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Literature Review

Since I am adding discussion forums using real-life scenarios to two different cohorts of students in the radiography program, I wanted to focus my literature on determining if allied health students working together would result in the outcomes I was hoping. I focused my review on the following areas:

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  • Collaborative learning and student outcomes

  • Instructional design of blended learning classrooms in allied health professions.

  • Impact of collaboration on critical thinking in allied health professions.

  • Student engagement in creating significant learning environments.

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I was reassured in the research that student engagement and participation using real-life scenarios led to more positive outcomes. However, the literature was not extremely specific to radiography so I know that what I am doing will be original research. 

Introduction

              Blended learning is a valuable tool that can be purposefully added to the radiography curriculum to increase accessibility of content to students but also offer opportunities for collaboration between different cohorts of students. Adding an online discussion forum to two traditional face-to-face classes affords the opportunity for students at various levels to work together for problem-solving and peer review. The conversion to a more intense pace of our curriculum has altered the ability of our students to make appropriate and early connections between content areas resulting in a drop in the ability to readily adapt to challenges and modifications based on patient needs. I believe that adding multiple digital elements to crossover between groups of students will provide more opportunity for these content connections to be made so that newer students can make the connection of content sooner. The goal is enhanced critical thinking. This type of enhanced engagement by having different perspectives based on experience and knowledge has cited improved student learning outcomes (Garrison & Vaughan, 2013). The more advanced students will be offering insight and perspective and giving real-life challenges to the newer students regarding modifications that they would need to make due to patient condition to produce better radiographs. The newer students will be challenging the more advanced students with both lack of experience and engagement to problem-solve. My research question is: Does collaboration between first semester radiography students and fourth semester radiography students impact critical thinking in real-life scenarios with the first semester students? This is the primary question for my action research although I have several layers of interest that I plan to add if this first action research plan works as intended.

 

Review of the Literature

Definition of blended learning

              Bonk and Graham (2012) most popularly defined blended learning as an educational approach that combines face-to-face instruction with online learning activities, allowing for a mix of both synchronous (real-time) and asynchronous (self-paced) learning methods. This model leverages the strengths of both types of environments to enhance the overall educational experience. It also allows for greater flexibility and personalization in education. Although originally defined in 2006, they have updated their research but still define it the same as a combination of delivery methods that are both flexible and personalized to individual needs and preferences that enhances student engagement, motivation, and learning outcomes.

Types of Blended Learning

         Many types of blended learning models have been outlined and updated through the course of practice. The focus will be on the three types of blended learning that are most relevant to the action research plan.

Rotation model

         In this model, Staker and Horn (2013) describe that the students can rotate between different learning modalities, this can include face-face instruction, online instruction, and small group activities. Students are engaging with real-life scenarios online (online case studies or virtual simulations) and will also supplement them with in-person sessions for deeper analysis, discussion, or application. There are several subtypes within this rotation model. Christensen et al. (2024)  extensively discuss this in the K-12 area of instruction. Real-life scenarios are valuable for contextualizing learning, applying knowledge to practical situations, and promoting critical thinking skills in blended learning environments. Their integration depends on how they support the learning objectives and enhance the overall educational experience.

Complementary model

         Online learning is primary, where interactions and discussions primarily occur in the virtual space of the discussion forum. In person sessions complement the online component providing opportunities for practical demonstrations, simulations, or group projects (Bonk et al, 2012). Discussion forums play a crucial role in facilitating asynchronous communication and collaboration among students and instructors in the online component of the course, while face-to-face sessions can focus on activities that require physical presence and firsthand engagement. This model is also described by Fink (2003) as the online lab model. Picciano (2017) provides a framework using this model for using multiple learning modalities and technology to enhance interaction and collaboration effectively. Again, the goal being to create a more personalized learning experience that is both flexible and accessible to the student’s needs.

Enriched virtual model.

         White (2019) discusses the future of high school education using the enriched virtual model, students primarily learn online so students can engage with content and activities at their own pace, while face-to-face sessions offer opportunities for interactive learning, application of knowledge, and collaborative activities. Teachers do play a vital role in guiding students through their online work, giving feedback and conducting in person sessions to provide direct support with either group work or one-to-one support. This blended approach supports a balanced learning experience that leverages both online resources and in-person interactions to foster comprehensive learning outcomes.      

Advantages of Using Discussion Forums

         Awofeso et al. (2015) evaluated the use of online collaboration in discussion forums, specifically in health science programs as an advantage because it enhances the overall learning experience and engagement by effectively facilitating knowledge sharing and collaboration between groups that normally may not interact. Katoue et al. (2021) research agrees that collaboration using real-world scenarios engages groups of students, also health care professionals but from varying specialties, which would not normally interact with an opportunity to explore actual healthcare challenges working together on case studies that involve patient diagnosis, treatment planning and management. Using reflection and feedback from peers and instructors, these students can identify areas for improvement but also the importance of communication among health professionals and the inevitable teamwork that is so important in healthcare. Students’ perceptions were that the collaboration had a positive influence on their value of teamwork especially regarding other healthcare areas.

             Costello et al. (2014) also supports these educational tools by highlighting using communication technology tools to facilitate learning for health professional students. Online discussion boards, virtual patient scenarios and other interprofessional educational platforms do bridge the gap between the classroom practice and clinical learning. This is an area of such significant importance in increasing competence earlier in the process of education that results in real world consequences.

              Payan-Carreira et al. (2019) systematic review provided that finding instructional strategies that are effective in promoting critical thinking is the key benefit of using discussion boards. This focused specifically on implementing discussion boards that were directly relevant to health science education and were highly effective in promoting critical thinking. They found real-life scenarios relevant to the students that require them to apply their knowledge to complex, real problems, this fosters critical thinking skills.

              Better learning transfer from the classroom to the clinical practice in nursing was the finding from Carless-Kane & Nowell (2023). Students are much more likely to remember and apply what they have learned when they have practiced using realistic scenarios. This should apply for health professionals also.

             Hayward et al (2006) also offered a unique perspective in that using this type of online collaboration tools gives students an opportunity to become more culturally competent through peer mentoring. This study used students from among different healthcare disciplines to strengthen their understanding of cultural competence and boost their ability to work in more diverse clinical settings with confidence. Although this study is from 2006, the importance of cultural competence in healthcare has not changed the value.

Barriers to Implementing Collaborative Learning

             The most obvious barrier to implementing collaborative learning via technology would be if students and faculty struggle with the software or technology. Inadequate access to reliable internet and insufficient technical support always comes into question and could be a reason for decreased engagement or participation. This can also be a very time intensive process to implement (Costello et al, 2014).

              Another barrier identified in the research about implementing collaborative learning through discussion boards is its useful effect on long term student outcomes. Although some newer data does exist for implementing real-world scenarios into learning it is not explicitly related to discussion boards. Bonk et al, (2012) discusses that though the short-term benefits have been well-observed and documented, the long-range impact is still in question. Lasting effects of knowledge retention and professional skills have not been appropriately documented to prove the benefit.

              An additional gap identified in the literature is the lack of diverse student populations in the study of blended learning using real life scenarios. As mentioned previously, Hayward et al, (2006) was the best example looking at diversity using this type of collaborative learning as it applies to health sciences. This is extremely outdated by educational standards. More research needs to be done to use a less homogenous student population and if methods need to be tailored to diverse groups (Awofeso et al, 2015).

             Measuring student engagement and the quality of the interactions with real-life scenario activities is another great concern. What type of metric should be used to appropriately measure these outcomes? There is no current method according to Costello et al. (2014) to capture the depth or impact on student learning and participation. Awofeso et al. (2015) also addresses this as a disadvantage because there is no way to ensure equal participation.

Summary

         Conclusions drawn from this body of literature is that there is more research to be done in the area of using blended learning in health science curriculums. Although nothing is lost from implementation of blended learning within the radiography curriculum, the true long-term student outcomes are still in question. The time intensive process for implementation and lack of quantitative ways to measure the data do give pause.

This Review and the Field of Education

         This review highlights one small but significant piece of blended learning. Using collaborative learning tools, specifically discussion forums that use interprofessional students and real-world scenarios, can be highly effective in providing opportunities for students to apply real world problem solving for practical purposes.

Strengths and Weaknesses of this Body of Literature

                  The strengths of the literature that reviewed was that there are studies within healthcare education that show that collaboration between distinct groups of healthcare providers using real life scenarios do contribute to effective teamwork and improved critical thinking. Collaboration among different specialties of students also results in effective learning experiences.

                  The weaknesses in this body of literature are that most of the references provided some general guidance and frameworks for online and collaborative learning but did lack detailed guidance on specific technologies or platforms for discussion boards. A wide variety of disciplines that might not translate to specific recommendations within radiography. There was also a lack of practical implementation strategies in the literature. Few of the references also gave comprehensive methods for assessing the effectiveness of discussion boards.

                    What I see missing in the literature is limited focus for specific technologies. I did find a very current study on implementing blended learning into a radiography curriculum, but it was only in Spanish. In trying to find a comparable study in English, the reference only was for medical students learning radiographic anatomy.

Focus of the Current Study

         This literature review was immensely helpful in providing guidance on how to inform my action research plan. Establishing a metric for evaluating online discussion forums so there is a viable way to measure outcomes. I also need to provide a distinct way for both adequate quality and equal engagement among the students. Creating relevant topics for radiography so critical thinking can be engaged, students stay engaged and motivated will also be a priority.

 

 

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References

 

Awofeso, N., Hassan, M., & Hamidi, S. (2015). Individual and collaborative technology-mediated learning using                 Question & Answer Online discussion forums – perceptions of public health learners in Dubai, UAE.                       Open Learning: The Journal of Open, Distance and e-Learning, 31(1), 54–63.                                                              https://doi.org/10.1080/02680513.2015.1120662

Bonk, C. J., Graham, C. R., Cross, J., & Moore, M. G. (2012). The Handbook of Blended Learning Global                              Perspectives, local designs Curtis J. Bonk; Charles R. Graham. John Wiley & Sons.

Carless-Kane, S., & Nowell, L. (2023). Nursing students learning transfer from classroom to clinical practice: An                    integrative review. Nurse Education in Practice, 71, 103731. https://doi.org/10.1016/j.nepr.2023.103731

Christensen, C., Staker, H., & Horn, M. B. (2024, May 29). Is K–12 blended learning disruptive? An introduction to               the theory of hybrids. Christensen Institute. https://www.christenseninstitute.org/publications/hybrids/

Costello, E., Corcoran, M., Barnett, J., Birkmeier, M., Cohn, R., Ekmekci, O., Falk, N., Harrod, T., Herrmann, D., Robinson, S., & Walker, B. (2014). Information and communication technology to facilitate learning for students i                in the Health Professions: Current uses, gaps, and future directions. Online Learning, 18(4).                                      https://doi.org/10.24059/olj.v18i4.512

Fink, L. D. (2013). Creating significant learning experiences, revised, and updated: An integrated approach to                    designing college courses L. Dee Fink. Jossey-Bass.

Garrison, D. R., & Vaughan, N. D. (2013). Blended learning in higher education: Framework, principles, and                        Guidelines. Jossey-Bass.

Hayward, L. M., Canali, A., & Hill, A. (2006). Interdisciplinary peer mentoring: A model for developing culturally                   competent health care professionals. Journal of Physical Therapy Education, 19(1), 28–40.                                        https://doi.org/10.1097/00001416-200501000-00005

Katoue, M. G., Awad, A. I., Dow, A. W., & Schwinghammer, T. L. (2021). Interprofessional Education and                                collaborative practice in Kuwait: Attitudes and perceptions of Health Sciences students. Journal of                        Interprofessional Care, 36(1), 117–126. https://doi.org/10.1080/13561820.2021.1884537

Orong, D. O., Alcantara, Z. M., Asok, Jr., G., Baguasan, M. P., Bretaña, I. G., Evangelio, J. R., & Galimba, E. J.                      (2013). The relationship between teaching strategies and academic performance of radiologic                                 technology students. Advancing Radiologic Technology Research, 1(1).                                                                       https://doi.org/10.7828/artr.v1i1.360

Payan-Carreira, R., Cruz, G., Papathanasiou, I. V., Fradelos, E., & Jiang, L. (2019). The effectiveness of critical                       thinking instructional strategies in Health Professions Education: A systematic review. Studies in Higher                  Education, 44(5), 829–843. https://doi.org/10.1080/03075079.2019.1586330

Picciano, A. G. (2017). Theories and frameworks for online education:  seeking an integrated model. Online                        Learning, 21(3). https://doi.org/10.24059/olj.v21i3.1225

Staker, H., & Horn, M. B. (2012). Classifying K-12 blended learning. Innosight Institute.

White, J. (2019, July 25). Is the enriched virtual blended-learning model the future of high school? Blended                      Learning Universe. https://www.blendedlearning.org/is-the-enriched-virtual-blended-learning-model-the-             future-of-high-school/ 

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