Saba Ahmed, Pharmacy Lecturer at Bradford College
During August 2020, I was tasked with updating course materials for the ‘Respiratory disorders’ lesson on the higher education (HE), BTEC Level 4 Professional Diploma in Pharmacy Clinical Services course that I teach at my local FE (further education) college situated in West Yorkshire. I am a dual professional, now mainly teaching HE science disciplines and occasionally undertaking locum work as a registered pharmacist to keep a hand in practice. Recently I completed the Level 7 Postgraduate Diploma in Education and Training, and I have started my second year in my teaching post. The course I teach on is for registered pharmacy technicians. It is a self-directed CPD (continuing professional development) course, delivered remotely, and it supports learners with clinical knowledge development as well as enhancing clinical skills. Courses such as these are vital to support registered pharmacy professionals in maintaining their CPD and are critical to revalidation. I will be using Brookfield’s critical lenses model of reflection (2017) to complete this reflection, in order to demonstrate how integral each lens is in the quality assurance aspect of course updates for HE healthcare courses when supporting NHS pharmacy teams in different settings. The four lenses are:
- own perspective (scrutinising this through the autobiographical lens by taking into account the previous experiences of the individual, their thoughts and feelings)
- theoretical perspective (assessing the incident to determine if relevant guidelines, policies and published research can provide further insight)
- peer lens (taking into consideration the advice and experience of more experienced colleagues and other professionals)
- student vantage point (giving the student voice an adequate platform, and understanding it from a learner experience).
As Gibbs (1988, cited by the University of Birmingham, 2015) puts it:
‘It is not sufficient to have an experience in order to learn. Without reflecting on this experience it may be quickly forgotten or its learning potential lost’ (p. 9).
Throughout my practice so far, I have found using Brookfield’s critical lenses (2017) over other reflective models, such as the Gibbs Reflective Cycle (1988) more relevant to teaching on healthcare courses. Even though, post-registration, many healthcare professionals may use the latter model, where it can serve as a reflective exercise to learn from a critical incident such as a dispensing error or a mistake in the administration of medication, it does not delve deep enough to factor in the student perspective for trainee/newly registered healthcare professionals undertaking HE courses, and does not accommodate wider contexts such as current guidelines and theoretical knowledge related to the area of practice in a concrete manner (University of Birmingham, 2015). The same can be expressed for other models that I have come across, such as Rolfe et al.’s ‘What? So what? Now what?’ reflective model (2001, cited in University of Connecticut, nd).
This model again asks key questions to help learn from a critical incident in order to understand the nature of the event/incident (What?), the impact of the said event/incident (So what?) and finally next steps required (Now what?), which are fundamental elements to ongoing CPD for healthcare professionals in practice and those undertaking courses to facilitate expansion of clinical knowledge. Yet it does not accomplish this in a detailed enough manner, where deep introspection should be undertaken using a multifaceted approach to enable learners to deliberate on how an incident could relate to identifying future CPD opportunities. Additionally, the other models don’t consider how incidents coincide with local or national guidelines, whereas the theoretical perspective of Brookfield’s reflective model (1995) challenges learners and teachers to assess issues from the vantage point of literature and guidelines published in the area. Other models, in my opinion, don’t go far enough to challenge individual healthcare professionals and lecturers teaching a science discipline to assess how their practice may have gaps in local protocols and national NHS agendas. Examining this in a broad sense, I would argue that the other models of reflection may be somewhat effective in gaining an insight into how course updates or assessments can be improved upon. There is a deficit, nonetheless, in appreciating how changes in practice and updates in theoretical knowledge for all disciplines should impact on quality assurance in course updates or day-to-day teaching.
Applying Brookfield’s model of reflection (1995)
The remainder of this reflective account will focus on how a rich reflection using the four critical lenses of Brookfield’s model (1995) was used as a quality assurance mechanism to improve course materials for the course on which I teach.
Reviewing this through the autobiographical and theoretical lenses, I realised that this course needed revising, as newer drugs in respiratory disorders had recently been licenced and the lesson needed to incorporate these to ensure that the students had up-to-date knowledge on the current treatments available.
Analysing this through the theoretical lens as a newly qualified lecturer, I ruminated on learning theories that I had learnt about as part of my studies for the level 7 PG diploma in Education and Training, mainly focusing on how constructivism, humanism and situated learning theory are quite central to my teaching practice. Updating course materials to reflect the current pandemic and how pharmacy professionals can help to dispel myths was something I wanted to concentrate on as a consequence. By making learning more connected to current events, the learning becomes much more relatable and relevant for students on any course. As an unintended side effect, the pandemic has offered this opportunity for all disciplines to revise learning materials.
Bearing this in mind, I constructed a case study for the online learning materials for the formative assessments, with questions set to portray how vital pharmacy professionals can be in educating patients and in tackling misleading social media posts. Such tasks, centring on situated learning theory blended with constructivism elements, help yield an improvement in clinical research skills and assist learners to reflect on what happens at the grassroots levels in clinical settings to generate advances in the area of clinical pharmacy service provision. By amalgamating different learning theories with clinical content from my own pharmacy practice, especially that stemming from my work at NHS 111, it helped me to formulate learning activities that enable significant learning to take place for the students in an authentic context. It informed how humanist and constructivist theories and aspects of situated learning theory could assist in the course renovations that I was in the midst of completing (Scales, 2008). Although this was probably something felt by all, with the myriad of difficulties associated with online teaching, I felt that time was in short supply for this aspect of my teaching.
I used the second case study in this course to emphasise the dangers of shisha use and its links to increasing the risk of acquiring serious medical conditions such as respiratory diseases and cardiac medical disorders (British Heart Foundation, nd). From my practice in my second role as a pharmacist, I have noted that this can often be overlooked and is worthwhile exploring and educating patients on, particularly in respect of younger patients.
Assessing the original course from the student perspective, I found from previous student evaluations that one website link was no longer functioning, and some of the students had remarked that they ‘would have preferred some visual resources to break the text in the lesson’, a sentiment shared from the peer perspective when the course lead agreed with this comment. Using Brookfield’s lenses, this facilitated a rich reflection from different perspectives, including the student voice being given an adequate platform. It served as a vital quality assurance measure to help me to revise the course (Brookfield, 2017). Armed with this knowledge, I then sourced reputable videos on asthma pathophysiology online to help make the lesson more visually stimulating. This supports learners who prefer more visual stimuli and is supported by researchers such as Roell (2019).
I garnered more from the peer perspective by sharing the first draft of the newly updated course with my course lead and fellow course lecturers. It added another dimension for effective checks in the quality assurance process for course updates at our local college. I was able to gather valuable feedback to help me edit the lessons, such as removing another website link that no longer worked, and to help restructure the pharmacological treatments used in respiratory diseases in a more succinct fashion within the online lesson materials.
Collaborative practice like this between peers helps to forge a strong sense of community of practice, which is important to foster in order to reduce the isolation felt from lone working as a lecturer (Kennedy, 2005), as experienced in August last year, when the guidance from my local FE establishment recommended teaching staff to continue working remotely where possible. The government guidance on COVID-19 restrictions last year was ever-changing, and locally there were variations. In the area in which I am based, the local guidance was more reflective of the local infection rates at the time.
Pre-COVID-19, my community of practice was based at the college, where I was able to seek advice on teaching and on course materials within the staffroom during breaks. Yet during the lockdown period, such readily available access to more experienced lecturers was difficult to obtain. Guidance for FE settings during the pandemic was not static, with my FE setting taking into account the high infection rates and thus the advice was to encourage all teaching staff to work remotely where possible. Our teaching team had to contend with challenges such as remote working and teaching using online platforms (with the bustling nature of busy homes and sometimes intermittent internet connections just a few of the obstacles that we all most likely experienced). We therefore had to wield technology to better effect in order to form a digital community of practice, where the hub of lecturers used Microsoft Teams and internal emailing systems, alongside WhatsApp and Telegram, to keep in touch and offer assistance on any issues. This provided much-needed valuable support, especially for those new to the profession such as myself. I was able to share my course updates with more experienced teaching staff so they could provide advice on where to make further enhancements.
Conducting a thorough analysis using different vantage points was of paramount importance to help ensure that I effectively updated the course materials. This is my second year of teaching actively, and scrutinising the lesson in this level of detail under different lenses was indispensable for the course updates aspect of my teaching practice. I hope that the newly revamped lessons are well received by all, and the new academic year will shed light on this and on any possible further tweaks required. Quality assurance measures should not be dismissed as a tick-box exercise because, in my opinion, they are essential to achieving quality improvement in education and in ensuring that courses remain current to reflect changes in practice, which is necessary for all courses.
British Heart Foundation (nd) Shisha. Available at: www.bhf.org.uk/informationsupport/risk-factors/smoking/shisha (accessed 4 July 2021).
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Gibbs G (1988) Learning by doing: a guide to teaching and learning methods. Oxford: Further Education Unit, Oxford Polytechnic.
Kennedy A (2005) Models of continuing professional development: A framework for analysis. Journals of In-service Education 31(2): 235–250.
Roell K (2019) The visual learning style. Available at: www.thoughtco.com/visual-learning-style-3212062 (accessed 3 July 2021).
Scales P (2008) Teaching in the Lifelong Learning Sector. Maidenhead: Open University Press.
University of Birmingham (2015) A short guide to reflective writing. Available at: https://intranet.birmingham.ac.uk/as/libraryservices/library/asc/documents/public/Short-Guide-Reflective-Writing.pdf (accessed 3 July 2021).
University of Connecticut (nd) Reflection models. Available at: https://edtech.uconn.edu/multimedia-consultation/portfolios/reflection-models/# (accessed 3 July 2021).