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1 Nova Explore Publications Nova Journal of Medical and Biological Sciences Vol. 4(1), 2015:1-5 PII: S X Research Article Students Perception of Program Modifications in Respiratory Therapy Mansour AlOlewah 1, Ruben Restrepo 2 1 Lecturer, AlMaarefa College for Sciences and Technology, Respiratory Care Program Riyadh, Kingdom of Saudi Arabia, molewah@mcst.edu.sa 2 Professor, University of Texas Health Science at San Antonio Abstract Abstract: King Saud bin Abdulaziz University has adopted the Respiratory Care program from South Alabama University (SAU) in United State of America and modified the program to fit the standards and recommendations of the Saudi Ministry of Higher Education (SMHE) based on Saudi culture, needs, and resources as well as new recommendations for curriculum design: objectives; to evaluate KSAU-HS Respiratory Care students experience with the unmodified SAU Respiratory Care curriculum and to obtain students feedback and perceptions on the modifications and changes to the SAU Respiratory Care curriculum: design; fifteen senior students from batch 1 received the unmodified South Alabama curriculum, and 14 junior from batch 2 students received the modified program based on senior observational data, students feedback questionnaire and program evaluation outcomes. Conclusion: Data from the junior students show significant improvements in program satisfaction compared with data from senior students. Keywords: Progressive Disclosure, Students Perception, PBL, Focus group, External and Internal Evaluators Introduction The South Alabama University (SAU) respiratory program is well defined, organized and frequently evaluated to meet the standards of American higher education and to allow graduates to be eligible to sit for the National Board Exams. However, the Saudi Ministry of Higher Education s requirements for program recognition and accreditation are more authoritarian. Saudi culture and a lack of English language skills have put pressure on the SAU respiratory program to be adapted to fit the standards of the Saudi Ministry of Higher Education as well as Saudi culture and needs. These adaptations include methods of assessment, removal or rearrangement of subjects in the curriculum, and the means of instructional delivery to gradually bring the curriculum in line with expectations. For safety and brevity, we did not perform changes on the first batch; instead, we observed, documented and conducted various selfevaluation processes, such as SWOT analysis (Strength, Weakness, Opportunities and Threat) 1, Focus groups and the CIPP model (Content, Input, Process and Product developed by Daniel Stuff bean) 2. The modifications of the program were launched with the next group batch 2, based on the data analysis and recommendations from senior students, our observations and experiences and Master of Medical Education (MME/KSAU) recommendations for innovative curriculum development. In the effort to improve the quality of the program and to develop a solid, modern and adaptive curriculum that meets high expectations, we generated a comprehensive questionnaire based on the Saudi Ministry of Higher Education s indications of program success to identify the effectiveness of the changes to the program on both groups and to obtain their feedback. The questionnaire includes 52 questions that cover six categories (Management of Program Quality, Learning and Teaching, Learning and Resources, Faculty, Assessments and Clinical Rotations). Because students are the end users of the curriculum, their perceptions and experiences of these categories can provide information on appropriate developments and can contribute to determining whether these modifications have a positive impact. A questionnaire on students perceptions is the first step towards improving the program quality and different aspects of the curriculum development. Our next projects include a faculty survey, outcome assessment in different hospital markets and an assessment of interns perspectives. King Saud Bin Abdulaziz University for Health Science King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) is the first university in the Kingdom of Saudi Arabia and surrounding countries to specialize in health sciences and to utilize Problem-Based Learning (PBL) as an educational strategy. The establishment of KSAU-HS was announced by the custodian of the Two Holy Mosques King Abdullah bin Abdulaziz on the 25th of April, The university is one of the governmental universities supervised by the Ministry of Higher Education and governed by the regulations and statutes of the Higher Education Council. The College of Applied Medical Sciences (CAMS) is a newly established college at KSAU. All programs are taught in English by qualified faculty. Applied Medical Science graduates remain committed to improve the services in Saudi health care system. Progressive Disclosure Progressive disclosure is a comprehensive modified PBL method that uses 4-6 case scenarios each semester that match the topics covered in concurrent courses. Each case is covered over a period of two weeks after being assigned to 6-8 students, and the course director serves as the facilitator. The case is provided to students using a series of one-page documents that are presented to the students in order of the events from a clinical scenario. The group is asked to evaluate each page before proceeding to the next. Every page is assessed in terms of four headings: facts, hypothesis, learning issues, and plans. The facts include information that is objective Nova Journal of Medical and Biological Sciences Page: 1

2 or based on the clinical history, clinical examination, and laboratory findings. The list of hypotheses generated by the students reflects the assessment of the patient s condition, problems, and impressions of the diagnosis. The learning issues list a number of objectives to complete the patient s assessment and clarify the diagnosis. The plans constitute the necessary therapeutic approaches to solve, remedy, or improve the patient s health status. Throughout the case, the facilitator has access to the learning objectives. The facilitator guides students, answers questions as they arise, and redirects the students to engage in a particular line of discussion. 4, 5 Progressive disclosure provides an authentic context for assessing students use of comprehension strategies (reading, listening, and viewing), critical thinking (analyzing or evaluating information, particularly statements that are claimed to be true), and metacognition (what individuals know about their own thinking). Significant of the study Students perception of a program is very essential for the success of the program, yet, I went through the literature and found nothing similar have been done here in Saudi Arabia before of the students perception as the end user of any educational activities. Most of published studies also sake market and customer satisfaction and rarely done for education improvements purposes. The following elements can clarify the important of this study result; - In this study we re seeking perception not satisfaction to reach higher level of educational standards - It s a holistic study covers up to my knowledge- all educational aspects (subjects, classes, clinic, faculty, management, assessment) - The impact of modifications on students as well as on the curriculum development. - Change of educational strategy- first time in KSA- from teacher centered to student centered approach as in progressive disclosure - Build up the good image of the program in a competitive environment - Attract the fresh talented graduates of high school to join the program - Participation of students in the program may improve performance Study design This is a Curriculum Development Project designed to determine the feasibility and effectiveness of an educational intervention. The design can be described as a combination of a case study and action research. The development of the project requires a participatory action research approach in which the data gathering facilitates changes and improvements in practice. It can also be described as a participatory action research approach in that the project coordinator is in constant dialogue with the students, and students participation and contributions to the development are an integral part of the project. The action research process involves continual analysis, reflection and action to improve the program. "Action research has been described as an informal, qualitative, formative, subjective, interpretive, reflective and experiential model of inquiry in which all individuals involved in the study are aware and contributing participants. Action research has the primary intent of providing a framework for qualitative investigations by teachers and re-searchers in complex working classroom situations" (Dorothy Gabel, 1995) 6 The main characteristic of action research is learning by doing, which includes active learning in real situations, identifying the problem in a situation or a practical issue, studying the system, formulating solutions, collaborating to apply solutions, studying solutions and repeating the process if the results are not satisfactory. According to Rory O Brien, in action research there is a dual commitment...to study a system and concurrently to collaborate with members of the system in changing it in what is together regarded as a desirable direction. Accomplishing this twin goal requires the active collaboration of researcher and client, and thus it stresses the importance of co-learning as a primary aspect of the research process. 7 Senior students received the program as initially designed and junior students received the program with modifications. Data on implementation are valuable to explore the mechanisms through which the program achieves or fails to achieve an impact, to identify challenges to future implementation and to examine the relationship between implementation and outcomes. Material and Methods All 15 senior students enrolled in Batch 1 received the unmodified curriculum from SAU. Changes for the junior students of Batch 2 were based on the data obtained from observations of Batch 1, feedback and continuous program evaluation. Additionally, an invited tenured professor of respiratory care from the University of Texas Health Science at San Antonio, Ruben Restrepo, evaluated the program and provided valuable input prior to the preparation of this document. Data collection Direct observation and strict follow up: This method allows researchers to gather firsthand data about the program, process or behavior, to capture a variety of interactions, and to thoroughly explore the evaluation of the project, by directly observing operations and activities 8. The program director was very close with the students, attending most of their classes,, participate with them most of in and out classes activities and taking notes in which he was able to develop a holistic perspective and an understanding of the context within which the program operated. Students feedback: Student feedback is an invaluable component in the wide array of tools to improve teaching. By gathering feedback, courses can be adjusted mid-stream to improve students learning experiences. In the course of project monitoring a good consideration of students feedback end-of-term thus courses/subjects can be improved each year. Seeking student feedback connects students and instructors and creates a sense of good will 9. All we need to do is to ask what do you think of this subject/program? And then prepare yourself to catch up lots of rich information. With careful follow- up, we were able to listen to each individual comment and concern throughout the course at any time, with (literally) no barriers or limits, in addition, KSAU-HS policy to conduct block/course evaluations end of semester to determine student satisfaction and students perceptions of the delivery of the program Nova Journal of Medical and Biological Sciences Page: 2

3 during the semester and their performance. KSAU-HS uses the end-of-semester evaluation the educational process and to improve the input and to prepare for the next semester. Focus groups: Are a form of qualitative research in which a group of people are asked about their perceptions, opinions, beliefs and attitudes towards a product, service, concept, advertisement, idea, or packaging. Questions were asked in an interactive group setting where participants are free to talk with other group members. The process is guided by a trained facilitator 10. During the process of the program we confronted with some complains from the students for some subjects. We conducted a focus group meeting guided by three principal questions: What is your opinion about the quality of the Respiratory Care Program? ; What problems (if any) did you encounter? and How could these problems (if any) be solved for future program implementation? External and internal program Evaluators leaders: Engaging external evaluators and internal program leaders with expertise in education and respiratory care assisted in the implementation and planning of the future program. These evaluators provided new perspectives, develop new indicator measurements and contribute to the overall program designing to help answer questions such as Are we doing the right thing? and Are we doing the thing right? 11 We took the advantage of the presence of Mr. William Wojciechowski in KSAU-HS; Mr. William is MS, RRT, Chair & Associate Professor, Department of Cardiorespiratory Care, SAU and also Dr. Margaret Elzubeir, Professor in Medical Education, KSAU-HS to set a meeting and had a comprehensive discussion of the program designing and implementation Questionnaire: Is considered as one of the most popular method of conducting a scholarly research, It provides a convenient way of gathering information from a target population. At the end of the semester, we used a questionnaire as an additional means of gathering comprehensive information on the impact of the curriculum modifications on students. The questionnaire was developed based on; - The Saudi Commission standards and key performance indicators for program evaluation. -Reviewed by two seniors professors; Dr. Margaret Elzubeir and Dr. Roben Restrepo -The questionnaire consisted of 52 questions that cover six categories (Management of Program Quality, Learning and Teaching, Learning and Resources, Faculty, Assessments and Clinical Rotations) which make it comprehensive; nevertheless, the questionnaire utilized in this project was developed by the program director and therefore was not validated for use in a population dissimilar to our own. Own experience: Clinical practice and educational skills experience in respiratory field played vital role in the designing, implementation of the program and the selection of proper strategies and assessment. Furthermore, the program coordinators own experience contributes to the internal evaluation of the program, continuous scanning and brainstorming regarding successes or declines in the program s implementation. This approach is definitely under scope for potential bias if checks and balances are not included. The Program Coordinator addressed this issue by brainstorming and consulting with other respiratory care specialists. Analysis A well-designed and implemented case study will not produce credible evidence without sound data analysis. All collected data were kept in a safe place, the program director and coordinators had access to it. A codebook was generated, and questionnaire data was coded and entered into SPSS Version Data analysis consists of the descriptive and statistical methods used to summarize the information. The following outlines the data analysis plan for this project: - Baseline data before the start of the program were collected and described in tables and figures (e.g. characteristics of participants and staff). - Direct observation and student feedback analysis through self-analysis and study of the case, scenario and behaviors. - End-of-semester rating by academic affairs with the direct collection of points for every instructor was reviewed and presented in tables. - Data collected from focus group meetings was recorded, and field notes were taken for focus groups by the group members (program director, program coordinator, students and program secretary). Transcripts of the focus group meeting content were analyzed using an inductive content analysis approach whereby the main categories and subcategories were extracted according to the content of the answers to each question. - Analysis was conducted by the external evaluator from South Alabama University, and his report will be disseminated - Questionnaires: SPSS Result All senior and junior students enrolled in the project: 15 senior students from batch 1 and 14 junior students from batch 2, for a total of 29 students. The questionnaire was administered simultaneously, and a total of 52 questions covered six categories based on SMHE indications of program success and review by two senior advisors, Professor Margaret Elzubeir, KSAU Medical Education department and Professor Ruben Restrepo, University of Texas Health Science at San Antonio. A Likert scale was used for rating (strongly agree, agree, Neutral disagree). The second section (figure 2) shows Learning and Teaching. This section examines how students perceive their learning through the teaching methodology used in the program. Most of the junior students strongly agreed on this category (). However, only of the senior students strongly agreed, as shown in figure 2. Most of the seniors () agreed, with significant value of P= Third section (FIGURE 3) shows learning and resources, which include the resources available in the college (technology, classroom, labs, etc.) to support the learning process; of senior students strongly agreed, whereas only 15% of junior students strongly agreed. Most of the junior student s agreed (), and 31% disagreed, P= 0.55 Nova Journal of Medical and Biological Sciences Page: 3

4 The Fourth sections (figure 4) shows the effectiveness of faculty educational skills. The faculty is a contributing factor in the quality of education and is able to deliver knowledge in an appropriate manner that is suitable to the students level. We found that of juniors strongly agreed, as did 27% of seniors. Most of the students agreed, with 55% of seniors and of juniors, P= Figure 1 Management of Program Quality Figure 2 Learning and Teaching % 9% Disagree % Figure 3 Learning and Teaching % 2 15% 15% 9% 8% 31% Figure 4 Faculty 6 55% % Fifth section (figure 5) shows the assessment. The assessment tools used in the program cover the objectives and the appropriate tool for each objective; 69% of the juniors strongly agreed, whereas only 9% of the seniors strongly agreed. Most of the seniors (55%) agreed. None of the juniors disagreed, compared with of the seniors, P= Nova Journal of Medical and Biological Sciences Page: 4

5 The sixth section (FIGURE 6) shows the clinical rotation, which considers the importance of clinical rotation in the program and does the clinic bear and complete the didactic learning to complete the education cycle. None of the seniors strongly agreed, most of the seniors agreed (82%), and only did not like the clinic. The juniors strongly agreed () and agreed (31%), P=0.05. The overall results of the questionnaire for both groups showed that 62% satisfaction among seniors and 74% satisfaction among juniors about the curriculum (design, process, implementation and changes) Discussion Under the direction of the Associate Dean of the College of Applied Medical Sciences (CAMS), KSAU is attempting to facilitate the smooth implementation of South Alabama University s (SAU) Respiratory Care curriculum. The goal is to fit the standards and recommendations of the CAMS to the departmental needs and resources established by the Saudi Commission for Program Accreditation. The curriculum designing process included a literature review and recommendations of the Master of Medical Education program of KSAU-HS regarding innovations in medical curriculum design. Data from Batch 1 and Batch 2 provided valuable insight into the impact of the program s modifications. However, the program is being continuously evaluated to monitor the quality and to determine the future development The respiratory care curriculum is the result of considerable and continuous effort. Although it is based on an American University (South Alabama University) with vast experience in PBL, we must consider the details and discuss each point to determine whether it suits the program and how the curriculum can be adjusted or manipulated to fit our goals, culture and resources. The recommendations of the Master of Medical Education in KSAU dominate most of the significant elements of the program. Long-term experience dealing with different levels of students, student feedback and continuous monitoring and observation has a significant impact on the curriculum adjustments. The success of the program comes from student participation in the curriculum. The senior students in batch 1 dedicated their time and learning experience to facilitate the curriculum development and improvement through frequent meetings and discussion on each subject with persons in the same field. They provided feedback and recommendations with an emphasis on the clinical applications of knowledge. Diverse knowledge delivery to fit different learning styles (including lectures, practical instruction, bedside te aching, discussion etc.), careful selection of clinical instructors, and collaboration with different ICU teams contribute to formulating the structure of the curriculum. The junior students in batch 2 showed motivation and appreciation to batch 1. Feedback from both batches had a significant impact on the curriculum design. The data from the questionnaires for both batches cover 5 categories with 52 questions, addressing nearly all aspects of education from the students perspective. These data indicate the significant imp act of the curriculum modifications among the junior students, P= The promising results of these modifications provide the impetus to continue program evaluations and to continue to monitor and develop the curriculum. These results also reflect the impact of the changes on the program and on the students performance. References 1. California State University Stanislaus. Strategic planning SWOT analysis 2. Daniel L. Stufflebeam. Evaluation Models, Viewpoints on Educational and Human Services. Edited by Daniel. Stufflebeam, George F. Madaus, T. Kellaghan 2nd edition p AlKhazim M. College message of King Saud Bin Abdulaziz University: Mishoe SC. Problem-Based Learning: Any influence in respiratory care? 5. Respir Care 2002; 47(5): Barrett, T., Mac Labhrainn, I., Fallon, H. (Eds) Handbook of Enquiry and Problem-based Learning. Galway: AISHE and CELT, NUI Galway Gabel, D. NARST President's Speech. Presented at the annual meeting of the National Association for Research in Science Teaching, San Francisco, CA April 24, O'Brien, R. An Overview of the Methodological Approach of Action Research. In Theory and Practice of Action Research (2001) 8. Wikipedia Organization Evaluation. 9. Teaching effectiveness program, using student feedback. 10. The Free Encyclopedia, Wikipedia Organization, Focuses Group. 11. National Community Crime Prevention Program. External and/or internal evaluation, deciding what works best for your organization Nova Journal of Medical and Biological Sciences Page: 5