#7 Game based learning with Simone Titus

In this episode of the SAAHE podcast I speak to Simone Titus about her PhD research project on the use of game-based learning. Simone talks about how this approach can lead to improved student engagement and collaboration, as well as some of the challenges she faced. She also describes how she wrote her final thesis, including the final year in Dublin with a mobility funding grant.

Simone Titus is a teaching and learning specialist in the Faculty of Community and Health Science at the University of the Western Cape. She graduated with a PhD in Education from the University of Cape Town where she developed an interest in the use of emerging technologies as a tool to mediate learning.

Her special research interests are focused on game-based learning and using emerging technologies to foster cross-cultural interaction, learning and engagement in higher education. During the past seven years, Simone has taught undergraduate and postgraduate students and she has a growing number of Masters and PhD students who are under her supervision. Her current portfolio involves developing teaching and learning strategies in health science and interprofessional education. She has been the recipient of, amongst others; the South African and Netherlands Programme for Advanced Development (SANPAD), AESOP Mobility to the University College of Dublin and has been awarded grant funding for various other projects.

You can find out more about Simone’s work at her ResearchGate and Google Scholar profiles.


Titus, S. & Ng’ambi, D. (2014). Exploring the use of digital gaming to improve student engagement at a resource poor institution in South Africa. Academic Conferences International.

The hard task of assessing “soft” skills: Notes from a regional seminar

On the 12th of September, the Western Cape SAAHE regional committee hosted a half-day seminar on the topic of assessing “soft” skills. We had 40 participants who spent a few hours discussing different approaches to assessing things like professionalism, interpersonal skills and graduate attributes. This post presents the notes taken during the discussion from the seminar, with some additional information added after the fact, together with links to external sources. We share it here in the hope that others may find it useful.

The point was made that these should perhaps not be called soft skills given that soft has the unintended connotation of being “unimportant” or “easy”. Should these be referred to rather as: Complex skills? Intrinsic roles (e.g. as described in competency frameworks)? Graduate attributes? Critical cross-field outcomes?

Tools that can be used in the context of a course / module / block

  • Assessment of Physiotherapy Practice (APP) tool
    • This is a Physio-specific tool that is used in the clinical practice module at SU, addressing the development and assessment of soft skills. Students tend to score low when they start using it, then get better over time. Principles to think about here are progress testing and the testing effect (for learning theory and for learning skills). For a nice systematic review of a range of clinical practice assessment tools, including the APP, see O’Connor, A., McGarr, O., Cantillon, P., McCurtin, A., & Clifford, A. (2017). Clinical Performance Assessment Tools in Physiotherapy Practice Education: A Systematic Review.
  • Feedback from patients in Linguistics
    • Has the added advantage of boosting students’ confidence but we also need to bear in mind that patients may need to be prepared in advance. In the experience of some, patients tend to be overly complimentary about student performance (e.g. “everything was perfect”).
    • Scope of undertaking: No indication of how many students
  • Longitudinal matrix
    • UWC Occupational therapy department developed a matrix over four years considering the following: UG graduate attributes and core competencies; Weighted according to the four years; Used Bloom’s taxonomy as a guide for levels e.g., know about communication in the first year; application and integration in the fourth year.
    • Scope of the undertaking: About 50 per year level
  • Module handovers
    • At the end of every term or every semester, lecturers sit and hand over what was covered and what still needs to be covered in upcoming modules to bridge gaps in learning, module expectations and what students struggle with. Individual students who are struggling are raised in regular staff meetings
    • Scope of the undertaking: 50 students
  • Create opportunities for students to develop but then don’t actually assess
    • It is questionable with respect to the degree to which these things can be taughtThese opportunities might consist solely of 1) do something, 2) get feedback on what you did, 3) reflect.

Practicalities of deploying approaches

  • Designing and managing a distributed curriculum
    • Nursing at UWC has Interpersonal skills sessions for first-year students e.g. death and dying; washing a baby – observation of how student washes baby, makes eye contact with the baby, etc.
      • three times a week; four scenariosuse simulated patientsfacilitated by mentorsfizzles out in later yearsScope of undertaking: over 1000 students in programme; 300-350 in first year
    • UCT has two courses that run in the first year and incorporate soft skills: Becoming a Professional and Becoming a Health Professional (all disciplines are working together in these courses)
      • A challenge is whether the principles addressed here are followed through in later years, particularly in the clinical yearsIn addition, there is some evidence that isolated modules like this aren’t very effective at developing what is essentially an integrated skill that must be used across domains
  • Understanding fully what you are trying to help students to learn
    • For example, iare communication skills about mastering isiXhosa as a language or about understanding culturally appropriate communication e.g. the role of eye contact and body position in communication?
      We need to understand the role of cultural humility (see here and here for more information) in the context of understanding and assessing soft skills – ensuring that students recognise that difference of any sort has an impact and moderating yourself and your behaviour accordingly.Role modelling is very important in this regardAre we assessing things like “punctuality” and “dress code” under the broad name of “professionalism”?
  • Symbolism is important – soft skills should be communicated as being integral rather than peripheral
    • Shouldn’t be “putting it on the side as a different mark” on a rubricAll aspects of the curriculum should be integrated; a signal that clinical expertise is necessary but not sufficientAssessment system should be designed in such a way that a student cannot pass on clinical reasoning alone yet have poor communication skills or empathy (see below)Using soft skills tools that do not contribute to decision making can be  a two-edged sword e.g., if Nursing students must log 4000 clinical hours, this equates to an impact curriculum; student focuses on the technique so much they forget there is a patient in the bed; rote behaviours are emphasised, rather than soft skills, in order to demonstrate the technique (think here about the quote adapted from Rees & Knight, 2007: “Do we want [health care workers] who are professional, or will we settle for [health care workers] who can act in a professional manner?”)Important to consider the instrument and purpose of the assessment; if the student doesn’t understand that communication is part of the manual technique, then they will not focus on / address / bother with communication skills.
  • We could consider using longitudinally collected narrative data obtained from clinicians, patients, peers, etc.
    • We currently compartmentalise information about students because we have modular systems within universities and institutions
      There is little or no longitudinal collation and consideration of data
    • Consider narrative, qualitative approaches to collecting assessment data: Maybe each clinician writes a short paragraph about the students’ behaviour e.g. “the student rolled their eyes a bit every time I spoke to them” – this says something about a student’s professionalism without having to assign a number to a definition of what “professional” means.
      • once in 4 years or if three people out of 25 have a problem with an aspect of student behaviour, maybe it’s not an issue; but if 18 out of 25 note issues and make qualitative, open-ended claims about student behaviour, that is a different story
    • An example of a Physiotherapy school in New Zealand collating narrative feedback alongside quantitative data was discussed in some depth in a podcast you can listen to here.
    • The individual preceptor or tutor isn’t burdened with making pass-fail decisions about a student – all they have to do is write a short narrative where they don’t even have to define the behaviour i.e. is this about “communication” or “professionalism”? All they need to do is describe an observed behaviour.
      • lowering the stakes for the preceptors
    • This helps us to evaluate the aggregate picture over time rather than make decisions based on single snapshots of performanceProgrammatic approach to assessment suggests applying criteria used to illustrate rigour for qualitative research – trustworthiness; credibility; dependability; confirmability

How do we use the information?

  • Only make decisions with high resolution data
    • Can’t make defensible decisions about soft skills using tiny amounts of data collected on a single clinical placementCees van der Vleuten uses the idea of the pixel resolution of the “picture” we have about a student. He suggests that we gather and collate small numbers of pixels over time to generate a high-resolution picture of what is going on.
  • This takes pressure off any one clinician as being “responsible for” a student’s failure
  • Helps avoid the problem of “failure to fail”
    • If I have to make a defensible decision, I rather make no decisionThen, the student reaches the final year and everyone agrees the student shouldn’t be there
  • Each clinician / tutor / preceptor just contributes their 3 or 7 or 4 pixels worth of data towards building the composite picture, without the pressure of pass-fail decision making attached to the data collection
  • These small pixels don’t form the basis for any single decision but are rather summed over the duration of the programme; so, rather than “professionalism” counting for 5% of a single assessment task, you have many tasks where those marks are added up over time.
  • Separate data collection from decision making
    • this kind of principle could have systemic implicationsfor all of the principles we mention, there are implications for programme design i.e. it’s hard to fit these ideas into our traditional curriculum models.
  • Use collective decision making
    • Anonymise the observations; give them to a panel of five clinicians to make a judgement about competent / not e.g. is this someone you would hire? No? Not competent.Is it defensible?
      • if you have 60-70 observations from 23 preceptors over 2 years, it will be (again, consider qualitative criteria for rigour as mentioned above)once such a system is in place, there are bound to be legal challenges but we cannot let that dictate what is sound practice and our current system faces legal challenges anyway – it is not as though it is perfect
    • Avoid spending too much time on students who are clear fails or clear passes (i.e., spending hours “agreeing vigorously”); rather focus energy on borderline students eg 5% or 1SEM or some such measure either side of the cut score

Incorporating this into assessment programmes and bureaucratic systems

  • This should be incorporated into rules of progression or for the award of a qualification rather than used at module level
  • We need to circumvent the tyranny of an assessment bureaucracy that demands a numerical mark to enter against a credit bearing course code on the university’s computer system
  • Options to consider
    • make a “competent” judgment (don’t use numerical scores) for each of a series of soft skills it a prerequisite / DP requirement for access to the next year of study or to the exit exams
    • make a “competent” judgement for each of a series of soft skills a subminimum requirement for the award of a qualification (irrespective of scores in other domains)
    • this would ensure that there are meaningful consequences for not being competent in soft skills that are valued in the programme and ensure that the student who scores 80% overall but is very unprofessional or very poor communicators does not qualify
    • Could convert letter grades (what the assessor gives e.g. A = Excellent, B = Good, C = Borderline, D = Weak) to number grades (what the system needs to be captured e.g. 80%, 70%, 60%, etc.)
  • This would require some planning about what kind of remediation to put in place

Best publication award 2018

This award is made for a full-length article or a chapter, published in the five years to 31 Dec of the previous year, with a South African first author. (This will change in 2019 with Zimbabwe joining as a region). This year, for the first time, a joint award was made.

Müller, A. (2013). Teaching lesbian, gay, bisexual and transgender health in a South African health sciences faculty: addressing the gap. BMC Medical Education, 13: 174.

This publication summarises empirical research on the inclusion of sexual orientation and gender identity-related health disparities and health concerns in the health sciences curricula at the University of Cape Town. Understanding the exclusion of these topics has direct practical relevance to South African health professions education: sexual orientation and gender identity are important social determinants of health (Logie, 2012; Pega and Veale, 2015), and healthcare providers thus need the knowledge, attitudes and practical skills to provide competent care to lesbian, gay, bisexual and transgender patients. The American Association of Colleges of Medicine released a detailed guide on how to integrate topics related to sexual orientation and gender identity into medical curricula (Eckstrand and Sciolla, 2014). Understanding the current gaps in our curricula is the first step full-length curriculum reform that meaningfully incorporates these topics.

Badenhorst, E., & Kapp, R. (2013). Negotiation of learning and identity among first-year medical students. Teaching in Higher Education, 18(5), 465-476.

This paper addresses the identity shifts that students in an academic development programme undergo.  Whilst such programmes endeavour to support the notion of widening access, and thereby offering students support to overcome learning barriers, cognisance should be taken of the psychological toll this has on students’ well being.  The transition from school to university poses particular problems, specifically with regards to alienation.  Many students encounter an unfamiliar dominant academic culture that does not foster a sense of belonging. Educators should be aware the alienation could impact negatively on students’ performance – especially if these students are further put into support programmes that separate learning activities from the majority of the student body.

Prof. Fatima Suleman – Winner of the 2018 Distinguished Educator Award

The 2018 SAAHE Distinguished Educator Award was made to Prof Fatima Suleman. Fatima is Professor in the Discipline of Pharmaceutical Sciences, in the School of Health Sciences at the University of KwaZulu-Natal (UKZN). She has demonstrated a commitment to the development of teaching, mentoring and supervision skills in new academics and assisting other academics with developing their Teaching Portfolios for Performance Management and Promotion. She has developed international partnerships for undergraduate and postgraduate teaching, within and beyond Africa. At UKZN, she conceptualized and coordinated the development of two completely online Masters programmes in Pharmacy and Health Sciences. Fatima has been involved in various international grants to develop health professions education. With a NORHED grant, she facilitated the development of online or blended Masters programmes in Mozambique and Malawi; she was involved in the Medical Education Partnership Initiative grant; she was a panel member on WHO Technical Working Group on Health Workforce Education; and Principle Investigator Council for AFREhealth.

Other awards she has garnered include the Distinguished Teacher Award for UKZN in 2010; the Distinguished Teacher award by Academy of Pharmaceutical Sciences of South Africa in 2011; and a TAU Fellowship 2015 (Teaching Advancement at University (TAU) Fellowships).

#6 – A humanistic pedagogy for student support

In this episode, I talk to Dr Mpho Jama about how a humanistic pedagogy could be key to facilitating student success through enhanced support. She suggests that it is in the human relationships between teachers and students that we must look to provide higher, more subtle levels of support for students.

Dr Jama is the head of the Division of Student Learning and Development in the Faculty of Health Sciences at the University of the Free State. Mpho does research on student retention, Humanistic pedagogy and Qualitative Social Research. Her PhD thesis is entitled: Designing an academic support and development programme to combat attrition among non-traditional medical undergraduates.

Resources for this conversation

Jama, M. (2017). Applying a humanistic pedagogy to advance and integrate humane values in a medical school environment. Perspectives in Education, 35(1):28-39.

Jama, M. (2016). Academic Guidance for Undergraduate Students in a South African Medical School: Can we guide them all? Journal of Student Affairs in Africa, 4(2):13-24.

Jama, M. (2010). Designing an academic support and development programme to combat attrition. PhD thesis. 10.13140/RG.2.1.1882.5120.

Jama, M., Monnapula-Mapesela, M & Beylefeld, A.A. (2008). Theoretical perspectives on factors affecting the academic performance of students. South African Journal of Higher Education, 22(5).

Jama, M. & Beylefeld, A.A. (2007). “Thou shallt know thy student”. What pre-university attributes characterised the first-year medical students that were denied examination access in 2007, and what competencies did they lack? Poster presentation.

More of Dr Jama’s work can be found on her ResearchGate profile.

#5 – A critical pedagogy for online learning, with Michael Rowe

In order to graduate physiotherapy students who are able to thrive in increasingly complex health systems, professional educators must move away from instrumental, positivist ideologies that disempower both students and lecturers. While the potential for pedagogical transformation via the integration of digital technology is significant, we must be critical of the idea that technology is neutral and be aware that our choices concerning tools and platforms have important implications for practice.

Earlier this year the Critical Physiotherapy Network published Manipulating practices: A critical physiotherapy reader. The book is a collection of critical writing from a variety of authors dealing with a range of topics related to physiotherapy practice and education.  One of the interesting features of this collection is that it is completely open access, which means that the authors, and not the publishers, have the intellectual property rights to make choices about what is permissable to do with the content of the book. While the entire book is available in different formats, including PDF, HTML, EPUB and XML, there is no audio version.

This SAAHE podcast is a recording of one chapter in the collection, entitled “A critical pedagogy for online learning in physiotherapy education“. We are using the SAAHE blog to experiment with sharing content in different formats, and would love to hear your feedback on whether or not this is something you would like to see more of.

In order to graduate physiotherapy students who are able to thrive in increasingly complex health systems, professional educators must move away from instrumental, positivist ideologies that disempower both students and lecturers. Certain forms of knowledge are presented as objective, value-free, and legitimate, while others – including the personal lives and experiences of students – are moved to the periphery and regarded as irrelevant for professional education. This has the effect of silencing students’ voices and sending the message that they are not in control of their own learning. While the integration of digital technology has been suggested as a means for developing transformative teaching and learning practices, it is more commonly used to control students through surveillance and measurement. This dominant use of technology does little more than increase the cost-effectiveness and efficiency of information delivery, while also reinforcing the rigid structures of the classroom. Physiotherapy educators who adopt a critical pedagogy may use it to create personal learning environments (PLEs) that enable students to inform their own learning based on meaningful clinical experiences, democratic approaches to learning, and interaction with others beyond the professional programme. These PLEs enable exploration, inquiry and creation as part of the curriculum, and play a role in preparing students to engage with the complex and networked systems of the early 21st century. While the potential for pedagogical transformation via the integration of digital technology is significant, we must be critical of the idea that technology is neutral and be aware that our choices concerning tools and platforms have important implications for practice.

#4 – Case based learning, with Corne Postma

In this episode I speak to Corné Postma from the University of Pretoria. We discuss his PhD research where he looked at the use of case-based learning to develop clinical reasoning in undergraduate Dentistry students. Corné used both quantitative and qualitative data to determine that students’ clinical reasoning ability improved after using a case-based approach to learning.

Corné is an Associate Professor in the Department of Dental Management Sciences, School of Dentistry, at the University of Pretoria. He is a specialist in Community Dentistry by training and his primary teaching responsibility lies in the domain of Comprehensive Patient Care, which includes patient communication, patient administration, clinical reasoning and patient management. He is also involved in developing other non-clinical skills such as self-awareness, ethics, professionalism, leadership, team work and health advocacy skills in dental students.

Corné has a very broad clinical research interest, which correlates with the generalist requirement of Comprehensive Patient Care. He has a particular affinity for health professions education research, which is closely linked to the development of different kinds of soft skills in students. His research outputs can be viewed on Google Scholar. Corné is a SAFRI (Sub-Saharan African Foundation for the Advancement of International Medical Education and Research Regional Institute) as well as a TAU (Teaching Advancement at University) fellow.

Resources for this conversation

#3 – Standard setting, with Scarpa Schoeman

In this episode of the SAAHE podcast I speak to Prof. Scarpa Schoeman, Director of Undergraduate Medical Education at the Wits Medical School, Faculty of Health Sciences, University of the Witwatersrand, where he leads and directs the Graduate Entry Medical Programme. Scarpa and I talk about the (almost) universal pass mark (cut score) of 50% and the problems with this as a standard. We also discuss possible alternatives to standard setting that take into account the validity and reliability of the assessment scores, as well the difficulty of the test.

Scarpa has published a variety of peer-reviewed articles and presented at international conferences on the topic of medical education and assessment. His research interests include assessment and standard setting (the Cohen method in particular), as well as the educational environment for medical students. His clinical interests and practice focuses on Emergency Medicine. He also acts as Assessment consultant to the Colleges of Physicians, Obstetrics and Gynaecology, Paediatricians and Anaesthetists of South Africa. He is a Fellow of the Higher Education Academy in the United Kingdom and is a part-time tutor in Assessment and Standard setting for the CME at Dundee University.

Resources for this conversation

#2: Mapping exit-level assessment, with Christina Tan

I recently spoke with Christina Tan, a PhD graduate from the University of Stellenbosch, who conducted research into the validity of assessing exit-level outcomes in an undergraduate medical programme at three medical schools.

This is the second in our podcast series on research in health professions education. If you have any suggestions for future conversations, please let us know in the comments.

If you’d like to read more about Christina’s work, here is one of her recent papers: Tan, C., van Schalkwyk, S., Bezuidenhout, J. & Cilliers, F. (2016). Mapping undergraduate exit-level assessment in a medical programme: A blueprint for clinical competence? African Journal of Health Professions Education 8(1):45-49. DOI:10.7196/AJHPE.2016.v8i1.546

Note: In order to listen to this podcast you will need to install a podcast app on your phone or tablet. iPhones come with one pre-installed and you can choose from a variety of options on Android devices. Once the podcast app is up and running, search for “SAAHE” and subscribe to the podcast. You will now be able to download any of the episodes for offline listening when you’re out and about.

#1: Patient-centredness, with Elize Archer

Welcome to a new SAAHE initiative where we have conversations with people doing interesting work in health professions education. In this conversation, I talk to Elize Archer, a recent PhD graduate from the University of Stellenbosch. Elize conducted her research on patient-centred approaches to clinical practice among medical students. In our conversation, we discuss different aspects of patient-centred practice, how to think about developing this mindset in students, and some of the challenges to its implementation.

You can read more about Elize’s work here: Archer, E. & van Heerden, B. (2016). Undergraduate medical students’ attitudes towards patient-centredness: a longitudinal study. DOI:

We hope that this is the first of many such conversations and your comments and feedback are welcome. In particular, we’d love to hear your suggestions about PhD and group research projects that have the potential to change practice. If you know of anyone doing work that you think would be valuable to be shared more widely, please do let us know. I apologise for the audio quality at times during the recording. This is something that we’ll work on improving in the future. The conversation is just short of 50 minutes. I hope that you enjoy it.