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Beyond chalk and talk

Undergraduate education is changing in response to technological advances and demands in healthcare. Daloni Carlisle spoke to two innovators

When first year physiotherapy students arrive at Keele University this autumn they will be launched into a new curriculum which emphasises early contact with patients and close working with other professionals.

‘Everything is being driven away from the acute sector and  moving  towards the community, and people’s homes,’ says Professor Marilyn Andrews, pro-vice chancellor at the university and former head of the school of health and rehabilitation. 

‘We now have to produce graduates who are able to work in primary care, intermediate care, the private and voluntary sectors. These are very different environments,’ she says. 

Early patient contact

Under the new curriculum, developed with £1.6million for the West Midlands strategic health authority, students will undertake three placements in their first year, in contrast to one under the old programme. During their first term they will spend two weeks shadowing student nurses in hospital, helping patients with activities of daily living.

The second term includes a 10-week day release programme when students will work alongside other professionals: occupational therapists, speech and language therapists, radiographers, doctors, nurses, medical students and social workers, both in hospitals and the community to gain an understanding of the multidisciplinary team. 

‘They should be out there in the community very early, exposed to what it is, like in healthcare. They can observe and learn fundamental shared skills,’ says Professor Andrews.

 The first year programme finishes with a three week placement to assess students’ clinical skills.

Virtual town

The new curriculum also makes use of a computer programme with virtual patients in a virtual town, with the scenarios becoming more complex as the course progresses. There will be a new emphasis on leadership and service improvement.

‘We need people who can drive forward services and innovate,’ says Professor Andrews.

‘We will be asking students to undertake leadership in their clinical environment and part of the assessements will be how they have helped lead services and drive them forward.’

Rising expectations

Professor Andrews, chair of the CSP’s quality assurance and enhancement group, cites the NHS Plan, published in 2000, and Lord Darzi’s 2008 report, Higher Quality Healthcare for All, as among the policy drivers for the new curriculum. 

‘There are four big drivers: the ageing population, with increasing numbers of people with long-term conditions and co-morbidities; changing lifestyles, with more people with obesity; advances in technology, leading to better diagnosis and new treatments, and patients having much higher expectations,’ she says.

Exploiting technology

At the University of Hertfordshire physio Heather Thornton, associate head of the school of health and emergency professions, is spearheading greater use of technology in the undergraduate curriculum. In 2005 she was instrumental in setting up the university’s £5.5million blended learning unit, funded by the Higher Education Funding Council for England. Blended learning  using technology to enhance students’ experience – is an effective part of the curriculum, she says.

‘Giving students choices and responsibility helps them tap into their inherent motivation,’ she says. ‘Face-to-face learning is essential because that is where students learn practical and clinical skills. But blended learning allows you to put other opportunities into the mix.’   

Students at the university make extensive use of wikis – websites that can be edited by users.  ‘Wikipedia is the best known wiki,’ says Dr Thornton. ‘It is a tool that allows you to author content and change what others have written. It allows students to work collaboratively. They are producing their own resource and and discussing their own knowledge. And at the end they have an artefact of their knowledge.’ 

Students might use a wiki to learn about the skeleton, for example. 

Critical reasoning

While the content might be learned from textbooks, a wiki allows students an opportunity for discussion which enhances knowledge, Dr Thornton argues.

‘It’s the participatory aspect that is so important,’ she says. ‘It gives students the skills to seek out information and apply it to their practice. It helps them reflect on what they are doing and compare the evidence base,’ she says. 

Learning is also enhanced, Dr Thornton feels, by the university’s intranet, StudyNet. ‘Much more than a website with lecture notes and reading lists it links everything the student does,’ she says. 

Of all the media in the course: podcasts, videoclips and interactive whiteboards, electronic voting seems particularly popular with students. 

Topics debated with the system include ‘There is no place for the medical model of patient care in the physiotherapy profession’ and ‘Setting up and running exercise classes in nursing homes is not the role of a physiotherapist.’

Students vote at the start, one team does a 10 minute presentation arguing for, another arguing against, and general discussion is followed by a concluding vote, ‘It’s fun, it’s cool and students love it,’ says Dr Thornton. 

It promotes critical reasoning as students have to draw on their clinical experience and  the evidence base, to convince their peers, she points out. 

Dr Thornton hopes that Hertfordshire’s physio graduates will emerge with skills for lifelong learning.

‘I can see a world where tomorrow’s practitioners will be using wikis to discuss how to implement NICE guidance or how to manage a patient. There are huge opportunities for us to use technology in practice,’ she says. 

‘I hope we are sending out students who will have the skills  practical , technical and leadership to make technical innovation a reality,’ she adds. fl

Fun way with a dry subject

A wiki, podcasts and peer assessment helped physio students at Hertfordshire University learn about the lumbar spine at the same time as improving their communication skills. Students were divided into five groups to research the five pathologies of the lumbar spine. Each group wrote a summary of a pathology on a wiki and then made a five minute podcast explaining it. The podcasts were uploaded on to the university’s StudyNet for all participants to assess their clarity.

The students felt that having to write, speak and listen to information about the subject reinforced their learning. ‘It did not feel much like work,’ one commented.  Their tutors  found it a fun way to explore a potentially dry subject.

Further information

New learning and development principles, developed by the CSP as part of Charting the Future, will be published on the website shortly.

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