Module Introduction through Lumi

Hello!

I am designing a blended learning course for adult learners to refresh and strengthen their knowledge of CT anatomy (also called cross-sectional anatomy). This means finding anatomical structures on images that were acquired with a CT scanner. Looking at images this way is quite different than what we think of as regular X-rays. I am using the LMS Canvas which has impressed me with its clean, simple, intuitive design and has many of the features of robust LMS. I organized the course content into modules, and embedded H5P content created in Lumi.  The first couple of modules of this course focus on refreshing the learner’s knowledge of CT images and 2D radiographs. Being comfortable with orientating oneself to the various views available and understanding anatomical directional terms that are used to describe locations provides a strong foundation for learning cross-sectional anatomy.

After the foundation is set, subsequent modules focus on identifying anatomical structures within the different body cavities. Each module will cover a different body cavity: thorax, abdomen, and pelvis. By the end of the course, the learners should have a solid understanding of cross-sectional anatomy. The learners will be able to explain the significance of this knowledge as it is applied to Image Guided Radiation Therapy, which I discussed in my course profile post.

All the didactic learning and assessment will be delivered online with weekly synchronous “class meetings”. This is a flipped classroom model, where the weekly class meetings will provide some context for the didactic material. I divided the course into weekly sections, and then put each week of work into its module. Completing one module each week should help the students group the learnings and help with retention. When designing the modules, I aimed to have each of them a copy of themselves to keep the structure simple and predictable. Each module includes a course presentation which includes the didactic information in the form of an interactive video, some activities to reinforce the learning (instant feedback), and an assignment worth a small number of marks. I included the assignment at the end of the course presentation so that the learners see it right away and they do not need to click around inside the LMS to access it. I will encourage collaboration on these written assignments, as they usually do anyway. Each module will contain the course presentation, an assignment, a short quiz (to show independent learning), and a weekly discussion. An exception is Module 1 which contains two course presentations. Module 1 Session A and Module 1 Session B can be viewed by clicking these links. After our readings last week, I have realized the importance of building community inside the virtual classroom. I have also witnessed this happen with this class, as we communicate with each other via Discord. Elements to the class that I will add to foster community are collaboration on assignments and discussion boards, providing a forum for a Q&A space as Katia did for us, and encouraging discussion in our weekly synchronous class meetings. We will also have weekly lab sessions when we meet together within the clinical environment to practice the image-matching software.

Working within Lumi was a fun yet time-consuming process. This is my first exposure to H5P, so a little research beforehand was also required. I loved the creativity involved, yet learning this new platform and its limitations took more time than I would have expected. I am still unsure if I completely understand, and I put a lot of things down to “user error”.  I look forward to feedback from the class about the 2 Lumi Course Presentations created for my course prototype.

Stepping Out 2024-02-13 01:42:29

**Long Post Alert**

I enjoyed the readings for this week’s class as they provided clarity into what I was trying to achieve in my online classroom. Over the years, I have learned and applied different engagement strategies, however, my attempts to engage the students within an interactive online environment were not always as successful as I would like.
Completing the readings made me realize that what was missing was community. Yes! This is what I was trying to achieve…. the sense of community. Without being intentional about building a class community was a missed opportunity to properly engage the learners. Making this commitment as an educator means being mindful to who is in your class, and creating interactions that foster relationship building.
How could I have missed that!? I think the answer to that question is, that other than one year during COVID, I have always had a blended classroom environment. (For those that are surprised it was only one year, I will explain. The School of Radiation Therapy is located within a healthcare facility, so the school follows the regulations of that facility. In-class learning was allowed to take place within the provincial masking and distancing guidelines. Since our class sizes are typically quite small, it was not difficult to comply with these rules).
Since the students are in class at times, I believe I relied on these interactions as the only source of community building, leaving the online environment lacking its community structure. Perhaps, this is the missing piece that will help increase online engagement.

The course I am designing is a hybrid/blended course in that it includes in-person lab sessions. All didactic learning will take place online.
Our blog question of the week is What forms of student/student-instructor interactions do you plan to implement in your course prototype? As I plan these interactions, I will be intentional to include relationship building opportunities between the students, as well as between the students and the instructor. In addition, the learning objectives and corresponding activities are guided by Bloom’s Taxonomy learning theory as it aligns well with healthcare programs.

The interactions I have planned to include are listed below including justification for their inclusion and any guidelines or assessments attached.

Weekly synchronous class meetings – including polls and MC review questions, exit slips
Justification: students and instructors engage in real-time interaction, which offers several benefits:
Affective domain: Synchronous classes facilitate social interaction among students and between students and instructors. This interaction fosters a sense of community and belonging which can enhance the overall learning experience and reduce feelings of isolation. The instructor will aim to foster intrinsic motivation and assist in maintaining a positive attitude towards learning. The goal is to encourage students to engage in learning for the inherent satisfaction it brings, rather than relying solely on external rewards or pressure.
Guidelines: there are guidelines for the instructor as well as the participants.
1) The class instructor needs to be prepared to facilitate the meeting. The instructor will have 2 topics prepared:
a. Responses to the previous week’s exit slips
b. A topic of the week to discuss
2) The instructor must create a safe space, whatever that means for the particular class. Speaking from experience, each year brings a different set of students from the last. What one group needs, another may not. The goal is to make the learners feel valued, respected, and empowered to participate fully in the learning process. Creating a safe space:

Set clear expectations and ground rules for respectful behavior in the online classroom. Emphasize the importance of kindness, empathy, and active listening. Model respectful and inclusive behavior.

Encourage the learners to ask questions, share their thoughts and experiences, and express their opinions in a non-judgmental environment.

Acknowledge students’ contributions and efforts. Provide constructive feedback in a supportive and encouraging manner.

Include diverse perspectives and voices in the curriculum and learning materials.

Be flexible and responsive to students’ needs and concerns. Listen actively to their feedback and be willing to adapt your approach as necessary to better meet their needs.

3) The students must follow the guidelines set out by the instructor regarding respectful communication and behaviour.
4) The students are encouraged to utilize the exit slips to communicate any questions or concerns in a safe way

In-person clinical lab sessions
Justification: these sessions are important for all three learning domains:
Affective domain – Not only does patient care need to be comprehensive, and delivered by skilled staff, but it also must address the psychosocial needs of the patients. Empathy and compassion also contribute to patient outcomes. Online environments cannot transfer these lessons adequately.
Provides an additional environment for relationship building between the instructor and the learners.
This is the instructor’s opportunity to teach honesty, transparency, and integrity to the learners through role modeling.
Psychomotor domain – Adult learners do well with practical applications where the didactic knowledge can be applied and transferred to practice. labs must happen before any clinical placement so the learners can practice using the matching software (this cannot be done online as this software cannot be accessed outside of the institution).
Cognitive domain – learning the image matching software, developing troubleshooting skills

Assessments/guidelines
Following each biweekly lab session, each student will participate in a debrief session. Debriefs following simulations in healthcare are an evidence-based practice that:
• allows participants to reflect on their performance during the simulation. It provides an opportunity to identify what went well and what could be improved. This reflection promotes active learning and helps participants to consolidate their knowledge and skills.
• provide emotional support to participants who may have experienced stress or anxiety during the simulation. Discussing their experiences in a supportive environment can help participants process their emotions and build resilience for real-life clinical situations.
• Are used to discuss evidence-based practices and guidelines relevant to the simulated scenarios. By aligning their actions with best practices, participants can improve the quality and safety of patient care.
• provides an opportunity for facilitators to provide constructive feedback to participants. This feedback can help participants understand their strengths and weaknesses and track their progress over time. Additionally, debriefing sessions may be used for formal assessment purposes, such as evaluating participants’ clinical competencies.

Weekly student-led discussion boards – Discussion groups will be encouraged. Each week one student will be responsible for posting a new topic and moderating the discussion.
Justification:
Encourages active participation
Develops critical thinking
Can provide a sense of belonging and pride of ownership
Assessments/Guidelines:
A small portion of their final grade is attached to student participation, including this activity. If the learner is having a hard time thinking of a relevant topic.

Collaborative student activities/Assignments – Students will be assigned to work together on a couple assignments, including the final assignment
Justification:
Collaboration encourages students to discuss and analyze course materials, leading to a deeper understanding of the subject matter. Through collaboration, students can fill gaps in their knowledge, gain new perspectives, and reinforce their understanding of key concepts. It continues to build a sense of community. Students continue to build applicable vocabulary and learn to work with a teammate. This mimics the real world of radiation therapy where RTs are always working with partners/teams
Assessments/Guidelines:
Formative assessments for smaller assignments. However final activity is part of the summative assessment.

Phew! That’s it. In my head, it all makes sense and covers all the bases….

Course Profile for Cross Sectional Anatomy for IGRT in Radiation Therapy

Background information

Radiation therapy is a common cancer treatment that uses high-energy x-rays to kill cancer cells or stoCancer treatment in a modern medical private clinic or hospital with a linear accelerator. Professional doctors team working while the woman is undergoing radiation therapy for cancerp them from growing and dividing. It’s a localized treatment, meaning it targets specific areas of the body where cancer cells are present while minimizing damage to healthy surrounding tissue. The treatments are individually designed for each person’s anatomy and treatment target area; thus precision is required to deliver the planned dose. There are many factors that contribute to differences between the planned dose and the delivered dose. One such factor is reproducibility in patient position on the treatment unit. Patient positioning is crucial  in radiation therapy because it ensures accurate delivery of radiation to the targeted area while minimizing exposure to surrounding healthy tissues.

To ensure accurate patient positioning, image matching happens prior to each treatment and is performed while the patient issymbol, radiation therapy room laying on the treatment couch waiting for the radiation beam to start. This is called Image Guided Radiation Therapy, or IGRT. Image matching in short, is looking at the image from the original “planned” treatment and matching it to the daily image of the patient on the treatment couch, the discrepancies are noted, bed movements are entered into the software which results in the patient moving to a position that matches the planned treatment image. Cross-sectional anatomy is included in the foundation of successfulimage matching. Acquiring and improving this skill is important to the success of the patient’s treatment as it is imperative that image matching is done in a time sensitive manner, to avoid any further patient movements. This course presents the function and application of Computed Tomography (CT) in the context of IGRT. The overarching goal is to provide students with a solid understanding of cross-sectional anatomy and its significance as it applies to IGRT.

The target audience for this course is adult learners who have chosen to work in health care. They have a minimum of two years undergraduate prerequisite courses as well as soDoctor examining X-ray images on display in MRI control room while in background nurse preparing the patient for examination test.me radiation therapy course prerequisites. Information in these pre-requisite courses include how CTscanners and Linear Accelerators work, 2D- radiographic anatomy and how knowledge of the lymphatic system is applied in radiation therapy.

The learners in this type of program are usually young adults with a wide variety of lived experiences. Academically speaking, some come directly from completing the required 2 years of undergrad courses, and others with a variety of type and number of degrees. In other ways, some have not yet left the family home, some have children, some have done extensive travelling, some are changing careers. Some have worked in hospitals; some have never been inside a hospital.

Design

This course is a blended design scheduled in weekly modules. It follows a flipped classroom model, as the benefits of this strategy align with this topic. The course includes asynchronous didactic material, weekly discussion boards and one synchronous online class meeting. Every other week there is a face-to-face lab session scheduled for hands on learning and skill practice. The tools used to deliver this course and their application are as follows:

Canvas provides the learning management system (LMS) to host content such as didactic modules that may contain documents, videos, quizzes, discussion forums, collaborations, and student progress/grades.Shot of a screen of teammates doing a virtual happy hour from their home offices.

Zoom provides the platform for the weekly synchronous class meetings. Screen sharing and the whiteboard are key functions for this activity.

ARIA software suite provides the image matching software for hands-on practice. This is only accessible within the CancerCare system.

IMAIOS provides high-quality cross-sectional anatomy and imaging content for daily practice and training of health professionals. This software offers a choice of regular, practice or quiz viewing mode to the learners.

The specific course objectives are listed here.

By the end of this course, learners will be able to:

  • List and explain the three cardinal viewing planes of CT imaging.
  • Using directional terms, describe the position of one anatomical structure as it relates to the position of another.
  • Explain the orientation of a CT cross-sectional image.
  • Compare the location of various structures between a cross sectional image and radiographic anatomy.
  • Describe the boundaries of and the anatomic structures contained within the: thorax, abdomen, and pelvis
  • Complete image matching on a variety of anatomical sites.
  • Explain how the Choose Wisely and Image Gently campaigns apply to Image Guided Radiation Therapy.

These learning objectives are met by providing didactic course modules for learning and virtual tools for practicing cross-sectional anatomy identification and image matching. To see the course layout in more detail, view the course ADDIE Template here. The formative and summative assessments of learning address the three learning domains, Cognitive, Psychomotor and Affective.

Formative assessment opportunities include assignments, multiple choice review questions/polls, discussions and exit slips during synchronous class meeting, discussion boards, module quizzes, and clinical reviews.

Two Summative assessment strategies are used. A final exam and a final clinical assessment where the students are required to complete an Image Matching task.

Risk Assessment

Any online delivery is susceptible to certain risks and barriers. Addressing these risks and barriers requires proactive strategies and support from both educators and institutions.

Mitigation strategies need to address risks and barriers around technical issues, mental health, academic integrity and motivation.

Technical issue strategies involve providing access to technology and resources. The University of Winnipeg as well as the School of Radiation Therapy both provide resources such as space and technology to students who: do not have access to necessary devices such as a computer or tablet, struggle with reliable internet access, or struggle with finding appropriate spaces within their home for working.

Mental health strategies include surveying students about how they feel regarding online learning. This is followed by addressing any concerns that are self-perceived or suspected by the instructor, according to school policies. Online learning can be an isolating environment that leads to disconnection between students and/or instructor. The bi-weekly face-to-face Clinical Development Activities should help mitigate any concerns.

Maintaining academic integrity risk strategies recognize that online assessments can be vulnerable to cheating and plagiarism. Online quizzes do use such strategies as randomizing not only the quiz questions, but the order of the multiple-choice answers. In addition, the lock down browser can be used at the instructor’s discretion. However, relying on individual integrity has been the approach of the School of Radiation Therapy. Guiding the students to understand the links between academic integrity and their future as ethical professionals can mitigate integrity breaches. This strategic approach involves communicating this message early and throughout their training.

Online learning has shown to affect a learner’s motivation. However, most adult learners are intrinsically motivated to succeed. In this case, their goal is to become the professional that they have chosen as their career.

“Adults are motivated to learn to the extent that they perceive that learning will help them perform tasks or deal with problems that they confront in their life situations. Furthermore, they learn new knowledge, understandings, skills, values and attitudes most effectively when they are presented in the context of application to real-life situations.”

Malcom Knowles

However, these young adult learners may still have under-developed self-discipline and time management skills. Therefore, a small amount of the final grade is given towards class participation.

If a learner requires extra time to gain the required proficiency prior to clinical placement, this will be arranged on a as needed basis.

Course design and rationale

I believe that no professional healthcare program can be taught exclusively online; nor does it have to be taught exclusively face-to-face. My assertion comes from two variables: the type of work they are learning to do and the uniqueness of the adult learner. The hybrid model is a great way to meet the needs of this group of adult learners; which is important to reaching my goal of developing empathetic, competent healthcare workers.

This course is designed within a hybrid learning environment. Rationale for each approach is described below.

Asynchronous Didactic Learning – Adult learning is less abstract and more goal oriented. They are more autonomous. They are responsible for their learning, which means being prepared for synchronous sessions, especially in a flipped classroom model. They have a full life outside of the program. These learners have family obligations, work obligations and hopefully a social life to keep them balanced. Time management is key to success in this group.

As image matching is completed on computers using special software, this approach to learning is ideal. The students will see the images

Synchronous Class Meetings – Adult learners are ready to learn, which can help with engagement, and their lived experiences can lead to deeper, more meaningful class discussions. Although I have experienced that this is very dependent on the group dynamic. Some classes are quite dynamic and others are not.

Face-to-Face Clinical Development Activities – Adult learners do well with practical applications where the didactic knowledge can be applied and transferred to practice. This course leverages this fact as it is necessary for labs to happen prior to any clinical placement so the learners can practice using the matching software (this cannot be done online as this software cannot be accessed outside of the institution). Here they will practice the specific task that will be required of them when they enter the clinical environment. Initially, the focusin on accuracy. Subsequently, the students’ goal is to to increase their skills to complete the task more quickly by the end of the semester.

While facilitating these sessions, the facilitators can vocalize their decision process, role modelling the importance of each step with the patients’ outcome in mind. As well, simulating the interaction between caregiver and patient, the instructors can role model the care and attention given to psychosocial needs within a certain clinical environment or situation.

Patients need to be the centre of all that is taught and learned. Not only does patient care need to be comprehensive, and delivered by skilled staff, it also must address the psychosocial needs of the patients. Empathy and compassion also contribute to patient outcomes. Online environments cannot transfer these lessons adequately. Of course, instructors provide real life examples that can convey the messages, but it is the real-life clinical environment where this learning occurs. In addition to the formal learning, there exists a hidden curriculum that cannot be ignored. Hidden curriculum can be explained as how unwritten rules are transmitted to the learners. A few examples are workplace cultures, norms, authority structures, gender roles, implicit biases, and attitudes. Over the years the term ‘hidden curriculum’ has been used to describe how negative behaviours, stereotypes, and biases are passed along within the profession. However, it is important to be aware of the hidden curriculum and teach positive lessons through everyday interactions while the learner is still developing their own perception of what it means to them to work as such a PHC provider. This is the instructor’s opportunity to teach honesty, transparency, and integrity to the learners through role modelling.

All three learning domains will be addressed as each plays their own role and are important in this task and career.

The cognitive domain is addressed within the didactic portion of this course through lessons, assignments and quizzes. These should be completed by the learners by the time the synchronous activities are scheduled.

Illustration of a modern radiation plan for cancer therapy of a patient with a brain tumor (meningioma).

Clinical Development Activities, or labs, cover the psychomotor domain. Students will be scheduled in small groups on the RT machines, either on weekends or after hours (as operational requirements permit). Here they will practice the specific task that will be required of them when they enter the clinical environment. Initially, the focus in on accuracy. Subsequently, the students’ goal to increase their skills to complete the task more quickly by the end of the semester. Some learners may require more time to gain the required proficiency than can be provided due to limitations in the availability of both clinical space and staff facilitators.

Discussion groups and clinical development activities will cover the Affective domain. Students will demonstrate the patient centred approach to IGRT through discussion and they will learn from their clinical role models in the Clinical Development Activities.

Already thinking differently..

Completing the readings after making my first two blog posts makes me realize that I am thinking differently already. It’s interesting to me that I did not think about the LMS I use (Desire2Learn/BrightSpace) as part of blended learning. Thinking about it though, I do post discussion topics, quizzes are done through the LMS, assignments are handed in and delivered back through the LMS, I post practice activities, reminders and other prompts through the LMS.

During the pandemic, like most of the world, I had to quickly move to remote learning (aka emergency remote learning). The course I teach is quite formula heavy with a lot of new concepts, which I demonstrate visually usually on the board. Without time to adapt my teaching modality, I had to quickly borrow hardware (Wacom monitor) and learn how to use Zoom functions such as the white board etc. Once my desk was set up, the rest was fairly easy. Additional challenges were almost exclusively on the students side, such as finding a space in a crowded home, sharing computer time with siblings, and bandwidth issues.

I enjoyed the article Old wine in new Bottles, and what really landed with me was that course design needs to adapt to the different environment, the new online environment. As it state, online learning puts the students in a space that is different than the face-to-face classroom. I find in the classroom it is the collaboration and ‘work together’ time that not only solidifies certain concepts, but it is here that gaps in knowledge are recognized and can be addressed and discussed as a group. New ways of achieving this need to be adopted if using an online model.

A question is posed in 10.5 The future of the campus – Teaching in a Digital Age – Second Edition (bccampus.ca). The authors say state that what we need to be asking is “what is the academic or pedagogical justification for the campus, when students can learn most things online?”. They go on to assert that on-campus activities must be meaningful.

Perhaps part of my answer to this question lies in my constructivist view and thoughts on collaboration.

Time for Reflection

Before I start this course, I wanted to spend a few minutes reflecting on what digital technology meant and how it is changing. Prior to 2020, digital content in my classroom meant saving larger files on the shared drive to save paper. It meant delivering the class content via PowerPoint and demonstrating examples on the white board. This picture is not my classroom, but it is surprisingly similar. Just like the instructor of this classroom, I had a tiny space of white board available behind the podium to the left of the screen to do physics equations, draw pictures of diverging radiation beams and stick figure patients. Utilizing more whiteboard space meant rolling up the screen, then pulling it down to continue with the slides – covering up the example I just drew on the board!

It wasn’t ideal but we made it work. I am sure the instructor of this classroom and I could have a very animated conversation about the limitations of this setup 🙂 Another piece of technology I incorporated into my lessons was the iClicker. There are newer tools to engage students, but it worked well, and allowed me to assess the level of knowledge transfer. The pandemic forced us all to learn quickly and change our teaching methods to deliver the same content over an online platform, Zoom in my case.  How do we deliver quizzes? How do we uphold the integrity of the test material? Eventually solutions to these challenges emerged.

Reflections part II

Technology in the classroom is a permanent fixture. Our world is much smaller now, the global landscape is very different, and in response, the way humans interact with each other, and the world has evolved. I am old enough to remember the pre-internet days, I have been a witness to this evolution.

Subscribers to constructivism will argue that face to face learning cannot be completely replaced. However, the practical benefits of online learning cannot be denied.  Beyond the practical, there are other benefits to using technology in the classroom.

Before diving into EC&I 834, I wanted to reflect on the benefits that technology has brought into my own adult classroom. Hopefully this will provide a “before and after” overview of my level of knowledge and beliefs towards technology and the adult classroom.

Within the first week of teaching over Zoom, I noticed an increase in student engagement. My adult classroom is very small (less than 10 students each year) and every year the class has a different dynamic. The class that started in 2020 was particularly quiet, and I had a hard time engaging them individually, with the exception of the iClickers which provided anonymous responses.  Even trying to get information about what they did over the weekend was like pulling teeth!

However, once I started teaching, students were asking questions in a private chat box. I was thrilled! Having the chance to correct misunderstandings or clarify difficult concepts prior to moving on is very important when building the foundations of a new concept, a new way of thinking, and a new way of applying mathematical concepts. I use these opportunities to customize in class review questions, targeting specific learning barriers.

I found that online learning also made using the “Flipped classroom” strategy more palatable for the students. They were better prepared for our synchronous online classes, and I could use our time towards applied learning.

It was interesting having this particular, very quiet, class as the first to teach over Zoom. It seemed to me that the differences in the teaching/learning environments were amplified. Another example. During in person classes, I often broke the students into small groups to work together to solve a particular problem. Collaboration leads to richer educational experiences. This class, however, would sit in groups of 2 or 3, and quietly work on their own.  What I found was, when I used breakout rooms in Zoom, they would actually work together, which also resulted in increased engagement, developing their critical thinking skills.

These are just a few examples of the benefits to switching to Zoom for this particular classroom. Although, I still hold on to my belief that there are benefits to face-to-face learning that cannot be met by the online platform. I found it more challenging to place the lessons into a real-world context. As I instruct future healthcare providers, the social context is very important.