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Ralph E. Green
Royal Melbourne Institute of Technology
The program, Take Care! Chronic Blood Transfusion was the result of a collaboration between the two authors, one of whom was at that time working in the area of instructional design in the Education Unit at the Royal Melbourne Institute of Technology (RMIT) and the other Lecturing in the Department of Applied Biology there. Other members of the working party included the Director and senior members of the nursing staff at the Red Cross Blood Bank.
Take Care! Chronic Blood Transfusion was designed to be used in this course as an interactive video program in response to the identification of a number of concerns and issues, outlined below, relating both to the educational processes being used in different subject areas in the undergraduate Medical Laboratory Science degree course at the RMIT and also, more generally, to vocational education.
Changes in the funding basis for the course meant that it was necessary to re-evaluate the aims and objectives of many subjects and to determine the most effective way of teaching them. It was decided to employ a multimedia approach and to develop a number of instructional packages. The degree of self learning and student interaction incorporated in each package was determined largely by the aims and content of the subject material being covered. Another concern was the cost in terms of time and materials required to develop and produce each package.
For a first year introductory subject in Haematology it was decided to use a series of self instructional booklets and to follow a Keller plan approach to help students understand and assimilate their laboratory based work. The booklets were produced using ReadySetGo! and make extensive use of graphics. The professional presentation of the booklets will allow cost recovery from students who are required to purchase them as their course text.
A second year subject in Introduction to Immunology requires students to come to terms with many new and often complex concepts. The grasping of concepts is often facilitated by the use of diagrams and figures. Quite often animation is also helpful where there is interaction and subsequent change in the items of interest. The computer program HyperCard® has been used to develop a number of stacks on the various topics in this subject. Extensive use has been made of the graphics capabilities of the program and stacks are printed and provided to students as hand outs during lectures. The stacks are being programmed and will eventually be available for use in Computer Aided Learning.
The vocational issues related firstly to a need to categorise and define the essential elements which students are required to understand to meet their future professional requirements. As medical laboratory scientists they will frequently be operating as part of a team with other members of the health professions such as nurses and doctors. A way had to be found, therefore, to relate concepts and principles learned in the classroom to future on the job training in the laboratory. Another of the authors' concerns was to provide clear guidelines for teachers both of undergraduate and postgraduates as to the level and depth at which it was appropriate to present these topics to students and in what sequence, again with emphasis on the need for students to be able to recognise and apply their knowledge in practical situations. Yet another concern was the need to make more effective use of the limited teaching time available and to present the subject in ways which would encourage students to understand concepts and principles and also to become more self reliant in their approach to learning. The vocational nature of the subject obviously lends itself to the use of a problem solving case study approach and this is the approach that was decided on.
The National Heart Lung and Blood Institute in the United States had in 1984, awarded a Transfusion Medicine Academic Award to Brown University to examine the state of transfusion medicine teaching and the application of new teaching technologies. Under this award the Brown University team, led by Dr James Crowley, commenced the production of a number of interactive video programs integrating the use of computers and video. A number of videos in this series were obtained for evaluation, but, once again, the topic material and approach used did not suit our purpose.
Although these objectives may appear to be mainly concerned with the giving of information, the authors were also concerned to influence the attitudes of students towards their responsibilities. Studies in the United States (Sazama, 1988; Honig & Bove, 1980) have indicated that most fatal transfusion reactions result from the transfusion of ABO incompatible blood. In the vast majority of cases the cause behind the transfusion of ABO incompatible blood was shown to be human error involving mistakes in patient, blood sample and donor unit identification. All participants in the transfusion of blood (medical scientists, nurses and doctors) were guilty of such errors.
A practical guide to current procedures and practice had recently been produced by the Red Cross Blood Bank (Blood and its Products), and it was felt that it was desirable to reinforce and promote vigorously the positive attitudes to good professional practice outlined in this manual. This could be done by presenting some of the content of the manual within the context of a case study which would demonstrate the practical application of the principles.
The issues that concern us here, however, raise questions regarding the design of instruction. Although in hindsight, many of these matters appear clear cut, the working party experienced them at the time as complex and unclear. This is scarcely surprising since the processes of design fall into the category of problem solving processes and these are frequently ill structured in the case of complex and 'real life' problems (Jackling et al, 1990, in preparation).
For example, it was desirable that the nurses should have some understanding of what the scientists were doing with the blood samples in the laboratory but it was not necessary for them to have detailed knowledge. The doctors, on the other hand, would need a certain amount of detailed knowledge of these procedures, but not to the degree required of the practising scientist. Similarly, the scientists and doctors should be aware that there existed detailed procedures for setting up the equipment for transfusion without requiring to know the precise nature of the details.
Having made the decision to create a real life situation, the next decision was whether to recreate this with the help of actors or to use actual patients and medical personnel. The choice of the latter was made on the grounds both of cost and that the professional audience for whom the video was intended would be more likely to respond positively to a real patient and real personnel. Further, the program was conceived as a teaching performance rather than a dramatic re-enactment, and for this purpose, 'real people' were considered more likely to convince learners.
Following on this point, was the question of how to ensure that teaching (and learning) were, in fact, occurring? It would be easy for a group to view the case study in a fairly superficial way. It was decided to identify a series of crucial moments in the course of the patient's history. These might be 'critical incidents' or relate to important procedural questions. At these points, the action would 'cut', and with the signal Take Care! a question would be posed for the student(s) to discuss or take a decision on before proceeding to the next segment of the video.
This leads us back to the first design question. How much information should be included in the program? As the focus was on facilitating cooperation amongst the three groups, it was inappropriate to include large amounts of scientific and technical information, although it was recognised, that particularly for the scientists, the knowledge component was of central importance. Scientific and technical information, however, is better presented and learned through the printed word. So should additional information relating to transfusion be presented in the resource book?
The decision taken by the team, after considerable discussion, was that it would be inappropriate to burden the resource book, which was intended to be used as a work book by those using the program, with an excess of technical information. It was decided that the important focus of the program, was to trigger discussion within local settings of the issues highlighted in the video. The function of the resource book was to remind students of these questions and to provide a series of ancillary questions for discussion relating to these issues. Although the importance of the technical knowledge was fully recognised, it was seen as being the responsibility of whoever led the discussion groups, to provide access to such information within the local setting.
One of the interesting features of the experience of developing this program was the movement from the concept of a self instructional package to an open learning program or module. The main features of a self instructional package relate to its self contained nature. It offers instruction in a specific area, and it provides all the information required for the student to acquire the relevant knowledge and skills without recourse to outside resources. A self instructional package addresses itself to each unique individual and takes little or no account of the individual's environment. The very term 'package' suggests strongly that all that the learner needs is provided within the package.
Open learning, on the other hand, addresses itself to the learner within his or her environment and, equally, to groups of learners within specific environments. For the learning to be complete, the learner must use the information provided within the context of the environment. In the case of this program, the environment may be the undergraduate classroom where the student will have the benefit of the teacher's experience and learning. But it may also be the clinical setting of the hospital where it may be used by clinical teachers and supervisors who draw on their particular expertise and specific 'local knowledge' to encourage the students to develop their own structures of learning which internalise the concepts and principles in the context of the real needs of patients and the organisational pressures to cooperate with others to achieve the best outcomes in patient care.
Student feedback was very positive with respect to the case study approach employed. They found the program of value in showing some of the practices that take place in the ward at the time of a blood transfusion being given.
Their main interest was directed to the segments of the program which entailed activities in the blood bank. They responded well to the open learning environment created by the video as it allowed them to put much of their theoretical knowledge into a practical situation.
Because of class timetabling, there was a relatively short time available in which to use the program with students and it was only possible to view part of the program. To view the entire program would probably take at least three separate sessions for Medical Laboratory Science students. This time requirement may not apply to nurses or doctors who are viewing the program to gain different information. Using the program on a number of different occasions may be a distinct advantage and permit issues to be discussed again after time for reflection on various aspects of the case study.
Editorial Panel (1987). Blood and its Products. A practical guide to handling and usage. Red Cross Blood Bank. Melbourne.
Honig, C. L. & Bove, J. R. (1 980). Transfusion associated fatalities: Review of Bureau of Biologics Reports 1976-1978. Transfusion, 20, 653-661.
Jackling, N. et al, Problem solving in the professions (in preparation).
Sazama, K. (1988). Transfusion-associated fatalities reported to the FDA between 1976 and 1985. American Society of Clinical Pathologists Teleconference Series. March 8.
| Please cite as: Lewis, J. H. and Green, R. E. (1990). Chronic Blood Transfusion: A video and resource book to facilitate teamwork in the treatment of patients requiring chronic blood transfusion. In J. G. Hedberg, J. Steele and M. Mooney (Eds), Converging Technologies: Selected papers from EdTech'90, 152-157. Canberra: AJET Publications. http://www.aset.org.au/confs/edtech90/lewis.html |