Connections in Higher Education

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1 Research and Development in Higher Education: Connections in Higher Education Volume 35 Refereed papers from the 35th HERDSA Annual International Conference 2 5 July 2012 Hotel Grand Chancellor, Hobart, Australia Stupans, Ieva & Orwin, Lindy (2012). How do we connect and engage students, learning in a distance mode, to develop verbal communication skills? In Brown, N., Jones S. M. and Adam, A. (Eds.) Research and Development in Higher Education: Connections in Higher Education, 35 (pp ). Hobart, Australia, 2 5 July Published 2012 by the Higher Education Research and Development Society of Australasia, Inc PO Box 27, MILPERRA NSW 2214, Australia ISSN X ISBN This research paper was reviewed using a double blind peer review process that meets DIISR requirements.two reviewers were appointed on the basis of their independence and they reviewed the full paper devoid of the authors names and institutions in order to ensure objectivity and anonymity. Papers were reviewed according to specified criteria, including relevance to the conference theme and sub-themes, originality, quality and presentation. Following review and acceptance, this full paper was presented at the international conference. Copyright 2012 HERDSA and the authors. Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patent Act, 2005, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers at the address above.

2 How do we connect and engage students, learning in a distance mode, to develop verbal communication skills? Ieva Stupans University of New England, Armidale, Australia [email protected] Lindy Orwin University of New England, Armidale, Australia [email protected] Research has indicated that students perform at least as well in distance courses as in faceto-face courses across a number of measures including critical thinking, sharing of personal perspective, and task-focused interaction. To date, there has been little published comparison of student outcomes in distance and on campus courses across verbal interaction skills. This paper reports on two approaches being utilized in a unique Australian undergraduate pharmacy program to connect and engage students learning in a distance mode, successfully providing opportunities for developing verbal communication, including patient and caregiver counselling. The need to scaffold counselling skill development through role plays, scenarios, oral presentations and case studies has been previously been identified, and in an on campus cohort can occur through face to face interaction. The approaches described, and preliminarily evaluated, in this paper are the use of synchronous webconferencing software and virtual scenarios in virtual worlds. Keywords: Pharmacy, synchronous web-conferencing software, virtual worlds Introduction Prospective mature aged students who seek career change are often restricted through mobility and financial constraints. Alternatives to traditional classroom based teaching are their only option. In health disciplines, apart from nursing, distance or off-campus programs have not been widely available. The University of New England in Armidale, NSW, Australia, is the only higher education institution in Australia offering an undergraduate degree in Pharmacy by distance delivery. The university has been one of Australia s leading providers of distance education and has a well-developed distance learning environment. With traditional distance education modalities, supported through online learning managements systems (LMS), content is relatively easily presented to students in a number of ways such as PowerPoint with recorded audio, access to library readings or notes. Traditional, oncampus students have multiple opportunities to informally meet and interact both socially and professionally. They also have opportunities for small group face to face discussions. In our university, face to face opportunities for students studying in the distance mode in some cases are provided through mandatory intensive schools, of three or four days duration for each subject, undertaken on campus. More recently, in distance education, connection with fellow students and teaching staff who are not co-located at an intensive school can also occur. In this case connections and consequently discussions can be facilitated through approaches such as asynchronous discussion forums, video conferencing and most lately synchronous technology in the form of web conferencing. The pharmacy teaching team is exploring how to use the Annual Conference

3 latter technology to further connect and engage students efficiently and effectively in additional learning opportunities. Keeping in mind that the students interactions with the content, with their teachers and with other students are considered of critical importance throughout the development of learning opportunities (Garrison, Anderson, & Archer, 2001), our key question has is whether we can develop learning opportunities which for a distance cohort of students can be evaluated as providing outcomes, particularly around verbal interactional skills, similar to those which may be achieved for a traditional on campus cohort of students. Of significance for the research presented in this manuscript, is the aspect of skill development with respect to verbal communication. It is important to acknowledge that across all discipline areas, verbal communication, along with written communication, information literacy, working with technology, working in teams and numeracy is included in a suite of generic skills (Australian Chamber of Commerce and Industry and Business Council of Australia, 2002) relevant to employability. In the case of the discipline discussed in this paper, there has been the recognition that pharmacists, as health-care professionals, have responsibilities for therapeutic selection and also very importantly communication with doctors, and other health professionals, patients and caregivers. Verbal communication, including counselling, is a key aspect of the contemporary pharmacy role and is included in competencies outlined in the Competency Standards Framework for Pharmacists in Australia (Pharmaceutical Society of Australia, 2010). Patient counselling is the term employed by the pharmacy profession to describe client interactional activities. The goal of counselling is to achieve the safe and appropriate use of medicines and therapeutic devices. Relevant therapeutic discussions aim to promote adherence to the prescribed or recommended treatment regimen, to optimise therapeutic outcomes and are, therefore, pivotal for competency. Patient counselling may range from simply stating the dosage of a drug as it is handed over to the client, through counter prescribing for common ailments, to giving advice with regard to lifestyle and health promotion issues... clients will be equipped with the resources to use any medications more safely and effectively, (Pilnick, 2003). Key communication skills in the counselling process include building rapport, explaining, questioning and listening to pharmacy patients (Hargie, Morrow, & Woodman, 2000). In terms of communication skills, and in particular counselling skills, the need for scaffolding through learning opportunities such as role plays, scenarios, group assignments, oral presentations and case studies, within Australian university pharmacy programs has been identified (Owen & Stupans, 2007). As discussed above, on campus students have opportunities for small group face to face discussions and also role plays. Role plays, specifically simulated pharmacist-patient interactions between students and tutors/actors, are central to many initiatives described in pharmacy education literature as regards counselling (Planas & Er, 2008; Marja-Leena, Paavo, Nina, & Pekka, 2008; Rickles, Tieu, Myers, Galal, & Chung, 2009). Role playing not only provides formative opportunities for students to improve their ability to counsel patients about appropriate medication use but they are used for summative assessment. This form of assessment is perceived by students to be authentic and aligns the teaching and assessment with their future professional contexts (Mueller, 2008). Students further value role plays as a form of assessment at university because they are keenly aware that it is also used in the professional board registration examinations in Australia. Students in the University of New England distance pharmacy program live in a very geographically dispersed area. Strategies such as video conferencing to selected sites are not appropriate, however online technologies can be employed as all students are expected to have Annual Conference

4 online access, albeit dial up or high speed access is not specified. This paper discusses two of the technologies adopted to connect and engage pharmacy students in learning opportunities. The first of these, the use of videos of virtual scenarios created in a virtual world to engage students, model best practice and provide triggers for reflective activities and the second synchronous web-conferencing software (in this case, Adobe Connect Pro) to synchronously connect students and staff providing opportunities for verbal communication, specifically counselling practice. The Study and its Findings The design of the learning around verbal communication skills is based on applying core elements of blended learning design (Carman, 2002). We have adapted these two elements, the first of which is engaging online content. The second element is the live event which in our case may be in the virtual classroom or actual classroom where communication is facilitated through synchronous web-conferencing software or in face-to-face opportunities respectively. Online content Learning objects in the form of videos were produced modelling various counselling practices to build students questioning repertoire and critical reflection skills. These videos used a technique called machinima (a term created from a combination of the words machine and cinema), a process for animated filmmaking within a real-time virtual 3-D environment instead of using traditional human actors and physical sets. The digital sets were created in two virtual world platforms, OpenSim and Second Life. The actors were avatars, digital personas that can be customised, dressed as patients and pharmacists. Animations and props were used to support the interaction between the avatars in support of the script. A street scene for the community pharmacy and a hospital ward were created in 3D to be used as the sets to allow for various counselling opportunities to be filmed. Middleton and Mather (2008) describe machinima as an attractive option for the creation of academic video as a catalyst for learning due to factors such as ease of access to virtual movie sets and production techniques. Challenges were faced in the OpenSim environment. As an open source, free software platform that emulates the commercial Second Life platform closely, OpenSim was technically capable of providing all the resources needed. However, Second Life has a thriving web based marketplace and a large population of content creators making the purchase of props, animations and avatar costumes fast and extraordinarily cheap - often free or just a few cents. Since OpenSim has a much smaller, scattered user base, assets are much harder to find and customisation makes the building both slower and more costly. With contractor rates ranging from $50 to $120 per hour, an item that could be purchased for a few cents readymade in Second Life would have cost a few hundred dollars to make from scratch using contract builders, scripters and animators. The excellent hospital in the medical precinct on the Auckland node of the New Zealand Virtual World (OpenSim) Grid provided appropriate establishing shots for the hospital videos. The rest of the action was filmed in Second Life using mostly props and animations purchased from the marketplace and a pharmacy building produced by the University of South Australia OpenSim project. Land rent in Second Life was higher than OpenSim environments but still more cost effective for this pilot than the cost of hiring contractors to make the many specialized items Annual Conference

5 and animations in a timely fashion. Costs can be offset by sharing land with other institutions. For a production environment, re-use of a range of assets and animations may make OpenSim a more affordable solution as it could be hosted on local computers on campus. Costs were still dramatically cheaper than using human actors and sets in the physical world. The production process consisted of script writing by teaching staff to create authentic contexts that would stimulate discussion of relevant scenarios, issues and challenges. Feedback was sought from industry representatives. Professional voice actors were engaged through an agency to create the dialogue from the script. Story boarding of the scenes identified the requirements. Sets, avatar actors and costumes, animations and gestures were readied in the virtual world and each scene filmed. On campus video editing staff collated the audio, video clips, titles and credits into the final videos. The scenarios (exemplar screen shot displayed in Figure 1) are being incorporated into the university s LMS to model practice and provide students with discussion triggers. Students may choose to watch these at times convenient to them and then participate in asynchronous discussions and/or post personal reflections. Scenarios may have alternate endings to demonstrate multiple approaches to provide comparison points for student discussion. Initial evaluation of online content Initial evaluation of the approach with the first fully produced scenario video has been undertaken. Students were recruited in face to face classes- either at intensive schools or in traditional face to face classes for on campus students. Students were provided with ipads displaying the video, and were then encouraged to discuss the scenario is small groups of two to three students. All students who were invited to participate in the survey did so through individually completing a paper-based student survey, results of which were manually collated. Findings Results from the survey (n=52 students) indicated that 90% of students believed that the scenario was enriching their learning. Many of the free text comments were similar to the following seeing the dialogue made it easier to envisage a real patient and pharmacist ; initiated discussion with others about the communication and interaction between the pharmacist and patient and we discussed what we thought of the scenario and how we would feel in a similar situation. Improvements were also suggested. These included several comments regarding the need for an opportunity to discuss more afterwards or interact more with it. It was interesting to note that 46% did not feel as if they were watching communication of real people in Second Life, however the literature suggests that the learners in the Net Generation don t differentiate between the real and virtual world or simply sees the virtual world as an extension of the real world (Frand, 2000). Our findings may reflect the proportion of our students who are mature age as opposed to Net generation. Initial results indicate that the online content developed was engaging and has encouraged us to work on the completion of several more scenarios. Annual Conference

6 Figure 1: Screen shot showing pharmacist avatar in the pharmacy. The virtual classroom Synchronous web-conferencing software is being used for distance students to provide live virtual tutorials in which students can acquire and practice counselling skills in the same role playing exercises typically used in traditional classrooms for students studying in an on campus mode. Synchronous web-conferencing software provides, through online access, a shared screen, and text and voice discussions. Students and staff can connect in real time allowing natural conversations.this means that students can participate in role plays and feedback to those undertaking the role play can be provided by other students and by teaching staff. Second year distance students participated in 13 online tutorials facilitated through synchronous web-conferencing software. Within these tutorials each student participated in three role play exercises. The intensive school period (held specifically for distance students) did not include additional formal counselling opportunities. Students in the traditional mode had either one or two opportunities each to practice counselling during the semester. They did not participate in virtual tutorials. The students studying in the traditional mode were also encouraged to undertake role play with each other outside formal teaching sessions. Assessment of distance students counselling skills was also undertaken in a synchronous web-conferencing software session. Preliminary evaluation of student outcomes for use of synchronous web-conferencing as opposed to face to face tutorials to support learning of counselling has been undertaken through review of student marks for the counselling assessment (results displayed in Figure 2). Students studying in the distance mode do not appear to be disadvantaged by having minimal access to face to face tutorials for practicing their counselling skills as opposed to those undertaking regular face to face counselling role play exercises. Students were not randomized to study mode and hence, pre-existing differences between students in each study mode, may have contributed to the findings. Some minor issues remain to be resolved including scheduling of sessions for students who have chosen to study flexibly at times which suit them. However, the value of synchronous web-conferencing software supported discussions is attested to by unsolicited comments in unit feedback such as The use of new learning media was a great asset...worked very well and provided greater access for the distance students and by requests Annual Conference

7 from these same distance students to set up student-led sessions for other subjects in which students were enrolled to permit synchronous web-conferencing supported discussions to enable collaborative problem solving and support of one and other. Figure 2: Distribution of marks for individual students for counselling assessment. Students studying in the distance mode (n=16) had practiced prior to the examination in tutorials supported by synchronous web-conferencing software supported tutorials. Students studying in the traditional mode (n=14) had practiced in face to face tutorials and informally with each other. Conclusions The approach we have taken with our distance students is one of a blended learning environment with integration of classroom face-to-face learning experiences, virtual learning experiences afforded through synchronous web-conferencing software and engaging online learning content. Recent publications have described similar issues around counselling and have discussed the implementation of a 3D virtual learning environment, with students undertaking counselling exercises in Second Life in an online Human Services counselling program (Walker, 2009). Recognizing issues faced by students with potentially poor Internet connections and graphics cards with limited capability, the program costs associated with use of Second Life, and the very steep learning curve associated with requiring students to engage in Second Life, our teaching team has adopted a different approach which has indicated excellent potential. With respect to the work presented in this paper regarding synchronous web-conferencing software and virtual scenarios, preliminary evaluation indicates effective implementation into the range of learning opportunities provided for these distance students. Outcomes appear to be similar to those which may be achieved for a traditional on campus cohort of students Annual Conference

8 References Australian Chamber of Commerce & Industry and the Business Council of Australia. (2002). Employability skills for the future. Canberra: Department of Education, Science and Training. Carman, J.M. (2002). Blended learning design: Five key ingredients. KnowledgeNet. Retrieved October, 2012 from Learning Design_1028.PDF Frand, J. (2000). The information-age mindset: Changes in students and implications for higher education. EDUCAUSE Review, 35, Garrison, D. R., Anderson, T., & Archer, W. (2001). Critical thinking, cognitive presence, and computer conferencing in distance education. American Journal of Distance Education, 15(1), Hargie, O. D. W., Morrow, N. C., & Woodman, C. (2000). Pharmacists evaluation of key communication skills in practice. Patient Education and Counseling, 39(1), Jensen, C., Farnham, S. D., Drucker, S. M., & Kollock, P. (2000, April).The effect of communication modality on cooperation in online environments. Proceedings of CHI 2000 (pp ). The Hague, Netherlands. Marja-Leena, H. R., Paavo, T., Nina, K., & Pekka, I. (2008). Feedback in patient counselling training Pharmacy students opinions. Patient Education and Counseling, 70(3), Middleton, A. J., & Mather, R. (2008). Machinima interventions: innovative approaches to immersive virtual world curriculum integration. ALT-J: Research in Learning Technology, 16(3), doi: / Mueller, J. (2008). Authentic assessment toolbox. Retrieved 1 st December, 2011 from faculty.noctrl.edu/toolbox/index.htm Owen, S., & Stupans, I. (2007). Experiential placements in Pharmacy (Carrick Institute DBI final report). Pharmaceutical Society of Australia. (2010). Competency standards framework for Pharmacists in Australia. Deakin, ACT: Author. Pilnick, A. (2003). Patient counselling by pharmacists: Four approaches to the delivery of counselling sequences and their interactional reception. Social Science & Medicine, 56(4), Planas, L. G., & Er, N. L. (2008). A systems approach to scaffold communication skills development. American Journal of Pharmaceutical Education, 72 (2 Article 35), Rickles, N. M., Tieu, P., Myers, L., Galal, S., & Chung, V. (2009). The impact of a standardized patient program on student learning of communication skills American Journal of Pharmaceutical Education, 73(1 Article 14), Walker, V. L. (2009). 3D virtual learning in counselor education: Using Second Life in counselor skill development. Pedagogy, Education and Innovation in 3-D Virtual Worlds, April. Copyright 2012 Ieva Stupans and Lindy Orwin. The authors assign to HERDSA and educational non-profit institutions a non-exclusive license to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The authors also grant a non-exclusive license to HERDSA to publish this document in full on the World Wide Web (prime site and mirrors) and within the portable electronic format HERDSA 2012 conference proceedings. Any other usage is prohibited without the express permission of the authors. Annual Conference