Activity 5

Flexible Learning Strategies in my Context.

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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.

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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)

Model	Explanation
Associative	Learning achieved by completing an activity through structured tasks (learning by doing)
Cognitive	Learning attained through understanding
Situative	Learning realized through social practice and cultural settings

References

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 http://www.ece.salford.ac.uk/proceedings/papers/ah_04.rtf

Kitson-Reynolds, E. (2009). Energising enquiry based learning through technology advances. British Journal of Midwifery,17 (2) 118-122.