MLS : CHAPTER 3 DISCUSSION & HOMEWORK

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Susan J. Beck, Ph.D., MLS(ASCP)CM and Vicky A. LeGrys, D.A., MT(ASCP) Division of Clinical Laboratory Science, The University of North Carolina at Chapel Hill Copyright 2014: The American Society for Clinical Laboratory Science

Learning Activities

The material presented in this chapter should enable the learner to:

1. Describe the sequence of steps involved in planning an instructional activity. 2. Choose a learning activity that will effectively implement a given course objective. 3. Analyze current lecture techniques and suggest ways to improve them. 4. Discuss the advantages and disadvantages of the various learning activities. 5. Describe a flipped classroom learning activity. 6. Distinguish role-playing and simulations by giving an example of each. 7. Describe the benefits of cooperative learning and problem-based learning compared to more

traditional learning activities such as the lecture. 8. Design instructional resources using the criteria given. 9. Discuss the effective use and advantage of the various instructional resources described in the

text. 10. Given an example of a specific instructional aid, evaluate the effectiveness of the aid in

enhancing mastery of the objective by the learner.

THE INSTRUCTIONAL SEQUENCE

Goals: The first step in planning an instructional activity is to identify goals. Goals are statements that describe the general knowledge skills or attitudes that the learner will possess after the instructional activity.

Objectives: The next step in instructional planning is writing objectives. Objectives are statements that describe the specific learning outcomes of an instructional activity and they are written in greater detail than goals. Objectives specify the observable knowledge, skills or attitudes that the learner is expected to exhibit after completing an instructional activity. Objectives serve to communicate the instructor's intent for a particular learning experience.

Learning Activities: Instructional activities or learning activities are chosen to help the learner master the objectives. They include such things as lectures, laboratory exercises, demonstrations, and online instruction.

Evaluation: An evaluation process should be planned to tell the instructor whether or not the learners were able to master the objectives and whether or not the instructor's approach was effective in assisting learners.

INTRODUCTION Once the goals and objectives for a particular learning experience have been developed, the instructor can select the resources and learning activities that will enable learners to master the objectives. The instructor may choose a variety of learning activities to facilitate the learner's mastery of the objectives. Learning activities described in this unit include:

 Lecture

 Flipped classroom

 Case studies

 Simulations and role playing

 Cooperative learning

 Problem-based learning

 Online instruction

 Student laboratory

THE LECTURE METHOD The lecture method represents the most popular learning activity used in the college classroom. It is the activity that is most familiar to both the learner and the instructor, particularly in formal educational programs. Advantages:

 It is the most efficient means of disseminating large quantities of information to any size group.

 The instructor can summarize and organize information from various sources and present material that is often more current than the learner's textbook.

 The instructor can augment, clarify, and highlight topics covered in the textbook and relate the material to other topics covered in the course or in other courses.

 The instructor can convey enthusiasm and interest about a topic.

 From a learner's perspective, the lecture often requires minimal input or preparation.

Limitations:

 Because the learner is passive, it is estimated that approximately 80 percent of what is presented in a lecture is forgotten within 2 months.1 To state it bluntly, "the lecture at its worst consists of transferring the notes of the teacher to the notebooks of the learners without passing through the minds of either."2 This kind of presentation promotes memorization, rather than problem solving. For this reason, the use of the “flipped classroom” where in the class time is spent on small group discussion and problem solving exercises is gaining popularity. 3,4

In order to make the lecture more of an active learning process, the instructor should ask questions during the lecture. Asking questions can serve many purposes: it involves the learner, it provides a mechanism of feedback for the instructor, and it provides reinforcement and review of the material. Techniques for effective use of questioning during a lecture include:

 Asking questions at various cognitive levels. Recall questions are useful for review or as a check of comprehension but should be used in moderation because they tend to promote memorization.

 Designing questions to elicit more than a simple "yes" or "no" response. Mechanistic questions and open-ended questions asking "how?" or "why?" are useful in assessing the learner's perception of what has been presented and in promoting interpretation skills. Questions can also be designed to promote analysis, synthesis and evaluation. Often these types of questions do not have one answer or even a correct answer and they are asked solely to challenge the learners and promote problem solving.

 Asking questions in a non-threatening and informal manner, providing adequate time for responding. The instructor should clearly state the question and wait several seconds after asking a question to elicit responses. If a learner is unable to answer a question, often it can be reworded or rephrased to draw the learner to the correct answer. In addition, instructors should avoid answering their own questions as this tends to inhibit learners from responding.

 To minimize the problem of unresponsive learners or having the same learners repeatedly responding, the instructor can call on other learners in the class in a rotating manner. While this may threaten a shy learner, this approach may provide an opportunity to strengthen the learner's communication skills.

 Audience response systems allow the learner to give rapid and collective feedback to the instructor and stimulate participation during the lecture. The audience uses a variety of personal computing devices such as smart phones, laptops or hand held clickers to provide real time responses. The responses can be entered anonymously or linked to the learner’s name and can be tabulated instantaneously and easily displayed. The use of the response systems increases learner engagement and also provides immediate feedback to the instructor regarding learners’ comprehension of the presented material. 5

 Another technique that may be useful in increasing learning participation, retention, and comprehension of the lecture material is for the instructor to pause a couple of times for about 3 minutes during the lecture. During this time, learners are asked to review their notes and confer with fellow learners for clarification of the material. At the end of the interval, the instructor can ask if the class has any questions.6

Organization of the Lecture The development and organization of a lecture should facilitate learning and stimulate interest. Effective use of lecture time is an important quality in teaching, especially in a clinical laboratory science curriculum. The dilemma of trying to cover everything can lead to frustration for both instructor and learner. Some of this pressure can be relieved by organizing the material and preparing handouts Introduction The lecture is most effective if it is organized into an introduction, body, and conclusion. The purpose of the introduction is to arouse curiosity. The introduction should strive to show the learner that what is going to be presented is both important and relevant. One way to do this is to begin the lecture with a case study or problem that can be answered or solved by the lecture material. The introduction should relate the present lecture to past lectures as learning is enhanced when new material is associated with previously acquired information.7 Many instructors summarize the previous lecture as a foreword to the present lecture. In addition, the introduction should provide insight into the lecture's organization. Body The body of the lecture should facilitate the retention and application of information and should promote problem solving. Repetition of key points increases the chance that the material will be retained. Learners retain images longer than they do words; therefore, using instructional aids can facilitate learning. Instructional aids also add variety to the lecture. Further, the use of relevant examples in a lecture enforces the importance of the material and encourages learners to apply the information to new situations. Conclusion In the conclusion, the instructor should summarize the key points, draw the lecture to a close, and describe future lecture plans. The instructor may want to stop the lecture 5 minutes before the end of class, to give the learners an opportunity to review their notes and compare their notes to the objectives. The instructor can then answer any questions that arise from the review. The conclusion of the lecture should not occur 5 minutes after the period is officially over; it is better to end the class a few minutes early than to habitually run over the allotted time. After class, it is helpful to make notes concerning the effectiveness of the lecture, any corrections, learner additions, or ideas to improve the lecture.

Delivery of the Lecture A well-delivered lecture can help make the driest of topics become interesting. Conversely, a potentially interesting topic and motivated learners can be rendered dull and listless by a poor lecturer. One of the most important characteristics of a good lecturer is enthusiasm. Maintaining enthusiasm is a continual process which may become more difficult when the lecture material is given repeatedly. For that reason, old lectures should be revised every year to update the material and to develop a fresh approach. To improve the delivery of the lecture, the instructor should:

 Vary the pitch and tempo to convey enthusiasm and energy.

 Avoid reading the lecture notes to the class.

 Speak with sufficient volume to convey confidence and be audible in the back row of the classroom.

 Talk to the learners, not at them.

 Establish eye contact with the audience to assess learner comprehension of the material and to determine whether or not the learners have become bored or distracted.

 Pace the presentation so that learners to take notes and process the information. Pauses can be effective and allow time for note-taking as long as they are not used excessively.

 Avoid nervous phrases and habits. Phrases such as "Um" and "okay" and habits such as tapping a pencil and waving a pointer are distracting to the learners and detract from the quality of the lecture. Lecturers may need to make conscious efforts to remove these habits and phrases from their speech patterns.

 Periodically, move around the front of the room but do not pace or wander aimlessly.

 Assume good posture and expressive facial features that have a positive impact on a lecture. Recording the Lecture There are a variety of technologies available to allow a lecture to be recorded (“captured”) live and made available on line to learners. Studies have shown that learners prefer courses that enable this feature. 7 Advantages to the learner include: the ability to access the lecture anytime; the ability to fast forward over content that is familiar, and to be able to pause, rewind and review content that is difficult. Disadvantages to lecturing capturing include concern that students will not attend classroom lectures or may not fully engage in the classroom lecture knowing that a recorded session is available. 8

THE FLIPPED CLASSROOM In a flipped classroom, new material is presented prior to the class meeting using online video lectures, podcasts or reading assignments. The class time is then spent integrating the basic knowledge into higher level cognitive skills such as analysis, application, evaluation and synthesis through the use of

case studies, small group discussions, and problem solving. Research has shown this technique to be effective in increasing student learning 3,4,9,10 In order to be successful the experience should include a mechanisms for making the students accountable for the pre-class assignments and evaluating their comprehension using online quizzes, worksheets or some other assignments which contribute to the final course grade.3

CASE STUDIES Case studies are effective learning activities to:

 promote interpretation and problem-solving skills.

 illustrate disease states or problems in the clinical laboratory such as instrument malfunctions, quality assurance problems and management situations.

To use case studies effectively, the instructor should:

 use objectives that emphasize the knowledge, skills and attitudes that are relevant to clinical laboratory practice and de-emphasize the importance of providing the correct diagnosis and/or treatment for the patient.

 modify the material to emphasize the relevant points, and delete material that is beyond the knowledge of the learner or is irrelevant to the objectives developed for the case study.

There are many sources of case studies, some of which are listed here:

 Journals such as the American Journal of Hematology

Clinical Chemistry Clinical Laboratory Science

Journal of Clinical Microbiology Laboratory Medicine New England Journal of Medicine

Transfusion

 Professional Associations

 Medical Grand Rounds or similar conferences

 Professional meetings

 Actual problems encountered in the clinical laboratory

SIMULATIONS AND ROLE- PLAYING Simulations and role-playing represent learning activities that are specifically designed to promote problem solving via learner involvement. Simulations create a structured, realistic situation in which

learners "play" themselves. In role-playing, the learner assumes the role of someone else, improvises, and solves a problem. Simulations and role-playing:

 provide a risk-free environment for promoting problem-solving skills and improving communication techniques

 are most useful for developing learning outcomes in the affective domain

 are most effective when they represent a situation that the learner will be likely to encounter

 can be time-consuming to develop and implement.

Simulations. The types of simulations most applicable to clinical laboratory science learners include:

1. Written. Given a written situation, the learner responds on paper. Feedback is given based on the learner's response.

2. Online. This is similar to written simulations; however, it is more versatile in its branching

capabilities.

3. Actual. A real-life situation is simulated. An example would be to create a point of care laboratory in the student laboratory. A simulation of this sort would allow the learner to evaluate instrumentation, perform quality control and instruct others in the proper performance of the assays.

Role-Playing. In role-playing, only a few learners participate while others observe. Role-playing episodes are short, usually less than 15 minutes, and deal with a specific problem. An example of a role-playing situation would be confronting another clinical laboratory scientist concerning unethical performance:

You observe a laboratory practitioner recording a result for a quality control test that you know she did not perform. As her:

a) co-worker, what will you do? b) supervisor, what will you do? In order to create an effective simulation or role-playing situation the instructor should:

 Set a time limit.

 Base the simulation or role-playing on defined objectives.

 Create the background by providing descriptions of the characters and the situation.

 Use volunteers in role playing and involve the audience by asking their reaction to the events.

 Follow the simulation and role playing by a discussion of what occurred, what can be learned, and how it could be applied to new situations.

 Focus on the role, not the person assuming the role, in critiquing the role playing.

COOPERATIVE LEARNING In an effort to increase the learner’s responsibility for his or her own learning and to develop problem solving and communication skills, some clinical laboratory educators are developing cooperative learning (CL) activities to supplement traditional learning strategies.11 CL is a type of learning activity involving a group of learners working together to solve a problem, such as a case study. Cooperative learning is useful for:

 promoting affective and higher cognitive skills

 increasing communication skills

 developing problem solving skills In CL, the learner assumes the role of both the instructor and the learner. Using knowledge previously acquired in the curriculum, the learner supplements it with additional information learned independently and then shares the new knowledge with the group, thereby teaching his or her peers. Oral and/or written presentations by the group are often a part of CL

PROBLEM-BASED LEARNING An extension of cooperative learning is problem-based learning (PBL). In PBL, learners working in small groups, are presented with a problem to solve. The difference between CL and PBL has to do with amount of prior knowledge the learner possesses. In PBL, the learners have not received any prior lectures on the content of the problem, or any reading assignments. An example of the problem would be a case study, clinical correlation, quality control problem or instrumentation troubleshooting.12 The goal of the PBL activity is for the learner to determine what information he or she does not know and what information needs to be learned independently in order to resolve the problem. The learner identifies the appropriate resources such as textbooks, journals, other learners and faculty and acquires the information. The instructor serves as a facilitator to the group process, not necessarily as a content expert. Proponents of PBL assert that while learners may cover up to 20% less in content compared to the traditional lecture format, this loss in content is offset by the numerous benefits of PBL for the learner. These benefits include 12:

 developing independent learning skills

 learning to communicate effectively with colleagues

 learning to function effectively in a group

 learning to solve problems, all of which are necessary skills for the future practitioner

ONLINE INSTRUCTION Online instruction is a form of individualized instruction in which the learning is learner paced and the information is usually presented in small, self-contained units. Learners are more active in this format of learning compared to the lecture format, because often they are required to respond frequently and are given immediate feedback Online instruction is most effective when the instructor closely monitors the learner's progress and aids the learner in the application of the knowledge gained. This topic is discussed in greater detail in the chapter on continuing education.

STUDENT LABORATORY Depending on the curriculum, a learner may spend a great deal of time in a student laboratory. The purpose of the student laboratory is to provide a structured setting in which students learn and practice laboratory procedures. The advantages of the student laboratory are:

1. The student has the opportunity to integrate theory with psychomotor skills in a non-threatening environment.

2. Basic skills can be repeated and evaluated until proficiency is achieved and the student is ready

to begin clinical laboratory rotations.

3. The student laboratory provides an opportunity for individualized instruction and feedback.

4. The student laboratory provides an opportunity for the instructor to recognize those students who do not possess the appropriate skills necessary to continue in the clinical laboratory science program.

Some limitations of student laboratories are:

1. They can be time-consuming for the faculty and costly in terms of reagents and equipment.

2. They have the inherent potential for keeping the student at the lower cognitive and psychomotor levels. The labs, at worst, can turn into "cookbook" exercises.

To improve the student laboratory experience, the instructor should:

1. Pre-run the exercises prior to the laboratory period. At that time, the instructor can discover what works, what does not work, and what needs to be modified.

2. Develop a laboratory manual. A laboratory manual should include objectives in all three

domains, laboratory procedures, study questions, worksheets, and evaluation criteria. It is

helpful to have the manual reviewed by someone outside of the subject area for clarity. The evaluation criteria should be clearly stated so that the students are aware of what is expected of them. The laboratory procedure should be given to the students well in advance of the laboratory period so that they can come to each session prepared.

3. Use the pre-lab discussion period for reinforcing theory and demonstrating any new procedures.

A post-lab period may be needed after some lab sessions to analyze data and allow the students to evaluate the assays they performed.

4. Correlate the exercises with the lectures in order to reinforce both learning activities.

5. Facilitate progression of the student's skills. Early sessions emphasize basic skills and techniques,

and adequate time should be provided to allow the student to master these techniques. After mastery has occurred, the emphasis of the laboratory should be on problem solving.

INSTRUCTIONAL RESOURCES TO FACILITATE LEARNING ACTIVITIES Used in the proper context, instructional resources can augment learning activities. They do not exist independently, however, and must be related to the goals and objectives of the course. There are a variety of course management systems that electronically coordinate teaching materials, such as Blackboard , Moodle and Sakai. These systems consolidate course documents, links to online resources, discussion boards, email, grading centers and test administration into one website location. Some of the more commonly encountered types of instructional resources in clinical laboratory science include:

 Course syllabus

 Textbooks

 Handouts

 Online materials Course Syllabus If the instructor is preparing an entire course, either for use in a CLS program or for continuing education purposes, the instructor should organize the learning activities in the form of a course syllabus. Using the objectives as a guide, the instructor can develop a course syllabus which reflects a logical sequence of topics progressing from basic information to complex theories and application. The instructor then allots each topic a specified amount of time. Often it is difficult for the new instructor to know how much time to devote to certain topics. In this situation, it is useful to acquire course syllabi from instructors in other clinical laboratory science programs to provide a rough estimate of time. An instructor may find that once the course begins, the schedule is unrealistic and requires revision. The

course materials can be distributed in paper form and/or centrally located on a course management system. A course syllabus can include the following information for the learner:

1. Course name, number, scheduled meeting time, and location 2. Instructor's name, office hours, and office location, email address and telephone number 3. Course goals 4. Course schedule of topics and applicable reading assignments 5. Assigned textbook and any recommended text(s) 6. Course assignments and test schedule(s) 7. Policy for late assignments and missed examinations 8. Policy for the use of laptops and smart phones in the classroom 9. Objectives. Some instructors prepare course objectives as well as individual topic objectives for

distribution at the beginning of the course. Others prefer to distribute the specific topic objec- tives at the time of presentation

10. Honor Code policy for the institution, where applicable Textbooks Many instructors select a textbook or reference materials for their course during the early planning stages. Print or electronic textbooks can be a source of remedial information for learners or can provide additional information beyond what is covered in the classroom. The textbook should be appropriate for the learner's level of comprehension. Often the textbook becomes a resource for future learning either in the student's clinical rotation or on the job. In many disciplines of clinical laboratory science there are standard textbooks that have a wide circulation; however, instructors should not feel compelled to adopt such a book unless it is consistent with their goals and objectives for the course. Many instructors find there is no one book which fits their needs and choose to provide course packets or assigned readings. Course packets are collections of articles selected from various textbooks, journals, or the instructor's own material that are reproduced and distributed to the learners. In using a course packet, the instructor needs to carefully examine the copyright laws. An alternative to course packets is assigned reading from texts and journals placed on reserve in the library or available with an electronic reserve links. Regardless of what resources are selected, the instructor should take the time during the first class period to go over the materials with the learners, explaining their purpose and how they are to be used. Feedback from the learners on the text or other reading assignments should be solicited and considered in future selection. Handouts Handouts, prepared by the instructor, and distributed prior to the learning activity, can facilitate the transmission of information. The handout can contain an outline of the topics for the lecture presentation, provide space for note-taking and include diagrams or tables that may be presented during the lecture. Providing the learner with diagrams or tables increases efficiency during the class time because the instructor does not have to allot time for the learners to copy the information into

their notes. Another advantage to providing diagrams or tables on the handout is that the instructor does not have to be as concerned with visibility if the image is on a computer slide presentation. Instructors can provide short statements concerning content in the handout, but they should avoid reprinting their lecture word for word, because learners are less likely to process the information during the class if they do not have to take any notes. The use of laptops by students in the classroom to take notes is problematic. Students tend to prefer using laptops versus hand writing for note taking; however their presence in the classroom can be distracting and lead to multitasking. A study revealed that students using laptops for notetaking had poorer outcomes on conceptual questions compared to students who took notes by hand . 13

The researchers suggested that laptop notetaking did not allow for processing of information because the notes tended to be verbatim transcripts of the lecture versus a synthetic process of information found in hand written lecture notes. 13

Online Materials Computerized multimedia can facilitate the retention of material by creating a visual image, clarifying abstract ideas, creating realism, and providing variety. Presentation software such as Microsoft PowerPoint are easy to use and incorporate downloaded graphics, animation, sound and videoclips. Other presentation software such as cloud based Prezi allow for extensive animation and creativity options. 14

For an effective presentation, the instructor should:

 Select a slide design that is simple and does not distract the learner from the information provided.

 Select a large enough font for clear visibility.

 Avoid crowding the slide with too much information. Text should be restricted to key concepts presented in bullet format, not complete sentences or paragraphs. Graphs should be designed to summarize data, or present trends versus individual points.

 Adhere to copyright laws.

 Avoid reading the material on the slides to the learners. Elaborate on the textual material, and describe the information presented in any images, graphs or tables.

 Project the individual slides for a sufficient amount of time for the learners to process the information.

SUMMARY After developing goals and objectives, the learning activities should be planned and organized to facilitate the learner’s mastery of the objectives. Objectives in different domains may be best addressed using a particular learning activity. For example, psychomotor skills are best taught in a student laboratory, and affective skills can be developed using simulations and videoclips. Using a variety of learning activities helps to address different domains and levels of objectives and increase the learner’s

interest and involvement in the process. Instructional resources can enhance learning activities when properly used. In selecting the resources, the following questions should be considered.15

 Is the instructional aid appropriate for the goals and objectives of the course?

 What are the relative advantages and disadvantages of the particular instructional aid?

 Does the instructional aid communicate the necessary concepts effectively?

 Is the instructional aid accurate and current?

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