Weeming Lau reflects on students’ contributions in co-creating high quality case scenarios for peer learning.

Mutual learning

As a medical educator for more than 15 years, I have learnt as much from the students as they have learnt from me. I personally don’t think that we should limit our students to what they have been taught, but rather be supportive in scaffolding their learning to the best of their ability. Some may say that doing this may derail the alignment between the curriculum and assessment. However, I beg to differ as I feel that we should be nurturing their learning for application beyond the campus gate.

The journey in collaborative partnership

I teach Clinical Skills to year 1 and 2 medical students. These are conducted on the campus on a weekly basis in small groups of about 12 students facilitated by a tutor. 

The Covid-19 pandemic threw all these activities off course with the virtual platform taking off at top speed. There are both pros and cons to a virtual platform. However, my impression is that many students felt that they were missing out on ‘proper’ and adequate learning due to the lack of regular hands-on practice in class, specifically for Clinical Skills which is a largely hands-on component in the medical program. This has been expressed by my students and has been highlighted by Saad et al, 2023 and Wilcha, 2020.

Here, I present 5 projects that I have run or designed to increase the practical learning of students through online approaches.

Project 1

I circumvented the perceived lack of applied learning, mentioned above, by using a set of online case scenarios that were created by a team of clinical skills tutors. These cases emphasise appropriate communication skills between a healthcare professional and the patient. Students were invited to attempt them and received immediate feedback at the completion of each case. However, I felt that this activity was rather teacher-centred as the cases were created by the teachers who led and dictated the 5W and 1H (When, Where, Who, What, Why…and How) in learning. 

In my regular discussions with students, I realised that teachers and students are sometimes speaking from different perspectives in relation to teaching and learning processes. It is analogous to a situation where they are standing on the opposite banks of the same river. Therefore, it is important for teachers to have regular, meaningful dialogues with students that aim to reduce hierarchy and bridge the divide.

I was also keen to know what students truly understood of what had been taught, and how they applied this in their studies.  Therefore, I steered my subsequent education-related projects to bring students’ voices into focus.

Project 2

I invited year 3 students to create authentic clinical skills scenarios for online learning. They were encouraged to include what they had learnt from the patients in the wards and from their clinical tutors. I showed them scenarios that were created by the teachers and advised them to apply a similar template. I suggested some topics with some basic guidelines on areas that should be included in the scenarios.

The focus of these scenarios was on communication skills (how questions should be asked by a health professional to a patient rather than what was asked) and medical professionalism, as these areas were integral to their clinical job. I felt that such resource creation has not been explored adequately in the faculty. In addition, students had to create 5-10 questions (each with four options) for each scenario and provide feedback for all options and be supported by reliable references. Therefore, the work was largely the students’ product.

As I was not keen on the infringement of copyrighted images, I suggested that students should draw their own. Examples from three of the students are shown below:

Image 1 demonstrates the professional behaviour of a medical student who arrived late in an unkempt state for bedside ward teaching (courtesy of Chittima Phakdee Som Bat with permission).

Image 2 shows a patient with Grave’s disease presenting with a neck swelling (courtesy of Yoganishalini Sagadevan with permission).

Image 3a – General appearance of patient presenting with malignancy (courtesy of Lai Yong Sheng with permission).

Image 3b – Neurological sign – a complication of malignancy (courtesy of Lai Yong Sheng with permission.

In a nutshell, I was truly amazed by the quality of work that students shared with me on my Google Drive. They worked independently in the initial phase, discussed with their peers, and amended the cases after my review. We had Zoom discussions to finalise the cases as we were located 300 km apart. They spent time seeking reliable and current references to support their responses to the questions that they created. For example, Yoganishalini Sagadevan provided a link to a Health care providers’ handbook on Hindu patients (developed by Queensland Health). The book provided rich data on Hindu Beliefs affecting healthcare” that would be valuable to the doctor managing a Hindu patient presenting with anaemia. 

In creating his case (Image 3a and 3b),  Lai Yong Sheng, shared his experiential learning and brought up challenges of students having different teachers with different perspectives on patient management. This is an important learning point for students, especially when learning is tied to assessment. We need to allay students’ concerns, helping them see that learning is a scaffolded journey of differences, and that they need to self-reflect, reason out and then apply, rather than be fearful of negative repercussions. This is the beauty of students’ contributions towards such case creation.

There were so many more examples of such work done by the students that I would like to share. My words of wisdom -”listen to the students’ voices, hear them out, consider their viewpoints and learn from them too!”

Project 3

With the onslaught of generative AI (GenAI), I have involved students in using ChatGPT (free version) to create scenarios to further their own learning through role play. 

As highlighted by Estelle Wallingford – “The rise of generative AI calls… It challenges educators to consider new ways to ensure students develop their underlying intellectual ‘tool kits’ in the face of technology which can, albeit with varying successes, mimic such reasoning processes.”

In addition to encouraging students to use ChatGPT ethically and wisely, I have worked with students in using role play to promote peer feedback and learning. These sessions were completed in small groups of four and students received feedback from each other. The sessions were recorded for review by teacher-researchers who provided feedback for further improvement in subsequent role play. I found these recordings valuable learning resources for myself as a teacher, as I could hear snippets of their honest discussions during the peer feedback discussion – the language that was used, and the style of feedback provision. This is fodder for me to better understand students’ concerns, and to address them effectively. I feel that this is an excellent way to have a consensus from different perspectives.

Project 4

I have extended the above online activity to include simulated patients in the context of telehealth, where students received multisource feedback from their peers, simulated patients, and teachers. These online sessions were conducted in the evenings where I was able to observe some of the sessions to provide immediate feedback to both students and simulated patients. In providing feedback, I feel that it is important that we as teachers have an honest dialogue with students to explore the best way forward in doing this. Like coffee, some students prefer it ‘hot’ and others like it ‘cold’. It is more important for students to appreciate the importance and impact of honest feedback than to simply accept “sugar-coated” or toned-down comments. Others may disagree with this approach but being clear about what students can expect during the first session usually sets a good pace and can produce fantastic outcomes in later weeks.

Project 5

I next plan to incorporate students’ cases in the creation of GenAI learning activities in both text and voice format, and am in discussion with Joel Moore on this. 

I personally find that having students as collaborative partners in creation of resources would probably answer the question posed by Mahbub Sarkar “How do you know if students actually understood the idea that was taught? What did they do or say (or what did they not do or say anymore) that shows they understood the idea?”

Reflecting on the benefits of collaborating with students

In conclusion, getting students to be partners in their learning not only benefits themselves but also enlightens the teachers who need to be aware of students’ perspectives on the ‘taught’ areas rather than adopt skewed views.

As teachers, we first need to take up this challenge in small steps as per Lao Tzu to achieve sustainable outcomes. After all, futuristic education is dynamic, and flexibility in thinking by educators will bring out the aroma and flavour of students’ collaborative efforts.

Before I sign off, I am keen to know and look forward to all your comments/feedback on this blog post, and how we can be more effective advocates for students’ voice and collaborative partnerships in teaching and learning. Thank you 😊

References

Saad, S., Richmond, C., King, D., Jones, C., & Malau-Aduli, B. (2023). The impact of pandemic disruptions on clinical skills learning for pre-clinical medical students: implications for future educational designs. BMC Medical Education, 23(1), 364.

Wilcha, R. J. (2020). Effectiveness of virtual medical teaching during the COVID-19 crisis: systematic review. JMIR medical education, 6(2), e20963.