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The Long View

The Optimist Club, Part 2: Longterm Perspective of the COVID-19 Challenge for Veterinary Education

In Part 1, I offered some suggestions about the immediate challenge of moving one’s instructional efforts rapidly online.   Hopefully, both faculty and students are flexibly adapting to the current reality.   As an example of an increase in search for “external” teaching resources, VetMedAcademy has seen its worldwide YouTube channel activity double just within the last month. For this reason, we have tried to release additional “public” videos, as many were “unpublished” links only found within our learning modules within our learning management system. Nonetheless, the vast majority of such learning modules are free to access to those who register. 

But even here, such videos are developed mainly to facilitate content “delivery,” where most of us still feel compelled to reinvent wheels. Throughout this, our hope is that faculty will spend less time on content creation but rather curate such content and spend more time on interactive instructional approaches to encourage deeper thinking and understanding by students. We still feel that such content videos need to be “packaged” with additional learning activities, ranging from formative questions to digital discussions to case analysis projects.  Such forms of problem-based learning then can become a way for students to cement content understanding and for instructors to mentor students to become reflective life-long learners.  

So, although some might say it’s too soon to predict the long-term outcomes for veterinary education, it might be appropriate to note how current efforts might be taken to advantage for future adaptation once everyone can return to the hallowed physical halls of academia.  On this note, I’d like to point out a recent post by Mary Kalantzis and Bill Cope of the University of Illinois, educator “futurists” in my mind, who really have sought to reshape thinking about 21st century instruction on their website https://newlearningonline.com  and the multimedia peer review learning and writing platform Common Ground Scholar (https://cgscholar.com). 1 As a disclaimer I have mentioned before, I have had the privilege of collaborating with them on educational research projects evaluating the latter platform for veterinary student case analysis.  On that note, I can comment that their didactic approach does translate to the training of a medical professional.2

The terms they use include “literacies” and “e-learning ecologies.”  Learning is less about the content and more about the process of discovery of it and reconstitution of acquired knowledge as “learning artifacts.”   Their recent commentary about the current adaptation of educational institutions to the coronavirus crisis is instructive to our profession too.1

In the spirit of optimism of Part 1, I’d like to highlight a few of their salient points about the current state of education that veterinary educators might want to consider as they seek to continue interaction with students in a meaningful way:

…the conventional wisdom remains, the gold-standard for learning is traditional face-to-face, while online is second-best.

They reject this “wisdom,” noting that most learning management systems simply reproduce some aspect of the face-to-face experience, and often don’t take advantage of the potential of digital e-learning platforms.  They show particular concern in today’s crisis:  

The danger is that, as people are thrown abruptly into online learning, they will be compelled to use flawed systems with limited training, confirming their worst fears about the quality of the online teaching and learning experience. 

They catalogue some key issues about education in general, that certainly have parallels in veterinary education.  The cost of education often is reflective of the need to replicate a certain physical plant for the training.  We can certainly argue that practical training in veterinary medicine requires this of us as educators before we release our graduates on the public. However, while it is beyond the scope of this article to provide detail, the veterinary profession has one of the highest debt to median income ratios of any medical profession.

They also identify something any observer to a veterinary classroom can note, i.e. an “attentional” crisis.  Almost all of our students have some digital device and it is apparent that many are not “tuned in” to the content being discussed in the front of the room. We try to represent this with a stylized version of an actual photo I once took in the back of a classroom. Of the 4 screens whose pattern you can actually see in this photo, all have something different being shown.  It is a good thing that the lectures are being recorded, so students can view them later at their own speed.  But wait, that’s what we’re advocating instructors to do up front!  And through interactive learning in a classroom, like discussing the most difficult concepts, or demonstrating problem-solving through case or problem presentations, the instructor in a blended learning classroom conveys as much about their thinking “process” as about “content.”

Dark Lecture

Kalantzis and Cope call this an “…absurdly sub-optimal cognitive load for today’s students...” So let’s look at their 5 main recommendations for the future of higher education (in bold), and try to apply their principles to the future of veterinary medical education.

1. Scale Up Higher Education and Scale Down Its Costs

As mentioned before, there may be limits to this, but it is important to note that many of the new veterinary schools are not seeking to create their own teaching hospitals,  and are using “distributed” practical experiences for their students.  More investment has been made in the pre-clinical years in clinical skills laboratories. What may be missing is the expectation that one of the skills would be searching for and critical application of relevant basic science and clinical evidence. This process can be simulated by faculty at all levels expecting a veterinary student to be not only a better consumer of information, but also a better interpreter of it. 

2. Develop Pedagogies of Social Knowledge and Collaborative Intelligence

On lectures, still the dominant form of instruction in most medical schools,  Kalantzis and Cope write:

Not only are these suboptimal forms of communication in the era of social media. Paradoxically, their communications architectures are systems of social isolation.

Please review the photo above! Hopefully, we can all agree that successful practice of veterinary medicine, and that includes any area of endeavor as a veterinarian, requires excellent communication and collaboration skills.  So, the pedagogies utilized to train our students should reflect this. It is not enough to lecture about its importance, or even to have an isolated “communications” laboratories. It needs to be embedded in every aspect of the student’s training.  So, engaging students around the content they are learning only helps deepen and personalize its meaning for them, and should lead to longer term retention, at least for the most relevant and important concepts.

Going beyond the potential of simple digital engagement, as in a social media feed, the fact that the interaction is couched as a digital mirror of their future roles as collaborators and peer reviewers, encourages a collective ownership of quality within the profession.  And in a profession worried about inequities in its training, in the well-designed e-learning platform, Kalantzis and Cope note:

…students earn none of the conventional rewards for arrogance, nor are they penalized by social inhibitions or reticence—dynamics that create imbalances of participation in traditional classrooms.

3. Create Pedagogies of Intense Engagement

Most veterinary faculty, reflecting on their existing content-intensive curricula in which the tradition is “efficient” delivery of such content is from faculty to students, might have a difficult time thinking about how to implement Kalantzis’ and Cope’s advice to use appropriate digital platforms to position learners as knowledge producers and co-contributors to knowledge communities.”  What veterinary faculty member has time or the incentive to design the appropriate “e-learning ecologies, leveraging the social-collaborative complexity enabled by social knowledge technologies”?

The answer might come on reflection of the “efficiency” of the original instruction…it might be efficient delivery for the instructor, but is the retention of such content by the learner efficient? How many times does a 4th year clinical instructor wonder whether something taught in the second or even third year was even taught at all? I have personally observed that the halflife for retention (apologies for the pharmacokinetic term from this pharmacologist) may be less than a few weeks!  So, when students, in response to a well-designed project, individually or collectively build out their content understanding while solving an instructor-posed problem or case, they are more likely to “own” that content.  You might argue, as many have argued against problem-based curricula, that such learning cannot be “comprehensive.” The answer to that resides in the fact that the halflife of medical information is now down to 70 days.2 If we can simultaneously accept the value of continuous formative assessments of engagement, perhaps buttressed by professional ontologies, standards and artificial intelligence, the digital community may provide the instructor a more comprehensive assessment of the student’s educational journey towards becoming a medical professional.  More importantly, this might allow instructors to focus on the next affordance of such a community.

4. Focus on Higher Order Thinking

In this blog, we have discussed the term “critical clinical thinking” or the equivalent phrase “clinical problem-solving.” Hopefully, all faculty can agree that we want to graduate excellent problem-solvers. And yet, most of our assessment processes encourage retention of facts, and often only until the day of the examination.  Given the speed of growth of medical information, let’s consider the following observations and progression of logic by Kalantzis and Cope:

Today, the devices that we keep close to our bodies serve us as cognitive prostheses. They remember things for us. We can look up far more knowledge than we could ever remember.

So, the foundational objectives of education change. Learning is about careful navigation of at-hand knowledge resources.

The core capacities required by graduates are changing rapidly. These reduce the importance of long-term domain memory. Today’s graduate capabilities include evidence-based reasoning, argumentation in support of verifiable claims, and testable judgement calls.

Online environments can uniquely achieve this, by leveraging collaborative knowledge processes. Instead of individual minds, the social mind is acknowledged in the provenance of knowledge and the collaborative contributions of peers in the learning process.

The authors don’t mention online environments as a “pie-in-the-sky” solution. They have been instrumental in developing the Common Ground Scholar (https://cgscholar.com ) multimedia peer review learning and writing platform on which these paradigms have been evaluated in veterinary and medical students. 3,4 

And yet, the hardest part in development and particularly adoption of such a learning paradigm is in the faculty (and student) acceptance that instruction is more about the journey than the content. 

5. Lifelong and Lifewide Learning

At the University of Illinois College of Veterinary Medicine, where I served as department head for almost 10 years,  developed a webpage organized as an instructional calendar, that included all of the content (usually PDF versions of Powerpoints) for the students.  Often students would off-load these to organize somehow on their computers.  Faculty tend to update and tweak presentations from year to year. However, for some reason, it was more technically difficult to provide updated files to classes who were previously instructed.  And when we asked about access after graduation as a means of review or a form of continuing education, well, this continued connection to their veterinary training was deemed the disparate realm of continuing education. I am pretty sure that our college isn’t unique in this regard, and, to be fair, today we are now seeing some of the best online CE efforts being used for veterinary training as well.   Why shouldn’t it be a continuum of sorts? On the CE circuit, I have often used a CE presentations that is similar to what I would present to veterinary students.  Kalantzis and Cope note this ideal that can be met, in part, by online learning:

Online learning, by contrast, can be embedded in the real world. It can be continuous, lasting for as long as life and stretching as wide as social and personal needs.

They bring knowledge and experience that we instructors could never have imagined, contributing this as partners in our knowledge communities. They can also test, live in real-world contexts, the new things they have learned in our classes.

Indeed, as I’ve noted before in this blog, our earliest experiences with distance learning with Veterinary Information Network brought home the potential that a learner is highly motivated to apply newly acquired understanding, and we observed practitioners doing so almost in realtime.  From the distance learning continuing education, they often learned how to diagnose a disease they may have previously missed, and returned to the online class to report their “application” of their knowledge, and seek refined guidance about additional workup and therapy.  Certainly, we can’t wait for relevance of instruction to occur only after graduation.

Optimistic Summary

If there is a long-term optimistic perspective of the educational challenges posed by the COVID-19 epidemic, it might be that veterinary faculty would come to a broader realization of the need to reshape their own instructional role, and simultaneously the level of student expectations as self-correcting lifelong learners.   And for all of this, we need to reshape our digital toolkit to make it scalable and sustainable.

As always, comments on these blog posts (VMA members just need to sign in) or stand-alone guest commentaries are always welcome.

Duncan C. Ferguson, VMD, PhD, DACVIM, DACVCP

Please email vma@vetmedacademy.org to suggest a contribution.

References

1. Kalantzis M, Cope B (2020): After the COVID-19 Crisis: Why higher education may (and perhaps should) never be the same. https://cgscholar.com/community/community_profiles/new-learning/community_updates/114650

2. Colacino C (2017). Medicine in a Changing World. 2016-2017 Alvin F. Poussaint, MD Visiting Lecturer Martín-J. Sepúlveda shares insights. https://hms.harvard.edu/news/medicine-changing-world

3. McMichael MA, Ferguson DC, Allender MC, Cope W, Kalantzis M, Haniya S, Searsmith MCS (2020). Use of a multimodal, peer-to-peer learning management system for introduction of critical clinical thinking to first year veterinary students. J. Vet. Med. Ed., in press.

4. Haniya S, Montebello M, Cope W, Tapping R (2018). Promoting Critical Clinical Thinking through e-Learning. in Proceedings of the 10th International Conference on Education and New Learning Technologies (EduLearn18). Palma de Mallorca ES.