Research article
Open Access

Large Scale Blended Learning Design in an Interprofessional Undergraduate Course in Norway: Context Description and Supervisors’ Perspective

Kari Almendingen[1], Jūratė Šaltytė Benth[2], Marianne Molin[1]

Institution: 1. Oslo Metropolitian University, 2. Campus Ahus University Hospital
Corresponding Author: Prof Kari Almendingen ([email protected])
Categories: Comparative Medical Education, Educational Strategies, Technology, Research in Health Professions Education, Simulation and Virtual Reality
Published Date: 08/06/2021

Abstract

Background: Society’s demands for better coordination of services for children, young people and their families, are increasing. Many professionals learn about collaboration in their specific professions without having the opportunity to collaborate across study programmes while undergoing pre-service training. Although interprofessional learning (IPL) has been suggested to achieve better services, better outcomes and reduced costs, IPL studies have mainly been restricted to health care.

 

Aim: to describe the transformation of an IPL course with plenary activities into an IPL blended learning course approach (no plenary activities) in conjunction with a quadrupling of the number of students, and to reflect on the possibilities and limitations related to structural and outcome aspects.

 

Methods: Design: exploratory cross-sectional study. Students (n=1,401) from teacher educations, health and social care study programmes worked in 196 IPL groups using a combination of digital learning resources and face-to-face discussions, during two days of seminars and through a group submission assignment. Supervisors (n = 39, response rate 61%) evaluated the course delivery through an online questionnaire.

 

Results: Three quarters of the supervisors were highly satisfied with the use of ‘student-active learning methods rather than lectures’, and the IPL blended learning approach. They ranked the students’ learning outcomes from the face-to-face activities on campus twice as high as that of the assignment, and three times higher than that of the syllabus. Nearly (92.3%) agreed that the blended learning IPL course was relevant for professional practice when working with children, young peoples and their families.

 

Conclusions: Blended learning is a feasible approach in the context of large-scale IPL. Supervisors agreed that the course was relevant to pre-service training on working with children, young people and their families. Since curriculums in professional studies are strictly regulated, this study may be useful for educators in higher education extending IPL beyond health care.

 

Keywords: Blended learning; Information and communication technology; Interprofessional learning; health study programs; social study programs; teacher educations; children; small group learning; face-to-face interactions; supervisors

Introduction

Despite high awareness, strong legal status and a generally high level of health and social services, challenges remain before fundamental rights for all children can be secured, even in a rich country like Norway (The Ombudsman for Children, 2019). Children in vulnerable situations face the highest risk of breaches in the fulfilment of their rights (Ministry of Children and Equality, 2017). In Norwegian legal terms, a 'child' means every person under 18 years of age. The term 'young people' is often used for people up to 25 years of age. Challenges relating to modern childhood include obesity, fractured families, and issues related to use of the internet. Interprofessional collaboration (IPC) has thereby been extended beyond health and social care professions to also include professions such as teaching and child welfare (Whiteley et al., 2014; Ministry of Children and Equality, 2017; Norwegian Society of Pediatricians, 2017; Fukkink and van Verseveld, 2019; Strunk et al., 2019).

 

Interprofessional learning (IPL) is defined by the World Health Organization (WHO) as being present when students from two or more professions learn about, from and with each other in order to prepare them for IPC and to improve collaboration and quality of care (WHO, 2010). IPL is recognised as being essential in the education of future professionals in order to equip them with skills, knowledge and attitudes that enable them to work together in meeting the needs of end users of services (Reeves et al., 2016). Although collaboration is a large part of the job for professionals working with children, youths and their families, many professionals learn about collaboration in their specific disciplines without actually having the opportunity to collaborate across disciplines while undergoing training (Strunk et al., 2019).

 

The implementation of IPL is a requirement for all Norwegian health and social care education programmes from the academic year 2020/2021 (Ministry of Education and Research, 2017a). The learning outcome descriptors should be in line with the National Qualifications Framework for Lifelong Learning, and on completion of their education, graduates should have achieved the two following shared learning outcomes: ‘be able to interact across disciplines, professions, and sectors, and across establishments and levels, and should be able to initiate such interaction’ and ‘have knowledge of children and young people and, as practitioners, should be able to take care of their needs in terms of treatment and/or services, ensure their participation, and safeguard their rights’. Despite shared learning outcomes, Norwegian institutions are free to choose their learning, feedback and assessment methods if the final knowledge and skills, as defined above, have been achieved. In teacher education programmes, priority is given to three interdisciplinary themes: democracy and citizenship, sustainable development, and public health and well-being (Ministry of Education and Research, 2015). School is an important arena for promoting mental and physical health in children and young people (Hood et al., 2017). However, to the best of our knowledge no large-scaled IPL study has been published including students from both teacher educations, and health and social care study programmes. There is a therefore knowledge gap concerning potential differences in learning outcomes from IPL courses that include students not only from health and social care programmes, but also from teacher educations.

The aim of this study is to describe the transformation of a traditional IPL course with plenary lectures for 350 students into an approach using blended learning on a large-scale (with no plenary activities) to meet a quadrupling of the number of students, and to reflect upon the possibilities and limitations related to this approach.

Methods

Setting

This study is part of a big educational initiative at Oslo Metropolitan University (OsloMet) in Norway, the ‘Interprofessional Interaction with Children and Youth’ (INTERACT) project (Foss et al., 2018). It is designed for students from the educational trajectories of health, social care and teacher education. The aim is to meet society’s demand for better coordination of services relating to children and young people, involving better interaction between professionals and better cooperation between children, young people, their families and the professionals. The project extended IPL beyond health and social care to also include teachers and child welfare workers, because these professions need to collaborate in the real life situations of children, young people and their families. Educators from the relevant professions, students, practitioners, management and user organizations were involved in the course development, as previously recommended (Barr et al., 2016).

The pilot course

A pilot course was offered to 350 undergraduate students in Spring semester 2018 (Foss et al., 2018). Students attained the study programmes Early Childhood Education and Care, Primary and Lower Secondary Teacher Education, Physiotherapy, Mensendieck Physiotherapy, Nursing, Social Work, Child Welfare and Occupational Therapy. Students from the involved educations was presented for the same teaching, tasks, and syllabus. The pilot course was organised as a combination of traditional lectures (5 hours and 15 minutes in total, with each lecture lasting 30 minutes) and IPL groups (Table 1). After two days of seminars, the students were tasked with individually conducting observations or conversations with a child, collaborating at three 2-hour meetings, and submitting an IPL group assessment. Each IPL group consisted of a maximum of eight students representing study programmes in the fields of teacher education, health and social care. The following work requirements had to be approved: participation in a seminar over 2 days and individually conducted observation or conversation with a child in advance of collaboration in IPL student groups. The group work was completed by handling in a digital assignment through the learning management system (LMS) Canvas. The aim of the group assignment was to link the seminar days, coursework tasks and the syllabus. The students could choose between four different digital formats; written text, Pecha Kucha, digital story and podcast. Each IPL group elected a group member who submitted the group work through LMS Canvas. Staff, master students and professionals from the workplace were trained as supervisors through courses and information meetings. The supervisors assessed and approved/failed the assignments and gave individual feedback to their IPL groups. The assessment was a formative assessment (assessment for learning), and since there was no exams or grades, the course requirement was purposely easy to pass. The aim of the group work and the group assignment was ‘Learning for practice’ (Barr et al., 2016). The total provisional workload was 40 hours.

Table 1Overview over the pilot course and the revised blended learning course

 

Pilot interprofessional learning course 1, 2

 

Interprofessional blended learning course 1

 

Year

 

Spring 2018

 

Spring 2019

Students, N 3

350

1,401

The learning outcomes

‘Has a general understanding of childhood and of the processes of coming of age as a child or youth in a society characterised by social and cultural diversity; is able to explore the daily lives of girls and boys and their subjective perceptions in this regard; has a basic understanding of interprofessional work with children, youths and their families.’

‘The course is about a) acquiring common knowledge about children and adolescents and b) learning about the observation of children and adolescents.’

In addition, each topic had separate specific learning goals related to the particular topic.

The coursework requirements

  • Participation in two days of seminars
  • After the seminar days: Individually conducted observations or conversations with a child; Collaboration in three 2-hour IPL group meetings; Submission of an IPL group assignment
  • Participation in two days of seminars
  • After the seminar days: IPL group meet once if needed; Submission of an IPL group assignment

Learning design

Traditional plenary lectures (total time: 5 hours and 30 minutes) and IPL group work. Printed material was handed out (handbooks, compendium, etc.)

Blended learning structured as a combination of face-to-face, case-based small group IPL interactions and the use of digital learning materials (total time pre-recorded videos: one hour and 18 minutes)

The assignment instructions

‘Choose a heading. Use concepts from Bronfenbrenner's model and at least two to three other professional concepts / perspectives. Create a presentation where you connect the experiences of conversations / observations and the professional perspectives you have chosen.’

‘Choose one of the four relevant video clips. Briefly describe what you observe in the clip. Choose and discuss a minimum of three academic concepts and use these to analyse and discuss your observations from the video clip. Describe the similarities and/or differences between what the members of the various study programmes in your group find interesting in the video clip.’

Submission formats

Academic text (max 3,000 word), Pecha Kucha (20 pictures x 20 sec), digital story or podcast (10 min)

Academic text (max 3,000 words), podcast (max 10 min) or video (max 10 min)

The criteria

‘Show that you have initial knowledge of children, youth and growing up; Show that you show interest in children and adolescents' experience of their daily lives and can link this to professional perspectives and concepts; Show that you are referring to relevant sources (APA style).’

‘Show that you can use professional concepts in the analysis of observation; Show that you have initial knowledge of children and adolescents; Show that you can give examples of different professionals' views of children and young people; Show that you are referring to relevant sources (APA style).’

Syllabus

100 pages

100 pages

1 The total provisional workload: 40 hours; 2 (Foss et al., 2018); 3 Divided into groups comprising eight students from health, social care and teacher educations study programmes

 

The blended learning course

The first delivery of the IPL course in the blended learning format was offered to 1401 students in Spring semester 2019 (Table 1). The course was made mandatory to bachelor students taking health, social care and teacher educations study programmes at OsloMet: Early Childhood Education and Care, Primary and Lower Secondary Teacher Education, Physiotherapy, Mensendieck Physiotherapy, Nursing, Social Work, Child Welfare, and Occupational Therapy at OsloMet. The students were divided into 196 pre-determined IPL groups in autumn 2018 with a maximum of 8 students/group. The students preparedness for IPL ahead of the course (Almendingen, Molin and Saltyte-Benth, 2021) and the students course evaluation (unpublished data) will be published elsewhere.

Due to the nature of the implementation, the IPL course description was broad, allowing for adjustments to be made after the pilot. The pilot showed that conversations with children proved to not be feasible due to privacy regulations and the large number of students. Instead, the students had to learn about observation as a method through watching video clips. Moreover, the students would only meet once after the seminar days, if needed.

A case-based blended learning approach in small groups is considered a useful strategy for facilitating IPL since it integrates components of traditional face-to-face discussions with online learning (Curran et al., 2008; Bryan and Volchenkova, 2016; Lillejord et al., 2018). Student-active learning is used as an approach to actively engage the students in the learning process through collaboration and discussion rather than having them passively receive information from their instructors (Lillejord et al., 2018). A socio-cultural constructivist approach is said to facilitate the move from teaching as content delivery to more student-active learning with an increased learning outcome (Vygotsky, 1978; Lillejord et al., 2018). In line with this, it was decided that a blended learning, small group approach would be used in the 2019 delivery, provided through the LMS application.

The revised primary learning objectives (Table 1) and the specific learning objectives related to the individual topics (Table 2), were developed in dialogue with the different stakeholders in autumn 2018. All enrolled students were invited to submit suggestions for the revised 2019 course through a web link embedded in LMS (autumn 2018) in order to improve the learning outcomes and increase student satisfaction. All digital learning material was embedded in LMS together with the student tasks to be carried out. Some digital learning material were produced by staff and colleagues from related fields of work, while others were embedded from elsewhere, such as free online public videos located on YouTube (total time spent watching embedded videos: one hour and 18 minutes, each video should ideally not last for more than 4 minutes).

In the case-based IPL discussions, it was emphasised that the students should ‘play their future professional role’ and take note of each other’s perspectives. Table 3 illustrates how a free online video published on YouTube was used as learning material (Table 3). This particular video shows a dialogue between professionals after a mother has tried to commit suicide, and highlights relevant laws and ethics (Ministry of Children and Equality, 2017). Such case-based discussions did not have a ‘correct answer’ but were designed to challenge the students to question their own knowledge and motivate them to seek new understanding. This is a student-centred form of teaching, where the students’ learning needs are at the centre. The idea is to build knowledge for the future, and the immediate purpose is to create engagement among the students. Some of the IPL activities included a critical component where the IPL groups were asked to discuss a session through, for example, a ‘one-minute paper’, which prompted the students to reflect on their learning activities. The blended learning design was consciously structured so that it directed the students to complete learning activities that would achieve the learning objectives (Ministry of Education and Research, 2017b).

Table 2: 2-Day Seminar Schedule

 

Seminar day 1: ‘The same child - different arenas: childhood’ 1, 2

 

9:00

Welcome

Establish the group

 

Icebreaker activities

10:00

Break

10:15

Children and youths’ rights

 

Learning objectives:

  • is familiar with the role and responsibilities of the Ombudsman for Children
  • is capable of explaining the Convention on the Rights of the Child
  • is familiar with the right to participation and co-determination as established by the Ombudsman for Children

11:00

Break

11:15

Youth ‘nowadays’

 

Learning objectives:

  • be familiar with what Ungdata3 is
  • reflect on how to employ research results in practical work with children and adolescents 

12:05

Lunch

12:45

Social and cultural diversity

 

Learning objectives:

  • increased awareness of what diversity is 
  • increased awareness of why you must acquire knowledge about diversity to be able to exercise your future profession in the best interests of children and adolescents 

13:30

Break

13:45

What about the surroundings?

 

Learning objective:

  • is familiar with the different systems of the Bronfenbrenner’s model

14:30

Break

14:45

Recognition of children and youth

 

Learning objective:

  • increased awareness of the importance of recognition

15:25

Finish time

 

Seminar day 2: ‘The same child – different arenas: interprofessional collaboration’ 1, 2

 

9:00

Children as relatives

 

Learning objectives:

  • introductory knowledge of children as relatives
  • introductory knowledge of the consequences of a lack of collaboration between the professions for children as relatives
  • introductory knowledge of ethical dilemmas, the duty to provide information and duty of confidentiality as obstacles to interprofessional collaboration for children as relatives

9:45

Children and youth 

 

Learning objectives:

  • Introductory knowledge of interprofessional collaboration regarding children
  • introductory knowledge of the consequences of a lack of collaboration between the professions for children
  • introductory knowledge of ethical dilemmas, the duty to provide information and the duty of confidentiality as obstacles to interprofessional collaboration for children

10:35

Break 

10:45

Observation

 

Learning objective:

  • Initial knowledge of observation as a method

11:00

Lunch

11:30

Submission of group work assignment 

 

Learning objectives:

  • carry out observation (of children / youths in four video clips)
  • reflect on to what extent topics that have been thematised during the seminar days are actualised in these video clips
  • have good academic group discussions that are incorporated into the assignment for submission

14:45

Evaluation of the seminar days

15:00

Finish time

1 This exact time schedule over the two days of seminar in the blended learning course was shown in learning management system so that the student groups could work independently; 2 The parent learning objectives: ‘The course is about a) acquiring common knowledge about children and adolescents and b) learning about the observation of children and adolescents’; 2 Students worked in interprofessional groups (maximum 8 students/group from teacher educations, health and social care study programmes) thorough both seminar day without plenary activities; 3 Ungdata: is a cross-national data collection scheme, designed to conduct youth surveys at the municipal level in Norway, http://www.ungdata.no/English

 

Table 3: An example of student active learning in small interprofessional learning groups

Introduction: ‘Children as relatives’ 1

When adults or children fall ill, sit in jail, disappear etc., one must ascertain whether children under 18 years are affected - including siblings. Failure in collaboration between teachers, social care and health professionals can have very serious consequences for children and adolescents, even when they are relatives.

Therefore, you should learn about ‘children as relatives’ via this interprofessional learning course.

Learning objectives:

  • introductory knowledge of children as relatives
  • introductory knowledge of the consequences of a lack of collaboration between professions
  • introductory knowledge of ethical dilemmas, the duty to provide information and duty of confidentiality as obstacles to interprofessional collaboration

Time: 09.20-09.45 o’clock:

Watch this video clip together: https://www.youtube.com/watch?v=w_itC3Lx_6o&t=13s 2

Discuss 3: The video clip 2 describes a situation that forms the basis for interprofessional collaboration. Think as you would in your future professional situation, and reflect on the following:

  • How should you cooperate as a team to ensure that the child in the video clip feels looked after, and can thus contribute to and influence decisions that affect his everyday life?
  • Which ethical dilemmas does this video clip thematise?

1 This is a copy of a page module as it was presented to the students in the learning management system; 2 The case-based video shows a dialogue among professionals after a mother has tried to commit suicide, and has been developed by the Family Centre for Relatives (http://parorendeprogrammet.no/om-oss) and published on YouTube; 3Used as a starting point for interprofessional interaction as part of a, 45 minutes session entitled “Children as relatives”

 

Separate Canvas modules entitled ‘Seminar Day 1’ and ‘Seminar Day 2’ were published on the respective seminar days (January 2019), thus ensuring that the students had the same opportunity to prepare for receiving the content. Each page in Canvas had learning goals related to the particular topic, a short introductory text, digital learning material and student activation tasks (an example is shown in Table 3). The pages had easily recognisable symbols indicating activities. Icebreaker activities were also provided to allow students to introduce themselves and become more comfortable learning from, with and about each other (WHO, 2010). In December 2018, digital learning content was published through LMS Canvas containing the syllabus, additional learning material and practical information. The groups started work on their group assignment on the second seminar day after lunch and could either submit the assignment at the end of that day, or later if necessary. Students had learnt about observation of children and young people during the seminar. Students should for their assignment choose one of four different video examples of children. The group assignment could be submitted in the form of an academic text (max. 3,000 words), a podcast (max. 10 minutes, mp3 format) or a video (max. 10 minutes, mp4 format). The supervisors visited the IPL groups during the second day of the seminars. Supervisors (n = 64) were recruited from staff (n = 36), master programme students (n = 8) and professionals working in the field (n = 20). They were offered supervision courses and information meetings. Because some supervisors were unable to attend the seminars, facilitators (n = 10) visited their IPL groups. All groups had to receive a visit by a supervisor, and supervisors who could not participate during the second day of seminars were asked to meet with their IPL groups after the seminar days. Interaction between the IPL groups and their supervisors was complemented by email and/or telephone contact. No other major changes were made from the pilot delivery (Foss et al., 2018).

Campus logistics

To put the seminar days into effect, 122 rooms had to be made available in nine buildings at the Pilestredet campus during the first week of January 2019. The nursing students were based at the Kjeller campus (20 km outside Oslo city), while the others were based at the Pilestredet campus in Oslo city. Due to the geographical distance between campuses, transportation by bus was provided for the students from the Kjeller campus. Staff were posted at all entrances on the first day of the seminars in order to help the students with practical issues. Approximately 100 people (staff, hosts, facilitators, supervisors and others) were involved with different aspects of the seminar days.

Supervisor outcome survey

At the end of the course, supervisors were contacted by email and invited to participate in an anonymous online, specially prepared course evaluation. The questionnaire developed was based on earlier questionnaire-based quantitative research using an anonymous self-administrated web survey (University of Oslo, 2020). ‘Nettskjema’ is a Norwegian tool for designing and conducting online surveys with features that are customised for research purposes. It is easy to use, and the respondents can submit answers from a browser on a computer, mobile phone or tablet. The questionnaire was given feedback on by university colleagues and revised accordingly. The survey included questions focusing on academic content, the use of the blended learning approach in small groups and practical aspects of the course. The question was worded ‘how much do you agree or disagree with the following statements, where 0 means “never” and 5 means “to a great extent,” i.e. the responses were scored on a Likert scale from 0 to 5. Two reminders were sent.

Data analysis

Data from the supervisor survey were presented as frequencies and percentages with groups of participants compared by a χ2-test. All tests were two-sided and results with p-values below 0.05 were considered statistically significant. No adjustment for multiple hypothesis testing was applied as the study was exploratory. Statistical analyses were performed in SPSS v25 (Statistical Package for Social Science).

Ethics

All participants gave their informed consent to participating in the study. Participation was voluntary and anonymous. The questionnaire did not include questions about personal health information or sensitive data. Gender was not included due to the low number of male students. The quantitative data were collected through an anonymous web survey specifically designed to meet Norwegian privacy requirements (University of Oslo, 2020). Data protection was approved by the Norwegian Centre for Research Data (NSD) (reference number: 741649).

Results/Analysis

Supervisors’ evaluation

The response rate was 61% (n=39). Most of the respondents (56.4%) were between 41 and 60 years of age and had backgrounds in the fields of health and social care (43.6%) and teacher educations (56.4%) (Table 4). Most (69.2%) had supervised 2–3 IPL groups. The majority (69.2%) had met the students at the seminar, whereas 5.1% had not had any contact with them. Slightly more than half (51,3%) reported having had digital contact with the students, and 15.4% had met the students after the seminar days. More than half (53.8%) had been supervisors in the pilot course, 56.4% had completed the supervisor course, 41.0% were present at the information meeting, and nearly 90% had studied both the curriculum and the digital content in LMS.

Table 4: Characteristics of supervisors, N (%)

Variable

(N=39)

Age

    30 years or younger

3 (7.7)

    31-40 years

8 (20.5)

    41-60 years

22 (56.4)

    60 years or older

6 (15.4)

Educational background

     Nursing

3 (7.7)

     Physiotherapy 

1 (2.6)

     Primary and Lower Secondary Teacher Education

10 (25.6)

     Early Childhood Education and Care

6 (15.4)

     Occupational Therapy

1 (2.6)

     Child Welfare

6 (15.4)

     Social Work

2 (5.1)

     Social Education

2 (5.1)

     Other

8 (20.5)

Educational background

     Health and social care 1

17 (43.6)

     Teaching and child welfare 2

22 (56.4)

 

During the interprofessional course:

How many groups did you supervise?

 

     2-3 groups

27 (69.2)

     > 3 groups

12 (30.8)

Have you been a supervisor previously?

 

     Yes

21 (53.8)

     No

18 (46.2)

How did you prepare for the supervisor role?

 

     I took part in supervisor courses

22 (56.4)

     I attended the information meeting

16 (41.0)

     I learnt about the syllabus

34 (87.2)

     I saw the videos in Canvas

34 (87.2)

     I read the group assignments

32 (82.1)

     I read about the students’ coursework requirement

35 (89.7)

     I read the course description

32 (82.1)

     I received information from other supervisors

8 (20.5)

     Other

2 (5.1)

1 Physiotherapy, Nursing, Social Work, Social Education and Occupational Therapy; 2 Early Childhood Education and Care, Primary and Lower Secondary Teacher Education and Child Welfare

 

More than 60% of the supervisors considered the seminar days (both the digital content and the group discussions) to give the best learning outcomes (Table 5). In comparison, only 15.4% reported that the extra group meeting contributed to the best learning outcomes, and only 17.9% reported that the syllabus resulted in the best learning outcomes.

Table 5: Distribution of supervisors’ responses *, N (%)

Variable

(N=39)

The seminar days – the digital content

24 (61.5)

The group discussions during the seminar days

25 (64.1)

The group meeting after the seminar days

6 (15.4)

The submission assignments

12 (30.8)

The syllabus

7 (17.9)

The combination of everything

14 (35.9)

Unsure

1 (2.6)

* to the question ‘What do you think gave the students the greatest learning outcomes (you can tick more than one box)?'

 

In order to see what the supervisors were most satisfied with, we merged the two highest categories (score 4 and 5) in the items in Table 6, and the following ranking was achieved: 82.0% on ‘how the academic content corresponds with the work methods on the seminar days and the assignment for submission’; 81.0% on ‘giving individual feedback’; 77.8% on ‘student-active learning methods rather than lectures’; 67.8% on ‘timetable management’; 66.6% on ‘the assignment’s relevance to professional practice’; 66.7% on ‘cooperation in the IPL groups’ and ‘the assessment criteria’; 65.7% on ‘the content of syllabus’; 63.9% on ‘the academic content of the seminar days’; 59.4% on ‘the workload’; and 56.7% on ‘the level of difficulty’.

To the question ‘Do you think the academic content (both the seminar days and the assignment for submission) is relevant to professional practice?’ 92.3% of the supervisors answered ‘yes’ and 2.6%, ‘no’. A large majority (92.3%) assessed the academic level of the submissions to be ‘as expected’ (data not shown).

Table 6Distribution of supervisors responses *, N (%)

Question

0

1

2

3

4

5

Unsure 

How the content corresponds with the methods?

0

3 (7.7)

0

4 (10.3)

19 (48.7)

13 (33.3)

0

Timetable management?

0

2 (6.5)

0

8 (25.8)

7 (22.6)

14 (45.2)

8

Academic content of the seminar days?

0

1 (2.8)

1 (2.8)

11 (30.6)

14 (38.9)

9 (25.0)

3

Assignment text for the assignment for submission?

0

3 (8.1)

1 (2.7)

3 (13.5)

13 (35.1)

15 (40.5)

2

Assignment’s relevance to professional practice?

2 (5.6)

1 (2.8)

3 (8.3)

6 (16.7)

12 (33.3)

12 (33.3)

3

Content of the syllabus?

3 (7.9)

2 (5.3)

1 (2.6)

7 (18.4)

14 (36.8)

11 (28.9)

1

Assessment criteria for the submission?

3 (7.7)

2 (5.1)

1 (2.6)

7 (17.9)

15 (38.5)

11 (28.2)

0

Giving feedback on the submission?

3 (8.1)

1 (2.7)

0

3 (8.1)

16 (43.2)

14 (37.8)

2

Level of difficulty for students?

0

2 (5.4)

4 (10.8)

10 (27.0)

11 (29.7)

10 (27.0)

2

Workload for the students?

0

2 (5.4)

1 (2.7)

12 (32.4)

14 (37.8)

8 (21.6)

2

Cooperation in the groups

0

2 (5.6)

2 (5.6)

8 (22.2)

11 (30.6)

13 (36.1)

3

Student-active learning methods rather than lectures?

0

2 (5.6)

1 (2.8)

5 (13.9)

13 (36.1)

15 (41.7)

3

* to the question: ‘How much do you agree or disagree with the following statements, where 0 means “never” and 5 means “to a great extent”’: ‘All in all, how satisfied are you as a supervisor with’; Unsure = These are not included in the calculation of percentages

Discussion

Structural aspects

Through the present course, OsloMet has provided a large-scale complex blended learning course for the first time. The transformation of a traditional IPL course with plenary lectures for 350 students into an approach using blended learning with no plenary activities for 1410 students went well. The transition from two days of seminar with passive learning in large auditoriums into two days of seminar with student active learning in 196 IPL groups placed in 122 different group rooms on campus was therefore manageable on the structural level.

Although the start-up requirements should not be underestimated, the provision of future large scaled courses at OsloMet will be less demanding and more sustainable because the necessary procedures have been established at the structural level. This implies that we solved dominant issues related to previously recognised IPL barriers that originate from the discipline-oriented organisation of education, practical and logistical challenges, and the fact that cross-faculty activities require non-standard administrative and extra financial arrangements (WHO, 2010; Reeves et al., 2016). The involvement of different stakeholders most probably contributed to the present results. The strong support from the management and staff in connection with both the transformation and course provision was crucial, and financial, administrative and academic support made the boundaries easier to cross.

The educational trajectories of health, social care and teacher educations harbour different disciplinary professional identity, culture, tradition, syllabus (Borg and Drange, 2019) etc., all of which may act as barriers for shared learning in IPL courses. OsloMet seized the opportunity to make this IPL course a part of the response to the new shared requirements for health and social care education (Ministry of Education and Research, 2017a). Whether these reforms and pre-service IPL will achieve better services, better outcomes and reduced costs remains to be determined.

Technologically enhanced learning has been widely adopted in IPL (Barr et al., 2016). The combination of reusable digital learning materials and face-to-face IPL group discussions on campus turned out to be the preferable structural approach at our University. Achieving digital transformation requires deep changes to both structures and traditions, which takes time (Lillejord et al., 2018). No advanced digital functions or tools that could have jeopardized this first-time course provision were applied. It should be noted that pre-service technologically enhanced learning cannot replace practice-based learning. 

Outcome aspects – supervisors’ evaluations

Blended learning and learning outcomes

The present study indicate that the supervisors showed high acceptance of the blended learning approach. Three quarters of the supervisors were satisfied with the use of ‘student-active learning methods rather than lectures’ in the IPL course. The self-administrated timetable management via LMS was positively evaluated, as well as the digital content.

Overall, the supervisors responded that the students achieved the best learning outcomes from the face-to-face activities on the seminar days. The seminar days mainly consisted of face-to-face discussion in the IPL-group. Although supervisors were positive regarding giving individual feedback on the submission assignment, they ranged the learning outcomes from the submission of assignment in the mid-range. Some (20.5%) of the supervisors had arranged to meet their IPL groups after the seminar days in order to help them to finish the submission assignment. The learning outcomes were reported to be weak for this additional group meeting. Reading the syllabus is an individual task, and the learning outcomes were presumed to be weak. In general, it is difficult to generalise IPL outcomes from courses (Barr et al., 2016; Shrader et al., 2017; Lindqvist et al., 2019). However, these supervisors clearly favoured the face-to-face IPL discussions as compared to other components of the blended learning course.

Formative assessment

The present formative assessment criteria were broad, because the confusion of ideas between different professions is known to be a barrier in some contexts (Green and Johnson, 2015). It is very difficult to assess whether the present supervisors gave comparable tutoring, assessment and feedback, or in other words, whether their supervision varied according to their own professional background and experiences. The IPL course’s greatest strength, its interprofessional expertise, can therefore also be a challenge because the diversity of perspectives can lead to differences of opinion regarding how supervision, assessment and individual feedback should be provided. Formative assessment has been found to play a vital role in development and delivery of IPL (Morison and Stewart, 2005; Wagner and Reeves, 2015; Barr et al., 2016). Assessment approaches for IPL are varied, and best practices have not been identified (Barr et al., 2016; Shrader et al., 2017). More extensive use of built-in tools in Canvas, such as SpeedGrader with Rubrics, would allow the evaluators (supervisors and/or students) to use assessment criteria, systematised through rubrics, in their assessments. One previous study reported that common learning activities and assessment methods could be developed and common standards set, however that study was restricted to health professionals (Morison and Stewart, 2005).

 

Relevance

There is a considerable use of health and social care services that address children, young people and their families. The vast majority of the supervisors responded that the course was relevant to professional practice. This is a very positive finding since there is a need for better IPC in kindergartens/schools and the health and welfare services (Anderson, 2013; Power et al., 2013; Hood et al., 2017; Martinussen et al., 2017; GDB 2017 SDG Collaborators (2017); Fukkink and van Verseveld, 2019).

Some of the present students will not work with children and young people as pupils/students/patients/clients in their future jobs. Students often respond more positively, and more readily see relevance, when they are learning with professionals with whom they anticipate working after qualifying (Barr et al., 2016). However, parents may be hospitalized, imprisoned, etc., and thus all candidates probably will meet children and young people as relatives. Norwegian law states that health care professionals should ensure that such children and young people should receive adequate information and follow-up. Children whose parents are suffering from substance abuse mental illness, or somatic disease are at risk of developing psychosocial problems, psychiatric diseases, and somatic diseases (Jakobsen and Christiansen, 2011; Gullbrå et al., 2014; Knutsson et al., 2016). Society’s demands for better coordination of services for children and young people are increasing. This course is therefore relevant to all students taking teacher education, health and social care degrees.

Several of the participating study programmes are among the dominant study programmes in Norway. The results may thus also be relevant to other higher education institutions since curriculums in professional studies are strictly regulated. The experiences described here may thus have wider societal relevance.

 

The role of the supervisor

One qualitative study found that university teachers have a wide range of views about IPL, in terms of its potential to enhance collaborative practice and care, and its role in helping students to achieve outcomes linked to IPL (Lindqvist et al., 2019). The role of the ‘blended learning supervisor’ and the role of the ‘interprofessional supervisor’ most probably differ from the ‘traditional supervisor’ role. Future studies should investigate aspects of IPL supervision and the IPL pedagogy style in order to achieve the best possible learning outcomes for the students.

 

Strengths and limitations

This study has both strengths and limitations. Firstly, the number of respondents was low. However, the response rate was high, and supervisors from all the involved study programmes contributed. Self-selection bias may threaten internal validity, but the diversity in our sample enhances the robustness of the findings. Another limitation is the use of self-reported data. However, the master students and professionals working in the field could be considered external peer reviewers. Strengths include the anonymous sampling of responses and the high number of IPL groups. It is not possible to make firm conclusions based on one single exploratory cross-sectional study from one university. We are not aware of any other published studies that describe the delivery of a large scaled blended IPL course that include students from both teacher education, and health and social care study programmes.

Conclusion

Although further development of digital solutions and methodologies, pedagogics, methods for co-construction, evaluation forms and professional ethics are all needed, this first time delivery of the IPL course in the blended learning format went well. Supervisors were overall positive to the blended learning course delivery, and to use of student active learning methods rather than plenary lectures. The face-to-face IPL group activities was favoured over the rest of the course. Supervisors agreed that students received relevant pre-service training on working with children, young people and their families. Since curriculums in professional studies are strictly regulated, this study may be useful for educators in higher education extending IPL beyond health care.

Take Home Messages

  • Society’s demands for better coordination of services for children are increasing. Interprofessional collaboration should there be extended beyond health and social care professions to also include professions such as teaching
  • Students from teacher educations, health and social care programmes attained a new blended learning interprofessional course
  • Supervisors agreed that the course was relevant for interprofessional practice when working with children, young people and their families
  • Supervisors ranked the students’ learning outcome from the face-to-face activities the highest
  • Blended learning with student active learning methods is a feasible approach even in the context of large-scale interprofessional learning

Notes On Contributors

Kari Almendingen is a professor in clinical nutrition at Department of Nursing and Health Promotion, Faculty of Health Sciences, at Oslo Metropolitan University, Norway. She was the project leder of this project. ORCID ID: https://orcid.org/0000-0002-2485-2334

Jūratė Šaltytė Benth is a professor in medical statistics at Institute of Clinical Medicine, Campus Ahus University Hospital, University of Oslo and Health Services Research Unit, Akershus University Hospital, Norway. ORCID ID: https://orcid.org/0000-0003-4199-2272

Marianne Molin is an associate professor in nutrition at Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway. ORCID ID: https://orcid.org/0000-0002-9425-2414

Acknowledgements

The authors wish to thank the participants for their contributions to this work. They also wish to thank the academic and administrative staff at Oslo Metropolitan University. A special thanks to Ellen Margrete Magnus, the head of administration. This study was funded by internal OsloMet funding.

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Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

All participants gave their informed consent to participating in the study. Data protection was approved by the Norwegian Centre for Research Data (NSD) (reference number: 741649).

External Funding

This article has not had any External Funding

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