Lesson_Plan

Lesson Plan The aim of this essay is to produce a lesson plan on the role of ethical principles in health care to a group of six learners at different stages of their training. Health professions are frequently faced with ethical dilemmas during the care of their patients. This may be the case because, when patients seek medical care they are not entering an ordinary social relationship; they often feel vulnerable because of the need to expose and share intimate and important aspects of their lives. Ethical principles offer tangible protection to both patients and doctors in these circumstances (Limentani A, 1999). Codes of ethics have been a longstanding element in the professional control of the behaviour of doctors, and indicate a commitment to act with integrity in extreme circumstances (Hurwitz B, Richardson R, 1997). The theory for my lesson will be based on the ‘four principles’ approach developed by Beauchamp and Childress (1989), which is based on: autonomy, non-maleficence, beneficence and justice. The intention of the lesson is to enable the students to reflect upon the moral dilemmas they would encounter and in the process understand the principles of medical ethics and consider its applications in the care they provide. The Learning Objective A clear objective is essential to determine what you want the students to learn and be able to do at the end of the class. There is no doubt that learning objectives enhance learning, but it should be based on the learners needs, not on the teacher’s preference (Houlden R, 1998). Thus, a learning objective is beneficial for the learner as well as the teacher. For the teacher it helps to identify what knowledge, skills, and attitudes the learner needs to acquire. It helps to guide selection of teaching activities to those which will best achieve these objectives and serves to connect content and assessment around learning. It gives learners a clear picture of what to expect and what’s expected of them. It forms the basis for evaluating teacher, learner and curriculum effectiveness. Learning objective is a statement in specific and measureable terms that describes what the learner will know or be able to do as a result of engaging in a learning activity. Its key elements are that it should be SMART- i.e. specific, measureable, attainable, relevant and targeted. Benjamin Bloom’s taxonomy (1956) of cognitive behaviour provides an insightful stair-step approach to thinking about the specific levels of learning. The levels include – knowledge, comprehension, application, analysis, synthesis and evaluation. The knowledge level refers to the level of memorization and regurgitation which is what is focussed on in undergraduate education. Recently these levels of learning have been revised by his associates. Amongst other modifications, Anderson and Krathwohl’s (2001) revision of the original Bloom’s taxonomy redefines the cognitive domain as where the Cognitive Process Domain and the Knowledge dimension intersect. The distinction between the categories is not always clear cut, although the Cognitive process and knowledge dimensions are represented as hierarchical steps. This taxonomy provides a framework for clarifying learning objective. Learning activities often involve both lower and higher order thinking skills as well a mix of concrete and abstract knowledge. In the revised taxonomy the knowledge dimension classifies four types of knowledge that learners may be expected to acquire ranging from concrete to abstract and it involves- factual, conceptual, procedural and metacognitive knowledge. The knowledge dimension is extended through a cognitive process dimension which represents a continuum of increasing cognitive complexity from lower order thinking to higher order thinking skills. Its main components are to remember or retrieve previous knowledge about the topic, understand the new material by interpreting or comparing it with previous knowledge, apply it to a situation, analyze or deconstruct it and find coherence, evaluate and critique performance and create new hypotheses. My lesson plan (appendix 1) has two objectives (element d), the first one would help the learners to identify the steps of ethical decision making in patient care. The second objective would be for the learners to apply the steps to an ethical dilemma. Applying Blooms revised taxonomy through my lesson plan, at the factual level they will need to understand the definition of medical ethics and values (elements e and h). During elements f, g, h and i, they will be processing at the conceptual level, where they will then need to understand the ethical rules, ethical principles, theory and ethical decision making process. During this process they would be exercising the lower order thinking skills of the cognitive process whereby, they will be trying to remember and recall elements about ethical principles that they would have read about in the past and try to understand and interpret what they recall to what is being taught. The perceptual level would then involve the learners analysing videos (elements e and l) and examples of cases (j and k) where they further enhance their understanding and compare what they are being taught amongst each other. The executive level would involve small group case- centred exercises, presentation of ideas, role plays and simulations (j and k) where they will have the chance to apply and analyse what they have learned. At the self awareness level they will be given the chance to discuss types of dilemmas that might be difficult for them and evaluate their own comfort level around using the process to make decisions (k and m). Finally the evaluation level would involve the end of class debrief, performance assessment and feedback (l, m, n). Using this model, active participation is encouraged amongst the learners. Discussion amongst learner’s at different stages (g, i , j, k, m) of their training would in turn encourage them to acquire knowledge that ranges from concrete to abstract and in turn contribute to higher order thinking. Why prepare for a lesson' Careful lesson planning is essential for its successful running. Rather than improvise, a good teacher would plan the lesson, procures the learning material required, list the procedure to follow and prepare for potential problems and pitfalls (Wagner K, 2004). There are different styles of lesson planning, but most contain similar elements as mentioned above by Wagner, based on what is known about promoting student learning. To help in the delivery of the medical ethics lesson, I explored three different types of lesson planning to ascertain which would benefit my teaching style. Robert Gagne (1962) identified nine instructional events and corresponding cognitive processes that can be used to support learning. They are often used as a framework for instructional development when the acquisition of intellectual skills is the goal of instruction. Madeline Hunter developed the seven steps to lesson planning (Hunter M, Russell D., 1976) which is often associated with the direct instruction method as well as behaviourist school of educational practice. There are many similarities between Gagne’s events of instruction and Hunter’s model of direct instruction. It is essential to remember that these steps are not a formula to be followed step by step, but a set of useful elements (Wolfe, 1987). Whilst direct instruction may be a part of one’s teaching style, it may not always favour adult learners. My objective whilst planning this lesson plan is to create an environment that is conducive to discussion among the learners who are at different stages of their training. I feel that the direct instruction model described above may not favour this. The Constructivism theory (Bruner, 1966, 1973) shifts the learning environment from one which is very instructor centred to one that is very learner centred. It is a theory of learning stating that learners construct new ideas or concepts based upon their past or current knowledge. It is a very open type of planning where instruction is designed by the teacher around a learning objective and allows the learner to transform the information, construct hypothesis and make decisions relying on a cognitive structure to do so. Roger Bybee (a contemporary of Bruner) and his team at The Biological Science Curriculum Study (BSCS), developed an instruction model for constructivism called the 5 E’s (2006). The five elements of this model are: Engage, Explore, Explain, Elaborate and Evaluate. This is the model of instruction that I have used for my lesson. The role of the teacher: using the constructivism model to encourage student participation. Active learning through active student participation is the essential ingredient of my lesson plan. Rather than take on a direct instruction approach, the teacher is taking on the role of a facilitator using the constructivism model and encouraging the learners to contribute during each element of my lesson plan. This does not mean the teacher is taking a back seat and letting the learners do all the work. On the contrary the facilitator is actively involved in every element of the lesson plan to facilitate their learning process. The role of the facilitator is to make suggestions, offer insights and help the group to engage in productive conversation (Schwarz 2002). At the onset of my lesson plan, during the engagement process, there is a brainstorming session (e). This is where the learners are encouraged to discuss various concepts and dilemmas of medical ethics amongst themselves, question themselves on how much they already know and generate curiosity. Brainstorming helps to encourage creativity and rapidly produce a number of ideas. It also helps to equalise the involvement of all the team members and foster a sense of ownership in the topic discussed (Osborn, 1967). The learner’s are at different levels of their training. I feel that the advantage of this is that they would have already applied principles of ethics in various stages of their training. Brainstorming would encourage the students to question themselves on what they already know about the principles of ethics and why a particular situation arose. Collaborative learning helps to enhance the learning proves by helping the students build upon their personal experiences while working with other students (Cabrera, 2002). At the exploration stage of my lesson plan (g); the learners are encouraged to work in groups. This is in order to persuade them to think freely, but within the limits of the activity. They are given the confidence by the facilitator to test predictions and hypotheses, form new predictions and hypotheses, try alternatives and discuss them with the other learners. The facilitator is not involved in the actual making of decision, but enables the participants to engage with each other directly (Schwarz, 2002). However, in general the facilitator is encouraging reflection around experiences, observing the students as they interact and asking probing questions to redirect the student’s investigation when necessary. There will be occasions where the facilitator will teach to define or clarify an idea or principle. This is evident at the explanation stage (g), where, after the instruction formally provides the definitions, explanations and new labels, the learners are encouraged to explain concepts in their own words and the teacher uses student’s previous experience as basis for explaining concepts. During this process the active dialogue between the learners is continuing, they try and comprehend the explanation the teacher offers, listen to each other’s explanation and are encouraged to question the explanation. ’There is evidence that class discussions, an ingrained component of collaborative learning, leads to higher cognitive development and knowledge retention’’ (Cabrera, 2002, p:21). Applying Bloom’s extended taxonomy here (appendix-2); the facilitator is enabling the learners to gradually progress through the various stages of the knowledge dimension. The facilitator provides the factual and conceptual knowledge which is the terminology of ethics, its principles and theories. Then the learners are facilitated to used the knowledge of criteria for determining when to use appropriate procedures and then finally at the metacognitive level, which would coincide with the extend stage, the learners are given the opportunity to apply the new labels, definitions and explanations through problem solving activities. Here they can use the previous information to ask questions, propose solutions and make decisions. They can then draw favourable conclusions from the evidence and check for understanding among peers. What does evaluation actually achieve' The final element of the constructivism model is the evaluation stage. There is no doubt that evaluation helps the teacher to determine if the learner has attained the understanding of the concepts discussed. But, I feel that it should be a two way process and it should be equally important for the learner to evaluate his or her own progression and knowledge and also evaluate if the actual learning process has enhanced or consolidated their knowledge and changed their behaviour. Assessment involves the measure of how much knowledge and skills the student has learned and evaluation of the adequacy of each student’s level of learning (Biehler, 1997). Biehler and Snowman (1997) identified four common reasons for assessment. Firstly it provides a summary of whether the student has met the teacher’s objective. Secondly it helps to monitor if the student understands the content of the material covered. Thirdly evaluation discovers learners who are having difficulty keeping up with the rest of the class and finally feedback from evaluation has positive effects on the teacher to teach and the various aspects of learning for the learner. In my lesson plan, because of the short span of the lesson, assessment of the student’s learning is happening constantly. Rather than rely upon a single type of assessment, I am employing various strategies to achieve this. One of the performance tools I have used is The Multiple Choice Questions (MCQ). I have employed this at two stages of my learning plan. At the engagement stage (e), I have used it to understand what the learners already know about the topic and finally at the evaluation stage (l), to look for evidence if the learner’s have changed their thinking or behaviour. The advantage with the MCQ is that it allows a broad assessment of foundational knowledge within a short period of time (Biehler, 1997. p: 451). This also serves as a self assessment for the leaner and allows them to assess their own learning and process skills. One of the ways of evaluating performance is assessment of direct demonstration by the learners. The brain storming session at the engagement stage helps me to identify what the learner’s already know about the topic. During the problem solving activity (j) the role play of the mock cases allows the students to show how well they have used the knowledge acquired to solve a unique problem. Throughout the lesson plan (g, i, j, k, l) the teacher is given the opportunity to observe the students as they apply their new concepts and skills. The final element of evaluation is feedback. The MCQs would serve as a feedback to both teacher and learner on how behaviour has changed. In addition to this written feedback about the lesson from the learners helps to measure impact, gives them the opportunity to critique the teacher and help in the development of the teacher. Diversity through collaborative learning. One of the aims of this assignment was to develop a learning plan for learners at different stages of their training. I feel that the constructivism model I have employed will help to achieve this and aid in Peer Assisted Learning (PAL). There is evidence that cross year PAL, where there is small group learning which includes a senior peer with a group of junior peer’s, helps to inspire learners (Romito, 2012). It also helps to achieve better cognitive participation and encourages them to contribute to the learning activity. After extensive meta-analysis studies, Cross and Major (2005) came to the conclusion that cooperative arrangements are superior to either competitive or individualistic structures on a variety of outcome measures, generally showing higher achievement, higher-level reasoning, more frequent generation of new ideas and solutions and greater transfer of what is learned from one situation to another. There is also some evidence available that shows collaborative learning helps to integrate different learning styles within the learners. Lundeberg and Moch (1995) observed that the collaborative nature of the student’s interactions promoted intellectual risk taking and connected understanding of concepts. Learning styles may differ depending on the age of the student, situational factors and the subject (Spoon and Shell 1998). In my lesson plan, at the engagement stage (f), I have divided the learner’s into groups of three and intend to mix the learner’s who are at different stages of their training. It is widely accepted that trainees have different styles of learning; therefore, an effective trainer should have the skill to understand the variations in his trainees learning style and tailor their teaching accordingly (Vaughan, 2001). I appreciate that in a 2 hour lesson it may be difficult to change the learner’s learning style completely. However, by mixing different individuals together hopefully there would be transference of ideas between themselves. One way of addressing this diversity in learning needs is by using varied teaching styles (Grasha, 1972). In my learning plan I have used direct instruction during exploration stage and also taken the role as a facilitator to encourage their thinking process. I accept that there may be some learners who would be more favourable to the traditional methods of teaching but as it may be important to use the unfamiliar methods of teaching to stimulate tension and enable lateral thinking (Kowoser & Berman, 1996). My intention is to use these diverse methods to achieve an enjoyable learning experience for the learner. How does it all fall into place' The mantra for all adult learners’ now is self directed learning. My intention while preparing this lesson plan was to use this at its core foundation and enable the learners to work together in groups to achieve this. This lesson plan has a clear objective and a clear step wise, well evidenced, plan to achieve this objective. Using the 5 E’s of the Constructivism Model, my intention was to facilitate collaborative learning and in the process achieve maximum learner participation. Rather than have a tick box exercise to ascertain whether all these elements were being achieved the structure of the lesson plan is easy to follow when facilitating a group. The diversity in assessment by direct observation, MCQs and written feedback helps to enable the teacher to judge if the group is moving forward in the right direction and whether the objectives have been achieved by individual members. By mixing learner’s at different stages of training I intend to achieve diversity in teaching and learning styles in collaborative learning by maximising learner involvement. My main aim was to achieve a lesson plan that was interactive and enjoyable for the learners and I feel this has been achieved. 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Retrieved from http://www.bscs.org/pdf/bscs5eexecsummary.pdf Cabrera, A., Amaury Nora, A., Crissman J., Terenzini, P. 2002. Collaborative learning: Its impact on college students' development and diversity. Journal of College Student Development; 43, 1:p20. Limentani A. The role of ethical principles in health care and the implications for ethical codes. Journal of Medical Ethics 1999;25:394-398. Gagne, R. 1962. Military training and principles of learning. American Psychologist, 18, 263-276. Grasha, JA., 1972. Observations on relating teaching goals to student response styles and classroom methods, American psychologist,27:144-47. Houlde R, 1998. Learning outcome objective. Annals RCPSC, Vol.31,7:327-332. Hunter M., Russell F. Planning for effective instruction: Lesson design. Los Angeles, California: Seeds Elementary school, 1976. Hurwitz B, Richardson R. Swearing to care: the resurgence in medical oaths. British Medical Journal 1997;315:1671-4. Kowoser,E, and Berman,N, 1996.Comaprison of paediatric resident and faculty learning styles:Implications for medical education. American Journal of Medical Science, 312(5):214-18. Osborn A.F. 1967. Applied Imagination: Principles and Procedures of creative problem solving (Third edition). NY:Charles Scribner’s sons. Romito,A. (2012) Peer Assisted Learning . In ‘The Essentialk Handbook for GP Traning and Education. Free webpage: http://www.essentialgptrainingbook.com/resources/web_chapter_03/03%20Peer%20Assisted%20Learning.pdf [Accessed 20/2/13]. Schwarz, Roger M. (2002) The Skilled Facilitator: A Comprehensive Resource for Consultants, Facilitators, Managers, Trainers and Coaches. 2e. San Francisco: Jossey-Bass. Spoon, J.C., and Shell, J.W. 1998.Aligning Student Learning Styles with Instructor Teaching Styles. Journal of Industrial Teacher Education, 35(2):41-56. Vaughan, L. & Baker, R. Teaching in the medical setting: balancing teaching styles, learning styles and teaching methods. 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