Wiki's for Higher Ordered Thinking

Wiki's for Higher Ordered Thinking Skills
“Wiki’s for Higher Ordered Thinking” was submitted to the Academic Publishing Wiki: Wiki Journal. This project is an extension of the many projects developed while enrolled in courses taken through the American College of Education. The wiki’s located on this journal is about proper uses of this phenomenon in the educational setting. The contribution reflects technology concepts to build higher ordered thinking skills among students matriculated into health programs at Sandhills Community College. The applications within the wiki could be applied to any curriculum; however, the wiki focuses on one curriculum project completed during the spring semester of 2012.
Overview
Educational technology at Sandhills Community College has been expanding more rapidly in the last five years due to the economy driving career changers though the doors. Despite state funding reductions, we have responded to increase demand for classes by offering hybrid and online courses. This has resulted in over 600 class sections that did not exist 10 years ago. In the last two years, the conversion to Moodle as our learning management system (LMS) has prompted concern for the pedagogical methods of teaching and learning within these courses. As we pursue accreditation reaffirmation, we are focusing our attention towards these online courses. Since we have 65 degree and diploma programs with one or more online course sections, we have started developing student-learning outcomes (SLO’s) for these courses. These outcomes must reflect a scaffold learning plan culminating in the achievement of the program goals that fulfill the mission of the college while adhering to acceptable standards of online learning (Sandhills Community College, 2011). 
During this process, we have been developing action plans reflective of the five goals outlined in this course that also aligns with our department philosophy of teaching and learning. In essence, we are seeking to create a student centered learning environment for a diverse population of students that is supported with collaborative problem based learning. This has become the theme for our Quality Enhancement Program (QEP) to be launched this summer. When considering our current efforts, we must first turn our attention to the current usage of the LMS to determine what technologies we could use more efficiently. This focus was determined from a preliminary analysis of a health science faculty survey distributed last year, which indicated a need to explore the features more extensively. The wiki feature was chosen to investigate alternative ways to support achievement of the SLO’s. 
Like the online Wikipedia site, students may create their own wiki as they create and collect artifacts during their educational journey. This form of documentation can be used as progressive project from beginning to end within a course or entire curriculum. The functional capabilities of wiki’s depend on the source. On the Sandhills campus, this feature is available to all users of Moodle, which is the campus learning management system (LMS) (Cole, 2005). 
Wiki Project
Wiki’s are ideal way to engage students in a collaborative learning project across various disciplines. Since students are not usually engaged with other curriculums after completing the general education courses, this could be a great pedagogical approach to promote teamwork with other health professions during their clinical year. While the wiki feature has been available on our campus LMS, the majority of faculties have not adopted this technology. While it appears to emerging on our campus in 2012, it appears that we are lagging behind others in the full use of this online technology (Hazari, North, & Moreland, 2009). In fact, a recent health science faculty poll at SCC revealed that they were not using this feature at all. 
Following this survey, several projects at Sandhills Community College were developed to uncover novel uses of the technology. One novel use of a wiki is the posting of case study research. Similar to the “old-style” term papers, these newer versions of an old idea will capture the imagination of the digital natives and challenge the digital immigrants to be creative (Bennett, Maton, & Kervin, 2008). The first project involved assigning students a wiki project to present patient conditions as part of a collaborative group project in one health science curriculum at SCC as a final senior project (Glassman & Kang, 2011) (Roe, 2010). 
In this project, students created a group wiki and individual wiki for assigned disease states. Students were encouraged to collaborate through the wiki, so the group could easily view updates. Once the group wiki was complete, each student randomly selected a disease state to produce a disease specific wiki. The final product included a student created disease map, comparison charts and graphs, and analysis of various treatment modalities. Students demonstrated their research capability in the creation of the final project using APA formatting. All projects were graded using an electronic rubric (see appendix). As a summative course project, the wiki served to encourage collaborative engagement as students achieved the stated student learning outcomes for the course (Donne, 2012)(Glassman & Kang, 2011). However, using the Wiki in this manner required more detail than the faculty predicted, so significant amount of thought was necessary to begin the process.
Lesson Planning
Grade Level
The grade level for this unit is the senior respiratory students in their fourth semester of the respiratory care curriculum at Sandhills Community College. During this semester, students are enrolled in their final core course and first clinical course. The class is a culturally diverse population made up 30% male and 70% female with a 35% percent minority population. The class consist of 17% African-American, 9% Asian, 9% American Indian, and 65% Caucasian. Traditionally, the minority students tend to avoid participating class for various reasons and the males also tend dominate the class discussions. Therefore, this curriculum unit was designed to ensure all students could participate with equal input. 
Content Knowledge and Skills
Prior level of knowledge. Students enrolled in the respiratory care at Sandhills Community College have six major student learning outcomes (SLO’s) to achieve prior to graduation: 1) Identify, collect, and record patient data needed for a patient care plan; 2) Evaluate patient data and make recommendations for respiratory intervention; 3) Determine the appropriateness of the prescribed respiratory care plan; 4) Monitor patient's objective and subjective responses to respiratory care interventions; 5) Recommend modifications in the respiratory care plan based on the patient’s response; 6) Independently modify therapeutic procedures based on the patient’s response. The student learning objectives one, two, three, and four have been achieved with the core curriculum courses. Over the first four semesters, the core curriculum courses have included basic physical assessment, pathophysiology therapeutics and diagnostics, pharmacology, mechanical ventilation, and advanced monitoring for patient having cardiopulmonary disease. 
Purpose of the curriculum unit. During this curriculum unit, students are ready to begin fulfilling objectives five and six. Since objective six is the main SLO identified as an area needing the most improvement, this lesson will focus on developing this important skill (Croft, 2011). This skill relies on the content knowledge and skills attained during the first four semesters. Therefore, the lesson is designed to review the necessary content while introducing new content identified during the lesson while developing their ability to make independent modification of therapeutic procedures based on a patient’s response. As the lesson proceeds, computer simulation software will expose students to new information while also reviewing previously learned information. 
Guiding Standards
State outcome standards do not exist for the respiratory care program at Sandhills Community College. The scope of practice standards are based on the National Board for Respiratory Care requirements for the entry-level and advanced level therapist credential. This standard is enforced by standards set by the Commission on Accreditation for Respiratory Care, which is the accrediting agency for the respiratory care profession (Smalling, 2011). The major program outcomes required by the Commission on Accreditation for Respiratory Care is based the scope of practice for registered respiratory therapist stated the commissions accreditation manual. 
Stated in the CoARC standard 4.01, “the program must prepare students to meet the recognized competencies for registered respiratory therapists identified in these standards (Smalling, 2011).” This standard includes 13 content and skills, which are measured using the NBRC examinations for the entry-level and advanced-level practitioner. The entry-level exam is required for licensing of the respiratory therapist, so it is the major program outcome that is reported each year to the state board and accreditation agency. Among the 13 areas, the one area identified on the national board results as needing improvement included “initiating prescribed respiratory care treatments, managing life support activities, evaluating and monitoring patient responses to such therapy and modifying the prescribed therapy to achieve the desired therapeutic objectives.” 
Standard III for both NBRC exams measure this required scope of practice. Since this standard covers eleven different sub-categories, two subcategories were identified through exam results (school report card) as having needing the most improvement. The first category is section F of the standard, which states graduates, must be able to determine the appropriateness of the prescribed respiratory care plan and recommend modifications when indicated by data. The second category is section H of this standard, which states that graduates must be able to independently modify therapeutic procedures based on patient’s response (“RRT,” 2011) (Croft, 2011). Both require higher ordered thinking in making decisions at the bedside. As identified on Blooms new taxonomy chart, Section H relies remembering, understanding, applying, analyzing, evaluating, and creating to meet this standard. Therefore, this single standard will be the focus of the lessons for this assignment. 
The technology standards for the content and skills level are not established by COARC. The COARC standard states “services available to the program that facilitate faculty and students in any teaching/learning modality, including distance education, in achieving the expected outcomes of the program. These may include, but are not limited to, library, computer and technology resources, advising, counseling, and placement services (Smalling, 2011, p. 7).” The technology standards are established by the individual colleges based on the program needs. Our technology plan is identified in our annual reports and intensive reviews every three years. The standard is part of the larger standard required by the NC Community College System (NCCCS) (The College Strategic Plan of Operations, 2010, pp. 10–11). 
Within this plan, the respiratory care program has established a minimum technology standard to meet the COARC accreditation requirements consistent with the college technology plan and the NCCCS standards. The minimum standards for classroom technology for the program include student email accounts; faculty and students web advisor accounts, desktop computers, printers, internet access, Moodle classroom management system, computer simulations, and online library access. In 2012, requirements required for the program include student personal I-Pads, e-books, or laptops. Students will be required to purchase online textbooks for classroom and online assignments. 
A written NBRC test was used to measure prior learning specific to the six learning outcomes within the respiratory care program. The computer-generated analysis provided the areas needing the most improvement for each student. This helped to individualize the experience as needed. Beyond the documentation provided in the computerized test and simulations, their ability to research pathophysiology and make sound therapeutic decision culminated in the development of a wiki page of the patient condition presented within the assigned computer simulations. Students also demonstrated program standards by completing a series of patient simulations. Based on the result of the testing, the outcome chosen to measure was “independently modifying patient care plans”. This outcome relies on student’s ability to recall, analyze, and apply previous information learned during the first four semesters of the program. 
Lesson 1: Remembering and Understanding. The activity for this lesson focused on recall and reinforcement of previous skills and knowledge necessary to complete a patient assessment in a clinical environment. Prior to attending class, students should complete a survey of the NBRC testing matrix. This survey is used to familiarize students with the standards. This is also a self-evaluation of the information they remember and understand. During class, students were given a NBRC formatted computerized test focusing on their ability identify, collect, and record patient data needed for a patient care plan. This simulated exam should help in the evaluation process of their ability to recall information related to this skill. It should also provide an analysis of the other learning objectives. 
Lesson 2: Applying. The activity for this lesson should focus on implementing an appropriate care plan based on the assigned pathophysiology within the computer simulation. This requires their ability to recall the information from lesson one regarding patient assessment. During class, a randomly chosen computer simulated patient scenario is used to assess students ability identify, collect, and record patient data needed for a patient care plan. In this lesson, they implement the appropriate care plan according the data collected. The computer analysis of the simulation should be copied onto a word document then uploaded to “advanced upload file” located in the lesson module within the Moodle classroom to document student completion. This should also be used by the instructor to evaluate student performance. Following completion of the simulation, a class discussion of the simulation should be conducted reinforce new information gleaned during the lesson. 
Lesson 3: Analyzing. The activity for this lesson should determine if student could effectively analyze the patient condition and the appropriateness of the prescribed respiratory care plan within the assigned patient simulation. Students should conduct online and textbook research prior to class using the previous assigned simulation. They should focus on the clinical management strategies for the pathophysiology presented in the simulation. The lesson should begin with an online chat of their findings. They can respond to two prompts with supporting research citations. For example: 1) What management strategies of the patient did they agree or disagree with? 2) What alternative therapeutic plans or techniques could be suggested? 
During the chat, students should be divided into two chat groups. Each chat group should have 10 minutes to discuss their first question. The first chat should end in a collective 10-minute class discussion offline with the instructor to consider the factors they agreed or disagreed. The second chat should be completed using the same format over a twenty-minute period. During the last 10 minutes, students should complete an online survey of their experience related to this student-learning outcome. 
Lesson 4: Evaluating. Evaluating patient data and making the appropriate recommendations for a respiratory intervention requires that students determine the appropriate method of monitoring patient status. The activity for this lesson activity should focus on monitoring a simulated patient's objective and subjective responses to respiratory care intervention. Students should complete an additional patient simulation prior to class using the computer simulation software. Students should record the subjective and objective information provided in the simulation. During the lesson, the online charting system should be used to document the findings as well recommend a plan of action. Once complete, the students should compare their chart notes. The medical director should review their plans to determine the appropriateness and he should provide feedback. The lesson should conclude with a discussion of the action plans. 
Lesson 5: Creating. The activity for this lesson should focus on developing a student’s ability in independently modifying therapeutic procedures based on the patient’s response within the patient scenario. Students should complete an additional patient simulation prior to class using the computer simulation software. They should be required to create a wiki page. The wiki page should include the patient history, assessment, and hospital course. Students should investigate the independent therapeutic decisions made within the simulation. 
Students should use the evidenced based National Institute of Health (NIH) PubMed web site to investigate their actions against the most current therapy. PubMed is a peer reviewed medical journal website that should be used to create bibliography. Students should post a reference list on the wiki for all of the major interventions they used. A short description of each intervention should precede each resource page. In addition, these should be used later in the semester for students to present their individual cases during the final exam period. In addition, students must show evidence that they independently completed 10 simulations upon completion of lesson five. thumb|right|500px
Materials and Resources
Lesson 1: Remembering and Understanding. The needs for this lesson include a faculty and student desktop or laptop computer with internet access. An online Survey Monkey account, Moodle account, and NBRC website access will also be needed to complete this assignment. In addition, online textbook access or hard copy text for RCP 211 will be needed for reference. 
Lesson 2: Applying. The needs for this lesson include a faculty and student desktop or laptop computer with internet access. Moodle account and computer simulation software will be needed to complete this assignment. Students will need to have a word program to develop a word file to upload their assignments using the “advanced upload file” located in the lesson module within the Moodle classroom. In addition, online textbook access or hard copy text for RCP 211 will be needed for reference.
Lesson 3: Analyzing. In addition to individual classroom computers with computerized patient simulation and internet access with a Moodle account, online textbook resources will be used to conduct research prior to class for the previous assigned simulation. In addition to the Moodle account, the chat function will be needed. 
Lesson 4: Evaluating. Individual computers with internet access with computer simulation software are needed to complete this assignment. Online access to online textbooks resources is necessary for research. In addition, a secondary computer program to simulate the hospital charting environment is necessary. The hospital charting system is to be used as method of creating the necessary digital artifacts used to document the SLO for this unit. 
Lesson 5: Creating. Individual classroom computers with computerized patient simulation and internet access with a Moodle account, online textbook resources will be needed to conduct research for the assigned simulation. The Moodle account wiki function will be needed to create the necessary digital artifacts specific for this SLO. In addition, PubMed student accounts will also be required to complete this assignment. 
[Creating the Wiki]
Using the simulations as the basis of their wiki research, digital artifacts were created by each student to document their learning outcomes form the simulations. Student was provided a rubric that outlined the necessary details to provide in the assigned cases. The wiki was to include the patient condition, history, hospital course as an introductory page. Additional pages were to reflect student research with an individual patient case to demonstrate their ability to make an evidenced based decision. Implementing care plans without knowing alternatives limits the effectiveness of a respiratory therapist in a clinical environment; therefore, the ability to research alternative evidenced based medical (EBM) practices is an essential skill for respiratory therapist to learn how to “independently modify patient care plans”. Patient simulation scores and evidenced based research posted on a Moodle wiki were used to document this skill. 
As a student centered action-learning project, the students would be in control of the content created. Assigning individual parts would appeal to the larger diverse population as some students may tend to shrink from expressing opinions out of fear. The fear of providing incorrect answers or feelings of inadequacy among the female and minority students results in an unbalanced discussions in the classroom. This type of assignment would allow for freedom of expression and support their need to be heard while promoting individualism and teamwork. Therefore, the goal of the wiki project would be to promote collaborative learning and individual expression, as they would experience as part of the healthcare team after graduation. 
While primarily a learning project, it can also serve as method of assessment. Unlike testing, this assignment allows for greater latitude of critical thinking and expression, since the answers are not fixed. Of course, a well-constructed rubric is required to ensure standards are communicated to students and to ensure compliance with the assignment goals and objectives. As a final project assignment, the wiki is an ideal capstone project that can also illustrate a student’s progress over time. One appealing feature of this format is the ability archive specific SLO’s to meet accreditation requirements as we must move beyond testing for documentation of student learning (Glassman & Kang, 2011) (Roe, 2010). 
Alternative Wiki Project
Based on the current trends in healthcare, program faculty members can also assign health topics to each group of students to present during the annual health fair event that is often part of many campus events. Using the latest technology, students should provide health assessments and health presentations to promote healthier lifestyles among the participants attending. The information gleaned from each participant should be entered into a database that should help analyze health risk for chronic obstructive pulmonary disease, diabetes, sleep apnea, and heart disease. Students should be collate and analyze the information upon completion for each health area assigned to be incorporated into a final capstone project. Using their findings, students could create a curriculum based wiki website for review by other professors as well as administration. Once reviewed an approved, the wiki’s should be published for community wide usage for those participants unable to attend.
This form of hands-on learning uses the constructivist viewpoint of learning by doing. It enhances student achievement as it transcends the classroom environment to engage students in a collaborative project across various curriculums to serve the greater good (Kamm, 2011). In fact, studies show that student retention and success improves when they are engaged in community events related to their education whether on or off campus (Burns, 2010). This is particularly true among minority groups (Overall, 2010). As a real world activity, achieving goal five should document the first four technology goals in a rigorous action learning capstone project for each graduating cohort during the final semester and serve as a retention measure second semester students. In addition, it should serve the greater good of the community and campus while helping students become better healthcare providers as well as citizens (Banks, 2008) (Banks, Cookson, Gay, Hawley, & et al, 2001).
Conclusions
While primarily a learning project, Wiki’s can serve as method of assessment. Wikis can allow students to demonstrate the knowledge gained during the course of program, so a carefully designed wiki project can be used to achieve this outcome. Unlike testing, this assignment allows for greater latitude of critical thinking and expression, since the answers are not fixed. Of course, a well-constructed rubric is required to ensure standards are communicated to students and to ensure compliance with the assignment goals and objectives. As a final project assignment, the wiki is an ideal capstone project that can also illustrate a student’s progress over time. One appealing feature of this format is the ability archive specific SLO’s to meet accreditation requirements as we must move beyond testing for documentation of student learning (Glassman & Kang, 2011) (Roe, 2010). Our experience at SCC illustrated that students can become curators of the information by producing an artifact for public display based on their research. They became ferocious consumers of the information as they transitioned into producers of their own knowledge (Roe, 2010).
References
Banks, J. (2008). Diversity, group identity, and citizenship education in a global age. Educational Researcher, 37(3), 129–140.
Banks, J., Cookson, P., Gay, G., Hawley, W., & et al. (2001). Diversity within unity: Essential principles for teaching and learning in a multicultural society. Phi Delta Kappan, 83(3), 196–203.
Burns, K. (2010). At issue: Community college student success variables: a review of the literature. The Community College Enterprise, 16(2), 33–62.
Glassman, M., & Kang, M. (2011). The logic of wikis: The possibilities of the Web 2.0 classroom. International Journal of Computer-Supported Collaborative Learning, 6(1), 93–112. doi: 10.1007/s11412-011-9107-y
Hazari, S., North, A., & Moreland, D. (2009). Investigating pedagogical value of wiki technology. Journal of Information Systems Education, 20(2), 187–198.
Kamm, B. (2011). Technology Curriculum and Planning: ET-504-Week 5 [Lecture notes]. Chicago, Illinois: American College of Education.
Overall, P. (2010). The effect of service learning on LIS students’ understanding of diversity issues related to equity of access. Journal of Education for Library and Information Science, 51(4), 251–267.
Roe, M. (2010). Wiki technology and the return to rigor. Leadership, 39(3), 20–23.
Royalty free image subscription from 123RF stock photography. (2012).123RF Stock Photos. Corporate. Retrieved from http://www.123rf.com/
Sandhills Community College. (2011). Discover Sandhills – The community’s college. Mission Statement. College. Retrieved February 1, 2011, from http://www.sandhills.edu/foundation/discover-scc.php
Appendix