Systematic Effective Instruction 1: Keys to Designing Effective Presentations

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Systematic Effective Instruction 1


Keys to Designing Effective Presentations


Margaret M. Plack, PT, DPT, EdD and Maryanne Driscoll, PhD


CHAPTER OBJECTIVES


After reading this chapter, the reader will be prepared to:



  • Design effective needs assessments to ensure that your presentation meets the needs of your learners.
  • Develop appropriate learner-centered objectives in 3 domains of learning to guide your presentation.
  • Differentiate between designing single presentations and presentations linked to a course or a curriculum.
  • Create effective motivational hooks and content boosters that capture your learners’ attention and maintain it while reinforcing learning.
  • Determine how best to sequence a presentation to optimize engagement and learning.
  • Select active learning strategies that will engage your learners, reinforce their learning, and enhance their retention.
  • Design formative and summative assessments to enhance teaching and learning.
  • Ensure alignment by linking curriculum, course, and learning objectives to learning activities and assessments.

Have you ever had to give a presentation during a morning class when the students were having their anatomy midterm that afternoon? Have you ever had to give an in-service to a group of therapists during lunch on a very busy Friday? Have you ever had to give a presentation at 8:00 AM on a Monday morning right after a holiday weekend? Finally, have you ever realized halfway through a lecture that you had been daydreaming and totally missed what the presenter was saying? In this chapter, we provide you with strategies that will help to grab your audiences’ attention and maintain it throughout your presentation, no matter what the content or when you might be presenting!



STOP AND REFLECT


You are asked to give a presentation on osteoporosis for a local, community-based women’s group. You have ample time for preparation, since the talk is scheduled for next month.


Reflective Questions



  1. What factors will influence your preparation?
  2. How will you decide what to teach?
  3. What teaching-learning activities will you use?

In responding to the scenario presented in the previous Stop and Reflect, you may have remembered, and reflected on, the various filters that influence the teaching-learning process presented in Chapter 1 of this text. You may have considered the cultural background and generational status of the audience, as well as the learning styles and characteristics of the adult learner. Next, you may have thought about your topic (osteoporosis) and what you know about it. Remembering that any new information must connect to prior knowledge, you may have reviewed some facts about osteoporosis that you learned in school. It is possible that you also may have remembered that your aunt was recently diagnosed with osteopenia, a precursor to osteoporosis, and that your grandmother had broken several bones due to osteoporosis. Having these episodic or autobiographical memories about your relatives arrive unprompted makes sense to you now that you know how the various memory pathways work together. Certainly, your grandmother’s story had an emotional impact on you, and you may wonder how you can help your audience to connect in a similar way. The topic of the presentation becomes a stimulus for anything that you connect with the word osteoporosis.


Often, the first question a novice presenter wants answered is, “How much time will I have?” This question may be followed by, “Who will be in the audience?” Although these questions address factors that are important, they are insufficient to determine how to best design an optimal teaching-learning activity. As you can see from this discussion, when asked to give a presentation, intuitively you may begin to consider many of the concepts presented earlier. However, you may not yet recognize all of the steps needed in preparing for a presentation. Whether you are giving a guest lecture in a doctor of physical therapy (DPT) class, speaking to a community group, or instructing a patient, there are a number of essential steps to be considered when you are preparing to teach.


This chapter describes a comprehensive, systematic approach to instruction that includes assessing the needs of your audience members, gaining their attention, and presenting appropriate content that meets the objectives that you have specified ahead of time. This approach incorporates periodic assessments, practice opportunities, and a summary. We know that we are more likely to learn and retain information more effectively when multiple memory pathways are engaged, so we emphasize the importance of active learning, using teaching strategies that are multidimensional and interactive. These concepts are reinforced in later chapters as you begin to see how these very same steps are important and effective not only for classroom or community presentations, but also in planning patient education activities.


WHAT TO CONSIDER IN PREPARING TO TEACH



CRITICAL THINKING CLINICAL SCENARIO


Consider the following 2 scenarios:



  1. You are preparing to teach a class on manual therapy to a group of DPT students.
  2. You are preparing to teach your patient an exercise regime for strengthening his lower back.

Reflective Questions



  1. What do you need to consider in preparing to teach in each of the these scenarios? Develop a list for each.
  2. How do your lists compare? What is similar about the 2 lists and what is different?

What did you include in your list of things that you need to consider? Most likely, you mentioned the content and the goals of or objectives for your topic. Perhaps your list includes providing an opportunity for your participants to practice the skills that you want them to learn, along with an opportunity for you to observe them practicing to see how well they learned the skills you presented. However, planning for optimal learning as Fink1 describes requires us to be even more comprehensive in our approach. We need to consider what the audience already knows about the topic; how to engage the learner’s attention, boost content, provide for different types of practice, and summarize content; and periodically assess mastery of what we have taught. We refer to this multistep process as Systematic Effective Instruction. Figure 5-1 shows the essential components needed to develop effective presentations.26


While this chapter focuses on developing effective presentations, it is important to remember that presentations often do not exist in isolation. Perhaps your presentation is part of a course or an entire curriculum, or maybe you are one presenter in a series of presenters at a continuing education course. You must consider your presentation as being one component in a series of learning opportunities for your learners. To optimize learning, it is important that the different presentations or planned learning experiences are well aligned. Do you know how your presentation relates to the objectives and goals of the course, curriculum, program, or other presentations? Do you know what the faculty expects the students to know or do by the time they finish your presentation, your course, or the curriculum? Do you know how the other faculty members typically teach, what they value, or their teaching philosophy? Is the program a traditional lecture-based program or is it a problem-based program, case-based program, or some combination? Where does your content fit within the overall sequence of courses—early, middle, or later in the curriculum? What content preceded your presentation and what will come after? Are you introducing new content or are you expecting them to have foundational knowledge upon which you can build? What assessment methods do other faculty members use?


Answering these questions will help you to situate your presentation in a way that builds upon content previously learned and is not simply redundant or too advanced for the learners. This concept of ensuring that your presentation fits within the course, curriculum, or sequence of presentations is called alignment (Figure 5-2), or, as we like to sometimes call it, “Linking the micro and macro!”



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Figure 5-1. Systematic effective instruction.


 



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Figure 5-2. Alignment: linking the micro and macro.


Alignment does not only refer to situating your presentation within the overall curriculum, but also includes making clear linkages between your course learning objectives, session learning objectives, session activities, session assessments, course assignments, and overall course assessment strategies. A well-aligned presentation optimizes learning, while a misaligned presentation can detract from the flow of the learning. We refer to this concept of alignment throughout the chapter as a reminder to be sure that your presentation is well aligned and to consider your presentation as part of a whole rather than in isolation.



ALIGNMENT: LINKING THE MICRO AND MACRO



  • Mission and vision of the program, school, college, and university
  • Terminal objectives/goals and outcomes (graduate expectations)
  • Faculty/program philosophy (faculty values)
  • Curriculum model (traditional lecture based, case based, problem based, hybrid, etc)
  • Educational theory and principles
  • Curriculum sequence
  • Specific courses (where in the curriculum the course falls)
  • Specific units within a course
  • Specific lectures
  • Activities and learning experiences
  • Assessment

KNOWING YOUR AUDIENCE AND ASSESSING THEIR NEEDS



CRITICAL THINKING CLINICAL SCENARIO


Revisit the scenario presented at the beginning of this chapter in which you are giving a presentation on osteoporosis to a group of women in your community.


Reflective Questions



  1. How would you approach the task if you knew that everyone in the audience had osteoporosis?
  2. How would you adapt your talk if you knew that the average age of members in the audience was 30 years?
  3. Would it matter to you if the average age was 55 years? If so, why? What would you add to your talk? Delete?
  4. Would you do things differently if you were told that the audience comprised health care workers, including nurse practitioners, who were interested in how to incorporate exercise into the recommendations that they usually give to women? How would you modify the content?
  5. What if your audience comprised DPT students learning about osteoporosis in an advanced orthopedics course? How might your content differ?

Who Is in Your Audience?


After reflecting on, and responding to, the previous Critical Thinking Clinical Scenario, it becomes clear that it is important for you to consider your audience and their needs before planning the content you wish to teach. You might describe different strengthening exercises for 25-year-olds than you would for 60-year-olds. You might include more information about physiology and kinesiology when presenting to health care practitioners or DPT students than you would for an audience of lay people. Given what we know about the brain and how neuronal connections are developed based on our prior experiences, it makes sense to learn as much about an audience as possible before designing a teaching-learning experience. In learning about your audience, it will be important for you to recognize and consider the following:



  • Learning styles of your audience members
  • Level of expertise (ie, novice to expert) of your audience
  • Expectations of your audience

What Kind of Learners are in Your Audience?


Even before conducting an actual needs assessment, we can make some general assumptions about the individual members of the audience. As we learned from our discussion on learning styles, a presenter should generally expect that all 4 learning styles will be represented in every audience. Without completing a formal assessment of each individual’s style, you can assume that, in any audience, some learners will prefer to watch and listen, while others might prefer to be active in the learning experience. At the same time, you will likely have participants who primarily want to hear about the theory and facts, while others might prefer concrete examples, anecdotes, and stories.7 The optimal teaching-learning experience includes something for each preference, which, if you remember, is the basis for our motto “teach around the wheel,” which was introduced in Chapter 1.


Garmston and Wellman3 provide us with a slightly different view of the audience than Kolb.7 In any given audience, they, too, encourage presenters to be cognizant of the presence of 4 different types of learners. They describe each type of learner as focusing on a different question. As a presenter you will want to be sure to answer the following questions posed by each type of learner:



  • Why should I pay attention to you? Who are you? What is the personal connection?
  • What is important? What are the facts? What is the objective information that you are presenting?
  • So what? What are the implications of what you are teaching? Why is it important that I learn what you are teaching?
  • What if? How can this information be adapted and reorganized to better meet my needs?

As you think about your topic, if you can imagine people asking these questions, then you can begin to organize your content to answer these questions and, in this way, satisfy the needs of each learner.



KEY POINTS TO REMEMBER


Every audience will likely have individuals who prefer the following:



  • To watch and reflect
  • To experiment and be active
  • Concrete examples and practical application
  • Theoretical and abstract concepts

Every audience will likely have individuals who will want answers to these specific questions:



  • Why?
  • What?
  • So what?
  • What if?

You will remember from Chapter 4 that Brown et al8 propose 2 additional factors to consider when thinking about the various types of learners in your audience. One factor is called structure building. Learners who are structure builders are able to pull out key points from new material and integrate them into meaningful mental models.8 Learners, described as high-structure builders, appear to be more efficient learners than low-structure builders. Unlike low-structure builders, high-structure builders can more easily distinguish between essential and nonessential information.8 If you want your learners to better retain information, you can help them become better structure builders by using specific strategies, such as highlighting key points, adding key questions to reading passages, and summarizing major concepts to help learners tune in more to key points as they read.9,10


Brown et al8 also describe 2 additional types of learners: rule learners and example learners. When given a series of problems, rule learners can more easily see similarities among problem types. They can more easily detect underlying rules, so, when they come upon a similar problem, they can more easily apply these basic principles again.8,11 Example learners, on the other hand, tend to focus on the characteristics of each problem or example itself. Because they have focused more on specific attributes of each problem and less on the similarities and differences between problems, they may have a more difficult time generalizing from what they had done previously.8,11 Once again, to enhance learning and retention in all audience members, a good strategy might be to help learners recognize the patterns and rules by having them compare and contrast examples, problems, and solutions rather than simply solving a series of individual problems.11,12 These types of strategies are important to consider as you work to align your learning activities with your learning objectives and with the needs of your audience members.


What Is the Level of Expertise of Your Audience?


The level of expertise of your audience is another factor to consider in determining the actual content that you will present. How much does your audience already know about the topic? Will you be introducing a topic to your audience for the first time? In her seminal work on the development of expertise in nursing, “From Novice to Expert,” Benner13 first described the Dreyfus model of skill acquisition.14 Jensen et al15 use this same model in their book, Expertise in Physical Therapy Practice. Dreyfus et al14 propose the following 5-stage model of skill development:



  1. Novice: Has no experience with the content, skill, or situation; this learner relies on rules and input from others to guide learning and performance.
  2. Advanced beginner: Has some exposure to or experience with the content and is just beginning to develop competence; this learner is less rule-governed than the novice, but still relies on others for guidance. He or she continues to need help in setting priorities and recognizing the important aspects of a given situation.
  3. Competent: Has some exposure and experience with the content and, as a result, has developed some degree of competence; with greater experience than the advanced beginner, this learner can begin to rely less on abstract rules and more on applying the information to make decisions in a given context. At this point, the competent learner can prioritize information and effectively apply the information to a variety of situations.
  4. Proficient: Has the ability to view the situation as a whole; this learner relies on past experiences and recognizes patterns to quickly see when something does not fit the pattern as expected. Unlike the learner in the competent stage, the proficient learner has enough experience to determine what aspects of a situation are most important.
  5. Expert: Has had significant exposure to and experience with the content and no longer relies on abstract rules; this learner can quickly discern a situation and knows when to take action. Given this learner’s depth of understanding and experience, he or she relies to a large extent on intuition.

Notice that even in this model, as novices, rules are critically important to the learner; however, as learners advance, what becomes equally critical is that they begin to build their own structures and rules around their prior learning. Understanding where along the continuum your learners’ abilities and experiences fall will help you to determine how to approach the teaching-learning situation. Figure 5-3 provides a pictorial view of the novice to expert continuum based on the work of a number of adult theorists, including Candy,16 Knowles et al,17 Pratt,18 and Benner.13



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Figure 5-3. Novice to expert continuum.


Figure 5-3 demonstrates how learners at the novice end of the continuum (ie, during early exposure) show a low level of competence and self-efficacy in the subject matter and, therefore, may be dependent upon direction from the teacher and may require a great deal of support in their learning. As a teacher, you will likely provide significant content information; you may take a more pedagogical approach and provide a great deal of structure, guidance, and supervision. As the learner develops some degree of competence, you may begin to provide less structure and direction and more guidance and feedback; you will want to provide more opportunities for independent practice, complex problem solving, application, and integration. Finally, if you are presenting to an audience of individuals with a high degree of competence, your role as an instructor would be to design a learning situation that requires learners to actively integrate the information into what they already know. Your presentation may require learners to be more independent and self-directed in their approach. For example, you may structure your presentation around a complex case study and require learners to take greater control through independent research and problem solving. You may also ask learners to reflect on the content, asking them to apply the information to a variety of situations in more creative and novel ways or to compare what they learned from the case analysis to their current practice.


For example, the concept of strength-training for people in their 80s may be new to someone who is unfamiliar with the latest research on the benefits of exercise for elderly individuals. If this were the case for your audience, the purpose of your presentation would likely be early exposure to the topic and you would likely be providing basic information; discussing indications, contraindications, and various types of strength-training activities; and using interesting case material to demonstrate the principles discussed. As the instructor, you will need to provide more structure and supervision.


On the other hand, perhaps your audience members have been exposed to the topic of strength training in the elderly already and they now want to develop competence in designing appropriate programs for residents of an assisted-living facility. In your presentation, you will more likely be guiding your learners through interactive discussions and practice with a variety of strength-training activities; you may guide them through a variety of case studies and use guided practice to help them develop exercise protocols for individuals with various health conditions.


Finally, if you are conducting an advanced continuing education course for master clinicians or experts, you may challenge your learners to apply and integrate the information to plan interventions for more complex geriatric patient cases, such as adults with intellectual and developmental disabilities. You will likely use small, group problem-solving activities to draw on the experience and depth of understanding of your audience members.



KEY POINTS TO REMEMBER


As learners develop expertise, they will move from novices to experts along the continuum of the following:



  • Early exposure
  • Developing competence
  • Approaching mastery

At each stage along the continuum, learners have different needs; therefore, teachers have the following different roles:



It is important to remember that you can have learners who have achieved a significant level of expertise in one content area, yet still be novices in another. As the instructor, understanding where along the continuum your learners’ knowledge, skills, and experiences are relative to the content you will be teaching is critical in designing your presentation.


What Are the Expectations of Your Audience?



STOP AND REFLECT


Have you ever gone to a presentation and walked out thinking, “How disappointing! That was not at all what I expected to hear”?


Reflective Questions



  1. How did this mismatch occur?
  2. How might this mismatch have been prevented?

It is also important that your planned presentation and the expectations of the audience are congruent, otherwise you may very well disappoint your audience and leave the presentation unsatisfied yourself. In presenting to any audience of adult learners in particular, they want to know the following:



  • What they will be expected to learn
  • How learning will occur and how it will be evaluated
  • Why it is important for them to learn what you are teaching
  • Who the teacher is and what qualifies him or her to teach the content


KEY POINTS TO REMEMBER


Adult learners will want to know:



  • What they will be expected to learn
  • How learning will occur and how it will be evaluated
  • Why it is important for them to learn what you are teaching
  • Who the teacher is and what qualifies him or her to teach the content

A personal introduction will help the learners understand who you are and what makes you qualified to teach them. Creating a plan and goals for your presentation and making them explicit to your audience during the introduction will help them understand the purpose of your presentation and why it is important, and will give them a sense of what you will expect from them as learners during the presentation. But, perhaps most important in designing a presentation is clarifying the needs of your learners. Designing your presentation around those needs will increase its relevance and both motivate your learners and add to the success of your presentation.6,19


What Are the Needs of Your Audience?


Once you have considered the audience in general, it is time to get more specific and learn as much as you can about the needs of the individuals who will participate in your learning experience. The needs assessment is the next essential step in developing an effective presentation. Conducting some type of needs assessment will allow you to tailor your presentation to best meet the needs of your learners. The needs assessment can also help you learn more about what people want to learn about the topic, their prior exposure to the topic, their preferred methods of instruction, and the time of day and location for instruction (eg, staff lounge vs library). The more information you have about the audience, the better you can customize your instructional design.


Ideally, your needs assessment should be done ahead of time. Taking the time to determine the needs of your audience members shows them that you care and can help you build a relationship with them before you even begin presenting. By gathering the information early, you can obtain specific examples or case material relevant to your audience members, which may also build interest and motivate them to participate in your presentation. Talking with your participants ahead of time may help you refine your content and mode of delivery or may even make you decide to change your topic all together. In some instances, the information gleaned from a needs assessment can help to determine whether your presentation is even necessary or feasible.6,19



KEY POINTS TO REMEMBER


Needs assessments may help you do the following:



  • Build relationships with your participants.
  • Build interest in and motivation for your topic.
  • Obtain specific and relevant case material for your presentation.
  • Determine the feasibility and applicability of your topic
  • Refine your content.
  • Refine your method of delivery.

Needs assessments are beneficial in all teaching-learning situations. Clinicians routinely perform needs assessments on their patients. For example, when developing appropriate home exercise instructions, the experienced clinician uses knowledge of the patient’s daily activities, personal goals, and current level of activity; all of which is information obtained formally or informally through prior interactions with the patient. Without labeling it a “needs assessment,” the clinician uses this background information to design a more effective home exercise program (HEP).


How Will You Assess the Needs of Your Audience?


There are numerous approaches to conducting needs assessment prior to meeting with your participants.4,6,20 Garmston and Wellman3 recommend an in-person or telephone conversation between the presenter and a number of key participants who may have different perspectives on the topic to be presented. In this era of Internet ease, an online discussion about these topics among representative participants and the instructor could easily substitute for an in-person conference or phone call. Table 5-1 provides sample questions that you might ask during this conversation to determine the needs of your audience.


Wlodkowski4 and Silberman and Auerbach6 describe a variety of needs assessment techniques. A list of sample needs assessment strategies, adapted from Wlodkowski,4 Silberman and Auerbach,6 and Silberman and Biech,19 along with an example of how each might be applied in physical therapy or in the health care arena, appear in Table 5-2.



CRITICAL THINKING CLINICAL SCENARIO


You have a world-renowned expert in women’s health coming to a major nearby metropolitan area in May. She would like to offer a continuing education conference on a topic of your choice and wants your clinic to sponsor it. Her fee for the 2 days is $5000 plus hotel, travel, and accommodations. You are personally very excited because that is your area of practice, but how do you decide whether to move forward?


Reflective Questions


In completing a needs assessment to determine the feasibility of sponsoring a continuing education conference. Consider the following:



  1. What would you need to know?
  2. Who would you assess?
  3. How would you assess them?

Although needs assessments provide the most useful information when completed ahead of time, this is not always feasible. You can do a needs assessment at the start of your presentation by using judicious questions. Completing a needs assessment ahead of time will give you a general sense of who will be in your audience; completing an on-the-spot needs assessment will give you a better sense of your specific audience. For example, if you are giving a presentation on how to teach skin self-examinations to prevent skin breakdown in the patient with diabetes, asking your audience, “Who has worked with patients who have had diabetes and diabetic ulcers?” will give you some indication of the audience’s experience related to your topic. Garmston20 provides a framework for the types of questions that you might ask at the start of your presentation, including: general, content-specific, theoretical, and practical questions. Table 5-3 provides some examples of on-the-spot assessments using this framework in teaching and learning and in health care.



TABLE 5-1


SAMPLE NEEDS ASSESSMENT QUESTIONS







SAMPLE QUESTIONS USED TO GATHER DATA IN A NEEDS ASSESSMENT


  • Who are the participants?
  • What is the composition of the audience in terms of roles and possible attitudes toward the topic?
  • What is the audience’s prior exposure to the topic?
  • What is their experience with the subject (novice, expert)?
  • What is their current level of knowledge? Skill?
  • What are their attitudes toward the topic?
  • How many participants will be present?
  • Do participants believe that they have a “need to know”?
  • Is attendance mandatory or voluntary?
  • What are the participants’ expectations about the topic? The presenter?
  • What is the context of this presentation? Is it part of a series of presentations? If so, what will come before and after this presentation?
  • How might the topic impact their current work activities?
  • Are there any underlying problems that I might encounter or needs that I should address?
  • What is a typical in-service like for them (ie, types of teaching strategies they are used to)?
  • What is the physical environment like?
  • Will I have access to resources (eg, Internet, handouts, projector)?
  • Are there any possibilities for follow-up?

Adapted from Garmston RJ, Wellman BM. How to Make Presentations That Teach and Transform. Alexandria, VA: Association for Supervision and Curriculum Development; 1992; Silberman M, Auerbach C. Active Training: A Handbook of Techniques, Designs, Case Examples, and Tips. 3rd ed. San Francisco, CA: John Wiley & Sons, Inc.; 2006.




Your needs assessments can help you with the alignment process as well. By completing a thorough needs assessment before you begin your planning, you can determine what prior knowledge your audience members have and what gaps you may need to fill. If you are teaching an advanced manual skill, you want to be sure that your learners have the foundational knowledge in anatomy, pathology, and orthopedics upon which to build before just layering on more advanced knowledge and skills.


Your needs assessment also can help your learners “pull information forward” from previous semesters. Making linkages to content presented earlier enhances vertical integration. Vertical integration is a way to ensure that new content reinforces and builds upon previous content. Horizontal integration, on the other hand, refers to linking your course content to content being presented simultaneously during a given semester. For example, a given semester might include both anatomy and foundations of examination. Communication among instructors would ensure that the anatomy content, such as upper-extremity anatomy, is taught in a way that teaching upper-extremity manual muscle testing reinforces and applies the content learned in anatomy.



ALIGNMENT: LINKING THE MICRO AND MACRO


Needs assessments accomplish the following:



  • Ask, “Where is my learner at the start of the course, and what does my learner need to move forward?”
  • Help you fill in gaps in your learners’ knowledge.
  • Help you and your learners pull information forward from previous semesters to enhance vertical integration.
  • Help ensure that your presentation fits within a series of presentations, a course, or a curriculum.


KEY POINTS TO REMEMBER



  • The more you know about the learners you teach, the better you can tailor your instruction to meet their needs.
  • Techniques for conducting needs assessment prior to a presentation include the following:

    • Face-to-face interview and discussion strategies
    • Paper-and-pencil or online questionnaires
    • Review of material, such as case records (deidentified), professional literature, and annual reports

  • On-the-spot needs assessment in the form of questions posed at the beginning and throughout a presentation can yield valuable information.
  • In assessing the needs of your audience, it is helpful to ask the following types of questions:

    • General questions
    • Content-specific questions
    • Theoretical questions
    • Practical questions

DEVELOPING LEARNER-CENTERED BEHAVIORAL OBJECTIVES



STOP AND REFLECT


You are giving a presentation to physical therapy students on developing patient education materials.


Reflective Questions



  1. What do you want your learner to know as a result of participating in your presentation?
  2. What do you want your learner to be able to do as a result of participating in your presentation?
  3. What do you want your learner to value as a result of participating in your presentation?
  4. How will you determine whether your presentation has been effective?

When planning any instructional activity, whether it is a verbal presentation or written materials, it is important to think about the outcomes that you want learners to produce before you actually begin designing the presentation. In The 7 Habits of Highly Effective People, Covey21 discusses the concept of “beginning with the end in mind” when planning a course of action. If teaching someone is the course of action that you are planning, then you need to think about the end result (the actual outcome) and what you want your learners to know, do, and/or value. Building on the premise that effective instruction must begin with clearly identified outcomes, educational researchers Wiggins and McTighe22 developed a widely used approach to curriculum design and classroom instruction called backward design. In addition to clearly specified objectives, backward design also requires the instructor to determine ahead of time how these outcomes will be assessed.22 Well-written objectives define the end result of your instruction and provide you with a road map to follow throughout both the design and the delivery of your presentation.



KEY POINT TO REMEMBER


Begin with the end in mind!


—Stephen Covey21


In the situation presented at the beginning of this section, you were asked to think about what you might want your learners to be able to do as a result of participating in your presentation on developing patient education materials. If you want your learners to physically create effective patient education materials rather than simply describe what must be considered in developing patient education materials, this outcome needs to be specified ahead of time, as this will drive not only the design of the instruction, but also the expected outcome and therefore the assessment of the learner. Developing learning objectives will help you to determine the content of your presentation and the methods that you will use in teaching the content. Using the learning objectives at the end of your presentation, as the basis of your assessments, will help you to determine whether the learner grasped the critical information presented and will provide you with feedback on how effective you were as an instructor. Learning objectives, often referred to as behavioral objectives, are specific statements of what you expect your learner to achieve as a result of a given presentation.



KEY POINTS TO REMEMBER


Well-written learning objectives will help you to do the following:



  • Define your content.
  • Determine the teaching methods that you will use.
  • Assess your learners’ performance (ie, did your learners learn what you expected them to learn?).
  • Assess your effectiveness as an instructor.

Bloom23 describes the following 3 distinct domains of learning:



  1. The cognitive domain, which refers to the development of knowledge, language-based information, and concepts to be learned. For example, physical therapy students are expected to identify the origins and insertions of various muscles and to design appropriate HEPs to strengthen certain muscle groups.
  2. The psychomotor domain refers to the development of motor skills to be mastered. For example, physical therapy students must learn how to transfer patients from a bed to a wheelchair and to adapt interventions for bedside treatment, which are examples of simple and more complex motor skills.
  3. The affective domain refers to the development of attitudes, feelings, beliefs, and values, which can range from simply recognizing the importance of something to the more complex level of actually integrating and adopting behaviors that reflect the value. For example, a patient might say, “I know I need to do my exercises more often,” demonstrating that he or she recognizes the value or importance of doing the HEP; however, a higher level of achievement would be when the patient integrates his or her HEP into his or her daily routine, demonstrating that he or she has adopted this value.


KEY POINTS TO REMEMBER


The 3 domains of learning described by Bloom23 are as follows:



  1. Cognitive (knowledge)
  2. Psychomotor (skill)
  3. Affective (attitudes, beliefs, and values)


CRITICAL THINKING CLINICAL SCENARIO


The following are examples of learning objectives that might be found in a DPT curriculum:



  • After this presentation, the student will be prepared to correctly list at least 3 2-joint muscles in the lower extremity.
  • By the end of this clinical internship, the student will be prepared to integrate the core values of professionalism into his or her daily interactions.
  • At the end of this course, the student will be prepared to consider issues of health literacy when working with all patients.

Reflective Questions



  1. Which domain of learning does each objective reflect?
  2. How might you change each of these objectives to address a different domain of learning?

Each domain of learning is distinct and should be considered in developing learning objectives. Bloom23 also developed a taxonomy, or hierarchical system of classifying objectives from simple (ie, recall) to more complex (ie, evaluation). Table 5-4 illustrates the taxonomic levels of learning in Bloom’s 3 domains of learning. Bloom23 and, later, Krathwohl et al24 and Simpson25 provide sample verbs for each level to enable instructors to write objectives that effectively target each level along the hierarchy. As you move up the hierarchy in creating objectives, you increase the level of complexity and challenge of each objective.



The objectives that you establish for any given presentation must meet the needs of the learners. As discussed earlier in this chapter, the level of expertise and the learning expectations of your audience will vary from a basic level of exposure to a topic to a higher-level expectation of content mastery and integration of information and skills into one’s current practice. If your expectations (ie, learning objectives) do not match those of your audience, both you and your audience will be disappointed. In a classroom, establishing expectations up front by using explicit and detailed learning objectives will help your learners to understand what your expectations are and will enable them to be better prepared to meet your expectations. Students often ask, “What will be on the test?” Having explicit learning objectives should help minimize the need for this question.


What follows is a more detailed description of the taxonomies within each of the 3 domains of learning defined by Bloom,23 along with some sample verbs for each level in the taxonomies, which may help you in developing appropriate learning objectives.


Cognitive Domain


If you take a look at your course syllabus, you may see that many of the objectives relate closely to the cognitive domain. The cognitive domain is typically the one domain with which instructors and learners are most familiar. However, just recognizing the domain of learning is insufficient in developing effective objectives. For example, at the end of the unit of instruction, you might want the students to explain the various tests and measures that can be used in assessing dysfunction of the knee or you might want them to develop a decision-making algorithm that will help them to decide when to use the various tests and measures presented. Both of these goals are within the cognitive domain of learning; however, they are at very different levels within that domain. The first objective is at the lower end of the cognitive hierarchy (ie, comprehension); while the second is at the higher end of the cognitive hierarchy (ie, synthesis).


The cognitive domain includes 6 levels within the hierarchy. The lowest level is knowledge, as complexity and challenge increase the cognitive processes move through comprehension, application, analysis, synthesis, and evaluation. Table 5-5 provides descriptions of each level of the hierarchy in the cognitive domain, sample verbs commonly used in developing objectives that target each specific level, and a sample objective for each level of the taxonomy.23



CRITICAL THINKING CLINICAL SCENARIO


You have recently planned several mini-lectures and have developed several objectives including the following:



  • Define andragogy.
  • Compare action learning to other methods of problem solving.
  • Provide one example of how you might use action learning in the classroom.
  • Define the elements of reflection.

Reflective Questions



  1. Where along the taxonomy of the cognitive domain would you place each of these objectives?
  2. How might you change each of these objectives to increase the level of expectation and challenge?


Psychomotor Domain


The psychomotor domain refers to skills that require some degree of movement or manipulation. Bloom and Krathwohl did not create a hierarchy with subcategories for the psychomotor domain as they did for the cognitive or affective domain. However, others, including Simpson,25 Dave,26 and Harrow27 did create hierarchies to address these behaviors. Simpson describes a hierarchy that moves from perception (the learner can use sensory cues to help guide his or her movements) to adaptation (the learner has mastered the activity and can adapt it to meet the needs of the situation). Dave’s26 taxonomy, on the other hand, moves from imitation to naturalization (the learner’s ability to perform the activity without needing to think about it), and Harrow27 moves from involuntary reactions to skilled movements. Table 5-6 provides descriptions of the taxonomy levels as described by Simpson25 and sample verbs and objectives.



CRITICAL THINKING CLINICAL SCENARIO


You are developing a presentation on the use of manipulation in managing cervical pain. Your audience is a class of second-year DPT students who are being exposed to manipulation for the first time.


Reflective Questions



  1. Can you write at least one goal for your presentation that addresses the psychomotor domain of learning and one that addresses the cognitive domain of learning?
  2. How would you modify these objectives if your audience included a group of clinicians who has recently begun to use manipulation in the clinical setting and would like to enhance their current level of competence and decision making related to using manipulation?


Affective Domain


In 1964, Krathwohl and Masia worked with Bloom24 to develop taxonomy of educational objectives for the affective domain. Objectives in the affective domain focus on the learner’s level of acceptance of values, beliefs, and attitudes. As with the cognitive and psychomotor domains, the affective domain was developed in a hierarchical manner from simple recognition, attention, and compliance to a situation or phenomenon to internalization of certain values and characteristics. However, with the affective domain, additional transitions occur as you move up the hierarchy of complexity. As complexity increases, there is a transition from concrete to abstract, from an external to internal locus of control, and from conscious to unconscious internalization of values. Table 5-7 provides descriptions of the taxonomy levels and sample verbs and objectives.24


For example, consider the concept of people first language. As a new health care professional student, you may be told by faculty that it is very important for you refer to your patients by their names, not their disabilities. It is not, “my knee patient,” rather, it is “Mr. K, my patient who has a knee problem.” You recognize the difference (receiving) and work hard to correct yourself when referring to patients because you know that is what is expected (responding). As you move up the hierarchy, you begin to realize that it is no longer simply an exercise in doing what is expected of you; rather, you begin to recognize how degrading it can be to be referred to as a disability rather than as who you are. You now consistently use people first language and actually begin to correct those around you when they do not (valuing). As you progress in your professional development, you not only value the need for using people first language, but you also begin to recognize and value the need to place your patient at the center of your care and to view your patient first as a person with needs and second as an impairment that needs correcting (organizing). Finally, as your worldview of your patient, your role in the therapeutic relationship, and your role as a professional expand, you begin to internalize the core values of the profession, making people first language a part of all that you do as a health care provider (characterizing).




CRITICAL THINKING CLINICAL SCENARIO


You are working with a third-year student on her final rotation in the clinical setting. You notice that she often arrives to clinic barely 5 minutes before your patients arrive and frequently leaves the clinic before her notes are completed.


Reflective Question



  1. To help clarify the expectations you have of your student, can you write 2 successive goals related to your student’s level of accountability? Write your first goal at the level of receiving and your second goal at the level of valuing on the affective domain taxonomy. Indicate by when you would expect your student to achieve each of these goals (eg, immediately, within one week, by the end of the internship).

These frameworks for developing educational objectives have been in use since their inception with little revision until 2001, when Anderson and Krathwohl28 revised the framework for the cognitive domain in recognition of our increased understanding of the complexity of the thinking process. This revised taxonomy includes the following 2 dimensions: (1) the cognitive process dimension and (2) the knowledge dimension (Table 5-8).28,29 Similar to Blooms original taxonomy, the cognitive process dimension has 6 levels (remembering, understanding, applying, analyzing, evaluating, and creating). The second dimension relates to the type of knowledge or the knowledge dimension and has the following 4 categories: factual, conceptual, procedural, and metacognitive. These 2 dimensions create a matrix that can be used to develop objectives across both the cognitive process and knowledge dimensions.


While the 6 hierarchical categories remain, a number of aspects of the original taxonomy were changed. Several categories were renamed using their verb form rather than the noun form in the naming convention. For example, rather than knowledge and comprehension, these categories became remembering and understanding. In addition, creating was added as a new category, just above synthesis and evaluation, which previously had been considered the highest levels of the cognitive domain. The change from nouns to verbs better captures the learner’s active thinking processes rather than behaviors. Perhaps more importantly, these 6 categories represent 25 different cognitive processes on a continuum from lower-order thinking to higher-order thinking as follows:




  1. Remembering: Recognizing, recalling
  2. Understanding: Interpreting, exemplifying, classifying, summarizing, inferring, comparing, explaining
  3. Applying: Executing, implementing
  4. Analyzing: Differentiating, organizing, attributing
  5. Evaluating: Checking, critiquing
  6. Creating: Generating, planning, producing

The second dimension, the knowledge dimension, includes the following 4 types of knowledge:



  1. Factual: Basic knowledge and facts students must know (eg, facts, terms, definitions)
  2. Conceptual: The knowledge of the relationships that exist between the facts (eg, patterns, categories, principles, theories, models)
  3. Procedural: The knowledge of how to perform something (eg, algorithms, decision-making frameworks)
  4. Metacognitive: The knowledge of how one thinks or processes information (eg, reflective process)

The addition of the knowledge dimension created a two-dimensional model rather than the original one-dimensional hierarchical model. The objectives are then written at the intersection of each of these 2 dimensions. See Table 5-8 for sample cognitive learning objectives using this revised taxonomy.28,29


Dettmer30 also proposes different modifications to Bloom’s Taxonomy. She advocates for a framework that is much broader in scope, encompassing the following 4 domains of learning: cognitive, affective, sensorimotor, and social. She also argues for a unification of these 4 domains, noting that to be a successful learner requires activity in all domains. She describes phases of learning characterized by realism (what learners should know), pragmatism (what learners can do), and idealism (to what learners aspire). Dettmer30 also suggests that there are 8 phases of learning that incorporate all domains that move from basic learning to applied learning to ideational learning. There is much that we still do not know and much left to study. Dettmer30 states:



Educators should never regard frameworks for educational taxonomies as finished and perfect. Research and development must be ongoing and the resulting information shared widely. Much remains to be studied, rethought, created, revised and studied again as teachers teach and learn and students learn and do.


While our understanding of the complexity of how we learn has grown significantly and some have advocated for change, Bloom’s Taxonomy remains the most widely recognized and used taxonomy for educational objectives. It is, in part, because of its widespread use, simplicity, and ease of implementation that we have decided to focus on the original conceptualization of Bloom’s Taxonomy in this text, rather than some of the more recent, more complex iterations. We do encourage those of you who might be interested to use the references provided as a springboard for additional studies about various educational taxonomies.


Finally, before we leave this discussion, it should be noted that, while we write objectives specific to each of the 3 distinct domains of learning, as Dettmer30 suggests, mastery may require some component of the other 2 domains. For example, when writing the objective “The student will respond effectively to emergency situations in the clinical setting,” the primary focus of this goal is that the student will recognize and respond, which lie in the affective domain. However, to recognize and respond appropriately assumes that the student already has knowledge of what constitutes an emergency (cognitive domain) and the skills needed to manage the emergency situation (psychomotor domain). In writing goals, it is important to recognize what prerequisite knowledge, skills, and behaviors the student might need to successfully achieve the stated goal.



STOP, DO, AND REFLECT


Take a look at some of your course syllabi.


Reflective Questions



  1. Can you identify the learning domain for each objective?
  2. Can you determine which level of the taxonomy the objective targets?
  3. Is each learning domain represented by at least one objective on the syllabus? If not, which one is missing? Can you write an objective that addresses that domain?
  4. Can you rewrite some of the objectives to reflect a higher level of challenge?
  5. Can you develop test questions that the instructor could use to assess whether you learned what was expected for each objective?


CRITICAL THINKING CLINICAL SCENARIO


You are a clinical instructor and are working with a student who is having significant difficulty demonstrating effective interpersonal skills. When interacting with patients, she continually interrupts when they are speaking. Even after asking a question, she does not listen or respond to what the patient is saying. You decide to write some goals to make your expectations more explicit for your student.


Reflective Question



  1. Can you create one objective each in the cognitive, affective, and psychomotor domains that would address this issue?

Using the analogy of objectives serving as a road map to help you stay on course during your presentation, you will want as detailed a map as possible. In developing a presentation, it is very easy to go on tangents and add interesting, but unnecessary, information. Having specific objectives will help you stay focused and on task.


Besides identifying the domain of learning and at what level of the taxonomy you expect your learner to perform, there are a number of other factors that should be considered in developing well-written objectives. For example, let us explore the objective, “The student will be prepared to use active listening skills, including rephrasing responses to facilitate effective communication in working with patients.” How will you determine whether the learner has met the objective? Must the learner demonstrate the desired behavior 100% of the time to be considered adequate? Would you consider 80% of the time acceptable for a novice, with the final goal being 100% once he or she has practiced enough? In all teaching-learning situations in the clinic or the classroom, you will want to consider questions like these when formulating your objectives. The answers to questions like these will help you to develop effectively written objectives.



Well-written objectives should specify not only what behavior you expect your learners to accomplish, but also under what conditions or in what context and what degree of mastery you expect. So, a more effective objective than the previous one might be, “By the end of this internship, the student will be prepared to use active listening skills, including rephrasing responses to facilitate effective communication in working with patients 90% of the time.” A mnemonic device that you can use to help you remember some of the components of a well-written objective is ABCD, described as follows31:



Audience: The “who”


Behavior: The “what”


Condition: The “when/how”


Degree of mastery: The “how well/how much”


The following is an example of a behavioral objective written using the ABCD framework:


After a lecture, the student will describe the physics of an ultrasound machine accurately.



A = the student


B = will describe the physics of an ultrasound machine


C = after a lecture


D = accurately


There are a number of pitfalls to writing objectives that should be considered. For example, instructors sometimes write objectives that describe their plans for the session (ie, they focus on their own behavior rather than on what they expect their learner to achieve by the end of the session). Objectives should always be learner-centered (ie, focused on what you want your learner to achieve). The following are examples of incorrectly and correctly written learner-centered objectives:



  • Incorrect: This lecturer will review the anatomy of the shoulder.
  • Correct: At the conclusion of this session, the student will describe the anatomy of the shoulder.
  • Incorrect: The student will be shown how to correctly perform a review of systems.
  • Correct: Following a demonstration, the student will correctly perform a review of systems.

However, because objectives provide a roadmap for both teachers and learners, some instructors find it helpful to create objectives for themselves and for their learners. These objectives describe what the instructor will do to ensure that the learner achieves the stated outcome objective. Sometimes working backward can help (backward design). Create the learner-centered objectives and then decide what you as an instructor will do to enable your learners to achieve those objectives. For example, if your learner-centered objective is, “The learner will apply the use of the reflective frameworks to develop questions in response to a role-play scenario,” as an instructor, your objectives might include the following:



  • The instructor will present the reflective frameworks.
  • The instructor will provide a narrative for students to practice identifying the various reflective components.
  • The instructor will demonstrate the creation of appropriate reflective questions.
  • The instructor will design a clinical role play in which students will practice using reflective questions.

It is important to distinguish between those objectives that guide the instructor’s presentation and those that describe the learner outcomes. Table 5-9 provides examples of presenter-centered vs learner-centered objectives.



CRITICAL THINKING CLINICAL SCENARIO


You are working with a student in the clinic on developing an educational presentation for the aides in the clinic on how to transfer a patient from the bed to a wheelchair using proper body mechanics. You have 1 hour to teach her about writing objectives. Your goal is to have your student create the learning objectives for the presentation.


Reflective Questions



  1. Can you write at least 2 learner-centered objectives for your session with your student? (ie, what are your expected outcomes for the student?)
  2. Can you write 2 learner-centered objectives you might expect your student to develop for the presentation? (ie, what are your student’s expected outcome for the aides?)

The focus of effective behavioral objectives is the learner and what behaviors or outcomes you expect from your learner, whether the learner is a student, a patient, an aide, or some other health care provider. An example of an appropriately written behavioral objective for a patient might be, “Following instruction by the physical therapist, the patient will accurately perform the prescribed HEP.”


A well-written behavioral objective also focuses on the outcome rather than process. We cannot directly observe or measure a process. We need to specify the outcome of a process to determine whether the process has occurred; the outcome should be measurable and observable. The following is an example of incorrectly and correctly written objective:



  • Incorrect: The student will research an evidence-based approach to the treatment of a grade 2 ankle sprain.
  • Correct: The student will provide a written synthesis of 5 evidence-based articles on the treatment of a grade 2 ankle sprain.

We have also observed instructors writing objectives that state the topic for discussion rather than describing what the learner is expected to do as a result of the instruction on the topic (outcome vs topic). For example, a clinical instructor (CI) might say to a physical therapy student, “Today, we’ll focus on the biomechanics of the shoulder.” We do not know what the CI expects the student to do at the end of the day. A more effective objective would be, “After our discussion, you will present the biomechanics of the shoulder to the other physical therapy intern.”


Another common mistake in developing objectives is to include more than one outcome in an objective. For example, the CI might tell the student to list and demonstrate the steps necessary to prepare a patient for massage. What if the student can list the steps, but cannot demonstrate the steps? Was this objective achieved? It is best to use one outcome; in this example, you might select the more complex of the 2 behaviors as an outcome or you might split this into 2 objectives, as follows:



  1. The student will list the steps that he or she will take to prepare a patient for a massage.
  2. The student will properly prepare the patient for massage.

Note also, in this case, the CI will be assessing 2 different domains of learning. The first objective is written to assess the student’s cognitive skills and the second is written to assess his or her psychomotor skills.


Finally, the more specific, objective, measureable, and observable the objective, the more effective it will be in making the expectations explicit and in determining whether the student achieved the expected outcome. For example, a common goal of clinical education is the development of professionalism in students. Without clear descriptions of desired behaviors, the CI and students can become frustrated. Your objective for your student might be, “To interact appropriately with family members and caregivers.” What does appropriately mean? Is your definition of this word the same as the student’s definition? Or, perhaps you have a student that lacks initiative or lacks professionalism. It would be the same as if you told your patient to go home and do his or her home exercises regularly. What do you mean by regularly? Does that mean once a day, twice a day, once/week? Again, you may have very specific definitions for these terms, which may or may not be congruent with your student’s or your patient’s definition. By making your objectives specific, objective, measurable, and observable, you will minimize confusion about your expectations and optimize your learner’s ability to achieve the desired outcomes. The following are some examples of incorrectly and correctly written objectives related to professionalism:



  • Incorrect: The student will use his or her free time productively.
  • Correct: The student will use his or her free time to collect evidence to support his or her selected patient interventions.
  • Incorrect: The student will demonstrate the core value of accountability.
  • Correct: The student will demonstrate the core value of accountability by ensuring that all written documentation is completed before he or she leaves for the day.

Table 5-10 provides some questions that you might ask yourself when writing objectives to ensure that they contain all of the information needed to be well-written and learner-centered.


May 30, 2017 | Posted by in NURSING | Comments Off on Systematic Effective Instruction 1: Keys to Designing Effective Presentations
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