Training and Education

When determining what to assess, one must first decide whether the skills to be assessed are considered training or education.  If the goal is for students to learn to perform a skill, then it is considered training.  Education is when a student learns material which they can build upon and use for future problem solving.

I routinely use both training and education in the content area that I teach.  An example of training that I use is in our Basic Patient Care laboratory course.  I am currently teaching venipuncture techniques in lab.  I believe there is a remarkable difference in “knowing” how to do something and being able to do it.  I “know” how to do the splits, but I can assure you that I can no longer actually do them!  This is where the benefit of having a hands-on lab comes in.  Students can practice their IV starting techniques on a mannequin arm that is filled with a blood-like fluid. 

 

Instructure and student using a mannequin arm



All of the students have access to the task analyses that are created for each skill they will be assessing on in lab.  This helps them to break down the steps as they practice.  There is always a certain amount of nervousness that students must learn to overcome before they can stick a patient for the first time.  This nervousness does not go away, but practice helps build confidence, and I believe confidence helps to steady a shaky hand.  As their instructor I am beside the student the entire time, offering guidance when needed, and feedback when the task is complete.  Once the student has mastered the mannequin arm they are allowed to move on to a classmate.  I use a very detailed grading rubric to assess the student’s performance when they attempt to prove competency on a classmate.  I assure them that it is not necessary to puncture a vein and advance the catheter until blood returns for the student to successfully pass the comp.  I do not believe this would be completely fair because not all patients are the same, nor do they all have good veins for venipuncture.  I assess their ability to follow protocol and use the proper techniques.  They are only allowed one attempt to stick a person.  This keeps our students from becoming human pincushions.  If the student does not pass I discuss the issues with the student and they try again on the mannequin arm until the problem is resolved.  Repetitive hands-on practice, reaching a level of proficiency, remedial training when proficiency is not met, focus on a specific behavior demonstrated, and the practice of assessing every skill learned, are all qualities that make this an example of training.

The Basic Patient Care course that compliments the lab section is a great example of education rather than the training as previously discussed.  The coursework provides the structure and foundation for the knowledge that the students will need to apply in their clinical rotations.  The material mainly consists of declarative knowledge, albeit a small amount of procedural knowledge is also covered.  Goal statements are an excellent way for the student to clearly identify the target outcomes of the material.  The material is exhaustive and must be generalized for assessment purposes.  While the student must use this knowledge to anticipate a variety of problem solving situations, the assessment cannot cover every situation that may occur in patient care.  Typical assessments I use for this course include both low and high stakes assessments.  A low-stakes assessment is an assessment in which the performance by the student does not have significant implication on their grade.  Low-stakes assessments in this course are used in the form of discussion questions, group activities, quizzes, and module exams.  High-stakes assessments are given considerable weight and have more of an implication on the student’s grade.     High-stakes assessments, such as a mid-term and final exam are given and weighted heavier than the low-stakes assessments.  These types of exams require higher test security and require a great deal of planning. 

Both training and education are distinctly different and are effective if used properly.   These types of learning should be chosen based on the goals that the instructor has for the learners.  If the instructor hopes to teach declarative and procedural knowledge, without problem solving, training may be the best method.  If problem solving is a desired skill then education may be the best path to take.

Learning Capabilities

I may be teaching Radiographic Anatomy this semester in a face-to-face classroom setting for the last time.  As our program moves towards distance education and the online format, I am thinking how this course may be restructured to meet the needs of the learner.  Currently, I use PowerPoint to display radiographs on the overhead projector for the class as we discuss the anatomy.  Students are also given a copy of the lecture so that they may actively take notes and label the radiographs.  This works as an excellent study tool. 

One of the first lessons covered in the Radiographic Anatomy course is how to properly hang films.  It sounds easy enough, but there are a surprisingly large number of rules that must be applied.  I would prepare a pre-test to assess the learners’ prior knowledge on anatomy (it is a pre-requisite of the program) to determine if we are all on the same page to begin with.  This is a form of declarative knowledge in which the learner can tell me what information they do, or do not know about the subject.  Students would then view the lessons on film hanging.  These lessons would contain multiple examples and demonstrations of both the correct and incorrect method to display a film for reading by the radiologist.

A great way for the learner to prove their understanding of the concept is to hang the films for themselves.  I have looked into a few online puzzle-type software programs that I may be able to use to make interactive assessments.  My goal would be to display an image incorrectly, and have the student manipulate the image until it is displayed correctly for reading.  For example, a radiograph of a posterioanterior right hand should be displayed as if the viewer’s eyes were the x-ray beam going through the image in the same manner in which the photons went through the extremity when it was imaged.  It should be hung on the viewbox for reading as if the patient were hanging from their fingers, with the radiographer’s marker on the lateral aspect of the anatomy. 

 On the assessment, the image may be displayed upside down, backwards, or flipped.  Concept knowledge can be demonstrated as described previously, or by giving the learner a multiple choice exam containing images of radiographs.  The student could be asked to choose which image is displayed correctly, or select the description which would best explain how to fix the radiograph. 

To demonstrate rule knowledge the student may be given a radiograph they have not been shown before and asked to apply the previously learned rules for film hanging to properly hang the film.  For example, if students were told that extremities are hung by the phalanges, although they have not seen a foot radiograph displayed, they should know that according to the rule, it should be hung by the toes. 

Problem solving knowledge may be assessed in this type of course by giving the student a mystery patient.  We also refer to this as “a day in the life of [a radiographer]”.  These types of assessments are designed to pull all of the learners’ knowledge together into a real-world situation.  The student is given a radiograph that has not been marked (this is a major no-no in radiography) and asked to display it.  The student must be able to correctly identify anatomy on a radiograph, and differentiate the organs visualized to be able to determine the patient’s left and right side of the body.  Then the student must apply the rules they have learned to properly display the image.