EdTech medic
EDUCATIONAL TECHNOLOGY, ONE STEP AT A TIME
Note to the reader: I am a paramedic educator and while the following is aimed primarily at paramedic educators, I am confident that if you read through this post you will get ideas on how to incorporate educational technology for whatever level you teach and in whatever case based or problem based learning you do in the classroom. Paramedics work in a world that is becoming increasingly digital. Global Positioning Systems (GPS) guide them to 911 calls. Automated vehicle locating (AVL) systems track the whereabouts of ambulances within a region to determine the best locations to position vehicles to optimize response times. Electronic patient care reports (ePCR) combined with AVL data provide statistical information on the nature, frequency and location of medical emergencies and the means to predict what, when and where emergencies will occur within a 24 hour period. Sophisticated patient care monitors provide information about heart rate, electrocardiogram(ECG) rhythm, oxygen saturation, exhaled carbon dioxide levels, the rate and depth of chest compressions during a cardiac arrest, and much more. Paramedics use apps to learn about the patient's prescription medications for insight into their medical history and to ensure that their medications don’t conflict with the drugs to be administered by the paramedic. Soon, paramedics will have access to patient records, including blood work and x-rays, through a health card. In the near future , the Internet of Things promises to revolutionize emergency response and patient care. For example, biometric devices and radio frequency identification (RFID) will alert paramedics before they enter a home that there is someone inside and will provide their vital signs on a heads-up display (HUD). Paramedic students are being prepared for in increasingly digitized world where electronic documents, bedside diagnostic devices, implanted artificial intelligence, smart prosthetics, computer to human interfaces and abstraction of “big data” are rapidly becoming commonplace. Not only do they need to be digitally literate to function in their chosen discipline, but can benefit greatly, as will be argued, by leveraging learning technologies in the classroom to acclimatize them for the real world and to augment their learning. Combining case-based learning with learning technologies has the potential to increase the efficiency and effectiveness of learning. Case Based Learning Pedagogy Case-based learning (CBL) is a student centered pedagogy in which students discuss real "medical" cases and collaborate through problem-solving activities. These group activities leverage prior learning, provide opportunities to construct new knowledge and there is evidence that “problems arouse situational interest [situated learning theory] that drives learning” (Schmidt, Rotgans, & Yew, 2011). CBL promotes active learning and improves critical thinking and problem solving skills (Popil, 2011). Group learning is also a pedagogy that leads to higher academic achievement (Tsay, Brady, 2012). The concept of CBL arose from medical training at the McMaster University School of Medicine in the late 1960s. However, it was first described as Problem Based Learning (PBL). Since then, the definition of PBL has morphed to a broader one that includes not just complex medical cases, but problems of any kind and within any discipline. Hence CBL is a subset of PBL (Barrows, 1986). Case-based learning is a form of learning that is incorporated in many health disciplines and is particularly prevalent in the field of high fidelity medical simulation.My focus here however will be on paramedic cases coupled with the integration of learning technologies in the classroom. With the ubiquity of smartphones ,tablets, and apps, educators who wish to leverage these learning technology tools in the classroom need a framework to help them determine whether an app or a piece of hardware is simply novel or whether it substitutes, augments, modifies or redefines (SAMR Model) the learning experience. At the substitution level, the technology replicates a task that was previously done without a computer or a learning technology with no functional change. For example, moving from a typewriter to a word processor and only using the typing function on the word processor. At the augmentation level, the technology offers a more effective tool to perform common tasks. For example, a prescription drug reference app might be considered an augmentation compared to a paper-based reference book, since the app will be updated regularly and will always be current, whereas the book will be out of date by the time it is published. This example might also be considered an augmentation since it is arguably easier to search for information in the search field of an app then it would be to flip back and forth from the index of a paper book. At the modification level, a quick response (QR) code might be used to take a student from a document to a website, a video, a quiz or some other relevant content which might otherwise occupy too much space on a single worksheet. Another example of modification might be the ability to highlight and annotate in digital documents such as eBooks or PDF files, and be able to edit and search for annotations and highlights. Another example of modification would be the ability for students to interact and collaborate with shared documents such as in a Wiki or using Google Docs. Finally, at the redefinition level, students might create a multimedia enriched and interactive document using iBooks Author or collaborate on the creation of a web-based mind map when distance is a barrier to face to face collaboration. Because new learning technologies are coming to the market faster than their value can be assessed, it’s important for educators to put pedagogy first and determine what, if any, technology facilitates the achievement of the learning objectives in either a more efficient or effective way (Watson, 2001). It has long been argued that smartphones, tablets, laptops and the use of apps are a distraction to students in the classroom. A common perception among educators is that electronic devices in the classroom are a source of students disengagement and distraction (Hassoun, 2014). Many educators are ambivalent at best when it comes to deciding how to manage the student use of technology in the classroom. When is comes to leveraging technology in the classroom, the results of studies on the use of laptops in the classroom has been mixed. Some studies have found that students who use laptops in the class have received higher grades (Wurst, Smarkola, & Gaffney, 2008), while other studies have found the opposite effect (Grace-Martin & Gay, 2001; Fried, 2008). Indeed, mobile devices can be a distraction, William & Pence (2011) suggest that as a way to manage the misuse of smartphones, laptops and tablets in the classroom, that there be a portion of the class designated as “technology on” and a portion designated as “technology off”. Is this fair however, given the many benefits of having continuous access to mobile technology, such as electronic notetaking for later review and editing, annotation of digitized slide handouts, literature searches, peer to peer discussion and learning, to restrict or prohibit the use of technology? Despite the potential challenges of keeping students on task with their devices, the tools available through these devices allow for the learning to be situated and personalized (Kidder, Romrell & Wood, 2014). In a survey of 156 university students, the benefits of continuous access to mobile technologies have been reported 30% more often compared with the challenges (Kay, & Lauricella, 2014). The benefits or negative repercussions of continuous use of mobile technology aside, the objective of this paper is to discuss the use of learning technologies for task-specific purposes. Apps in the Classroom For case based learning in my classroom, students are divided into groups and are given a single, double sided page, with what amounts to a story involving a real “call” (sample). The story describes what paramedics saw, heard, smelled and touched. It also provides information about the patient’s chief complaint, history of presenting illness/injury, signs and symptoms, medical history, medications, allergies, and the results of diagnostic tests performed on the scene such as vital signs, ECG, blood sugar level and whatever other diagnostics would be relevant to a given case. Students are encouraged to use several apps to aid them in solving the case such as Differential Dx, epocrates, Medscape, calculator, GoodReader, scan (QR scanner), Emergency Response Guide (Android ERG) and others. Few paramedics in the field, for example, use a paper based prescription drug reference since they become out of date quickly, don’t fare well in the paramedic environment, and many drug apps are free and stay current with regular updates. Therefore students are encouraged to use peer reviewed apps, such as epocrates or Medscape, to inform them about the drugs a patient is taking, to shed light on the patient’s medical history, to guide them in administering drugs that might conflict with the patient’s medication and to avoid medication related adverse events (Man, Nguyen, & Lin, 2014). Often times, patients are unaware of all of their medical conditions, or they may be found unconscious, and a paramedic can ascertain information about their medical history within seconds by looking at drugs they are taking and using a drug app when the paramedic encounters a drug with which they are not familiar. These apps also provide critical information about precautions, adverse reactions and contraindications.
Videos created using Reflector 2 and iMovie for iPad. You can also view them on the EdTechMedic YouTube channel To conserve real estate on the case sheet (see sample), i incorporate QR codes into the single page narrative to give students access to ECG strip images, web pages, articles, quizzes, photos, videos or other information relevant to the case. I’ve created a “public” folder on my Google Drive from which I can share links with my students. I used to use Dropbox until they eliminated their public folder option. With the information provided, students work collaboratively to formulate a differential diagnosis (list of possible conditions consistent with the information presented). To facilitate this process, students are encouraged to use web searches and/or apps such as Differential Dx which provides a differential diagnosis based on a patient’s most dominant symptom(s) or chief complaint which is typed into the app (see video). In contrast, a web search for a symptom can yield millions of results. The students then analyze the differential diagnosis to infer a provisional diagnosis (most probable condition consistent with the signs and symptoms presented).The next step in the exercise is to propose a treatment plan that is congruent with their “provincial medical directives” and that takes into consideration the risk:benefit ratio of each proposed medical intervention. Students, again, work in collaboration with their classmates, decide what assessments and procedures to document in the procedure section of the case form. Procedures can range from a basic head to toe assessment, vital signs, applying a dressing to a wound, to performing “controlled medical acts” such as inserting an intravenous line or administering a drug. Students have access their medical directives, which contain protocols and standing orders for treatments, using a PDF reader such as GoodReader or any other app that enables them to bookmark pages, draw, annotate and highlight. The alternative is an app such as the Ontario Base Hospital Clinical Guide. Using a calculator app, students can calculate drug dosages. convert pounds to kilograms when calculating patient weight, or convert Fahrenheit to Celsius when a patient has an American made thermometer. Conclusion Cased-based learning within a group is an effective way for students to construct their own knowledge through inquiry, discussion, debate and discovery. Incorporating learning technologies can stimulate student motivation (Law, Lee, & Yu, 2010), as it improves the efficiency and effectiveness of information discovery. Efficiency can be found in the use of a single tool, such as a tablet or smartphone combined with appropriate peer reviewed apps for the gathering of information. There are a number is sites that review medical apps such as “iMedicalApps”, which is a peer review site where “physician editors lead a team of physicians, allied health professionals, medical trainees, and mHealth analysts in providing reviews, research, and commentary of mobile medical technology” (2009). However, there is does not exist a uniform system of evaluating the quality of apps (Walker, 2011). It can be argued, although there is a paucity of quantitative research in this area (Young, 2009), that the benefit of access to multiple sources of information through learning technologies is superior to flipping through the pages of multiple books. In a recent randomized control trial, one of the few used to evaluate the iPad as a learning tool for math, the authors found that “78% of low achieving children showed improved mathematics skills [using an iPad], compared to a 17% increase in children who received normal [paper based] practice” (Kucirkova, 2014). The effectiveness of learning technologies is evident in the fact that apps are continually updated, in contrast with the paper based counterpart which is out of date by the time it hits the bookshelves. The use of learning technologies and tools such as mobile devices and apps also allows students to work in a clutter-free environment. Every information resource a student needs, a drug reference app, a QR code scanner app, an e-reader app, a calculator, search engine or other app a student needs, is encompassed in a single device. While some educators look for a single magical app that does all of what she wants, a blend of apps, or what some educators refer to as “app smashing” (Young, 2014) is suitable for school projects or case based learning. REFERENCES (2009). iMedicalApps | Reviews of Medical apps & Healthcare ... Retrieved December 1, 2014, from http://www.imedicalapps.com/.
Barrows, H. S. (1986). A taxonomy of problem‐based learning methods. Medical education, 20(6), 481-486. Fried, C. B. (2008). In-class laptop use and its effects on student learning. Computers & Education, 50(3), 906-914. Grace-Martin, M., & Gay, G. (2001). Web browsing, mobile computing and academic performance. Educational Technology & Society, 4(3), 95-107. Hassoun, D. (2014). “All over the place”: A case study of classroom multitasking and attentional performance. New Media & Society, 1461444814531756. Kay, R. H., & Lauricella, S. (2014). Investigating the Benefits and Challenges of Using Laptop Computers in Higher Education Classrooms. Canadian Journal of Learning and Technology, 40(2), n2.Kay, R. H., & Lauricella, S. (2014). Investigating the Benefits and Challenges of Using Laptop Computers in Higher Education Classrooms. Canadian Journal of Learning and Technology, 40(2), n2. Kidder, L. C., Romrell, D. & Wood, E. (2014). The SAMR Model as a Framework for Evaluating mLearning. Online Learning: Official Journal of the Online Learning Consortium, 18(2). Kucirkova, N. (2014). iPads in early education: separating assumptions and evidence. Frontiers in psychology, 5. Law, K. M., Lee, V., & Yu, Y. (2010). Learning motivation in e-learning facilitated computer programming courses. Computers & Education, 55(1), 218-228. Man, C., Nguyen, C., & Lin, S. (2014). Effectiveness of a smartphone app for guiding antidepressant drug selection. Family medicine, 46(8), 626-630. Popil, I. (2011). Promotion of critical thinking by using case studies as teaching method. Nurse Education Today, 31(2), 204-207. Schmidt, H. G., Rotgans, J. I., & Yew, E. H. (2011). The process of problem‐based learning: what works and why. Medical education, 45(8), 792-806. Tsay, M., & Brady, M. (2012). A case study of cooperative learning and communication pedagogy: Does working in teams make a difference?. Journal of the Scholarship of Teaching and Learning, 10(2), 78-89. Walker, H. (2011). Evaluating the effectiveness of apps for mobile devices. Journal of Special Education Technology, 26(4), 59-63. Watson, D. M. (2001). Pedagogy before technology: Re-thinking the relationship between ICT and teaching. Education and Information technologies, 6(4), 251-266. Wurst, C., Smarkola, C., & Gaffney, M. A. (2008). Ubiquitous laptop usage in higher education: Effects on student achievement, student satisfaction, and constructivist measures in honors and traditional classrooms. Computers & Education, 51(4), 1766-1783. Young, J. (2009). ERIC - 6 Lessons One Campus Learned about E-Textbooks. Chronicle of Higher Education, v55 n39 pA18. Retrieved from http://eric.ed.gov/?id=EJ847216. Young, D. (2014). Creating Innovative Student Projects with App Smashing. Educational Horizons, 93(1), 12-15.
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AuthorI am a paramedic educator and educational technology enthusiast. The "medic" part of this blog title simply refers to my paramedic background. Archives
October 2018
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