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Distributed Regulation Workshop

Susanne P. LajoieMcGill University

PhD Candidate Eric Poitras

MD, MA Candidate Dr Kevin Waschke

PhD Candidate John Ranellucci

PhD Candidate Ilian Cruz-Panesso

PhD CandidateLaura Naismith

Research AssociateDr. Jeff Wiseman

Principal InvestigatorDr. Susanne P. Lajoie

PhD Candidate Yuan-Jin Hong

MA Candidate Tara Tressel

MA Candidate Maedeh Kazemi

MA Candidate Christina

Summerside

PhD Candidate Mandana Bassiri

ATLAS LAB

MA Candidate Lila Lee

Outline

Definitions of shared or distributed regulation Examples of distributed regulation from our

data in medical problem solving What analytical techniques were used?

Definitions

SRL, metacognition and co-regulations Shared Mental Models

Definitions:Self-Regulation, Metacogniton and Co-

regulation Metacognition-private cognitions influenced by social

experiences (Hacker & Bol, 2004; Salonen, Vauras & Efklides, 2005)

Co-regulation: Social environment supports individual participation and learning (McCaslin, 2004) Requires awareness of own metacognitive experience as well as that

of partners engaging in task (Salonen et al.) Sociocognitive and affective behaviours intersect ---co-regulation

may decline when imbalances occur due to understanding (low prior knowledge) or content or mismatch in relations (bossy vs wallflower)

Groups can be multiple self-regulating agents that socially regulate each other’s learning (Volet, Summers & Thurman, 2009)

Definitions: Co-Regulation Volet (2009)—continuum of social regulation from individual

regulation within group to co-regulation as a group; calls for coding both social and content

High level Content processing: can be observed within an individual or group as : elaborating, interpreting, reasoning, building on ideas, explaining in one’s own words or help seeking for understanding

Low-Level Content processing: seeking help for details or facts, reading verbatim from text

Individual regulation features one speaker, co-regulation represents verbal contributions from multiple group members

Shared understanding of task goals and relevant knowledge (Orasanu, 2005;Klein et al., 1993;Cannon-Bowers, Salas & Converse, 93); shared explicit communication (closed loop communication- that once SMM developed communication can decrease); situation-specific metacognitive skills (awareness of what is needed in dynamically changing situations; mutual trust that “others” are doing their job.

SMM in medicine: shared understanding of goals, plans and actions for managing the patient effectively, shared situation awareness requires both metacognition and co-regulation

Mutual Trust

Definition: Shared Mental Models

Examples

Example 1. Co-regulation in collaborative groups solving a role play in technology and non-technology supported setting (Lajoie & Lu; 2006; Lu, Lajoie & Wiseman, 2007)

Example 2. Co-regulation in problem based learning activity (Hmelo et al.,2012; Lajoie et al,2012)

Example 3. Shared Mental Models in Trauma Team (Cruz-Panesso, Lajoie & Lachapelle, 2012.

EG in stage 2

EG in stage 3

EG work on the laptop

CG is discussing

ReceiverExample 1: Co-regulation in collaborative groups technology and non-technology supported (Lajoie & Lu; 2006; Lu, Lajoie & Wiseman, 2007)

Coding

Based on the Volet’s assumption that groups can be multiple self-regulating agents that socially regulate each other’s learning

Group discourse analyzed by speaker turns and for episodes that revealed metacognitive activity (planning, executing, monitoring, evaluation, elaboration) adapted from Meijer, Veenman & Van Hout-Wolters, 2006)

Analytics

Each metacognitive activity coded and converted to percentages per group for comparisons

Summed the total number of turns coded and divided by the total number of turns in the transcript. To calculate percent of different metacognitive activity types, we divided the sum of each type by the total number of codes for each transcript

Example 2: Co-regulation in PBL

Analyzed individual and group discourse using Volet’s framework High and low content processing Co-regulation and individual regulation

Coding unit: coded an episode with more than 2 speaker turns that have similar topics

Lajoie, S. P. Teaching and Learning through TRE's.

Presented at SALTISE, 2013

AdobeConnect- PBL dialogues with medical tutors in Canada and Hong Kong: Learning Objective was to learn how to communicate bad news to patients

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V: And of course, we have to note the emotion and the condition of the patient. [ELABORATING]M: So what do you mean on knowing the emotion, could you expand that a little bit? [HELP SEEKING FOR UNDERSTANDING]V: Say if the patient enters in the consultation room, and she is very depressed, so may be at that time, it may not be appropriate for us to break the news at that moment. [ELABORATING]M: Ok, so then once you have right setting and knows the emotion of the condition of the patient then what would you do? What kind o things that you would have to start to say? [HELP SEEKING FOR UNDERSTANDING]E: I think it would be good before getting straight to the bad news, you ask any questions that you might need to ask, like new symptoms or complaints or anything, because once given any bad news then it would be very difficult after that point to ask them relevant questions or gather information that you might need. [REASONING]K: Also perhaps, ask the patient what her expectation of the consulation is. [BUILDING ON IDEAS]M: Yeah, it makes a lot of sense. [AGREEMENT]E: I think I would also ask the patient what their concerns are, or depending on the test that you would’ve done, of course. But ar, in most cases I think it is something or information you cannot get after you gave the bad news. [ELABORATING]K: Maybe also ask the patient being accompanied by anyone, so that there’ll be a spouse, or a son, or daughter outside the consultation room, which might be of use later. [BUILDING ON IDEAS]

High-Level Co-Regulation

SVM

Regulation Low vs. High Content

High-Level Co-Regulation

EK

W

InstructorStudent

M K E V W0

1

2

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LowHigh

K: Yeah. [NO CODE] W: Couldn’t hear you, K. [NO CODE] K: Yes yes, I can, I am thinking about it, I too agree there’s

like everything are all three ideas, facts, and learning objectives are there but um… see the thing, I am not quite sure is some of the ideas but is actually I think is a fact, because it works like it is being documented in literature lots of doctors practice it and and and that’s what separates an ideas from facts, that facts is when idea is being exercise and brings results and it becomes facts like you can document it. So I mean, some of the points being proposed that sounds a bit more factual to me, but well for, it’s to mix with idea and certainly learning objectives. [REASONING]

High-Level Individual Regulation

SM K E V W0

1

2

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LowHigh

VM

Regulation Low vs. High Content

High-Level Individual-Regulation

EK

W

InstructorStudent

L: So [NO CODE] K: Sssso [NO CODE] L: Establish the connection with patient obtain patient’s

expectation, demonstrate empathy, okay um, what are the actual, what are other points that we have um covered. Ar, sensitivity to the patient, I think K also mentioned that right? [REPEATING]

K: Ar…Yeah, well, just adjusting your sensitivity before hand or something. [REPEATING]

E: I can ar, ar put at the top. [CLARIFYING] L: so so it’s a [NO CODE] K: um [NO CODE] L: um [NO CODE]

Low-Level Co-Regulation

SVM

Regulation Low vs. High Content

Low-Level Co-Regulation

EK

L

InstructorStudent

M K E V L0

1

2

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4

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LowHigh

K: Yeah. [NO CODE] V: That’s perfectly fine, maybe I can start first because that is me who

talk about it at the moment. Well, um maybe we can go through them one by one. The first one is “S”, is means the setting of the environment, which is already mentioned by E yesterday, and I think um, and many literature um um has documented that setting up an appropriate environment is important for breaking a bad news because a comfortable environment can help the patient to um prepare for what he is going to perceive. And the second thing “P” stands for perception, that means um the patient’s perception um because um this is important because um before we really um go to into the bad news we have to assess the patient how he or she feels that would help us to how much detail we are going to go at the patient at the moment, so this are the “S” and “P” for “SPIKES”. [PARAPHRASING]

V: Anyone wants to talk about “I” and “K”? [NO CODE]

Low-Level Individual Regulation

SVM

Regulation Low vs. High Content

Low-Level Individual Regulation

EK

L

InstructorStudent

M K E V L0

1

2

3

4

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LowHigh

Analytics

Using Volet’s framework each episode was coded and counted using codes for high and low content processing for both individual and group regulation

Next step will be to calculate percentage of individual vs. co-regulation and high vs. low content regulation in each type. The calculations will divide the coded total number in each category by the total number of turns in the transcript.

Example 3. Shared Mental Models in Trauma Teams Cruz-Panesso, 2011; Cruz-Panesso, Lajoie &

Lachapelle, 2012

Videotapes of actual simulations were reviewed to extract representative behaviors of SMMs

We coded: Development of common understanding of the own

role and other team members’ roles Anticipation of other team members’ needs Provision of information without explicit request

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L: “Mi put the airway”. (“Mi” is the participant playing the role of the airway) When the leader orders “Mi” to put the airway, this member was already looking for the instruments to do it. While ordering this, the team leader signals what procedures should be applied. For instance, when he is ordering the airway he signals to the head of the patient and gets them to approach the airway position,L: “Mo put the IVs”. Again, when the leader orders an IV he signals the arm of the patient.The patient arrives with a partner (is an actor) and the leader asks him some questions about the patient. The patient starts coughing and the leader goes up to assist the airway while at the same time assesses the level of consciousness of the patient, and informs the patient about the procedures: “I am putting some oxygen here”L: “Mary (the patient) can you heard me?”IV: reports “the IVs are in” After connecting the patient to the IVs, this participant gets ready to start revising the vital signs L: Looks at the IV and says “OK”IV: Opens the shirt of the soldier to examine the chest and the vital signsL: Moves from the airway to the chest and starts revising the vital signs with the stethoscope, while at the same time verbalizes what he is finding.L: Moves to the airway again and says: “I am going to intubate her” “ It may be a problem with the airway” and starts the intubation. Airw: Assist the leader with the intubation L: The partner of the patient –an actor- falls down and the leader says “Mo he needs some help”

Provision of information without explicit request

The leader helps team members to develop common understanding of their own role and other team members’ roles

Example 4. Shared Mental Models

L: “I can’t take more time, I’m going to make a surgical airway” Airw: (This team member was already looking for the intubation kit)

Anticipation of other team members’ needs:

Summary

Provided several definition and examples from our work

Still think the definitions are “under-development” I look forward to the broader discussion of these

terms Thank you for your attention