Student engagement in the development of a common core curriculum for health professions
Vivien Moffat1, Donna Burns2, Stuart Cable1
1. Universities Scotland, 2.QueenMargaretUniversity, Edinburgh
Conference Theme: Designing higher education of the future
Abstract
A new undergraduate structure for allied health professionals and nurses, building upon a common core curriculum aims to provide a flexible, patient/client-centred workforce equipped to meet tomorrow’s health needs. This paper outlines the rationale for using peer facilitated focus groups with recent, existing and prospective students to inform development of the new curriculum. The study aims to (a) ensure student involvement as key stakeholders in exploring the underlying principles of a core curriculum and (b) gain insight into the possible response of the student population to emerging curriculum models in terms of recruitment, retention and satisfaction.
Introduction
The Scottish Core Curriculum (ScCore) Project (ScCore 2009) aims to scope and pilot the reform of the four-year undergraduate honours degree for a range of allied health professional and nursing programmes within the framework of a common core curriculum in response to the need for a flexible, effective and employable healthcare workforce.The project will take account of arange of issues identified for both higher education and practice. These include: employment expectations and aspiration of graduates, preparation for new roles and the need to ensure effective ways of supporting learning and sharing of best practice(Scottish Funding Council/ NHS Education for Scotland 2008).
Within Scottish Universities programmes for nurses and allied health professionals have developed independently and to a large extent remain uniprofessional in format. There are exceptions in which students come together for learning on common content and there has been a significant increase in the opportunities for ‘shared' learning' to promote team working , mutual understanding and development of shared strategies and practice. However, programmes remain largely discrete focusing on developing a specific professional identity from the outset.
However, challenges for the future of healthcare include the need to adapt jobs and roles to reflect changes in the delivery of healthcare such as the shift from an acute, hospital-based to a preventive, community-based model (Scottish Government 2006). Such challenges suggest the need for a more integrated approach to the preparation of healthcare professionals.
In reconsidering the curriculum against major policy and practice trends a number of influences for curriculum to appear to have the potential to form the core of a curriculum. Most recently for example, the report ‘A Force for Improvement: the workforce response to Better Health, Better Care’ (Scottish Government 2009) set out ambitions far removed from a simple technical model of practice. It requires staff who are ‘ambassadors for health improvement, safety and quality’, who are able to mobilise individuals and communities for public health and education; who develop and deliver multidisciplinary models of care; who are motivated to develop and contribute more; and who undertake preventive actions and promote self-care.
A significant measure of the success of higher education is the preparedness for work of its graduates, achieved through high quality, best value learning opportunities. This requires sound pedagogy, effective educational organisation and a close working relationship between a wide range of stakeholders – patients/service users, employers, workforce planners, Government, academics, practitioners, regulators, professional bodies and students - to ensure a workforce fit for purpose. This study forms one strand of the work of theScCore Project aiming to involve students as co-researchers in the curriculum development process.
Engaging Students
Students are a significant group of stakeholders in relation to health education and also as representatives of the future workforce. Engaging students in the curriculum development process aims to ensure that any new curriculum reflects student aspirations and would be able to attract and retain students and compete with other existing programmes.
Educational research has suggested that students should be developed as active learners and partners in the development of knowledge (Bruffee 1999, Zimmerman 2002). The importance of including the student voice in the development and evaluation of education programmes has also been recognised (Loriz and Foster, 2001) as have the advantages of focus group methods which allow participants the opportunity to consider and discuss their responses rather than the more commonly used survey questionnaire approach which requires quick responses and gives little opportunity for respondents to qualify or elaborate on their answers (Barbour 2005).
Engaging students as facilitators may help to develop champions for a new curriculum. Student leaders can be effective role models and may help to facilitate change by engaging with peers more effectively than others, for example educators or researchers (Hoffman et al 2008).
The project is designed around a series of student-facilitated focus groups. This design is compatible with the focus group approach of open, exploratory and non-judgemental discussions where the nature and content of group interaction is the main source of data rather than answers to a series of questions directed by an ‘expert’ facilitator (Ivanoff & Hultberg 2006).
This approach also gives the opportunity for students to learn about the research and curriculum development process as well as promoting a sense of ownership (Loriz & Foster 2001).
Method
Student focus groups are being conducted in three Scottish regions. These are supervised by project staff but, where possible, facilitated by student representatives for whom this will provide an opportunity to develop research skills. Participants include current undergraduate students from a range of allied health and nursing undergraduate degree programmes and at different stages of preparation. Focus groups are also being conducted with groups of students completing access or Higher National Certificate (HNC) courses in health related subjects at Scotland’s colleges, with groups of recent graduates now working as registered health professionals as well as with groups of senior school pupils with an interest in pursuing a career in healthcare.
Recruitment
In each region,academic staff from the relevantHigher Education Institutions (HEIs) agreed to circulate information amongst students in order to recruit facilitators and focus group participants. Participants were recruited from students at level 2 or later in their programme of study. Facilitators either responded to the generally circulated invitation or were recruited through a direct approach to groups such as class representatives. Student facilitators were themselves involved in recruiting Focus group participants from amongst their peers.
Staff involved in the delivery of the HNC in healthcare at Scotland’s colleges agreed to invite their students to participate and school students were contacted through links with a widening access programme aiming to encourage interest in healthcare careers.Recent graduates were contacted through the HEIs and also through support programmes for newly qualified practitioners.
Preparation
Facilitators were prepared by attending locally organised focus group workshops and taking part in informal preparation sessions with project staff.Student co-researchers were involved in preparing materials and in discussions around the process of data collection and analysis. As the project progresses students will have the opportunity to become involved in the data analysis and writing up and reporting of findings. The focus group discussion was piloted with volunteer students in one region which allowed facilitators to practice data collection and analysis techniques and highlighted challenges for students in the facilitation process.
Format of focus groups
The study was designed to gain students’ perspectives on some of the underlying principles that might inform the development of a common core curriculum. These include the qualities and capabilities that students consider need to be developed in health care professionals as well aspreferred course structure and teaching and learning approaches. More direct questions about the feasibility and desirability of a common core curriculum seek to explore which aspects of a common core might attract, retain and satisfy future health professional students.
The Key research questions are:
- What attitudes, actions and behaviours, (‘capabilities’) do students consider should be developed through the education process to prepare ‘fit for practice’ health professionals?
- Do students consider that greater integration would equip them to become part of an effective health care workforce?
- How would students respond to a common core curriculum in terms of recruitment, retention and motivation?
Each focus group includesaround six participants and two or three facilitatorsand lasts around one hour. The first facilitator’s role is to lead the discussion, giving a brief explanation and checking consent for participation andaudio recording.This introduction also sets the ground rules aiming to assure participants of confidentiality and create an open, non-judgmental atmosphere. Supporting facilitators are involved in operating recording equipment and overseeing the timing of the discussion as well as taking notes, identifying speakers and key statements, andobserving and recording non-verbal communication amongst the group.
After the introductionthe discussion focuses on why participants chose their programme, their profession or HEI.The topic guide (box 1) then follows a framework of: structure, process and outcome to explore students’ expectations of their programmes, what teaching and learning works for them and which capabilities they consider need to be developed in preparation for a career in their own profession as well as in health care more generally.Finally students are asked directly how they would feel about the idea of a common core curriculum involving a common year or two years followed by specialist preparation. They would be asked for perceptions of advantages and disadvantages.
The topic guide may be adapted as the study progresses allowing new issues, questions or suggestions which are raised in discussions to be presented to future groups in order to test emerging themes.
Box 1 Focus Group topic guide
Analysis
All focus group discussions will be audio taped and transcribed and analysed using a grounded theory approach where data are coded, with codes then being organised into categories which can be compared to explore similarities and differences and to identify emerging themes (Barbour 2005). Qualitative data analysis software NVivo 8 (QSR International 2008) is being used to facilitate analysis. Transcripts will be read and re read and coded independently by more than one member of the research team in each area and subsequently discussed amongst the team along with facilitators’ notes and observations in order to identify emerging themes.
Early findings
Although data collection and analysis is on going, early findings from the first focus groups suggest a number of areas which can be explored in subsequent discussions:
Students:
- are open to the idea of a common core within their programme, recognising the importance of a shared value base across professions, however…
- are keen to develop a uni- professional identity at an early stage
- are very focussed on the vocational aspect of their preparation, at times questioning the benefits of a perceived focus on academic skills and seeing the academic preparation as a ‘hoop to be jumped through’ or a ‘means to an end’ i.e. merely as a requirement for professional registration
- recognise the need for person-centredness e.g. communication or ‘people skills’. Skills relating to person-centred practice were often described as having been sacrificed in favour of a more academic focus on theory and research and were often perceived as being acquired in practice situations or through life experience/maturity rather than being taught to students
“a lot of skills you learn while you’re (on placement), communication skills, you can’t teach communication skills, you can teach or you can inform people of things that affect communication but you can’t teach someone to talk to someone and how to interact with someone”
3rd year nursing student
- recognisethat both academic and practice staffas well as students need to ‘buy in’ to any new curriculum
“one of the negative things of IPE at the moment is the lecturers saying, ‘oh well, we don’t really want to be here but here we are again for another year’ that doesn’t give us any faith. Why are we there learning when they don’t want to be teaching us this?”
4th year OT student
Discussion
Early observations from this study raise questions about student engagement. Tensions between a vocational and graduate model of professional preparation are evident within the range of student opinions. Tensionsalso exist around the approach to health professional preparation, with students expressing a preference for a uni-professional model reflecting current practice, while government and employers are seeking graduates with more flexible generic skills.
This leads to a question about student engagement and the role of students as ‘consumers’ of education versus students as learners who come to education ready to be guided by the academic staff. An earlier reference to the suggestion that students should be ‘developed as active learners and partners in the development of knowledge’ presents a challenge when students express opinions which seem to conflict with the preferred course of action.
Of course student opinion is likely to be varied and to reflect the different formal and informal influences to which students have been exposed. This includes the culture amongst academic staff as well as the attitudes and opinions of those they work with in practice and their fellow students. This informal learning has been described as the ‘hidden curriculum’(Cribb and Bignold 1999).
Part of the process of developing students as active learners is to present persuasive arguments which challenge perceptions and enable informed debate, flexible thinking and willingness to embrace change. Student engagement within this study is about raising awareness of issues related to preparation of future healthcare professionals and encouraging discussion around the development of a common core curriculum as well as seeking student opinions on options for change.
Next steps
Data collection and analysis within the student engagement study is on-going and focus group discussions may involve further testing of emerging ideas from previous discussions. The larger ScCore project involves a steering committee representing the supporting organisations, a reference group including a broad group of stakeholders as well as working groups representing academic and service staff across Scotland. Findingsfrom this student engagement studywill inform debate and discussion of the approach to curriculum development amongst these groups. Findings will also be disseminated widely through publications and presentations and will be made available on the ScCore project web site (ScCore 2009).
Conclusion
A range of factors must be considered when scoping the development of a common core curriculum for health care professionals; labour market trends, lessons from workforce planning and national and international policy developments as well as ‘big picture’ educational thinking in terms of the broader attributes of graduates needed to respond to changing roles and careers and service, practitioner and user expectations.
Questions of the feasibility of bringing learning for the professions together within a common core curriculum are important but more belying this is the desirability of doing so, in short, what value might it bring to such issues as recruitment, retention, career choice and transfer, workforce need and student aspirations. Data collected through stakeholder consultations, workshops and national and international literature provide a backdrop against which to consider these critical questions.
Students are a key stakeholder group within this endeavour as any new curriculum must attract prospective students, satisfy on-going learning and development needs and equip graduates for future employment. This project therefore seeks to engage students in the curriculum development process by recruiting them as both facilitators and participants in a series of focus groups comprising current, potential and recent undergraduate students of allied health professions and nursing.
Representatives from the student facilitators were also included in the ScCore Project reference group, again ensuring that student perspectivesare considered in the development process. This study is on-going and findings from both the student focus groups and the main project will be reported as they emerge.
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