The Problem Radiation Biology (BIO 433) is taken by radiation therapy and nuclear medical technician students. Students enter the course with a variety of backgrounds and experiences, and will begin clinical work the following semester. The course focuses on fairly technical aspects of the properties of radiation, how it impacts with living tissues, and potential side effects on whole organisms. The radiation doses these students will be using to treat cancer are just below a lethal dose, and there is a significant risk of serious side effects on patients even if used properly. To help students see the relevance of the theoretical concepts case studies will be used in the course. One concern in the course is that we focus on the effects of radiation on molecules and cells, and that the students may not connect this with the fact that these cells are part of a patient's body. The doses of radiation being delivered, especially in radiation therapy, can cause serious damage. Goals of the project: Use a case study to help students to apply their knowledge of how radiation affects living organisms to a realistic case. Develop enhanced empathy for their patients to improve the care of their patients and the students attention to detail when providing therapy. Reflect on their progress and development as a health care provider. Summer 2008

Evidence of Student Learning & Methods of Analysis A discontinuous case study will be used that includes both diagnostic and therapeutic radiation treatments to diagnose and treat thyroid cancer. The case study will also include both short-term and long-term side effects of exposing patients to radiation. Students will be asked to describe and explain how radiation is being used therapeutically and diagnostically, and to explain the cause of the side effects. They will then be asked questions to measure their empathy towards treating patients with radiation and concerns of their own personal safety. The case study will be administered both the first and last days of class and evaluated with a rubric to test for understanding of content, ability to apply theoretical concepts to explain the case. Grounded theory will be used to measure the depth of empathy for their patient. Students will be given both drafts of their case study and given an opportunity to reflect on how their answers changed over the semester. A form with questions to guide their reflection will be provided, and their responses collected. Finally, students will be broken into groups of 6-8 students with a designated discussion leader and recorder to discuss their responses and identify any trends in their experiences. These group discussion reports will also be collected. In the final course survey a question allowing students to comment on the process of integrating case studies and reflection on their learning will be administered. Fall 2008 Radiation Biology Case Study

Project Summary Case studies are commonly used in medical education as a way for students to practice making diagnoses. In this project a case study will be given on the first and last days of class. The case will focus on both the diagnosis and treatment of thyroid cancer using radiation in the student's grandmother. Their grandmother was chosen to make them a third party advocate in the case, i.e. the students are not the patient or provider, but are hopefully empathetic for the patient. At three points during the case, the students will be asked specific questions on the theory and application of the clinical use of radiation. In addition the students will be asked about any concerns they may have in exposing patients to radiation. After performing the case the second time, the students will be given their case study responses from the beginning of the semester and asked to reflect on how their answers changed. They will then discuss this as a group to look for common trends. A student will act as secretary at the discussion, recording the comments made by their peers. Spring 2009

Annotated List of Helpful Resources & References Schneider-Kolsky, Michal; Wright, Caroline; Baird, Marilyn. Evaluation of selection criteria for graduate students in radiation therapy. Medical Teacher, 28:8, p214-219, 2006. Belinsky SB, Tataronis GR. Past experiences of the clinical instructor and current attitudes toward evaluation of students. Journal Of Allied Health, 6, pp. 11-6, 2006. Dawson C. Hypertension, perceived clinician empathy, and patient self-disclosure. Research In Nursing & Health, 8:2, pp. 191-8, 1985. Razavi D, Delvaux N, Marchal S, Durieux JF, Farvacques C, Dubus L, Hogenraad R. Does training increase the use of more emotionally laden words by nurses when talking with cancer patients? A randomised study. British Journal Of Cancer. 87:1, pp. 1-7, 2002. Smith, Karen; Clegg, Sue; Lawrence, Elizabeth; Todd, Malcolm J. The Challenges of Reflection: Students Learning from Work Placements. Innovations in Education & Teaching International. 44:2, p131-141, 2007. Lowe, Mandy; Rappolt, Susan; Jaglal, Susan; MacDonald, Geraldine. The Role of Reflection in Implementing Learning from Continuing Education into Practice. Journal of Continuing Education in the Health Professions. 27:3 p143-148, 2007. Pavlovich, Kathryn. The Development of Reflective Practice through Student Journals. Higher Education Research and Development. 26:3, p281-295, 2007. Clegg, Sue; Bradley, Sally. The Implementation of Progress Files in Higher Education: Reflection as National Policy. Higher Education: The International Journal of Higher Education and Educational Planning. 51:4, p465-486, 2006. Morgan, Jane; Rawlinson, Mark; Weaver, Mike. Facilitating Online Reflective Learning for Health and Social Care Professionals. Open Learning. 21:2, p167-176, 2006. Mok, Magdalena Mo Ching; Ching, Leung Lung; Cheng, Doris Pui Wah; Cheung, Rebecca Hun Ping; Ng, Mei Lee. Self?assessment in higher education: experience in using a metacognitive approach in five case studies. Assessment & Evaluation in Higher Education. 31:4, p415-433, 2006. Smith, Karen; Clegg, Sue; Lawrence, Elizabeth; Todd, Malcolm J. The challenges of reflection: students learning from work placements. Innovations in Education & Teaching International. 44:2, p131-141, 2007. Ottewill, Roger; Demain, Sara; Ellis-Hill, Caroline; Greenyer, Corinne Hutt; Kileff, Joanna. An expert patient-led approach to learning and teaching: the case of physiotherapy. Medical Teacher; 28:4, p120-126, 2006. Fall 2008

Preliminary Results, Findings, Conclusions, & Implications Students showed a statistically significant improvement in scores in all areas measured with the exception of diagnostic vs. therapuetic uses of radiation and concern about exposing others to radiation. The initial score for the first question was very high, so there was not much room for improvement. The question on concern had the lowest average of all questions, and did not change after the course (Figure 1). Analysis of student written responses to their concern about exposing others to radiation using Grounded Theory revealed that the numbers of students expressing concern dropped in half after the course. Students expressing concern were more likely to mention personal responsibility in what happened to a patient, and mention complications. In contrast, those indicating no concern were more likely to use phrases that deflected responsibility to other team members or rules and regulations, or to mention precautions that could be taken or the benefits to the patient (Figure 2). There was an overall positive trend in student confidence on understanding the theory behind radiation biology and their ability to work safely with radiation (Figure 3). In reflecting on the areas in which the students felt they improved the most in their pre and post surveys, they reported the most improvement in technical aspects of the course such as the importance of dose fractionation and function of certain isotopes. The students reported improvement the least often on questions dealing with concerns about side effects faced by the patient (Figure 4). Overall students seem to focus more on the technical aspects of the course rather than how the treatments affect an individual. Summer 2009 Figure 1 Figure 2 Figure 3 Figure 4

Career Relevance & Impact The WTFS SoTL project was a very valuable experience at this point in my career. I had published several peer reviewed SoTL articles, mostly focusing on how specific teaching methods impact student problem solving ability. This project was interesting, as it allowed me to focus on aspects of student learning not typically addressed in science courses, in particlular assessing affective learning objectives. I could not have done this without the help from colleagues and instructors from the multiple disciplines assembled for the WTFS program. Being able to discuss student learning with a diverse group of instructors not only highlights many of the similar challenges we face in the classroom, but allows cross-pollination of ideas and effective teaching practices. Spring 2009