An introduction to the design an use of technology in clinical training and education

1. Niall Winters, Caroline Pelletier, Catherine O’Keeffe & Sara Price
{n.winters, c.pelletier, c.okeffee, s.price}@ioe.ac.uk
@nwin | @eastriviera | @CatherineOKeef1
http://www.lkl.ac.uk | http://www.ioe.ac.uk |
http://www.londondeanery.ac.uk
June 26 2013
Technology Enhanced Clinical
Education
#tece #meded

2. Aim
• You will work with educational experts and
technologists to design a learning support tool
that addresses the needs of clinical
educators/trainers and trainees

3. Programme Dates
• 14.00-17.00, June 26th 2013 Introduction
– Outline problem spaces, generate initial ideas
• 10.00-13.00, July 22nd 2013 Development
– Develop the initial ideas into concrete learning support tools
– Pilot intervention
• 14.00-17.00, Sept 26th 2013 Tool refinement
– Pilot analysis resulting in extended development of the learning support tool
• October 2013 – April 2014 Feedback and iterative development (in-situ)
– Educational experts from the IOE will come to your workplace in October,
December, February and April to help further develop and evaluate the
learning support tool
• 14.00-17.00, May 22nd 2014 Reflection
– Reflection on the iterative extension of learning support tools resulting form
pragmatic use
• 14.00-17.00, June 26th 2014 Consolidation
– Drawing together and final outputs
– Best learning support tool Award

4. Agenda
• 14.00-14.15: Welcome and Introduction
• 14.15-14.45: The role of technology in clinical
training and education
• 14.45-15.15: Discussion of selected submitted
cases (and examples from the literature)
• 15.15-15.30: Coffee break
• 15.30-16.15: Group work on initial design ideas
• 16.15-16.45: Discussion
• 16.45-17.00: Next steps

5. Developing people for health and healthcare
working on behalf of
Faculty Development ….
in the new world

6. Why is TECE important?

7. National picture
• HEE’s Better Training Better Care (BTBC)
– Number of pilots funded
• Limited innovative uses of technology
• A Framework for Technology Enhanced
Learning (report from Dept. of Health)

8. 1. Local implementation and pilots
2. Role of the trainee
3. Role of trainers
4. Workforce planning
5. Improving careers guidance and availability
6. Integrated technology enhanced learning
1. Casebook for simulation, elearning, mobile learning (focus on
apps), with a showcase in early 2014
7. Broadening the Foundation Programme
8. Regulatory approach to supporting Better Training Better
Care
9. Funding and education quality metrics

10. What do we mean by education?
What do we mean by technology?

11. As Jerome Bruner (1996, p.
146) put it, learning ‘is not
simply a technical business
of well managed
information processing’.
Instead, learning can be
seen to involve an individual
having to make sense of
who they are and develop
an understanding of the
world in which they live.
From this perspective
learning can be seen as a
continuing process of
‘participation’ rather than a
discrete instance of
‘acquisition’ (Sfard 1998).

12. From Sfard (1998)

13. Technologies are not ‘neutral’ tools
but instead structure human activity
(Winner, 1986). How do they do this?
Lievrouw and Livingstone’s (2002)
description of three distinct – but
interconnected – aspects of what
‘technology’ is:
• Devices: the technology itself and
how it is designed and made
• Activities and practices: what
people do with technologies
(including issues of human
interaction, organizing, identity,
cultural practices)
• Context: social arrangements and
organizational forms that surround
the use of technologies (including
institutions, social structures and
cultures)

14. If education is a process of participation and
technologies structure learning activities, what
does this mean for designing and using technology
in clinical training?
A direct focus on practice is crucial

15. “The use of a practice lens to study technology use
in organizations focuses attention on what people
actually do with particular technologies in their
ongoing and situated activity.” (Orlikowski, 2000)

16. Examples

17. Example 1 (from submissions)
• An interactive website and webapp for post-
graduate trainees and nurses on the neonatal unit
that allows them (as a group) to keep a record of
their learning activity whilst on the neonatal unit -
including the outcomes of formal and informal
learning, practical procedures etc. This record may
be in the form of written posts, photo, audio or
video. It should also give the ability to have
interaction between seniors and trainees - asking
questions and leaving comments which can be
answered on the site. It should give the trainees
an easily accessible record of their learning
journey, and allow interaction amongst peers and
with seniors.

18. Example 1 (from submissions)
• An interactive website and webapp for post-
graduate trainees and nurses on the neonatal
unit that allows them (as a group) to keep a
record of their learning activity whilst on the
neonatal unit - including the outcomes of formal
and informal learning, practical procedures etc.
This record may be in the form of written posts,
photo, audio or video. It should also give the ability
to have interaction between seniors and
trainees - asking questions and leaving comments
which can be answered on the site. It should give
the trainees an easily accessible record of their
learning journey, and allow interaction amongst
peers and with seniors.

19. Questions
• What is the problem in your practice being
addressed?
– [Fill in]
• What is the technology in use?
– [Fill in]
• What activities will participants engage in?
– [Fill in]
• How will the technology support participation (a)
in practice and (b) between practitioners?
– [Fill in]

20. Example 2: Judgment
• Smartphone and web-based app for enhancing learning of
prescribing and therapeutics.
• Dual theme
– A virtual logbook of personal drug choices (known as p-
drugs) that students become familiar with for common
medical conditions. As they learn more about the drugs,
they enter the info into specified tabs (ie indication, dose,
route, side effects, interactions) in a cumulative way over
months/years to build a personal formulary, based on
current medical school top 100 drugs
– within same portal is the ability to work through example
patient-based clinical scenarios that lead the user to
therapeutic dilemmas, problems and decisions to enact
accurate and safe prescriptions on virtual drug charts, to
enhance the practical application of drug prescribing as
well as the theory as per 1 above.

21. Example 2: Judgment
• Smartphone and web-based app for enhancing learning of
prescribing and therapeutics.
• Dual theme
– A virtual logbook of personal drug choices (known as p-drugs) that
students become familiar with for common medical conditions. As they
learn more about the drugs, they enter the info into specified tabs (ie
indication, dose, route, side effects, interactions) in a cumulative way
over months/years to build a personal formulary, based on current
medical school top 100 drugs
– within same portal is the ability to work through example patient-based
clinical scenarios that lead the user to therapeutic dilemmas,
problems and decisions to enact accurate and safe prescriptions on
virtual drug charts, to enhance the practical application of drug
prescribing as well as the theory as per 1 above.
• Our view: explore the tension between evidence and practice
around decision making

22. Question
• What is the problem in your practice being
addressed?
– [Fill in]
• What is the technology in use?
– [Fill in]
• What activities will participants engage in?
– [Fill in]
• How will the technology support participation (a)
in practice and (b) between practitioners?
– [Fill in]

23. Pre-CbD Reflective Tool

24. Pre-CbD Reflective Tool

25. Themed Groups
Reflection
Caroline Fertleman
Gloria Esegbona
Chatenya Chauhan
Siobhan Cooke
Professional development of supervisors
Helen Burgess
Group learning
Hammad Khan
Videos of practice
Tara Renton
Roberta Brum
Claudia Salazar
Helen O' Toole
Jane Neerkin
Deen Mirza
David Sayer
Rekha Bhalla
Portfolio content
Clare Etherington
Andrew Perriam
Vikas Kapil
Allan Andy

26. Next steps
• Moodle
– Logins to be sent within a week
– Groups
– Papers and discussion groups

27. Next steps
• The project pro-forma, for presentation at the
next workshop
• Writing a scenario – an example:
Informal mentoring of GP trainees
As an educational supervisor of GPs, Paula is allocated her trainees in year 1 but
does not deal with them on a daily basis until year 3. During years 1 and 2, she is
working in practice while her trainees are based in secondary care. Some of her
trainees have requested that she explore opportunities for forms of unstructured
sharing of experience to support building up of the relationship at a geographical
distance. The trainees are interested in informal mentoring that moves away from
reflective logs and e-portfolios. Paula is not a keen user of technology in her work
(other than her PC) but she does have a smartphone. She is of the opinion that
technology could interfere with the quality of supervisory relationships, rather
than supporting it. Nevertheless, she is convinced by the enthusiasm of her
trainees and is intrigued when one of them sets up a private twitter group where
she and her trainees can share interesting links, and comments on each other’s
daily practices.