The SPICES Model: Educational Strategies in Curriculum Development

Ronald Harden developed a model that places the curriculum of a medical school along a spectrum of six educational strategies (1). This model, known as SPICES (an acronym for the six strategies) can be used in curriculum planning and development, in resolving problems within a curriculum, and for guidance in teaching methods and assessment. Teachers can use this model in curriculum analysis, review and development. This entry will look at an overview of the model.

Harden came up with this model after recognizing that newer medical schools were adopting innovative teaching methodologies when compared to older and more established programs. For example, McMaster University has been a leader in innovative educational developments, using student-centered learning, integrated teaching and community-based curricular models. They do so to meet the needs of the community in which their graduates will serve, and in which they are themselves located.

The six curriculum issues fall as follows:

Student- centered ----------------------- Teacher-centered
In a student-centered approach, students take more responsibility for their learning. In a teacher-centered approach, the teacher is the key figure and there is an emphasis on formal lecture or laboratory.

Problem-based ------------------------- Information gathering
This contrasts a model of learning based upon problem-solving to develop a usable body of integrated knowledge and problem-solving skills versus one that stresses the acquisition of facts, concepts and principles.

Integrated ------------------------------ Discipline-based
Integration is the organization of teaching mater to inter-relate subjects taught in different academic courses or departments. Discipline-based teaching centers around focus on classical coursework, such as anatomy or physiology, with clinical care coming later in the program.

Community-based -------------------- -- Hospital-based
Though this relates more to medical education than chiropractic education, the traditional hospital-based approach focuses teaching within the main teaching hospital, while community-based education allows students to receive their training in a community setting.

Electives -------------------------------- Standard program
Electives give students the opportunity to select subjects or projects of their own choosing, while in the standard program all the courses have been prescribed and all students must pass through them with little chance to find subjects of their own choosing.

Systematic ------------------------------ Apprenticeship-based (or opportunistic)
The traditional medical approach involved apprenticeship training where a student trainee would be “bonded” to a “master” and acquire skills by working for him (think House, MD on television). In a systematic approach, a program is designed for all students so that the experiences for their training are therefore covered.

All medical and chiropractic colleges can locate themselves somewhere along the continua noted above. Harden himself notes that it is not possible to state where along each spectrum would be the best location. And he further notes that positions at the extreme right or left of each strategy are likely not appropriate. But he does feel that these strategies offer teachers many advantages. I will take that up in a future post.


REFERENCES

1. Harden RM, Sowden S, Dunn WR. ASME Medical Education Research Booklet No. 18. The SPICES Model. Med Educ 1984;18:284-297

Quality Television (Not Educationally Related)

As we get toward the end of another term, and as the combined weight of all out efforts begins to bear down on us, I thought I would take one blog entry and not write about education, research, evidence-based practice, or educational technology. Instead, I wanted to focus just bit on passion, in the sense of each of us finding something we can be passionate about. I remember that when Dr. Christine Choate had just arrived at Palmer College and was holding an initial meeting of the research department, she asked each of us to talk about something we collected. What came out of that ice breaker went far beyond just being a set of interesting comments. We learned about each other that day, and found a depth and breadth of interests that was surprising in how people’s interests lay. I suspect that the same would be true were I to poll each of you. But in this case, I’ll offer up my own comments on one of my passions, quality television.

Let me start by saying that I don’t really watch TV like other people do, or so I believe. Of course, it is one way of relaxing at the end of a long day, but I do not view TV as a form of escapism. Instead, it is a form of investment. You see, for me, the characters are everything, not the plot or storyline; I invest in the character. You can view a program such as CSI: Crime Scene Investigators as a forensics procedural, or you can view it as a continuing story involving the growth of the characters. For me, it is the latter, and it is that fact that brings a deeper reading of the show to my pleasure in watching it. But hold that thought.

The writer Kristin Thompson defines quality television as having "a quality pedigree, a large ensemble cast, a series memory, creation of a new genre through recombination of older ones, self-consciousness, and pronounced tendencies toward the controversial and the realistic" (1) From modern perspectives, the program most people would define as quality television is HBO’s The Sopranos. But this is not the program I view as exemplifying quality television. I have another in mind.

For anyone who knows me, that program would be Buffy the Vampire Slayer. Okay, so now we have a blog post dedicated to chiropractic education that is singing the praises of a now-cancelled television program about a teen-age cheerleader who is the one person in the world to fight off the threat of vampires. So sue me. :-) What makes this program quality television is that it has probably the best written scripts in TV history, scripts which exhibit self-awareness and memory, so that little bits that appear early in season 2 turn out to have major implications in season 5, where the characters grow, where good and evil are not dichotomous, where everything is shades of grey. Where the episodes range from the hysterically funny to the bone-crushingly painful and poignant, and where everything that everyone does has implications that later have to be addressed. It is no wonder that a cottage industry has arisen around the academic study of Buffy; there is a major online journal devoted to it (http://www.slayageonline.com/), many books, and yearly conferences which are attended by scholars in philosophy, religion, media studies, cultural analysis, film and video, etc. And still it remains hard to get people to see past the name of the program, which is the primary reason people do not watch. Yet, it is rich viewing.

Last year added a new program to my list of quality television. This was the spectacular HBO program In Treatment, which was an experimental series that revolved around the patients seen by a cognitive therapist, Paul, played by the actor Gabriel Byrne. The conceit was that the program was broadcast 5 days a week (weekdays), with each day of the week dedicated to a different patient: Monday was Laura, Tuesday Alex, Wednesday Sophie, Thursday Jake and Amy, and on Friday, Paul himself sees his own former mentor Gina. So the program required commitment from viewers since the storylines, while each able to stand alone, made better sense and had better resonance when viewed in total, since events that occur during the course of therapy in one patient have implications for what happens when Paul sees his other patients and in how he relates to his wife. The acting was superb, and Diane Wiest won an Emmy last week for her portrayal of Paul’s therapist Gina. But the break-out role was played by young Australian actress Mia Wasikowska as Sophie, a truly damaged young gymnast whose story goes nowhere you think it will. This is the mark of quality television; you know all the tropes (young gymnast who won’t eat equals anorexia… except, it doesn’t) and the program subverts them. (PS. The DVD arrives in mid-October).

In my pantheon of quality television, I would include Buffy, In Treatment, The Sopranos, The Wire, The X- Files, CSI: Crime Scene Investigators (Las Vegas only), NYPD Blue, The West Wing, The Simpsons, Six Feet Under, Deadwood, and Lost (which actually I dislike intensely). And truth is, when I watch, I am looking not only at the story, the characters, the memory and everything else, but for material I can even build into my lectures, presentations and professional writings. It’s the best of all worlds.


REFERENCES

1. Cited at http://72.14.209.104/search?q=cache:Mu4rK9VuVDcJ:davidlavery.net/Essays/50_Key_Buffy.pdf+quality+television&hl=en&ct=clnk&cd=191, accessed September 29, 2008

Qualitative Research, Part 4

In this last entry on qualitative research, I’d like to turn my attention to the concept of rigor. Here, we are referring to issues raised by the terms validity and reliability. And we are more familiar, and more comfortable, with what these terms mean when contextualized in a quantitative setting, where we look at questions about whether an instrument we are using actually measures what we claim it measures (such as a pain scale measuring pain) or whether we would get the same outcome in the same patient using the same instrument. But it is much harder to apply these terms to qualitative research. They have to be conceptualized differently in this setting. As Liamputtong notes, “At the heart of the problem with the concepts of validity and reliability in qualitative research is the relationship between the observer and observed ‘reality’.” (1) This is a significant issue when one considers postmodern concepts of reality, where the claim is made that there is no such thing as an observed reality, we are all observers.

In qualitative research, there are 4 approaches to rigor: naïve realism, interpretive realism, postmodernism and hermeneutic realism.

▪ Naïve realism: In this approach, to be rigorous is to ensure that the research describes what is really there in the real world and that this is something one can do repeatedly. You will see this immediately captures standard definitions of validity and reliability. The general idea here, as embodied in positivism, is that there is a reality that exists external to the observer. This reality is fixed and is not influenced by its being observed (so, this is not necessarily the case at the level of quantum physics, for example). It is felt that this particular approach to rigor contains flaws; for example, what do we mean by a fixed reality when we are discussing someone’s culture? Is “culture” objective and unchangeable? When we study people, it is much harder to support a positivist approach, as we are studying people’s lived experiences- which mean something different to each person.

▪ Interpretative realism: In this approach, rigor revolves around the study of social relations, taking subjectivity into account but trying to minimize its effects. This form of rigor is an outgrowth of phenomenological sociology, where the idea is for researchers to try to be “value free” in their studies. This is often seen as the most common approach to the problem if rigor in qualitative research, in that it is closest to trying to use the methods of quantitative research as its goal. It is also often called “postpositivism.”

▪ Postmodernism: In this approach, the entire idea of rigor is rejected; or, it is entirely recontextualized as demonstrating the absence of a relationship between reality and a study’s findings. Postmodernists posit that there is no independently knowable reality; knowledge is based on assumptions and our interpretations and is constructed by us. Now, the extreme edge of this approach is known as radical relativism, which argues that that all beliefs and interpretations are equal since there is no objective reality to which we might make comparisons, but I note that this is the radical edge, and most postmodernists are not willing to take issues this far. For example, we can ask what “gender” means. How do we answer? Is it as simple as “male or female?” What does it mean to be masculine? In the United States, it might mean one thing; in Sub-Saharan Africa another. In many ways, we construct the answers to these questions, based on our own assumptions. But with regard to qualitative research, if we accept multiple interpretations of reality, how does that then affect validity? The questions asked here are important, are now part of our “culture wars” but need to be seriously considered in qualitative research settings.

▪ Hermeneutic realism: This approach notes that research does give us information about events in the real world, but also notes that we must consider the political and socially constructed nature of the findings. It rejects the notion from naïve realism that knowledge is something whose validity can be known with certainty; it is comfortable in living with uncertainty. It does attend closely to the political implications and import of research, because our knowledge of the findings is always colored by our culture and is therefore socially constructed.

All the above are just short introductions to detailed discussions about the philosophical basis for rigor in qualitative research. They help demonstrate that conducting qualitative research requires different considerations in developing rigor; given that most of us are more familiar and more comfortable with quantitative research, should we wish to use qualitative methods it will help us understand the context in which our research should proceed. With this short few entries, I hope I have piqued your interest and you will consider conducting such a study.


REFERENCES
1. Liamputtong P, Ezzy D. Qualitative research methods, 2nd edition. South Melbourne, Australia; Oxford University Press, 2006

Qualitative Research, Part 3

The objectives of sampling in qualitative research differ from those in quantitative research. The reason for that difference is that with qualitative research we are not concerned with our ability to generalize the information we collect to a larger population, which is the entire point of the sampling methods used in most quantitative studies. The sampling in qualitative research is called “purposive.” This means that it is intended to describe the processes of a phenomenon, and not its distribution. Our goal is to obtain information-rich cases that allow us to look in-depth into the phenomenon our study is examining. Again, the entire idea is to look at interpretation and lived experience.

Liamputtong and Ezzy (1) list a number of different sampling methods that may be used in qualitative research. They include the following:

▪ Extreme or deviant case sampling: where we select cases that are unusual or distinctive in order to illustrate the processes under examination.
▪ Maximum variation sampling: where we try to select cases that provide for wide ranges in the experience or process under examination.
▪ Homogenous group sampling: here we select a sample to minimize variation and to maximize homogeneity to getter better depth in the process under examination.
▪ Typical case sampling: where we select a case because it is not in any way unusual or atypical.
▪ Critical case sampling: where cases are selected to illustrate processes where the processes would be thought least likely.
▪ Criterion sampling: all cases meet some set of pre-specified criteria. This allows in-depth study of a phenomena, providing rich information.
▪ Stratified purposive sampling: where we select cases from some previously identified subgroups.
▪ Snowball or chain sampling: where after identifying an initial group of respondents, we ask them to suggest other possible participants.
▪ Opportunistic sampling: where as a project develops and as new information is discovered, opportunities to go in new directions arise that are taken advantage of.
▪ Convenience sampling: where we invite whomever we can easily locate and involve. It is often confused with purposive sampling, but Liamputtong and Ezzy (1, p. 49) note that this is a mistake because it does not theorize the sample.
▪ Volunteer sampling: where we obtain participants by advertising for them.
▪ Triangulated sampling: we can combine any of the above as strategies for creating our project develop.

As always, the best method to use is the one that best helps you answer the questions you are asking. It is the best tool for the situation, and the decision to use sample method as opposed to another will be driven by the needs of your project.

REFERNECES
1. Liamputtong P, Ezzy D. Qualitative research methods, 2nd edition. South Melbourne, Australia; Oxford University Press, 2006

Qualitative Research, Part 2

Qualitative research places interpretation at the center of activity. What we are looking at is how people interpret and give meaning to their experiences and actions. There is a quote by David Karp that provides insight into this process. In his work, he was looking at depression and had this to say: “I’m not primarily interested in explaining what causes depression or how to cure it because I don’t think anyone can answer those questions. Instead, I’m interested in how depressed individuals make sense of an inherently ambiguous life situation. I’m interested in how a depression consciousness unfolds over time, how people think about psychiatry and medications, and how they deal with family and friends.” (1) He as not gathering quantitative data via, for example, a survey that asked specific questions, but instead was interested in how people interpret what it means to suffer from depression. Quantitative methods simply cannot address that question.

Rossman and Rallis (2) summarize the common features of qualitative research: that it occurs in the natural world, that it has a focus on content, that it may use multiple methods, that it is emergent and that it is interpretive. It is also worth noting that qualitative studies may often lead to quantitative studies as the basis for human belief emerges from the study of how they experience their world. What does it mean to the patient when he or she checks off a score of 6 on a Visual Analogue Scale? If I check a 6 and you check a 6, does it mean the same thing to both of us? This is not a question you can answer using quantitative statistical means.

Liamputtong and Ezzy (3) state that there are three questions which much be answered at the outset of any qualitative study. The first is, what is the theoretical framework within which the study is being conducted. The second is, what is the substantive issue being researched. The final question is, what are the desired outcomes of the study? These are all inter-related questions, and no single one of them has priority over the other two. However, the manner in which the research is conducted relates very much to the framework, and a future entry will look at some of the theoretical frameworks for conducting this interesting form of research.

REFERENCES
1. Karp D. Speaking of sadness: depression, disconnection and the meanings of illness. New York, NY; Oxford University Press, 1996
2. Rossman GB, Rallis SF. Learning in the field: an introduction to qualitative research, 2nd edition. Thousand Oaks, CA; Sage Publications, 2003
3. Liamputtong P, Ezzy D. Qualitative research methods, 2nd edition. South Melbourne, Australia; Oxford University Press, 2006

Qualitative Research: An Introduction

If you look at the rubrics which comprise part of the process of applying for promotion to associate or full professor, you will see that there are separate entries for the publication of research papers, divided into quantitative and qualitative research. While most of us are more than familiar with standard quantitative research, we may be less so with regard to qualitative studies. Yet certain information can only be gleaned using qualitative methods, and so I hope here to spend a short amount of time describing a bit about this form of research.

In quantitative studies, we gather information that is converted into numbers, so that the data can be statistically analyzed. A simple example would be to conduct a study where we look at changes in pain scores before and after a chiropractic adjustment. Using statistical methods, we would derive a mean pre-adjustment score, and then a mean adjustment score, and perhaps we would then compare these pre and post scores to a second group of individuals who received a different intervention. The appropriate statistical methods would allow us to test the strength of our hypotheses and determine whether our results reached statistical significance. This is the kind of research we are familiar with. But embedded in this research are other questions. For example: what does it mean to the patient that his or her pain score improved by 2.4 points? We learn nothing about the lived experience of the patient in this study.

What qualitative research does is “elicit the contextualized nature of experience and action, and attempts to generate analyses that are detailed, ‘thick,’ and integrative (in the sense of relating individual events and interpretations to larger meaning systems and patterns).” (1) We are focused, in qualitative research, on meaning and interpretation. It is a method to help us understand what meaning people ascribe to their behaviors and actions. This is not something that can be addressed using statistical methods. Instead, we need to use different methods, equally rigorous in comparison to quantitative research, but appropriate to the kinds of questions we ask in qualitative research. As Liamputtong notes, “ Metaphors, meanings and interpretations require the more fluid, but no less rigorous, methods employed by qualitative research.” (1)

We can conduct a study that shows that people with back pain are more depressed than people without back pain’ statistics can clearly show a link between back pain and depression. But why are people with back pain depressed? Can a survey be sufficient to answer that question? Or, can we drill deeper? Qualitative methods can provide us the means to do so.

I will follow this entry with more information on qualitative methods. Hang tight until then.


REFERENCES
1. Liamputtong P, Ezzy D. Qualitative research methods, 2nd edition. South Melbourne, Australia; Oxford, 2006:2

Learning Styles

The tendencies and characteristics that students use in their learning are known as learning styles. These styles may influence how students learn, as well as how instructors teach. Understanding something about learning styles may help instructors create the most effective learning environment and impact their instructional design. I think we are already aware, from our learning objective development process, that learning styles are combinations of cognitive, affective and physical factors, which are then used to use to help the student navigate through the learning process. As defined by Sadler-Smith a learning style is “a distinctive and habitual manner of acquiring knowledge, skills and attitudes through study or experience.” (1)

There have been a number of attempts to classify learning styles. As early as 1966, Hudson (2) made a distinction between convergers and divergers. Convergers generally followed linear thinking, using a step-by-step approach to arrive at the “right” answer. The diverger was more fluid and flexible, approaching a problem from a number of different directions, some of which might be quite novel. He felt that convergers would learn best from convergent teachers, and divergers from divergent teachers. Pask (3) used this model to develop his own, breaking learning styles into holists and serialists. The holist used an overarching conceptual framework to help contextualize learning, while the serialist learns in a piece-by-piece fashion, creating knowledge out of smaller pieces of information. Holist learning is mainly associated with art training, while serialist learning would more characterize the average medical or chiropractic setting. Kolb (4) took these 2 approaches and used them to devise his own, which involves divergers and convergers, as well as assimilators and accommodators. In his model, the divergers uses creative ideas and diverse views, the converger is good at problem-solving and implementation, the assimilators uses inductive reasoning to generate theory and integrate ideas, and the accommodator actively applies knowledge but adapts to changing circumstances. These were used to develop Kolb’s Learning Styles Inventory, which was later used to develop The Learning Styles Questionnaire of Honey and Mumford (5). This tool is still used today.

When we begin to ask how we can best develop deep learning in our students, one of the components we need to look at is the styles of learning students use. It is a challenging environment to do so. Certain technologies that younger students use today did not exist when many of us had our undergraduate, graduate or teacher training. This includes the presence of the web, and of instructional platforms such as BlackBoard and WebCT. We have to adapt to these technologies and we can do so most effectively when we understand how our students learn.

REFERENCES
1. Sadler-Smith E. Learning style and instructional design. Innovations Educ Training Internat 1996;33:185-193
2. Hudson L. Contrary imaginations. New York, NY; Penguin, 1966
3. Pask G. Styles and strategies of learning. Br J Educ Psych 1976;46:128-148
4. Kolb DA. Experimental learning experience as a source of learning and development. London; Prentice Hall, 1984
5. Honey P, Mumford A. Using your learning styles. London; Maidenhead, 1986