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Masters in Health Professions Education 2018 – 2020

Maastricht University

Unit 1

Assignment 1B

Design an educational session

Date

??-??-????

Name(s) Student(s)

Bart Thoonen

ID-Number

I830098

Background

Why did I choose this program as my individual assignment?

Personal learning goals:

- Based on previous experience I found this the most challenging

- Application of literature on IPL in a simulation/game-format

- To evaluate our own template (Nijmegen template) and provide some recommendations for improvement

The Nijmegen template:

Figure 1

The Nijmegen template consists of a fixed set of paragraphs (Figure 1). Authors are free to use each paragraph where applicable. The template is provided within a content management system (program-bank). When in editing mode, short instructions and tips for authors are provided. These are indicated in italics and between square brackets in this document. The ‘Teacher instruction' section is invisible to students in the learning environment. Within the context of the Nijmegen curriculum we refer to educational sessions as ‘Programs', so in this document I will use the term ‘program' for the educational session as described in unit 1-assignment 1B.

Introduction

[Why this program? State the relevance of this program in the introduction. Tip: Relate relevance to the according themes (end-terms) of the curriculum.]

Do you remember the 2007 Q-fever outbreak in the Netherlands? What if this would have been caused by multi-resistant bacteria? Antimicrobial resistance (AMR) is a multifaceted problem. Difficult to control outbreaks are a typical high impact consequence of AMR. Containment and prevention of outbreaks requires commitment and collaboration within a broad field of stakeholders. In this program you act in a Role Playing Game (RPG) based on an outbreak scenario. You learn to apply strategies to tackle the outbreak and to prevent AMR.

Apart from developing strategies, the ability to present them in a persuasive manner to engage others is also important for you as future health scientist. In this program you will practice the AIDA model to present your proposal in a short pitch.

Preparation

[How should participants prepare for this program? E.g. read papers, collect materials from practice, discuss in advance with supervisor, etc.]

You will need what you have learned in PBL cases and the field-work. You are ready to start this program once you have a satisfactory grade for the knowledge test and have finished your field-work report. Prepare for the first meeting by studying the meaning and use of the AIDA presentation model.

Program

[What is the subject of the program. What will participants do (subject, theme, summary of program)? How long is the session? Who are the participants (mentor-group, several combined groups, large groups, etc). Who will be teaching?]

In this Role Playing Game (RPG) you are part of a task force of field experts. You are invited by local authorities to provide a solution to the following problem:

A recent multi-resistant bacterial outbreak of Trumpasaurus rex among pigs has occurred in your area. The infecting agent proves to be highly contagious and virulent, resulting in massive pig deaths. There is a severe impact on the availability of spare-ribs. It is the middle of the BBQ season. Pig farmers are suffering heavy (financial) losses. The bacteria has spread to some humans, resulting in severe illness requiring hospitalisation. Due to multiresistance treatment is difficult, requiring a cocktail of expensive antibiotics.

Local authorities have set up a fund (10.000.000 CU*) for containment and prevention of this outbreak. As members of a task force you are invited to come up with a proposal to stop the outbreak and prevent future recurrence. What would you do and how would you spend the budget? Based on a detailed plan, outlined in a short presentation, it is your task to acquire the funds. The winner will get a real prize. Can you save the BBQ-season?

*Currency Units

Rules of the game:

- Each task force consists of 5 members of your tutorial group.

- Each task force member represents a field expert.

- You play the role of the field expert you have visited in your field-work assignment.

- Each task force has a total budget of 2 hours to consult field-experts (from field work assignment) for additional input. (help-line)

- Each task force has a budget of 1 hour (on top of initial meeting) coaching assistance to guide your task force through the game.

- Present your proposal to the funding committee (panel) in a 10 minutes pitch, followed by 15 minutes discussion with audience and panel.

- Justify your proposed actions using the content of the first three weeks of the current unit.

- The panel consists of field experts. Based on a rubric the panel will judge your proposal and appoint the winner.

- The winning team earns vouchers for the famous Rosie's grill restaurant.

This program consists of three meetings:

- Monday 1-3pm: Introduction

o Introduction to the RPG

o Exercise pitch techniques (AIDA model)

o Start your task force

- Friday 9am-12pm: Symposium

o Present your solution (10 min)

o Discuss your solution with panel and audience (15 min)

- Friday 1-3pm: Debriefing

o And the winner is..

o What did we learn from the RPG?

Competencies and learning goals

[What will participants learn? Describe the learning goals and relate these to the competency profile. Try to be specific and indicate how participants learn each competency.]

This program finalizes the unit. Main goals are integration and application of acquired knowledge, skills and attitudes. By solving an authentic scenario in  a simulated setting you learn to…:

- … collaborate in inter-professional teams

- … recognize the impact of various sectors on the propagation and development of antibiotic resistance, including the role of health care providers, patients, veterinarians, agriculturists, food handlers, and governments

- … recommend (an) additional method(s) to improve the control and/or the prevention of AMR in a specific setting

- … compose and perform a succinct and persuasive sales pitch suggesting an action plan to address an AMR outbreak

Teacher instruction (this section is invisible for students)

[Provide here what the teacher/instructor needs to prepare and perform this program. Provide additional documents (not for students) relevant for preparation. Provide links to useful materials.]

Time table:

- Monday 1-3pm: Introduction

o 0-15 min - Introduction to the RPG: Main instructor introduces the RPG by describing the scenario, rules of the game and purpose of the meetings. Check for clarity and provide room for questions. At the end the large group splits into 6 taskforces. Each taskforce is assigned a room and coach.

o 15-25 min – Transfer time: taskforces and coaches go to their rooms.

o 25-120 min - Exercise pitch techniques (AIDA model), startup taskforce and plan further activities/meetings

- Friday 9am-12pm: Symposium

o 0-10 minutes: Main instructor welcomes all participants. Explain rules and purpose of the symposium: 6 taskforces. 25 minutes per taskforce for presentation and discussion. After every 2 rounds there will be a short break (5 min).

o 10-65 min: two presentations, followed by short break

o 65-120 min: two presentations, followed by short break

o 120-175 min: two presentations, followed by short break

o 175-180 min: spare time

- Friday 1-3pm: Debriefing

o 0-15 min - And the winner is..: Main instructor welcomes everyone back and asks panel for their findings. Do we have a winner?

o 15-60 min - What did we learn from the RPG?: debriefing session with taskforce group and coach.

o 60-90 min – wrap up: each taskforce presents main learning points / take home messages

o 90-120 min – game evaluation: what went well and where can we improve the RPG? (may take less than 30 mins).

Instruction for supporting staff:

- Main instructor:

o as main instructor your role is to instruct the game and guide the program.

o At the first meeting it is important to verify if the purpose and the rules of the game are understood by all taskforces.

o During the symposium you will be session chair. Make sure to manage time. Prepare some questions (contact coaches if necessary) to stimulate discussion if needed.

o You are chair of the debriefing session. Ask panel to comment on this morning's presentations and to appoint the winner. After handing out vouchers to the winning task force, instruct task forces and coaches to start debriefing.  Ask each taskforce to present their main learning points/take home messages during wrap up. Summarize all findings (what did we learn?) to conclude this part. Finally invite all participants to provide feedback on the RPG-format. To what extend were they able to prepare the symposium in the given time? To what extend was the scenario challenging and engaging?

- Group coaches:

o As group coach your main task is to guide each taskforce towards successful collaboration. Make sure that the task force is aware that they have to take further initiative to make use of your coaching and that this is limited to max 2 hours. Take into account that there is limited time. Under such condition (limited time and budget) the start-up of the group and the midpoint are crucial moments for success. Carefully observe how the group starts up and how group members involve each other. If the group fails to accelerate halfway the week (midpoint), a brief intervention may be necessary. Ranging from interrupting the group for re-adjustment to some brief suggestions for the group to consider.

o Start the first meeting with a brief exercise: verify that students understand the AIDA model. Ask each taskforce member to prepare a 2 minute pitch (based on AIDA model) to present one initial idea for the RPG based on their expert-role. Use this as a starting point for discussion and brainstorm. Assure that the taskforce ends the first meeting by making appointments.

o Start the debriefing session by complimenting the task force on their achievement. Ask them to reproduce the process and if they have specific feedback questions. Provide group with your observations and feedback and ask them to reflect on the following issues:

 [info from IPE papers on relevant themes for observation and feedback]

- Panel members:

o As field-expert, involved in this unit, you will act as help-line for the taskforces. Keep track of consultation-time on the provided on-line spreadsheet, so that each task-force can monitor their available consultation budget.

o Keep in mind the constructivist paradigm, when responding to questions. In your case as consultant, try to advise groups where to find answers instead of providing them answers right away. If a task forces asks feedback on their level of understanding, you can provide additional information and correct misunderstandings if needed.

o During the final symposium you will be a panel member. Your task is to judge the presented proposals (based on a rubric that will be handed to you), appoint a winner and provide students with feedback. After each presentation, feel free to ask questions and contribute to the discussion. After the final presentation the panel will have time to discuss and appoint the winner during the lunch break. Please use the provided rubric to justify your choice.

Logistics

[This section provides a link to instructions for the support desk on the required logistics.]

Invite and instructs field experts in time

Reserve rooms for all of the sessions

Contact Rosie's for vouchers

Assign students to task forces (5 students in each taskforce, select students from same tutorgroup and assure that each student has visited a different field-expert)

Invite 6 coaches and assign them to the taskforces.

Complete program

[If the current program is part of a larger program (eg series of activities) you can describe here the relation to the larger program. E.g. what precedes and follows the current program.]

This program is part of the elective unit ‘Beware of the superbugs!'. Additional information on this unit is available in the unit guide.

Justification

Main aims of the Role Playing Game educational session are integration and application of earlier acquired knowledge, skills and attitudes. This requires complex learning, which adds to previous knowledge by having students to use previous knowledge, skills and attitudes to solve a problem with high complexity. In our unit design intended learning outcomes are described for the Role Playing Game. (Bogaty, Mithoowani, Mukhtar, Rudaks, & Thoonen, 2018) Besides application and integration of previously acquired content, learning outcomes for this program focus on the multifactorial complexity of AMR and the role of interprofessional collaboration to deal with AMR and its consequences. Addressing interprofessional aspects in medical education has been acknowledged by a global independent commission. One of their proposed reforms for 21th century medical education is the “…Promotion of interprofessional and transprofessional education that breaks down professional silos while enhancing collaborative and non-hierarchical relationships in effective teams. (Frenk et al., 2010). Several authors have described strategies and outcomes of interprofessional education that seem fit to justify choices within this program. (Hammick, Freeth, Koppel, Reeves, & Barr, 2007; O'Halloran, Hean, Humphris, & Macleod-Clark, 2006; Oandasan & Reeves, 2005; J. Thistlethwaite, Moran, World Health Organization Study Group on Interprofessional, & Collaborative, 2010; J. E. Thistlethwaite & Vlasses, 2017) As the model of O'Halloran et al was developed especially to introduce opportunities for undergraduate students, this model fits both content and context of this program. (O'Halloran et al., 2006) This model is named the facilitated collaborative interprofessional learning model. It incorporates elements from three pedagogies: guided discovery learning, collaborative learning and interprofessional learning. (O'Halloran et al., 2006). To help the development of learning activities a checklist for collaborative interprofessional learning exercise was drawn up. Below I will describe how I have applied this checklist to justify choices made in this educational session.

Application of checklist

The checklist consists of the following main sections:

Provide students with a productive learning environment:

Is it relevant? Will it allow students to meet the learning outcomes for the unit?

The relevance of this program is explained both in the unit design (Bogaty et al., 2018) and in the first paragraph of the program. Based on the principles of constructive alignment (Biggs, 1996), the learning activities used in this program were aligned with the learning objectives, as described in the unit guide. (Bogaty et al., 2018)

Is it sufficiently challenging?

This game is challenging as students have to address an authentic problem with high complexity. Complexity and authenticity are increased by adding time and budget constraints. Inspired by the concept of whole-task models we have chosen to simulate a real-life task, without describing single elements in too much detail. (van Merriënboer, 2017) Using a simulated task within a role play setting is appropriate to meet our learning goals, as the role-playing group scenario promotes collaboration while learners problem-solve together and share in the decision-making process social nature of role-play makes it a valuable approach within interprofessional education. (van Soeren et al., 2011) Finally a competitive element has been added to motivate and challenge students by awarding the winning task force with vouchers for the highly appraised Rosie's grill restaurant.

Is there adequate support in place?

Although this program builds upon previous content from pbl-cases and field work, students may need additional input from the field experts. In addition, time for the task forces to prepare for the symposium is short and there is little time for trial and error. Therefor support is provided both on the content and on the group process. Each task force has a limited amount of consulting time for additional support from field experts. Field experts are instructed in advance to respond to questions with the constructivist paradigm in mind. Based on earlier observational studies under similar conditions task forces are likely to behave different while performing their task, but are likely to follow a highly congruent timing in group dynamics according to the punctuated equilibrium concept. (Gersick, 1988) According to Gersick group members use time as a heuristic for deciding how long they will remain on the same track and when they must forge ahead. (Gersick, 1989) Based on these findings coaches are instructed to pay special attention to the initiation phase and the midpoint. Finally students are supported in their training skills by introducing the AIDA model. (Rawal, 2013) This model is easy to use and is offered to students as a possible strategy for their presentation.

Will students have control over their own work?

Students have sufficient control over their work. Each task force will produce its own output. Instructions intentionally have as little detail as possible (van Merriënboer, 2017) and task forces have their own responsibilities in how they make use of their coach and consulting field experts.

Does it require students to formulate questions and seek the help of other group members?

Each student represents a different field expert in the task force. So they need to rely on each other's expertise

Does the group have to produce something?

Each task force produces a solution to the AMR outbreak. The solution and the way it is presented will be assessed with a rubric during the symposium. Elements of the rubric are the authenticity of the solution (is it original and realistic?) and how persuasive the solution is presented. The provided presentation strategy (AIDA model) is a realistic model for selling ideas, using cognitive and affective elements.

Does it require students to act as representatives of their profession only in a way that is appropriate to their pre-registration status and stage in their programme? Students are instructed to act as field experts in the task force. They are prepared to do so based on what they have learned in previous PCL-cases and the field-work activity. In case this was insufficient, they can consult field experts for additional support.

Generate genuine inter-dependence

Do the students have to depend on each other to complete the exercise successfully?

Due to the complexity of the AMR outbreak realistic solutions need input from various field-experts. If students do not exchange ideas and collaborate they cannot complete the exercise successfully. At the first meeting a brief exercise is scheduled to expose task force members to possible solutions from each individual viewpoint. This is likely to act as starting point to recognize the relevance of different field experts and to find a possible common ground for the final solution.

Does it allow division of work between members of the group—are there differentiated and complementary roles (with titles if necessary) for group members to apply for/select from?

As time is relatively short, groups will need to divide work. Contributions from each field of expertise are most likely complementary. This is based on the complexity of the AMR problem, as described in the unit guide. (Bogaty et al., 2018)

Will it allow group members to supply unique skills that will enable the group to achieve goals that the individuals otherwise could not?

This program allows task force members to supply knowledge and skills in their role as field expert. As stated before, input from multiple experts is needed to design a proper solution.

Will it require students to share resources, i.e. the necessary information, meanings, concepts and conclusions?

One of the learning objectives of this program is that students recognize the impact of various sectors on the propagation and development of antibiotic resistance, including the role of health care providers, patients, veterinarians, agriculturists, food handlers, and governments. They will need to share insights and concepts from different areas in the field. Bu doing so recognition of the multi-facetted nature of AMR and AMR related problems is likely to icrease.

Does the assessment reinforce the inter-dependence?

Positive interdependence exists when individuals perceive that they can reach their goals if and only if the other individuals with whom they are cooperatively linked also reach their goals and, therefore, promote each other's efforts to achieve the goals. Success of each task force may depend on the transition from self-interest to mutual interest by each member. (Johnson, Johnson, & Smith, 2007) In this program the final product (solution to outbreak and presentation) are assessed by a rubric. Assessment methods in the unit have the primary aim to provide students useful feedback. Finally the best task force effort will be rewarded a prize. If a task force was successful in defining and presenting a solution to the AMR outbreak,  this will be ‘rewarded' by positive feedback. From a behaviouristic point of view (Ormrod 2016) this is likely to reinforce positive inter-dependence.

Foster differentiation and mutual inter-group differentiation

Will it allow students to explore the differences as well as the similarities in the professions they represent?

Will it allow each profession's valued identity on specific dimensions to be identified and acknowledged?

Will each profession be able to contribute something special to the exercise?

Will the contributions to be made by each profession encourage the students to acknowledge and value the strengths of other professions?

Allow equal contribution

Will it allow all members of the team to invest in the success of the project?

Will it allow the group to generate common goals?

Will all members have equal status?

Will it allow students to reflect on their past experiences?

Reflections on and recommendations to improve our template

- Change order (ILO's above program, improves construct alignment)

- Provide cues aiming at constructing learning experiences instead of teaching activities

- Most programs are single units. Low continuity and few possibilities for learning cycles. Add longitudinal programs?

-

References:

Biggs, J. (1996). Enhancing teaching through constructive alignment. Higher Education : The International Journal of Higher Education and Educational Planning, 32(3), 347-364.

Bogaty, C., Mithoowani, S., Mukhtar, F., Rudaks, I., & Thoonen, B. (2018). Beware of the superbugs. Maastricht.

Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., . . . Zurayk, H. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet, 376(9756), 1923-1958. doi:10.1016/S0140-6736(10)61854-5

Gersick, C. J. (1988). Time and transition in work teams: Toward a new model of group development. Academy of Management journal, 31(1), 9-41.

Gersick, C. J. (1989). Marking time: Predictable transitions in task groups. Academy of Management journal, 32(2), 274-309.

Hammick, M., Freeth, D., Koppel, I., Reeves, S., & Barr, H. (2007). A best evidence systematic review of interprofessional education: BEME Guide no. 9. Med Teach, 29(8), 735-751. doi:10.1080/01421590701682576

Johnson, D. W., Johnson, R. T., & Smith, K. (2007). The State of Cooperative Learning in Postsecondary and Professional Settings. Educational Psychology Review, 19(1), 15-29.

O'Halloran, C., Hean, S., Humphris, D., & Macleod-Clark, J. (2006). Developing common learning: the new generation project undergraduate curriculum model. J Interprof Care, 20(1), 12-28. doi:10.1080/13561820500471854

Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: the learner, the educator and the learning context. J Interprof Care, 19 Suppl 1, 21-38. doi:10.1080/13561820500083550

Ormrod , J. E. (2016). Human learning (Seventh editon. Global edition ed.). Essex: Pearson Education Limited.

Rawal, P. (2013). AIDA Marketing Communication Model: Stimulating a purchase decision in the minds of the consumers through a linear progression of steps. International journal of multidisciplinary research om social & management sciences, 1(1), 8.

Thistlethwaite, J., Moran, M., World Health Organization Study Group on Interprofessional, E., & Collaborative, P. (2010). Learning outcomes for interprofessional education (IPE): Literature review and synthesis. J Interprof Care, 24(5), 503-513. doi:10.3109/13561820.2010.483366

Thistlethwaite, J. E., & Vlasses, P. H. (2017). Interprofessional education. In J. A. Dent, M. H. Harden, & D. Hunt (Eds.), A practical guide for medical teachers. Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto: Elsevier.

van Merriënboer, J. J. G. (2017). Instructional design. In J. A. Dent, M. H. Harden, & D. Hunt (Eds.), A practical guide for medical teachers. Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto: Elsevier.

van Soeren, M., Devlin-Cop, S., Macmillan, K., Baker, L., Egan-Lee, E., & Reeves, S. (2011). Simulated interprofessional education: an analysis of teaching and learning processes. J Interprof Care, 25(6), 434-440. doi:10.3109/13561820.2011.592229

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