what we're supposed to be teaching them …
The commitment to teaching and the intrinsic rewards of teaching were evident (n=19). But lack of feedback and connection affected some teachers’ perceptions of themselves as good teachers, as well as having an impact on retention and how appreciated they felt. One stated:
I guess it would be nice to feel, have some feedback and feel valued really.
Providing explicit extrinsic rewards for teaching, such as library access and access to Blackboard (the university’s course management system), helps to overcome isolation and demonstrates that the university values its clinical teachers. This was mentioned as important by two participants.
From the responses, the key contribution of technology in bringing together clinical teachers from distant locations to share ideas, expertise and experience was evident. This is similar to what Wenger has termed a 'Community of Practice'8. Advice from expert educational advisors from within the university suggested that such a 'Community of Practice' could be created by using freely-available web-based desktop videoconferencing software. As a result, two trial run meetings were hosted, where at the end of each meeting attendees (n=7) were asked for their reflections on the process. Results are summarised in Table 2.
Table 2: Reflections on videoconferencing amongst a group of university academics involved in medical education
From the outset of this study, we anticipated that it would be possible to identify and then respond to the consensual IT preferences of clinicians for a form of educational support. However, we unexpectedly found that clinical teachers had a more important need to feel connected with the university and with each other. Videoconferencing offers the potential for the creation of ‘Communities of Practice’ and to offer educational support to clinical teachers.
Infrastructural problems, time pressures and computer skills are all factors which discourage participation in online technologies. Motivation to use a new technology may be critical9. For example, a 'perceived need' by users has been found to be important in the adoption of an online discussion group10.
Overall, as noted elsewhere, technical problems with videoconferencing proved frustrating11. Some clinical teachers, particularly GPs, would not have IT experts on hand. It is speculated that clinicians would become frustrated and lose interest if encountering technical problems. Thus, the excellent potential of videoconferencing would be lost. One solution might be to incorporate training for videoconferencing or IT support into educational support3,5. Training of videoconference facilitators or course convenors may also be necessary.
Participation in videoconferencing may be easier and more fluid if clinical teachers have met previously at workshops. The importance of group dynamics in videoconferencing has been observed elsewhere12,13. The creation of the 'Community of Practice' via videoconferencing would need to take into account Salmon’s9 stages of e-learning: access and motivation; online socialization; information exchange; and knowledge construction and development.
Synchronous communication via videoconferencing does not fit with a need for 'just in time' provision of support which allows busy clinicians to dip into resources or support at a time which suits them. However, based on the premise that 'offering preceptor development – even when preceptors do not participate – is a form of preceptor support'4, offering videoconferencing could help demonstrate that the university has a commitment to maintain communication with and support for its clinical teachers, regardless of location.
1. Christensen S, Thistlethwaite J. Developing general practitioners' teaching skills: Student enhanced learning. The Clinical Teacher. 2009;6(4):225-228.
2. Woolley T, Gupta TS, Thistlethwaite JE. Effective & enthusiastic rural preceptors - what they need to know and what they need to have: An integrated approach to the support and training of rural clinicians who teach medical students on placement. Townsville: General Practice and Rural Medicine, School of Medicine, James Cook University; 2006.
3. Bramson R, Vanlandingham A, Heads A, Paulman P, Mygdal W. Reaching and teaching preceptors: Limited success from a multifaceted faculty development program. Family Medicine. 2007; 39(6):386-388.
4. Langlois JP, Thach SB. Bringing faculty development to community-based preceptors. Academic Medicine. 2003; 78(2):150-155.
5. Baker PG, Dalton L, Walker J. Rural general practitioner preceptors - How can effective undergraduate teaching be supported or improved? Rural and Remote Health. (Online) 2003; 3(1):107. Available from: www.rrh.org.au
6. McKimm J, Swanwick T. Web-based faculty development: E-learning for clinical teachers in the London Deanery. The Clinical Teacher. 2010; 7(1):58-62.
7. Reynolds RJ, Candler CS. MedEdPORTAL: Educational scholarship for teaching. Journal of Continuing Education in the Health Professions. 2008; 28(2):91-94.
8. Wenger E. Communities of practice: Learning, meaning, and identity. Cambridge: Cambridge University Press; 1998.
9. Salmon G. E-moderating: The key to teaching and learning online. London: Kogan Paul; 2000.
10. Steinert Y, McLeod PJ, Conochie L, Nasmith L. An online discussion for medical faculty: An experiment that failed. Academic Medicine. 2002; 77(9):939-940.
11. Newman C, Martin E, McGarry DE, Cashin A. Survey of a videoconference community of professional development for rural and urban nurses. Rural and Remote Health. (Online) 2009; 9(2):1134. Available from: www.rrh.org.au
12. Allen M, Sargeant J, Mann K, Fleming M, Premi J. Videoconferencing for practice-based small-group continuing medical education: Feasibility, acceptability, effectiveness, and cost. Journal of Continuing Education in the Health Professions. 2003; 23(1):38-47.
13. Cannavina G, Stokes CW, Cannavina C. Evaluation of video-conferencing as a means to facilitate outreach and work based learning. Work Based Learning in Primary Care. (Online) 2004; 2(2):136-147.