Dr Kelly Gray (Department of Health Sciences) says it’s been trial and error to achieve that balance of synchronous and asynchronous activities that keep students engaged in the online environment. But now she and her students are reaping the benefits with engagement going through the roof! In this article (and in two posts to follow shortly!), Kelly shares her findings to help us all cut to the chase! As told to Kylie Coaldrake and Karina Luzia.

Halfway through Session 2 2020, I felt I was getting better at teaching online. Then I got halfway through 2021 and thought I had nailed it but I’m now at the point where I’m going to stop saying that because there’s still so many more things I can come up with and so many better ways to do it, but I think that’s all testimony to how the landscape has so dramatically shifted.

I’m a bit of a jack of all trades!

Q Kelly, can you tell us a bit about the units that you’re teaching?

I currently teach units in the Doctor of Physiotherapy and the Macquarie MD. My background is in physiotherapy, but I’ve had a very unusual career in that I’ve done case management and lots of different things so I’m a bit of a jack of all trades and tend to teach across a range of topics. I teach Interprofessional Healthcare (PHTY8103) and we cover safety, quality, ethics and person-centered care. I also teach Health and Wellbeing Across the Lifespan B (Chronic and Complex Care) (PHTY8206) and Global Women’s Health in Advanced Physiotherapy Practice B (PHTY8308). They’re probably my three main units that I write the tutes and lessons for. In the Doctor of Physiotherapy, I teach across all three years, so I am very privileged to see the progression of our students from their foundational learning to the point of entry into their professional careers.

I’m interested in observing how others teach

Q Are the units you teach likely to change? Do you get swapped around into different units, or is your teaching fairly settled?

No, it’s not settled. I envy people who get the same units to teach each year. I’m yet to have that experience, there’s always something new. But you know what, one of the most amazing things about being able to teach into a lot of areas (as much as it is an uphill battle learning new things and I’d love to go on a little bit of autopilot) I get to see what other people do. And people do things in different ways.

I was so excited when they started having the Open for Observation sessions because I think it is such a useful learning tool to watch what other people do.

Each time I look into someone else’s unit I pick up something. That’s where a lot of my scaffolding comes from – learning from other people and seeing what they do.

Simulating clinical placement online

Q What were the specific challenges and opportunities in adapting your clinical placements units for online delivery?

We faced a huge challenge during the first lockdown as many of our clinical partners shut down and some of our final year students (who were due to graduate at the end of June) were at risk of not completing the mandatory hours required for professional registration. To combat this, we developed an online clinical simulation pathway designed to simulate clinical placement. It was one of the hardest and most fun things I have been involved with.

To do this we looked to the iLearn Lesson Plan (created using iLearn Lesson Activity). The lesson plans are designed to take you through sequential pages, so unlike the iLearn workbooks you must proceed in a certain order and cannot jump around chapters. This met our needs as a clinical placement would work in the same way – you couldn’t suddenly jump to seeing your patient without first receiving a handover. The lesson plans were a sensory experience which mimicked clinical placement, lots of videos (of us pretending to be in hospitals, clinics) and talking to the camera as if it was the student.

Dr Emre Ilhan and Dr Kelly Gray in the Clinical Simulation Lesson Plans giving a handover to students on the simulated placement.

We dressed up in our clinical attire, we had phones ringing in the background, ventilator noises, sometimes we were interrupted by other clinicians – all things you have to deal with on clinical placement.

After the lesson plan we created iLearn pages called Think and Do – these were tasks which mimicked tasks you might do on a clinical placement – like attend a journal club, provide a multi-disciplinary handover or make a brief presentation on an unusual condition.

We released content in real time, so each day a new lesson would unlock, and the patient’s condition or circumstances would change, just as it does in real clinical placement.

There were so many opportunities which arose from this experience, and it’s when we began to realise the potential of what could be done asynchronously.

Delivering effective online medical education

In this 5 min video Kelly explains how the online clinical simulation pathway was created and how students make their way through it.

In tutorials we also used iLearn activities to drive learning. For example, as part of their Community Clinical Placement, our first-year students have a task where they write a clinical handover and then a self-reflection piece. The online platform provided new and superior opportunities to drive early formative feedback. We did this by getting students to complete case studies and reflections as part of tutorial work using the Form Builder in H5P (Editor’s note: Kelly will be talking more about H5P in an upcoming TECHE post). The form builder takes the user through steps to building a form. At each step of building a handover and reflection piece we provided top tips at the top of the page. These top tips were based on the feedback had provided students after completing their assessment in the prior year. In this way, the top tips prompted students each step of the way.

Dealing with negative feedback: a ‘no blame’ approach

Q You clearly value student feedback on your teaching and you’re very pragmatic about that feedback, even if it’s not so positive.

There will be failures. There are always failures. That’s just the way it works. Take it as a learning curve. We don’t have to be perfect at this the first time around and we won’t be – but the measure will be whether we get back up and try again and learn something new. That’s what will make this great.

I’m a big feedback person. I don’t get upset about the negative stuff. I just move forward and think what can we try that’s different? I ask students to tell me if there’s something they don’t like – then I try to come up with a way around it.

In healthcare, we have a no-blame approach when there is an adverse event. We do not assign personal blame. For example, there was a recent tragic case of a girl who passed away due to a multitude of errors, and instead of blaming, an inquiry was launched into acute care in hospitals which looked at the systems in place and working out how to develop systems to reduce human errors and to allow humans to do the best they can – because we will always have errors. That’s just a natural part of life. But I don’t know if we’ve got to that place in teaching yet, and so my pragmatic view here comes from a place where I can look at there being things in my teaching that I can personally and directly improve.

What have I got in my teaching toolbox to make my teaching better?

It might not be the content or the modalities that you can change but instead, for example, maybe there are aspects to this specific task that you can adapt to give a better experience? There are so many factors that come into it. If you can step back and think about all those factors, you will continue to do better and sometimes even if you don’t change, things around you can change. I think my pragmatism comes from working in healthcare and being involved in a lot of root cause analysis, and a working environment where we understand that systems can help people do better. If people are worried about transitioning online, don’t think about it failing! Think about how you can best harness what you have in your toolbox to deliver the best online experience. Our systems are evolving and already what we can do is getting better and becoming easier to do.

What I’ll keep

Q What are some of the things that you’ve tried that you think you will keep using in the future?

Padlets are not going away from me, ever. I will use them in face-to-face tutorials.

 An example of a padlet used in my tutorial. This was populated while students were in breakout rooms. “I loved watching their progress in real time and could tailor who I assisted during the activity.”

I love polling students online anonymously. I teach ethics and there’s nothing like polling someone about an ethics question then giving them additional information and then re-polling them five minutes later and seeing how their perspective has shifted. I can’t simulate that in-person with a show of hands.

We talk a lot about the student up the back of the class who doesn’t want to put their hand up.How do we offer them a chance to be involved? The power of anonymity sometimes gives people more confidence.

An example of an online poll using the ‘choice’ activity tool in iLearn.

In the areas that I teach we are back to in-person tutorials. My challenge now is – how do I get the asynchronous stuff into those tutorials, how do I link it? We’ve started doing it on Zoom where we have asynchronous activities for which students bring their answers into the tutorials at the start and then we have a discussion because I know lots of people have missed the discussion that you get with the live lectures and being able to throw a topic out there to everybody.

That sweet spot between synchronous and asynchronous delivery

Q What issues or aspects of your teaching do you find yourself thinking about or reflecting on most of the moment?

I’m a reflector. I teach reflective practice. I recently attended a cultural intelligence training (I’m a member of the Diversity and Inclusion Committee) – the lady who delivered it was amazing. One of her comments struck a chord – she said “If I try to create the best learning experience, I’m probably likely to create something that meets my own expectations. But it might not meet the students.”

This prompted me to really think about what it is that the students need, rather than me thinking how can I make this the best, how do I make it more interactive? I’m really starting to approach it as ‘What do students need? What do I want them to know at the end? And I think you can hear that coming through in my multiple-choice question writing for example. So that’s the teaching aspect that I’ve been reflecting on.

But one of the big things I’ve started really reflecting on recently has been weighing up the pros and cons of synchronous versus asynchronous delivery, and there’s probably a sweet spot, I think in the middle somewhere. There are probably some things that are good when done live to allow people to chat, and I’m hoping that’s what we get with our tutorials.

The delivery of lectures online and moving to these online modules gives people the opportunity to engage when they are ready to and in their own time. I teach postgraduate students too, and in my experience, they’re a different kettle of fish to the undergraduates. There are often people with young families, juggling full or part time jobs, mortgages and rent. iLearn insights shows me that they go into these workbooks at all times of the day and at all times of the week and they are re-visiting them during assessment preparation. I’m also a mum of little kids, so I appreciate being able to do things in my own time.

By adapting and providing flexibility we have the opportunity to provide a learning experience which was not possible in the past.

I have to start weighing up what elements of online asynchronous learning can I bring to live and in-person tutorials? What is it that I want? Why do I want this particular discussion? I pull things out of my tutorials and move them into my lectures and then adapt my tutorials to have discussions and for things that I think are better to be live. The benefit is that my engagement has gone through the roof compared to my Echo recordings from past years.

I teach into a unit about interprofessional health care ethics, quality, and safety. When you come into the Doctor of Physiotherapy program after deciding you want to be a physiotherapist, the things that interest you most are learning how to put your hands on people and fix them. So if someone is in the background, talking to you about codes of conduct and quality, that doesn’t really interest you much.

So by about Week 6, I’m having to work really hard to keep them engaged and it’s a tough sell to begin with, but after going asynchronous, we are selling it in far greater numbers. People are showing up to tutorials and student engagement via iLearn Insights show amazing numbers.

We had a book and film club that ran in Week 12. The last time we ran that live we had six students in a lecture theatre that should hold 150. When we transitioned it online, we had 78 people respond to that forum. So I took that to mean that maybe I need to stop thinking that people don’t want to learn, it’s just that it is something they need to do in their space in their time, and I need to give them that opportunity. So that’s what’s working really well for us at the moment.

I taught with the MD program this year and they had a new unit convener. At the end of the session, he said he really liked the workbooks I introduced* [*see more on Kelly’s use of iLearn Workbooks in an upcoming TECHE post] and was going to start using them. He’d got engaged in the content too, and that for me was really a nice compliment. But there are a hundred ways to skin this teaching thing; I’d be lying if I didn’t say I didn’t do this sort of thinking through my teaching outside of work hours.

Sometimes I just wake up in the middle of the night and think ‘I could try it this way’.

Asynchronous is not evil

Q From everything we’ve talked about today, what do you see as being most relevant for other teaching staff to think about in relation to their own teaching? And do you have any advice to pass on?

I’m not sure I have advice – we are all pretty new to this! The transition to online learning has been a steep learning curve and one which has been time consuming.

What’s been most relevant for me is to not look at asynchronous as some kind of evil form of delivery. I think it’s often seen as a lesser form. I think it’s harder, but I think it can make a better product because it forces you to be prepared and to know exactly what needs to happen and what needs to come out of each session rather than thinking on the spot.

I think it’s making me teach better actually, because I can’t waffle anymore. I have to write it down. I have to be succinct.

So for me, I don’t think asynchronous is a lesser mode. I think they both have their place.

We’re still on this journey, we may never get to the destination, and we haven’t had a good opportunity to run this well yet as we’re still in COVID – we haven’t come out of it and we’re not there yet. We haven’t found the ideal blended approach and we might get that in the next few years, and so I think we need to stay open-minded to that and not just go straight back to in-person teaching.

My advice for people is to acknowledge that it does take time to begin with. It’s a big new skill. It’s not a simple transition, it is something very different to delivering face to face. But it is worth it. If you can put the effort in and really spend that time building a good workbook, you will start to reap the benefits of it later, particularly from a time perspective, but also for the student experience.

Two things I would emphasise are:

  1. Find people who know about these things. There’s no need to walk the path alone. If there’s something, anything that we’ve learned is that we should all stay connected and there’s many ways to do that. Go to people, don’t be shy.
  2. You can never do enough activities!

I’ve had a really great hour. I love talking about teaching, so this has just been like the best hour of my day today. I’m going to go back to marking!

The closing words from our interview with Kelly!

Curious as to why this article is called ‘Filling condoms with frozen peas’?

Let Kelly explain in this 3 min audio snippet:

Dr Kelly Gray

Kelly Gray is a Senior Lecturer, Teaching and Leadership academic in the Department of Health Sciences, Faculty of Medicine, Health and Human Sciences. She is passionate about teaching, constantly exploring new ways to engage students. She is a committee member of Connected Curriculum, who were recently awarded an AAUT citation for the development of high quality asynchronous online modules. Her research focuses on physiotherapy in paediatrics, including orthopaedics, respiratory and burns.
View Kelly’s research profile.

* Postscript: Kelly had so much useful advice for working with specific tools such as iLearn workbooks and with H5P, we’ve saved these for stand-alone posts so look out for these – coming soon to TECHE!

Useful links and resources:

  • How to set up iLearn lesson activities: Visit the ACTIVITIES page of the MQ Technologies and tools website, go to the section headed ‘Assessment Activities’ and click on the accordion titled ‘Lesson: creating a lesson activity’.
  • Padlet
  • H5P user guides and examples
  • Observation of teaching

Banner image: Mike Catabay
Toolbox and peas images: Shutterstock
All other images supplied by Kelly Gray.

Posted by L&T Development

The Learning and Teaching Staff Development team works with staff across the University to ensure they are supported to facilitate quality learning for students. This includes offering professional development, contributing to curriculum and assessment design, recognising and rewarding good practice, supporting peer review of teaching, and leading scholarly reflection. Email professional.learning@mq.edu.au with questions or requests.


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