Health education and collaborative writing: Asynchronous online discussions

Similarly to education, the health care domain is usually organised around a dual mode in which students and professionals are exposed to formal education in schools, universities, or continuing education settings, while simultaneously acquiring professional experience in internships. In order to support learners in exploiting the competences acquired in these different environments, the use of asynchronous online discussions seems to represent an interesting option explored in various health education programmes (from health and social care students to doctors).

Giulia Ortoleva  Writing to Share, Sharing to Learn

58 Asynchronous online discussions for professional development

Asynchronous online discussions (AODs) can be defined as conferences occurring on the Web, asynchronously and in written mode, in which learners are required to participate in various discussion threads by reading and contributing to them (Benfield, 2002). These can be conducted through forums, mailing lists, or other systems (like wikis). The fact that the discussion is conducted asynchronously allows participants to work at their pace and from different places (Fitzsimmons, 2007), which is particularly suitable for health professionals. In addition, the written mode of the discussion allows for a cumulative construction of the argument which facilitates deep thinking and reflexive processes (Baker, de Vries, Lund, & Quignard, 2001). Following a socio-constructivist view of learning, online discussions seem to be particularly suited to encouraging learners to analyse real incidents or events encountered in practice. This activity is considered as a way to promote critical thinking and clinical reasoning, and it has a long tradition in the health domain (Higg & Jones, 2000; Mann, Gordon, &

Macleod, 2009).

Asynchronous online discussions are also associated with the development of communities of practice (Wenger, 2000; Dillenbourg, Poirier, & Carles, 2003). Through the discussion tools, the members of these communities, who share one interest and/or one professional role, can discuss about their practice to acquire new competencies and to modify their professional behaviour. These types of communities are especially useful for health professionals working in clinical settings where they need to operate in critical situations, as they allow them to discuss their decision-making process without being professionally exposed.

Although various studies indicate how to make an effective use of online discussions (Rovai, 2007;

Salmon, 2011), little is known about the real impact of this tool on learning in terms of academic outcomes, professional practice, or personal improvement (Thomas, 2013). In the next section, we will present three examples of studies using asynchronous online discussions for the professional development of health care practitioners (see table 2).

Table 2. Examples of studies analysing asynchronous online discussion in health care education Authors Participants Activity Research

self-59 writing and the way collaboration between participants is orchestrated.

Role of writing

The use of writing to encourage reflection and comparison with others is central in the implementation of this type of activity. Koops et al. (2012) conducted a research on medical students during their clerkship, analysing the use of asynchronous discussions to debate clinical problem-solving papers written individually by the students. In this Clinical Appraisal of a Topic (CAT) task, students were asked to formulate a clinical question about a problem encountered in the workplace, followed by a critical investigation of the literature (Parkes, Hyde, Deeks, & Milne, 2009). The authors estimated that students would profit from a discussion with their peers on their papers (Bennet et al., 1987) and wanted to observe whether the participation in this discussion would influence their decision to revise the CAT paper.

Online discussions can also be used to share real-life experiences. Ortoleva, Schneider, and Bétrancourt (2013b), working with health and social care apprentices, used the critical incident technique (Flanagan, 1954; Schulter et al. 2008) to collect significant episodes experienced by students during their internships. After this individual writing phase, learners were asked to provide

Giulia Ortoleva  Writing to Share, Sharing to Learn

60 written comments to their peers by asking questions, suggesting other possible behaviours in similar situations, and providing general comments. Peer collaboration was used here as a way to step back from personal experiences, embracing the perspectives of others and stimulating collective knowledge construction (Scardamalia & Bereiter, 1994; 2006; Davies, 2002). Collaboration not only served to encourage learners to engage in socio-cognitive conflicts, but it also provided an overview of various workplace practices that single learners cannot experience during their training.

Results

To judge the effectiveness of AOD for learning and professional development, different aspects of the collaboration and the interaction among the participants can be measured and observed. Koops et al.

(2012) explored whether the discussion had an impact in participants’ revisions of their individually written papers of critical situations encountered in the workplace. After the discussion phase, 51% of the 47 medical students participating in the research revised their papers. Analysis of the interaction on the forum highlighted that students’ paper revisions seemed to be associated with an intense activity during the discussion with peers, as well as with higher task-focussed discussions. These results seem to confirm that the use of a forum to conduct written discussions in medical education could support students in reflecting on their practice and in learning collaboratively during their clerkships.

From a different perspective, Ortoleva et al. (2013b) measured the effect of writing and discussions on knowledge acquisition and self-efficacy belief adjustment compared to individual writing only. The results did not show significant improvement in any of these dimensions. However, two effects were observed: in the first place, the more that learners engaged in a significant episode lived by a fellow apprentice by providing suggestions and comments, the more they learned, improving their performances at the knowledge-acquisition test. Moreover, apprentices reacted positively to the writing activity in general and to the peer-commenting phase in particular, leading to a high level of engagement in the task. This result confirms the literature of the domain, which sustains that the quality of the interaction between apprentices is a fundamental aspect in collaborative learning contexts (Suthers, 2006).

Thomas (2013) performed a literature review based on 14 studies analysing the use of asynchronous online discussions in the health sector. Despite the heterogeneity in the methodologies of these studies, some interesting overarching conclusions could be derived. All the studies analysed showed some effect of AODs on learning. In this result, the mode of e-moderation and structuring of the activity seemed to play a significant role (Johnson, 2006). In particular, structured discussions (e-moderated) induce higher order thinking than unstructured discussions (without moderation). Moreover, Johnson observed that the impact on learning is enhanced when it is mandatory for learners to participate in the activity, rather than when it is voluntary. Finally, Thomas concludes that in order to encourage learners towards reflective and critical thinking, they have to be exposed to an asynchronous online

61 discussion tool for an extensive period of time, while limited and punctual utilisation may be less effective.

2.3.3.3 Discussion

The research examples presented in this chapter, with the different approaches observed and their range of target populations, account for the potentialities and limitations of the use of wikis and asynchronous online discussions for professional development. Various roles can be attributed to the writing task in this type of activity, and collaboration and individual writing can be mixed and combined in different ways. Overall, the interesting and contrasting results of these studies highlight the potential of these tools to support communities of practice and to provide participants with environments to overcome the isolation experienced in their working practice. Additionally, as mentioned above, this type of writing activities also have great potentialities for knowledge building and co-construction. In this sense, they can serve as ways to provide learners with environments were to share resources and discuss knowledge, in order to create new shared understandings. Collaborative writing activities have therefore a great potential in supporting the integration of theoretical, practical, self-regulative and socio-cultural knowledge, which represent the foundation of the integrative pedagogy model (Tynjälä, Häkkinen & Hämäläinen, 2014). On the other hand, these studies also show how collaborative writing, and particularly knowledge building, are effortful activities which seldom happens spontaneously. The recommendations driven by the results of these studies represent one way to encourage collaborative writing and to support the successful implementation of computer-based activities.

As far as the use of wikis is concerned, different authors agree in pointing out the need to provide technological support for wiki participants (Kim et al., 2012) to ensure the basic skills needed to use the tool, while also modifying teachers’ mind-sets associated with the use of technology in their practice (Hadjerrouit, 2014). Additionally, even for teachers who are competent in using technology, it is important to consider that this type of activity represents an investment of time and effort, and adequate resources should be allocated to it (Donnelly & Boniface, 2013).

Moreover, for both wikis and asynchronous online discussions, an important aspect for the effective implementation of these tools is associated with the design of the activity which learners will have to perform. Various studies demonstrated a reluctance of learners in collaborating, showing that this type of sharing practice does not happen spontaneously, even when computer support is provided with this aim (Dillenbourg, 1999; Kreijns, Kirschner, & Jochems, 2003), also in regard to the cognitive load that collaboration implies (Dillenbourg & Bétrancourt, 2006). To overcome this issue, Hadjerrouit (2014) suggests that participants should be prepared for the collaborative activity and powerful discussion tools should be provided to them. Moreover, he points out that collaborative writing should be integrated into a well-constructed scenario in which collaboration is explicitly valued and evaluated

Giulia Ortoleva  Writing to Share, Sharing to Learn

62 (Mindel & Verma, 2006), or even mandatory for learners (Johnson, 2006). Donnelly and Boniface (2013) further suggest that regular face-to-face sessions combined with the use of the collaborative environment would represent an interesting solution, allowing the conversation to continue beyond the organised meetings. Thomas (2013) additionally points out the importance of the mode of e-moderation (Johnson, 2006) and of the amount of time spent working on the environment.

2.3.4 Conclusion

In this chapter we discussed the potential of computer-supported collaborative writing activities to sustain professional development. After introducing the concept of collaborative writing and the technological tools that can support this activity, we analysed empirical research using two types of collaborative writing tools: wikis and asynchronous online discussions.

Overall, this review and exploration of the use of different technologies for professional development allowed us to conclude that even if the potentials of the two tools analysed are distinct, they can both support the building and maintenance of communities of practice, and are sometimes implemented for similar purposes, as encouraging sharing and discussions among peers is fundamental for professional development.

Even if in wikis, participants are enabled and supposed to collaborate in the construction of a common content, it is not infrequent for users to conduct in them the same type of activities supported by asynchronous online discussion environments. The reason for this practice may be associated with the fact that the use of wikis to create common content requires a higher level of collaboration, which, as mentioned above, has to be supported with well-designed activities providing a specific value and an explicit evaluation to the interaction among peers. Moreover, the use of a tool to support collaborative knowledge construction represents a change of paradigm if compared to more classically performed activities, which is harder to accomplish than the adaptation of an existing paradigm, as in the use of asynchronous online discussions (Albion, 2008). This aspect should always be considered when deciding to use any type of technological support for a collaborative writing activity.

In this sense, we consider that, while online discussions are easier and more directly implemented, the use of wikis for professional development will require longer training, both on the use of technology and on the mentality of the users. In our opinion, the potential of the utilisation of technological tools for this purpose should be further explored, in consideration of the recommendations that emerged in the research analysed.

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