MEDEV

School of Medical Sciences Education Development

Introduction

iSUS is an ICT placement management system which helps students evaluate their learning, choose learning objectives, find ways of fulfilling them, and reflect on the outcome.

Applying the “signup” principle through this technology enhances the learning opportunities available to placements students, and provides a powerful quality enhancement tool for a distributed curriculum.

Supporting placement learning

Dental, veterinary and medical members of the LTSN-01 constituency met at Manchester airport on 6th May to consider: "How can we assure quality in external placements?"

There were interesting differences between, for example, a procedural specialty like dentistry and a more transactional one like medicine.

But there were remarkable commonalities: the need to qualitymanage casemix, learning opportunities, tutor performance and educational outcomes.

E-learning, broadly defined as "any learning that takes place through ICT", is mostly used to transmit subject matter from teacher to learner.

But could it help assure placement quality, a workshop group asked? This paper describes one such application.

Development context

iSUS was developed in Hope Hospital, Salford. The Manchester problembased curriculum gives students simultaneous placements in community and hospital, organised around the integrated, thematic structure of the curriculum.

We were surprised how little crossover there was between the active, learnercentred behaviour of PBL groups and what happened in placements. Students grumbled they had insufficient teaching; teachers grumbled the students had insufficient initiative.

Maximising opportunities

It is a strange paradox that practitioners are overwhelmed by the number of placement students, whilst students access less than 10% of the clinical activity that is overwhelming the practitioners.

Surely empowered students, in the language of modern learning theory, could make better use of what is on offer. We invented the concept of ‘signups’, according to which every meeting (inpatient and outpatient) between a patient and professional in the hospital is a potential opportunity for experience based learning.

We inventoried those activities, and found an extra 6h/student/week of untapped opportunities. Mark Foster, then a third year student, developed an IT ‘signup system’ (SUS) that could place signups at students’ disposal and help them manage their timetables. The system quickly became part of Salford medical students’ learning landscape.

Distributed clinical learning

Including overseas electives, district hospital and health centre placements, teaching hospital firms and medical school lectures and tutorials, medicine is a very ‘distributed’ curriculum. Rapid communication between geographically dispersed people is one of the most powerful things ICT can offer. Once SUS was made available on the web, students used it from outside the hospital as often as inside it. SUS,we realised, was a “distributed learning technology”.

Spreading the word

Clearly defined, explicit learning objectives are a sine qua non for placement learning in an integrated curriculum. We knew what the clinical objectives were, but our students and teachers didn't. We began to explore how SUS could make those objectives clearer to all parties.

Directing students towards appropriate learning opportunities.

If students feel like small fish in a big pond and both they and teachers are unaware of curriculim objectives, can we be surprised we struggle to find enough learning opportunities? It was tackling this probem that gave our revised technology its name. "iSUS" (i standing for "intelligent") matches sign up opportunities to curriculim objectives and individual learning need, computed dynamically.

Student-centred learning

Fine to tell students what they should learn and lead them to relevant opportunities, but how does that fit with student-centred learning theory? Reflection is the process through which students make those objectives their own, monitor their progress, and choose how to use their time.

Our technology, we reasoned, should lead students through the reflective process. The first step was to individualise it. Each student had a homepage which displayed their timetable and progress towards curriculum objectives in an entirely personal way.

At the heart of iSUS is a feedback cycle. When students book learning opportunities through iSUS, they are prompted to give feedback next time they login. Even when learning opportunities come up independently of iSUS, they frequently log their learning voluntarily.

Feedback cycle

• Give feedback on your most recent learning experience
• Review the objectives of your current module and wider curriculum
• Identify gaps in your learning
• See what is on offer
• See what other students have said about it
• Choose your next learning experience
• Learn!

Quality assurance

Since feedback lies at its heart, iSUS is a powerful evaluation tool.

Having evaluated their learning, students compare their progress with the aggregate learning of their peer group, benchmarked against absolute standards of adequacy. The peer group collectively evaluates the various placements.

Education leads and curriculum administrators can examine aggregated feedback. Managerial staff can analyse who is doing what, and to what standard, in relation to the SIFT contract.

End of module questionnaire

Whilst developing iSUS, we were exploring other ways of evaluating student-centred clinical learning. We developed and implemented an evaluation scale and demonstrated its reliability and validity.

Students complete it at the end of each placement independently from, and in addition to, their use of iSUS. Response rates are high. Each consultant has an iSUS homepage.

Together with the results of all textual and numerical iSUS feedback, placement evaluation feeds directly into their homepage. So, ICT is not just managing placements but "closing the quality loop".

How it all happened

During summer 2002, two computing science masters students used ideas developed by Martin Brown and Tim Dornan to design and prototype a solution.

In October that year, a first group of third years piloted it and gave a clear ‘thumbs-up’; by February 2003, half the Salford Y3 students were using it.

By October 2003, all 113 Salford Y3 students and the first cohort of clinical students in Preston were using it.

Future plans

Plans are well advanced to "roll the technology out" to years 4 and 5, to other sites, and to other health professions curricula. Fundamental system redevelopment is planned.

In the meantime, another technology is being developed to promote "intelligent" dialogue between students and teachers in support of problem based learning. Curriculum strands are even harder to integrate than curriculum blocks; our ""ViDerm" project is prototyping a virtual, integrated dermatology strand, spanning the whole curriculum.

Further reading

SUS, Foster M, Dornan T. Self-directed, integrated clinical learning through a signup system. Med Educ 2003; 37:656-9.

iSUS, Dornan T, Brown M, Powley D, Hopkins M. A technology using feedback to manage experience based learning. 2004; Accepted subject to revision.

Electronic clinical skills portfolio, Dornan T, Maredia N, Hosie L, Lee C, Stopford A. Development of a webbased undergraduate clinical skills portfolio. Med Educ 2003; 37:500-8.

Evaluation of placement learning, Dornan T, Scherpbier A, Boshuizen H. Towards valid measures of self-directed clinical learning. Med Educ 2003; 37:983-91.

Dornan T, Boshuizen H, Cordingley L, Hider S, Hadfield J, Scherpbier A. Evaluation of self-directed clinical education: validation of an instrument. Med Educ 2004; in press.

Placement teachers’ reactions to PBL curriculum, Dornan T, Scherpbier A, King N, Boshuizen H. Clinical teachers and problem based learning. Phenomenogical study. Med Educ 2004; in press.