Learning when to refine teaching with technology| MEDICUS 2024 Issue 1

Learning when to refine teaching with technology
By Nicole Lim, Senior editor

Prof Fernando Bello, leads the serious game elective module. In the latest cohort, participants conceptualised not just mobile or computer-based games but also explored traditional board games as a means to achieve their learning outcomes // Credit: Norfaezah Abdullah, Duke-NUS

“It gives you that little bit of bravery and confidence to just try,” said Dr Jill Lee of the benefits of the Technology-Enhanced Learning for Health Professions Education executive certificate—confidence that led the associate programme director for the SingHealth Obstetrics & Gynaecology Residency Programme to add instructional TikTok videos to the pre-class preparation material for medical students who come to learn the art of vaginal examinations in labour.

Lee and one of her residents produced a video to demonstrate the varying degrees of dilation of a woman’s cervix during labour, providing standardised reference points for what is otherwise open to highly subjective descriptions.

And it worked. In a pilot study with 20 medical students, they demonstrated that all of the students found the video more useful and accessible than conventional teaching approaches of using for example stencils of different sizes. And all but one agreed that the video made them more confident in performing vaginal exams in real life.

@caleblcw A one minute guide of how obstetric vaginal examinations are performed! 🤰👩‍🍼👶#medtok #obgyn #labourward #baby #childbirth #obstetrics ♬ Suns - Official Sound Studio

While this may have been a success, Lee is not one to get distracted by technology.

“Adding technology for the sake of it doesn’t bring anything to the table,” she said. “I think that in some situations, technology can even hinder the learning experience, leaving the learner struggling with the technology part, and the focus is gone from the content.”

And that is precisely the confidence that the four-module credit-earning course aims to equip its graduates with—a strong foundation in educational theory as well as how to incorporate technology to effectively enhance their teaching.

Filling the knowledge gap

The idea for the course first emerged in 2019 out of a hunch.

“We had this suspicion that there was a knowledge gap in the understanding of how to use educational technologies effectively,” said Professor Fernando Bello, co-director of the certificate and associate dean for technology-enhanced learning and innovation at Duke-NUS.

“Especially as we are continually bombarded with all sorts of different tools that can be used for education but do all our educators have the frameworks that could help them critically assess whether this is something that would enhance their teaching?” said Bello.

Prof Fernando Bello (centre) is flanked on the left by course co-director Assoc Prof Nigel Tan and on his right by deputy director Asst Prof Jason Lee as they accept the 2023 Golden Apple Programme Excellence Award from then SingHealth Group CEO Prof Ivy Ng and Duke-NUS representative Prof Roger Vaughan // Credit: Academic Medicine Education Institute

Together with the course’s deputy director Assistant Professor Jason Lee, Bello conducted a survey in 2021 to understand the experience and readiness of educators to use these technologies. They found that both experience and readiness varied dramatically across individuals and professions.

Obstetrician Jill Lee, for example, already had a master’s in medical education but she wanted to deepen her skills to effectively use some of these latest technologies to support her learners and harness big data to improve teaching and, ultimately, patient care.

“We’re in the privileged position where we employ in excess of 85 or even 90 per cent of our graduates, so we now have the volume that will allow us to fully assess the residency training programme,” she said.

Similarly, Ms Elizabeth Phua, a nurse educator with the Singapore National Eye Centre who had already earned a diploma in higher education, enrolled to enhance her technology integration skills.

“My diploma had only a small component on technology. But that’s where I got interested in learning more about using technology better,” said Phua, who before enrolling in the course, had been involved in developing a mobile game to help nurses new to the operating theatre manage the steep learning curve.

“The serious game helps them develop non-technical skills like situational awareness and revise technical knowledge, like the kind of instruments that have to be prepared, in a non-stressful way,” explained Phua, who completed the certificate in 2022.

Course deputy director Asst Prof Jason Lee is a passionate educator who is working on ways to create more opportunities for educators to access workshops and courses to deepen their expertise // Credit: Norfaezah Abdullah, Duke-NUS

From educator to student to improve learning outcomes

With their varied educational backgrounds and the changing nature of best teaching practices, the first step was to bring everyone—clinicians, nurses, allied health professions and course administrators—on to the same level, decided the team behind the course, which is co-directed by Associate Professor Nigel Tan, the associate dean for the MD programme at Duke-NUS and group director for undergraduate education at SingHealth.

Through the two core modules, Jason Lee equips participants with a strong foundation in education theory as well as the necessary critical thinking skills to assess how best to harness technologies to achieve their desired learning outcomes before participants choose two from a series of electives focusing on different technologies, such as simulation, AR and VR as well as data analytics.

“The biggest misconception is that this is how I learned and therefore this is how you would learn,” said the assistant professor with Duke-NUS’ technology-enhanced learning and innovation department, who specialises in understanding how technology can be used to help students achieve their learning outcomes.

Teaching methods have changed, attention spans are changing and with access to more content than ever, instilling critical thinking skills has become crucial.

“A lot of healthcare professionals focus on imparting this content knowledge,” he added, thereby inadvertently neglecting helping the learner synthesise the information and develop their critical thinking skills.

“That’s why we focus heavily on reflective learning. We encourage our participants to go back, think about what they have done and use peer support as a way to learn and form a community of practice that will enrich education across our academic medical centre’s campus.”

A buzzing community

While the team has yet to do a full impact study, anecdotal evidence shows that the course can deliver on its vision of creating a buzzing community of educators. For Phua, for example, attending the course didn’t just introduce her to a wider range of teaching tools and educational frameworks:

“It was really eye-opening because it gave me access to this network of educators in different professions across SingHealth institutions, beyond the Outram campus. And it enhanced the way I look at things, showing me a wide spectrum of how educators teach using different platforms.”

For Jill Lee, the course made her aware of the many educators around her: “It can feel like you’re fighting your battles alone. But then you realise there’s one, or more than one, of you in every department. You gain an entire community of like-minded individuals across healthcare professions whom you can fall back on and discuss your successes and failures.”

And she hopes that the course will help to bring practitioners from the different health professions together, so that their varied perspectives can be incorporated into learning experiences.

Expanding their reach

Getting referrals from others across the campus who would like to partner with the education team at Duke-NUS to develop new learning tools is another sign of a healthy and dynamic educational environment.

“A team at KKH were keen on developing an educational game aimed at children to help them understand diabetes and the importance of managing diabetes well,” said Bello.

Collaborating with students from the Singapore University for Technology and Design, they are now working on a game where players take care of a pet. Filled with mini games and trips to the supermarket to purchase healthy food for the pet, players can earn coins and are rewarded by seeing their pet flourish.

The course’s impact is further extended by its graduates, who not only come back to share their experience with other cohorts, but by bringing the principles of the course to their departments and programmes. Jill Lee, for example, is looking to introduce the fundamentals of teaching to her residents.

“The idea is that our residents complete three sessions when they are junior residents and again when they are seniors, so that they can modify their teaching and learning practices as they mature,” she said. And she is now working with Jason Lee on this part of the residency education training programme.

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Phua, too, is making sure that the knowledge she has gained benefits all the educators at her institution: “I make sure to transfer the knowledge gained so that our programmes can be improved across the board. We want our learners not only to meet the learning objectives but enable them to better implement what we teach into their practice.”

Initiating the positive feedback loop

“This closes the circle,” said Bello, “We wanted to both fill a gap in terms of the understanding and principles of education, build a community that contributes back and make sure that we can support the educators when they want to make use of any of these technologies.”

And the course, which is the only such course in Singapore, remains popular, with demand from educators often outstripping available places.

“We usually get nominations that far exceed our capacity,” said Bello.

In 2023, Bello, Tan, Jason Lee and their course collaborators received a nod from the SingHealth Duke-NUS Academic Medical Centre’s Academic Medicine Education Institute, winning a Golden Apple Programme Excellence Award. The award recognises educational programmes that create or improve a curriculum or pedagogy leading to high-quality teaching and learning.

But the team wants to help educators beyond the Academic Medical Centre to level up too.

“The course has been warmly received on our campus,” said Bello, “so we really want to expand it, first to the other clusters in Singapore and then invite even regional participants, to foster a dynamic medical education community.”