​​Teaching​ Stories

​​Mock Drill: Simulator Mediated Activity for Resuscitation Training (SMART)​

 Azmat Khan, Assistant Professor, School of Nursing and Midwifery (SONAM), Pakistan

 October 5, 2018

I am a graduate of AKU-SONAM-Pakistan, and I have been teaching in an undergraduate nursing program (BScN) for several years. I teach Bachelor of Science in Nursing (BScN) fourth year program's clinical course where students are expected to work in the emergency department (ED) and provide care to patients in vulnerable situations. Over the years, I have observed that the students usually avoid performing Cardio-Pulmonary Resuscitation (CPR) in emergency situations. They feel anxious and fearful even while obser​ving CPR and tend to stay far from the resuscitation team. I decided to use a Simulator-Mediated Activity for Resuscitation Training (SMART) in the simulation lab at CIME, to reduce their anxiety and enhance their clinical skills. I purposely use mannequin (Resusci Anne Simulator) as the simulator has high quality airway management with endotracheal tubes, spontaneous breathing, live defibrillation and synchronized ECG, IV insertion, blood pressure and pulse monitoring, Quality Chest compression feedback on the SimPad, voice, lung and heart sounds for basic simulation training. I teach the session in four phases namely: pre-session briefing, orientation, implementation, and modeling and debriefing.

Pre-session briefing

This is conducted, a day prior to actual mock drill a pre-session briefing. I engage students in discussions around life threatening arrhythmias, algorithms and resuscitation team roles.

Orientation

In this phase, I divide students into two groups (Group A and B), and orient them on simulated ED room, mannequin, simulator and equipment (Crash Cart, Defibrillator, Ambo bag, Oxygen flow-meter).

Implementation

I provide a scenario to students in Group A and they share roles as a resuscitation team. I regulate SimPad to provide them with specific situation and they run a Mega Code on simulated mannequin according to the given scenario (used American Heart Association testing mega code scenarios). During resuscitation activity, I provide different arrhythmias through SimPad and according to these arrhythmias students select an appropriate algorithm and run the code.

Also, I assign a student from Group B to video-record the whole activity while the rest of Group B members observe critically from the adjacent observation room and make notes on Group A's activity. After the performance of one group, roles of both the groups are switched. 

Modelling and Debriefing

After the performance of both the groups, we discuss the activity. Subsequently, I model CPR for the students on the mannequin having the pre-set arrhythmias. The students then demonstrate CPR and get feedback on their performance and I re-demonstrate where necessary. Thereafter, we debrief the session using the recorded videos where students reflect and discuss what and how they have learned and how can they perform better.

Post-SMART evaluation

Students' feedback on the use of SMART was sought and 81% students indicated that the mock-drill enabled them to meet their objective of identifying cardiac dysrhythmias and performing algorithms in their resuscitation teams. 94% were satisfied with the learning methodology used in the mock-drill and 93% of the students found SMART useful in enhancing their knowledge and skills regarding CPR. Some students shared:

 "The mock drill was fruitful and I suggest more of these kind of mock drills as practice make a person perfect".

 "SMART mock-drill was a good initiative as it helped me reduce my anxiety towards CPR. It should be organized for all BScN students."

 "The drill was a nice practice to give same exposure to what we might face in critical area".

Conclusion

In nursing education, simulation based technology and simulation environment plays a crucial role in providing students with hands-on practice where they can engage in recursive practice and learn through their mistakes which contribute towards becoming a competent and a safe nurse. Next time I teach the course again, I plan to go a step further and take the learners to the Emergency Room to enable them apply their learning in the real-life critical area. My students and I have benefitted greatly using SMART approach. I recommend SMART approach to all faculty who teach CPR to health care professionals.​

Kiran picture.jpg 

Evoking a rhythm for learning in Health ​and Development ​

Kausar S. Khan, Senior Lecturer, Community Health Sciences, Medical College, Aga Khan University, Karachi.

July 31, 2018

I teach the program of Community Health Sciences to undergraduate and graduate medical students at AKU. I also teach short courses to people from non-governmental and government organizations. My teaching is inspired by Paolo Freire and Carl Rogers, whereby the learner is 'engaged' in the subject to be learnt. I strongly believe that 'people remember what they discover' and, therefore, while teaching I engage learners in making meaning of the subjects/ideas introduced. In short, I follow the maxim, that learners are not empty vessels that have to be filled by some expert.

The following is an example of a very specific teaching strategy that I developed and used with the first-year undergraduate medical students (80+ students), while teaching the topic of health and development. My aim was to help them comprehend the complex and evolving relationship between health, poverty and development; identify determinants of health in Pakistan; discuss factors affecting determinants and propose ways to eradicate elements that negatively affect health. The students sit in rows after rows in a large hall; average age is 17 years. I used PowerPoint presentation to flash the topic and introduce the content of the topic. I distributed what I call 'Students – Worksheets', which have seven sections that correspond with the questions raised during my presentation.  In the worksheets, each student is requested to write his/her responses to questions raised. A short (5 min) video clip on health issues in Karachi is shown, and students write down the salient health issues raised by the film. After every section filled in the Worksheet, students share what they have written. Students at one point are asked: "For better health outcomes of the most vulnerable and marginalized, who should define development?" (Question displayed on a slide of the power-point presentation). This is the rhythm of the class room session – questions raised, students write their response on the Worksheet, share their response, and power presentation moves on. For example, section 6 on the worksheet required students to write what they learnt from the session and in section 7 they write their reflexive note (reflexivity is introduced to the students in an earlier session). Worksheets are collected at the end of the session.

It is quite striking that the majority of students successfully write the reflexive notes and, barring a few, are able to separate their thoughts and feelings. In my experience, the process of separating feelings and thoughts is often not easy for learners. An example from students' reflexive notes, reads: "Empathy leads to a will to change things. I thought about how to help the poor after I graduate. I understood the importance of community health, I felt empathy for my community." It was also very striking that the learning (section 6) went beyond the stated objectives of the session.

Having experienced the efficacy of Student-worksheets in my classroom, I believe that the worksheet provides the students the opportunity to first access their own understanding/opinions before listening to other views while remaining focused on the learning task. When the students shared what they wrote, they were open to hear and appreciated diverse point of views and were not disrespectful towards each other. For me, worksheets have always worked – they stimulate students to think and share their thoughts with others. My role in teaching is simply appreciating students' thoughts and validating them. The student-worksheets are taylor made for every session, however, the section 6 and 7 i.e. what have you learnt; and reflexive note remains same all across.​

Game based learning: using technology to enhance active learning in a health assessment course​

​​​Ms. Beth  Waweru, Instructor, School of Nursing and Midwifery, Kenya.
August  17, 2017​

 

Introduction

My teaching philosophy evolves around active learning and understanding of concepts by the students and that learning has to be interestin​g. My approach of teaching hence reflects this philosophy and that is why I chose Kahoot as part of my instructional methods in the Health Assessment Course.


Concept of Digital Game Based Learning (DGBL) as used in Health Assessment Course

The theoretical foundation of games as a teaching and learning strategy was first described by Kolb in his experiential learning model. Game-based learning is considered to be risk free and it encourages exploration and trial-and-error actions with instant feedback and hence stimulates curiosity and learning(Hussein, 2015). Digital game-based connects educational content with computer or video games and can be used in almost all subjects and skill levels. With advancement in technology, students need to be prepared to participate in the globalized technological society of the 21st Century in the course of their learning. Learning also need to be interactive and interesting with instant feedback.

What is Kahoot?

“Kahoot! is a free online classroom response system designed to allow instructors to quickly and easily create question-based learning games that can be used to assess student learning, review concepts, teach new material, and/or facilitate classroom discussions”(Graham, 2015). The Kahoot platform is a simple and intuitive game development tool that allows instructors to skip the technical hurdle they might otherwise encounter in developing a digital game and focus instead on instructional outcomes (Graham, 2015).

My Experience

I mainly use Kahoot to evaluate whether students have done their pre-lesson reading and how well they have understood the material. It assists me to utilize the limited lesson time to clarify concepts that were not well understood and build on what is already known. Occasionally, I use Kahoot, to evaluate post lesson.

Initially, some students resisted. In my first lesson, some students were reluctant to connect to Kahoot and opted to work with their desk mates. So I had just a few participants but I rewarded the winners. In subsequent lessons I had more participants all hoping to be cheered up as winners and as we progressed it became more interesting.

At the end of the course, I did a simple evaluation of Kahoot as a teaching strategy. I used a likert scale type of questions with 1-4 points. There were also two open-ended questions of what they liked most and what they did not like about Kahoot. Most of the responses on the likert scale questions ranged between 1-2. Twenty-four out of twenty-six students participated in the evaluation. Most students rated the use of Kahoot high. Below are some of the students’ responses on what the students liked most and what they did not like:

The use of Kahoot: “ made lessons interactive” “Very interesting and fun” “Encouraged me to read prior to lessons” “Enabled me improve thinking ability” “Fast way of learning concepts” “Nice way of keeping learners awake”. 

Some students felt that the time for answering the questions was not enough as stated in this comment: “there was no time to think”. Use of technology was also a challenge.

Conclusion

DGBL engages students in their learning and makes learning interesting.  The instructor is able to assess whether or not learning has taken place and can give prompt feedback to students. 

References

Graham, K. (2015). TechMatters: Getting into Kahoot!(s): Exploring a game-based learning system to enhance student learning. LOEX Quarterly, 42(3), 4. 

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Hussein, B. (2015). A Blend​ed Learning Approach to Teaching Project Management:

A Model for Active Participation and Involvement: Insights from Norway. Education Sciences, 5(2), 104. ​

February  11, 2017​


Flipping the classroom-Use of Moodle in the Teaching and Learning of Reproductive Health Nursing: A Teaching Story by Ms. Jane Kabo, Senior Instructor, School of Nursing and Midwifery, Kenya.

"As an instructor for Reproductive Health Nursing, I believe that every student deserves quality teaching and learning processes. Quality teaching and learning experiences enhances students’ achievement. Students come with unique experiences and backgrounds, and therefore it is pertinent to adapt the classroom teaching according to the needs of the learners. 

I intentionally choose strategies that maximize students’ learning rather than choosing those, that are easy-to-use. For example, group works are more difficult to organize and manage, as compared to lectures. However, group work is more effective than lectures because it engages students in learning and allow them to take control of their own learning. 

The flipped classroom is a pedagogical model which reverses what typically occurs in class and out of class. Students are first exposed to the material outside of class, in the form of video-based lectures. Subsequently, class-time is used to engage in activities like problem solving, creating, critiquing, analysis and synthesizing of information. Students take ownership of their learning by using flipped approach as it keeps them engaged in and outside classroom.  The pedagogy has enabled me to apply more of active learning strategies by placing the responsibility for learning upon the student, giving me a role of a facilitator rather than one way provider of information. I have moved from instructor-centered to student-centered learning environment while using flipped approach and my students are able to interact prolifically with each other, the content and the instructor. 

Use of Moodle platform while flipping classroom, has allowed me to use variety of methods to engage the learners and to provide online support for my course.  Providing a central space on the web where students can access a set of tools and resources anytime anywhere allows them to work flexibly in and out of class. Through the platform, learners ask questions (in and out of classroom) without feeling embarrassed as their anonymity is maintained. I’m able to access students’ questions, summarise, organise and analyse them, and address them during my face to face lesson. I’m also able to share resources beforehand and engage students in discussion forums. Linking the assignments with the lessons and posting quizzes on line has saved me time, postage and paper.

The use of moodle to flip my classroom has supported learning throughout; expanded course offerings and experiences; increased student engagement and motivation; and accelerated learning. From my experience, the technology has improved educational productivity in a number of ways; and students learn faster in and out of class. It reduces the cost of instructional materials and increases efficiency (instructor’s time).

However, there are a few challenges in using flipped classroom and technology. For example, teachers may find it difficult as it takes a lot of time to design higher order thinking tasks. Students may find it difficult to take charge of their learning especially out of the classroom, and some students are not tech-savvy and thus they may find it difficult to work online effectively. Some planned strategies may not work well while delivering the course, and thus, teacher needs to rethink and redesign course as per students’ needs. ​

In conclusion, applying the flipped philosophy has enabled me adopt a teaching approach that allows me to adapt, in the online environment, the strategies that I use in face-to-face classes. The benefits of the flipped classroom model outweigh the challenges. The implementation of the model becomes easier over time. Moreover, it equips students with skills required in a changing technology landscape and instructors need to integrate knowledge, instructional practices, and technologies."

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Use of Active Illustration in Patient Education:​

Ms. Nausheen Salim, Senior Instructor, School of Nursing And Midwifery, Karachi.

January  13, 2017​

 

Ms. Nausheen Salim, Senior Instructor , SONAM Pakistan shares her teaching story and experience as a teacher and nurse: ​​ 

"Although I am a nurse by profession, I value my identity as a teacher. Teaching nurses in a clinical setting provides them with important on-site hands-on experience of patient care. One important clinical skill that I teach nurses is patient education. This involves educating patients to help them understand “what has happened to them,” “what are the possible causes,” “how can it be treated,” and “what is the future plan for care.”​

“Active Illustration Technique” is a useful tool to use with patients and their families to inform them about their disease process and to help them make decisions about their proposed plan of care. By using the scientific knowledge base, effective communication skills, and simple metaphorical exemplars, a nurse can help the patient understand the medical diagnosis.  For example, the metaphor of blocked water pipes is used to generate discussion about the risk factors, pathophysiology, signs and symptoms, and complication of high blood pressure. ​

To use active illustration technique, one needs to think of various life processes and compare them with real-life phenomena existing in society. This also involves thinking about how the disease could adversely affect the life processes. After choosing the metaphor from daily life, one illustrates the process using stick-figure drawings while conversing with the patient. To use this strategy, one only needs to have an A4-sized paper and a pencil.

There are two pre-requisites for successful use of this strategy: knowing the language of the patient and complete knowledge of the disease process under discussion. However, this strategy may not work in certain circumstances, for instance, if a patient is not interested or ready to hear the details of his/her disease or he/she is not in a state of mind to comprehend the issue. 

My students use a variety of exemplars and metaphors in educating their patients about the health problems they are experiencing. Students report that “this technique enhances patients’ understanding of their conditions.” Consequently, “it enhances their competence in implementing any proposed plan of care.” They also find it “useful in developing a rapport with the patients and their families.” In addition, it develops a “sense of trust and mutual respect between patients and student nurses.” This is beneficial for patient compliance with treatment and post-treatment care. Also, this technique could lead patients’ improved satisfaction for the care provided, a better understanding of the role of nurses, and enhancement of nurses’ self-worth. ​

In conclusion, I think this strategy is applicable to most disciplines in general and nursing education in particular. Using on-the-spot narration of the phenomenon at hand, using metaphors and visual illustrations, and engaging learners’ multiple senses can lead to a better understanding of how complicated medical knowledge can be effectively transferred."​


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Patients at the Heart of Teaching:

A Blended Learning Course Experience -  Dr. Sameena Shah

​December  05, 2016​​

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Dr. Sameena Shah, Associate Professor Family Physician, Medical College, Karachi, Pakistan s​hares h​er teaching story on how Blended Learning Faculty Development Programme has equipped her with critical online pedagogical skills. This is her experience:

“I am a consultant Family Physician at the Aga Khan University. In addition to being a clinician, I am also a teacher, and I love what I do. 

Since 2012, I have been working extensively to develop and establish palliative medicine services including ‘end of life care’ at the Aga Khan University Hospital. As an emerging area in Medical Education in Pakistan, in order to increase capacity at AKUH and AKHSP, I have designed and developed regular face-to-face courses and workshops on Palliative Care for postgraduates and physicians.

In 2013, I participated in the Faculty Development Programme for Blended Learning. 

My participation in the programme equipped me to use online pedagogies to reach physicians remotely in areas such as Interior Sindh, Gilgit-Baltistan, Karachi and AKU residents both on and off-campus.

Providing awareness about the human dimension of patients to ensure their holistic wellbeing and care has always been at the core of my teaching. In addition to the scientific side of medicine, students need to be sensitive to their patients’ and patients families’ socio-cultural and emotional dimensions to be able to facilitate effective care and management in clinical settings and indeed the community.

Previously, I used role-play and presentations to teach core concepts. With the blended learning approach, I now create ‘online’ patient stories as a resource to organise a number of teaching and learning activities. 

To ensure holistic and patient-centred learning I have created varied socio-economic and cultural settings for each patient that highlight key issues. Moreover, I have included lab reports, radiological investigations and hand-written prescriptions as part of the patients’ narratives. 

Towards the end of the course, students participate in a practical component where they visit a hospice and observe clinical consultations in real-time. The course concludes with a workshop based on the patient stories to teach and practice counselling skills through evidence based role-play strategies.

Through fictionalising real-life accounts and encouraging students to review them not only as clinical scenarios but ‘stories’, routinely moderating discussions and reasoning on online discussion forums, presenting students with probing questions and clarifying concepts, the patient’s life is at the centre of teaching and learning activities.

Feedback highlighted the usefulness of “interdependence” in discussions where participants were able to learn from each other. They appreciated the way patient stories were presented with incorporation of sensitive issues, and how visuals such as reports and prescriptions were added. 

However, a few of the participants felt that the interaction on online discussions could be improved by more faculty member and peer input and more frequent live summary sessions for clarification of queries. This did strike a chord, as a challenge with this methodology for me has been establishing an adequate view of students’ progress, due to the asynchronous nature of discussions. However, reviewing students’ responses is always helpful to understand what they have learned and where they need assistance. 

It was a learning curve, but by the end of discussions, I was able to ascertain the level of understanding of my students. Another challenge is structuring the task with relevant questions, activities and visual details so as to make it as real as possible. Linking it to the objective of the course and at the same time giving enough freedom to students to think and work independently is yet another challenge. I overcome these challenges by detailed planning and provision of pre-reading material to help students to come prepared to the (online) and classroom lectures.

I also want to highlight the importance of professional development in designing a course in such an innovative format; I learned by doing! Faculty mentors and course designers at the Network of Blended and Digital Learning provided me with strong pedagogical knowledge about blended learning, provided feedback on course design and developed digital learning artefacts for this course. Another important aspect to my learning were reflective conversations where course designers would ask me difficult but interesting questions on why I would like to design and teach a concept in a certain manner, how learning materials should be presented or how it can enhance students’ engagement in learning. Moreover, we would critically reflect upon the challenges and collaboratively devise strategies to overcome them for next offerings of the course.​

Based on my experiences, I recommend that we should the attempt to make our teaching more patient-centred in content and clinical practice and include more student-centred in teaching and learning activities. It is also important to make changes of the courses as per student feedback.”


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The Pedagogy of Service Learning

Mary Oluga, Assistant Professor and Coordinator, MEd Part-Time Programmes

​March 16, 2015​​

 

​In the last 30 years, I have taught learners ranging from primary school children to adults undertaking a Master in Education. Needless to say, my teaching philosophy has experienced a metamorphosis during this period. Today, I understand that the ultimate aim of education should be to develop an inquisitive mind, which, at the same time, seeks answers to questions raised by such a mind. This enables an individual to seek real answers that aim to improve society. This philosophy is intricately embedded in my teaching presently. Subsequently, as an educator, I often seek improvement for myself and others by engaging in reasoned thought. 

Working with practitioners I always endeavour to encourage reasoning. One of the ways in which I have taught in this manner is through engaging my students in service learning – “a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility and strengthen communities” (Eyler et al., 2001). I have found it most appropriate because service learning combines learning goals and community service in ways that enhance both student growth and the common good. 

Teachers are often confronted with sensitive and controversial issues in their classrooms but are required to display a neutral and objective position. This is difficult and unreal. Hence, I have used both community service learning (CSL) and community based learning (CBL) to deal with such issues. For example, with the former, my groups of MEd students went into a community to engage the latter in thinking of solutions to problems in th​e community. With CBL, groups of teachers and school administrators were brought into the institution and my group of master’s students facilitated a classroom-like workshop. Once, the students used interactive theatre to engage the community in discussing two social issues: abortion and female genital mutilation. In interactive theatre, the actors speak directly to the audience or engage them in actions, thus breaking the imaginary wall between the performers (students) and the audience (community). Both approaches often attract the attention of other staff and faculty. I attribute this to the spontaneous ways in which the strategies offer realistic solutions to realistic problems.

After every session of service learning, I get the students to reflect on their learning. The lessons learnt by both the students and me help me improve on the structure of subsequent sessions. 

While I recommend that educators should employ engaged pedagogies, I also recognise the challenge in "allowing the time" for this to take place. Elements of the intended outcome should be introduced gradually in the course or discipline taught. The course overview and objectives should state very clearly the purpose and justification for using service learning, as this pedagogy has implications on time, money and other resource materials. 

The outcomes of service learning are immediate and are reflected in the attitudinal changes the students and community often share after such learning moments. The gains for the students are best captured by this comment from one of the MEd students after carrying out service learning, “We do not have to wait until the end of school for our students to see the impact of our teaching.” Indeed, the comment applies to me, too. I live my teaching as my students live their learning.​

​​If you are i​nterested in sharing your teaching story, please contact Zeenar Salim​.

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