THE MARY STUART PROJECT

David RobertsonSchool of Health Sciences

Faculty of Health & Social Caredavid.robertson@rgu.ac.uk

THE ROBERT GORDON UNIVERSITY

THE MARY STUART PROJECT

Aim: To utilise and evaluate innovative methods in promoting teaching and learning and to gain international

perspectives on the management of individuals with multiple sclerosis.

Aim: To investigate the potential of problem based learning (PBL) supported by communications technology, to develop key, transferable and requisite skills and

knowledge, critical for practice as an occupational therapist.

THE MARY STUART PROJECT

PROJECT PARTNERS

David Robertson Dr Jennifer Caldwell both: School of Health Sciences: Occupational Therapy, RGU

Robin McCannon Occupational Therapy, University of Wisconsin, LaCrosse

Dr Charles Juwah, Centre for the Enhancement of Learning and Teaching, RGU

Dr Abdulaziz Elfessi Mathematics, University of Wisconsin, LaCrosse

Inspiration

World Federation of Occupational Therapists

European Network of Occupational Therapists in Higher Education

American Occupational Therapy Association

UK College of Occupational Therapists

Statements

• WFOT (2002): "Educational programmes for occupational therapists need to have strong and ongoing links to the international occupational therapy community".

• AOTA(1998): "Students must develop an appreciation of the influence of international occupational therapy contributions to education, research and practice".

Literature Review

• Published literature– Southern Hemisphere esp. Australia– Rural North America– Geographically remote but relatively affluent

Mainly medical and nursingLittle or no occupational therapy literature

Anecdotal literature or commentaries

Limitation: (searched journals published in English only)

Information Technology• Videoconferences

Internet protocol videoconferencing Internet Protocol (IP) videoconferencing technology

is a relatively new and a lower cost alternative to the ISDN/ATM system.

• Virtual CommunityThe Robert Gordon University Virtual Campus,

(http://campus.rgu.com/) is a web based virtual learning environment which delivers online courses and has over 10 000 members from 109 countries.

Why Evaluate?

• “Existing overviews of the field do not provide high quality evidence with which to provide robust answers to questions about the effectiveness of problem based learning". (Newman 2003)

• The lack of rigor in the assessment of the educational effectiveness of communication and information technology in medical education is an issue that remain to be addressed. (Ward 2001)

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Questions• Did this method of delivery, problem based

learning supported by videoconferencing and a virtual community, allow students to achieve specified learning outcomes?

• What were the students' perceptions of educational technology as a method of exchanging information with faculty and students from another country?

• What were the strengths and the limitations of the methods selected?

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Sample

• N=30 (15 U.S., 15 Scottish)• 28 females, 2 males• Age range 20-29 years. • Scottish students: year 3 of a 4 year

BSc(Hons) in occupational therapy. • U.S. students: final semester of a

baccalaureate occupational therapy programme.

• Both groups of students had previous experience of PBL although the format of the PBL was different in each institution.

Method• Action Research

– a collaborative inquiry, conducted by practitioners, focused on improving the quality and diversity of the teaching practices in the participating institutions

• Pre-test / post-test design • Qualitative Data

– Questionnaires– Subject and researcher focus groups – Virtual community logs– Transcription + analysis of the

videoconferences

Outline content of the videoconferences.Videoconference

1. Introduction and orientation to the virtual community, release of Mary Stuart’s medical and social history.

Videoconference 2. Student groups present their assessment strategies, release of

exemplar assessments.Videoconference

3. Student groups present their treatment strategies, release of exemplar treatment plan, discharge summary, photographs and plans of Mary Stuart’s home.

Videoconference 4. Student groups present their resettlement strategies. Group

reflection on the influence of healthcare systems directly on management of Mary Stuart.

Videoconference 5. Focus group 1.

Videoconference 6. General discussion focussed on healthcare systems and their

influence on the practice of occupational therapy.Videoconference

7. Summary and focus group 2.

Videoconferencing

Virtual Community• Send and

receive messages

• Post and read messages on a group forum

• Reading and resource room

• Download case documents

Mary Stuart's Home: Plans

Mary Stuart's Home: Pictures

Data Analysis• Content acquisition

•Two way ANOVA with repeated measures to assess mean differences between the two time points (pre and post)

•Overall impressions of project• Means from likert scale questions

•Transcription of videotaped focus groups

• Instructional technology

• Likert scale ratings of usefulness

• Descriptive statistics of utilisation

• Pearson correlation for utilisation of technology and satisfaction of learning experience.

Results• Content acquisition:

• 2 way ANOVA with repeated measures yielded a significant difference between the time points (pre and post test) for all participants for all learning objectives (p0.01).

• The mean score increased from pre to post test indicating an increased level of understanding.

Results• Overall impressions of PBL experience

– The experience was beneficial in understanding international occupational therapy practice: mean 4.5/5

– The experience was beneficial in understanding what occupational therapy has to offer individuals with multiple sclerosis: mean: 4.0/5

(These results were generated from 5 point Lickert scales. A score of 5 indicated strong agreement with the statement).

Students indicated that the videoconferences contributed to increasing their:

•understanding of international occupational therapy practice

•understanding of occupational therapy with individuals with multiple sclerosis

•understanding of cultural differences between Scotland and the U.S.

• (mean ranges 3.5-4.1/5 scale)

Results: Instructional Technology

Results: Instructional Technology

Students indicated that the virtual community somewhat contributed to increasing their:

•understanding of international occupational therapy practice

•understanding of occupational therapy with individuals with multiple sclerosis

•understanding of cultural differences between Scotland and the U.S.

• (mean ranges 3.1-3.7 scale)

Results: Virtual Community

• Most students (21) self-reported using the virtual community weekly or more often

• Mean no. of logins was 11.9 (range 2 - 42)• Scottish students accessed the virtual

community significantly more often than US students (p<0.05)

• US students, who expressed significantly more confidence using technology at pre-test, maintained their level of confidence.

• Scottish students demonstrated a significant improvement in their self-perceived confidence in using the virtual community (p0.01) and videoconferencing (p0.05)

Clinical Reasoning• Videoconferences were videotaped and

transcribed• Student statements demonstrating clinical

reasoning were identified.• Classification of the statements was

undertaken by two researchers following reliability testing (inter-rater reliability 91%)

• These statements were classified according to Mattingly & Fleming (1994).

Clinical Reasoning• Procedural reasoning (61% of statements)

– focuses on the process used to maximize clients’ functioning. (deficits and disabilities)

• Conditional reasoning (27% of statements)– focuses on understanding of clients’ feelings

about themselves and about the intervention they receive. (understanding and feelings)

• Interactive reasoning (12% of statements)– Focuses on the understanding of clients’

disabilities in specific life contexts. (needs, occupational performance and environment)

Liu, Chan and Hui-Chan (2000)

UWL student: “This was an excellent way to communicate with the Scotland students.”

UWL student: “I felt this was an excellent experience that most students do not have the opportunity to participate in.”

RGU student: “A project based on videoconferencing was really exciting.”

RGU student: “This was a very worth while experience, it has opened a window to go over to America and experience life working as an OT there.”

Results: Strengths Student Focus Group

Staff Focus Group: Strengths

• Exciting method of exposing students to international OT practice

• Cost effective

• Opportunity to work with faculty and students from a different institution and country.

• Opportunity to explore alternative teaching methods.

• Technology support staff found the technology connections overall went smoothly.

Learning from mistakes

• Synchronise PBL formats, ensure the expectations and goals of students can be met

• Have a contact and back up system in case of technology failure.

• Osmosis is a poor method of distributing information.

• Acknowledge differences in time pressures• Acknowledge differences in experience• Remember that clock changes are not

universal

Suggestions• It is initially time consuming to set up

the case.• Students and staff need time initially to

familiarise themselves with the technology.

• Layout of the videoconferencing facilities may determine the style of PBL adopted.

• Students need to be able to relate to the individual in the case study therefore awareness of cultural norms is essential

The Mary Stuart ProjectSummary: Further Development

Development of Technology

Development of Materials

Development of Skills

Dissemination

Collaboration