Radiography (2009) 15, 242e246

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Adopting a blended approach to learning:Experiences from Radiography at QueenMargaret University, Edinburgh

M.M. Cockbain a,*, C.M. Blyth a, C. Bovill b, K. Morss c

a Radiography, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive,Musselburgh, Edinburgh EH21 6UU, UKb Edinburgh and Teaching and Learning Service, University of Glasgow, Glasgow, UKc Centre for Academic Practice, Queen Margaret University, UK

Received 14 February 2008; received in revised form 29 July 2008; accepted 1 August 2008Available online 18 September 2008

KEYWORDSProgramme redesign;Blended learning;Learner centred

* Corresponding author. Tel.: þ44 (0E-mail address: mcockbain@qmu.a

1078-8174/$ - see front matter ª 200doi:10.1016/j.radi.2008.08.001

Abstract The perspective of the radiography teaching team at Queen Margaret University(QMU) was that a transmission mode of programme delivery was sub-optimal in helpingstudents to learn and make links between theory and practice. Programme redesign adopteda blended learning approach with both face-to-face and online learning aimed at enhancingthe students’ control over their own learning. Online tasks within Web Classroom Tools(WebCT) were used as an integral part of careful programme design, which resulted in a pro-gramme enabling synthesis of the skills, knowledge and competencies acquired in theacademic and clinical environments.

With the move towards a more learner-centred, blended educational experience for thestudents the lecturers’ role shifted to that of facilitator with WebCT providing the tutor witha more transparent view of student learning. Lecturers plan learning activities that build uponthe skills students have developed through learning in groups, online and in class.

The explicit connections that now exist between the academic programme and the oppor-tunities for applying knowledge in practice allow students to engage more deeply in theirlearning.ª 2008 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Introduction

Radiography is an ‘active’ profession in terms of its prac-tical application, the different environments in which it

)131 474000.c.uk (M.M. Cockbain).

8 The College of Radiographers.

takes place and the client groups and members of themultidisciplinary health care teams encountered. It istherefore important to provide students with an ‘active’educational experience to prepare them for their profes-sional life and to meet the Standards of Education andTraining.1 Increasingly, expectations within the professionand those of its stakeholders are that radiographers willwork autonomously, demonstrate the ability to analyse and

Published by Elsevier Ltd. All rights reserved.

Adopting a blended approach to learning 243

evaluate the needs of health care delivery, understandroles of other health care professionals and optimisepatient care through using a critical and reflectiveapproach to decision-making.

In higher education the theory and practice of learningand teaching encourages individuals to become autono-mous and take responsibility for developing their profes-sional knowledge and skills and to place value on lifelonglearning.2,3 In order to respond to the external professionalrequirements and those of the university, radiographyprogrammes need to provide opportunities for students tolearn in ways that will increase student responsibility fortheir own learning, reduce their level of dependence onstaff and prepare them for the rigours of the workplace bydeveloping high level cognitive and transferable skills.

This paper outlines significant and substantial changes tothe following three programmes at QMU: PostgraduateDiploma in Radiotherapy and Oncology; BSc (Hons) Diag-nostic Radiography and BSc (Hons) Therapeutic Radiog-raphy.4,5 These changes represent a paradigm shift in theway students learn, with academics undertaking radicalalterations to the way they ‘teach’. These developmentshave been enabled by careful curriculum design whichoptimises the face-to-face and electronic elements ofa blended approach to learning and aims to enhancestudents’ control over their own learning.6

Background and rationale

Before changes were made to programme delivery, it wasthe consensus of the teaching team that students werehighly dependent on staff and often engaged in surfacelearning.7 What was predominantly a ‘transmission’ modeof delivery was not effective. The team therefore felt thata significant shift in pedagogy was required in order toincrease deep learning and enhance autonomy. The pro-gramme needed to become more flexible to be inclusive ofthe varied demands and requirements of learners. Student/staff contact time needed to focus more on high qualitydiscussion and problem solving in order to facilitate studentengagement and deeper learning.8 The staff also wanted tocreate learning communities grounded in principles ofequality and of collegiality, fostering genuine discussionand peer support.

Prior to programme redesign both undergraduate (UG)programmes used a traditional lecture and tutorial approachwith a high level of face-to-face contact between lecturersand students. In addition modules had become so genericthat the level of specialist knowledge and skills being taughtwas not adequate in preparing students for clinical practice.Feedback from clinical placement staff supported this view.Students were failing to make connections betweenacademic and clinical modules. Increasingly academicmodules were not constructively aligned with the students’current level of clinical learning outcome.9

The juncture between development of the pre-regis-tration Postgraduate Diploma in Radiotherapy and Oncologyand the review of the UG programmes offered the oppor-tunity to incorporate some of the emerging ideas aboutblended learning6 and the innovative use of the virtuallearning environment, WebCT.

A blended learning approach to teaching and learningactivities was chosen as it involves the planned combinationand integration of face-to-face classroom activities withlive, directed and self directed e-learning opportunities.This blended approach was not an ‘add on’ to the existingdidactic approach as redevelopment of the programmeallowed for full integration of the online and face-to-faceelements. Additionally the academics believed that effec-tive blended learning facilitates a community of learningand inquiry by encouraging discussion, debate, negotiationand agreement which are seen as attributes of highereducation.10

The new design assumes that independent study throughWebCT will be central to delivery and time with staff will bespent developing high level cognitive, transferable andpractical skills.

WebCT is a powerful electronic environment offeringfresh possibilities for our pedagogical approach. The facil-ities it offers are web-based tools which allow instructorsand facilitators to build and manage learning content andprovide an engaging environment for students. There aretools to facilitate student participation, communication,collaboration, assessment and evaluation, all of which arepivotal in achieving the blended approach to teaching andlearning staff were looking to achieve. If used as an integralpart of careful programme design, it is possible to producea programme which supports synthesis of the skills,knowledge and competencies required in the academic andclinical environments.

Programme redesign

Programme redesign was informed by the key pedagogicaltheories of social learning,11,12 constructivism13 and expe-riential learning.14

Constructivists, as the name implies, view learning asbeing ‘constructed’ on the foundations of prior knowledgeand as an active rather than a passive activity. They seeactive engagement between the learner and what is beinglearnt as a process which adds new knowledge, in a waythat is understandable to the learner, to what they alreadyknow. The constructivist learning environment encouragesthe learner to gain the skills for finding suitable solutions tothe real world problems they will encounter.15 Interactionwith the social environment is also central to the devel-opment of understanding and specifically, interaction withothers is seen to provide the forum for testing under-standing and to view the understanding of others.16

Within the framework of experiential learning, definedas the ‘process whereby knowledge is created through thetransformation of experience’,14 it can perhaps be statedthat everyone has a wealth of experience that can be usedto develop skills.17 Eriksen (2001), in McAuliffe (2001),16

agree, stating that all students bring their experiences intothe learning environment to inform the learning of othersand this type of engagement is important to the redesign ofthe programme. It is this connection with others thatmoulds a community of inquiry as it encourages dialogue ofa reflective nature in both written and verbal forms andthese varied forms of interaction meet the students diverselearning requirements.10

244 M.M. Cockbain et al.

Most professional knowledge is acquired throughuniversity based education and this may be too limited toallow newly qualified graduates to manage the complexproblems encountered in everyday professional practice.The splitting of theory and practice is seen to cause an‘unnatural divide for both professionals and their clients’.18

There has been active collaboration between clinical andacademic staff throughout programme redesign to ensurefull integration of the blended learning model. This hasseen the development of workshops in both clinical andacademic environments utilising staff from both areas ofexpertise in the educational process. Clearly therefore, themodel of choice for curriculum design was ‘constructivealignment’.9 This model states that individual learningresults from what the learner engages in and that teaching/learning activities and assessments must harmonise withthe learning outcomes of the programme in order tosupport that learning. Consequently an enquiry-based,student-centred approach was adopted involving activeengagement between the learner and what is being learnt.Enquiry-based learning inspires students to learn forthemselves and brings a research-orientated approach tothe subject.19

The role of the lecturer was to become that of a facili-tator of learning who should take into account the abilityand prior knowledge of the learners as they set the learningtask.20

Implementation

To increase learner engagement within modules, theWebCT area has been designed to be colourful and attrac-tive in order to interest students and encourage them toexplore the area.

Students are provided with paper and online copies ofstudy guides which outline the modules and clearly stateareas of study for each week of the semester.

They are encouraged to use these as a schedule for studyand as a scaffolding to support their learning.

Developing student autonomy

Enhancing students’ responsibility for their own learning iscrucial within teaching.21 Modules that commence in thefirst year are planned specifically to support early devel-opment of responsibility and autonomy and to introducestudents to the concept of blended learning.

In these early stages there is more face-to-face tutorialtime scheduled to support students to further developresponsibility and autonomy. This allows them to raiseconcerns and ask questions relating to specialist subjectareas and WebCT use. There are handouts and quizzes aswell as task-based discussions that all aim to encouragestudents to become more engaged with the subject as wellas with their tutor and peers. Materials and tasks within theWebCT area are directly relevant to regular tutorialsessions and therefore help to connect student engagementonline with student engagement in the classroom.

Students can, and are expected to, access learningresources within WebCT at times convenient to their indi-vidual learning requirements. For example the inclusion of

a number of narrated PowerPoint presentations within theonline materials, along with accompanying scripts, allowstudents to choose when and how they engage in thesubject matter. It also enables students to revisit thematerial as many times as they wish and is a valuableresource for revision prior to assessments. Because today’sstudent population has diverse needs, they benefit fromflexible access to electronic learning resources inacademic, clinical and off-site environments. Programmeevaluation has demonstrated that the extended access tothese materials is particularly useful to students withspecial educational needs or those whose first language isnot English.

Lecturers also provide tutorial materials online andmake it clear that students are expected to study them andprepare for the face-to-face discussions. With narratedPowerPoint presentations replacing some lectures,students soon realise the importance of using the contacttime with lecturers for useful discussion. A clear messagefrom lecturers early in the programme, and the lack ofcontent-laden face-to-face sessions prompts students toprepare and keep up-to-date.

Developing cognitive and transferable skills

Students learn through online tasks and by having oppor-tunities to use and experience these resources in a way thatbest suits the individual learner.14,22,23 These experiencesprovide students with a framework to learn to analyse andsynthesise their knowledge. Face-to-face tutorials andonline discussion focus on enquiry-based learning withdifficult concepts or challenging case studies provided bythe lecturer or from students’ practice placements. Forexample, they are required to debate and negotiate whyparticular clinical approaches should be adopted by justi-fying their opinions with appropriate evidence. Discussionwith regard to how the radiographer would liaise withcolleagues from a multi-professional team to ensure thebest care for the patient focuses on the patient’s needs andenables lecturers to encourage students to use a wide rangeof knowledge gained in, for example, anatomy or cytology,and connect this knowledge to the reality of the patientexperience. These activities, along with group work tasks,also help develop teamwork and communication skills.

Developing a learning community

The individual construction of learning is complemented bythe communal spaces within WebCT through the use ofinteractive online asynchronous discussions. Discussionshelp students to make sense of their learning within a socialcommunity and examine their own knowledge, skills andviews against those of others. This renegotiating of mean-ings and learning with others is consistent with theories ofsocial learning,11 social constructivist learning in virtualenvironments24 and the concept of learning communitiesand communities of practice. The presence of a communityis essential to stimulate the commitment required bystudents to aid their progression through the stages ofcritical inquiry.12,25 These academic and social communi-ties create a broad peer and lecturer support network for

Adopting a blended approach to learning 245

students that facilitates learning, strengthens linksbetween university and clinical placements and contributesto progress at university through enhanced social andacademic integration.26

Students are often asked what they would like to discussin tutorials. In one undergraduate module studentscomplete a quiz online and then discuss in tutorialsanything they fail to understand. Discussion in class andonline enables lecturers to know the way students arelearning and thereby adjust tutorials to student needs.Student tracking tools within WebCT enable lecturers toascertain how, and how often, students are using the onlinearea and this helps them to respond more quickly and ina more tailored manner to individual needs.

The online format allows the lecturer to review all thediscussions and to give feedback, correcting misconcep-tions if necessary. Students then have the opportunity toappraise their responses against feedback. Some of thiswork is guided by the lecturer and other discussions arestudent-initiated and mediated.

Students initiate requests for help as well as respondingto their peers with support and advice. This is mediated bylecturers who help when needed. Students often offer theirown unprompted help to one another by sharing usefulinformation, reading and websites.

The new programme design aims to provide betteralignment of topics being studied in university and betterapplication of this knowledge in practice. In addition, linksare strengthened between university and the workplacewhere students can access WebCT resources in theirprofessional practice settings. The opportunity for qualitydiscussion and debate with peers and lecturers aspires tohelp students to develop higher cognitive skills throughreflecting on, and making sense of the resources they havestudied online.

Assessment

In line with the adopted blended learning approach,assessment strategies adopt both traditional and on-lineformats as it is not possible that one form of assessment canreliably assess student performance.27 Modules use a widevariety of assessment methods throughout the programmeand where possible, student choice is maximised withinassessments to allow for the varying learning styles of thestudents.

It is important that students achieve professionalcompetencies so assessments are designed to be relevant toreal work situations. However, lecturers have attempted toredesign assessments to be both an assessment OF learningas well as an assessment FOR learning.28

Online quizzes used for formative assessment aredesigned to enable students to judge their own perfor-mance and develop skills of self-appraisal useful for futurelearning.29 The quizzes give students choice about whenand how many times they complete them. Feedback isavailable online, with the quizzes linked directly to face-to-face tutorials where students can ask further questions.Combined with lecturer and peer feedback this formative‘self-feedback’ can be a valuable contribution tolearning.29 Students appreciate being able to use theseavailable resources for revision at the critical stages they

are needed. Where lecturers have removed quizzes to ‘de-clutter’ online areas, students who have failed to completean online formative assessment are motivated enough torequest additional access. A student proactively requestingassessment of any sort would not have occurred in theprevious programme design.

In one module students are required to produce an essaywith set learning outcomes. Each individual studentdelivers a short presentation to their peers and lectureroutlining how they will achieve the learning outcomes.Other groups will often express interest in similar areas ofwork so the students use online and tutorial discussion tonegotiate. The lecturer guides students in ways that mayimprove their designs in order to better meet the learningoutcomes or the student’s own aims.

Students have opportunities to practice key skills inimage interpretation through links to high quality elec-tronic images. Using these resources, they can practicediagnostic skills online with opportunity for repetition,practice and revision until they develop confidence in theirskills. Discussion in tutorials offers students an opportunityfor formative feedback before having to interpret radio-graphic images in examination conditions.

Many departments now use digital and/or computerisedtechnology to capture images and students are currentlyrequired to interpret images in both traditional and digitalformats. Digital images are smaller than the traditionalformat so increased image interpretation skills are requiredto detect subtle abnormal variants. Before introducingsummative Objective Structured Pattern Recognition andImage Interpretation Examinations (OSPRIIE) in an elec-tronic format via WebCT, students were only assessed ontheir interpretation of the traditional radiograph. The newstrategy mirrors clinical practice in a modern electronicenvironment. This does not, however, totally exclude theuse and interpretation of traditional radiographs which areutilised throughout the professional modules and in imageinterpretation workshops.

Conclusion

There is no one ‘right’ media for the delivery of any pro-gramme as each has its own drawbacks. It could be arguedthat the main one in the redesigned programme is the lackof social interaction that takes place in a conventionalsetting. However, the perspective of the radiographyteaching at QMU was that the previous lack of alignmentbetween academic and clinical modules was not optimumin helping students to learn and make links between theoryand practice. The explicit connections that now existbetween the focus of the programme in university and theopportunities for applying knowledge in practice allowstudents to engage more deeply through applying theirknowledge of the subject in practice. On-going evaluationof learning is taking place and the results of this evaluationwill be published.

Students can choose when and how to engage as pro-grammes change from the old style lecture and tutorialformat to an emphasis on blended learning. Studentsengage in these tasks individually or collaboratively andconstruct their learning in ways that are more individuallymeaningful. Lecturers now plan learning activities that

246 M.M. Cockbain et al.

build upon the skills students have already gained throughtheir awareness of how students are learning in groupsessions, online and in class.

Traditionally a lecturer can only assess a student’slearning through their finished products, through thequestions they ask, their absence from class, or their finalengaging presentation. However, through online discussiontools in WebCT, lecturers can see more clearly whichstudents are engaging deeply in learning, which studentsare really struggling and the level of contribution differentstudents demonstrate. Lecturers can gauge when to offermore support and when to leave students to work things outfor themselves.

With the move towards a more learner-centred, blendededucational experience for the students, the lecturers’ rolehas shifted to that of a facilitator and has enabled staff tohighlight to students that if they come unprepared fortutorials, the facilitator has no role. As a facilitator thelecturer can draw on their own experience and knowledgeto move discussion onto higher cognitive levels.

Staff have realised that ‘WebCT doesn’t do it for you’.The use of a virtual learning environment often brings earlyexpectations that the online nature of work will mean lessteaching and more free time. As staff realise how muchmaterial they need to pre-prepare, how often they need toaccess online discussions and assessments, this is in fact notthe case as time is just allocated differently.

To implement such change is an evolutionary processrequiring constant evaluation, revisiting and revising.Communication between all involved is essential for itssuccess. Adopting a blended approach to incorporating on-line teaching strategies is a cultural change for bothstudents and academic staff and commitment by all isparamount to the successful implementation of an effec-tive electronic learning environment with positive supportat subject and institutional level essential in enabling thesechanges to take place.

Conflict of interest

The authors have no conflict of interest.

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