Developing and Implementing a Blended Learning Framework

Since 2011, I have strategically been implementing a blended learning approach (figure 1) in my teaching, aimed at increasing opportunities for students to engage in dialogue with me, and with each other – both online and especially face-to-face.  I believe that dialogue is powerful in inspiring students to become active in their learning, motivating them to higher levels of thinking, as well as to applying and integrating the course content with other disciplines, and to real-world problems. I have selected a blended approach to maximise the efficiency of face-to-face time with students, and by carefully selecting technology and learning tools, to embed important graduate capabilities like teamwork and reflection.  I believe that to be a deep learner, students need to both interpret and contribute to the knowledge base. I have therefore provided opportunities for students to peer teach, review, and to design and develop teaching resources for their cohort. I believe that this kind of active learning is powerful and changes the learner’s conceptual understanding of the discipline and its applications.  

My innovative approach to blending has had a positive impact on learning by students, as demonstrated by this entry in the reflective journal: ‘We made many decisions that weren’t “by the book” (as in we hadn’t planned for them to happen) and this came out of discussing our thoughts on content/script/filming etc. Despite each of our team members researching and writing up a script for each of the 5 upper limb sports injuries, we still collaborated in terms of acting out the injury and tried to include moments of comic relief, most of which was unplanned. This task has put us in the place of the lecturer – we have had to think about how to present our cases so that the class will understand and learn from the case. I am surprised at how much I have learnt by reflecting on our team assignment and class work’ (Student, ANAT2451, May 2015) 

Providing an enabling learning environment 

An important aspect of learning anatomy is mastering the language of the discipline.  From my teaching experience, I believe that student engagement in learning is increased as they grasp the language of anatomy and engage in discussion with increasing confidence.  For this reason, I deliberately create a culture in which students are comfortable and safe to engage in dialogue regarding the content being taught. I strive to be approachable and concerned about students’ learning while clearly communicating the expectations of the course.  Through this active dialogue I have been able to identify troublesome concepts and to resolve them as soon as possible.  An example of this is that I was able to identify that many students who speak English as their second language confused terms used in anatomy like ‘quadriceps’ and ‘quadratus’ – knowing this has enabled me to be more deliberate in communicating the meaning of words in my own teaching, and to share this information and insight with my course tutors and colleagues.  The positive effect of encouraging dialogue on student engagement and motivation is evidenced in CATEI student feedback that includes: ‘She was always enthusiastic and had interesting information.  I found her style easy and friendly which made my learning experience enjoyable and forced me to keep on top of things so that I could discuss in the lab.’ (ANAT3141 student, 2012), and ‘great assistance when you wanted to improve your learning – she was always easy to talk to and had time to walk you through it’ (ANAT2511 student, 2011), and ‘not giving away too much info when questions need answering, rather guiding and encouraging students input’ (ANAT3121, 2011). 

Making learning relevant 

My teaching philosophy is about framing learning in meaningful ways that are relevant to the future profession of the learner. Each face-to-face session has been transformed into activities that scaffold students in inquiry-driven tasks. Through this, I strive to engage students in deeper learning by demonstrating the relevance of learning outcomes by making explicit integration with other disciplines, or to clinical/professional practice. I provide multiple opportunities for students to find answers to their questions, to construct knowledge as they discover ‘for themselves’ and problem-solve.  In every activity, I include clinical and functional relevance, and correlations with medical imaging, health, biomechanics or biomedical applications. In weekly tutorials, students work on a problem-based case that focuses on the anatomical basis that underpins function or understanding a clinical scenario.  Students have commented that the application exercises motivated them to learn: ‘she makes us think about ‘whys’. clinical cases makes stuff easier to understand – makes her lectures interesting too cos its not just things you read in the text’ (ANAT2451 student, 2012); ‘I loved  how she made us design a gut’ (ANAT2511, 2012); ‘very patient and relaxed lecturer…allows information to sink in.  I liked the surgery videos she uses’ (ANAT2451 student, 2012) and ‘best labs…because she tells us why it is important to know things as she goes. makes it easier to learn’ (ANAT2511 student, 2013).  

I believe passionately that cadaveric specimens are the best resources for learning anatomy.  For this reason I encourage students to explore the cadaveric resources at every opportunity and to find answers to questions from exploration and ‘troubleshooting’ for themselves.  In laboratory sessions, for example, I often respond to questions by posing another question and working with the learner towards finding the solution or answering the question. I believe that this approach models a way to think through issues to students and helps them develop problem-solving skills. This method of engaging students is well received and over the years, CATEI comments have confirmed this, including: ‘interactive teaching style which actually requires students to think for themselves’ (ANAT3121 student, 2009); ‘she always asks questions to help students to think- great teaching skill’ (ANAT3121 student, 2009); and ‘she provides ‘first-hand’ learning experience- makes us use visual, auditory, personal experience’ (ANAT2451 student, 2012), and ‘Nalini made the labs the best way to learning anatomy’ (ANAT3141 student, 2013). 

Incorporating teaching innovations 

I am always seeking to improve the student learning experience and to embrace innovations and advances that can stimulate learning in anatomy.  It is for this reason that I embraced blended learning and ‘flipped classroom’ approaches to teaching in my courses. I believe that in blending the curriculum, there needs to be alignment between the ‘technology’ selected and the learning outcome targeted – sometimes the use of a simpler tool is the best. As an example to illustrate my use of simple but powerful tools is the use of ‘body painting’. In 2011 I attended an anatomy conference in which ‘body painting’ was presented as an effective learning tool. After researching this, I incorporated body painting into activities focused on learning neurovascular anatomy – the impact was better than I expected. Student’s uptake and engagement in this activity was very positive and exceeded my expectations. Students (from ANAT2451 and ANAT3141) commented that: ‘this was the most fun I have had learning in a long time’;  ‘best thing I did at uni this year’; ‘made anatomy real’; and one unsolicited email (ANAT2451 student 2013): ‘I am really enjoying this course.  Thank you for this mornings lab – it was so much fun.  I was finding the brachial plexus branches too much but after drawing it on XX I don’t think I will forget it easily.  Also seeing it made it more clear to me why I was studying the course of the nerves’.   

Virtual Anatomy Adaptive Tutorials (V-AnATs) supporting learning activities 

Examining cadaveric resources is a fundamental part of learning anatomy. Student access to the anatomy laboratory and cadaveric resources is limited and as a result, students do not have easy access to the best resource to learn anatomy outside of the practical sessions.   In response to this and other issues (such as limited number of high quality specimens), I began developing the V-AnATs at the end of 2010 using SmartSparrow’s Adaptive e-Learning Platform (AeLP). The tutorials, based on high quality images of cadaveric specimens, also incorporate clinically and functionally applied anatomy cases to allow students to apply their basic knowledge and engage in critical thinking. The V-AnATs provide immediate, relevant and individualised feedback as the student progresses through the tutorial. For my blended courses, I have designed a suite of V-AnATs that are: 1. fully aligned with learning outcomes for each course; and 2. support each of the learning activities.  Initially, the V-AnATs were available online to students to use voluntarily as part of their formative assessment in the course. As the AeLP has become more robust in functionality, these tutorials have now become fully embedded in the courses as part of the online tutorial learning activities and summative assessment of the course.   As part of the Biomedical Education Skills and Training (BEST) network (https://www.best.edu.au) , I have also designed a suite of more than 40 adaptive tutorials to support anatomy teaching of all regions of the human body – these are used by colleagues from UNSW, as well as other universities throughout Australia, in their teaching. The breadth of this impact is highlighted by this quote from Dr Danni Maguire, BEST community manager ‘Nalini is a valued academic member of BEST. Over the course of 2 years, Nalini’s tutorials are so engaging, scalable and relevant, that they have attracted a lot of interest with more than 1490 views and an uptake of 60 adaptations by the academic community. Nalini is a very active member of the BEST Community. She has presented at our annual community summits and webinars, showcasing how adaptive tutorials make an impact on student learning.’ (August 2015).