Using wikis to promote
the personal and professional development of
undergraduate medical students:
a report for the CETL ...
This project has been funded by the CETL Fellowships funding at the CETL in Developing
Professionalism, University of Live...
Using wikis to promote the personal and professional development of UG medical students
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Executive Summary..................
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Executive Summary
Introduction
T...
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Facilitators and barriers
Facili...
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Drawing attention of students to...
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Key terms and abbreviations
Key...
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1. Introduction: professionalis...
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Wikis, the technology used in t...
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possibilities offered by wikis ...
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2. Aims
The research questions ...
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Each wiki was pre-structured bu...
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4. Findings: the learning conte...
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Figure 3 Students' range of lea...
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This response indicated a narro...
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Figure 4 The group wikis set up...
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Students also posted book refer...
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5. The benefits of using wikis ...
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Figure 7 The two main benefits ...
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“Professionalism is hard to fin...
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5.2 Wikis as online spaces for ...
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Developing identity through onl...
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of makes me reluctant to use th...
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6. Teaching & learning, technic...
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technology, both in terms of an...
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of wikis (2008). In line with o...
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Key points – Group work and sha...
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Students saw whole year-group w...
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Key points – Professional ident...
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i.e. if the wiki was updated, s...
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the pilot, small-scale nature o...
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It is not yet clear without fur...
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growth and structure, i.e. how ...
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Key points – Managerial issues
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7. Project summary and outcomes...
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professionalism to which studen...
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There were a number of facilita...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
Using wikis to promote the personal and professional development of undergraduate medical students:  a report for the CETL...
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Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism

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Using wikis to promote the personal and professional development of undergraduate medical students:
a report for the CETL in Developing Professionalism.

Cite this report as:
Dangerfield, P; Varga-Atkins, T with contributions from Bunyan, N; McKinnell, S; Ralph, M; Brigden, D and Williams D (2009) Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism. Liverpool: University of Liverpool.

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Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism

  1. 1. Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism February 2009
  2. 2. This project has been funded by the CETL Fellowships funding at the CETL in Developing Professionalism, University of Liverpool. Website: http://www.liv.ac.uk/cetl Project leader: Dr Peter Dangerfield spine92@liverpool.ac.uk School of Medical Education University of Liverpool, Sherrington Buildings, Ashton Street Liverpool L69 3GE Phone: 44 (0) 151 794 5502 Project researcher: Tünde Varga-Atkins tva@liverpool.ac.uk Educational Development, Centre for Lifelong Learning University of Liverpool, 128 Mount Pleasant, Liverpool L69 3GW Phone: 44 (0) 151 794 1180 With contributions from: Dr David Brigden, PBL facilitator Nick Bunyan, Learning Technologist Dr Steve McKinnell, PBL facilitator Martin Ralph, Blackboard and Learning Technology Coordinator Dr David Williams, PBL facilitator Cover design: Robin Sellers Wiki logo design: Paul Duvall Acknowledgements: We would like to thank the contributions of all those 2007/08 first-year undergraduate MBCHB students at the University of Liverpool who took part in this pilot and offered their own time to give feedback. Please cite this report as: Dangerfield, P; Varga-Atkins, T with contributions from Bunyan, N; McKinnell, S; Ralph, M; Brigden, D and Williams D (2009) Using wikis to promote the personal and professional development of undergraduate medical students: a report for the CETL in Developing Professionalism. Liverpool: University of Liverpool.
  3. 3. Using wikis to promote the personal and professional development of UG medical students 5 Executive Summary......................................................................................................................................7 Key terms and abbreviations ......................................................................................................................10 1. Introduction: professionalism and web2.0 technologies .....................................................................11 1.1 Originality.........................................................................................................................................13 1.2 Scope and limitations of the report...................................................................................................13 1.3 Report structure ...............................................................................................................................13 2. Aims ...................................................................................................................................................14 3. Methodology......................................................................................................................................14 4. Findings: the learning context.............................................................................................................16 4.1 Student engagement in the wikis......................................................................................................18 5. The benefits of using wikis for students’ development of professionalism ..........................................21 5. 1 Wikis as a shared resource and knowledge-base..............................................................................22 5.2 Wikis as online spaces for developing identity as a professional........................................................24 6. Teaching & learning, technical and managerial issues of using wikis....................................................27 6.1 Teaching and learning issues.............................................................................................................27 6.2 Technical issues ................................................................................................................................32 6.3 Managerial issues .............................................................................................................................33 7. Project summary and outcomes..........................................................................................................38 7.1 Project summary...............................................................................................................................38 7.2 Project outcomes..............................................................................................................................39 8. Conclusion and recommendations......................................................................................................43 8.1 Recommendations for the development of professionalism..............................................................43 8.2 Recommendations for the future implementation of wikis ...............................................................43 8.3 Further research ...............................................................................................................................44 9. Project impact ....................................................................................................................................45 References .................................................................................................................................................46
  4. 4. Using wikis to promote the personal and professional development of UG medical students 6
  5. 5. Using wikis to promote the personal and professional development of UG medical students 7 Executive Summary Introduction The purpose of the study was to introduce wikis in a problem-based learning context and explore how this web2.0 technology may be used to enhance medical students’ learning in a blended environment, especially relating to their development of professionalism. Aims The research questions were: to what extent the use of wikis can enhance student learning in the area of students’ personal and professional development; what are the facilitators and barriers to student learning in professional and personal development, in particular, those associated with the use of such technology? Methods The use of wikis was piloted with four first-year problem-based learning groups (32 medical students) at the University of Liverpool. The study took an interpretivist approach gathering qualitative data in the form of focus groups and a small-scale survey on the perceptions of the participants as to their self-assessed impact of the pilot on their personal and professional development. Triangulation of methods involved both students, as well as their facilitators, in the data collection, combined with online system statistics. Transcripts of the focus group sessions were analysed using thematic content analysis. Findings The problem-based learning (PBL) groups were an important part of students’ learning, both academically and socially. Students displayed a range of collaboration patterns in-between PBL sessions, including offline and online modes such as informal chatting, using online social networks, email and phone calls. Students demonstrated a range of engagement patterns in the wiki, some posted contributions, some only viewed others’ posts and some did not log on at all. Students most frequently posted web links to the wikis. Benefits There were two main ways in which wikis were beneficial to medical students’ learning in a problem- based learning context: Wikis acted as a shared resource and knowledge-base with students being able to share their identified learning resources which answered their identified learning objectives on personal and professional development in-between their face-to-face sessions. Wikis promoted students’ development as a reflective professional by having to think about the quality of resources that they contributed to the shared wiki space. This reflection, in turn, then had the benefit of creating an online identity, which promoted students’ sense of developing professionalism through interacting in a more formal, online space.
  6. 6. Using wikis to promote the personal and professional development of UG medical students 8 Facilitators and barriers Facilitators and barriers which influenced student engagement with the wikis have been identified as: Those students who were more aware of what the purpose of wikis was, were more likely to engage with them. The trusted, safe environment of private, small-group wikis was seen more conducive to student participation than large-group wikis, as students claimed to be more confident in making postings to a private wiki. Positive group dynamics were an important indicator for students’ engagement. Members of effective groups were more likely to share their resources both face-to-face and online. As no one wanted to be the first to post in a wiki, a wiki pre-populated with some resources and links on personal and professional development was seen as encouraging to students. Confidence in one’s own information skills facilitated engagement. Where students were unsure about the reliability or the quality of the resource they found, they were less likely to post it. Some students found their current methods of learning ‘good enough’. They lacked motivation to use wikis in order to share their learning. A number of students found the wiki tool’s interface as ‘plain’ and ‘boring’, especially in comparison with online networking sites such as Facebook. This directly hindered their engagement. More importantly, the lack of alert-function in the examined wiki tool meant that students were not notified when new postings were made in their group wiki. This made it more difficult for students to engage; students were used to the comfort of their online social networking sites (Facebook) alerting them about group member activities. Hands-on demonstration of the wiki tool was preferred to written guidance. The history function of the wiki was less known to students. This knowledge may have helped those less confident in making contributions when they were unsure about the quality of resources to be posted. Scalability The report highlighted a number of issues with regards to scalability of the pilot. These included: Access and privacy: who has read/write access to the wiki? The remit of the wiki: what is the remit of contributions? Wiki lifecycle: can future students use the wiki and its contributions? Wiki functionality: what functions does the tool have? Support needs and resources: how to balance benefits versus support needs? Recommendations A set of recommendations on the future implementation of similar projects included: Making pre-loaded resources on professionalism available in the wikis, where possible, quality-assured by staff. Introducing the various purposes of wikis to students (from sharing resources to discussion/questions forum) and negotiate their use based on their preferences as awareness of purpose seemed to increase engagement.
  7. 7. Using wikis to promote the personal and professional development of UG medical students 9 Drawing attention of students to how participation in online collaborative spaces may be relevant in their future career, e.g. by introducing them to other online professional spaces and showing them examples of practitioners communicating online. Considering other wiki tools which have an alert system, a user-friendly interface and flexible access-rights functionality. Considering a two-level wiki which consists of small private group areas and a joint year- group area. Creating a trusting environment to overcome the issue of student confidence when posting to the wiki. Further research The study has also identified further areas of research including: The benefits and issues that may arise when the pilot is scaled up to a whole year group; the benefits and issues that may arise when students use wikis over successive academic years in the form of a long-term study; the role of the moderator in the wiki; the appropriateness of other tools which may serve a similar purpose to wikis (e.g. social bookmarking). Project impact The study has contributed to the scarce evidence-base on the use of web2.0 technologies in medical education and identified both practical issues for the future implementation of similar projects as well as further areas for research.
  8. 8. Using wikis to promote the personal and professional development of UG medical students 10 Key terms and abbreviations Key terms Problem-based learning Problem-based learning in this report refers to a student-centred method of learning in which students collaboratively solve problems, identify their learning objectives, seek and evaluate relevant learning resources and reflect on their experiences. Professionalism Defining professionalism would be the remit of a whole project. Thus without attempting to offer a finite definition, professionalism will be used to refer here to the individual who possesses the knowledge and skills that enables them to join the medical profession as well as a high standard of work ethics, behaviour and attitude. One essential characteristic of a ‘professional’ is their ability to reflect on their own learning, attitudes and behaviour. Web2.0 tools/technologies Second generation web (or web2.0) tools or technologies are user-centred tools based around collaboration and sharing. Examples include multimedia sharing sites (YouTube, Flickr), social networking sites (Facebook), wikis and blogs etc. Wikis Wikis are web2.0 tools; they are public or private websites that allow the non-technical user, or groups of users, to write, edit and update web content easily. Wikipedia is one example of a public wiki. Abbreviations CETL Centre for Excellence in Teaching and Learning ICT Information and Communication Technologies PBL Problem-Based Learning
  9. 9. Using wikis to promote the personal and professional development of UG medical students 11 1. Introduction: professionalism and web2.0 technologies This chapter introduces today’s healthcare context and the role of professionalism, describes what web2.0 technologies, especially wikis, are – together with the rationale for the study which tests the use of wikis in the development of professionalism with medical students. It describes the originality of the study, its limitations and the report structure. The purpose of the study was to introduce wikis in a problem-based learning context and explore how this web2.0 technology may be used to enhance medical students’ learning in a blended environment, especially relating to students’ development of professionalism. Professionalism has an important role in the current healthcare context. Today’s medical students not only need to acquire knowledge and skills but also develop professional attitudes and behaviour (GMC 2001, 2003), and so acquiring a new identity as a doctor or medical professional (Wagner et al 2007). Practising professionals are increasingly employing and relying on technologies that share patient information, interacting with institutional computer systems, seeking information or participating in online communities for their own professional development. Recent years have also seen a greater emphasis on collaboration in the UK healthcare system, with healthcare being delivered through practitioners working in teams with their own and other professions. These changes towards the importance of collaboration have been taking place in parallel with the advent of a new group of technologies, also called as ‘web2.0’ tools (Figure 1). Figure 1 Examples and characteristics of web2.0 tools ‘Web2.0’, or ‘second generation’ tools: are highly collaborative; are easy-to-use; users do not need to have technical expertise or web design skills; include social networking sites (e.g. Facebook, MySPace), wikis (e.g. Wikipedia), blogs (web diaries), social bookmarking (e.g. del.icio.us) etc.
  10. 10. Using wikis to promote the personal and professional development of UG medical students 12 Wikis, the technology used in this study, are one example of web2.0 tools. Wikis are collaborative websites. They allow a public or a private group to collaborate on web content, documents and multimedia resources and build up a shared resource to which all the group members can contribute. An important feature of a wiki is its history function, which displays users’ contributions in chronological order, with an option to revert to previous versions, if necessary. All these features make wikis a potentially useful tool for student learning. The rationale for this study was to pilot the use of a particular web2.0 technology, wikis, in medical education. The characteristics of medical undergraduate students, the curricular context of problem- based learning and the nature of wikis all converged to this end. Various current research dealing with today’s generation of students (also called the ‘NetGeneration’) has found that students rely heavily on the web and information technologies both in their studies and, even more so, in their social lives (Conole et al 2006). A recent survey revealed that over ninety percent of students use social networking and about fifty percent are users of blogs and wikis (JISC/IPSOS MORI 2008). That online social interactions take central place in students’ lives has been shown by other studies too (see e.g. Sandars and Morrison 2008). This is further evidenced by the growth in the use of these web2.0 tools in the last two years (Kennedy et al 2008). The problem-based context in which this study was introduced is based around students negotiating their own learning objectives, needing to draw on their information literacy skills in locating, synthesising and evaluating resources to fulfil these objectives. Students then integrate these with their prior knowledge and share their understandings within their problem-based learning groups. Learning about professionalism (at least at the location of the study, the University of Liverpool) is one explicit strand of these identifiable learning objectives. As Cruess and Cruess (2006) argue, much of learning about professionalism is based on socialisation and interactions with the peer group being an important source of learning for these students (Sandars and Morrison 2008). The principles of interactions, socialisation and peer collaboration are essential characteristics of web2.0 technologies. Studies have also shown that students are more likely to employ these tools in their social interactions and are less aware of their potential for their studies (Trinder et al 2008; Boulos et al 2006). How wikis may benefit students’ learning has been described by other studies. One such study argues that the collaborative nature of wikis, i.e. that students can edit and comment on pages created by others, facilitates group work in an online environment (Doolan 2007) and these peer contributions help students by ‘regulating one another’s learning through online technologies’ (Boulos et al 2006). Learning about professionalism requires students to think critically, reflect, make links and structure their ideas. Studies have found that the asynchronous nature of the tool as well as its organically growing structure, which students need to manage, can be linked to increased reflectivity (Nicol et al 2005). In the context of this study focusing on students’ learning about professionalism, students would not only see where others are up to in their own thinking through their wiki contributions, but how others develop theirs, jointly constructing their understandings around themes of professionalism. Thus, introducing web2.0/wiki technology in a problem-based learning context seemed pertinent in exploiting the collaborative potential of this online tool, as well as responding to the cultural gap between students’ and their educational institution’s use of web2.0 technologies (Trinder et al 2008). In particular, McGee and Begg (2008) recognised the
  11. 11. Using wikis to promote the personal and professional development of UG medical students 13 possibilities offered by wikis for students to add information and materials relevant to their own learning aims to small group wikis and hence to contribute to their learning. 1.1 Originality Although the use of wikis is getting more and more widespread in teaching and learning, their use has been mainly reported from disciplines other than medical education (such as architecture, engineering, media etc.) (e.g. Rick and Guzdial 2006). The originality of the proposed study was due to the lack of research evidence available from within medical education on the use of wikis. The study aimed to close this gap. It aimed to combine the strengths of this technology for the pedagogic context in medical education and make available the valuable lessons learned not just about how ICT can enhance student learning, but how such methods can be effectively designed and delivered to students. Whilst the project offered insights into the use of wikis in a medical PBL context, other disciplines which also use PBL may also benefit from this approach. 1.2 Scope and limitations of the report This report aims to capture the outcomes of introducing the use of wikis in a first year medical context. It reports on an innovative and experimental pilot during which a range of data was collected and analysed to ensure the rigour of findings. Nonetheless, the report and its findings are constrained to some extent by limitations such as the small scale of the pilot as well as the relatively short timescale in which it was conducted. In this sense, the hope is that this study has been able to illuminate the various opportunities and issues that can, and have, arisen through the introduction of such innovative technologies. Whilst the authors are also mindful that the technology employed is constantly evolving. 1.3 Report structure The remaining chapters of the report is organised as follows: Chapter 2 – describes the aims of the study; Chapter 3 – introduces the methodology; Chapter 4 – elaborates the learning context; Chapter 5 – summarises the benefits of using wikis in student learning on professionalism; Chapter 6 – details the various teaching and learning, technical and managerial issues of the implementation, with special reference to the scalability of the pilot; Chapter 7 – summarises and discusses the project findings; Chapter 8 – concludes the study with recommendations; and finally, Chapter 9 – highlights project outcomes.
  12. 12. Using wikis to promote the personal and professional development of UG medical students 14 2. Aims The research questions of the project were: • to what extent the use of wikis can enhance student learning in the area of students’ personal and professional development; • what are the facilitators and barriers to student learning in professional and personal development, in particular, those associated with the use of such technology? 3. Methodology The use of wikis was piloted at one institution, the University of Liverpool, where problem-based learning (PBL) sessions provide the main vehicle for medical students to acquire the knowledge-base of the ‘core curriculum’. Students each week had to identify a set of learning objectives from their problem-based scenario related to personal and professional development (PPD), which they then needed to research. Figure 2 A problem-based learning session - identifying learning objectives The study was carried out with ethical approval from the University. Four PBL groups involving 32 first-year medical students were selected on the basis of the facilitators volunteering to take part. Once the facilitators’ and the groups’ approvals were received, a group-wiki was set up for each group on the aspects of personal and professional development for each PBL scenario under discussion.1 The wiki tool used for the project was TeamsLX, the tool available in the institutional virtual learning environment, Blackboard. Each student was introduced to the project at the first PBL session in the second semester. They all received a printed guide describing how they could use and interact with the tool. One wiki was set up for each module and group so that only the group’s members and the facilitators could access the wiki. Students used the wikis to share resources or ask questions relating to these learning objectives on professional development (they also had the option to relate them to the other strands of objectives such as ‘structure and function’ etc.). 1 Each two-week module is based around an imaginary clinical scenario, from which the PBL group derives learning objectives. From each scenario, students are expected to identify learning objectives under the four curricular themes - Structure and Function (SF); Individuals, Groups and Society (IGS); Population Perspective (PP); and Professional and Personal Development (PPD).
  13. 13. Using wikis to promote the personal and professional development of UG medical students 15 Each wiki was pre-structured but students were informed that they could develop their own structure should they wish to. Due to the short timescale of the pilot, the use of wikis involved a discrete medical learning scenario (from conception to birth) spanning a four-week period in their second semester (Feb-April 2008). This meant that two wikis per group were set up initially. As the wiki pilot was extended for a further three modules until May 2008, a further three wikis were created for each group. With such a small, exploratory study it was important to look, not for immediate changes in students’ assessed performance, but at their views, attitudes and behaviours about their own learning experience. Hence the study took an interpretivist approach using qualitative data to inform developments in the use of the tool as well as collect perceptions of the participants as to their self- assessed impact of the pilot on their personal and professional development. Tutors’ perceptions as to the professionalism-related learning outcomes of students were also collected and compared with those of students. Triangulation of methods ensured that research findings were checked against one another by involving both students and tutors in the data collection, combined with system statistics on the use of the tools (such as access and student contributions). Each participating student was given a brief questionnaire at one of the PBL sessions with a confidential return envelope. Altogether eight questionnaires were returned (25% response rate). A focus group session, with a free-lunch incentive, was arranged at which students could return the questionnaires and discuss their project experiences. Eight students took part in the focus group, predominantly from one PBL group. This may have showed some bias in that the participants were amongst the keenest who also worked well as a group (see Section 6.1 on group work and sharing). In order to boost data collection and minimise this bias, the other groups were also followed up and three further, brief, focus groups were set up with the participating student groups in March/April 2008. A follow-up focus group with two of the groups were arranged at the end of May 2008 so that student reflections could be gained after a more extended period of wiki use from the participating students. Interviews were also conducted with two of the three tutors who facilitated the participating PBL groups in order to gain their perspectives on the student learning experience and project outcomes. The focus group sessions were transcribed. These transcripts and the qualitative survey data were all analysed using thematic content analysis. Frequency tables of the survey data were also prepared. Being mindful of the limited response rate and potential bias in representation, this small-scale quantitative data has therefore only been used as illustrative of student experiences in the project complementing the qualitative analysis.
  14. 14. Using wikis to promote the personal and professional development of UG medical students 16 4. Findings: the learning context This chapter contextualises the research findings by describing students’ learning patterns and perceptions of professionalism and concludes with the project findings in terms of how students engaged with, and interacted in, the wikis made available to them. It was important for the research to locate students’ experiences with this new technology by placing it in the context of their overall learning experience. Therefore, the study gathered data on students’ learning patterns within the problem-based learning context, which also included their online behaviour within and outside the course requirements. Since the purpose of the study was to look at how the use of web2.0 technologies may enhance students’ learning on professionalism, students’ perceptions of professionalism were also elicited. Finally, online observation of how the different student groups engaged with their wiki is summarised. All these contextual data served as the basis for the discussion and analysis of project outcomes in subsequent chapters. The students’ learning experience is considered first. With regard to the first-year students who took part in the pilot study, the problem-based (PBL) learning group to which they belonged, seemed to be an important part of their learning experience. Not only educationally, but through the social bonds, friendships that they have made were important in providing a safe, trusted learning environment where their confidence as university students and would-be-professionals grew. Students frequently mentioned that these peer-group interactions were particularly useful at the initial stages of their course when they were ‘feeling their way’ around the university, “double-check*ing+ yourself with the group as you go along” (Focus Group 3). Students also talked about developing various strategies and patterns of learning in the first semester, which helped them with the shift from school to university. These included working out which resources were useful to consult, including resources in the institution’s virtual learning environment, Blackboard: “It’s like you know *that+ for S+F *structure and function+ you use this textbook, for PPD [personal and professional development] you use that textbook, use the internet for this, then you do that and it’s just getting … your efficient habits.” Focus Group 3 As far as collaboration between the problem-based learning sessions was concerned, students’ behaviour tended to vary. Some collaborated in various forms with one another, whilst others did not necessarily draw on members of the group. Those who collaborated tended to do so via face-to- face and online methods, the latter including social networking, email, telephone and instant messaging. Sharing resources, such as web links and books, were predominantly an unplanned and incidental aspect of these personal interactions, both face-to-face and online (McGee and Begg 2008).
  15. 15. Using wikis to promote the personal and professional development of UG medical students 17 Figure 3 Students' range of learning patterns in-between PBL sessions One way that students interacted and shared resources online was setting up online social networking groups in Facebook2 for their PBL group; this was particularly the case in the first semester when social bonds were forming. Out of the four PBL groups in the second semester, when the pilot was conducted, only one formed an online social network on Facebook for their group. A recurrent theme was how students differentiated between their social and academic (“work”) lives and did not like the two to get mixed up with one another: “if with PBL when you are sharing information, you are just sharing it. But if it’s *VLE/wiki+ like, it seems like it’s work!” Confirming the findings of other studies (e.g. Trinder et al 2008), this study’s students also preferred to keep their social and academic spheres separate. They preferred to interact socially in their unmonitored, informal online social networks and conduct their academic learning – anything “work-related” – in the institutionally provided space of the virtual learning environment: “I would be more likely to put things on that [wiki] or look at [the wiki] the same time as going on VITAL to check my emails because it is work. On Facebook, I just want to check what other people are up to or talk to other people.” (Focus Group 1) As far as students’ ICT (information and communications technology) context was concerned, most students claimed that they were relatively confident with ICT and most had their own PCs or laptops. Students’ perceptions of professionalism were also elicited in the study. The small-scale survey data showed that students claimed to understand the concept of professionalism in general and in medicine, and understood what personal and professional development was. They also viewed the problem-based learning process positively in that it raised their awareness of professional development and, in the majority, their interest in ethical issues. Focus-group discussions elaborated the picture of their perceptions. When asked about what professionalism meant to them, students responded with a few typical answers such as: “careers. What’s the role of GPs. Job descriptions.” 2 http://www.facebook.com
  16. 16. Using wikis to promote the personal and professional development of UG medical students 18 This response indicated a narrow view of professionalism, i.e. the boundaries of job roles and career paths. Other students had a more formed, complex view of professionalism (Jha et al 2006), such as: “Professionalism is the process of tackling daily activities in a serious manner alongside the application of the related principles, laws and ethics of the profession.” (survey response). In one instance, a student articulated: “Professionalism is not something you can learn over the internet. It’s a social skill. It’s a lifestyle.” (Focus Group 1) These different perceptions of professionalism could be attributed to the different strategies that students employed in their learning about professionalism. Those students who mainly identified professionalism with the learning objectives related to personal and professional development, which tended to be job roles, seemed more likely to have a more narrow interpretation of it. Whilst other students, who associated professionalism with other aspects of their medical career such as attitudes, behaviour and interactions had a more developed, holistic view of it. Key points – Findings: the learning context The problem-based learning (PBL) groups were an important part of students’ learning, both academically and socially. Students displayed a range of collaboration patterns in-between PBL sessions, including offline and online modes such as informal chatting, using online social networks, email and phone calls. Students preferred to keep their social and work spaces separate. Therefore, when it came to ‘doing work’, they did not want this to encroach in their private online social networking spaces; they were happy to work in the institutionally provided wikis and virtual learning environment. Students demonstrated a range of perceptions with regards to professionalism, from seeing professionalism as purely concerned with job roles, through to more developed understandings. What follows next is a description of project findings with regards to how students engaged in the wikis which were set up for them on a voluntary basis. 4.1 Student engagement in the wikis A private wiki was set up for each problem-based learning group for each of the two modules, which spanned four weeks (Figure 4).
  17. 17. Using wikis to promote the personal and professional development of UG medical students 19 Figure 4 The group wikis set up for each module in Blackboard (TeamsLX wiki) This was then extended on an optional basis to include a further three modules (for a further six weeks). Students were provided with a ‘how-to guide’ on using the wikis, but interestingly, they tended to find out how the wiki worked on a basis of trial-and-error. Due to the short lead-in time available in the pilot, it was not possible to do a hands-on demonstration for each group. Some students found wikis easy to use, whilst other students did not find them as straightforward. There were also a number of students who initially did not see the purpose of using the wiki for their learning. Students displayed a variety of attitudes in terms of their interactions in the wiki. Some posted items by editing their group’s wiki pages, some only viewed others’ interactions and there were students who had not logged on to the wiki at all. The four groups differed in the extent of their wiki participation, with some groups being more active than others. In terms of the posted material in the wikis, web links were the most frequently contributed items (Figure 5). Figure 5 A student contribution to the group wiki – a web reference on professional roles
  18. 18. Using wikis to promote the personal and professional development of UG medical students 20 Students also posted book references. In one case, when a student felt that he was struggling with one learning objective, he posted a question to the others in the group. In another instance, a whole section on the role of the health visitor was posted (Figure 6). Figure 6 A student contribution to the group’s wiki: the role of the Health visitor Despite the short lead-in time and duration of the pilot, students engaged with the wiki and edited the wiki pages with their contributions. In terms of the wiki structure, the pilot phase set out a page structure which students could follow (i.e. they only had to edit the pages with their contributions rather than having to create their own pages afresh). Some students followed this structure and some created their own new pages. After the initial focus group session at which the wiki structure was further discussed with the participating students and slightly re-organised for the subsequent modules, there was a tendency for these students to use the pre-set structure. This suggested the usefulness of a negotiation process between students (and/or the facilitator) about the wiki structure. Students had a better understanding of how they were to structure their contributions and grow the wiki pages in a logical fashion. Key points – Findings: student engagement in the wikis Students tended to get to know how the wiki worked on a trial-and-error basis. Students demonstrated a range of engagement patterns in the wiki, some posted contributions, some only viewed others’ posts and some did not log on at all. Students more frequently posted web links rather than typed-up content to the wikis. Some PBL groups were more active than others in the wiki. Involving students in negotiations about the structure and purpose of the wiki enhanced students’ understanding of how they could make better use of the wiki for their learning.
  19. 19. Using wikis to promote the personal and professional development of UG medical students 21 5. The benefits of using wikis for students’ development of professionalism This chapter summarises the way in which wikis can enhance student learning on professionalism. Findings point to two main ways in which this can happen. Firstly, wikis can act as a shared knowledge-base and resource for students’ learning about professionalism by way of helping them to collate useful links and resources which answer their identified learning objectives on personal and professional development. Secondly, interaction in the more formal wiki space can promote reflection and the development of the online identity of medical trainee students. Chapter 4 discussed students’ perceptions of professionalism and the two main strands in which students engaged with it in their learning. At a more direct level, students identified discreet learning objectives related to personal and professional development for each of their problem- based learning scenarios and attempted to fulfil these objectives during and between their PBL sessions. At a more indirect level, students’ PBL discussions, as well as other curricular activities, contributed to and promoted their development as future medical professionals. On the basis of this study’s findings, two main areas of benefits have emerged in relation to these two ways of students’ learning about professionalism. Firstly, wikis helped students in finding, compiling, evaluating and sharing resources related to their learning objectives on professionalism. That is: wikis acted as a useful collaborative learning resource and knowledge-base. Secondly, it was demonstrated by the study that the online wiki spaces could have a role in enhancing students’ development of professionalism in a wider sense. One theme that emerged in relation to students’ use of wikis was how wikis could promote students’ development as reflective practitioners, i.e. by having to think about the quality of resources that they contribute to the shared wiki space. Linked to this theme, another important finding indicated that by students separating their online social and academic spaces, they become concerned with how they act as individuals in both spheres, as a ‘student’ in the former, and as a ‘professional’ in the latter. This reflection, in turn, then has the benefit of creating an online identity, which promotes students’ sense of developing professionalism. Figure 7 summarises these two main benefits as they emerged during the research. The following two sections take each benefit in turn, to discuss them in detail.
  20. 20. Using wikis to promote the personal and professional development of UG medical students 22 Figure 7 The two main benefits of using wikis to enhance medical students' learning about professionalism Key points – Benefits of wikis: The two main areas of using wikis in student learning on professionalism were shown to be: o Wikis can act as a shared resource and knowledge-base. They allow students to share their identified learning resources with one another in –between their face-to- face sessions. o Wikis can act as online spaces for developing students’ identity as a professional and their development as reflective professionals. 5. 1 Wikis as a shared resource and knowledge-base One of the main benefits that students reported concerned their ability to share resources on their identified learning objectives in-between their PBL sessions. When other students found a relevant resource on the area of personal and professional development and posted it to the wiki, the whole group was able to see it online. Sharing links in this way helped students study the relevant learning objectives. Some students found these links especially useful when they had seemed to waste a lot of time and effort on identifying resources for the given learning objective. This benefit was all the more welcome as students found personal and professional development to be the least well provided for out of the four strands associated with their problem-based learning scenarios:
  21. 21. Using wikis to promote the personal and professional development of UG medical students 23 “Professionalism is hard to find resources on, so ... it’s quite useful to share them.” (Focus Group 3) The small-scale survey responses also signalled a positive attitude from students who accessed or contributed to the wiki. They reported an enhanced understanding of personal and professional development, they said that they shared more resources as a result of the wiki and that it improved collaboration within the group. To a lesser extent, these students also agreed that wikis contributed to their professional development and enhanced the PBL process. This was confirmed in the focus groups with one student suggesting that resources put up in the wiki by other students helped clarify their problem-based learning discussions: “*X+ put references on for certain pieces of information, which made it a lot easier to understand what she was talking about in PBL.” (Focus Group 1) Another student commented that if they were unable to find a resource on professional learning to put in the wiki then it may be an indicator that their learning objective needed amending, which they could do in the wiki without waiting until the next problem-based learning session. Some students also found this method of sharing better than their previous methods which were emailing and texting one another. In another student’s view, wikis had the potential to display different perspectives on the same issue, which they saw as a useful characteristic, especially when it came to discussing more complex professional issues: “If there is a very difficult question, or one that you can only see one way, you can put it up to see how other people approach it in different perspectives” (Focus Group 2) In Chapter 4, the importance of the PBL group in creating a positive peer environment for students’ learning was highlighted. Wikis were seen to benefit students in this sense too. Students considered the use of the wiki as a potential medium which, being located in their PBL group, strengthened group cohesion and opportunities for positive peer feedback. This was due to being able to see how others progress in searching for and thinking about the identified learning objectives online in- between sessions. Students commented on feeling a lack of confidence especially in the early period of their arrival to university. They saw these wiki interactions in-between sessions as potentially beneficial in increasing their confidence in their own ability to achieve their set learning objectives. Key points – Benefits of wikis when acting as a shared resource and knowledge-base Wikis helped students to share resources with one another in-between their face-to-face sessions. This is particularly useful as professionalism seemed to be an area where resources were difficult to locate. Wikis helped clarify PBL discussions. By being able to check one another’s wiki contributions online, students felt more confident about their learning.
  22. 22. Using wikis to promote the personal and professional development of UG medical students 24 5.2 Wikis as online spaces for developing identity as a professional The previous section demonstrated the benefits of using wikis in relation to the particular learning objectives. Before describing another major area of benefits arising from the use of wikis, it is necessary to highlight two aspects of professionalism, at least as the concept was interpreted by the author of this research study. This interpretation viewed the essential characteristic of a ‘professional’ as their ability to reflect on their own learning, attitudes and behaviour. Further, that the development into a ‘professional’ was very much concerned with a reflection on what it meant to be a professional, i.e. a sense of emerging professional identity. What emerged from this study was that wikis were seen as beneficial related to both of these aspects. Thus, the fact that wikis promoted students’ reflection and sense of identity-formation demonstrated their potential for students’ development of professionalism. How these benefits materialised are discussed below. Towards becoming reflective Using wikis helped students reflect on their learning. When talking about the problem-based learning objectives in personal and professional development, students’ reported their main source of information to be the internet. They cited websites – such as the General Medical Council, the National Health Service and the Department of Health – as useful sources for finding out information to complete their learning objectives. Some drew on family and friends for information. However, because students engaged in locating resources via the internet, the issue of the difficulty in judging the quality of internet resources emerged: “Things like group discussion I think help to tie in everything we have been learning ‘cos on the internet you get so many different resources give slightly different opinions on professionalism.” (Focus Group 3) Students found it hard to evaluate whether the internet resource was good quality and reliable. As a result of these expressed uncertainties, some students were more hesitant to contribute the resource they found to the group wiki. Students did not want to be seen to ‘be wrong’ in front of others by posting up an unreliable web resource.3 As opposed to the informal social networking space where these fears were not present, the fact that students felt faculty members could see what they had posted, meant that they were less confident in contributing to the wiki space in case the resource was not of high quality. These comments demonstrated a developing sense of professionalism, exactly because students realised the importance of the quality and reliability of resources in their learning as trainee medical professionals. These tentative attitudes expressed by students when consulting the internet for resources on professionalism therefore at the same time indicated that they were becoming more reflective. McGee and Begg (2008) similarly argue that in the current technological environment, information literacy skills are requisite skills in higher education where “future physicians need to be adept at locating and synthesising info from a variety of sources”. The project then demonstrated how these information literacy skills could be promoted through the use of wikis, and how these contributions could promote students’ becoming more reflective professionals. 3 Students also listed a range of other sources which they draw on to develop their professionalism during their course such as their communication skills module or clinical practice; and the importance of interaction and real-life settings – however, the discussion of these is outside the remit for now.
  23. 23. Using wikis to promote the personal and professional development of UG medical students 25 Developing identity through online wiki spaces As one student commented, this web2.0 type technology “introduced *her+ to a new way of learning”. Although she also commented that due to the short time-scale of the pilot, its full benefits were not yet explored or were not evident to her, this student saw that through the use of wikis, trainee students could learn how to interact online. What emerged from this and other students’ views was a way in which online wiki spaces could contribute to the promotion of professional identity. How this may take place is discussed below. As Wagner asserts, part of medical education is about acquiring a new identity as a doctor and medical professional (Wagner et al 2007). Whilst Hilton and Slotnick (2005) describe this development in relation to the communities of practice model in which the young trainee attempts to copy the behaviour of their more experienced and senior professional with whom they come in contact. These stages of identity-forming were observable during the wiki pilot as well. That some students expressed a need for a staff member to offer their expertise in helping them to monitor the quality of wiki contributions suggested exactly this: they wanted to rely on and copy their behaviour until they were confident enough in their own. Similarly, not wanting to be seen to ‘be wrong’ in front of staff members – when students were aware that faculty members may have monitored their wiki contributions, even if they did not, – also suggested a sense of forming professional identity, manifested online. The role of technologies, especially that of web2.0, in developing students’ identity has been discussed by others too. Sefton-Green (2004) for instance describes how through their participation in online social networks, students become used to negotiating a range of identities, which then helps them to explore their identity. Similarly to this, Collis and Moonen argue that: “the many different kinds of communication, representation and collaboration tools collectively referred to as web2.0 that are now being used by learners of all ages and levels outside formal education requirements are making fast inroads because they offer effective ways to be heard, to connect, to find and share, and to build identity” (quoted in Trinder et al 2008) With particular reference to medical students, the stage of students presenting themselves to their peers and receiving feedback is an important part of their professional development (Niemi 1997). The various technologies offer a platform for students to develop their self-identity (Sandars 2008 quoting Livingstone 2002). As was seen in Section 4 on learning context, the pilot’s students did make extensive use of informal, online social networking to interact with one another in, and beyond, their peer group. These interactions took place in a trusted, informal environment where students could be themselves: ‘students’. They talked about the freedom of making mistakes and no one observing them or making judgements as to their competence. As soon as they entered the realm of the wikis, which were seen to be set up by their course instructors, and to which facilitators also had access, their behaviour changed, they took on a different, ‘professional’ identity. This was an identity which they identified as ‘work’ and with being a professional medical trainee. In this sphere, rules of engagement changed and students were keen to be seen acting as ‘professionals’ when it came to their wiki contributions: “When you are online, you tend to be a lot more informal than face to face. Basically you like have to develop to [do] communication in a professional way. I guess that kind
  24. 24. Using wikis to promote the personal and professional development of UG medical students 26 of makes me reluctant to use this wiki thing, because we are just used to informal chatting. I wouldn’t be [acting] professional with these people [referring to PBL group]. I am not saying that [group laughs], but I wouldn’t like to try to give up that kind demeanour, just like a friend to a friend. “ Focus Group 1 That both the informal social networking and the wiki contributions were acted out in the same peer group has caused some tension in relation to this identity: “Why would we be writing professionally as like really formal to [one another]? We are not like esteemed colleagues [laughs- all participants laugh+.” Focus Group 1 The above perception demonstrates that students were aware of an innate need to act professionally in the wiki. However, they found it difficult to adjust and act professionally in the same peer group with which they interacted informally in their private online spaces. The above perception also highlighted some lack of awareness as to the benefits of ‘being professional’ online, i.e. that these online interactions may have another aspect of developing skills which the student would be able to employ in their future career as a medical professional. Thus, although the benefit of using wikis demonstrated a potential in students’ identity-formation as professionals, by way of contrasting their informal and formal online learning spaces, this potential may need further highlighting to students. Key points – Benefits of wikis when acting as online spaces for identity development Wikis can help students become more reflective practitioners as they are ‘forced’ to evaluate the resources before they share them. Students identified the wiki spaces (as provided by the institution) with ‘work’ which also meant that they interacted differently in their informal, private online spaces as opposed to the wikis. Students wanted to appear ‘professional’ when contributing to the wiki and were concerned with the quality of their contributions and not wanting to be seen ‘wrong’ or ‘stupid’. These different interactions showed how online wiki spaces can help develop students’ professional identity. The merits of acting professionally online were not always evident to students, suggesting that these need to be explicitly highlighted to them. The fact that not all students experienced these above benefits to the same extent draws attention to the various issues that influenced student engagement as well as the outcomes of the wiki pilot. These issues are discussed in the next chapter.
  25. 25. Using wikis to promote the personal and professional development of UG medical students 27 6. Teaching & learning, technical and managerial issues of using wikis This chapter describes the various teaching & learning, technical and managerial issues which influenced students’ engagement with wikis. The main identified teaching and learning issues included wiki awareness, privacy, group work and sharing, the ‘populatedness’ of the wiki, reliability, motivation and professional identity. Whilst managerial issues predominantly concerned the scalability of the pilot. The previous chapter highlighted the main benefits of using wikis as evidenced from this research. The student survey, the focus group discussions together with the observation of online wiki interactions gathered a number of issues related to student engagement. Some of these issues were general teaching and learning issues, some of these were related to the use of wikis as a web2.0 technology or specific to the particular wiki tool (TeamsLX) used in the pilot and finally, some concerned the way wikis were set up and managed. These issues are grouped and discussed in the next three sections: teaching and learning, technical and managerial. 6.1 Teaching and learning issues First, the teaching and learning issues are considered, including those educational issues that influenced the perceived effects of learning benefits of wiki use either from the instructors’ or students’ points of view. These included awareness of the wiki technology, privacy, group work and sharing, the ‘populatedness’ of the wiki, concerns of reliability, gains in professional identity and lack of student motivation. These will be explored below. Wiki awareness Studies concerned with today’s generation of young students have claimed that there is a widespread awareness between students of new types of technologies such as social networking, blogging and wikis (see Prensky 2001). Recent studies, however, found that students’ degree of familiarity differed when it came to the different types of web2.0 technologies. Whilst students extensively used online social networking (e.g. 91%), they were both less familiar with and comfortable using wikis and blogs for instance (52%) (JISC/IPSOS MORI 2008). It is interesting to note that while many students use Wikipedia for researching their studies, a high proportion of them are not aware of what a wiki is or how to use it (JISC/IPSOS MORI 2008). This finding was confirmed by the current study. It appeared during focus group discussions that before the pilot started, students had not been aware of what wikis were or had not used them before. One student, when prompted about Wikipedia being similar to the wiki, exclaimed with surprise: “Is that a form of the wiki?” Once students were equipped with the knowledge as to the purpose of the group wikis (whether it was resource sharing or discussions around the learning objectives) and how they could be used for their learning, they seemed to value wikis more. This confirmed another finding from related e-learning studies, i.e. that students, although familiar with web2.0 technologies for their social purposes, do not necessarily see the educational value in them without further structure and guidance from their educator (Trinder et al 2008). The findings of this research study confirmed that students were less aware of the wikis than the abovementioned studies suggested. Students’ learning curve was greater than with other, more familiar types of web2.0 technologies, such as social networking tools or even blogs. These point to the need for careful scaffolding when introducing students to this
  26. 26. Using wikis to promote the personal and professional development of UG medical students 28 technology, both in terms of an introduction to the tool as well as how they will be used in their studies. As mentioned above, those students who took part in a discussion at one of the focus groups as to the nature and structure of wikis, did show an increased engagement with the tool after the focus group session. Key points – Wiki awareness Students demonstrated less awareness of wikis as a technology than expected on the basis of previous studies. The more students were aware of what wikis were, the more likely they were to be engaged with them. Privacy Many students contrasted their interactions in the institutionally provided group wikis with that of their own private social networking tools. As mentioned before in Chapter 4 on learning context, students predominantly used Facebook for their own social purposes, although also commented that in Facebook they discussed their learning or sharing resources on an ad-hoc basis. They associated this online social networking space with safety and comfort where they did not have to worry about having to appear professional, they could be themselves, students: “you feel more free to express yourself” (Focus Group 1) Because the institutional wiki was set up for the students by the medical faculty, they associated this space as one that was being ‘monitored’ and therefore not private; even though only their groups and their facilitator could access it and there was no intention of the faculty monitoring their contributions. Purely because of where the wiki space was located (i.e. within the institutional VLE), students felt that they were in a different environment over which they had no control. The effect of this perception was that students were less motivated to contribute to the wiki, or at least that they had to make more purposeful judgments as to when to contribute or not, more so than they would have made in their private social networks. If students identified their online Facebook networks with privacy and their wiki space with a ‘public’ space, there was another dimension of this dichotomy: the separation of social and work spheres, respectively: “Facebook is primarily a way of communicating with friends. Whereas the Wiki is a way of communicating things that you’ve found that are relevant to work. So *pause+ it’s seen as something that’s work not something that’s social so you’re less tempted to use it.” (Focus Group 3) The fact that students saw the wiki space as “work” did tend to affect their engagement with wikis; though this occurred differently in the case of different students. Some appreciated the separate work space and preferred working in the wiki, whilst others preferred to stay in their social Facebook space. This polarised behaviour was also observed in the JISC/IPSOS MORI study concerning the use
  27. 27. Using wikis to promote the personal and professional development of UG medical students 29 of wikis (2008). In line with other studies (Sandars et al 2008), students also highlighted that it would not be a solution to move the institutional web space to their preferred online networking space as they would not use it: “I think if you do add it [wiki] to a social site then no one will use the social thing because they will think the faculty are watching or checking all what they are all doing.” (Focus Group 1) The characteristics of the wiki space then, in which students shared their learning within their peer group, whether it was seen as an informal/social/private place or whether a formal/work/public space affected students’ interactions. The solution, on the basis of student comments and as Sandars et al (2008) also suggested, was not necessarily moving one space into the other, but looking at managing control and ownership within the institutionally set-up wiki space. Many students commented that they preferred small-group based wikis, in which access was restricted to their eight-person PBL group. This offered them a trusted and safe environment in which they felt confident making contributions, as opposed to having to contribute to large wikis to which the whole year group had access. Key points – Privacy Students who liked the separation between their online work and social spaces, tended to appreciate and use the wiki space more for their learning. When students found the wiki space too ‘public’ for their interactions, they were less likely to see the benefits of this space for their learning and so, they preferred to keep their discussions about the problem-based learning objectives within their own private (online/offline spaces). Private, small-group based wikis were welcomed by students. This was because their known problem-based group ensured a trusted, safe environment where they did not need to worry about the quality of their contributions and how they were seen by other group members. Group work and sharing Group work and willingness to share resources with others were issues which emerged during the introduction of wikis. As seen in Chapter 4, different PBL groups engaged with the wiki at varying levels, some being more active than others. In one instance, although students accessed the wiki, the group did not contribute to it at all. Facilitators suggested that some groups worked better together as a group than others, with the more cohesive groups being more active online as well. Reticence to share resources, albeit on a small scale, was also a reason why those less willing to engage in the wikis did not contribute to it. Cultural differences went some way to explain this student attitude, though as students themselves said, it only characterised a small proportion of students. These issues related to group dynamics though not specifically relevant to the use of web2.0 technologies per se, were nevertheless important pedagogical aspects of the learning context which influenced student engagement.
  28. 28. Using wikis to promote the personal and professional development of UG medical students 30 Key points – Group work and sharing Positive group dynamics were an important indicator for students’ engagement. Groups which worked well together in face-to-face sessions were more likely to share resources with one another online. Cultural issues related to sharing, i.e. students being reticent to share their learning with others, were also found to act as a barrier to engagement, though this concerned only a few individuals. ‘Populatedness’ One optimal condition that students saw for using wiki in their PBL context was when the wiki was already populated with items such as web or other resources. An empty wiki was daunting for them. They did not want to be the first to contribute: “I think everyone hesitates to put something in it at the moment. You don’t want to be the first person that starts …” (Focus Group 1) The ‘populatedness’ of the wiki was linked to levels of sharing and access. Students appreciated that whilst a small, peer-group based wiki had advantages in terms of privacy, it also meant a limited amount in terms of the volume of postings (with a maximum of eight members being able to post to the wiki). Students felt that a wiki available to the wider student group – for instance to the whole year – though losing in privacy, would allow a greater number of contributions to the benefit of all member students. ‘Populatedness’ of the wiki was not just a quantitative issue. Students also expressed the view that they would have liked to have access to a wiki which was already populated by resources related to professionalism and checked by staff members. This would not only have initialised their contributions but would have offered them a guide as to what they should be learning and guiding them in terms of selecting the ‘right’ kind of information for their study. This finding coincided with that of Cruess and Cruess (2006) who also identified institutional support including adequate resources important for students’ development of professionalism. That said it also signals a tension between the problem-based learning approach where part of the learning is to find, evaluate and use information and resources. To summarise, whether resources already existed in the wiki, either by peer members or faculty staff, influenced students’ confidence in posting contributions to the wiki. A tension between the preference for a private, trusted wiki space between the issue of ‘populatedness’ was also discovered during the pilot, which was linked to the extent of member access (small group versus large group). Key points – ‘Populatedness’ The lack of pre-existing resources in the wiki, the lack of ‘populatedness’, was daunting for students. Many did not want to be the first to contribute. Students welcomed the idea of contributing to wikis which were already populated by resources on professionalism and which were quality assured by staff.
  29. 29. Using wikis to promote the personal and professional development of UG medical students 31 Students saw whole year-group wikis as having advantages as these large wikis would have potentially contained more resources to choose from for their learning about professionalism. However, this caused a tension between their previously expressed preference for private, small-group based wikis. Reliability As already discussed in relation to the benefits of wikis to student learning in chapter 5, students in their reflections about their wiki engagement expressed a concern as to the quality of postings of their wiki contributions. A number of students commented that they did not want to be seen to be posting ‘wrong’ or irrelevant content. Apart from the reliability of resources being linked to issues of professionalism such as identity and confidence, this student concern had a pedagogical impact as well. These comments brought up the issue of the need for monitoring and editorship in the wiki. Some students conveyed the view that they would have liked staff members to act as monitors over their own and their peers’ contributions, as they were better judges of the quality of resources. They found the lack of quality-assured materials, especially in the area of personal and professional development a difficulty, given that this area was the most difficult to find resources on. There was also some discussion about what should happen to the postings that were deemed not to be right – whether they were to be deleted or to be commented upon and evaluated. One student observed that as different groups had defined different learning objectives for the same learning scenario, one resource may be relevant for one group and not to the other. Key points – Reliability In their reflections on wiki engagement, students expressed a concern as to the reliability of the resources contributed to the wiki. Students did not want to be seen ‘wrong’ when posting to the wiki. Where students had more confidence in their information literacy skills, they were more likely to share resources within the wiki. Students found the lack of quality-assured materials by staff members and professionals a difficulty in their learning about personal and professional development. They welcomed the idea of having a staff member who would monitor the quality of contributions. Professional identity Chapter 5 highlighted that the use of wikis promoted students’ development of professionalism by making them reflect on the way they interacted in different online spaces. This was achieved by juxtaposing their interactions in the formal wiki and informal social networking spaces. However, not all students were aware of this indirect benefit, i.e. that interacting online and discussing professional issues with their peers through wikis could lead to an appreciation of what role similar online spaces may play in their future career. For instance, they did not draw a connection between their own wiki use and that medical professionals may draw on similar online communities of practice in their careers for their own personal and professional development.
  30. 30. Using wikis to promote the personal and professional development of UG medical students 32 Key points – Professional identity Not all students appreciated, or were aware of, the benefits that interacting in more formal online spaces, such as wikis, could bring to their future professional career and development. Motivation As far as student motivation was concerned, there were a number of students who did not engage in using wikis for their problem-based learning studies. There were a number of possible reasons for this. Some students stated that their “current methods are good enough”, meaning that the way they discussed their learning and shared resources between sessions, e.g. via email, text and face-to- face, were suitable methods. The other main educational reason for being less engaged was due to students being strategic learners. If students did not see the immediate benefits of wikis for their exams, they did not feel the need to be engaged (McGee and Begg 2008). What transpired from the focus group discussions was that the majority of students still favoured making their own paper- based notes (though some students did some of this on their laptops) which they brought to the next session. This meant that students who did engage in the wiki were more motivated to share links with one another rather than typing up content for others to see. Key points – Motivation Some students found their current methods of learning about professionalism ‘good enough’ (which could be either offline or online, individual or peer methods); they lacked motivation for using the institutionally provided wikis. This was linked to the voluntary nature of wikis - their use was not aligned to any assessment tasks; students being strategic learners did not feel compelled to use the wikis for their learning. Motivation to use wikis for their studies was also linked to technical issues, which are discussed in the next section. 6.2 Technical issues The technical issues that influenced students’ perceptions as to the benefits of using wikis for their learning included two main aspects: issues of usability (such as the interface and functions of the wiki tool) and training & support needs. Usability As for usability, where students expressed more negative views of the wiki, these tended to relate to its interface (the chosen tool was the the TeamsLX wiki in the institutional learning environment, Blackboard). These comments were typically like: the wiki was “too boring”, “plain” and “uninteresting”. In many instances students compared the wiki tool to that of Facebook, with the latter being the preferred option for its user-friendly, colourful and engaging interface. This was true for the functionalities that both offered. Students liked the fact that Facebook was activity-centric and that it notified them of recent activities. Similar alerts were not available in the TeamsLX wiki,
  31. 31. Using wikis to promote the personal and professional development of UG medical students 33 i.e. if the wiki was updated, students were not notified of this. They actively had to log in and scroll through each page to see whether there were any new changes. Some students also struggled with navigating round the wiki. Training and support needs The importance of hands-on learning and getting familiar with the structure of the wiki in face-to- face sessions was also confirmed. Due to the short lead-in time available for the set-up of the pilot, it was not possible to conduct a face-to-face training session and this was commented on by students. The written guide, although helpful in some cases, was not satisfactory in guiding them as to what they could do in the wiki. This was because those more confident with ICT were happy to experiment with the wiki on a trial-and-error basis, whilst those less confident did not draw on the guide either. Students were not too aware of the history function of the wiki; this was shown by their concern of potentially making mistakes in the wiki or posting something wrong, not realising that the option of deleting or amending contributions was one of the main aspects of wikis. Had they been aware of this functionality, the knowledge that their posting could be reverted could have helped their confidence in making contributions to the wiki. What these technical issues pointed to was the importance of alerts when using wikis in similar group contexts as well as the value of making the wiki appealing, perhaps through the use of images and colours. Having the need for a face-to-face training session in which the purpose, structure and navigation of wikis were explained to and discussed with students was in strong evidence on the basis of student accounts. Key points – Technical issues Usability Students’ engagement was negatively influenced by the design and interface of the wiki tool. Students preferred the interface of Facebook to that of the wiki tool piloted (Teams LX) as they found it easier to use and more friendly and colourful. Students had to actively log in to the wiki and check each page one-by-one to see whether anything has been added. This lack of functionality with regards to alerts, otherwise a central function of web2.0 tools such as Facebook, was also a major impediment for student engagement. Training and support needs Not having a dedicated face-to-face session had the effect of some students not logging on at all, due to a lack of ICT confidence. Students preferred a hands-on introduction to the wikis as opposed to reading a written guide. The history function of the wiki was less well known to students. 6.3 Managerial issues There were a number of considerations which pointed beyond the technical capabilities of the chosen wiki tool. These concerned the set-up and management of the wikis. This section therefore discusses how these managerial decisions impacted on the achieved learning benefits of wikis. Given
  32. 32. Using wikis to promote the personal and professional development of UG medical students 34 the pilot, small-scale nature of the study, it was important to consider any issues within the research with a view of what would happen when the pilot is scaled up, in this instance, with the introduction of wikis to the whole first-year group. Therefore this section first discusses any managerial issues that the introduction of wikis brought about during the pilot, which were access, privacy, remit and navigation. As the pilot was conducted in the context of problem-based learning groups, it was decided to restrict access to the wikis to the eight-member PBL group. The group’s facilitator and the researchers on the project also had access to the wiki. Students liked this privacy: “One thing about that PPD thing [wiki] which was good was the fact that it is private and other groups can’t see what we have written.” Focus Group 1 Although students also commented that in this privacy set-up they could be losing out due to not seeing other groups’ contributions: “But I also think it’s a disadvantage as well because sometimes being able to see with the PBL learning objectives, being able to see what other people have written is beneficial as well.” Focus Group 1 Further, it was decided that for each problem-based learning scenario a new wiki would be created; this meant to make it easier for students to relate resources to their identified learning objectives for that module (as opposed to creating an overall wiki for instance for the duration of the pilot). In this set-up however, the potential for the wiki’s remit to act as a cumulative resource over the lifetime of the student, or even just the year, was muted. To match this remit at the module level (the two weekly-learning scenario), the wiki was linked to the relevant module in Blackboard, i.e. students had to click at least four clicks to access it within the hierarchical navigation. All these managerial decisions (small group vs large group access; privacy; remit; and location in terms of navigation – see Table 1) influenced student contributions to the wiki. Table 1 Managerial considerations of the wiki setup Managerial considerations Details Access Who has access to the wiki? Small or large group? Privacy Is the wiki open to others who are not members? Private (members-only) or public (non- members have read access) wiki? Remit What is the remit of the wiki? Is it linked to the module or cumulatively to more modules over the years? Location/Navigation Where is the wiki located? Can students click into it at the top level or do they need to navigate through various levels of hierarchy to access it?
  33. 33. Using wikis to promote the personal and professional development of UG medical students 35 It is not yet clear without further researching other wiki tools whether these managerial decisions could be consolidated in other wiki tools by enhanced functionality or whether they are decisions that need to be made on the basis of weighing up the advantages and disadvantages of each option. Issues for scalability of the pilot The small-scale pilot also offered an opportunity to consider the managerial issues with regards to its scalability, i.e. implementing the use of wikis in PBL groups across a whole year (with some 300 medical students). These need to be taken into account alongside the above mentioned managerial considerations. The identified issues mainly concern: access to the wiki - whether only a small (e.g. problem-based learning group) or the whole- year group has access to it and whether non-members can read wiki contributions or not; its setup in relation to the remit of the wiki - i.e. what is the boundary of the wiki– is it just for discussing the relevant problem-based learning scenario or does it follow a broader purpose to record students’ learning; the lifecycle of the wiki - whether and how students access/interact with it in subsequent years; Some of the solutions to the issues may be directly determined by the available functions of the chosen wiki tool. Whether or not both institutionally or externally available tools can be chosen will be determined by the institution. So what follows is a consideration of these various managerial issues as mentioned above, highlighting what potential solutions would need to be taken into account for the success of up-scaling the pilot to a whole medical year-group. Issue 1: Access and privacy: who has read/write access to the wiki? Issue description: On the one hand, students preferred to share their learning online in their familiar peer groups. This meant that they liked the fact that the wikis were only accessible to their own group. Another reason for this was the recognition that one group’s learning objectives would not necessarily be the same for other groups and they would not have the same purpose/resources to identify. On the other hand, students realised that wikis open to the whole year group would yield more contributions in terms of resources, purely because they would be coming from a significantly larger group. The solution needs to consider: a wiki structure that offers different levels of access. This could potentially mean a two-level wiki, which a) has discrete private group areas for students to discuss their own learning objectives and ask questions which they may not want to ask in front of the whole group and b) a joint year-group area for the whole year. This latter could consist of resources which were found to be of good quality by the small groups, as well as questions which the small problem-based groups are finding hard to answer or finding it difficult to find resources on. Issue 2: The remit of the wiki: what is the remit of contributions? Issue description = during the pilot, wikis were set up for each discrete learning scenario. This remit is not necessarily reflecting the iterative nature of the medical curriculum. Wikis could also be set up which would span a wider remit, beyond the learning scenarios. The first solution poses problems in terms of searchability. Students at their later stages of their training would need find information in a potentially high number of wikis. The latter cumulative-wiki solution would present issues of
  34. 34. Using wikis to promote the personal and professional development of UG medical students 36 growth and structure, i.e. how information could be structured in the wiki so that students could organically and logically be able to grow their wikis during their training. One issue, and this may be particular to the institution where wikis were piloted, was that the problem-based learning groups change each semester so any group-related wikis would need to deal with this extra complexity. The solution needs to consider: whether wikis at the learning scenario level are useful for student learning (mini-wikis) or whether wikis would need to serve a wider cumulative purpose. Again, could this tool consolidate these opposing purposes? Issue 3: Wiki lifecycle: can future students use the wiki and its contributions? Issue description: the wiki pilot was conducted within a semester of students’ training for 2-5 discrete learning scenarios. The question arises as to what would happen to wikis in their subsequent years of training as well as these wikis relationship to the new in-take of first year students. If the wiki pilot continues, will students be able to easily access and find information in their past wikis? Would the new first-year students be able to benefit from the contributions made by previous first-year peers? The solution needs to consider: how this accumulation of knowledge is managed: whether it is managed in one wiki or across several wikis (linked to the previous issue of wiki remit). For instance, whether wiki contributions could be accessed and re-used by students in the following years. There may not be an easy solution. Different alternatives such as opening up wikis or perhaps exporting wiki pages may need to be considered. Issue 4: Wiki functionality: what functions does the tool have? Issue description: the chosen wiki tool for the pilot had various constraints in terms of its technological capabilities. One of the main limitations was that the tool did not have an alert function. Students also found the interface less engaging. The solution needs to consider: other wiki tools which may be external, third party tools. Institutional constraints may play a part in whether this choice is openly available. Given that the main purpose for students to use wikis was sharing links to resources rather than sharing content, other tools such as social bookmarking systems could also be considered. Issue 5: Support needs and resources: how to balance benefits versus support needs? Issue description: there are about 35 problem-based groups in a medical year at the pilot institution. If wikis were set up for each of these (or even if a joint group wiki was set up with different access areas), the process of setting up these groups would require significant support and set-up time. The solution needs to consider: the large-scale nature of benefits of using wikis and measure them against these resource needs. It is true that with regards to scalability more questions than answers emerged as a result of the pilot. These questions are important in identifying the issues that would need to be considered when scaling up the pilot to a whole year group. It was also possible however to make some practical recommendations as to future implementations for the use of wikis in medical education, especially relating to the development of professionalism. These are expressed in the section 8.
  35. 35. Using wikis to promote the personal and professional development of UG medical students 37 Key points – Managerial issues Five issues were identified which need to be considered when scaling up the pilot. These were: Access and privacy: wiki access, whether creating small or big group wikis influences student engagement with benefits and disadvantages in the case of both. A potential solution could be considered which offers different levels of access. Wiki remit: the implementation needs to consider whether wikis at the learning scenario level are useful for student learning (mini-wikis) or whether wikis would need to serve a wider cumulative purpose. Wiki lifecycle: the longevity of wiki usefulness surfaced as a managerial issue, i.e. whether wikis are created for a discreet learning period or whether they can provide a more cumulative resource base for students. Wiki functionality: given the functional restrictions of the wiki tool, future implementations need to consider other available tools, subject to institutional constraints. It could even be that other web2.0, such as social bookmarking, tools could also facilitate the sharing of resources on professionalism. Support needs vs benefits: implementation of the wiki project, if carried out similarly to the pilot, would require significant support and set-up time which needs to be measured against the expected benefits of using wikis for enhancing student learning.
  36. 36. Using wikis to promote the personal and professional development of UG medical students 38 7. Project summary and outcomes This chapter summarises the study and the outcomes of the project. 7.1 Project summary The purpose of the study was to introduce wikis in a problem-based learning context and explore how this web2.0 technology may be used to enhance first-year medical students’ learning in a blended environment, especially relating to their development of professionalism. Group-based wikis were set up for the duration of the pilot associated with a particular learning scenario. This meant that students were able to share and discuss resources online related to their identified learning objectives as a group. During the pilot phase, all four groups had the opportunity to access and use the wikis for their study. Student interactions in the wiki, based on online observations as well as focus group comments, differed not just from group to group but also on an individual basis. Some groups, and some individuals, were more active than others. Some students contributed to the wiki, whilst others just viewed it, and again others did not log on at all. Students tended to experiment with the wikis on a trial-and-error basis rather than reading any support material. Data were collected in the form of a small scale survey and focus groups discussions. Through this, it was possible to gather information about the learning context of the participating students as well as to locate the benefits that students experienced when using wikis for their learning about professionalism. The learning context of these first-year students involved the importance of students’ peer group (both the immediate problem-based learning group and beyond) in their learning. These students were also at an important point of development as university students, formulating and developing their learning strategies appropriate to the university environment and requirements. These strategies included the selection of online resources for their study. It was also a phase when they were growing in confidence as learners, supported by the feedback of their facilitators and peers. The social bonds which they created were an important part of this, with an indication that some of this social interaction happened within their online social networking groups outside the institutional environment. As far as the development of professionalism was concerned, students demonstrated a range of perceptions from the concrete ‘professionalism is about job roles’ to more complex views which amalgamated professional attitudes with duty of care obligations through to associating professionalism with ‘a lifestyle’. Most students used the internet for discovering resources for fulfilling their learning objectives related to professionalism. Students identified professionalism as an area that was least provided for by the institution as well as an area which was hard to find information about. All these perceptions pointed to the need for having access to resources, especially web resources, on professionalism. Students’ concern about not just trusting any resource pointed to a sense of their developing identity as a reflective practitioner who was concerned with the quality and relevance of the resources. Students identified that they needed the skills of being able to search, evaluate and synthesise resources in order to be able to post to the wikis; skills which they associated with senior professionals and staff members. Indirectly then this was a stage in
  37. 37. Using wikis to promote the personal and professional development of UG medical students 39 professionalism to which students aspired to. This was evidenced by their ambition to be ‘right’ when posting contributions to the wiki. The role of web2.0 technologies in helping students to experiment with and develop various (online) identities was evidenced in other studies. This pilot’s students were also very aware that they had different identities when interacting in their private social networking groups and when they contributed to the institutional, small-group wiki. These different platforms in some instances existed peacefully next to one another, whilst other students talked about the tension of the two (the private vs public space, the ‘social’ vs the ‘work’ space, the student vs the trainee medical professional) with students being uncomfortable when having to act differently in front of the same group/ the same people that they would have talked to in their online social networks. What was learnt during the study was that students were less aware of how their online interactions in the wiki may be relevant in their future career as medical professionals. Key points – Project study Wikis were introduced in a PBL context with a small number of first year undergraduates. Predominantly qualitative data were collected as part of this pilot study. Individual students as well as the PBL groups engaged with the wikis to differing extents. 7.2 Project outcomes The students who engaged with the wikis clearly experienced benefits in their studies. These benefits fell into two main areas: wikis as a knowledge-base to share resources on professionalism, and wikis as online spaces for the development of identity as a reflective professional. Firstly, wikis offered a useful way for students to reference resources in the area of personal and professional development and share these with the whole problem-based learning group in between-sessions. This meant that students not only gained in time efficiency but were able to prepare better for their next session. Some students found that wiki contributions made by others helped clarify their problem-based learning discussions. Sharing and discussing resources in wikis also helped with their lack of confidence – a common issue in their first-year of study, when students were less sure both about the material to be learnt and the extent to which they needed to learn it. Students did not need to wait until the next session as they were able to see how others tackled the learning objectives through the wiki contributions of others. Secondly, the more indirect learning benefits concerned the development of student identities as future professionals facilitated by the more formal learning space of the wiki. Although this could also cause tension, students recognised that they acted differently in the wikis than in their own informal social networks. This recognition, coupled with their reflections on the quality control issue of wiki contributions, has moved students along their journey as trainee professionals, tacitly introducing them to the concept of online professional identity. A further outcome for those students engaged in the wiki was that through their engagement in the searching, evaluating and synthesising of information resources, their information literacy skills were enhanced; not directly, but because they were reflecting on the value of the resources in the first place.
  38. 38. Using wikis to promote the personal and professional development of UG medical students 40 There were a number of facilitators and barriers which influenced these positive outcomes in terms of enhancing students’ learning about professionalism. These were teaching & learning, technical and managerial factors. On the one hand, students’ awareness of the purpose and structure of wikis helped their engagement. Similarly, private, small-group wikis were more conducive to student contributions as students were more confident posting in a small than a large group. Less effective group dynamics and reticence to sharing, on the other hand, hindered student activity in the wikis. Students’ information skills helped determine whether the resources they found were reliable. Students who were more confident in their own ability to search, evaluate and synthesise information, also found it easier to make contributions to the wiki, whereas those less confident, even if they found useful resources were less likely to contribute. Students’ engagement in using wikis for sharing resources was also affected by their motivation. Some did not see a benefit in using wikis, and stated that their current methods of learning were good enough, others appreciated that wikis introduced them to a new style of learning. With regards to technical barriers, the students who did not engage in the wikis, claimed that this was to some extent due to usability issues, such as the boring and uninspiring interface of the wiki tool and its lack of alert function. Most of the students held their online social networking tools as a good example of what a motivating tool should look like. Most of the students claimed that they were fairly ICT-literate. Despite the ease of use of the wiki tool, the importance of hands-on sessions, which were not possible to do within the pilot, was highlighted by the fact that students preferred to learn to use the tool by trial-and-error rather than through written guides. As far as scalability of the project was concerned, the pilot was important in highlighting the potential managerial considerations for such a future implementation. These concerned levels of access within the wiki (small or large group) linked to the potential in terms of the ‘populatedness’ of the wiki. ‘Populatedness’ of the wiki was an important aspect in students’ judgement of its use. They recognised that wikis with higher volumes of contributions would be more useful for their learning about professionalism. The remit of the wiki was another consideration which determined their potential use to students, i.e. whether it was restricted to a discreet learning scenario or whether it was set-up for the accumulation of knowledge over a longer period of students’ learning. The restrictions in terms of the functionality of the tool also acted as barriers for student engagement. One such example was that the lack of the alert function, meant extra work on the part of the student in having to check for updates by their peers by having to keep logging in to the wiki. This has naturally put off some students from making extensive use of the wiki. Further, the lack of certain functions also highlighted that one managerial consideration needs to be the evaluation of other available wiki tools in comparison with the institutional wiki tool to discover whether they would be more suitable tools to use for the purpose of the study and beyond.

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