Author: Linsey Duncan-Pitt (linsey.duncan-pitt@wlv.ac.uk)

JISC e-Learning Activity Area: e-portfolios

Higher Education Academy Subject Centre: health sciences and practice

 

Case study tags: online learning, an effect on learning, an effect on student personal development, student satisfaction with e-learning, innovation in learning and teaching, staff personal development, a positive effect on recruitment, a positive effect on retention, an influence on policy,use of resources, modifications to learning spaces, management of learning assets,an effect on social equality, tangible benefits of e-learning, university of wolverhampton, e-portfolios, health sciences and practice

 

Background & Context

 

This case study examines the use of a personal learning space offered by an e-portfolio system in two undergraduate programmes: nursing and midwifery, and is authored by two teachers: one responsible for a nursing programme and the other responsible for a midwifery programme.

 

Why did you use this e-learning approach?

 

Following an in-house workshop in April 2005, the nurse teacher decided to pilot the use of an e-portfolio system offered by PebblePad to develop a community of learners and later a community of practice of teachers, practitioners and learners in a group of non-traditional nursing students undertaking a Diploma in Nursing route called the 'family-friendly programme'. At this time the University had not adopted the use of e-portfolio across the entire institution but was preparing to do so for the academic year 2005-6. One of the factors which influenced the nurse teacher's decision to adopt this approach was the need to be able to evidence managed off-site study time activity to meet the Nursing and Midwifery Council (NMC) 'theory hours requirement'. The tutor was influenced in the choice of pedagogical approach by the increasing body of literature about online communities of practice. Experience also informed decision-making: students who follow unusual and minority programmes are often made to feel (overtly or covertly) that they are different and this has a negative impact on the student's self-esteem and confidence. It seemed important to ensure that these students felt part of a community that was supportive since approximately 60% would be non-traditional entrants and used to more intensive academic support in their FE colleges.

 

What was the context in which you used this e-learning approach?

 

The family-friendly route is a 4 year and 4 month programme (usual programme length is 3 years). It is aimed at those students with school-aged children wishing to study for a nursing career whilst taking advantage of all the major school holidays and shorter attendance times (10.00 - 14.00hrs) during theory blocks. This programme is located within a post-1992, 'widening-participation' University located in a densely-populated conurbation. Two cohorts of students have commenced on this programme since its inception. The average age of students on the programme is around 30 years (range 20 to 45). Entry qualifications include Access to HE, NVQ or BTEC Diploma. Fewer students have traditional qualifications obtained some time ago and have decided to change careers. The e-portfolio system has been used from the beginning with these cohorts. A full-time programme runs alongside and these students are not formally using the e-portfolio at this time. One of the main problems envisaged was that students applying for the programme would not have the requisite IT skills. Another was the need to work at encouraging student use by teacher engagement. In the early stages the numbers of teachers using this system were small and their experience of using e-portfolio and collaborative tools was limited. A small team was selected to work with these groups and training was offered to the personal teachers of these students.

 

What was the design?

 

Existing modules were adapted to accommodate the length of the students' programme i.e. 15 month academic year instead of 12 month. Existing VLE material ranging from PowerPoint presentations, streamed video and audio to self-assessment questions were repurposed to fit the alternative programme. This supported the timetabled theory and practical (skills lab) sessions and the remaining theoretical hours of study were supported by work located in the VLE.

 

The e-portfolio system was used to provide the backbone of the evidencing of Managed Off-Site Study Time (MOST) for three modules. One module required the students to summarise their additional study using an e-portfolio template called a 'thought' record. An applied physiology/nursing skills module required the students to present a variety of evidence: scores from a self-assessment test in the VLE, a completed workbook chapter or discussing the findings from monitoring pulse and respirations on friends and family.

 

A sample webfolio (see example) was developed by the module teacher and was then shared with the students with copy permissions so that they could develop their own version independently. This sample was seeded with suggested points at which they could hyperlink evidence of their study for the first 6 weeks of the module (seen in brackets here). The rest of the pages were then left blank to encourage the students to develop as they wished. The managed off-site study activities were identified in the module guide and the module material was located in the VLE. The e-portfolio materials were easy to construct and required little technical skill beyond being able to work with the e-portfolio templates, upload documents and create hypertext links to those documents. To support their clinical placement part of the course, the students were asked to start a web log using another tool in the e-portfolio system and were asked to share this with their personal teacher. They were asked to write a weekly account of their practice placement and it was suggested to them that they could use the 'thought' tool to construct reflective practice accounts which were required for their clinical assessment in practice documents. Because these could be printed off they provided a transitional piece of writing as it was not felt feasible at that point to use the e-portfolio for clinical practice records.

 

How did you implement and embed this e-learning approach?

 

Implementation: Staff involved in the programme had an initial workshop of two hours plus mentoring support from the course coordinator. The students had 4 sessions programmed into the induction 4 week programme. On day one the students began their course in the IT suite and were shown the MLE and the e-portfolio tool. There were off-site activities programmed using the collaboration tools in the e-portfolio. During the 4 weeks the three module teams launched the webfolios and shared them with copy permissions so that students could work on their own copies.

 

Evaluation: The staff and students were asked to evaluate the experience of using the e-portfolio subjectively. The coordinator was very present in the community and the dialogue of the participants provided a rich source of data about the processes and outcomes of using the system.

 

Issues and Problems: At least 50% of the first group did not have much experience of using the internet and 4 students did not have a computer. This was despite the fact that the programme was publicised as one which required 'good IT skills, possession of broadband facilities at home being an advantage.' However, because the students perceived the benefits of being in touch with their peers outside of the classroom, they quickly obtained computers and now these students are the most avid users. With the second cohort (a year later), access to IT facilities proved to be problematic in the induction programme and input on the e-portfolio system was much reduced. The emphasis switched from using webfolios to weblogs mainly because accessing the lab within the limitations of this cohort's attendance time proved difficult. Although supplementary material is available to these users, the ones who found IT difficult did not use this material and preferred face-to-face instruction in how to use the technology. Bringing on board some new staff as the group size increased was made easier having taken some steps to embed the use of e-portfolio across the School of Health. However, there are still some staff involved in the programme that rarely use the tools, mainly because they prefer not to engage in written frequent dialogue with students and instead use a model of occasional face-to-face tutorials.

 

Technology Used

 

What technologies and/or e-tools were available to you?

 

The literature has examples of using email, web-based discussion boards (in or outside of VLE/MLEs) and chat rooms to develop online communities of practice, although these are not well reported in the healthcare profession's literature. Our institutional VLE had in-built discussion tools but these were limited in that they could be created within a topic but could not be integrated alongside content. This functionality was later added. In contrast, the e-portfolio system offered a 'kit' of features which were felt to be most conducive to online learning community support, in particular the provision for each user to set up a blog space without any institutional intervention. Unlike the VLE, the e-portfolio system facilitated the setting of more sophisticated privacy settings when sharing material with others. The system used is called PebblePad and was developed by a team comprising staff, ex-staff and ex-students of the institution with significant pedagogical input from teaching colleagues and their students. Pebble Learning is now a commercial company. There were no institutional restrictions on the choice of tools to support these learners. The institution does have a minimum quality standard in respect of e-learning support - all modules must have a minimum presence in the VLE of a module guide, but development of support for modules is pedagogically driven. All modules across the nursing and midwifery programmes have multimedia materials embedded in the VLE. Current imperatives driving the use of e-portfolio across the wider School of Health population of students and staff are those of the wider national and international agendas JISC (2006) but at the outset these were not considerations.

 

Tangible Benefits

 

What tangible benefits did this e-learning approach produce?

 

Tangible benefits are hard to demonstrate, given the novel nature of the programme selected for the first pilot of e-portfolio. The group of students is one that will have more precarious personal circumstances and so attrition on the programme is higher, proportionately, than for other groups but the reasons for attrition relate to the students' personal life rather than the course. The students are highly positive about the use of the e-portfolio to share experiences and gain feedback. Given that none of the use of e-portfolio in these two groups is associated with summative assessment it is significant that all but 3 out of 45 students across the two cohorts are sharing clinical practice blogs or webfolios. Staff comments are that they know their personal students better as a result of more interaction through the sharing of regular journal entries. This model has been adopted by staff at another centre with full-time students and they are reporting greater awareness of the difficulties encountered by students in their early clinical placements and are more responsive to those difficulties.

 

Direct cost comparisons are also difficult to determine. What has become apparent through the use of the tool is that current roles adopted by teachers in relation to the learner's journey may need to be re-examined. Using the e-portfolio to integrate theory and practice may result in the personal teacher having a bigger role in the clinical practice experiences of the students rather than the teachers designated to support specific clinical link areas. The tangible benefits for us as teacher-practitioners are that there is clear evidence that students are engaging more enthusiastically and more frequently in the meaningful conversations about practice that professional education aspires to create. The following is one of many examples of how the use of the e-portfolio system fits the notion of learning as a collaborative, social, dialogic and iterative process, (Garrison and Anderson 2003, Lave and Wenger 1991, Wenger 1998, 2005, Laurillard 1993, Lillis 2001).

 

Gayle is a student nurse in the second year of her Diploma in Nursing programme. When she commenced on the programme she lacked confidence in herself and was not in the habit of utilising e-learning. She did not own a computer. This is her comment on how she found using the e-portfolio system originally. NB The ground rule in using the asynchronous communication tools is that we aim for clear communication but that typographical errors are accepted.

 

'I admit that when we were first introduced to pebble pad I hated it. I could not see how it would benefit us or help us to gel as a community (and I am a technophobe). However to be perfectly blunt, I would have been well and truly lost without pebble pad whilst out on placement. It is easy to think you will cope, you are self aware and confident whilst you are in the safe surroundings of the Universities four walls. However when you are actually out on placement it is nothing like you expect (speaking for myself of course). You encounter experiences and see things you never dreamed of and whilst we are privileged in one respect, it can also be a frustrating and isolated time. We were in University for four months, we saw each other for five days a week and we became a close knit community. I don't think any of us had much idea just how hard it would be adjusting to not being 'together'. I suppose I was lucky in a way because I was on placement with two members of our little family but I know others who were totally on there own (as in they had no one on placement with them from our community). At times it was puzzling, frustrating, lonely and left you feeling shocked and on occasion angry by the things you saw. Having access to pebble pad and being able to 'keep in touch' helped me immensely. On more than one occasion during placement I have had to question myself, my views and beliefs and without the aide of pebble pad and being able to share things with you all I would I may have joined others from our community and quit! You can become very blinkered about your views and only see one side of things no matter how self aware you are, having the opportunity to share these thoughts with others and ask for their input has been of tremendous help to me over the past few months. I can honestly say it has to be one of the best things I have learnt from my short time at University and I would sincerely like to thank ******* and ******* for giving us this wonderful learning opportunity THANK YOU!'

 

This student may have felt the same about any tool which allowed for asynchronous communication however we have noted that student and staff feel less inclined to use the asynchronous communication tools in the institutional VLE than in the e-portfolio system. This student described herself as a technophobe yet 3 months later was 'spotted' on a internet discussion group responding to a student nurse who had shared that he couldn't understand the profession's 'obsession with reflection'. Gayle's comments suggested that she had found real value in becoming a reflective student nurse through the use of e-portfolio. That she was seeking out communities of learners on the internet from her original position as a technophobe was significant.

 

This next example from her second year of practice shows how the e-portfolio has supported a constructivist approach to learning. The original reflection she shared is approximately 900 words long but essentially she shares an experience she has when visiting a community with the Health Visitor. The HV had identified the area as being one that had been designated an area of high social deprivation. Gayle's reflection shared that she was from that community and that she had been surprised and disconcerted by what she perceived as labelling. For example:

 

'I realise that social classification is a term used mainly with regards to a person's health. If you do not have access to some things that others do then you are at a disadvantage. I cannot help thinking that by using labels like 'deprived' you are placing people at a disadvantage from the start. The patient who lives in a deprived area of my placement setting had a better furnished home than I do, but this does not make me worse off than she is. Yet she is classed as deprived.'

 

Within the same shared reflection the student indicates that she understands how social deprivation is used as a term but still struggles to frame this within her own experience. She shared this reflection with teaching staff from the module team and this elicited replies from three teachers. This exemplifies to us the concept of situated learning discussed by Lave and Wenger:

 

'Situated learning... in which learning is not merely situated in practice - as if it were some independently reifiable process that just happened to be located somewhere; learning is an integral part of generative social practice in the lived-in world... its constituents contribute inseparable aspects whose combinations create a landscape - shapes, degrees, textures - of community membership... the form that the legitimacy of participation takes is a defining characteristic of ways of belonging.' (Lave & Wenger, 1991, p.35)

Out of a mass of evaluative comments these are two which are typical responses to the invitation: 'Tell me about your experience of using the e-portfolio with/in this route'.

 

Two typical evaluation comments from staff supporting students with use of the e-portfolio system (unedited)

 

'I have to admit that I felt a bit overwhelmed at first and didn't really have an understanding of how to use it or its potential. However since I've become a bit more familiar with it, I think its been great, there's lots of potential and its good to be able to keep in touch with the students. I think its major benefits are that it seems to have empowered students and facilitated their relationship as a group. As you know I have had concerns about some of the info that students have shared with me by this method but then they may have done that face to face anyway.

 

I'm looking forward to using it with the next group and to introducing it to the MH groups'

 

'I would agree entirely with this suggestion, for some of the group e-portfolio has given them immense confidence. By sharing ideas and group problem solving the family friendly students appear to be miles ahead of our full time route students in terms of their development. From my perspective as a teacher, e-portfolio helped to create a close working relationship with our students, particularly as I felt I was actively supporting the students in both their theory and practice, which felt very holistic and seamless'

Other benefits were that we were able to identify risks to students when they were working in placement and respond to those more quickly.

 

Early evaluation suggested that, for the first cohort, the anxieties around using more e-learning than they anticipated were high. Some commented that they had not anticipated needing to use computers on a nursing programme even though they had noted the expectation that students applying for the route would benefit most if they had good IT skills. This remained the case with the second cohort. However, the first cohort had more students who were returning to education having obtained entry qualifications some time ago. The second cohort had more students entering the programme immediately following FE courses. These seemed to adapt to the use of the blended learning approaches more easily. It may be that there is some displacement occurring in relation to this as the first cohort experienced severe bursary related problems in the early stages. After hearing about the potential benefits of e-portfolio, the midwifery team seized the opportunity to go on a two day training event, some with reluctance, but the majority were excited at the prospect of developing new skills. Within a very short time, the whole of the team were won over by this new learning tool, and soon developed a shared vision of how it could be incorporated into the midwifery curriculum. Previous experience has revealed that the desire to do something is not enough to sustain motivation, and finding the time for extra-curricular activities is difficult. It was therefore opportune that within 6 months of the e-portfolio training, the midwifery curriculum was due for revalidation. With a degree of nervousness, the team agreed to take the plunge, and embed it in the midwifery curriculum and now e-portfolio is an integral part of the clinical practice modules. Students must develop and maintain an e-portfolio of evidence that they share with their practice mentors and personal tutor. Summative assessment is submitted via an assessment gateway (an institutional space - in contrast to the personal learning space offered by the e-portfolio system).

 

As the midwifery team were all novices with e-portfolio, and with varying degrees of IT skills and commitment, I admit to feeling that there were many times I wondered whether we had taken on too much too soon, but as this was to be a major part of the new curriculum, we could not afford for it to fail. Continued support from the TSL coordinator has been key to the successful implementation of e-portfolio. Leading up to validation and approximately every 3/4 months subsequently, the team have got together to refresh e-portfolio skills and openly discuss any concerns and difficulties in a safe learning environment.

 

To maintain and develop our e-portfolio skills in readiness for curriculum validation, and subsequent implementation of e-portfolio, the team explored ways of using e-portfolio in curriculum management. Sharing documentation and participating in online discussion about the curriculum developments proved to be an innovative and effective way of engaging partners and the team in developing the curriculum. Subsequent to validation, all the documents have been uploaded into a webfolio, and are not only available to the midwifery team, but this weblog has also been shared with external examiners and key staff in the School. Feedback on this has been extremely positive.

 

The first cohort on the curriculum that has embedded the use of 'e-portfolio' is 5 months into their course, and as a team, we are finding that e-portfolio is being used more widely within the programme than was anticipated. Some of the tools have been used instead of current approaches. For example, a group of students used a collaborative webfolio to explore smoking cessation in pregnancy using a PBL model. Staff have also used the webfolio to create webquests instead of using the VLE and are using meetings records and action planning tools for administration and project work.

 

One of the most exciting and rewarding experiences, of using e-portfolio, has been seeing how effectively students have been using this to enhance and develop their practice. In addition to the summative components of the e-portfolio, students have developed additional records of learning. The daily diary of experience has given the personal tutors a good insight into students' clinical experience, and has been a focal point for reflective discussions, and signposting further learning activities.

 

A blog set up for students to keep in touch whilst on placement has facilitated peer support, as students have been quick to respond to each other with advice, support and tips of how to overcome problems. The advice students give to each other via the blog, appears to be sound, and as it is from a student perspective, in some cases better than that which could be given by academics; though in some cases, advice has been supplemented by academic staff. There is no evidence of the impact of e-portfolios on minimising attrition, but it is evident from the online conversations that students are urging each other to 'hang on in there and not give up' and to seek help.

 

It has been particularly pleasing to see that students have shared their e-portfolios with practice mentors (non-university staff and with no prior experience of training with e-portfolio) and some practice mentors have used the comment facility to verify records of training. However, we have encountered some problems with access via NHS Trust IT systems, but the response to the problems, by the Trusts has been positive, and NHS Trusts are actively working with the University to improve on-site access. It is evident that some practice mentors have very limited IT skills, and training and support of mentors in this area is something that will need to be developed to further enhance the effectiveness of e-portfolio in developing clinical practice. To enable e-portfolio to be accessed and shared more widely in the workplace, will also require investment to purchase hardware to support its use.

 

A notable advantage of e-portfolio over a paper based copy, has been the ability for students to continue working on and adding to their portfolio, whilst it is shared with the personal tutor. This is in contrast to my experience with paper based versions, when students would have to wait to have their portfolios returned. With the use of e-portfolios students never have to put their learning on hold.

 

From early on in the midwifery course (first 3 weeks) students sensed the potential of PebblePad in enhancing their learning, as revealed through their comments:

 

'Well I can see the potential with PebblePad for building your portfolio and keeping track of experiences, just not sure my skills are quite up to using it yet!'

 

'I have had a play around with PebblePad but like the others it is very alien and I feel the need for more help with it. I can see that it has great potential, and will be very useful to our work...'

 

'I really think PebblePad is quite great, has so much potential for us all. I'm a really big organiser, so I'm loving it...'

 

As a team, we have had to be very responsive to students to sustain their motivation, and help them overcome any difficulties they have had in getting to terms with its functions. As it has been a relatively short time since we have introduced e-portfolio into the curriculum, it is early to boast any tangible benefits, however our early experiences of using it is very positive, and we have no regrets embedding it into the curriculum.

 

Did implementation of this e-learning approach have any disadvantages or drawbacks?

 

It is hard to frame the difficulties in terms of drawbacks or disadvantages. The challenges posed by adopting the technology centre on repurposing the current curriculum and ways of working so that the increased use of e-portfolio as a formative, developmental tool which integrates theory and practice learning is not difficult. At this point we could not point to a reduction in time or expenditure - the converse is true as staff have had to acquire new skills and respond to students' needs. However, this is because at present we are still exploring the best ways of using the tools within the restrictions of existing way of working and we are evolving alternative ways of relating to student's evidence of achievement. One issue that teachers and some students identified with the first cohort was a concern with the high level of disclosure of a few students. These issues seemed to be related to establishing the ground rules that would need to be developed in any group encounter.

 

How did this e-learning approach accord with or differ from any relevant departmental and/or institutional strategies?

 

Adoption of the use of e-portfolios with these nursing students preceded the development of a departmental or institutional strategy. Initially the VLE seemed to be privileged over this tool in terms of institutional imperatives to engage, despite the provision of the e-portfolio system to all staff and students. The community of early adopters influenced the direction in which the institution is moving in terms of adoption of e-portfolio across the curriculum. Where the opportunity arises, curriculum teams are modifying their assessment strategies to incorporate the e-portfolio. The Centre of Excellence in Learning and Teaching invested in the secondment of members of staff from schools which supported the innovation. One of the authors of this case study then developed a strategy for gradual and sustained embedding by using a combination of extended staff workshops and mentoring to increase the numbers of e-portfolio-literate staff. This model influenced other schools and the staff mentoring approach is being adopted throughout the University for the next academic year through the Pathfinder Project. In the School of Health we are looking towards a major curriculum review and revalidation in 2008 as an opportunity to examine how the e-portfolio can be used to support students in theory and practice learning. We are working with placement providers to examine how we might best bring the clinical mentors into the relationship.

 

Lessons Learned

 

Summary and Reflection

 

Embedding of technology into the curriculum relies on moving from early adoption to sustained engagement. The versatility of this tool has provided multiple points of engagement by both staff and students and a personalisation of the learning opportunities that were not offered by the VLE. The relative ease with which staff can construct web based learning materials has been an inducement to develop skills in the use of the system overall. Both staff and students have welcomed the opportunities for closer interaction via the collaborative tools and for many it suits their constructivist learning framework.

 

Taking this forward across the wider undergraduate healthcare student population will be a challenge in terms of providing training for both staff and students but in particular the student population. In other departments within the institution trainers have been employed to work with students to create large-scale use of the e-portfolio in a key skills/PDP module but there is no overall institutional coherence in approach and there are missed opportunities for central learning and teaching departments to learn from the experience of the innovators in the schools. In the School of Health a number of healthcare students do not come equipped with enough IT skills to feel confident to explore new technology and these students require more intensive support. Engaging staff in our healthcare economies will be the next focus for the work as without their involvement the e-portfolio will be an academic exercise lacking grounding in clinical practice.

 

Further Evidence

 

'Peer support was a feature in the online environment.'

 

'Having access to pebble pad and being able to 'keep in touch' helped me immensely. On more than one occasion during placement I have had to question myself, my views and beliefs and without the aide of pebble pad and being able to share things with you all I would I may have joined others from our community and quit!'

 

'...for some of the group e-portfolio has given them immense confidence. By sharing ideas and group problem solving the family-friendly students appear to be miles ahead of our full-time route students in terms of their development.'