Sunday, 8 July 2012

Indigenous learners

image from author's own collection
Some key messages have been described in relation to how we can best support indigenous learners: knowing your learner, knowing the demands and knowing what to do (from Whakatipuranga Arapiki Ako Report,  2010) among them. Having reflected in activity four about issues of access and equity, these ideas go a step further, towards solution-seeking rather than identification of the issues. I have been aware of a tendency  to ‘homogenise’ Pacific ethnicity into one ‘category’, where in fact much diversity exists between various Pacific identities, and I am reminded that within the literature pertaining to Māori educational achievement a similar tendency is observable, despite the diversity of iwi across the country. The School of Midwifery has a number of strategies in place to keep tika/tikanga visible, but we are also cognisant that regional differences between Kai Tahu (in the South) and Ngati Toa/Te Atiawa (here in the North) mean we cannot apply one set of tika/tikanga practices across all our student body and activities.
Expanding the blended undergraduate midwifery programme to the lower North Island has seen an overall rise in the numbers of enrolled students identifying as Māori and Pacific. This is great for midwifery, as although all midwives should be culturally competent, it will be a great day when women of any ethnicity have an option to be cared for by a midwife of their own ethnicity. Currently, 5% of midwives with practicing certificates identify as Māori, 1.1% as Pacific and 3.2% as Asian, in a context where the ethnicity of birthing women comprise (respectively) 20.5%, 10.5% and 9.3% of the population (MCNZ Workforce Report, 2010). Incremental progress is being made in this area of midwifery education, with a satellite of the Auckland University of Technology offering local midwifery education in the Counties region of South Auckland to actively address this issue there. Midwifery does, admittedly, have a way to go.
Because a number of barriers exist institutions could be more proactive about giving indigenous learners access to the technology required to support blended learning, as the cost of computing equipment etc is significant. This was seen as a successful strategy in Clayton, Rata and Baral’s (2004) paper. Other aspects that appear to be fruitful relate to how we as educators approach and support education of indigenous learners by being mindful that education needs to be viewed as ‘collective good’, not a personal good (Greenwood & Te Aika, 2009). The five key elements identified in the Hei Tauira Report as being crucial to successfully supporting Maori learners are Toko ā-iwi, ā wānanga (institutional and iwi support), Tikanga (use of local values and protocols), Pukenga (use of ‘experts’ – or suitably qualified staff and leaders), Ako (reciprocal learning and teaching styles) and Huakina (removing the barriers to access, or ‘opening the doors’) (p. 2). The holistic nature of Durie’s Te Whare Tapa Whā model is as resonant for education as it is for health, acknowledging that the complex matrix of spiritual, family, physical and emotional congruence is what makes for the best outcomes.
In the school of midwifery we strive to incorporate tika/tikanga practices as much as possible. We use greetings in te reo and keep mindful of tapu and noa in respect to eating in our learning environments etc. We try to use imagery in our resources that is inclusive, (like the ‘learning story’ about the tui presented in the Whakatipuranga Arapiki Ako (2010) document) and our students all spend two days on a local marae in their first year where they participate in marae life, a Te Tiriti O Waitangi workshop and prepare their pepeha (mihimihi) for presentation to those present. Students may present their assignments in te reo if they prefer, although the process around this means that the assignment is translated by a Māori staff member outside the School and then marked in English by a lecturer. When we have a fluent speaker on the staff who is a midwife this will be a much more valuable process for the students, as prior knowledge about midwifery is an important aspect to understanding the kaupapa of the assignment.
Other challenges we face with our indigenous learners relate to balancing whānau responsibilities and study – respected student midwives are often called upon to attend tāngi, powhiri etc which can impact on their availability for study experiences, particularly on-call periods for births. A significant issue also is that because their numbers are quite small, whenever pronouncements are made about learning outcomes in relation to ethnicity, they can feel quite exposed because everyone knows who they are! When they are being successful this is great, but when unsuccessful it is clearly not. The pakeha students do not experience this same level of scrutiny as no-one knows who makes up the statistics, and so reporting outcomes by ethnicity (although undoubtedly useful if used to identify strategies to improve outcomes) can be detrimental in the short term to the students currently enrolled.
Assessment strategies such as exams, essays, video etc do not always suit some learners, but I do not perceive that this divide is along lines of ethnicity. As mentioned in a previous blog, one student has lamented that she is unable to create a song or weave a mat while describing her understanding of a particular area of subject matter. In the third year we do have one assessment where the student produces an artwork representing an aspect of their learning, and some amazing work is produced for this assessment. However, “jo public” expects a midwife to be a safe practitioner, and artworks do not reassure the public of clinical excellence, so as one strand in an assessment policy I’m glad this one exists, but it cannot conceivably be expanded to the whole programme!
image from author's own collection

I am busy searching the databases for some articles to add to my learning plan for antenatal screening, examining Maori and Pacific women’s ideas and experiences around screening – the Bioethics Council has done some work in this are so I will focus my search there for now…

Clayton, J., Rata-Skudder, N. & Baral, H. (2004). Pacifika communities online: and implications. Retrieved from
Greenwood, J. & Te Aika, L-H. (2009). Hei tauira: Summary document. Retreived from
Midwifery Council of New Zealand, (2010). The midwifery workforce report. Retrieved from

Friday, 6 July 2012

Activity 9- sustainability

Engaging with the resource materials for this section of the course has lead me to reflect on the things that have enabled me to sustain myself as a midwife for over 20 years. Spending 20-odd years on-call, while raising a family, studying, and (for the last ten) living on a ten-acre block with the ‘work’ that entails, it is energizing to think about what has kept me going. It comes to down to a few basics: a really loving and supportive family, loving and supportive midwifery practice colleagues, (since being employed at OP) a loving, supportive and flexible work environment, and, in midwifery, the thrill of supporting couples becoming families, and knowing it’s possible to make a difference, one birth at a time, to how people view their world and recognize what is important in it. There can be no more sustainable activity than having a baby – it is all about the future!
The OP Education for Sustainability Policy, has a graduate profile vision that includes “being action competent as a sustainable practitioner in the[ir] field”. The Policy values experiential learning and inquiry-based learning over talking-head-at-the-front-of-the-class learning, and leaves it to each School to develop its own strategies around sustainability, either by weaving a thread of sustainability throughout their programme or by having dedicated papers about it.
Recognising that student workload can have a profound impact on student attrition and progression (Lockwood, 2005) it is important to get the balance right when constructing courses.  The Midwifery School has a range of papers with varying credit values, based on the model of each credit point being roughly equivalent to 10 hours study. In practice I am unsure reliable this scale is. Learners take variable lengths of time to complete modules, some look only at ‘need to know’ rather than ‘nice to know’ material in an effort to minimize time spent (and maximize overall course coverage) and I have known of a student who strategically failed an assessment in order to have time to study for the resit opportunity, because the workload at the time was unsustainable.
Workload is a very real issue for midwifery students, because in addition to all their study commitments they are required to be on-call for much of their three years, so need the ability to ‘drop everything and go’ and any time. This impacts greatly on their study, especially around essay deadlines etc, where we encourage students to have their assessments completed 48 hours prior to the deadline, in case they are called to a birth that may take 24 hours. They learn very good time management skills which will sustain them into the future as practicing midwives!

"Hey!, you're the only one trying to move so fast" cartoon by Prof Hiroshi Takatsuki

Practical steps we take in the School to foster sustainability include discouraging students from printing out course materials which are all available online, and as downloadable pdf files. We suggest they carpool when they are attending weekly SPF sessions and Intensive blocks, as the travel is huge for some. When constructing modules for Moodle learning packages, I make a point of signposting clearly which parts of the material are necessary to know, and which parts are additional reading for those with particular interest in the topic or who wish to explore a topic further. I think this is a useful strategy as it enables students to allocate their time in the way that best meets their personal learning needs.
We have two papers specifically focused on sustainability, the first year paper being about global/environmental and personal sustainability topics, and the third year paper focusing more specifically on how they intend to sustain themselves in practice once they graduate. They look at different models of midwifery practice, group practices etc and business models that they reflect on the success or otherwise of. We have them think about how they will organize time off/time out, and explore support networks and frameworks available to them as new graduate practitioners eg the Midwifery First Year of Practice Programme, where the student selects a mentor to assist them to navigate their way through their first year of being a registered midwife. During their second year students are invited to reflect on sustainability issues throughout each paper that they complete.
Looking at the sustainability of midwives in practice, Wakelin & Skinner (2007) identified that paradoxically, it was the things that midwives said sustained them in practice (the quality of the relationships they developed with the women, and continuity of care) which also lead midwives to leave practice. Their recommendations included a strong statement about the need to develop practice arrangements that allowed for structured time off so that a reasonable work/life balanced could be achieved. It is important for student midwives to see this reflected in the practice of midwives they work alongside in their clinical placements, so midwives role-model sustainable practice as a way of ensuring ongoing profession-sustainability.
Lockwood, F. (2005). Estimating student workload: readability and implications for student learning and progression. Retrieved from
Otago Polytechnic Education for Sustainability Policy. Retrieved from
Wakelin, K. & Skinner, J. (2007). Staying or leaving: a telephone survey of midwives exploring the sustainability of practice as Lead Maternity Carers in one urban region of New Zealand. New Zealand College of Midwives Journal, 37, 10-14.

Techno-emergent, that's me!

The last two days have been spent accessing the resources and breaking out of my comfort zone around technologies for learning. In addition to this, I finally bit the bullet and bought an iPad, which I have been resisting for awhile now despite my colleagues' huge enthusiasm for them. But having gone there, I can see the amazing potential of this new tool (toy?) in both my role as a lecturer, and as a practising midwife.

Anyway, I've been exploring two 'trend technologies' in relation to my screening learning package. One has a small, direct connection, the other could be the 'thin edge of the wedge' of a much bigger prospect! On my new iPad, I found an app called "Quiz Creator" which can be used on mobile devices (phones, iPads etc), so have been thinking about creating a quiz which students could use to assess their knowledge about the different aspects of pregnancy screening 'on the go'. At present (and as discussed in a previous blog) students (and registered midwives) can go to the National Screening Unit website, enrol, and do a series of quizzes. Once they have completed the quizzes - and attained a minimum 80% pass rate- they can print a certificate, which for registered midwives has some professional development points attached for their recertification process.

"Quiz Creator" enables me to design a quiz with several different types of questions - multi-choice, mutliple answer, short answer etc, which the students can download, complete, and share with me (or share among themselves). Flexibility is increased in this scenario becasue the students can participate anywhere anytime, so there are no location or time boundaries for this formative learning activity. I guess the barrier to this might be if the student does not have access to a device which can support the quiz app, but it could be made available online through Moodle as well to accomodate those who only have Moodle access.

The second thing I have been exploring, and have actually grown quite excited about, is the idea of e-portfolios. (I know these are not new - but I have shied away from even thinking about them til now!). Mahara is a free e-portfolio package that has many great features: it is an Open Source package, interfaces with Moodle so students can conceivably login in either Moodle or Mahara and have links from one to the other. The e-portfolio enables students to create 'Views' (pages of content) that they can choose to share with no-one, their immediate classmates, their lecturer, or the world! They can upload documents, video, images, assessments. I can see that an e-portfolio would be a great way for student midwives to collate a permanent record of their experiences, reflections, assessments etc. They can also create social media sites within the portfolio, so they can communicate with one another (and therefore collaborate on group projects).

An e-portfolio could contain one View which relates to each component of their course, and in relation to screening for example, if they did the quizzes in the NSU website, they could upload their Certificate of Attainment into the Screening View, along with their reflections of practice experiences related to screening, they could upload relevant articles, or even video of themselves role-playing an informed-choice discussion about screening options with a classmate for assessment purposes, sharing it with a lecturer.

The e-portfolio links to many aspects of flexible learning - it is learner centred, time and location independent, the content can be whatever the student/ lecturer determines is necessary to meet the learning outcomes of the course, or indeed, the whole degree! I'm sold.

Wednesday, 4 July 2012

Activity 8: Learning Theory

Situated learning, communities of practice & Positioning Theory
I have really enjoyed revisiting the LCL theoretical content, and applying it to my FL situation. At the time I was quite connected to the theory of andragogy (Knowles,1989) which contends that adult learners have their own perspectives and experiences to bring to their learning, are motivated and goal-oriented and therefore can practically apply their knowledge to new learning experiences. As I clicked around a bit more within the Theory into Practice Database, I was reminded about Situated Learning Theory and the idea of ‘communities of practice’.

‘Communities of practice’ have been described as “groups of people who share a concern or a passion for something they do, and learn how to do it better as they interact regularly” (Ewenger, 2006) and this idea resonates strongly within the midwifery literature. Rogers (2010) describes how interprofessional learning (IPL) gives student midwives a strong sense of who their own ‘community’ is within a multi-disciplinary setting, and explores the benefits of the sense of belonging, reaffirmation of the midwifery role and socialization students identified by being exposed to different disciplines and their processes. Social interaction and context are important parts to the jigsaw of knowledge construction, and situated learning concept of new practitioners learning in context alongside experts fits neatly with a midwifery worldview that is based on partnership and equity. In our case, the ‘expert’ is not only the experienced midwife, but also the pregnant woman, who brings her expertise about her body and her own previous experience into the student’s learning context.
Second year midwifery students learning about antenatal screening options are required to ‘engage’ on a number of different levels; learning the ‘facts’,  and the theory underpinning why screening programmes exist, and the critique attached to this. They are required to reflect on their own experiences of screening, and their philosophical views in relation to screening (is it thinly-veiled eugenics? Is it empowering for families to have access to knowledge about their babies? etc) and thus become culturally competent to provide care in the screening context. The way they learn about screening is multi-faceted, to meet the needs of their differing learning orientations, as elements of all four (behaviourist, cognitivist, humanist and situational) orientations can be discerned among our learners. They demonstrate surface learning by describing what screening tests are available, and when they are offered etc, but as they move into practice contexts deep learning becomes apparent as they are enabled to have meaningful informed choice discussions with women and their families about screening options.
Thinking about how ‘present’ the students are in this learning process led me past situated learning and communities of practice (which are undoubtedly elements of ‘how it works’ for them) but I uncovered an article which really made me prick my ears up, as it seemed to more fully capture the nature of our students’ experiences. Let me explain…
Positioning theory applied to midwifery education moves beyond the idea of reflective practice being a way of assimilating and making sense of experience in order to create new understanding (knowledge) and focuses more closely on the ‘conversations’ that are socially situated and constructed, and which lead to learning-in-context (Phillips, Fawns & Hayes, 2002). As mentioned, the students not only learn from books etc, and from midwives as they discuss/debrief practice experiences, they are also fully engaged with the women they are providing care to, and so these conversations (and the women’s knowing and experience) also contribute to the student’s learning. Positioned as women (as all our students currently are) and (for many) as mothers, and as learners, all parties to these ‘social conversations’ can explore a deeper conversation in relation to antenatal screening, in which the student midwife and the woman (and the precepting midwife) share their understandings and create a learning environment that is reciprocal. This links back to surface and deep learning too, as the student learns the technicalities around screening, but in a value-laden context honouring the woman and what she brings, and thus deep learning occurs in this space also as connections are made that solidify the concepts of partnership, professionalism and informed choice and consent.
Ewenger, (2006). Communities of practice: a brief introduction. Retrieved from
Knowles, M. (1980). The modern practice of adult education. New York: Adult Education Company.
Phillips, D. Fawns, R. & Hayes, D. (2002). From personal reflection to social positioning: the development of a transformational model of professional education in midwifery. Nursing Inquiry 9(4) 239-249.
Rogers, K. (2010). Exploring the learning experiences of final-year midwifery students. British Journal of Midwifery 18(7) 457-564.

Tuesday, 3 July 2012

Activity 7: OER , have been mulling it over for weeks now...

Wow, my head is spinning after diving into the Open Education Resources: A User Guide for Organisations, this morning, it is indeed a bottomless pit of opportunity!

There is so much capacity-building potential in this model, and as I read through the transcripts of the interviews of some OP staff a few phrases jumped out at me:
“the purpose of OER is access to resources without having to reinvent the wheel, and the realisation that just providing access doesn’t necessarily mean grant the qualification – it provides access to learning… the greatest reason we can have is Ako – to teach is to learn… in teaching someone else you learn alot about yourself” (Khyla Russell)
“…the concept of intellectual property: it’s crazy and restrictive… if you share your intellectual property you haven’t lost anything…” (William Lucas) and
“It’s not just giving, it’s receiving as well” (Terry Marler).
I think the reason these phrases were resonant for me was that I have felt a sense of unease about OER since first hearing about it at a presentation at OP earlier this year. My unease has arisen from a few different sources: I absolutely believe in the concept of freely available material (but see as many barriers as enablers to the people who may really wish to be educated – ie those in developing countries who have neither the infrastructure nor the equipment, nor the literacy skills to partake), and I love the idea that others can pick up and run with your resources and adapt them to context/language/culture as necessary (with only a tinge of ‘but that’s mine!’) – where the learning about oneself and one’s own reactions can be instructive!
I think my main concern has been about its application to my own context; midwifery. As a degree programme, and with legal requirements about suitability to practice etc, not to mention the intense media scrutiny that midwifery education is constantly under, I have worried about this notion of ‘free-for-all’ in relation to health professional education. The idea that ‘anyone can get a midwifery degree’ has been problematic for me, as I believe it takes a set of very particular personal attributes to succeed in this programme. I feel reassured however about the ways in which OER might be applied to midwifery, that will not diminish but rather strengthen what we already have on offer. For example, I can see that an OER resource that examines those issues of what it takes to be a midwife, interviews with current and past students, pregnant women who have been supported by student midwives, and midwifery staff, might be a logical first place to begin. This resource could be posted so that prospective students of midwifery can make a realistic assessment of whether midwifery might be for them, and what supports they will need to have in place etc if they choose to undertake the degree.
I can see that there might be several course components that could be made Open Access, and indeed already there are some resources available to students that have come from open sources, which are valuable parts of their learning. So my knee-jerk reaction has been tempered, and I have learnt a bit about myself along the way!
Strategies that could be used would include reusable wiki resources, eBook and open textbook tools for covering content, and video of skills, communication exercises etc. OER philosophy is important to teaching and learning because it will enable students to benefit from accessing the best resources, made by experts in their respective fields, as components of larger courses specific to their needs. The Creative Commons Attribution Copyright License enables staff and students to share their resources, with an option to maintain ‘ownership’ as long as the resource is correctly attributed. The benefits of OER are that anyone can use, share, edit and adapt the resource to meet their own / their learners’ needs, and so resource developers must we willing to ‘let go’ to some degree, and look forward to ‘their’ work being enhanced and developed in ways they may wish they had thought of, or indeed that they may be shocked by!

Activity Six B, more planning... I guess thinking about this new idea, and a Blended Learning Template approach:

Overall Strategy: the development of a blended learning strategy for second year midwifery students to cover course content related to antenatal screning options.

Strategy for Content: there will be a variety of content components, ranging from a video I will make of a role-play between a midwife and a woman, where the midwife discusses the screening options, with an emphasis on informed choice and decision-making. There will links to external websites eg National Screening Unit where theoretical content about screening programmes is offered, and where students are able to enrol in an online series of workbooks with formative quizzes included to assess their learning as they go. There will also be a Moodle exe package with relevant information about related professional frameworks, legislation, and screening pathway information.

Strategy for Communication: there will be facilitator:student communication via Adobe Connect tutorials, discussion fora where students can share their experiences of both hearing midwives in clinical practice discuss screening, and also their own discussions in practice with their follow-through women. Forum posts can facilitate student:student communication, alongside Adobe sessions.

Strategy for Activities: in addition to what has already been covered in content, as an activity students can be directed to select one aspect of screening (eg initial antenatal blood test, combined first trimester screening, gestational diabetes screening, family violence screening etc) and prepare a short teaching session for their SPF group. This peer-to-peer teaching opportunity means each student will learn about all the screening strategies but will only be doing a fraction of the 'work' of learning by themselves, and there will be a tutor on hand to clarify any misperceptions/misinformation. Each student can prepare a summary sheet for their colleagues with main points and relevant references.

Strategy for Assessment: assessment for this learning package willbe formative only, as this is just one small aspect of a much larger paper (Midwifery Scope of Practice) which has its own summative assessment. Formative assessments might include the online quizzes in the NSU resources, and participation in the peer-teaching component within the student's own SPF group.

Activity Six: Planning...

One of the things I've become aware of as I work my way through the Course material is that I haven't consistently landed on a 'thing' which I want to address as a thread throughout the course. I have meandered through both postgraduate and undergraduate aspects of my teaching, using examples from each to highlight different aspects of my musings about flexible learning. It is time to settle down!

I've been thinking alot about one particular aspect of learning that the students become acquainted with more specifically in the beginning of the second year of undergraduate midwifery education. This is the area of antenatal screening, which is an area that students need to have sound knowledge about, but also a level of sensitivity in relation to the way that this discussion occurs with pregnant women. It used to be that the first visit with a pregnant woman was a great opportunity to latch onto her excitement and thrill about her pregnancy, congratulate her warmly and begin the journey of learning about her aspirations and hopes for her pregnancy, birth and beyond.

With the advent of earlier and earlier opportunities for screening, the first visit has beome one of "congratulations - fantastic - you're pregnant BUT..." and the need to have a frank and somewhat sobering conversation about how things might not be perfect and what technologies are available to assist us to uncover the possibilites of imperfection. This is tricky ground, and an area that students identify as being something that makes them nervous. So I think my plan is shaping up into thinking of an inclusive, thoughtful and thorough preparation for the students to tackle this aspect of care, by piecing together a variety of strategies to cover this complex content.

There is plenty of theory and research to introduce to them about the screening options on offer, but at present they don't have so much available to them about how to communicate effectively with women about this, how women feel about being offered this level of scrutiny of their pregnancies, what women of diffferent ethnicity or cultural/religious affiliations think about this information etc. I think a more complete package of learning that encompasses these additional apsects (besides the 'facts' about the screening offerred) would make for better-prepared students, and therefore ultimately a better service to women in the community who might consider that more of their own needs are being met.

So perhaps I will plan to create a learning package that covers more ground, and in ways that will expand student thinking beyond 'the facts' and give them additional tools to work with when discussing this important aspect of care.

Activity 5

Flexible Learning Strategies in my Context.
For this activity I am going to describe one learning area for our first year midwifery students, and demonstrate how we can use several approaches to teach, reinforce, and develop both competence and confidence in this area of skill development.
VENEPUNCTURE describes the skill of obtaining a blood sample from a consenting person. This skill is introduced in the first year of our midwifery degree, and is considered a basic midwifery skill. At first many students feel very nervous about the idea of puncturing someone’s vein to obtain a sample. They worry about: hurting the person, missing the vein (and therefore not getting the sample), and holding the needle steady once in, to be able to change blood tubes. Usually students have mastered the giving of injections by the time venepuncture comes along, and we find this helps to decrease their anxiety around actually putting a needle in someone else!
The acquisition of this skill is dependent on applying several layers of learning. Students begin by completing an online theoretical learning package (on Moodle) which covers all the theory they need to know, eg anatomy, where the vessels are which might be used, where the nerves are which need to be avoided etc. They learn about the equipment used. They learn about the appropriate sequence to completing the skill, including aspects of informed consent, safe handling of equipment, site selection for inserting the needle etc.

When they come together at an Intensive block (face-to-face, large class situation) we revise the theory, and the students all have opportunities to practice the skill on a ‘dummy arm’. This allows them to use repetition as a learning tool, and they talk each other through the ‘skill sheet’ which is the ‘sequential step’ sheet for successfully completing the skill, including the informed consent, the taking of the sample, the documentation, and all the safety aspects. Their ultimate goal is to have this skill sheet signed off by a lecturer or midwife in practice, upon successful demonstration of the skill, which will usually occur in practice at a later date, when the students themselves deem they are confident to complete the assessment.
Once students feel confident on the dummy arm, many of them choose to practice the skill on one another, under the supervision of a lecturer. This is reinforced and practiced in our weekly small group sessions (SPF groups – six to eight students in each group with one lecturer). Then students attend a local laboratory where they complete a four hour clinical placement, taking blood samples from consenting members of the community, under the supervision of the phlebotomy staff at the lab.
Template for Blended Learning Strategy:
Overall Strategy: a blended learning strategy for learning the skill of venepuncture.
Strategy for Content: Moodle package for theoretical learning related to the skill, includes formative quiz to allow student to assess own learning as they progress through the package. Theoretical components includes related anatomy and physiology, site selection, equipment, informed consent, safe handling/universal precautions etc.
Strategy for Activities: sequential opportunities for skill acquisition as confidence develops: use of ‘dummy’ arm, practice on peers/lecturer with instant feedback, practice on ‘real people’ in the community.
Strategy for Communication: interaction between lecturer/student (Moodle, forum posts), interaction between students (forum posts, practice on one another/feedback), interaction between students and community (in safe environment and under supervision) – very ‘hands on’ communication!
Strategy for Assessment: skill sheet sign off – most importantly, this occurs when the student says they are ready to be assessed, not when the lecturer determines they are ready.
This strategy is both resonant of Heinz & Proctor’s (2004) claim that blended learning is “the effective combination of different modes of delivery, models of teaching and styles of learning” (p.1) but also covers the five elements described in Salmon’s model, which encourage students to engage with both each other and the facilitator ie access and motivation, online socialization, information exchange, knowledge construction and development (Salmon, 2002, cited Heinz & Proctor, 2006). Another model, described by Mayes & Frietas (2004, cited in Kitson-Reynolds, 2009) ensures that varying learning styles are included, as is evident in the venepuncture skill acquisition process; Models of Constructivism (Kitson-Reynolds, 2009, p.119)
Learning achieved by completing an activity through structured tasks (learning by doing)
Learning attained through understanding
Learning realized through social practice and cultural settings

Heinze, A. & C. Procter (2004). Reflections on the use of blended learning]. Education in a Changing Environment. University of Salford, Salford, Education Development Unit. Retrieved from
Kitson-Reynolds, E. (2009). Energising enquiry based learning through technology advances. British Journal of Midwifery,17 (2) 118-122.