Back in class for the undergraduate midwifery students in our new blended learning programme

I have been blogging about the development and progress of our new programme for undergraduate midwifery education. Class of 2009

This photo graph and article appeared in the Otago Daily Times during our first intensive in January.

Our new programme has a longer academic year than our previous programme, beginning earlier in the  year and finishing later. Instead of being divided into two semesters our new programme is divided into three trimesters. Each trimester begins with the students coming together in class for two weeks of sharing, learning, doing class presentations (which are part of the assessment processs) and having some face to face lectures.  It is really good to see everyone back together. We all know each other quite a bit better and there is an air of cammeraderie and friendship.

How is it going?

We decided to get some feedback from the students about how the programme is going for them. What is working well and what they feel needs to change.

Yesterday the students got into groups and discussed this then fed back to the class. This is what I took out of this discussion.

It was overwhelmingly postive. The students said they are enjoying the course and the online learning. There were only one or two who said they felt they would prefer to be in class and have lectures, most are more than happy with being able to engage with the learning resources when they want to and in the way that suits them.

Online resources:

Feedback on the online learning resources was very positive. Most like this way of learnign and enjoy the quizzes and activities.  They have aparticular topic that they cover each week and are given a list of questions related to that topic to investigate and discuss in the Elluminate session later in the week. The students wanted the questions to be posted at the same time as the modules.

Online quizzes

The learning resources are interspersed with quizzes and case studies to make the students think and to improve the learning experience. Most of the students enjoy these althous some acknowledge that they feel now compulsion to do them and so do not bother.  They felt it might help if the Quiz had to be completed before progressing on with the module and this is something I am going to look into. They particularly liked doing the crosswords but some of the quizzes were less useful. In particular they mentioned a memory game that I had set up so I will not bother with that one again. I have had trouble getting crowwords to work for me so I will have to find out how I can do this from those that are managing to get crosswords up. I was told Hot potatoes was a good programme for this and I have tried but have not managed to master it yet. I have done some lovely crosswords in Eclipse but i cannot get them to load properly so that the students can use them. These activites are formative assessments which are recognised as an integral part of online learning and so it is important that we find ways to help the students engage with these to improve their learning and the retention of the material they are covering.


We use Elluminate for weekly class tutorials which the whole class can attend online. Again most really appreciate this and find these tutorials useful the questions that have been put to them in the online learning for the week are discussed here. A couple of students said they would prefer video conference . There was also some discussion about the possibility of having a class session for those in Southland and Dunedin who can attend while doing the same think on Elluminate for those who cannot attend or prefer to be online. This would be very tricky I think as there is alot for the lecturer to consider in facilitating an Elluminate session, text chat, voice chat and running the material on the white board screen. I think trying to manage this online and face to face at the same time would be too difficult and we do not have the manpower to run session twice.

Some students are very willing to discuss issues in Elluminate, some prefer just to text. some said they would be happy to speak face to face but do not feel so confident online. They wanted to point out that if they do not speak it does not mean that they are not engaging or learning. Some just like to sit and listen and learn. This is very similar to the classroom situation and it seems to be the same people who are happy to talk in class that are the ones who are happy to speak online. The lack of body language cues was discussed as a disadvantage.

Practice skills

The students are really enjoying the midwifery practice experiences they are getting. They are aware that thsi is much more than the previous students had and they really appreciate this. I had hoped that some of the skills assessment would be able to be done in an actual clinical setting with the midwives in practice but this is proving very difficult to achieve. The midwives feel a bit threatened and overwhelmed by these skills assessment forms and this is not happening so we will have to go back to doing this in the class room setting.

Small group tutorials

The students really like the small group tutorials and most feel that these are working really well for them, helping with the course work and learning and providing an opportunity to debrief and learn together.


Overall it seems that the programme is working well for the students. I would like to try to do something to help them engage more with the formative assessments we have in place and will look into the idea of making these compulsory to complete before moving on. At least for some of the quizzes. I think the change to doing some of the skills assessment in the weekly face to face session will be positive. I have been reluctant to do this previously as it would be outside the topics time tabled for the week and was worried that this may confuse the students but I think they can all see the rationale and I think this will work. It is very pleasing that this feedback was so postiive. We also gave the students a questionnaire to complete and that is being analysed. It will be interesting to see if these results are any different to this feedback.

Pedagogical strategies for distance learning

I came across this article ” Pedagogical strategies for building community in graduate level distance education courses” By Eileen McElrath and Kate McDowell, assistant professors in library information services. McElrath and McDowell describe the importance of community to learning and present Brown’s 15 step process to community building in online classrooms.  These steps are, from 1 to 15, tools, comfort level, self assessment and judgments, similarities, needs met, time allotted, supportive interaction, substantive validation, acquaintances/friends, earning trust and respect, engagement, community conferment, widen circle, long term/personal communication, camaraderie. These steps occur in three stages, making friends online, community conferment or acceptance and camaraderie.  They suggest that these processes are facilitated when modeled by instructors and go on to describe strategies which can support this community involvement and shared learning.  Supporting the students in developing a sense of community helps to prevent student isolation. It helps to keep the students motivated and interested in the course. It creates a sense of belonging, that members of the group matter to one another, which has been identified as important for academic success.  The strategies suggested not only help the students to relate to one another, and gain a sense of community, but they also help the students identify the relevance of the course content to their own personal experiences as well as the experiences of their classmates.

Maslow’s hierarchy of needs explains the processes required to reach a state of self actualisation. The basis for this is a sense of safety and security.  This is also important for online learning or distance learning. Supportive interaction is an important part of establishing an online community. Students need to learn how to learn online, they need guidance and support to do this. As they are coming to terms with this new way of learning they need reassurance and ‘reminders to be kind to themselves’ during the course. The distress that can be associated with technology failures, which are bound to occur from time to time, can be alleviated by acknowledging this possibility early in the course and having a back up plan for when these issues occur, both for the facilitator and for the students. In a course that I was involved in, Facilitating online learning communities, several of us had established a network on skype, when we had trouble with the elluminate programme, through which we were connecting as a class, we were able to instantly talk to one another and share what information we had about what was happening. Students also started to use the discussion forum in a synchronus way and established another means of communication through this mechanism. This certainly reduced our anxiety and annoyance with the process and helped me realise the importance of back up communication, whether that is another online source or a cell phone network, anything that facilitates communication when things are not going as they should.

McElrath and McDowell suggest creating a course chat section where students can readily ask any questions in an open format, as they would in a face to face class, allowing other students to share in the discussion and offer their suggestions as well as receiving feedback from the lecturer. They go on to suggest some activities where students can share their own experiences in terms of the course content which can relate to the course outcomes and form a basis from which the students can not only share stories but learn the realities associated with the theoretical components of the course. The entire article is well worth a read for anyone involved in distance or online education.

So how to do I see this applying to the work I am doing at present, establishing a midwifery practice course with a blended learning format. Students will be enrolled in this course, which is part of the entire undergraduate programme being developed in a blended format. Students will not just be based around the confines of Polytech but will be in  groups, some in Dunedin, some in Invercargill and perhaps also in the Central or north Otago areas. The entire class will come together four times a year for a couple of weeks each time and the groups will meet face to face for half a day a week for tutorial support and some learning. The rest of the course content will be online, most of the theoretical components will be learned at a distance. Although the students have regular small groups with whom they can interact on  a regular basis I believe it is important that they also share a sense of identity with the larger class group.

In face to face teaching we often start the session by asking who has experienced this? And start the group discussion from there,  moving on to the theory behind the topic. For example with blood pressures I will ask if anyone has had their blood pressure taken. Has anyone found this to be a painful experience, have they had unanswered questions when their blood pressure has been taken. We then use this as a basis to learn the important aspects of taking blood pressure. I think we could do this online through a discussion forum. We could  use the responses to establish a basis for learning about estimating and recording blood pressure. This is a constructivist approach to learning and the authors of this article suggest that we should be open about this. Students should understand about constructivism and how this applies to their own learning needs. Most midwifery practice skills would be suited to this approach.

I could write more but it is late and I am tired so may return to this another time.

E Learning for midwives

In my roll as a midwife in a rural facility I have been enrolled in a course which is completely online. This is the first practical midwifery course I will have done in this way. It is about breast feeding and human lactation and is an international course for lactation cunsultants. I have bogged more about this in my midwifery blog. I am interested in this not only for the course content which will be useful for my midwifery practice, I hope, but also to see how the course is constructed. It has been deveoped using the moodle platform.

Blended learning in midwifery education.

Do we really understand the potential?

I have been looking at this video. Wouldn’t this have been a great conference to be at? How exciting that we are entering a new era of midwifery education at this time and potential that is there for us and our students, as long as we leave the doors open enough to be able make the most of what the world wide web has to offer. As Myles says the virtual world has a lot to offer but needs to stay connected to the real world. We can do that, we can make the most of both!

Flexible learning: it is not just about distance (Collins, Moonen, 2001)

This is a review and critique of readings (Collins & Moodie, 2001) for week one of the Designing for flexible learning practice course .

Learning to learn

Image from: Miffdesigners photos at

This reading outlines what is meant by the term “flexible learning” . This term is often confused with online learning or e-learning (Khan, 2005), although delivery may be a component of some courses delivered in a flexible manner it is only one of many ways in which flexibility can be achieved. Flexible learning is learner centred and allows students greater flexibility in their learning experience. Flexibility can be achieved in a variety of ways. Consideration can be given to flexibility of time for course work and timing of assessments. There may be flexibility in the content where a loose structure allows students to explore. There may be flexibility around the entry requirements for a course or how and when a course is delivered. Course material may also be delivered in a variety of flexible ways. The degree of flexibility that can be achieved in any course will be individual to the particular course and the expectations of outcomes for the students. Flexibility can provide increased opportunities for those who would otherwise find study difficult to achieve, those with young families who would find full time study difficult, those who are employed full or part time and are unable to attend regular classes or those who live at a distance from the place of learning (Collins, 2001). People with a particular disability may also find this type of study more do-able. Collins et al. suggest that the underlying factor governing the success of a flexibly delivered course is the culture and support of the institution. Various ways of making the content and processes of a course more flexible are discussed and also the restraints that may influence the degree of flexibility that can be achieved. A formula for is presented in chart form with x and y axes. X is the degree of flexibility and Y is the goal of the activities. The tighter the angle the less flexibility can be achieved, more of the course content is material delivered to and acquired by the student. The looser the angle the more flexibility can be achieved. In this instance learning occurs through participation and contribution to group learning and less is through material which is delivered. Acquisition therefore leads to less flexibility and participation leads to more flexibility. Knowles (1991) suggests that adult learners learn best by participating as opposed to passively acquiring information. Learners need a higher level of self motivation when participating in flexible learning. Some students may find the degree of self direction particularly challenging and may require individual strategies to help them achieve. Instructors in this type of course need to be responsive to the individual needs of students. Flexibility for the student also means flexibility for the instructor who may be able to also be more flexible in their working hours Collins et al suggest that the instructor could respond to students at any time, even at home with a cup of tea in hand. Greater flexibility for students is a challenge for institutions not only in the complexity of providing resources to enable greater flexibility but also in the challenge of supporting students and staff who feel that change is being forced on them and resist change. Staff may not be willing to be so flexible in their hours of work.

I am already familiar with many of the aspects of flexible delivery as our institution Otago Polytechnic have been moving towards greater flexibility in delivery of courses for several years now. Since I have been employed here, over the last 5 years, the School of Midwifery have made significant changes to the way the course is delivered and further major change is due to occur next year. We will be merging with Christchurch Polytechnic school of midwifery and working in an entirely new curriculum which has been developed over the last couple of years in consultation with Christchurch. This course will involve students living at a distance from the institution and a larger component of online delivery. We will retain face to face delivery of essential components of the course. A small core of staff from both schools have been working on the new curriculum but the hard work of putting this into action is just beginning now. In preparation for this I enrolled in Facilitating online learning communities and now this current course Designing for flexible learning practice. I am motivated, interested and keen to learn about technology and its use in supporting flexible learning for our students. I am not sure that this is so for all staff and I foresee many challenges ahead. As components of the course are being delivered online, currently through blackboard, some students have expressed concern and anxiety about the level of self directed learning involved. With support students have managed to cope and usually change their thinking about the online component. Students enrolling in a course where they understand a large proportion is delivered at a distance may have a different perspective and expectation. The added value to the student needs to be identified. At the moment I feel that the success or failure of this venture will rest heavily on the willingness of the staff to go the extra mile. I am concerned that there may be a presumption of cost saving in an exercise such as this, where in fact the evidence, including this reading, suggest it may actually cost more in financial terms (Collins et al, 2001)

I am also interested in making courses that we currently run for registered midwives more widely available through open access to the course material. I would like to see us offer greater support to midwifery in the developing world through access to open course material. To this end I have made contact with a midwife overseas and hope to be able to work on a joint venture in time which would see courses for continuing professional development for midwives being made available in open access format that will benefit midwives locally and internationally. I have established two midwifery wikis. One is more general information on midwifery and the profession and practice of the midwife and the other is a wiki supporting midwives collaborating in second life.


Collins, B., Moonen, J. (2001) Flexible learning in a digital world. Open and distance learning series. London: Kegan Page Ltd.

Khan, B.H. (2005). Learning features in an open, flexible, and distributed environment. AACE Journal, 13(2), 137-153.

Knowles, M. S. (1990). The adult learner: A neglected species. Houston: Gulf Publishing Company.