KempenE.pdf - UFS

EXPERIENTIAL LEARNING IN THE EXPANDED SCOPE OF THE

UNDERGRADUATE OPTOMETRY PROGRAMME AT THE UNIVERSITY OF

THE FREE STATE

by

ELZANA KEMPEN

Thesis submitted in fulfilment of the requirements for the degree

Philosophiae Doctor in Health Professions Education

(PhD HPE)

in the

DIVISION HEALTH SCIENCES EDUCATION

FACULTY OF HEALTH SCIENCES

AT THE UNIVERSITY OF THE FREE STATE

October 2020

PROMOTER: Prof M.J. Labuschagne

Head: Clinical Simulation and Skills Unit Faculty of Health Sciences University of the Free State

CO-PROMOTER: Dr M.P. Jama

Head: Division Student Learning and Development Faculty of Health Sciences University of the Free State

i

DECLARATION

I hereby declare that the work submitted here is the result of my own independent

investigation. Where help was sought, it is acknowledged. I further declare that this work

is submitted for the first time at this University and Faculty towards a Philosophiae Doctor

degree in Health Professions Education and that it has never been submitted to another

institution of higher education.

_____________________ ___09.10.2020____

Ms E. Kempen Date

I hereby cede copyright of this product in favour of the University of the Free State.

_____________________ ___09.10.2020____

Ms E. Kempen Date

ii

DEDICATION

To Claus

My loving husband and my best friend

Hebrews 12:11

No discipline seems pleasant at the time, but painful. Later on, however, it produces a

harvest of righteousness and peace for those who have been trained by it.

iii

AKNOWLEDGEMENTS

I wish to express my sincere thanks and appreciation to the following persons:

My promoter, Prof Mathys Labuschagne, Head: Clinical Simulation and Skills Unit,

Faculty of Health Sciences, University of the Free State, for his remarkable support

and guidance, respected mentorship and confidence in me.

My co-promoter, Dr Mpho Jama, Head: Division Student Learning and

Development, Faculty of Health Sciences, University of the Free State, for her

encouragement, support and valuable advice and contributions.

Dr Johan Bezuidenhout and Elmarie Robberts, Division Health Sciences Education,

Faculty of Health Sciences, University of the Free State, for their leadership and

support during this study.

The undergraduate students in the Department of Optometry, University of the

Free State, who participated in this study, for their valuable contribution making

this study a success.

Dr Hannamarie Bezuidenhout (PhD HPE), Language Practitioner, for the language

editing of the thesis, valuable inputs and formatting the thesis and references.

Prof. Marietjie Nel, University of the Free State, for her expertise and assistance in

assuring the authenticity of the data analysis.

Dr Lynette van der Merwe, Undergraduate Programme Director of the medical

programme in the School for Clinical Medicine, Faculty of Health Sciences,

University of the Free State, for her contribution as facilitator and controller of

transcriptions of the focus group interviews.

Dr L. Bergh (DLitt, et Phil), University of the Free State, for the translations of the

focus group interviews.

My colleagues at the Department of Optometry, University of the Free State. I

sincerely appreciate your encouragement, practical tips and continued interest.

Health and Welfare Sector Education and Training Authority (HWSETA), for

providing a bursary to fund this study.

My parents, parents-in-law and family for your unfailing support, prayers and

inspiration.

My precious husband, Claus and two children, Carli and Lander. I treasure your

unconditional love and allowing me the time to complete the thesis.

To my Heavenly Father with whom nothing is impossible.

iv

Learning is an experience, everything else is just information

Albert Einstein

v

TABLE OF CONTENTS

Page

CHAPTER 1: OVERVIEW OF THE STUDY

1.1 INTRODUCTION ……………………………………..………………...... 1

1.2 BACKGROUND TO THE RESEARCH PROBLEM …..…………………. 3

1.3 PROBLEM STATEMENT AND RESEARCH QUESTIONS ……………. 4

1.4 OVERALL GOAL, AIM AND OBJECTIVES OF THE STUDY …………. 5

1.4.1 Overall goal of the study ……………………………………………..... 5

1.4.2 Aim of the study ………………………………………………………….. 5

1.4.3 Objectives of the study ……………………………………………....... 6

1.5 DEMARCATION OF THE FIELD AND SCOPE OF THE STUDY …..... 6

1.6 SIGNIFICANCE AND VALUE OF THE STUDY ……………………...... 7

1.7 RESEARCH DESIGN OF THE STUDY AND METHODS OF

INVESTIGATION ……………………………………………………........

8

1.7.1 Design of the study …………………………………………………....... 8

1.7.2 Methods of investigation ……………………………………………..... 9

1.8 COMMUNICATING THE FINDINGS ………………………………...... 10

1.9 ARRANGEMENT OF THE THESIS …………………………………….... 11

1.10 CONCLUSION …………………………………………………………...... 12

CHAPTER 2: EXPERIENTIAL LEARNING APPLIED IN TEACHING AND LEARNING

IN HIGHER EDUCATION IN THEORY AND CLINICAL MODULES

2.1 INTRODUCTION ………………………………………………………… 13

2.2 OPTOMETRY IN SOUTH AFRICA ……………….……………………. 14

2.2.1 Scope of practice as a registered Optometrist in South Africa 14

2.2.2 Undergraduate optometry education in South Africa………..... 17

2.3 EXPERIENTIAL LEARNING………………………………………….... 20

2.3.1 Historical development………………………………………………... 20

2.3.2 Definition of experiential learning………………………………….. 23

2.3.3 Elements of experiential learning…………………………………… 25

2.3.3.1 Experience ……………………………………………………………….. 26

2.3.3.2 Teaching-learning methods to create a learning experience ... 30

vi

2.3.3.2.1 Traditional lectures ……………………………………………………….. 30

2.3.3.2.2 Flip the classroom …………………………………………………………. 33

2.3.3.2.3 Small-group work learning ……………………………………………….. 35

2.3.3.2.4 Simulation ………………………………………………………………….. 37

2.3.3.2.5 Interprofessional Education ………………………………………………. 39

2.3.3.2.6 Case presentation …………………………………………………………. 43

2.3.3.2.7 Peer assessment …………………………………………………………… 45

2.3.3.2.8 Bedside teaching …………………………………………………………... 48

2.3.3.2.9 Clinical skills training ………………………………………………………. 50

2.3.3.2.10 Clinical education ………………………………………………………….. 53

2.3.3.3 Reflection ………………………………………………………………… 56

2.3.3.3.1 Benefits of reflection ………………………………………………………. 57

2.3.3.3.2 Models of reflection ……………………………………………………….. 58

2.3.3.4 Role of educator ………………………………………………………… 60

2.4 CONCLUSION ……………………………………………………………. 61

CHAPTER 3: RESEARCH DESIGN AND METHODOLOGY

3.1 INTRODUCTION ………………………………………………..………. 63

3.2 THEORETICAL PERSPECTIVES ON THE RESEARCH DESIGN 64

3.2.1 The research design of this study……………………………………. 64

3.2.1.1 Research paradigm ……………………………………………..……… 64

3.2.2.2 Qualitative research ……………………………………………...……. 66

3.3 RESEARCH METHODS ……………………………………………..…... 68

3.3.1 Literature Review …………………………………………………..….. 68

3.3.2 Questionnaire survey ………………………………………………..… 68

3.3.3 Focus group interviews ……………………………………………….. 69

3.4 DATA COLLECTION ……………………………………………….……. 70

3.4.1 Questionnaire survey ………………………………………………….. 70

3.4.1.1 Target population …………………………………………………….... 71

3.4.1.2 Description of sample and sample size ……………………………. 71

3.4.1.3 Pilot study ………………………………………………………………… 72

3.4.1.4 Data collection ………………………………………………………….. 72

3.4.2 Focus group interviews ……………………………………………….. 74

3.4.2.1 Target population …………………………………………………….... 74

vii

3.4.2.2 Description of sample and sample size …………………………… 74

3.4.2.3 Pilot testing …………………………………………………………….... 75

3.4.2.4 Data collection ………………………………………………………….. 75

3.5 DATA ANALYSIS ……………………………………………………….... 76

3.5.1 Description phase …………………………………………………….... 79

3.5.2 Recontextualisation phase …………………………………………… 80

3.5.3 Analysis phase …………………………………………………………… 80

3.5.4 Interpretation phase …………………………………………………... 81

3.6 ENSURING THE QUALITY OF THE STUDY …………………………. 81

3.6.1 Credibility ………………………………………………………………... 82

3.6.2 Transferability …………………………………………………………… 82

3.6.3 Dependability ………………………………………………………….... 82

3.6.4 Confirmability …………………………………………………………… 83

3.7 ETHICAL CONSIDERATIONS ……………………………………….... 83

3.7.1 Approval ………………………………………………………………….. 83

3.7.2 Informed consent …………………………………………………….... 83

3.7.2.1 Questionnaire survey ………………………………………………….. 84

3.7.2.2 Focus group interviews ……………………………………………….. 84

3.8 RIGHT TO PRIVACY AND CONFIDENTIALITY ……………………. 84

3.6 CONCLUSION ………………………………………………………….... 85

CHAPTER 4: RESULTS OF THE QUESTIONNAIRE SURVEY: ANALYSIS AND

DISCUSSION

4.1 INTRODUCTION ……………………………………………………….. 86

4.2 DEMOGRAPHY OF THE SAMPLE …………………………………….. 87

4.3 DATA ANALYSIS OF THE QUESTIONNAIRE SURVEY …………... 88

4.4 REPORTING OF THE RESULTS, DATA ANALYSIS,

DESCRIPTION AND DISCUSSION OF FINDINGS OF THE

QUESTIONNAIRE SURVEY …………………………………………… 89

4.4.1 Results of the questionnaire survey on traditional lectures 91

4.4.1.1 Lectures for the purpose of this study ……………………………. 91

4.4.1.2 Analysis and description of the experiences and perceptions

of undergraduate optometry students on lectures ……………. 91

viii

4.4.1.3 Summary and discussion of the experiences and perceptions

of undergraduate optometry students on lectures ……………. 101

4.4.2 Results of the questionnaire survey on flip the classroom …… 105

4.4.2.1 Flip the classroom for the purpose of this study ……………….. 105


of undergraduate optometry students on flip the classroom 109


of undergraduate optometry students on flip the classroom 117

4.4.3 Results of the questionnaire survey on small-group learning 122

4.4.3.1 Small-group learning design for the purpose of this study ….. 122


of undergraduate optometry students on small-group

learning …………….…………….…………….…………….…………. 123


of undergraduate optometry students on small-group

learning …………….…………….…………….…………….…………. 129

4.4.4 Results of the questionnaire survey on simulation ……………. 133

4.4.4.1 Simulation design for the purpose of this study ………………... 133


of undergraduate optometry students on simulation ………… 134


of undergraduate optometry students on simulation ………… 139

4.4.5 Results of the questionnaire survey on interprofessional

education …………….…………….…………….…………….……….. 142

4.4.5.1 Interprofessional education for the purpose of this study …... 142


of undergraduate optometry students on interprofessional

education …………….…………….…………….…………….……….. 144


of undergraduate optometry students on interprofessional

education …………….…………….…………….…………….……….. 150

4.4.6 Results of the questionnaire survey on case presentation …... 154

4.4.6.1 Case presentation for the purpose of this study ……………….. 154

ix


of undergraduate optometry students as presenters of case

presentation …………….…………….…………….…………….……. 155


of undergraduate optometry students as presenters of case

presentation …………….…………….…………….…………….……. 163


of undergraduate optometry students on attending case

presentation …………….…………….…………….…………….……. 166


of undergraduate optometry students on attending case

presentation …………….…………….…………….…………….……. 181

4.4.7 Results of the questionnaire survey on peer assessments …... 186

4.4.7.1 Peer assessment for the purpose of this study …………………. 186


of undergraduate optometry students on peer assessment

used with other teaching-learning methods ……………….. 188


of undergraduate optometry students on peer assessments

in the module Clinical Optometry (COPT 4800) ………………… 193


of undergraduate optometry students on peer assessment … 201

4.4.8 Results of the questionnaire survey on bedside teaching ……. 205

4.4.8.1 Bedside teaching design for the purpose of this study ……….. 205


of undergraduate optometry students on bedside teaching .. 206


of undergraduate optometry students on bedside teaching .. 215

4.4.9 Results of the questionnaire survey on clinical skills training 220

4.4.9.1 Clinical skills training for the purpose of this study …………… 220


of undergraduate optometry students on clinical skills

training …………….…………….…………….…………….………….. 221

x


of undergraduate optometry students on clinical skills

training …………….…………….…………….…………….………….. 232

4.5 CONCLUSION …………….…………….…………….…………….….. 236

CHAPTER 5: RESULTS OF FOCUS GROUP INTERVIEWS: ANALYSIS AND

DISCUSSION

5.1 INTRODUCTION …………….…………….…………….……………… 237

5.2 RESEARCH TEAM AND REFLEXIVITY …………….…………….…. 239

5.2.1 Personal characteristics …………….…………….…………………. 239

5.2.2 Relationship with participants …………….…………….…………. 239

5.3 STUDY DESIGN …………….…………….…………….………………. 240

5.3.1 Theoretical framework …………….…………….…………….…….. 240

5.3.2 Participant selection …………….…………….…………….……….. 240

5.3.3 Setting …………….…………….…………….…………….…………… 241

5.3.4 Data collection …………….…………….…………….…………….… 242

5.4 DATA ANALYSIS AND FINDINGS …………….…………….……… 243

5.4.1 Data analysis …………….…………….…………….…………….…… 243

5.4.2 Reporting the data …………….…………….…………….………….. 244

5.4.2.1 Focus area 1: Personal opinion on the research project …..… 245

5.4.2.2 Focus area 2: The overall feelings about the learning

environment …………….…………….………………………………… 246

5.4.2.3 Focus area 3: Theoretical grounding and integration of

theory and clinical practice ……………..….…………….…………. 248

5.4.2.4 Focus area 4: Factors that influenced the Pathology clinical

learning environment …………….…………….…………….………. 254

5.4.2.5 Focus area 5: Recommendations on the enhancement of the

learning environment in the Pathology clinic …………….…….. 270

5.5 SUMMARY OF FINDINGS OF RESULTS AND DISCUSSION OF

FOCUS GROUP INTERVIEWS …………….…………….……………. 279

5.6 CONCLUSION …………….…………….…………….…………….…… 281

xi

CHAPTER 6: RECOMMENDATIONS ON EXPERIENTIAL LEARNING IN THE

EXPANDED SCOPE OF THE UNDERGRADUATE OPTOMETRY

PROGRAMME AT THE UNIVERSITY OF THE FREE STATE

6.1 INTRODUCTION …………….…………….…………….………………. 282

6.2 RECOMMENDED EXPERIENTIAL TEACHING-LEARNING

FRAMEWORK …………….…………….…………….……………….….. 284

6.2.1 Lectures …………….…………….…………….…………….…………… 287

6.2.2 Flip the classroom …………….…………….…………….…….………. 287

6.2.3 Small-group learning …………….…………….…………….………… 288

6.2.4 Simulation …………….…………….…………….…………….….…….. 288

6.2.5 Interprofessional education …………….…………….……………... 289

6.2.6 Case presentation …………….…………….…………….……….……. 289

6.2.7 Peer assessment …………….…………….…………….………….…… 290

6.2.8 Bedside teaching …………….…………….…………….……………… 290

6.2.9 Clinical skills training …………….…………….…………….………… 291

6.2.10 Clinical education …………….…………….…………….…………….. 292

6.3 RECOMMENDATIONS ON DIFFERENT ROLES AND

ATTRIBUTES OF THE EDUCATOR IN THE EXPERIENTIAL CYCLE 292

6.3.1. Abstract conceptualisation …………….…………….…………….…. 293

6.3.1.1 Knowledgeable …………….…………….…………….…………….….. 294

6.3.1.2 Create an interest …………….…………….…………….…………….. 294

6.3.2 Active experimentation …………….…………….…………….……… 294

6.3.2.1 Provide guidance …………….…………….…………….……………… 295

6.3.2.2 Be approachable …………….…………….…………….…………….… 295

6.3.3 Concrete experience …………….…………….…………….…………. 295

6.3.3.1 Build confidence …………….…………….…………….………………. 295

6.3.3.2 Implement ground rules …………….…………….…………….……. 296

6.3.4 Reflective observation …………….…………….…………….………. 297

6.3.4.1 Lead by example …………….…………….…………….………………. 297

6.3.4.2 Mediator …………….…………….…………….…………….………….. 297

6.4 RECOMMENDATIONS FOR A SAFE LEARNING ENVIRONMENT.. 298

6.4.1 Familiarity …………….…………….…………….…………….………… 299

6.4.2 Small group …………….…………….…………….…………….……… 300

6.4.3 Free to ask questions …………….…………….…………….……….. 301

xii

6.4.4 Learning without risks …………….…………….…………….………. 301

6.4.5 Peer learning …………….…………….…………….…………….……. 302

6.4.6 Personal contact …………….…………….…………….……………… 303

6.4.7 Consistency …………….…………….…………….…………….……… 303

6.4.8 Achievable objective …………….…………….…………….………… 304

6.5 RECOMMENDATIONS FOR EFFECTIVE IMPLEMENTATION OF

EXPERIENTIAL TEACHING-LEARNING METHODS IN

PATHOLOGY MODULES IN OPTOMETRY EDUCATION …………. 306

6.6 CONCLUSION …………….…………….…………….…………….……. 309

CHAPTER 7: CONCLUSION, RECOMMENDATIONS AND LIMITATIONS OF THE

STUDY

7.1 INTRODUCTION …………….…………….…………….…………….… 310

7.2 OVERVIEW OF THE STUDY …………….…………….…………….….. 310

7.2.1 Research question 1 …………….…………….….………….…………. 311



7.3 CONCLUSION …………….…………….…………….……….…………. 315

7.4 LIMITATIONS OF THE STUDY …………….…………….……………. 316

7.5 CONTRIBUTION OF THE RESEARCH …………….…………….……. 317

7.6 RECOMMENDATIONS …………….…………….…………….………… 317

7.7 CONCLUSIVE REMARK …………….…………….…………….………. 318

REFERENCES 319

xiii

LIST OF APPENDICES

APPENDIX A-1 QUESTIONNAIRE FOR REFLECTION

APPENDIX A-2 VRAELYS VIR REFLEKSIE

APPENDIX B-1 AGENDA AND QUESTIONS FOR FOCUS GROUP INTERVIEW

APPENDIX B-2 ETHICAL APPROVAL LETTER FOR AGENDA AND

QUESTIONS FOR FOCUS GROUP INTERVIEW

APPENDIX C TRANSLATION OF FOCUS GROUP INTERVIEW AUDIO

RECORDING

APPENDIX D HSREC APPROVAL LETTER FOR THE STUDY

APPENDIX E-1 CONSENT TO PARTICIPATE IN RESEARCH AND

INFORMATION DOCUMENT (ENGLISH)

APPENDIX E-2

TOESTEMMING TOT DEELNAME AAN NAVORSING EN

INLIGTINGSDOKUMENT (AFRIKAANS)

APPENDIX F-1 REQUEST FOR PARTICIPATION IN FOCUS GROUP AS PART

OF A RESEARCH PROJECT

APPENDIX F-2 VERSOEK OM DEELNAME IN FOKUS-GROEPONDERHOUD

AS DEEL VAN NAVORSINGSPROJEK

APPENDIX G-1 CONSENT TO PARTICIPATE IN RESEARCH: FOCUS GROUP

APPENDIX G-2 TOESTEMMING TOT DEELNAME AAN NAVORSING: FOKUS-

GROEPONDERHOUD

APPENDIX H-1 OVERVIEW OF THE THEMES, CATEGORIES AND

SUBCATEGORY OF OPTOMETRY STUDENTS’ PERCEPTIONS

ON THEIR EXPERIENCE OF LECTURES



ON THEIR EXPERIENCE OF FLIP THE CLASSROOM



ON THEIR EXPERIENCE OF SMALL-GROUP LEARNING



ON THEIR EXPERIENCE OF SIMULATION



xiv

ON THEIR EXPERIENCE OF INTERPROFESSIONAL

EDUCATION



ON THEIR EXPERIENCE AS PRESENTERS OF CASE

PRESENTATION



ON THEIR EXPERIENCE ON ATTENDING CASE

PRESENTATION

APPENDIX H-8 OVERVIEW OF THE THEME, CATEGORIES AND


ON THEIR EXPERIENCE OF PEER ASSESSMENT USED WITH

OTHER TEACHING-LEARNING METHODS



ON THEIR EXPERIENCE OF PEER ASSESSMENT USED IN

THE MODULE CLINICAL OPTOMETRY (COPT 4800)



ON THEIR EXPERIENCE OF BEDSIDE TEACHING



ON THEIR EXPERIENCE OF CLINICAL SKILLS TRAINING

APPENDIX I SESSION FACILITATION FOR PATH 4802 AND GENA 2612

LECTURE

APPENDIX J INFOGRAPHIC PRESENTED TO STUDENTS TO EXPLAIN THE

FLIP THE CLASSROOM APPROACH

APPENDIX K-1 GENA 2612 FLIP THE CLASSROOM PLANNING TEMPLATE

APPENDIX K-2 DGNS 3702 FLIP THE CLASSROOM PLANNING TEMPLATE

APPENDIX K-3 PATH 4802 FLIP THE CLASSROOM PLANNING TEMPLATE

APPENDIX L OVERVIEW OF SIMULATION SESSION

APPENDIX M OBJECTIVES OF THE APPRENTICESHIP SESSION IN

PATHOLOGY CLINIC

APPENDIX N DECLARATION FROM LANGUAGE PRACTITIONER

xv

LIST OF TABLES

TABLE 2.1 DIFFERENTIATION BETWEEN TRADITIONAL EDUCATION

AND EXPERIENTIAL LEARNING WITHIN DEWEY’S

PHILOSOPHY ………………………………………………………. 21

TABLE 2.2 PROFESSIONAL SKILLS ACQUIRED DURING BEDSIDE

TEACHING ……………….………………………………………….. 50

TABLE 3.1 RESPONSE RATE OF SECOND- TO FOURTH-YEAR

UNDERGRADUATE STUDENTS REGISTERED AT THE

DEPARTMENT OF OPTOMETRY, UNIVERSITY OF THE FREE

STATE, 2017 ………………………………………………………... 71

TABLE 3.2 UNDERGRADUATE MODULES IN WHICH THE DIFFERENT

TEACHING-LEARNING METHODS WERE APPLIED ............ 73

TABLE 4.1 NUMBER OF SECOND- TO FOURTH-YEAR

UNDERGRADUATE OPTOMETRY STUDENTS THAT

COMPLETED THE QUESTIONNAIRE SURVEY ………….....…. 87

TABLE 4.2 DEMOGRAPHICAL DATA OF THE SAMPLE (N=68) ….……… 88

TABLE 4.3 STRENGTHS OF LECTURE AS IDENTIFIED BY

UNDERGRADUATE OPTOMETRY STUDENTS, UFS ……….…. 96

TABLE 4.4 STRENGTHS OF FLIP THE CLASSROOM AS IDENTIFIED BY


TABLE 4.5 WEAKNESSES OF FLIP THE CLASSROOM AS IDENTIFIED

BY UNDERGRADUATE OPTOMETRY STUDENTS, UFS …..…. 114

TABLE 4.6 ASSESSMENT CRITERIA APPLIED BY STANDARDISED

PATIENT ………….………………………………………………….. 134

TABLE 4.7 STRENGTHS OF SIMULATION AS IDENTIFIED BY


TABLE 4.8 WEAKNESSES OF INTERPROFESSIONAL EDUCATION AS

IDENTIFIED BY UNDERGRADUATE OPTOMETRY

STUDENTS, UFS ……………………………………………………. 147

TABLE 4.9 STRENGTHS OF PRESENTING AT CASE PRESENTATION AS

IDENTIFIED BY UNDERGRADUATE OPTOMETRY

STUDENTS, UFS ……………………………………………………. 158

TABLE 4.10 FACTORS THAT ENHANCED LEARNING DURING THE

ATTENDANCE OF CASE PRESENTATION ……………………… 176

xvi

TABLE 4.11 STRENGTHS OF PEER ASSESSMENT IN THE CLINICAL

MODULE AS IDENTIFIED BY UNDERGRADUATE

OPTOMETRY STUDENTS, UFS …………………………………… 197

TABLE 4.12 STRENGTHS OF BEDSIDE TEACHING AS IDENTIFIED BY

UNDERGRADUATE OPTOMETRY STUDENTS, UFS ………….. 211

TABLE 5.1 SUMMARY OF FOCUS AREAS, THEMES AND CATEGORIES

OF THE FOCUS GROUP INTERVIEWS CONDUCTED ……...… 244

TABLE 5.2 FACTORS THAT CONTRIBUTED TO A SAFE LEARNING

ENVIRONMENT …………………………………………………….. 254

TABLE 5.3 CHALLENGES EXPERIENCED IN THE PATHOLOGY

CLINICAL LEARNING ENVIRONMENT ………………………… 257

TABLE 5.4 NEGATIVE ASPECTS OF THE RUBRIC USED IN

ASSESSMENT IN THE PATHOLOGY CLINICAL LEARNING

ENVIRONMENT …………………………………………………….. 268

TABLE 6.1 RECOMMENDATIONS FOR EFFECTIVE APPLICATION OF

EXPERIENTIAL TEACHING-LEARNING METHODS IN

PATHOLOGY MODULES IN OPTOMETRY EDUCATION …….. 306

xvii

LIST OF FIGURES

FIGURE 1.1 A SCHEMATIC OVERVIEW OF THE RESEARCH PROCESS ... 10

FIGURE 2.1 A DIAGRAMMATIC OVERVIEW OF THE CONCEPTUAL

FRAMEWORK THAT WILL BE DISCUSSED …………..…….… 13

FIGURE 2.2 WCO CATEGORIES OF OPTOMETRIC SERVICES ….….……. 15

FIGURE 2.3 KOLB CYCLICAL MODEL OF KNOWLEDGE DEVELOPMENT 23

FIGURE 2.4 FRAMEWORK FOR EXPERIENTIAL LEARNING ……….……. 25

FIGURE 2.5 EXPERIENTIAL LEARNING FRAMEWORK …………………... 28

FIGURE 2.6 DALE’S CONE OF EXPERIENCE ………………….……………... 29

FIGURE 2.7 PRINCIPLES OF TEACHING PSYCHOMOTOR SKILLS …….. 51

FIGURE 2.8 GIBB’S REFLECTIVE CYCLE ………………………….…………. 59

FIGURE 3.1 CONSTRUCTION AND INTERPRETATION AS MEANS OF

ACCESS TO THE WORLD OF EXPERIENCE …………….…….. 66

FIGURE 3.2 A DIAGRAMMATIC OVERVIEW OF THE CONTENT DATA

ANALYSIS GUIDELINES USED FOR THIS STUDY ……….…. 78

FIGURE 4.1 SUMMARY OF THE EXPERIENCES AND PERCEPTIONS OF

UNDERGRADUATE OPTOMETRY STUDENTS ON

LECTURES ………………………………………………………….. 101


UNDERGRADUATE OPTOMETRY STUDENTS ON FLIP THE

CLASSROOM ………………………….……………………………. 117


UNDERGRADUATE OPTOMETRY STUDENTS ON SMALL

GROUP LEARNING ……………………………….………………. 129



SIMULATION …………………………….………………………… 139

FIGURE 4.5 DESIGN OF THE IPE SESSIONS AT THE FOHS, UFS ….……. 143



INTERPROFESSIONAL EDUCATION ………………..………… 151


UNDERGRADUATE OPTOMETRY STUDENTS OF CASE

PRESENTATION …………………….…………………………….. 164

xviii



ATTENDING CASE PRESENTATION ………….……………….. 181


UNDERGRADUATE OPTOMETRY STUDENTS ON PEER

ASSESSMENTS …………………………………………………..… 201


UNDERGRADUATE OPTOMETRY STUDENTS ON BEDSIDE

TEACHING ………………………………………………………….. 216


UNDERGRADUATE OPTOMETRY STUDENTS ON CLINICAL

SKILLS TRAINING ………………………………………………… 233

FIGURE 5.1 ADAPTED COREQ* CRITERIA CHECKLIST FOR

REPORTING FOCUS GROUP INTERVIEWS ………………….. 238

FIGURE 5.2 SUMMARY OF FOCUS GROUP INTERVIEWS ………………... 280

FIGURE 6.1 HIERARCHICAL RECOMMENDATION SYSTEM FOR THE

EFFECTIVE IMPLEMENTATION OF EXPERIENTIAL

LEARNING ………………………………………………………….. 283

FIGURE 6.2 A RECOMMENDED EXPERIENTIAL TEACHING-LEARNING

FRAMEWORK FOR USE IN THE UNDERGRADUATE

OPTOMETRY LEARNING PROGRAMME ……………………… 286

FIGURE 6.3 RECOMMENDED ROLES AND ATTRIBUTES OF THE

EDUCATOR IN THE EXPERIENTIAL CYCLE ………………….. 293

FIGURE 6.4 ELEMENTS RECOMMENDED TO CREATE A SAFE

EXPERIENTIAL LEARNING ENVIRONMENT ………………… 299

xix

LIST OF ABBREVIATIONS

BIO Binocular Indirect Ophthalmoscope

B. Optom Bachelor of Optometry

CAIPE Centre for the Advancement of Interprofessional Education

CBE Community Based Education

CHE Council on Higher Education

COREQ Consolidated Criteria for Reporting Qualitative Research

FoHS Faculty of Health Sciences

HSREC Health Sciences Research Ethics Committee

HPE Health Professions Education

HPCSA Health Professions Council of South Africa

ICF International Classification of Functioning Disability

IPE Interprofessional Education

IPL Interprofessional Learning

KERP Kolb Educator Role Profile

LMS Learning Management System

MCC Medicine Control Council

NHI National Health Insurance

OECD Organisation for Economic Co-operation and Development

PBOPD Professional Board of Optometrist and Dispensing Opticians

SAGES Seminar Approach to General Education and Scholarship

SAOA South African Optometry Association

SAQA South African Qualification Authority

SP Standardised patients

UFS University of the Free State

UKZN University of KwaZulu Natal

WCO World Council of Optometry

WHO World Health Organisation

xx

SUMMARY

Key terms: experiential learning; higher education, qualitative research;

experiences and perceptions; teaching-learning methods; theory and clinical

training; recommendations for optometry education; millennial generation.

With the dynamic change in the scope of practice of optometry, it has become essential for

universities to provide students with sufficient and appropriate learning opportunities to

enable them to progress from being a student to taking up the role of a professional

optometrist. In the research project reported here, a study was conducted with a view to

establishing and compiling recommendations for educators in the Department of Optometry

at the University of the Free State (UFS), in order to create meaningful learning experiences

with effective experiential teaching-learning methods. This study was initiated in response

to the identification of a gap in the knowledge regarding experiential learning in theory and

clinical education of the optometry degree programme at the UFS.

The aim of the study was to investigate how different teaching-learning and assessment

methods of the experiential learning cycle should be applied to enhance the learning

environment and promote the integration of theory and practice in the expanded scope of

the undergraduate Optometry programme at UFS. In order to achieve the aim of this study,

a qualitative approach was followed. To investigate the experiences and perceptions of

registered optometry students regarding the different teaching-learning methods and

assessments, based on experiential learning and used in the pathology modules, data were

gathered by means of an open-ended questionnaire survey among second- to fourth-year

registered undergraduate optometry students at the UFS in 2017, as well as focus group

discussions with the fourth-year optometry students.

These findings, as well as the data collected from the literature survey, were incorporated

to fill the gap in knowledge by formulating recommendations on the effective

implementation of experiential teaching-learning methods. Important findings based on the

analysis of the data (opinions, feelings and perceptions of student respondents) addressed

issues such as the approachability of educators, consistency in the learning environment,

student-lecturer relationships, earlier exposure to clinical environment, peer mentoring and

peer assessment, exposure to a variety of cases and time for reflections with feedback, and

more.

xxi

From the findings, a set of recommendations ensued, including a recommended experiential

learning framework, recommendations on the different roles and attributes of the educator,

and recommendation on elements required to create a safe experiential learning

environment. These recommendations can be implemented by the Department of

Optometry to create an optimal learning environment.

It is hoped that the outcomes of this study will be valuable to both educators and students

and ultimately will be to the benefit of the patients making use of optometry services.

Generally speaking, these findings and recommendations may also prove valuable for other

schools and departments in faculties of health sciences. Not only are the recommendations

based on the views of a millennial generation but also as experiential learning has been

found to be exceptionally appropriate and useful to enhance the application of theory in

clinical work.

EXPERIENTIAL LEARNING IN THE EXPANDED SCOPE OF THE

UNDERGRADUATE OPTOMETRY PROGRAMME AT THE UNIVERSITY OF

THE FREE STATE

CHAPTER 1

OVERVIEW OF THE STUDY

1.1 INTRODUCTION

In this study, the application of experiential learning in health sciences education was

addressed. The study was conducted by collecting data from optometry students registered

at the University of the Free State (UFS), South Africa at the time of the study. The data

provided evidence for the development of recommendations for the implementation of

experiential learning in the expanded scope of the undergraduate optometry programme at

the UFS.

The Health Professions Council of South Africa (HPCSA) approved the expanded scope for

the practice of optometry in South Africa in December 2014. Hence, the focus of the new

undergraduate optometry learning programmes need to include ocular therapeutics. This

scope will have an impact on the pathology modules as the expansion of the scope includes

the management of certain eye diseases and the prescription of therapeutic drugs to

patients. Therefore, the emphasis of this study was on the current pathology modules of

the undergraduate optometry programme at the UFS.

Educators recognise experiential learning as truly influential. This type of learning creates

an understanding of human learning behaviour and presents a way of structuring a course

in a certain way to improve student learning (Chavan 2011:128). In addition, experiential

learning focuses on how individuals learn through individual ways as they react to individual

perceptions of experiences (Yardley, Teunissen & Dornan 2012:103). Students, as

recognised by Dewey’s philosophy, are individuals with different needs. Experiential

learning can meet the needs of each individual by facilitating individualised instruction. This

type of instruction enables the student to interact with the content that should be learned

(Roberts 2003:7). It, therefore, is important for educators to provide a meaningful

educational experience that has the potential for learning based on the individual needs of

students (Fowler 2008:428). Fowler (2008:429) concludes that an experience is not merely

2

a matter of exposure to an event; an element of the experience needs to be internalised

and positioned in relation to existing knowledge and experiences.

Orîndaru (2015:683) makes it clear that students in higher education are perceived as

consumers that are actively involved in their learning. For this reason, it is important to

research the effectiveness of a specific teaching-learning method and incorporate the

students’ perceptions and ideas on how to enhance the specific teaching-learning method

and the overall learning environment. Toothaker and Taliaferro (2017:348), who proclaim

that an educational approach that is personalised through the perceptions of students may

transform the learning environment and lead to a deeper understanding of knowledge,

confirm this motion.

This study, therefore, may serve as a directive to enhance the transformation of learning

in the expanded scope of the undergraduate optometry learning programme for optometry

students. The aim of this study was to provide recommendations for such transformation

that is both pedagogically sound and based on the empirical evidence of the experiences

and perceptions of the undergraduate students of the optometry programme at the UFS.

This will contribute to the enhancement of the integration of theory lectures and clinical

education through experiential learning. Furthermore will the research provide insight in

the teaching-learning and assessment methods that are likely to be most effective to

overcome the current mismatch between reality and the assumptions underlying the

traditional structure and approaches as mentioned by the Council on Higher Education

(CHE) and the HPCSA (CHE-HPCSA 2013:17).

The aim of Chapter 1, Overview of the study, is to orientate the reader regarding the

study. In the first sections, the background to the research problem is given, followed by

the problem statement and research questions, as well as the overall goal, aim and

objectives of the study. Thereafter, the demarcation of the field and the envisaged

significance and value of the study are explained. This is followed by a brief overview of

the research design and methods of investigation. The chapter is concluded with a layout

of the subsequent chapters and a short, summative conclusion.

3

1.2 BACKGROUND TO THE RESEARCH PROBLEM

Worldwide, optometry is practiced in different ways according to the policies, legislation

and scope of practice of the professional boards of different countries. With the approval

of the expanded scope of practice, universities in South Africa with full accreditation have

been requested by the Professional Board for Optometry and Dispensing Opticians (PBOPD)

to revise the curriculum of the Bachelor of Optometry (B.Optom) degree to include Ocular

Therapeutics.

The UFS has identified five focus areas for transformation in teaching-learning (UFS 2017a:

Online). Among these are student engagement and transformed pedagogies. The main

objective of student engagement includes the encouragement of students to take

responsibility for their learning. This can be done by engaging in effective teaching

behaviours that are student-centred. The UFS has identified the following six views on which

student-centredness is based:

1. The dependence on active rather than passive learning

2. Emphasis on deep learning and understanding

3. Increased responsibility and accountability on the part of the student

4. An increased sense of autonomy in the learner

5. An interdependence between teacher and learner

6. Mutual respect in the learner-teacher relationship.

In addition, the UFS also urges educators to transform the way in which they teach to

respond better to the real needs of the UFS students. Toothaker and Taliaferro (2017:345)

hold the same view and explain that insight must be gained in students’ perceptions to

identify their needs and adapt teaching-learning methodology to optimise learning

pedagogies. The researcher has identified that a way of enhancing the learning environment

for the current generation of students at the Department of Optometry at the UFS is through

Kolb’s Experiential Learning Cycle (Kempen & Kruger 2019:6). That this was the right

decision to make, is in correspondence with Toothaker and Taliaferro (2017:348), who

purport that millennial or Y-generation students (born in the period 1981–2000) are

attracted to experiential learning.

4

Moreover, experiential learning provides the student with the opportunity to apply the

information directly in order to be self-efficient and learn from the experience. Experiential

learning has been found to be effective by increasing the students’ awareness of their own

knowledge, applying it to actual situations and the ability to understand, control and

manipulate their own cognitive processes to become self-directed learners (Manolis, Burns,

Assudani & Chinta 2012:45). Fowler (2008:428) posits that experiential learning has the

potential to result in self-growth. This self-growth ranges from the individual to communities

and includes aspects such as professional, personal and academic education. Tofade,

Samimi-Gharai and Rodriquez de Bittner (2016:429) claim that with the integration of

experiential learning in theory and clinical education, students will be challenged to acquire

more skills and become more confident and competent in their professional career. Lastly,

Wurdinger and Allison (2017:27) conclude that students enjoy experiential learning and

that it is popular amongst students as it leads to deeper learning.

1.3 PROBLEM STATEMENT AND RESEARCH QUESTIONS

With the HPCSA-approved expanded scope for Optometrists in South Africa, the focus of

the new undergraduate optometry programmes will need to include training of Ocular

Therapeutics in the curriculum. The expansion of the scope of practice includes the

diagnosis of conditions and prescription of certain therapeutic drugs to patients, which

impacts the pathology modules directly. Compiling the content of the pathology modules

was guided by the expanded scope to ensure alignment with the new outcomes for

managing and prescribing therapeutic drugs to patients. The HPCSA approved the content

for the expanded scope of practice. Consequently, the delivery of the pathology modules

needs to be constructed in such a way to ensure that integration takes place between the

theory explained in theory lectures and knowledge application during clinical training. As

mentioned in the introduction, experiential learning may enhance student learning and

enhance the theory-clinical transfer of learning.

For education to be effective, innovative, evidence-based teaching-learning should be

provided (UFS 2017a: Online). Based on the background provided, the problem addressed

in this study was the lack of researched information regarding experiential learning in

theoretical and clinical education in the optometry programme at the UFS. Currently no

recommendations exist for addressing the students’ needs for enhanced learning

experiences in the classroom and the clinical setting. Ensuing from this is the need for the

5

teaching-learning and assessment methods used in the pathology modules to prepare

students better for clinical practice in the expanded scope of the new undergraduate

optometry programme at the UFS.

To address the stated problem the following research questions were asked:

1. How can experiential learning be utilised to enhance the learning environment in

theory lectures and clinical education in the pathology modules of the

undergraduate optometry learning programme at the UFS?

2. What are the experiences and perceptions of currently registered undergraduate

optometry students regarding the teaching-learning and assessment methods,

based on experiential learning, used in the pathology modules?

3. What are the factors that should be considered in the implementation of

experiential learning through different teaching-learning and assessment methods

in the expanded scope of the undergraduate optometry programme at the UFS?

1.4 OVERALL GOAL, AIM AND OBJECTIVES OF THE STUDY

The overall goal, aim and objectives of the study were as follows:

1.4.1 Overall goal of the study

The overall goal of the study was to enhance teaching-learning in the undergraduate

optometry programme of the UFS by improving the integration of theory and clinical

practice through experiential learning.

1.4.2 Aim of the study

In striving to achieve the overall goal, the study aimed to investigate how different teaching-

learning and assessment methods of the experiential learning cycle should be applied to

enhance the learning environment and promote the integration of theory and clinical

practice in the expanded scope of the undergraduate optometry programme at the

University of the Free State.

6

1.4.3 Objectives of the study

To achieve the aim, the following objectives were pursued:

1. To conceptualise, from the literature, an extensive and in-depth account of the

history, development and current status and use of experiential learning in

teaching-learning in health sciences education with specific reference to teaching-

learning methods in health sciences education. This provided the necessary

context for the experiential education component of the study. This objective

addressed the first research question and data used to achieve it, were collected

by conducting an extensive literature review.

2. To investigate the experiences and perceptions of the currently registered

optometry students regarding the different teaching-learning and assessments

methods, based on experiential learning, used in the current pathology modules.

This objective addressed the second research question, and in the study, data

were collected by means of questionnaire surveys and focus group interviews to

attain the objective.

3. To enumerate the factors that should be considered to formulate recommendations

on experiential learning to enhance the integration of theory and clinical practice

in the expanded scope of the undergraduate optometry learning programme at the

UFS. This objective addressed the third research question and was pursued by

means of a literature review, and the results of the student questionnaires and

focus group interviews conducted with the undergraduate optometry students of

the UFS.

1.5 DEMARCATION OF THE FIELD AND THE SCOPE OF THE STUDY

The findings of this study may be applied in the Department of Optometry at the UFS. As

the researcher aimed to provide a comprehensive report on the perceptions and

experiences of the above-mentioned undergraduate student body, it is also interdisciplinary

as it spans across health professions education (HPE) and optometry as fields of study. The

suggested recommendations for experiential learning could be used by the Schools of

7

Medicine, Allied Health Professions, and Nursing in the Faculty of Health Sciences (FoHS)

at the UFS.

This study was conducted in the field of HPE and resides in the domain of curriculum

development with a view to exploring students’ perceptions and experiences regarding the

different teaching-learning and assessments methods, based on experiential learning, used

in the current pathology modules in order to enhance the curriculum accordingly.

In a personal context, the researcher is qualified as an optometrist and obtained a B.Optom.

degree and a Postgraduate Diploma in Sports Vision from the University of Johannesburg.

She also obtained a master’s degree in HPE (cum laude) at the UFS. She furthermore has

been involved in the undergraduate training of health professionals at the Department of

Optometry in the FoHS, UFS since 2012.

The researcher’s interest in experiential learning fits in with her holistic approach to the

development of a student as she realises the necessity to create an enhanced learning

experience in which the student can be actively engaged. The participants in the study were

second-, third- and fourth-year undergraduate optometry students registered during 2017

in the FoHS, UFS, who completed a voluntary questionnaire during various contact sessions.

In addition, the fourth-year undergraduate optometry students of 2017 also participated in

two focus group interviews.

The study was conducted in the Department of Optometry, UFS, between January 2017

and June 2019, with the empirical research phase from February to September 2017.

1.6 SIGNIFICANCE AND VALUE OF THE STUDY

No data are available of studies done on the current perceptions and experiences of

undergraduate optometry students regarding the different teaching-learning and

assessments methods, based on experiential learning and used in pathology modules.

The value of this research is to be found in the recommendations that may be used for any

speciality modules in the optometry curriculum. These include Contact Lenses, Binocular

Vision, Low Vision and Paediatric Vision, as these speciality modules and the Pathology

8

module are structured similarly. The content delivered through experiential learning

provides a guide to meet individual needs and enhance the transformation of learning.

This study may contribute significantly to curriculum enhancement through the different

teaching-learning and assessment methods used. The recommendations will render the

learning experience, offered by means of experiential learning, valuable, as it is planned in

a pedagogically sound way (cf. De Oliveira, Do Prado, Kempfer, Martini, Caravaca-Morera

& Bernardi 2015:50). Teaching-learning and assessment of the pathology modules will be

structured to incorporate the recommendations of the students to enhance the learning

programme and produce students who are able to practice in the expanded scope of

practice and comply with the expansion of the scope of practice of optometrists by the

HPCSA.

1.7 RESEARCH DESIGN AND METHODS OF INVESTIGATION

As an introduction to the empirical study, a brief overview of the design of the study and

the methods of investigation is given. A detailed discussion will follow in Chapter 3,

Research design and methodology.

1.7.1 Design of the study

A qualitative case study design was used to ensure a comprehensive understanding of the

research problem. Qualitative research is described as a term that refers to various

strategies used to explore human behaviour, experiences, perceptions and motivations

(Clissett 2008:100). Qualitative research attempts to provide a comprehensive description

of participants’ experiences and the meanings they create from interaction with other

people in their environment (Springer 2010:20). Stella, Lingard and Kennedy (2014:371)

point out that the goal of qualitative research is the careful understanding of subjective

experiences and perspectives. The reasoning for the qualitative approach that was used in

this study has been confirmed by Hanson, Balmer and Giardino (2011:375), who explain

that qualitative research is suitable to answer questions on how students understand and

experience learning environments. Therefore, to achieve the aim of this study, data were

collected, analysed and interpreted qualitatively.

9

1.7.2 Methods of investigation

In this qualitative case study, the researcher relied on a literature review, a written

questionnaire with open-ended questions, and focus group interviews for data collection.

After careful examination of the literature available, experiential learning and its application

in higher education were defined and described. Making use of the background supplied by

the literature on experiential learning for the different teaching-learning methods provided

the required information for the application of experiential learning in the pathology

modules involved in this study.

The aim of the questionnaire survey was to determine students’ perceptions and

experiences regarding the different teaching, learning and assessment methods, based on

experiential learning, used in the current pathology modules of the optometry curriculum.

By using the questionnaire as a data collection instrument, the students were encouraged

to engage in reflective practice. For this purpose, the open-ended questionnaire was based

on Gibbs’s cycle of reflection (Gibbs 2013:14). The focus group interviews provided

additional data and contributed to the interpretation and confirmation of the data obtained

from the questionnaire surveys (Johnson & Christensen 2008:210; Bernard & Ryan

2010:41).

Content analysis was used for the data analysis in this case study, as Patton (2002:453)

purports that content analysis is an appropriate method for data analysis in case studies.

An inductive approach was followed according to which the categories identified through

content analysis were used to develop recommendations for the pathology modules in the

expanded scope of the optometry programme at the UFS using experiential learning (cf.

Elo & Kyngäs 2007:109).

A schematic overview of the study is given in Figure 1.1 on the following page.

10

Figure 1.1: A SCHEMATIC OVERVIEW OF THE RESEARCH PROCESS [Compiled by the researcher, Kempen 2016]

1.8 COMMUNICATING THE FINDINGS

The research findings will be made available to the FoHS Management, as well as the

appropriate Faculty Committees involved in the enhancement of teaching, learning and

assessment in the Schools of Clinical Medicine, Allied Health Professions, and Nursing.

The researcher also will present the findings to a wider audience at appropriate educational

research forums, national and international, and by submitting manuscripts containing the

findings to accredited journals in order to contribute to the research field in health sciences

education.

01

02

03

05

07

09

04

06

08

10

Preliminary literature study

Protocol

Evaluation committee

Permission of the regulatory authorities, UFS

Ethics committee

Extensive literature review

Questionnaire survey: Planning & data collection

Focus group interviews: Planning & data collection

Data analysis and interpretation of results Discussion of results and

formulation of

recommendations

Preparation of thesis 11

Final submission of thesis 12

11

The researcher will submit the findings of this research to academic journals with a view to

publication, as the researcher hopes to contribute to the scholarship of teaching-learning

and the field of health sciences education.

1.9 ARRANGEMENT OF THE THESIS

This research report has been arranged as follows:

In this chapter, Chapter 1, Orientation to the study, a brief introduction to and

background of the study were provided, and the problem, including the research questions,

was stated. The overall goal, the aim and the objectives were stated and the research

design and the methods that were employed were briefly discussed to give the reader an

overview of what is contained in the report. The researcher demarcated the field of the

study and elucidated the envisaged significance and value of the outcome for health

sciences education. This was followed by a brief description of the research design and

methods of investigation used. Figure 1.1 (cf. 1.7.2) provided a schematic overview of the

study, followed by a brief discussion of the ways in which the findings will be communicated

to internal and external audiences.

In Chapter 2, Experiential learning applied in teaching and learning in higher

education in theory and clinical modules, a contextualisation and conceptualisation

are provided of experiential learning and its application in higher education.

In Chapter 3, Research design and methodology, the research design and the methods

applied will be described in detail. The data collecting methods and instruments and data

analysis will be discussed.

Chapter 4, Results of the questionnaire survey: analysis and discussion, is devoted

to a report on and discussion of the results and findings of the questionnaire survey - the

first data collecting method employed in the study.

Chapter 5, Results of the focus group interviews: analysis and discussion, will

provide additional data to the questionnaire survey. This chapter deals with the perceptions

and experiences of the participants of the focus group interviews regarding the pathology

clinical environment.

12

In Chapter 6, Recommendations for experiential learning in the expanded scope

of the undergraduate optometry programme at the University of the Free State,

recommendations made by the students regarding the implementation of experiential

learning will be discussed. .

In Chapter 7, Conclusion, recommendations and limitations of the study, an

overview of the study, the conclusions reached, the recommendations and the limitations

of the study will be brought to the reader.

1.10 CONCLUSION

Chapter 1 provided the introduction and background to the research undertaken regarding

the use of experiential learning as enhancement of undergraduate optometry education and

training at the UFS.

The next chapter, Chapter 2, entitled Experiential learning applied in teaching and

learning in higher education in theory and clinical modules, will be a report on the

study of relevant literature.

OPTOMETRY in South Africa

Scope of practice as a registered Optometrist in

South Africa

Optometry education in

South Africa

EXPERIENTIAL LEARNING

Historical development

Definition of experiential learning

Elements of experiential learning

CHAPTER 2

EXPERIENTIAL LEARNING APPLIED IN TEACHING AND LEARNING IN

HIGHER EDUCATION IN THEORY AND CLINICAL MODULES

2.1 INTRODUCTION

In this chapter, the literature review will provide context regarding the training of

optometrists as well as the scope of practice of optometry in South Africa. Experiential

learning is conceptualised and a discussion follows on the in-depth insights gained on

experiential learning in teaching and learning in health sciences education with specific

reference to teaching-learning methods.

Figure 2.1 provides a conceptual framework for this chapter:

FIGURE 2.1: A DIAGRAMMATIC OVERVIEW OF THE CONCEPTUAL FRAMEWORK THAT

WILL BE DISCUSSED [Compiled by the researcher, Kempen 2017]

Experiential learning applied in teaching and learning in

higher education and optometry education in South Africa

14

2.2 OPTOMETRY IN SOUTH AFRICA

Career opportunities for students after graduating with an optometry degree, according to

the University of the Free State’s website (UFS 2018:Online), include employment in public

and private health sectors, as well as research and training in South Africa. Currently, 3 754

optometrists are registered with the Health Professions Council of South Africa (HPCSA)

(Daffue 2018).

Public health services have functioned without optometry in the mainstream of health

services. According to the South African Optometry Association (SAOA), only 3% of

registered optometrists in 2011 worked in the public sector (SAOA 2011:10). This is in

contrast with the aim of National Health Insurance (NHI) that is currently under discussion.

The insurance will aim to make equal access to healthcare possible and will improve South

Africa’s health status and health systems’ performance. With the implementation of NHI,

the SAOA proposes that optometry should be integrated into the mainstream health services

alongside Nursing, Ophthalmology and other health-care professions (SAOA 2011:16). In

this regard Ferreira (1993:59), more than two decades ago already, stated that optometry

should not only serve as a point of entrance to vision-care problems but to the entire

spectrum of health care.

2.2.1 Scope of practice as a registered optometrist in South Africa

Lewis (1994:76) stated that defining the scope of practice in optometry is difficult, but

critically important to optometric education. The scope of practice of optometry is

sufficiently dynamic to respond to the changing needs of a country in order to best meet

the needs of the public with respect to vision care. With a clear understanding of the

boundaries of optometry in South Africa, higher education institutions offering the

optometry programme will be able to make the skills and competencies of the graduates

specific and accurate according to the scope of practice (Lewis 1994:76).

Therefore, the scope of practice of a registered optometrist in South Africa will be explained

to set the scene for a discussion of the status of undergraduate optometry education in

South Africa, with the focus on the training offered by the UFS.

15

The World Council of Optometry (WCO) was the first and is the only optometric organisation

to have established official relations with the World Health Organisation (WHO). The WCO

concept of optometry is:

Optometry is a healthcare profession that is autonomous, educated, and regulated

(licensed/registered), and optometrists are the primary healthcare practitioners of

the eye and visual system who provide comprehensive eye and vision care, which

includes refraction and dispensing, detection/diagnosis and management of disease

in the eye, and the rehabilitation of conditions of the visual system (WCO 2016:

Online).

The scope of optometry is applied differently in different countries. Figure 2.2 depicts the

different WCO categories of optometric services offered at the various levels of the

profession. Previously, the primary service rendered by an optometrist was the cutting and

fitting of lenses, but the scope of practice has evolved throughout the 20th century with an

increasing emphasis on healthcare. The optimal function of optometry is the refracting and

prescribing lenses for visual correction, as well as the diagnosis and treatment of ocular

diseases. In this figure, it is also clear where diagnostics and therapeutics fit in the scope

of practice.

FIGURE 2.2:WCO CATEGORIES OF OPTOMETRIC SERVICES [Adapted from Naroo 2009:102]

Treatment of eye diseases

Diagnosis of eye diseases

Screening for eye diseases

Refraction,Prescription, Dispensing

Dispensing 0

1

2

3

4

Dispensing Optician

Refracting Optician

Optometrist

Optometrist

Doctor of Optometry

Level of care

Diagnostics

Therapeutics

16

The road for optometry to be become an independent medical profession in South Africa

was not easy. Final closure of the Medical Council’s register for optometrists only took place

in 1980. With passing the university exams, an optometrist is automatically eligible for

registration with the HPCSA. The Professional Board for Optometry and Dispensing

Opticians (PBODO) shares the objectives of the HPCSA (HPCSA 2008: Online).

Act 56 of 1974 was re-titled ‘Medical, Dental and Supplementary Health Service Professions

Act’. The acts pertaining to the scope of the profession of optometry include the following:

a) The performance of eye examinations on patients with the purpose of

detecting visual errors in order to provide clear, comfortable and effective

vision; and

b) The correction of errors of refraction and related factors by the provision of

spectacles, spectacle lenses, spectacle frames and contact lenses, and the

maintenance thereof, and the use of scheduled substances as approved by

the board and the Medicine Control Council or by any means other than

surgical procedures (RSA DoH 2007).

The similarities between the scope of practice of optometry in South Africa and the WCO

concept is that in South Africa optometry is seen as an independent primary health care

service (Jacobs 2001:2), which is regulated by a professional board such as the HPCSA.

When the profession came into being in 1924, the practice of optometry was limited to the

core category of optometric service of the WCO, namely refraction and dispensing.

However, as specialised equipment was introduced, optometrists could deliver more

advanced services in speciality areas (Mashige & Naidoo 2010:78). According to the

University of KwaZulu Natal (UKZN 2018: Online), these advanced speciality areas are:

Ocular refraction and dispensing of glasses

Binocular vision

Vision therapy

Sports vision

Low vision and vision rehabilitation

Contact lenses

Paediatric vision

Neuro optometry

Ocular pathology screening and diagnosis

17

Act 56 of 1974, the Health Professions Act (RSA 1974: Online), however, limited the scope

of the profession in South Africa to the detection and treatment of visual errors and

diagnosis of eye diseases, not the management thereof, as stated by the definition of the

WCO (see Figure 2.2).

The use of drugs during the examination of eyes within the scope of practice of optometry

was legislated only after 2001 and ensued in the current exit-level outcome of the B.Optom

degree which reads:

To apply appropriate learning strategies in the management and delivery

of eye-care products, therapy and medication, with the knowledge of

minimum standards of optometric care (CHE-HPCSA 2013:179).

With the approval of this outcome, diagnostic procedures were incorporated in the

undergraduate optometry learning programmes in South Africa in 2001 and optometrists

who qualified after 2005 were able to register with the HPCSA with diagnostic privileges.

These optometrists have permission to purchase, store and utilise diagnostic drugs as

approved by the HPCSA. Optometrists are able and allowed to do certain tests to detect

eye diseases, but still have to timeously refer the patient with the supporting documentation

to other professionals (CHE-HPCSA 2013:182).

The legislation governing the scope of practice allowed South African optometrists to treat

ocular diseases, but approval was still required from the HPCSA and the Medicine Control

Council (MCC) (Ramkissoon 2017: Online). With the incorporation of optometrists into the

mainstream health services in mind, the PBODO applied for prescription rights for

optometrists from the MCC and received approval for the Ocular Therapeutics application

in December 2014. In 2016 the Minister of Health, on recommendation of the MCC,

compiled and updated the schedules to include optometrists with therapeutic privileges

(RSA DoH 2016:26).

2.2.2 Undergraduate optometry education in South Africa

In 1924, British-trained optometrists formed the South African Optometric Association

(SAOA) and optometry was recognised as a profession in this country. The then Technikon

of the Witwatersrand established the first part-time diploma course in optometry in 1930.

18

The University of the North (now University of Limpopo) offered the first four-year degree

course in 1975. In 1979, the University of Durban-Westville (now University of KwaZulu-

Natal) also started offering a four-year degree followed by the Rand Afrikaans University

(now University of Johannesburg) (Mashige 2010:14). The University of the Free State’s

Department of Optometry was established in 2002.

The curriculum of the bachelor degree in optometry to a large extent concurred with British

curricula (Kriel 2017: Online), but Oduntan, Mashige, Kio and Boadi-Kusi (2013:361) stress

the importance of refining the current curriculum to be geared to satisfying the needs of

South Africans by more emphasis on primary health care, as well as eye health promotion.

Kriel (2017: Online) mentions that a paradigm shift is needed for the profession to claim its

core role in the diagnosis, prevention and management of ocular diseases. Currently, the

education and training of optometrists in South Africa entails a four-year, undergraduate

bachelor degree based on a core of scientific disciplines and is practice-orientated (Jacobs

2001:1). The PBODO has accepted the following definition for the education and training

of optometric practitioners in South Africa:

to provide students with opportunities to acquire competencies to render a

professional service to the community as optometrists, i.e. they should

achieve the necessary knowledge, skills, professional thinking, behaviour and

attitudes in all ramifications of primary eye and health care to be able to

pursue their profession as optometrist (CHE-HPCSA 2013:160).

The expansion of the scope of optometry in South Africa heralded an exciting and dynamic

time for the profession, especially in education. Universities with full accreditation have

been requested by the PBODO to re-curriculate the current B.Optom degree to include

Ocular Therapeutics (Kriel 2017: Online). Already qualified optometrists with diagnostic

privileges may complete a post-graduate course in ocular therapeutics approved by the

HPCSA. UKZN, in partnership with the State University of New York, currently is the only

institution offering such a course.

The education and training of undergraduate optometry students at the UFS are in line with

the requirements of the South African Qualifications Authority (SAQA). The first- and

second-year optometry curricula mainly consist of theoretical modules of basic and visual

sciences. The third- and fourth academic years’ modules are more practical and clinical

19

modules are built into the curricula. During the two clinical years (3rd and 4th academic

years), the focus is on the different specialised services an optometrist can offer.

The quality assurance authority, demands that any programme of learning must intend to

raise individuals’ awareness of the importance of reflecting on and exploring the variety of

strategies to learn more effectively in order to contribute to full personal development, as

well as the social and economic development of society (OECD 2008:78). This correlates

with one of the purposes of higher education as stated in the Education White Paper as:

To meet the learning needs and aspirations of individuals through the

development of their intellectual abilities and aptitudes throughout their lives.

Higher education equips individuals to make the best use of their talents and of

the opportunities offered by society for self-fulfilment (RSA DoE 1997).

One of the key roles of higher education identified by the Department of Education is to

fulfil human resources development through the mobilisation of human talent and potential

through lifelong learning. This development will contribute to the social, economic and

intellectual life of a rapidly changing society. Students should be equipped with the essential

skills, knowledge and values in order to prepare them for their various social roles as

effective citizens (RSA DoE 1997).

This corresponds with one of the motivations for the qualification in a B. Optom as set out

by the CHE and the HPCSA that:

The qualification will equip learners with competencies which are designed to be

progressive in depth and complexity allowing the learner to integrate professional

specific with critical cross-field outcomes enabling the application of skills and

knowledge in general settings as well as to engage in lifelong learning through

research and professional development (CHE-HPCSA 2013).

20

2.3 EXPERIENTIAL LEARNING

Kolb (1984:20) argues that learning based on experience is a fundamental part of how

humans learn and develop. De Oliveira et al. (2015:50) relate to this statement by

proclaiming that experience is essential for learning and professional development in health

sciences education. In the following section, the concept of experiential learning will be

discussed.

2.3.1 Historical development

Experiential learning theories aim to explain the process of individual transformation. Due

to this individualism, the underpinning philosophical principle of experiential learning is

constructivism, which recognises that there may be many convincing truths (Chavan

2011:128). With this in mind, different experiential learning theories that exist come to the

fore. One theorist’s name that is most commonly linked with experiential learning is Kolb

(Yardley et al. 2012:103). Kolb’s experiential learning theory is one of the best-known

educational theories in higher education (Chavan 2011:127)

Kolb’s experiential learning theory is based on three traditions from Dewey, Lewin and

Piaget (Kolb & Kolb 2005:193). Dewey defined experiential learning as a process by which

the learner creates meaning from direct experience (Chavan 2011:126). Dewey’s philosophy

has several vital concepts enclosed in the theory that everything occurs within a social

environment. Dewey’s theory of experience views experience as a cycle of trying that begins

with the detection of a predicament, then formulating and applying a solution that leads to

an experience that will have consequences that can confirm or reject the solution

(Wurdinger & Allison 2017:28).

Table 2.1 contains the key components of Dewey’s philosophy and how he differentiates

between traditional education and experiential learning or, as he argued, a progressive

approach to education (Yardley et al. 2012:103).

21

TABLE 2.1: DIFFERENTIATION BETWEEN TRADITIONAL EDUCATION AND EXPERIENTIAL LEARNING WITHIN DEWEY’S PHILOSOPHY

[Roberts 2003:3]

Key components Traditional education Experiential learning

Knowledge

Predetermined to prepare

them for their professional

career.

Controlled by the experiences of

the students.

Content

organisation

Isolated, does not allow

integration.

Allow students to apply knowledge

in different situations.

Teacher’s role Existing knowledge is

transferred to students.

Facilitates meaningful experiences

to engage students actively.

Kurt Lewin had a significant interest in group dynamics and action research and developed

training groups, known as t-groups (Yardley et al. 2012:104). Based on his work, he

affirmed that learning was best facilitated in an environment where there were

argumentative tension and conflict between direct concrete experiences and

conceptualisation (Kolb 1984:9). Experiential learning models were developed by

addressing the tension created within these groups.

Piaget’s work was focused on the development of knowledge during childhood by

documenting a schematic sequence of thought on the qualitative approach children used in

endeavouring to solve a problem. Piaget described assimilatory (the organisation of

experiences into progressively multiform models for future use) and accommodatory

(adaptation of these models in the light of new experiences) interactions as important

factors to determine intelligence. Furthermore, he suggested that intelligence is constructed

qualitatively by experience, in which environmental interactions are fundamental (Yardley

et al. 2012:104).

These views on the role of experience in education made Dewey, Lewin and Piaget vital

advocates of experiential education and inspired Kolb’s concept of experiential learning.

Kolb claimed that people learned through discovery and experiences that formed the way

they grasped knowledge (Ruhi 2016:204). Kolb’s view on learning (1984:26) is well known

through literature. These views boiled down to the following:

1. Learning is best conceived as a process in which students are allowed to engage

in the learning process and not concentrate on outcomes.

22

2. All learning is re-learning and seen as a continuous process grounded in

experience. Students’ philosophy of education and the ideas students have must

be extracted to be examined in order to integrate them with more developed ideas.

3. Learning requires the resolution of disagreement between logically discussed,

contrasting modes of adaptation to the world. During the process of learning, it is

mandatory to take different views of reflection, action, feeling and thinking into

consideration.

4. Learning is a holistic process that involves the integrated function of the total

person.

5. Learning results from synergetic transactions between the person and the

environment.

6. Learning is the process of creating knowledge. This includes a constructivist theory

of learning where social knowledge is transformed into personal knowledge of the

student.

Kolb’s experiential learning theory further views learning as dynamic and is based on a

learning cycle driven by the determination of the dual interactions of action/reflection and

experience/abstraction (Kolb & Kolb 2017:11). Kolb’s four-stage cyclical model of

knowledge development describes how knowledge is created through the transformation

of experience. Figure 2.3 represents the cycle that starts with the completion of a Concrete

Experience, followed by Reflective Observation. Through this crucial stage, students make

sense of the experience. A theory or Abstract Conceptualisation is constructed where

students identify possible acquired principles, form a personal opinion and then assimilate

this into their existing knowledge (Yardley et al. 2012:104). This is then tested through

Active Experimentation (Kolb & Kolb 2017:12).

23

FIGURE 2.3: KOLB CYCLICAL MODEL OF KNOWLEDGE DEVELOPMENT

[Kolb & Kolb 2017:11]

To summarise, these theorists introduced important concepts, some many decades ago,

that are still relevant in health sciences education. Dewey has reported the vital role of a

teacher that shifted from conveying information to students to being a facilitator of learning.

Also, his educational movement based on ‘experience plus reflection equals learning’ has

become well established in educational literature (Fowler 2008:427; Austin & Rust

2015:143). Piaget’s observation regarding intelligence and that it is shaped by experience

and not a fixed trait indicates the supportive role an educator can play in mentoring students

by providing them with these learning experiences. Lastly, Kolb focused the attention on

the process of reflection and the importance of understanding the meaning of an

experience.

2.3.2. Definition of experiential learning

According to Fowler (2008:428) and the CHE (2011:72), international literature discussing

experiential learning refers to a variety of meanings, practices and principles and due to

the variety of applications it cannot be explained with one definition. Several authors have

conceptualised it over the years:

Transform

Com

pre

hensi

on

Concrete experience

Abstract conceptualisation

Reflective

observation

Active

experience Experience

24

McGill and Weis (1989 in Allodola 2014) explain that experiential learning is the process

whereby people engage in a direct encounter, then purposefully reflect upon, validate,

transform, give personal meaning to and seek to integrate their different ways of knowing

(Allodola 2014:24)

Kolb (1984:10) explained that Experiential learning takes place when, a) a person is

involved in an activity, b) he looks back and evaluates it, c) determines what was useful or

valuable to remember, d) and uses this information to perform another activity.

Burnard (1991 in Allodola 2014) summarised experiential learning as: learning by doing,

which involves reflection and is an active rather than a passive learning process (Allodola

2014:24)

Lewis and Williams (1994 in Schwartz 2012) defined experiential learning as:

In its simplest form, experiential learning means learning from experience or learning by

doing. Experiential education first immerses learners in an experience and then encourages

reflection about the experience to develop new skills, new attitudes, or new ways of thinking

(Schwartz 2012:2).

Fowler (2008:430) avers that experiential learning is holistic and defines it as experiential

learning is the learning which results from the coming together of experience, of a certain

quality, with meaningful reflection (Fowler 2008:430).

The CHE (2011:72) broadly refers to experiential learning as learning that entails

meaningful learner involvement and defines it as learning through reflection on doing.

Boud and Walker (2000 in Allodola) developed five propositions concerning experiential

learning. According to their definition experience is the foundation of and stimulus for

learning; learners learn actively, in a holistic way, which is socially and culturally constructed

and influenced by the socio-emotional context in which it occurs (Allodola 2014:25).

Allodola (2014:37) identified the following terms that are often used as synonyms but also

are seen as elements of experiential learning. These terms include collaborative learning,

critical thinking, cooperative learning, reflection and reflection practices. The literature also

describes experiential learning practices as service-learning, problem-based learning, action

25

learning, adventure education and simulation and gaming (Kolb & Kolb 2017:8; Wurdinger

& Alison 2017:29).

In conclusion, experiential learning is about learning achieved through the appropriate use

of experience; by reflecting on the experience, new meaning is created from which new

implications for action can be drawn.

2.3.3. Elements of experiential learning

From the different conceptualisations of experiential learning provided by the literature, it

is clear that this type of learning is dependent on two critical factors, namely experience

and reflection. Fowler (2008:430) constructed a simple framework for experiential learning

based on these principles. Figure 2.4 illustrates this basic framework. The author also

stressed the importance of the interaction between an experience and a reflection and not

merely the presence of these two principles.

FIGURE 2.4: FRAMEWORK FOR EXPERIENTIAL LEARNING [Fowler 2008:430]

Factors, as Fowler (2008:431) mentions, that influence this interaction between experience

and reflection will influence learning. These factors need to be identified in order to provide

the students with a good quality experience and a meaningful reflection. A focused

discussion on the practices behind these two factors in experiential learning as well as the

role of the educator to contribute to the learning process will be discussed in the following

sections.

Factors which prevent or are

barriers to learning

LEARNING

EXPERIENCE REFLECTION

Factors which enhance

learning

Factors which enhance

learning

26

2.3.3.1. Experience

Choosing the correct experience, according to the literature, is determined by two factors,

namely subject matter and the needs of the students. According to Yardley et al.

(2012:103), the starting point for a meaningful learning experience should be the needs of

the students, while Ortega, Murayama, Holmes, Taylor and DePeters (2011:591) maintain

that experiential learning theorists suggest that subject matter should determine the

educational environment. This has been confirmed by Kolb and Kolb (2017:16), who explain

that with the use of experiential learning, there is a special relationship between the

educator, student and subject matter. These authors place the focus of the experience on

the subject matter and therefore advise that the teaching-learning approach must match

the subject matter.

Roberts (2003:5) states that planning for any educational activity is important. Roberts

(2003:5) further elaborates on key points for the planning of an experiential activity. These

include:

The correct experience should be selected for the students. It is critically important

that the experience should be in the student’s ability.

The environment should be conducive to the experience to lead to growth.

Directions for the execution of the experience should be determined.

The experience should be flexible to ensure that the desired outcome can be

reached.

Two major categories of experiential learning exist, namely field-based experiences and

classroom-based learning. According to Schwartz (2012:3), field-based experiences

comprise learning internships, practicums, cooperative education, and service-learning,

while classroom-based experiential learning include role-playing, games, case studies,

simulations, presentations, and various types of group work.

Different teaching-learning methods can be applied to provide the students with an

experience during classroom-based learning. For a learning experience to be good, it must

elicit students’ ideas, test them and integrate newer and more refined ideas (Ruholl &

Boyajian 2007:73). Kolb and Kolb (2017:12) stress that it is important to note that in the

experiential learning cycle it is not only the concrete experience mode of purely experiencing

27

that is experiential, but all modes (active experience, reflective observation and abstract

conceptualisation) are experiences. Toothaker and Taliaferro (2017:345) discovered an

important feature of the needs of millennial students. They state that this generation of

students are group-orientated learners that choose a teaching-learning method that has

structure. Students in their study also revealed that teaching-learning methods such as role-

play, group work, team presentations and case studies would help students to engage

better during a lecture.

Ruhi (2016:205) proposes a pedagogical framework based on the experiential learning

theory. This framework was designed for business schools, but due to the experiential

learning theory being highly interdisciplinary and addressing learning and educational issues

in many fields, it can be applied in health sciences education as well (Kolb & Kolb 2017:13).

This framework aims to provide a foundation for educators and a template for teaching

strategies as well as student activities. It involves pedagogical practices that extend across

all types of experiential processes. The relationship between these two factors is indicated

with darker (stronger alignment) or lighter shaded intersections. Figure 2.5 depicts this

educational framework.

28

FIGURE 2.5: EXPERIENTIAL LEARNING FRAMEWORK [Ruhi 2016:205]

Pedagogical

Practices

Learning

Processes

Concrete

Experience

Reflective

Observation

Abstract

Conceptualisation

Active

Experimentation

Cognitive modes Experiencing &

Feeling

Watching &

Reflecting

Thinking &

Analysing

Doing & Exploring

Lectures &

Seminars

Case

Discussions

System Demos

& Screencast

Tutorials

Simulation &

Interactive

Assessments

Workshops &

Walkthrough

Assignments

Capstone

Project

Theore

tical

Applie

d

Primary Mapping

Secondary Mapping

29

Read

Hear

View images

Watch video

Attend exhibits / sites

Watch a demonstration

Participate in hands-on workshop

Design collaborative lessons

Simulate or model a real experience

Design/perform a presentation - do the real thing

Tell

Show

Do

Furthermore, the configuration of this framework is designed for educators to select

activities according to different levels of immersion. These levels correspond with the Cone

of Experience (Figure 2.6) of Edgar Dale (1946), which indicates the progression of an

experience from most abstract (listening) to most concrete (doing). The significance of the

Cone of Experience is the information about how much people remember when they went

through a specific experience. With this information, educators can make informed decisions

about which activities will work best (Davis & Summers 2014:2).

FIGURE 2.6: DALE’S CONE OF EXPERIENCE [Davies & Summers 2014:2]

The framework described above correlates with the application of Kolb’s experiential

learning theory that was applied to the teaching-learning methods used in theory lectures,

practical work, and clinical course work as employed in the Department of Optometry at

the UFS. This, especially, is the case in the third- and fourth academic year of the

undergraduate optometry programme during which the four modes of Kolb’s learning cycle

are utilised (Kempen 2015:84).

In the non-clinical years (first- and second-year) of the undergraduate optometry

programme, the theory regarding the skills and the context within which they will be

mastered and applied are predetermined, mainly by the lecturers. Similar to Ruhi’s

framework (see Fig. 2.5), in this case a traditional lecture may be seen as an abstract

experience. Kolb and Kolb (2017:13) agree with Ruhi (2016:208) and add that when a

student respects and imitates the lecturer, the experience also may be concrete. Wurdinger

People generally remember:

10 % of what they read

20% of what they hear

30% of what they see

50% of what they

hear and see

70% of what they say

90% of what

they do

30

and Allison (2017:35) found that lectures still continued to be a dominant teaching-learning

method. To include experiential learning within this method, educators should integrate

other methods such as student presentations and collaborative learning.

Tutoring takes place during practical training when students are able to demonstrate the

skills to their peers with the skills being explained with repeated demonstration. Students

then are provided the opportunity to practise the skills on patients, under supervision. After

the concrete experience, the students have to reflect on the case and prepare a case

presentation for fellow students and lecturers. This provides an opportunity for the student

to reflect on the direct experience with the patient and for fellow students to learn from

reflective observation (Kempen 2015:84).

2.3.3.2 Teaching-learning methods to create a learning experience

With this information and the framework proposed by Ruhi (2016:205), an experiential

teaching-learning framework for use in the undergraduate optometry learning programme

can be developed. The teaching-learning methods will include traditional lectures, flip the

classroom, small group learning, bedside teaching, simulation, interprofessional education,

case presentation, peer assessments and clinical skills training. These teaching-learning

methods also will be placed on a continuum from theoretical (lectures) to applied (clinical).

A more detailed conceptualisation of these teaching-learning methods in higher education,

as well as in an experiential learning framework, will be discussed in the following

paragraphs.

2.3.3.2.1 Lectures

In undergraduate courses, a lecture remains the cornerstone of education (Matheson

2008:218), the most employed tool for information transmission in higher education

(Schmidt, Wagener, Smeets, Keemink & van der Molen 2015:12), and forms the backbone

of a university’s learning experience (Penson 2012:73). Penson (2012:73) also adds that

lecturing is a particularly suitable teaching technique in a health sciences degree, due to

the vast amount of knowledge that needs to be assimilated. Thus, lectures are seen as the

most suitable teaching-learning method for teaching the theory and the basics of health

sciences. Lectures also prepare the student for clinical practice and to apply the knowledge

31

in a clinical setting (Charlton 2006:1261). For this reason, core content of the

undergraduate optometry curriculum at the UFS is still covered in theory sessions.

Traditional lecture-based learning is defined as a teaching-learning method that involves a

continuous formal verbal discussion on a particular subject and is a way for students to

obtain the necessary background knowledge (Matheson 2008:218; Wolff, Wagner,

Poznanskie, Schiller & Santen 2015:85). Lectures also have been classified as a teaching-

learning pedagogy that has a teacher-centred approach where the focus is placed on the

transfer of information and measured in terms of the student’s ability to recall the content

(Toothaker & Taliaferro 2017:345). This objectivist model, where a student is seen as an

empty vessel to be filled with knowledge, has been criticised in the past (Gehlen-Baum &

Weinberger 2014:171). Penson (2012:73) explains that it has to be replaced by

constructivist thinking, in which a student is actively involved in the teaching-learning

process as this will promote deep learning and encourage self-directed learning (Wolff et

al. 2015:85; Schmidt et al. 2015:17). This is emphasised by Ghazali, Ishak, Saat, Arifin,

Hamid, Rosli, Mohammed, Othman and Kamarulzaman (2012:67), who advocate for

superficial approaches to teaching-learning to be discouraged, while an environment which

promotes deep learning and makes high-quality student learning possible should be the

focus for effective teaching. Therefore, lectures must be designed in a way such to support

student learning and students should be equipped with a detailed understanding to enhance

clinical practice and promote safe practice (Penson 2012:73).

Toothaker and Taliaferro (2017:345) warn that lectures may disengage students from the

learning process; therefore, to ensure full effectiveness of a lecture, it needs to be well-

structured, expressive, and clear. As mentioned before, the focus should shift from a

passive transmission of information to a more active learning experience with activities,

questioning and reviews to cater for the individual needs of students (Matheson 2008:220).

Penson (2012:73) provides a more recent definition of a lecture according to which it is

seen as a learning event in which an academic staff member interacts with several students.

The session still mostly involves the lecturer speaking on the topic at hand, but it can also

include activities that will include the students in the learning process.

Lectures have been criticised for being outdated, ineffective and inefficient and often have

been removed and replaced by other educational methods (Matheson 2008:2018). In

contrast to Penson’s statement (2012) about the suitability of lectures in health sciences

32

education, DiPiro (2009:1) proclaimed that lecturing was an inappropriate teaching-learning

method as it is a passive form of teaching that is unlikely to lead to knowledge construction

and retention. It furthermore does not consider students’ individual needs, the facts that

are delivered during lecturing may become outdated rapidly, and a lecture does not

encourage the development of skills such as critical thinking and problem-solving. Penson

(2012:72) argues that these reasons can only be applied to poorly prepared lectures or

badly designed courses and Schmidt et al. (2015:13) add to this argument by stating that

lectures are just as effective in transmitting information as other teaching strategies. For

this reason, Charlton (2006:1265) urges that instead of phasing out lectures, lecturers

should strive to improve their lectures. Charlton (2006:1261) also posits that lectures must

be much more effective than they are given credit for, as lecturing as a teaching-learning

method has survived for such a long time and so much official criticism.

The mere fact that students still attend lectures, even when it is not compulsory, indicates

that they still prefer the lecture as a primary mode of instruction (Charlton 2006:1263). This

preference also may be true for the Y-generation that prefers face-time contact with

lecturers to create an understanding of a subject (Van der Merwe, van Zyl, Nel & Joubert

2014:13). Schmidt et al. (2015:13) also explain that lectures are helpful to students when

they struggle with difficult concepts.

Van der Merwe et al.’s (2014:13) study found that the use of technology was essential and

that the Y-generation students prefer visual data to text data. A correlation between lecture

delivery in Health Sciences and students’ satisfaction and attitude exists (Ghazali et al.

2012:70). Consequently, to improve learning and invoke student interest during a lecture

session, the lecturer should make use of presentation software such as PowerPointTM or

Prezi (Savoy, Proctor & Salvendy 2009:858; Gehlen-Baum & Weinberger 2014:172). In a

study by Ghazali et al. (2012:70), it was found that the main factor and highest strength

contributing to lecture delivery effectiveness was the lecturers’ characteristics and

personality. Schmidt et al. (2015:13) state that a lecturer can engage students by being

charismatic. A lecturer should also be respectful, knowledgeable, approachable, engaging,

communicative, organised, responsive, professional and humorous (Ghazali et al. 2012:70).

It is clear from the literature that lectures, when designed correctly, can stimulate higher-

order thinking and motivate students to engage in the learning process (Matheson

2008:219). This is confirmed by Penson (2012:72), who claims that lecturing is an excellent

33

method to encourage learning as part of an overall strategy in university education. As

discussed earlier (cf. 2.3.3.1), lectures are part of the experiential cycle as lecturing sessions

provide students with the opportunity to make meaning of an experience and construct

knowledge that is more theoretical and comprehensive. In addition, it also offers learning

opportunities that involve logical thinking and ideas that will ensue in an understanding of

the problem and the opportunity to actively plan for the next experience (Kempen 2015:89).

2.3.3.2.2 Flip the classroom

Student engagement is listed in the literature as one of the key components of effective

teaching and an essential part of learning (O’Flaherty & Phillips 2015:85). Bryson and Hand

(2007:352) maintain that students are likely to engage in learning when the environment

is conducive to learning and when they are challenged to higher-order thinking. This can

be done through flip the classroom, which is a student-centred teaching-learning approach

(O’Flaherty & Phillips 2015:85; Betihavas, Bridgman, Kornhaber & Cross 2016:15) that

promotes an active, deep learning experience (Bristol 2014:43). In addition, this approach

appeals to a variety of learning styles (Lage, Platt & Treglia 2000:30; Roehl, Reddy &

Shannon 2013:45; Roach 2014:76; McLaughlin, Roth, Glatt, Gharkholonarehe, Davidson,

Griffin, Esserman & Mumper 2014:237). This approach entails the delivery of print-, audio-

or video-based material to students outside lecture time in order for them to master the

basic concepts. The lecture time is then focused on the application of knowledge by

engaging students in productive, creative exercises (Sharma, Lau, Doherty & Harbutt

2015:327). Roach (2014:75) purports that flip the classroom complements the traditional

classroom, and does not replace it. In addition, Talbert (2015:13) explains that the

traditional group learning space is transformed into an individual learning space as well as

a dynamic interactive learning environment.

Harrington and Oliver (2000:23) have found that students are unable to use previously

obtained knowledge to solve real-life problems. This may be due to traditional lecturing

reducing education to the mere transformation of information and is ineffective in

developing the student’s capacity to use the information (Mazur 2009:51). Another

explanation provided by Gilboy, Heinerichs & Pazzaglia (2015:109), is that passive learning

does not challenge students’ thinking nor does it guide and encourage them to apply

information. Njie-Carr, Ludeman, Ching Lee, Dordunoo, Trocky and Jenkins (2016:134)

34

purport that due to the lack of knowledge application, students struggle to meet the

complex and multiple needs of patients that they encounter in clinical practice.

Bristol (2014:43) adds that the motivation for using the flip the classroom approach includes

the reality of content overload in health sciences education and the diverse needs of the

millennial students. O’Flaherty and Phillips (2015:85), who highlight the fact that flip the

classroom meets the expectations of the current generation of students, support this view.

Therefore, according to Roehl et al. (2013:45), this holistic approach will appeal to the

typical millennial learner who thrives in an environment of variety and change.

The foundational element of flip the classroom, as described by Bristol (2014:51) and Mazur

(2009:51), is the responsibility of students to gather information. As a result of this, they

are able to cover the course material at a pace suitable to their learning style (McLaughlin

et al. 2014:237; Roach 2014:76). Using this element compels students to take ownership

of their learning (O’Flaherty & Phillips 2015:85). Betihavas et al. (2016:20) claim that by

using flip the classroom, students will learn how to learn, apply information and acquire

capabilities and competencies, rather than just to collect information. The lecturer can

support and guide the students in using the more in-depth learning process and can help

students to establish relationships with their pre-existing knowledge and the new

information presented (Sharma et al. 2015:327).

In this form of pedagogy, the lecturer acts as an advisor, facilitator, mentor or coach during

class time and supports students with the application of abstract knowledge which was

gained outside class time (Bristol 2014:45). This can be done through interactive activities

such as working through problems or cases (Sharma et al. 2015:327), completing a

homework group assignment (Lage et al. 2000:32), or student presentations and

discussions (Gilboy et al. 2015:110). In health sciences education, the classroom can

become the clinical environment (Bristol 2014:45). Gilboy et al. (2015:112) point out the

importance of using only a few active learning activities when the flip the classroom strategy

is applied to a whole module. This will allow students to become accustomed to this

teaching-learning method, according to which they are encouraged to focus on the

application of the knowledge rather than the process of the method.

Reports of student perceptions of flip the classroom are conflicting to some extent, but

generally positive (Bishop & Verleger 2013:1; Gilboy et al. 2015:110). Lage et al. (2000:35)

35

found that even though students perceived a workload increase in this inverted approach,

they appeared more motivated during class time and preferred this type of classroom

format. In a study by Hanson (2016:82), students reported that this pedagogical approach

increased their understanding and enhanced broader and deeper thinking. Hanson also

found that the fact that students could study independently and listen to information

repeatedly was noted as beneficial. O’Flaherty and Phillips (2015:85) also comment on the

advantages of students working at their own pace, as well as the flexibility that the use of

technology creates in terms of when they may engage with electronic resources. This

promotes self-directed learning (Hauer 2014: Online). On the other hand, Berrett (2015:2),

as well as Talbert (2015:16) mentions that some students dislike flip the classroom

considering that they cannot passively receive information in class, but have to be actively

involved in the learning process. This finding has been confirmed by Hanson (2016:83),

who states that some students still prefer instructional learning for the same reason.

Gilboy et al. (2015:110) concluded that this instructional approach was being used more

often in health care disciplines, as it demonstrates improved teacher-student interaction, as

well as an increase in student engagement. This approach not only provides opportunities

to enhance theory-practice integration (Njie-Carr et al. 2016:133), but Kolb’s learning cycle

also comes into play. Flip the classroom provides students with an active learning

experience (O’Flaherty & Phillips 2015:86), namely to conceptualise information and be

granted the opportunity to engage in higher-order thinking and creativity (Roehl et al.

2013:48; Njie-Carr et al. 2016:135).

2.3.3.2.3 Small-group learning

In higher education, small-group work has been cited as an effective teaching-learning tool

and the literature has shown that the use of group work benefits the student learning

process (Crosby 1996:190; Gatfield 1999:366; Ashraf 2003:213; Rudland 2009:80). Group

work is a student-centred, active teaching-learning method that will promote deep learning

(Jackson, Hickman, Power, Disler, Potgieter, Deek and Davidson 2014:118), self-directed

learning (Crosby 1996:189) and student engagement (Allan 2016:81). Rudland (2009:80)

described group work as a teaching-learning method where students participate and

interact with each other while completing a task.

Health professions students should be equipped with interpersonal skills that entail effective

communication, empathy, active listening, cultural competence, and professionalism

36

(Skinner, Hyde, McPherson & Simpson 2016:22). To work effectively in a group may be one

of the most important interpersonal skills for any professional, and it encourages

communication, collaboration, cooperation and compromise.

The current student generation, the millennials, are classified as being group-orientated

(Toothhaker & Taliaferro 2017:345). Therefore, the use of group projects and small-group

learning has become more and more popular in undergraduate courses for the reason that

it provides students with the opportunity to experience the challenges of working in groups

and to better prepare them to function as part of a group (Gatfield 1999:366; Chapman &

Van Auken 2001:117; Chapman 2006:298). Ashraf (2003:213) and Lim, Geduld, Checkett,

Sawe and Reynolds (2017:26) add peer learning and peer modelling to the benefits of group

work. Jackson et al. (2014:117) who state that students benefit from tutoring and learning

support from each other also hold this view. Crosby (1996:190) explains that when a

student participates in a small-group discussion or task, previously acquired understanding

will be activated and within the group possible deficits may be identified, while fellow group

members will aid in facilitating new comprehensions.

Crosby (1996:189) identified characteristics that should be present when applying small-

group learning as a teaching-learning method. The most important feature of a small group

is active participation. Allan (2016:81) warns that students are passive learners and

therefore show resistance to group work where they are forced to participate in the learning

process actively. The second important element of this pedagogy is that the task and

objectives should be clearly defined and focused (Crosby 1996:189). For this reason,

instructional guidance is regarded as one of the key contributions to a positive learning

experience and an important step to avoid frustration during innovative group assignments

(Allan 2016:81). Chapman and Van Auken (2001:125) highlighted the importance of

instructors informing students of the multidimensional aspects of working in a group

coupled with reinforcement of the multiple learning objectives that a group project serves.

Similarly, to achieve the outcomes of this pedagogy, students’ concerns about group work

should be addressed (Allan 2016:81). Although the benefits of working in a group are clear,

students have voiced various factors that influence their learning negatively when working

in a group. These factors arise, as Jackson et al. (2014:117) explain, due to the dynamics

of each individual’s knowledge, attitude towards learning, experiences and personality.

Furthermore, Chapman and Van Auken (2001:118) mention that not only do students fear

37

that their grades will be negatively influenced due to group work, but unfair work

distribution and inefficiencies in coordinating efforts to find time to work together also

contribute to a negative attitude towards group work as a learning experience. These

challenges were also reported by Jackson et al. (2014:120), who mention that poor

communication, problems regarding accessibility, insufficient responsiveness and the

perceived level of engagement all are stumbling blocks that students have to overcome to

produce a shared piece of work. Allan (2016:87) makes it clear that time and interpersonal

conflict always will be issues during group work, but should not be allowed to cause an

unsettled learning environment. To overcome these barriers, positive attitudes and

cooperation are required from the side of all students involved. Rudland (2009:83) states

that the key factor which is crucial for success with group work is the positive commitment

of each student.

Interpersonal skills require development and practice (Skinner et al. 2016:22). It is clear

that the use of group work not only contributes to improving knowledge construction but

also adds value to a broad range of interpersonal skills (Lim et al. 2017:26). Chapman

(2006:299) maintains that participating in a small-group discussion or assignment is an

essential aspect of adult education and the use of group work in education combines

intellectual and social development. McCrorie (2014:123) concludes that group learning can

be a fulfilling and effective experience at any stage of medical education.

2.3.3.2.4 Simulation

Simulation can be defined as a near representation of an actual life event; may be presented

by using computer software, role play, case studies or games that represent reality, and

actively involve learners in applying the content of the lesson (Billings & Halstead

2005:425). Smithson, Bellingan, Glass and Mills (2015:852) elaborated on the two

classifications of simulation, namely high-fidelity or low-fidelity simulation. The classification

refers to the degree to which the skill or skills in the real task are captured in the simulated

task. High-fidelity simulation includes high-fidelity computer-aided simulators and

standardised patients (SP) where actors, community members or fellow students act as

patients in order to simulate a scenario accurately and consistently. High-fidelity simulation

provides a realistic context for practising and measuring clinical skills and competencies

containing aspects of the reality of the experience. An example of a low-fidelity simulator

38

is the intravenous insertion arm used for students to practise giving intravenous injections

(Maran & Glavin 2003:22).

Simulation has formed an integral part of health-related education for decades (Smithson

et al. 2015:852). Although this may be true for medicine and nursing education, simulation,

as defined above, is neither as widespread nor as advanced in optometry programmes.

Nonetheless, should simulation be adopted in all health education curriculums to improve

learning outcomes, student preparedness for practice as well as patient safety will be

enhanced (Smithson et al. 2015:860). Ker and Bradley (2014:175) point out that simulation

is a method that can be used to facilitate any learning with one main goal, that is, to develop

and maintain safe health care providers. From the definition provided by Ziv (2009:217),

who explains that simulation is an educational activity that utilises simulative aids to enable

educators to enhance the educational message by simulating the clinical scenario, it is clear

that there is no reason for simulation not to be included in optometry programmes in South

Africa.

The literature has shown that SP simulation contributes to the enhancement of the learning

environment in health professions education (Chen, Kiersma & Abdelmageed 2015:816).

This may be due to the fact that students find SP simulation realistic and useful to improve

their skills. Although, Draper, Moller, Aubin, Edelstein and Weiss (2012:97) described

students’ experiences of SP simulation as positive, enjoyable and empowering; students

also reported that they could benefit more from interaction with a real patient. This factor

is important to consider, as Draper et al. (2012:97) maintain that due the requirement of

significant resources for using SP simulation, on the African continent real patients are used

to teach and assess skills more often.

Brandenburg and Pesudovs (2014:19), however, highlight the importance of

communication skills and affective skills required by an optometrist and further mention

that these skills should be trained through experiential learning. Simulation uses experiential

learning techniques (Ker & Bradley 2014:181) where the student is seen as the central

focus of this learning experience (Hope, Garside & Prescott 2011:714). Therefore,

simulation is seen as an active learning experience that offers a wide range of learning

opportunities (Nel & Stellenberg 2015:177). Simulation is not a standalone learning strategy

and should be used as a complementary process to support theory delivery and application

(Hope et al. 2011:714). Gaps in clinical exposure, such as the lack of sufficient exposure to

39

and participation in effective communication techniques and interprofessional experiences

can be addressed by making use of simulated situations (Smithson et al. 2015:852);

actually, a marked improvement in students’ verbal skills after the use of simulation has

been reported by students.

Another important key point to remember is that in order for a student to interact,

experiment, explore new topics and construct new knowledge they need to feel safe and

comfortable in a situation (Hope et al. 2011:711). Simulation builds on the learning theory

of constructivism (Botma 2014:2), and with the use of this teaching-learning method, the

student and facilitator are able to apply theory to practice in a safe environment (Hope et

al. 2011:714) promoting deliberate practice (Botma 2014:3). Likewise, simulation includes

ways of applying theory to practice by making principles learned in a lecture come alive

(Nel & Stellenberg 2015:117). Slater, Bryant and Ng (2016:369) also postulate that

simulation will decrease students’ anxiety, increase critical thinking and enhance learning.

Hope et al. (2011:713), Botma (2014:3) and Smithson et al. (2015:859) report that the use

of simulation builds confidence within the students. Confidence will influence future learning

and development of skills (Hope et al. 2014:714), and that will motivate students to do it

again because they know what they are doing (Botma 2014:3). Simulation promotes clinical

competence and reflective thinking skills (Nel & Stellenberg 2015:178). Chen et al.

(2015:816) noticed that students’ perceptions of confidence are improved when they are

able to go through the experiential cycle again after they have received feedback on their

first experience. New concepts will be formulated which will lead to further reflection when

students are exposed to new experiences. Ker and Bradley (2014:181) conclude that

experiential learning achieves the aim of simulation as it provides a safe opportunity to

experience health care without compromising patients.

2.3.3.2.5 Interprofessional education

The goal of health professions education (HPE), according to Thistlethwaite (2015:299), is

the enhancement of patient care. By the same token the role of collaboration, as one of the

core competencies set out by the HPCSA, should be included in health sciences teaching-

learning programmes in South Africa (HPCSA 2014: Online). Traditionally, students from

health sciences faculties, including optometry, have been educated in isolation (McLeod &

Bush 2015:1). Recently, universities are committed to training graduates who will be able

40

to work as effective members of a health care team (Lapkin, Levett-Jones & Gilligan

2013:90); therefore, universities worldwide have integrated interprofessional education

(IPE) in their curricula (Rhoda 2016:213) as IPE can be used to train students effective

teamwork and to reach the goal of HPE. A positive shift towards IPE training also is seen in

universities in South Africa (Filies, Yassin & Frantz 2016:229). This teaching-learning

method will become increasingly important in optometry training in future, because with

the expansion of the scope of practice, optometrists will practice more in interprofessional

settings (Mcleod & Bush 2015:1). According to Christian, Maclver and Alfieri (2015: Online),

interprofessional collaboration is well established between optometry and ophthalmology,

but collaborative practice with other health professions is not standard practice.

The main objective of IPE is to prepare students to function in a collaborative team,

consisting of members from different health care professions who have specialised

knowledge, skills and abilities, to provide improved patient-centred care (Buring, Bhushan,

Broeseker, Conway, Duncan-Hewitt, Hansen & Westberg 2009:1; Lapkin et al. 2013:90).

This correlates with the core competencies of IPE, which include the identification of roles

and responsibilities, patient-centred care, professional ethics and interprofessional

communication. The main competency of IPE, however, is collaborative practice (Rhoda,

Laattoe, Smithdorf, Roman & Frantz 2016:225).

The definition that describes IPE with all the encompassing properties is provided by Buring

et al. (2009:2):

Interprofessional education involves educators and learners from two or more health

professions and their foundational disciplines who jointly create and foster a

collaborative learning environment. The goal of these efforts is to develop knowledge,

skills and attitudes that result in interprofessional team behaviours and competence.

Ideally, interprofessional education is incorporated throughout the entire curriculum in

a vertically and horizontally integrated fashion.

A term that is used interchangeably with IPE is interprofessional learning (IPL), and the

Centre for the Advancement of Interprofessional Education (CAIPE) defines IPL as occasions

when two or more professions learn from and about each other to improve collaboration

and the quality of care (CAIPE 2002: Online).

41

Lapkin et al. (2013:91) and Filies et al. (2016:231) state that effective collaboration and

communication have a role to play in developing a variety of skills, as well as mutual respect

that contributes to the competence of health professionals. Collaborative practice

furthermore will lead to the development of responsibility, accountability and a feeling of

being in control of one’s behaviour. Bondevik, Holst, Haugland, Baerheim, and Raaheim

(2015:175) report that not only will IPE aid in developing positive attitudes among

professions, it also will strengthen students’ professional roles as they obtain a broader

perspective on handling patients.

The guidance provided by the facilitator plays a significant role in the understanding of a

student’s role in the interprofessional team. Rhoda et al. (2016:227), in a study into

students’ perceptions and experiences of IPE, found that although students highlighted the

fact that they had learnt a great deal about the scope and practice of other disciplines, they

did not gain a solid understanding of their roles during the interprofessional training. The

students believed that the facilitator should guide the interaction with other professions and

focus on the task to provide clarification on roles and responsibilities. Peterson and

Brommelsiek (2017:2) note that, in order to manage various learning situations that may

be encountered during an IPE experience, the facilitator should provide immediate

constructive feedback, reinforce key points and provide positive comments during the

sessions.

Bondevik et al. (2015:175) in their study found that students were of the opinion that IPE

provided a safe learning environment as other members of the group might follow up on

something that one had missed. Once these students are qualified, they tend to continue

to rely on other professions’ input and assistance in difficult situations and complex cases.

This, according to Filies et al. (2016:231), results in rendering effective, efficient and reliable

healthcare services. In addition, Filies et al.’s study (2016) found that students felt more

secure in their own roles and wanted to show the competencies of their profession in the

best way possible, while learning as much as possible from the other members of the

interprofessional team. These outcomes correlate with the learning outcomes for IPE that

Thistlethwaite and Moran (2010:511) put forward, and which include the following:

Teamwork that includes cooperation and accountability.

Knowledge of the different roles and responsibilities, and expertise of health

professionals.

42

Effective communication that will include the expression of one’s opinion, but also

the listening to other members of the team in order to make shared decisions.

Transferring interprofessional learning to the clinical setting through learning and

reflection.

Patient-related factors such as patient safety issues and the recognition of patients’

needs.

Ethics and attitudes relating to teamwork. Respect, understanding and

acknowledgement of ideas of other professionals.

Equally important is that an IPE programme should be designed to increase student

confidence, planning, control and composure and commitment in providing patient-centred

care (Peterson & Brommelsiek 2017:2).

Barnsteiner, Disch, Hall, Mayer & Moore (2007:147) suggest that IPE should be

implemented early in a curriculum to avoid the existence of stereotypes amongst

professions that already may be formed in the first-year of studies. They find this

implementation very challenging as there is a lack of opportunities to bring students from

different schools or departments in the faculty together for the specific purpose of learning

and understanding each other’s roles as most health sciences education takes place in silos.

In a study by Van Wyk (2015:825), it was also found that due to each school in the FoHS

at the UFS focusing only on its programme outcomes and professions, interactive teaching-

learning (among professions) logistically is problematic to arrange. In contrast with

Barnsteiner et al.’s view in this regard (2007:147), Van Wyk (2015:825) states that the

implementation of IPE in the early years of study will not be effective as students have not

yet developed their own professional identity and role clarification.

Filies et al. (2016:232) listed indicators according to which the impact of IPE teaching and

training could be measured. These include the feedback received from patients together

with patient outcomes with regard to the evaluation of the patient and the improvement of

the patient’s condition. Secondly, the opportunity for the participants to provide constructive

criticism and to effectively communicate within an interprofessional team to develop mutual

respect also was listed as a measurement criterion. Other methods of measuring the

success of IPE were focus group interviews, questionnaires, reflective journals, portfolios

and observation during clinical practice. Even though the literature reports mixed results

relating to the learning outcomes of IPE, no study reported entirely negative outcomes with

43

the use of IPE. Clinical decision-making ability, knowledge scores and interprofessional

communication styles have been noted to improve with the use of IPE (Lapkin et al.

2013:101).

The definition of IPE indicates that learning is more likely to take place through a shared

experience than through a didactic transmission (Thistlethwaite 2015:300). Treadwell, van

Rooyen, Havenga and Theron (2014:3) explain that with the use of collaborative care

activities, a constructivist theory is followed, as students are challenged to interpret the

experience and then construct meaning by incorporating their personal experience and its

meaning in their existing knowledge. IPE, therefore, can be seen as a concrete experience

on the experiential learning cycle. This teaching-learning method will become increasingly

important in optometry training in future due to the expansion of the scope of practice

which will take optometry more into interprofessional settings (Mcleod & Bush 2015:1).

2.3.3.2.6 Case presentation

Grand rounds, which in essence entail case presentations, have a long history in medical

education (Herbert & Wright 2003:1248) and still are a very popular and effective teaching-

learning method in health sciences education (Agee, Komenaka, Drachman, Bouton, Caruso

& Foster 2009:361). Traditional grand rounds, as described in the literature, originated from

bedside teaching. Due to popularity, the attendance of students increased and the teaching

moved from the bedside to a lecture hall (Agee et al. 2009:361). Initially the patients

involved were present during the discussion, but recently the focus has shifted to the

condition itself; therefore, the patients no longer are part of the discussion (Sandal, Iannuzzi

& Knohl 2013:560). Agee et al. (2009:361) explain this as a migration of focus from patient-

based to lecture-based training. Laibhen-Parkes, Brasch and Gioncardi (2015:338) define

case presentation as a learning experience that summarises a case study or group of case

studies with related content. They furthermore define a case study as a verbal or written

description of a clinical problem where important history and clinical findings are provided.

Therefore, the patient’s condition is used for a direct purposeful learning experience.

This teaching-learning method follows a strategy of capturing the interest of the student by

applying patient-centred, evidence-based practice (Gardner, Woollett, Daly, Richardson &

Aitken 2010:737). Case discussions provide an educational platform for the improvement

44

of clinical knowledge development (Gardner et al. 2010:737), while increasing the student’s

diagnostic reasoning abilities (Stieger, Praschinger, Kletter & Kainberger 2011:351)

Sandal et al. (2013:562) provide guidelines for the format of case presentations. They

recommend that the case presentation be didactic as well as interactive to accommodate

different learning styles. The cases presented must be carefully selected and the topics

discussed should be educational. The presenter should be able to hold the audience’s

attention and must be evaluated to improve effectiveness. When these recommendations

are applied the audience will experience the benefits of case presentations.

Many benefits are attributed to case presentations. Fasbinder, Heys, Holland, Keerthy,

Murdoch-Kinch and Inglehart (2015:510) list three benefits of this pedagogy. First, case

presentations provide students, staff and others with the opportunity to share information

which increases participants’ knowledge. Secondly, by having a few presentations on a

topic, a more in-depth understanding of the topic can be developed. The third benefit

mentioned by Fasbinder et al. (2015:511) is the improved communication between

participants. Sandal et al. (2015:361) summarise the benefits by stating that case

presentations disseminate knowledge, result in changes in the health professional’s

behaviour and improve patient outcomes.

Herbert and Wright (2003:1248) report that case presentation always has been a respected

teaching-learning method, but due to audience boredom and, as often happens, lack of

case appropriateness, it has lost its attraction. Agee et al. (2009:361) also report that the

efficacy of case presentations have been questioned. Sandal et al. (2015:561) list reasons

for the decrease in the value and use of case presentation during case presentations as

reported by Herbert and Wright (2003:1248). These include poor organisation, poor

teaching skills by the presenter, the fact that the focus shifts from patient-centredness, and

a lack of punctuality by presenters and attendees. Regardless of this Herbert and Wright

(2003:1250) still advocate that case presentations are valuable and have a definite place in

health sciences education.

Fasbinder et al. (2015:510) suggest that case presentation should be used as an approach

to create an educational environment where principles such as critical clinical thinking and

integration of knowledge can be implemented. Case presentation also creates an ideal

platform for reflection and reflective observation and form part of the experiential learning

45

cycle (Kempen 2015:87). King, Joseph and Umland (2017:770) explain that reflection is a

method by which deep learning occurs when students are required to contemplate an

experience. Tsingos, Bosnic-Anticevich and Smith (2014:1) assert that reflection can be

used to enhance the transfer of theory learnt to practice. For this reason, reflection on

cases presented as part of case presentation as a teaching-learning method, as it currently

is applied in the undergraduate optometry programme, is applicable for this study.

2.3.3.2.7 Peer assessments

The aim of assessment in higher education should be to motivate students to master

knowledge, promote effective learning and enable them to learn from the assessment

process and feedback (Vu & Dall’Alba 2007:541). Morris (2001:508) highlights the

importance of assessment to the learning process and points out that it should not be

separated from the learning process. With this in mind, peer assessment is a valuable

assessment and learning tool and it can be used in formative and summative assessments

(Gielen & De Wever 2015:316; Jhangiani 2016:180) to obtain a holistic view of students’

understanding and skills (Alias, Masek & Salleh 2015:310). Topping (2009:20) defines peer

assessment as an activity that is planned for students to take the responsibility to consider

and specify the level, value, or quality of projects, presentations or evaluations of other

students who are at the same academic level. Pharikh and Sheenan (2016:821) explicate

that with peer assessment students will master the skill in providing constructive feedback

on work completed by peers.

The aim of this teaching-learning method, when used during formative assessments, is to

improve the effectiveness and quality of teaching (Vickerman 2009:222; Cox, Peeters,

Stanford & Seifert 2013:311; Ramm, Thomson & Jackson 2015:824). Topping’s (2009:20)

and Gielen and De Wever’s (2015:315) view is an expansion of this opinion in that they

explain that peer assessment is intended to help students to help each other, identify their

strengths and weaknesses, target areas for remedial action and develop metacognitive and

other personal and professional skills. Equally important is that peer assessment provides

immediate, individual feedback from peers while the learning is happening (Topping

2009:22). To provide and receive feedback are seen as an integral part of student learning

and equips students with valuable professional skills that prepare them for future learning

(Alias et al. 2015:310, Gielen & De Wever 2015:315). With the use of immediate feedback,

46

the gap between current and desired performance can be closed (Gielen & De Wever

2015:316).

Peer assessment has become a popular assessment tool in health sciences education (Cox

et al. 2013:311; Rush, Firth, Burke and Marks-Maran 2012:220). With the shift from

assessment of learning to assessment for learning, students need to act as partners in the

assessment process (Gielen & De Wever 2015:315). For this reason, peer assessment ought

to be included in an assessment strategy as it involves students successfully in the

assessment process and promotes a sense of ownership, personal responsibility and

motivation (Morris 2001:508; Vu & Dall’Alba 2007:541; Topping 2009:24). Morris

(2001:508) states that the use of peer assessments creates a deep learning experience,

while Dent and Harden (2009:308) state that this approach will promote lifelong learning.

Vu and Dall’Alba (2007:542) also found that peer assessment creates a platform for

independent learning. These conclusions are echoed in the findings of Rush et al.’s

(2012:220) study that confirm these advantages of peer assessment and add more benefits

such as that students obtain insight in how others undertake similar clinical problems and

students master the ability to give and receive constructive criticism. Peer assessment thus

is confirmed as a valuable pedagogical tool that promotes the learning process and has the

potential to be transformational (Jhangiani 2016:184; Ramm et al. 2015:286).

Topping (2009:21) points out that the peer assessment can be applied in different ways in

a module, proclaims that a range of activities can be assessed thus, and the role

assignments also can vary. Peer assessment also can be conducted at several points during

the learning process, providing continued practice for the assessors and feedback on the

progress to the assessed (Alias et al. 2015:310). For successful implementation, the roles

of both the instructors and students should be well-defined (Elshami & Abdalla 2016:9).

The responsibility of the assessor, according to Gielen and De Wever (2015:315), involves

the following:

1. The assessors need to be proficient in their skills or knowledge and familiar with

the assessment criteria;

2. They have to evaluate a peer’s performance;

3. They must compose a meaningful peer feedback message that includes

information such as what was right or wrong and how to correct the errors that

were made.

47

In accordance, the student who is being assessed must be able to create a discussion on

the feedback, to make changes accordingly, and be ready and willing to follow the advice

received in order to enhance the quality of the performance (Gielen & De Wever 2015:315).

With the use of this guideline, peer assessment will promote collaborative learning and

creates an opportunity for students to have to work together to accomplish a learning

objective (Gielen & De Wever 2015:317). This is confirmed by Ramm et al. (2015:826) who

stated that students experienced the use of peer assessment positively, and that they

mention that the responsibility of being involved in an assessment was experienced as

valuable as students acquire new and valuable perspectives. Pharikh and Sheenan

(2016:822) in a study found that the skills learned by means of the use of peer assessment

as part of the teaching strategy improved students’ self-assessment aptitudes, their

knowledge of grading objectives (which raised their awareness of their shortcomings) and

their ability to communicate with peers about academic matters.

Notwithstanding the numerous advantages of peer assessment, Rush et al. (2012:220)

warn that the use of peer assessment is not without challenges. Elshami and Abdalla

(2016:10) report that from the perspective of students, the practice of peer assessment is

challenging and stressful. Students may not have the same thorough understanding of a

situation, which may lead to uncomprehensive and/or worthless feedback, ensuing in a

waste of time. In another scenario, students may be biased towards friends, or be reluctant

to provide constructive criticism because of a fear of offending their peers. Students thus

perceived the peer assessment process as time-consuming and concerns were raised about

feedback from low-performing students, while others might not take the process seriously

(Elshami & Abdalla 2016:12). Some students also might feel more comfortable with

receiving feedback than with providing feedback to their fellow students (Pharikh &

Sheenan 2016:821).

In the face of the challenges mentioned above, Elshami and Abdalla (2016:12), however,

proclaim that peer assessment has a positive impact on student learning through the mere

reality of engaging students in learning. Hence, it can be seen as an active learning strategy

that supports a variety of student learning styles (Vickerman 2009:222). Therefore, peer

assessment is an appropriate strategy for inclusion in the experiential learning model, as it

encourages critical thinking (Morris 2001:508; Pharikh & Sheenan 2016:821) and reflective

observation (Elshami & Abdalla 2016:9). Morris (2001:508) and Vickerman (2009:222)

conclude that peer assessment does not only benefit students academically, but also

48

develops critical cross-field skills and professional skills, such as reflective, listening and

interpersonal skills, that will be required during their professional careers, and that serve

as a basis for future (life-long) learning.

2.3.3.2.8 Bedside teaching

Sir William Osler introduced bedside teaching to medical training in the early 1900s. As one

of the most popular role-models in modern medicine, he only taught students at the bedside

and showed them how to use all their senses when examining and managing a patient

(Nair, Coughlan & Hensley 1997:341). Bedside or ward-based teaching, therefore, can be

defined as clinical teaching done in the presence of a patient (Williams, Ramani, Fraser &

Orlander 2008:257). Qureshi (2014:70) adds to this definition that it is clinical teaching

where patient-centred care is directly observed and learned. It provides an optimal

opportunity for students to learn clinical skills, clinical reasoning, communication skills, and

interpersonal skills as well as for educators to role model a holistic approach to patient care

(LaCombe 1997:218; Dent 2009:96; Salam, Siraj, Mohamad, Das & Yousuf 2011:1; Peters

& Ten Cate 2014:77; Garout, Nuqali, Alhazmi & Almoallim 2016:261). Furthermore, Nair et

al. (1997:346) assert that the bedside is the only site where history taking, physical

examination, empathy and a caring attitude can be taught and learnt by example. Ramani,

Orlander, Strunin and Barber (2003:84) confirm this opinion and explain that these crucial

elements of education for good patient care cannot be effectively accomplished in a

classroom.

Bedside teaching may be defined in different ways (Beckman 2004:343), and different

teaching models are described in the literature that can be utilised in bedside teaching

(Dent 2009:100). Apprenticeships together with role modelling and ward round teaching

are regarded as instructional models for managing bedside teaching that may be applied in

an undergraduate optometry programme such as that of the UFS (cf. Dent 2009:100).

LaCombe (1997:218) points out that these two instructional models also were responsible

for the inception and development of mentoring. When the apprenticeship instructional

model is applied in health sciences education, students are provided with the opportunity

to build confidence through observing good practice, while ward rounds also allow students

to see physical signs of various diseases and conditions in real patients (Dent 2009:100),

including patients with ocular pathology.

49

Dent (2009:96) explains that the learning triad during this teaching-learning method

comprises a patient, student and the supervisor/tutor - the recipe for an effective student

learning experience. Patients are seen as the cornerstone of this teaching-learning method

(Garout et al. 2016:261). For the patient to be actively involved in the learning process,

information about the session must be provided to them and they must be ensured that

the discussions taking place during bedside visits and patient information shared with

students will be dealt with strictly confidentially. Williams et al. (2008:260) caution that

orientating the patient and explaining the purpose of the bedside encounter are important

signs of respect not to be negated, as such actions will foster trust and cooperation. In the

same vein, Chretien, Goldman, Craven and Faselis (2010:786) warn that the examination

of patients in the presence of the students may be experienced as an invasion in the

personal space of patients, and the patients may very well be concerned about possible

embarrassment and the risk of objectification. Even so, LaCombe (1997:219) states that

some patients enjoy being involved in this teaching-learning method. This is confirmed by

Peters and Ten Cate (2014:80), who found that patients appreciated bedside teaching as

they felt that extra time and special attention were given to their medical situation.

The teaching-learning environment must be conducive to learning as students may feel

intimidated by an unfamiliar environment. The tutor or supervisor should ensure that all

students participate and that the anxiety that a student may feel be allayed (Dent 2009:97).

A supervisor using good communication skills can make students feel secure by providing

adequate demonstrations, explanations and formative feedback (Garout et al. 2016:262).

In a study by Williams et al. (2008:261), it was found that students believe that simple

reassurance from the facilitator is enough to alleviate their anxiety. Peters and Ten Cate

(2014:77) also find that when supervisors provide suitable guidance, students are more

motivated to engage in clinical reasoning and problem-solving.

Amin and Eng (2003:203) state that bedside teaching does not provide sufficient

opportunities and time for students to master communication skills, as the teaching of

communication skills is a structured educational activity and bedside teaching under-

represents the knowledge component of communication skills. Contrary to this view,

however, in a study conducted by Nair et al. (1997:343) students reported that the bedside

teaching-learning method was an effective method for teaching professional skills, which

included communication skills.

50

Professional skills can be divided into three categories, as given in Table 2.2.

TABLE 2.2: PROFESSIONAL SKILLS ACQUIRED DURING BEDSIDE TEACHING [Nair et al. 1997:344]

Conventional skills Problem-based learning skills Administration skills

Physical examination

History taking

Communication

Basic science

Evidence-based medicine

Self-directed learning

Organisational skills

Time-management

Record keeping

This is confirmed by Williams et al. (2008:258) who state that students perceive bedside

teaching as valuable and essential for learning skills related to effective communication,

physical examination, clinical reasoning and professionalism. Another important key is the

students’ recognition of the value of observing experienced clinicians which also supports

the use of role-modelling in this teaching-learning method (Williams et al. 2008:262). To

recapitulate, Byszewski, Hendelman, McGuinty and Moineau (2012:2) state that students

have identified bedside teaching as a key component of a positive learning environment

and the only way for transferring professionalism, which is one of the core competencies in

a health science curriculum.

2.3.3.2.9 Clinical skills training

Health professions education aims to produce competent professionals displaying not only

cognitive and personal skills but also clinical skills to meet the needs of society (Aggarwal,

Grantcharov & Darzi 2006:697). Teaching clinical skills is a core component of

undergraduate health education (Sadideen & Kneebone 2012:397). The hallmark of the

approach to teaching clinical skills is graduate independence while ensuring patient safety

(Grantcharov & Reznick 2008:1129). Ker (2009:87) defined a clinical skill as any action by

a health care practitioner involved in direct patient care which impacts on clinical outcomes

in a measurable way.

Vogel and Harendza (2016:1) suggested that certain teaching-learning methods for clinical

skills might result in better performance, thus highlighting the importance of choosing the

correct teaching-learning method. In the same breath, Vogel and Harendza (2016:5)

concluded that it is very difficult to provide comprehensive guidelines on the best method

for teaching a clinical skill.

51

Aggarwal et al. (2007:697) state that to be technically proficient in clinical skills is crucial

for delivering satisfactory outcomes in terms of patient care. They further explain that to

become skilled in any procedure, a strategy to master the skill associated with a procedure

needs to be developed to help students learn more effectively. The objective of such a

strategy, according to George (2001:557), should be to optimise the use of time, but still

produce a satisfactory learning experience for the student.

A systematic strategy for learning required skills can be explained by applying by the

fundamental principles of teaching psychomotor skills. Sadideen and Kneebone (2012:397)

state that the successful completion of a clinical skill depends on the successful acquisition

and execution of a psychomotor skill. These fundamental principles are illustrated in Figure

2.7.

FIGURE 2.7: PRINCIPLES OF TEACHING PSYCHOMOTOR SKILLS [George 2001:557]

As described by George (2001:557) the seven principles of teaching psychomotor skills start

with the conceptualisation of the skill. Aggarwal et al. (2007:697) explain that clinical skills

learning start with procedure-specific knowledge. This includes an understanding of the

CONCEPTUALISATION

Understand cognitive elements: Why? When?

With what?

VISUALISATION

How? Skill demonstration

Learner imitation

VERBALISATION

Narration of steps Learner manipulation

PRACTISE

CORRECTION AND RE-INFORCEMENT

SKILLS MASTERY

Routinely perform the skill

Learner articulation

SKILLS AUTONOMY

02

01

03

04

05

06

07

Perform the skill Learner precision

Immediate and

positive

Perform skill without error

Learner neutralisation

52

value and relevance of the procedure, as well as the preparation and instruments involved

in using the skill. This phase correlates with the cognitive phase of teaching a clinical skill

by Gagne (1985) as listed by Ker (2009:91). The conceptualisation is followed by

visualisation and verbalisation. Only after having seen, heard and repeated the steps

involved in performing the skill, the student will be able to perform and practise the skill. A

crucial element while practising to perform the skill is the immediate correction of mistakes

to reinforce the correct performance. The last two principles include the mastery of the skill

followed by autonomy in performing it. Aggarwal et al. (2007:698) state that the most

important key to developing autonomy is time devoted to deliberate practice. Ker (2009:92)

agrees and states that deliberate practice is vital to incorporate all the important elements

of the skill. This also has been confirmed by Sadideen and Kneebone (2012:398), who add

that deliberate practice is crucial for the development of mastery.

George (2001:558) mentioned the reasons for students performing poorly in clinical skills.

First, the student might not have the inherent ability to perform the task. This characteristic

includes strength and fine motor coordination ability and skill. Secondly, the demonstration

or description of the skill could have been inadequate/inappropriate. This might be due to

a lack of confidence on the side of the clinician regarding his/her own practical skills (Vogel

& Harendza 2016:1). Another interesting finding of Vogel and Harendza’s (2016:4) literature

review is that better results were achieved in assessments where the students were taught

by full-time academic staff instead of part-time staff. Not only is the correct demonstration

important, but the student also has to pay attention during the demonstration to be able to

recall what has been done. Other reasons for poor performance are that the student

previously might have acquired the skill incorrectly or that the reinforcement of the

technique was improper. Last, affective factors such as fear, intimidation, distraction,

embarrassment, lack of belief in the value of the skill, sense of skill irrelevancy or

performance anxiety will influence the performance of the skill.

Vogel and Harendza (2016:5) state that the only absolute recommendation to improve

clinical skills mastery is the actual involvement of the student and not only an observation.

Aggarwal et al. (2007:699), however, propose that the complete procedure first should be

observed when being performed by different experienced clinicians. This may be achieved

by providing students with video-based recordings of the technique. Not only will video clips

enable the fragmentation of a procedure, but Vogel and Harendza (2016:4) also found that

students who had access to video clips obtained better results in performing a specific skill.

53

It furthermore has been shown that self-guided or self-directed learning has been beneficial

for mastering different clinical skills; however, it must be ensured that students practise the

correct technique (Vogel & Harendza 2016:5). Grantcharov and Reznick (2008:1131) also

noted that not all students acquired knowledge and skills at the same rate. It, therefore, is

essential to confirm that skills improve and that the students perform the procedure in

accordance with the principles of safe practice. This can be done with the use of regular

assessment and feedback.

Experiential learning, as mentioned by Aggarwal et al. (2007:698), values the impulsive

nature of the medical field. As soon as a student has acquired the basics of a technical skill,

experiential learning enables the application of this knowledge to new situations, thus the

learner always is actively involved. Sadideen and Kneebone (2012:398) also argue that the

theory of constructivism, an important concept of experiential learning, plays a vital role in

teaching practical skills as students are more likely to acquire a practical skill-based on a

similar previous learning experience.

2.3.3.2.10 Clinical education

Health sciences education is characterised by the close relationship between theory and

practice (Papastavrou, Lambrinou, Tsangari, Saarikoski & Leino-Kilpi 2010:177). Clinical

education refers to providing guidance and feedback on the personal, professional and

educational development of a student in terms of his/her experiences and providing

appropriate patient care (Ernstzen, Bitzer, Grimmer-Somers 2010:25). A student

experiences and learns various aspects of the professional role as a health care provider

within the clinical environment (Mann, Gordon & Macleod 2009:614). Walter, Lo and

Maloney (2018:612) agree by stating that clinical education teaches students about the real

world of clinical practice. Walker, Cooke, Henderson and Creedy (2013:504) and O’Mara,

McDonald, Gillespie, Brown and Miles (2014:208) proclaim that effective clinical learning

experiences are strategic and vital for students to gain the ability to apply theoretical

knowledge and skills. The authors further mention that the goal of clinical learning is the

preparation of competent and safe professionals that provide high-quality care in a dynamic

health care context.

Papp, Markkanen and von Bonsdorff (2003:263) indicate that clinical practice increases a

student’s competence including independence and self-directedness. They also define a

self-directed student as someone who is aware of one’s limitations and potential, and has

54

a sense of responsibility and an active attitude. Additionally, they emphasise the importance

of ensuring that a student’s clinical experience also is a learning experience, as the clinical

setting is an important component in the whole learning process of a student. For this

reason, the students, and, consequently, their learning are the focus of clinical education

and seen as the most influential factor for the enhancement of the learning environment,

but Papp et al. (2003:263) discover that equally important are the influence of the

supervisors. O’Mara et al. (2014:208) support this view and mention that the relationships

students have with the supervisors affect their perceptions of the clinical learning

environment.

As highly as students value clinical practice and know that they primarily are responsible

for optimising their clinical experience (Papp et al. 2003:267), they perceive the clinical

environment as stressful (Walker et al. 2013:510; Papastavrou et al. 2010:177). Papp et al.

(2003:263) and Papastavrou et al. (2010:1180) report elements that students require to

have an optimal learning experience. Within a clinical learning environment, students want

to feel appreciated; they need support; appreciate quality and regard the attitudes and

behaviours of clinical staff to be important for the learning experience. The student’s

confidence levels increase when they feel part of a team, are treated with mutual respect

(Papastavrou et al. 2010:180), and when the supervisors are welcoming and helpful

(O’Mara et al. 2014:211). These elements highlight the fact that the learning environment

is dependent on the role of the supervisor (Ernstzen et al. 2010:28), and O’Mara et al.

(2014:208) confirm that the actions of supervisors strongly influence students.

Papastavrou et al. (2010:177) refer to an individual that takes a supervisory role as a

mentor, link teacher or preceptor, and found the relationship between a student and a

supervisor to be crucial for the professional development of the student. They further

suggest that the clinical supervisor should also be the lecturer responsible for theory as this

will enhance the theory-practice integration. Launer (2014:115) is in agreement with this

suggestion and adds that clinical supervision is the most general form of supervision in

medical education and in the training context it may overlap with theory training. Ernstzen

et al. (2010:28) and O’Mara et al. (2014:208) mention qualities a supervisor should have

to create a pleasant learning environment. First, a supervisor’s expectations should be clear.

Second, supervisors should not be critical, have favourites or be unpredictable in their

responses. To create an optimal learning environment the supervisor should be

enthusiastic, approachable and flexible. A relationship between the supervisor and student

55

in which the student feels free to ask questions when unsure about something is integral

to the relationship. Finally, a supervisor should not limit the student’s experience by taking

over patient care. Another important responsibility of the supervisor is to provide sufficient

opportunity for students to reflect on their experiences to integrate their feelings and

emotions in their learning process (Mann et al. 2009:608) and to understand their responses

to the experience (O’Mara et al. 2014:212).

O’Mara et al. (2014:208) refer to a challenging clinical learning environment, as an

environment in which a lack of expertise exists, as well as a discrepancy between the

student’s ability and the type of patient. It, therefore, is important to consider well when is

the correct time to expose the student to the clinical learning environment. Theory and

clinical practice should complement each other (Papp et al. 2003:267). The reality is that

the clinical environment is dynamic and it is a challenge to plan an optimal learning

environment for a clinical experience (O’Mara et al. 2014:208). In concurrence with this,

Papastavrou et al. (2010:177) contend that the clinical learning environment is

unpredictable and the complex variables influence students’ learning experiences. O’Mara

et al. (2014:210) urge that the timing, amount, and type of clinical experience, and

demands from concurrent modules should be taken into account in a curriculum design.

Ernstzen et al. (2010:26) provide a list of teaching-learning opportunities which will promote

the enhancement of clinical education. These opportunities include demonstrations of and

discussions on patient management, feedback on students’ clinical skills, and clinical

assessment. Ernstzen et al. (2010:28) also include factors that students perceived as

creating the optimal learning environment. These factors include:

An open, relaxed relationship between the student and the supervisor, allowing

students the opportunity to ask questions and make mistakes.

Open discussions.

Different sources of information.

Demonstrations and guidance of patient management with the supervisor acting

as a role model.

The availability of equipment.

Innovative strategies to enhance experiential learning mentioned by Tofade, Samimi-Gharai

and Rodriquez de Bittner (2016:430) involve a mentoring programme where junior students

56

are paired with senior students to share learning experiences, especially during clinical

education. They found that such a strategy had improved students’ clinical performance, as

well as communication and teamwork.

In order to learn from any learning experience, but especially a clinical experience, students

should have the opportunity to reflect on the experience (Paterson & Chapman 2013:133).

Tsingos-Lucas, Bosnic-Anticevich, Schneider and Smith (2016:1) refer to reflective practice

as an umbrella term to describe the professional strategy to improve one’s practice

continuously. More specifically, King et al. (2017:770) refer to reflective practice as a

process by which learning occurs through an individual’s reaction to an experience. In the

next section, the importance of this critical factor in experiential learning will be discussed.

2.3.3.3 Reflection

Boud et al. (1985 in Mann et al. 2009:597) define reflection as a generic term for those

intellectual and affective activities in which individuals engage to explore their experiences

in order to lead to a new understanding and appreciation. Husebø and O’Regan (2015:368)

elucidate that reflection is a process of learning from experience, considering and evaluating

previous knowledge in the light of these experiences, and then incorporating the new

knowledge to inform future practice. From this explanation, it is clear that to learn

effectively from an experience, reflection is essential, especially to connect and integrate

new knowledge with existing knowledge and skills. Abstracting knowledge through an

experience may generate new knowledge that allows for new insights and understanding

in future situations, even if it is not the same situation (Mann et al. 2009:596; Tsingos et

al.2014:1).

The purpose of reflection includes to re-define the understanding of knowledge, the

development of self-awareness and to evaluate the appropriateness of actions (Forrest

2008:229). Another purpose of reflection in education is to create meaning from complex

situations (Mann et al. 2009:610). To create meaning during the reflective process is seen

as the core of experiential learning. Tsingos et al. (2014:1) refer to this as critical reflection.

Critical reflection has a prominent role in health professions education, especially in the

clinical environment. It encompasses the process of creating an understanding of how

someone solves a complex problem and what motivates one’s judgement and decision

making (Delany & Watkin 2009:412).

57

2.3.3.3.1 Benefits of reflection

To be able to reflect is an essential characteristic of a competent health care professional

(Mann et al. 2009:596). The most important benefit of reflection is that it helps in

establishing required links between theory and clinical practice (Mann et al. 2009:608). This

has been identified as the most crucial step in professional education (Tsingos et al. 2014:1;

Toothaker & Taliaferro 2017:346). Tsingos-Lucas et al. (2016:1) assert that this link of

theory with application might address challenges that arise especially in the clinical learning

environment. Ernstzen, Statham and Hanekom (2014:217) indicate that the application of

theory and techniques in the clinical environment is essential for the transition of a student

into the role of a professional practitioner. This process of application in the real world is

described by Botma, Van Rensburg, Coetzee and Heyns (2015:499) as transfer of learning

or theory-practice integration.

Other benefits of reflection listed in the literature are:

Reflection after an experience results in deeper learning and students will

experience a more positive learning experience (Mann et al. 2009:608; Paterson &

Chapman 2013:133; Tsingos et al. 2014:1; Tsingos-Lucas et al. 2016:1).

Reflective practice may improve the relationship between the lecturer and student

and consequently the quality of teaching (Mann et al. 2009:608).

Students find reflection valuable and report that reflection assists them to relate

theory knowledge and real-world experiences (Delany & Watkin 2009:412; King et

al. 2017:776).

Reflective skills improve critical thinking, problem-solving, clinical reasoning and

decision making, communication skills, self-directed learning, professional

development and lifelong learning (Tsingos-Lucas et al. 2016:1). King et al.

(2017:777), however, mention that for reflection to be effective, students have to

be self-directed learners who are curious, equipped and motivated to learn.

Professional and personal growth happens when students think critically about how

an experience has affected them (King et al. 2017:770).

Although reflection offers the opportunity to identify the strengths and weaknesses of a

student and consequently determines the specific learning needs (Mann et al. 2009:614),

Bouldin (2017:8) mentions that care should be taken as the identification of the weaknesses

and performance gaps may affect a student’s belief about their capabilities. Other

58

challenges or barriers to reflection cited by Bouldin (2017:8) include limited time, the

demand on mental energy, and distraction. In the same breath, Bouldin (2017:8) concludes

that reflection has the potential to improve the resilience of students.

2.3.3.3.2 Models of reflection

Two types of reflection are described by Forrest (2008:229), as well as Kauffman and Mann

(2014:12): reflection-in-action and reflection-on-action. Reflection-in-action occurs during

an experience and is described by Forrest (2008:229) as reflection that happens in a short

space of time. Reflection-on-action is the process of thinking through an experience after it

has happened (Forrest 2008:229), thus, considering what has happened (Kauffman & Mann

2014:13).

Reflection should challenge a student in terms of their understanding of themselves, their

attitudes and their behaviour (Paterson & Chapman 2013:133). In order to do this, the

student must attempt to work out what has happened during the learning experience, what

they think of it and how they feel about it; why who has been involved and when (Husebø

& O’Regan 2015:369). Important to note is that critical reflection is not concerned with the

how (Tsingos et al. 2014:4). There are several reflective models to assist students to answer

the what, why, who and when questions (UK Essays 2018:Online). Such models must be

brought to the attention of students, and they must be encouraged to apply reflection

regularly.

During reflection students must be guided through different phases. Kaufman and Mann

(2014:13) describe a model that was designed by Boud et al. (1985) as an iterative process

of reflection that comprises three phases. The first phase entails the experience, followed

by the second phase that is described as returning to the experience and which involves

dealing with negative and positive feelings. Delany and Watkin (2009:417) explain that it is

important to identify the elements that underpin the student’s experience and include

emotions, thoughts and actions during this phase. After re-evaluating the experience, the

last phase of the process involves the outcomes in which new perceptions on the experience

may lead to a change in behaviour.

59

Kaufman and Mann (2014:13) emphasise that any reflective model should highlight the

emotional aspects of an experience. Gibbs’s reflective cycle has been linked to reflective

practices within healthcare disciplines and builds on Kolb’s experiential cycle by adding the

important dimension of emotion (Husebø & O’Regan 2015:368). The focus of this reflective

cycle is to include personal feelings and thoughts as well as recommendations for future

actions. After an experience, students should be guided through the six stages of Gibbs’s

reflective cycle. Figure 2.8 illustrates the stages of the cycle with each step informing the

next.

FIGURE 2.8: GIBBS’S REFLECTIVE CYCLE [Husebø & O’Regan 2015:370]

To summarise, Tsingos et al. (2014:3) state that the outcomes of reflection may include a

new way of doing something, the clarification of an issue, the development of a skill or the

resolution of a problem. Kaufman and Mann (2014:15) affirm that a learning environment

that values and supports critical reflection is essential.

1. Description

What happened?

2. Feelings

What were you

thinking and

feeling?

3. Evaluation

What was good and

bad about the

experience?

4. Analysis

What sense can you

make of the

situation?

5. Conclusion

What else should

you have done?

6. Action plan

What will you do in

future?

60

2.3.3.4 Role of the educator

With the application of any pedagogical framework, it is vital to create a learning

environment that respects, supports and empowers students to overcome fear and take

courageous action toward mastery (Kolb & Kolb 2017:33). The millennial students prefer

frequent, positive reinforcement from an educator (Toothaker & Taliaferro 2017:350). Mann

et al. (2009:610) also stress the importance of creating a learning environment that

encourages reflection. This environment is dependent on the behaviour of supervisors or

lecturers. Various roles have been discussed as played out in teaching-learning strategies.

At this point in the discussion, however, it is deemed necessary to return to the different

roles the educator has to adopt during different phases in the experiential learning cycle.

Kolb and Kolb (2017:18) elaborate on these roles in their self-assessment instrument called

the Kolb Educator Role Profile (KERP). They are:

During a concrete or reflective observation experience, the educator has to take

on a facilitator role. The facilitator has to promote a personal experience and

facilitate the students through the practice of reflection on this experience. The

focus is placed on the learner and the meaning of the experience for the learner.

A subject expert role is needed when an experience of abstract

conceptualisation/reflective observation is used. Within this role, it is important to

teach by example and encourage critical thinking. This is true for knowledge that

is delivered through lectures where students are stimulated to reflect, analyse and

think.

For active experimentation and abstract conceptualisation, students are motivated

to master the application of knowledge and skills. During this experience, an

educator has to be a standard-setter or to adopt the role of an evaluator. The

function of this role is to create performing activities and set performance

requirements.

In the instance where students apply new ideas (formulated through active

experimentation) to a concrete experience, the educator has to coach students to

apply the knowledge to reach their goals. This role is collaborative and encouraging

to help students to learn from their experiences.

In addition, during a clinical learning experience where all four modes of the learning cycle

may be applied, the educator needs to provide appropriate support, and role-model clinical

61

leadership behaviours such as effective problem-solving, decision-making skills and

teamwork (Walker et al. 2013:504). Walter et al. (2018:612) stressed the importance of

the relationship between a student and a supervisor in clinical education to fully develop

the student to a health professional.

From these roles, it is clear that educators, irrespective of the role that they have to adopt,

need to stimulate students to analyse information and knowledge, have an open mind,

create good learning conversations, and to allow students to move from the experience into

deep reflection to conceptualise application in order to take action (Kolb & Kolb 2017:35).

In a programme known as SAGES (Seminar Approach to General Education and

Scholarship), students have to identify specific actions and behaviours of educators that

enhance their learning experience. Kolb and Kolb (2017:38) summarised these actions and

started by explaining that students perceived a positive learning experience as one where

lecturers were not the focal point of the class and masterly diverted attention from

themselves to create an environment for students to express their ideas and opinions. When

the students delve deeper into an idea, they also want to be challenged, but in a supportive

matter. The students also valued the learning experience where the lecturer treated them

as equals and where they could feel that their opinions and points of view were respected.

This goes hand in hand with the action where the students feel that the lecturer has a

genuine interest in their personal lives and ideas and that they know them. Lastly, it

mattered to the students that their lecturers should be knowledgeable and should maintain

a high level of student engagement for some time.

2.4. CONCLUSION

Even though obstacles such as financial constraints, having to cover required parts of the

curriculum (for which they often did not have enough time), large class sizes and classroom

structure have been mentioned in the literature (Wurdinger & Allison 2017:36), when

lecturers realise the benefits of experiential learning, these obstacles can be overcome.

Advantages of experiential learning include inspiring students to be effective problem

solvers, to become self-directed learners, to learn from their mistakes, enhancing life skills

and being extremely effective in helping students to be creative (Wurdinger & Allison

2017:36). In addition, Chavan (2011:129) indicates that experiential learning activities in a

62

curriculum have been shown to improve students’ grades. One possible reason for this is

that it may change the students’ attitude towards challenging concepts. Chavan (2011:129)

further mentions that when educators in health sciences use experiential learning, it will

provide students with the competencies to be successful in their professional careers and

on a personal level; it motivates students by showing them how the knowledge they have

mastered can be applied to their personal lives too.

As with any degree in health sciences, optometry students need to study for mastery. For

mastery to take place, a deeper understanding of material needs to be created that can be

recalled and applied in clinical situations. Carlson (2016: Online) mentions that active

learning helps students to analyse, arrange and evaluate course material and it leads to a

longer retention of information to use in clinical situations. She also stresses that active

learning promotes deep learning which healthcare students need. Experiential learning is

an active learning strategy that will engage students in their learning processes (Austin &

Rust 2015:143). In agreement with Chavan (2011:129), Austin and Rust (2015:145) define

experiential learning as a high impact learning practice that has been proven to increase

not only student retention but also engagement.

In conclusion, in this chapter the researcher discussed the findings of the literature review,

focusing on undergraduate optometry education in South Africa and the scope of practice

of a registered optometrist. Experiential learning then came under scrutiny, and the

development and definition of experiential learning were elucidated, as well as its

application in different teaching-learning methods in higher education.

In the next chapter, Chapter 3, Research Design and Methodology, the philosophical

stance and conceptual framework of the researcher, as well as an overview of the

methodology and research design used in this study will be described.

CHAPTER 3

RESEARCH DESIGN AND METHODOLOGY

3.1 INTRODUCTION

The word research is used in the vernacular to describe almost all kinds of collecting

information on a topic, or looking things up – this, however, is not scientific research.

Scientific research is the exploration, discovery and careful study of unexplained

phenomena (Brink 2003:2). Leedy (1997:3) describes research as the systematic process

of collecting and analysing information (data) in order to increase our understanding of the

phenomenon with which we are concerned.

The demands made on higher education and specifically health sciences education are

increasing and decision-makers and academics need to act pro-actively to ensure the needs

are satisfied. The phenomenon addressed in this study is the expansion of the scope of

practice of optometrists in South Africa (HPCSA 2008: Online; CHE-HPCSA 2013:17), and

the problem that had been identified and needed to be solved was adapting the optometry

environment to prepare students sufficiently to be able to satisfy the requirements of the

scope of practice. The primary objective here was to find a way to improve the integration

between what has been taught in the classroom and its application in a clinical setting. The

aim of this study thus was to develop recommendations for using experiential learning to

promote the integration of theory and clinical practice in the expanded scope of the

undergraduate optometry programme at the UFS.

In order to determine how experiential learning might be applied to promote the integration

of theory and practice, the experiences and perceptions of registered undergraduate

optometry students regarding the teaching-learning and assessment methods used in the

pathology modules were investigated. As this study would deal with perceptions,

experiences and opinions, the best way to go about it was to use a qualitative approach.

In this chapter, an elucidation of the theoretical perspectives on the research design and

methodology is provided, after which the methods applied and the data collection

strategies, as well as the data analysis methods used in this study, are explained in detail.

64

Thereafter a discussion follows on the process of data collection, sample selection, the pilot

study and data analysis. Finally, aspects of quality assurance, namely credibility,

transferability, dependability and confirmability as well as ethical considerations, are

discussed.

3.2 THEORETICAL PERSPECTIVES ON THE RESEARCH DESIGN

Once the research problem had been identified, it was necessary to decide what kind of

study would be best to answer the research questions and solve the problem. In this

section, the research design will be discussed.

3.2.1 The research design used for this study

Research design can be defined as a strategy of enquiry (Ebersohn, Eloff & Ferreira

2007:130). Denzin and Lincoln (2000:371) explain that a strategy of inquiry includes skills,

assumptions and practices that the researcher will employ, firstly, to connect theoretical

paradigms to strategies of investigation and, secondly, to methods for collecting empirical

data. The design of a study refers to the plan or blueprint of how the study will be conducted

(Mouton 2009:55). In this study, a qualitative case study design was made use of.

In research a clear distinction must be made between the design and methodology applied.

The research methodology refers to the systematic, accurate and methodological execution

of the design (plan) of a study or research project (Mouton 2009:55). The research

paradigm, which describes the methodological philosophy that supports the study, will be

discussed first, followed by a discussion on qualitative case study research.

3.2.1.1 Research paradigm

The term research paradigm refers to the researcher’s epistemological, ontological and

methodological principles, which are basic sets of beliefs that direct the activities of a

qualitative researcher (Denzin & Lincoln 2000:19). For this study, a qualitative, interpretive

paradigm was adopted. Within this paradigm the researcher elicited undergraduate

optometry students’ experiences and perceptions of the different teaching-learning and

assessment methods, based on experiential learning, used in the pathology modules in the

65

UFS undergraduate optometry learning programme. The study population comprised

optometry students registered for the pathology modules at the time of the study.

A qualitative paradigm was suitable for this study due to the focus on the interpretation of

‘lived experiences’ that are crucial to the learning of undergraduate optometry students (cf.

Cooper, Fleischer & Cotton 2012:1). The participants in this study were requested to share

their experiences and understanding of the educational environment, which boils down to

sharing views, opinions and ideas (cf. Tavakol & Sanders 2014:839), which is what

qualitative research is about.

Denzin and Lincoln (2000:19) claim that all research is interpretive and guided by a set of

beliefs and feelings about the world (ontology) and how it should be understood and studied

(epistemology). In the case of this study, the researcher believes that students have their

own beliefs and feelings on how they view the teaching-learning environment and how they

understand the knowledge in optometry. Additionally, the researcher views the theory of

constructivism as an explanation of how knowledge is constructed. Constructivism is the

view that human beings construct knowledge, and meaning, rather than find or discover

knowledge (Schwandt 2000:197). Illing (2014:335) further explains that meaning is

constructed out of the world and objects that already exist in the process of social

interchange. Constructivism is the philosophical principle underpinning experiential learning

(cf. 2.3.1).

The purpose of research in the qualitative tradition is to understand how people create

different versions of reality (Yardley et al. 2012:103). As illustrated in Figure 3.1, the

researcher gained access to the perceptions and experiences of undergraduate optometry

students through their constructed concepts, the knowledge derived from these and how

they created different realities in the teaching-learning environment. These concepts then

were used to interpret the experiences, perceptions and opinions, and to understand and

ascribe meaning to these (Flick 2004:90).

66

FIGURE 3.1: CONSTRUCTION AND INTERPRETATION AS MEANS OF ACCESS TO THE

WORLD OF EXPERIENCE [Flick 2004:90]

Within the constructivism paradigm, the researcher will endorse a relativist ontology and

adopts a subjectivist epistemology (Denzin & Lincoln 2000:21). The researcher believes that

the undergraduate optometry students can live in very different worlds based on different

sets of meaning as they have developed their own meaningful knowledge from their

experiences (cf. Illing 2014:336). The researcher, who is involved as an educator in all the

pathology modules in the undergraduate optometry programme at the UFS, can relate to

the students and the optometry learning programme and takes up the role of facilitator in

the research. The researcher values the active involvement in her students’ learning and

trusts that it will enhance the learning environment and promote deep learning.

3.2.2.2 Qualitative research

Currently, two approaches to research are used, the qualitative and the quantitative. The

methodological paradigms of these two approaches differ vastly. The quantitative paradigm

is based on positivism, aims to use objective measurements, and is used to test hypotheses

CONSTRUCTION

of concepts and

knowledge

INTERPRETATION

understanding,

ascribing meaning

WORLD OF

EXPERIENCE

events and activities

67

and theories composed of variables. Variables are measured in numbers, and data are

analysed by means of statistical procedures (Fouché & Delport 2002:79).

Qualitative research stems from an interpretative paradigm, and aims to understand aspects

of life and the meaning people attach to life experiences. The qualitative researcher thus is

concerned with understanding and observation, rather than controlled measurement.

Johnson and Christensen (2008:48) list five specific types of qualitative research:

phenomenology, ethnography, case study, grounded theory and historical research. Case

study research is more diverse than the other types of qualitative research mentioned and

typically strives towards describing, exploring and understanding how each case exists

holistically in its real-life context (Johnson & Christensen 2008:48; Anthony & Jack

2009:1175). This holistic approach is in accord with the constructivist view as the theoretical

framework for this study. Also, the popularity of a case study as an approach to a

constructivist enquiry has been confirmed by Anthony and Jack (2009:1172); hence the use

of a case study and constructivism in this study.

Petty, Thomson and Stew (2012:378) explain that the main aim of case studies is to create

an understanding of the distinct characteristics of a case. A case, as defined by Stake

(2000:436), is a ‘‘specific, complex functional thing’’, while Johnson and Christensen

(2008:406), as well as Stella et al. (2014:374), refer to a case as a bounded system that

may include a person, a clinic, a classroom, an institution, a programme, a policy or a

system. Bassey (1999:58) defines a case study in the educational context and refers to an

educational case study as an empirical enquiry into aspects of an educational activity,

learning programme or institution. In this study, an empirical enquiry was made on the

educational activities in the pathology modules in the undergraduate learning programme

of the Department of Optometry at the UFS.

According to Stake (2000:437), three different kinds of case studies exist: intrinsic,

instrumental and collective case studies. The intrinsic case study, with the emphasis placed

on describing the particulars of a case rather than making generalisations, is prevalent in

educational research and was used in this study (cf. Johnson and Christensen 2008:408;

Springer 2010:406).

In the qualitative case study approach employed, information was collected by means of

focus group interviews and a questionnaire with only open-ended questions to gather the

required data from registered undergraduate optometry students at the UFS.

68

3.3 RESEARCH METHODS

The strategy of inquiry, as described by Denzin and Lincoln (2000:22), connects the

researcher to specific methods of collecting empirical data. In this qualitative case study,

the researcher relied on a literature review, a written questionnaire with open-ended

questions, and focus group interviews.

3.3.1 Literature review

According to De Vos, Strydom, Fouche and Delport (2011:135), the aim of a literature

review is to conceptualise a research problem and locate it in a body of theory, that is, to

put it in a specific context. The literature review serves to put the researcher’s effort into

perspective, situating the topic in a more extensive knowledge pool, creating a foundation

based on existing, related knowledge.

Mouton (2009:87) explains that a literature review is not a gathering of text, but creating

a body of collected scholarship. In this study, the review of the literature improved the

knowledge of the researcher about the topic under investigation. The literature review

aimed explicitly at conceptualising experiential learning and identifying best practices for

this type of learning in higher education, and more specifically in health professions

education (HPE). The information gained from literature provided the necessary background

and context to construct and implement experiential learning in some of the current

pathology modules in the optometry curriculum at the UFS.

3.3.2 Questionnaire survey

According to McMillan and Schumacher (2001:34), questionnaire surveys are used regularly

in education research to describe attitudes, values, perceptions and other types of

information. Johnson and Christenson (2008:170) point out that a researcher attempts to

measure several different kinds of characteristics of a specific target population with the

use of a questionnaire.

The questionnaire survey in this study used a qualitative approach with only open-ended

questions (Johnson & Christenson 2008:176). Hanson et al. (2011:379) explain that open-

ended questions in written questionnaires will produce data that focus more on pre-selected

themes. The authors state that the questions should be formulated to allow for the

69

perceptions and ideas of the participants to emerge in the data. Meyer, Van Schalkwyk and

Prakaschandra (2016:61) add to this by indicating that the completion of the questionnaire

facilitates the act of inspection, which allows time for the participants to reflect on the value

of the experience before writing down their thoughts.

The aim of the questionnaire survey was to determine students’ perceptions and

experiences regarding the different teaching-learning and assessment methods, based on

experiential learning, used in the current pathology modules of the optometry curriculum.

Through the use of the questionnaire, the students were encouraged to engage in reflective

practice. With this in mind, Gibbs’s cycle of reflection (Husebø & O’Regan 2015:369) was

adapted in the questionnaire. According to this cycle, a series of six questions were

presented to the participant (cf. 2.3.3.3.2). The six questions available from the existing

literature were adapted for this study (cf. Burns & Grove 2005:31). The questionnaire was

available in English and Afrikaans and students were able to answer the questions in English

or Afrikaans (see Appendix A).

Gibb’s reflective cycle correlates with the kind of questions proposed by Patton (2002:348).

These include questions about experience and behaviour, opinion and values, feeling and

emotions, knowledge, and background.

3.3.3 Focus group interviews

Skinner (2007:320) explains that focus group interviews are interviews with groups of

people meeting in a non-threatening environment to provide an opportunity to elucidate

the participants’ views on a specific topic. The purpose of focus group interviews is to

provide a secure, tolerant and non-threatening environment where participants who share

certain characteristics can express their perspectives about a specific topic (Greeff

2005:299).

In this study, the focus group interviews provided additional data and contributed to the

interpretation and confirmation of the data obtained from the questionnaire surveys (cf.

Johnson & Christensen 2008:210; Bernard & Ryan 2010:41). The focus group interviews

were conducted with the fourth-year, undergraduate optometry students concerning their

experiences and perceptions of their experience in the Pathology clinic. The use of the focus

group encouraged open discussion and provided an understanding of areas that are not

70

covered through conventional methods (Barbour 2005:743). Levato and Wall (2014:390)

concluded that the use of focus group interviews in health sciences education could

determine what students think about a course and also evaluate their knowledge and

experience in answering why they think that way.

The importance of a focus group, as explained by Freeman (2006:492), centres on the

interaction between participants. For this reason, the number of participants should be small

enough to encourage all the participants to make a contribution, yet large enough to allow

for different opinions to be voiced across the whole group, rather than dividing into smaller

parallel discussions (Krueger & Casey 2015:80). Krueger and Casey (2015:84) urge that the

use of participants who know and work closely with each other should be avoided as such

groups will have their own pre-existing dynamics and have a potential for being biased. In

contrast, Kritzinger (1995, in Freeman 2006:493) believes that pre-existing groups may be

useful as the interaction and exchange of beliefs, attitudes and feelings may be more

natural. Johnson and Christensen (2008:210) agree with Kritzinger, as they maintain that

a focus group must be homogeneous in order to promote discussion. This was the course

adopted in this study, as all the participants knew each other and had studied together for

almost four years.

3.4 DATA COLLECTION

Information collected in the study was done by means of a questionnaire survey and focus

group interviews. Questionnaires probably are the most common form of collecting

information in research projects. Questionnaires can be applied in various ways; in this

study, the questionnaires were handed to the participants and completed during class time.

3.4.1 Questionnaire survey

The decision to use a questionnaire for data collection was made taking into consideration

factors such as time limits, costs and the size of the sample. Another reason was that the

questionnaire would impel the participants (students) to reflect on the teaching-learning

methods employed in their course. The questionnaire proved to be a suitable measurement

instrument in this study, as the participants all could read the questions, it was believed

that they would answer honestly, as they had been informed the study was aimed at

improving the teaching-learning in the optometry course, therefore, it was to their and

71

future students’ benefit, and they were regarded as informed and knowledgeable about the

matters addressed in the questionnaire (cf. Delport 2002:175).

As mentioned earlier (3.3.2), the questionnaire comprised six questions and was adapted

from Gibb’s cycle of reflection.

3.4.1.1 Target population

A target population consists of a group of individuals who have and share certain specified

characteristics (De Vos et al. 2011:223). As this study was an intrinsic case study, the cases

for the research had been identified earlier (cf. Stake 2000:446). The target population was

the second- to fourth-year undergraduate students in the Department of Optometry at the

UFS in 2017. This target population can be described as a finite population as it consisted

of a fixed number of elements and the researcher was able to determine its totality (Tavakol

& Sandars 2014:840).

The Department of Optometry is one of the five Departments in the School for Allied Health

Professions in the FoHS at the UFS. Table 3.1 provides the number of registered

undergraduate optometry students in the FoHS, UFS in 2017.

TABLE 3.1: NUMBERS OF SECOND- TO FOURTH-YEAR UNDERGRADUATE STUDENTS

REGISTERED AT THE DEPARTMENT OF OPTOMETRY, UNIVERSITY OF THE

FREE STATE, 2017

[Compiled by the researcher (Kempen) for the purpose of this study from information obtained from

the Division Student Administration: Office of the Dean, FoHS, UFS, February 2017]

3.4.1.2 Description of sample and sample size

Sampling refers to the portion of a population drawn to participate in a study. Such a portion

is considered to be representative of the population (Strydom & Venter 2002:198). Sample

selection was applied for the questionnaire survey and focus group interviews.

The sample consisted of the second- to fourth-year undergraduate students of the

Department of Optometry of the School for Allied Health Professions in the FoHS, UFS who

voluntarily agreed to complete the anonymous questionnaire during contact sessions.

YEAR OF STUDY/ACADEMIC YEAR II III IV TOTAL

NUMBER OF STUDENTS 20 31 17 68

72

As none of the students indicated that they were not willing to participate, the sample size

was the total number of second- to fourth-year, registered undergraduate students of the

Department of Optometry at the UFS, that is, 68, as indicated in Table 3.1 above. The

sample included males and females from different ethnic groups, with ages ranging from

19 to 33.

3.4.1.3 Pilot study

A pilot study is an essential part of a questionnaire survey to pre-test the items and picks

up any other possible deficiencies (Strydom 2002:214). The questionnaire was subjected

to a pilot study conducted on seven English- and seven Afrikaans-speaking fourth-year

undergraduate students that had been registered students in the Department of Optometry,

UFS during 2016. The fourteen students completed the pilot study on 9 September 2016 in

the seminar room at the National District Hospital. Students that were scheduled for

Pathology clinics on that day were approached and asked to complete the anonymous

questionnaire during the contact session voluntarily.

A short verbal introduction was given about the study, and the students were asked to

reflect on the learning experiences they had in the Pathology clinic during the year of 2016.

The pilot study was scheduled to coincide with the last scheduled Pathology clinic and a

week after the assessments had been completed in this specific clinic. Participants were

asked to sign the consent form before completing the questionnaire. The researcher was

available for the duration of the pilot study for enquiries.

The time needed to complete the questionnaires, as well as any confusing questions or

misunderstandings were noted. The students completed the questionnaire within 20–30

minutes, and no problems were raised during the completion time. Questionnaires were

coded, but the data from these questionnaires (used for the pilot study) were not included

for analysis. Thereafter, only editing changes were made to the questionnaire.

3.4.1.4 Data collection

The data were gathered after a specific teaching-learning method was applied. This was at

different times for each academic year group according to their timetable. The

undergraduate optometry students could complete the questionnaire either on the

73

Bloemfontein campus of the UFS or at the optometry clinic at the National District Hospital,

where they received clinical skills training.

The study was briefly introduced to the students by the researcher who explained the

research process, reflective cycle and questionnaire to each year group before the first

teaching-learning method was applied. Consent for participation was also obtained during

this contact session. Before the application of the teaching-learning method to create a

learning experience, the rationale and outcomes were explained to the students. The

questionnaire was handed out to the students only once they had completed a teaching-

learning method in one of the modules concerned. The clinical module involved was the

Clinical Optometry module (COPT 4800) with a focus on the Pathology clinic sub-module,

as well as case presentation. The theoretical modules included the General Pathology

module (GENA 2612) in the second-year of study and the Ocular Pathology module (PATH

4802) in their fourth-year. The practical module involves the demonstration and practise of

the diagnostic procedures dealt with in the Diagnostic skills (DGNS 3702) module. Table

3.2 indicates which modules the respective teaching-learning strategies discussed in

Chapter two (cf. 2.3.3.2) were applied.

TABLE 3.2: UNDERGRADUATE MODULES IN WHICH THE DIFFERENT TEACHING-

LEARNING METHODS WERE APPLIED [Compiled by the researcher, Kempen 2017]

Teaching-learning method:

GENA 2612

DGNS 3702

PATH 4802

COPT 4800

Traditional lectures

Flip the classroom

Small group work learning

Simulation

Interprofessional Education

Case presentation

Peer assessment

Bedside teaching

Clinical skills training

The researcher was involved in all the mentioned pathology modules; therefore, no

permission was needed from other optometry lecturers to distribute the questionnaire after

academic contact sessions. The questionnaires were completed anonymously, and no

74

personal information was required of the participants. On completion of the questionnaires,

the participants placed the questionnaires in a box to ensure anonymity and confidentiality.

3.4.2 Focus group interviews

Focus group interviews are meaningful when the researcher wants to explore thoughts and

feelings and not merely behaviour. The aim of the focus group interviews was to contribute

to the interpretation and confirmation of the data obtained from the questionnaire surveys

(cf. Johnson & Christensen 2008:210; Bernard & Ryan 2010:41). Therefore, significant

results from the questionnaires were used to formulate the topics for discussion during the

focus group interviews. The agenda for the focus group interview (Appendix B-1) was

formulated only after the completion of the data collection of the questionnaire survey data.

Additional ethical approval was obtained for this part of the data collection (added as an

addendum) (Appendix B-2).

The target and survey population, as well as the description of the sample and sample size

for the focus group interviews will now be explained, as well as the data collection and the

procedures for pilot testing.

3.4.2.1 Target population

The target population for the focus group interviews was the 2017 fourth-year

undergraduate students in the Department of Optometry at the UFS who had completed

the concrete experience of the cycle of experiential learning at the Pathology clinic.

3.4.2.2 Description of sample and sample size

The sampling process for selecting an appropriate and a representative number of elements

from the population (Johnson & Christensen 2008:223) for the focus group interviews

entailed a purposeful, non-probability sampling technique, as the participants shared a

specific trait, namely being fourth-year undergraduate optometry students at the UFS.

Coyne (1997:624) explains that a sampling method must ensure that the sample selection

will be in accordance with the aim of the research. Patton (2002:230) confirms Coyne’s

opinion in stating that:

75

The logic and power of purposeful sampling lies in selecting information-

rich cases for in-depth study. Information-rich cases are those from which

one can learn a great deal about issues of central importance to the

purpose of the inquiry, thus the term purposeful sampling.

The sampling method supported the aim of the study, as all the fourth-year undergraduate

students in the target population were selected. As illustrated in Table 3.1, the fourth-year,

undergraduate optometry class of 2017 consisted of only 17 students. The sample

population consisted of the fourth-year, undergraduate students in the Department of

Optometry, UFS who had been registered during the year 2017, and who consented to

participate in the focus group interviews.

With such a small number of students, it was possible to have two focus group interviews

that included the total number in the target population, as Tong, Sainsbury and Craig

(2007:351) contend that an ideal focus group should consist of four to twelve members.

The sample included males and females of all ethnic groups and ages.

3.4.2.3 Pilot testing

The agenda and question for the focus groups were discussed with the promotors of the

study, as well as the interview facilitator, a member of the FoHS with experience in Health

Sciences Education research and the focus group interviewing method. The question was

evaluated in terms of clarity and usefulness and refined to meet the purposes of the focus

group interviews.

3.4.2.4 Data collection

Two focus group interviews were conducted. Masadeh (2012:66) advises that the interview

facilitator (also called the moderator/interviewer) should be someone other than the

researcher to avoid prejudice. Prince and Davies (2001:208) comment on the selection

criteria for the facilitator by saying that:

… moderators who display an intrinsic interest with the research topic, overt

friendliness, a sense of humour, an insatiable interest in people, a curiosity

and openness to new insights, and a willingness to listen are more likely to

encourage participants to share their experiences’

76

The focus group interviews were facilitated by an expert in the field of focus group

interviews. The focus group interviews took place on 31 July and 7 August 2017. The focus

group interviews were planned according to the participants’ schedules and were conducted

at the Clinical Simulation and Skills Unit in the School of Biomedical Sciences at the FoHS,

UFS. The environment was comfortable, convenient and inviting to promote a productive

atmosphere that encourages conversation and trust (cf. Greeff 2005:309; Skinner

2007:320-321).

The researcher was an observer during the focus group interviews, but was not visible to

the participants as the venue at the clinical simulation unit is equipped with a one-way

mirror. The interviews were recorded with a tape recorder (with their consent). This ensured

that the participants’ views were reflected accurately (cf. Tong et al. 2007:356). The

researcher (as an observer) made detailed notes and handled the logistics of the interview

(cf. Greeff 2005:306-307).

3.5 DATA ANALYSIS

In this study content analysis was used with the purpose to provide knowledge, new insights

and a representation of facts in order to attain a full and condensed description of the

experiences of students and optometrists in the pathology modules in the optometry

curriculum (Elo & Kyngäs 2007:108). Content analysis was suited for this case study as

Patton (2002:453) mentions that case studies are suitable for content analysis. An inductive

approach was followed as the categories identified through content analysis were used to

develop recommendations for the implementation of experiential learning in the optometry

programme at the UFS (cf. Elo & Kyngäs 2007:109). This was done through the researcher’s

interaction with the data while discovering patterns, themes and categories (cf. Patton

2002:453).

Hsieh and Shannon (2005:1278) defined content analysis as a research method for the

subjective interpretation of the content of text data through the systematic classification

process of coding and identifying themes or patterns. This is elucidated by Patton’s opinion

(2002:453) of content analysis as an analysing method aimed at searching through the data

for recurring words and themes. According to Graneheim and Lundman (2004:105), content

analysis is a popular qualitative approach used in educational research and has been applied

to diverse data and to numerous depths of interpretation.

77

As content analysis is used to make replicable and valid inferences by interpreting and

coding textual material and systematically evaluating texts of qualitative data, the content

analysis process was used to analyse the questionnaires. The researcher described what

the respondents actually said, stayed close to the text by using the original wording and

described the visible and obvious (cf. Graneheim & Lundman 2004:105; Bengtsson 2016:8).

Latent content analysis was used for the focus group interviews to include silences, sighs,

laughter and posture (cf. Elo & Kyngäs 2007:108). This has been described by Graneheim

and Lundman (2004:105) as the underlying meaning of the text.

Even though content analysis has fewer rules to follow as it is not linked to any specific

science (Bengtsson 2016:8), Merriam (2002:171) mentioned that data analysis in qualitative

research is the only aspect that should be done in a preferred way. Patton (2002:433)

mentions that no formula exists to transform data into findings. The researcher was guided

by three phases, namely description, analysis and interpretation, as described by Burns and

Grove (2005:95). This corresponds with the four stages described by Bengtsson (2016:11)

and the inductive approach described by Elo and Kyngäs (2007:110), as illustrated in Figure

3.2. As all qualitative research deals with some interpretation (Patton 2002:446), these

steps were taken to ensure that a high degree of quality was maintained throughout the

process.

78

FIGURE 3.2: A DIAGRAMMATIC OVERVIEW OF THE CONTENT DATA ANALYSIS

GUIDELINES USED FOR THIS STUDY [Compiled by the researcher, Kempen 2017]

Organise

Preparation

Report

Manifest content analysis Latent content analysis

Inductive Approach

Qualitative content analysis

Questionnaires Transcribe

Recommendations on experiential learning in the expanded scope of the

undergraduate Optometry programme at the UFS

Description / Decontextualisation

Analysis / Categorisation

Interpretation / Compilation

Identify categories

Abstraction

Attach meaning and significance to categories

Include supporting quotations

Type data (memoing)

Read and re-read data

Review aim and purpose

Identify unit of analysis

Identify unit of meaning

Identify corresponding

concepts

Create initial code list

Recontextualisation

79

3.5.1 Description phase

The description phase is also known as the preparation phase of the data analysis. In this

phase, the biographical data collected by means of the questionnaire survey and focus

group interviews were analysed by means of descriptive statistics. This was done in order

to describe the sample and participants in the study. Data regarding the number of

participants, their age, gender and academic year were included.

For each teaching-learning method, an in-depth discussion was included in the context in

which the questionnaire was completed. This, according to Nieuwenhuis (2007:103), is

essential as analysed themes and patterns will help in the understanding of the perceptions

and constructed reality of the participants as they relate to a specific teaching-learning

method. Due to the involvement of the researcher in the modules in which the teaching-

learning methods were used, the researcher understood the context of the data as well as

the circumstances under which the data were collected; therefore she was able to detect

and take into account misrepresentations that might have appeared in the data (cf.

Bengtsson 2016:8).

During the descriptive phase or decontextualisation stage, the researcher achieved an

intimate knowledge of the data and obtained a sense of the whole by typing the

questionnaires and the focus group transcriptions verbatim (cf. Niewenhuis 2007:104).

Memoing, as described by Nieuwenhuis (2007:105), was also done by writing comments

and impressions throughout the typing process. Patton (2002:463) mentions that this is the

first step to organise the data in themes. The questionnaires that were answered in

Afrikaans also were translated into English by the researcher, and a language practitioner

(Appendix C) translated the focus group transcriptions. Thereafter the documents were

read and re-read (cf. Elo & Kyngäs 2007:109; Patton 2002:440; Petty et al. 2012:381). To

identify significant data, as Patton (2002:463) recommends, the researcher then focused

the analysis by reviewing the aim of the questionnaire survey and the focus group interviews

(Taylor-Powell & Renner 2003:2). Guided by the aim, the researcher identified the unit of

analysis. Elo and Kyngäs (2007:109) emphasise the importance of deciding precisely what

to analyse and in how much detail. Bengtsson (2016:10) defines the unit of analysis as a

sample and explain that the researcher has to decide if the data will be analysed as a whole

or divided into smaller units. Consequently, the data from each question in the

questionnaire for each teaching-learning method were put together and the analysis was

80

focused on how the group responded to each question, while the transcripts from the focus

groups were treated in its entirety as suggested by Graneheim and Lundman (2004:106).

Equally important is the detail of the analysis. A meaning/content/coding unit refers to a

compilation of words or statements that relate to each other through their content and

context (Graneheim & Lundman 2004:106). Elo and Kyngäs (2007:109) mention that a unit

of meaning can contain a paragraph, one sentence or it can consist of one word. The basic

unit of meaning decided on was a stimulus word or theme word (cf. Filies et al. 2016:230).

The data then were examined repeatedly to identify concepts that corresponded with the

research questions and objectives (cf. Merriam 2002:176; Meyer et al. 2016:62), and to

identify meaning units that contained information that brought insight which the researcher

needed (cf. Bengtsson 2016:11). Thereafter, the meaning units were condensed to create

an initial code list, which acted as labels for the important meaning units (cf. Graneheim

and Lundman 2004:107; Hanson et al. 2011:379).

3.5.2 Re-contextualisation phase

As the success of content analysis depends significantly on the coding process (Hsieh &

Shannon 2005:1285), Bengtsson (2016:12) describes the re-contextualisation stage during

which the researcher has to ensure that all aspects of the data have been covered in relation

to the aim. During this stage, the researcher re-read the original text together with the

code list to confirm that the information corresponds with the aim. To prevent the

researcher from becoming overwhelmed by the volume of data, the data for each

questionnaire and focus group interview were organised and saved in separate folders, and

each step of analysis was saved in these different folders to facilitate easy retrieval and to

go back to examine the broader context in order for the data to be re-contextualised.

Furthermore, a number for identification was allocated to each respondent and the data

were marked and typed accordingly (cf. Niewenhuis 2007:104).

3.5.3 Analysis phase

The next stage involved the analysis or categorisation and abstraction. This stage is seen

as the core feature of qualitative content analysis as it answers the question ‘what?’

(Graneheim and Lundman 2004:107). Categories were identified and refined with the use

of response codes (Castro, Kellison, Boyd and Kopak 2010:348-354). Hsieh and Shannon

81

(2005:1285) describe categories as patterns in or themes of content that share a

commonality and are directly expressed in the data or are a result of the analysis. During

this stage, data were classified as belonging to a particular group (Elo & Kyngäs 2007:111).

Through this generation of categories, a general description of the research topic was

formulated (cf. Elo and Kyngäs 2007:111). The number of categories were reduced by

creating a table with initial themes and patterns, and connections within and between

themes were made to create primary and sub-themes (cf. Taylor-Powell & Renner 2003:5).

An independent co-worker checked the groupings and categories to ensure authenticity.

The co-worker also ensured that the meanings stayed the same when the data of the

questionnaires as well as the focus group interview transcriptions were translated.

3.5.4 Interpretation phase

In the final stage, interpretation or compilation, the themes and connections were used to

explain the findings and to attach meaning and significance to the analysis (cf. Taylor-

Powell & Renner 2003:5). Thematic categories were further refined to include supporting

quotations as made by the participants. This ensured that the researcher stayed close to

the original meaning and context of the data (Bengtsson 2016:12). Group interaction, as

well as the individual contributions, was taken into consideration with the analysis of the

data collected from the focus group (Greef 2005:311). For content analysis to reveal

developing trends and patterns, both verbal and observational data were included in a

complete record of the discussion (cf. Stewart, Shamdasani & Rook 2007:15).

The researcher then derived meaning from the data by making disciplined interpretations

of the themes and integrating the data obtained by means of the two data collection

methods to develop recommendations for the implementation of experiential learning in the

expanded scope of the optometry programme at the UFS.

3.6 ENSURING THE QUALITY OF THIS STUDY

The four criteria for the evaluation of the quality of qualitative research are credibility,

transferability, dependability and confirmability (Schurink, Fouché, & De Vos 2011:419;

Shenton 2004:63). These terms also are applicable (synonymous criteria) to ensure the

rigour of the study in the constructivist paradigm (Denzin & Lincoln 2000:21) and will be

discussed in the following subsections.

82

3.6.1 Credibility

Credibility refers to the quantitative researcher’s equivalent concept of validity and is seen

as the essential factor in establishing trustworthiness (Shenton 2004:64). Tavakol and

Saunders (2014:844) state that a study is credible if the data and the interpretations are

valued as truthful. In addition, Graneheim and Lundman (2004:109) mention that credibility

refers to how well the data collection and analysis address the intended aim of the study.

To increase the credibility of the study, well-established research methods were used in the

qualitative research approach to ensure that the aim of the study was addressed. The data

collection and analysis were iterative (cf. Merriam 2002:170). Furthermore, a variety of data

were collected from different perspectives to ensure triangulation and enough detailed data

to create an extensive understanding of the topic of the study (cf. Hanson et al. 2011:280).

With the use of triangulation, the data were confirmed and ensured to be complete (cf.

Houghton, Casey, Shaw & Murphy 2013:13).

The analysed and interpreted data from the focus group interviews also were verified with

the study participants to ensure that the findings were a true reflection of their perceptions,

experiences and views (cf. Petty et al. 2012:383). Lastly, the researcher was familiar with

the case study environment (cf. Houghton et al. 2013:13) and a relationship of trust had

been established between her and the participants (cf. Shenton 2004:65).

3.6.2 Transferability

Transferability refers to the extent to which findings can be transferred to other settings

and the probability that the study findings will add meaning to these settings (Polit & Beck

2006:511; Speziale & Carpenter 2007:49). Graneheim and Lundman (2004:110) point out

that the researcher can only make suggestions regarding the transferability of the research

findings. The transferability of this study was addressed by presenting the findings in a way

that allows other researchers to decide if the findings are transferable or not.

3.6.3 Dependability

Clissett (2008:104) cautions that dependability is challenging to achieve in qualitative

research. This has been confirmed by Petty et al. (2012:383) who explain that a qualitative

83

study cannot be replicated due to differences among people and contexts, as well as the

passing of time. Dependability, according to Schurink et al. (2011:420), indicates whether

the research process is coherent, well documented and audited. This was achieved with the

researcher keeping an audit trail of procedures and processes during the research process.

3.6.4 Confirmability

Confirmability refers to the objectivity or neutrality of the data or the analysis and

interpretation of the data (Polit & Beck 2006:497). The outcome of the data should be

grounded in the participants’ voice rather than the researcher’s motivation, interests or

views (Tavakol & Sandars 2014:844). This was achieved by clarifying the links between the

results and the data collected (cf. Clissett 2008:104). Shenton (2004:72) explains that steps

must be taken to guarantee that the findings are the result of the experience and ideas of

the participants and do not take after the characteristics and preferences of the researcher.

The use of triangulation of the data as well as the paper trail of procedures, data analysis

and interpretations enhanced the confirmability of this research.

3.7 ETHICAL CONSIDERATIONS

Approval for the study was sought from the bodies concerned and the respondents, and

the participants’ right to privacy and confidentiality was assured.

3.7.1 Approval

Approval for the research project was obtained from the Health Sciences Research Ethics

Committee (HSREC) of the UFS, as well as the Vice-Rector, Research; the Dean of the FoHS,

the Head of the School for Allied Health Professions, and the Head of the Department of

Optometry at the UFS. The HSREC number is 128/2016 (Appendix D).

The study in no way limited, affected or imposed on any human rights. No discrimination

towards participants for any reason was condoned.

3.7.2 Informed consent

Informed consent was provided by the participants to complete the questionnaires as well

as for participation in the focus group interviews. These are discussed below.

84

3.7.2.1 Questionnaire survey

All members of the target population received information about the study in either

Afrikaans or English, according to their preference, and the questionnaires were available

in both Afrikaans and English. The informed consent letter was based on the guidelines for

informed consent as prescribed by the General Guidelines of the HSREC (Appendix E).

By giving consent, they voluntarily agreed to participate in the research, and they were

allowed to withdraw from the study an any given moment during the completion of the

questionnaire. There was no form of compensation for participation in the study. The

questionnaires were anonymous and participants were assured that all information would

remain confidential.

The name and contact details of the researcher, as well as of the Secretariat of the HSREC

of the FoHS were made available to the participants on the information letter.

3.7.2.2 Focus group interviews

The request for participation was sent out via email to the target population (Appendix F).

Written informed consent was obtained from the participants prior to the focus group

interviews (Appendix G). Information and consent forms regarding the focus group

interview were available in Afrikaans and English, according to the language policy of the

UFS in 2017.

Participants were informed that participation in the focus group was voluntary, and they

were assured that they could withdraw from the study at any time during the focus group

interviews.

3.8 RIGHT TO PRIVACY AND CONFIDENTIALITY

The information gathered during the questionnaire survey was given anonymously and in

no way names or personal information could be linked to the information provided. The

researcher’s name and contact details were available to all participants at all times and

participants will have access to the published results of the study.

85

Participants in the focus group interviews were guaranteed that all information would

remain confidential. No respondent’s name appeared on any documents. The privacy of the

participants was protected at all times during the focus group interviews, for example, they

were requested not to make use of their own or peers’ names when responding and

participating during the interview.

3.9 CONCLUSION

In Chapter 3, an overview was provided of the research design and methodology employed

in the study, as well as the procedures that were followed.

The choice of design and methodology was proven to have been successful, as the

researcher succeeded in collecting the required information, and thorough analysis of the

data could attain the aim and objectives of the study. Adequate planning of the research

process was evident as the study was completed without a hitch or major problems. In the

next chapter, Chapter 4, entitled Results of the questionnaire survey: analysis and

discussion, the results of the questionnaire survey and the findings of the data that were

collected and analysed during the study will be reported and discussed.

CHAPTER 4

RESULTS OF THE QUESTIONNAIRE SURVEY: ANALYSIS AND DISCUSSION

4.1 INTRODUCTION

The purpose of this chapter is to present the results of the questionnaire survey that was

completed for this study. The questionnaire was designed to determine the experiences

and perceptions of the optometry students registered at the UFS at the time of the study,

regarding the different teaching-learning methods used in the pathology modules. These

teaching-learning methods were based on experiential learning. The questionnaire design

was based on Gibbs’ reflective cycle, as described in Chapter 3 (cf. 3.2.2), in order for the

student to reflect on the experience evoked by the teaching-learning method that was used.

The questionnaires were completed after a specific teaching-learning method was applied.

As was pointed out in Chapter 3 (cf. 3.4.1.1), 68 registered undergraduate optometry

students were involved in completing the questionnaires at different times for each

academic year group according to their timetables.

A pilot study (trial run) was conducted to pre-test the measuring instrument, that is, the

questionnaire. For the purpose of the pilot study, fourteen questionnaires were completed

by seven English-speaking and seven Afrikaans-speaking fourth-year undergraduate

students that were registered in the Department of Optometry, UFS in 2016. On completion

of this trial run, only minor amendments were made to clarify items in the questionnaire

where appropriate. The data thus collected was not used during the analysis.

The demographic information collected from the sample will be presented first. The

quantitative results reflecting demographic information of the students participating in the

questionnaire survey include a description of the student population and their distribution

in the Department of Optometry. Data regarding age, gender and academic year are

included. Thereafter the results of the part of the survey dealing with each teaching-learning

method will be presented and discussed separately. A description of how each teaching-

learning method was used will be provided, followed by the results and discussion. Each

teaching-learning method will conclude with a summative discussion of the data.

87

Appendix H contains tables with the main categories as well as the sub-categories of the

results having a bearing on each specific teaching-learning method. The chapter will come

to a conclusion with some final remarks.

4.2 DEMOGRAPHY OF THE SAMPLE

The target population included the second- to fourth-year undergraduate students

registered in the Department of Optometry at the UFS during the year 2017 (cf. 3.4.1.1).

As mentioned in Chapter 3 and illustrated in Table 3.1 (cf. 3.4.1.1), the total number of

second-years were 20, while 31 third-year students formed part of the target population.

The fourth-(final) year undergraduate class included 17 students.

The questionnaires were administered during different academic contact sessions for which,

according to the rules of the FoHS, students have to achieve an attendance rate of 80%.

After each teaching-learning method (mentioned in Chapter 3) had been employed in that

contact session, the students that were present completed the questionnaire. Most of the

contact sessions were with fourth-years only, unless otherwise mentioned. Table 4.1

represents the response rate for each of the nine teaching-learning methods used.

TABLE 4.1: RESONSE RATE OF SECOND- TO FOURTH-YEAR UNDERGRADUATE OPTOMETRY STUDENTS THAT COMPLETED THE QUESTIONNAIRE SURVEY

Teaching-learning method Number of participants (n) Response rate (%)

Traditional lectures

Second-years 20 100

Fourth-years 17 100

Flip the classroom

Second-years 20 100

Third-years 31 100

Fourth-years 16 94,11

Small-group work learning 20 100

Simulation 17 100

Interprofessional Education 17 100

Case presentation

Presenters 17 100

Audience 67 98,52

Peer assessment 17 100

Bedside teaching 17 100

Clinical skills training 31 100

Total number of completions 307 99,43

88

The results are representative of the sample population, as an overall response rate of

99.43% was achieved. The questionnaire was completed on separate occasions by the

specific year group that had been exposed to the specific teaching-learning method. On

completion of the period during which the nine teaching-learning methods (Table 4.1) had

been used during contact sessions, a total of 307 questionnaires had been completed.

In the first part of the questionnaire participants were asked to provide information as to

their gender, age, and current academic/study year. The results of these demographical

data are summarised in Table 4.2.

TABLE 4.2: DEMOGRAPHICAL DATA OF THE SAMPLE (n=68)

Academic (study) year % of the sample Gender

Male Female

Second (n=20) 29.41% 35.00% 65.00%

Third (n=31) 45.59% 29.03% 70.97%

Fourth (n=17) 25.00% 23.53% 76.47%

Total (n=68) 29.41% 70.59%

The third-year class represented the biggest percentage of the sample population, namely

45,59%. The sample population was dominated by females and only 29.41% was male.

The median age of the students was 21.0 years with a minimum age of 19 and maximum

age of 33. According to the data, the majority of participants (60.29%) fall in the 21-22

years age group. The second-largest group, 33.82% of participants were between 19-20

years old. The remaining 5.89% of participants were in the 23–33-year old age group.

In the following section, the analysis of the data collected by means of the questionnaire

survey will be reported and discussed.

4.3 DATA ANALYSIS OF THE QUESTIONNAIRE SURVEY

The process of data collection and data analysis is described in Chapter 3 (cf. 3.4.1.4) and

can be summarised as follows:

The participants were introduced to the specific, teaching-learning method and the

learning experience was applied with the use of the teaching-learning method.

89

After the completion of the experience, the participants were asked to complete

the questionnaire.

The qualitative data were analysed by the researcher, as described in Chapter 3

(cf. 3.5). The researcher prepared the data by typing and translating the responses

collected by means of the questionnaires. By typing and translating the responses

herself, the researcher ensured that she became familiar with the data.

At this point, the researcher revisited the aim of the study to ensure that the

information gained corresponded with the aim of the study.

The responses then were organised by the researcher into themes with categories

and sub-categories by using codes that emerged from the responses. For each of

the teaching-learning methods, a table was created with categories and sub-

categories.

The data analysis then was verified by an independent researcher. It was ensured

that the independent researcher was familiar with qualitative data analysis. This

independent researcher has ample experience, not only in qualitative data analysis

but also in postgraduate studies in Health Professions Education and is the retired

head of the HPE Department at the UFS. This process contributed to the

trustworthiness of the research.

4.4 REPORTING THE RESULTS, DATA ANALYSIS, DESCRIPTION AND

DISCUSSION OF FINDINGS OF THE QUESTIONNAIRE SURVEY

In order to simplify the analysis process, each question of the questionnaire was analysed

and discussed separately. From the questions, the themes were derived. The themes that

emerged from the questionnaire were:

Theme 1: Objectives

Theme 2: Objectives successfully achieved

Theme 3: Feelings before, during and after the experience

Theme 4: Strengths

Theme 5: Weaknesses

Theme 6: Factors that enhanced learning and understanding

Theme 7: Personal changes

Theme 8: Feelings about assessment used

Theme 9: Recommendations

90

These themes applied to each of the teaching-learning methods used for the purpose of

the study (cf. 3.4.1.4), except in some cases where no assessment was done. Each theme

with its categories was summarised in table form (Appendix H) and is discussed in this

report. Direct quotes from the participants’ answers are given in text to enhance the

trustworthiness of the study.

The first teaching-learning method addressed in the questionnaire responses was traditional

lectures, which will be reported and discussed first.

91

4.4.1 Results of the questionnaire survey on traditional lectures

______________________________________________________________

In the following section, the application of lecturing as a teaching-learning method will be

discussed, followed by the results and a discussion of the questionnaires that were

completed after this specific method was applied.

4.4.1.1 Lectures for the purpose of this study

Due to the fact that there is no set of standards for what constitutes a lecture, it is essential

to describe the characteristics of a lecture (Penson 2012:73). For the purpose of this study,

one lecture out of a series of lectures was chosen in the PATH 4802 (fourth-year) and GENA

2612 (second-year) modules, respectively. The characteristics of these lectures are

described in the following paragraphs.

In PATH 4802, the lecture sessions were designed to draw together different elements of

the course, helping students to organise and make sense of their clinical learning

experiences and to reflect on their learning needs (cf. Penson 2012:75). To actively involve

students in the theory lecture, case-based clinical examples were incorporated and a

discussion related to the case was facilitated during the session (cf. Wolff et al. 2015:89).

During the GENA 2612 lecture, a concept map was drawn to link to previous knowledge

and visually represent knowledge organisation (cf. Wolff et al. 2015:89). The lecture session

was designed to provide the general pathology principles of healing and repair. For both of

these lectures in the PATH 4802 and GENA 2612 modules, the lecturer made use of a

presentation with Prezi. The session facilitation is illustrated in Appendix I.

A total number of 20 second-year students and 17 fourth-year students completed the

questionnaire, which constituted a 100% response rate.

4.4.1.2 Analysis and description of the experiences and perceptions of

undergraduate optometry students on lectures

Each theme, with its categories and subcategories was summarised in a table (Appendix H-

1). The categories and the subcategories that emerged from the second- (referred to as

P2) and fourth-year students’ (referred to as P4) responses were combined in the data

92

analysis. To indicate each theme, they are numbered, bold and underlined while the

categories are only underlined. The complete data analysis and description, with direct

quotes from the participants on the analysis, are to follow.

Theme 1: Objective

The participants were asked to identify the objectives of the specific teaching-learning

method (lecturing). The categories that emerged under this theme were: Purpose of a

lecture, creation of better understanding, provision of an opportunity to ask questions, and

testing knowledge.

Purpose of a lecture

Participants elaborated on the purpose of a lecture as an objective in this study. They stated

that the purpose of a lecture is to introduce the material to students by

presenting/delivering the subject, to explain the content, to provide information, to teach

and inform. Also, a lecture enables the students to learn and to study better, to know and

remember, and to build knowledge.

To learn more about macular disorders and explain to us what we are going

to see on the various disorders and how to identify them. [P4_4]

To convey the necessary information to the students and discuss the work

thoroughly and answers questions. [P2_12]

Creation of better understanding

Some participants (mostly in the second-year) contended that the objective of a lecture is

to create a better understanding of the work.

To assist students with a better understanding of the work by means of

pictures and a slide show… [P2_6]

Provision of an opportunity to ask questions

A number of fourth-years felt that the objective of a lecture is to provide an opportunity to

ask questions about the work discussed. Due to this, they felt that there is an open channel

of communication with the lecturer.

93

... To allow us to have the opportunity of asking questions after the lecture.

This provides an open channel of direct communication with our lecturer

[P4_3]

Testing knowledge

The session included a class test to follow the week after on the work had been discussed.

Some participants noted this as an objective of the teaching-learning method.

To explain the work and to be tested on it … [P4_10]

To give a good presentation in class and being tested on it. [P2_7]


All the fourth-years and most of the second-years agreed that the objectives of this

teaching-learning method had been achieved successfully. On completion of the experience,

the students mentioned that they had a knowledge base and an understanding of the work.

They felt that this was achieved by the work having been presented well and with clear

explanations. In addition, they stated that the presence of the lecturer to answer questions

also contributed to the success of the experience. Some of the second-years felt that the

objectives only had been achieved moderately and indicated that the objectives had been

achieved due to them being compelled to study for the test.

Yes, the work was clearly explained. The lecturer was present in the class so

we could ask questions when we struggled. [P4_10]

Indeed. The students have been given the opportunity to get a better

understanding of the content of the work by asking questions when they

were uncertain. [P2_12]

It helped to hear the information, but I really understood it when I started

learning it myself. [P2_13]

94


The second question of the questionnaire asked the participants to reflect on their feelings

before, during and after the experience. In this theme, feelings, the analysis was according

to the sub-themes; before, during and after. Three categories were identified, namely

positive, neutral and negative, as analysed and discussed below.

i. Feelings before

Mostly positive feelings were reported before the participants started with the learning

experience. The participants stated that they were calm, comfortable and at ease or did not

have any specific feelings at the start of the experience. This could be ascribed to the

students being familiar with the teaching-learning method. The participants also reported

excitement and that they were intrigued by the work that would be discussed. As with the

positive feelings, they mentioned that they did not feel anything in particular, due to it being

a ‘normal’ lecture.

I felt at ease, as this method of teaching is used for most of our lectures.

[P2_3]

Comfortable – the same feeling like any other lecture. [P4_2]

No specific emotion was felt, just ordinary lecture, so there was no

uncertainty. [P4_7]

The second-years also reported negative feelings before the experience. Feelings of being

anxious, unprepared, unsure and sceptical were noted. There were participants that also

noted that they were not in the mood for the lecture.

Like before any class, not in the mood for it. [P2_1]

ii. Feelings during

Both year groups mentioned positive feelings. The second-years mainly felt attentive while

the fourth-years felt interested during the experience. The second-years’ feelings (attentive,

engaged, involved and motivated) were motivated by the prospect of a test. Both groups

95

felt comfortable and informed during the lecture. Some of the fourth-year participants also

noted that they felt enlightened, intrigued and satisfied. Neutral feelings were noted.

Motivated to pay attention after being told that we will be tested. [P2_7]

I felt like this teaching method is how all my classes are, so I was

comfortable. [P2_18]

Negative feelings also were mentioned. Some participants felt bored, tired and lost interest,

while others felt lost and found it challenging to pay attention to the lecture.

Tired, lecture was tiring and had difficulties in staying attentive. [P2_2]

iii. Feelings after

The overall feeling after the experience (after the lecture as well as the class test) was

positive and the participants felt informed and that the experience created an understanding

of the work, cleared up uncertainties and that they had more knowledge. Some participants

felt only informed after going through the work at home on their own and not directly after

the lecture. Other feelings mentioned were curiosity, motivated, relieved, at ease, confident

and satisfied.

Only after active learning for the test did I remember the information, not

after the lecture [P2_8].

I understand the work and feel better prepared for the semester test [P4_9].

There were a couple of participants that also had neutral feelings after the experience,

while a fourth-year participant felt negative and that the experience was not informative.

This specific participant [P4_13] had neutral feelings before and reported being bored

during the experience as well.

Theme 4: Strengths

The participants identified eight strengths of this teaching-learning method. The list of the

strengths is provided in Table 4.3 on the next page with direct quotes from the participants.

96

TABLE 4.3: STRENGTHS OF LECTURE AS IDENTIFIED BY UNDERGRADUATE OPTOMETRY STUDENTS, UFS

STRENGTH DIRECT QUOTE FROM PARTICIPANTS

1. The assessment forces you to go and

study on your own

It forces students to make contact with the work

early and memorise it before the big test. [P2_9]

2. Work is (personally) explained

Difficult concepts were explained, and lecturer made

sure that each student was on board and

understood. [P2_17]

3. Able to make notes during the lecture You were able to make notes throughout the lecture

to understand it better when you study. [P2_19]

4. Uncertainties are cleared up during the

lecture

Any uncertainties were cleared up with the lecturer’s

presentation of the work [P2_20]

5. Additional information is provided Additional notes were discussed on certain conditions

supplementing the class slides. [P4_7]

6. Provides an opportunity to ask questions

and receive answers

If I had a question about something, I could

immediately get answers while talking about the

specific section I had a question about. [P4_4]

7. Provides basic knowledge /

8. Provides a good foundation

… I already have a foundation for my own learning

[P2_13]

9. Provides a channel of communication to

the lecturer

The open channel of communication between

lecturers and students is possible [P4_3]

Theme 5: Weaknesses

Three categories emerged from the responses to the question about the weaknesses of this

teaching-learning method. These are analysed and described below.

Loss of attention and concentration

The participants mentioned that during the lecture, they lost attention and concentration.

They elaborated that this was mainly due to the lecture not being interactive, interesting or

exciting. They also felt that it was too long and that they just read from the slides. Some

second-year participants stated that it was boring. The familiarity of the teaching-learning

method also caused them not to pay attention.

It can feel very familiar quickly. You get used to lectures, which can lead to

boredom and less attention to the work. [P4_1]

97

It is not always so interesting in the lecture; interest is easily lost. [P2_7]

This method is not interesting enough to improve student interest in topics.

[P4_16]

Information overload

A fourth-year participant felt that the lecture provided too much information at once.

Not a real-life example

The fact that the lecture was an explanation of theory only was noted as a weakness by

participants.

It's very theoretical and one does not see the condition of a living patient,

just on the screen or photos, does not learn in a natural setting. [P4_2]


The participants were asked how they thought the teaching-learning method enhanced

their learning and understanding. According to the participants, the assessment provided

an opportunity to go through work and thus be confronted with the work more than once.

The participants also noted that the assessment created an awareness of the knowledge

they had on the subject. One participant mentioned that it places the responsibility on me

and that is good [P2_7].

Being familiar with a lecture as a teaching-learning method was noted again and the

participants mentioned that it enhanced their learning. Other factors identified were that

during the lecture, the participants were introduced to the work and the lecturer provided

good explanations of the work through examples, illustrations and videos. This created a

knowledge base for them. They also mentioned that the layout of the information was

simple, comprehensive, and the information was presented in an orderly matter, practical,

interesting and visual. The fourth-year group indicated that their learning was enhanced

because the work was discussed over a period and they had an opportunity to ask

questions. The second-year group pointed out that paying attention during the lecture

enhanced their learning.

98

The lecturer explained the work comprehensively with appropriate examples

and pictures. I had a good base when I went to study. [P2_6]

When I studied on my own, I could use the explained information that I

received in class to understand certain concepts better. [P2_13]


Within this theme, the data analysed indicated that the participants mainly felt that no

personal changes that they could have implemented would have enhanced their learning

experience. A few of the participants mentioned that they could have paid more attention,

ask or think of more questions or prepared better.

To make more notes and to pay attention. To sit with my workbook next to

me and follow the work with the presentation. [P2_1]

Theme 8: Feelings about the assessment used

Four sub-themes on the assessment were identified through the analysis. They are overall

feelings, fairness, memorandum used for the assessment, and feedback. A report and

discussion on these sub-themes follow below.

i. Overall feelings

Positive, neutral and negative feelings were noted in the data. The overall feelings

experienced by the second- and fourth-year groups were positivity and that the assessment

was well planned and presented. Participants felt that the assessment was good and

necessary as it smoothed away uncertainty. They also found it helpful and it motivated

them to keep up to date and challenged them to do better. They also mentioned that it

prepared them for future assessments.

Felt it was necessary to get to know the work, it forces you. [P2_9]

Neutral feelings also were expressed as the participants felt they were used to this type of

assessment, but for the same reason, a fourth-year participant was negative about the

99

assessment. Other negative feelings were due to the type of questions and a second-year

was disappointed with the final result.

The class test, not looking forward to a class test, and the motivation is not

always there to study because we are writing so much (class tests) [P4_5].

ii. Fairness

All the fourth-years and most of the second-years felt that the assessment was fair. The

fourth-years mentioned that the questions were on standard to test knowledge. A variety

of work was assessed and it was based on the work discussed. Two second-years felt that

it was not fair as it did not address the outcomes specified in their workbook.

Very fair. A variety of the work was asked that tested knowledge over a

broad spectrum [P4_1].

iii. Memorandum used for the assessment

The overwhelming feeling about the memorandum used for the assessment was positive.

The fourth-year group all felt that it was fair, complete, comprehensive and understandable.

The second-years also felt that it was fair, to the point and sufficient, but some also

mentioned negative feelings about the memorandum as it was also mentioned that it was

not complete and, while it was found to be a positive factor that peers marked the test,

some found it slightly odd.

The memo used was to the point and easy to understand. [P2_18]

iv. Feedback

The participants found the feedback positive and mentioned that it was good, sufficient,

comprehensive and helpful to ensure a better understanding and highlighted areas which

they should work on. Some of the participants, however, expressed the opinion that minimal

to no feedback was provided.

Could clearly see what I / student still don’t know and have to work on.

[P2_12]

100


The recommendations that were mentioned to improve the experience are divided into

three categories, namely recommendations for the lecturer, recommendations regarding

the lecture presentation, and recommendations with a bearing on the assessment itself.

Recommendations for the lecturer:

The lecturer should:

Provide explanations of specific terms

Provide examples

Ask questions during the lecture

Involve the students by asking questions, etc. [P2_10]

Provide regular breaks:

More regular breaks during the lecture, because you can only

concentrate for so long. [P4_17]

Encourage students to prepare for class.

Students should prepare to maximise the learning from this method. [P2_17]

Make the slides available before the class.

Recommendations for the lecture presentation:

The lecture should be:

Interactive / include an activity.

To maybe incorporate a game. [P2_13]

Lively.

Visual.

More pictures can help you to understand better exactly what each

condition looks like and what to look for. [P4_6]

Practical.

Have a summary at the end.

Recommendations for the assessment:

Students should be informed about the assessment.

Outcomes of the assessment should be specified.

Specify the learning outcomes or if everything must be studied. [P2_6]

If pictures are used during an assessment, it should be enlarged.

101

4.4.1.3 Summary and discussion of the experiences and perceptions of

undergraduate optometry students on lectures

A summary of the analysed data regarding the experiences and perceptions of

undergraduate optometry students about the lecture as a teaching-learning method is

presented in Figure 4.1 and discussed below.

FIGURE 4.1: SUMMARY OF THE EXPERIENCES AND PERCEPTIONS OF

UNDERGRADUATE OPTOMETRY STUDENTS ON LECTURES [Compiled by the researcher, Kempen 2018]

The familiarity with this teaching-learning method is highlighted throughout the data and

was mentioned in almost every theme. The participants mentioned in response to the first

question regarding the objectives of the teaching-learning method that it was an ordinary

or a normal’ lecture. Correspondingly, most of the feelings the students experienced before

the lecture was due to them being accustomed to this teaching-learning method. The

Lecture LECTURE

Familiar method

Calm

At ease

Not in

the

mood

LECTURE

Provides basic

knowledge

Should be grounded

Presentation Visual

Well-structured

To the point

Lecturer

Knowledgeable

Create interest

Explain well

102

familiarity made them feel positive (calm, comfortable and at ease), neutral (normal) and

negative (not in the mood). It is interesting to see that some participants listed the

familiarity as a weakness of this teaching-learning method, while others recognised it as a

factor that contributed to the enhancement of their learning. In agreement with the

literature (Charlton 2006:1263), some participants preferred the traditional, classical lecture

as a teaching-learning method. A fourth-year (P4_3) stated, I prefer sitting in a traditional

setting as I feel I get more knowledge and understanding of the topic. Based on the data

collected in this study, students might have felt this positive because they valued the time

that a lecture provides for them to interact with the lecturer and that it opens up a channel

of communication. They respect the knowledge of the lecturer and appreciate the comfort

of being free to ask questions when unsure. Another factor identified in this study of

millennial students, apart from the contact they want with lecturers, is that it seems that

students of this generation do not want to figure out something for themselves and, as

Schmidt et al. (2015:13) explain, a lecture provides a space where a superior explains

difficult concepts.

Lectures are criticised as students become disengaged during the learning process offered

by lecturing (cf. 2.3.3.2.1). This was confirmed in this study and students noted it as a

weakness. Although most participants responded that they were attentive and interested

during the lecture, a few mentioned they had become bored and lost interest. Factors

contributing to this was that lectures were not always interactive or practical. As much as

it is the responsibility of the lecturer to involve the students to make the lecture more

interactive, it also is the responsibility of the students to ask questions during the lecture.

This will ensure that deep learning takes place. The researcher found the fourth-year class

more engaged than the second-year class. This may be due to them being more senior

and, therefore, more comfortable with the lecturer, realise the importance of understanding

the work, or because the work that was discussed focused on ocular pathology and not

general pathology like in the second-year lecture. What became evident from the study is

that to ensure students are engaged in the teaching-learning process during the lecture,

they should come to a lecture prepared. The researcher found that asking the students to

prepare is not sufficient. A recommendation based on the findings is to have an online test

or an activity that the students have to complete beforehand to encourage them to prepare

before the lecture.

In accordance with literature, as discussed in Chapter 2 (cf. 2.3.3.2.1), the participants in

this study also indicated that in order to improve and make a lecture more effective it should

103

be supported with more visual aids such as clear slides (Van der Merwe et al. 2014:13) and

must be well-structured. Furthermore, the presentation should take place in an orderly

manner and be to the point. Participants in the study pointed out that a simple, practical,

comprehensive presentation and notes enhanced their learning. The lecturer, therefore,

must create an interest in the topic and should further elaborate on the topic by providing

appropriate and well-explained examples. Prezi is a lively presentation tool and rendered

listening to the lecture more pleasant and kept students’ attention fixed. Although Penson

(2012:73) mentioned the suitability of lectures to provide vast amounts of information, the

extent of the information that was discussed during the lectures relevant to this study seems

to have been overwhelming and participants in this study indicated this as a weakness.

These findings suggest that ideally, specific topics should be discussed over a more

extended period of time.

According to Ruhi’s experiential learning framework (2016:205), a lecture mainly provides

an opportunity for abstract conceptualisation and, secondly, the students are able to

observe reflectively. Of importance is that the main aim of a lecture should not only be for

the student to be able to recall all the work discussed immediately, but a lecture should

provide clarifications on concepts and ensure that students have the necessary knowledge

to analyse and think about by themselves. More so, students should be motivated during a

lecture to work through the study material by themselves in order to reflect on what was

discussed. An assessment later will compel students to study the material again. With the

use of an assessment, the responsibility is shifted to the students and in the study, they

indicated that it suited them. The assessment further provides an opportunity for them to

clear up any uncertainties. The analysis of the data further indicated that some participants

could only recall knowledge after they had had the chance to work through the content by

themselves, but the lecture experience made it easier for them to study the content later

on their own, and the objective to create an understanding of the work was achieved.

This result of the study confirms that lectures are effective in the transformation of

information. Yes, some students will be bored and not pay attention, but more important is

the time set aside for them to have contact with someone that has expert knowledge about

a specific topic and that they can get instant clarification should there be any uncertainties.

Key factors that played a role in the creation of the optimal learning environment for a

lecture in this study were found to be the familiarity of the teaching-learning method, the

clear explanations from the lecturer and the comprehensiveness and to-the-point design of

104

the slide presentation. Lastly, the assessment grounded the knowledge base obtained from

the lecture.

The next teaching-learning method that will be reported on is flip the classroom.

105

4.4.2 Results of the questionnaire survey on flip the classroom

______________________________________________________________

In the following section, the application of the teaching-learning method, flip the classroom,

will be discussed, followed by the results and discussion of the questionnaire responses

received after this specific teaching-learning method had been applied.

4.4.2.1 Flip the classroom for the purpose of this study

Sharma et al. (2015:328) advise that smaller innovation steps are much easier to implement

with any teaching-learning method. For this reason, the flip the classroom approach was

applied during three contact sessions in three pathology modules, one for each year group

but not to a whole semester module. The modules involved were General Pathology (GENA

2612), Diagnostic skills (DGNS 3702) and Ocular Pathology (PATH 4802).

The following steps were followed with the implementation of the flip the classroom

approach:

The rationale behind flip the classroom, as well as the process, was explained to

the students to get them on board and to alleviate the possibility of negative

feelings such as uncertainty and that this would be an unnecessary addition to

their workload (Talbert 2015:17; O’Flaherty & Phillips 2015:89). In addition, the

potential benefits of flip the classroom were explained to students to ensure the

success of the approach (Gilboy et al. 2015:112; Hanson 2016:83). This was done

with the use of an infographic template (Appendix J).

A flip the classroom planning template (Appendix K) was used in all three modules

to help organise the components of a flip the classroom (Gilboy et al. 2015:111).

The video clips were kept simple to avoid information overload. The content and

the delivery were organised to support the student in mastering content knowledge

and to prepare for the application of that content in the class (Gilboy et al.

2015:11).

It was ensured that all registered undergraduate students had access to the

internet and to Blackboard® – the online learning management system (LMS) used

at the UFS.

Students were expected to come to class prepared; therefore, before entering the

class, the students had to complete an online quiz on the content that was

106

discussed in the video clips. The marks counted towards their continuous

assessment mark for their predicate.

Active learning activities, with the topic objectives in mind, were used to create a

variety for students.

The assessments were appropriately designed to engage students more deeply

with the content.

General Pathology - GENA 2612

The topic of the flip the classroom lecture the process of the human body’s reaction to and

adaptation after cellular injury. The flip the classroom planning template (Appendix K-1)

was designed in preparation for the approach used in this module and specifically this

lecture.

Short You-Tube video clips relevant to the topic of interest were uploaded to Blackboard®

for the students to have access to the videos. The students were encouraged to make notes

while watching these videos and also to read through the relevant chapter in their study

guide. The students had to complete an online quiz which was seen as their admission to

enter class. The marks for the quiz counted towards their continuous assessment mark for

their predicate.

On arrival at the class session, the lecturer started the session by asking if there were any

questions. This provided the students with the opportunity to ask questions if there was

anything that was unclear or if they required additional information. If no questions were

asked, the lecturer assumed that the students clearly understood the assigned material.

Subsequently, the students were divided into six groups and instructed to create a concept

map together in order to review the process discussed. Roehl et al. (2013:45) list conceptual

mapping as one of the activities that can be used during a teaching-learning method to

promote deep learning. Poster paper and markers were supplied to each group as well as

the rubric according to which the concept map would be marked. Peer-assisted learning or

peer-to-peer collaboration, as used during this activity, fosters the active learning process

when knowledge and skills are acquired through helping and supporting among status

equals (Bishop & Verleger 2013:7). The lecturer observed the process and was available

throughout the session to guide the students’ thinking, as well as to clarify misconceptions

or incorrect information.

107

The groups then presented their concept maps to the class. The marks allocated for the

concept maps also contributed to their continuous assessments and concept maps were

handed in and marked according to a rubric that was available beforehand to the students.

The students were informed that the work also would be assessed during formative and

summative assessments.

Twenty (20) second-year students, accounting to a 100% response rate, completed the

questionnaire.

Diagnostic skills - DGNS 3702

The flip the classroom approach was utilised for teaching the slit lamp procedures in this

practical module. The students had been briefly introduced to the slit lamp in their second

academic year. With this approach, the clinic was used as the classroom environment where

activities were completed (cf. Bristol 2014:45). The flip the classroom planning template

(Appendix K-2) was followed in this module and specifically this theme.

A short video clip that explains the procedures that need to be followed during a slit lamp

evaluation was uploaded onto Blackboard®. The students were encouraged to make notes

while watching the videos and also to read through the relevant notes that had been

provided. Similar to the GENA 2612 module, the students had to complete an online quiz,

which was seen as their admission to enter the practical. The marks for the quiz counted

towards their pre-practical assessment for their predicate.

On arrival to the practical session, the lecturer started by asking if there were any questions.

Feedback on the online test was given to provide additional information and to ensure that

everything was clear. The students then paired up and practised the slit lamp procedures

on each other. The facilitators were available throughout the practical time to guide the

students’ thinking as well as clarify misconceptions or incorrect information.

After one week, a peer assessment was done with the rubric provided.

A 100% response rate was achieved with 31 third-year students completing the

questionnaire.

108

Ocular Pathology - PATH 4802

In the fourth-year Ocular Pathology module, the flip the classroom session was developed

for the diabetic retinopathy theme. A flip the classroom planning template (Appendix K-3)

was designed in preparation for the approach used in this module and specifically for this

theme.

Short video clips relevant to the topic of interest were recorded by the researcher, who also

is the module leader and lecturer for this module. The video clips were uploaded to

Blackboard® for the students to have access to the videos. Additional to the videos, the

students were provided with articles and notes to read through before class. Similar to the

other modules where the flip the classroom approach was used, the students had to

complete an online quiz which was seen as their admission to enter class. The marks for

the quiz counted towards their continuous mark for their predicate.

The format of the class was similar to the one used in General Pathology (GENA 2612). The

session started with time for questions and answers, followed by the students being divided

into groups. The groups were each provided with a posterior fundus photograph and had

to analyse the stage of diabetic retinopathy. The groups were instructed to compile a case

according to the fundus photograph they received. A week before the activity, the students

were asked to bring laptops to the class to design the case study. While they compiled the

cases, the lecturer observed the process and was available to guide the students’ thinking

and to clarify misconceptions or incorrect information.

Eventually, each case study was presented to the class and formed part of the students’

continuous assessment. Of note is that the students had been informed that the specific

content also would be assessed during formative and summative assessments.

A response rate of 94.11% was achieved with 16 out of the 17 fourth-year registered

students completing the questionnaire.

109


undergraduate optometry students on flip the classroom

Each theme, with its categories and subcategories were summarised in a table (Appendix

H-2). The categories (underlined) and the subcategories that emerged from the responses

of the second- (referred to as P2_), third- (referred to as P3_) and fourth-years’

questionnaires (referred to as P4_) were combined in the data analysis. The data analysis

and description, with direct quotes from the participants’ responses, will now be discussed.

Theme 1: Objective

Almost all the participants confirmed that the objective of the teaching-learning method

was to flip the classroom. Another category that emerged from the responses of the fourth-

year group was that the objective of this teaching-learning method was to create an

understanding of the topic.

Flip the classroom

Participants identified the following three activities of what flip the classroom entails:

i. Prepare (independently) before class/practical or go through the material at home.

ii. Apply the knowledge through a class activity. (Working with others to create a

mind-map or a case presentation or practise the technique)

iii. Present the class activity and having it peer-assessed.

Self-study at home, lecturer highlights important information and addresses

any confusion. Group work and presentation in class. [P2_12]

To learn the procedures of slit lamp examination by self-study at home and

a practical, non-threatening peer examination under the supervision of

lectures. [P3_16]

Online videos were used to lecture at home and doing a case presentation

during class time and presenting them to colleagues. [P4_7]

Creating a better understanding

Some participants (mostly in fourth-year) mentioned that the objective of this teaching-

learning method was to create a better understanding of the work.

110

To assist students with a better understanding of the work by means of

pictures and a slide show… [P2_6]


Most of the participants were of the opinion that the objectives had been achieved

successfully. The second- and third-year group ascribed it to the fact that they were

compelled to attend the session / practical prepared, which they felt made them responsible

for their own learning. Also contributing to the success in this regard were the clear

explanations on the videos and the online test. Second-year participants also mentioned

that the presentation they had to do was visual and every group had a different approach.

Yes. It made me take the time and go through the work. [P2_9]

Yes, the articles and videos explained the work well … [P3_5

The fourth-year participants responded that the teaching-learning method was challenging,

effective, enjoyable and interactive and the objectives were achieved because the

construction of a case created discussions and they had to do research. They also

contended that they could ask questions in a safe learning environment and worked through

the content more than once.

Yes, the teaching style caused learners to discuss the topic among

themselves and do research. [P4_8]

Some of the students responded that the objectives were achieved only moderately as they

still needed clarity from the lecturer on certain aspects.

It was successful to send me more prepared for the class, but I could not

understand certain topics sufficiently on my own. [P2_3]

Other students proclaimed that the teaching-learning method did not achieve the objective

as they struggled to remember the online lectures.

111



before, during and after the experience. In the sub-themes, three categories were

identified. These categories were positive, mixed and negative, and are analysed and

discussed below.

i. Feelings before

The participants reported that they had mostly negative feelings before they started with

the learning experience. They responded that they felt nervous, stressed, tense and unsure,

due to not knowing what to expect. The second-year participants also reported nervousness

and they were not eager to work with others in a group. The aspect of public speaking also

made them unenthusiastic, anxious and scared. Fourth-year participants were sceptical and

suspicious about the benefit of this teaching-learning method as well as the explanations

provided by the online lectures. The negative and mixed feelings reported from the third-

years were mainly due to the peer assessment.

I was nervous and stressed because I did not know what to expect. [P2_7]

I was afraid that I would not understand the work and I thought that the

lecture would be self-study. [P4_1]

Some participants reported positive feelings and felt confident, ready and prepared. Others

were pleased and excited to work with fellow students in a group and stated that they were

interested in this new experience and looked forward to studying on their own time.

Was pleased to work in a group. [P2_13]

Excited, it is the first time that the class is not only presented and you have

to go and study afterwards, but you are actively involved the whole time.

[P3_19]

ii. Feelings during

The mutual positive feelings experienced by the second- and fourth-years were enjoyment,

excitement and interest. These feelings were due to the teaching-learning method being

112

interactive and creative. The fourth-years also noted that they were at ease to work with

others and that it was convenient to learn in their own time. The feelings from the third-

years were mainly about the peer assessment and will be discussed in section 4.4.7.

When I saw what we need to do, I was excited because it is a creative way

to learn the work. [P2_17]

I felt at ease, as working in a group helps you to fill the gaps in your own

knowledge, by giving you a new perspective on the subject. [P_2]

Some participants felt negative and reported that they felt anxious, nervous and scared due

to the presentation and public speaking. Some were frustrated with the online videos when

they had trouble viewing it at home. They also mentioned that they still felt confused, lost

and uncertain about certain aspects and the expectation of the activity. Frustration also

was noted amongst the participants in the second-year group, due to working with others.

Nervous, I stumbled over my words and could not give all my knowledge.

[P2_16]

I was frustrated at times, like when the online lecture battled to load…

[P4_14]

iii. Feelings after

Most of the participants felt positive after the experience. They felt informed, more at ease,

calm, appreciative and satisfied with the learning experience. Other factors that contributed

to the positive feelings were the group work, the presentations of peers and the online

videos that provided a good explanation.

Impressed and it was not a boring lecture where you sit for 2 hours and

listen and half the time are daydreaming. [P2_11]

Negative feelings also were expressed. Some second-years participants felt that the

presentations were boring because the same topic was given to all groups. Some fourth-

years did not like that the activity included public speaking, with one of them mentioning

that he/she preferred a class lecture more than an online lecture. [P4_5]

113

Theme 4: Strengths

The participants identified eight strengths of this teaching-learning method. The list of the

strengths is given in Table 4.4, with direct quotes from the participants.

TABLE 4.4: STRENGTHS OF FLIP THE CLASSROOM AS IDENTIFIED BY UNDERGRADUATE OPTOMETRY STUDENTS, UFS


1. It forces you to go through the work by

yourself

… forces students to prepare for class and think

for themselves beforehand, not only listening in

class [P3_5]

2. Working with others

Builds confidence, encourages team spirit,

dependence on one another, building

relationships [P2_1]

3. There is a task to be completed By doing a task, it forced me to make the

knowledge my own and to understand [P2_16]

4. Lecturer available … lecturers are there to correct and encourage

you [P3_13]

5. Having a peer assessment

You learn from other’s mistakes through peer

assessments as well as the way on how the

student approach [P4_3]

6. Done over a period of time / repetition of

work / Adequate time

We went through the work several times

[P2_20]

7. Active learning experience You don’t even realise that you are busy to

learn, it is very spontaneous [P3_19]

8. Fun, creative and practical way of learning It is a creative way of learning and helps to set it

out practically [P2_17]

Theme 5: Weaknesses

The weaknesses identified by the participants are listed on the next page in Table 4.5, with

direct quotes from the participants.

114

TABLE 4.5: WEAKNESSES OF FLIP THE CLASSROOM AS IDENTIFIED BY UNDERGRADUATE OPTOMETRY STUDENTS, UFS

WEAKNESSES DIRECT QUOTE FROM PARTICIPANTS

1. Not a personal lecture from the lecturer I would’ve learned more from a class lecture

than an online lecture [P4_5]

2. Working together with others Some people could just depend on others and

learn nothing out of it [P2_11]

3. Requires self-discipline from the student to

prepare

It takes a lot of self-discipline to do the work by

yourself at home [P4_12]

4. It is a very time-consuming experience Time – it takes a lot to prepare and prepare

diligently [P3_28]

5. The experience made use of internet and

technology which is not always reliable

The electronic nature of this method allows for

more electronic difficulty [P4_2]

6. The activity involved public speaking

Everybody is not equally comfortable speaking

in front of groups - this can lessen enjoyment

and effectivity of the learning method [P4_15]

7. Having a peer assessment

Because you are so comfortable with your peers

you get too relaxed and do not practise

optimally [P3_19]


During the analysis, factors were identified that the participants had reported as enhancing

learning and understanding. Most of these factors corresponded with the strengths

mentioned in Table 4.4 in Theme 4 of this discussion. Only those that differ will be reported

and discussed below.

Students had to take responsibility for learning

The participants posited that they felt responsible for their own learning and that enhanced

their learning.

I had to make sense of the work for myself to explain the work to my peers

in order for them to understand [P2_16]

The environment was comfortable and informal

The participants mentioned a few times that the environment was safe and they were

comfortable to ask questions.

115

Different teaching-learning method

The teaching-learning method was different from what students were used to.

This method is different from how I study for tests. So, it enhanced my

understanding by forcing me to do different study methods. [P2_5]


Participants noted that they could prepare better and spend more time on the module. They

also mentioned that to improve their understanding of the work, they could have asked

more questions, paid more attention and could have taken notes. The third-years felt that

they could have asked the lecturer to observe the technique that they were practising. In

addition, they felt that if they had controlled their emotions better during the peer

assessment, they would have fared better. The fourth-year participants mentioned that

they could have found time to work together on the case presentation.

I could ask more questions and explanations to understand the unfamiliar

concepts [P2_3]

To focus less on tension, seeing that it makes you forget and take away your

focus from the assessment [P3_26]

Come together as a group to put the case together so that the information

would fit together better [P4_17]

Theme 8: Feelings about the use of assessment used

Peer assessment was used to assess the activity in this teaching-learning method. For the

purpose of this study, the results of the analysis of the assessment were discussed in section

4.4.7. under the teaching-learning method, Peer Assessments.


The recommendations from the students for the preparation at home included that the

learning material (online lectures) should not be placed on Blackboard®, but physically

handed to the students, in order for them not to have to use their own internet connections.

116

If it was placed on Blackboard®, it should be ensured that it would work. They also

recommended that online videos should be made by the lecturers and should be more

specific and concise. Some recommended that more videos should be used; others

recommended that fewer videos should be used.

Our lecturers can make their own video tutorials on techniques that they

put online beforehand [P3_14]

Provide video material via memory stick [P2_2]

The main recommendation to enhance the class experience was that the lecturer should

provide a class lecture and an opportunity to ask questions. The third-year group

recommended that the lecturers should demonstrate the technique and should have one-

on-one sessions with the students.

Also, do a class lecture just to fill in gaps where students might have missed

or not have listened for some reason in the lectures online [P4_5]

Also, there must be a supervisor all the time to see if that what you are doing

is correct [P3_21]

The participants also made the following general recommendations on the activity itself:

More time to complete the activity

Remove peer assessment

The activity should not be done in groups

Provide a different topic for each group

Provide the information beforehand in written format.

Finally, some participants recommended that flip the classroom should be applied more,

while others mentioned that it should not be the primary teaching-learning method.

117


undergraduate optometry students on flip the classroom

A summary of the analysed data on the experiences and perceptions of undergraduate

optometry students on flip the classroom is presented in Figure 4.2. The discussion follows

the figure.


UNDERGRADUATE OPTOMETRY STUDENTS ON FLIP THE CLASSROOM [Compiled by the researcher, Kempen 2018]

The results of the experiences and perceptions of optometry students on flip the classroom

are in accordance with recent research on the topic, as discussed in Chapter 2 (cf.

2.3.3.2.2). It would appear through the analysis of the data that flip the classroom does

promote deep learning, as mentioned by Bristol (2014:43), and participants in this study

expressed the opinion that they first had to gain a clear understanding of the work before

they could explain it to their peers. This method further increased student engagement by

Student

Preparation at home

Resp

onsib

le fo

r learn

ing

118

being an interactive and creative teaching-learning method. This, however, seems not

always to be a personal preference of the students.

In contrast to what was the case with traditional lectures, the students’ feelings at the

beginning of this experience were mainly negative. It may be due to the experience being

new, which caused uncertainty. Additionally, the feelings of anxiousness probably might be

attributed to the unfamiliarity with the flip the classroom approach, yet it has been

mentioned as a factor that eventually enhanced their learning. For this reason, it appears

that this generation of students prefers to be challenged by a learning experience that is

different from the usual, for example, a traditional lecture, and confirms that they enjoy a

variety and change (Roehl et al. 2013:45). These negative feelings reported by the

participants also confirmed the importance of explaining the rationale for flip the classroom

to the students, as stated by Talbert (2015:17) and O’Flaherty and Phillips (2015:89).

Important to note is that the feelings on completion of the experience were mainly positive,

but it is still not clear whether students would prefer this as a regular learning experience,

as also has been mentioned in the studies done by Bishop and Verleger (2013:1), as well

as Gilboy et al. (2015:110).

The data analysis of the questionnaires identified the three areas of flip the classroom: (a)

Preparation at home, (b) Activity in class, and (c) Assessment of activity. Within these three

areas, the roles of the student, the lecturer and the environment in the learning experience

also were highlighted. It also became evident from the data that flip the classroom

stimulated all four learning modes of Kolb’s experiential learning model. It appeared that

the online lectures and the preparation at home stimulated the abstract conceptualisation

mode in Kolb’s learning cycle, similar to what O’Flaherty and Phillips (2015:86) pointed out.

Through the activity, the design of the presentation by the second- and fourth-year groups,

as well as the time provided to the third-years to practise the skills demonstrated, the

students were able to engage with active experimentation and as mentioned in Dale’s cone

of experience (cf. 2.3.3.1), by this they will remember 90% of what they did. In addition,

in this study, the activity included a presentation and a peer assessment that activated the

concrete experience and reflective observation, which might not be true for other flip the

classroom activities. The experience of presenting the activity as well as being peer

assessed caused some of the participants to experience unease, but they still reported it as

valuable in the learning experience. Lastly, the peer assessment provided an opportunity

for the students to observe their peers’ work and reflect on their own understanding.

119

The opinions regarding the online videos were conflicting; some of the participants

responded that more videos should be used, while others would prefer fewer. In agreement

with O’Flaherty and Phillips (2015:85), the participants of this study also reported that they

enjoyed the convenience of watching the online videos at their own time and pace and in

an environment where they were comfortable. Others responded that as the lecturer was

not available in person when they watched the videos, it created uncertainty.

Even though they were positive about taking responsibility for their own learning and

mentioned a few times that the preparation at home had helped them, participants disliked

that they had to prepare, as it required self-discipline and private time. For this reason,

some of these participants recommended that the lecturer should still provide a brief

introduction with explanations of concepts. Also, as mentioned in the steps of the

implementation of this method, time was provided before the activity for the students to

ask questions and clear up any uncertainties. No questions were asked in either of the year-

group sessions and the researcher, therefore, assumed that the students understood all the

assigned material. Still, the main recommendation was a lecture with time to answer

questions. However, such a presentation will defeat the purpose of the approach and it no

longer will be student-centred but teacher-centred, causing the objective of flip the

classroom not to be attained successfully, and the implementation of this method will be

more time-consuming. This recommendation also might have been due to students being

uncertain about their own ability to create an understanding, or to their dislike of being

actively involved in the learning process, and preferring passive instructional learning, as

mentioned by authors such as Berrett (2015:2), Talbert (2015:16) and Hanson (2016:83).

This can be linked to the analysed data of the lecture experience (cf. 4.4.1) and confirms

that students prefer a personal explanation by the lecturer of concepts and immediate

clarifications of uncertainties, instead of having to figure matters out for themselves.

Another recommendation students offered is more feasible, namely to have customised

videos made by their own lecturers and not use generic videos. It is also evident from the

data that the participants did not like to read articles; they found it unnecessary and

preferred specific and concise information in the form of notes.

An interesting finding was that the participants also identified the use of technology and

the internet as a weakness of this teaching-learning method. They mentioned that it was

unreliable and found it frustrating. These feelings may also be because some had to use

their own data to connect to the internet, therefore extra costs, something that seems to

create a lot of negativity.

120

The participants mentioned that with the use of the class activity, they could express their

knowledge in a logical and practical way. This contributes to deep learning. The class

activities were designed to be completed in groups to meet the characteristics of the

millennial students of being team orientated. However, this was perceived by different

students as a weakness and as a strength. While some participants enjoyed working with

others, others maintained that not everyone contributed to the same extent of the activity.

Nonetheless, it was still identified as a key factor that contributed to the enhancement of

the learning experience. Worth mentioning is that it seems that the fourth-years were more

eager to work with their peers than the second-years. This may be due to them being more

mature and comfortable with each other, as they had known each other longer. Working in

teams creates discussions and the students have the opportunity to hear how their peers

understand and approach the work. In the same way, the class activity and time provided

an opportunity for the students to interact with the lecturer. Something that the participants

valued highly.

An important element of this teaching-learning experience was the peer assessments that

were done to assess the different activities. Participants indicated that the assessment

environment should be safe and comfortable and should be orientated towards student

learning. The assessment should also provide an opportunity for reflection, something that

also contributed to the success of this teaching-learning method.

For the second- and fourth-year groups, the assessment consisted of a presentation.

Participants were positive about the presentation since they were offered visually, but at

the same students experienced negativity because it entailed public speaking. Even though

public speaking is something that students should be able to do, care should be taken when

designing an assessment with public speaking because the anxiety created may overshadow

the opportunity for the student to learn. The irony is that there was clear evidence that

they disliked presenting, but the students found the presentations of other students

valuable.

In conclusion, the analysed data from this study confirmed that flip the classroom was

experienced as a student-centred learning approach that encouraged students to adopt a

deep approach to learning. The repetition of the work through the three different stages of

flip the classroom and the engagement of students in the activity, as well as the assessment,

contributed to the success of this teaching-learning method. There are, however, no clear

indication that students prefer this method to a traditional lecture, and it seems that this is

121

in accordance with Roach’s (2014:75) recommendation to use flip the classroom only as a

complementary method to traditional lectures. The results emphasised that students during

this experience should take responsibility for their own learning, something they are

hesitant to do. It further points out that students want personal contact, interaction and

explanations from the lecturer, but also enjoyed the online videos. Lastly, the results

indicate that a learning environment should be comfortable and safe, allowing students to

ask questions and providing them with the opportunity to explore.

Small-group learning is the next teaching-learning method that will be discussed.

122

4.4.3 Results of the questionnaire survey on small-group learning

______________________________________________________________

In the following section, the application of the teaching-learning method small group

learning will be discussed, followed by the results and discussion of the questionnaires that

were completed after this specific teaching-learning method was applied.

4.4.3.1 Small-group learning design for the purpose of this study

Group learning may take numerous forms and each type of group produces different kinds

of learning experiences and knowledge generation (Crosby 1996:192; Jackson et al.

2014:119). The small-group learning activities for the purpose of this study were based on

experiential learning. Two different methods were used in two different pathology modules.

These methods were developed to facilitate collaboration and encourage students to work

together and engage in exchanging ideas (Jackson et al. 2014:120). Peer assessment was

used to assess the group work.

First, as discussed in the flip the classroom experience (cf. 4.4.2.1), the activity in the GENA

2612 and PATH 4802 modules made use of a tutorial small-group method. The task that

was given to the students was to critically analyse, clarify and expand on the subject matter

covered during the online lectures to design and present a mind map (GENA 2612) and a

case study (PATH 4802) of the study material. The results of this experience were discussed

in the previous section (cf. 4.4.2.3).

Secondly, a seminar approach was used in the module GENA 2612. Students were assigned

the task to research a topic and present the results in the form of a poster. Clear instructions

for completing the task were given to the students. The task was given at the beginning of

the module, which gave them ample time to conduct the research and prepare the poster

(cf. Crosby 1996:193). To ensure that each student contributed to the project and learnt

new skills, each member of a group had to present the poster to fellow students (cf. Crosby

1996:193; Ashraf 2003:213).

A total number of 20 second-year students completed the questionnaire, which indicates a

100% response rate.

123


undergraduate optometry students on small-group learning

Each theme, with its categories and subcategories, was summarised in a table (Appendix

H-3). The data analysis and description, with direct quotes of participants, are related

below.

Theme 1: Objective

The first question of the questionnaire was: What were the objectives of the session in

which the teaching-learning method was used? One category emerged from this theme:

To work in a group on an assignment.

The participants mentioned that they had to work together doing research in order to create

a poster. The poster was individually presented and peer-assessed.

To create interaction between students and ensure that every student had

to present, thus had to know what was going on. [P4]


Almost all the participants reported that the objectives were achieved successfully. The

teaching-learning method created an opportunity for the students to work together and

also to present the work in an interesting and understandable way.

Yes, each member of the group contributed equally, and it was an efficient

way to minimize the workload of a large project. [P3]

One participant, however, was of the opinion that due to work being divided amongst the

group members, the objective of this teaching-learning method was not achieved.

Not really, we as a group gave each group member a section to research,

and I did not understand the information that the rest of the group members

got. [P1]

124


The second question of the questionnaire asked the participants to reflect on the feelings

they had before, during and after the experience. The categories that were identified within

the sub-themes are analysed and discussed below.

i. Feelings before

The participants mostly reported that they had negative feelings before they started with

the learning experience. They were not enthusiastic about working in a group and some

reported having felt sceptical, discouraged and nervous to work in a group. Positive feelings

(mainly optimistic) towards group work also were analysed. The other positive (excitement)

and negative (nervousness) feelings were towards the presentation which formed part of

the learning experience.

Optimistic due to the fact that I would be working with people I had never

worked with before. [P19]

I was a bit sceptical as group work can be ‘messy’ if the whole group doesn’t

participate. [P15]

Nervous, because it is always hard for me to stand up and present in front

of people. [P6]

ii. Feelings during

The participants experienced positive, neutral and negative feelings during the small-group

teaching-learning method. While some participants experienced the group work as without

complications and they contended they had fun and enjoyed working together; others

experienced negative feelings because of the unequal division of work. Again, some feelings

mentioned were due to the presentation that formed part of the experience. Some

participants felt positive, prepared and relaxed during the presentation, while others felt

nervous and under pressure. Participants also became confused and frustrated about the

information they researched.

I enjoyed working together and seeing others’ work methods. [P15]

125

Tasks may not have been divided equally amongst group members and not

all gave the same amount of effort. [P18]

Nervous, because I didn’t feel like I was prepared enough for the

presentation. [P14]

iii. Feelings after

Only positive feelings were experienced after the teaching-learning method. Most of the

participants felt relieved and happy. Others were satisfied and successful as they regarded

it as a creative way to learn and because of the multiple efforts that contributed to the

assignment. Participants also mentioned feeling good and well informed.

Generally satisfied with the outcome, the project was time-effective and

easier to complete with multiple people’s efforts. [P3]

Glad that I’ve accomplished a lot because of the creative way we had to do

the project. A good way to learn. [P7]

Satisfied; we as a group reached all our goals regarding the assignment. [P8]

Theme 4: Strengths

The participants identified six strengths in this teaching-learning method (small-group

learning).

Group work

One of the major strengths identified was working together on the assignment. They

mentioned that group work decreases the workload, was time-effective and encouraged

teamwork, as one learns how to work together. They further mentioned that the group

work was interactive and provided opportunities to get to know fellow students (peers).

Another strength of group work mentioned was that the participants could gather different

viewpoints on the work.

Everyone gets to put in effort in order for the whole group to achieve the

desired goal. Encourages teamwork. [P6]

126

Get to know your fellow students better, i.e., who will work, who is a bit lazy,

etc. [P18]

Presentations

The second most identified strength was the presentation and listening to and observing

the presentations. Participants stated that the presentations were given under relaxed

conditions, and having to do individual presentations and inform others about their group

assignment made the work more understandable. The presentation also prepared them for

public speaking and developed their communication skills.

The fact that we had to give a presentation and listened to other groups

helped a lot. [P2]

You learn better, you don’t get easily bored. You learn even more by teaching

others . P7]

Research

Some participants mentioned the aspect of doing research as a strength in this teaching-

learning method.

That a lot of research had to be done to understand the concepts. [P13]

Interesting topics

The assignment topics were interesting and the participants contended that it maintained

their interest. The participants also related that focusing on one disease had been a

strength.

Good topics were chosen and I stayed interested. [P2]

Available lecturer

Another strength reported was that the lecturer was available throughout the process to

attend to students queries during the time the students were working on the assignment.

Sufficient time

The participants experienced the time to complete the assignment as sufficient and

mentioned it as a strength.

127

Theme 5: Weaknesses

A few participants mentioned that they could not identify any weaknesses in this teaching-

learning method. The remainder identified two main weaknesses that had emerged.

Group work

The opinion was expressed that not everyone in the group had pulled their weight and that

poor communication among group members had hampered them.

If you have a group member that isn’t working or have a member that is too

fussy, it can be unpleasant. [P15]

Presentations

The following weaknesses in the students’ presentations were identified:

Participants reported that the presentations were too long and contained too much

information to take in.

The groups did not have an organised structure and not everyone paid attention to

or were interested in the presentations.

The lecturer interrupted during the presentations, which affected the presenter.

If the presenter was uncomfortable with public speaking, the group’s mark was

affected negatively.

The group’s marks can be less, due to not everyone in the group dealing well

with oral presentations. [P13]

Some people talked too long and let me lose focus sometimes. [P2]



their learning and understanding. The participants stated that it was a creative teaching-

learning method that helped them to become familiar with the work by the elaboration of

the content. The main factor which enhanced their learning was performing the actual

research for the assignment. Even though the factor of working together in a group was

mentioned, the participants mentioned that because they had to individually present the

poster caused them to be more involved in designing the poster. The participants benefitted

128

by evaluating the presentations, which provided an overview of other diseases. Finally, the

assignment groups and the presenting groups were small enough for the participants to

feel safe to ask questions when they were unsure.

Just the fact that everybody had to do research and everyone had to present

the information forced us to study the information. [P8]


The participants were asked whether they could recommend any personal changes that

should be implemented to enhance their learning experience. Most of the participants

responded that they had no recommendations for changes and that they had a positive

experience. One participant was of the opinion that he/she should have prepared better

and paid more attention during the presentations.

To be more prepared when you present and to pay more attention when the

others present. [P10]


The assessment used in this teaching-learning method was peer assessment. For the

purpose of this study, peer assessments are discussed as a teaching-learning experience

on its own; therefore, the feelings students expressed will be discussed in section 4.4.7.


The final theme from the data collected by means of the questionnaires was the

recommendations from the participants to enhance the learning experience with the use of

small-group learning. A high number of participants remarked that they had no

recommendations to make. The analysed categories that emerged will be described below.

One participant recommended that the expectation of the assignment should be clear and

that they should be able to choose their group members themselves. Another

recommendation was that before the individual poster presentations, a discussion by the

lecturer should be done on the diseases.

129

Have a supervisor with the appropriate knowledge on the content go through

the work before the presentation takes place to ensure accurate info used.

[P12]

The participants recommended that the experience should not involve a presentation, as

not everyone is comfortable with public speaking. Lastly, they recommended more time for

the presentations and that everyone should be involved in the end when questions are

asked.


undergraduate optometry students on small-group learning


optometry students on small-group learning is presented in Figure 4.3 and discussed in the

following section.

FIGURE 4.3: SUMMARY OF THE EXPERIENCES AND PERCEPTIONS OF UNDERGRADUATE OPTOMETRY STUDENTS ON SMALL GROUP LEARNING

[Compiled by the researcher, Kempen 2018]

SMALL-GROUP

LEARNING

Creates

interaction among

students

Sceptical

Discouraged

Apathy

Nervous

Optimistic

Enjoyment

Calm

Decreases workload

Different viewpoints

Encourages teamwork

Getting to know your peers

...it is group work

Not everyone in the

group works on the same standard

130

The results of the questionnaire survey offered valuable insight into the students’ lived

experiences concerning small-group learning. The results to a significant extent were in

accordance with findings of recent research on the topic (cf. 2.3.3.2.3).

The analysis indicated that small-group learning indeed promoted interaction amongst

students, as mentioned by Rudland (2009:80). The participants identified the creation of

interaction among students as one of the objectives of small-group learning as a teaching-

learning method. The benefits of such interaction were acknowledged by the participants

throughout the survey. That small-group learning created an opportunity for the students

to get to know their fellow students better, was reported as a benefit of this interaction.

Another benefit identified, which corresponds with Jackson et al.’s findings (2014:117), was

that the participants valued the different viewpoints of their peers when doing the research

together. On the topic of research, in this teaching-learning experience it was experienced

negatively, as participants reported feelings of confusion and frustration. As this was the

second-years’ first research project, these feelings may be attributed to them being

inexperienced with collecting the appropriate information.

Another objective of small-group learning cited in the literature (Skinner et al. 2016:22) is

that this teaching-learning method encourages communication. Something that should be

noted is that, in this study, participants felt that the communication between the group

members was poor. This weakness influenced the experience and learning of the

participants as they felt confused and unsure during the experience due to poor

communication. One recommendation to improve communication is to let the students

choose their own group members. This, however, will influence the opportunity to get to

know other students, as mentioned earlier.

With millennial students who are regarded as being a team-orientated generation, one could

assume that the feelings on this teaching-learning experience should be overwhelmingly

positive. This was not the case in this study. The before feelings were dominated by feelings

of discouragement, apathy, nervousness and scepticism. These feelings were due to, as

one participant described it ... group work can be ‘messy’ [P15]. Contrary to the before

feelings, this specific participant, in the end, enjoyed the group work, and in accordance

with Jackson et al. (2014:117) who mentioned that group work alleviated stress due to the

contribution of everyone’s work. Likewise, feelings identified corresponded with the specific

team-orientated characteristics of the millennial students. Some participants in this study

found group work fun and enjoyed working with their peers, although seniority played a

131

role in the feelings experienced during group work. A notable finding in the flip the

classroom experience (cf. 4.4.2), which involved small-group learning, is that the second-

years felt frustrated working with others, while the fourth-years felt at ease and were

excited and enjoyed working with others, and they reported having a positive learning

experience due to working together.

Regarding the research assignment, the participants indicated that they had divided the

work and it seemed that they worked in isolation to complete the task. The possibility also

exists that some group members did more than others. Measures should be set in place to

avoid such obstacles to effective group work; in this study, this was accomplished with the

use of a presentation. To promote the positive commitment of each individual student, part

of the experience was a presentation of the poster by each member of the group. These

presentations promoted deep learning as a participant mentioned, I understand more

because I had to teach others [P7]. The presentations also prepared students for public

speaking and honed their communication skills. Another important factor identified that

corresponds with findings of other research on teaching-learning methods was that some

of the students did not feel comfortable with public speaking (cf. 4.4.2.2, cf. 4.4.6.2);

therefore the perception reigned that the whole group’s marks would be negatively affected.

This may suggest that the effectiveness and success of small-group learning depend on the

activity provided for the students to complete within their groups.

In conclusion, group work as part of health sciences education is inevitable. The benefits

and interpersonal skills gained through group work outweigh the negative feelings

experienced by students. The researcher believes that, although this generation of students

is described as students enjoying group work, personality is probably still the deciding factor

whether a student will prefer group work as a learning experience. This is in agreement

with Jackson et al.’s opinion (2014:117), who assert that due to different personal

dynamics, a student will either love or hate group work. In this study, some of the

participants also were concerned about how their marks might be influenced negatively

when working with others, similar to Chapman and Van Auken’s finding (2001:118). This

may indicate that students that are academically stronger seem not to prefer group work.

The more senior year students might be more familiar with group work or more comfortable

with their peers, or be more self-confident and therefore might have a more positive

experience working with others. It seems as if small-group learning creates a learning

environment in which students feel safe to explore amongst their peers, therefore, this

teaching-learning method stimulates the active experimentation learning mode on the

132

experiential cycle. However, it also appears as if the students did not have confidence in

their own ability to create knowledge as it was reported that the students felt frustrated

doing the research and recommended that the lecturer should still present a lecture on the

topics (diseases) of the assignments. Other than ensuring that students knew exactly what

was expected of them, there were no definite recommendations on how to improve the

experience for the students.

The next teaching-learning method’s analysis that will be reported and discussed is

simulation.

133

4.4.4 Results of the questionnaire survey on simulation

______________________________________________________________

In the following section, the application of the teaching-learning method, simulation, will

be discussed, followed by the results and discussion of the questionnaires that were

completed after this specific teaching-learning method was applied.

4.4.4.1 Simulation design for the purpose of this study

The intent of simulation using standardised patients (SPs) in optometry programmes in

South Africa is similar to that in pharmacy programmes, namely to strengthen knowledge,

teach a wide variety of professional skills, and develop appropriate attitudes (Smithson et

al. 2015:854). Slater et al. (2016:369) are in agreement with this and added that SP

simulation also improves communication and enhances clinical knowledge.

This simulation exercise in this was driven by the following objectives (cf. Ker & Bradley

2014:176):

After the simulation session, the student must be able to:

• Collect, analyse, organise and critically evaluate clinical information.

• Effectively communicate the diagnosis and management plan.

• Show the ability to be a health advocate.

The overview of the scenario can be seen in Appendix L. The SPs were volunteers from the

community. Chen et al. (2015:812) proclaim that students prefer that staff and peers do

not act as SPs when interactive communication practices are conducted. Debriefing was

done after each session to ensure that the students had an opportunity to reflect on the

experience in order to transform the experience into a learning experience. An important

aspect was the feedback provided by the SPs as this added valuable context for sharpening

the students’ patient care skills (Chen et al. 2015:812). The assessment criteria the SPs had

to use to judge the students’ degree of performance are provided in Table 4.6 on the

following page.

134

TABLE 4.6: ASSESSMENT CRITERIA APPLIED BY STANDARDISED PATIENT

Did the student: Yes / No

1. 1. Introduce him- or herself?

2. 2. Explain what he or she was going to discuss with you?

3. 3. Explain the diagnosis and management in terms that you understood?

4. 4. Remain professional and ethical at all times?

5. 5. Demonstrate effective communication skills?

6. 6. Show compassion with your situation, but still remained true to the

profession and the scope?

A total number of 17 fourth-year students completed the questionnaire, which was a 100%

response rate.


undergraduate optometry students on simulation.

Each theme, with its categories and subcategories is summarised in a table (Appendix H-

4). The findings of the data analysis are discussed, and direct quotes from the participants’

responses are provided to substantiate the findings. There were no assessment themes for

this teaching-learning method.

Theme 1: Objective


which the teaching-learning method was used? The first objective the participants identified

was that the simulation was aimed at improving their communication skills. Participants also

noted that simulation provided an opportunity to improve skills such as being a health

advocate for one’s patient. Another objective mentioned was that simulation created a real-

world scenario and participants noticed that they could practise their professional conduct

in this scenario. Lastly, simulation was found to build confidence.

To illustrate a situation that may occur in private practice. To be a patient

advocate, to communicate with a patient and a receptionist and to know how

to carry over certain news. [P3]

135


The participants unanimously felt that the objectives of simulation were successfully

achieved. Contributing factors to the success of this teaching-learning method were that

the scenario illustrated a real-life situation and participants had to illustrate professional

conduct. This experience also took students out of their comfort zone and provided them

with an opportunity to act with confidence, and professionally and to be a health advocate

for their patients.

Yes, simulation session was very realistic and addressed real problems. [P5]



before, during and after the experience. In the sub-themes, three categories were

identified, namely positive, neutral and negative, which are analysed and discussed below.

i. Feelings before

All the participants responded that they had experienced negative feelings before the

simulation session. Feelings of anxiousness, confusion, nervousness, being scared and

stressed, as well as uncertainty were mentioned. These feelings were mainly due to the

participants not knowing what to expect.

A bit on my nerves because you are not entirely sure what to expect and

what you will experience. [P1]

ii. Feelings during

The participants reported they had experienced positive, neutral and negative feelings

during the simulation experience. Most participants, however, indicated that they had felt

comfortable, confident, reassured and in control. These feelings were mainly due to them

realising that they did possess the knowledge and skills to perform the task.

I felt professional and in control of the situation. I was able to do what was

asked with confidence. [P17]

136

One participant reported feeling out of her/his depth, while two others felt stressed and still

uncertain.

Very uncertain, never done anything like that. [P12]

iii. Feelings after

Only positive feelings were experienced after the simulation was completed. Participants

felt satisfied and felt that the experience was informative. The simulation sessions reassured

and prepared the participants, and they felt more confident to handle similar situations in

future. Other positive feelings noted were appreciation, happiness and readiness.

I feel grateful and surer of what to do, should I be placed in these situations

again. [P13]

Theme 4: Strengths

The participants identified six strengths of this teaching-learning method. The list of the

strengths is given in Table 4.7, together with direct quotes from the participants.

TABLE 4.7: STRENGTHS OF SIMULATION AS IDENTIFIED BY UNDERGRADUATE

OPTOMETRY STUDENTS, UFS


1. Real/realistic/authentic and applicable

experience

It is hands-on and realistic. I think it would really

help to ease the going into real practice next year

… [P15]

2. Provide confidence It teaches you to have confidence and to be

confident in your work. [P8]

3. Safe learning environment It is nice not to feel stressed about getting marks

for the action. [P6]

4. Improve communication skills To learn better communication skills [P2]

5. Demonstrates how to advocate for yourself

and the patient

Teach you to stand up for yourself. [P7]

6. Promotes integration The integration of the theory and then the

physical application of it. [P1]

7. Practical experience … you learn better when you do something

practically by yourself. [P6]

137

Theme 5: Weaknesses

Most of the participants mentioned that they had found no major flaws in simulation, but

from the responses of the students who mentioned weaknesses, two categories emerged,

which will be analysed and described below.

Students were not sufficiently prepared

Some participants felt they had not been sufficiently prepared for the simulation and were

not sure what to expect, and that created uncertainty.

Too little information was given beforehand about what is going to happen

and what is expected of me. [P17]

Confusion may arise due to simulated patients.

Some participants expressed the opinion that there was confusion because the simulated

patients had not been prepared well enough before the simulation, because they forgot the

script, and the simulated patients with whom different students had to deal, did not act

exactly the same.

The patient should be briefed more on the cases as many forget their script.

[P14]

Theme 6: Factors that enhanced learning

The main factor in simulation which enhanced the students’ learning, according to their

responses, was that it provided a practical, applicable, real-life experience offering an

opportunity to improve their communication skills, as well as the effective management of

the patient. This teaching-learning method also increased the participants’ confidence and

professionalism. Other positive factors mentioned were that the simulation was performed

in a safe learning environment and the participants had the opportunity to learn from others’

experiences.

It tested me without feeling like a test, therefore it let me realise with what

I struggle and with what I am good at. [P3]

Prepared me to be a better professional and to handle patient management

more effectively. [P5]

138


The participants were asked if any personal changes were experienced that they could have

implemented to enhance their learning experience. Most of the participants reported that

no changes occurred and that they had a positive experience. Other participants, however,

responded that they could have enhanced their learning by asking more questions about

the expectation of the session and by being more involved in the experience. Still, others

mentioned factors that would result in a better outcome but were not necessarily factors

that would enhance their learning. These included being more persistent and open with the

‘patients’ as well as acting with more confidence.

Fully buy into the idea and to take it seriously. [P12]


The last theme from the data collected with the questionnaires was the recommendations

from the participants to enhance the learning experience with the use of simulation. The

majority of the participants recommended that simulation should be used more often in the

optometry programme. They also recommended that it should be used in different

scenarios; with different simulated patients, and the degree of difficulty should vary. The

participants also recommended that the themes of simulation sessions should correspond

with the schedule of the theory lectures in the module.

I think more simulation sessions with different scenarios must be used in the

syllabus; it helps to have more practical experiences and not only theoretical

knowledge. [P1]

Some participants recommended individual feedback from the simulated patient. On the

topic of the simulated patients, the participants recommended that the SPs should be

trained to have the exact information that corresponds with the clinical notes and the SPs

also should ask more questions about the disease for the students to practise their skill to

explain the management.

Maybe to get a note at the end by the SP to say what you can personally

improve on and if he was satisfied. [P16]

139

Participants also recommended that students should be provided with more information in

advance to prepare for the simulation.

I would, however, have told the students about it beforehand. Arriving at

this without being prepared for it is quite unnerving and a bit of a shock.

[P10]

Lastly, they recommended that they should be able to take notes with them to the scenario.


undergraduate optometry students on simulation


optometry students on simulation is presented in Figure 4.4 and discussed in the following

section.

FIGURE 4.4: SUMMARY OF THE EXPERIENCES AND PERCEPTIONS OF UNDERGRADUATE OPTOMETRY STUDENTS ON SIMULATION


The results of the data collected with the questionnaires clearly indicated that

undergraduate optometry students saw simulation as a favourable teaching-learning

method. This was attributed to several factors that included the practical application of

theory, and the execution and discussion of the simulation experience in a safe learning

Success

factors

Promotes

integration

Skills

Development

Safe learning environment Realistic / appropriate environment

Well-trained simulated patients

Theory – practice integration

Confidence

Professionalism Communication

Safe health care providers Better patient management and care

Outcome

140

environment. The safe learning environment can be attributed to the simulated experience

allowing the participants to make mistakes without it being detrimental to the patient or

causing them to receive poor marks. It seems that students value an approach that provides

an opportunity to learn without risks, something with which simulation achieves success.

Similar to other studies (Hope et al. 2011:714), participants in this study also recognised

the experience as being realistic and appropriate to the profession. This factor contributed

to the enhancement of learning for the participants.

Participants valued simulation learning and recognised that it provided an opportunity to

improve their communication skills, indicate professionalism and demonstrate the effective

management of a patient. In accordance with findings reported in the literature (Hope et

al. 2011:713; Botma 2014:3; Smithson et al. 2015:859), a significant finding of the analysis

of this study was that simulation provided the participants with confidence. This finding

became evident in the second theme, namely the feelings the participants experienced

before, during and after the experience. Before the experience, all the participants

experienced feelings of anxiety, confusion and nervousness. This probably may be due to

the participants never having had an encounter with simulation before these experiences.

This caused them to feel scared and unsure, as they did not know what to expect. In

contrast, the feelings they experienced afterwards were overwhelmingly positive.

Interesting to note is that this was the only learning experience where some students’

feelings changed from entirely negative before the experience to totally positive after the

experience. Participants mentioned that this experience made them realise that they

possessed the required knowledge and skills, and after the simulation, they felt better

prepared and ready for their professional career. The change from negative to positive with

regard to their feelings is similar to the feelings mentioned about the flip the classroom

experience (cf. 4.4.2.2) and confirms that this generation of students enjoys being

challenged with new/different learning experiences. It seems that feelings such as anxiety

and nervousness due to a new learning experience create anticipation that may contribute

to the success of the experience.

To alleviate the negative feelings experienced before simulation, the participants suggested

that the lecturer should provide more information in preparation for the session. This lack

of preparation also was identified as a weakness of the simulation experience. There were

multiple enquiries before the experience of what and how they should prepare for the

sessions. The researcher ensured the students that they did have all the theoretical

knowledge and skills necessary to complete the simulation and it should be mentioned that

141

the students were properly briefed on the day of the experience on the outcome and the

process. Taking this into consideration, it may indicate that the students disliked being

caught off guard, but as one participant mentioned … if we could have prepared more, it

would have been more an oral than just being yourself [P8] and the researcher could not

agree more.

The other weakness mentioned involved the SPs. Although some participants mentioned

that the SPs were consistent and friendly, others were of the opinion that the SPs should

be trained to understand their exact role and also to ask more questions to provide the

opportunity for explanations. This corresponds with Draper et al.’s (2012:97) finding that it

should be accepted that simulation is performed under artificial conditions and that students

may benefit more from a real patient. Although there are vast numbers of patients available

in the public health sector in Africa, and certainly in South Africa, that can be used to teach

skills (Draper et al. 2012:97), with the analysis of the data, the researcher became aware

of the need of students from the UFS to encounter learning situations which they will

encounter in the private health sector. Currently, the training is focused on the public health

sector, as the clinic is situated at a District Hospital in Bloemfontein and students seem to

be comfortable with the protocols that are followed within this public health facility, but

most of the students will be working as professionals in the private health sector after they

have graduated (cf. 2.2). For this reason, simulation should be applied more frequently in

the undergraduate optometry programme at the UFS. It is recommended that more

simulation sessions with different scenarios, different SPs and with a varying degree of

difficulty be applied throughout the programme.

The evidence gathered from the study confirms that simulation learning was positively

evaluated by the participants. The findings of this study suggest that simulation provides

an active learning experience that provides students with confidence and improves

communication and professionalism, which may enhance patient care and management.

Ruhi’s experiential learning framework (2016:205) indicates that with the use of simulation,

the active experimentation mode is primarily activated, followed by the secondary, concrete

experience. Having analysed the findings of this study, the researcher would like to add

that reflective observation also was used. Participants mentioned that due to the debriefing

they could learn from their own experiences, as well as those of their peers by reflecting

on the experience.

The next experience that will be discussed is interprofessional education.

142

4.4.5 Results of the questionnaire survey on interprofessional

education

______________________________________________________________

In the following section the application of the teaching-learning method, interprofessional

education (IPE), will be discussed followed by the results and discussion of the

questionnaires that were completed after this specific teaching-learning method had been

applied.

4.4.5.1 Interprofessional education for the purpose of this study

The first exposure to IPE for undergraduate optometry students at the UFS only occurs

when they have reached their advanced optometry practice experiences in their fourth-

year. A four-week interprofessional education experience with the use of a case-based

simulation was used to build effective person-centred patient and interprofessional

relationships within the FoHS at the UFS (cf. Botma & Labuschagne 2017:8). The health

care professionals included in the sessions were all fourth-year students in the FoHS and

included students from medicine, physiotherapy, occupational therapy, dieticians, nursing,

biokinetics, radiography and optometry. The sessions are designed and implemented as a

FoHS initiative and lecturers from the different professions’ departments act as facilitators

for an IPE group. The module outcome for the sessions was:

At the end of the four Interprofessional Education (IPE) sessions, you will be

able to develop a plan to promote collaboration among healthcare

professionals based on the International Classification of Functioning

Disability and Health (ICF) in order to improve health outcomes (Botma &

Labuschagne 2017:5)

One of the goals of the IPE sessions at the UFS is to prepare the students for the

community-based education (CBE) rotation in Trompsburg. Trompsburg is a CBE project of

the FoHS at the UFS in the Southern Free State to develop a community-centred

collaborative framework for sustainable, holistic healthcare and social development

incorporated in the curricula of the FoHS (UFS 2017b: Online). The Department of

Optometry joined this initiative in 2017 and sent third-year optometry students to the

platform. The fourth-year students still attended the IPE sessions as the Department

143

regarded the experience as essential for the students’ professional career. Figure 4.5

illustrates the design of the sessions.

FIGURE 4.5: DESIGN OF THE IPE SESSIONS AT THE FoHS, UFS [Botma & Labuschagne 2017:3]

The first session of the IPE experience was used to explain different concepts such as the

International Classification of Functioning Disability and Health (ICF) and the core

competencies such as collaboration, communication, professionalism, and value clarification

to illustrate IPE principles to the students. For the simulation sessions, an unfolding diabetic

case was chosen, and standardised patients were used. In the first scenario, the students

had to attend to a diabetic patient who was admitted to the ward. The groups of students

from the professions involved had to interact with the patient as a team and started

planning a management plan for the patient according to the ICF. The case unfolded further

the next week when the patient had to undergo a lower leg amputation. The students had

the opportunity to compile an interprofessional plan for collaboration and shared it with the

whole group in the final session.

There were no assessment criteria for the students and their attendance counted towards

clinical attendance.

A total number of 17 fourth-year optometry students completed the questionnaire, which

represented a 100% response rate.

Didactic IPE

Introdution to IP practice

First simulation session

Second simulation session

Compile IP plan for collaborative practice

144

4.4.5.2 Analysis and description of the experiences and the perceptions of

undergraduate optometry students on interprofessional education

Each theme, with categories and subcategories is summarised in a table (Appendix H-5).

The data analysis and discussion of the findings, with direct quotes from the participants’

responses, are to follow. No assessment theme figured in this teaching-learning method.

Theme 1: Objective

Only one category was identified in this theme. The main objective identified by the

participants for this teaching-learning method was:

The introduction to and preparation of students for collaborative practice.

From this category, a few subcategories arose, which are: working together with other

health professionals, the development of a management and treatment plan, and promoting

patient-centred care. The participants contended that the purpose of IPE was to work

together with other health professionals. With the use of this method, an understanding of

each other’s role would be created that would contribute to developing an optimal

management plan that would be best for the patient.

To be introduced to other professions and what they do and how they play

a role in patient-centred care and also how we can all work together. [P15]


Three categories were identified and analysed in this theme. The majority of participants

responded that the objectives had been achieved successfully, while a few indicated that in

their opinion, the objectives had not been achieved successfully. A few more had mixed

feelings in that they posited that the attainment of some objectives was successful, but for

other objectives, it was unsuccessful.

The participants that indicated the objectives had been attained successfully, motivated in

their responses that it was due to them having been informed of the different roles of health

care professionals, having contact time with other health care professionals, and working

together with other health care professionals.

145

Yes. By working with the different professions, I learned what exactly those

professions do. Therefore, I can respect what they do more. [P6]

Other participants mentioned that the objectives only were achieved in certain areas. It was

mentioned that the learning did not take place in a real-life setting, while others felt that

the objective was only achieved due to the simulated scenario.

Yes and no. The sessions where we saw the patient did. The sessions where

we were in Metro 4, no. [P9]

A minority of the participants were of the opinion that the objective of this teaching-learning

method was not achieved. According to them, these sessions were only informative sessions

and they were not part of the implementation (going to Trompsburg), therefore, the goal

of these sessions was not clear. Another participant asserted that there was no structure

and the large number of students made the group work challenging.

No, …., there were too many students that made group session classes

harder to do as there was very little structure. [P5]



before, during and after the experience of IPE. In the sub-themes, two categories were

identified, namely positive and negative and these were analysed and are discussed below.

i. Feelings before

Most of the participants experienced negative feelings before the IPE experience. Feelings

of nervousness, confusion, being unmotivated and uncertainty were mentioned. These

feelings were mainly due to the participants not knowing what to expect and that they felt

it was going to be time-consuming

Sceptical, as all Allied Health professions were going to work together. I was

unsure as to what was expected of us. [P5]

Other participants had positive feelings, such as excitement and curiosity.

146

I was excited about getting to know a little more about each profession. [P1]

ii. Feelings during

The feelings experienced during the IPE sessions were mostly positive. The participants

enjoyed working with other health professionals and felt excited, interested, informed and

educated. Some of them responded that they also felt calm, comfortable and relaxed.

It was interesting actually to see what different professions can actually do.

[P4]

Some participants still felt negative and had feelings of confusion, frustration and irritation.

This was mainly due to the feeling that this experience had been a waste of time. One

participant mentioned that the large crowd of students created anxiety.

Irritated in the first and last sessions. It was dragged out and felt like a waste

of time. [P9]

iii. Feelings after

After the learning experience, the participants again experienced negative as well as

positive feelings. More than half of the participants were glad that the experience was over

and reported that it was time-consuming and not applicable.

It was good to finish. It was a time-consuming process with a lot of aspects

that didn’t seem applicable to us. [P12]

The other participants’ responses indicated that they had enjoyed working with others and

felt that they were better educated and informed about other health professions’ roles.

Some also asserted that the experience had made them humble and more competent.

I feel that I now understand each profession’s role better and I will now be

able to refer patients to the right person if the need arises. [P10]

147

Theme 4: Strengths

The participants identified three strengths of IPE as a teaching-learning method.

The main strength was that this teaching-learning method created the opportunity to work

with and learn about other professions. Some participants responded that they learned

much from working in a team and observing what other professionals were doing. This

teamwork also resulted in holistic patient management.

It forces you to get to know and respect other professions more. It also

incorporates a more varied management plan that covers every aspect of

the patient. [P12]

Another essential strength identified by the student participants was the practical

application of theory during the interprofessional simulation session.

Everything that was talked about in the first session was practically

incorporated in the 2nd and 3rd session, which helped me to see where each

health profession fits into a patient’s treatment. [P1]

Participants also identified the interaction with the simulated patient during IPE sessions as

a strength of the experience.

The interaction with the patient was very effective. [P9]

Theme 5: Weaknesses

The participants identified seven weaknesses of IPE as a teaching-learning method. The list

of the weaknesses is given in Table 4.8, including direct quotes from the participants to

exemplify their opinions.

TABLE 4.8: WEAKNESSES OF INTERPROFESSIONAL EDUCATION AS IDENTIFIED BY

UNDERGRADUATE STUDENTS, UFS [Table continue on next page]

WEAKNESSES DIRECT QUOTE FROM PARTICIPANTS

1. A large group of people

I also think the number of people and the sizes of the

groups made it difficult to allow everyone to communicate

with the patient effectively within a given time [P6]

148

2. Objectives weren't clear and no

guidelines were provided

Never was the group told whether there is a better way of

handling the patient, there was improving suggestions,

but no definite guidelines. [P11]

3. The goal of the sessions was not

achievable

The goal was too big and not achievable to me. [P16]

4. Not all the professions had the

same involvement in the case study

There wasn’t really much to do for all the professions, the

OTs and PTs had a lot to do, but the Optoms and

biokinetics and radiographers couldn’t really give hands-

on care during the sessions. [P5]

5. Not a real-life environment Not having an entirely real-life environment to practise in

[P8]

6. A time-consuming process with too

much repetition

It is a very time-consuming process, which creates a

negative feeling towards the experience. [P12]

7. Not applicable

Knowing that you are not participating in Trompsburg

experiences doesn’t motivate you to be more interactive

and participate in the activities. [P2]


Three factors that enhanced learning were identified by the participants. They were:

Working together in a group

The participants mentioned that working together in a group with the patient was

something they had not experienced before and that it enhanced their learning.

Interaction with other health care professionals

The interaction with other professionals provided a better understanding of the scope of

practice of other health professionals. The participants mentioned that it indicated how

other professionals worked and that they benefited by seeing how they treated a patient.

The teaching-learning method was applied practically

The practical application of the teaching-learning method through simulation enhanced the

learning for some of the participants.


The participants were asked if there were any personal changes that they could have

implemented to enhance their learning experience. A participant felt that he/she could have

149

paid more attention while another mentioned that he/she could have read more on the

patient’s condition.

I could have read up more on the patients’ condition and the different ways

I could help them. [P10]


The last theme from the data provided by the questionnaires was the recommendations of

the participants on how to enhance the learning experience of IPE. Two recommendations

stood out. The first is that the participants recommended that the sessions should be of

shorter duration. The participants also recommended less theoretical activities and that the

simulation should be done in one session.

Keep it shorter. It loses its power when it is drawn out. [P9]

Another main recommendation was that better explanations on the expectations should be

provided to the students before each session. From this category, the sub-category of

facilitators emerged. Participants recommended that the facilitating should be uniform and

facilitators should know what was expected from the session and effectively communicate

it to the students. Another recommendation was that a guideline should be provided on the

management plan of the patient.

Providing a guideline as to what needs to happen when handling a patient

with all professions present. [P11]

Other recommendations were that a bigger space should be provided for the first and last

sessions as well as for smaller groups. In addition, the participants recommended that

during these sessions, a lecturer from each profession should provide a summary of the

role of that profession.

It would be nice if a lecturer from each profession could give a short

summary of that profession and their scope at the first IPE session so that

everyone can understand each other’s role better. [P10]

150

Recommendations on the simulation sessions included that more simulation sessions should

be arranged. Drama students should act as simulated patients to handle the bigger groups

and the simulated patient should provide constructive feedback. One participant

recommends that IPE should be illustrated in a real-life setting and not a simulation. With

the implementation of this recommendation, another participant recommended that a

rotation could be set up for different professions to sit in when another profession treated

a patient.

A rotation could rather be implemented like a Dietician can observe how an

Optom helps a patient and vice versa. Resulting in more in-depth contact-

time, instead of superficial understanding of each profession. [P12]

Lastly, it was recommended that the students scheduled to attend the Trompsburg rotations

should attend these sessions.

Involve the year group that is going to participate in the Trompsburg

rotations so they can receive the full benefit thereof … [P2]


undergraduate optometry students on interprofessional education.


optometry students regarding simulation is presented in Figure 4.6 on the following page

and discussed in the following section.

151

FIGURE 4.6: SUMMARY OF THE EXPERIENCES AND PERCEPTIONS OF UNDERGRADUATE OPTOMETRY STUDENTS ON INTERPROFESSIONAL

EDUCATION [Compiled by the researcher, Kempen 2018]

The identified purpose of this method correlates with the literature on IPE (Buring et al.

2009:2; CAIPE 2002: Online). Participants emphasised that IPE created a platform for

different health professions to work together with the focus on the patient - thus, it was a

patient-centred learning experience. For the participants in this study, this shared

experience generated an understanding of the role and responsibilities of each health

profession. Participants asserted that this understanding ensued in respect and power-

sharing, and consequently, effective communication amongst the professions in future.

These skills correspond with the collaborative practice findings of Lapkin et al. (2013:91)

and Filies et al. (2016:231).

Although the weaknesses identified in this study outweighed the strengths of this teaching-

learning method, the benefits of the optometry students’ exposure to IPE training became

apparent throughout the data. They had contact with other professions during the first and

last sessions, but the participants mentioned that the objective only was achieved

successfully when they worked together with the other professionals while seeing the

simulated patient. This may indicate that, due to the simulation session having been a

practical exercise, students learnt more from a practical session than a theoretical session.

Also, the simulation sessions could have put everything for the students into perspective,

and they were able to construct meaning based on the experience, therefore, the other

sessions, as the participants called them should not be disregarded. This indicates the

Patient care Respect Power-sharing Communication

Should be: Clear Achievable Relevant

Should be: Uniform Informed Communicative Source of guidance

Focused Different scenarios Real-life Involve all

professions

Shared experience Working together Physical contact

session

IPE

152

importance of the use of more than one mode of the experiential learning cycle within a

teaching-learning method. In this scenario, three modes were made use of, namely abstract

conceptualisation when the students had to analyse their different roles and work

collaboratively towards a proper treatment and management plan. With the use of

simulation, the concrete experience and active experimentation modes were activated, as

mentioned in the simulation discussion (cf. 4.4.4.3). Although time was scheduled for a

debriefing session to provide for reflection, the researcher was unsure whether all groups

actually had a debriefing, as none of the participants mentioned anything on debriefing

(neither positive nor negative).

Secondly, the learning experience was negatively influenced by a few variables. The

students posited that the purpose of this IPE experience was neither achievable nor

relevant. The expectation of some of the participants was to be part of the Trompsburg

rotation, and those who did not have this opportunity found the IPE sessions irrelevant

(although relevant to the profession of optometry). This also became evident from the

analysis of the feelings the students experienced. Some participants had positive feelings

during the experience but afterwards felt that it was not applicable to them. Having

experienced the exercise as not relevant to them might have contributed to the participants

feeling that the sessions were time-consuming and repetitive, and also not conducted in a

real-life setting.

Although the IPE experience was also new, like flip the classroom and simulation, as

previously discussed (cf. 4.4.2.3; cf. 4.4.4.3), negative feelings experienced before the

application of IPE were mainly due to the objective being unclear, creating uncertainty

about what to expect. These feelings highlight the importance of communication between

the facilitator and the students, as mentioned by Rhoda et al. (2016:227). Better

communication on the purpose of IPE, as well as the process that these sessions would

follow, also would have prevented the students from feeling that there was no structure to

achieve the objective, and probably would alleviate the feelings of this method being

unnecessary. In addition, in spite of lecturers previously having provided information on

each profession and the finding that IPE was more meaningful when conducted in small

groups, the participants still recommended that a lecturer should provide the

communication and not a student, as was the case in this study. This correlates with the

finding of the flip the classroom (cf. 4.4.2.3) approach, and it now seems that this

generation of students prefers to receive information from a superior and not peers or self-

study. It may also be that when a student is not comfortable with speaking in front of

153

others, even in a small group, that student will not be able to provide all the relevant

information to students from other professions to clearly understand their professional role.

It also is vital to notice that the large group of students made the participants anxious and

irritated, which had an impact on their experience. Some of them enjoyed attending to the

patient as part of a group, while others mentioned that it made the communication with

the patient difficult and that some students might not feel comfortable speaking in front of

a larger group. It is important to note that these fourth-year optometry students were a

small group and that they might have been accustomed to working in smaller groups. That

some students felt uncomfortable speaking in front of others was reported after other

teaching-learning methods as well.

Contrary to the findings of Filies et al. (2016:231), the participants in this study never

mentioned that the IPE experience resulted in them being more secure in their role as

Optometrists. Participants mentioned that a weakness was that due to the type of scenario,

not all professionals were equally involved and complained that they could not contribute

as much as the other health professionals like physiotherapists and occupational therapists.

This may be avoided in a real-life setting, or by using more simulation sessions with different

scenarios. This also points out the importance of including optometry in an IPE setting to

show Optometrist what they can contribute. Not only will such inclusion enhance holistic

patient-care, but the profession of optometry will also grow in the health care sector as

Optometrists will become part of the health care team, and not be the health professional

that you only find in the shopping mall.

To conclude, the analysis of and reporting on the data made it clear that the majority of

participants benefited from this learning experience (IPE), and that the primary competency

of collaborative practice was achieved. It became evident from the data that participants

wanted the objective of a teaching-learning method to be clear, achievable and relevant.

They required a learning experience to have structure and requested guidance and clear

communication throughout the process. The participants in this study were unfamiliar

working in a large group of students and preferred a smaller group for learning to take

place.

The following teaching-learning method that will be discussed is case presentation.

154

4.4.6 Results of the questionnaire survey on case presentation

______________________________________________________________

In the following section the application of the teaching-learning method, case presentation,

will be discussed, followed by the results and a discussion of the information gained from

the questionnaires that were completed after this specific teaching-learning method had

been applied.

4.4.6.1 Case presentation for the purpose of this study

The Department of Optometry has adopted a didactic case presentation teaching strategy.

This has been found the most common format for case presentation in health sciences

education (Agee et al. 2009:361). From their second-year of study, students have to be

present on a Friday morning and attendance of the whole group of students, as well as the

departmental academic staff, is compulsory. At each case presentation, general optometry

cases are presented by students in their third-year of study and specialised optometry cases

are presented by fourth-year students.

The exit level outcome of such a session is that the student has to demonstrate the

application of required theoretical knowledge and clinical skills during the presentation to

fellow students and optometrists of a clinical case that has been analysed and on which

they have reflected, with due consideration of the appropriate management of ocular and

visual problems. Through this reflection, the students are able to draw connections between

knowledge learned in the classroom and the learning experiences they have in the clinic

(King et al. 2017:770). Students from different year groups should be able to build on the

different levels of knowledge required to perform a comprehensive eye examination on a

patient, make the correct diagnosis and plan for the management of the case.

To adhere to the guidelines mentioned by Sandal et al. (2013:562), the presenters are

assessed according to a rubric. Facilitators, optometrists and fellow students do the

assessment. The assessment mark counts towards the predicate mark for the relevant

module.

A total number of 17 fourth-year students completed the questionnaire as presenters, which

represented a 100% response rate, and 67 out of 68 students of the sample population

155

(second- to fourth-years) completed the questionnaire at the end of the semester as

audience, representing a 98,52% response rate.

The analysis and description of the data collected from the presenters will be dealt with

first, followed by the results and a discussion of the data collected from the audience.


undergraduate optometry students as presenters of case

presentation

The themes, with their categories and subcategories are summarised in a table (Appendix

H-6). The data as analysed and a description with direct quotes from the participant’s

responses then follow.

Theme 1: Objective

The participants were asked to identify the objectives of case presentation as teaching-

learning method. One main category with four sub-categories emerged from this theme.

The presentation of a clinical case to peers

Within this category, four sub-categories were analysed. The participants responded that

in order to present the clinical case they had to reflect on their experience in the clinic,

analyse the tests performed on the patient and the results, and study other cases similar

to the relevant clinical case. The advice provided by peers and lecturers on a specific case

is included. Respondents described the objectives as follows:

Presenting a case seen in the clinic, where you then present the clinical

finding and do research on a relevant topic. Students and lecturers then

advise you on how to improve skills. [P3]

The purpose of case presentation is to present one of your patients that was

seen in clinic; to analyse the tests that you did and do research about a topic

and to learn from your mistakes. [P12]

156


All the participants agreed that the objectives were successfully achieved, but one

participant was of the opinion that there was no opportunity to ask questions, and therefore

responded with mixed feelings on the success of the method.

Yes and no. The experience teaches one a lot about your case, but it doesn’t

feel like an appropriate opportunity to ask questions of our own. [P13]

There were several factors that contributed to the successful achievement of the objectives.

First, the participants mentioned that with the construction of the presentation, they had

to reflect on the case seen in the clinic and a deeper understanding thus was created, and

they could learn from their mistakes. The research also contributed to the success and

participants found the research fascinating. It was also mentioned that presenting the case

in front of their peers provided an opportunity to grow in self-confidence.

Yes, it forced me to go and read up on my patient’s disease and to study the

work in order for me to answer possible questions. [P6]


Within this theme, feelings, three sub-themes were analysed. These included the before,

during and after feelings. These sub-themes are analysed and discussed below.

i. Feelings before

Three categories emerged from this sub-theme. Most of the participants felt negative and

mentioned feelings of stress, nervousness and being scared. These feelings surfaced mainly

due to the fact that this experience involved public speaking in front of the whole

Department of Optometry.

Very stressed, as it is stressful to present a case in front of the Optom

Department [P4]

Mixed feelings also were reported. These were nervousness and enjoyment, as well as

pressed for time and excitement.

157

On my nerves, but it was nice to do the research. [P16]

A couple of participants had positive feelings, such as excitement and enjoyment.

Excited to talk about my interesting case I had in the clinic that had myself

and the supervisors thinking outside the box. [P9]

ii. Feelings during

The negative feelings experienced during this teaching-learning experience were a

continuation from the before feelings. Most participants still felt stressed, nervous and

scared.

I was very stressed during the presentation; the biggest challenge was

speaking in front of people. [P11]

Positive feelings experienced during the case presentation were calmness, confidence,

satisfaction and enjoyment. These feelings were due to some participants enjoying the

research and working hard on their case to ensure they knew what was going on.

Full of confidence, I enjoyed using my research, I worked hard to make sure

I was doing a good job. [P6]

Mixed feelings also were reported. Although some participants later became more confident,

calm and enjoyed the presentation, the stress and nervousness did not completely subside.

I enjoyed the experience but was still a bit nervous. [P17]

iii. Feelings after

Almost all the participants responded that they had positive feelings after the case

presentation. They mostly were relieved as they found it a positive experience. Other

feelings mentioned included enlightenment, happiness and satisfaction. These positive

feelings were mainly due to the participants’ feelings on that they worked hard, that the

experience was informative, and that it enhanced integration between practical and clinical

application.

158

It was a good experience and I learned from my mistakes as well as form

other’s cases, research and mistakes. [P7]

One participant felt negative and drained after the experience.

I felt drained, but I was happy when it was over. I felt less stressed. [P13]

Theme 4: Strengths

In this theme, strengths, ten categories were identified during analysis. The list of these

categories is tabled in Table 4.9, with direct quotes from the participants.

TABLE 4.9: STRENGTHS OF PRESENTING AT CASE PRESENTATION AS IDENTIFIED BY

UNDERGRADUATE OPTOMETRY STUDENTS, UFS

STRENGTHS DIRECT QUOTE FROM PARTICIPANTS

1. Learning from your own and others’

mistakes

You have the opportunity to learn from you own case /

mistakes. [P4]

2. Reflecting on a clinical case ... it also helps to do reflection. [P16]

3. Learning from other students’ cases ... it is also good to learn from your fellow classmates.

[P17]

4. Doing research Also, to do research and learn more about something I do

not know much about. [P14]

5. Motivation to do a thorough eye

examination

It forces you to go out of your way in the clinic to do

everything as well as possible so that the lecturers do not

catch you out during your presentation. [P6]

6. Builds self-confidence Building self-confidence. [P7]

7. Creates interaction with other

people

Helps you interact with people. [P10]

8. Provides information It is also an opportunity to provide information to the

third- and second-years. [P15]

9. Forces you to think on your feet It forces us to think fast and step out of our comfort

zones. [P13]

10. Improves clinical skills Teaches you a lot about how to handle patients. [P10]

159

Theme 5: Weaknesses

The participants mentioned a few weaknesses of this experience. Two of these weaknesses

were mentioned more commonly than the others, namely that this experience involved the

presentation to a large audience, and some participants found it stressful because it might

turn humiliating, uncomfortable and unpleasant. These fears might be due to the questions

that are asked at the end of the presentation, and as a participant mentioned, may put a

student on the spot [P8]. Also mentioned were the remarks from supervisors that could

sometimes expose the student.

The fact that it is done in front of many people can often make non-public

speakers feel uncomfortable and can at times be very unpleasant. [P13]

The second most reported weakness was that ground rules were not respected and

students and lecturers came in late, disturbing the presenter. Other weaknesses, according

to participants, are that they felt that it was a time-consuming process and that it might

not be relevant to junior students in the department, as students in the early years might

not understand the information as the theory has not been explained yet.


The factors identified that enhance the learning of the participants correlate with the

strengths mentioned earlier. Similar to the strengths, in this theme, the participants

highlighted the fact that the personal research enhanced their knowledge and

understanding.

The research I did improve my knowledge and will enable me to be a better

practitioner [P3]

Another category in this theme was that learning was enhanced by the experience

stimulating the thought process of the participants.

It helped me to think critically about the case I was presenting. [P7]

Participants also asserted that their learning was enhanced by the mistakes being

highlighted and the feedback provided after their presentation.

160

I also learned a lot out of my questions and advice that was given to us after

each presentation. [P6]

Other factors that enhanced learning in the view of the student participants were the

exposure to new cases, time to reflect and the opportunity for in-depth study.

By having time to think about my case, I learned a lot about how to improve

my way of testing eyes. [P14]

It helped to study everything carefully, and make sure you have a good

understanding of everything. [P16]


Under this theme, most of the participants expressed the view that personally they could

not recommend any changes that they would have wanted to implement to enhance their

learning experience. A few recommended changes, however, were listed, for example, they

could have asked fellow classmates to have a look at the presentation before they brought

it before the whole group, they should have stressed less, and they could have made fewer

mistakes.

I would allow some of my classmates to look at my case to point out any

shortcomings that I may have missed and to help with my confidence when

speaking in public. [P13]

Theme 8: Feelings about the assessment

Four sub-themes on the assessment were identified through the analysis. They are overall

feelings, fairness, memo used for the assessment, and feedback. These sub-themes will

now be reported and discussed.

i. Overall feelings

The overall feelings about the assessment used in this teaching-learning experience were

mainly positive. Participants felt that the assessment was fair and useful. Participants also

161

indicated that the assessment provided an excellent learning platform, aided in self-growth

and identified areas for improvement.

Helped me grow through the faults I make and show me where I can improve

in presenting. [P7]

Two negative feelings, namely stress and being scared, were also noticed. These feelings

were due to the public speaking aspect involved in this assessment.

It is very stressful, but you learn to speak in front of people and how to

explain something in layman’s terms. [P2]

ii. Fairness of the assessment

The majority of participants felt that the assessment was fair and the reasons postulated

were the peer assessments, as well as assessments by the supervisor and that the rubric

had been provided in order for them to know what to expect.

Fair, peer assessment as well as lecturer assessment. [P7]

Some participants expressed the opinion that the fairness of the assessment depended on

the number of assessors on the day, as well as the subjectivity of the assessors.

… also about personal preference and opinion, so it varies from person to

person. [P6]

iii. Memo used for the assessment

Almost all the participants had positive feelings regarding the memo/rubric used during the

assessment of case presentation. Participants were of the opinion that the rubric was fair,

comprehensive, easy to understand, familiar, good and well set out.

Well outlined, know what is expected of you. [P1]

In contrast, a participant reported that the rubric was unfamiliar.

162

I don’t really know what the rubric looks like. [P10]

iv. Feedback provided

Most of the participants experienced the feedback positively and mentioned that it was

enriching, informative, helpful, relevant and sufficient.

It was sufficient, pointing out things that I have missed and doubted about.

[P9]

A participant experienced the feedback negatively and described it as harsh, while another

felt that it could have been more specific.

The feedback can, at times feel a little harsh, but it is the main thing helping

in the advancement of knowledge. [P13]


Most of the participants proclaimed that they did not have any recommendations to make

to improve the case presentation.

I think case presentation is handled very well and professionally. [P17]

The recommendations made by the other participants, when analysed, were found to be

mainly focused on one sub-category, namely, to create a safe learning environment.

Primarily this refers to the feedback and questions the students were asked after the

presentation. Firstly, the participants recommended that the supervisor involved in the case

should review the case before the presentation.

Supervisors guide students in clinic and help with differential diagnosis and

final diagnosis. Thus, the final diagnosis isn’t always that of the student, but

a supervisor. It will help if supervisors give feedback on cases before

presented. [P3]

Secondly, the criticism provided should be constructive and not break down the students’

self-esteem.

163

The criticism is not constructive, but instead has an emotional impact and

breaks someone’s self-esteem. [P11]

The participants also felt that a feedback session should be done to include all the

presenters at the end of all the presentations.

Using the feedback as a learning opportunity for everyone instead of just the

speaker. [P13]

Lastly, in this category, the participants recommended that the questions asked to each

presenter should be limited.

Four other categories also emerged in this theme. Ground rules should be set, and the

students should be reminded of them continuously. A participant recommended that the

door should be locked as soon as the students started with a presentation and kept locked

for the duration of the presentation to avoid the presenter being distracted by latecomers.

Another participant recommended that the cases should be made available to all students.

Participants also recommended that more information should be provided in terms of

expectations and the last recommendation was to provide the students with more time to

do the research.

Giving more information on what is expected of each student in the third-

and fourth-year – as we are a little confused as to how it may differ for the

different year groups. [P13]


undergraduate optometry students as presenters of case

presentation


optometry students on case presentation is presented in Figure 4.7, on the next page, and

discussed in the following section.

164


UNDERGRADUATE OPTOMETRY STUDENTS OF CASE PRESENTATION


From the responses of the students, it could be inferred that case presentation provided an

opportunity for students to reflect on a clinical case they had observed and consequently

activating the reflective observation mode of the experiential learning cycle. This is similar

to the framework proposed by Ruhi (2016:205). Participants in this study confirmed that

principles such as critical thinking and integration were stimulated during the reflection (cf.

Fasbinder et al. 2015:510). It, therefore, is surmised that reflective practice, in this instance,

did enhance learning, as participants mentioned that going through the process improved

their clinical skills. These findings are in agreement with the findings of Gardner et al.

(2010:737) and Stieger et al. (2011:351). The researcher also observed in the clinic that as

soon as a student realised that they could use a specific clinical case for their presentation,

they would pay more attention to the examination and also asked the supervisor more

questions. The students also were asked to mention during the presentation if there was

anything they would have done differently or any additional tests they could have done to

manage the patient better. This also enhanced learning as they reflected back and critically

analysed their actions and how they could have done it differently. For this reason, it seems

that the experience stimulated the thought processes of the participants and the abstract

conceptualisation mode was activated. Having thus analysed their actions and thought

process helped them to learn from their mistakes.

Reflection Research Feedback Presentation

Improves clinical skills

Stimulates thinking

Enhances knowledge and

understanding

Study in-depth Creates a deeper

understanding

Grow in

confidence

Learns from mistakes

Creates interaction

Motivation to do a

thorough exam

Unpleasant,

causes stress

Exposes student Must build

confidence

165

The research element of case presentation was perceived as most useful. Participants

responded that the research caused pleasant feelings. The research promoted an in-depth

study of the specific case they were involved in, and, therefore, participants maintained

that the research had enhanced their knowledge, as well as their understanding of aspects

of the particular case. Although students are motivated to do research on what they have

seen in the clinic, it may be that they do not always take the time to read more on the

specific case. Therefore, case presentations compelled them to make time to do research

on the case, as the research was mandatory and it seemed as if the students were

motivated to provide their peers with interesting and useful information.

Not only had the mode of reflective observation, as well as abstract conceptualisation been

activated, but with the presentation, the students went through a concrete experience too.

The third element, the presentation of the clinical case, was perceived with mixed feelings.

The presentation involved the activity of public speaking and the participants experienced

the usual negative feelings linked to the fear of public speaking. It should be noticed that

almost all the participants experienced positive feelings after the presentation that may

indicate that the fear of public speaking did not negatively influence the learning experience.

It seems that through this experience, the participants gained confidence and a sense of

satisfaction. This was especially true for the participants who mentioned that they had

worked hard to be prepared for the case presentation. With this in mind, it appears that

with case presentation student are responsible for the success of this concrete experience.

With the public speaking element, some might be driven to be as prepared that they can

be, while others are hindered by the fear.

The most significant finding of the analysis of the data on this experience was the voice of

the participants urging educators to remember that they are merely students and should

be treated as such. This manifested in the last element of this learning experience, namely,

feedback. An essential criterion of feedback is that it should happen in a safe learning

environment, which, based on the data of this study, was not the case. One participant

mentioned that case presentation is a learning experience and not a court trial [P11].

Therefore, care should be taken that supervisors/assessors do not emotionally cut the

student down in the presence of their peers by being too critical. It seems that destructive

criticism can have lasting effects, not only on this specific experience but also on their whole

experience as a student. It is important that the supervisors that attend case presentation

have the students’ best interest at heart and that their feedback and questions asked have

166

solid ground, but care should be taken of the tone of voice and the way in which questions

are put to students, as it seems that students are sensitive to that.

Similar to what Fasbinder et al. (2015:510) reported, participants indicated that a case

presentation provided a platform to share valuable information gained from the case.

Students will make mistakes while they are still learning, and care should be taken not to

instil a fear that will hold them back from exploring. As much as the presentation is the

responsibility of the student, it is the responsibility of the educator to provide a comfortable

and safe environment where the student (and others) can learn from these mistakes.

Students should never feel that they are exposed and especially in this case, where they

presented a case that was guided in the clinic by a supervisor. Hence, they recommended

that the supervisor should be involved in the preparation of the case presentation as well.

This might have alleviated the stress as the students then would know they had the support

of their supervisor.

In conclusion, it seems that case presentation enhanced the clinical learning for participants

in this study. This was due to the reflection and research on clinical cases seen on the

clinical platform. The presentation provided an opportunity to share this personal learning

experience as well as to improve the confidence of the student to participate in public

speaking.


undergraduate optometry students on attending case presentation

The following discussion deals with the analysis and description of the data collected after

the attendance of case presentation during the year 2017. Each theme, with its categories

and subcategories is summarised in a table (Appendix H-7). The data analysis and

description, with direct quotes from the participants’ responses of different academic year

groups.

Theme 1: Objective

The first question of the questionnaire asked the participants to identify the objectives of

the teaching-learning method. One main category emerged from this theme. Almost all the

participants indicated that the objective of attending a case presentation was to learn from

fellow students’ clinical cases and experiences that were shared and discussed.

167

To share knowledge and experiences with other students which you learned

or acknowledged during the clinic when working with patients. [P12]

To see different cases and how it was managed and diagnosed. You get to

see different cases which you haven’t been confronted with. [P33]

To learn about new and interesting cases and topics so as to further expand

our knowledge on various topics relating to optometry. [P48]

Within this category, a few sub-categories emerged, and most of these sub-categories

overlapped across the three-year groups involved. The first sub-category that came to the

fore throughout the data was that they learnt from the mistakes that other students had

made.

For the second and third-years to learn from what was presented by the

third- and fourth-years; what they did wrong or what they could do in the

future. [P9]

To learn from other’s mistakes so that we can be the best optometrists one

day. [P62]

The second sub-category identified under objectives was that the presentation of the case

improved their clinical skills, as they observed different clinical experiences of their peers.

To see different cases of patients, to improve our clinical techniques and to

know how to approach different types of patients. [P22]

The last sub-categories only were present in the data of the third- and fourth-year groups.

Participants in these groups specifically mentioned that with the presentation of the case,

they would improve their knowledge of pathology because rare cases often were presented.

Then also to learn interesting pathology that you don’t see often. [P27]


Most of the participants indicated that the objectives were successfully achieved. The three-

year groups purported that they benefited from the exposure to different, interesting and

168

rare cases. They mentioned the cases were informative and that they learned something

new each week that helped with the preparation and the approach to similar situations in

the clinic. They also reported that the cases stimulated their critical thinking and created a

better understanding of certain concepts.

Yes, through listening to other students’ cases, we can identify the correct

procedure to perform an eye exam. [P19]

Yes, it did, because everyone presents on different cases involving different

conditions, thus you come across stuff you don’t always do in class, etc.

[P29]

Yes, it is very informative and interesting to hear about unique cases.

[P60]

The second contributing factor to the successful attainment of the objectives was that due

to the presentations, they could learn from the mistakes made by fellow students.

Yes, as others, as well as yourself, can learn from you and correct possible

mistakes to prevent errors in the future in order to give the patient the best

possible care. [P12]

Yes, students present their case and tell you what they learnt and did wrong.

[P50]

Yes, you learn to do things differently when mistakes were made. [P66]

Participants also learned from the experiences their peers had in the clinic. With the sharing

of their experiences, participants expressed the opinion that their clinical techniques had

improved and they had received clinical advice they could apply when working with their

own patients.

Yes, each time you learn something new and you can benefit from other’s

experience. [P32]

Yes, …especially in second year I picked up a lot of clinical pearls that were

very useful in third-year. [P37]

169

Other sub-categories in this category included the comments made by the lecturers and the

advice provided which contributed to making this teaching-learning method successful. In

addition, the participants asserted that it was a new way to approach teaching and learning,

and the presentations were well presented with good explanations and proper discussions.

Yes, the students explained their respective topics really well. [P4]

A few participants were of the opinion that the objectives of this teaching-learning method

had not been achieved. A participant explained that it depended on the quality of the

presentation, while others mentioned they had found it difficult to concentrate on a Friday

morning. A second-year participant mentioned that he/she did not understand what was

presented as the theory had not been discussed with them, while a third- and a fourth-year

student mentioned that the feedback was demoralising and that the case presentations had

a stressful and critical vibe.

However, the questions and comments after presenting were sometimes too

demoralising that it made everyone uncomfortable and scared to present.

[P36]


The feelings the participants reported they had experienced before, during, and after the

sessions were analysed and are reported below.

i. Feelings before

Positive and negative feelings were equally distributed in the responses of the participants’

feelings before the experience. Participants voiced negative feelings mainly because the

case presentation was early on a Friday morning and for this reason, they did not feel

happy, but annoyed, tired and not in the mood. A second-year student mentioned feelings

of irritation and intimidation and felt nervous, as he/she did not have a theoretical

background to what was presented. A third-year fellow reported having felt confused and

another one felt uninformed for the same reason.

Irritated and intimidated. As 2nd year I know little and I get on my nerves if

the 3rd and 4th years speak with a lot of knowledge (it feels unreal that I

170

almost have to treat patients), and I felt that I had little knowledge and was

unsure why I had to attend. [P10]

Some third-years did not have any specific feelings and mentioned that they did not have

any expectations and that it is like a regular class.

Just like attending a normal class. Not nervous or stressed, because you’ll

only be listening. [P33]

Positive feelings, such as excitement, being interested, feeling relaxed, calmness, curiosity

and eagerness, were reported. Participants recognised this was a good teaching-learning

method and they were eager to listen and excited to acquire new information.

I was excited to see many new things and learn about weird and wonderful

cases. [P42]

ii. Feelings during

The whole group of participants contended to have felt interested and informed during the

case presentations. This interest and the feeling of expanding their knowledge were

triggered by the unique and fascinating cases presented, and especially the research.

Very interested, especially when the students gave their speech about

something they had to research. [P5]

Participants reported that due to the interesting cases, they could pay attention and felt

captured, intrigued and engaged. Some participants felt relaxed while they could observe

the case, while others felt the cases stimulated their analytical thinking.

Captured in the moment, I get captivated with the case as if I was there

myself. [P31]

Other positive feelings of excitement and enjoyment were also mentioned as participants

found this method to be educational, insightful and interactive.

171

Participants also reported mixed feelings. Their feelings were dependent on the type of case

and the way it was presented. A fourth-year participant only found the research part of the

case useful.

The case itself (patient) is mostly not useful, but the research is. [P56]

Negative feelings mentioned which were experienced during case presentation were

boredom, being confused, not paying attention, and being irritated.

Irritated by having to listen to things while mostly stressed about the coming

pathology clinic. [P61]

iii. Feelings after

Most of the participants reported that they felt positive after the experience. That they

gained a feeling of being informed came to the fore in the data of all three-year groups.

Participants mentioned that they have better knowledge and were more prepared for the

clinic after this experience. Other feelings that were related to being informed were

expressed by declaring their feelings of becoming educated, enlightened, enriched, fulfilled

and satisfied. These feelings they reported were mainly due to the participants experiencing

the case presentation as a meaningful interactive teaching-learning method.

I will certainly remember the situations, and I’m better aware of what is

expected of me. [P11]

Fulfilled, because it was a good teaching method where I could be active in

the asking of questions and learn from cases. [P22]

The participant who reported neutral feelings before this experience still felt neutral

afterwards, and mixed feelings also were noted.

Excited, but still stressed. Excited to see I learnt something but stressed

about all the possible mistakes one can make. [P10]

A few participants responded that they experienced negative feelings after the case

presentation. Feelings that were reported were of relief, confusion, being overwhelmed,

172

tiredness, being scared and upset. These negative feelings originated mostly from the

comments and questions after the case presentation.

Scared and upset more often than not because the lecturers’ comments

made me question my career choice. [P36]

Theme 4: Strengths

Under this theme, three main categories with sub-categories emerged from the data. These

are analysed and reported below.

A variety of different cases are presented

The strength that the participants mentioned most was that the case presented exposed

them to unique cases that some of them will never encounter in clinics themselves. This is

due to the presenters aiming to present their most interesting cases and sharing the

experience they had with an unusual eye condition. With this exposure to clinical cases,

participants realised that it improved their clinical skills as well as patient management and

communication skills.

Getting to see different cases, examination methods, diagnoses and

management as well as getting to know more about the condition. [P33]

What is presented is what the presenter has come across first-hand and may

be relatable to what we’ve seen in the clinic or have learned about in one of

our lectures. [P1]

The presentation of the cases made this teaching-learning method also a visual learning

experience and some participants appreciated this visual stimulation as a strength. Some

participants also reported that with the presentation of the case, their clinical and analytical

thinking were stimulated.

You can always broaden your thinking and you get to practise how to analyse

a case. [P52]

The second category in this theme was about how learning took place through this teaching-

learning method. The participants mentioned that they had learnt from their peers. They

explained that they most likely paid more attention because their classmates were

173

presenting. The participants also reported that their peers were at the same intellectual

level and they could relate better to peers than to lecturers. One participant mentioned that

these sessions created an opportunity also to get to know fellow optometry students.

Often, we learn more from our peers because they talk on a similar

intellectual level. [P53]

The participants also mentioned that they learnt from others’ and their own mistakes. This

strength was mentioned a few times. Participants realised that learning from their own and

others’ mistakes would prevent them from repeating those mistakes. For this reason, case

presentation was found to provide an effective platform to prepare students for the future.

Always a better way (on) how you would approach such a patient without

making the same mistakes. [P55]

You learn the best through mistakes, so you can relate to the students

presenting and learn from their mistakes [P13]

Some participants in the third-year group acknowledged the research part of the case as

valuable.

The additional research about cases helped me with more knowledge about

optometry. [P43]

Finally, in this category, some participants remarked that the questions and feedback

provided after each case were insightful.

Some questions that lecturers ask are also educational and help you to

understand better. [P33]

The last category in the theme, namely strengths, elicited responses having a bearing on

the benefits of being a presenter. The following sub-categories emerged from being a

presenter. These strengths correlate with the data represented in Table 4.9 (cf. 4.4.6.2).

174

Being a presenter:

Creates a responsibility to be diligent in the clinic in order to have a meaningful case to

present.

It makes you work harder in the clinic to make sure you have a good case

to present on. [P58]

Aids in personal development through the preparation of the case

It is very nice to do self-study and research on something you find interesting

and excites you during the presentation because you would like to convey

your knowledge for others to also find it interesting. [P32]

Builds self-confidence

It also builds confidence to speak in front of others. [P32]

Theme 5: Weaknesses

The main weakness of this teaching-learning method, as identified by the participants, is

that they were of the opinion that this method was not applied in a safe learning

environment. This weakness was reported throughout the data. Participants felt exposed

during this experience and perceived it as intimidating. They provided the following reasons:

The feedback sometimes was destructive.

The manner in which the questions were asked was negative.

Challenging questions were asked.

Mistakes were only pointed out and not explained.

Only got judged on one case.

Marks depended on the evaluators present.

Not feel safe in environment – you feel on edge if presenting if you’re going

on an execution. [P45]

175

The feedback of the evaluators is a bit harsh at times and not critically

constructive, which not only puts a damper on the proceedings but fuels the

negative association with this experience. [P2]

The second weakness was that some of the theory had not yet been discussed with the

second- and third-years. This was not mentioned only by the second- and third-years, but

by the fourth-years as well, as they had experienced it when they were in their early study

years.

The second years may feel lost in the beginning because there are terms

used that had not been taught to us yet, and then we don’t necessarily

concentrate and the learning experience was wasted. [P9]

The third weakness mentioned was that the cases presented were inconsistent (not always

meaningful). Participants reported that their experiences were dependent on the type of

case, manner of presentation and the research topic.

Not every case presentation is interesting. People sometimes choose the case

based on which case they handled the best and not necessarily the most

interesting case they had [P54]

Another weakness identified was that the sessions sometimes were too long and tedious

and then students did not concentrate. The participants also complained about too much

repetition. In contrast, however, a second-year participant mentioned that a weakness was

that the number of presentations was not sufficient.

It's sometimes too long. The student talks on a certain subject for too long

and loses the audience's attention. [P34]

Other weaknesses mentioned were that the cases presented were not first-hand

experiences of the audience, the experiences involved public speaking, and the large group

of students caused some students to feel uncomfortable. In addition, a participant stated

that nobody followed up on what had been discussed, and other students also complained

about the sessions being scheduled early on a Friday morning.

176


The nine factors that were identified in this theme corresponded with the strengths of this

teaching-learning method mentioned earlier. These factors are presented in Table 4.10 with

direct quotes from the participants.

TABLE 4.10: FACTORS THAT ENHANCED LEARNING DURING THE ATTENDANCE OF

CASE PRESENTATION

ENHANCING FACTORS DIRECT QUOTES FROM PARTICIPANTS

1. The exposure to different cases

I saw a wide variety of different types of cases

as well as diseases that I was not aware of and

would have taken me years to obtain experience

in all these cases myself. Now I saw all of them.

[P22]

2. A practical way to indicate correct techniques

and procedures to enhance clinical skills and

patient management

Showed me different ways in which people

approached the same cases and helped me

prepare for similar cases. [P47]

3. Learn from peers and from peers’ and own

mistakes

Some of the students explained complicated

terms in laymen’s terms and that made me

understand the concept more [P23]

4. Each case was well discussed and provided

new in-depth information

Every time you learn something new. [P31]

5. The research that was presented created a

better understanding

The research topics give us a better

understanding of other conditions. [P50]

6. The discussions and questions afterwards

gave insight

Discussions and questions asked helped a lot.

[P18]

7. The association with the experience of

another student

You feel a closer association to the work

because it is peer-based. [P2]

8. Provides an opportunity to analyse a case By analysing a real-life case, I now know how to

approach certain problems / conditions. [P64]

9. Helps to keep up to date

It helped a lot, forced me to revise and read up

on theory already discussed throughout the

year. [P56]


Most of the participants made recommendations that will be reported on in the following

theme. Many of the participants mentioned no personal changes, while a few stated that

177

they could have paid more attention, rose earlier and be more alert during the experience.

Lastly, they acknowledged that they could have taken more notes to enhance the learning

experience for themselves.

Getting up earlier to feel better at case presentation. [P20]


Under this theme, the participant’s reports on their feelings about the assessment will be

discussed. The overall feelings expressed as well as the feelings they had on the fairness,

the rubric used for the assessment and feedback will be discussed as sub-themes.

i. Overall feelings

In general, the feelings reported from a learning perspective were mainly positive.

Participants reported that they felt positive about the assessment and that it was enjoyable

and a good way to learn from their fellow classmates. The fourth-year participants

maintained that the assessment was objective because lecturers, as well as peers, were

responsible for the assessment. Other feelings about the assessment were that it was

insightful, interactive, helpful, necessary, comprehensive and motivating.

It is a nice educational experience for everyone, not only the presenter. [P30]

The negative feelings that were reported for the assessment were mainly as a result of the

public speaking aspect of the experience and the feelings that the comments and questions

after the presentation were harsh and unnecessary.

Negative. I believe it is cruel and too stressful to present in front of all these

people. [P47]


The majority of participants felt that the assessment was fair. The participants mentioned

that the same rubric was used for everyone and that everyone was allowed to ask questions

and be involved. In addition, they contended that there was enough preparation time, the

assessment was comprehensive and more than one lecturer assessed the case

presentations.

178

Fair. All important points are assessed and given marks for. [P53]

A few of the third-year participants mentioned that the fairness of the assessment depended

on the presenter’s public speaking ability, the feedback provided by the supervisors, and

the level of complexity of the case presented.

Some cases are more difficult than others, so fairness is not always the same.

[P38]

Some participants reckoned that the assessments were unfair. Reasons for this were that

in their opinion the students presenting first would make more mistakes than those

presenting later in the year. In addition, the level of difficulty of the cases were mentioned.

Again, some participants responded that not everyone was comfortable with public speaking

and that they were put under pressure with difficult questions.

Unfair, some students are more comfortable speaking in front of people.

[P51]

iii. Rubric used for the assessment

The participants had a positive perception of the rubric used for the assessment. It was

found fair, comprehensive, focused, sufficiently well explained and well laid out.

(The rubric was) fair and covered all aspects. [P54]

However, negative feelings were also voiced. Some of the third-year participants mentioned

that they were unsure about the rubric, as they had never seen the rubric. A couple of

fourth-year participants responded that the rubric was subjective and incomplete.

iv. Feedback provided

The feelings reported about this theme varied. Some of the participants expressed their

feelings as positive and maintained that the feedback was good, helpful and sufficient and

had aided them to identify mistakes, while others had negative feelings regarding the

feedback and maintained that the feedback was not of a high standard, was minimal and

sometimes cruel and degrading.

179

Feedback is excellent and I like when lecturers explain certain things that

they picked up during the presentation. [P44]

Sometimes cruel and degrading, mainly because it is done in front of

everyone. [P28]


The first recommendation made by the participants involved the attendance of case

presentation. Second-, third- and fourth-year participants maintained that second-year

students should only attend in the second semester after some theory had been explained.

In contrast, some third- and fourth-year students posited that even first-years should

attend, while one fourth-year participant mentioned that only third- and fourth-years should

attend. In addition, the participants emphasised that everyone should be on time.

I would let the second-years sit in for the second semester when they have

been taught the majority of the terms and tests being talked about so that

they know what’s going on. [P9]

In conjunction with the first recommendation, the second recommendation included that

there should be a brief explanation of concepts in order for everyone to understand the

case to be discussed.

As a second-year, we don’t have as much knowledge about everything the

3rd and 4th years have, so I am lost sometimes, but I try to make it out. So,

I will say that they must just give a brief overview of the things they talk

about we have not done. But it is a great learning method. [P13]

Also, a few participants, especially from the third-year group, recommended that the time

of the case presentations should change and it should be moved from a Friday and start

later. One fourth-year participant recommended that it should happen on alternating

Fridays.

With regard to the presentations, the participants recommended that the duration of the

presentations should be shorter and there should be fewer presentations on one day.

180

Participants also mentioned that the presenters should be well prepared. The third- and

fourth-year participants, in particular, proposed that the supervisor involved in the case

should provide guidance to the students before the presentation. Some third-years

mentioned that more information should be provided beforehand for the presenters to

prepare better.

Providing rubrics to the students or a format of what should be presented.

[P40]

Supervisors of a specific case should see the students’ case beforehand to

help them iron out the kinks. [P57]

The participants also recommended that the case reports should be available after the

presentation.

The cases presented the day should be made available on Blackboard for

anyone who wishes to learn more / reflect back on a past case presented.

[P64]

The participants also made recommendations about the type of case presented. The

participants stated that there should be a standard set for cases to prevent non-interesting

cases to be presented. One participant even mentioned that only fourth-years should

present as the most interesting cases are seen in specialised clinics. Moreover, it should be

ensured that there is no repetition of cases. A fourth-year also mentioned that the research

should be on new information and not a repetition of lectures. Lastly, they recommended

that lecturers also present unusual cases they had seen.

On the assessment, the participants recommended that there should be more peers

involved in the assessment. To create an environment of sharing and learning, one

participant recommended that the assessment should not count for marks. Fourth-year

participants recommended that the rubric should change to include the level of difficulty of

the case and that the rubric should also be discussed. A pre-determined panel of assessors

was also recommended.

All observers are to judge the presenter. [P37]

181

Linked to the recommendations in the presenter section, and to create a safer learning

environment for the students, the participants made recommendations regarding the

feedback and question session after each presentation. The participants mentioned that in

their opinion, the feedback should be less critical and more positive, constructive and

supportive. A number of participants also recommended that the feedback should be given

in private to each presenter and not in the presence of the whole audience.

Lecturers just being a bit more compassionate – it is terrifying to present a

case in front of 3rd years. Invariably stupid mistakes are made, but students

should not be patronised. [P42]

More educational and supportive rather than the bad criticising environment

it is at this stage. [P59]

Regarding the questions, the participants recommended that they should be asked in a

more positive manner, limited to each presenter and to involve each year group - a student

from each year group should ask a question.


undergraduate optometry students on attending case presentation


optometry students on attending case presentations is presented in Figure 4.8. and

discussed in the subsequent section.

FIGURE 4.8: SUMMARY OF THE EXPERIENCES AND PERCEPTIONS OF UNDERGRADUATE OPTOMETRY STUDENTS ON ATTENDING CASE

PRESENTATION [Compiled by the researcher, Kempen 2018]

CASE

PRESENTATIONS

=

PEER LEARNING

Exposure to

variety of most

interesting cases

Feedback and

questions:

Valuable and

insightful, but critical

and judgmental

182

Analysis of the questionnaires on this particular experience identified that undergraduate

optometry students perceived case presentations as a favourable teaching-learning

method. The benefits for the presenters had been noticed, as discussed in the previous

section, but in reality, the facilitators had to ask students to pay attention and put away

their cell phones or other study material during the case presentations. Therefore, the

positive response was unexpected.

The main element contributing to this positive experience was that peer learning took place

through the presentation of a personal clinical experience. Students recognised that they

learnt much from their peers and supported the use of case presentation as a teaching-

learning method. Participants reported that they were more likely to listen and pay attention

to a presentation of a peer than of a lecturer. This is in contrast to the data analysis of the

results on lecturing (cf. 4.4.1.2) and flip the classroom (cf. 4.4.2.2), where the participants

emphasised the importance of receiving information from someone they acknowledged as

a knowledgeable superior. The participants asserted that they regarded the explanations of

concepts as provided by their peers at the same intellectual level, but it also might be due

to the close association they had with the experience of their peers and that they respected

the work that the presenter had done and the effort of standing in front of a group of

people to present the case.

The exposure to different, interesting and unique cases was acknowledged as a key factor

that enhanced the learning of this experience. It seems that students preferred a visual,

practical teaching-learning method, and perceived the presentation of a clinical experience

beneficial as well as the research component that also added to the knowledge

enhancement. Attending a case activates the reflective observation mode on the

experiential learning cycle and for the researcher, as an observer in the audience, it was

apparent that the students enjoyed the freedom to be in control of when and to what they

paid attention.

The data suggested that through the case presentations, the students could identify the

correct clinical techniques and consequently, this enhanced their clinical skills and

management of conditions. This finding corresponds with the statement of Gardner et al.

(2010:737) on case presentation and clinical knowledge improvement. For this reason, the

participants in this study felt educated, enriched, satisfied and informed after going through

this experience. Similar to findings reported in the literature (Sandal et al. 2013:562), this

study suggests that benefits of the experience depended on the type of presenter.

183

Presenters should be well prepared and the supervisor involved in the clinical case should

guide the presenter before the presentation. Under such guidance, the presenter will

present the case with confidence and improve the effectiveness of the experience. The

emphasis should be on guidance only, as students should still take responsibility for the

presentation as previously mentioned (cf. 4.4.6.3). Other reasons related to the

effectiveness of the experience also surfaced in this study and included punctuality of

attendees and the selection of the cases to avoid repetition. The time slot on a Friday

morning was the only time when the students in all three-study years (second to fourth)

were available. The participants might perceive that time as too early, but the case

presentations started at the same time as the lectures on the other days of the week.

However, for some or other reason, there always were a few students that arrived late and

blamed it on traffic or the lack of parking on campus. Perhaps there was a psychological

reason, namely that Friday is the end of the week and the energy levels for attending

lectures are generally low. Although it will be an administrative nightmare, maybe another

timeslot should be chosen - a time slot that is not early in the morning and not on a Friday,

but it first should be established whether it really was the time of day at which the

presentations were offered or the activity itself that impacted the students’ ability to

concentrate. On the perception of repetition, the cases presented were dependent on the

type of cases the students had experienced in the clinical environment. Although there are

specific measures in place to limit the repetition of cases, it is unfortunately unavoidable.

The fourth-year students had a broader spectrum of cases to choose from, as they had to

present specialised cases from the five specialised clinics, but only a limited variety is

present among the general cases from which the third-years must select one to present.

The aim is that the students must master the way in which eye examinations are conducted,

and they must know which procedures to perform and how to interpret the results. Also,

the time should be available for opportunities for the students in the audience to gain clarity

on any uncertainties.

The opinions on the study-year level of the students who should attend case presentations

were conflicting. Second-year optometry students did not have the theoretical and clinical

knowledge to understand and follow most of the concepts as they only had optometric

theory and methods explained during their second study year. For this reason, some

perceived the experience as overwhelming and had feelings of uncertainty that might have

influenced their experience negatively. However, the overall analysis of the data indicated

that case presentation prepared students for the future and the early exposure was found

valuable. This supports continuing with the attendance of second-years, although some

184

participants will disagree. The researcher is of the opinion that with this early exposure the

students are empowered to progressively build their theoretical and clinical knowledge and

ultimately their understanding and independence, which will favour their ability to do their

own presentation in future, and in general will encourage participation in discussions on

clinical matters. Early exposure to clinical situations also serves as motivation and fosters

the integration of theory and clinical practice. This was confirmed by the responses of a

number of fourth-year optometry students who expressed the opinion that, after having

gone through this experience for three-years, they recommended that even first-years

should become part of this teaching-learning exercise. This confirms the positive

contribution of this experience over a number of years. Furthermore, the positive outcome

of early attendance, therefore, should take precedence over the opinions of students who

were of a mind that those students who present later in the year have an advantage, as all

of them had the same exposure.

The success of this experience, however, was overshadowed by an atmosphere that was

perceived by participants as stressful, degrading, critical, judgemental and cruel. The fear

of public speaking might have contributed to these feelings, but these feelings probably

largely may be attributed to the way in which the feedback was given by a lecturer/assessor

during and after the presentations of the cases. For this reason, the learning environment

was perceived as unfavourable by the students - as one participant stated, not educational

and supportive [P59]. This critical factor also has been identified in the data collected from

the presenters and therefore requires urgent attention within the Department. For an

optimal learning experience, students need to feel safe. No learning experience should be

driven by fear. To feel safe, they should have the courage to make mistakes and learn from

the mistakes, a vital factor that has been highlighted by participants. In this specific scenario

the learning of the presenter, as well as the student in the audience was negatively

influenced, as the audience empathised with the presenter and became anxious about the

day it would be their turn to present. The feedback and questions at the end of the

presentation must complete the experience, and lecturers should use this as a teaching

opportunity. As mentioned before, the researcher has never experienced that the comments

made were uncalled for, but there might have been times when the manner or voice and

tone in which the comment was made might have caused the students to feel the remark

was derogatory, or even cruel and a personal attack. Lecturers should take care to be more

sensitive. The participants appreciated the feedback and perceived the questions as

valuable, hence supervisors should pay attention to be more compassionate and non-

judgmental towards the students while pointing out areas of improvement for not only the

185

presenter to learn but also the audience. As mentioned previously, it is inevitable that

students will make mistakes (even under the guidance of a supervisor). The researcher is

of the view that the attitude of the lecturer/assessor attending the case presentation and

the manner in which they provide feedback will determine whether the presenting students

and the audience will learn and benefit from these mistakes. Lecturers/assessors rather

should have a positive influence on students’ confidence and provide motivation not to

repeat the mistakes. Perhaps paying attention to the atmosphere in the venue during a

case presentation may change the students’ attitude towards attending the presentation

early on a Friday morning and students (especially the second-years) might feel more

comfortable to actually participate in the discussion afterwards, which currently is not the

case.

Nonetheless, the majority of participants in this study perceived the teaching-learning

method as positive. Clear examples were provided of enhancement of clinical practice, a

factor that improved their confidence in patient management and communication.

Therefore, the results of this study confirmed Herbert and Wright’s (2003:1250) opinion on

the value and definite place of case presentation as a teaching-learning method.

The next teaching-learning method that will be analysed and discussed is peer assessments.

186

4.4.7 Results of the questionnaire survey on peer assessments

______________________________________________________________

In the following section, the application of the teaching-learning method, peer assessment,

will be discussed and followed by the questionnaire results and a discussion of the

responses of the students after having experienced peer assessment.

4.4.7.1 Peer assessment for the purpose of this study

Peer assessment should be conducted as part of a curriculum, and care must be taken that

the assessment is relevant and the application useful (Finn & Garner 2011:443). Gielen and

De Wever (2015:317) explained that the lecturer should provide detailed instructions on

the expected performance before implementing peer assessment. Pharikh and Sheenan

(2016:822) confirm the importance of formal instruction to students in this regard as it may

improve students’ confidence to assess their peers’ work and enhance the feedback that

they provide. Therefore, before each peer assessment session a short training session was

offered to explain how the assessment criteria should be applied and how to use the specific

rubric (cf. Finn & Garner 2011:444; Alias et al. 2015:310). The learning objectives of the

session were also explained to the students to ensure that they understood the alignment

of the assessment criteria with the outcomes (cf. Rush et al. 2012:221; Elshami & Abdulla

2016:9).

For the purpose of this study, peer assessment has been used multiple times on different

occasions, as explained below.

Peer assessments used with other teaching-learning methods

Peer assessment in the module GENA 2612 was used for the group assignment as well as

the flip the classroom approach. The students were randomly divided into groups and

instructions about the assignment were communicated at the beginning of the module. The

rubric was also provided to the students.

On the day of the presentation, students had three to five minutes to present the poster.

Each member of the group had an opportunity to present, therefore, everyone had to

contribute to the group assignment. The groups rotated around the posters until all the

posters had been presented to each group.

187

After each presentation, the students were allowed time to score the rubric. To increase

the validity and reliability of this peer assessment, it was done anonymously and more than

one assessor assessed each poster (cf. Vickerman 2009:223). The mark of the assignment

accounted for 30% of their predicate. The total sample population of 20 second-year

students completed the questionnaire on each teaching-learning method, respectively. This

represented a 100% response rate.

Peer assessments were used in modules DGNS 3702 and PATH 4802 to complement the

flip the classroom approach (cf. Topping 2009:23), by assessing the activities that occurred

when this approach was applied. In DGNS 3702 students had to assess each other, with

the use of a rubric, on the slit lamp procedures. The peer assessment in DGNS 3702 had a

twofold aim - to promote student engagement and to get familiar with the rubric that would

be used during formative and summative assessments. Thirty-one (31) third-year students

completed the questionnaire that represented a 100% response rate.

The flip the classroom activity in PATH 4802 entailed the design of a diabetic retinopathy

case which was presented to the whole class. Peer assessment was used by the students

to critically analyse each presentation and adjudicate the understanding of the other group

of students of the process of diabetic retinopathy (cf. Rush et al. 2012:220). The students

were provided with an opportunity to reflect on the clinical assessment of a diabetic patient,

as recommended by Jhangiani (2016:180). The students were familiar with the rubric as it

was the same rubric that was used for the case presentations. Of the 17 fourth-year

students, 16 completed the questionnaire, which is a 94.1% response rate.

Peer assessment in the Pathology clinic

Peer assessments also were introduced in the clinical module, COPT 4800 (Pathology clinic).

Due to peer assessments during the clinic sessions, the students were enabled to identify

areas needing improvement, and misconceptions and knowledge gaps could be identified.

The students who did the assessment also learnt how to use the rubric, and they became

acquainted with the marking criteria (cf. Alias et al. 2015:316).

Students were randomly divided into groups and each student had the opportunity to assess

and to be assessed. Since the results of the assessment may be biased depending on

friendship bonds, popularity or hostility (Topping 2009:24), a rubric was provided for each

188

assessment to ensure that the student was marked objectively and that the feedback

provided would be consistent (Elshami & Abdulla 2016:12).

Supervisors were available throughout the assessment to ensure proper implementation

and to provide support to the students (Vu & Dall’Alba 2007:551; Vickerman 2009:222;

Elshami & Abdulla 2016:9). After each assessment, the students were encouraged to

provide immediate feedback to their peers (Topping 2009:22). Students were informed that

feedback should be informational, motivational or reinforcing (Gielen & De Wever

2015:317).

The response rate for the completion of the questionnaires was 100%; 17 fourth-year

students completed the questionnaire.


undergraduate optometry students on peer assessments used with

other teaching-learning methods

Within this analysis, only one theme was identified, namely the students’ feelings about

assessment, with four sub-themes. The sub-themes with their different categories and

subcategories are summarised in a table (Appendix H-8). The data analysis and discussions,

with direct quotes from the participants’ responses, will be reported in the same sequence

as the sub-themes. The discussion of the results is included in the combined discussion at

the end of this section.

Theme 1: Feelings regarding assessment

The theme, feelings regarding assessment, included the following sub-themes: overall

feelings, fairness of the assessment, feelings on the rubric used, and feedback.

i. Overall feelings

In this sub-theme, the participants expressed their feelings about the peer assessment used

with the other teaching-learning methods. The majority of participants had overall positive

feelings about the peer assessment; they felt creative, comfortable, content, interested and

productive.

189

Second-year participants reported that the peer assessment experience was pleasant, fun,

fair, interesting and successful. Feelings of contentment and satisfaction were reported.

The participants reported that these feelings could be attributed to the relaxed assessment

environment, the final mark was an average from a few assessors’ marks and their peers

understood the assessment conditions.

I feel glad that it was peer assessed as the others understand the work we

had to put in and nervousness of presenting. [P7]

Third-year participants found the peer assessment useful and helpful to clarify procedures

and expectations, and it helped to identify weaknesses and improve their time

management. These participants also felt that peer assessment promoted a calm learning

environment.

Positive, creates the impression of an actual assessment but cultivates

calmness. [P20]

Some of the third-year participants felt excited, happy, relaxed and satisfied with the

teaching-learning experience and found the experience very useful as it is a practical way

of learning. In addition, they felt that the assessments were in the best interest of the

student, improved their skills and were proper preparation for the formal assessment.

... good technique of assessment. Will help to prepare for the formal

assessment. [P31]

The fourth-year participants expressed their feelings by responding that the peer

assessment broadened their knowledge as they were forced to understand the work and

pay attention to enable them to present their cases. Another positive factor was that the

peer assessments were a different kind of teaching-learning method and, similar to the

second-years, the participants mentioned that peer assessment was fun and enjoyable.

It was fun, and all of us felt that we learn rather than just writing tests. [P14]

Some participants in the second- and third-year had mixed feelings on the assessment.

They felt stressed and anxious, but the peer assessment was a positive learning experience

190

and they learned a lot. One participant responded by acknowledging he/she felt

uncomfortable being assessed by peers.

A few participants of each year-group voiced negative feelings towards peer assessments.

They reported that they felt lost and that the assessment mark was not an accurate account

due to it being a peer assessment.

Not very accurate. Some of us understand the work better, therefore, will

receive better marks. [P16]

Some of the negative feelings originated from the assessment entailing group work as well

as a public-speaking component. A second-year participant felt that the assessment did not

create an understanding of the work, and a fourth-year participant felt that it created

negative energy and that it triggered anxiety. The participants also mentioned that the

marks of the assessment were not a true reflection of the understanding of the participants.

... I don’t like the vibe it brings when students ask each other questions and

put each other on the spot like this. It brings negative energy to the class.

[P10]


Almost all the second-year participants felt that the assessments were fair. This was due to

everyone receiving the same opportunity to do well. Most third-year participants felt that

the assessments were fair and provided reasons such as that the assessments replicated

formal assessment conditions, were consistent, and they had no say in who would be

assessed by whom. They were well informed about the assessment and everyone was

assessed according to the same rubric within the same amount of time. Being assessed by

a peer ensued in no-one feeling discriminated against or being put under pressure.

Good, because we as students were all equal and is still busy to learn, so it

is nice to learn from them (peers) and listen to their techniques. [P20]

All the fourth-year participants reported that the assessment was fair, mainly because it

was a peer assessment. The fact that it was also a group assessment and everyone used

the same rubric also contributed to the fairness of the assessment.

191

I believe the assessment is fair as you are assessed by peers with the same

point of understanding as you. [P10]

Some participants mentioned that the public speaking component of the assessment

affected the fairness as not everyone feels comfortable doing it. One participant felt the

assessment was unfair because ...we always give each other good marks. [P16]

A few second-year participants stated that the assessments were unfair due to the peers

having no previous assessment experience.

... some students may be excessively strict as they may have no previous

assessment experience. [P10]

A participant in third-year felt that the assessment was unfair due to peers assessing with

no help from the lecturer.

Not fair, we as students do not always know what is correct according to the

standards. [P2]

iii. Rubric used in the assessment

Second-year participants felt positive about the rubric that was used. They mentioned that

it was appropriate, comprehensive, fair, good, sufficient, understandable and well thought

through. In contrast, some participants had negative feelings about the rubric and felt that

the sections overlapped and were not specific and that the rubric was vague and

ambiguous. While some felt the rubric was complete and user-friendly, others mentioned

that the rubric was confusing, inadequate and subjective.

Feelings regarding the rubric reported by the third-year participants also were

overwhelmingly positive. The participants claimed that the rubric was well compiled,

complete, correct, descriptive, sufficient and understandable. They also mentioned that the

rubric was clear, and spelt out expectations well, and had fair rating criteria. Some

mentioned that with the help of the rubric attention was focused and that it was easy to

follow. The rubric also contributed to the fairness of the assessment and the participants

mentioned that it was objective and were available before the assessment.

192

Extremely helpful, gave additional insight to important procedures to follow.

[P4]

In contrast, a couple of third-year participants felt that the rubric was vague and inaccurate.

Due to the inexperience of students regarding marking, it may not be the

most accurate. [P11]

The fourth-year participants described the rubric used in the assessment as clear,

comprehensive, sufficient, summarised, well-constructed and user-friendly. One participant

did feel that the rubric had grey areas, as these areas were not included in the instructions.

Presentation tools and references is a grey area as it was not included in the

instruction. [P7]

iv. Feedback on the assessment

Limited data on the feedback were received from the second-years as most participants felt

that no feedback was given. This might be true and perhaps indicated that the junior

students might not feel sufficiently comfortable to provide feedback to others. Some of the

second-year students, however, mentioned that the feedback was good, effective and

adequate.

Some third-year participants stated that they found the feedback after the assessment good

and helpful and felt happy and satisfied with the feedback. The feedback created a

calmness, set the participants at ease, and provided an opportunity to reflect on the

experience and see it from different perspectives.

Good – saw other perspectives and was actually able to reflect instead of

jumping to another thing. Helps you see where others were battling vs where

you battled. [P13]

The majority of these participants mentioned that the feedback was complete, to the point,

informative, sensitive and personal and that the small group created a safe environment

for them to share their feelings. They found it helpful to talk to the lecturer and felt that

the lecturer listened.

193

The lecturer listened and explained some of the issues. [P30]

One participant experienced the feedback negatively, as he or she felt uncomfortable to

share feelings.

I am not too fond of speaking about my feelings. [P21]

The analysis of the responses of the fourth-year students revealed that the participants felt

the feedback was adequate, constructive, informative, sufficient and helpful. The feedback

was said to enable participants to identify weaknesses and to take note of remarks that

could be applied to improve future presentations. Although a small number of students

were of the opinion that the feedback was comprehensive, one participant did feel that no

feedback was given on general mistakes. They valued the feedback that was given by peers.

The feedback was constructive. It helped that our peers also could give

feedback, and the use of feedback improved our understanding without

humiliation. [P2]

4.4.7.3 Analysis and description of the experience and perceptions of

undergraduate optometry students of peer assessments in the

module Clinical Optometry (COPT 4800).

Each theme, with its categories and subcategories is summarised in a table (Appendix H-

9). The data analysis and description of the findings with direct quotes from the participants’

responses are discussed.

Theme 1: Objective

Two categories were identified within this theme. The first objective identified was: To

become familiar with the assessment process in the Pathology clinic. Participants claimed

that peer assessment enabled them to experience the feeling of being assessed.

… to stimulate what an assessment would feel like when it is formative. [P13]

Sub-categories that emerged from this category were:

194

(i) Get to know the rubric

A large number of participants mentioned that the objective of peer assessment was to get

to know the rubric that was used during the assessment.

(ii) Work against time

Participants proclaimed that the peer assessment took place under assessment conditions

and forced them to work against time as they would do in a regular teacher-driven

assessment.

… to push myself to work fast and do everything as I would in a real

assessment. [P5]

Participants reported that the second objective of this teaching-learning experience was to

learn from peers.

To learn from each other how other test and identify mistakes for each other

[P10]


Almost all the participants felt that the objectives of this teaching-learning method had been

achieved successfully. Most of the participants noticed that after the experience, they knew

what to expect in an assessment and they became familiar with the rubric.

Yes, I as supervisor saw what was expected on the rubric and also which

tests are indicated and which are not during an examination. [P7]

Other participants also mentioned that they learned from their peers. The peer provided

another perspective and valuable insights. A participant mentioned that the presence of the

peer made him/her more comfortable as it was the first time in the clinic for this specific

participant. In contrast, another participant felt that the objective had not been achieved

due to it being his/her first clinic and the presence of the peer made it more stressful.

Factors that contributed to the successful achievement of the objectives were that the

participants felt that the teaching-learning method was used in a learning environment that

195

was relaxed, pressure-free and comfortable, and the assessor could observe without testing

a patient.

I felt that it provided a comfortable environment where we felt free to ask

questions and give advice to help each other with learning. [P15]



before, during and after the experience. The majority of the participants reported they had

negative feelings before the assessment, but positive feelings afterwards. There were a

small number of participants that felt negative throughout the experience. The feelings, as

reported by the participants at different stages during the experience, are reported below.

i. Feelings before

Mostly negative feelings were expressed before the start of the experience. Feelings of

anxiousness, nervousness, stress and unhappiness were noted, mainly due to the

connotation to it being an assessment. The participants also felt uncertain about the

expectation and the purpose of this teaching-learning method.

Was a bit on my nerves, like with a normal assessment. [P2]

The most mentioned positive feeling was that of excitement. This excitement was due to a

number of reasons. The participants felt excited to see what case they would get, to see

the flow of the rubric, to observe and assess and be assessed by a peer, and consequently

to learn from the peer.

Excited about getting myself evaluated and learning from my assessors’

insights. [P14]

One participant felt neutral about the experience and had no specific expectations on how

it would be.

196

ii. Feelings during

During the experience, most participants experienced positive feelings. They became calm,

relaxed, comfortable and more at ease. Some became really absorbed in the experience

and challenged themselves to perform well. Others mentioned that they found it interesting

and enjoyed the experience.

I felt more at ease, knowing that there is someone who is learning with me

in the case situation. [P15]

Some participants reported negative feelings in that the patient made the experience

challenging, frustrating and rushed. Others were anxious, nervous and flabbergasted about

making mistakes.

Frustrated and rushed. My patient was very frustrating and didn’t really

understand the instructions very good. [P16]

iii. Feelings after

Almost all the participants felt positive after the experience. Most of them felt satisfied with

the experience, as well as with their performance. Some also mentioned that they felt

relieved, informed, confident and more comfortable with the clinic and the assessment.

Satisfied, also more confident in diagnosing certain conditions in a patient.

[P6]

There were participants who still had negative feelings after the experience and felt

disappointed in their own ability.

Theme 4: Strengths

The participants identified seven strengths in this teaching-learning method. These seven

strengths of peer assessment, with direct quotes from the participants, are illustrated on

the next page in Table 4.11.

197

TABLE 4.11: STRENGTHS OF PEER ASSESSMENT IN THE CLINICAL MODULE AS IDENTIFIED BY UNDERGRADUATE OPTOMETRY STUDENTS, UFS


1. Get familiar with the assessment process

and the rubric

I was able to know how an examiner feels and

what the objectives of the examination are. [P3]

2. Done in a comfortable environment Peer assessments allow us to go through the work

in a comfortable environment. [P15]

3. Provides an opportunity to identify own

knowledge

You can see on which level you are, without it

counting marks. [P11]

4. Improved clinical skills You have to pay close attention to procedures. [P9]

5. To be able to learn from peers I learned from my peers’ strengths and

weaknesses. [P3]

6. Real-life experience It gives a real-life feel to what would be expected.

[P13]

7. Stimulates thinking process

It allows you to think more than when usually

examining the patient and thus improves the way

you approach things. [P8]

Theme 5: Weaknesses

Five weaknesses were identified from the completed questionnaires. These are reported

below.

Having a person with you while you test a patient

Within this category, some participants mentioned that the extra person made

communication with the patient difficult and also created nervousness.

Having someone there all the time makes the patient nervous as well as the

examiner. [P11]

The feedback was not done respectfully

A participant mentioned that they did not receive any feedback from the peer assessor and

another mentioned that the feedback was given in front of the patient, making them seem

incompetent.

198

Peers might be prejudiced

Participants mentioned that peers might be biased towards some students. That it was

someone they knew made the situation uncomfortable, as they did not want to make

mistakes in front of friends and people they knew well. A few participants also mentioned

that their peers might not have had sufficient knowledge to be able to assess correctly.

We as students do not always know what the correct answer is and when

and where to penalise due to this. [P8]

The rubric

The rubric was considered a weakness of the experience. Participants mentioned that it had

not been explained and made available before the experience and the way it has been

compiled was regarded open for discussion.

I think the rubric leaves a lot to own interpretation. [P15]

Time-consuming process

The last weakness identified was that the experience was a time-consuming process. This

was mainly due to the broken equipment in the clinic.

Broken equipment, especially the slit lamps in the clinic, is a major concern.

A lot of time is spent waiting for equipment. [P16]



their learning and understanding. The main factor that enhanced learning was the guidance

that the experience provided to become more familiar with the Pathology clinic, the

assessment procedure, and the rubric.

I understand the flow better and also what is expected of me when

examining a patient. [P7]

Secondly, the fact that they had the opportunity to learn from their peers was also

mentioned. Seemingly the peer assessment provided another perspective and approach to

199

the techniques. Participants also valued learning from their peers’ mistakes and the

feedback provided.

I’ve learned more by asking help from my friend and seeing what we each

struggled with. We have different strengths, so we use our unique set of

strengths to improve each other’s knowledge. [P15]

Other factors promoting learning were that the peer assessment provided the participants

with confidence, helped with integration and problem-solving skills and probed their critical

thinking. As they also went through the experience, they could identify areas in which they

needed to improve. Lastly, they mentioned that the practical aspect of the teaching-learning

experience enhanced their learning.

Practical exposure is always helpful in retaining information. It allows you to

take note of small mistakes everyone makes. [P8]


From the theme, personal changes, the following categories emerged. Some of the

participants felt that the findings should have been checked.

Being able to check findings and do the procedures (necessary) as well,

although this would be time-consuming. [P9]

Other changes were to have more confidence, to listen to the peer, not to be intimidated

and too aware of the assessor and to ask the assessor more questions. Some also

mentioned that they could have taken notes and worked through the rubric with their

assessor at the end.


The last theme from the information on the questionnaires was the recommendations from

the participants to enhance the learning experience with the use of peer assessments. Some

participants recommended that this experience should be implemented more regularly and

in all the speciality clinics.

200

To do this more than once, better, and more experience will always benefit

the learning and examinations during the year. [P12]

Regarding the experience itself, the participants recommended that the students should

choose their own assessor, they should be placed in a clinic with working equipment, should

have only one patient to see in the clinic for that day, the findings should be re-checked,

and if only done once, it should be done later in the year.

Only get the person being assessed to see one patient on that day so as to

thoroughly invest in the learning method and to focus on the case at hand.

[P6]

On the feedback, the participants recommended that time should be provided for the

feedback to be more comprehensive. It should also be done during the examination, but

not in front of the patient.

It would be nice if the assessor and the lecturer/supervisor could give

thorough feedback on the eye examination and also give tips on how to

improve. [P5]

The participants also recommended that the rubric should be explained, made available

before the session and be changed to yes/no criteria.

A rubric with yes/no or a clear system, where it is easy to mark and count

marks would be better [P15]

Lastly, they recommended that this experience should be repeated with a supervisor being

the assessor.

Maybe have a peer assessment as well as a mock assessment where you

actually get evaluated by the supervisor, but the mark doesn’t count for

anything. [P1]

201


undergraduate optometry students on peer assessment

A summary of the data on the experiences and perceptions of undergraduate optometry

students regarding peer assessment is presented in Figure 4.9. A discussion on the data

follows after.


UNDERGRADUATE OPTOMETRY STUDENTS ON PEER ASSESSMENTS


From the analysis of the data, it may be inferred that peer assessment overall was perceived

as a positive learning experience. Throughout the data, it is evident that peer assessment

created a comfortable, relaxed and calm learning environment where learning took place

without students being pressured or discriminated against. One of the factors that seemed

to have contributed to this safe learning environment was that participants felt that peers

PEER

ASSESSMENTS

Calm, relaxed

environment

May be

uncomfortable

Student-

centred approach

Peers understand the condition in which

assessment takes place

Learning with and

from peers. Identify own knowledge

Peers may be biased for or against another peer

Anxious and nervous to make mistakes in front of

peers

Creates

negative

energy

Peers do not have sufficient

knowledge

Practical and

effective

202

understood the conditions under which the assessment took place and therefore they had

more empathy towards the students being assessed. On the contrary, a number of

participants in this study pointed out that even though the learning environment was mainly

perceived as safe, peer assessment could create negative energy between students and

trigger anxiety if not implemented correctly. It is, therefore, crucial for a facilitator of

learning to be present in the environment where the peer assessment takes place to prepare

and provide guidelines and guidance throughout the peer assessment process. The

facilitator might have to adopt a mediator role in peer assessments to ensure that the

assessment does not create an environment where students have carte blanche on the

handling of the assessment. The use of a rubric limits the possibility for the students to be

biased and jeopardise the assessment of classmates. The participants mentioned that the

use of a rubric contributed to the fairness of the assessment.

In the clinical environment, peer assessment promoted learning through the observation of

a real-life experience. In support of Topping’s (2009:20) definition of peer assessment,

participants mentioned that while assessing and being assessed they could learn with and

from each other and identify their own knowledge and the level at which they were.

Probably, this awareness of their level of knowledge consequently improved their clinical

skills and clinical reasoning as they were able to observe a different approach from a

different perspective and learn from the mistakes their peers made or the advice the peer

assessor provided. It is also possible that after going through this learning experience,

students had more confidence in their own ability to consult patients as the experience

provided a fitting example for the students to build on or change their own way of examining

a patient.

Contrary to Alias et al.’s findings (2014:310), the data of this study indicated that the results

of the peer assessment (marks according to the rubric) were not a true reflection of the

learning that took place and consequently of the understanding of the work or real

competency. It should be noted that it seems from the responses that students mostly give

each other good marks. This was true for this study as well, although some participants

expressed the feeling that peers might have had preconceived ideas and could be biased.

Secondly, in concurrence with Elshami and Abdalla’s views (2016:10), it seems as if some

students did not have sufficient knowledge to distinguish between right and wrong and

therefore were incompetent to assess another peer accurately. Taking this into

consideration, the researcher is of the opinion that peer assessment should possibly for this

reason not be implemented as a formative assessment, as suggested by Gielen and De

203

Wever (2015:3160) and Jhangiani (2016:180), but rather, like in the case of this study, act

as preparation to an assessment and to familiarise the student with the rubric that will be

used in an assessment.

It was interesting to note that although peer assessment should create an independent

learning platform (Vu & Dall’Alba 2007:542), the participants of this study requested the

assistance of a supervisor and recommended that the experience should be repeated before

a formative assessment, but with the peer assessor replaced by a supervisor or that a

supervisor should be more involved. The participants also mentioned that the assessment

was unfair due to the supervisor not helping. Although impractical due to time and human

resources constraints, this also is in contrast with the definition of peer assessment as

defined by Topping (2009:20), who proclaimed that the responsibility for the assessment

should be on students’ shoulders, but in this study, it seemed that the students did not

want to take ownership of the learning process. Perhaps the request that a

supervisor/lecturer should be involved in the assessment indicates that even though it

seems that the students had a positive experience with a peer, they would still prefer to

learn from and receive confirmation of their abilities from someone with more authority

and, in their perception, someone who has more knowledge. This finding surfaced

throughout the data on other teaching-learning experiences such as lecturing (cf. 4.4.1.2)

and flip the classroom (cf. 4.4.2.2).

The findings of this study concur with Elshami and Abdalla’s (2016:12) findings that peer

assessment was found to be time-consuming. It should be noted that in this particular study

the researcher is of the opinion that the peer assessment did take longer as it should, due

to broken equipment in the clinic resulting in students having to wait to perform specific

tests. This created frustration not only for the students but also for everyone involved, the

patients as well as the supervisors. Although every effort was made to ensure that all the

equipment was in working order, it must be taken into account that it is the Department of

Health’s responsibility to repair the equipment and the process usually takes some time.

The aspect that was lacking in the peer assessment in this study was immediate individual

feedback, as described in the literature as an integral part of the peer assessment process

(Gielen & de Wever 2015:315). Although some participants mentioned that they received

feedback during and after the assessment, the lack of feedback was identified as a

weakness and should be addressed. Although it was mentioned during preparation for the

peer assessment that students should stay together after the experience and go through

204

the rubric to have a discussion on the assessment, it seemed that the students that had

assessed left, and the others continued with the clinic. The lack of feedback also could be

due to the students feeling uncomfortable to point out mistakes and areas that required

improvement, and that junior students felt incompetent or unfit to provide feedback. The

feedback session of the peer assessment of the slit lamp exercise in the module DGNS 3702

was conducted in the presence of the facilitator who guided the students in the process of

reflection. Responses, in this case, were overwhelmingly positive, indicating that the

involvement of the facilitator is essential in the feedback process after peer assessment -

not only to ensure that it takes place, but also that it be done constructively. Any feedback

or comments after observations or examinations always should be done professionally and

respectful and in private.

In conclusion, similar to what was found in the literature (cf. 2.3.3.2.7), peer assessment

was identified as a practical teaching-learning method that engages students throughout

the learning process. The effectiveness of this teaching-learning method is ensured by the

compulsory active involvement of both parties. The data indicate that peer assessment

encouraged all four modes of the experiential learning cycle, with abstract conceptualisation

and reflective observation being primarily activated. Equally important, the data indicated

that peer assessment was regarded as a student-centred approach and in the best interest

of the students.

The following teaching-learning method that will be discussed is bedside teaching.

205

4.4.8 Results of the questionnaire survey on bedside teaching

______________________________________________________________

In the next section the application of the teaching-learning method, bedside teaching, will

be discussed, followed by the results of the questionnaire survey on bedside teaching and

a discussion of the responses on this specific teaching-learning method.

4.4.8.1 Bedside teaching design for the purpose of this study

Bedside teaching can be defined in various ways. For this reason, it should be clarified what

constituted the bedside teaching in this educational setting. The bedside teaching model

that was used for this study was an apprenticeship.

Apprenticeship, together with role-modelling, is seen as one of the teaching models for

managing bedside teaching (Dent 2009:100). The reasons for using an apprenticeship

approach are threefold. First, to role model a holistic approach to patient care, second, to

provide an opportunity to demonstrate a physical examination of a patient, and the third

reason is for the students to be able to observe the protocol followed in the pathology clinic

(Dent 2009:96). In addition, it provides the supervisor with a valuable opportunity to teach

professionalism without theoretical lecturing (Ramani et al. 2003:113).

In the optometry curriculum where this study was conducted, bedside teaching or role

modelling is practised throughout the clinical rotation, but three sessions were scheduled

explicitly for students to be able to observe a supervisor examining and managing a patient

from the case history until the management plan was discussed with the patient. Three

students were assigned to a supervisor for the session. The supervisors assigned to these

sessions were involved in the pathology clinic, as well as in the teaching of ocular pathology

and had experience in the field of pathology.

Before each session, the students were oriented regarding the objective of the session (cf.

Ramani et al. 2003:113). During the orientation session, students were informed about the

educational objectives for the session (Appendix M) and what would be expected from them

(cf. Dent 2009:102). The environment was familiar to the students, as they had dealt with

patients already in their third-year of study in general clinic rotations. Williams et al.

(2008:258) compiled a list of knowledge and skills acquired during bedside teaching. These

knowledge and skills outcomes formed the objectives for the session, namely:

206

Obtaining a case history

Performing a physical examination

Generating a differential diagnosis

Formulating a management plan

Applying clinical reasoning

Communicating effectively

Exhibiting professional bedside demeanour

Demonstrating empathy

Performing diagnostic and therapeutic procedures

Acquiring knowledge about medical instrumentation.

The students also were provided with the clinical notes as well as the protocol that was

used during the Pathology clinic and were encouraged to familiarise themselves with the

documents and procedures.

Patients that were booked for this session were introduced to the supervisor and students

and informed that the session would be a teaching encounter where the students would

observe the supervisor performing a pathology eye examination on the patient. The patients

were also reassured that they could ask questions at any time of the examination and that

they could feel comfortable with the procedure (cf. Salam et al. 2011:3).

After the session, when the patient had left, the students had the opportunity to ask

questions and time was provided to clarify aspects of uncertainty. A short debriefing session

was held to ensure that there were no feelings of anxiety among the students.

A total number of 17 fourth-year students completed the questionnaire, representing a

100% response rate.


undergraduate optometry students on bedside teaching

Each theme, with categories and subcategories, was summarised in a table (Appendix H-

10). The data as analysed and a discussion substantiated by direct quotes from the

participants’ responses are provided below.

207

Theme 1: Objective


which this teaching-learning method was used? The categories that emerged from this

theme were: demonstration of clinical thinking, demonstration of clinical skills and

demonstration of the flow of the clinic.

Demonstration of clinical thinking

A number of participants responded that the objective of bedside teaching was the

demonstration of clinical thinking. They mentioned that observing the supervisor handling

a patient would demonstrate the thinking process of the supervisor in a clinical environment.

To get a better ... way of thinking in approaching a pathology patient. [P5]

Demonstration of clinical skills

Some participants identified the demonstration by a supervisor of clinical skills as an

objective of bedside teaching. They mentioned that the teaching-learning method provided

the opportunity to observe certain procedures that should be performed specifically on a

pathology patient. While the majority of the participants concentrated on tests, some

participants mentioned that bedside teaching includes the demonstration of the handling

and treatment of the patient as well.

... to get to know the work-up and protocol of assessing a pathology patient.

[P4]

... what tests to do and how to do the test, by observing the method of a

lecturer .... [P12]

Demonstration of the flow of the clinic

Most of the participants mentioned that the objective of bedside teaching was to

demonstrate the flow of the clinic.

... to observe the flow of the specific clinic. [P12]

Related to the demonstration of the flow of the clinic, the participants mentioned that the

purpose of this teaching-learning method was to make them more comfortable with and

208

familiar to the clinic, as well as to ensure that they knew what was expected from them to

be better prepared to deal with patients by themselves.


In this theme, one category emerged, namely, that the participants felt the objectives had

been achieved successfully by using the teaching-learning method.

All the participants agreed that through the teaching-learning method, the objectives of the

session had been achieved. Due to using bedside teaching as a teaching-learning method,

the flow of the clinic was illustrated, and the students experienced calmness and self-

confidence.

Yes, we could observe how an optometrist handles a pathology patient and

how they handle the flow of the entire clinic. [P11]

Yes, I feel much calmer about the pathology clinic and I feel I can now see

and help a patient with more self-confidence. [P13]

A few participants mentioned that they preferred learning by observation and this

experience successfully achieved that.

Definitely, I learn through seeing and hearing, so it was very insightful for

me to go through the process. [P1]

The fact that the supervisors were friendly and helpful also contributed to the success of

the method. One student felt that the success of this method depended on the patient and

that it could have been better if the patient definitely had a pathology.

Yes, although I also feel that if it can be organised that the patient seen

definitely has pathology, a lot more can be learned. [P3]



before, during and after the experience. In the sub-theme, two categories were identified,

namely positive and negative feelings, and these are analysed and discussed below.

209

i. Feelings before

Mostly positive feelings were reported before the participants started with the learning

experience. The participants were excited to learn from the supervisor and to see a real

patient with possible pathology.

I was excited to see my first pathology and to take tips on how examiners

prefer to do techniques. [P2]

The participants also reported that they were interested and curious; interested in being

part of the experience and curious to see pathology in a patient. They also felt reassured

that they would be guided before they had to examine a patient on their own.

It was a reassuring thought that a supervisor would help us before seeing

our first path patient without guidance. [P15]

A few students felt negative before the experience. Feelings of being uncertain,

uncomfortable, nervous, afraid and scared were noted. These feelings were mainly due to

the students not knowing what to expect.

I felt a bit uncomfortable. My expectation was that it was going to be a

session in which we are told everything that we are doing wrong instead of

making us part of the process. [P1]

ii. Feelings during

The participants only experienced positive feelings during the bedside teaching-learning

method. Participants felt inspired and interested while observing the supervisor testing a

patient. They further felt part of the experience and found the experience stimulating,

informative and helpful; thus making them feel more at ease. During the experience, they

also felt they could identify their own weaknesses to improve on them.

The participants had these positive feelings mainly due to them being given the opportunity

to ask questions when they were uncertain, the supervisor explaining everything without

trying to catch them out and working together in a small group.

210

Inspired. It was very inspiring to see how the lecturer works with the patient

and how much knowledge the lecturer has about the patient's condition. [P9]

I became more familiar with the evaluation process and glad that we could

openly ask questions and also learn from other students' questions that I did

not think of. [P5]

iii. Feelings after

A couple of participants voiced negative feelings after the experience. They were

disappointed because the patient they had did not present with any pathology.

Afterwards, when the patient was diagnosed without pathology, I was

disappointed. I did learn from the experience, but not as much as I had

hoped. [P3]

The rest of the participants noted positive feelings after the experience. Most of them felt

excited as the experience prepared them to see a patient on their own with more

confidence. Some of them felt satisfied as they saw pathology in a patient. Other feelings

mentioned were that they felt calmer, reassured, relieved and informed.

Satisfied as it showed me how certain conditions and characteristics present

and also gives an idea of how to approach certain situations. [P2]

I now know more about how to approach and treat a pathology patient, and

I feel more confident to see a real patient for the first time, rather than just

having only theoretical knowledge. [P5]

Theme 4: Strengths

The participants identified nine strengths of this teaching-learning method. These nine

strengths, with direct quotes from the participants, on bedside teaching, are depicted on

the next page in Table 4.12.

211

TABLE 4.12: STRENGTHS OF BEDSIDE TEACHING AS IDENTIFIED BY UNDERGRADUATE OPTOMETRY STUDENTS, UFS


1. Created an understanding of the clinic

To me, it was definitely how to distinguish which

tests were indicated or not. And decide why you

want to do a certain test if it is not really indicated.

Then how the flow will be. [P7]

2. Having a real-life example

"Learning by example". It is good to explain on a

paper, but seeing it with a real patient is very

helpful. Better than ordinary practical sessions

where it is demonstrated on students. [P10]

3. Create an opportunity to identify areas for

improvement

It immediately shows you areas where your

weaknesses lie and you need to improve. [P1]

4. It is an interactive learning experience It was not boring and I felt that I wanted to

contribute and participate. [P14]

5. There is an opportunity to ask questions The boldness to ask questions contributed to a

better understanding ... [P17]

6. The theory is applied practically ... I could physically see the theory practically

applied ... [P14]

7. Probes critical thinking It probes critical thinking. [P2]

8. Exposes students to different situations Exposes students to different situations. [P2]

Theme 5: Weaknesses

Three weaknesses emerged from the analysis of the data on this teaching-learning method.

These weaknesses, as identified after the analysis of the students’ responses, are discussed

below.

Experience is limited to one patient / one condition only

Due to time constraints, this experience could only be illustrated on one patient with a

possible condition. The participants identified this as a weakness and would have liked to

be able to go through this experience with a variety of patients.

The only weakness I can think of is that I would like an experience like this

for each of the major conditions. [P2]

212

Type of pathology differs for each group

Different groups saw different patients; therefore, the patients’ conditions were different.

The participants felt that this inconsistency affected their learning in terms of the pathology.

The type of patient you get determines how much you learn in terms of the

degree of difficulty of the pathology. [P14]

Patient is exposed

Some students felt that during this experience the patient was exposed and mentioned that

the patient should also be part of the evaluation instead of everyone just discussing the

patient’s condition.

... it is not nice for the patient that everyone watches what is wrong with

him/her and that everyone is talking about him/her. [P6]



their learning and understanding. The main factor mentioned was the practical observation

of a professional at work. According to the participants, the supervisor applied critical

thinking, illustrated professionalism, and provided good explanations of tests and how to

apply time management.

It helped a lot to see practically what someone does, how one thinks about

things what you see or do not see, how to get to the final diagnosis and how

to think critically. [P6]

This was all done in a safe learning environment, which was identified as a second factor

that enhanced their learning.

... feeling safe because we are in a learning environment and so it's okay if

you do not know. [P14]

Also, the participants felt that they were part of the experience where they had the

opportunity to see the ocular pathology clinically and were able to ask questions.

213

We were also given the opportunity to do the tests after the supervisor

explained what signs we had to look out for. [P15]

Lastly, the participants stated that this method enhanced theory-practice integration which

was demonstrated in a real-life setting.

Different tests and aspects of pathology now come together. [P5]


The participants were asked if there were any personal changes that they would have

implemented to enhance their learning experience. Most of the participants felt that there

were no changes they could recommend and that they had a positive experience; however,

three participants mentioned the following:

They could have asked more questions.

By asking more questions, it's hard for me to expose myself and possibly

look stupid. [P10]

Interact more.

I think to interact more with the lecturer will be much more beneficial. [P1]

Review the pathology before the experience.

It might have helped to review the pathology we have already learned before

that time. [P6]


The last theme from the questionnaires were the recommendations from the participants

to enhance the teaching-learning experience with the use of bedside teaching. The analysed

categories will be described below.

This teaching-learning method should be applied throughout the curriculum

More than half of the participants recommended that bedside teaching should be

implemented in all the specialised clinics for fourth-years as well in general clinic in third-

year. They felt that it was an excellent way to prepare for the clinic and to demonstrate

what is expected from the students. The experience also provided them with self-confidence

214

and they felt better emotionally; therefore, they felt they would be able to care better for

their patients.

Expand it to all the specialised 4th year clinics, as well as before the 3rd year

to see patients in the general clinic. This should help things get smoother

with more self-confidence, students in better emotional conditions and,

consequently, better care for each patient. [P10]

More than one type of patient should be seen during this teaching-learning experience

Some of the participants recommended that more patients should be seen. This

recommendation can be linked to one of the weaknesses identified in Theme 5. The main

reason for this recommendation is for them to be exposed to different types of pathology

and to observe the investigation and management thereof from a supervisor.

Each group should have an opportunity to see 2 or more patients so that

more pathology can be seen. [P14]

A patient with pathology should be seen

This category also appeared in Theme 2 as well as Theme 3. The same participants that

were disappointed after the experience recommended that the patient used for bedside

teaching should have ocular pathology present. Another participant stated that if they had

seen a patient with pathology, it would help them to handle difficult situations better

throughout the year.

A patient with more pathology to help us better deal better with challenges.

[P16]

To experience this with different optometrists / supervisors / ophthalmologists

The participants recommended that this experience should be repeated with different eye-

care professionals. This will enable them to observe different methods of investigation as

well as different ways to manage a patient.

More time for reflection

A participant recommended that more time should be allowed for reflection as this would

provide an opportunity for the students to ask more questions.

215

These clinical cases should be discussed in a lecture

The participants also recommended that clinical cases, as well as the work-up and

management thereof, should be discussed during theory lectures as it would keep the

students’ attention.

... much more of value than just listing the signs and symptoms. The clinical

case is much more intriguing for studies and possible assessments. [P4]

Recommendations for the lecturer

A participant provided recommendations for the lecturer / supervisor. These included the

supervisor to involve the students in the procedure and to provide explanations or reasons

for doing specific procedures. Also, to have an in-depth discussion about the management

plan. The participant also stated that the supervisor should be prepared.


undergraduate optometry students on bedside teaching


optometry students on bedside teaching is presented on the next page in Figure 4.10 as

the learning triad with the essential key factors that emerged from the data of this study.

216

FIGURE 4.10: SUMMARY OF THE EXPERIENCES AND PERCEPTIONS OF UNDERGRADUATE OPTOMETRY STUDENTS ON BEDSIDE TEACHING


Bedside teaching is a generally well-perceived experience from the student’s perspective.

The objectives identified by the participants corresponded with the definition of bedside

teaching provided in Chapter two (cf. 2.3.3.2.8). The data indicated that during bedside

teaching, clinical skills and clinical reasoning were demonstrated. Participants in this study

noted that they were able to observe an eye-care professional demonstrating conventional

skills such as history taking, communication and physical examination, as well as the

demonstration of the holistic approach to and treatment of a patient that includes

compassion towards the patient. As a result, it seems that with this experience, the students

were exposed to non-technical skills and professional attributes that, as Ramani et al.

(2013:384) mentioned, cannot be taught in a classroom. In this study, the supervisors also

took the opportunity to inform the students of the overall functioning of the clinic. That

includes the arrangement of the clinical notes as well as the administration that needs to

be completed. It was reported that due to this exposure, it was ensured that the students

SUPERVISOR

STUDENT PATIENT Interactive & Involved

Learning triad

APPRENTICESHIP

Demonstrates

the what, why

and how

Observer Focus of

examination

217

knew what was expected of them during the year; something that perhaps made them

more comfortable in this specific clinic.

The success of bedside teaching was mentioned by all the participants, consistent with prior

work in this field (Byszewski et al. 2012:2). Participants noted that the experience was

insightful, interesting and probed thinking. The experience further contributed to their

excitement and self-confidence to see patients on their own. A significant result for the

experiential learning cycle was that students that prefer to learn by observation might

benefit significantly from this teaching-learning method. Further analysis showed that the

strengths identified in this teaching-learning method also corresponded with the objectives

of this method. The students felt that the functioning of the clinic was practically illustrated

in an interactive way as they were provided with a real-life example. Probably they valued

the observation of the supervisor applying the theory practically while evaluating and

interacting with a real patient.

The overwhelming feelings experienced by the students of this teaching-learning method

was positive. The negative feelings that were brought up before the experience were due

to this being something they had not experienced before; therefore, they were uncertain

about what to expect. This concurs with the feelings they had experienced before flip the

classroom (cf. 4.4.2.2) and simulation (cf. 4.4.4.2); both also were new experiences to the

students. The recommendations the students made might indicate that the students did

appreciate this teaching-learning method. They recommended that this method should be

implemented more frequently in other clinics as well and that it should not be limited to

one patient only. Important to note that as mentioned earlier in the application of this

teaching-learning method (cf. 4.4.8.1), apprenticeship is applied throughout the year, but

not with this intensity. Therefore, students will be exposed to different patients and

pathology during the course of the year. During this experience, the supervisors could only

consult two patients each in the allocated time for the clinic and two clinics were used for

this experience. Unfortunately, due to the demands of service delivery in the public health

sector, it might not be practical to repeat this experience more than once a year. This

particular year group also comprised a small group of students; larger classes would put

enormous strain on the supervisor and the functionality of the clinic, should this experience

be implemented as recommended. A recommendation from the researcher is to implement

bedside teaching from the second semester in the students’ third-year. Another possibility

for utilising bedside teaching or role modelling more often would be to let the fourth-years

218

do the role-modelling and allowing the third-year to sit in as an observer. This should be

explored further.

The findings of the questionnaire survey provide a useful blueprint for the successful

application of the components of the learning triad in bedside teaching, namely the patient,

student and supervisor (Dent 2009:96). The role of the supervisor was mentioned several

times right through the responses and students identified the observation of the supervisor

as the most critical factor that influenced their learning. With this in mind, the participants

recommended that the experience should be repeated with different eye-care professionals

in order to gain from different views and ways of approaching a patient. Corresponding

with the data reported in the literature (Williams et al. 2008:261), the results also indicated

that the supervisor seemingly played an important role with regard to the feelings of the

students. It may be that the friendliness of the supervisors and their willingness to assist

provided a sense of reassurance for the students; thus highlighting how essential it is for

supervisors to create a safe learning environment at all times. Within a safe learning

environment, students might use the opportunity to ask questions more frequently, and

supervisors should facilitate in-depth discussions about the management of a patient by

involving the students. The participants in this study had the perception that this method

was interactive and they were involved in the examination. It, therefore, is possible that

this teaching-learning method was experienced as safe as the supervisor took responsibility

for the treatment and management of the patient, and the students only had to observe

and air their opinions. It appears that the students valued this ‘learning without risks’, as

the researcher calls it.

The literature describes the patient as the foundation of the learning triad (Garout et al.

2016:261). Notably, students stated that more could be learned when the patient presented

with a pathology. To avoid disappointment, as was experienced by the students in this

study, it should be emphasised that the ultimate goal should be patient-centred teaching,

regardless of the diagnosis (Chretien et al. 2010:790). As in a previous study by Chretien

et al. (2010:786), the students also mentioned the patient was exposed. Therefore, care

should be taken to inform the patient about the teaching experience and the patient should

provide consent for the supervisor to use him/her for the purpose of teaching. In this study,

the patients were not asked to comment on the experience; therefore, their feelings were

not included in the data.

219

Lastly, it seems that students could take responsibility for their own learning during this

experience. In this learning triad of supervisor, patient and student, the students felt that

it was their responsibility to take part in the experience and not the supervisor’s duty to

involve them. This highlights the view that it is vital for students to realise that if they do

not ask questions, their learning will be limited. Again, an environment should be created

where students have the courage to ask questions or make comments without feeling

exposed or stupid, and it appears as if the students in this study felt safe in the small group

and learned from each other. Students also expressed the opinion that the experience might

have been even better if they had reviewed the theory before coming to the clinic or brought

textbooks or class notes with them. This might be indicative of students having started to

realise their own responsibility in their learning.

In conclusion, the research findings provided empirical evidence that bedside teaching has

relevance to the experiences of learning in the clinical education programme for

undergraduate optometry students. Three of the four modes of Kolb’s experiential learning

cycle are applicable in this teaching-learning method, with reflective observation having

been highlighted by the participants. Active experimentation would be implemented as soon

as the students started consulting patients on their own.

The next and last teaching-learning method’s analysis that will be reported and discussed

is clinical skills training.

220

4.4.9 Results of the questionnaire survey on clinical skills training

______________________________________________________________

In the following section, the application of clinical skills training as a teaching-learning

method will be discussed, followed by the results and discussion of the questionnaires that

were completed after this specific teaching-learning method was applied.

4.4.9.1 Clinical skills training design for the purpose of this study

Even though Ker (2009:87) provided a definition for a clinical skill (cf. 2.3.3.2.9), Vogel and

Harendza (2016:2) explained that there was no unique definition to describe clinical skills.

Different terms like procedural skills, practical skills and technical skills are used

inconsistently in the literature to describe similar or overlapping clinical skills, including

aspects of a physical examination. In the module, Diagnostic skills (DGNS 3702), the clinical

skills required to diagnose ocular diseases are trained. These techniques form the

foundation for the investigation and management of a patient with ocular pathology. The

exit level outcome of this module is for the student to demonstrate the required knowledge

and understanding of the theory of the diagnostic skills as well as the execution of the skills

in order to diagnose ocular pathology. Students have to be competent in the following skills

to qualify with diagnostic privileges, as explained in Chapter 2 (cf. 2.2.1).

These skills include:

Indirect biomicroscopy with the use of a 90 dioptre (90D) lens and a slit lamp or a

binocular indirect ophthalmoscope (BIO). This skill enables Optometrists to

examine the posterior fundus of the eye for any abnormality.

Tonometry. This skill is used to measure the pressure of the eye, an essential

aspect of any eye examination to screen for certain diseases.

Gonioscopy. This skill refers to viewing the anterior angle of the eye for any

abnormalities with the use of a three-mirror lens.

The skills were taught by means of a combination of self-study and a structured programme

as recommended by Vogel and Harendza (2016:7). Before each diagnostic skill

demonstration, the students had to prepare for the procedure by doing self-study on the

theory of the skills. All the necessary materials were placed on Blackboard®. Video clips on

the procedures were also uploaded for the students. A structured demonstration of each

221

procedure was then done by a facilitator, and thereafter the students had the opportunity

to practise the skill on peers with the availability of the facilitators to assist.

After the completion of the assessment, 31 third-year students completed the

questionnaire, representing a 100% response rate.


undergraduate optometry students on clinical skills training

Each theme, with its categories and subcategories are summarised in a table (Appendix H-

11). The data analysis and description, with direct quotes of the participants’ responses,

follows.

Theme 1: Objective


which the teaching-learning method was used? One category emerged from this theme.

To practically learn how to perform diagnostic techniques

Most of the participants reported that the objective of this teaching-learning method

involved the demonstration and practising of the diagnostic techniques, 90D and BIO. Some

participants felt they were left on their own to practise, while others mentioned that

facilitators were available. The objective also involved an assessment of these skills.

We were shown what was expected of us, and then we were sent to clinics

to practise these methods. [P27]

We were left to learn on our own, but the supervisors were there when you

needed help. [P30]

Lecturers are available while students continue to practise the 90D and BIO

techniques. They demonstrated the techniques at the beginning and did an

assessment at the end. [P31]

222


Under this theme, three categories emerged. Most of the participants felt that the objectives

had not been achieved, while some felt they had been achieved partly. The majority of the

participants expressed the opinion that the objectives had been achieved.

The factor mentioned most as a reason for being unsuccessful in achieving the objective

was that the participants had experienced the demonstration as incomplete and that they

had to do self-study on the techniques. This was especially true for one specific technique.

Participants also felt that the facilitators did not interact with them and were not helpful

and supportive during the session.

No, I feel there was not enough demonstration and never shown how it

should look like and what we should see on a real eye. [P1]

No, I didn’t feel that the supervisors were at all helpful over the past few

weeks and I don’t feel prepared like I know what I’m doing. [P25]

While some felt that there was enough time to practise, and they could achieve the

objectives, others felt that there was not enough practise opportunity, especially under

supervision. This also was due to the lack of equipment.

Yes, we had a lot of practical exercise, especially with 90D and had time to

master the technique. [P4]

Some students also mentioned that the lack of a peer assessment made them feel

incompetent, and therefore they could not master the technique.

No, I feel that a peer assessment is very good to gain confidence, and it

helps you much more than just walking into an assessment. [P13]



before, during and after the experience. In the sub-themes, before and during feelings, two

sub-categories, namely feelings about assessment and feelings about the teaching-learning

223

method were analysed and are discussed below. In the last sub-theme, responses on the

feelings after the experience, the feelings after the assessment, and after the completion

of the teaching-learning method were combined in only one category.

i. Feelings before

The feelings students reported to have had before the learning experience were divided

between positive and negative feelings. Participants voiced feelings of motivation,

relaxation and especially excitement to learn a new technique. Some mentioned that they

felt calm, eager and well prepared for the assessment.

Motivated, eager. I was motivated to master this and practised really hard

to achieve that. [P20]

Calm and eager to get it over and receive some feedback and methods to

improve skills. [P17]

The negative feelings students had before the experience included nervousness, stress and

uncertainty. These were mainly due to the procedures being unfamiliar and the uncertainty

of what to expect.

I was on my nerves because it was unfamiliar procedures. It also sounded

very challenging. I was overwhelmed when I read the articles. [P29]

Most of the negative feelings mentioned by the participants in this sub-theme were about

the assessments. Participants felt anxious, inadequate, frustrated, incompetent, nervous,

unsure and stressed before the assessment. These feelings were due to these participants

feeling that they did not have enough time to practise.

ii. Feelings during

Only one participant felt positive during the experience. This particular participant found it

exciting to examine the eye in more detail. The other positive feelings were expressed

during the assessments. A few participants felt positive, calm, confident and less tense

during the assessment and experienced an improvement in their technique.

224

… realised I had improved my way of performing the techniques from the

first time I did them. [P18]

The feelings during the experience and assessment were reported to be overwhelmingly

negative. Some participants felt hopeless and struggled during the experience, but

mentioned that it improved.

In the beginning, I lost hope as it was challenging at first, but it got better.

[P20]

Others felt negative, frustrated and unsure during the experience. These negative feelings

were due to limited equipment and time to practise, and they felt there was no feedback

during the experience.

Negative, not receiving feedback about mistakes that we made during

practise and not enough practise, especially with the BIO. [P14]

Most of the participants felt anxious, concerned, confused, frustrated, nervous, panicky,

stressed, tensed and unsure during the assessment.

Stressed, because couldn’t clear the images as I could sometimes do in

practise. [P6]

I was frustrated and wanted to cry. [P13]

iii. Feelings after

The feelings after the teaching-learning method, which included the assessment, were

mainly negative. Participants felt angry, disappointed, frustrated, unhappy, unsure and

upset afterwards. These feelings were mainly true for one of the techniques as they felt

they did not have enough practise time to learn the technique and facilitators were not

interactive when they practised. Some noted that their negative feelings were due to being

nervous during the assessment and not the experience as a whole.

Angry and upset – neither procedures went well as supervisors weren’t

interactive enough, NOT enough practise. [P6]

225

Disappointed. I knew I could do it, I was confident, but couldn’t control my

nerves during the practical. [P20]

Some also mentioned that they still were not comfortable or confident or satisfied and still

felt stressed. One participant mentioned a feeling of indifference after the completion of

the teaching-learning method.

I realised at the end of my assessment today that I do not feel totally

comfortable with BIO. It did not go well. 90D was satisfactory as far as I

could see and interpret what I needed. [P29]

Positive feelings also were reported. Some participants felt enriched, happy, good, relaxed,

satisfied and motivated to do better. These positive feelings again were predominately due

to BIO and that they felt the assessment pointed out areas that they needed to improve.

Again, more relaxed, realised that small mistakes that were made because

you know exactly what to look for. [P5]

Theme 4: Strengths

Two participants reported that in their opinion, there were no strengths in this teaching-

learning method.

No strengths definitely. Teaching ourselves on stuff we don’t know anything.

[P7]

The other participants identified the following strengths in this teaching-learning method.

The following categories were identified during analysis:

Learn to be independent, disciplined and responsible in own time

Most participants averred that this teaching-learning method made them independent,

disciplined and responsible for their own learning and that learning could take place in their

own time. This strength created an interest and better understanding of the work for the

participants and helped with self-directed learning.

226

The fact that you can learn on your own time and work on your skills until

you have mastered it. [P22]

You should be disciplined to practise by yourself even if the lecturer is not

standing next to you. [P27]

Enough time to practise

The second most identified strength is the amount of time available to practise. Participants

mentioned that they had sufficient time to practise the skills needed to perform with these

two techniques. Some participants mentioned that as there was no peer assessment, they

could practise more.

A lot of practical experience / practise and was able to do the 90D a lot and

really make sure about everything that I have to be able to do. [P4]

Practical application

Another strength mentioned was that the teaching-learning method is practical. Participants

had to use the equipment and perform these techniques themselves.

It is nice to do and see it yourself practically. [P28]

Availability, demonstration and guidance from the facilitators

A few participants mentioned that the fact that the facilitators were available and

demonstrated and guided the practical were a strength.

Practical sessions with supervisors showing you what to look for. [P2]

Comfortable environment to ask questions and practise

Linked to the previously mentioned strength, the participants reported that the learning

environment was comfortable and that they were comfortable to ask questions when they

needed assistance.

You feel more comfortable when someone is not standing with you. [P14]

227

Having an assessment

Lastly, the participants noted that the assessment improved their confidence, indicated

areas for improvement and helped them to work under pressure.

It shows you where you have to improve practically. [P23]

Theme 5: Weaknesses

In this theme, weaknesses, a few categories were identified. These are reported below.

The same participant (P7) that felt that there were no strengths in this teaching-learning

method reported that everything in this method could be called a weakness. The weakness

mentioned most often was the equipment. Participants complained that there was not

enough equipment (especially the BIO). One participant stated that it was difficult working

with some of the equipment. Due to the lack of equipment, the students identified

insufficient practise time as another weakness.

Not enough devices for everyone to practise; people do not get enough time.

Every week just 5 minutes with BIO is not enough. [P14]

… there is insufficient time to practise BIO, even if you come after hours.

[P2]

Another weakness regarding practising time that the participants pointed out was that they

felt they had to practise on their own. This created uncertainty and they felt inexperienced.

You are unsure if you do not understand the procedures correctly since you

are on your own. [P22]

Linked to this, participants felt that the facilitators were not helpful, interactive and not

present all the time. They also noted that the facilitators did not provide enough guidance,

and felt that the demonstrations by the facilitators were incomplete and done only once.

Not enough guiding from supervisors beforehand to assist in the things we

are not aware of what to do. [P20]

228

The assessment was also raised in the weakness theme. Participants felt that they were

unprepared for the assessment and that the assessment made students nervous;

consequently, they made mistakes. They also felt that there was no feedback provided after

the assessment. Other weaknesses were that there were no theoretical classes in this

teaching-learning method, and one participant felt this was a passive approach to learning.

You do not gain enough knowledge. It is a very passive approach to studying.

[P13]


In this theme, the participants were asked to identify factors that enhanced their learning

and understanding. Some of the participants felt that there were no factors and mentioned

that their learning was not enhanced. This was contributed to by the participants feeling

that they had to practise and learn these techniques by themselves.

It didn’t. You had to help yourself the whole time. Yes, you could call the

lectures and ask for help, but with the levels of these procedures, it is far

from enough. [P6]

In contrast, other participants felt that students were able to practise on their own to

enhance their learning and the facilitators were available when they needed assistance.

They also felt that they had sufficient time to practise.

It let me figure things out for myself and let me gain a better understanding

of how to keep or handle the lenses. [P20]

... whenever we were not sure about anything, we could ask supervisors to

help, and they explained and helped a lot. [P4]

Enough practise and experience to do the two techniques successfully. [P5]

Another enhancement factor of this teaching-learning method was the fact that it involves

much practical application.

229

It worked well – it helps to do something practically what you learned

theoretically. [P28]

The assessment was also mentioned as a factor that enhanced the students’ learning as it

could identify their weaknesses. Lastly, the rubric that was available before the assessment

provided the participants guidance on how to prepare.

I now know what requires more attention and what to work on in the future.

[P19]


The participants were asked if there were any personal changes that they could have

implemented to enhance their learning experience. Most of the participants provided

recommendations in this theme which will be reported under the Recommendation theme.

A few participants mentioned the following:

- They could have asked for assistance

I could have asked for more help and guidance. [P21]

- Practise more

I could’ve come to practise more often on Friday afternoons. [P4]

- Watch more videos on the technique


Four sub-themes on the assessment has been identified through the analysis. They are

overall feelings, fairness, memo used for the assessment and feedback. The results of these

sub-themes are reported below.

i. Overall feelings

The overall feeling before the assessment was negative. Not only were the usual negative

feelings of an assessment noted like anxiousness, nervousness, tension and uncertainty,

but participants also felt angry, sad, frustrated and horrible.

230

Negative. Feel very sad and unfulfilled that I could not show what I could do

every time in practicals before the assessment. [P8]

A few participants had neutral feelings about the assessment, while the rest felt positive.

They felt that the assessment was fair. Some mentioned that it was due to the rubric being

available before the assessment and others said it provided a good indication of their

progress. They also felt it was effective, good and successful and felt happy about it.

I feel the assessment was fair and a good indication of my progress. [P21]

ii. Fairness

Most of the participants felt that the assessment was fair. Factors contributing to the

fairness included the availability of the rubric before the assessment and that the

assessment was done by a supervisor with the use of a rubric.

Very fair, assessments were all done by the supervisor and on the rubric.

Mark allocation was also very fair. [P4]

One participant felt it was reasonable, and another was uncertain about fairness. A few felt

that the assessment was fair for the one procedure, but not for the other.

It was fair for 90D, but BIO I feel none of us was well prepared. [P2]

Some felt the assessment were not fair. Reasons provided included that they felt:

- Certain information was not given.

- They did not have enough time to practise.

- They had to use different equipment during the assessment.

- One group was advantaged by being assessed a week later.

iii. Memo used for the assessment

The overwhelming feeling of the memo/rubric used for the assessment was positive.

Participants mentioned that the rubric was transparent and well compiled; also, efficient,

fair and helpful. A few mentioned that the rubric was reasonable while others mentioned

that it was, in a positive way, strict.

231

Maybe a bit strict, although it is good for preparation. [P19]

Negative feelings also were expressed. One participant felt that it could be misinterpreted

and another said that it was unclear.

iv. Feedback

The responses to the category of feedback were mixed. Some felt positive and reported

that the feedback was constructive, good, helpful and sufficient. A few felt that the feedback

was better with one of the techniques than the other. The rest felt incomplete to no

feedback was provided.


The last theme from the information collected through the questionnaires was the

recommendations from the participants to enhance the practical learning experience. The

four analysed categories are described below.

More equipment should be acquired

The recommendation most of the participants made was that there should be more

equipment available for them to practise. This is particularly true for the BIO.

The university must purchase another BIO or two with the prism in front.

[P29]

Provide more time to practise

The participants recommended that more time should be made available in the clinic in

order for them to practise. They also mentioned that there should be better control over

practising times and schedules should be drawn up to ensure that everyone gets the same

opportunity to practise with the available equipment.

I think there has to be a time limit in each practical session for BIO because

the 1st ones take a while and then the rest have to be quick to take turns.

[P27]

232

Recommendation for assessments

The participants recommended that there should be peer assessments before the formative

assessment. They further recommended that the supervisors’ assessments should not count

for marks.

Instead of a peer assessment – mock assessment where a supervisor sits

with you under supervisor assessment conditions and actually helps you, so

you actually know what to look for. [P6]

They also recommended that there should be sufficient feedback after the assessment in

order for them to know what they should improve.

Recommendations for facilitators

Participants recommended that facilitators should be approachable, be more involved and

interactive, helpful and provide more assistance and guidance. Some participants

recommended that a supervisor should be present the whole time and stand next to them

while they practise. They also recommended a question and answer session.

Teach the students how to do the methods, then go and have a look if

everyone can do it and help them – be actively involved in their education.

Provide help and advice and stand next to students and let them repeat what

they learn and do. [P28]


undergraduate optometry students on clinical skills training

A summary of the analysed data on the experiences and perceptions undergraduate

optometry students reported on the clinical skills training is presented in Figure 4.11, on

the next page. A discussion on the data follows.

233


UNDERGRADUATE OPTOMETRY STUDENTS ON CLINICAL SKILLS TRAINING [Compiled by the researcher, Kempen 2018]

It seems that the participants in this study understood the objective of this teaching-

learning method. From the responses, they identified three important key factors that

formed part of the process of teaching a clinical skill. These were the demonstration, the

time provided to practise skills and the assessment. These factors relate to the phases

described by Gagne (1985), as mentioned by Ker (2009:91), namely the cognitive phase,

associative phase and autonomous phase. The role of the facilitator was obvious in all three

factors. Within the demonstration phase, the reflective observation mode of the experiential

learning model is stimulated. Active experimentation is the mode that is activated during

the other two phases.

DEMONSTRATION

COGNITIVE PHASE

Ensure confidence

PRACTISE

ASSOCIATIVE

PHASE

ASSESSMENT

AUTONOMOUS

PHASE

Clinical skills training Facilitator’s role

Provide structure

Provide feedback

After the

demonstration, it

should be ensured

that students have

established their

own routine for the

skill

During practise

enough equipment

should be available

with facilitators

rotating between

students

Constant feedback

should be provided to

ensure that students

became autonomous in

using the correct

technique

234

It appears from the analysed data that some participants had a totally different experience

than others as factors that influenced the experience were mentioned in both the strength

and weakness themes. Considering the data and the responses of the participants, two

prominent questions enter one’s mind: Who should take responsibility for students’

learning? And who is to blame for poor performance in an assessment?

Seemingly, some participants valued the independence they had during this teaching-

learning method, where they could take responsibility for their learning. In contrast,

however, other participants made it clear that their poor performance was due to them

having had to practise and study on their own. This might have been due to some

participants experiencing the affective factors of performance, mentioned by George

(2001:558), more than others and needed confirmation and the presence of a facilitator all

the time. Furthermore, it should not be assumed that students would ask for assistance

during practising times. Even though some participants mentioned that they were

comfortable to ask questions and for assistance, some vehemently expressed the opinion

that the facilitators were not interactive, helpful or provided enough guidance for them to

be prepared for the assessment. Even though this might explain why they did not ask for

assistance or used the time available productively, the facilitator still should have ensured

that students performed the skills correctly and initiative should be taken to rotate between

the students while they were practising.

What is important and became evident from the data, is that students should have the

discipline and opportunity to practise on their own, but only once they are confident and

comfortable with the basics of the skill. Therefore, with the student: facilitator ratio making

it impossible for facilitators to be present with one student all the time, the facilitator should

ensure that students have conceptualised, visualised and verbalised the skill before they

have to practise on their own. Also, students should first develop their own routine for the

skill with cues from the facilitator. Despite the practicality of this teaching-learning method

that was pointed out as a factor that enhanced learning, participants identified the lack of

theoretical lectures as a weakness. It also became evident from the data that the students

did not want to do self-study or watch online videos, and they valued the actual

demonstration of the technique by a facilitator with whom they were familiar. This suggests

that to lay the foundation of the skill and to ensure that the students understand the

cognitive elements of the skill, the participants in this study preferred that theory should be

explained and the demonstration should be done by a facilitator, and not as advised in the

literature by Vogel and Harendza (2016:4) through video-based illustrations.

235

As mentioned in Chapter 2 (cf. 2.3.3.2.9), the assessment of clinical skills is vital to ensure

that students practise the correct technique to develop autonomy. Data from this study

confirmed the importance of the assessment for the improvement of skills and confidence,

but the negativity it created was not expected from the participants. Participants felt

unprepared. An important factor that influenced the time available for preparation for the

assessment was the availability of the equipment. The Department only has two BIOs

available, one of which was not in a working condition during the data collection period of

this study. As mentioned earlier, the process to fix equipment or to acquire new equipment

is really challenging for the Department. The students were informed that only one BIO

was available and from the data, it seemed that enough time was provided, but due to only

one instrument being available not all the students could practise in the given time. The

negative feelings voiced about this teaching-learning method were attributed mainly to this.

It is true that departments should ensure that the required equipment be available for

students, but some participants felt that it was the responsibility of the facilitator to ensure

that the students all had an opportunity to practise, as they could not organise the schedule

amongst themselves. At the time of the study, no rules or policies existed to ensure that

the facilitators managed and controlled students’ time for practising. The researcher, who

was a facilitator in this module, felt that students should take responsibility to sort out the

use of the equipment, but it seemed that they were not able to share and provide each

other with an opportunity to use the limited equipment. Participants in this study from the

start of the module were encouraged to practise in their own time, but from the data

collected, it seemed that some students did not make use of the opportunity.

Based on the discrepancies in the data collected about this teaching-learning method, a

conclusion might be made that the practical teaching-learning did not go as planned, and

the participants in the study blamed everyone except themselves. Participants had six

weeks of scheduled practising time, and facilitators were available to guide and assist them

during those scheduled times. None of the negative feelings that surfaced after the

assessment was mentioned earlier. It became clear that this generation of students in this

module expected personal contact time, structure, and constant guidance and confirmation

from a facilitator. Some of them did not display the discipline to take responsibility for their

learning; therefore, they depended too heavily on facilitators. Facilitators, thus, should at

all times ensure that there are no grey areas in a teaching-learning method on which a

student can blame poor performance.

236

4.5 CONCLUSION

Chapter 4 provided an overview of the results of the data analysis, and elucidations and

discussions of the findings of the responses on the open-ended questionnaires. The results

from the survey on each teaching-learning method supplied answers to the second research

question (cf. Chapter 1, 1.3). The data gathered during the surveys were valuable and

contributed towards supporting the recommendations of effective implementation of

experiential learning in the expanded scope of practice of the undergraduate optometry

programme at the UFS.

In the next chapter, Chapter 5, Results of the focus group interviews: analysis and

discussion, the findings of the focus group interviews will be reported and discussed.

CHAPTER 5

RESULTS OF FOCUS GROUP INTERVIEWS: ANALYSIS AND DISCUSSION

5.1 INTRODUCTION

The purpose of this chapter is to present the results of the focus group interviews conducted

for this study. Two focus group interviews were conducted in order to provide an

opportunity for an open discussion amongst participants to identify issues that were

regarded most valuable to the participants relating to their experiences of the Pathology

clinic (cf. Sofaer 2002:330; Barbour 2005:743; Levato & Wall 2014:390). As described in

Chapter 3 (cf. 3.5), the primary purpose of the data analysis and interpretation was to

obtain a description of the experiences and perceptions of students about the Pathology

clinic (cf. Elo & Kyngäs 2007:108).

As outlined in Chapter 3, the focus groups consisted of fourth-year undergraduate students

of 2017 in the Department of Optometry at the UFS. The focus was on how participants, as

consumers, perceived and experienced the educational environment during the Pathology

clinic. This was done in order to provide additional data to supplement the data collected

by means of the questionnaires. Thus triangulation of data occurred, enhancing the

credibility of the findings of this study.

The quality execution of the focus group interviews will ensure credible and useful results

(Sofaer 2002:333). With this in mind, the design of the focus group interviews was done

carefully, paying attention to quality in order to significantly and purposefully contribute to

the quality of the research and the process of data collection and analysis as described in

Chapter 3 (cf. 3.4.2.4). To further enhance the quality of the study in terms of credibility,

transferability, dependability and confirmability (cf. 3.6) the consolidated criteria for

reporting qualitative research (COREQ) created by Tong et al. (2007:349-357) were used

for reporting the focus group interview data. Figure 5.1 summarises the 32-item checklist

that is grouped into three domains, namely research team and reflexivity, study design and

analysis and findings.

238

*COREQ = CONSOLIDATED CRITERIA FOR REPORTING QUALITATIVE RESEARCH

FIGURE 5.1: ADAPTED COREQ* CRITERIA CHECKLIST FOR REPORTING FOCUS GROUP

INTERVIEWS

Compiled by the researcher, Kempen 2018 (cf. Tong et al. 2007:351-356)

In the sections to follow the three domains with reference to the items listed in Figure 5.1

will be discussed.

DOMAIN

01

DOMAIN

02

DOMAIN

03

A. Personal characteristic (COREQ 1-5) Facilitator and/or researcher credentials, occupation,

gender, experience and training

RESEARCH

TEAM

AN

D

REFLEXIV

ITY

STU

DY D

ESIG

N

AN

ALYSIS

AN

D

FIN

DIN

GS

B. Relationship with participants (COREQ 6-8) Established relationships, participant knowledge of interviewer, characteristics of interviewer

C. Theoretical framework (COREQ 9) Methodological orientation and theory that underpin the study

H. Participant selection (COREQ 10-13) Sampling, method of approach, sampling size, non-participation

G. Setting (COREQ 14-16) Data collection, attendees, demographic data regarding

sample

F. Data collection (COREQ 17-23) Interview guide, repeat interviews, audio recording, field

notes, duration, transcripts returned

E. Data analysis (COREQ 24-28) Number of coders, description of coding tree, derivation of

themes, software, participant checking

D. Reporting (COREQ 29-32) Quotations presented and identified, consistency between

data and findings, clarity of major and minor themes

239

5.2 RESEARCH TEAM AND REFLEXIVITY

In this section, the personal characteristics of the facilitator and the researcher will first be

discussed, followed by their relationship with the participants.

5.2.1 Personal characteristics

The focus group interviews were conducted by a female academic staff member of the UFS

who had completed a PhD in HPE with the focus on an educational approach for the

generational profile of undergraduate students in the FoHS, UFS and had made use of focus

group interviews in her research design. In addition, the abovementioned facilitator is

qualified as a general medical practitioner and had obtained an M.B.Ch.B. degree as well

as the degree M.Med.Sc. (Surgery) at the UFS. She has been involved in both

undergraduate and postgraduate training of health professionals in the FoHS, UFS, since

1995, and currently serves as the Undergraduate Programme Director of the medical

programme in the School for Clinical Medicine, FoHS. She was appointed as the facilitator

for this study due to her being an independent and competent academic who takes a special

interest in creating a learning community that engages and motivates students. She is

friendly, has a sense of humour and excellent listening skills, and is someone who could

create a non-threatening environment for the participants in which to share their feelings -

characteristics that Greef (2005:306) suggested a facilitator should have.

The credentials of the researcher, who was an observer during the focus group interviews

and made field notes on verbal and non-verbal aspects of the participants’ reactions, were

described in Chapter 1 (cf. 1.5). As described in Chapter 3 (cf. 3.2.1.1) her active

involvement as an educator in the Pathology clinic contributed to her ability to identify with

the experiences and issues that the participants were faced within the clinical environment.

These credentials of the facilitator and observer ensured the credibility of the findings of

the focus group interviews.

5.2.2 Relationship with participants

The facilitator and researcher as academic staff members of the FoHS were familiar with

the student participants. The participants were aware that the data generated from the

240

focus group interviews would be used for the purpose of the completion of a PhD study.

This was stated in the request for participation (cf. Appendix F), as well as on the consent

forms (cf. Appendix G). The facilitator also stated the purpose at the onset of the focus

group interviews.

The facilitator was not personally involved in the research. She was unbiased, had no

assumptions and did not personally gain from the focus group interviews. The researcher

probably was biased and had certain assumptions regarding the outcomes of the focus

group interviews as she was involved in the Pathology clinic as a supervisor, had knowledge

of the results of the questionnaires, had conducted the literature review, and designed the

agenda for the focus group interview. For this reason, she did not participate in the

discussion of any activities and only acted as an observer who was not visible to the

participants. This ensured that there were no influences on the participants’ responses

during the focus group interviews, which contributed to the transparency of the process.

5.3 STUDY DESIGN

In this section, the second domain of the COREQ checklist, that includes the theoretical

framework, selection of participants, focus group setting and data collection, will be

discussed.

5.3.1 Theoretical framework

Grant and Osanloo (2014:13) referred to the theoretical framework of a study as the

blueprint that provides a structure that guides the research by relying on formal theory. A

qualitative case study research design together with a constructivist research paradigm

guided this study. These aspects were discussed in Chapter 3 (cf. 3.2).

5.3.2 Participant selection

Purposive sampling was used as it involves the selection of participants who share specific

characteristics to provide ample data relevant to the research question (cf. Tong et al.

2007:352). The sample selection method was described in Chapter 3 (cf. 3.4.2.2)

241

Fifteen fourth-year undergraduate optometry students participated in the focus group

interviews. All fourth-year students (17) were invited to the interviews personally and via

e-mail by the researcher. Two students who had confirmed their availability did not arrive

on the scheduled day for the second focus group interview due to being ill. Therefore, the

number of participating students for the first focus group was nine and the second one six,

which, according to Greef (2005:305), rendered the group sizes adequate to allow each

participant to engage in the discussion, thereby to ensure the widest variety of responses.

The participants also were allowed to indicate in which focus group they wanted to

participate and it may be assumed that they chose to be with the peers with whom they

felt most comfortable. This was done to ensure optimal participation of each participant.

No participant refused to participate or withdrew during either of the focus group interviews.

5.3.3 Setting

The focus group interviews were both conducted in the debriefing room at the Clinical

Simulation and Skills Unit in the School of Biomedical Sciences at the FoHS, UFS. The setting

was familiar but neutral to all participants. A hospitable environment was created with

participants seated comfortably in a half-circle in front of the facilitator. There were no

tables between the participants and the facilitator to promote openness and a non-

threatening environment. No one else besides the participants and the facilitator was

present. The researcher observed the interview through a one-way mirror from a room next

door. To ensure participants’ comfort, drinks and sweets were available in the room and

accessible throughout the interview.

The dates for the focus group interviews were on 31 July 2017 and 7 August 2017. There

were two male participants in each focus group and seven females in the first and four

females in the second focus group. The fourth-year undergraduate optometry class

comprised 76,5% female and 23,5% male students, which explains the higher number of

female participants. All the participants, as well as the facilitator, used Afrikaans which was

their first language. The participants were encouraged to express themselves in the

language they preferred to ensure clarity and to enhance the understanding, hence both

focus group interviews were conducted in Afrikaans.

242

5.3.4. Data collection

The data collection method was discussed in Chapter 3 (cf. 3.4.2.4). Issues of credibility,

transferability, dependability and confirmability (cf. 3.6), as well as ethical considerations

(cf. 3.7) for the focus group interviews, were also discussed in Chapter 3.

Significant findings from the questionnaires were identified and used to formulate an

agenda with the interview question for the focus group interview and subsequently, the

specific areas of interest. This agenda may be viewed in Appendix B. To facilitate the

discussion and to allow a dynamic flow with active participation the facilitator made use of

this agenda, Compiled by the researcher, with questions and areas to probe. The aim was

to formulate clear, simple, concise, open-ended questions. This agenda was pilot tested as

described in Chapter 3 (cf. 3.4.2.3).

The facilitator commenced with the focus group interviews by welcoming the participants,

putting them at ease and providing a brief description of the purpose of the research and

the focus group interview. The process of the focus group interview and the ground rules

were explained to the participants. These included the confirmation of voluntary

participation, confidentiality and anonymity, as well as the use of a number to identify their

input. These aspects were all stated in the information and request for participation

document that had been made available to the participants before the focus group interview

(cf. Appendix E). The number allocated to each participant was used for reporting purposes.

The facilitator concluded the interview with a summary of what was discussed and ended

by thanking the participants for their inputs.

To ensure an accurate reflection of the participant’s opinions, the focus group interviews

were audio-recorded. As mentioned previously, the researcher, as an observer, made field

notes on participants’ gestures and non-verbal reactions. Transcriptions of the audio

recordings were made by the researcher in Microsoft Word format. The transcriptions were

made available to each of the participants in the focus group interviews individually, as well

as to the facilitator, with the request to confirm within a month’s time whether the

transcription was a true reflection of what was discussed. None of the participants indicated

any corrections on the transcripts and the facilitator also confirmed the accuracy of the

transcription. The Afrikaans transcriptions then were translated into English by an

independent translator (Appendix D). The final, translated transcripts of the two focus group

243

interviews were used as a database for the analysis and interpretation of the focus group

interviews. These transcripts are available on request.

The duration of the first focus group interview was 82 minutes and the second one 70

minutes, which was in line with the indication on the agenda. The responses from the

second group generated similar data to the first and there were no more new opinions or

issues raised and data saturation was reached.

5.4 DATA ANALYSIS AND FINDINGS

In this section, the data analysis and the reporting of the findings will be discussed. The

analysis process has been described in Chapter 3 (cf. 3.5).

5.4.1 Data analysis

The researcher coded the data from the final, translated focus group transcriptions, which

included the written transcriptions from the audio recordings, as well as the field notes of

the researcher.

The data were analysed by the researcher with the use of a content analysis process, as

described in Chapter 3 (cf. 3.5). The overview of the guidelines followed during the content

analysis is summarised in Figure 3.2 (cf. 3.5). To prepare for the analysis, the researcher

typed the data herself, then read the transcribed data repeatedly to ensure familiarisation

with the data. As the researcher became more familiar with the data, an initial code list was

created through the identification of a unit of analysis and meaning and corresponding

concepts. The researcher then confirmed that the information corresponded with the aim

of the study before themes and categories were identified from the data. This was first

done manually by highlighting the themes and categories that came to the fore in the

responses to the questions. For this process, the researcher worked through the

transcriptions several times using different colours for the various categories and themes

identified. The categories were then transferred into a table and consequently interpreted.

In ensuring the quality of the study, the qualitative analysis was verified with the assistance

of an independent expert, appointed by the supervisors. This verification included the

verification of the data coding, quality assurance and trustworthiness of the final

transcriptions. The interpreted data will be discussed in the following section.

244

5.4.2 Reporting the data

In this section, the data will be reported according to themes and categories, as suggested

by Tong et al. (2007:356), with supporting quotes from the participants to add to the

transparency and trustworthiness of the data. The Afrikaans quotes were all translated to

English, as discussed in section 5.3.3. To initiate the focus group process, one open-ended

question was asked. The question was: Based on your experience in the Pathology clinic

this year, which factors can contribute for the clinical experience to provide a safe learning

environment where integration of knowledge and the application of critical thinking are

possible in order for you to feel competent and confident to manage a patient according to

the current scope of optometry?

From the analysis of the data, the focus fell on five major focus areas, namely:

Personal opinion of the research project

The overall feeling regarding the learning environment

Theoretical grounding and integration of theory and clinical practice

Factors that influenced the Pathology clinical learning environment

Recommendations on the enhancement of the learning environment in the

Pathology clinic.

The findings will be reported according to these focus areas and will include the themes

and categories, supported by quotes, given in italics and the numbered paragraph (_P) in

brackets to give a reference for the quote. The prefix 1_ or 2_ before the numbered

paragraph in brackets refers to the first and second focus group, respectively. In Table 5.1,

a schematic summary of the focus areas, themes and categories is given.

TABLE 5.1: SUMMARY OF FOCUS AREAS, THEMES AND CATEGORIES OF THE FOCUS

GROUP INTERVIEWS CONDUCTED [Table continues on next page]

FOCUS AREAS THEMES (BOLD) AND CATEGORIES

1. Personal opinion on the

research project.

Necessity

2. The overall feelings about the

learning environment.

Role of assessment in the learning environment

Thrown in at the deep-end

Feeling in favour

In opposition to

Improvement of knowledge

245

3. Theoretical grounding and

integration of theory and

clinical practice

Characteristics of the lecture contributing to

integration

Qualities of lecturing staff contributing to

theoretical grounding

Factors that influenced the integration of

theory and clinical practice.

Sound theoretical and clinical skills foundation

Practical application of knowledge

4. Factors that influenced the

Pathology clinical learning

environment

Factors that contributed to a safe learning

environment

Challenges experienced in the Pathology

clinical learning environment

Supervisor attributes

Positive attributes

Negative attributes

Assessment

The impact of the supervisors on subjectivity

- Insufficient numbers of assessors

- Supervisor’s frame of mind

- Type of patient

Time

Patient referrals

Rubric used for the assessment

Role of constructive feedback

5. Recommendations on the

enhancement of the learning

environment in the Pathology

clinic

Assessment

Supervisor

Earlier exposure to the clinical environment

with rotation with ophthalmologists and

students

Ensure exposure to a variety of cases

Time and equipment

Theoretical grounding

5.4.2.1 Focus area 1: Personal opinion on the research project

One major theme regarding the participants’ personal opinion on the research project was

identified, namely, necessity.

246

Theme 1: Necessity

Three of the participants mentioned that the research study and this type of research is a

necessity in an educational programme and they expressed the hope that the findings of

the study would be implemented ... because it just makes it better [1_P116].

Discussion: The researcher appreciated that the students mentioned that they

acknowledged the effort of the researcher and agreed that the findings of this study would

improve the learning environment of the students at the UFS Optometry Department.

5.4.2.2 Focus area 2: The overall feelings about the learning environment

The second focus area concerning the experiences of the participants was the overall

feelings about the learning environment. Three themes were identified, namely (i) the role

of assessment in a learning environment, (ii) thrown in at the deep-end, and (iii) the

improvement of knowledge.

Theme 1: Role of assessment in a learning environment

One of the participants summarised the overall feeling by stating … like I’m summarising

as well now, we feel safe …[1_P118], but important to note are the next few words … if it’s

not assessment. The assessment in this learning environment caused the learning

environment feeling unsafe to the participants, as they felt the supervisors did not help

them. One participant expressed the feeling that in any learning environment, even if it is

an assessment, the supervisors should remember that they are there to learn, and made

the following remark: Even if it is an assessment, even if it is just a regular clinic, if we don’t

know something, then there is a reason why we don’t know it and then we want to know

what it is. So, just explain it to us ... [1_P21].

Theme 2: Thrown in at the deep-end

Participants strongly voiced the feelings that they felt they were thrown in at the deep-end

and were ‘broken down’ to be built up, there’s a bit of a stigma that to execute a learning

method you first need to break someone before you can build that person up again

247

[1_P106], and they felt they were left on their own to survive as one participant mentioned

…they teach the work, complete it and that’s it, you have to swim [1_P107].

While some perceived it as positive, others were firmly against this approach. Two

categories emerged from this theme, namely feeling in favour, and in opposition to.

Category: Feeling in favour

One participant mentioned that this type of approach is a good way of learning to be

independent and comment that … especially like in Pathology clinic it’s nice to see how they

do it and then you have to swim there. I think it’s a better way than when someone is

always holding your hand [1_P108].

Category: In opposition to

Others disagreed with this kind of approach as it made them feel more incompetent and

they really struggled to build their confidence again. The facilitator confirmed this feeling

and the participants in the first focus group interview agreed to experience this feeling. One

participant strongly agreed and reported that … I fell from the deep-end, down two meters

deeper and … really struggled to reach the surface again [1_109]. The same student stated

that I really don’t believe in it [1_P109]. Some mentioned that this approach had been

followed from their first-year of studies and the change only occurred in their fourth and

final-year. One participant felt that the learning environment of the Pathology clinic was the

environment where negative feelings were least experienced, as she mentioned …I think it

was my favourite clinic actually where I least felt that I was taken down or so, so I actually

enjoyed it. [1_P112].

Theme 3: Improvement of knowledge

Some participants indicated that the learning environment did not change, but as they

gained knowledge, their learning experience changed. The following remark was made:

I also think this is the way everyone experiences it, in the beginning, you are

somewhat unsure, it is an unfamiliar environment and then as you become

used to everything then, then you feel as if you have more self-confidence

[2_P5].

248

Discussion: It seems that the overall feelings regarding the learning environment did not

only apply to the Pathology clinic, but to the whole optometry programme. The perception

of the participants that they were thrown in at the deep-end and broken down should not

be taken lightly, even if lecturers did that unintentionally. It also seemed that how they

responded depended on the individual student’s personality. Some students felt they had

to prove themselves and found it demotivating. This influenced their whole learning

experience throughout their studies. The researcher agrees that a student should never be

ridiculed, and also agrees with Papp et al. (2003:263) that clinical education should create

a ‘self-student’. These authors are of the opinion that the sooner a student takes

responsibility the better.

Participants indicated that they felt alone; that the supervisors did not provide the support

that they needed. This corresponds with the remarks made about clinical skills training (cf.

4.4.9.2) when students also mentioned they were left to figure some procedures out on

their own. Similarly, some students enjoyed independence, while others mentioned that

they would appreciate the presence of a supervisor constantly. What should be noted here

is that students in the clinic are never left alone. There always are supervisors in the clinic

to assist. However, this might indicate that they need more assistance, or the manner in

which they are assisted should be investigated.

It also appears from the data of the focus group interviews that assessment played a

significant role in how participants felt about the learning environment, and it seems that

the assessment influenced the participants’ feelings negatively. These negative feelings

expressed towards assessment correspond with the feelings about assessment observed in

the clinical skills training (cf. 4.4.9.2).

Participants’ feelings about the learning environment shifted in the positive direction during

the year. This could be due to the improvement of their knowledge, as mentioned by the

participants.

5.4.2.3 Focus area 3: Theoretical grounding and integration of theory and

clinical practice

This focus area concentrated on the theoretical grounding required for application and

integration of theory in the Pathology clinic. The facilitator initiated the discussion on this

focus area by asking: Do you think that in general the lectures were of such a nature that

249

they were useful in clinic? [Facilitator]. Everyone agreed by nodding their heads and they

mentioned elements of the lectures, as well as opinions on the lecturing staff that

contributed to the integration of the theory and clinical practice. Most of the data emerged

from the first focus group and three themes were analysed in this focus area. They were:

(i) Characteristics of the lectures contributing to integration, (ii) qualities of lecturing staff

contributing to theoretical grounding, and (iii) factors that influenced the integration of

theory and clinical practice.

Theme 1: Characteristics of the lecture contributing to integration

The theoretical groundwork was perceived, as one participant described it, the theory was

good and extensive ... [1_P34]. Among the characteristics identified were compliments and

these provided additional information on the data regarding lectures collected by means of

the questionnaire (cf. 4.1.1). Remarks made by participants were:

... the integration between subjects is also good, because it feels to me, this

year with the (Clinical medicine module) it is really nice because we get (the

ophthalmologist’s) input on it, … hmm, who obviously sees the things in

theatre and deals with it, so you get that very theoretical part and then also

the practical application of it, which is good for integration. It is good to hear

it twice from different perspectives. [1_P35]

... there were always pictures with it. They took the trouble to add videos,

to show us specifically. [1_P34]

Their lectures are available beforehand. [1_P42]

... there are also ongoing assessments, ... there are class tests every week,

so it forces you to pay attention to it weekly. [1_P41]

Discussion: There was functional integration between the different pathology modules

and it appears that participants highly regarded the different perspectives they received

from the optometrists and the ophthalmologist presenting in the modules. It came to the

fore that participants not only preferred to learn from someone whom they perceive as

knowledgeable, but they also valued different views from different eye-care professionals.

This view agrees with their opinions on the lecturing method (cf. 4.4.1.2).

250

Their appreciation for lecturers paying attention to making the presentations visual also was

mentioned by the participants. It should be noted that Ocular Pathology is one of the

subjects, in the researcher’s mind, that cannot be explained well without pictures and

photographs. The more visual examples and explanations a lecturer provide to the students,

the better. Their preference for a more visual presentation is not surprising and links with

findings of the data analysis of the questionnaire survey (cf. Chapter 4). It can be said with

confidence that this generation of students prefers a visual learning experience.

All the participants gave due recognition for the slides being made available, indicating that

it is important for the participants to have access to the slides. This showed that having the

notes on the lectures provided them with peace of mind as they had the information to

study for the tests and exams. The ongoing assessments also were mentioned as a way of

keeping the participants up to date with the work. This is in agreement with the opinion

expressed in the discussion of lecturing as a teaching-learning method, (cf. 4.4.1.3), namely

that students should be compelled to prepare and study, as many students do not have the

self-discipline to do it themselves.

Theme 2: Qualities of lecturing staff contributing to theoretical grounding

One participant in the first focus group made the following comment:

I also just think it can differ for other people, but I think the right people

presented pathology. I feel that the people who presented it are good

teachers, so they had a way of conveying it and I think that if one had it with

other lecturers, who are not good teachers per se, it would not necessarily

have led to such good integration as it had [1_P36].

The facilitator then raised the following question:

May I ask you then, to share just a little more about what you would say,

makes them good teachers? [Facilitator].

The qualities mentioned are a contagious passion for the subject. The lecturers were well

prepared and had the ability to simplify difficult concepts with comprehensive, practical

explanations due to personal experience. These qualities are discussed below.

251

Discussion: The manner in which the knowledge was transferred contributed to the

integration of knowledge for the participants. They mentioned that the lecturers teaching

in these modules had a passion for the subject and this passion was contagious, as one

participant mentioned ...they do not only have a passion for the subject but that they have

a passion for making us passionate about the subject. [1_P39]. In addition, the lecturers

had the ability to simplify difficult concepts. One participant voiced it as follows: I think it’s

their way of simplifying things and explaining it like that ... they always tried to explain it in

a different way [1_P36].

Adding to this quality was that the lecturers explained everything and did not provide certain

themes to be studied as self-study. This was highly appreciated by the group.

Another quality of the lecturers that caused students to find lecturing positive and the

lecturers ‘good’ to which the whole group agreed, was the ability to make … a very difficult

concept practical [1_P38]. The participants proclaimed that this quality gave the lectures a

personal touch and contributed to the opinion that it was due to the lectures that they had

the practical experience due to working with an ophthalmologist. A participant voiced it as

follows … they really make it their own, because our pathology lecturers ... have worked in

such a setting, like with an ophthalmologist [1_P43]. Multiple participants agreed with this

statement as the facilitator confirmed that it was not only the practical examples but also

that they could learn from the lecturer's practical experience as she stated, … what you say

is that the theoretical knowledge wasn’t only theory, it was theory that gave you some

clinical information with it, so it made more sense [Facilitator].

Lastly, one participant voiced a fundamental quality. This was on the topic of subject

preparation: Subject preparation was also done very well. They know what they’re going to

present that day and what is in their slides [1_P40]. Everybody agreed with this statement

and laughed uncomfortably when the participant added that it was not the case in all the

modules.

Theme 3: Factors that influenced the integration of theory and clinical practice

Integration of theory and clinical practice is a critically important part of health care

education and the participants were prompted to discuss whether they could integrate the

knowledge they obtained in the theoretical grounding of the Pathology module in the clinical

252

environment. The overall feeling was that it was challenging at first, as one participant

stated:

I think in the beginning it was quite difficult because you come out of your

third-year and you are still working according to the book, but the more

you’re in the clinic, … the more comfortable you become with everything,

the better things get [1_P21].

For one participant, the integration was especially tricky due to the vast amount of work

that needed to be integrated. She stated:

I don’t know if it’s just me, but just the enormous amount of information that

must be integrated at once where there is suddenly this patient sitting in

front of you and we need to remember three years’ things all of a sudden to

make sense of what is in front of you [1_P19].

None of the other participants added comments to this statement. Two factors were

identified that influenced the integration and were the categories identified for this theme.

The first category was (i) Good theoretical and clinical skills foundation, and the second

was (ii) Practical application.

Category: Sound theoretical and clinical skills foundation

The participants proclaimed that they had a good background of theoretical knowledge and

clinical skills. The basic concepts had been grounded before they entered the clinical

environment and this contributed to a better clinical learning environment. The following

remarks were made:

I also feel that we had in the third-year a very good ... pathology theoretical

knowledge [1_P23].

I think it was really a good thing that in your third-year you had to get all

your diagnostic, hmm, procedures and privileges before you go into the

Pathology clinic in the fourth-year … [1_P32].

253

Category: Practical application of knowledge

Some of the participants felt that due to them having the opportunity to see the different

pathologies discussed in theory classes, made the integration possible. They articulated it

as follows:

… when you see it in the clinic, then it’s easier, because you know ...

basically, the theory behind it [1_P22].

… once you saw it, you won’t ever forget it again, because what you see in

the book and what you see in real life are completely different [2_P27].

The issue of when the application of theory should happen was raised. Some participants

felt that the theory should be applied immediately and made the following comments:

To me, it’s easier to learn if I learn it and see it immediately ... [1_P25].

… but feel that third-year work I have only now mastered 100% since I saw

it in patients ... I think we would have mastered that anterior pathology

better if we also saw it in patients all the time [1_P26].

Others felt that it was good that a foundation was laid before they entered the clinic. The

following remarks supported this:

… say for instance you had Pathology clinic last year and we had not yet

learned the theory, then it would have been very difficult for you, ... So, I

think this is why I found it good to do everything first [1_P27].

… it was good that we did what we did last year and are doing this year what

we’re doing… [1_P28].

Discussion: A sound theoretical foundation is crucial for the successful integration of

theory and clinical practice. The characteristics that contributed to the integration of the

theoretical grounding were discussed in the previous focus area. The participants valued

that they had obtained a good foundation of the knowledge and clinical skills before

entering the clinical environment. Therefore, although participants felt they were thrown in

at the deep-end (cf. 5.4.2.2), they had the theoretical background before entering the clinic.

254

From the data, it became clear that integration took place naturally as soon as the

participants had the opportunity to apply their knowledge practically, whether immediately

after the theoretical grounding or only after all the theory had been discussed. This is

confirmed by O’Mara et al. (2014:208) who stated one should ensure the student has the

capability to see patients before exposing them to the clinical environment. The current

ocular pathology theoretical module is split into anterior (third-year) and posterior (fourth-

year). Some students mentioned that they would prefer to be exposed to patients with

anterior pathology during the completion of the third-year module.

5.4.2.4 Focus area 4: Factors that influenced the Pathology clinical learning

environment

The next focus area dealt with the factors that contributed to the influences in the clinical

learning environment, specific in the Pathology clinic. The themes that emerged were:

factors that contribute to a safe learning environment, challenges experienced in the

Pathology clinical learning environment, supervisor attributes, and the last theme was the

assessment.

Theme 1: Factors that contributed to a safe learning environment

Under this theme, a few factors were identified that contributed to a safe learning

environment conducive to learning. These factors are as expressed by participants are given

in Table 5.2.

TABLE 5.2: FACTORS THAT CONTRIBUTED TO A SAFE LEARNING ENVIRONMENT

[Table continue on next page]

FACTORS CONTRIBUTING TO A

SAFE LEARNING ENVIRONMENT DIRECT QUOTE FROM PARTICIPANTS

Free to ask questions

I’ll say it was a safe learning environment. We could

safely ask questions if at all at any time during the clinic

itself we had a question or felt uncertain about anything.

[2_P1]

Availability of knowledge and opinions

… there were many opinions and knowledge around you,

so it’s a nice environment to ask if you don’t know

something. [1_P1]

Familiar environment

And everyone knows everyone, like the lecturers that are

there that help us, we know them, if there’s someone

255

from outside we know them as well, we’ve seen them

somewhere already and so. [1_P2]

Able to learn from each other

I also think that we learn from each other, like if someone

else had an interesting patient that day and mine was not

so interesting that day. [1_P4]

Availability of an Ophthalmologist

..there is an ophthalmologist ... he finalises our diagnosis

if you are correct or wrong, you know like someone who

really knows had a look at it, so you feel safe to, yes with

the work that you’ve done. [1_P3]

Exposed to a variety of pathology

... we saw many different pathologies. So, I think it’s good

that we could be at that hospital because we learn a lot

... we really get the opportunity to see some of the

extremes. [1_P20]

First exposure was with a supervisor

... the lecturers saw a patient with us, ... It helped a lot,

it really made me feel very comfortable. [1_P6]

Discussion: In correspondence with the literature (cf. 2.3.3.2.10), in both focus group

interviews the first factor that was mentioned that contributed to a safe learning

environment was that the participants felt they had the freedom to ask for help when they

needed it. This has been mentioned as an integral element in a learning environment

(Ernstzen et al. 2010:28; O’Mara et al. 2014:208). When this was mentioned, all the

participants nodded their heads in agreement. This specific perception was also evident in

the data of the questionnaires discussed in Chapter 4, especially in their experiences in

lectures (cf. 4.4.1.2), bedside teaching (cf. 4.4.8.2) and clinical skills training (cf. 4.4.9.2)

With this perception, they might have felt that they were thrown in at the deep-end, but

they were not left alone to swim. Contributing to this factor, the participants stated that

much knowledge and opinions were available to answer the questions they had. The

participants of this study mentioned their preference to get information personally and from

someone familiar and knowledgeable (cf. 4.4.2.2; cf. 4.4.5.2; cf. 4.4.9.2). It seems that this

was the case in the Pathology clinic as well. It further appears from this theme that they

felt comfortable as they were familiar with the environment, knowing each other and the

supervisors involved. Also, the participants valued the apprenticeship experience they had

at the beginning of the year to introduce them to the clinic. The data from the focus group

interview confirmed the data from the questionnaires and all the participants were in

agreement that this experience made them more comfortable in the clinical environment

and provided a guideline they were able to follow (cf. 4.4.8.2). This concurs with the finding

of Ernstzen et al. (2010:28), as one factor that will create an optimal learning experience.

256

Participants further expressed the opinion that the environment lent itself to learning from

each other - another factor that contributed to a positive, safe learning environment. This

could be due to the fact that this class was a small group of students and they felt

comfortable to discuss their different experiences with each other. It could also be seen in

the small-group learning experience - this group of students felt at ease working as a team

(cf. 4.4.3.1).

The fact that the clinic is situated in a government hospital enhanced the learning

environment and contributed to the quality of the learning environment for the participants

as they were exposed to a variety of patients. It should also be noted that the optometry

clinic is in the same building as the Ophthalmology Department. Therefore, some patients

are seen first at the optometry clinic (as being the primary eye-care provider) before they

are referred to the ophthalmology clinic, and for this reason, the students are exposed to

different kinds of patients with pathology. In addition, they also felt safe with the availability

of an ophthalmologist who could confirm their diagnosis and provide immediate feedback

on the patient’s condition. This is not surprising, as mentioned in the discussion on their

experiences on lectures (cf. 4.4.1.3), it also appeared that this generation of students wants

instant reassurance on their work and with the availability of the ophthalmologist, it could

happen.

Theme 2: Challenges experienced in the Pathology clinical learning environment

The participants noted some challenges they experienced in the pathology clinical learning

environment that might have caused anxiety and uncertainty contributing to an unsafe

learning environment. It was especially noted that the participants in the second focus

group experienced more challenges in the clinic than the participants in the first focus

group. Something that is worth mentioning about the two focus groups is that although the

facilitator in both discussions started with the same question on What factors do you think

contribute to a safe learning environment, specifically now in a clinical area? What, in your

opinion, contributes to a safe learning environment? [Facilitator]. In the second focus

group, she also added … or what made you feel it is not a safe learning environment?

[Facilitator]. It is for this reason, the researcher suspects, that the second focus group

reported more challenges - they were asked directly to comment on what made them feel

unsafe and immediately responded by mentioning the challenges. It might also have been

that because the discussion started on a negative note, throughout the analysis, it was

observed that the second focus group’s comments tended to be more negative.

257

The following table, Table 5.3, represents the challenges and some of the phrases the

participants used regarding their challenges:

TABLE 5.3: CHALLENGES EXPERIENCED IN THE PATHOLOGY CLINICAL LEARNING ENVIRONMENT

CHALLENGES EXPERIENCED DIRECT QUOTE FROM PARTICIPANTS

Limited time allocation

... they added time to the patients. Now I feel every patient

is unique ... if the patient takes three hours, then the patient

takes three hours. [1_P10]

Broken equipment

... half of the slit lamps in the clinic are broken, so half of the

time you wait for your turn at a slit lamp., ... So, it makes it

very difficult for us. [2_P11]

False referrals They (the patients) are referred for no reason [2_P43]

High expectations from

supervisors

I think in the beginning ... they expect quite much of you. I

think they have high expectations of you, ... it’s difficult in

the beginning ... [1_P16]

Language barrier Because we could not really communicate with them, we

could also not get a solution for them. [1_P95]

Learning dependent on patient

… it (learning) all depends on your patient, ... if you don’t

have the right patient, you can’t practise it (procedures).

[2_P18]

Type of pathology limited

.. .because the one guy sees al the interesting cases, by

chance, and then the one guy just gets twenty glaucoma

suspects at the end of the year. So, it also makes it difficult,

because then you don’t expand your knowledge, you just see

it every time. [2_P62]

Not practically and theoretically

equipped to see patients at the

beginning

... we do not have all the knowledge, theoretical, that you

know or you do not feel competent to diagnose, ... [2_P4]

Focus on patient numbers

I also think, now it is only about the numbers that we must

get. [2_P25]

Discussion: According to literature, the perception students have of the clinical

environment is that it is stressful (Walker et al. 2013:510; Papastavrou et al. 2010:177)

and, consequently, it is emphasised that the challenges that contribute to the stressful

environment be identified. The first challenge discussed is the limited time allocated to

spend with each patient. This issue was raised in both focus groups and the participants

also provided reasons why they experienced challenges with the time allocation. These

258

challenges may be seen in isolation, as well as in combination with broken equipment, lack

of equipment, false referrals from the General clinic and some patients being more

challenging than others, which should be taken into consideration. The researcher

acknowledges the challenges the students voiced in terms of lack of time and all the issues

contributing to wasting time; albeit these are being addressed continuously. It should be

noted, however, that students have 120 minutes to spend with a patient and it would be

unfair towards the patient to be examined for longer than this allocated time. For this

reason, supervisors emphasise time management and using time productively. It should

also be mentioned that as the year goes by, students get much better with their time

management and it happens only occasionally that a supervisor has to intervene to address

the issue.

The participants found it a challenge to live up to the high expectations supervisors had.

These expectations made them unsure and caused them to doubt their abilities. This

challenge substantiated their overall feeling of being thrown in at the deep-end, which

brings to mind a crucial aspect that Walker et al. (2013:504) and O’Mara et al. (2014:208)

mentioned, namely that to be effective clinical learning experiences should be geared to

enabling students to master the application of theoretical knowledge and skills.

An issue about language was also raised as a challenge, as the students found it challenging

to help patients who did not understand them, and that consequently affected their

learning. Most of the patients seen at National District Hospital speak Sesotho and this

group of students was predominantly Afrikaans-speaking. Some of the patients did

understand English or Afrikaans, but some understood only Sesotho. UKZN has a basic

isiZulu language module in the first-year where students learn the basics of isiZulu to be

able to assist their patients in isiZulu (UKZN 2019: Online). Therefore, it might be a good

idea to include a module to introduce students to basic Sesotho during their first- or second-

year at the UFS.

A number of participants mentioned that they always saw patients with the same type of

pathology, therefore, it did not contribute to new knowledge. Although the participants

reported that they had seen a variety of patients, they complained that they were not

exposed to a variety of pathology. Perhaps this should not be seen in a negative light, as

with the repetition, the knowledge they gained was embedded and the pathology they saw

at the clinic probably is what they will encounter most often in practice as well.

259

Participants also discussed the experience of being unfamiliar with the clinic at the

beginning, especially with some of the procedures and they regarded themselves as not

practically and theoretically sufficiently equipped to see a patient. They also felt not

adequately informed in that that they had not received all the information or full

information. They then added that for some of the tests they had to read up information

by themselves. The participants in the first focus group were of the opinion that they had

a good theoretical foundation (Theme 3 of Focus area 3; cf. 5.4.2.3), while this perception

merely was mentioned in the second focus group. It might be true that some specialised

tests are explained later during the year (they mentioned Neuro Optometry), but these are

not the regular procedures that are indicated on the clinical sheet and the supervisors are

very attentive to these individual cases. In addition, during the bedside teaching experience,

all the information that they required had been provided (cf. 4.4.8.1); therefore,

maintaining that they did not feel practically equipped and well informed came as a surprise.

The specific number of patients the students had to see, also was regarded as a challenge

and they purported that this had a negative influence on their learning. This challenge, with

the concomitant problem of unsuitable patients, they had to see in the Pathology Clinic,

added to their anxiety about seeing the required number of patients. Students have to see

fifteen pathology patients during their studies as stipulated by the HPCSA. Without seeing

this number of patients with pathology, the students will not be able to register at the

PBODO.

Theme 3: Supervisor attributes

The attributes of the supervisor or lecturer are also discussed under this focus area as it

influenced the feelings of the participants about the learning environment and

consequently, it affected the quality of the learning environment. The facilitator prompted

the participants on this topic and asked, How does the lecturer or supervisor contribute to

alleviating your anxiety or uncertainty? ... Is it something that is important to you?

[Facilitator], and the response was ... very much ... yes [1_P5]. Two categories were

analysed in this theme, namely positive and negative attributes. These categories are

reported and discussed below.

260

Category: Positive attributes

Most of the positive attributes of the supervisors that contributed to a safe learning

environment were mentioned during the first focus group interview. The group agreed that

they make it really feel safe [1_P7] and concluded with (they) really go out of their way in

Pathology clinic to make us comfortable [1_P113]. The positive attributes included that the

supervisors were always willing to help and stimulated the students’ thinking process. They

were knowledgeable, but also eager to learn with the students. Lastly, they acted humanely

towards them and the patients and never let them feel small.

Discussion: The positive attributes that were identified by the participants in this study

are in accordance with the attributes mentioned in the literature and discussed in Chapter

2 (cf. 2.3.3.2.10). Participants mentioned that the supervisors were always willing to help:

They were always willing to offer advice on your patient, so even if you did not ask for it

they would contribute... [1_P5], and that they stimulated students’ thinking while assisting:

They do not prevent us from broadening our knowledge, they first give you the opportunity

and if you’re perhaps wrong, they’ll correct you [1_P7]. The participants recognised that

the supervisors were knowledgeable and maintained high-quality work, as one participant

stated, you’ll never be able to say that they don’t know what they’re doing. They’re really

good at what they do, they have very sound knowledge and it’s really a good thing to learn

from them [1_P119]. This attribute corresponds with what Papp et al. (2003:263) and

Papastavrou et al. (2010:118) reported with regard to how students responded to quality

in a learning environment and are consistent with the results of the questionnaire surveys

(cf. Chapter 4).

In the same way, they also valued the feeling that the supervisors learned with them, as

one participant remarked:

... the lecturers often made me feel that they’re not going to pretend to be

so clever or try to be kind of better than you and that when they also don’t

know, they acknowledge it, ... So, then you feel as if you learn with them

and they can contribute something and you learn from the start [1_P8].

For this reason, the participants felt part of a team, and as Papastavrou et al. (2010:118)

mentioned, this may increase their confidence levels. They also appreciated that one

261

specific supervisor never let them feel small and worded it as follows: ... never lets you feel

stupid, you can always ask ... always give you an answer without letting you feel small

[2_P68].

It seems that the academic staff members focused mainly on the learning that should take

place during the clinical education and perhaps unintentionally forgot to illustrate patient-

centred care, and the participants mentioned that the external supervisors (mostly those

from private practice) acted more humane towards them as well as the patients - something

that they valued highly.

Category: Negative attributes

The majority of participants in the second focus group did not experience the learning

environment as safe and raised a few aspects regarding the supervisors that created

feelings of uncertainty, humiliation and incompetence that consequently affected the

learning environment negatively. These negative attributes of the supervisors will be

discussed subsequently.

Discussion: The one aspect that was raised in both focus groups that contributed most to

the uncertainty amongst the participants in the learning environment was that they felt

there were inconsistencies amongst the supervisors. The participants used phrases such as

they were not all on the same wavelength [1_P9] and, they are not on the same page

[2_P14]. This did not only refer to the application of different techniques, but also to the

knowledge supervisors thought the participants should have. They identified factors that

might have caused these inconsistencies. These included the different educational

backgrounds of the supervisors and also that some supervisors were not up to date with

the theory content, as one participant mentioned, ...the lecturers don’t always know who

what we learned, so then they think we must know this, but we haven’t learned it from that

one and then … [1_P18]. Papastavrou et al. (2010:177) surmise that the supervisor

responsible for the clinic should also be the lecturer of the specific speciality area. The

researcher (who also was a supervisor) was the module leader for the theoretical module,

but the supervisor responsible for the clinic was not involved in the theory training. The

other supervisor was an external supervisor who had been involved in this clinic for a couple

of years. Therefore, it might have been that discrepancies occurred regarding expectations

supervisors had of students. Participants mentioned that due to the supervisors being in

262

the clinic year after year, they assumed that the students had the necessary knowledge, as

one participant concluded ... the lecturers become used to every year, ... they assume that

we also need to know it by now. This perception might be related to the high expectations

the participants mentioned in Theme 2, Focus area 4 (cf. 5.2.4.2) and possibly indicated

that supervisors tended to continue from the previous year, instead of resetting their

expectations.

A factor that contributed significantly to the safe learning environment experienced by the

participants and mentioned in the first theme, as well as the previous category of this focus

area, was that the participants felt comfortable to ask questions and experienced the

supervisors as helpful. In contrast to this positive experience, one participant in the second

focus group experienced supervisors as not approachable, as she mentioned, ... actually, I

experienced totally the opposite this year. Many of our supervisors will first scold you before

they help you [2_P2]. The facilitator prompted if anyone else in the group had the same

experience, but the other participants laughed uncomfortably and looked straight ahead.

During the first focus group discussion, some participants mentioned that the supervisors

were untactful and made them feel incompetent in the presence of a patient; one remarked,

... but the lecturers … are not all equally tactful. So, if you make mistakes, then some of

them scold you in front of the patient and then the patient thinks you’re incompetent

[1_P13]. This remark is related to another participant’s opinion who stated that especially

the academic staff supervisors, were very clinical and, ... they forget kind of that, uhm,

human side of thinking not of the patient and not of the student [1_P105]. These actions

of the supervisors, namely being untactful and handling the students very clinically, seemed

to have caused the participants to doubt their abilities. This specific negative attribute also

had been mentioned in the comments on peer assessment used in this clinical module (cf.

4.4.7.3), and the supervisors should be reminded that their actions have the most

substantial influence on the student’s experience in the clinic (O’Mara et al. 2014:208).

Also discussed as a negative attribute was the feeling that some supervisors forced learning

on the participants and did not allow them to learn practically, as one participant explained,

... like not all the supervisors will tell or show, actually the show is more important to me

than the tell [2_P20]. In addition, it was also reported that I’ll just say that knowledge isn’t

the problem, but sometimes conveying the knowledge is [1_P120]. It seems that the

participants recognised the supervisors as good role models, but the supervisors only told

them what do to.

263

Theme 4: Assessment

This theme involves the discussion on how the participants experienced the assessment in

the Pathology clinical learning environment. As mentioned before in the second focus area,

students experienced the clinical learning environment as a safe learning environment,

except when it came to assessment (cf. 5.4.2.2). Later in the focus group discussion, the

facilitator summarised it as follows: The idea that I get is that initially you were very positive

about the lecturer really helping you a lot in the practical environment, but as soon as it

came to assessment then your experiences were very negative [Facilitator]. She then

enquired: Is it so that the same people whom you said just now made you feel safe to

learn from makes it feel unsafe when it comes to assessment? [Facilitator]. The answer

from multiple participants was that those were different people. It is therefore important to

take note of the factors that influenced the assessment in this specific study negatively.

In this theme, five categories were analysed and are now discussed.

Category: The impact of the supervisors on subjectivity

The first category that emerged from the assessment theme was the impact of the

supervisors / assessors on the assessment environment, especially on the subjectivity. One

participant in the second focus group interview stated … your mark is very much dependent

on the supervisor assigned to you [2_P3]. This was confirmed by another participant

stating, I think if I saw a patient now, and I had every supervisor that assessed me, I

would get different marks, ... [2_P32]. The sub-categories that came to the fore were the

insufficient number of assessors, dependability of the supervisor’s frame of mind, and type

of patient.

These sub-categories will be discussed and supported by directly translated quotes from

the participants’ responses in both focus groups.

Sub-category: Insufficient number of assessors

During both focus group interviews, the insufficient number of assessors and consequently,

the issue of having one assessor assessing two students simultaneously was emphasised.

264

Not being present all the time caused the assessor to miss valuable information and the

participants reported that this also influenced the patient’s perception of the student.

A lecturer had to run between two students and the value, valuable

information is missed, and then they can make their own interpretation

[1_P46].

...then I would do my things and ask my questions and then he comes and

would do exactly the same things with the patient again and then the patient

thinks I’m incompetent [1_P47].

Sub-category: Supervisor’s frame of mind

During the first focus group interview, the participants mentioned that the assessment was

subjective depending on the supervisor’s frame of mind. Everyone verbally agreed when

the facilitator confirmed this opinion by saying, Okay, is it a general perception of everyone?

[Facilitator]. The participants mentioned the following:

Depending on the lecturer’s mood that day, it is really so, because I actually

had a good experience with the lecturer, but they did not [1_P49].

It really depends on the emotion of the day. I feel emotion should not really

interfere with the personal view, it’s a professional career, and we must all

remain professional [1_P58].

It is very subjective. It depends on how your supervisor feels that day, what

their experience is, what tests they think are important, as opposed to what

we learned is important, how they interpret something as opposed to how

we were taught to interpret it [2_P31]. [Non-verbal: participant suddenly

spoke very incoherently]

Sub-category: Type of patient

The participants felt that the type of patient, together with the supervisor assigned to you,

had a major influence on the assessment in terms of subjectivity. One participant described

it thus: ... yes, because every patient that you get is also very different, not one of us gets

the same patient, so every supervisor manages a patient in the way he would manage him

265

[1_P51]. It was also mentioned that some patients did not cooperate and that could make

the diagnosis and management difficult and should be taken into consideration. The

participant worded it as follows: … but your patient really determines a lot, because if they

cannot cooperate well, then it really makes it difficult for you [2_P38].

Discussion: It seems that the supervisor’s objectivity was a noteworthy issue in the

assessments. The perception that the supervisors were subjective during the assessment

was repeatedly mentioned in both focus group interviews, and it seems that it had a

remarkable impact on the way they experienced the learning environment. There were a

few factors mentioned that led students to this specific opinion. Firstly, the participants

were of the opinion that during the assessment the assessor should be present all the time

to avoid missing valuable information of the evaluation and consequently then assumed

that certain aspects of the evaluation were done, omitted or done incorrectly. This is

something that had been discussed within the Department. Unfortunately, due to

insufficient finances, no more supervisors could be appointed in order for the ratio to be

1:1 during the assessment; and not all optometrists were comfortable with the procedures

used during pathology clinic to do assessments; therefore, only a limited number of

supervisors were equipped to assess in this specific clinic. Also, to run the assessment over

more than two clinics would influence the service delivery negatively, as fewer patients can

be seen during this time. The fact that the students have to comply with seeing a required

number of patients also have to be kept in mind. Nonetheless, this complaint should be

taken seriously by the Department.

The participants also noted that the assessor should always be neutral and a personal

emotional state should not interfere with the assessment process. The human factor of the

supervisors had been mentioned before and care should be taken from the assessor’s side

not to let personal feelings interfere with the assessment process.

It was interesting to note that the participants were of the opinion that different supervisors

(not the ones that are typically involved in the clinic) made them feel unsafe during the

assessment. This observation adds to Papastavrou et al.’s (2010:177) claim mentioned in

Chapter 2 (cf. 2.3.3.2.10) that the theoretical lecturer and clinical supervisor involved in the

training environment have a better understanding of the assessment environment and have

the knowledge to create a safe learning environment.

266

Category: Time

The next category that developed regarding factors that influenced the assessment in the

Pathology clinical learning environment was the issue of time. Not only did time present a

challenge in the clinical environment (Theme 2 of this specific focus area), but as one

participant noted early in the second focus group discussion …this is a major problem in

assessment [2_P12].

This category is very closely linked to the previous sub-category, as participants felt that

time depended on the type of patient they had to examine. One participant voiced it as

follows: I don’t feel there must be time limits because I know one cannot time … [unclear

audio] …, but it must be taken into account what type of patient you have and the case

you have … [1_P53].

It also became evident that the participants felt that the supervisors were not all consistent

with regard to time limits, and some were more lenient than others. They mentioned the

following:

… not all lecturers keep time with assessments and that time is often not

added [1_P32].

… Because they do not always stop the clock when you need to [2_P12].

… my supervisor was really lenient, ... really went out of her way to give me

the time. Later on, she told me not to worry about the time [1_P54].

Discussion: The participants’ disfavour with the use of time in the assessment might be

understandable, as the students do not get marks for everything they do when their time

has run out. Some students failed assessments due to this. However, it seemed that

students tended to forget that the aim of clinical education was to demonstrate the reality

of clinical practice, as proclaimed by Walter et al. (2018:612). As professionals in a busy

clinical practice, they should be able to see a patient in a minimal amount of time, think on

their feet, only perform necessary tests and manage the patient accordingly. Therefore, as

mentioned previously (Theme 2), students are trained to manage their time effectively and

they are assessed under the same conditions. Time always will be an issue in any clinical

assessment, and consensus on time limits will remain problematic. Yet, it appears from the

267

data that supervisors did not apply time consistently and this should be avoided to ensure

fairness.

Category: Patient referrals

From the data collected during the focus group interviews, the next category that emerged

was the referrals of patients that had been evaluated during the assessment. There was a

difference of opinion amongst the participants whether they should have access to the

referral letter or not. Those who agreed that they should not have access to the referral

letter made the following remarks:

we don’t get the diagnosis or the referral letter or so, which is totally fair,

because at the end of the day you need to show them how you think [1_P57].

I don’t feel we should get something; I feel it forces you to think; it forces

you to learn [1_P80].

I also understand that one must learn and everything and it pushes you kind

of to think a bit deeper [2_P41].

Others had a different opinion and stated:

I feel it’s totally unrealistic because I think if we place ourselves in a real-

world situation [1_P79].

…. but if you do not know what the person is referred for, you are not going

to know what you need to do to screen and then you do something that,

according to them, is not indicated, but you do it just to find out [2_P37].

I think it is difficult to remember that you sit there with really nothing…

[2_P38].

They have explained it to us as well why and I understand why, but I still

think it’s not fair [2_P40].

The issue of false referrals also was raised again (Theme 2), and one participant

commented … that the patient was referred, but actually nothing is wrong [2_P39].

268

Discussion: The booking of pathology patients always is a challenge and to ensure that

the patient has pathology only patients that are referred from another clinic are booked for

assessments. To ensure fairness and consistency in the assessments with regard to the

information the student receives, the referral letter is withheld from the student, as the

information in the referral letters differs. This action seems to have influenced the

participants mentally as well as emotionally. Some felt that they should receive the letter;

others agreed with the situation as it was. The objective of the assessment is to assess

whether the student has the ability to critically think about the evaluation, diagnosis and

management of the pathology. The participants acknowledged this, as one participant

stated … I also understand that one must learn and everything, and it pushes you kind of

to think a bit deeper [2_P41].

Also, as the evaluation starts with the case history when a referral letter is present - and

false, as can happen - as was mentioned earlier, the student has a preconception on the

diagnosis and may focus only on those aspects mentioned in the referral letter and runs

the risk of missing necessary data. Therefore, the referral is not made available to the

students to ensure that they apply their own thinking and abilities to analyse the case and

after having conducted their own case history, they decide on the way they think the

examination should go.

Category: Rubric used in the assessment

The next category that emerged deals with the rubric that is used during the assessments.

Table 5.4 represents the negative aspects of the rubric that were raised during both focus

group interviews. These are supported with direct quotes from the participants’

contributions to the interviews.

TABLE 5.4: NEGATIVE ASPECTS OF THE RUBRIC USED IN ASSESSMENT IN THE PATHOLOGY CLINICAL LEARNING ENVIRONMENT [Table continue on next

page]

Aspects of the rubric Direct quotes from participants

Subjective

I think the rubric definitely contributes a lot due to the fact that it’s

subjective. Yes, that’s all I’d like to say. [2_P50]

We know how the procedure must be done, but the way the rubric is

compiled, it is more kind of an impression mark that you have to give.

[2_P51]

269

… it is open to your supervisor’s interpretation, so they can kind of

decide, do they think this is good and I also think their opinions differ

a lot. [2_P49]

Not understandable I’ve read through it well. I don’t understand it at all [1_P61]

Not user-friendly Yes, it is, it is, we found it very difficult, actually to use that rubric

yourself, so, yes, you don’t really know how they tackle it. [2_P52]

Not case specific I feel the rubric, ugh, it’s very good, but it does not provide for all

types of cases. [1_P61]

Structured to prevent

good marks

It’s, to me, it’s a difficult assessment like you pass, but you do not do

well. [1_P36]

One positive aspect experienced about the rubric was the fact that there were no immediate

failing criteria as one participant mentioned: I just want to say, one positive thing about

the rubric is that you cannot fail [1_P77].

In both focus group interviews, the experiences they had with peer assessment were also

mentioned. In the first focus group, a few participants maintained that peer assessment

was a valuable learning experience that contributed to them knowing the rubric, as one

participant mentioned: I liked it that we, uhm, evaluated friends because we know the

rubric, so we went through it intensively, sat together and it was just another learning

process that you saw a patient kind of with someone [1_P44]. In contrast, participants of

the second focus group expressed the opinion that the peer assessment was not useful to

get to know the rubric. They reported that due to them not being familiar and confident

with the rubric, they were unsure about how to apply the rubric correctly.

Discussion: The participants confirmed their perception on the rubric, which was similar to

the findings of the data of the questionnaire survey on the peer assessment used in the clinic

(cf. 4.4.7.3). According to the responses made about the peer assessment, the rubric was

regarded as a weakness of the experience. It seems that the main issue with the rubric was

that it added to the perception of subjectivity and the students found it very difficult to

understand. It must be mentioned that although the rubric provides an extensive outline for

each criterion, it is difficult to use during the assessment, and it takes time to get familiar with

and use the rubric effectively. Important aspects were mentioned that need further

investigation to make the rubric understandable, user-friendly, more case-specific and arrange

the mark allocations reasonably.

270

Category: Role of constructive feedback

The last category in the theme of assessment that emerged from the focus group interviews

was the role of constructive feedback. Participants appreciated the constructive feedback

session after the assessment. The remarks made during the focus group interviews included

the following:

I would like to say something positive about assessment, which is that the

new thing that they brought in to have a full feedback session after your

assessment [1_P59]

I have a good experience, every time, irrespective of the supervisor. I did

receive feedback every time [Non-verbal: two other participants agreed by

nodding their heads] [2_P33]

It is a very valuable thing. [1_P60]

I would like to see that they make it compulsory, ... it is something that helps

one a lot and you learn much from it [2_P34].

Discussion: The participants in this study confirmed the importance of constructive feedback.

From the phrases that the participants used, it became clear that feedback can transform an

assessment into a learning experience. This can be linked to the findings of the questionnaire

survey which indicated that when feedback was used in the teaching-learning methods, it was

perceived positively by students, as discussed in Chapter 4 (cf. 4.4). Feedback should be

compulsory and care should be taken to ensure that it is constructive and valuable to the

student.

5.4.2.5 Focus area 5: Recommendations on the enhancement of the learning

environment in the Pathology clinic

The last focus group area that was analysed and will be discussed deals with the

recommendations the participants made on the enhancement of the learning environment in

the Pathology clinic. The themes that emerged from the data collected during the focus group

interviews were:

271

Theme 1: Recommendation on assessment

The participants in both focus group interviews mentioned the assessment and provided

recommendations on how the assessment procedure might be improved to ensure that it

was conducted in a positive learning environment.

The participants proclaimed that to render the assessment less subjective, as discussed in the

previous focus area (cf. 5.4.2.4.), an oral station should be added in addition to the clinical

evaluation of the patient. Knowing there will be an oral station, they thought they would be

able to prepare better for the assessment. The participants voiced it as follows:

… add an oral station, with the same lecturer, ... because then it also really

tests your knowledge. [1_P55]

The use of a continuous assessment system was also suggested. According to the participants,

this will ensure that the supervisors are present throughout the assessment, as the same

participant explained later in the discussion. The participants recommend that it should be

done via a schedule that would make provision for the students to be assessed by different

supervisors to ensure the same learning experience

… use continuous assessments throughout the year, [1_P58]

…you are assured that the lecturer is going to be there for the duration of the

clinic... [1_P86]

The issue regarding the referral letter (cf. 5.4.2.4) also was discussed in this focus area,

but only during the second focus group’s interview. The participants came to the conclusion

that they should have access to some parts of the referral letter and motivated it as follows:

I don’t think they have to give you the whole referral letter. They also don’t

have to provide the diagnosis, because you have to reach it, but they can

just mention a few … things [2_P41].

… highlight some of the tests of the clinical notes of the third-year or the

person that referred the patient, ... It’s a starting point [2_P42].

272

As mentioned before (cf. 5.4.2.4), the structure of the rubric needs further investigation to put

right the perception that students expressed, namely that the rubric contributed to subjectivity.

The participants recommended that the rubric should be structured containing a list, as the

participants explained,

… you have a rubric and then it indicates there all you have done – YES /

NO, everything you did – YES / NO, and then the lecturer marks what you

did, yes or no. [1_P65].

… I think it will help if it is kind of like a list that they tick off, ‘okay, this

person did this, and this, but not this’ and give a mark accordingly

[2_P47].

Others agreed and mentioned that with such a rubric, the supervisor would have to be

present in the evaluation room all the time and suggest that the constant presence would

make the assessment less subjective:

… it will force the lecturer to be with you more, he must physically, or

she must physically check whether you have done it [1_P69].

... Then it’s also less subjective; then you did it, or you didn’t [1_P66].

Other recommendations regarding assessment were that it should be ensured that the

students have seen sufficient patients before the first assessment, and they also

recommended that the type of pathology (anterior or posterior) should be specified.

… I think that what will really help one’s knowledge is we have two

substantial pathology assessments; if one assessment can be anterior and

one posterior [1_P76].

Lastly, a participant recommended that the complete assessment should be recorded and a few

supervisors should assess the student on the recording. He stated it as follows:

there could be a few cameras in the clinic [laughter from the whole

group] and afterwards all the lecturers sit down and watch how you

tested, and they all give a compound mark instead of one guy sitting

there and everything just depends on him [2_P59].

273

Discussion: Most of the recommendations made, according to the participants, will reduce

the subjectivity of the assessment. The oral station, perhaps, rather should be an extension

of the specific case in order to assess a deeper understanding of the students’ diagnosis of

the patients, and their way of thinking.

The continuous assessment looks like an obvious solution; however, the Department of

Optometry does not have the manpower to sustain an assessment every week. This will

mean that there is only one supervisor available to supervise the rest of the clinic and that

will jeopardise the learning environment for those students. To video record, the

assessment may be an option, but implementation will be difficult because video recording

could impose on patients’ privacy and will have financial implications for the Department

(to buy cameras).

The element that is highlighted throughout the focus group interview discussion on

recommendations for the improvement of the assessment is consistency. Changing the

rubric, ensuring supervisors are present all the time, adding continuous assessment, and

providing the same time for preparation for all students are recommendations by the

participants who actually merely wanted consistency during assessments. Keeping this in

mind and as mentioned before, providing the participants with the referral letter, or part of

the referral letter as recommended, will open up the feelings of inconsistency, as not all

referral letters have the same information. It should also be noted that it appears that the

reason for wanting the referral letter is to have more information. Perhaps they think they

are entitled to the information. As mentioned in the previous focus area (cf. 5.4.2.4) the

participants acknowledged the fact that without the referral letter they are forced to think,

thus the fact that they do want access to the referral letter might also be that they feel that

it will make the assessment easier.

Theme 2: Supervisors

In this theme, recommendations were made on the vital attributes of the supervisors and

how the supervisors might contribute to a safer learning environment. The attributes that

were identified are reported together with direct quotes from the participants’ comments,

and this is concluded with a discussion on the recommendations regarding the supervisors.

274

The participants mentioned a few attributes that they regarded important for a supervisor

to display in order for them (students) to feel safe and for supervisors to create the optimal

learning environment. These attributes are listed with the direct quotes included:

Provide constant communication

I think the most important thing to me is that they must communicate with us ...

we are there to learn and we don’t only learn from a book, we learn mostly from

practicums and from them. [2_P65]

Be approachable

... because it gives us confidence, and it boils down to approachability again

[1_P110]

I think they will also have patience and understand that one is also afraid in

clinics because it also helps that one will be more comfortable to ask questions.

[2_P66]

Be helpful and supportive

he kind of helps you reach the correct answer but asks you why this would

be possible [1_P101].

I just think support is better than anything else. If you get support, then you

try once again [1_P114].

So, I think it is often just necessary that they must remember that if you’re

supportive of a student that they are going to flourish [1_P19].

Enhance confidence through acknowledgement and believing in the student

...if they give you acknowledgement for what you do and say, ‘listen here

well done like really it was good,’ then you also feel like, Yes, but great I

I’m actually going to reach it ... [P1_110].

I think one thing that can also change is that lecturers can also give positive

feedback as well. I think we’ll get more self-confidence then, you know, if

you know, yes, these are my strengths and this is really what I’m good at

... [2_P58].

275

So, I just think it is something that stands out for me, you can be confident

in yourself and in your own techniques, but the moment that someone does

not also believe in you enough, then you feel incompetent [1_P103].

Collaborate with other supervisors

... supervised by one supervisor and with two that cooperate, it will also

help … [2_P60].

Be present

... that you can just get used to it that your lecturer is sitting there and

watching you the whole time... [2_P57].

Know what to expect of the students

... orientate the supervisors as well, beforehand, about what they can

expect of us or not [2_P13].

Discussion: The relationship between the student and the supervisor is the most critical

factor influencing the learning environment for the student (Ernstzen et al. 2010:28). The

attributes that the participants in this study recommended that a supervisor should have

corresponded with those discussed in the literature (Papp et al. 2003:263; Ernstzen et al.

2010:28; Papastavrou et al. 2010:118; O’Mara et al. 2014:208). All of these attributes may

reduce the level of stress the student experiences during the clinics and will create a safe

learning environment where the students will have the confidence to apply their theoretical

knowledge and skills.

Theme 3: Earlier exposure to the clinical environment with rotation with ophthalmologists

and students

During both focus group interviews, the third theme that emerged was the recommendation

regarding earlier exposure to the clinical environment. It was recommended that they

rotated with the ophthalmologist, an initiative that was implemented with the current third-

years. They also recommended a rotation with a fourth-year student in the Pathology clinic

in the third-year of study. The following remarks were made:

276

I think to rotate with the ophthalmologists while they do surgery and see

patients, to me, this definitely stands out way above everything else [1_P81].

an excellent opportunity to rotate in clinics with ophthalmologists [1_P28].

… then a third-year sits in with a fourth-year when they see patients because

... in your third-year to just sit in the clinic with a fourth-year and just to see

what he does in the clinic, like that you would just get an idea of the flow

[2_P55].

Discussion: The recommendation regarding earlier clinical exposure by rotating with

ophthalmologists as well as with senior student year groups was supported by all the

participants in both focus groups. The Department of Optometry is fortunate to be in close

proximity of the Ophthalmology clinic, as mentioned previously, and is also the only

Optometry Department in South Africa that has this advantage. Also, in accordance with

Tofade et al. (2016:430), the participants recommended a peer mentoring programme to

enhance the clinical learning experience.

Theme 4: Ensure exposure to a variety of cases

The next theme that emerged had a bearing on the participants’ recommendation that it

should be ensured that they had equal exposure to a variety of cases.

... it will just be quite nice if one can just have like a bit of variety with the

patients you see. [2_P62]

It was also recommended that an opportunity should be created where everyone could

learn from other’s experiences. This can be achieved by having a reflection session at the

end of each clinical session or individually with the supervisor.

... the supervisor or the one that manages the clinic, to when there is a rare

thing to call the students to come and have a look., ... [2_P27]

… after the clinic, there must be an opportunity to talk about each one of

our patients, what we saw, what were the signs, what were the systemic

things that contributed, so that we can also learn through each one’s case

[2_P25].

277

Discussion: Even though the participants identified the exposure to a variety of pathology

as a decisive factor in the learning environment (cf. 5.4.2.4), they also felt that some of

them still see the same type of pathology. This links to the statement of Papastavrou et al.

(2010:117) that the clinical learning environment is unpredictable, as the type of patient

cannot be predicted. Therefore, measures should be in place to ensure that the students

do get equal exposure and the recommendations made will definitely help in this regard.

The most important recommendation from this theme is about the time for reflection.

Theme 5: Time and equipment

The issue of time and equipment was mentioned by both focus groups. Participants

requested leniency regarding time and that broken equipment should be taken into

consideration.

The following was mentioned:

Just to be more accommodating regarding equipment, say that is broken ... it’s

difficult, because it also creates a lot of conflict, among us ... it created many,

some frustrations [1_P31].

I would like to make another suggestion, I think to find a way, I can’t say how,

but to be more lenient with time allocations. [2_P44]

Discussion: It seems that time, or rather the lack of time, always will be an issue,

especially in the current clinical setting with the balance to be maintained between service

delivery and student learning. Students should be encouraged to deliver effective

professional treatment to each patient in a timely manner. The availability of equipment

was listed as one of the factors that would enhance a clinical learning experience (cf.

Ernstzen et al. 2010:28), and it is evident from this study that damaged equipment plays a

momentous role in the students taking longer than usual to perform a task and it also

creates frustration and tension in the learning environment. As mentioned previously, this

issue is addressed continuously with the Head of the Department and the Department of

Health, and much effort is made to ensure that everything is in working order.

278

Theme 6: Theoretical grounding

The last theme that came to the fore from the focus group interviews were

recommendations on the theoretical grounding to enhance the integration of theory and

clinical practice.

The participants recommended that within the theory lectures, the approach to how to

investigate specific pathologies should be included, as one participant summarised:

… we never learn to test for it, ... So, they don’t really teach us how to

approach something if you expect that he is going to have it or something

like that. [2_P29]

Secondly, they recommended that the revision lectures on the anterior segment of the eye

should be at the beginning of the year and not in the last semester as scheduled. The

participant worded it as follows:

…if we could have had it at the beginning of the year. Then it would have helped

[2_P28]

Lastly, it was recommended that an orientation session be included for the students to

know what is expected of them, to discuss all the tests briefly, and for students to have

time to practise the tests. The following suggestion was made:

… work with us through the patient step by step, so that we know how each

procedure works, how much time we have, and how to make a diagnosis.

[2_P15].

Discussion: In accordance with Papp et al. (2003:267), who noted that theory and clinical

practice should complement each other, the participants made a valuable recommendation

to include the approach of the investigation into the theory lectures in order to enhance the

clinical learning environment. The revision of the anterior segment examination, as well as

the orientation session, will contribute to the student’s self-confidence as they will know

what to expect. The aim of the apprenticeship experience was to indicate the flow of the

clinic and students indicated that the experience was beneficial (cf. 4.4.8.2). Even though

279

the participants still pointed out that time should be provided for them to get orientated

and to practise the skills demonstrated before they are exposed to the patient.

5.5 SUMMARY OF FINDINGS OF RESULTS AND DISCUSSION OF FOCUS

GROUP INTERVIEWS

The results of the focus group interviews provided answers to the research questions

presented in Chapter 1 (cf. 1.3). A summary of the focus group interviews with the essential

components is given in Figure 5.2.

The data of the focus group interviews added another dimension to the research as

participants could express their feelings on their experience in the clinical learning

environment. The focus group interview agenda provided a detailed question to guide the

discussion, and from the participants’ responses, focus areas with themes and categories

were developed. These were all revealed by extensive, noteworthy quotes. Within each focus

area, valuable information was obtained to provide recommendations on the implementation

of experiential learning in a learning environment (cf. 1.4.2).

280

Focus area 4: Factors that influenced the Pathology clinical learning environment

Factors that influenced the integration - Good theoretical and clinical skills foundation - Time of practical application of knowledge

Challenges experienced in the Pathology

clinical learning environment

- Limited time allocation

- High expectations - Learning dependent on patient

- Not practically and theoretically equipped to see patients at the beginning

- Focus on patient numbers

Supervisor attributes

Positive Always willing to help Stimulate your thinking Not making you feel small Knowledgeable High quality of work Learned with them Acted humane

Negative Inconsistencies Untactful Acts only clinical Forced learning Not allowing to learn practically Kept a personal distance

Assessment The impact of the supervisors on subjectivity

Time Patient referralsRubric used in the

assessmentRole of constructive

feedback

Focus are 3: Theoretical grounding and integration of theory and practice

Focus area 5: Recommendations on the enhancement of the learning environment of the Pathology clinic

Supervisor - Provide constant communication - Be approachable - Be helpful and supportive - Enforce confidence in the student - Collaborate with other supervisors - Be present - Know what to expect of the students

Earlier exposure to the clinical environment

- Rotation with ophthalmologist and senior students

Exposure to variety of cases

- Reflection

Time and Equipment

- More leniency

Theoretical grounding - Add evaluation protocol

Assessment - Add Oral station - Continuous assessment - Ensure enough patients are seen - Record assessment - Specify patients - Referral letter - Rubric

Factors contributing to a safe learning

environment

- Safely ask questions - Availability of knowledge and opinions

- Familiar environment - Able to learn from each other

- Availability of an Ophthalmologist

- Exposed to a variety of pathology - First exposure was with a supervisor

Characteristics of the lecture - Integration between subjects - Different perspectives - Visual presentation - Availability of lectures - Ongoing assessments

Qualities of lecturing staff - Passion for the subject - Simplify difficult concepts - Explain everything - Ability to make a very difficult concept practical - Having practical experience - Good subject preparation

Focus area 1: Personal opinion on the research project Focus area 2: The Overall feelings about the learning environment

FIGURE 5.2: SUMMARY OF FOCUS GROUP INTERVIEWS [Compiled by the researcher, Kempen 2019]

Necessity

Role of assessment; Thrown in at deep-end; Improvement of knowledge

281

5.6 CONCLUSION

Chapter 5 provided an overview of the results of the data analysis, as well as a description

of and a discussion on the findings of the focus group interviews. The data from the focus

group interviews were used to complement the results from the questionnaire survey used

in this study.

In Chapter 6, Recommendations for the implementation of experiential learning

in the expanded scope of the undergraduate optometry programme at the

University of the Free State, the researcher will combine the results from the focus

group interview and the questionnaire in order to formulate recommendations for the

implementation of experiential learning in the expanded scope of the undergraduate

optometry programme at the University of the Free State.

CHAPTER 6

RECOMMENDATIONS ON EXPERIENTIAL LEARNING IN THE EXPANDED

SCOPE OF THE UNDERGRADUATE OPTOMETRY PROGRAMME AT THE

UNIVERSITY OF THE FREE STATE

6.1 INTRODUCTION

An in-depth study was conducted aimed at finding and providing recommendations for

the implementation of experiential learning in theoretical and clinical education. The

implementation of these recommendations may improve the theory-clinical integration

in the optometry undergraduate programme at the University of the Free State.

The need for effective student-centred teaching-learning and assessment methods, with

the focus on student engagement and responsibility, requires universities to incorporate

students’ perceptions to enhance the learning environment according to their needs (cf.

1.1). Experiential learning proved to be favoured by the current generation of students

and this study investigated the perceptions and experiences of the undergraduate

optometry students of different teaching-learning and assessment methods based on

experiential learning (cf. 1.2).

The undertaking was to provide theoretically grounded recommendations for the

implementation of experiential learning in the undergraduate optometry programme at

the UFS. The formulation of the recommendations in this chapter is based on researched

information collected by means of a literature review (cf. Chapter 2), as well as the

empirical research findings of both the questionnaire survey (cf. Chapter 4) and the focus

group interviews (cf. Chapter 5). The collection of different sets of data was performed

in a structured and systematic manner (cf. Chapter 1-5). With the use of a variety of

methods, triangulation of results was ensured, contributing to comprehensive

recommendations for experiential learning.

Figure 6.1 illustrates the premises underlying the recommendations made for the

effective implementation of experiential learning in the pathology modules of the

optometry programme at the UFS.

283

FIGURE 6.1: HIERARCHICAL RECOMMENDATION SYSTEM FOR THE EFFECTIVE

IMPLEMENTATION OF EXPERIENTIAL LEARNING [Compiled by the researcher, Kempen 2019]

Chapter 4 and Chapter 5 of this thesis provided detailed discussions on the perceptions

of the students on the different teaching-learning methods applied. These discussions

formed the groundwork for an experiential learning framework. This chapter, Chapter 6,

provides a hierarchical recommendation system that starts with a recommended

Literature review (cf. Chapter 2) and

Perceptions on experiential teaching-

learning methods (cf. Chapter 4 & Chapter 5)

Recommended experiential

learning framework

(cf. 6.2)

Recommendations on the different

roles and attributes of the educator

(cf. 6.3)

Recommendations to create a safe

experiential learning environment

(cf. 6.4)

Recommendations on the effective

implementation of experiential learning

(cf. 6.5)

284

experiential teaching-learning framework for use in the undergraduate optometry

learning programme at the UFS. The second level of recommendations has a bearing on

the different roles and attributes the educator has to adopt for the application of the

framework. The last level contains recommendations on the different elements that will

create a safe experiential learning environment. The recommendations on the effective

implementation of experiential learning in the pathology modules of the optometry

programme at the UFS are built on the combination of these three levels. Although the

recommendations provided in this chapter offer a variety of suggestions, which may be

applicable to any health sciences education programme, throughout the study, the focus

was on optometry students and pathology modules. The chapter will close with a

conclusion.

6.2 RECOMMENDED EXPERIENTIAL TEACHING-LEARNING FRAMEWORK

The comprehensive range of findings generated from the literature review and empirical

study specifically supported the researcher in gaining an evidence-based understanding

of the alignment of the different modes of experiential learning and the teaching-learning

and assessment methods that were used. This understanding allowed the researcher to

develop a strong foundation on which to formulate an experiential teaching-learning

framework for use in the undergraduate optometry learning programme. The

experiential learning pedagogical framework proposed in Chapter 2 (cf. 2.3.3.1) provided

the template for this framework, as seen in Figure 6.2. The various teaching-learning

methods applied to create a learning experience are positioned alongside the experiential

learning processes and the underlying cognitive modes (cf. 2.3.3.2). The alignment

between the teaching-learning methods and learning processes is illustrated with dark

(primary alignment) and light (secondary alignment) shaded intersections.

286

FIGURE 6.2: A RECOMMENDED EXPERIENTIAL TEACHING-LEARNING FRAMEWORK FOR USE IN THE UNDERGRADUATE OPTOMETRY LEARNING PROGRAMME [Compiled by the researcher, Kempen 2019]

Experiential learning cycle modes

Teaching-learning methods Concrete

Experience

Reflective

Observation

Abstract

Conceptualisation

Active

Experimentation

Lectures

Flip the Classroom *depending on the activity *depending on the activity

Small-group learning

Simulation

Interprofessional Education

Case presentation (presenter)

Case presentation (attendant)

Peer assessment

Bedside teaching (apprenticeship)

Clinical skills training

Clinical education

Theore

tical

Clin

ical

Primary alignment Secondary alignment

287

The following subsections offer a summary of the various teaching-learning methods and

their alignment with experiential learning processes, as indicated in the recommended

experiential teaching-learning framework (Figure 6.2).

6.2.1 Lectures

As noted in the literature, lectures as a teaching-learning method managed to survive a fair

amount of criticism to be still seen as the appropriate method to convey a large amount of

information. The main benefit of lectures is the opportunity it creates to obtain the

necessary theoretical background knowledge and the basics of health sciences (cf.

2.3.3.2.1). In the context of pathology modules in the undergraduate optometry

programme, the value proposition of lectures should be the personal explanations, the

offering of information from different perspectives and the time it provides to ask questions

and receive immediate answers (cf. 4.4.1.2; cf. 5.4.2.3). In this study, lectures were

confirmed as the method of choice to cover the core content of the programme, with

familiarity with this method highlighted (cf. 4.4.1.3). The study confirms that to optimise

the lecturing experience, measures should be taken to ensure that students are actively

involved and take responsibility for their learning (cf. 2.3.3.2.1; cf. 4.4.1.3). To further

enhance the experience, the data in this study indicated that the lecture presentation should

not merely be an oral presentation, but also offer a visual and practical experience, and

continuous assessments should be used to gauge students’ understanding. Continuous

assessment may both encourage students to prepare for the lecture or to ground the

knowledge basis obtained from the lecture (cf. 4.4.1.2).

6.2.2 Flip the classroom

To support the development of deep learning through effective student-centred teaching

behaviours, the flip the classroom teaching-learning method offers a suitable learning

experience (cf. 4.4.2.2). As a teaching-learning method, flip the classroom strongly

complements lectures by providing an additional means to engage students in the primary

alignment of the active experimentation mode seen in Figure 6.2. Depending on the activity

chosen, the concrete experience and reflective observation modes can also be highlighted,

which was the case in the flip the classroom experience used for this study. If the situation

requires stimulation of all four modes of the experiential cycle and enhancing theory-clinical

integration, the activities may include the construction and presentation of a case study to

encourage students to apply knowledge and to analyse scenarios to provide management

288

options. In addition, to design such activities in clinical skills training after the basic concepts

have been mastered through online videos also proved to be successful (cf. 4.4.2.1). The

findings of the study also indicated that flip the classroom enhances student independence

and increases students’ sense of responsibility. It was further confirmed that flip the

classroom should not be used too frequently, and although the repetition of work ensures

that the required information is captured, the process can be very time consuming for the

student (cf. 4.4.2.2).

6.2.3 Small-group learning

As highlighted in Chapter 2, one of the benefits of implementing small-group learning is the

development and practise of interpersonal skills such as communication, collaboration,

cooperation and compromise (cf. 2.3.3.2.3). The training of these skills is essential for any

student to transition to a competent health care professional and although all students do

not prefer small-group learning, it was confirmed, for the millennial generation of students,

that it should form an integral part of any health sciences programme (cf. 2.3.3.1; cf.

4.4.3.3). It was suggested that the small-group learning environment generates peer

learning, and the benefits of the interaction peer learning create, were emphasised in this

study (cf. 4.4.3.3; cf. 4.4.6.2; cf. 4.4.6.4; cf. 4.4.7.2; cf. 4.4.7.3). The study showed that

there are benefits when the group members are randomly selected, but there are also

benefits when students choose their groups. The framework indicates that small-group

learning only stimulates the active experimentation mode; therefore, small-group learning

should be used in conjunction with another teaching-learning method where active

experimentation is not used, such as lectures, case presentations and bedside teaching.

6.2.4 Simulation

The use of simulation in optometry education in South Africa is not as prevalent as in other

healthcare programmes. In the context of the optometry programme at the UFS, it might

be because the Department has access to an abundance of patients due to an agreement

with the Department of Health of the Free State Province (cf. 4.4.4.3). Although the

literature encourages the use of real patients to teach and assess skills, this study confirms

and highlights that simulation, with the use of standardised patients, provides a safe

learning environment for students to apply theoretical skills without risks (cf. 4.4.4.2).

Simulation further proved to enhance the theory-practice integration, which will ensure

289

more reliable and confident health care providers (cf. 2.3.3.2.4; cf. 4.4.4.3). As illustrated

in Figure 6.2, simulation involves all four modes of the experiential learning cycle; therefore,

simulation is favoured as one of the most useful experiential teaching-learning methods

that can be used. The findings of his study are in agreement with the literature that

simulation should be used to support theory delivery (cf. 2.3.3.2.4; cf. 4.4.4.2). Regarding

the pathology modules in the optometry programme at the UFS, it can be seen as an

intermediate teaching-learning method to bring together theory and clinical training that

may be used to develop and practise interpersonal skills such as communication.

6.2.5 Interprofessional education

With the prospect of incorporating optometry into the mainstream health services with the

implementation of NHI, training of optometrists to function as part of a collaborative team

will become inevitable (cf. 2.2; cf. 2.3.3.2.5). In this study, IPE demonstrated to be

successful in creating a learning experience where different health professions work

together to enhance patient care (cf. 2.3.3.2.5; cf. 4.4.5.3). With the current IPE

experience, three of the four experiential learning modes were used (cf. 4.4.5.3). The

affirmative response to the practical application of theory through a simulated scenario

confirmed the benefits of the use of simulation in a learning environment (cf. 4.4.4.2; cf.

4.4.5.2). The results of this study suggest that to implement IPE successfully, attention

should be paid to providing precise instructions regarding the objectives and goals of the

sessions. Due to a large number of students participating in IPE sessions, it should also be

ensured that every student has a meaningful learning experience. Careful planning of and

consistency in the facilitation of sessions are vital factors that will contribute to a positive

outcome for all students involved (cf. 4.4.5.3).

6.2.6 Case presentation

As noted in Chapter 2, case presentation constitutes a presentation that allows the students

to present their analysis of clinical experiences. The main benefit of case presentation,

whether being a presenter or an attendee, is that due to a variety of cases presented, it

offers an educational platform to develop the student’s clinical knowledge as well as

diagnostic reasoning abilities (cf. 2.3.3.2.6; cf. 4.4.6.2.). It is also well suited to convey the

same information and clinical pointers to all students simultaneously (cf. 4.4.6.4). In this

study, the most valuable aspect of case presentation highlighted by the participants was

290

that students could learn from their own as well as others’ experiences and the mistakes

they made, but most importantly they had an example to refer back to when they

encountered a similar experience. This finding supports the theory of constructivism, which

is a foundational principle of experiential learning (cf. 2.3.1; cf. 2.3.3.2.9). Case

presentation primarily makes use of the reflective observation mode, something that the

participants of this study highly favoured (cf. 4.4.6.4; cf. 4.4.8.3). For the students, being

a presenter additionally highlights the concrete experience as well as the abstract

conceptualisation mode (cf. 4.4.6.3 cf. Figure 6.2). The public speaking aspect of this

teaching-learning method creates anxiety, not only amongst the students who present but

also amongst students attending as they carefully observe how their peers are treated when

presenting (cf. 4.4.6.2; cf. 4.4.6.4). It is recommended that facilitators should particularly

be careful about how they provide feedback to the case presenter. The manner in which

feedback is given affects not only the presenter but also the learning milieu (cf. 4.4.6.3; cf.

4.4.6.5).

6.2.7 Peer assessment

Peer assessment has several advantages for educators as well as students. For students,

this teaching-learning activity promotes confidence, as it provides an opportunity to assist

or be assisted by fellow students by giving or receiving feedback, and they can determine

their level of knowledge and areas requiring improvement (cf. 2.3.3.2.7; cf. 4.4.7.2; cf.

4.4.9.2). Consequently, for educators, this saves valuable time by obtaining a clearer picture

of students’ understanding and skills, and hence it helps them to improve the effectiveness

of their teaching (cf. 2.3.3.2.7). In contrast to what the literature indicates, namely that

peer assessments promote important principles such as responsibility, independence, sense

of ownership and collaboration, the students in this study preferred not to take full

responsibility and assess other students independently; instead, they requested that the

supervisors be more actively involved (cf. 4.4.7.2; cf. 4.4.7.3). Peer assessment mostly

affords students the ability to watch and reflect (reflective observation), as well as to do

and explore (active experimentation). In the context of this study, it is recommended that

peer assessment should be implemented in preparation for formative assessment and not

as formative assessment (cf. 4.4.7.4). Also, regardless of the opinion that it is a time-

consuming process and students feel reluctant to do it, time should be set aside for proper

feedback, which is seen as an integral part of peer assessment (cf. 2.3.3.2.7; cf. 4.4.7.2).

291

Participants in this study preferred that an educator be present during the feedback time

(cf. 4.4.7.4)

6.2.8 Bedside teaching

Bedside teaching, or more specifically, apprenticeship, successfully illustrates the

professional conduct of an optometrist and, in the context of this study, in the clinical

pathology environment (cf. 2.3.3.2.8; cf. 4.4.8.2). The main benefit of this teaching-

learning method is the active involvement of students in the clinical experience, without the

responsibility of the treatment and management of the patient (cf. 4.4.8.3). Secondly, the

observation of a role model demonstrating clinical skills on a real patient and in the actual

clinical setting is valuable (cf. 4.4.8.2). Consequently, the most influential factor in this

teaching-learning method is the way in which the supervisor behaves towards the patient

as well as the students during the experience (cf. 2.3.3.2.8, cf. 4.4.8.2). This experience

was highly appreciated during the study, and it might be due to the reflective observation

mode of the experiential learning cycle that is primarily used and preferred by the study

participants (cf. 4.4.8.2). The study participants also recommended that the apprenticeship

activity should take place more often, and with different eye-care professionals and with

patients that present with different ocular pathologies.

6.2.9 Clinical skills training

In congruence with the findings of the literature review, three key factors that form part of

the clinical skills training were identified in the study, namely demonstration (reflective

observation), the time provided to practise (active experimentation), and assessment

(concrete experience) (cf. 4.4.9.3). It may be said that the demonstration of the skills

determines the course and outcome of the clinical skills training process and facilitators

should ensure that students acquire and master the correct techniques and are confident

and comfortable with the basics of the skill before they practise on their own (cf. 2.3.3.2.9;

cf. 4.4.9.3). In addition, it was noticed in this study that not all students enjoyed the

independence and responsibility of practising to become autonomous in performing a

technique (cf. 4.4.9.2). For this reason, it is recommended that the facilitators provide

constant guidance and confirmation to the students and not to assume that if students do

not ask, they are proficient in a technique (cf. 4.4.9.3). Equally important is the availability

of the equipment and disposables that are used during the training of the procedures. A

292

lack of equipment and broken equipment create frustration in the learning environment as

well as tension amongst students (cf. 4.4.7.3; cf. 4.4.9.2; cf. 5.4.2.4).

6.2.10 Clinical education

Clinical education encompasses the personal, professional as well as the educational

development of a student, and the learning environment should be adequate for students

to increase their ability to integrate knowledge from theory to clinical practice (cf.

2.3.3.2.10). The results of this study correlate with literature in that students perceived the

clinical environment as stressful (cf. 2.3.3.2.10; cf. 5.4.2.4). This study indicated that

students valued informed opinions from the supervisors in the clinical setting. Students also

felt theoretically equipped to see patients and free to ask for assistance. However, these

positive factors were overshadowed by the perception that the supervisors’ expectations

were too high - a factor that caused anxiety (cf. 5.4.2.4). The study participants also

confirmed that time, availability of equipment, and type of patients, as well as the

requirement to see a certain number of patients, affected the clinical learning environment

adversely. The role of the supervisor and assessment are two factors that have a significant

influence on the clinical environment (positive or negative) and were repeatedly mentioned

by participants in this study (cf. 5.4.2.4). As depicted in Figure 6.2, similar to simulation

and peer assessment, in clinical education, all four modes of the experiential learning cycle

are involved. Study participants recommended that the reflective observation mode should

be utilised more to ensure that they improve before their next clinical experience (cf.

5.4.2.5).

6.3 RECOMMENDATIONS ON DIFFERENT ROLES AND ATTRIBUTES OF THE

EDUCATOR IN THE EXPERIENTIAL CYCLE

The influence that the educator had in each teaching-learning and assessment method was,

in this study, a determining factor in the perceptions of the experience. The literature

described four roles that assist in the application of experiential learning (cf. 2.3.3.4). In

agreement with the Kolb Educator Role Profile (KERP), mentioned in Chapter 2, this study

also identified specific roles in each of the modes of the experiential learning cycle according

to the perceptions and experiences of the students. Figure 6.3 is a schematic representation

of the different roles and attributes identified that an educator is expected to adopt and

fulfil during the different modes of the experiential learning cycle. A discussion on each of

these roles follows.

293

FIGURE 6.3: RECOMMENDED ROLES AND ATTRIBUTES OF THE EDUCATOR IN THE EXPERIENTIAL CYCLE


6.3.1 Abstract conceptualisation

Lectures are the only teaching-learning method that primarily uses abstract

conceptualisation. The literature identified the vital role that a lecturer’s characteristics and

personality have in the effectiveness of a lecture (cf. 2.3.3.2.1). Other teaching-learning

methods also make use of abstract conceptualisation, but only secondarily (cf. Figure 6.2).

This study identified that during an abstract conceptualisation experience, an educator

should be knowledgeable and should excite interest in the topic among students.

ROLES AND

ATTRIBUTES OF THE EDUCATOR

294

6.3.1.1 Knowledgeable

Students appreciate receiving information from someone they perceive as knowledgeable

(cf. 2.3.3.2.1; cf. 4.4.1.3; cf. 5.4.2.3). This was emphasised by a participant who stated

that the strength (of a lecture) is that the information is explained by a person who knows

what they are talking about [P2_3]. This role concurs with the subject expert role described

by Kolb and Kolb (cf. 2.3.3.4). The participants further perceived someone with knowledge

as someone who had practical experience in the relevant matter. With practical knowledge,

the lecturer can adopt a personalised approach in transferring information (cf. 5.4.2.3). A

recommendation from the peer assessment experience was that a supervisor should replace

the peer assessor, indicating that students require confirmation and reassurance from a

person in authority (cf. 4.4.7.4).

6.3.1.2 Create an interest

To enhance the learning environment during an abstract conceptualisation experience, the

lecturer should excite an interest in the topic (cf. 4.4.1.3). This can be done with clear

explanations of the topic; simplifying difficult concepts and making concepts practical (cf.

5.4.2.3). Students of this study pointed out that a visual presentation with pictures and

videos stimulated their interest (cf. 4.4.1.3; cf. 5.4.2.3). A valuable recommendation from

the participants of this study was to include the approach of the investigation into the

theoretical lectures in order to enhance the clinical learning environment. Lastly, an

important element in arousing interest is that the lecturer should have a contagious passion

for the subject and the participants valued a well-prepared and enthusiastic lecturer (cf.

5.4.2.3).

6.3.2 Active experimentation

Active experimentation is used in the experiential cycle to test new knowledge that was

assimilated during abstract conceptualisation (cf. 2.3.1). A few teaching-learning methods

primarily complied with the requirements of this mode. They were flip the classroom, small-

group learning, simulation, interprofessional education, peer assessment, clinical skills

training and clinical education (cf. figure 6.2). Educators should provide guidance and be

approachable during this experiential learning mode.

295

6.3.2.1 Provide guidance

Students should be guided and motivated to be independent and have confidence in their

abilities (cf. 2.3.3.2.9). Participants of this study strongly expressed that they preferred

constant guidance from the educator and for the educator to be present during active

experimentation (cf. 4.4.5.3; cf. 4.4.9.3; cf. 5.4.2.5). As mentioned in Chapter 2, during an

active experience, the educator should act as an advisor, providing clarifications and

keeping the focus on the task (cf. 2.3.3.2.2; cf. 2.3.3.2.5). The educator also may guide

the students by providing constructive feedback, highlighting key points and offering

affirmations. In order to fulfil this role, an educator should be knowledgeable and have

confidence in his/her own ability (cf. 2.3.3.2.9; cf. 6.3.1.1)

6.3.2.2 Be approachable

Data from this study reveal that students request immediate clarifications (cf. 4.4.1.3; cf.

cf. 4.4.2.3). For this request to be granted, educators should be experienced by students

as approachable (cf. 5.4.2.5). This role will create an environment in which they will feel

safe and comfortable to ask questions or assistance when they feel unsure of themselves.

This role is related to the two elements that should be present in a safe learning

environment, that is, the freedom to ask questions (cf. 6.4.3) and personal contact with the

educator (cf. 6.4.6).

6.3.3 Concrete experience

The literature and the findings of this study are in accordance that the attitude of an

educator significantly influences a concrete experience (cf. 2.3.3.2.10; cf. 4.4.6.5; cf.

5.4.2.4). During this mode of the experiential learning approach, educators should build

students’ confidence and implement ground rules.

6.3.3.1 Build confidence

In the focus group discussion, one participant stated that when a lecturer or someone in a

position of higher authority than you believe in you, then you believe in yourself [1_P19].

This emphasises the role of the educator in building students’ confidence. After the analysis

of the questionnaire on the clinical skills experience, the researcher is of the opinion that

296

students will only take responsibility for their learning when they have confidence in their

own ability (cf. 4.4.9.3). Educators can strengthen students’ confidence by being helpful,

supportive, and sensitive, and providing encouraging feedback and acknowledgements (cf.

4.4.6.5; cf. 4.4.7.4; cf. 5.4.2.5). Students should never feel exposed or embarrassed. For

this reason, feedback should be provided privately and not in front of the patient or fellow

students (cf. 4.4.6.3; cf. 5.4.2.4), except, of course, when the feedback is only positive –

in such a case it will boost the student’s confidence if the patient and/or peers hear that

he/she has done the examination well.

Perhaps a more systematic approach in the clinic should be used, allowing students to take

more and more responsibility gradually. In this study, students indicated that by observing

an eye-care professional, their confidence increased (cf. 4.4.8.3). For this reason, it might

be a good idea to introduce the pathology clinic to students in their third-year, allowing

them, as recommended for the bedside teaching-learning method (cf. 4.4.8.2), to sit in and

observe a fourth-year student in the clinic (cf. 5.2.4.5). It was further recommended that

they should rotate with ophthalmologists during theatre and ward rounds (cf. 5.4.2.5). From

personal experience by working with an ophthalmologist for several years, the researcher

is of the opinion that rotation with the ophthalmologist will provide an opportunity for

exposure to a different opinion and additional knowledge. This links with the findings on

the theoretical grounding and factors contributing to the integration of knowledge in that

the participants valued different perspectives and believed that these would contribute to

their self-confidence (cf. 5.4.2.3).

6.3.3.2 Implement ground rules

The literature explains that poor organisation may decrease the value of a teaching-learning

experience (cf. 2.3.3.2.6). In the analysis of the questionnaires, it was found that the

presenters of case presentations made a clear point that students and lecturers who enter

late disturbed the experience for the presenter. Also, in the focus group discussion, one

participant commented that they sometimes give surprise evaluations and that makes you

nervous because then you’re not always prepared for it. So, they must just let us know

[1_P87]. These perceptions highlighted the importance of ensuring that students are aware

of the rules and what is expected of them (cf. 4.4.1.3; cf. 4.4.6.2). Implementing and

following ground rules will create a consistent, safe learning environment (cf. 6.4.7), as is

the case with setting achievable objectives that can be accomplished through good

297

organisation (cf. 4.4.5.3; cf. 6.4.8). Especially during case presentations, rules and

guidelines should be in place and made known to the students, especially regarding

punctuality and the feedback provided. The feedback should never expose the student and

be disparaging, but must be done in a way that builds confidence and shows that the

facilitator believes in the students’ abilities (cf. 6.3.3.1; cf. 4.4.6.3).

6.3.4 Reflective observation

Reflective observation provides an opportunity to make sense of an experience (cf. 2.3.1).

Case presentations (presenter and attendant), peer assessment, and bedside teaching (cf.

Figure 6.2) primarily offer an ideal breeding ground for this mode. During reflective

observation, the educator has to lead by example and adopt the role of mediator.

6.3.4.1 Lead by example

After the bedside teaching experience, a participant made the following statement: I learn

through seeing and hearing, so it was very insightful for me to go through the process [P1].

This statement highlights the fact that students learn through observation and an educator

should lead by example (cf. 4.4.8.3). Results of this study confirmed that specific skills,

such as professionalism, empathy and a caring attitude could only be taught by example

(cf. 2.3.3.2.8; cf. 4.4.8.3). Participants in this study identified the educators as good role

models (cf. 5.4.2.4). A good role model illustrates clinical skills and cares for the patient

with a friendly and willing attitude (cf. 4.4.8.3; cf. 2.3.3.2.10). The students noted and

appreciated the compassion the educators had towards them as well as the patients (cf.

5.4.2.4). As a walking example of the profession, an educator should continuously

communicate with the students, as one participant confirmed by stating: So, just talk to us,

because what we see in our clinic, remains with us [2_P65].

6.3.4.2 Mediator

The educator should act as a mediator in an environment where peer learning will take

place, for example, during peer assessment and case presentations (cf. 4.4.7.4). Students

should be encouraged to provide feedback on their peers’ work, something they are

reluctant to do (cf. 2.3.3.2.8; cf. 4.4.7.4). As a mediator, an environment should be created

where students can ask each other questions or provide feedback without creating negative

298

energy. Therefore, the educator should guide the interaction between the members of the

group (cf. 2.3.3.2.5).

Equally important is mediating a student’s personal reflective process after a learning

experience. Looking at the benefits of reflection (cf. 2.3.3.3.1), the researcher agrees that

more effort should be made to institute reflection as standard practice during clinical

training. Although the students have the opportunity to reflect as presenters in case

presentations (cf. 4.4.6.2), this may indicate that they need more opportunities to reflect

with the assistance of the educators. Students are exposed to other students’ experiences

during case presentations (cf. 4.4.6.4), but to make it more pathology specific, it should be

done after the clinic. The practical implementation could be a challenge because most of

the time the clinic never ends on time, and students have to hurry to be in time for their

next commitment; thus, to incorporate time for reflection during clinic hours will be

challenging. A slot might be arranged in the time allocated for the theoretical module to be

used for a reflective session during which the students that have been in the clinic on Friday

could share their experiences. The educator then could mediate the session by means of a

question and answer approach to guide the students’ reflective thinking processes (cf.

4.4.6.3). With this recommendation, however, it should be ensured that the lecturer also is

responsible for the clinic, which at the time of the study was not the case.

6.4 RECOMMENDATIONS FOR A SAFE EXPERIENTIAL LEARNING

ENVIRONMENT

Vital to any learning experience is that it should happen in a safe learning environment as

students then will interact, experiment and construct new knowledge, which is

indispensable factors for experiential learning (cf. 2.3.3.2.4; cf. 4.4.6.3). A few elements

that contributed to a safe learning environment were identified in this study and are

illustrated in Figure 6.4 on the next page. A discussion on the elements follows the figure.

299

FIGURE 6.4: ELEMENTS RECOMMENDED TO CREATE A SAFE EXPERIENTIAL LEARNING

ENVIRONMENT [Compiled by the researcher, Kempen 2019]

6.4.1 Familiarity

Familiar teaching-learning methods, such as a lecture did not create any anxiety for the

participants in this study (cf. 4.4.1.2). Unfamiliar teaching-learning methods, such as flip

the classroom, simulation, and bedside teaching did create negativity at the beginning of

the experience, but due to the activities being carried out in a familiar environment under

guidance of a familiar lecturer, their feelings at the end of the experience were

overwhelmingly positive (cf. 4.4.2.3; cf. 4.4.4.3; cf. 4.4.8.3). This was confirmed during the

focus group discussion when it was mentioned that being familiar with the environment and

with the supervisors made them feel safe (cf. 5.4.2.4).

At a more personal level, one participant had the following opinion on the supervisors:

There often is a huge gap between lecturers and students and it’s as

if they create it from their side, and then we increase it, because we

FAMILIARITY

SMALL GROUP

FREE TO ASK

QUESTIONS

PEER

LEARNING

PERSONAL

CONTACT

CONSISTENCY

LEARNING

WITHOUT RISKS

ACHIEVABLE

OBJECTIVE

1

3

5

7

2

4

6

8

300

sort of shrink away, because it feels to me as if often it is from a sense

of arrogance, and I personally feel as a lecturer you must actually be

a servant, because you have a service that you provide to the

University and to students and that you must be far more approachable

[1_P104].

It seems that this generation of students is more comfortable with staff members when

there is familiarity. Staff members were trained during a time when the lecturers and

supervisors had to be shown utmost respect, and it might have been that the current

supervisors (who all had graduated more or less the same time) kept a professional distance

and always interacted professionally with the students. This might have caused the students

to perceive the supervisors as not approachable, which is in contrast with what was

mentioned as an overwhelmingly positive attribute, namely that the supervisors always

were willing to assist students (cf. 5.4.2.4). One of the aims of the current Integrated

Transformation Plan (UFS 2017a: Online) of the UFS is to create a culture where students

experience humane pedagogies and to encourage empathy in academic and support staff.

Therefore, the staff must work towards achieving the aims of the ITP.

The entitlement characteristic of this generation of students perhaps is perfectly illustrated

in this participant’s statement, referring to the supervisor as a servant, which reminds of

Orîndaru’s (2015:683) statement about students being consumers in higher education (cf.

1.1). As much as the researcher wants the students to realise that the supervisors are just

ordinary people with a life beyond being a lecturer or supervisor, the researcher is of the

opinion that students should not be too personal or familiar with her as she believes that a

student will always be a student and as soon as things do not go their way, students could

use personal information to manipulate the supervisor or academic system. This could be

seen during the clinical training experience when the participants who had a bad experience

during the assessment were quick to blame the supervisors involved in the module (cf.

4.4.9.3).

6.4.2 Small group

A learning environment should be created where students are allowed to explore new ideas

(cf. 4.4.2.3). Data from this study confirmed that students felt safe to explore amongst their

peers in a small group (cf. 4.4.3.3). The primary purpose of small-group learning is that it

301

creates interaction amongst students (cf. 2.3.3.2.3; cf. 4.4.2.3; cf. 4.4.3.3). During such

interaction, different viewpoints are expressed - something that the students in this study

valued (cf. 4.4.3.3). Participants in this study were used to a small group due to the small

number of students in the class. However, they were exposed to working in a large group

of students during the IPE experience and that caused anxiety and even irritation for some

students (cf. 4.4.5.3). Also, in a smaller group, students are familiar with their peers and

feel comfortable to ask questions or assistance when they feel embarrassed to ask the

supervisor (cf. 4.4.7.4). The size of the group of students should also be considered when

a learning activity involves public speaking, such as a presentation. It was evident

throughout the data that the anxiety some students experience when speaking in front of

a large group of students overshadowed the positive side of the learning opportunity (cf.

4.4.2.3; cf. 4.4.5.3; cf. 4.4.6.3; cf. 4.4.6.5).

6.4.3 Free to ask questions

The literature describes an optimal learning environment as one where students are allowed

to ask questions and make mistakes (cf. 2.3.3.2.10). Throughout the data, students

mentioned that they had the opportunity to ask questions when they felt uncertain or

needed clarifications (cf. 4.4.1.3; cf. 4.4.8.3; cf. 4.4.9.3; cf. 5.4.2.4). Students felt

comfortable to ask questions when the educator was approachable (cf. 6.3.1.4), and in a

supportive environment where they were familiar and worked in a small group (cf. 6.4.1;

cf. 6.4.2).

6.4.4 Learning without risks

A safe learning environment refers to an environment where students are allowed to make

mistakes and learn from their mistakes without being adversely affected (cf. 4.4.6.5).

Simulation provides the ideal environment where students are in a position to learn without

risks. They perceived an environment without risks as conditions where learning could take

place without having to bear the responsibility of making a diagnosis and managing a

patient. This was true for the simulation experience, as well as the bedside teaching

(apprenticeship) experience (cf. 4.4.6.5; cf. 4.4.8.3). Students further mentioned that the

presence of an ophthalmologist made them feel safe in the clinical environment (cf.

5.4.2.4). With the ophthalmologist available, the responsibility of the management of the

patient shifted from the student and this might have been the reason why they felt safe,

302

like with the bedside teaching experience (cf. 4.4.8.3) where they were involved in the

management decision, but did not take responsibility for it. Working and learning together

in a team also created a safe learning environment as the responsibility is shared (cf.

2.3.3.2.5). With this in mind, the earlier introduction to the pathology clinic recommended

earlier, where junior students observe senior students in clinic, will create an opportunity

for students to learn without risks, something that they seem to enjoy (cf. 4.4.4.3; cf.

4.4.8.3; cf. 6.3.3.1).

Another aspect that will create an environment where the students learn without risk is

when they can learn during an activity without having to face the prospect of getting marks

for what they are doing, such as simulation sessions and the peer assessments in the clinic

(cf. 4.4.4.3; cf. 4.4.7.4).

6.4.5 Peer learning

A participant in the focus group mentioned that ... you learn better from your peers or from

your fellow students than you learn from a, uhm, lecturer actually [1_P100]. In this study,

peer learning took place during small-group learning and the flip the classroom approach

(cf. 4.4.2.3; cf. 4.4.3.3), as well as during case presentation and in the clinic during peer

assessments (cf. 4.4.6.5; cf. 4.4.7.4). In correspondence with the literature, participants in

this study valued the different viewpoints from their peers (cf. 2.3.2.3; cf. 4.4.3.3).

Observing a peer’s work offered students the opportunity to reflect on their own

understanding of the work (cf. 4.4.2.3; cf. 4.4.6.5).

Students felt safe when they learn from each other because they are at the same academic

level. They also had empathy with each other and participants in this study noted that they

were more comfortable when studying or working with peers - they trusted them and would

ask peers rather than lecturers for assistance when they were unsure about matters

pertaining to the theory they had to master or the clinical or skills training (cf. 4.4.6.5; cf.

4.4.7.4). During the case presentations, students mentioned that they had respect for each

other’s work and efforts (cf. 4.4.6.5). Data from the focus group interviews indicate that

fourth-year students might feel more capable and it would increase their sense of

achievement if they could assist in the teaching process (cf. 5.4.2.5). Rotating with a fourth-

year student in the clinic will be useful for the participants to get to know the flow of the

clinic and become more familiar with the clinical environment (cf. 6.3.3.1; cf. 6.4.1; cf.

303

6.4.4). The researcher believes that students do value learning from each other, but that

they still require confirmation and reassurance from an educator, as mentioned in the

discussion on the educator’s role and being knowledgeable (cf. 6.3.1.1).

6.4.6 Personal contact

Participants in this study mentioned a few times that they preferred and valued personal

contact and interaction with and explanations from a lecturer (cf. 4.4.1.3; cf. 4.4.2.3; cf.

4.4.5.3). With personal interaction, lectures can provide immediate clarification on

uncertainties, something that the millennial generation demands (cf. 4.4.1.3; cf. 4.4.2.3).

The personal contact also has been requested by students in the flip the classroom

approach (cf. 4.4.2.3) as well as during the clinical skills training experience (cf. 4.4.9.3).

It might be that online and standardised videos used to take different approaches to a

technique and that students prefer to observe the demonstration as done by someone with

whom they feel comfortable and who is available immediately to answer questions and clear

up uncertainties.

6.4.7 Consistency

The IPE experience was negatively influenced due to inconsistency amongst the different

groups. When using IPE as an instructional method, it was recommended that facilitators

should use a consistent approach to create a stable and structured learning environment

(cf. 4.4.5.3). Due to the unpredictability of the clinical environment, educators should not

be unpredictable too in their responses (cf. 2.3.3.2.10; cf. 5.4.2.4). Consistency amongst

educators will ensure that all students enjoy the same learning opportunities (cf. 5.4.2.4).

In the clinical environment, the various supervisors should be familiar with the different

protocols, relevant techniques and ground rules. This will ensure that supervision conducted

by various supervisors still concurs (cf. 5.4.2.5).

The element of consistency also is related to the issue of the availability of equipment. In

the focus group discussions, the participants voiced feelings such as frustration with the

learning environment due to broken equipment. Particular attention should be given to

providing a clinical environment with enough equipment in working condition to avoid

conflict amongst students as well as students and supervisors (cf. 4.4.9.3; cf. 5.4.2.5).

304

Care should be taken to be consistent during an assessment. The assessors should be

constantly reminded that the focus of the assessment should be on the process of patient

examination, final diagnosis and management. A clinical protocol must be available to guide

(and protect) the assessor as well as the student; as one participant of the focus group

interview maintained: … I think it was the best way to go from what the protocol says into

the clinic [1_P33]. Therefore, to avoid subjectivity and to ensure consistency amongst

different assessors, an assessor should use the rubric as well as the protocol as guidelines

to assess a student (cf. 5.4.2.4). If the rubric and protocol are followed the type of patient

will not affect the student’s marks. It might be true that when a student has to see a patient

that is not cooperative, it may have an effect on their stress levels, but they should still be

able to handle the examination and follow the protocol.

It was noted in the data that external supervisors created an environment that felt unsafe

during assessments (cf. 5.4.2.4). A reason could be that the external supervisors did not

feel as familiar with the pathology clinic and therefore were more rigorous in the students’

assessments. This might imply that the external supervisors who assist with assessments

should be more effectively orientated to ensure consistency amongst the assessors’

approaches. The orientation should not only be on the assessment and how to mark

according to the rubric, but they should also be informed of the scope of the theoretical

modules and the protocol that is followed in the clinic regarding the management of the

patients. It should be noted that when a student fails or when there is a borderline case,

the supervisor that assessed should always consult the person responsible for the clinic and

validate the student’s mark allocation. In such a case, the person responsible may provide

a different perspective and may confirm the mark or guide the supervisor to look out for

specific aspects.

6.4.8 Achievable objective

Students should be well informed about the objective of each learning experience. Students

participating in this study reported feelings of nervousness, uncertainty and confusion when

it was perceived that the objective was not clear, appropriate or realistic (cf. 4.4.5.2; cf.

5.4.2.2). This element relates to the previous element, namely, consistency. The

participants recommended that the objectives always should be clearly communicated and

implemented uniformly (cf. 4.4.5.3). Equally important is the focus of the objective. During

the IPE sessions, case presentations (attendance), and bedside teaching, students tended

305

to only focused on the end product and not the processes followed in pursuance of attaining

the objective (cf. 4.4.5.3; cf. 4.4.6.5; cf. 4.4.8.5). Such an approach left them feeling

disappointed in the case of bedside teaching and overwhelmed in the case of case

presentations. In concomitance with this element, the issue of complying with the required

number of patients also was raised. The anxiety caused by this requirement is experienced

by all students in different clinics. Obviously, to comply with this places undue stress on the

students and it is evident from the focus group discussions that it influenced their learning

negatively (cf. 5.4.2.4).

In addition, educators should be cautious regarding the level of the expectations they have

of students. During the focus group interviews, participants strongly expressed that the

expectations the educators initially had of them in the clinical environment were too high.

This ensued in the students doubting their abilities, and feeling that they were left without

support and unduly cut down to size (cf. 5.4.2.2; cf. 5.4.2.4). One important thing that the

researcher noticed in the clinic was that some students preferred to act like robots. They

only physically performed the procedures and they expected the supervisor to tell them

what to do and analyse the results in order to instruct the next step. This should be avoided

at all cost. Within the clinical environment, which is mainly a concrete experience, students

should be able to go through the mode of abstract conceptualisation where they have to

consider and analyse the results in order for them to construct knowledge and improve

before their next experience. Maybe that was what supervisors expected when the students

experienced it as being left to cope on their own, whereas it merely is a process of the

students’ thinking processes being stimulated. For this reason, it is important to remember

that students should be guided to achieve the objective with confidence (cf. 6.3.2.1; cf.

6.3.3.1).

Furthermore, as mentioned in the analysis of the data collected, during the focus group

discussion, the students in this study proclaimed that they had a sound theoretical

knowledge and skills base and were allowed to ask questions when they felt unsure.

However, it seemed as if students, on entering the clinical situation, did not immediately

have the ability to apply their knowledge in a clinical setting (cf. 5.4.2.4). This might indicate

that a strategy that progressively builds on the students’ professional role is needed. This

may be done by leading by example, being present and being approachable (cf. 6.3.2.2;

cf. 6.3.4.1).

306

6.5 RECOMMENDATIONS FOR EFFECTIVE IMPLEMENTATION OF EXPERIENTIAL

TEACHING-LEARNING METHODS IN PATHOLOGY MODULES IN OPTOMETRY

EDUCATION

The following table, Table 6.1, offers recommendations for the effective implementation of

the various teaching-learning methods to make the experiential teaching-learning

framework more accessible. These recommendations are compiled from the literature (cf.

2.3.3.2) as well as the results of the questionnaire survey (cf. Chapter 4) and focus group

discussions (cf. Chapter 5)

TABLE 6.1: RECOMMENDATIONS FOR EFFECTIVE APPLICATION OF EXPERIENTIAL

TEACHING-LEARNING METHODS IN PATHOLOGY MODULES IN OPTOMETRY EDUCATION [Table continues on the next page]

Teaching-learning

methods

Objectives Recommendations

Lectures Provide information to

create a better understanding.

Interact with students

to clear up uncertainties

immediately.

Convey relevant information through a

presentation that is visual and with a simple, comprehensive layout of slides (cf. 4.4.1.3).

Provide practical examples through case studies

and clear explanations of concepts by simplifying them (cf. 5.4.2.3)

Incorporate clinical investigations to ensure

integration with clinical practice (cf. 5.4.2.5)

Involve students with the encouragement of an

assessment (cf. 4.4.1.3)

Flip the

Classroom

Provide information

via online lectures.

Promote the

application of information by using

an interactive activity.

Design and create personal videos that align

with theme objectives and course objectives

(cf. 4.4.2.3). Ensure that the online video is accessible, easy

to access, and user-friendly (cf. 4.4.2.3).

Complement video resources with references to

textbooks and academic articles (cf. 4.4.2.3)

Make an effort before the start of the activity to

answer questions (cf. 4.4.2.3). Select interactive activities that challenge

students and encourages active engagement

(cf. 4.4.2.3). Provide support and guidance during the

activity (cf. 6.3.2.1)

Small-group learning

Create interaction

among students.

Organise group activities to complement

another teaching-learning method (cf. 6.2.3). Encourage group discussions to ensure a

variety of perspectives to emerge (cf. 6.3.4.2).

Provide exact details on the expectation of the

outcome of the group work (cf. 6.4.7).

Design assessments to ensure the positive commitment of each student (cf. 4.4.3.3).

307

Simulation Encourage practical

application of theory

through a simulated case.

Ensure that students have the theoretical

background to perform the simulation

(cf. 4.4.4.3). Design realistic scenarios that students will

encounter in their professional careers

(cf. 4.4.4.3). Formulate the scenarios for the students to

elicit the demonstration of different

interpersonal skills (cf. 4.4.4.3). Train the standardised patients properly to

ensure that they understand their exact roles

and ensure authenticity (cf. 4.4.4.3).

Encourage group discussions during debriefing

for students to learn from others’ experiences (cf. 6.3.4.2).

Interprofessional

education

Promote collaboration

amongst healthcare

professionals

Formulate sessions with clearly laid out steps,

but also leave room for students to explore

multiple perspectives (cf. 4.4.5.3; cf. 6.4.7). Refrain from unnecessary repetition and ensure

the objective of each session is clear,

achievable and relevant (cf. 4.4.5.3; cf. 6.4.7). Select case studies for the simulated scenario

that equally involves each profession

(cf. 4.4.5.3).

Ensure facilitators are all on the same page and

that the guidance of the sessions is consistent (cf. 6.4.6).

Case presentation

Apply the required

theoretical knowledge and clinical skills

during the

presentation of a clinical case

Set clear ground rules and apply the rules

consistently (this includes staff members) (cf. 6.3.3.2).

Let the students know about the expectation of

the case presentation. The supervisor that has

attended the case in the clinic may guide the student through the reflective process (cf. 6.4.7).

Motivate presenters to prepare well and provide

them with pointers on presentation skills as

well as designing slides (cf. 4.4.6.3).

Ensure that a variety of cases is selected to be

presented to avoid repetition (cf. 4.4.6.5). Encourage active participation from the

audience with peer assessment and involve

them to ask presenters to explain specific clinical procedures done (cf. 4.4.6.5).

Inform supervisors to pay attention to the

manner in which they provide feedback or ask questions. It should be constructive and done

in a way that does not humiliate the student

(cf. 6.3.3.2). Make the cases presented available and

supplement the information with relevant

articles (cf. 4.4.6.4).

308

Peer

assessments

Students take

responsibility to

evaluate and learn from other students

who are at the same academic level.

Provide guidelines on the use of the rubric

(cf. 4.4.7.4; cf. 5.4.2.4).

Create an environment that stimulates the

assessment environment, but also an environment that is comfortable and conducive

to learning (cf. 4.4.7.4). Organise student teams in which they are at

ease with each other to explore and collaborate

(cf. 4.4.7.4). Incorporate additional time for comprehensive

feedback (cf. 4.4.7.4).

Ensure that feedback is done constructively and

professionally (cf. 4.4.7.4).

Bedside teaching Clinical teaching

where students can observe and learn

patient-centred care

directly from example.

Ensure that the patients are orientated; explain

the purpose of the examination to them, and guarantee that their clinical information will be

kept confidential (cf. 4.4.8.3).

Convey relevant information on the clinical

examination with a focus on familiarising students with the protocol used in the specific

clinic (cf. 4.4.8.3). Emphasise the ultimate goal of patient-centred

teaching, regardless of the diagnosis

(cf. 4.4.8.3; cf. 6.4.8). Reassure students and provide suitable

guidance with clear communication throughout

the examination (cf. 6.3.2.1).

Provide explanations and reasons for

performing procedures (cf. 6.3.4.1). Incorporate an in-depth discussion on the

management plan as well reflection on the

experience to answer any questions the students might have (cf. 4.4.8.3).

Clinical skills

training

Demonstrate clinical

skills and techniques

that form the foundation for the

investigation and management of a

patient.

Provide a theoretical background to the skill via

lectures and assess students’ knowledge before

the demonstration of the technique (cf. 2.3.3.2.9; cf. 4.4.9.3).

Spend sufficient time on proper demonstration

of the technique. The demonstration should be physically performed by a supervisor on a

patient (maybe a student) (cf. 4.4.9.3).

Ensure that the student grasps the correct

technique and understands the correct procedure before allowing them to practise on

their own (cf. 4.4.9.3; cf. 6.3.3.1) Engage with students regularly to ensure that

they have mastered and perform the technique

correctly (cf. 4.4.9.3; cf. 6.3.2.1).

Perform peer assessments at multiple points to

identify weaknesses (cf. 4.4.9.3). Set aside enough time and equipment for

students to practise their skills (cf. 4.4.9.3; cf. 5.4.2.5).

309

Clinical

education

Apply theoretical

knowledge and clinical

and professional skills to become competent

and safe professionals

Design academic modules in such a manner

that most (if possible all) theory is discussed

before students enter the clinical environment (cf. 2.3.3.2.10; cf. 5.4.2.4)

Ensure that students are familiar with the

clinical setting before they engage with patients (cf. 5.4.2.4).

Set a realistic expectation that escalates with

the student’s ability of theory-practice integration (cf. 5.4.2.2; cf. 6.4.8).

Organise the clinical environment so that

students are exposed to different opinions as

well as a variety of patients (cf. 5.4.2.5). Provide a clinical environment with enough

working equipment and consumables

(cf. 5.4.2.5). Arrange a reflective session after a clinical

experience. The reflection can be done just

after the clinic or during the next contact

session with the students (cf. 5.4.2.5). As supervisor be approachable, helpful and

supportive (cf. 6.3.2.2; cf. 6.3.3.1).

Ensure that all supervisors are like-minded and

up to date with the latest theoretical information and skills (cf. 5.4.2.4; cf. 6.4.8).

Compile assessments to be objective and

consistent and provide constructive feedback (cf. 5.4.2.5)

These recommendations represent a short version of the findings of the literature review

and the empirical study. It is believed that these experiential teaching-learning methods

will enhance optometry teaching-learning and add value for both educators and students –

to the benefit of the health care consumer, namely the patients these students will deal

with once they enter professional practice.

6.6 CONCLUSION

Chapter 6 provided recommendations on the effective implementation of experiential

learning in the undergraduate optometry learning programme at the UFS. The underlying

premises of these recommendations include the recommended experiential learning

framework and recommendations on the different roles and attributes of the educator, as

well as recommendations on elements required to create a safe experiential learning

environment.

In the next chapter, Chapter 7, Conclusion, recommendations and limitations of the

study, a summative discussion, limitations of the study, conclusion and recommendations

from the study will be provided.

CHAPTER 7

CONCLUSION, RECOMMENTATIONS AND LIMITATIONS OF THE STUDY

7.1 INTRODUCTION

Experiential learning has been defined as a process by which the learner creates meaning

from a direct experience. Effective teaching behaviours, based on the needs of the students,

will create meaningful educational experiences. With these experiences, students will be

able to construct new knowledge and ultimately take responsibility for their learning.

The aim of the study was to investigate how different teaching-learning and assessment

methods based on the experiential learning cycle could be applied to enhance the learning

environment and promote integration of theory and clinical practice in the expanded scope

of the undergraduate optometry programme at the UFS (cf. 1.4.2).

The purpose of this chapter is to provide a brief summary of the study, including an

overview of how each research question was answered. Concluding thoughts on the

findings of this study, and limitations and contribution of the study, including

recommendations on the way forward, will also be included and the chapter will end with

conclusive remarks.

7.2. OVERVIEW OF THE STUDY

The research was executed and completed based on three research questions. The findings

of the research served as premises for the theoretically grounded recommendations for the

effective implementation of experiential learning in the undergraduate optometry

programme at the UFS.

In Chapter 1 (cf. 1.3), an outline of the research questions was presented. These research

questions guided the research study and shaped the outcome which is presented in this

final chapter. In 7.2.1, 7.2.2 and 7.2.3 the research questions are reviewed together with

the main findings of each research question.

311

7.2.1 Research question 1

The research question as stated reads:

How can experiential learning be utilised to enhance the learning environment in theory

lectures and clinical education in the pathology modules of the undergraduate optometry

learning programme at the UFS?

The following objective was pursued:

To conceptualise, from the literature, an extensive and in-depth account of the history,

development and current status and use of experiential learning in teaching-learning in

health sciences education with specific reference to teaching-learning methods in health

sciences education.

This research question aimed to provide the necessary context for the experiential

education component of the study. In Chapter 2, experiential learning in higher education

in theory and clinical modules was conceptualised and contextualised. The main areas

which were studied are: Optometry in South Africa (cf. 2.2) and Experiential learning (cf.

2.3). For better understanding and clarity, these primary areas of study were categorised

into subdivisions:

The context of this study was provided with a discussion on optometry in South Africa

(cf. 2.2). This section focused on the scope of practice as a registered optometrist in South

Africa (cf. 2.2.1) that determines the content of undergraduate optometry education in

South Africa (cf. 2.2.2).

To create a better understanding of the concept of experiential learning, the section

on experiential learning (cf. 2.3) focused on the historical development (cf. 2.3.1) that

led to the definition of experiential learning (cf. 2.3.2), followed by the elements of

experiential learning (cf. 2.3.3). The first element was the experience (cf. 2.3.3.1) that

comprised the teaching-learning methods to create a learning experience (cf. 2.3.3.2).

These included, Lectures (cf. 2.3.3.2.1), Flip the classroom (cf. 2.3.3.2.2), Small-group

learning (cf. 2.3.3.2.3), Simulation (cf. 2.3.3.2.4), Interprofessional education (cf.

2.3.3.2.5), Case presentation (cf. 2.3.3.2.6), Peer assessments (cf. 2.3.3.2.7), Bedside

312

teaching (cf. 2.3.3.2.8), Clinical skills training (cf. 2.3.3.2.9) and Clinical education (cf.

2.3.3.2.10). The second element of experiential learning discussed was reflection (cf.

2.3.3.3). Under reflection, the benefits of reflection (cf. 2.3.3.3.1), and models of reflection

(cf. 2.3.3.3.2) were discussed. This section was concluded with the role of the educator

(cf. 2.3.3.4).

An overview of Chapter 2 is provided in Figure 2.1.


The research question that was stated reads:

What are the experiences and perceptions of currently registered undergraduate optometry

students regarding the teaching-learning and assessment methods, based on experiential

learning, used in the pathology modules?


To investigate the experiences and perceptions of the currently registered optometry

students regarding the different teaching-learning and assessment methods, based on

experiential learning, used in the current pathology modules (via a questionnaire survey

and focus group interviews).

Different teaching-learning methods that align with the experiential learning cycle were

discussed in Chapter 2 (cf. 2.3.3.2). A questionnaire survey (cf. 3.3.2; cf. 4.1; Appendix

A) and focus group interviews (cf. 3.3.3; cf. 5.1) were used to determine the experiences

and perceptions of the undergraduate optometry students on these teaching-learning and

methods.

The questionnaire, with open-ended questions, was presented multiple times to the sample

population comprising 68 undergraduate optometry students registered at the School for

Allied Health Professions, in the FoHS, UFS during 2017 (cf. 3.4.1.1). After providing

consent to complete the questionnaire at the beginning of the data collection, participants

of a specific year group were asked to complete the questionnaire on separate occasions

313

after they had been exposed to a specific teaching-learning method (cf. Table 4.1). A pilot

study was conducted prior to this survey (cf. 3.4.1.3).

The results and discussion on the findings of the questionnaire survey dealt with the

experiences during and perceptions on different teaching-learning methods of the

undergraduate optometry students. The questionnaire consisted of questions the responses

of which would create a demographic profile of the participants, and the questions based

on the different stages of Gibbs’s reflective cycle for the students to reflect on their

experience to identify their perceptions (cf. 2.3.3.3.2; cf. 3.3.2).

The main findings of these sections were presented under the following headings:

Demographic description of the sample (cf. 4.2), and Reporting the results, data analysis,

description and discussion of findings of the questionnaire survey (cf. 4.4). The perceptions

and experiences on each teaching-learning and assessment method were analysed,

reported and discussed separately under the following nine themes:

Theme 1: Objectives



Theme 4: Strengths

Theme 5: Weaknesses



Theme 8: Feelings about assessment used

Theme 9: Recommendations.

Focus group interviews were also employed and provided additional data that contributed

to the interpretation and confirmation of the data obtained from the questionnaire surveys

(cf. 3.3.3; cf. 5.1). The focus group interviews were done to determine the fourth-year

undergraduate optometry students’ experiences and perceptions of their experience in the

Pathology clinic (cf. 3.4.2.1). The data of the focus group interviews were presented in

Chapter 5 (cf. 5.4.2) according to the COREQ criteria (cf. 5.1). Five major focus areas were

analysed and discussed, namely:

314

Personal opinion of the research project (cf. 5.4.2.1).

The overall feeling regarding the learning environment (cf. 5.4.2.2).

Theoretical grounding and integration of theory and clinical practice (cf. 5.4.2.3).

Factors that influenced the Pathology clinical learning environment (cf. 5.4.2.4).

Recommendations on the enhancement of the learning environment of the

Pathology clinical learning environment (cf. 5.4.2.5).


The research question that was stated reads:

What are the factors that should be considered in the implementation of experiential

learning through different teaching-learning and assessment methods in the expanded

scope of the undergraduate optometry programme at the UFS?


To enumerate the factors that should be considered to formulate recommendations on

experiential learning to enhance integration of theory and clinical practice in the expanded

scope of the undergraduate optometry learning programme at the UFS. (via a literature

review, questionnaire survey and focus group interviews).

In order to address research question 3, a discussion on the perceptions and experiences

of the students on each teaching-learning method was presented (cf. 4.4; cf. 5.4). The

formulation of the recommendations on experiential learning in the expanded scope of the

undergraduate optometry programme at the UFS were based on these findings together

with the findings in the literature study (cf. Chapter 2). The recommendations followed a

hierarchical system as illustrated in Figure 6.1 (cf. 6.1). The first level of the

recommendations were a recommended experiential teaching-learning framework

(cf. 6.2). The different teaching-learning methods and their alignment with the experiential

learning cycle were discussed within this framework.

The second level included recommendations on the different roles and attributes of the

educator in the experiential cycle (cf. 6.3). The results from this study identified a variety

of roles and attributes which could be adopted to enhance the learning experiences for the

315

students (cf. Figure 6.3). The last level consisted of recommendations to create a safe

experiential learning environment (cf. 6.4).

From the factors mentioned in Chapter 4 and Chapter 5, as well as from these three levels

of recommendations, recommendations for effective implementation of experiential

teaching-learning methods in pathology modules in optometry education were

made (cf. 6.5)

7.3. CONCLUSION

In the definitions of experiential learning in the literature two principles are highlighted,

namely the experience and the reflection afterwards. It is important to note that the

interaction between these two principles is paramount and is influenced by factors

which will either enhance the learning or be a barrier for learning to take place. Teaching-

learning methods should be based on researched information and theories that explain why

certain methods are more effective and under which circumstances. The study originated

from a need to identify these factors in order to provide optimal learning experiences, which

are specific and customised for optometry students.

To address the need, the researcher compiled recommendations for the effective

implementation of teaching-learning methods that will create a learning experience. These

include a recommended experiential learning framework, recommendations on the role and

attributes of the educator and recommendations on the elements to create a safe

experiential learning environment.

The study followed a qualitative case study design and made use of a combination of

methods to generate data to form the premise of the recommendations (cf. Chapter 3).

The literature study regarding the research topic (cf. Chapter 2) was followed by a

questionnaire survey. The questionnaire surveys were completed by second- to fourth-year

undergraduate optometry students to establish their experiences regarding and perceptions

on teaching-learning methods based on experiential learning. This was followed by focus

group interviews with fourth-year optometry students to determine their experiences and

perceptions in the clinical environment. A detailed description on these perceptions and

experiences was presented (cf. Chapter 4 and Chapter 5). The different factors identified

316

were synthesised to compile the recommendations made by the researcher regarding the

effective implementation of experiential learning (cf. Chapter 6).

Apart from a recommended experiential framework provided on how the teaching-

learning methods used align with the different modes of the experiential cycle,

recommendations were provided on the different roles and attributes of the educator.

These roles and attributes included being knowledgeable, creating an interest, providing

guidance, being approachable, building confidence, implementing ground rules, leading by

example and acting as mediator. Elements required to create a safe learning

environment also were discussed. Students feel safe in an environment with which they

are familiar, and when they are familiar with each other, the educators, and the

surroundings. Small-group learning also creates a safe and familiar environment. Both these

elements create an environment where they feel safe to ask questions. Students value an

environment where they are able to learn without influencing their marks or disadvantaging

the patients. They enjoy learning from their peers, but also need the personal contact with

educators. Elements such as consistency and an achievable objective also were discussed.

Finally, recommendations for the effective implementation of each of the

teaching-learning methods discussed were made (cf. Table 6.1).

7.4. LIMITATIONS OF THE STUDY

The researcher recognises the following limitations in the study:

The study was conducted specifically aimed at undergraduate optometry students at the

UFS. This was done to ensure uniformity in the application of the teaching-learning

methods, but it could also be relevant to other optometry schools, as well as other Health

Sciences Departments in South Africa.

The questionnaire survey and focus group interviews produced ample data. Although the

researcher reported all the data, all the aspects could not be discussed in full in this thesis.

Data regarding the research questions were described comprehensively and additional data

will be discussed in further publications.

317

Due to the vast amount of data, the study focussed only on the students’ experiences and

perceptions. Recommendations were made to create an environment that address only their

needs.

7.5. CONTRIBUTION OF THE RESEARCH

The overall goal of the study was to enhance teaching-learning in the undergraduate

optometry programme of the UFS by improving the integration of theory and clinical

practice through experiential learning. The researcher is of the opinion that the research

made a valuable contribution to new knowledge with the overall goal achieved by providing

recommendations on the effective implementation of experiential learning.

These recommendations can assist optometry educators with the application of different

teaching-learning methods based on the needs of the students. The implementation of

experiential learning according to these recommendations will be done in a pedagogically

sound way and it might make a noteworthy contribution that will impact significantly on the

learning environment in theory and clinical education. The researcher, with this study,

contributed to filling the identified need and graduates will have the ability to practice within

the expanded scope of practice.

7.6. RECOMMENDATIONS

In order for the study to yield significant and valuable results, the following

recommendations are made, namely

That the findings of the study are made available to the Executive Committee of

the Department of Optometry for consideration and implementation.

That the Department of Optometry at the UFS implement the recommendations

made in this study to ensure students are provided with optimal learning

experiences.

To expand research to different speciality areas in the optometry curriculum of the

UFS.

That the findings of the study be presented through presentations for staff

development within the Faculty of Health Sciences, UFS and that different

318

departments customise and implement the recommendations in order to enhance

their learning environment.

That educators realise the important role they play in the creation of the optimal

learning experience. This might be done through workshops for staff development

within the Faculty of Health Sciences.

The results of this study be presented at relevant national and international

conferences and published in relevant accredited journals.

That further research be done including a larger sample from all the Optometry

Departments in South Africa and in different Health Sciences Departments.

That further research be done to align these recommendations with generic

outcomes and the level descriptors of SAQA.

7.7. CONCLUSIVE REMARK

Experiential learning can respond to the needs of each student. Meaningful educational

experiences that are personalised and will engage students and motivate them to take

responsibility for their own learning, enhance the learning environment and promote theory-

practice integration.

This study attempted to provide direction to educators in optometry in order for them to

develop safe learning experiences that motivate students to achieve excellence in the

competencies and knowledge required to qualify as a competent Optometrist. With these

experiences students will be equipped to integrate knowledge between theoretical and

clinical practice, which will be of utmost importance in the expanded scope.

REFERENCES

Agee, N., Komenaka, I.K., Drachman, D., Bouton, M.E., Caruso, D.M. & Foster, K.N. 2009.

The Effectiveness of Grand Rounds Lectures in a Community-Based Teaching Hospital.

Journal of Surgical Education 66(6): 361-366.

Aggarwal, R., Grantcharov, T.P. & Darzi, A. 2007. Framework for Systematic Training and

Assessment of Technical Skills. Journal of American College of Surgeons 204(4): 697-705.

Alias, M., Masek, A. & Salleh, H.H.M. 2015. Self, Peer and Teacher Assessments in Problem-

Based Learning: Are They in Agreement? Procedia: Social and Behavioural Sciences 204:

309-317.

Allan, E.G. 2016. “I hate Group Work!”: Addressing Students’ Concerns About Small-Group

Learning. Insight: A Journal of Scholarly Teaching 11: 81-89.

Allodola, V.F. 2014. The effects of educational models based on experiential learning in

Medical Education: an international literature review. Tutor 14(1): 23-49.

Amin, Z. & Eng, K.H. 2003. Basics in Medical Education (1st edition). Singapor: World

Scientific Publishing Co. Ptye. Ltd.

Anthony, S. & Jack, S. 2009. Qualitative case study methodology in nursing research: An

integrative review. Journal of Advanced Nursing 65(6): 1171-1181.

Ashraf, M. 2003. A Critical Look at the use of Group Projects as a Pedagogical Tool. Journal

of Education for Business 79 (4): 213-216.

Austin, M.J. & Rust, D.Z. 2015. Developing an Experiential Learning Program: Milestones

and Challenges. International Journal of Teaching and Learning in Higher Education 27(1):

143-153.

Barbour, R.S. 2005. Making sense of focus groups. Medical Education 7: 742-750.

Barnsteiner, J.H., Disch, J.M., Hall, L., Mayer, D. & Moore, S.M. 2007. Promoting

interprofessional education. Nursing Outlook 55:144-150.

320

Bassey, M. 1999. Case study research in educational setting. Philadelphia: Open University

Press.

Beckman, T.J. 2004. Lessons Learned from A Peer Review of Bedside Teaching. Academic

Medicine 79(4): 343-346.

Bengtsson, M. 2016. How to plan and perform a qualitative study using content analysis.

Nursing Plus Open 2: 8-14.

Bernard, H.R. & Ryan, G.W. 2010. Analyzing Qualitative Data. Thousand Oaks, California:

Sage Publications.

Betihavas, V., Bridgman, H., Kornhaber, R. & Cross, M. 2016. The evidence for ‘flipping

out’: A systemic review of the flipped classroom in nursing education. Nurse Education

Today 38: 15-21.

Berrett, D. 2015. How ‘Flipping’ the Classroom Can Improve the Traditional Lecture. The

Chronical of Higher Education, Inc. A Guide to the Flipped Classroom: 2-6.

Billings, D.M. & Halstead, J.A. 2005. Teaching in Nursing: A Guide for Faculty, (2nd Edition).

St Louis, Elsevier.

Bishop, J.L. & Verleger, M.A. 2013. The Flipped Classroom: A Survey of the Research.

https://www.researchgate.net/publication/285935974_The_flipped_classroom_A_survey_

of_the_research/link/59820779a6fdccda901f1e3e/download

Retrieved on 7 October 2016.

Bondevik, G.T., Holst, L., Haugland, M., Baerheim, A. & Raaheim, A. 2015. Interprofessional

Workplace Learning in Primary Care: Students from Different Health Professions Work in

Teams in Real-Life Settings. International Journal of Teaching and Learning in Higher

Education 27(2): 175-182.

Botma, Y. 2014. Nursing students’ perceptions on how immersive simulation promotes

theory-practice integration. International Journal of Africa Nursing Sciences 1: 1-5.

https://www.researchgate.net/publication/285935974_The_flipped_classroom_A_survey_of_the_research/link/59820779a6fdccda901f1e3e/download

https://www.researchgate.net/publication/285935974_The_flipped_classroom_A_survey_of_the_research/link/59820779a6fdccda901f1e3e/download

321

Botma, Y. & Labuschagne M.J. 2017. IPE facilitator guide. University of the Free State.

Botma, Y., Van Rensburg, G.H., Coetzee, I.M. & Heyns, T. 2015. A conceptual framework

for educational design at modular level to promote transfer of learning. Innovations in

Education and Teaching International 52(5): 499-509.

Bouldin, A.S. 2017. Reflection is not reflexive. American Journal of Pharmaceutical

Education. 81(9): 7-9.

Brandenburg, R. & Pesudovs, K. 2014. Teaching Communication Skills: An Australian

Optometry Program’s New Course. Optometric Education 40: 19-27.

Brink H.I. 2003. Fundamentals of research methodology for health care professions (6th

Impression). Landsdowne: Juta & Co.

Bristol, T.J. 2014. Flipping the Classroom. Teaching and Learning in Nursing 9: 43-46.

Bryson, C. & Hand, L. 2007. The role of engagement in inspiring teaching and learning.

Innovations in Education and Teaching International 44(4): 349-362.

Buring, S.M., Bhushan, A., Broeseker, A., Conway, S., Duncan-Hewitt, W., Hansen, L. &

Westberg, S. 2009. Interprofessional Education: Definitions, Student Competencies, and

Guidelines for Implementation. American Journal of Pharmaceutical Education 73(4): Article

59.

Burns, N. & Grove, S. 2005. The Practice of Nursing Research. (5th ed.). Missouri: Elsevier

Saunders.

Byszewski, A., Hendelman, W., McGuinty, C. & Moineau G. 2012. Wanted: role models –

medical students’ perceptions of professionalism. BMC Medical Education 12(115): 1-9.

CAIPE (Centre for the Advancement of Interprofessional Education). 2002. Defining IPE.

https://www.caipe.org/about-us

Accessed on 5 April 2017.

https://www.caipe.org/about-us

322

Carlson, N.B. 2016. Teaching Optometry Students How to Study Actively. Optometric

Education 41(2).

https://journal.opted.org/article/teaching-optometry-students-how-to-study-actively/

Retrieved on 13 June 2017.

Castro, F.G., Kellison, J.G., Boyd, S.J. & Kopak, A. 2010. A Methodology for Conducting

Integrative Mixed Methods Research and Data Analyses. Journal of Mixed Methods Research

4(4): 342-360.

Charlton, B.G. 2006. Lectures are such an effective teaching method because they exploit

human evolved psychology to improve learning. Medical Hypothesis 67: 1261-1265.

Chapman, H. 2006. Towards effective group-work in nurse education. Nurse education

Today 26: 298-303.

Chapman, K.J. & Van Auken, S. 2001. Creating Positive Group Project Experiences: An

Examination of the Role of the Instructor in Students’ Perceptions of Group Projects. Journal

of Marketing Education 23(2): 117-127.

Chavan, M. 2011. Higher Education Students’ Attitudes Towards Experiential Learning in

International Business. Journal of Teaching in International Business 22: 126-143.

CHE (Council on Higher Education). 2011. Work-Integrated Learning: Good Practice Guide.

HE Monitor 12. Pretoria:CHE.

CHE and HPCSA. 2013. Memorandum of understanding between the Council on Higher

Education and the Health Professions Council of South Africa. Pretoria: CHE-HPCSA.

Chen, Y., Kiersman, M.E. & Abdelmageed, A. 2015. Evaluation of student perceptions of

standardized patient simulation on patient counselling confidence during introductory

pharmacy practice experiences. Currents in Pharmacy Teaching and Learning 7: 811-818.

Chretien, K.C., Goldman, E.F., Craven, K.E. & Faselis, C.J. 2010. A Qualitative Study of the

Meaning of Physical Examination Teaching for Patients. J Gen Intern Med 25(8): 786-791.

https://journal.opted.org/article/teaching-optometry-students-how-to-study-actively/

323

Christian, L.W., Maclver, S. & Alfieri, S. 2015. Evaluation of Interprofessional Education and

Collaboration in Optometry. Optometric Education 40(3): Online.

http://journal.opted.org/article/evaluation-of-interprofessional-education-and-collaboration-

in-optometry/

Retrieved on 5 April 2017.

Clissett, P. 2008. Evaluating qualitative research. Journal of Orthopaedic Nursing 12: 99-

105.

Coyne, I.T. 1997. Sampling in qualitative research. Purposeful and theoretical sampling:

Merging or clear boundaries? Journal of Advanced Nursing 26: 623-630.

Cooper, R., Fleischer, A. & Cotton, F.A. 2012. Building Connections: An Interpretative

Phenomenological Analysis of Qualitative Research Students’ Learning Experiences. The

Qualitative Report 17: 1-16.

Cox, C.D., Peeters, M.J., Stanford, B.L & Seifert, C.F. 2013. Pilot of peer assessment within

experiential teaching and learning. Currents in Pharmacy Teaching and Learning 5: 311-

320.

Crosby, J. 1996. AMEE Medical Education Guide no. 8 Learning in Small groups. Medical

Teacher 18(3): 189-202.

Daffue, Y. 2018. Department of Statistics and Data Analysis. Health Professions Council of

South Africa. Pretoria: HPCSA.

Personal communication on 7 December 2018.

Davis, B. & Summers, M. 2014. Applying Dale’s Cone of Experience to increase learning and

retention: A study of student learning in a foundational leadership course. QScience

Proceedings (Engineering Leaders Conference)

https://dx.doi.org/10.5339/qproc.2015.elc2014.6


http://journal.opted.org/article/evaluation-of-interprofessional-education-and-collaboration-in-optometry/

http://journal.opted.org/article/evaluation-of-interprofessional-education-and-collaboration-in-optometry/

https://dx.doi.org/10.5339/qproc.2015.elc2014.6

324

Delany, C. & Watkin, D. 2009. A study of critical reflection in health professional education:

‘learning where others are coming from’. Advances in Health Science Education 14:411-

429.

Delport, C.S.L. 2002. Quantitative data collection methods. In De Vos, A.S., Strydom, H.,

Fouché, C.B. & Delport, C.S. (Eds) Research at Grass Roots for the Social Sciences and

Human Services Profession. (3rd edition). Pretoria, South Africa: Van Schaik Publishers.

Dent, J.A. 2009. Bedside teaching. In Dent. J. A. & Harden, R.M. A Practical Guide for

Medical Teachers (3rd edition). Churchill Livingstone: Elsevier.

Dent, J.A. & Harden, R.M. 2009. A Practical Guide for Medical Teachers (3rd Edition).

Churchill Livingstone: Elsevier.

Denzin, N.K. & Lincoln, Y.S. 2000. Introduction: the discipline and practice of qualitative

research. In: Denzin, N.K. & Lincoln, Y.S. (Eds). Handbook of Qualitative Research. (2nd

edition). Thousand Oaks, CA: Sage Publications.

De Oliveira, S.N., Do Prado, M.L., Kempfer, S.S., Martini, J.G., Caravaca-Morera, J.A. &

Bernardi, M.C. 2015. Experiential learning in nursing consultation education via clinical

simulation with actors: Action research. Nurse Education Today 35: 50-54.

De Vos, A.S., Strydom, H., Fouché, C.B. & Delport, C.S. (Eds). 2011. Research at Grass

Roots for the Social Sciences and Human Services Profession (3rd Edition). Pretoria, South

Africa: Van Schaik Publishers.

DiPiro, J.T. 2009. Why Do We Still Lecture? American Journal of Pharmaceutical Education

73(8): Article 137.

Draper, C.E., Moller, N., Aubin, L., Edelstein, G. & Weiss, R. 2012. Developing a

standardised patient programme in a primary healthcare curriculum: A needs analysis.

African Journal of Health Professions Education 4(2): 97-101.

Ebersohn, L., Eloff, I. & Ferreira, R. 2007. First steps in action research. In K. Maree (Ed.).

First Steps in Research. Pretoria: Van Schaik.

325

Elo, S. & Kyngäs, H. 2007. The qualitative content analysis process. Journal of Advanced

Nursing 62: 107-115.

Elshami, W. & Abdalla, M.E. 2016. Diagnostic radiography students’ perceptions of

formative peer assessment within a radiographic technique module. Radiography 23(1): 9-

13

Ernstzen, D.V., Bitzer, E. & Grimmer-Somers, K. 2010. Physiotherapy students’ and clinical

teachers’ perspectives on best clinical teaching and learning practices: A qualitative study.

SA Journal of Physiotherapy 66(3):25-31.

Ernstzen, D. V., Statham, S.B. & Hanekom, S.D. 2014. Physiotherapy students’ perceptions

about the learning opportunities included in an introductory clinical module. African Journal

of Health Professions Education 6(2): 217-221.

Fasbinder, D.J., Heys, D.R., Holland, G.R., Keerthy A., Murdoch-Kinch, C.A. & Inglehart,

M.R. 2015. Grand Rounds for Dental students: An Exploration. Journal of Dental Education

79(5): 510-522.

Ferreira, J.T. 1993. The development and practice of Optometry in South Africa. The South

African Optometrist 52(2): 59-60.

Filies, G.C., Yassin, Z. & Frantz, J.M. 2016. Students’ views about an interprofessional world

café method. African Journal of Health Professions Education 8(2): 229-233.

Finn, G.M. & Garner, J. 2011. Twelve tips for implementing a successful peer assessment.

Medical Teacher 33: 443-446.

Flick, U. 2004. Constructivism. In Flick, U., Von Kardorff, E. & Steinke, I. (Eds). A Companion

to Qualitative Research. London: Sage Publications.

Forrest, M.E.S. 2008. Learning and teaching in action. Health Information and Libraries

Journal 25:229-232.

326

Fouché, C.B & Delport, C.S.L. 2002. Introduction to the research process. In In De Vos,

A.S., Strydom, H., Fouché, C.B. & Delport, C.S. (Eds.) Research at Grass Roots for the Social

Sciences and Human Services Profession. (3rd Edition). Pretoria, South Africa: Van Schaik

Publishers.

Fowler, J. 2008. Experiential learning and its facilitation. Nurse Education Today 28: 427-

433.

Freeman, T. 2006. ‘Best practice’ in focus group research: making sense of different views.

Journal of Advanced Nursing 56(5): 491-497.

Gardner, G., Woollett, K., Daly, N., Richardson, B. & Aitken, L.M. 2010. Innovation in clinical

learning for the acute hospital environment: Nursing grand rounds. Nurse Education Today

30: 737-741.

Garout, M., Nuqali, A., Alhazmi, A. & Almoallim, H. 2016: Bedside teaching: an underutilized

tool in medical education. International Journal of Medical Education 7: 261-262.

Gatfield, T. 1999. Examining Student Satisfaction with Group Projects and Peer Assessment.

Assessment & Evaluation in Higher Education 24(4): 365-377.

Gehlen-Baum, V. & Weinberger, A. 2014. Teaching, learning and media use in today’s

lectures. Computers in Human Behaviour 37: 171-182.

George, J.H. 2001. A Simple Five-step Method for Teaching Clinical Skills. Family Medicine

33(8): 557-578.

Ghazali, A. R., Ishak, I., Saat, N.Z.M., Arifin, R.A.Z., Hamid, A., Rosli, Y., Mohammed, Z.,

Othman, M.S. & Kamarulzaman, F. 2012. Students’ perception on lecture delivery

effectiveness among the Faculty of Health Sciences lecturers. Social and Behavioural

Sciences 60: 67-72.

Gibbs. G. 2013. Learning by doing: A guide to teaching and learning methods. London:

Further Education Unit at Oxford Polytechnic.

327

Gielen, M. & De Wever, B. 2015. Structuring peer assessment: Comparing the impact of the

degree of structure on peer feedback content. Computers in Human Behaviour 52: 315-

325.

Gilboy, M.B., Heinerichs, S. & Pazzaglia, G. 2015. Enhancing Student Engagement Using

the Flipped Classroom. Journal of Nutrition Education and Behaviour 47: 109-114.

Graneheim, U.H. & Lundman, B. 2004. Qualitative content analysis in nursing research:

concepts, procedures and measures to achieve trustworthiness. Nurse Education today 24:

105-112.

Grant, C. & Osanloo, A. 2014. Understanding, selecting, and integrating a theoretical

framework in dissertation research: Creating the blueprint for you house. Administrative

Issues Journal: Connecting Education, Practice and Research 4(2): 12-26.

Grantcharov, T.P. & Reznick, R.K. 2008. Teaching procedural skills. Practice 336: 1129-

1131.

Greeff, M. 2005. Information collecting: Interviewing. In: De Vos, A.S., Strydom, H.,

Fouché, C.B. & Delport, C.S. (Eds). Research at Grass Roots for the Social Sciences and

Human Services Profession (3rd Edition). Pretoria, South Africa: Van Schaik Publishers.

Hanson, J.L., Balmer, D.F. & Giardino, A.P. 2011. Qualitative Research Methods for Medical

Educators. Academic Paediatrics 11(5): 375-386.

Hanson, J. 2016. Surveying the experiences and perceptions of undergraduate nursing

students of a flipped classroom approach to increase understanding of drug science and its

application to clinical practice. Nurse Education in Practice 16: 79-85.

Harrington, J. & Oliver, R. 2000. An Instructional Design Framework for Authentic Learning

Environments. Educational Technology Research and Development 48(3): 23-48.

328

Hauer, K. 2014. Do online learning and flipped classrooms have better outcomes than face-

to-face, teacher guided learning?

https://meded.ucsf.edu/sites/meded.ucsf.edu/files/documents/research-and-development-

medical-education/hauer-flipped-classroom-pearl-2014.pdf


Herbert, R.S. & Wright, S.M. 2003. Re-examining the Value of Medical Grand Rounds.

Academic Medicine 78(12): 1248-1525.

Hope, A., Garside, J. & Prescott, S. 2011. Rethinking theory and practice: Pre-registration

student nurses’ experiences of simulation teaching and learning in acquisition of clinical

skills in preparation for practice. Nurse Education Today 31: 711-715.

Houghton, C., Casey, D., Shaw, D. & Murphy, K. 2013. Rigour in qualitative case-study

research. Nurse Researcher 20(4): 12-17.

HPCSA (Health Professions Council of South Africa). 2008. Professional Boards: Optometry

and dispensing opticians. Pretoria: HPCSA.

http://www.hpcsa.co.za/hpcsa/default.aspx?id=69

Retrieved on 9 July 2017.

HPCSA (Health Professions Council of South Africa). 2014. Core competencies for

undergraduate students in clinical associate, dentistry and medical teaching and learning

programmes in South Africa. Pretoria: HPCSA.

Hsieh, H. & Shannon, S.E. 2005. Three Approaches to Qualitative Content Analysis.

Qualitative Health Research 15: 1277-1288.

Husebø, S. E. & O’Regan, S. 2015. Reflective Practice and Its Role in Simulation. Clinical

Simulation in Nursing 11: 368-375.

Illing, J. 2014. Thinking about research: Theoretical perspectives, ethics and scholarship.

In Swanwick, T (Ed). Understanding Medical Education: Evidence, Theory and Practice (2nd

edition) Oxford: Wiley Blackwell.

https://meded.ucsf.edu/sites/meded.ucsf.edu/files/documents/research-and-development-medical-education/hauer-flipped-classroom-pearl-2014.pdf

https://meded.ucsf.edu/sites/meded.ucsf.edu/files/documents/research-and-development-medical-education/hauer-flipped-classroom-pearl-2014.pdf

http://www.hpcsa.co.za/hpcsa/default.aspx?id=69

329

Jacobs, M. 2001. The Education and Training of the Optometric Practitioner in South Africa.

Unpublished Magister Artium, Johannesburg: University of Johannesburg.

Jackson, D., Hickman, L.D., Power, T., Disler, R., Potgieter, I., Deek H. & Davidson, P.M.

2014. Small-group learning: Graduate health students’ views of challenges and benefits.

Contemporary Nurse 48(1): 117-128.

Jhangiani, R.S. 2016. The Impact of Participating in a Peer Assessment Activity on

Subsequent Academic Performance. Teaching of Psychology 43(3): 180-186.

Johnson, B. & Christensen, L. 2008. Educational Research: Quantitative, Qualitative, and

Mixed approaches (3rd edition). California: Sage Publications, Inc.

Kaufman, D.M. & Mann, K.V. 2014. Teaching and learning in medical education: How theory

can inform practice. In Swanwick, T. (Ed.). Understanding Medical Education: Evidence,

Theory and Practice (2nd edition). Oxford: Wiley Blackwell.

Kempen, E. & Kruger, S.B. 2019. Kolb’s learning styles of optometry students at the

University of the Free State, South Africa. African Vision and Eye Health 78(1): 1-6

Kempen, E. 2015. The Learning Styles of Optometry Students at the University of the Free

State. Unpublished Magister Artium, Bloemfontein: University of the Free State.

Ker, J.S. 2009. Clinical skills centre teaching. In Dent. J.A. & Harden, R.M. A Practical Guide

for Medical Teachers (3rd edition). Churchill Livingstone: Elsevier.

Ker, J. & Bradley, P. 2014. Simulation in medical education. In Swanwick, T. (Ed.).

Understanding Medical Education: Evidence, Theory and Practice (2nd edition). Oxford:

Wiley Blackwell.

King, A.E., Joseph, A.S. & Umland, E.M. 2017. Student perceptions of the impact and value

of incorporation of reflective writing across a pharmacy curriculum. Currents in Pharmacy

Teaching and Learning 9: 770-778.

330

Kriel, S. 2017. Is it time for a new model for optometry? Vision magazine

https://visionmagazineonline/2017/09/22/is-it-time-for-a-new-model-for-optometry/


Krueger, R.A. & Casey, M.A. 2015. Focus groups: A Practical Guide for Applied Research

(5th edition). California: Sage Publications Inc.

Kolb, D.A. 1984. Experiential learning: Experience as the source of learning and

development. New Jersey: Prentice-Hall.

Kolb, A. & Kolb, D. 2005. Learning Styles and Learning Spaces: Enhancing Experiential

Learning in Higher Education. Academy of Management Learning & Education. 4(2): 193-

212.

Kolb, A. & Kolb, D. 2017. Experiential Learning Theory as a Guide for Experiential Educators

in Higher Education. A Journal for Engaged Educators 1(1): 7-44.

LaCombe, M.A. 1997. On Bedside Teaching. Annals of Internal Medicine 126(3): 217-220.

Lage, M.J., Platt, G.J. & Treglia, M. 2000. Inverting the Classroom: A Gateway to Creating

an Inclusive Learning Environment. The Journal of Economic Education 31(1): 30-43.

Laibhen-Parkes, N., Brasch, J. & Gioncardi, L. 2015. Nursing Grand Rounds: A Strategy for

Promoting Evidence-Based Learning Among Paediatric Nurses. Journal of Paediatric Nursing

30: 338-345.

Launer, J. 2014. Teaching and learning in medical education: How theory can inform

practice. In Swanwick, T. (Ed.). Understanding Medical Education: Evidence, Theory and

Practice (2nd edition). Oxford: Wiley Blackwell.

Lapkin, S., Levett-Jones, T. & Gilligan, C. 2013. The effectiveness of interprofessional

education in university-based health professional programs: A systematic review. Nurse

Education Today 33: 90-102.

https://visionmagazineonline/2017/09/22/is-it-time-for-a-new-model-for-optometry/

331

Leedy P. 1997. Practical research: Planning and design (6th edition). Up Saddle River, New

Jersey: Prentice Hall Inc.

Levato, C. & Wall, D. 2014. Programme evaluation: Improving practice, influencing policy

and decision-making. In Swanwick, T. (Ed.) Understanding Medical Education: Evidence,

Theory and Practice (2nd edition). Oxford: Wiley Blackwell.

Lewis, T.L. 1994. Defining the Scope of Practice of Optometry. Optometry and Vision

Science 71(2): 76-79.

Lim, A.G., Geduld, H., Checkett, K., Sawe, H.R. & Reynolds, T.A. 2017. Pioneering small-

group learning in Tanzanian emergency medicine: Investigating acceptability for physician

learners. African Journal of Health Professions Education 9: 24-28.

Mann, K., Gordon, J. & MacLeod, A. 2009. Reflection and reflective practice in health

professions education: a systematic review. Advances in Health Sciences Education 14:595-

621.

Manolis, C., Burns, D.J., Assudani, R. & Chinta, R. 2012. Assessing experiential learning

styles: A methodological reconstruction and validation of the Kolb Learning Style Inventory.

Learning and Individual differences 23(2013): 44-53.

Masadeh, M.A. 2012. Focus Group: Reviews and Practices. International Journal of Applied

Science and Technology 2(10): 63-68.

Maran, N.J. & Glavin, R.J. 2003. Low- to high-fidelity simulation: A continuum of medical

education? Medical Education 37(1):22-28.

Mashige, K.P. 2010. Optometric education at Westville: past, present and future. The South

African Optometrist 69(1):14-20.

Mashige, K.P. & Naidoo, K.S. 2010. Optometric practices and practitioners in KwaZulu-Natal,

South Africa. The South African Optometrist 69(2): 77-85.

332

Matheson, C. 2008. The educational value and effectiveness of lectures. The Clinical

Teacher 5: 218-221.

Mazur, E. 2009. Farewell, lecture? Science 323: 50-51.

McCrorie, P. 2014. Teaching and leading small groups. In Swanwick, T. (Ed.).

Understanding Medical Education: Evidence, Theory and Practice (2nd edition). Oxford:

Wiley Blackwell.

McLaughlin, J.E., Roth, M.T., Glatt, D.M., Gharkholonarehe, N., Davidson, C.A., Griffin, L.M.,

Esserman, D.A. & Mumper, R.J. 2014. The Flipped Classroom: A Course Redesign to Foster

Learning and Engagement in a Health Professions School. Academic Medicine 89(2): 236-

243.

McLeod, A. & Bush, S. 2015. Pilot Assessment of Teaching Anterior Segment Evaluation to

Develop Interprofessional Education Programs. Optometric Education 40(3):1-5.

McMillan, J.H. & Schumacher, S. 2001. Research in Education: A Conceptual Introduction.

New York: Longman.

Merriam, S.B. 2002. Qualitative Research: A Guide to Design and Implementation. New

York: Jossey-Bass, A Wiley Imprint.

Meyer, R., Van Schalkwyk, S.C. & Prakaschandra R. 2016. The operating room as clinical

learning environment: An exploratory study. Nurse Education in Practice 18:60-72.

Morris, J. 2001. Peer assessment: a missing link between teaching and learning? A review

of the literature. Nurse Education Today 21: 507-515.

Mouton, J. 2009. How to succeed in your Master’s and Doctoral Studies. Pretoria: Van Schaik

Publishers.

Nair, B.R., Coughlan, J.F. & Hensley, M.J. 1997. Student and patient perspectives on

bedside teaching. Medical Education 31: 341-346.

333

Naroo, S.A. 2009. Optometry and optics in Europe. Contact lens & Anterior Eye 32: 101-

102.

Nel, N. & Stellenberg, E.L. 2015. Nursing students’ perception of simulation as a clinical

teaching method in the Cape Town Metropole, South Africa. African Journal of Health

Professions Education 7(2): 176-179.

Nieuwenhuis, J. 2007. Qualitative research designs and data gathering techniques. In K

Maree (ed.). First steps in research. Pretoria: Van Schaik.

Njie-Carr, V.P.S., Ludeman, E., Ching Lee, M., Dordunoo, D., Trocky, N.M. & Jenkins, L.S.

2016. An Integrative Review of Flipped Classroom Teaching Models in Nursing Education.

Journal of Professional Nursing 33(2): 133-144.

Oduntan, O.A., Mashige K.P., Kio, F.E. & Boadi-Kui, S.B. 2013. Optometric Education in

Africa: Historical Perspectives and Challenges. Optometry and Vision Science 91(3):359-

365.

OECD (Organisation for economic co-operation and development). 2008. Reviews of

National Policies for Education: South Africa.

http://www.education.gov.za/LinkClick.aspx?fileticket=sKsxhYorWOk%3D&..


O’Flaherty, J. & Phillips, C. 2015. The use of flipped classrooms in higher education: A

scoping review. Internet and Higher Education 25: 85-95.

O’Mara, L., McDonald, J., Gillespie, M., Brown. H. & Miles, L. 2014. Challenging clinical

learning environments: Experiences of undergraduate nursing students. Nurse Education in

Practice 14: 208-213.

Orîndaru, A. 2015. Changing Perspectives on Students in Higher Education. Procedia

Economics and Finance 27: 682-691.

http://www.education.gov.za/LinkClick.aspx?fileticket=sKsxhYorWOk%3D&..

334

Ortega, K.P., Murayama, W.C., Holmes, L.N., Taylor, S.J. & DePeters, E.J. 2011. Case study:

Experiential learning exercises to enhance learning in a university nutrition course. The

Professional Animal Scientist 27: 591-298.

Paterson, C. & Chapman, J. 2013. Enhancing skills of critical reflection to evidence learning

in professional practice. Physical Therapy in Sport 14:1 33-138.

Patton, M.Q. 2002. Qualitative Research and Evaluation Methods (3rd edition). Thousand

Oaks CA: Sage Publications.

Papastavrou, E., Lambrinou, E., Tsangari, H., Saarikoski, M. & Leino-Kilpi, H. 2010. Student

nurses’ experience of learning in the clinical environment. Nurse Education in Practice 10:

176-182.

Papp, I., Markkanen, M. & von Bonsdorff, M. 2003. Clinical environment as a learning

environment: student nurses’ perceptions concerning clinical learning experiences. Nurse

Education Today 23: 262-268.

Penson, P.E. 2012. Lecturing: A lost art. Currents in Pharmacy Teaching and Learning 4:

72-76.

Peters, M. & Ten Cate, O. 2014. Bedside teaching in medical education: a literature review.

Perspectives on Medical Education 3: 76-88.

Peterson, J.A. & Brommelsiek, M. 2017. Interprofessional education to foster

communication and resilience among health professional students. Journal of

Interprofessional Education and Practice 7: 1-3.

Petty, N.J., Thomson, O.P. & Stew, G. 2012. Ready for a paradigm shift? Part 2: Introducing

qualitative research methodologies and methods. Manual Therapy 17: 378-384.

Pharikh, B.T. & Sheenan, A.H. 2016. Student pharmacists’ perceptions of the

implementation of peer assessment instruction and activities within a didactic course.

Currents in Pharmacy 8(6): 821- 826.

335

Polit, D. F. & Beck, C. T. 2006. Essentials of nursing research - methods, appraisal and

utilization. Philadelphia: Lippincott Williams & Wilkens.

Prince, M. & Davies, M. 2001. Moderator teams: an extension to focus group methodology.

Qualitative Market Research: An International Journal 4(4): 207-216.

Qureshi, Z. 2014. Back to the bedside: the role of bedside teaching in the modern era.

Perspectives on Medical Education 3: 69 -72.

Ramani, S., Orlander, J.D., Strunin L. & Barber T.W. 2003. Whither Bedside Teaching? A

Focus-group Study of Clinical Teachers. Academic Medicine 78(4): 384-390.

Ramkissoon, P. 2017. Recognition of ocular therapeutics in Optometry. Vision 23(3)

http://visionmagazineonline.co.za/2017/09/23/recognition-of-ocular-therapeutics-in-

optometry/


Ramm, D., Thomson, A. & Jackson, A. 2015. Learning clinical skills in the simulation suite:

the lived experiences of student nurses involved in peer teaching and peer assessment.

Nurse Education Today 35: 823-827.

Rhoda, A. 2016. Introducing interprofessional education, practice and research in a higher

education setting. African Journal of Health Professions Education 8(2): 213.

Rhoda, A., Laattoe, N., Smithdorf, G., Roman, N. & Frantz, J. 2016. Facilitating community-

based interprofessional education and collaborative practice in a health science faculty:

Student perceptions and experiences. African Journal of Health Professions Education 8(2):

225-228.

Roberts, T.G. 2003. An Interpretation Of Dewey’s Experiential Learning Theory.

https://files.eric.ed.gov/fulltext/ED481922.pdf


Roach, T. 2014. Student perceptions toward flipped learning: New methods to increase

interaction and active learning in economics. International Review of Economics 17: 78-84.

http://visionmagazineonline.co.za/2017/09/23/recognition-of-ocular-therapeutics-in-optometry/

http://visionmagazineonline.co.za/2017/09/23/recognition-of-ocular-therapeutics-in-optometry/

https://files.eric.ed.gov/fulltext/ED481922.pdf

336

Roehl, A., Reddy, S.L. & Shannon, G.J. 2013. The Flipped Classroom: An Opportunity To

Engage Millennial Students Through Active Learning Strategies. Journal of Family &

Consumer Sciences 105(2): 44-49.

RSA DoE (Republic of South Africa. Department of Education). 1997. Education White paper

3: A Programme for the transformation of Higher Education. Pretoria: Department of

Education.

RSA DoH (Republic of South Africa, Department of Health). 2007. Regulations defining the

scope of the profession of Optometry. Pretoria: Department of Health.

RSA DoH (Republic of South Africa, Department of Health). 2016. National Government

Gazette Volume 612 Number 40041. Pretoria: Department of Health.

Rudland, J.R. 2009. Learning in small groups. In Dent, J.A. & Harden, R.M (Eds). A Practical

Guide for Medical Teachers (3rd edition). Livingstone: Elsevier.

Ruhi, U. 2016. An experiential learning pedagogical framework for enterprise systems

education in business schools. The International Journal of Management Education 14: 198-

211.

Ruholl, L. & Boyajian, R. 2007. The Senior Wellness Project: Focus on experiential learning.

Teaching and Learning in Nursing 2: 72-79.

Rush, S., Firth, T., Burke, L. & Marks-Maran, D. 2012. Implementation and evaluation of

peer assessment of clinical skills for first-year student nurses. Nurse Education in Practice

12: 219-226.

Sadideen, H. & Kneebone, R. 2012. Practical skills teaching in contemporary surgical

education: how can educational theory be applied to promote effective learning? The

American Journal of Surgery 204: 396-401.

Salam, A., Siraj, H.H., Mohamad, N., Das, S. & Yousuf, R. 2011. Bedside Teaching in

Undergraduate Medical Education: Issues, Strategies, and New Models for Better

Preparation of New Generation Doctors. Iran Journal of Medical Science 36(1): 1-6.

337

Sandal, S., Iannuzzi, M.C. & Knohl, S.J. 2013. Can We Make Grand Rounds “Grand” Again?

Journal of Graduate Medical Education 5(4): 560-563.

SAOA (South African Optometry Association). 2011. Submission in response to the Green:

Paper National Health Insurance in South Africa.

http://www.mm3admin.co.za/documents/docmanager/C97E4C72-D696-4E42-B491-

D49D93B964CC/00021686.pdf

Retrieved on 9 January 2016.

Savoy, A., Proctor, R.W. & Salvendy, G. 2009. Information retention from PowerPointTM and

traditional lectures. Computers & Education 58:858-867.

Schmidt, H.G., Wagener, S.L., Smeets, G.A.C.M., Keemink, L.M. & van der Molen, H.T.

2015. On the Use and Misuse of Lectures in Higher Education. Health Professions Education

1: 12-18.

Schurink, W., Fouché, C.B. & De Vos, A.S. 2011. Qualitative data analysis and interpretation.

In De Vos, A.S., Strydom, H., Fouché, C.B. & Delport, C.S.L. Research at grass roots: For

the social sciences and human service professions (4th edition). Pretoria: Van Schaik.

Schwandt, T.A. 2000. Three Epistemological stances for Qualitative Inquiry. In: Denzin,

N.K. & Lincoln, Y.S. (eds) Handbook of Qualitative Research (2nd edition). California, USA:

Sage Publications.

Schwartz, M. 2012. Best practices in experiential learning.

https://www.ryerson.ca/content/dam/lt/resources/handouts/ExperientialLearningReport.pdf

Retrieved 28 June 2018.

Sharma, N., Lau, C.S., Doherty, I. & Harbutt, D. 2015. How we flipped the medical

classroom. Medical Teacher 34(4): 327-330.

Shenton, A.K. 2004. Strategies for ensuring trustworthiness in qualitative research projects.

Education for Information 22: 63-75.

http://www.mm3admin.co.za/documents/docmanager/C97E4C72-D696-4E42-B491-D49D93B964CC/00021686.pdf

http://www.mm3admin.co.za/documents/docmanager/C97E4C72-D696-4E42-B491-D49D93B964CC/00021686.pdf

https://www.ryerson.ca/content/dam/lt/resources/handouts/ExperientialLearningReport.pdf

338

Skinner, D. 2007. Qualitative methodology: an introduction. In: Joubert, G. & Ehrlich, R.

(Eds). Epidemiology: A Research Manual for South Africa (2nd Edition). Cape Town, South

Africa: Oxford Southern Africa.

Skinner, K.L., Hyde, S.J., McPherson, K.B.A., Simpson, M.D. 2016. Improving students’

interpersonal skills through experiential small-group learning. Journal of Learning Design

9: 21-36.

Slater, L.Z., Bryant, K.D. & Ng, V. 2016. Nursing Student Perceptions of Standardized

Patient Use in Health Assessment. Clinical Simulation in Nursing 12: 368-376.

Smithson, J., Bellingan, M., Glass, B. & Mills, J. 2015. Standardized patients in pharmacy

education: An integrative literature review. Currents in Pharmacy Teaching and Learning 7:

851-863.

Sofaer, S. 2002. Qualitative research methods. International Journal for Quality in Health

Care 14(4): 329-336.

Speziale, H.J.S. & Carpenter, D.R. 2007. Qualitative research in nursing: Advancing the

Humanistic Perspective (4th edition). Philadelphia: Lippincott Williams & Wilkens.

Springer, K. 2010. Educational Research: A Contextual Approach. United States of

America:John Wiley & Sons.

Stake, R.E. 2000. Case studies. In: Denzin, N.K. & Lincoln, Y.S. (Eds). Handbook of

Qualitative Research (2nd edition). California, USA: Sage Publications.

Stella, N.G., Lingard, L. & Kennedy T.J. 2014. Qualitative research in medical education:

Methodologies and methods. In Swanwick, T. (Ed). Understanding Medical Education:

Evidence, Theory and Practice (2nd edition). Oxford: Wiley Blackwell.

Stewart, D.W., Shamdasani, P.N. & Rook, D.W. 2007. Focus Groups: Theory and Practice.

In: Applied Social Research Methods Series (2nd edition). California, USA: Sage

Publications.

339

Stieger, S., Praschinger, A., Kletter, K. & Kainberger, F. 2011. Diagnostic grand rounds: A

new teaching concept to train diagnostic reasoning. European Journal of Radiology 78: 349-

352.

Strydom H. 2002. The pilot study. In De Vos, A.S., Strydom, H., Fouche, C.B. & Delport,

C.S. (Eds.) Research at Grass Roots for the Social Sciences and Human Services Profession.

3rd Edition. Pretoria, South Africa: Van Schaik Publishers.

Strydom H. & Venter L. 2002. Sampling and sampling methods. In De Vos, A.S., Strydom,

H., Fouché, C.B. & Delport, C.S. (Eds). Research at Grass Roots for the Social Sciences and

Human Services Profession (3rd edition). Pretoria, South Africa: Van Schaik Publishers.

Talbert, R. 2015. Toward a Common Definition of ‘Flipped Learning’. The Chronical of Higher

Education, Inc. April: 14-17.

Tavakol, M. & Sandars, J. 2014. Quantitative and qualitative methods in medical education

research. AMEE Guide No 90: Part II. Medical Teacher 36: 838-848.

Taylor-Powell, E. & Renner, M. 2003. Analysing Qualitative data.

https://pdfs.semanticscholar.org/8ee4/a0c8532720200bb4359cf5a3741fac60ca74.pdf

Retrieved on 5 December 2017.

Thistlethwaite, J.E. 2015. Interprofessional Education and the Basic Sciences: Rational and

Outcomes. Anatomical Sciences Education 8: 299-304.

Thistlethwaite, J. & Moran, M. 2010. Learning outcomes for interprofessional education

(IPE): Literature review and synthesis. Journal of Interprofessional Care 24(5): 503-513.

Tofade, T., Samimi-Gharai, M. & Rodriguez de Bittner, M. 2016. Strategies to grow

experiential learning programme: The role of administrators. Currents in Pharmacy

Teaching and Learning 8: 429-436.

Tong, A., Sainsbury, P. & Craig, J. 2007. Consolidated criteria for reporting qualitative

research (COREZ): a 32-item checklist for interviews and focus groups. International Journal

for Quality in Health Care 19(6): 349-357.

https://pdfs.semanticscholar.org/8ee4/a0c8532720200bb4359cf5a3741fac60ca74.pdf

340

Toothaker, R. & Taliaferro, D. 2017. A phenomenological study of millennial students and

traditional pedagogies. Journal of Professional Nursing 33(5): 345-349.

Topping, K.J. 2009. Peer Assessment. Theory Into Practice 48(1): 20-27.

Treadwell, I., van Rooyen, M., Havenga, H. & Theron, M. 2014. The effect of an

interprofessional clinical simulation on medical students. African Journal of Health

Professions Education 6(1): 3-5.

Tsingos, C., Bosnic-Anticevich, S. & Smith, L. 2014. Reflective Practice and Its Implications

for Pharmacy Education. American Journal of Pharmaceutical Education 78(1): 1-10.

Tsingos-Lucas, C., Bosnic-Anticevich, S., Schneider, C.R. & Smith, L. 2016. The Effect of

Reflective Activities on Reflective Thinking Ability in an Undergraduate Pharmacy

Curriculum. American Journal of Pharmaceutical Education 80(4): 1-12.

UK Essays. 2018. Models of Reflective Practice for Education.

https://www.ukessays.com/essays/education/the-models-of-reflective-practice.php


UFS (University of the Free State). 2017a. Integrated Transformation Plan. Bloemfontein.

https://www.ufs.ac.za/docs/default-source/all-documents/the-ufs-integrated-transformation-

plan.pdf?sfvrsn=9752a521_0


UFS (University of the Free State). 2017b. Faculty of Health Sciences Home. Bloemfontein.

https://www.ufs.ac.za/health/faculty-of-health-sciences-home/faculty/community-based-

education

Retrieved on 5 January 2017.

UFS (University of the Free State). 2018. Department of Optometry. Bloemfontein

https://www.ufs.ac.za/health/departments-and-divisions/optometry-home

Retrieved 25 March 2018.

https://www.ukessays.com/essays/education/the-models-of-reflective-practice.php

https://www.ufs.ac.za/docs/default-source/all-documents/the-ufs-integrated-transformation-plan.pdf?sfvrsn=9752a521_0

https://www.ufs.ac.za/docs/default-source/all-documents/the-ufs-integrated-transformation-plan.pdf?sfvrsn=9752a521_0

https://www.ufs.ac.za/health/faculty-of-health-sciences-home/faculty/community-based-education

https://www.ufs.ac.za/health/faculty-of-health-sciences-home/faculty/community-based-education

https://www.ufs.ac.za/health/departments-and-divisions/optometry-home

341

UKZN (University of Kwa-Zulu Natal). 2018. Services offered by Optometrists. Durban.

http://optometry.ukzn.ac.za/Services-offered.aspx


UKZN (University of Kwa-Zulu Natal). 2019. Undergraduate courses. Durban.

https://optometry.ukzn.ac.za/undergraduatecourses/


Van der Merwe, L.J., van Zyl, G.J., Nel, M.M. & Joubert, G. 2014. How we see ‘Y’: South

African health students’ and lecturers’ perceptions of Generation Y students. African Journal

of Health Professions Education 6(1): 13-16.

Van Wyk, R. 2015. Simulation as educational strategy: an interprofessional approach at the

Faculty of Health Sciences, University of the Free State. (Unpublished M dissertation).

Bloemfontein: University of the Free State.

Vickerman, P. 2009. Student perspectives on formative peer assessment: an attempt to

deepen learning. Assessment & Evaluation in Higher Education 34(2): 221-230.

Vogel, D. & Harendza, S. 2016. Basic practical skills for teaching and learning in

undergraduate medical education: A review on methodological evidence. GMS Journal for

Medical Education 33(4): 1-19.

Vu, T.T. & Dall’Alba, G. 2007. Students’ experience of peer assessment in a professional

course. Assessment & Evaluation in Higher Education 32(5): 541-556.

Walker, R., Cooke, M., Henderson, A. & Creedy, D.K. 2013. Using a critical reflection process

to create an effective learning community in the workplace. Nurse Education Today 33:

504-511.

Walter, L., Lo, K. & Maloney, S. 2018. What impact do students have on clinical educators

and the way they practise? Advances in Health Sciences Education 23: 611-631.

Williams, K.N., Ramani, S., Fraser, B. & Orlander, J.D. 2008. Improving Bedside Teaching:

Findings from a Focus Group Study of Learners. Academic Medicine 83(3): 257-264.

http://optometry.ukzn.ac.za/Services-offered.aspx

https://optometry.ukzn.ac.za/undergraduatecourses/

342

Wolff, M., Wagner, M.J., Poznanski, S., Schiller, J. & Santen, S. 2015. Not another boring

lecture: engaging learners with active learning. The Journal of Emergency Medicine 48(1):

85-93.

World Council of Optometry (WCO).

http://www.worldoptometry.org/

Retrieved on 24 March 2016.

Wurdinger, S. & Allison, P. 2017. Faculty Perceptions and Use of Experiential Learning in

Higher Education. Journal of E-learning and Knowledge Society 13(1):27-38.

Yardley, S., Teunissen, P.W. & Dornan T. 2012. Experiential learning: AMEE Guide No.63.

Medical Teacher 34(2): 102-115.

Ziv, A. 2009. Simulators and simulation-based medical education. In Dent, J.A. & Harden

R.M. (Eds). A Practical Guide for Medical Teachers (3rd edition). London: Churchill

Livingstone, Elsevier.

http://www.worldoptometry.org/

LIST OF APPENDICES

APPENDIX A-1 QUESTIONNAIRE FOR REFLECTION

APPENDIX A-2 VRAELYS VIR REFLEKSIE

APPENDIX B-1 AGENDA AND QUESTIONS FOR FOCUS GROUP INTERVIEW

APPENDIX B-2 ETHICAL APPROVAL LETTER FOR AGENDA AND

QUESTIONS FOR FOCUS GROUP INTERVIEW

APPENDIX C TRANSLATION OF FOCUS GROUP INTERVIEW AUDIO

RECORDING

APPENDIX D HSREC APPROVAL LETTER FOR THE STUDY

APPENDIX E-1 CONSENT TO PARTICIPATE IN RESEARCH AND

INFORMATION DOCUMENT (ENGLISH)

APPENDIX E-2

TOESTEMMING TOT DEELNAME AAN NAVORSING EN

INLIGTINGSDOKUMENT (AFRIKAANS)

APPENDIX F-1 REQUEST FOR PARTICIPATION IN FOCUS GROUP AS PART

OF A RESEARCH PROJECT

APPENDIX F-2 VERSOEK OM DEELNAME IN FOKUS-GROEPONDERHOUD

AS DEEL VAN NAVORSINGSPROJEK

APPENDIX G-1 CONSENT TO PARTICIPATE IN RESEARCH: FOCUS GROUP

APPENDIX G-2 TOESTEMMING TOT DEELNAME AAN NAVORSING: FOKUS-

GROEPONDERHOUD



ON THEIR EXPERIENCE OF LECTURES



ON THEIR EXPERIENCE OF FLIP THE CLASSROOM



ON THEIR EXPERIENCE OF SMALL-GROUP LEARNING



ON THEIR EXPERIENCE OF SIMULATION



ON THEIR EXPERIENCE OF INTERPROFESSIONAL

EDUCATION



ON THEIR EXPERIENCE AS PRESENTERS OF CASE

PRESENTATION



ON THEIR EXPERIENCE ON ATTENDING CASE

PRESENTATION



ON THEIR EXPERIENCE OF PEER ASSESSMENT USED WITH

OTHER TEACHING-LEARNING METHODS



ON THEIR EXPERIENCE OF PEER ASSESSMENT USED IN

THE MODULE CLINICAL OPTOMETRY (COPT 4800)



ON THEIR EXPERIENCE OF BEDSIDE TEACHING



ON THEIR EXPERIENCE OF CLINICAL SKILLS TRAINING

APPENDIX I SESSION FACILITATION FOR PATH 4802 AND GENA 2612

LECTURE

APPENDIX J INFOGRAPHIC PRESENTED TO STUDENTS TO EXPLAIN THE

FLIP THE CLASSROOM APPROACH

APPENDIX K-1 GENA 2612 FLIP THE CLASSROOM PLANNING TEMPLATE

APPENDIX K-2 DGNS 3702 FLIP THE CLASSROOM PLANNING TEMPLATE

APPENDIX K-3 PATH 4802 FLIP THE CLASSROOM PLANNING TEMPLATE

APPENDIX L OVERVIEW OF SIMULATION SESSION

APPENDIX M OBJECTIVES OF THE APPRENTICESHIP SESSION IN

PATHOLOGY CLINIC

APPENDIX N DECLARATION FROM LANGUAGE PRACTITIONER

APPENDIX A-1

QUESTIONNAIRE FOR REFLECTION

ENGLISH

Questionnaire 1

DEPARTMENT OF OPTOMETRY HSREC 128/2016

QUESTIONNAIRE FOR REFLECTION

You have been asked to participate in a research study.

You have been informed about the study by Ms. Elzana Kempen (researcher). She will be

available throughout the completion of the questionnaire.

You have given consent to participate in this research project. Your participation in this

research is voluntary, and you will not be penalised or lose benefits if you refuse to

participate or decide to terminate participation.

The questionnaire consist of the following sections:

Section A requires biographical data.

Section B focusses on the questions for reflective practice.

Section C relates to your recommendation.

Instructions:

Please complete each question by providing a brief response / comment.

Your recommendation / opinion can be given within the comment sections.

It will take approximately 20 - 30 minutes to complete the questionnaire.

Office use only

SECTION A: BIOGRAPHICAL DATA 1-3

In the following section, biographical information is requested. Please make a cross (X) in

the appropriate box for each item, except for question 1 where you write the number.

Example

2. What is your gender? (a) Male 1

(b) Female 2 X

1. What is your age? ______Years 4

2. What is your gender? (a) Male 1 5

(b) Female 2

3. In which year are you currently

academically?

(a) Second 1 6

(b) Third 2

(c) Fourth 3

Questionnaire 2

Please indicate which teaching and learning method you’ve just completed. (The

researcher, Ms E. Kempen will inform you)

………………………………………………………………………………………………………………………………..

SECTION B: REFLECTING ON YOUR EXPERIENCE OF THE TEACHING AND

LEARNING METHOD AND ASSESSMENT

1. What were the objectives of the session in which the teaching and learning method was

used?

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

1.1. Do you feel that the teaching and learning method achieved the objectives of this

session successfully? Please elaborate?

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

2. How did you feel before, during and after this teaching and learning method /

experience? Please explain.

2.1. Before:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

…………………………………………………………………………………………..……………………….

2.2. During:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

Questionnaire 3

2.3. After:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………..

3. Based on your experience, what would you say are the strengths of this teaching and

learning method?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

4. Based on your experience, what would you say are the weaknesses of this teaching and

learning method?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

5. How do you think the teaching and learning method enhanced your learning and

understanding of the work?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

Questionnaire 4

6. What changes could you have implemented to enhance your learning experience

(positive/negative) during this teaching and learning method?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

7. How do you feel about the assessment that has been used in this teaching and learning

method? Please specify your feelings under the following headings:

7.1. Overall feelings of the assessment:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………..

7.2. Fairness of the assessment:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

7.3. Rubric / memo used during the assessment:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

7.4. Feedback provided after the assessment:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

Questionnaire 5

SECTION C: RECOMMENDATION

8. What can you recommend to enhance the teaching and learning method and the

assessment in the future?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

Thank you once again for supporting the research for my PhD degree, your time and

commitment is greatly appreciated.

APPENDIX A-2

VRAELYS VIR REFLEKSIE

AFRIKAANS

Vraelys 1

DEPARTMENTE OPTOMETRIE

HSREC 128/2016

VRAELYS VIR REFLEKSIE

U is versoek om aan ‘n navorsingstudie deel te neem.

U is oor die studie ingelig deur Me Elzana Kempen (navorser). Me Kempen sal beskikbaar

wees ten alle tye met die voltooing van die vraelys.

U het alreeds toesteming verleen tot deelname aan die navorsings projek. U deelname aan

hierdie navorsing is vrywillig, en u sal nie gepenaliseer word of voordele verbeur as u weier

om deel te neem of besluit om deelname te staak nie.

Die vraelys bestaan uit die volgende afdelings:

Afdeling A vereis biografiese data.

Afdeling B fokus op vrae op refleksie praktyk.

Afdeling C hou verband met jou aanbevelings.

Instruksies:

Voltooi asseblief elke vraag deur ‘n kort reaksie / kommentaar daarop te verskaf.

U kommentaar / opinie kan gegee word binne die kommentaar gedeelte.

Dit sal ongeveer 20 - 30 minute neem om die vraelys te voltooi.

Slegs vir kantoorgebruik AFDELING A: BIOGRAFIESE DATA 1-3

In die volgende afdeling word na biografiese data verwys. Maak asseblief ‘n kruisie (X) in

die toepaslike blokkie vir elke item, behalwe vir vraag 1 waar jy slegs ‘n nommer sal

neerskryf.

Voorbeeld

2. Wat is jou geslag? (a) Manlik 1

(b) Vroulik 2 X

1. Wat is jou ouderdom? ______Jaar 4

2. Wat is jou geslag? (a) Manlik 1 5

(b) Vroulik 2

3. In watter akademiese jaar is jy huidiglik? (a) Tweede 1 6

(b) Derde 2

(c) Vierde 3

Vraelys 2

Dui asseblief aan watter onderrig en leer metode jy tans voltooi het. (Me. E Kempen sal u

in kennis stel).

………………………………………………………………………………………………………………………………

……

AFDELING B: REFLEKSIE OP U ONDERVINDING VAN DIE ONDERRIG EN LEER

METODE EN ASSESSERING.

1. Wat was die doel van die sessie waarin die onderrig en leer metode gebruik is?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

1.1 Voel jy dat die onderrig en leer metode die doel van die sessie suksesvol bereik het?

Brei asseblief uit.

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

2. Hoe het jy gevoel voor, gedurende en na die onderrig en leer metode / ervaring.

Verduidelik asseblief.

2.1 Voor:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

2.2. Gedurende:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

Vraelys 3

2.3. Na:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………..…….

3. Gebasseer op jou ervaring, wat kan jy uitlig as die sterk punte van die onderrig en leer

metode?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

4. Gebasseer op jou ervaring, wat kan jy uitlig as die swak punte van die onderrig en leer

metode?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

5. Hoe dink jy het die onderrig en leer metode jou leer en verstaan van die werk verbeter?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

Vraelys 4

6. Is daar enige manier hoe jy jou leerervaring (positief / negatief) tydens die onderrig en

leer metode kan verander?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

7. Hoe het jy gevoel oor die assessering wat in die onderrig en leer metode gebruik is?

Spesifiseer asseblief jou gevoelens onder die volgende opskrifte:

7.1 Algemene gevoelens oor die assessering:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

7.2. Regverdigheid van die assessering:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

7.3. Rubriek / memo wat gebruik is tydens die assesering:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

7.4. Terugvoer wat verskaf is na die assessering:

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

Vraelys 5

AFDELING C: AANBEVELINGS

8. Wat kan jy aanbeveel om die onderrig en leer metode in die toekoms te verbeter?

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………

Weereens dankie dat u my navorsing vir my PhD graad geondersteun het, u tyd en

toewyding word baie gewaardeer.

APPENDIX B-1:

AGENDA AND QUESTIONS FOR FOCUS GROUP INTERVIEW

AGENDA AND QUESTIONS FOR FOCUS GROUP INTERVIEW

TITLE OF THE RESEARCH STUDY: Experiential learning in the expanded scope of the

undergraduate optometry programme at the University of the Free State.

MAIN QUESTION FOR FOCUS GROUP:

Based on your experience in the Pathology clinic this year, which factors can contribute for

the clinical experience to provide a safe learning environment where integration of

knowledge and the application of critical thinking are possible in order for you to feel

competent and confident to manage a patient according to the current scope of optometry?

A. INTRODUCTION:

NUMBER QUESTION TIME FRAME

INTRODUCTION: Introduction and explanation of the focus group

interview and the purpose of the study.

Confirm confidentiality and anonymity.

Explain procedure, eg. recording of the session

5 – 10 min

10 minutes

B. FOCUS GROUP INTERVIEW AREA 1– SPESIFIC AREAS OF INTEREST:

1 Based on your experience in the Pathology clinic, which factors can

contribute to a safe learning environment?

a. PROBE: In what why did the supervisors contribute to alleviate

or aggrevate any anxiety that will hinder your learning

process?

b. PROBE: What challenges did you encounter during your clinical

experience?

c. PROBE: Can you identity the expectations that were placed on

you?

15 minutes

2 During your clinical experience, were you able to integrate the

knowledge you have gained in your second, third and fourth year to

treat and manage your patient?

a. PROBE: What hindered your integration process?

b. PROBE: How do you think did the clinical experience enhance

your learning and understanding of the work?

c. PROBE: Do you feel that the theoretical knowledge were

presented in a way for you to apply it during clinic?

15 minutes

3 What are your thoughts on the assessment for competence in the

Pathology clinic?

a. PROBE: What were your experience and perceptions regarding

assessment process?

b. PROBE: Can you elaborate about the acceptability of the rubric

that was used to test your competencies?

15 minutes

45 minutes

C. FOCUS GROUP INTERVIEW AREA 2– SUGGESTION OF ENHANCEMENT :

4 Do you have any recommendation to enhance the clinical experience?

a. PROBE: Is there any way you could have changed (positive /

negative) this experience for you?

b. PROBE: What are the most important things that should be

addressed during pathology clinical training?

15 minutes

5 Are there any additional important points that you would like to

mention?

5 minutes

15 minutes

D. CONCLUSION

Wrap up session

Thank participants for their valuable input and time

Reaffirm confidentiality and anonymity

Way forward: Verbatim transcription send to each for confirmation,

field notes and the latter to facilitator, final analysis to facilitator and

study leaders.

5 minutes

5 minutes

END OF SESSION 75 MINUTES

Total time needed for focus group interview

75 minutes (1 hour and 15 minutes)

APPENDIX B-2:

ETHICAL APPROVAL LETTER FOR AGENDA AND QUESTIONS FOR FOCUS GROUP

INTERVIEW

APPENDIX C:

TRANSLATION OF FOCUS GROUP INTERVIEW AUDIO RECORDING

APPENDIX D:

HSREC APPROVAL LETTER FOR THE STUDY

APPENDIX E-1:

CONSENT TO PARTICIPATE IN RESEARCH AND INFORMATION DOCUMENT

(ENGLISH)

DEPARTEMENT VAN OPTOMETRIE DEPARTMENT OF OPTOMETRY

HSREC 128/2016

CONSENT TO PARTICIPATE IN RESEARCH AND INFORMATION DOCUMENT

Dear student,

I’m conducting research to develop a framework for experiential learning in the expanded

scope of the undergraduate Optometry programme at the University of the Free State. In

this study I want to investigate the views of current registered Optometry students

regarding the different teaching and learning methods, based on experiential learning, used

in the current pathology modules. Your cooperation in completing the questionnaire is

kindly requested. There is no risk involved in this study. The benefits include that the data

from this project can be used in order to apply experiential learning for the Optometry

curriculum and to enhance its efficacy for Optometry students.

Your participation in this research is voluntary, and you will not be penalised or lose benefits

if you refuse to participate or decide to terminate participation. You will remain anonymous

and your data will be treated confidentially at all times. You will not receive any

compensation for completing of the questionnaire. Your profile will remain confidential and

will be used for research purposes only. The results of this research project may be

published and/or presented at forums and congresses.

Your co-operation is greatly appreciated. Any questions about the research can be

addressed to me or the Secretariat of the Health Sciences Research Ethics Committee, UFS

at telephone number (051) 4052812, if you have questions about your rights as a research

subject.

The research study, including the above information has been verbally described to me. I

understand what my involvement in the study means and I voluntarily agree to participate.

_____________________ __________________

Signature of participant Date

Thank you in advance for your assistance.

APPENDIX E-2:

TOESTEMMING TOT DEELNAME AAN NAVORSING EN INLIGTINGSDOKUMENT

(AFRIKAANS)


HSREC 128/2016

TOESTEMMING TOT DEELNAME AAN NAVORSING EN INLIGTINGSDOKUMENT

Geagte student,

Ek is besig met navorsing om ‘n raamwerk to ontwikkel vir ‘n integreerde patologie modules

vir die uitgebreide omvang van Optometrie deur ervaringsleer. In hierdie studie wil ek die

huidige uitsigte van geregistreede Optometrie studente op die verskillende opvoedkundige

strategieë, gebaseer op ervaringsleer, in die huidige patologie leerplan, ondersoek. U

samewerking met die invul van die vraelys word vriendelik versoek. Daar is geen risiko

verbonde aan die studie nie. Die voordele sluit in dat die data uit hierdie projek gebruik

kan word om ervaringsleer toe te pas op die Optometrie kurrikulum en die effektiwiteit

daarvan kan verbeter vir Optometrie studente.

Deelname is vrywillig en u kan op enige gegewe oomblik aan die studie onttrek sonder

enige nagevolge. U sal anoniem bly en die data sal vertroulik gehanteer word ten alle tye.

Daar is geen vergoeding vir die voltooiing van die vraelys. U profiel sal vertroulik bly en sal

slegs gebruik word vir navorsing doeleindes. Die resultate van hierdie navorsingsprojek

mag gepubliseer word en / of aangebied word op forums en kongresse.

U samewerking word hoog op prys gestel. Enige vrae aangaande die navorsing mag gerig

word aan my of die Sekreteriaat van die Gesondheidswetenskappe Navorsings Etiek

kommitee, UV by telefoon nommer (051) 4052812, indien u enige vrae het oor u regte as

‘n proefpersoon.

Die navorsingstudie, insluitend die bogenoemde inligting is verbaal aan my beskryf. Ek

begryp wat my betrokkenheid by die studie beteken en ek stem vrywillig in om deel te

neem.

________________________ __________________

Handtekening van deelnemer Datum

Baie dankie, by voorbaat vir u hulp in die verband.

APPENDIX F-1:

REQUEST FOR PARTICIPATION IN FOCUS GROUP INTERVIEW AS PART OF A

RESEARCH PROJECT


24 July 2017

Dear participant,

Re. REQUEST FOR PARTICIPATION IN FOCUS GROUP INTERVIEW AS PART OF A

RESEARCH PROJECT

Project title: Experiential learning in the expanded scope of the undergraduate optometry

programme at the University of the Free State.

I am doing research to develop a framework for experiential learning in the expanded scope

of the undergraduate Optometry programme at the University of the Free State. In this

study I want to investigate the views of current registered Optometry students regarding

the different teaching and learning methods, based on experiential learning, used in the

current pathology modules. I request your participation in this research study as a member

of a panel of participants for a focus group interview.

The focus group interview is a means of gathering qualitative data that will be used in the

abovementioned study. Participants are selected because they have been identified to be

skilled in the topic under discussion or make a meaningful contribution towards it. The

focus group will be led by an interviewer skilled in group communication and will last for a

maximum of 100 - 120 minutes.

During the focus group interview, you will be asked to participate in a group environment

responding to a pre-set list of questions. The purpose is to stimulate in depth discussion

based on findings of student perceptions on teaching and learning methods as determined

from the questionnaire in order to generate data that can be used to improve the delivery

of pathology modules in the Department of Optometry. The members of the group will

consist of peers from the Department of Optometry.

There is no risk in being involved in the study. The benefits include that the data from this

project can be used in order to apply experiential learning for the Optometry curriculum

and to enhance the efficacy thereof for optometry students.

Your participation in this research is voluntary, and you will not be penalised or lose benefits

if you refuse to participate or decide to terminate participation. Every effort will be made to

keep personal information confidential, and the data will be used for research purposes

only. For example, you will be allocated a number during the discussion that will be used

to identify your input, so your name will not be mentioned in the study results, and to ensure

that all information is treated with strict confidentiality. Only the researcher will have access

to the names and corresponding numbers of the participants of the focus group. Absolute

confidentiality cannot, however, be guaranteed, as personal information may be disclosed

if required by law. This will be for the sole purpose of quality assurance and data analysis.

The results of this research project may be published and/or presented at forums and

congresses.

The focus group interviews are scheduled for the following dates and times.

Monday 31 July 2017; 14h00 – 16h00

Monday 7 August 2017; 14h00 – 16h00

Please note that the study has been approved by the Health Sciences Research Ethics

Committee, UFS (HSREC 128/2016). Should you be willing to participate, a consent form

will be made available to you. I sincerely hope that you will favourably consider my request.

Please contact me should you have any queries in this regard.

Thank you very much for your attention.

Yours sincerely,

Elzana Kempen

Contact details: Ms E Kempen

Telephone: (051) 405 2692

Email: [email protected]

Contact details: Promoter: Dr M.J. Labuschagne

Telephone: (051) 405 2072


Contact details: Co-promoter: Dr M.P. Jama

Telephone: (051) 401 7771


Contact details: Secretariat (Health Sciences Research Ethics Committee)

Telephone: (051) 405 2812

mailto:[email protected]


APPENDIX F-2:

VERSOEK OM DEELNAME IN FOKUS-GROEPONDERHOUD AS DEEL VAN

NAVORSINGSPROJEK


24 Julie 2017

Geagte deelnemer,

Re. VERSOEK OM DEELNAME IN FOKUS-GROEPONDERHOUD AS DEEL VAN

NAVORSINGSPROJEK

Studie titel: Experiential learning in the expanded scope of the undergraduate optometry

programme at the University of the Free State.

Ek is besig met navorsing om ‘n raamwerk to ontwikkel vir ‘n integreerde patologie leerplan

vir die uitgebreide omvang van optometrie deur ervaringsleer. In hierdie studie wil ek die

uitsigte van huidige geregistreede optometrie studente op die verskillende opvoedkundige

strategieë, gebaseer op ervaringsleer, in die huidige patologie leerplan, ondersoek. U

deelname in hierdie navorsingstudie as ‘n lid van ‘n paneel deelnemers vir ‘n fokus-

groeponderhoud word versoek.

Die fokus-groeponderhoud is ‘n metode om kwalitatiewe data in te samel wat gebuik sal

word in bogenoemde studie. Lede word geselekteer omdat daar geïndentifiseer is dat hulle

vaardighede het wat verband hou met die onderwerp onder bespreking of omdat hulle ‘n

betekenisvolle bydrae daartoe mag lewer. Die fokus-grouponderhoud sal gelei word deur

‘n onderhoudvoerder wat vaardig is in groepkommunikasie, en sal duur vir ‘n maksimum

van 100 - 120 minute.

Gedurende die onderhoud sal u gevra word om deel te neem in ‘n groep-omgewing met

reaksies van ‘n vooraf bepaalde lys vrae. Die doel is om in diepte bespreking te stimuleer

wat gebaseer is op studente se persepsies oor die verskillende opvoedkundige strategieë,

soos bepaal in die vraelys. Die data wat genereer gaan word kan gebruik word om die

lewering van die patologie modules te verbeter in die Department van Optometrie. Die lede

van die group sal ook uit ander studente van die Departement van Optometrie bestaan.

Daar is geen risiko verbonde aan u betrokkenheid by die studie nie. Die voordele sluit in

dat die data uit hierdie projek gebruik kan word om ervaringsleer toe te pas op die

Optometrie kurrikulum en die effektiwiteit daarvan te kan verbeter vir Optometrie studente.

U deelname is vrywillig en anoniem en u kan op enige gegewe oomblik aan die studie

onttrek sonder enige nagevolge. U persoonlike inligting sal sover moontlik vertroulik gehou

word, en die data sal slegs vir navorsingdoeleindes gebruik word. U sal byvoorbeeld tydens

die bespreking ‘n nommer ontvang wat gebruik sal word om u insette te identifiseer, sodat

u naam nie genoem sal word in die studieresultate nie, en om te verseker dat alle inligting

met streng vertoulikheid hanteer sal word . Slegs die navorser sal toegang hê tot die name

en ooreenkomstige nommers van die deelnemers aan die fokus-groeponderhoud. Algehele

vertroulikheid kan egter nie gewaarborg word nie, omdat persoonlike inligting bekend

gemaak mag word indien die wet dit vereis. Dit sal alleenlik vir die doel van

gehalteversekering of data-analise wees. Die resultate van hierdie navorsingsprojek mag

gepubliseer word en / of aangebied word op forums en kongresse.

Let asseblief daarop dat die studie deur die Gesondheidswetenskappe Navorsings

Etiekkommitee (HSREC 128/2016) goedgekeur is. Sou u gewillig wees om deel te neem,

sal ‘n toestemmingsbrief aan u voorsien word. Ek vertrou opreg dat u my versoek gunstig

sal oorweeg. Kontak my gerus sou u enige verdere navrae in hierdie verband hê.

Baie dankie vir u aandag.

Elzana Kempen

Kontak besonderhede: Ms E Kempen

Telefoon: (051) 405 2692

E-pos: [email protected]

Kontak besonderhede: Promotor: Dr M.J. Labuschagne

Telefoon: (051) 405 2072


Kontak besonderhede Co-promotor: Dr M.P. Jama

Telefoon: (051) 401 7771


Kontak besonderhede: Sekretariaat (Gesondheidswetenskappe Navorsings

Etiekkommitee)

Telefoon: (051) 405 2812




APPENDIX G-1:

CONSENT TO PARTICIPATE IN RESEARCH: FOCUS GROUP INTERVIEW


CONSENT TO PARTICIPATE IN RESEARCH: FOCUS GROUP INTERVIEW

You have been asked to participate in a research study, as a member of a focus group.

The title of the research is:

EXPERIENTIAL LEARNING IN THE EXPANDED SCOPE OF THE UNDERGRADUATE

OPTOMETRY PROGRAMME AT THE UNIVERSITY OF THE FREE STATE.

You may contact Ms E Kempen at telephone (051) 405 2692 or [email protected] or the

promoter, Dr M.J. Labuschagne at telephone (051) 405 2072, or co-promoter, Dr M.P. Jama

(051) 401 7771 at any time if you have questions about the research. You may contact the

Secretariat of the Health Sciences Research Ethics Committee, UFS at telephone number

(051) 4052812 if you have questions about your rights as a research subject.

Your participation is voluntary, and you will not be penalised or lose benefits if you refuse

to participate or decide to terminate participation.

To be completed if you are going to particpate:

I have been informed by the study by Ms E Kempen. The date and time for the focus group

is scheduled for 31 July 2017 / 7 August 2017 at 14h00 at the Simulation unit of the School

of Medicine.

The research study, including the above information has been described to me. I

understand what my involvement in the study means and I voluntarily agree to participate

in the focus group.

Full names: ___________________________________

Signature of participant: ___________________________________

Date: ___________________________________

Contact number: ___________________________________

E-mail address: ___________________________________


APPENDIX G-2:

TOESTEMMING TOT DEELNAME AAN NAVORSING: FOKUSGROEP ONDERHOUD


TOESTEMMING TOT DEELNAME AAN NAVORSING: FOKUSGROEP ONDERHOUD

U is versoek om aan ‘n navorsingstudie deel te neem, as ‘n lid van ‘n fokusgroep.

Die titel van die navorsingstudie is:

EXPERIENTIAL LEARNING IN THE EXPANDED SCOPE OF THE UNDERGRADUATE

OPTOMETRY PROGRAMME AT THE UNIVERSITY OF THE FREE STATE.

U mag Me E Kempen by telefoonnommer (051) 405 2692 of [email protected] of die

promotor, Dr M.J. Labuschagne by telefoonnommer (051) 405 2072, of mede-promotor, Dr

M.P. Jama, by telefoonnommer (051) 401 7771, te enige tyd kontak indien u navrae het

oor die navorsing. U mag die Sekretariaat van die Gesondheids-wetenskappe Navorsings

Etiekkommitee, UV by telefoon nommer (051) 4052812 kontak indien u enige vrae het oor

u regte as proefpersoon.

U deelname aan hierdie navorsing is vrywillig, en u sal nie gepenaliseer word of voordele

verbeur as u weier om deel te neem of besluit om deelname te staak nie

Vul asseblief in indien u gaan deelneem:

Ek is deur Ms E Kempen oor die studie ingelig. Die datum en tyd vir die fokus-

grouponderhoud is geskeduleer vir 31 Julie / 7 Augustus 2018 by die Simulasie eenheid van

die Skool van Geneeskunde

Die navorsingstudie, insluitend bogenoemde inligting, is aan my beskryf. Ek begryp wat my

betrokkenheid by die studie beteken en ek stem vrywillig in om deel te neem aan die fokus-

groeponderhoud

Volle name: ___________________________________

Handtekening van deelnemer: ___________________________________

Datum: ___________________________________

Kontaknommer: ___________________________________

E-posadres: ___________________________________


APPENDIX H-1

OVERVIEW OF THE THEMES, CATEGORIES AND SUBCATEGORY OF THE

EXPERIENCES AND PERCEPTIONS OF OPTOMETRY STUDENTS ON LECTURES

Overview of the themes, categories and subcategory of the experiences and perceptions of

optometry students on lectures

THEMES: CATEGORIES AND SUBCATEGORIES

Second years Fourth years

1. Objective Purpose of a lecture

Delivering of work [P12, P20]

Present work [P7, P19] To explain work [P1,

P15, P17] To inform [P2] To learn [P3] To teach [P8] To know [P10] To remember [P11]

Creation of a better

understanding of the work [P6, P9, P13, P16]

Testing of knowledge [P5,

P7, P14, P18, P20]

Purpose of a lecture

Present work [P13] To explain work [P1, P4,

P8, P9] Provide information [P1,

P5] Build knowledge [P2,

P14, P15] To introduce material

[P8] To learn [P2, P4, P6,

P11, P12] To study [P9]

Creation of a better understanding [P12, P16,

P17]

Provision of an opportunity to ask questions [P1, P3]

Provides a channel of communication [P3]

Testing of knowledge [P5,

P9]

2. Objectives

successfully

achieved.

Moderately [P11, P13]

Only created an understanding when material were studied for test [P13]

Yes

Could ask questions when unsure [P13]

Good explanation of work [P3, P16, P17]

Knowledge and understanding was tested [P4, P5, P18]

Forced to learn [P20]

Yes

Created a base of knowledge [P11, P17]

Created an understanding [P4, P16]

Explained clearly [P10] Information were well

presented [P5, P6, P7] Could ask questions

when unsure [P3]

3. Feelings (i) Before

Positive

Anxious (Excited) [P2] At ease [P3] Calm [P13, P15] Comfortable [P20] Content [P4] Good [P14] Positive [P10] Prepared [P4, P5, P19]

Positive

At ease [P16] Calm [P14] Comfortable [P2] Intrigued [P9] Excited [P4]

Neutral [P7, P8, P16, P18] Neutral [P1, P5, P6, P8, P12]

Normal [P10] No specific feelings [P3,

P7, P11, P13]



Negative

Anxious [P9] Not in the mood [P1] Sceptical [P12] Unfamiliar [P11] Unprepared [P15, P17] Unsure [P6]

Negative

Not in the mood [P17]

3. Feelings (ii) During

Positive

Attentive [P1, P6, P8, P9, P12, P16, P17]

Calm [P9] Challenged [P5] Comfortable [P18] Engaged [P16] Good [P14] Informed [P11, P19] Involved [20] Motivated [P7] Positive [P10]

Positive

Interested [P1, P2, P5, P6, P9, P11, P14, P15]

Comfortable [P4] Enjoyment [P3] Enlightened [P16] Intrigued [P7] Satisfied [P10] Insightful [P11] Informed [P7, P17]

Neutral [P3] Neutral [P12, P17]

Negative

Bored [P13] Difficult to pay attention

[P1] Disappointed [P4] Lost [P15] Lost interest [P12] Tired [P2]

Negative

Bored [P11, P13]

3. Feelings

(iii) After

Positive

Informed [P2, P3, P6, P8, P11, P12, P13, P14, P15, P17, P18]

Curious [P19] Motivated [P4] Relieved [P9]

Positive

Informed [P1, P2, P3, P4, P7, P9, P10, P12, P14, P15, P16, P17]

At ease [P3] Confident [P2, P7] Satisfied [P5]

Neutral [P16] Neutral [P1]

Negative

Not informed [P13] 4. Strengths The assessment force you to

go and study on your own [P4, P5, P8, P9, P12, P13,

P14, P20]

Work are explained [P13, P15, P16, P17]

Able to make notes during

the lecture [P19]

Uncertainties are cleared up during the lecture [P20]

Provide an opportunity to ask

questions and receive

answers [P14, P16, P18] Provides a good foundation

[P13] Channel for communication

[P7]

The assessment force you to

go and study on your own [P6]

Work are personally

explained [P16]

Additional information are provided [P7]

Provide an opportunity to

ask questions and receive answers [P1, P2, P4, P13,

P16]

Provide basic knowledge

[P3, P12]

Provides a channel of communication to the

lecturer [P3]



5. Weaknesses Loss of attention and

concentration [P1, P2, P10,

P12, P13, P16, P18] Not interested [P7] Not interactive [P8] Not exiting [P15] No association [P10] Read from slides [P11,

P13] Becomes boring [P1,

P3, P12]

Information overload [P14]

Loss of attention and

concentration [P13]

Too familiar [P1, P16, P17]

Too long [P3] Not interactive [P5] Not interested [P16]

Not a real life example [P2]

6. Factors that

enhanced learning Confronted with work more

than once [P12]

Created an awareness of

knowledge [P4, P5]

Created an understanding of the work [P9, P13, P14,

P15]

Familiar method [P7]

Force to study for test [P8, P20]

Own responsibility [P7]

Created a base of

knowledge [P3, P6, P10,

P18]

Lecturer explained the work [P1, P6, P16, P17]

‘through examples, illustrations and videos’ [P1]

By paying attention in class

[P2, P11, P18, P19]

Assessment provide an opportunity to go through

work [P2, P4, P6, P16, P17]

Provided an understanding of work before studying [P3,

P4]

Introduction to work [P8, P11]

Done over a period of time

[P10]

Good explanation of the

work was provided [P1, P13, P15]

Layout of information

Simple layout [P5] Comprehensive [P7] Were together [P1]

The lecture was:

Practical [P9, P12] Interesting [P6] Visual [P2, P14]

Provide an opportunity for

questions [P3]

7. Personal changes Pay more attention [P1,

P15]

Prepare more [P5] Think of questions [P19]

Ask more questions [P16,

P17]

Pay more attention [P6]

8. Feelings on the

assessment (i) Overall feelings

Positive [P10, P14]

Good [P5, P13] Fairly good [P6,

P19] Necessary[P9] Fair [P8, P12]

Reasonable [P2] Satisfied [P15] Reasonable [P20]

Helpful [P1, P3, P18] Informed [P7] Challenged [P5] Motivating [P5]

Well planned and presented [P11, P17]

Positive

Good [P11, P15] Eliminate

uncertainty [P4] Good idea [P3] Helpful [P13]

Keep up to date [P2, P6]

Indicate important work [P16]

Type of questions Fair [P10, P17] Well set [P9] On work that was

discussed [P10] Good questions

[P14 Neutral [P16] Neutral [P1, P12]



Negative

Disappointed [P4] Negative

Not motivated [P5] Type of questions

Overwhelmed [P7] Wrong focus [P8]

8. Feelings on the assessment

(ii) Fairness

Positive

Very fair [P11, P12, P19]

Fair [P1, P3, P7, P8, P10, P14, P15, P16, P17, P18, P20]

Fair enough [P4, P5] Good [P2, P13]

Positive

Very fair [P9 Fair [P6, P8, P12, P13,

P14, P17] Better idea of what

to expect [P5] Everyone has the

same assessment [P2]

On standard [P11] Questions based on

work discussed [P3, P4, P7]

Set memo [P16] Tested your

knowledge Variety of work

asked [P1, P10] Good [P15]

Negative

Outcomes should be adapted / matched [P6, P9]

8. Feelings on the

assessment

(iii) Memo used

Positive

Not strict [P1] Appropriate [P9] Fair [P3, P4, P5, P6, P8,

P10, P16] Good [P20] No problems [P7] On standard [P12] Peers marking [P17] Sufficient [P2, P14, P15] To the point [P18] Well-defined guidelines

[P11]

Positive

Adaptable [P2, 13] Complete [P3, P6, P8] Comprehensive [P15] Comprehensive and

understandable [P17] Correct mark allocation

[P1, P4, P13, P14] Fair [P5, P7, P10, P12,

P16] Good [P11] Straight forward [P9]

Negative

Peers marking [P16] Not complete [P13]


(iv) Feedback

Positive

Adequate [P17] Clarified concepts [P18] Excellent [P4] Fair [P8] Good [P2, P5, P6, P15] Helpful [P1] Positive [P10] Provided insight in short

comings [P12] Sufficient [P9, P14]

Positive

Ensured better understanding [P1]

Clear memo discussion [P10]

Comprehensive [P5] Good [P3, P9, P11, P12,

P14, P15] Helpful [P4] Learn from mistakes

[P2]

Neutral [P16]

Negative

Minimal [P7] None [P13]

Negative

None [P7, P8, P13, P16, P17]



9. Recommendations Lecturer:

Provide explanations of certain terms [P16, P17]

Provide examples [P1, P15]

Ask questions during the lecture [P2, P9, P10, P16]

Encourage students to prepare for class [P17, P19]

Make the slides available before the class [P11]

Lecture presentation:

More interactive [P1, P8, P13, P18]

More lively [P13] More visual [P1, P4, P10,

P12, P13] Provide a summary at

the end of the lecture [P11]

Assessment:

Inform students about assessment [P18]

Outcomes should be specified [P6, P9]

For the lecture presentation:

More practical [P2 More interactive [P1, P5,

P13, P17] More visual material [P3,

P4, P5, P14]

For lecturer:

Provide more regular breaks [P11, P17]

Have a revision slide show [P12]

Make the slides available before the class [P5, P7]

Assessment:

Pictures should be enlarged [P3, P7]

APPENDIX H-2


PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS PERCEPTIONS

ON FLIP THE CLASSROOM

Overview of the themes, categories and subcategory of the perceptions and experiences of optometry students perceptions on flip the classroom


Second years Third years Fourth years

1. Objective Having a flip the classroom

approach [P2, P6, P12, P14, P20]

To prepare for class at home [P3, P4, P7, P9, P11, P15, P16, P19] Study independently

[P4] To do group work in class

[P1, P5, P11, P12, P19] Summarise work as a mind

map [P10] Review work practically

[P13] To present a mind-map [P4,

P5, P8, P12, P15, P17, P18]

Having a flip the classroom approach

[P5, P6, P8, P14]

To prepare before the practical [P3, P16, P17, P27]

Efficient practical application of technique [P4, P7, P10, P12, P24, P25, P27, P29, P31]

Having peer assessments [P2, P14, P16, P18, P19, P21, P22, P23, P28, P31] Preparation for formal

assessments [P1, P3, P11, P13, P17, P26, P29, P30]

Reduce anxiety [P20] Identify challenges [P28]

Having a flip the classroom approach

[P1, P5, P7, P11, P12, P14, P16]

To motivate students to work through material at home [P9]

Provide a platform to share knowledge obtain at home [P2, P10]

To teach and explain the content to fellow class mates [P6]

To do a case presentation [P13] Creation of an understanding of a topic

[P3, P4, P6, P8, P13]

2. Objectives

successfully achieved.

Moderate [P13]

More or less [P2] Somewhat [P1] Yes and no [P3]

Moderate

More or less [P2] Still need guidance [P16, P25]

No

Struggle to remember online lectures [P10]

Yes

Forced to prepare for class [P6, P9, P16] Responsible for own

learning [P4]

With the use of the presentation [P10] Visual presentation [P8] Each group had a

different approach [P5]

Yes

Had to come to practical prepared [P9] Good explanations by the

articles and video [P5, P15] Had to do online test [P6]

Observed and doing techniques (applying knowledge) [P4, P5]

Peer assessments [P15, P28, P30] Learn from each other’s

mistakes [P7, P21] Provided clarification

Yes

Challenging and effective [P5] Could ask question in a safe

environment [P2] Created discussions [P8] Creation of a case [P4] Different teaching and learning

method [P3, P12, P13] Enjoyable [P13] Interactive [P16] Online lectures [P5, P6] Through doing self- research [P11] Went through work more than once

[P12]


o On expectation [P11, P31]

o On procedure [P13] o On what to work on

[P22, P23, P26, P28] Practical learning method [P10,

P27] 3. Feelings

(i) Before

Positive

Confident [P10] Excited

Working with others [P5] Interested

New experience [P11] Need to prepare [P12] Pleased

Working with others [P13]

Ready Felt prepared[P3]

Positive

Confident Felt prepared [P7]

Excited [P13] Actively involved in learning

[P19] Felt prepared [P13]

Prepared [P5] Relaxed [P2, P29]

Learn on own time [P20]

Positive

Curious [P3 Excited [P4 Interested [P2 Looked forward

Study on own time [P8

Mixed ‘Excited, but a little

sceptical’ [P15]

Mixed

Stressed, but calm / motivated [P3, P10]

Anxious, but prepared [P8] Scared, but relieved [P13] Scared, but excited [P15] Uncertain, but calm [P17] Nervous, but calm [P24]

Negative

Anxious [P18] Negative [P16] Nervous

o Did not know what to expect [P1, P7]

o Working with others [P14]

Stressed o Did not know what to

expect [P7]

Negative

Anxious [P4] Supervisor present [P12,

P28] Not prepared [P30] Assessment feeling [P6, P9,

P31] Nervous [P1]

Not know what to expect [P14]

Negative

Afraid Self-study [P1]

Anxious Public speaking [P15]

Nervous Expectation [P2]

Not motivated [P11] Postponed [P10]

Self-study [P10] Scared


Not excited o Public speaking [P8]

Not in the mood [P9] Not too eager

o Working with others [P4]

Overwhelmed [P20] Sceptical [P6, P19] Unsure

o Did not know what to expect [P2, P17]

Assessment feeling [P16, P21]

Stressed [P18, P25] Not know what to expect

[P11] Tense [P22]

Assessment feeling [P23] Not know what to expect

[P26, P27] Worried [P25]

Public speaking [P15] Sceptical

Benefit [P6] Online lecture [P16]

Suspicious Benefit Online lecture explanation

[P12] Unnecessary [P14] Unsure [P1, P13, P15]

Different learning method [P7]

Benefit [P3, P5, P9] Self-study [P9] Expectation [P5]

3. Feelings

(ii) During Positive

Enjoyment Interaction [P4]

Excitement Creative [P17]

Fun [P11] Good

Hear different views [P12]

Helped [P9] Informed [P14] Interested

Different views [P8] Relaxed [P1] Worked well [P15]

Positive

Calm [P4, P25] Knew the work [P5, P30] Supervisor helpful [P24]

Comfortable [P9, P22] Less tense [P26] Positive stress

Motivated [P10] Relaxed

Comfortable environment [P6]

Assessment did not count marks [P6]

Knew what is expected [P8] Supervisor helpful [P12, P16] Supervisor comfortable [P17] Could ask questions [P6,

P17, P20]

Positive

Enjoyment Different learning method

[P1] Working with others [P1] Learning on own time [P3,

P16] Excited

Working with others [P13] Interested

Online videos [P12] At ease

Working with others [P2] Convenient

Learning on own time [P15] Positive learning experience [P4,

P5]

Mixed [P5] Mixed

Anxious, but calm Supervisor present

Nervous, but relaxed [P1]

Mixed [P6]


Stressful, but comfortable Supervisor helpful [P3]

Stressful, but relaxed [P18]

Negative

Anxious Presenting [P10]

Frustrated Online videos [P2] Working with others

[P13] Lost

Did not understand concepts [P3]

Nervous Different teaching and

learning method [P7] Presenting [P16]

Tired [P18] Stressed [P19] Uncertain

Expectation [P6]

Negative Struggled [P21] Limited time [P23]

Anxious Assessment feeling [P27] Fear of failing [P28] Not prepared [P29] Under pressure [P7]

Confused [P31] Scared

Limited time [P15] Stressed [P2]

Supervisor present [P14] Under pressure

Not prepared [P11]

Negative

Confused Expectation [P7]

Frustrated Online videos [P14]

Nervous Public speaking [P2]

Not motivated [P9]] Scared

Public speaking [P15] Could not concentrate

Learning on own [P11]

3. Feelings

(iii) After

Positive [P20]

Encouraged [P12] Calmer [P16] Happy [P19]

Builds confidence [P1] Impressed

Not a boring lecture [P11]

Informed [P3, P6, P8, P9, P14, P18] Presentations [P3]

More at ease Have an understanding

of the work [P2] Pressured [P15]

Positive

Learned from the experience [P3, P6, P9, P15]

Identified areas to work on [P6, P7, P26]

Interaction with supervisor [P14]

Accomplished [P10] Calm

Identified areas to work on [P4, P22]

Competent Know what is expected [P24]

Determined Supervisor helpful [P28]

Positive

Relieved Feedback [P7]

Positive [P4] Working with others P15] Online videos and class test

[P2] Reflection [P8]

Good learning experience [P6] Working with others [P11]

Appreciative Online videos [P10]

Satisfied Online videos [P12]

Amazed


Relieved [P7, P9, P10]

Good Reflected back on experience

[P27] Identified areas to work on

[P5] Informed

Know what is expected [P17] Positive anxiety

Identified areas to work on [P11]

Relaxed [P18 Learned from the experience

[P1, P8] Identified areas to work on

[P20, P31] Relieved [P13, P30]

Learned from the experience [P12, P16]

Identified areas to work on [P29]

More prepared [P25] Satisfied [P19]

Created an understanding [P1]

Satisfied Presentation [P12] Created an understanding

[P12, P13] Successful

Presentation [P3] Benefitted [P16] Competent [P14]

Neutral [P4]

Negative

Disappointed [P23] Could not complete the

assessment [P21] Stressed

Expectation [P2]

Neutral [P9]

Negative

Boring [P5] Disappointed [P13, P17] Regret [P10]

Negative

Public speaking [P15] Prefer a lecture [P5]

4. Strengths It forces you to go through the

work by yourself [P3, P6, P9,

P10, P15, P17]

Working on your own time and pace [P2, P4]

Working with others [P1, P4, P5,

P7, P7, P11]

There is a task to be completed [P16]

Visual presentation [P2, P8]

It forces you to go and prepare before the practical [P4, P5, P6, P8, P11, P14,

P28, P31]

Online resources helpful [P16, P22]

Done at own time [P8, P16] Not using time that can be used to

practice [P15] Having a peer assessment

It forces you to go through the work by yourself [P9, P11]

Having the online videos [P5, P10] It is convenient [P7, P16] Could be repeated and played

back [P2, P7, P13] Short and to the point [P6] Visual [P3]


Creates a discussion [P4] Provides confidence [P7,

P11] Provides the opportunity

to listen to other groups [P13]

Elaboration on topics [P18] The way the work was

organised (mindmap) [P13] Lecturer available [P14]

Fun, creative and practical way

of learning [P17, P19]

Repetition of work [P12, P20]

Knowledge can be tested [P14]

Helps with identifying weaknesses [P1, P2, P6, P11, P23, P31]

Preparation for formal assessments [P6, P8, P17, P21, P24, P25]

Learn from peers [P7, P18, P22, P28]

Exposes student to assessment circumstances [P11, P12, P19]

Does not count marks [P13, P29] Safe learning environment [P29]

There is interaction and help from lecturer [P3, P5, P13, P16, P19, P28]

The feedback improves skills [P10,

P14

The reflection

Helps with identifying weaknesses [P26]

Provided a safe and comfortable environment [P27]

Well informed and knew what is

expected [P3]

Rubric was provided beforehand [P26]

Adequate time to practice the

technique [P3, P30]

Active learning experience [P10]

‘You don’t even realise that you are busy to learn, it is very spontaneous.’ [P19]

Different way of presenting [P12]

Study by yourself [P1]

Working with others [P1, P4, P8, P9, P11, P12, P13, P15]

The case presentation

Forced you to understand the work [P1]

Practical application [P4, P9, P13] Preparation for future [P8]

Having a peer assessment [P3, P10]

Done over a period of time [P12]

Creative [P6]


5. Weaknesses Working together with others

[P4, P5, P10, P11, P14]

No discussion from lecturer [P3, P7, P20]

Have to prepare [P15]

A lot of work to do at home

[P12]

Have to have internet access [P2]

Not sure what to expect [P6]

Peer assessment [P1]

Presentations:

Presentations are repetitive and can get boring [P16, P17, P19]

Presentations can create confusion [P13]

Only visual [P8] Skills required are not

relevant for course [P9]

Limited time [P4]

Articles are too long and not relevant

[P16, P22, P24]

Peer assessment:

Puts you under pressure [P7] Causes anxiety [P23, P26, P27,

P29] Insufficient time [P12, P13, P15] Are not taken seriously [P4, P20] Too comfortable with peers [P19] Uncertainty about procedures

[P2] Supervisor not always present when

practicing or doing assessment [P4,

P16, P21, P22, P24, P25]

There is no lecture [P14, P18]

Requires self-discipline from the student [P5, P15]

It is a very time consuming

experience [P8, P10, P28, P31]

Not enough practise time [P3, P30]

Working together with others [P10,

P11]

Finding time [P3, P7, P8] Some avoid working [P6, P12]

Must have self-discipline [P10, P12]

Technology:

Not always reliable [P2, P14] Had to use own data [P16]

Time consuming [P1, P3, P4, P9, P12]

Online lecture

Prefer a class lecture [P5 ] Still unsure about work [P9] Lecturer not personally available

[P15] Public speaking [P15]

6. Factors that enhanced learning

Working in a group [P15, P18]

By creating a mindmap

Express knowledge [P1 Summarise content [P3 Logical way [P14 Practical way of learning

[P12, P17]

Had to go through the work [P3, P3, P6, P7, P9]

Responsibility of learning [P4,

P16]

Visual presentation [P2, P8]

Pressured to work [P10]

Repetition of work [P19, P20]

Different learning method [P5]

By being forced to prepare for the

practical [P6, P9, P20, P24]

Did the procedure self with guidance and feedback from supervisor [P12,

P13, P15]

Having a peer assessment [P17, P27, P31]

Help peers [P1 ] Identified weaknesses [P2, P7,

P21, P23, P26, P29] One-on-one learning [P6] Confirm knowledge of skills [P11] Getting feedback [P16]

Practical application [P22]

Practice/learning with peers [P3,

P19]

Done over a period of time [P12

The preparation before class [P1,

P12

Informal comfortable learning environment [P11

Learning at own pace [P2

Online videos [P5]

Short and focused [P6 By presenting and seeing a case

Application of knowledge [P4 Learning from peers [P2, P6, P8 Helped with integration [P9, P13 Learned from mistakes [P10

Repetition of work in different ways

[P3, P4


The videos used were insightful [P3,

P14, P16]

Observation [P4] Study on own time [P8]

Spend more time on the module [P9]

Reflecting on the work [P5]

Different learning method [P11, P15,

P16]

7. Personal changes Ask more questions [P3]

Change attitude [P7, P16]

Go through presentation before presenting [P10]

Pay more attention [15, P19]

Detailed planning [P10]

Prepare [P15, P16]

Spend more time [P9]

Ask a lecturer to observe technique and questions [P2, P10, P17, P21,

P25]

Get comfortable with equipment [P23, P28, P29]

Control emotions better [P26, P27]

Practice more [P16]

Prepare better [P8, P9, P10, P20,

P29]

Control emotions better [P15]

Take more notes [P8]

Find time to work together on the case presentation [P2, P10]


(i) Overall feelings

Positive [P6, P14, P20]

Creative [P8] Comfortable

Know the rubric better [P7]

Good [P10] Appropriate [P18] Content [P1] Enjoyment [P11] Fair [P15] Interested [P12] Productive [P13]

Positive [P1, P15, P22, P24] Clarify procedures and

expectations [P13] Calm learning environment

[P19] Helped [P27] Identified weaknesses [P11] Learned about time

management [P30] Useful [P12]

Excited Practical way of learning

[P14] Informative [P8]

Good [P16, P20] Get to know the rubric [P6] Improves skills [P7] Best interest of the student

[P9] Relaxed environment [P17] Preparation for formal

assessment [P26, P31]

Positive Broaden knowledge [P4, P7,

P8, P16] Enjoyable / Fun

Knowledge were applied [P12, P14]

Fair [P9] Good

Forced to understand [P1] Were not alone [P2] Forced to pay attention [P5] Use different method [P6] Got familiar with the rubric

[P11, P13] Identify weaknesses [P3, P13]

Neutral [P4, P5] Negative

Not excited

Peer assessment [P10

Triggered anxiety [P15


Happy

Effective teaching and learning method [P4]

Helpful [P28] Learned a lot [P3]

Needed Good preparation [P23]

Relaxed [P29] Satisfied [P10]

Mixed [P17, P19] Mixed

Stressed, but learned a lot [P2]

Anxious, but positive experience [P5

Negative

Not everyone works well in a group [P2]

Not everyone is comfortable speaking in front of people [P2, P9]

Lost [P3] Not accurate [P16]

Negative

Uncomfortable to be assessed by

peer [P25


(ii) Fairness

Positive

Fair [P7, P8, P9, P13, P14, P17, P18]

Positive

Fair [P1, P3, P4, P7, P8, P9, P13, P14, P24, P25, P28, P29] Assessment conditions [P11] Consistent [P6] Cannot chose who is

assessing you [P19] Informed in advance [P26] Everyone is assessed on the

rubric [P23, P30, P31] Everyone gets the same

amount of time [P19, P27, P30, P31]

No discrimination [P10] No pressure [P5] Peers [P16, P20]

Positive

Fair [P1, P6, P10, P13] Group assessment [P2, P15,

P16] Peer assessment [P3, P4,

P7, P8, P11, P14] Same rubric [P12]


Moderate [P1, P4, P11, P12] Negative

Not a true reflection [P9 Negative

Not fair [P3, P20] Peer assessment [P10,

P15] Public speaking [P16]

Negative

Not fair

Assessed by peers [P2 Lecturer does not help [P21

9. Feelings on the

assessment

(iii) Memo used

Positive

Applicable [P14] Appropriate [P18] Clear [P4, P7] Complete [P6, P20] Concise [P4, P11] Detailed [P9] Fair [P10, P12] Good [P1, P16] Helpful [P19] Standard [P2] Sufficient [P3] User friendly [P11] Well laid out [P6, P7, P17]

Positive

Clear [P8] Compiled well [P1, P12, P23,

P25] Complete [P18] Correct and effective [P31] Descriptive [P8] Easy to follow [P16] Objective [P28] Good [P2, P7, P17, P27]

Available before assessment [P9, P10]

Explain what is expected [P6, P13]

Fair rating criteria [P15] Helpful

Know what is expected [P3, P20, P21]

Provide additional insight into procedures [P4]

Sufficient [P24, P29] Understandable [P8, P30] Focus your attention [P26]

Positive

Adequate [P8, P9] Clear [P12, P14] Comprehensive [P4, P15] Fair [P5] Good

Well understood [P10] Same rubric as Case

presentation [P3, P6] Sufficient

Same rubric as Case presentation [P11]

Summarised [P13] User friendly [P4] Well-Constructed [P2]

Negative

Confusing [P5] Not complete [P15] Not specific [P13] Subjective [P8, P10]

Negative

Not specific [P14 Not accurate [P11

Negative

Has grey areas [P7]



(iv) Feedback

Positive

Good [P3, P12, P17, P19] Effective [P4] Adequate [P18]

Positive

Clear [P19 Good

Became more calm [P2] More at ease [P4] Complete [P17] Helped to talk to lecturer

[P28] To the point [P13, P18]

Happy Small group provides safe

environment to share [P27] Helpful [P1, P9, P12, P16, P25]

Opportunity to raise difficulty More at ease [P5] Informative [P3] Individual growth [P7] Provide different

perspectives [P13, P20, P23] With reflection [P26]

Learn from others Group discussion [P11]

Lecturer listened [P14, P30] Satisfied [P10] Sensitive and personal [P31] Sufficient

Address uncertainties [P8]

Positive

Adequate [P9] Constructive [P2, P13] Comprehensive [P4, P5, P13,

P15] Good [P3, P10]

Identified weaknesses [P7] Help with future

presentations [P8] In-depth [P12] Informative [P9] Sufficient [P14, P16] Useful [P5]

Negative

None [P2, P5, P8, P14, P16, P20]

Bad [P1]

Negative

Not too fond to share feelings [P21]

Negative

Not complete [P1]


11. Recommendations Lecture must provide a brief

presentation with explanations of concepts [P11, P15, P16,

P20]

Activity

Students should be informed about the details of the activity and assessment [P1, P2, P13] Provide extra

information [P3] Specify expectations

[P6] Provide more time to do the

activity [P4, P16] Remove peer assessment

[P1] Activity should not be done in

groups [P9] Different topic per group [P5,

P16] Groups to work together [P4] Rubric should be more

objective [P10] Add more visual content [P8] Provide feedback [P14]

Should not be used as primary teaching method [P4]

Learning material should not be

posted on Blackboard [P2]

Apply this teaching and learning

method more often [P1, P7, P10, P30, P31]

Have more examiners to provide different opinions [P10]

Have more peer assessments [P13, P14]

The technique should be demonstrated by the lecturer [P2]

Lecturer should have one-one-one

sessions with students [P12]

There should be more interaction with lecturer [P13, P25]

Lecturer should be present all the time [P21]

Lecturer should do the assessment and not peers [P13, P15]

Feedback sessions should be done in

all practical sessions [P5, P14, P16, P21, P27]

Provide more time for the assessment

[P18, P21]

Online video’s and tutorials should be

Made by own lecturers [P14] Be more specific and concise

[P16] Make more use of videos

[P22, P29] Should be less [P25]

Inform students about what to expect

Questions may be asked [P2

The class activity should be:

Different [P7] More diverse [P13] More interactive [P6] Should have been given before-

hand [P4] Information on the activity should be

given in written format. [P7]

The lecture should have a class

lecture [P1, P5, P9, P13]

Ensure technology works [P2 P14]

There should be an opportunity to ask questions [P15]

Involve the whole class in questions

after the feedback [P9]

Provide feedback

To be implemented more [P8, P16]

APPENDIX H-3:


PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS ON SMALL-

GROUP LEARNING

Overview of the themes, categories and subcategory of the perceptions and experiences of

optometry students perceptions on small-group learning


1. Objective To work in a group on an assignment [P8, P14, P15, P16, P20]

To preform research / study a disease [P1, P2, P3, P9, P11, P13, P16, P17, P19]

Create a poster [P1, P2, P3, P18] Have peer assessment [P6, P7] Individually present the poster [P1, P2, P3, P5, P4, P7, P10,

P11, P12, P13, P16, P17, P19, P20] 2. Objectives


Yes [P5, P8, P9, P11, P13, P14, P16, P18, P20]

Worked together as a group [P3, P6, P15, P17, P19] Individual learning [P2] Presentation

Individual [P4, P7] Interesting way [P10] Understandable [P12]

No Work were divided [P1]


Positive Enthusiastic [P12] Excited

Presentation [P4] Good [P9]

Presentation [P5] Optimistic

Working with peers [P19]

Negative [P3]

Discouraged [P16] Not enthusiastic [P2] Sceptical [P14] Nervous [P17]

Presentation [P4, P6, P13, P14, P20] Stressed [P10]

Did not know what to expect [P11] Uncertain [P1, P8]

3. Feelings

(ii) During

Positive

No complications [P2] Enjoyment [P15] Fun [P19] At ease [P17] Calm [P10] Good [P9] Positive [20] Prepared [P7] Relaxed [P5, P6, P8]

Neutral [P3]

Negative

Work not divided equally [P18] Boring [P4] Confused [P1] Frustrated [P16] Nervous [P13]

Not prepared [P14] Under pressure

Presentation [P11]



3. Feelings

(iii) After

Positive [P1]

Good [P16] Improved knowledge [P9]

Effective Peer assessment [P5]

Happy [P6, P13, P19] Informed [P12] Not stressed

Everyone contributed [P15] Relieved [P4, P10, P11, P14, P17, P20] Satisfied [P3, P8] Successful

Multiple efforts [P2] Creative way of learning [P7]

4. Strengths The fact that it was group work

Decreases workload [P3] Different viewpoints [P11] Encourages teamwork [P6] Getting to know your peers [P3, P18] Time effective [P3] Interactive [P4] Working together [P8, P14, P15, P17, P19, P20]

Giving and listening to presentations [P2, P10]

Individual presenting [P4] Relaxed conditions [P5] Teaching others [P7] Developed communication ability [P10] Prepares for public speaking [P14, P19] Made the work more understandable [P12]

To do research [P1, P8, P13, P16]

Good topics

Stayed interested [P2] Focussing on one disease only [P11]

Lecturer available [P9]

Enough time [P9]

5. Weaknesses Group work [P18]

Not everyone in the group works on the same standard [P3, P15, P17, P19]

Poor communication between group members [P1, P3] Presentations

Too long [P2, P11] Too much information to take in [P10, P11] No organised structure [P4] Not paying attention [P5] Not everyone is interested [P20] Lecturer moved in between presentations [P4] Marks get affected if someone in the group is

uncomfortable with public speaking [P13, P14]

Only gained knowledge about one disease [P16]

6. Factors that

enhanced learning

It is a creative teaching and learning method [P4]

Working together in a group [P3, P18]

By doing the actual research [P8, P9, P10, P11, P12, P13, P15,

P16, P19]

Helped to became familiar with the work [P14]

There was elaboration on the content [P11]

By doing peer-evaluation [P2]



The presentations provided an overview of other diseases [P3, P6]

By having individual presentations of the posters [P5, P7, P8,

P16, P17]

The fact that it was small groups [P11]

7. Personal changes Pay more attention [P10]

To be better prepared [P10]


i. Overall feelings

Positive Relaxed environment [P5] Peers understand the conditions [P7]

Content [P6] Fun [P20] Fair [P18, P19] Good [P4, P9, P11, P17]

Good method of learning / learning experience [P8, P12]

A lot of assessors [P16] Interested [P2, P10] Pleasant [P15] Satisfied [P3] Successful [P13]

Negative

Still do not understand [P1] Public speaking [P14

8. Feelings on the

assessment ii. Fairness

Fair [P2, P4, P5, P6, P11, P12, P14, P15, P18, P19]

Everyone had a chance to present [P8] Same opportunity [P20]

Semi-Fair [P3, P7]

Not everyone is good with presenting [P13] Not Fair

‘...we always give each other good marks.’ [P16]


iii. Memo used

Positive

Appropriate [P7] Comprehensive [P19] Fair [P6, P7, P12, P15, P18] Good [P2, P3, P4, P9, P11] Sufficient [P8, P10] Understandable [P15, P16] Well thought out [P14, P16]

Negative

Sections overlap [P5] Not specific [P16] Vague and ambiguous [P3]

8. Feelings on the

assessment iv. Feedback

Good [P8, P11, P15, P20]

9. Recommendations The expectation should be clear [P16]

Chose group members self [P9]

Should be able to listen to all questions from the different groups [P8]

The experience should not involve a presentation [P3

Have more time for presentations [P11]

The lecturer should discuss the diseases before presentations

[P12]

APPENDIX H-4:


PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS PERCEPTIONS

ON SIMULATION


optometry students perceptions on simulation


1. Objective To improve communication skills [P1, P2, P3, P6, P7, P8, P9, P10,

P11, P12, P13, P16] To improve skills on being an health advocate [P1, P2, P3, P5, P6,

P9, P10, P12, P13, P14]

To simulate a real situation [P3, P4, P15, P17]

Practice professional conduct [P7, P8] Approach to a patient [P4] Independency [P17]

To build confidence [P7]

2. Objectives successfully

achieved.

Yes [P2, P11, P12, P13, P16] Real life situation [P1, P3, P4, P5, P7, P9, P14, P15] Out of comfort zone [P4] Illustrated professional conduct [P6, P8, P17] Provided confidence [P7]

3. Feelings

(i) Before

Negative

Anxious About expectation [P13]

Confused [P16] Not sure what to expect [P11]

Nervous [P4] Not sure what to expect [P1, P7, P14, P15, P17]

Scared [P10] Not sure what to expect [P12]

Stressed New experience [P3] Not sure what to expect [P8]

Unsure [P4, P6, P9, P10, P9, P11, P13] Not sure what to expect [P2, P5]

3. Feelings

(ii) During

Positive

Comfortable [P7] Confident [P2, P5, P9, P11, P15, P17] Enjoyment [P16] Excitement [P8] In control

Have the knowledge to handle the situation [P3, P6] Professional [P13, P17]

Reassured Have the knowledge to handle the situation [P1]

Relaxed [P14

Neutral [P4]

Negative

Out of character [P10] Stressed [P8] Uncertainty

New experience [P12]



3. Feelings

(iii) After

Positive

Better prepared [P12] Calm [P9] Confident [P1] Good learning opportunity [P2, P8]

Reflection [P15] Grateful [P13] Happiness [P4, P6] Informative [P3, P10, P11] Impressed [P3] More at ease [P12, P16] Readiness [P17] Reassured [P14] Relieved [P5] Satisfied [P3, P6, P7] Surety [P13]

4. Strengths Real / Realistic / Authentic experience [P1, P3, P4, P5, P6, P9, P10, P11, P12

The people involved are well trained Consistent [P3] Friendly [P6]

Appropriate to the profession [P3, P11] Provide the student with confidence [P2, P4, P8]

It is done in a safe learning environment

Not counting marks [P6, P10]

Improve communication skills [P2, P10]

Demonstrates how to advocate for yourself and the patient [P2, P7]

Promotes integration [P1]

Practical experience [P6]

5. Weaknesses Preparation of students were not sufficient [P1, P12, P15, P117

There can be discrepancies in terms of the situation due to the simulated patients [P5, P13, P14

6. Factors that

enhanced learning Provided an opportunity to improve communication [P1, P9,

P12, P14]

Provided confidence [P4, P6, P11]

Opportunity to learn from other's experience [P6]

Demonstrated how to manage a patient effectively [P5, P16]

Indicated professionalism [P1, P5]

By providing a practical applicable real-life experience [P2, P7,

P8, P9, P13, P17]

Performed in a safe learning environment [P3]

7. Personal changes Ask more questions [P17]

Have more confidence [P15]

Be more involved [P12]

Be more open towards patients [P14]

Be more persistent [P10]

Pay more attention to mistakes [P8]

8. Recommendations Apply simulations to the whole curriculum [P4, P9, P14]

With different scenarios [P1, P7, P15] With different simulated patients [P2, P1] Apply more frequently [P3] Varying degree of difficulty [P4] Session should correspond with the theory schedule [P6]

Individual feedback from the simulated patients must be

provided [P4, P5, P7, P16]



Provide students with more information before simulation [P4, P10, P12, P17]

Simulated patients should:

Be trained to understand their exact role [P5] Ask more questions on the disease for the student to

explain [P7] Students should be able to take notes with them to the scenario

[P13]

APPENDIX H-5:


PERCEPTIONS AND EXPERIENCES OF OPTOMETRY ON INTERPROFESSIONAL

EDUCATION


1. Objective To introduce and prepare the students for collaborative practice [P3,

P4, P12, P13]

Work together with other health professionals [P1, P6, P7, P10, P11, P14, P15, P17] Understand each other’s role [P9, P10]

Develop a management and treatment plan [P2] Promote patient-centred care [P5, P8, P13, P16]

2. Objectives


Yes [P7, P17]

Informed of different roles [P1, P3, P13, P15] Working with different professionals [P6, P10] Contact time with other professionals [P12]

Yes and no

Not a real-life setting [P8] Only the sessions with simulation [P9]

No [P4, P16]

Only theoretical, no implementation [P2] Too much students [P5] No structure [P5] Goal wasn’t clear [P11]


Positive

Curiosity [P7] Excitement [P1, P4, P8]

Negative

Confused [P6] Nervousness

Not knowing what to expect [P15] Not motivated

Time consuming [P9] Sceptical [P5] Uncertainty

About expectation [P2, P3, P5, P10, P11, P13, P14] Goals were not clear [P12]

3. Feelings

(ii) During

Positive [P10]

Build friendships [P1] Calm and informed [P15] Comfortable and relaxed [P13] Educated [P17] Enjoyment [P3, P5, P6, P8] Excitement [P9] Informed [P1, P3] Interested [P8, P11, P12]

Negative

Anxiety A lot of people [P16]

Broken confidence [P12] Confused [P2] Frustration [P5] Irritated [P9, P16]

Waste of time [P7, P9, P11, P14] 3. Feelings

(iii) After

Positive

Better understanding [P4, P17] Competent [P13] Educated [P10] Enjoyment [P8] Humbled [P9]



Informed [P1, P2, P6, P15]

Negative

Not applicable [P3, P11, P12, P16] Disappointed [P4] Glad it is over [P5, P6, P7, P9, P12] Time consuming [P7, P12, P14]

4. Strengths Creates the opportunity to work and learn from and about other

professions [P5, P8, P10, P11, P12, P13, P15, P16, P17]

Work as a team [P3, P7, P10] Work with different people [P4] Teaches holistic patient management [P14]

Practical application of theory explained [P1, P2, P6, P7]

Having a simulated patient to interact [P8, P9, P13]

5. Weaknesses Large group of people [P8, P16]

Not everyone comfortable with speaking in such a large group [P3]

Made communication with patient difficult [P6] Objectives weren't clear and no guidelines were provided [P11]

Not fully explained [P1] Did not know what is expected [P1, P6]

Group facilitator not communicating [P12] The goal was too big [P16]

Not all the professions had the same involvement in the case

study [P5, P14, P15]

Not a real-life environment [P8]

Time consuming process [P4, P7, P12]

Repetitive [P9, P13] Not applicable

Not going to Trompsburg [P2, P17] 6. Factors that

enhanced learning By working in a group [P7, P8, P10, P15]

Interaction with other health professions [P1, P2, P3, P5, P6, P13, P17]

The learning method was applied practically [P9, P10, P11]

7. Personal changes Pay more attention [P13]

Prepare more on the patient’s condition [P10]

8. Recommendations Bigger space for 1st and last session [P8]

Reduce the sessions [P7, P9, P11, P14, P15]

Illustrate IPE in a real-life setting [P8]

Instead of these sessions, a rotation could be set up. [P12]

Lecturer from each profession should provide a summary of the profession [P10]

Provide better explanations on what is expected from the

students at each session [P1, P5, P6, P16]

Facilitators: Should be uniform [P5] Should know what is expected from them [P5, P12]

Less improvisational work and more guideline work [P11]

Simulation sessions

Use drama students [P3] More simulation session [P4] Simulated patients should give constructive feedback [P12]

Smaller groups [P13, P16]

Students that go to Trompsburg must do these sessions [P1, P2]

APPENDIX H-6:


PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS AS PRESENTERS

AT CASE PRESENTATION


optometry students as presenters at case presentation


1. Objective To present a clinical case to peers [P1, P2, P3, P4, P5, P9, P11,

P12, P17

All students to learn [P4, P5, P7] Grow in presenting skills [P7, P11] Learn from mistakes [P12]

- To reflect back on a clinical case [P10, P14, P15, P16]

- To analyse the tests performed on a patient [P12]

- To do research relevant to a clinical case seen [P3, P5, P12] Learn more on relevant topic [P5, P7] Broaden your knowledge [P6, P13]

- To be provided with advice from peers and lectures on a specific case [P3]


achieved.

Yes [P1, P4, P12, P15, P17] - Created a better understanding [P10] - Could answer questions [P9] - Forced to do research on a specific condition [P6, P7]

Research was interesting [P10] - Stimulated thinking [P11] - Time to reflect [P14] - Learned new things [P2, P5] - Learn from mistakes [P3] - Grow in self-confidence [P7] - Opportunity to go through a case thoroughly [P16]

Yes and no

- No opportunity to ask questions [P13] 3. Feelings

(i) Before Positive

- Enjoyment Research [P14]

- Excitement [P9]

Mixed

- Nervousness and enjoyment [P16] - Pressed for time and excitement [P6]

Negative

- Stressed [P1, P2, P3, P12] Presenting to the whole Department [P1, P4, P10, P11] Unsure about questions [P3, P17]

- Nervous [P13, P15] Public speaking [P5, P7]

- Scared Public speaking [P8]

3. Feelings

(ii) During

Positive [P16]

- Calm [P10] - Confident [P8, P15]

Worked hard [P6] - Satisfied [P9] - Enjoyment [P7]

Mixed

- Nervous, but confident [P1] - Calm, but stressed [P2] - Nervousness and enjoyment [P17]

Neutral [P4]

Negative

- Stressed Public speaking [P3, P11, P12]

- Nervous Public speaking [P5, P14]

- Scared [P13]



3. Feelings

(iii) After

Positive [P15]

Informative [P7, P9, P11] Enhance integration [P12]

- Enlightened [P5] - Happy [P17] - Relieved [P1, P2, P3, P4, P8, P10, P14, P17] - Satisfied [P6]

Negative - Drained [P13]

4. Strengths Learning from your own and other’s mistakes [P4, P11, P12, P13]

Reflecting back on a clinical case [P16]

Learning from other student’s cases [P7, P9, P17] - Presenting most interesting cases [P2, P8] - Different approaches [P11]

Doing research [P14, P17]

- Improves knowledge [P3, P6, P7, P10] Motivation to do a thorough eye examination [P1, P6, P17]

Builds self-confidence [P7, P16]

Create interaction with other people [P10]

Provides information [P15]

Force you to think on your feet [P13]

Improves clinical skills [P10]

5. Weaknesses Presenting to a large audience can be: - stressful [P3, P4] - humiliating [P4] - uncomfortable and unpleasant [P13]

Students and lectures come in late and are disturbing [P6, P14, P15, P16]

Some questions put the student on the spot [P8]

Remarks from supervisors inappropriate [P6]

- Criticism can make students feel exposed [P11, P12] Time consuming process [P1]

Younger years of student might not understand [P5]

6. Factors that

enhanced learning Research enhance knowledge and understanding [P3, P5, P7,

P10, P13, P15, P17]

The experience stimulate the thinking process [P4, P6, P7, P8,

P9, P11]

Mistakes are highlighted [P1]

Advice given after the presentation [P6]

Expose to new cases [P2, P8]

Time to reflect [P14]

Study in-depth [P16]

7. Personal changes Ask help from peers [P13] Improve on mistakes [P14] Stress less [P2]


i. Overall

feelings

Positive Good learning platform [P3, P5] Aids in self-growth [P7, P14] Identify areas to improve [P9]

Fair [P10, P11, P17] Can obtain good grades [P1] Purposeful [P6] Sufficient [P15]

Useful [P13] Negative

- Stressful [P2, P4] - Scared [P8]



8. Feelings on the


Fair [P2, P3, P5, P8, P9, P10, P11, P13, P14, P15, P16, P17]

Peer and lecturer assessment [P3, P7] Rubric provided [P4

Dependable [P1] Assessors for the day [P1 Personal preference [P6


iii. Memo used

Positive

Fair [P2, P3, P4, P5, P8, P13, P17] Comprehensive [P9, P14, P16] Easy to understand [P15] Familiar [P7] Good [P11] Well set out [P6, P16]

o Know what is expected [P1] Negative

Unfamiliar [P10] 8. Feelings on the

assessment

iv. Feedback

Positive - Enriching [P3] - Informative [P4, P14] - Helpful [P4, P5] - Relevant [P2] - Sufficient [P6, P9, P11]

Negative

- Harsh [P13] - Must be more specific [P7]

9. Recommendations A safe learning environment should be created [P11]

Feedback before the case presentation from the supervisor involved should be implemented. [P3, P4, P5, P10, P12]

A constructive feedback session should done after everyone

presented. [P1, P10, P11, P13]

Limit the amount of questions asked after the presentation [P1]

The door should be locked [P6]

The cases should be made available to all the students [P9]

More information should be provided on the expectation [P13]

Provide more time to do research [P5]

APPENDIX H-7:

OVERVIEW OF THE THEMES, CATEGORIES AND SUBCATEGORY ON THE

PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS ON ATTENDING

CASE PRESENTATION

Overview of the themes, categories and subcategory of the perceptions and experiences of optometry students on attending case presentation


Second years Third years Fourth years

1. Objective To learn from a case that was seen

in clinic and presented [P1, P2, P3, P4, P5, P7, P8, P11, P12, P13, P15,

P17, P18, P19] Learn from other’s mistakes

[P9, P14] Improve clinical skills [P16]

Improve patient care [P6]

Different approaches [P8]

To learn from fellow student’s clinical

cases and experiences that is shared and discussed [P20, P22, P23, P24, P25, P27,

P28, P29, P30, P31, P32, P33, P35, P36, P37, P38, P39, P40, P41, P42, P43, P44,

P46, P47, P48, P50]

Learn from mistakes made by other students [P24, P27, P35, P44, P47, P49, P50, P51]

Improve clinical skills [P21, P22, P34, P40]

Learn more about pathology [P26, P27]

To learn from fellow student’s clinical

cases and experiences that is shared and discussed [P52, P53, P54, P55, P56, P57,

P58, P59, P60, P61, P63, P64, P65, P66, P67]

- Learn from clinical mistakes [P53, P59, P62]

- Build knowledge on pathology [P62]


achieved.

Yes - Different and interesting

cases are presented [P5, P15] Preparation for clinic

[P1, P9, P14, P19] Introduction to new

knowledge [P3, P8, P10, P11]

Creates an understanding [P6]

- Learn from mistakes [P12, P13, P16]

- Well-presented Good explanations [P4,

P7] Discussed properly

[P18]

Yes

Exposes you to different type of patients and interesting cases [P20, P22, P25, P29, P34, P36, P42, P44, P45] o Approach to clinical cases

[P40] o Learn something new every

week [P33, P43, P48, P51]

o Stimulates critical thinking

[P38]

o It is educational [P35, P38] Learn from mistakes [P21, P23,

P24, P27, P30, P50] Learn from other’s experiences

[P20, P30, P32] o Improve clinical techniques

[P41] o Received clinical pearls [P28,

P37]

Comments made from lecturers [P22]

Yes [P52, P55, P62, P67]

Expose you to rare interesting cases [P54] o Informative [P60, P63]

o Preparation for similar

clinical situations [P58]

o Learn something new every

week [P56, P64]

Learn from mistakes [P53, P65

P66]

Build confidence for public speaking [P57]


o Advice received [P39]

Different teaching and learning method [P26]

Well-presented [P46]

Sometimes

- Depending on quality of presentation [P2]

Partially

Difficult to concentrate on Friday morning [P47]

Have to pay attention [P49]

No

- Does not understand what is presented [P17]

No

Feedback are demoralising [P36] No [P61]

Stressful and critical vibe [P59]

3. Feelings

(i) Before

Positive

Good teaching method [P16]

Eager To listen [P8]

Excited [P2, P6] Learning new

information [P3, P4, P19]

Interested How to record clinical

information [[P5] Knew what to expect [P11] Relaxed [P1]

Positive

Calm [P27] Curious P30] Eager [P35, P50] Excited [P21, P26]

Learning new information [P42]

Interested [P48] Looked forward

To explanations [P43]

Positive

Excited [P64] Relaxed [P66]

Good learning opportunity [P53]

Neutral [P47]

No expectations [P28]

Like a normal class [P33]

Mixed

Nervous and excited [P31] Mixed

Hard to wake up, enjoy time with other year groups [P63]


Negative Irritated and intimidated

Presenters have a lot of knowledge [P10]

Not happy Early in the morning

[P9, P14] Not in the mood [P15] Tired [P13, P17, P18]

Early in the morning [P12]

Negative Early in the morning [P36,

P44, P49] Annoyed

o Early in the morning [P22] Confused [P23] Did not look forward [P38] Nervous [P32] Not in the mood [P25]

o Early in the morning [P34] Not useful [P20, P29] Stressed [P51] Tired [P40]

o Early in the morning [P24, P37, P41, P45]

Uninformed [P46] Unsure [P39]

Negative Confused

In second year [P54] Nervous [P67] Not in the mood [P61] Not looking forward

Early in the morning [P62] Not motivated [P55] Stressed [P57, P59] Tired

Early in the morning [P56, P58, P60]

Unsure If there will be something

interesting [P52] In second year about terms

[P65]

3. Feelings

(ii) During

Positive

Attentive o Good learning

experience [P19] Good [P8] Informed [P16] Interested [P3, P10, P11,

P13, P15, P18] o Especially the research

[P5] o Fascinating cases [P9]

Intrigued [P6] Relaxed [P1]

Positive

Captured [P31] Engaged [P26, P37] Enjoyment [P21, P36]

Educational [P38] Excited [P26]

Learning something new [P22, P50]

Insightful Can improve yourself [P25]

Interactive [P44] Interested [P29, P30, P35, P39,

P43, P48, P49] New knowledge [P24, P34] Paid attention [P27]

Intrigued [P42] Interesting learning

experience [P20] Informed [P46] Observing [P45]

Positive

Confident [P67] Informed [P63] Interested [P54, P55, P58, P65]

Expands knowledge [P53] Unique cases [P64]

Relaxed [P66] Thinking [P52]


Relaxed [P32] Better understanding

Explanations of techniques [P23]

Mixed Sometimes captivated,

sometimes bored. [P2] Interested, difficult paying

attention [P14]

Mixed

Sometimes interesting, sometimes bored [P41] Depending on presenter

[P40] Depending on tiredness

[P47]

Mixed

Case not useful, research is [P56]

Not knowing what audience is thinking [P57]

Sometimes interesting, sometimes bored [P62]

Negative

Bored and confused [P17 Not attentive [P12

Negative

Bored [P33] Non-interested cases [P28]

Stressed [P51]

Negative

Bored [P60] Irritated

Stressing about clinic afterwards [P61]

Nervous [P59] 3. Feelings

(iii) After

Positive

Good [P8] Informed [P4, P19]

Had better knowledge [P1, P3]

Patient relationships [P6]

Learn something new [P9]

Know what is expected [P11]

Intrigued [P15] Motivated

Improve own techniques [P6]

Relaxed [P17] Relieved [P19]

Not presenting yet [P16]

Positive [P44]

Confident More knowledgeable [P20]

Created interaction [P38] Educated [P45] Enlightened

Prepared for clinic [P40] Excited [P31] Fulfilled

Good interactive teaching method [P22]

Glad Informed [P34]

Happy [P32, P51] Informed [P23, P35, P43, P49]

Learned a lot [P21, P29] Prepared for clinic [P30] Valid learning experience

[P37] Inspired

Positive

Educated o Interaction with peers [P53]

Enriched o Form own opinions [P54]

Informed o Different approach [P52] o Improve in clinic [P55, P65] o More knowledge [P63] o Learned from peers [P67]

Relaxed [P66] Relieved

o Learned a lot [P57, P62] Satisfied [P64]


Knowledgeable [P26, P46, P48, P50]

More prepared for clinic [P42] Motivated

Not to repeat mistakes [P24] Satisfied [P25, P31, P41] Useful learning experience [P39]

Neutral Normal class [P33]

Mixed

Excited, but stressed [P10]

Mixed

Informed and nervous [P27]

Negative

Confused [P12] Overwhelmed [P2] Tired [P13]

Negative

Did not learn [P28] ‘It is cruel’ [P47] Scared and upset [P36]

Negative

Relieved it is over [P59, P60, P61] Sympathetic

o Towards presenters [P58] 4. Strengths Different cases and research are

presented [P8, P17]

Interesting [P4] Just three presentations

[P15] Cases from a real

experience [P1, P3, P10] Visual teaching and learning

method [P5]

Improve clinical skills [P6,

P16]

Learning takes place:

learning from peers [P2, P14, P18]

from other's mistakes and experiences [P9, P10, P12, P13] Practical teaching and

learning method [P13]

A variety of different cases are

presented [P20, P25, P29, P33, P50]

Most interesting cases [P38, P41, P44, P45, P48, P49]

Visual teaching and learning

method [P24]

Stimulates critical thinking and self-reflection [P35, P38, P40, P47] Identify strengths and

weaknesses [P27] Learning takes place:

from peers [P23, P24, P34, P37, P44, P47]

from other's and your own mistakes [P21, P23, P28, P30, P35, P36, P40, P45, P49, P51] Good learning platform to

prepare students for the future [P42, P44, P50]

Provides exposure to unusual eye

conditions [P63, P65, P66]

Stimulates clinical and analytical thinking [P52, P54, P64] Identify knowledge expected

[P56] With the presentation of different

cases the following skills can be learned:

Patient management [P59] Communication skills [P57]

Learning takes place:

from peers [P53, P60, P61, P62, P65] get to know the students in

the Department [P62] from other's and your own

mistakes [P53, P55, P60, P62, P63]


Good learning platform

to prepare students for

the future [P7, P11]

Questions provides insights

[P19]

from the questions and feedback from the group and lecturers [P22, P33, P39]

from the research [P40, P43, P45]

Learning can take place at own

pace [P26]

Creates a responsibility to diligent in

clinic [P39]

Builds self-confidence [P40]

Managing a patient [P23] Public speaking [P22, P32]

Personal development through

preparing for the case [P31, P32, P39, P46]

Good learning platform to prepare students for the

future [P67]

Creates a responsibility to be diligent in clinic [P58]

5. Weaknesses Not done in a safe learning

environment o Feedback are sometimes

destructive [P2, P13] o Mistakes are only pointed

out and not explained [P6, P13, P16]

Theory has not been discussed with second and third years [P9,

P10, P12, P14, P17]

It is dependable on o the type of case [P3, P18] o manner of presentation [P5,

P15] Session can get too long [P14,

P19]

There is only a limited number

of presentations [P4] Not a own experience [P11]

Not done in a safe learning

environment - Feedback is sometimes

destructive [P30, P36, P39, P45, P51]

- Difficult questions are asked [P27, P35]

- The manner in which the questions are asked is negative [P27, P28, P33, P40]

- The experience is very

intimidating [P32]

- Only gets judged on one case

[P41]

- No specific feedback are

provided [P50]

Theory has not been discussed with

second and third years [P23, P38]

It is dependable on the type of case

[P42, P48]

Not done in a safe learning

environment - Feel exposed [P58] - The manner in which the

questions are asked is negative [P55]

- Feedback is sometimes destructive [P59]

- Marks depend on evaluators present [P62]

Theory has not been discussed with

second and third years [P62, P65] It is dependable on:

- the type of case [P52] - manner of presentation [P54] - research topic [P60]

Can get too long and boring [P53, P62, P66] - There is a lot of repetition [P56]

Involves public speaking [P57]


- Research not always correlates to the case [P30]

Can get too long and boring [P24,

P31, P33, P34, P39, P47] - Ease to loose concentration

[P20, P25, P34, P37, P43, P49] Large group of students make it

uncomfortable [P21, P22] That it is early on a Friday morning

[P26, P47]

Nobody follows up on what was

discussed [P64]


Exposure to different cases [P5,

P19]

Indicated correct procedures [P8]

Practical teaching and learning method [P9, P13]

Preparation for the future

[P3, P11, P14]

Learning from mistakes [P12]

The cases were well discussed [P4]

In depth information provided [P1]

The research that was

presented created a better understanding [P5]

Motivated to do own research [P6, P7, P17]

Can associate with work

Experienced it through actions of another student [P2]

The discussions and questions

afterwards were insightful [18]

Exposure to different cases [P20,

P22, P25]

Indicated techniques and procedures to enhances clinical skills and patient

management [P30, P33, P35, P38, P39, P40, P41, P43, P44, P45, P46,

P47, P48, P49]

Practical teaching and learning

method [P24, P34, P42]

Learn from peers and their and own

mistakes [P21, P23, P26, P32, P35,

P37, P50]

Each case provides new information

[P26, P28, P31, P35]

Learn about ocular conditions [P33, P36, P39, P46, P49]

In depth information provided

[P51]

The research presented created a

better understanding [P32, P50]

Questions afterwards provided better insight [P24, P27]

Based on a real life experience [P29]

Indicated clinical techniques that

should be performed in certain cases

[P53, P54, P60, P61, P62, P66]

Helped with own cases seen in

clinic

Learn from peers and from their and

own mistakes and experiences [P52,

P54, P63, P65]

Each case provides new information [P53, P62, P63]

In depth information provided

[P62]

Research that has been done

[P57]

Provides an opportunity to analyse a

case [P51, P64]

Identify own knowledge [P52]

Helps to keep up to date [P56]

7. Personal changes None [P1, P3, P6, P16]

Pay more attention [P5, P8]

None [P26, P29, P46]

Pay more attention [P20, P43]

None [P54, P67]


Get up earlier [P20]

Take more notes [P31, P39, P45]

Pay more attention [P57, P60, P61,

P66]

Be more rested [P66]

Take notes [P53]

8. Feelings on the

assessment (i) Overall

feelings

Positive [P1, P10]

Fair [P16] Happy and eager to learn

[P13] Good [P9, P11, P12, P19]

Details of assessment were provided [P4]

Improved knowledge [P5]

Comprehensive [P3]

Positive [P34]

Fair [P24, P49] Comprehensive [P37] Good [P20]

Enjoyable [P21] Good way to learn [P23,

P30, P33, P42] Learn from fellow classmates

[P26] Insightful [P24] Interactive [P40] Helpful [P36] Motivating [35] Necessary [P29, P39] Thorough [P20] Useful [P39] Well thought and planned [P22]

Positive [P67]

Improved skills [P64]

Fair [P57, P58] Good way to learn [P52] Being assessed by lecturers

and peers [P53] Objective [P54]

Good [P59] Comprehensive [P66]

Mixed

Intimidating, but useful and motivating [P8]

Fair, but can get boring [P17]

Mixed

Builds confidence, but stressful [P27]

Positive, but frustrating [P32] Nerve wrecking, but let you think

on your feet [P46] Questions are harsh, but have a

good purpose [P48] Neutral [P50]

Negative [P18]

Extreme [P2] Stressful

Being on the spot [P6] Sympathetic]

Questions are offensive [P15]

Negative Involves public speaking

[P28, P51] Unnecessary difficult

questions [P31, P44] Unnecessary harsh

comments [P38]

Negative

Stressful [P56]


Unfair Public speaking [P14]

Cruel [P47] Nervous [P25, P41, P45]


(ii) Fairness

Positive

Fair [P1, P4, P5, P6, P8, P9, P15, P17] o Assessed by a few

lecturers [P3] Good [P10, P11, P16, P18,

P19]

Positive

Fair [P20, P21, P22, P23, P25, P26, P31, P32, P33, P40, P42, P44, P48, P49] Same rubric for everyone

[P29] Enough preparation time

[P37] More than one lecturer

assess [P39] Everybody can ask questions

[P46, P50]

Positive

Fair [P58, P66, P67] Comprehensive [P53] Rubric used [P55] More than one lecturer

assess [P57] Feedback provided [P64]

Good [P54, P59]

Dependable

o Not everyone comfortable with public speaking [P28]

Feedback depends on supervisors present [P30, P36]

Difficulty of case presented [P38]

Negative

Some cases are more difficult than others [P52]

Not same amount of assessors [P56]

Negative

Unfair [P12] Not everyone

comfortable with public speaking [P14]

Unsure Not being assessed [P2,

P13]

Negative

Not fair [P27, P34, P35]

Students presenting first will have more mistakes [P24]

Under pressure and judged on only one case [P41]

Some students received help with their cases [P45]

Only some get difficult questions [P47]

Not everyone comfortable with public speaking [P51]



(iii) Memo used

Not applicable as second years are not being assessed

Positive

Comprehensive [P22, P39] Fair [P24, P33, P34, P42, P46,

P48, P49] Know what is expected [P27]

Focussed [P21] Good

Indicate important factors [P37]

Sufficient [P29, P31] Relevant [P29] Well enough [P20] Well explained [P31] Well laid out [P48]

Positive

Fair [P58, P59] Complete [P54, P55, P62,

P64, P66] Good

Know what to expect [P56] Easy to understand [P67]

Neutral [P47]

Negative

Unsure [P28, P30, P32, P44, P50, P51] o Never received rubric [P23,

P26, P38, P40, P41, P45]

Negative

Subjective [P53] Incomplete

o Should assess for difficulty of case [P52]

Unsure [P57] 8. Feelings on the

assessment (iv) Feedback

Not applicable as second years are not being assessed

Positive [P34

Critical and fair [P46] Enough [P20, P21] Fair [P29] Good [P23]

Could identify mistakes [P22, P37]

Learn from supervisors [P26, P42, P44]

Constructive [P39] Timely [P48]

Helpful [P29, P38] Immediately [P21] Sufficient [P31]

Positive

Fair [P59] Good [P57, P66] Thorough and helpful [P64]


Neutral [P47]

Mixed

Insightful, but harsh [P40] Mixed

Harsh, but necessary [P58]

Negative

Cruel and degrading o Done in front of everyone

[P28] Minimal [P32] None [P33, P51] Not on standard

o More should be provided [P24]

Not positive [P45] Scary [P27] Only sometimes [P50] Uncomfortable [P36]

Negative

Minimal [P54] None [P52, P55, P56, P62, P67] Vary [P53]

9. Recommendations Attendance:

Second years should only attend later in the year [P9, P12]

There should be a time for brief

explanations of concepts [P13,

P17]

Presentations:

The time for the

presentation should be less

and less presentations on

the day [P4, P13, P14, P16]

Presenters should be well

prepared [P5]

Case reports should be made

available [P15, P18]

Attendance:

First years should also attend [P44]

Second years should only attend later in the year [P22, P30]


explanations of concepts [P23]

The time slot of case presentation should change [P20, P30, P34, P36,

P47]

Presentations:

The time for the presentation

should be less [P50]

Presenters should be well

prepared [P43]

Attendance:

First years should also attend [P67]

Only third and fourth years to attend [P62]

Everyone should be on time [P54]


explanations of concepts [P65]

The time slot of case presentation

should change

Should be alternating weeks

[P62]

Presentations:

The time for the presentation

should be less [P56]

Guidance from the supervisor should be provided before the


Provide information on the case

that will be presented

beforehand [P11]

Feedback and questions:

Individual private feedback

should be given [P2]

Questions should be asked

in a positive manner [P10]

The environment should be

more welcoming [P6, P10]

Guidance from the supervisor

should be provided before the

presentation [P41]

Information should be provided

beforehand [P28, P36, P38, P40]



Assessment:

Have peer assessments to

involve the students [P25, P37]

Should not count marks – only a platform for sharing and learning [P32]

There should be a set panel of

assessors [P30]

Feedback and questions:

Less critique [P26, P41, P48] Feedback should be positive or

constructive [P24, P27, P36, P40, P41, P42, P45, P50]

Questions should be asked in a positive manner [P28]

Limit questions to the presenter. [P33, P35, P36, P47, P51]

Let students from each year group ask questions [P35, P50]

The standard of the case that is

presented should be set [P38, P47]

Lecturer / Optometrist can also

present a case [P21]

The environment should be more relaxed [P45]

presentation [P55, P57, P58, P59]



Assessment:

The rubric should change [P52] Rubric should be discussed [P53] There should be a set panel of

assessors [P62, P56] Feedback and questions:

Feedback should be supportive [P65]

Individual feedback should be provided [P52, P57]

Ensure that there is no repetition of cases [P61]

Research should be done on new

information and not repetition of lectures [P60]

Only 4th years to present [P62]

APPENDIX H-8:

OVERVIEW OF THE THEME, CATEGORIES AND SUBCATEGORY OF THE

PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS OF PEER

ASSESSMENT USED WITH OTHER TEACHING-LEARNING METHODS

Overview of the theme, categories and subcategory of the perceptions and experiences of optometry students of peer assessment used with other

teaching- learning methods

Module code and

teaching and learning method

used with peer

assessment.

GENA 2612 Small group

learning

GENA 2612 Flip the

classroom

DGNS 3702 Flip the

classroom

PATH 4802 Flip the

classroom

1. Feelings on

the

assessment i. Overall

feelings

Positive

Relaxed environment [P5]

Peers understand the conditions [P7]

Content [P6] Fun [P20] Fair [P18, P19] Good [P4, P9, P11,

P17] Good method of

learning / learning experience [P8, P12]

A lot of assessors [P16]

Interested [P2, P10] Pleasant [P15] Satisfied [P3] Successful [P13]


Creative [P8] Comfortable

Know the rubric better [P7]

Good [P10] Appropriate [P18] Content [P1] Enjoyment [P11] Fair [P15] Interested [P12] Productive [P13]

Positive [P1, P15, P22, P24]

Clarify procedures and expectations [P13]

Calm learning environment [P19]

Helped [P27] Identified

weaknesses [P11] Learned about

time management [P30]

Useful [P12] Excited

Practical way of learning [P14]

Informative [P8] Good [P16, P20]

Get to know the rubric [P6]

Improves skills [P7]

Best interest of the student [P9]

Relaxed environment [P17]

Preparation for formal assessment [P26, P31]

Positive

Broaden knowledge [P4, P7, P8, P16]

Enjoyable / Fun Knowledge were

applied [P12, P14]

Fair [P9] Good

Forced to understand [P1]

Were not alone [P2]

Forced to pay attention [P5]

Use different method [P6]

Got familiar with the rubric [P11, P13]

Identify weaknesses [P3, P13]


teaching-learning methods

Happy Effective teaching

and learning method [P4]

Helpful [P28] Learned a lot [P3]

Needed Good preparation

[P23] Relaxed [P29] Satisfied [P10]

Neutral [P4, P5] Mixed

Stressed, but learned a lot [P2]

Anxious, but positive experience [P5]

Mixed [P17, P19]

Negative Still do not

understand [P1] Public speaking

[P14]

Negative Not everyone

works well in a group [P2]

Not everyone is comfortable speaking in front of people [P2, P9]

Lost [P3] Not accurate [P16]

Negative

Uncomfortable to be assessed by peer [P25]

Negative

Not excited Peer assessment

[P10] Triggered anxiety

[P15] Not a true reflection

[P9]

1. Feelings on

the assessment

ii. Fairness

Fair [P2, P4, P5, P6, P11, P12,

P14, P15, P18, P19] Everyone had a

chance to present [P8]

Same opportunity [P20]

Positive

Fair [P7, P8, P9, P13, P14, P17, P18]

Positive

Fair [P1, P3, P4, P7, P8, P9, P13, P14, P24, P25, P28, P29] Assessment

conditions [P11] Consistent [P6] Cannot chose

who is assessing you [P19]

Positive

Fair [P1, P6, P10, P13] Group

assessment [P2, P15, P16]

Peer assessment [P3, P4, P7, P8, P11, P14]

Semi-Fair [P3, P7]

Not everyone is good with presenting [P13]

Moderate [P1, P4, P11, P12]



Informed in advance [P26]

Everyone is assessed on the rubric [P23, P30, P31]

Everyone gets the same amount of time [P19, P27, P30, P31]

No discrimination [P10]

No pressure [P5] Peers [P16, P20]

Same rubric [P12]

Not Fair ‘...we always give

each other good marks.’ [P16]

Negative

Not fair [P3, P20] Peer assessment

[P10, P15] Public speaking

[P16]

Negative

Not fair

Assessed by peers [P2]

Lecturer does not help [P21]

1. Feelings on

the assessment

iii. Memo

used

Positive

Appropriate [P7] Comprehensive [P19] Fair [P6, P7, P12, P15,

P18] Good [P2, P3, P4, P9,

P11] Sufficient [P8, P10] Understandable [P15,

P16] Well thought out [P14,

P16]

Positive

Applicable [P14] Appropriate [P18] Clear [P4, P7] Complete [P6, P20] Concise [P4, P11] Detailed [P9] Fair [P10, P12] Good [P1, P16] Helpful [P19] Standard [P2] Sufficient [P3] User friendly [P11] Well laid out [P6,

P7, P17]

Positive

Clear [P8] Compiled well [P1,

P12, P23, P25] Complete [P18] Correct and effective

[P31] Descriptive [P8] Easy to follow [P16] Objective [P28] Good [P2, P7, P17,

P27] Available before

assessment [P9, P10]

Positive

Adequate [P8, P9] Clear [P12, P14] Comprehensive [P4,

P15] Fair [P5] Good

Well understood [P10]

Same rubric as Case presentation [P3, P6]

Sufficient Same rubric as

Case presentation [P11]

Summarised [P13]



Explain what is expected [P6, P13]

Fair rating criteria [P15]

Helpful Know what is

expected [P3, P20, P21]

Provide additional insight into procedures [P4]

Sufficient [P24, P29] Understandable [P8,

P30] Focus your attention

[P26]

User friendly [P4] Well-Constructed

[P2]

Negative

Sections overlap [P5] Not specific [P16] Vague and ambiguous

[P3]

Negative

Confusing [P5] Not complete [P15] Not specific [P13] Subjective [P8, P10]

Negative

Not specific [P14] Not accurate [P11]

Negative

Has grey areas [P7]

1. Feelings on the

assessment iv. Feedback

Good [P8, P11, P15, P20] Positive

Good [P3, P12, P17, P19]

Effective [P4] Adequate [P18]

Positive Clear [P19] Good

Became more calm [P2]

More at ease [P4] Complete [P17] Helped to talk to

lecturer [P28] To the point [P13,

P18] Happy

Small group provides safe environment to share [P27]

Positive

Adequate [P9] Constructive [P2,

P13] Comprehensive [P4,

P5, P13, P15] Good [P3, P10]

Identified weaknesses [P7]

Help with future presentations [P8]

In-depth [P12] Informative [P9] Sufficient [P14, P16] Useful [P5]



Helpful [P1, P9, P12, P16, P25] Opportunity to

raise difficulty More at ease [P5] Informative [P3] Individual growth

[P7] Provide different

perspectives [P13, P20, P23]

With reflection [P26]

Learn from others Group discussion

[P11] Lecturer listened

[P14, P30] Satisfied [P10] Sensitive and personal

[P31] Sufficient Address uncertainties

[P8] Negative

None [P2, P5, P8, P14, P16, P20]

Bad [P1]

Negative

Not too fond to share feelings [P21]

Negative

Not complete [P1]

APPENDIX H-9:

OVERVIEW OF THE THEME, CATEGORIES AND SUBCATEGORY OF THE

PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS ON PEER

ASSESSMENT USED IN THE MODULE CLINICAL OPTOMETRY (COPT 4800)


optometry students on peer assessment used in the module clinical optometry


1. Objective To become familiar with the assessment process used in

Pathology clinic [P2, P5, P6, P7, P13, P16]

Get to know the rubric [P1, P4, P8, P9, P10, P11, P12, P13, P17]

Work against time [P5, P10, P11] To be able to learn from peers [P1, P2, P10, P14, P15]


achieved.

Yes

Know what to expect in an assessment [P1, P3, P4, P9, P13, P16] o More familiar with the rubric [P3, P4, P7, P12, P13]

Improved skills [P6] Learned from peer [P2, P11, P14, P17] Done in a safe learning environment

o Relaxed environment [P5] o Pressure free / comfortable environment [P15] o Involved without testing patient [P8]

No

First clinic [P10] 3. Feelings

(i) Before

Positive

Excited o About the type of case [P1] o To see the flow of the rubric [P7] o Good learning experience [P12] o Learning from peer [P14] o To observe and assess [P15]

Happy [P8, P9] Neutral [P13]

Negative

Anxious [P17] Nervous [P2, P15] Stressed [P4, P6, P11, P13] Unhappy [P10] Unsure

o About purpose [P3] o About expectation [P4, P6, P14, P16]


Positive

At ease [P15] Calm [P11] Challenged [P1] Comfortable [P14] Enjoyment [P12, P15] Interested [P7, P13] Invested [P13] Relaxed [P6, P14]

Negative

Challenged [P1] Frustrated [P13, P15] Nervous [P10, P17] Flabbergasted [P10] On edge [P10] Rushed [P15]

3. Feelings

(iii) After

Positive

Learned a lot [P1] Realised weaknesses [P5, P15]

Comfortable [P2] Confident [P6, P8, P15]



Informed [P3, P9] Relieved [P11, P16, P17] Satisfied [P6, P7, P12, P13, P14]

Negative

Disappointment [P10, P13] 4. Strengths Get familiar with the assessment process and the rubric [P2, P3,

P5, P10, P12, P13]

Assist in time management [P1, P2, P6, P11, P15, P16] Done in a comfortable environment [P15]

Provides an opportunity to identify own knowledge [P5, P10, P14, P17]

Improved clinical skills [P9, P16]

To be able to learn from peers [P2, P3, P4, P6, P13, P15]

Real-life experience [P13]

Stimulates thinking process [P7, P8, P11]

5. Weaknesses Having a person with you while testing a patient: Makes communication difficult with patient [P6] Creates nervousness [P11]

Feedback from assessor

Lack of feedback [P5]

In front of patient [P11]

Being assessed by peers [P12]

Can be bias [P17] Does not have sufficient knowledge [P8, P9, P13] Feel uncomfortable with someone you know [P10]

Rubric

Still unsure about rubric [P2] Not explained before the assessment [P4] Open for interpretation [P15]

Time consuming process [P1, P3, P16]

6. Factors that

enhanced learning Provided guidance to become more familiar with Pathology

clinic, the assessment procedure and the rubric [P2, P4, P5, P7,

P10, P12, P13]

Provided confidence [P6]

The observation of an eye examination [P3]

Were able to identify areas for improvement [P5, P11]

Helped with integration [P2]

The opportunity to learn from peers [P4, P15]

Approach of certain techniques [P1, P14] Learn from their mistakes [P8] From the feedback provided [P15] Provided another perspective [P17]

Probed critical thinking. [P9]

Helped with problem-solving skills [P16]

Practical way of learning [P8]

7. Personal changes For findings to be checked [P8, P9, P 14]

Have more confidence [P17]

Listen to peer [P6]

Not getting intimidated [P15]

Not be so aware of assessor [P10]

Ask more questions to fellow student [P1]

Take more notes [P15]

Work through rubric at the end [P2]

8. Recommendations Should be implemented more regularly and in all clinics [P12,

P13] Student should be able to choose own assessor [P10]

The students should be placed in clinics with working equipment

[P16]



Feedback

Should be comprehensive [P2, P5] Feedback should be done in private [P11] Time should be allowed during examination for feedback

[P8] Should be done later in the year [P10]

Only one patient should be seen when having the assessment [P6, P8]

Findings should be re-checked [P9, P14]

Rubric

Should be explained [P4] Should be given before the assessment [P15, P17] Should have a yes/no criteria [P15]

Have a supervisor assessment that does not count marks [P1,

P13

APPENDIX H-10


PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS ON BEDSIDE

TEACHING


optometry students on bedside teaching


1. Objective Demonstration of clinical thinking [P2, P5]

Demonstration of clinical skills [P4, P6, P8, P11, P12, P13, P14,

P15

Illustrate patient care [P7] Demonstration of the flow of the clinic [P3, P5, P7, P8, P9, P10,

P11, P12, P16, P17]

Make students feel comfortable with the clinic [P1, P3, P14] Ensure students know what is expected of them [P3, P13,

P17] To make students more familiar with the clinic [P2]


achieved.

Yes

Enjoy it [P14] Illustrated the flow [P16] Insightful [P13, P14, P17] Interesting [P15] Learning through observation [P1, P4] Made them excited [P12] Made them feel calmer [P11] Probes thinking [P5] Provided self-confidence [P5] Supervisor helpful attitude [P15] Dependent on type of patient [P3]

3. Feelings

(i) Before

Positive

Excited [Almost all of the participant] Curios [P5] Interested [P11] Reassured [P15]

Negative

Afraid [P14] Scared [P7] Uncertain [P17] Unsure [P4] Nervous [P9]


Positive

Astonishment [P1] Committed [P4] Curious [P4] Enjoyment [P14] Excitement [P4] Familiar [P5] Helped [P3] Informative [P3] Inspired [P9] Interested [P8] Learned [P11] More at ease [P7] Not overwhelmed [P17] Part of the experience [P15] Reassured [P13] Relaxed [P14] Stimulated [P2]

3. Feelings (iii) After

Positive

More at ease [P8, P12] Assured [P10]


optometry students on bedside teaching

Calmer [P7] Comfortable [P11] Confident [P5, P15, P17] Excited [P9, P12, P15, P16, P17] Familiar [P13] Grateful [P1] Informed [P7] Prepared [P9] Reassured [P10, P17] Relieved [P14] Satisfied [P11]

Negative

Disappointment [P3, P6] 4. Strengths Created an understanding of the clinic [P7, P8, P9, P12, P13, P15,

P16]

Having a real life example [P1, P4, P5, P8, P9, P10, P11]

Create an opportunity to identify areas for improvement [P1, P13]

It is an interactive learning experience [P1, P3, P4, P5, P11, P14,

P17]

There is opportunity to ask questions [P3, P5, P6, P13, P16, P17]

Theory are applied practically [P2, P6, P14, P17]

Probes critical thinking [P2, P15]

Exposes students to different situations [P2]

5. Weaknesses Experience is limited to one patient / one condition only [P2,

P13, P16

Type of pathology differ for each group [P6, P10, P14]

Patient is exposed [P1, P4, P6]

6. Factors that

enhanced learning Practical observation of a professional [P5, P6, P7, P8, P9, P12,

P13, P14, P15, P16]

Example of how to apply critical thinking

Illustration of professionalism

Good explanations of tests

Time management

Safe learning environment [P14, P15]

Part of the experience [P3, P15]

Integration [P2, P5, P13]

Seeing pathology clinically [P2; P4]

Opportunity to ask questions [P9, P13, P16]

“...It gave me a more real and genuine feeling” [P11]

7. Personal changes Could have asked more questions [P1, P10]

Interact more [P1]

Review pathology before coming to clinic [P6]

8. Recommendations The teaching and learning method should be applied throughout the curriculum [P1, P7, P8, P9, P10, P11, P12, P13, P15, P17]

More than one type of patient should be seen in this experience

[P2, P13, P14, P16]

A patient with pathology should be seen [P3, P6, P16]

To experience this with different optometrists / supervisors / ophthalmologists [P12, P17]

More time for reflection [P1]

These clinical cases should be discussed in a lecture [P4]

Recommendations for lecturer [P14]

Must involve students

Include a discussion of management plan

Provide explanations for reasons of performing procedures

Be prepared

APPENDIX H-11


PERCEPTIONS AND EXPERIENCES OF OPTOMETRY STUDENTS ON CLINICAL

SKILLS TRAINING


optometry students on clinical skills training


1. Objective To practically learn how to perform diagnostic techniques [P1,

P2, P3, P4, P5, P6, P8, P9, P13, P16, P17, P19, P20, P21, P22, P26, P27, P31]

o To practice skills independently [P11, P18, P25, P30] o To be assessed on practical skills [P12, P18, P23, P24, P29]

2. Objectives


Yes [P8, P17, P19, P23, P28]

Enough practice time [P4] Students learn from each other [P18]

Yes and no

Still unsure about one technique [P21, P22, P27] Not enough practice opportunity for the one technique [P5] Need more help from lectures [P9]

No [P12, P15, P26]

Demonstration incomplete [P1, P10, P14, P31, P3] Had to do self-study [P6, P7]

Supervisors: Did not interact [P6] Not helpful [P25] Not supportive [P29]

Not enough equipment [P11] Not enough practice opportunity [P24] Not enough supervised practice [P2, P16] Wants peer assessment [P13, P20, P30]

3. Feelings

(i) Before

Positive

About teaching and learning experience Calm [P25] Eager

To learn new technique [P10, P20] Excited [P4]

To learn new technique [P9, P11, P14, P22, P27, P31]

Motivated [P20] Relaxed [P5]

About assessment Calm [P17] Eager [P17] Prepared [P8]

Negative

About teaching and learning experience o Anxious [P30] o Frustrated [P1] o Nervous [P2, P19, P29] o Stressed [P13, P15, P16, P24, P30] o Uncertain [P4, P15, P23, P31]

About assessment o Anxious [P21] o Bad [P26] o Incompetent [P18] o Nervous [P18, P29] o Not confident [P7] o Stressed [P3, P6, P12, P21, P23]



3. Feelings

(ii) During

Positive

During the teaching and learning method Excited [P22]

During assessment Positive [P10] Calm [P16, P17] Confident [P17] Improved [P18] Less tense [P23]

Negative

During the teaching and learning method Negative

Limited equipment and time to practice [P11, P14, P29, P31]

No feedback during practicals [P14] Frustrated

Limited time to practice [P4, P22] Hopeless, but got better [P20] Struggled, but it got better [P27] Unsure

About correctness [P28]

During the assessment: Anxious [P17, P24, P26, P30] Bad [P8] Concerned [P2] Confused [P24] Frustrated [P13, P21, P25] Nervous [P18, P19] Stressed [P3, P15]

Limited time [P5] Could not perform like practices [P6]

Tensed Felt unprepared [P12]

Unsure [P1, P4, P15] 3. Feelings

(iii) After


Enriched [P22] Happy

Only about one technique [P21] Good [P4]

Only about one technique [P17, P31] Motivated [P9, P18] Relaxed [P5] Relieved [P16, P24, P30] Satisfied

Only with one technique [P29] Negative [P3, P8, P10, P11, P14]

Angry Supervisors not interactive [P6] Interpret rubric wrong [P12]

Disappointed [P1, P12, P15, P20, P26] Frustrated [P21] Indifferent [P25] Not comfortable

Only with one technique [P29] Not confident [P7] Not satisfied [P13]



Stressed [P15] Unhappy [P2] Unsure [P28] Upset

Not enough practice time [P6] Only about one technique [P17]

4. Strengths None [P6, P7]

Having an assessment

Improves confidence [P17] The assessment indicates areas for improvement [P23] Work under pressure [P19]

Learn to be independent, disciplined and responsible in own time [P9, P12, P13, P15, P22, P26, P27, P29, P30]

Helps with self-directed learning [P16] Creates an interest [P25] Creates better understanding [P18]

Practical application [P24, P28] The use of the equipment [P8]

Supervisors:

The availability of the supervisors [P2] Demonstration and guidance [P10, P31]

Comfortable environment to ask questions [P14, P21]

Enough time to practice [P3, P4, P5, P20, P21]

No peer assessment [P1, P11] 5. Weaknesses Everything [P7]

Demonstration

Incomplete [P15, P27, P29, P31] Only once [P28]

Equipment

Not enough (especially BIO) [P4, P5, P10, P11, P14, P16, P18, P20, P21, P24, P26, P29]

Difficult to work with some [P8] Assessment

Unprepared [P12] Lack of feedback [P17] Nervous and makes mistakes [P23]

Insufficient practice time [P2, P4, P11, P29]

No theoretical classes [P3]

Passive approach [P13]

Practice on own [P15, P16, P20, P28, P30]

Creates uncertainty [P22] Inexperience [P25]

Self-directed learning [P9]

Supervisors

Not helpful [P1, P2] Not interactive [P6] Not enough guidance [P20, P21 Not with you all the time [P11] Not pointing out mistakes [P14]


No factors [P1, P6, P7, P11, P13, P14, P26]

Enough time were provided to practice [P4, P5, P27]

With the assessment weaknesses were identified [P3, P18, P19,

P29, P30]

Practical application of theory [P2, P23, P28, P31]

By self-learning and mastering the technique [P10, P12, P16, P20, P21]

Supervisor assistance and feedback were available [P2, P4, P8]

Rubric were available before the assessment [P24]



7. Personal changes Asked for help [P7, P21, P25, P31]

Practice more [P4, P18, P24, P25, P30]

Watch more videos on the techniques [P11, P14]

8. Feelings on the

assessment i. Overall

feelings

Positive

Fair [P9, P18, P31] Rubrics were provided before assessment [P4] Good indication of progress [P21]

Effective [P19] Good [P12, P23]

90D [P17] Happy

90D [P2] Successful [P5]

Neutral [P14, P25, P27]

Negative [P11, P13, P20, P28, P29]

Limited time [P24]

- Angry [P6, P7] - Anxious [P1, P26] - Bad [P3, P7] - Challenging [P22] - Disappointed [P7, P12] - Frustrated [P6, P7] - Horrible

BIO [P2] - Nervous [P10, P22] - Tensed [P16] - Sad [P8] - Uncertain [P15]

BIO [P5] - Upset [P6]

8. Feelings on the


Fair [P3, P5, P9, P10, P11, P14, P16, P18, P19, P21, P22, P24, P26,

P30, P31]

Done by supervisor with a rubric [P4] Had the rubric before the assessment [P27]

Mixed

Fair for 90D, unfair for BIO [P2, P17] Reasonable [P29]

Uncertain [P15]

Not fair Certain information were not given [P1] Not enough time to practice [P6, P7] Used different slitlamp [P8] Different groups assessed different weeks [P12, P13, P20,

P25, P28]


iii. Memo used

Positive [P28]

Clear [P1, P4, P22, P23] Efficient [P17] Fair [P4, P5, P6, P7, P11, P14, P18, P21, P25, P30] Good [P2, P3, P26]

o Available before the assessment [P8, P9, P27] Helpful

o Available before the assessment [P16] Well set [P31] Reasonable [P10, P29] Strict [P20, P24]

o Good preparation [P19]



Negative

Can be misinterpreted [P12] Unclear [P15]


iv. Feedback

Positive [P28] - Constructive [P9] - Fair [P19] - Good [P8]

Know what to improve on [P4, P13, P18, P26, P27] - Happy [P25] - Helpful [P9] - Sufficient [P22] - Welcome [P23]

Mixed

None with 90D, friendly with BIO [P1, P6, P10, P21] None with BIO, useful with 90D [P20, P29]

Negative [P7] - None [P5, P11, P12, P14, P16, P17] - Incomplete [P2, P24]

8. Recommendations Acquire more equipment [P2, P10, P11, P14, P18, P20, P22, P24,

P26, P28, P29, P30]

Provide more time to practice [P4, P7, P8, P18, P23, P26]

Better control over practice times [P7, P11, P27] Assessments:

Have peer assessments [P3, P9, P12, P13, P29] Have a supervised assessment that does not count marks

[P2, P6, P17, P20] Provide feedback after assessments [P10, P19]

Supervisors:

Be approachable [P1] Demonstrate on a patient [P5, P31] Be more involved by being helpful and interactive [P6, P9,

P11, P13, P15, P20, P22, P25, P28] Provide more assistance and guidance [P8, P16, P19, P21] Stand next to student while practicing [P1, P10, P14, P28] Have a question and answer session [P12]

APPENDIX I

SESSION FACILITATION FOR PATH 4802 AND GENA 2612 LECTURE

PATH 4802

Specific

Learning

outcomes

Content

outline

Media /

mode

Teaching /

learning

strategies

Assessment strategies

Integrate all

knowledge in

order to diagnose

a patient with a

macular disorder

from a case

study, including

signs and

symptoms,

associated

systemic diseases

and management

/ treatment plans.

Lecture notes

PATH 4802

study guide

Textbook

(Kanski)

Prezi

Lecture

Case

studies

(provide

examples of

clinical case

studies seen

in clinic)

What: Did the student

understand the

pathology involved in a

macular disorder and is

able to correctly manage

and refer the patient to

the appropriate health

care professional?

How: Class test

When: Week 7

GENA 2612

Specific

Learning

outcomes

Content

outline

Media /

mode

Teaching /

learning

strategies

Assessment

strategies

Healing:

To be able to

define healing.

To be able to

discuss the

different factors

that influence

healing.

To understand

the healing

process in special

tissues.

GENA 2612

Study Guide

Lecture

notes

Additional

information:

Youtube

video

Prezi /

videos /

concept

map

Class

test

Lecture

How: Did student grasp

the concept of healing

and are able to discuss

the different factors that

influence healing as well

as explain the healing

process?

Where: Class test

When: Week 5 in class.

Repair:

To be able to

define repair.

To be able to

discuss the

complications of

repair.

To understand

repair in other

tissues.

GENA 2612

Study Guide

Lecture

notes

Additional

information:

Youtube

video

Prezi /

video /

concept

map

Class

test

Lecture

How: Did student grasp

the concept repair and

are able to explain the

complications as well as

repair in other tissues?

Where: Class test

When: Week 5 in class

APPENDIX J

INFOGRAPHIC PRESENTED TO STUDENTS TO EXPLAIN THE FLIP THE

CLASSROOM APPROACH

APPENDIX K-1

GENA 2612 FLIP THE CLASSROOM PLANNING TEMPLATE

Study unit: 2

Topic: Environmental, cellular injury and bodily responses

Learning Objectives for topic: 1. Understand how a cell reacts to external environment stressors. 2. Conceptualise the concept of adaptation and all the pathological

processes. 3. Describe the response of the human body to cellular injury.

Resources needed: Poster paper, markers, 10 – 15 minute video clips. Video’s on Blackboard

#1 - Introduction to pathology - etiology, pathogenesis, morphology term

http://www.youtube.com/watch?v=VVBs0sb4Hvw #2 - Introduction to pathology - hypertrophy, hyperplasia

http://www.youtube.com/watch?v=6WM14LLHNyo #3 - Introduction to Pathology - Atrophy, Metaplasia

http://www.youtube.com/watch?v=yeubwXJUHmg #5 - 8 ways cells can become injured - hypoxia, ischemia, aging, etc

http://www.youtube.com/watch?v=HuMDGw2nx1s #7 - Overview of Reversible cell injury and necrosis: microscopic m

http://www.youtube.com/watch?v=cZH-Xd8SWUs

Before class / offloaded content

During class / student-centered learning

After class

Activities: Watch lecture and videos, take notes, read through study guide.

Instructor: Monitoring for

understanding Clarify difficult

concepts Clear up

misconceptions Students (group work): Concept map

activity Presentation and

discussions

Assessments: Complete online- quiz. (Marks count towards continuous assessment for predicate)

Concept-map that will be marked according to rubric provided.

Questions as part of semester test and examination.

http://www.youtube.com/watch?v=VVBs0sb4Hvw

http://www.youtube.com/watch?v=6WM14LLHNyo

http://www.youtube.com/watch?v=yeubwXJUHmg

http://www.youtube.com/watch?v=HuMDGw2nx1s

http://www.youtube.com/watch?v=cZH-Xd8SWUs

APPENDIX K-2

DGNS 3702 FLIP THE CLASSROOM PLANNING TEMPLATE

Study unit: 1

Topic: Slitlamp

Learning Objectives for topic: Perform slitlamp competently, comfortably and efficiently in order to effectively examine the anterior segment of the eye and interpret the clinical findings.

Resources needed: Poster paper, markers, 10 – 15 minute video clip. Video on Blackboard

Six sweeps by Dr T Freddo http://www.gio.co.za/



After class

Activities: Watch lecture and videos, take notes, read through notes.

Supervisor: Monitoring for

efficiency and competency.

Available for demonstrating technique

Students: Practice slitlamp

procedures in clinic on peers

Assessments: Complete online- quiz. (Marks count towards pre-practical assessment for predicate)

Peer assessment Formative assessment according to rubric.

APPENDIX K-3

PATH 4802 FLIP THE CLASSROOM PLANNING TEMPLATE

Study unit: 2

Topic: Diabetic retinopathy

Learning Objectives for topic: 1. Understand the process of diabetic retinopathy. 2. Explain signs and symptoms related to diabetic retinopathy. 3. Create a possible management plan to treat diabetic retinopathy. 4. Compile / analyse a diabetic retinopathy case study

Resources needed: Poster paper, markers, 10 – 15 minute video clips. Video’s on Blackboard



After class

Activities: Watch lecture and videos, take notes, read through study guide and articles.

Instructor: Monitoring for

understanding Clarify difficult

concepts Clear up

misconceptions Students (group work): Analyse fundus

photograph with diabetic retinopathy.

Compile case study for specific diabetic patient.

Presentation of different cases.

Assessments: Complete online- quiz. (Marks count towards continuous assessment for predicate)

Presentation of case that will be marked according to case presentation rubric.

Case study questions as part of semester test and examination.

APPENDIX L:

OVERVIEW OF SIMULATION SCENARIOS

SIMULATION CONCEPT PLAN (SCENARIO 1)

Simulation date(s) and times 13 June

Lecturer E Kempen Department Optometry

Extension Module code PATH 4802

Simulation Outcome:

The student should be able to:

Collect, analyse, organise and critically evaluate clinical information.

Communicate effectively the diagnosis and management plan.

Show the ability to be a health advocate.

Overview of Scenario:

Students will have the role as an optometrist and there will be standardised patients

acting as patients.

Students will be provided with clinical notes of a diabetic patient with irreversible damage

to the eye. The student will be provided with time to analyse the case and write down

the management of the patient.

The student then has to discuss the diagnosis and management with the patient. The

patient will then also ask for a drivers license form for the student to complete, but the

patient does not qualify for a drivers license and the student has to explain that to the

patient.

Door instruction (Instruction to student):

A patient was seen at a clinic where you work. The complete examination was done and

it is your responsibility to discuss the diagnosis and management plan with the patient.

Study the clinical notes from a patient diagnosed with diabetic retinopathy. Complete the

management plan, where after you will discuss the diagnosis and management plan with

the patient.

Instruction to SP:

Case History:

You are an uncontrolled diabetic patient

for 15 years and have irreversible vision

loss due to the diabetes.

Smoker.

Main goal is to renew your driver’s license,

which you failed at the traffic Department.

Personality:

You can be yourself.

Specific Instructions:

You have been at the clinic the whole day and many eye tests and examinations have

been done to you. This is the last step where the optometrist must explain to you the

diagnosis and management plan.

The student should introduce him / herself and explain to you that he / she will discuss

the diagnosis and management with you.

You are aware that you have diabetes, but you are not aware of the damage that it

has done to your eyes. You do not realise the importance of the fact that you should

control your diabetes. Questions should be asked like: “but how did this happen? What

can I do to reverse the damage?”

After 5 minutes or if the student ask if you have any further questions you must

present a drivers license form and ask the student to complete the form since you have

failed the test at the traffic department and that you really need to renew your license.

The student will inform you that you do not qualify to drive. You will be very upset and

start to bribe the student to complete the form.

Clothing required:

Nothing specific.

Provide a sketch of one station:

Equipment required (total) and Props:

Table

2 Chairs

Clinical notes

Extra paper for student to write management plan

Purple license form for drivers license

Patient must have a soft drink with him / her.

Supporting documents or books for simulation:

Description:

Driving License Form Supplied by Self

Video recording of sessions:

NOT REQUIRED x REQUIRED

Assessment checklist Distribution of roles

Did the student… Activity Person Responsible

1. Introduce him or herself? Briefing of SPs Lecturer x CSU

2. Explain what he or she is going to discuss with you?

Debrief External x SP x

3. Explain the diagnosis and management in terms that you understood?

Additional Information

4. Remain professional and ethical at all times?

5. Communicate effectively?

6. Showed compassion to your situation, but still remained true to the profession and the scope?

SIMULATION CONCEPT PLAN (SCENARIO 2)

Simulation date(s) and times 20 June

Lecturer E Kempen Department Optometry

Extension Module code PATH 4802

Simulation Outcome:

The student should be able to:

Collect, analyse, organize and critically evaluate clinical information.

Communicate effectively the diagnosis and management plan.

Show the ability to be a health advocate.

Overview of Scenario:

Students will have the role as an optometrist and there will be standardised patients as

patients.

Students will be provided with clinical notes of a patient with wet macular degeneration

and the patient should be seen by an ophthalmologist urgently. The student will then

phone the ophthalmologist practice and speak to the receptionist where the receptionist

inform the student that the only available date is in 6 weeks.

Door instruction (Instruction to student):

You’ve seen a patient who has come to you as an emergency due to acute vision loss

and the patient was diagnosed with wet macular degeneration. The patient should be

seen immediately by an ophthalmologist. You have to phone the practice, which is the

only one in town, to make an appointment.

Instruction to SP:

Case History:

You are a receptionist to an

ophthalmologist – the only one in town.

Personality:

You can be yourself.

Specific Instructions:

You work at the only ophthalmologist practice in town. You are very protective over

your doctor’s schedule and when an optometrist phone to demand an appointment for

a patient, you inform him/her that the first available appointment is in 6 weeks.

You can ask the student why it is so important that the doctor have to see the patient

today or tomorrow.

The tipping point should be if the student inform you that the patient will go blind.

Clothing required:

Nothing specific.

Provide a sketch of one station:

Equipment required (total) and Props:

Table

Chair

Telephone

Clinical notes

Extra paper for student to write management plan

Video recording of sessions:

NOT REQUIRED x REQUIRED

Assessment checklist Distribution of roles

Did the student… Activity Person Responsible

1. Introduce him or herself? Briefing of

SPs

Lecturer x CSU

2. Explain why he or she is calling? Debrief External x SP x

3. Explain the diagnosis and management of the

patient with you?

4. Remain professional, ethical and polite at all

times? Additional Information

5. Communicate effectively?

6. Showed the ability to be a health advocate for

the patient?

APPENDIX M:

OBJECTIVES OF THE APPRENTICESHIP SESSION IN PATHOLOGY CLINIC

APPENDIX N:

DECLARATION FROM LANGAUGE PRACTITIONER

DECLARATION

16 January 2020

TO WHOM IT MAY CONCERN

I herewith declare that I did the language editing of the thesis compiled as report of the

research on Experiential learning in the expanded scope of the undergraduate Optometry

programme at the University of the Free State, conducted by Elzana Kempen, student

number: 2012135865.

Track changes were used for corrections, comments and recommendations, and the

student was responsible for accepting/ rejecting the changes and recommendations,

and for finalising the document.

Dr MJ Bezuidenhout PhD [HPE]; BA [Languages]

Language Practitioner

Waverley Bloemfontein

e-mail: [email protected]

Cell: 0724360299

SAVI /SATI membership number 1003226

South African Translation Institute


KempenE.pdf - UFS

Documents

Transcript of KempenE.pdf - UFS