Internationalising the curriculum 5 years’ experience of an online MSc course

Internationalising the curriculum 5 years’ experience of an online MSc course Professor Trish Greenhalgh

Acknowledgement This presentation draws on insights, experiences and contributions from all the staff on the Masters in International Primary Health Care at UCL

Sent to Trish’s PA by African student “Dear Professor Marcia, Please allow me to thank you for […]. Please Prof. we are not at the same level and this type of learning is totally new to people like me. I have all along been subjected to the old way of learning what we call cramming the knowledge, memorize and pour on paper during exams and then pass or fail. Such type of learning tests only knowledge and not skills and attitudes. Therefore M------ University uses the old methods of 1900s. I shall try to catch up and to keep in step with the university - UCL- requirements. I have purchased a modem, I have internet now in my house and I will be working after work and minimize working in office and in Kampala cafés. God bless you Marcia, X----”

“This type of learning…totally new” • Constructivist (students generate knowledge in tutor-facilitated groups) • Problem-based and/or applied • Technology-supported • Expects and rewards advanced study skills • Reflection and scholarly critique valued over reproduction of facts

Five key challenges • Where students are coming from • English competence • ‘Generalisable’ versus ‘local’ knowledge • Connectivity • Affordability

1. Where students are coming from “I have all along been subjected to the old way of learning what we call cramming the knowledge, memorize and pour on paper during exams and then pass or fail.”

1. Where students are coming from …from feedback on first assignment Distinguishing fact from opinion or speculation. Some of you did this well; but many were weak on this core skill. […] A particular issue is distinguishing your personal moral values from scientific evidence. More than one student said something like “to prevent AIDS people should get married”. There is some truth in this but you must spell out your argument logically: “HIV is a sexually transmitted infection; the risk of transmission is greatly increased with the number of sexual partners; one policy for reducing HIV transmission is abstinence until marriage and monogamy thereafter”. However, even with this longer version, I would like to see you ‘problematise’ this statement so you can discuss it in a scholarly way. Without such an analysis your statement is just dogma, and you will lose marks for dogma.

2. English competence 3 major problems • Students don’t understand the intellectual nuances of discussions – hence don’t participate as ‘Masters level’ • Students run out of time in exams – hence underperform in relation to their ability • Students miss out on subtle cues – hence ‘put their foot in it’

2. English competence Student criticising a member of staff who had posted a transcript of a consultation with a patient: "He was too quick,had no empathy for the patient, no canselling skills exhited, potrayed poor relationship to the patient, and he forgot the criticall values of responding to the suffering positively. He stigmatised the patient and the way he explained the scientific explanations eg circulation of blood in your leg is dread ful. He wasrude, not ethical and poor interpesonal skills."

2. English competence …example of advice in student manual Politeness and hedging Hedging is not being too certain about what you are saying. In informal writing, it can be a form of good manners. In the discussion rooms, don’t label someone else’s contribution ‘stupid’ – they could be very offended! HEDGE – say ‘I think there’s a better interpretation’. Remember that no one can see your expression or hear your voice so make sure you don’t offend someone, for example by making a joke which they take seriously. Emoticons might help here, but be careful not to overuse them. Ideas of politeness vary a lot between different countries, so if you think someone has been rude, then it’s worth asking them about it in a private email. They may have had no intention at all of offending you, but were just behaving in the way that is normal in their country.

3. ‘Generalisable’ vs ‘local’ knowledge

3. ‘Generalisable’ vs ‘local’ knowledge Example of tutor ‘weaving’ contributions from a ide range of international students: “Well done everyone – lots of great contributions in this thread. Many of you have identified the main characteristics of psychology as applied to primary health care – it’s about attitudes, motivation, behaviour, emotions, and the nature of learning. I was interested in the different examples used in this thread – smoking, HIV, female genital mutilation, antisocial behaviour in disaffected youth[…]”

4. Connectivity “I have purchased a modem, I have internet now in my house and I will be working after work and minimize working in office and in Kampala cafés.”

4. Connectivity Tutor about a new cohort of African students: “I definitely want to do what we can to help them since they've been very impressive in the discussions. One went 40 km on a bus today because his local internet was down and he travelled to the nearest town with an internet cafe ”

4. Connectivity From new student based at WHO Middle East: “I will going on a field trip to Baghdad during the period 5-12 September 2007 part of a team to strengthen the MoH capacity in dealing with the cholera epidemic outbreak in the northern part of the country and support them on drawing lessons learnt and future actions to strengthen their surveillance system. I will have intermittent access to internet I will be able to complete the first weeks successfully I will also download all the lectures for the second week and will try my best to be on line but what happens if I miss a day or two and I try to compensate this in the following days will I be penalised?”

4. Connectivity Posted by this student’s personal tutor in SCR: “X---- is going to be absent from the course 5-12 September due to going on a field trip to Iraq (see email below). I have advised her that she will not be penalised for missing a couple of days etc but to try and keep on top of things.... in any case the experiences she will gain when in Iraq will be of great interest to the other students and tutors.”

5. Affordability From African student: “I am writing to request for further information regarding payment of examination entry fee. Other than the local fees levied by the external centre (British Council) which I have inquired it's 45 pounds per paper, does the scholarship contribute anything towards the same to the UCL? or are we expected to pay the university other examination fees? I hope my querries are clear!”

5. Affordability Comment from tutor in SCR after a suggestion that the students pay the £45 up front and claim back from us: “But 45 quid is two weeks' salary so I can understand it if people can't run to it, especially when supporting various orphan waifs like they all seem to do!”

Summary: key challenges • Some (but not all) students start a million miles away from liberal intellectual traditions • English competence goes beyond IELTS (though this is an important prerequisite) • Parochial experiences and examples can produce confusion and bad feeling • Connectivity problems cannot be solved by a list of ‘entry requirements’ and a disclaimer • ‘Little extras’ can potentially bankrupt students

Summary: some principles • Things that are implicit and unproblematic to ‘home grown’ students may need spelling out in explicit detail (e.g. in a student manual) and repeated frequently (e.g. in TMA feedback) • Parochial examples can (with judicious tutor input) produce generalisable insights • The rules may need to be suspended when students get cut off from the Internet • As well as full bursaries, there needs to be a pot for ‘sundry expenses’ of students from developing countries

Posted in reflection forum by Chinese student repeating dissertation year “This reflection exercise has brought me from a perplexed novice researcher into a encouraged learner in 'reflective learning'. […] It is probably because in the past I was taught that academic research had to be objective, unbiased, impersonal, third person and not involving the researcher's personal perspectives/views/feelings, and I used to believe that to be an unshakable truth. I have a mental struggling to use the letter 'I' in my writings. I learned that reflection can make me to develop a greater 'ownership' of my work and the awareness of my learning process and learning curve. I am testing out and incorporate more of my deeper thoughts in the process of doing the project into the dissertation.”

From research interview with a student “And the other, really positive thing that this virtual learning does, is it puts you in contact with people from all over the world. And that is so phenomenal because we are all you know, we all work in very different environments, but we are all facing the same problems. It is just mind boggling how similar some of our problems are. From developing world to developed world to everything in-between, we are all treating sick people, and even though the context is so different sometimes, there is a core element there that is just the same, so it really gives you a sense of fellowship with other healthcare professionals all over the world.”

THANK YOU FOR YOUR ATTENTION Professor Trish Greenhalgh

Internationalising the curriculum 5 years’ experience of an online MSc course