Ebook Teaching and learning in physical therapy – From classroom to clinic (2/E): Part 2

Part 2 book “Teaching and learning in physical therapy – From classroom to clinic” has contents: Optimizing conditions for teaching and learning movement, facilitating behavior change, teaching and learning in the clinical setting - striving for excellence in clinical practice,… and other contents.

7 Systematic Effective Instruction Adapting Instruction for Varied Audiences and Formats Margaret M Plack, PT, DPT, EdD and Maryanne Driscoll, PhD After reading this chapter, the reader will be prepared to: Define the non-negotiable elements of systematic effective instruction Apply the non-negotiable elements to a variety of presentation formats Use the non-negotiable elements to problem solve a variety of common instructional mistakes Identify additional variables that influence instructional design Adapt presentations to meet the demands of various formats and time frames In the introductory chapter, we asked you to “Stop and Reflect” on what you think of when you think about “Teaching and Learning in Physical Therapy.” From there, we explored what the learner brings to the learning situation and the characteristics of our learners, we examined the reflective process and discussed how to facilitate critical thinking on the part of our learners (students and patients), we described the structure and function of the brain and the implications of current brain research on teaching and learning, and we presented a systematic approach to designing effective teaching-learning situations By now, you recognize the complexity of your role as an educator You know that teaching is much more than simply telling your patients or audience what is important and expecting that they will learn it and remember it, or relying on the old mantra “show one, one, teach one.” Teaching requires a systematic and comprehensive approach to understanding your learners, focusing their attention, presenting materials in a manner that meets their needs, and continually reinforcing the learning so that they can achieve behav ior change and/or knowledge retention Teaching requires deliberate design and planning By now, you also recognize just how much teaching is an integral part of being a health care practitioner and how each teaching-learning situation is unique In the previous chapters, we presented the principles behind effective teaching, whether in the classroom or clinical setting However, as noted in previous chapters, each teaching-learning situation is unique, and, as health care professionals, we engage in a great variety of teaching Plack MM, Driscoll M Teaching and Learning in Physical Therapy: From Classroom to Clinic, Second Edition (pp 219-237) © 2017 SLACK Incorporated 220  Chapter activities For example, you may be asked to present at a community fair or a national meeting, you may want to present your scientific findings in a poster or platform presentation format, you may be invited to a workshop that lasts hours or a continuing education course that lasts days, you may be called upon to participate in a panel discussion, or you may be asked to teach in a doctor of physical therapy (DPT) classroom or laboratory These presentations can span across the clinic, hospital, classroom, laboratory, conference room, or community setting How can you use the principles discussed in the previous chapters to prepare for the variety of teaching-learning situations that you may be expected to engage in physical therapy practice? This chapter is designed to build on the principles of systematic effective instruction presented in Chapters and as you think about how you might adapt your presentation to meet the demands of dif ferent presentation formats and dif ferent audiences Which components of the principles of systematic effective instruction are non-negotiable and which ones can be modified or deleted depending on the situation? What else must you consider in trying to meet the demands of the requested presentation format? What will you if you arrive and find that your audience is much more knowledgeable than you anticipated or the room set-up is not what you had planned? What will you if your presentation is taking much longer than you had planned? Will you be ready? To begin this chapter, we would like you to take some time to ponder the scenarios presented in the following sections (continued) Systematic Effective Instruction 3: Adapting Instruction for Varied Audiences and Formats   221 did not stop to gauge the expertise—or lack of expertise in this case—of her audience Giving too much information, without allowing any time to process that information, can be overwhelming to an audience The end result might be that students shut down and disengage altogether from the learning situation Each of the scenarios described above would have benefitted from a plan B, a modified plan of action that would allow the presenter to make a few changes based on direct observations and information obtained from, and about, the audience early on (ie, an on-the-spot needs assessment) In the first scenario, had MJ included an on-the-spot needs assessment she would have realized how knowledgeable the audience was, could have omitted much of the background rationale and theory, and could have spent more time on discussing the curriculum itself For those in the audience with less knowledge, she may have provided handouts and used a few minutes in small groups, during which time audience members with greater expertise may have been able to answer the questions of the more novice participants This same solution may have also benefited in the second scenario and would likely have taken much less time to accomplish than individual introductions The small group activity would have enabled participants to both In the first scenario, MJ was excited about her topic introduce themselves and share their expertise with their and wanted to convey as much information as possible in group members, and would have provided background a 30-minute time frame, so she designed a highly strucinformation for the novice audience members In TR’s case, tured and extensive PowerPoint presentation, taking care a discussion with a member of the faculty who is familiar to ensure that all of the information she planned to present with the students’ level of knowledge and the expectations was included Given the expertise of the audience, MJ also of an entry-level practitioner may have helped her to deterwanted to make sure that she appeared credible, so she mine what to include and exclude from her presentation In spent a great deal of time making sure that the audience addition, sequencing her presentation in a way to provide recognized the steps she took in creating the curriculum sufficient processing time would have engaged the learners and how it was based in evidence and grounded in theory and enabled them to ask questions along the way The problem is, however, that she spent so much time on the How you know what to consider when planning background information that she had to rush through the a modification to your original plan? As a novice precurricular design, which is what the audience really wanted senter, you may be overwhelmed by the idea of planning to hear To her credit, MJ reflected on her presentation and more than one way to conduct your presentation Start the feedback she received Given another opportunity, she with simple modifications, such as differentiating between did reframe her presentation So, what went wrong with her background or basic information and more advanced second presentation? This time, she wanted to be sure that information Then, if you discover through a few questions she fully understood who was in her audience and what at the beginning that your audience participants are more each hoped to take from her presentation; however, getting knowledgeable or experienced than you expected, you can to know a large audience one by one is time consuming skip over the extra background information and make the and may be boring for many of the participants Again, she extra information available for audience members who are used so much time getting to know her audience that she less familiar As described in Chapter  5, active learning ended up rushing through the content that was relevant and strategies can also help everyone to learn more effectively meaningful to her participants In the third scenario, TR was excited to have been asked You can design an activity in which participants discuss back to her alma mater to share her expertise She was (review) basic information to be sure that everyone is at anxious to an excellent job and wanted to provide the the same level In this way, those with expertise can share students with as much information as she could because their knowledge with novice participants, and the novice she knew that she had not received this information when participants will have enough information for you to be able she was in school The problem here was twofold: (1) the to move through your presentation without having to first more expertise you have on a topic, the harder it is to know review all of the basic information needed These active learning strategies can be as brief as a few seconds or much what is need to know vs nice to know; and (2), again, TR 222  Chapter longer, and the duration of each activity can be modified to meet the needs of the group In general, we recommend planning at least activities of dif ferent lengths for even brief presentations of 30-minute duration If time is going by more quickly than you anticipated, you can eliminate or spend less time on one activity In all scenarios a solid needs assessment, refined learning objectives, and some active learning strategies could have enhanced the presentations greatly Each of the scenarios presented is dif ferent and required specific design considerations; however, in any presentation, there are still some non-negotiables to consider In each of the preceding scenarios, there was a wellintentioned presenter who experienced disappointing results In this chapter, we consider a variety of dif ferent presentational formats that require dif ferent design considerations To optimize your teaching, regardless of the instructional situation, we consider certain components of systematic effective instruction to be non-negotiable The components or elements of systematic effective instruction were presented in detail in Chapter 5 Figure 7-1 summarizes those elements that are considered to be non-negotiable Let us consider the non-negotiables as they apply to the opening scenario In attempting to ensure credibility of her presentation, MJ used 120 slides to convey as much as possible about her model for teaching communication There was a mismatch between her goals and the audience’s expectations In this instance, the presenter could have done a quick on-the-spot needs assessment and asked participants if they were clinicians or academicians and if Figure  7-1 The non-negotiables of systematic effective instruction they had encountered challenging patients with whom it was difficult to communicate The presenter might have asked the participants to think about any questions or concerns they hoped would be addressed during the workshop Once the participants had spent 30 to 60 seconds thinking about their questions/concerns, they could have turned to a person nearby to exchange their questions/concerns Lastly, the presenter could have asked for questions/concerns from the larger group and written these on a flip chart or digital white board to be put on hold or revisited during or at the end of the session Within to minutes, the presenter could have learned something about the audience’s expectations and could have clarified the extent to which the planned presentation would address their concerns Audience members also would have learned quickly whether to stay in this workshop session or to leave and find another session more appropriate for them Asking audience members to reflect on questions and concerns that they hope will be addressed and responding to these expectations can serve both as a needs assessment and a motivational hook It will help focus the participants’ attention to the topic of the presentation Personal connections to relevant concerns also help establish context for the workshop material In describing the purpose of the workshop, the presenter has the opportunity to present the specific learning objectives of the session as well Assuming that this, in fact, was not a workshop, but rather it was a presentation about a recently developed program for improving communication, it would be impor tant to consider ways to engage the audience (active learning) as much as possible and to boost the content in a meaningful way The presenter might have shown video clips of students engaged in clinic-based role plays before they learned the new techniques These video clips could have been followed by an opportunity for audience members to speak with participants nearby to critique the student-patient Systematic Effective Instruction 3: Adapting Instruction for Varied Audiences and Formats   223 role-play scenarios Several comments about the student performance from the audience could have been shared in the large group This brief discussion could have been followed by a brief lecturette (lasting 10 minutes) about the new communication training program Following this lecturette, a second video clip showing students using the new communication techniques could have been presented Once again, audience members could have commented on the student role plays, with instructions to compare and contrast the dif ferent communication approaches they had observed (lasting to minutes) Based on observations and comments from the audience, the instructor could have reviewed the key points of the new communication training program and highlighted the dif ferent outcomes observed in the role plays This 2– to 3–minute encapsulation could have served as a summary of the presentation This interactive presentation could have been done within the same 30-minute time frame originally allotted for the lecture plus PowerPoint presentation The adapted version contains all of the components necessary for effective instruction and is much more likely to engage learners Although we emphasize the importance of incorporating certain components of effective instruction regardless of the teaching-learning situation, these are not the only variables to be considered when designing your instruction Additional variables appear in Table  7-1 Creating optimal teaching-learning experiences requires you to consider both the non-negotiable components of effective instruction and the unique characteristics of your situation These unique characteristics or variables may include, but may not be limited to, the audience, time frame, format, room set-up, and equipment available, and context TABLE 7-1 Audience Time frame Format Room set-up Equipment and other resources Context 224  Chapter Audience Time Frame The people who comprise your audience definitely influence your instructional plan As discussed in detail in Chapter 1, the participants may have dif ferent expectations of your presentation, depending on their level of experience, current knowledge of the topic, cultures, generational differences, learning styles, and purpose for using the content that you are presenting What about participants of dif ferent ages or literacy levels? For example, if you are presenting information on the benefits of aerobic conditioning to a high school health class vs a group of senior citizens at the local community center, you will likely need somewhat dif ferent pacing (ie, ratio of content and process), content boosters, and active learning strategies Even in a setting where you assume a more homogeneous audience in terms of education and experience, such as when you present at a conference of professional peers, it is impor tant to consider the specific audience in your session Are these participants clinicians, academicians, or a combination of the 2? Are they expecting a lecture or a workshop format? How familiar are they with your topic? More often than not, you should expect a fair amount of diversity in your audience The key is to make the presentation as relevant as possible for the audience If you discover that most of the group is familiar with the key background information needed in your presentation but a handful are not, you may provide less of the background information you had prepared and frame it as “review for many of you and new information for some of you.” Clearly stating that you are aware of, and accommodate for, these differences in baseline knowledge indicates that you recognize and value the characteristics of this specific audience Earlier in the chapter, we presented scenarios where the topic was the same and the time frame was dif ferent This situation is common Imagine that you have conducted research on the benefits of specific interventions for individuals who have sustained below-knee or transfemoral amputation Many of the patients lost their limbs as a result of diabetes, motor vehicle accidents, and war injuries In addition to your expertise in orthopedics, you have developed competence in diabetes management, patient education about skin care, and selection criteria for various prosthetic sockets You have the potential to teach a number of topics to a variety of audiences, including physical therapists, physical therapy students, patients, and caregivers in a variety of settings, formats, and time frames Let us look at how the time frame can influence your instructional design Table 7-2 describes various design options that you might consider for these dif ferent time frames and  dif ferent audiences In the examples provided in this table, note that there are several impor tant differences in design based on these variables After assessing the needs of the audience, it was determined that the in-service presentation for the experienced physical therapists need not include objectives and content related to background information and anatomical changes resulting from the types of amputations Given the expertise of your audience, you could assume that they will remember key information on basic anatomy, or that they could retrieve this information with little difficulty If you were unsure of the audience’s immediate recall of pertinent anatomy, you might consider using one of the content boosters described for the DPT class (eg, anatomy review sheet) You could distribute an unlabeled diagram of the relevant anatomy and ask participants to label all, or selected parts, and then compare them with someone nearby Within minutes, participants would be up to speed Systematic Effective Instruction 3: Adapting Instruction for Varied Audiences and Formats   225 TABLE 7-2 Needs assessment On-the-spot questions (2 minutes) Key consultation with course coordinator about current knowledge of amputation, interventions for patients with amputation, and experience adapting physical therapy interventions, 2-weeks prior On-the-spot questions (1 to minutes) Goals/learning objectives Compare/contrast physical therapy interventions for this population Discuss prevalence and causation of below-knee and transfemoral amputations Discuss contraindications (1 minute) Describe anatomy impacted by these amputations Adapt exercises for people with below-knee and transfemoral amputations Demonstrate correct implementation of exercises with people who have dif ferent types of simulated amputations Explain contraindications for doing various exercises (3 to minutes) Motivational hook(s) Content booster(s) and active learning strategies Show pictures of patients with dif ferent level amputation, doing dif ferent exercises Question to group, “How could exercise ‘A’ be modified for patient ‘B’?" (1 to minutes) PowerPoint presentation of key points (10 minutes) Paired practice of exercises, each partner doing one on the other (5 to minutes) Paired discussion of a case-scenario handout where contraindications are embedded in chart notes (4 to minutes) First hook: Pictures of people doing physically challenging tasks (eg, skiing, sky diving) Ask question: What physical impairment these people share? (1 to minutes) Second hook: Diagram of leg with muscles/tendons/ligaments/skeletal components indicated and not labeled Ask students to correctly label all anatomical features, individually, and then compare and correct in pairs (5 to minutes) Third hook: Demo physical therapy exercise on able-bodied student and ask group how it could be modified for someone with transfemoral amputation (3 to minutes) PowerPoint presentation of key points related to increased incidence of people with amputations due to diabetes, motor vehicle accidents, and war injuries (10 minutes) Paired correction of anatomy review sheets (5 to minutes) PowerPoint presentation describing most common anatomical changes due to amputation and impact of these on function (10 minutes) Demonstration of adapted exercises (5 to 10 minutes) Paired practice of various exercises, with presenter and course coordinator circulating among students (15 to 20 minutes) PowerPoint presentation about contraindications to performing these exercises and physical and/or chart indicators of conditions that are contraindications (15 minutes) Problem solve case with simulated chart information; paired activity with handouts (10 to 15 minutes) (continued) 226  Chapter TABLE 7-2 (CONTINUED) Summary Question and answer session (2 minutes) Presenter reviews key points (3 minutes) on the pertinent anatomical information This activity could also serve as a motivational hook if it were done at the beginning of the presentation The anatomy review would be completed in a few minutes in an interesting, active way and would eliminate the need for including an in-depth review of the anatomy in your presentation Table 7-2 included approximate time frames next to each of the components of the presentation This is particularly helpful in planning your content to meet the demands of dif ferent time frames Keeping this handy during your presentation can also help you to determine whether you are on track to meet your stated objectives If certain aspects of the presentation are taking longer than anticipated, having Question and answer (2 to minutes) Presenter reviews key points (3 minutes) Activity: Ask group to think of any new information, shift in perspective or reaffirmation of previously learned information that occurred for them as a result of this presentation Ask group to call out total of of these before final 1-sentence statement from presenter (2 minutes) this timeline in front of you can help you to quickly make adjustments to your presentation and still meet the stated objectives (eg, which components of my presentation can I modify on the spot? Is there content that I can omit? Can I modify, shorten, or omit the next small group activity so I can stay on time?) In fact, preparation for a professional conference usually begins with the submission of a written proposal, which goes through a competitive, peer-review process before being accepted for presentation Typically, the abstract is accompanied by an outline of the content and listing of proposed activities with the amount of time designated for each activity as suggested in Table 7-2 Table 7-3 provides a sample of a proposal submitted for a 2-day continuing education course If you look closely, you will notice that a 2-day continuing education course essentially consists of several iterations of motivational hooks, brief content lecturettes, content boosters, and active learning strategies We consider these elements to be the building blocks of effective presentations The non-negotiables of systematic effective instruction can help you to design presentations of any length, from as little as 15 minutes to as much as 15 weeks of course content and more! Systematic Effective Instruction 3: Adapting Instruction for Varied Audiences and Formats   227 TABLE 7-3 Preconference Course: Preconference Instructional Course—2 day Systematic Effective Instruction: Grabbing Your Audience’s Attention and Maintaining it Throughout Your Presentation M.M Plack, Physical Therapy, The George Washington University, Washington, DC; M Driscoll, Physical Therapy, Touro College, New York, NY Multilevel Have you ever been faced with an instructional challenge such as being asked to present a mandatory in-service—at lunchtime or at the end of the day on Friday? Have you ever tried to teach first-year DPT students about professionalism—just before an anatomy midterm? How can we grab our audience’s attention, maintain it, and be sure that they learned what we wanted them to learn? This 2-day workshop will present a systematic approach to designing effective presentations Participants will experience a broad array of instructional strategies, apply them to topics of their choice to enhance their own presentations, and consult with one another to develop optimal methods of delivery This workshop will present a systematic method of instruction and will engage the whole learner in a time-efficient and effective manner Whether you are a presenter or evaluator, this model provides a 7-step framework that will help you plan, implement, and assess effective presentations From the needs assessment to the summative assessment, this model utilizes a variety of active learning strategies that incorporate learners’ past experiences and learning styles Participants will learn about motivational hooks, content boosters, active learning strategies, and practical formative and summative assessment techniques Strategies for gauging attention and changing the energy of the group to maintain focus will be modeled Participants will experience a variety of active learning strategies that can easily be incorporated into a continuum of educational designs that range from brief in-services to semester-long courses Participants are encouraged to bring a topic or presentation to work on throughout the day Participants will work in small groups to apply, practice, and fine tune the methods discussed This presentation will culminate in an enjoyable summative activity that will allow participants to integrate what they have learned while enabling the instructors to assess whether learners have assimilated content sufficiently for use Apply the elements of systematic effective instruction, including needs assessments, motivational hooks, content boosters, active learning strategies, summaries, and formative and summative assessments Develop effective presentations that incorporate active learning strategies Describe a summative experiential activity that engages the whole brain and reinforces integration, application, and deeper learning Critique plans to enhance the effectiveness of future presentations Develop summative activities for assessment purposes Apply the lessons learned to future educational presentations through the development of individual action plans Instructional strategies, presentation strategies, active learning strategies AM 20 min: Lecturette: Overview of systematic effective instruction 10 min: Small group activity: Factors to consider in designing a presentation 30 min: Lecturette: Audience and instructor characteristics 30 min: Small group activity: Characteristics of the adult learner and motivating instructors 15 min: Break 45 min: Lecturette: Learning styles 45 min: Small group activity: Self-assessment of personal learning styles 60 min: Lunch PM 20 min: Lecturette: Needs assessment 20 min: Small group activity: Needs assessment (continued) 228  Chapter TABLE 7-3 (CONTINUED) 30 min: Lecturette: Determining content and behavioral objectives 20 min: Small group activity: Behavioral objectives 15 min: Break 20 min: Lecturette: Reinforcing content 30 min: Small group activity: Motivational hooks and content boosters 15 min: Newsprint gallery review: Share motivational hooks, behavioral objectives, content boosters that were developed by the individual small groups 30 min: Individual work sessions and peer consultation AM 20 min: Lecturette: Active learning strategies, guided practice, and independent practice 60 min: Small group activity: Active learning strategies 20 min: Small group activity: Application of active learning strategies to individual topics 15 min: Break 20 min: Lecturette: Check for understanding, formative and summative assessments 20 min: Small group activity: Develop appropriate formative and summative assessments 20 min: Individual work sessions and peer consultation 60 min: Lunch PM 20 min: Lecturette: Summaries 20 min: Small group activity: Develop a summary for each individual topic 20 min: Newsprint gallery review to share active learning strategies, summaries, and formative and summative assessments that were developed by the individual small groups 10 min: Debrief on newsprint gallery review min: Muddiest points, summary, and questions and answers 15 min: Break 50 min: Small group activity: Participants will engage in a jigsaw integrative activity to reinforce, integrate, and summarize the content presented 15 min: Summary of the days 10 min: Muddiest points, summary, questions and answers, and summarize 30 min: Open work sessions and peer consultation Case studies, questions and answers, small and large group discussions Questions and answers, small group discussions, newsprint gallery reviews 35 to 50 people AV Set (LCD, AV Cart, Screen, Lavaliere microphones, Laser Pointer) Round tables, no stage (one of the presenters has a physical disability), newsprint Fink D Creating Significant Learning Experiences San Francisco, CA: Jossey-Bass; 2003 Jensen E Teaching With the Brain in Mind Alexandria, VA: Association for Supervision and Curriculum Development; 1998 Lujan, HL, DiCarlo S Too much teaching, not enough learning: what is the solution? Advan Physiol Educ 2006;30:17-22 Silberman M, Auerbach C Active Training San Francisco, CA: Jossey-Bass/Pfeiffer; 2006 Wolfe P Brain Matters: Translating Research Into Classroom Practice Alexandria, VA: Association for Supervision and Curriculum Development; 2001 (continued) ... in this book We need to Plack MM, Driscoll M Teaching and Learning in Physical Therapy: From Classroom to Clinic, Second Edition (pp 23 9 -26 8) © 20 17 SLACK Incorporated 24 0  Chapter know what... in this workshop in a number of teaching and learning conferences including the CSM and APTA Annual Conference She has been involved in ongoing research related to adult learning principles and. .. is beginning to get the feel Motor Learning: Optimizing Conditions for Teaching and Learning Movement  24 3 TABLE 8-1 Cognitive stage The individual is seeking to understand what it takes to perform