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Cycle 1: The Art of Performance “A jazz performance centers on the process of creation.

The final objective is not only the finished product, but the path taken towards it.” - American saxophonist, Davie Liebman Action My approach to this question was based on the perceived inhibition of nursing and medical staff toward the use of online technologies for department training. While many colleagues are attentive during my Streaming Media Creation class, many fail to put their classroom learning into practice. Prior to joining my organization, I had no teaching experience. I would cover the terminology and material, demonstrate a “how-to” for using the equipment, and hope my colleagues would follow through. I decided to approach my classroom discussions differently based on what I saw as an indifferent attitude toward online training. As I began my research, open ended classroom discussions began to peel away the layers of the problem. Ultimately, the nursing and medical staff saw the promise of online training technologies, but also felt that they were not technologically savvy enough to create online training material on their own. While the classroom provided the appropriate base knowledge, it did not allow learners to, as author David Perkins states, “see the whole game.” (Perkins, 2009) This led me to shift my teaching focus from technology training to content development. I extended an invitation to those currently enrolled in the class, as well as those who had attended the class throughout the year. This invitation offered my full technological support, as well as the use of our organization's video studio, to create media presentations. The invitation came with two core responsibilities for the learners, which I defined based on Grant Wiggins and Jay McTighe's Understanding by Design: Know your content, and know your audience. (Wiggins and McTighe, 2005) I hoped that by allowing colleagues to work collaboratively in the studio, it would create and environment of legitimate peripheral participation to compliment the formal knowledge in the classroom. Case Studies • Aquilla

Aquilla has been a nurse for over 30 years. She is currently one of the registered nurses who heads our organization's bedside PICC team. A PICC line “provides the best of both worlds concerning venous access. Similar to a standard IV, it is inserted in the arm, and usually in the upper arm under the benefits of ultrasound visualization.” (“What is a PICC,” 2010) Aquilla, like many registered nurses, often overextends herself in an effort to provide optimal patient care. Therefore, it is difficult for her to provide effective troubleshooting during off hours. She came to me with a clearly defined problem: “We get too many calls from less experienced nurses who are unsure how to secure, flush, or remove the PICC lines. They call us during all hours of the night, and we'd like to create a resource for them to refer to. How can we do that?”

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Aquilla had unknowingly taken the first step toward creating an effective streaming media presentation: identifying a need. I advised her to enroll in my January Streaming Media Creation class to discuss it further and allow her to familiarize herself with the process. Early January can be a slow time for hospital staff, and due to time constraints and the technology covered, I keep my class sizes very small. As it turned out, Aquilla was the only person registered for my January class and we had the benefit of a one on one session to discuss her project specifically. I began by demonstrating the capabilities or rich media presentations, which are comprised of a video presentation window accompanied by a pane for other assets such as slides, images, and flash animations. (Figure 1.1) Fig 1.1

Aquilla began to exhibit the same apprehension and doubt that I had seen on the face of many learners over the past year. My approach was to simplify the language. I told her that her main focus should be on her message. What would you like your audience to learn? What do you think would most accurately convey your message? I asked her to take the software out of the equation, and think about how she would train someone who was standing next to her. These elements would define her training, and the software would simply act as a tool for delivery. She explained that she would like to create a powerpoint checklist for the care and maintenance of PICC lines, and accompany that with a visual demonstration of PICC line replacement. My response was simply, “I can do that.” I felt that this language placed less emphasis on Aquilla to be responsible for the production of her material. “I” can do that. “You” simply need to arrive prepared and with your goals in mind. I scheduled time in the studio for Aquilla and she arrived with an assistant carrying a hospital training mannequin, a bag of supplies, and a printout of her powerpoint slides complete with notes and a written script. She explained to me that she had timed her presentation and read her script over several times the night before. I set up the camera, sound, and lighting, and filmed her performance. Throughout the production, Aquilla showed no signs of apprehension and offered up ideas in regards to camera angles and

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the placement of other multimedia assets. By taking the technical reigns, it seemed as though I had relieved Aquilla of a burden and allowed her to focus on her message and participate in the technical aspects of production only as much as she was comfortable with. We created a balance. I was able to take responsibility for the production, but still allow her to feel as though she had creative control over her project. The result was a high quality product that she was ready to share with her department (Figure 1.2). Fig 1.2

Kathy

Kathy works for Medical Staff Services and is also the Continuing Medical Education (CME) Program Coordinator. She came to me with a unique problem. She wanted to capture and stream Continuing Medical Education lectures for physicians, but these lectures could not be pre-recorded in a studio as they happened throughout the facility with a live audience. We met to discuss the options and she was very worried about the responsibilities of running recording and capture equipment. Because Kathy welcomes physicians at the door and signs them in for education credit, she really felt that the burden of overseeing the production was too overwhelming. My solution was to discuss the different software interfaces available to her, and compromise. She decided during a pre-production meeting that the slide content and voiceover were the most important, so we chose to eliminate the video portion. I would go to the conference room, set up the equipment, and start the recording. Kathy would then be responsible once it was up and running. This allowed her to address her normal registration tasks as well as oversee the production. Once the meeting was captured, I would sync the slides in a software editor. Much like my experience with Aquilla, I chose a scaffold-ed learning approach that introduced Kathy to streaming media strictly as a content expert. She was responsible for the material as it was to be presented, while bearing very little of the technical burden. I

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did my best to assess her threshold for working with technology and let her operate just above it, in hopes that she would become more confident over time exploring ways in which streaming media presentations can enhance Continuing Medical Education programs. Kathy continues to play a role in the presentation design and delivery. She has utilized the software to attach documents and links to presentations, and has also expanded her use of streaming beyond regularly scheduled Continuing Medical Education lectures. She has recently overseen the production and online hosting of several symposiums and “special sessions,” and her utilization and involvement with streaming media continues to grow. I saw an opportunity with both Aquilla and Kathy. Like many of my colleagues, they both had a great working knowledge of their department's material and could envision a use for streaming media, but they were ultimately hindered by fear and apprehension about the technology. By shifting their focus to the material to be taught rather than the technology, I allowed them to uncover the benefits of online training tools on their own. This got them thinking about ways to build upon what they already knew about streaming media and to progress at their own pace. Research Cycle one reflects a redrafting of my initial research plan. When I began to think about my research, my focus was solely on the technology and how my colleagues should be learning it. The first draft of my plan failed to keep the ultimate goal in mind, which is to increase the use of streaming media as a clinical training tool. This cycle fits into my research as a stepping stone to a scaffold-ed learning approach. Previously, I was attempting to teach technology and send colleagues off with “pre-packaged” classroom knowledge that they could use in the field. My cycle one action allows for much more flexibility in their learning styles and also allows me to get to know each individual learner. By catering to the personal needs of each clinical department, I will be able to introduce project-based learning that demonstrates the capabilities of streaming media, as well as provides colleagues with knowledge of both the technology and its corporate processes. Evidence The evidence collected for my first cycle included observed behaviors by colleagues throughout the production process, as well as ongoing feedback from learners and their managers. Learners were asked to reflect on their experiences and whether or not they felt more comfortable creating streaming media presentations. I also observed the reactions from other department members and managers, and inquired as to whether or not they thought the online content added to their department training modules. From a quantitative standpoint, I collected publishing statistics from the organization's media management system. Using this system, I was able to extract statistics on the number of streaming media presentations published, the number of presentation views, who they were published for, and how many colleagues returned to create online material following their first experience. These numbers provided some insight as to how much, if at all, streaming media usage by clinical staff had increased.

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Returning to the story of Aquilla, our PICC line nurse, it's important to note that her specialized field is not one that requires her to create much online material. What she did do, however, had a remarkable impact on her department and their clinical training. The following is an excerpt of an email sent by her manager to her department and carbon-copied to me: "Congratulations to Aquilla and Angie for doing an awesome job in completing their video!! Aquilla and Angie identified a clinical problem in their everyday practice. Together they decided to create this video to increase staff awareness and improve the care and maintenance of the SOLO PICC and STATLOCK catheter device in order to prevent complications such as catheter clotting, site infections, and dis-lodgement. This video is part of their career ladder and will be available online for all staff to view!" As for Kathy, our Continuing Medical Education Coordinator, she represents a group of colleagues who may need a personal introduction to the technology in order to see how they can make it work for their departments. Kathy has become one of our most active streaming media users and currently records and publishes a weekly Continuing Medical Education lecture. She has also coordinated the online publishing of two full-day symposiums aimed at educating physicians. Figure 1.3 shows a sample of Kathy's publishing statistics for 2010. Fig 1.3

Presentation Title

Creator

Log-Ins/View s
4 6 4 2 5 7 5 6 3 5 11 4 3 3 4 2 3

FMC General Medicine Conference Series: 19 Jan 2010; Colder Than A... Kathy FMC General Medicine Conference Series: 26 Jan 2010; VTE… Kathy FMC General Medicine Conference Series: 02 Feb 2010; HepC Kathy FMC General Medicine Conference Series: 09 Feb 2010; Int. NeuroradiologyKathy FMC General Medicine Conference Series: 16 Feb 2010; Zoology Kathy FMC General Medicine Conference Series: 23 Feb 2010; Patient at Risk Kathy FMC General Medicine Conference Series: 02 March 2010; Knee Pain Kathy FMC General Medicine Conference Series: 09 March 2010; Infection ControlKathy FMC General Medicine Conference Series: 16 March 2010; Sepsis Kathy General Medicine CME Conference (Special Session) Kathy FMC Vascular Symposium - Best Treatment For Claudication Kathy FMC Vascular Symposium - W hat's Most Important? Kathy FMC Vascular Symposium - PAD Screening Kathy FMC Vascular Symposium - Imaging and Intervention Kathy FMC Vascular Symposium - Point/Counterpoint I Kathy FMC Vascular Symposium - Point/Counterpoint II Kathy FMC Vascular Symposium - Limb Salvage Kathy

Kathy's Continuing Medical Education team is still determining where on the intranet to promote these events, which explains why the viewership numbers are low. Figure 1.4 looks at presentations that depict a more accurate viewership sample.

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Presentation Title
Care and Maintenance of PICC Lines “The Inside Scoop” Employee Open Forum FMC Nursing Fashion Show March FMC Nursing Town Hall Life Directions: Strength Exercise Life Directions: Zumba Demo

Creator
Aquilla Scott Scott Linda Leslie Leslie

Log-Ins/Views
129 28 1648 268 501 640

Fig 1.4 Aquilla and Kathy represent a sample of colleagues who have utilized streaming media effectively in their departments. Presentations have been created for other clinical departments, as well as Human Resources, Benefits, and Corporate Communications. In many of these scenarios, learners began with a timid approach and began to become more active in the production process as it progressed. As one nurse, Terry, spoke of producing her “Coumadin 101” presentation, “It was very easy to handle the equipment and, in fact, I assisted last week in setting up the equipment for Dr. Davis. I believe you completed that slide show and streaming video too. He did it in a room all by himself which I found interesting. I have told many people of this capability.” She even spoke of plans to re-record the presentation in the studio because she felt that she could achieve better sound quality. It's this type of thinking that demonstrates a more production-minded attitude and indicates a higher level of engagement. In subsequent cycles, I will continue to record the feedback of colleagues and analyze publishing statistics. While it is less personal, overall usage data can be used to determine whether or not my actions are having a positive effect. If the goal of my research is to make learners more proactive in using streaming media technologies, a higher number of overall presentations would suggest that users are becoming more comfortable with the technology and are exploring different ways to use it. Figure 1.5 shows the total number of published presentations from the two months prior to my cycle one action, and compares them to the statistics gathered after the two month cycle.

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The overall use of streaming media saw a steady climb throughout cycle one. This was in part due to colleagues such as Kathy, who have found ways to utilize streaming and have become repeat users. In future cycles, I will focus on those who are not participating in an effort to uncover the reasons why. Analysis/Reflection My cycle one action was a vital first step in my research that forced me to examine our entire streaming media training process. The process was implemented prior to my date of hire, so I never really had to think about its effectiveness. I simply viewed it as “just the way it's done.” My series of actions are aimed at combating inaction. Our training is designed to empower colleagues to use streaming media in their own department training programs. However, further observation showed that the training was not meeting that objective. I wrestled with several actions before deciding to invite users into the studio to produce online content with my assistance. There were several reasons for this decision. First, as Jean Lave and Etienne Wenger point out, “To take a decentered view of masterapprentice relations leads to an understanding that mastery resides not in the master but in the organization of the community of practice of which the master is part.” (Lave and Wenger, 1991, pg 94) Our streaming media department had not yet established a sense of community. The streaming solution offered little support beyond the training class and was not an inviting environment for newcomers. When colleagues left the class, they felt that they were alone in their endeavors and became less proactive because there was no

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community to provide insight or accountability. Second, after studying the theories of Seymour Papert, I began to explore a social constructionist approach. My initial idea for a cycle one action was centered around group activities in the classroom. I wanted to pair up the learners and have them create a presentation together using the software. My theory was that they would generate new knowledge based on their collaboration and differing experiences with technology. Something about the idea didn't quite fit. The final concept that tied it all together came from David Perkins. Perkins wrote that, “Some versions of problem-based learning, project-based learning, and so on can be too loose, especially as learners get started. The learners need clear, worked-out examples and strong guidance, gradually faded back.” (Perkins, 2009, Pg 36) This tied directly to the scaffolding approach that I had considered earlier, but with a much broader scope. I realized that I was limiting my possible actions by confining them to the training class. If I really wanted to utilize the theories of Lave, Wenger, Papert, and Perkins, I needed to step outside of the classroom and create an environment where legitimate peripheral participation, constructionist learning, and “making learning whole” could coexist. The action of inviting colleagues to create a purposeful presentation in a real world setting with effects and implications that mattered to them helped create a learning community that hadn't existed. Furthermore, the events that transpired helped level the playing field and let others view my role as that of a collaborator, rather than an instructor. The fall semester classes introduced me to a number of learning theorists and allowed me to refine my thoughts about learning and what it meant to me. Seeing as the only formal streaming training that existed in my organization came in the classroom, I was free to create activities that catered to each learner individually, assuming they demonstrated enough interest to participate. In his book Making Learning Whole, David Perkins (2009, pg. 53) poses three questions:

• • •

What is one thing you understand really well? How did you come to understand it? How do you know you understand it?

Asking myself these questions proved to be the foundation for my action. When I began my career in media, I was hired as a technician for an audio-visual production company. I had studied film and video editing as an undergraduate student, but had no experience in live event production. While I didn't know it then, the production company granted me access to my first professional community of practice. I worked events with lead technicians, sound engineers, and lighting designers, and as time progressed I was given more responsibility. Soon, things that had caused me problems in the past became second nature. Reflecting on my own experiences learning about technology, I realized that the best way to train colleagues to create online content was to recreate a similar community of practice where newcomers could gradually be exposed to various aspects of production in a familiar corporate setting. The response to my first cycle has been somewhat surprising. A handful of colleagues have really inspired me through their ambition and hard work. I'm reminded of Vygotsky's zone of proximal development, because what my colleagues can accomplish with my help has not only helped them better understand the technology, it has allowed me to use their clinical knowledge to step out of my own comfort zone and think about new ways to incorporate streaming media into clinician practice. Prior to my

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action cycle, I thought of myself solely as a classroom instructor, but I have more recently begun to develop ways to work with clinicians outside the classroom environment to form a stronger community. By exposing learners to what I do, and becoming more familiar with what they do, we can address ways to move our organization's streaming media program forward, rather than limiting the capabilities by limiting the learning experience. Next Steps My first cycle is an ongoing process, because new colleagues and opportunities to introduce newcomers to the streaming community will continue to exist. For my second cycle, I will look at ways to generate interest among those that have not yet participated. I'm hoping that open ended discussions with clinical staff will provide some insight as to how to move forward.

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