Archive for August, 2011


Questioning strategies in Healthcare Training develop critical thinking, decision making, and problem solving in students. Bloom’s taxonomy of the six levels of cognitive learning can be used to provide a framework for creating questions. Bloom’s taxonomy starts from the simplest level of learning to the most complex level.  Simplest levels denote Knowledge and Complex levels denote Evaluation.

Sample Question for Knowledge Test:

Intravenous Urogram

Knowledge Test

Asking a learner to define Intravenous Urogram, (IVU) would test his/her knowledge levels.

Sample Question for Evaluation:

Intravenous Urogram

Complex Evaluation

A question is posed to the learner to  assess a request to perform an IVU on a patient allergic to iodine. Experiential activities/ simulations can be built to guide the learner in decision making. In this case, the learner gets to immerse in a simulated scenario, evaluate patient vitals, reports and assess the conditions under which an Iodine-allergic patient can be subjected to Intravenous Urogram.

Studies:

A baccalaureate nursing program study determined what proportion of terminal objectives for clinical nursing courses are high level objectives (analysis, synthesis, evaluation), and are the kinds of questions asked by teachers and students during clinical conferences of a high level also.  Despite the fact that stated objectives specified higher cognitive-level thinking, lower-level questions comprised 98.94% of the total number of questions asked by teachers and students in the clinical conferences surveyed.

Another study was performed within an Australian nursing program to examine clinical teachers’ use of questioning strategies.   The teachers’ years of classroom and clinical teaching experience, years of clinical experience, and academic qualifications were studied to see if an association between various qualifications and levels of questions existed.  Bloom’s taxonomy of the cognitive domain was used as a framework for the study.  The findings revealed clinical teachers asked more low-level questions (91.2%) than high-level questions (4.4%).

Lower level questioning do not promote critical thinking as they only trigger recall of information in the learner’s mind.  A simple recall of information does not enhance students’ understanding of the information in a meaningful way. Higher level questioning facilitates the development of critical thinking because it is aimed at higher cognitive levels, which involves application, analysis, synthesis and evaluation.   Educators should take advantage of stimulating questions more often to help create meaningful active learning instead of just prompting the simple recall of knowledge from students.

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Scenario- based learning stages a context, within which learners live and work in their everyday life. It’s based on the concept of situated cognition, which is the idea that knowledge can not be developed and fully understood independent of its context(Randall 2002). Scenario-based learning puts the student in a situation or context and exposes them to issues, challenges and dilemmas and asks them to apply knowledge and practice skills relevant to the situation (www.ucl.ac.uk).

Scenario- based learning has particular advantages for practice- based discipline areas where the experience of practitioners is especially relevant to what constitutes knowledge and understanding in the field. Using scenario-based learning in the field of Healthcare has brought forward many such advantages to learners that count on practical experience in everyday activities.

Let us consider a case where Indira Gandhi National Open University conducted such a scenario-based learning project. 10 academic programs were chosen to be included into this project.

The following frame work was given to develop the scenarios:
1. Define critical competencies for graduates of the program
2. Identify learning outcomes for students in the program
3. Identify learning context and develop suitable learning scenarios that reflect the events in life and work of persons who have acquired these competencies
4. Define learning activities assessable and non assessable tasks.
5. Identify all learning resources and instructional opportunities
6. Identify and define cooperative and collaborative learning opportunities using technologies.
7. Identification and definition of opportunities for feedback and remediation.

Let us study a sample scenario as an example:

Discipline: Civil Engineering

Topic: Structural Analysis

Learning Objectives:

1) To distinguish between static and dynamic loads
2) To conceptualize the influence lines
3) To differentiate between Influence Line Diagram (ILD) and Bending Moment Diagram (BMD)

Scenario:

It was a shining morning of October. All students of your class are in cheerful mood traveling to Roorkee in Jan- Shatabdi Express for educational trip with Prof. Dutta.
Suddenly, you feel a shock as train stops abruptly. While waiting for the train to re- start, it is leant that due to some accident on the bridge ahead, the train will not move at least for next 5 hrs.
Out of curiosity you all move to the accident site with Prof Datta. You observe that there is a lot of distortion of the track and even the rails have gone out of place. While discussing the reasons of track failure, Amit points out the presence of visible cracks in the side beam
of the bridge. Suresh asks Prof. Datta whether the bridge failure is due to excess loading.

In turn, Prof. Datta asks the students, whether they remember different types of loading on the structures. You all start naming the different types of loading, you have seen earlier.

Learning Activity 1:

a) List out the different types of loading on structures.
b) Categorize the above list into static and dynamic loads.

After going through the list, Prof. Dutta asks you that why the live loads are not considered as dynamic load when the movement of goods and human beings are considered in the live load.

Learning Activity 2:

Identify the characteristics of static loads and dynamic loads.

Prof. Datta asks the learners to tie a rope across two poles tightly. He then asks Suresh to hang four bricks at four different places and observe the deflected shape of the rope.

Simulation 1: Prof Datta asks you to remove the three bricks from the rope starting from the right pole and observe the deflection of rope at mid point.

simulation activity

Simulation 2: The he asks to repeat the same exercise by moving the brick at points B, C , D and E subsequently and observe the deflection at mid point each time.

simulation activity

Conclusion: The whole scenario-based learning program was developed to be very challenging and was able to completely immerse the learners into the learning cycle.