Action Research Project Cycle Two

EDC-638C Participatory Action Research

Cycle Two Report

REVIEW OF ACTION RESEARCH PROJECT

The problem that I have identified is the need to improve students’ ability to have a deeper understanding of concepts taught in Periodontology courses, and then demonstrate the ability to implement these concepts during patient care.  And, therefore the purpose of my action research is to learn how to increase students’ learning with a deeper understanding of the concepts being taught in the didactic courses on Periodontology.  The broad research question for this action research project is “can the incorporation of collaborative learning strategies improve students’ learning with deeper understanding?”

The initial question addressed in cycle one was “if students utilize a wiki to build, discuss and reflect on periodontal concepts presented in DEH-33 Periodontology will it result in a deeper understanding of the concepts addressed during this class?” This question required the assessment of the perceptions of the dental hygiene students and the clinical faculty on the students’ demonstration of periodontal knowledge and understanding during patient care.  Cycle one included the use of the wiki and the redesign of DEH-43 Periodontology curriculum using the Understanding by Design model.

The outcomes from cycle included the students’ acknowledgement that the use of the wiki was helpful for them to expand their knowledge and they enjoyed using it.  The use of the wiki to develop a site with evidence-based information on periodontal concepts and to develop cases allowed students to work collaboratively together but was only the first step of this process.  Its limitations could be a design flaws or inherent limitations in the use of wikis.  Therefore, I’ve decided to add an additional collaborative tool to cycle two to complement the use of the wiki.

The second and profoundly dramatic outcome was the lack of consensus of student expectations from clinical faculty who are assessing them each day in clinic.  This was not expected and became a focal point for consideration prior to designing and launching cycle two.  How can students’ performance be effectively assessed if faculty members don’t agree what knowledge and understanding the students should be able to demonstrate at this point in the curricula? 

 

TRANSITION FROM CYCLE ONE TO CYCLE TWO

Prior to the implementation of cycle two, I held three clinical faculty calibration sessions to discuss the expectation of the level of knowledge students should be able to demonstrate in clinic and to come to agreement on these expectations.  All clinical faculty participated and it appeared that all appreciated the opportunity to openly discuss concerns and student expectations.  At the conclusion of the last calibration session, it was agreed that clinical faculty members would participate in weekly discussions on Google groups to continue an open discussion on the expectations of students’ level of understanding.

 

INTRODUCTION TO CYCLE TWO

My goal and direction of my action research project has been consistent since its inception but what has changed is an understanding of the forces that affects the success of students. I did some further research to determine what other collaborative tools had been used with success in professional programs.  I found that the discussion boards have been used successfully with both faculty and peer facilitators.  Further research found that many dental schools have incorporated peer led learning groups due to the lack of faculty and have had some success with this process.  I have used peer educators in the past but the outcome was unpredictable.  Now that I have a clearer understanding of the impact of the course design on students learning and after having a lengthy conversation with a dental student who expressed the sense of empowerment he felt with this exercise, I have chosen revisit the peer led learning activities.

Cycle two continued the use of a wiki as a site for students to build a resource for periodontal concepts.  To complement the wiki development, weekly discussion board or in class discussion were designed around essential questions.   The last two components involve the continual use of Understanding by Design model for DEH-43 Periodontology and the assessment of students demonstration on understanding of Periodontology concepts during patient care.

The specific question for cycle two is “can the use of wiki as an ‘information gathering tool’ in conjunction with the peer and faculty lead discussion on a discussion board facilitate a deeper understanding of periodontal concepts?”

 

ACTION OUTCOMES AND RESULTS

Utilization of the Wiki Site 

The use of the wiki started from the first day that URL (http://deh43.wikispaces.com/) was distributed and has had a constant flow of students on it daily.  Students have been using this site more consistently than in cycle one. This wiki site is for their use and is not a graded assignment.  I feel this was a way for students to have an informal learning experience and it follows Paul Ramsden’s belief that “learning is interpreting and understanding reality in a different way. Learning involves comprehending the world by interpreting knowledge.” If was my belief that having the students do literature searches to find the latest research information and then sharing and interpreting it in a collaborative environment would strengthen their learning and understanding of the periodontal concepts.

In cycle one there was minimal traffic on the wiki and use by students between week two and week fourteen (two weeks prior to the end of the semester). In cycle two there has been 100% involvement by the students that is an improvement over cycle one.  This may be due to the students’ familiarity with using a wiki and the use of this site to prepare for the National Board Exam that took place on March 24, 2009. The students deepening understanding of concepts are evident on the wiki.  An example is when a paragraph was written on the wiki with inaccurate information from a non-peer reviewed source and two students question the information.  After this, four students found research that contradicted the original information and ultimately the original paragraph was rewritten to reflect current and accurate information.  They then went on to explain why the original information was incorrect and the consequences in patient care for using this information.

The average student visit to the wiki is 49 visits a week with a range of 110 to 1. The one visit being the week of the National Board Exam where the students had no periodontal assignments.  And, all students have been one the site each week. 

My general impression is that having the wiki being built as a reference site is an effective tool and has kept the students engaged in its use.  I have heard students in clinic referring their classmates to the wiki for an answer to a clinic question, which enhances its relevance to the students.  Is it facilitating a deeper understanding?  I believe it is by the understanding that is occurring to determine what information will be place on the wiki and the fact that its being used occasionally at chairside during patient care to assist the students in their treatment plans and treatment of patients.  I’m uncertain if I will ever be able to qualitative or quantitatively be able to assess the impact of the wiki on the students learning and deep understanding of periodontal concepts. 

The Utilization of the Discussion Board

The incorporation of the discussion board to answer essential questions was based on constructivism theory of learning.   The students were entering DEH-43 Advanced Periodontology with three semesters of dental hygiene knowledge and two semesters of Periodontology knowledge so their ability to build, expand, conceptualize and construct new, deeper understanding with their current knowledge is an example of constructed knowledge.  Constructivism also focuses on active student involvement. The desire to have active student involvement and with the feedback about on how a student felt empowered by peer led discussion board and class discussions, I decided to incorporate peer moderated and led weekly discussions on WebCT discussion board or in class discussions.  Periodontal topics were provided to the student to provide some direction. 

The outcomes of the discussion board were impressive.  Students pushed themselves to completely understand at topic.  The following is a discussion board posting where a student addresses the essential question and then incorporates her clinical experience to further her thoughts and then concludes with a high level of critical thinking through the asking of two pertinent questions. 

  My research indicates the use of antibiotics for the treatment of periodontal disease highly recommended as an adjunctive therapy to SRP. Antibiotics alone are not effective in the treatment of periodontal disease. The question is, what is more beneficial for the patient? Systemic antibiotic therapy or local delivery antibiotic therapy? Personally, I think it would depend on the patient. Are they on any other medications? This would definitely have an impact on which route to take. Medications can contraindicate other medications and have adverse reactions. In my research I found one study that showed there was no significant difference. In either routes of administration with tetracycline, another words, they were both effective.  Another study showed that amoxicillinvwas more efficacious than CHX as an adjunctive therapy. I believe this issue will be patient specific and medication specific. What microorganisms are we targeting, specifically, and does the medication target that species specifically? Would we need to do a microbial analysis on patients to be optimal in our treatment with antibiotic therapy?

Student Survey on Use of Wiki, Peer Moderators and Discussion Board

Six weeks into DEH-43 Periodontology the students were sent an eight question survey developed on Survey Monkey.  There was a 90% return rate on the survey.  The survey supports that the use of the wiki and discussion board has provided an avenue to transfer knowledge to a deeper understanding of periodontal concepts.  Here are some survey results to support this conclusion.

Question #1:Has the use of the discussion board to discuss periodontal topics in DEH-43 allowed you to expand your knowledge of the specific periodontal topics?

Question #2: Has the use of the discussion board to discuss periodontal topics in DEH-43 allowed you to deepen your understanding of the specific periodontal topics?

 

My observation of having a peer moderator for each weekly discussion seemed to allow students to be more open with the knowledge they didn’t have.  This allowed for the students to work towards providing clinical examples and/or references for the student to use to learn the knowledge that was lacking.  The students were questioned about the perceived benefits of using a peer moderator for the discussion. 

Question #6: Has having a peer moderate the discussion boards and in class discussion enhanced your obtainment of knowledge and deepen your understanding of the topics being discussed?

The majority of the students’ felt that having peer led discussions somewhat enhanced their acquisition of knowledge.  One student justified her response by stating, “Working together helps brainstorming come together more. I may think of something and point something out that someone else did not think of and vise versa and I learn a lot from this.” Two other comments regarding the need for faculty presents “Peers do amazing, but does need instructor guidance in some cases” and “I learn better when instructors on are discussion boards facilitating the discussion asking questions.”

Clinical Faculty Wiki and Discussion Board Deep Understanding Survey

Clinical faculty members continued to evaluate students’ ability to implement periodontal concepts into patient care.  The clinical faculty started the semester with a renewed sense of understanding and anticipation in what the students would be able to demonstrate in clinic.  The faculty continued to comment on the students’ enthusiasm and the student initiated conversations about periodontal concepts being discussion on the discussion board.

Did the faculty feel that the students were able to display a deeper understanding of Periodontology this semester when compared to last semester?  The clinical faculty members were sent a six-question survey through survey monkey to attempt to answer this question.   Nine surveys were sent and there was a 78% (7) return rate.  The following is an example of one of the questions asked on the faculty survey.

Question #2: The Class of 2009 have been able to demonstrate a deep understanding when determining the need for and the utilization of local delivery of antimicrobials including antibiotics during treatment planning and patient care? This question is related to students’ performance in DEH-40 only.

The responses to this question are representative of all responses to the survey.  Two of the faculty write that they have not had a scenario where the students they been working with had to utilize the information yet the answered “strongly disagree” that the student is able to demonstrate this understanding.  The results of the survey didn’t correlate with the faculty discussions on the google group site and triggered a faculty meeting to discuss the discrepancy.  This meeting brought to light that only two of the seven clinical faculty had incorporated the agreed upon expectations from the three calibration sessions. Therefore the discrepancy on clinical expectations remains a pivotal issue with this action research project.

REFLECTIONS

Cycle two lasted for only four weeks, which was half the time of cycle one, so it seemed to be over immediately.  My action research project is part of a course so the steps that have been initiated for cycle two will remain in place until the end of the semester. This will enhance my interpretation of the impact of cycle two. 

I find it’s easy to get caught up in students’ enthusiasm for the use of the wiki.  I continue to remind myself of what Dewey stated about the importance of finding an experience that will match the desired outcomes. "Hence the central problem of an education based upon experience is to select the kind of present experiences that live fruitfully and creatively in subsequent experiences" (Dewey).  I do believe the wiki is enhancing the transmission of knowledge to a deeper understanding but I don’t feel it can accomplish this independently.

My reflections on the outcomes of cycle two include the difficulties that I’m having separating my desire to find a solution to the initial problem of the action research project and whether what the actions I’ve implemented are directly affecting the desired outcome.  I believe I’ve assumed too much ownership in the success of this project during the process of cycle two. 

Additionally, during this cycle, I changed my focus somewhat from the designer to an observer of two groups: students and clinical faculty members.  I was trying to determine if the identified problem with faculty’s expectations had been resolved, at least to some degree.  It is evident that this is a continual issue.  I believe that this problem is a topic for a parallel action research project and will require many different cycles to bring the faculty together in philosophy and expectations of students. Until this happens, I believe the assessment of my current action research project will always be somewhat skewed.

The reflections on my actions during cycle two are mixed. I feel my frustration with the clinical faculty was evident and it resulted in a less than open communication. I believe this also connected with my weakness in listening to others as they are expressing their opinions. I need to learn to my role of administrator and return to the role of a peer to be embraced by the clinical faculty.  I’ve also found the opposite to be true with students. I can listen and be engaged with them for hours. This identifies a very important change in behavior that I need to incorporate for the success of this action research project and to strength my leadership abilities.