Sessions Jan Åke Gustafssonsalen - KI's Educational congress 2022

Fostering Master Adaptive Learners: An Agent for Organizational Learning

Heather Billings and Elissa Hall

Background: The growing awareness of the significance of the Master Adaptive Learner (MAL) model in health professions education necessitates the development of interprofessional education experiences designed to advance adoption and transference of adaptive expertise principles to the learning environment and health care systems (Cutrer 2017, Branzetti 2022).

Adaptation of expertise over time is essential within the dynamic health professions care systems, and must be practiced across the continuum of training; all members of the health care team must develop and draw upon principles of adaptive expertise in order to be successful in meeting the needs of the evolving patient population (Mylopoulos and Woods 2018).

Aim: This proposal builds upon the authors’ previous work developing continuous professional development to increase conceptual understanding of MAL among health professions (HP) educators and learners. To address, embrace, and enhance the training of future healthcare providers as an organization, promoting elements of adaptive expertise has become an increasing focus. We seek to promote awareness and adoption of the MAL framework at the institutional level as an integrated strategic priority.

Method: For 10 years, the Mayo Clinic has held an annual, multi-site, interprofessional faculty development event, the Education and Technology Forum (ETF), designed to advance knowledge and skills related to pedagogy and technology, support innovation in education, and create a community of practice (Billings et al, 2022). Over the past several years the ETF has focused on the evolving intersecting roles of the HP educator, learner and learning environment; this work has guided strategic priorities and innovations across the organization.

Results: The 2022 ETF, “Building Adaptive Expertise”, was structured as a 3-hour, synchronous, virtual event coupled with asynchronous pre-and post-event curated resources to reinforce discovery and self-regulated learning. Participants developed a shared vocabulary and deepened conceptual understanding while learning how to cultivate adaptive expertise in their own learning, teaching, and supervising practices. Deliberate by design, the synchronous session was segmented, or chunked, aligned with the Master Adaptive Learner framework (i.e. plan, do, assess, and adjust) for participants to create a shared mental model, experience the MAL framework in practice, and facilitate learning transfer through coaching (Cutrer 2021).

Conclusions: Establishment of the ETF community has contributed to a learning environment where participants can be vulnerable, draw from personal motivators and embrace a growth mindset. The ETF has been attended by over 1,700 HP educators (physicians, allied health professionals, basic scientists, nurses, etc.) and education staff (technologists, instructional designers, administrators, coordinators, faculty developers, specialists, etc.), with >93% indicating it was a valuable use of time and >96% reporting they learned something they will apply in practice. The ETF not only serves as an incubator for innovation and solution generation but also as a fertile environment to advance and reinforce organizational learning and practices.

Scholarship of Teaching and Learning - a model for continuous pedagogical development

- Lena Boman

Background/Problem: In Strategy 2030 it is stated that Karolinska Institutet should be characterised by pedagogical innovation and lifelong learning. Today, almost half of the universities in Sweden have developed models for defining pedagogical competence at different levels. Karolinska Institutet does not have a clear description of what pedagogical skill means, and which pedagogical merits and competence are required for teachers. This needs to be analysed and described.

Scholarship of Teaching and Learning is a model for pedagogical development with the purpose to improve university teaching and the teachers’ pedagogical competence. The goal is to increase students’ learning through the teachers’ systematic investigative approach to their own teaching and sharing their experiences with colleagues.

Aim: The aim of the project is to increase the opportunity for teachers to develop their pedagogical competence and to describe an alternative career path alongside the research career. The goal is to develop, implement and evaluate a model of Scholarship of Teaching and Learning at the Division of Nursing.

Method: The project started 2020 in a dialogue with the management of the Division of Nursing. Several workshops with the teachers were performed during 2021-2022. The concept and models of pedagogical development have been discussed. The work to define three levels of pedagogical competence i.e., basic, experienced and excellent, has been initiated and will continue during the autumn 2022. The pedagogical competence will be linked to teachers’ different tasks and responsibilities and what support there is for their further development.

The model is planned to be implemented during the spring 2023 and evaluated 2023-2024 through surveys, focus groups and individual interviews. The definition of competencies at different levels needs to be calibrated with Karolinska Institutet’s requirements and, for this purpose, a collaboration between the Division of Nursing and the Unit for Teaching and Learning has begun.

Results: An interim evaluation of the workshops shows that the teachers appreciate the development of a pedagogical model and find it vital to clarify the different levels of pedagogical competencies linked to their tasks. It also gives a clearer picture of what is expected of them and what pedagogical competence development are expected. Preliminary results of the evaluation will be presented during the autumn 2024. The results are expected to form the basis for development of pedagogical competence and clarify possible career development for teachers. The pedagogical model is also expected to highlight the quality of evidence-based teaching. The results will be shared within as well outside Karolinska Institutet.

Conclusion: We believe that the development of a pedagogical model will support Karolinska Institutet’s pedagogical plan and inspire other departments to clarify competence and tasks for teachers with different positions. It can also increase the collaboration between universities, not at least with the Stockholm university where a model for Scholarship of teaching and learning has been developed, but also internationally.

Pedagogical ambassadors in doctoral education - a pilot project in KI 2022

Gabrielle Paulsson-Berne

Background: Five Pedagogical ambassadorships for doctoral level education were awarded at Karolinska Institutet at the end of 2021. Pedagogical ambassadorship (Bolander Laksov, K. Högre utbildning Vol. 10 | Nr. 2 | 2020 | 16–20 ) stems from an idea that faculty are given the possibility to lead a pedagogical development project for their department or research education program in collaboration with the university pedagogical unit.

Aim: The purpose of this one-year pilot project at KI was to stimulate pedagogical development in doctoral courses by partly financed time for pedagogical ambassadors (PAs) as well as the start-up of a pedagogical network in doctoral education with the support from the unit for Teaching and Learning (UoL). The focus of the project was to develop and promote an educational culture with close partnership with the heads of the departments. Method The PA positions were announced and five PAs were selected among the applicants.

Each PA had designed a development project in connection to the PA’s own engagement in doctoral education at KI. These were the included projects:

1. Development and implementation of a Training of Teacher (ToT) workshop
2. Development of methods to co-design learning activities such as debate.
3. Development of the Research School for Clinicians in Epidemiology.
4. Development of methods for active student participation in online learning.
5. Development of a model for PhD students´ involvement in undergraduate education at KI.

A contact person was assigned within the Teaching and learning unit at KI to facilitate the collaboration within the group as well as with the pedagogical unit. Monthly meetings and round table discussions have been the regular contact points complemented with individual meetings between the PAs.

Results: Through the interaction within the group and with educational developers at UoL the projects are being implemented, modified and further developed. After the initial six months several of the projects have formed collaboration. The current status of the project and its developments and challenges will be presented during the conference.

Conclusion: By forming a network between active faculty members from different doctoral programmes at KI new pedagogical developments and collaborations have been possible. The format of the programme, with individual projects and close interactions with pedagogic developers at the Teaching and learning unit, has led to new and fruitful connections enhancing possibilities for future development in doctoral education.

A Meta-analysis of course development projects - resources for continuous learning

- Henrika Florén, Thomas Nixon, Helen Gelin

Background: Different course development projects have been carried out during 2021 and 2022. Several of these projects have collaborated with the Unit for Teaching and Learning in developing different types of digital resources, or with the pedagogical reshaping of courses, to better meet the needs of teaching and learning in digital environments.

Aim: The aim for this presentation is to show a synthesis of results from the work with course development, which can be generalized and contribute to a continuous leaning for those who teach and for the organization. We contribute with a meta-analysis of several different course development projects, considering their formulated aims, work processes, results, or partial results, and overreaching evaluations. We ask – what can we learn from the work with course development in collaboration with teachers and staff from the Unit for Teaching and Learning, and how can this be used to continuously enrich pedagogical activities? We here focus on processes for supporting course development, what we have found to spotlight and keep, and areas in processes and collaboration which need improvement.

Over-reaching results from the work with course development projects include improved processes för work with and around course development. We will also show concrete examples of resources produced for, and together with, specific projects, that can now be used in all areas of KI’s education. In conclusion, the meta-analyses of the work with course development project that this has resulted in resources that can be used on course, program and institutional levels.

These are resources produced within specific projects but also by staff from the Unit for Teaching and Learning. In addition, more effective processes and structures for course development are proposed, which could improve continuous learning and pedagogical development.

Tying the knot between faculty development and educational change in clinical settings

Agnes Elmberger

Background: Clinical workplaces offer important learning experiences for the next generation of health professionals. However, many clinicians are unprepared for their teaching responsibilities, and the complexity of health care present challenges for clinical education. To address these concerns, faculty development has been singled out as fundamental and there is now widespread provision of activities aiming to support teaching clinicians and essentially to improve clinical education. While these initiatives are often appreciated, there are questions regarding their impact on teaching and if and how they may contribute with educational change in practice.

Aim: The overall aim of this thesis was to explore faculty development and educational change in clinical settings.

Method: The thesis employed a socio-cultural perspective and activity theory was applied to emphasise individuals as acting within social and cultural systems. Four qualitative studies were conducted exploring the experiences of clinical educators, defined as clinicians with designated teaching roles. Study I explored how clinical educators’ engagement in faculty development was affected by the systems they act within. Study II applied a multi-institutional collective case study design and explored experiences of working with educational change in clinical workplaces from the perspective of clinical educators from two different countries. Study III explored how clinical educators integrated educational innovations developed in a faculty development programme into their clinical workplaces.

Building from the same programme, Study IV identified aspects of that programme that had supported participants in working with educational change in practice.

Results: The findings suggest that tensions arise between the activities of education, research and patient care, where education is afforded low value and priority. This is manifested in the organisation and management of teaching, the attitudes and beliefs about teaching and the lack of resources and incentives for teaching within clinical settings. The findings illustrate how these tensions limit clinical educators’ opportunities for faculty development and educational change beyond individual dimensions of teaching.

Further, the thesis offer insights into how educational change may unfold following faculty development and emphasise this as dynamic and collaborative processes. The concept of collaborative knotworking is put forward to illustrate how faculty development can contribute to educational change in clinical settings, highlighting that both faculty development participants and their workplace communities are active agents influencing processes of change.

Conclusion: This thesis contributes to the understanding of educational change as dynamic, interactive and influenced by the context in which it unfolds. It also illustrates how clinical educators’ agency and approaches to change are shaped by structures in their workplaces, and that their elbow room to work with educational change is constrained due to tensions between activities in clinical settings. As such, the findings challenge the overreliance on individual approaches in faculty development and alludes to the limitations with ideas of transfer of stable knowledge and skills. Rather, the thesis argues that current faculty development may need rethinking if it is to tie the knot with educational change in clinical settings, and, in essence, if it is to enhance teaching in the health professions.

Pedagogical experiences from an educational development project

Marie Halvorsen, Linda Ekenros

Background: Practical skills within physiotherapy education have traditionally been taught face-to-face. The start of the pandemic in spring 2020 forced teachers to use different approaches to their teaching. Blended learning which combines face-to-face learning and digital learning design, has grown rapidly to be commonly used in physiotherapy education. Research comparing blended learning to traditional classroom teaching has found that blended learning might improve better learning outcomes. Knowledge of how to foster students´ practical skills in a blended learning environment is needed to provide meaningful and effective learning.

Aim: The aim of this project was to develop a pedagogical model for blended learning within practical skills training in physiotherapy and evaluate students’ perceptions and course outcomes. The specific aims were to - Design a pedagogical model for blended learning on practical skills using flipped classroom within the physiotherapy education - Implement the pedagogical model in a course on basic physical examination within physiotherapy. - Explore the outcome of the pedagogical model for blended learning, in terms of students’ satisfaction and learning outcome

Method: This project was performed through a multiple-step process: firstly, a critical review of previous course evaluations was performed, secondly an inventory of learning activities suitable for blended learning using the Activity Based Curriculum design, and thirdly, a draft of a new course structure was created. Forth, the draft was reviewed through semi-structured interviews and after that, the fifth step with revision and implementation of the new course structure was performed. Finally, in the sixth step, course evaluation based on the students’ perceptions and the outcome of the new course design was reviewed.

Results: At the first step of the process, a lack of digital learning activities and material was identified. Therefore, a pedagogical model of blended learning was designed. For the digital environment, short theoretical lectures were recorded and embedded together with videos on tutorials for practical skills. Flipped classroom sessions were designed involving recorded short theoretical lectures that were embedded into the learning platform.

In addition, video-recorded tutorials showing physical examinations were provided for students to prepare for the face-to-face skills training. The course was implemented gradually over two semesters and small adjustments in the design were made along the way to suit the context. Based on the student's self-evaluation a small favorable change in students 'perceptions of the course was found.

Conclusion: The findings from this pedagogical project suggest that students well perceived the blended learning model. Further research is needed to explore the effectiveness of different digital learning designs in physiotherapy education. Keywords student-centered learning, blended learning, flipped classroom, physical therapy education, digital learning.

Ongoing research on psychotherapy education and live supervision for clinicians

Emma Högberg Ragnarsson

Background: In order for mental health clinician training to be effective, immediate educational outcomes are not sufficient: competence gains must also be implemented and sustained. Although recent research has presented suggestions for improving quality in clinician training in evidence-based interventions, there is still a dearth of knowledge regarding the extent to which new competencies are used in clinical practice, as well as of a clear understanding of critical factors influencing these processes. Consequently, mental health organizations risk investing time, money and effort in ineffective training.

Aim: We aim to collect data from participants enrolled in routine clinician training courses, before, after, and continuously up to 12 months following end of training to learn about their development of knowledge and self-rated use, as well as multiple systems-contextual (SC) determinants hypothesized to influence these outcomes. The SC model underscores the importance of contextual factors (e.g., therapist variables, organizational support, and quality of training program) for clinician uptake and adoption.

Method: A literature review, expert panel, focus group interviews, cognitive interviews and a pilot of one of the subscales, informed the development of the survey. Data collection for the main study started this semester, and is planned to continue for three years.

Results: Developing this study has shed light on the challenges of assessing outcomes and utility of clinician workforce training. Is “train and hope” all we can do, or are there ways to measure effects of educational efforts? Further, the literature review of determinants exposed little research on malleable individual-level variables hypothesized to be associated with training outcomes. Therefore, we have developed a sub-scale, exploring psychological flexibility and its’ potential role in learning acquisition and transfer.

Conclusion: Although we will have to wait for data and data-analyses, we wish to take this opportunity to present our work this far, and discuss related challenges and dilemmas with others with similar interests.

Medical student´s self-efficacy – important for their well being

Annika Östman Wernerson

Background: Medical school is challenging for many students, and studies have reported that students struggle with high workload, stress and emotional challenges. When faced with such problems, individuals use various coping strategies. In addition, self-efficacy, ie a person’s belief in his/her capability to achieve a certain goal, has been found to be an important protective factor to the negative consequences of stress.

Aim: We aimed to investigate if self-efficacy is associated with different coping strategies in emotionally challenging situations during medical education, and whether these variables, in turn, were associated with medical students’ perceived mental health.

Method: Data was collected by means of a web-based survey to medical students at all seven medical schools in Sweden. The survey included items from established instruments on coping strategies and perceived mental health. In addition, items on medical students´ self-efficacy were constructed by the research group. 647 students answered (28% response rate), of which 61% were women. Data was analysed statistically.

Results: Medical students’ self-efficacy was significantly and positively correlated to active coping strategies such as problem solving, cognitive restructuring, and expressing emotions. On the other hand, self-efficacy was significantly but negatively correlated to perceived mental health problems and more passive coping strategies, such as problem avoidance, social withdrawal, and self-criticism. This indicate that students with a high belief in their capabilities use more active coping strategies when faced with emotional challenges and are less likely to experience mental health problems. Furthermore, students with low self-efficacy are more likely avoid problems, experience mental health issues and are also more likely to worry about becoming burned out in their future work in health care.

Conclusion: Our findings suggest that students with low self-efficacy and less constructive coping strategies are at the risk of developing mental health problems and burn-out. Strengthening students´ self-efficacy and providing emotional support may be a way forward.