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 Table of Contents  
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 16-18

Blended learning in the 21st century: The need to tailor it to the changing learner self-direction levels during different phases of health professions education and beyond

Department of Medical Education and Community Medicine, Believers Church Medical College, Thiruvalla, Kerala, India

Date of Submission15-May-2021
Date of Decision17-May-2021
Date of Acceptance18-May-2021
Date of Web Publication26-Jun-2021

Correspondence Address:
Dr. Thomas V Chacko
Department of Medical Education and Community Medicine, Believers Church Medical College, Thiruvalla, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amhs.amhs_117_21

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How to cite this article:
Chacko TV. Blended learning in the 21st century: The need to tailor it to the changing learner self-direction levels during different phases of health professions education and beyond. Arch Med Health Sci 2021;9:16-8

How to cite this URL:
Chacko TV. Blended learning in the 21st century: The need to tailor it to the changing learner self-direction levels during different phases of health professions education and beyond. Arch Med Health Sci [serial online] 2021 [cited 2022 Aug 14];9:16-8. Available from: https://www.amhsjournal.org/text.asp?2021/9/1/16/319372

”If we teach today's students as we taught yesterday's, we rob them of tomorrow.” - John Dewey

”Investing in education and providing 21st century skills for students are fundamental components to the nation's continued prosperity.” - Craig Barrett

The ways in which we learn, and the preferred mode of learning, have seen many changes over the years, but in recent times, the changes have been more revolutionary than evolutionary. Learning in the restricted confines of the classroom is now getting challenged due to various reasons such as easy and increased online access and usage of online resources by the younger generation and the increasingly popular “work from home culture” trend among IT professionals and IT industry that finds it economical and work–life balance-friendly. Besides these changes, in the field of health professionals, after they qualify, are too busy with practice to spare the time to sit in a classroom for their continuing professional development (CPD) credits that they are required to accumulate to keep themselves updated with new knowledge generated through research that is influencing practice. Added to these reasons, most of us have been forced into online teaching–learning due to COVID-19 pandemic. Gone are the days when students were prohibited from bringing their cellphones into the classroom as it was considered a distraction for the student, and in the process, it also distracted the teacher. Now, students are encouraged by the teacher to bring their own mobile devices to engage the students in active learning. Realizing the value of this, institutions are gearing up to provide the IT network infrastructure that supports and enables online access in the classroom.

We should also note that we are teaching in the 21st century and our graduates should be equipped for success in the 21st century with the “four Cs of 21st-century skills for critical learning and innovation” such as Critical thinking, Communication using digital media in diverse environments, Collaboration with team members with complimentary abilities, and Creativity.[1] The new schools of 21st-century learning are more outcome-based, research-driven, student-centered with active collaborative learning that encourages higher-order thinking and is facilitated by greater use of multimedia. These skills just do not happen by accident but must be consciously cultivated by designing appropriate learning experiences.

On similar lines, the learning spaces in institutions for the 21st-century skills are now being built on new sets of assumptions that recognize that learning happens anywhere, any time, and as a result of group activity in collaborative teams and team teaching that happens in multiple reconfigurable linked learning spaces in contrast with the ones of old where it is assumed to happen only in classrooms, at fixed times, and as a result of individual activity facilitated by one teacher per class in separate single classrooms.[2]

Blended learning has emerged in response to this new norm described above. Blended learning, in simple terms, is blending the two worlds and learning paradigms, i.e. old classroom training and e-learning of the 21st century, using the best that each has and can offer. Here, the “face-to-face learning” by individuals in classrooms (and from textbooks, projects/assignments) gets blended with “connected learning” by groups of learners learning from and with each other using a variety of easy-to-access online resources including from YouTube and other online access-friendly repositories supplemented by social media that serves the purpose of scaffolding and social learning and taps on the synergy of being part of networks and communities of practice.

In blended learning, blending of old ways of learning with the 21st-century learning experiences designed by the teacher can be made to happen in time both synchronously (all learners learning at the same time) and asynchronously (at individual learner's own convenient time and pace). The teacher can also plan the instructional design such that learning can happen in the sequential order from individual self-learning to teacher-led small-group instruction in the face-to-face as well as personalized online to collaborative online learning modes. The key to effective learning in the blended learning (as also in face-to-face) mode is to ensure learner engagement with the learning resources by making them to think and apply the information for problem-solving or application of knowledge for doing a professional task. This is more so in the synchronous online mode as it is easy for the learner to get “disconnected” (and “hide”) if not constantly engaged via carefully crafted short duration activities and by avoiding the need to listen to long YouTube or monotonous presentations. Applying Mayer's multimedia instructional design principles for effective communication while using multimedia and Gagne's nine events of instructional design for effective lesson planning to make face-to-face mode sessions effective also applies even more so to blended learning experience where the critical element of eye contact for holding attention is missing. In blended learning, making it clear to the learner the learning outcomes and how that will be measured before each of the short multimedia presentations or short activities will get them interested and involved in the learning process and avoid going into “switch off” mode. A model for designing a blended learning intervention for the 21st-century student involving “the whole-brain approach” and is founded on learning needs assessment and the learning tasks and then scaffolding it with a blended learning intervention is described by Eagleton.[3]

In the past, after qualifying as a professional, blended learning was in vogue as a “distance learning” option mostly as a means for professional growth for knowledge update with the skill part being introduced and reinforced via “contact sessions.” This mode of distance learning was frowned upon as of less value if the learner underwent their graduate professional education course in this distance learning mode.

However, in the context of the COVID pandemic, even regular health professions education (HPE) teaching–learning sessions have entered the blended learning mode to avoid or minimize duration of physical contact. With “lockdowns” being enforced periodically to tide over periods of outbreak waves in the community, blended learning of the curricular portions is now here to stay in which the lower cognitive domain portions of the curriculum being delivered online through self-reading of textbook portions by the students and the higher cognitive domain portions of the same being delivered online in either collaborative learning groups engaged through group work or through assignments where they are required to apply knowledge gleaned from self-study of textbook portions. Then, once the students return from the lockdown, they receive the onsite part of the blended learning where the skill component of the competency is given an opportunity for the students to acquire through deliberate practice of the skill under supervision of the faculty facilitator who is also expected to give timely and appropriate feedback on the learner's performance.

Apart from the use of the usual principles of instructional design such as the Gagne's nine events, the ADDIE framework, the Dick and Carey model for training module design that are available to guide and design instruction for individual sessions and for individual courses, a good understanding is needed about the types and stages of progression in adult learning that takes place across the phases of undergraduate course, the postgraduate period, and the period following professional qualification as a healthcare professional engaged in CPD to improve the quality of practice as reflected by improvement in patient satisfaction with care provided and better patient care outcomes. The learners undergo changes in learner maturity with the learning that happens during early professional course (learning of basic sciences) being delivered in teacher-centered pedagogic style to a student in a lower end of learner maturity. This is followed by classical adult learning using application of their learning during the clinical phase with predominance of self-directed learning (SDL) and then transitioning to self-determined learning (heutagogy) during the postprofessional qualification period where the matured learner determines what course or skill to learn and become better at.[4]

Therefore, when we teachers are entrusted with designing blended learning-based instructional sessions/courses to different learner groups in different stages of HPE as described above, as facilitators of student learning, we need to be aware of which adult learning principles apply and work for motivating and facilitating their learning. A “one-size-fits-all” strategy of using the blended learning mode to all learners, irrespective of their stage of learner maturity and stage or level of self-direction during the phases of professional education course or after professional qualification, will not work. One needs to diagnose the learner in terms of their further learning needs, their level of learning maturity and level of SDL ability to match it with methods of instruction, and the content as well as making course outcomes known to learner so that the learners are motivated to learn, are continuously engaged in active learning, and made to reflect on implications of their learning to their role as a healthcare professional. Various attempts have been made to introduce flipped classroom as a form of blended learning to engage the learner in the online mode for teaching of basic sciences in professional courses, and one such attempt is described as a model that highlights the need for involvement of all stakeholders, i.e. students, the teachers, and the course designers.[5]

During the postqualification phase, when we design blended learning for practicing health professionals, we need to be cognizant of the fact that the healthcare practitioners are in the stage of self-determined learning where they determine (choose) what they want to learn more and want to become professionally better at. Hence, activities that help them identify what is the “care gap” in their practice that would improve patient satisfaction and care outcomes would help them to choose the courses they would like to undergo. Helping them develop their own personal and professional development plans, creating opportunities for deliberate practice and reflection on their practice and build their e-portfolio that captures their progress in learning as well as evaluation of impact on practice is the way forward. At this stage of professional development, s/he being in the self-determined learner stage, the types of courses we need to offer them are blended learning opportunities in the form of workshop series or fellowship programs in their targeted field of professional development within their specialty. Involving them in collaborative learning in communities of practice within their specialty's care teams makes blended learning more effective to ensure better course outcomes that translate into improved quality of patient care and that translate to better care outcomes.[4]

To summarize, blended learning scaffolds learning in the classroom or at the workplace; it enables the learner to learn at their own time, own pace, at their own place that is convenient for them and can use their own strategy for learning that works for them. Moreover, therefore, to make it more effective, it is important to ensure that you design the course by diagnosing the learner (stage of learner maturity, learning gaps, and further learning needs) so that a tailor-made blended learning program is designed to bridge this gap in appropriate learner setting and including opportunities for collaborative learning in learning groups or communities of practice that are connected at their workplace or through virtual online e-mail or WhatsApp group (or other social) networks that make them better equipped as healthcare professionals through experience sharing of what works.

”We now accept the fact that learning is a lifelong process of keeping abreast of change. And the most pressing task is to teach people how to learn.”- Peter Drucker

”Education is the passport to the future, for tomorrow belongs to those who prepare for it today.”- Malcolm X

  References Top

Pacific Policy Research Center. 21st Century Skills for Students and Teachers. Honolulu: Kamehameha Schools, Research and Evaluation Division. Research and Evaluation; 2010. Available from: https://pdf4pro.com/view/research-amp-evaluation-students-and-teachers-ec17.html. [Last accessed on 11 May 2021].  Back to cited text no. 1
Newton C, Backhouse S, Fisher K, Gan L, Grose M, Hes D, et al. Future Proofing Schools The Phase 1 Research Compilation. Faculty of Architecture Building and Planning, University of Melbourne; 2011 .Available from http://hdl.handle.net/11343/159099. [Last accessed on 2021 May 11].  Back to cited text no. 2
Eagleton S. Designing blended learning interventions for the 21st century student. Adv Physiol Educ 2017;41:203-11.  Back to cited text no. 3
Chacko TV. Emerging pedagogies for effective adult learning: From andragogy to heutagogy. Arch Med Health Sci 2018;6:278-83.  Back to cited text no. 4
  [Full text]  
Miles CA, Lee AC, Foggett KA, Nair B. Reinventing medical teaching and learning for the 21st century: Blended and flipped strategies. Arch Med Health Sci 2017;5:97-102.  Back to cited text no. 5
  [Full text]  


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