Illustrated examples the use of e-learning within the IoP
By
Julian Fletcher
5th August 2009
Introduction
The following examples of e-learning activities within the IoP will be described and
where evidence is available to support it, show how these e-learning activities have
enhanced the experiences of the respective students participating in them:
1. Dual Diagnosis Interactive Learning.
2. Child and Adolescent Psychiatry: Media-rich e-learning materials to enhance
clinical skills development.
3. Basic Mental Health Studies Interactive Learning.
4. MSc Neuroscience: Recorded lectures.
I will now discuss each activity in turn.
1.
Dual Diagnosis Interactive Learning
(i)
Description of activity
The Dual Diagnosis Interactive Learning video case study was developed in winter
2008 for the use of students following the Dual Diagnosis Programme according to
the specification of Programme Leader Harvey Wells. It was designed to solve the
following problems:
•
Students on clinical skills courses often struggle with rehearsal of skills.
•
There is limited time on classroom days and a large amount of material to cover.
•
The expectation is that students will practice their skills in their clinical area,
however,many students don’t get clinical support in their workplace and some
students lack the confidence to use the skills with service users (patients).
In order to solve these problems an e-learning resource was developed in order to
provide students with the opportunity to engage with the skills needed to both
sucessfully pass their course examinations and which they would use in their
ongoing clinical practice. A requirement for the resource was that it should require
students to engage interactively with it rather merely passively watching video case
study examples. It also needed to address a learning deficit that many students
regularly experience, namely the diffulty in being able to listen to the patient whilst
simultaneously recording salient clinical details.
The e-learning resource developed by Harvey Wells in conjunction with the IoP
Education Development Manager (Julian Fletcher) and the then IoP E-Learning
Developer (Amandeeep Cheema) to meet these requirements was called Dual
Diagnosis Interactive Learning and is shown in Fig 1 overleaf.
The Dual Diagnosis Interactive Learning is accessed from the Dual Diagnosis
Blackboard Virtual Learning Environment (VLE) course but can also by used in stand
alone DVD format.
Fig 1 Dual Diagnosis Interactive Learning
It consists of a series of video exemplars demonstrating the clinical skills and
particular interventions used in clinical practice. The video clips themselves feature
Harvey Wells in the role of the clinician engaged in dialogue with the patient, a
recovering drug addict played by an actor. Filming was carried out by the IoP Media
Support Unit.
Students can interactively engage with this resource in two ways:

by downloading a copy of the ‘Cognitive Therapy Scale’ (See Figs 2 an 3
overleaf) used in the patient assessment and rate the therapist’s competence
in using this scale whilst watching video of the therapist performing the
assessment. Students are advised to consider ‘what worked well?’ and ‘what
could have been done differently?’ Interacting with the recourse in this way is
designed to familiarise students with assessment standards.

by downloading templates for a series of clinical interventions (See Figs 4 and
5 ) and whilst watching the video of each intervention pratice recording the
clinically relevant information on the corresponding template as if the student
was in a session with the patient featured in the video. At the end of each
intervention video, students are able to download a model answer (See Fig 6)
to compare with what they have recorded themselves. Interacting with the
recource in this way is designed to give students the opportnity to practice
recording the clinical details of a patient.
Fig 2 Dual Diagnosis - rating therapist using cognitive therapy scale
Fig 3 Cognitive Therapy Scale
Fig 4 Dual Diagnosis - practising clinical intervention recording skills
Fig 5 – Blank template used to record clinically relevant information for intervention
Fig 6 Clinical intervention model answer
(ii)
How has the activity enhanced student learning?
Harvey Wells provided the following summary feedback on the use of the Dual
Diagnosis Interactive Learning resource:

IoP students have started to use this resource on the on the Spring 2009 Dual
Diagnosis Taught Short course programme and the initial feedback from them
has been very positive. One feedback comment from a former student was
“Doing this course has given me the tools and the confidence in working with
dual diagnosis”
(see http://www.iop.kcl.ac.uk/courses/?id=37 for the origin of this quotation ).
Here is further more detailed feedback from Harvey on the use of the Dual Diagnosis
Interactive Learning resource:
“Below, I have included some feedback from the first cohort of students to have used
the learning resource:
- An excellent role model approach, which motivated me to attain higher standards in
my own practice.
- The role play that is on web CT was a very helpful way of learning and was very
good for practicing as well as confidence building.
- [The video resource] helped to link lecture sessions and aided learning and
practice.
- [The video resource] helped me to understand and appreciate approaches to
working with clients.
- Role play on Web CT is of very high quality
The South London and Maudsley NHS Trust have been very positive in their
feedback about the resource development and would like to see this expanded to
include aspects specific to the other courses: Medication Management and
Enhanced Skills. This has been reinforced by Stuart Lancashire as head of section.
My experience of the Learning Resource was that it changed the way students
engaged with in-class role play demonstrations. Ben and I have been doing example
role plays for several years and normally students just watch us and comment
afterwards. Because of what the video had asked them to do (in terms of writing
down the clinical salient information), students on this cohort did this in class without
being prompted to do so. I was completely unaware that students were filling in their
templates whilst Ben and I were in role play until the end when I looked up to see
that all students had completed it. This was the first time this had ever happened and
the only thing that is different is the video resource. What they had written wasn't
perfect, but it gave Ben and I the chance to offer feedback on their work. They
clearly had watched the videos and had changed the way they were interacting in
class. I think it has been really helpful.
I also have some evidence to show that repeated viewings of the same video
produce cumulative changes in understanding (although I haven't written this up yet).
Students were asked to watch the same clip (the one on how to start a session) and
were asked to report what they had just seen. Watching the video multiple times
changed their understanding of what was being taught.”
2.
Child and Adolescent Psychiatry: Media-rich e-learning materials to
enhance clinical skills development
(i)
Description of activity
In the 2006/2007 academic year the IoP won £3840 of College Teaching Funding to
develop the Media-rich e-learning materials to enhance clinical skills
development e-learning project to support the IoP’s Masters degree in Child and
Adolescent Psychiatry.
The Masters in Child and Adolescent Psychiatry degree provides clinical training for
overseas: clinicians, psychiatrists, child psychologists and paediatricians, many of
whom speak English as a second language. These students require considerable
language support to enable them to engage in a clinical setting in the UK. Some
students are able to attend courses at the KCL language unit, but this is unable to
provide them with the clinical context required.
Funding was won to develop e-learning materials enabling students to practice
appropriate clinical formulation skills to enhance the face to face sessions
currently provided. These e-learning materials were in the form of case studies which
enabled students to access clinical language demonstrations from expert therapists
in video, audio and text format.They provided students with opportunities to practice
their own formulation skills in their own time in a non-threatening online environment,
and reflect on their learning process in consultation with programme tutors. The
case studies were embedded in the MSc Child and Adolescent Mental Health
Blackboard VLE course so that they could be accessed online by the students
enrolled on this course. These e-learning resources were developed by Anula
Nikapota, the Masters in Child and Adolescent Psychiatry Programme Leader in
conjunction with the then IoP Education Development Manger(Nicky Groves), and
the then IoP E-Learning developer (Amandeep Cheema).
The e-learning materials designed to improve students’ clinical formulation skills
worked in the following way:
Four interactive case studies were created (see Fig 7 overleaf):
Two intial case studies were created in 2007:


Ryan – a 9 year old boy who is persistenly in trouble at school
Clara – a 15 year old girl who is self-harming
These were added to in 2008 by a further two case studies:


Trevor – a 15 year old boy who is displaying odd behaviours
Alison – a 9 year old girl refusing to attend school
Fig 7 Four Interactive Case Studies used by students to practice their clinical
formulation skills
For each case study, The student will be introduced to the client’s problem and any
background information. A video clip will demonstrate an experienced clinician
questioning the client to illustrate appropriate questioning style and techniques – Fig
8 overleaf shows such a clip from the ‘Clara’ case sudy.
Fig 8 ‘Clara’ case study
Students are able to seek further information (such as school reports) and are able
to make their own notes throughout the activity. Once the students have viewed all of
the relevant information they will be asked to write their own formulation of the case.
They will be prompted to write under each of the following fields: 'introductory
sentence’, ‘precipitating factors’, ‘pre-disposing factors’ and ‘perpetuating factors’.
Students will be able to save/print a copy and keep it or email it to their tutor for
feedback or help.
Once they have completed the formulation report they are able to read a model
answer for the formulation (they will not have access to the model answer before
then).
(ii)How has the activity enhanced student learning?
The ‘Ryan’ and ‘Clara’ case studies were released to students for the first time in
September and November 2008. Students accessed the case studies in their own
time using WebCT (the VLE in use at the time by the IoP and now superseeded by
Blackboard). A ‘virtual supervisor’ guides them through the interactive information
gathering process until they have enough information to complete a formulation
report and diagnosis.
Survey feedback from the students for the first two case studies has been quite
varied. Some students found the case studies were pitched at the right level, while
others felt it was ‘too simplistic’. Some students found the navigation easy to follow
while others found it confusing – particularly Ryan, which led to some changes for
the user interface.
All students agree that they like this style of independent, interactive learning and
asked for more case studies to be built, with more complex cases. Most agreed that
the case studies helped to familiarise them with a South London clinical setting and
had aided their understanding of assessment and formulation skills and knowledge
of the ICD-10 (International Statistical Classification of Diseases and Related Health
Problems). They enjoyed being able to work at their own pace, to be able to revisit
the modules in their own time and to print them out.
3.
Basic Mental Health Studies Interactive Learning
Within the MSc Mental Health studies’ Basic Mental Health Studies Blackboard
course there are two interactive video case studies Case 1 and Case 2.( These are
currently hidden from students so no student feedback on there use is available at
present).Each of theses case studies work in the following way (see Fig 9):
Fig 9 Case study tutorial screen
The controls shown highlighted in the top right corner of the screen enable pages
from the case study to be printed, bookmarked and stepped through. A screen can
also be opened to take notes which can in turn be added to a notebook (see Fig 10):
Fig 10 Notebook

Each case study also has an associated discussion forum.
In Case 1 you are asked by the A&E consultant (see Fig 11) to review one of their
patients:
Fig 11 A & E Consultant

This patient is a 20 year old man, who appears disturbed and thinks people
are out to get him (see Fig 12). You must choose the appropriate means to
assess him from the options presented.
Fig 12 Patient

At the end of the case study you receive a score and an overall debrief based
on the choices for have made to assess the patient (see Fig 13).
Fig 13 Debrief screen
In Case 2 you are asked by the A&E consultant to review one of their patients,
Sarah, aged 19 who has just taken an overdose and is accompanied at A&E by her
boyfriend (see Fig 14):
Fig 14 A & E Consultant, patient & boyfriend

You must choose the appropriate means to assess Sarah from the options
presented which includes interviewing Sarah herself (see Figs 15 and 16)
and her boyfriend (see Fig 17) seperately.
Fig 15 Interview with Sarah
Fig 15 A further interview with Sarah
Fig 17 Interview with Sarah’s boyfriend

You also can also receive more information about Sarah and her family
background from the A&E consultant (see Fig 18):
Fig 18 Receiving further information about patient from the A&E consultant
4.MSc Neuroscience: Recorded lectures
(i) Description of activity
John Stephenson, the MSc Neuroscience Programme Leader has recorded the
MSc Neuroscience Programme lectures using the Speechi tool in a Flash format for
the lecture slides with corresponding audio narration of the lecture (See Fig 19
for an example slide ):
Fig 19 Example of an MSc Neuroscience audio narrated lecture slide
Students can access these lectures online from the MSc Neuroscience Moodle VLE
course site (see Fig 20 below) thus enabling them to view them at home should they
have internet access as well as from a computer within the IoP itself. This is
particularly relevant for the part time students who may be off campus for the greater
part of their studies, but is made use of by full time students of the course as well.
Fig 20 Recorded lecture available from MSc Neuroscience Moodle VLE course
Further background infromation about MSc Neuroscience Programme
Once students have been accepted onto the programme (pre-enrolement stage),
they are given access to an e-learning site in Moodle where they can view Flash files
of all the slides from the previous year’s programme, introductory material, reading
lists and other preparatory material.
Once students have enroled, they are given access to other areas of the e-learning
site where they can watch/listen to AV files of all the previous year’s lectures and
download pdf files of the lecture handouts. Thus students can access these
recordings beforehand and prepare themselves for their updated lectures. These
updated lectures are also recorded and uploaded, usually within 1-2 hours of them
being given, overwriting those from the previous academic year. This facility enables
students to replay all their lectures, a feature that is of considerable value to students
with, for example, dyslexia, who may have difficulty taking notes during a lecture,
and to students whose first language is not English. These recordings are also a
valuable aid to revision and to writing coursework essays (coursework essays are
submitted online, through Turnitin, removing the need for the student to visit the
programme office).
(ii)How has the activity enhanced student learning?
John carried out an online survey amongst the students of the MSc Neuroscience
Programme to gain feedback as to how useful they found the recorded lectures. The
survey consisted of 9 questions and 45 respondents participated in it. I will now go
through each survey question and present the survey response to it.
This shows that the overwhealming majority of respondents (89%) watched 11 or
more recorded lectures. The most frequent number of lectures consulted was
between 21 and 49 lectures.
This shows that the overwhealming majority of respondents (75%) watched over half
the recorded lectures which they consulted in full and nearly a quarter of
respondents watched in full all the lectures that they consulted.
This shows that most respondents did not watch all the lectures they consulted in
full, though a significant minority (21%) did.
This shows over half of the respondents (53%) missed less than 10 of the ‘live’
lectures that they subsequently consulted online, the majority of students (86%)
missed less than half of the lectures that they subsequently consulted online and
only two respondents consulted recorded lectures because they missed all the
corresponding live lectures. In other words on balance the recording of lectures was
not being used as a substitute by students for attending the ‘live’ lecture in person.
In reviewing the respondents’ answers to why they consulted the recorded lectures
other than because they missed the original ‘live’ lecture, some common reasons
have emerged namely:

to go back and review any points that students didn’t understand cleary the first
time they were presented in the lecture.

to make notes on the additional spoken information that the lecturer may have
imparted in the lecture but which wasn’t present in the visual lecture slides
themselves,especially if the student didn’t have sufficient time during the “live”
lecture to annotate a printed set of slides they had downloaded prior to the
lecture and bought with them.

For review of material in preparation for taking examinations
All these reasons indicate that students gain an enhanced learning experience from
using audio narrated online lecture slides.
Overwhelmingly the respondents viewed the recorded lectures with their audio
narration is a positive enhancement to their learning. Other IoP courses whether they
are hosted in the Blackboard or Moodle VLE might benefit from recording their
lectures in a similar fashion.
Response 29:
“Invaluable. As a part-time student, the lectures started around 18 months
before the exams so it has been hugely beneficial to be able to hear the
lectures again.”
Shows how recorded lectures can help keep the content of a lecture familiar to a part
time student who may face very large gaps between attending the ‘live’ lecture and
being examined on what was taught in it.
Two points of concern regarding recorded lectures should also be borne in mind
however, namely :
Response 6:
“fairly useful when the lecturer described facts and figures not useful when it
came to the lecturer annotating diagrams verbally - thre were no written
annotations on some diagrams.”
Possibly this indicates the need for diagrams to be more extensively labelled to
match the corresponding spoken explanatory information?
and
Response 34:
“Very useful resource. But there are just so many of them it can feel
overwhelming.”
Possibly presenting the lectures in timed, manageable chunks during the course
using the “selective release” functionality of a VLE and some additional guidance on
which lectures to concentrate on at particular points in the course and for particular
course examinations, may help to overcome any information overload perceived by
some students in using the recorded lectures.
This shows that the overwhelming majority of respondents (88%) did not consider
that the recorded lectures were a replacement for the “live” lectures and therefore it
can be inferred from this that those respondents still considered attending the “live”
lecture itself to be an important part of their learning.
This is one of the most interesting responses to the survey in the sense that opinion
is broadly divided in half as to whether the absence of recorded lectures means
more note taking would take place in the lectures to make up for this. This may be a
relflection on the differing ways respondents are able to recall the spoken content of
the “live” lecture to help them put the visual lecture slides in context. Some may be
able to memorise this information without having to write it down in note form during
the “live” lecture in full confidence that they will be able to recall it anyway come
examination time whereas other respondents may feel that in the absence of the
spoken lecture content being available for future reference in recorded format, it
would be more important for them to take notes of this spoken content during the
“live” lecture in order to help them subsequently recall it for, for example future
examinations and work. A further question to consider is how distracting is note
taking and dictation, from actually concentrating and trying to understand the spoken
content of the lecture as it is delivered live? A selection of responses to survey
question 6 seem to indicate that recorded lectures help to diminish this problem e.g.
Response 26:
“The recording of lectures is essential. Whilst lectures are a good way to
transfer expert knowledge, it simply is not feasible to hold complete attention
for one hour, four times a day. The opportunity to look at a recorded lecture
allows it to be stopped and rerun if things are not understood. This is
especially important to the psychologists, who will not understand some of the
terminology used, and so can use this opportunity to look up some
background information. Allowing the flow of information from the lecture to be
stopped allows for more effective and extensive note taking, as one is not
listening, thinking, and writing all at once.”
Once again in the main these comments are remarkly positive on the benefits of
recorded lectures as borne out by previous survey responses, however I wish to
highlight some constructive criticism raised by two of the responses, namely:
Response 19
“When students ask questions/make comments in class, you can't ususally
hear what they are saying, only what the lecturer responds, which is
frustrating and can waste a large chunk of time while you work out what was
said or how long the discussion is going to continue. “
Can a technical means by found to capture the students’ spoken questions in the
lecture, possibly by improving the sound capture facilities of the lecture hall itself, or
more prosaically, by the lecturer repeating out load the question asked them , before
answering it, so that it is picked up by their microphone and recorded?
“When something is indicated with a pointer in real time, it obviously doesn't
show up on the recording so sometimes it's hard to tell what is being referred
to.”
Secondly can an animated pointer facility be superimposed and recorded on the
visual lecture slides so that pointer indications made by the lecturer can be recalled
and made more sense of when a student comes to later watch the lecture online?
Response 22
“If a lecture you didnt attend was for some reason not recorded it was
disappointing. If a lecture you attended but wanted to listen to again to help
with revision and it was partly or not at all recordeed it was disappointing.
Therefore recorded lectures are useful as assurance.”
This highlights the importance of quality control to ensure all lectures related to the
course are available in recorded format and the audio narration is sufficiently clear.
The availability of the the resources of the IoP’s own “in house” media support unit
should be taken advantage of to ensure such quality control in e-learning course
content.