Radiation therapy students’ ... - Wiley Online Library

Original Article

Radiation therapy students’ perceptions of a wiki Gay Dungey1 and Peter Gallagher2 1 2

Department of Radiation Therapy, University of Otago, Wellington, New Zealand Peter Gallagher, Medical Education Unit, University of Otago, Wellington, New Zealand

SUMMARY

Background: This pilot study aimed to gain the perceptions of first-year students using a wiki as a learning tool for the Bachelor of Radiation Therapy degree in New Zealand. Literature suggests that wikis have great potential as an educational tool for both lecturers and students, because they encourage collaborative learning and resource sharing. In 2015, the ‘Otago Wiki’ platform was introduced as a part of the degree. Methods: The first-year students were allocated into groups of four. Using the ‘Otago Wiki’ tool,

each group created their own wiki page by addressing assigned tasks over the course of the year that related to a fictional patient. At the end of the year they were invited to participate in an online Survey Monkey™ questionnaire, which 15/26 students completed. We used a conventional approach to code the free-text responses for our content analysis. Results: Three main themes emerged from the qualitative data: group work experience; developing a greater selfawareness of radiation therapy; and improving the learning

experience. Although there is room for improvement, the quantitative data indicate that most students found the wiki to be a valuable group exercise, helping them to understand the patient experience. Conclusion: Overall, the students’ perceptions of the wiki as a learning tool indicated that it was a worthwhile experience. Moving forward, wikis will continue to be used and incorporated into other modules in the first year. Setting clearer goals for each task would enable the students to use their time more efficiently in the future.

Literature suggests that wikis have great potential as an educational tool for both lecturers and students

© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education. THE CLINICAL TEACHER 2017; 14: 1–6 1

Web 2.0 technologies have been increasingly used in higher and health care education over the last decade

INTRODUCTION

R

adiation therapy students in New Zealand undertake the Bachelor of Radiation Therapy degree (BRT) as a 3-year, full-time programme at the University of Otago. Each year of the degree combines classroom and clinically-based learning opportunities. One module, Radiation Therapy and Oncology I (RT&O), spans the first year of the degree and has clinical application. A key challenge has been to engage clinically naïve students with the course material, enhance their learning and enable the students to appreciate that cancer is not always the only health or personal issue faced by patients throughout their treatment. The educational literature indicates that social media positively affects learner satisfaction and feedback.1 Web 2.0 technologies (e.g. blogs, wikis, RSS feeds, podcasts and social networking sites, such as Facebook™) have been increasingly used in higher and health care education over the last decade. A number of health professional programmes have implemented wikis, and report that the use of a wiki has great potential as an educational tool for both lecturers and students.2–4 Wiki technology consists of one or more web pages where those with permission can work collaboratively to create and edit the content. Collaborative learning has been reported to improve the student experience and learning outcomes.3,4 An additional advantage of the wiki is that the content can also be moderated by the facilitator, if necessary.5 University of Otago Wikis have additional features, including increased security and user management features that mean the site can be restricted to users at the University. The Otago Wiki

Table 1. Class characteristics at the end of year 1, 2015 n

%

21*

80.7

5

19.3

19*

73.1

• Maori

1

3.8

• Pacifica

2

7.7

• Asian/Other

4

15.4

Gender • Female • Male Ethnicity • NZ European/Pakeha

Mean age across the year group: 19.7 years *Two female Pakeha students withdrew from the Bachelor of Radiation Therapy degree (BRT) during the year, reducing the class numbers from 28 to the reported 26 in this table.

platform was introduced to the students in the RT&O module. The purpose of the wiki was to give students a better opportunity to understand and explore what it is like for a patient to manage everyday life whilst going through a cancer diagnosis, and treatment. The aim of this pilot study was to gain the perceptions of first-year students using a wiki as a learning tool.

METHOD An ‘Otago Wiki’ page was created through IT services, and students and interested lecturers were individually registered as users. The first-year students were divided into seven groups of four. Two students withdrew from the BRT during the year, however, leaving two groups with three students. Group numbers were small, as recommended in the literature, to enhance collaborative learning.2,3 Students were intentionally allocated so that each group had a mix of gender and ethnic backgrounds (Table 1), and each group was required to participate in creating a wiki page as part of their coursework for the module. The students were then assigned 10 tasks spaced

throughout the year, which required the student groups to apply RT&O curriculum detail to their patient. Each task was carried out after the content had been covered in a class (Table 2). The first task involved creating the patient for which all groups were given the same brief: a fit 62-year-old male who liked to cycle 20 km a day and lived in the city. The students started their wiki pages by creating this man’s life history, so at the end of the session there were seven different fictional men all with a name, nationality, address, marital, family and religious status, and a social history, including favourite food and other hobbies. The rest of the nine tasks were related to the 62-year-old’s journey from noticing symptoms of prostate cancer, to a cancer diagnosis, treatment, side effects, emotional and social issues, involving himself and his family, and post-treatment care (Figure 1). The students were able to question and discuss issues with the lecturer. In the second semester the students complete another module: ‘Radiation Therapy Planning Concepts’. For this module, the students were able

2 © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education. THE CLINICAL TEACHER 2017; 14: 1–6

Task 1

Fictional patient given a name and patient history

Themes The three themes that emerged from the data were:

Task 2

Patient noticed urinary changes

• group work experience;

Task 3

GP orders diagnostic tests; patient searches the internet

Task 4

Results confirm high-risk prostate cancer

• developing a greater selfawareness of radiation therapy;

Task 5

Volumetric modulated arc radiotherapy (VMAT)

Task 6

Radiation therapy treatment experience

Task 7

Family issues

Task 8

Patient reflection on his treatment

Task 9

Post-treatment instructions

Task 10

Patients overall experience

Table 2. Assigned wiki tasks

Figure 1. Students engaged in discussing their wiki patient

to draw upon the profile of the patient that they had created in the wiki. Thus the patient was used across two modules as part of the assessment process in the first year of the degree. Study participants Following ethical approval from the University of Otago Ethics Committee (reference D14/419), all first-year students (n = 26) were invited to participate in the study via e-mail, sent a participant information sheet and a link to an online questionnaire. The data were collected when the researcher had finished teaching responsibilities with the students. The questionnaire was anonymous and the survey was open for a month. Development and analysis of the questionnaire The questionnaire was developed by the authors to gain specific

feedback on the students’ perceptions of the wiki, and as a result of pilot testing consisted of nine questions (Table 3) and four Likert-scale questions (Table 4). Qualitative data were obtained via the optional free-text responses to nine predominately open-ended questions. A conventional approach to content analysis was used to code the responses to each question and to examine the interrelationships within the data; reoccurring themes were then collated.6 Quantitative data were collected using a five-point Likert scale.

RESULTS Fifteen (58%) of the 26 students completed the entire questionnaire. Respondents reflected the class demographic, with 13 being female.

Not everyone contributed to the workload, or enjoyed the wiki experience or group work

• improving the learning experience. Group work experience The students identified both positive and negative aspects of working in small groups. Being assigned to a group, and the group size, was perceived by most students to be beneficial (Box 1, Participants 12 & 15). Although students appreciated being assigned to groups and reported that the group discussions enhanced their learning, not everyone contributed to the workload, or enjoyed the wiki experience or the group work. Some felt challenged by working in a group (Box 1, Participants 2 & 8). Developing a greater selfawareness of radiation therapy Overall, the students indicated that the wiki page gave them a more holistic view of what a patient might be going through before, during and after treatment. Some students expressed empathy towards their wiki patient (Box 1, Participants 1, 4 & 6) Improving the learning experience Students indicated that they did not always understand what was asked of them, and appeared to lose sight of the aim of some tasks, and most said that there was too much time assigned to complete the tasks (Box 1, Participants 3 & 14). Some students signposted that they would appreciate the inclusion of their wiki patient into the course content of other modules (Participant 12). Overall student experience The students completed the Likert scale questionnaire detailed in Table 4.


The groups were created to generate as much diversity as possible, which appeared to aid learning

Table 3. Free-text response questions Question 1

How did developing the wiki patient enhance or limit your understanding of radiation therapy and oncology concepts?

Question 2

Did you find the tasks were set at an appropriate level? In your response, consider the level of content expected for each task

Question 3

What improvements would you suggest to enhance your learning?

Question 4

How did working in a group enhance or limit your learning experience? In your response consider being assigned to a group and the size and participation of the group members

Question 5

How could the wiki group work be improved?

Question 6

How did the wiki assist your learning in other papers?

Question 7

If the wiki were to be an assessed component of RADT116: Radiation Therapy and Oncology, what do you think would be the best way to assess them?

Question 8

Overall what did you enjoy, and what didn’t you enjoy, about creating the wiki?

Question 9

Is there something else you would like to add or comment on about being involved in the wiki process this year?

Despite there being room for improvement, Table 1 indicates that overall most of the students found the wiki to be a valuable group exercise, and it helped them to understand the patient experience.

DISCUSSION The aim of this study was to gain the perceptions of students using wikis as a learning tool in the first year of their degree.

Interestingly the students appreciated being assigned to groups, indicating that this assisted with their learning, although not everyone participated equally. Zheng et al.7 reported that many factors, including gender, ethnic background, personality and personal interests, may negatively affect the way groups interact. Although this study was limited by the gender, age and ethnic mix of the students available, the groups were purposefully

created to generate as much diversity as possible, which appeared to aid learning in most groups. This requires further investigation with more radiation therapy cohorts. Teamwork is an important skill in radiation therapy. To aid student engagement, previous research suggests giving students clear prescriptive instructions on the overall aim of the wiki, even including direction on word counts and referencing styles, to ensure that all students understand the task from the outset. Others suggest allowing the students themselves to assign roles and agreements within their groups to ensure safety and an evenly shared workload, with their progress reviewed on a regular basis.8,9 Also recommended is a more consistent presence of the facilitator, particularly early on in the process.8 This approach is described as instructional scaffolding by Kim, who found that well-structured direction for computer-supported collaborative learning, such as wikis, also has the potential to enhance critical thinking in students.10 Although instruction was given to students on this study it could have been more prescriptive for both modules. The students indicated that there was a need to better signpost the relevance of each task and its importance to the

Table 4. Student perceptions of their experience; number of respondents and percentages Question

Not

Limited

Moderate

Q1: How would you rate the ease of using the ‘Otago Wiki’ platform?

n = 0 (0%)

n = 2 n = 5 (13.33%) (33.5%)

Q2: How would you rate the value of the wiki in helping you think about a patient experience?

n = 0 (0%)

n = 2 n = 4 n = 3 (13.33%) (26.67%) (20%)

n = 6 (40%)

Q3: How effective were the tasks in engaging you to participate in peer learning?

n = 0 (0%)

n = 0 (0%)

n = 3 (20%)

Q4: Overall, how valuable were the wikis as a learning tool?

n = 0 (0%)

n = 4 n = 1 (26.67%) (6.67%)

n = 6 (40%)

Mostly

Very

n = 5 (33.5%)

n = 3 (20%)

n = 6 (40%)

n = 8 n = 2 (53.33%) (13.33%)


Box 1. Student free-text comments Theme 1: The group work experience • Four in a group was a good size and I thought working together built our relationships. Working as a group helped develop our knowledge. Participant 12 • Working in a group allowed us to split the workload, which allowed us to increase the detail of our work, which in turn increased our understanding. Participant 15 • All the members of my group felt the same about the wikis, so we were just interested in finishing the tasks. The group work took away a lot of stress from the whole exercise as the workload was shared. I didn’t mind being assigned a group and everyone participated although not too enthusiastically. Participant 2

Setting clearer goals for each task would enable the students to use their time more efficiently

• Sometimes I didn’t enjoy the group I was in and we always had contradicting ideas, which was sometimes difficult, but it often came out right in the end anyway. Participant 8 Theme 2: Developing a greater self-awareness of radiation therapy • We could refer to the patient to understand what sort of side effects he is likely to experience and when they will occur. Also on how to control and reduce the severity of the side effects and it will have an impact of his life. It also helped me understand that some side effects will have a bigger impact on some patients but not on others due to life style and tolerance levels. Participant 4 • Allowed me to put things into perspective more easily and draw on multiple papers as well as personal experience. This also greatly allowed me to empathise more with what patients go through and I did get rather attached to the fictional character. Participant 1 • I feel that in a way I was able to bond with a patient and was concerned for the outcome for them. Participant 6 Theme 3: Improving the learning experience • Group work should be talked about in class and with the lecturer more, as I felt we were left to do it on our own. Participant 3 • I believe the tasks were set at an appropriate level, but I also believe that we were given too much time to do them. Participant 14 • Perhaps incorporate the wiki patients into other classes, which would help join the dots of how everything we learn relates together … It could be useful if the other staff members had an understanding of our wiki patients and were able to use them as examples in their classes: e.g. Health Care Communication, Health and Human Behaviour, Planning Concepts, and Anatomy and Imaging. Participant 12

module. Most students thought that there was too much time allocated to address the tasks in this study, which suggests that being more prescriptive and setting clearer goals for each task would enable the students to use their time more efficiently in the future. From the quantitative data, student perceptions of the wiki are mostly positive. The majority rated it as a valuable learning tool that aided their understanding of patient experience. Despite positive student ratings of the wiki, the findings of the qualitative data also indicated that a number of students ranked their experience as limited or mid- range, indicating changes are required.

All of the data have been collected via student self-report, which is a limitation to this pilot study. There may be bias in how students rate their experience in order to please the teaching staff; this may also be a consideration in their written responses to the open-ended questions. The aim of creating diverse groups was also limited by the gender and ethnic mix available in the class. Therefore, ethnic minority views were not represented in this study. Overall, the wiki was a worthwhile experience for the students and will continue to be used in the degree. A more structured approach to the relevance of each task will be highlighted by the lecturers. Further research will examine

whether improvements in this approach, and incorporating the wiki into other first-year modules, enriches the overall student learning experience. REFERENCES 1. Bergl P, Muntz M. Using social media to enhance health professional education. Clin Teach 2016;13(6):399–404. 2. Mi M, Gould D. Wiki technology enhanced group project to promote active learning in a neuroscience course for first-year medical students: an exploratory study. Med Ref Serv Q 2014;33:125–135. 3. Zitzelsberger H, Campbell KA, Service D, Sanchez O. Using Wikis to Stimulate Collaborative Learning in Two Online Health Sciences Courses. J Nurs Educ 2015;54:352–355.


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Corresponding author’s contact details: Gay Dungey, Department of Radiation Therapy, University of Otago, Wellington South, Wellington 6242, New Zealand. E-mail: [email protected]

Funding: None. Conflict of interest: None. Acknowledgements: The authors would like to acknowledge the students who agreed to be part of this study – their feedback has improved the future use of the wiki in the degree. Ethical approval: Ethical approval was sought and approved from the University of Otago, Ethics Committee (ref. D14/419). doi: 10.1111/tct.12707
