Exploring features of integrative teaching through a microanalysis of connection-making processes in a health sciences curriculum

Abstract

The interconnected nature of knowledge in the health sciences is not always reflected in how curricula, courses, and learning activities are designed. Thus have scholars advocated for more explicit attention to connection-making, or integration, in teaching and learning. However, conceptual and empirical work to guide such efforts is limited. This study analyzed classroom processes to determine what connections educators promoted in their classrooms and how those connections were made. A qualitative, focused ethnography design explored connection-making in a health science curriculum. Eight instructors were observed during ten class sessions resulting in 35 h of video data. Video data were entered into the observational software, Noldus Observer, and coded using continuous sampling. Frequency and duration of connections made were calculated in Noldus. Connection-making involved four interactive elements: The topic under direct consideration, other domains of professional knowledge (practice, student experience, research, theory, other content, core construct of the profession, external influences, metacognition), the integrative processes instructors used to connect a topic to other knowledge domains (informal example, stories, questioning, linking statements, formal cases, and program descriptions), and the learning and instructor context (type and purpose of course, instructor personal and professional experience). These elements are presented as an initial integrative learning taxonomy that can be used to guide explicit attention to connection-making in education and research.

Appendix: Code book

Behavior and definition	Modifier and definition	Examples
Behavior group: connections made Rule: If connections are attempted but are weak or vague, make a note in the comments section to that effect, e.g. “details of this link are largely left to students to make independently-not explicitly made by instructor
No connection code when no obvious connection is made or when the previous code has ended but not new connection has begun	None
Connection to practice code when the instructor CLEARLY relates the class topic to a practice situation or scenario	Method: Informal example instructor offers an “impromptu” example that relates the topic to a practice event or experience. While the instructor may be drawing on personal experience, the example is given generically. Example seems to “pop out of instructor’s head” on the spot. Distinguish from an informal example in a lecture that is simply an elaboration on the topic and not a clear connection to practice	Instructor spontaneously describes how a client with a cognitive impairment might perform a task
	Method: Story instructor links the topic to practice by telling a personal story from his or her own practice or personal experience. The instructor uses story-telling and it is clearly a personal experience. Has a clearly developed narrative structure and fully describes what happened. MUST have a connection to practice	Instructor tells story of speaking up on FW Instructor tells the story of her dad or of her journey to OT Instructor tells story of coaching soccer Student tells a story from FW
	Method: Question the instructor asks a question that prompts the students to make their own connections between the topic and practice. Code only when a question is used independently of an informal example or story	“Based on this information, what would you want to do when working with clients?” Instructor asks, “what activity might you set up to work on this skill?” Instructor A asks a series of questions to get students to link outcomes to group process
	Method: Statement the instructor tells student s how a topic relates to practice	Instructor tells students what “you want to look for as an OT”
	Case: Formal case with questioning the instructor provides a formal case, but also asks multiple questions about how changing or alternative case-conditions would affect students’ reasoning about what to do in practice	Instructor asks “what if” questions related to Juanita’s case
	Case: Formal case for direct application of content the instructor uses a formal case to illustrate how a topic relates to practice, but does not ask questions and does not change conditions of the case
	Case: Program description the instructor informs students about the services provided by a program, or uses a formal case that involves a program as the client, e.g. ATRC or when students work with a program-based case vs. an individual client	Instructor explains what services the ATRC provides
Connection to students’ experience code when the instructor relates the class topic or directs class attention to students’ personal experiences. Discussion of FW or field-based experiences are coded as Experience, not Connection to Practice. Code instructor’s past experience as Connection to Practice story or connection to practice informal example	Type: Past/current experience with OT the instructor asks students to draw upon their observations, fieldwork, or personal experience with OT. Could include CCP, ATRC, service learning, and application of OT concepts/ skills in a non-OT setting	Instructor asks students what cognitive issues they observed when working with their community partners. Seminar students talk about what they did in their community sites
	Type: Past/current experience non-OT the instructor asks students to draw upon their personal experiences outside of OT	Students in Instructor’s class use OA concepts to explain their experiences giving tennis lessons
	Type: Classroom experience the instructors or students refer to an experience inside the current course or class	Instructor refers to the experiences students just had with the lab stations
	Type: Future experience the instructor refers to students as future practitioners. Refers to students as “you” when talking about a future practice situation	Instructor says, “an attorney comes to you and asks you to justify the assessment you used…what will you be able to say and what can’t you say based on the reliability of this assessment?” Instructor talks about students becoming change agents in the profession Rachel describes future for OT in addressing career development
Connection to theory/model/delivery approach code when the instructor uses theory to explain a topic or relates the class topic to theoretical principles, or links topic to an explanatory service delivery model, or offers explanations of underlying concepts or reasoning.	Nature of reference to theory: Implicit the instructor states or draws upon theoretical principles within OT, but does not explicitly refer to the statement as a theoretical principle	Instructor refers to the connection between boredom, pain and activity duration/engagement
	Nature of reference to theory: Explicit the instructor states or draws upon a theoretical principle within OT, and points out to students that he or she is using a theoretical principle	Instructor tells students which aspects of ATRC are Direct Service and which are Indirect Service Instructor presents PEO as it relates to cognition Instructor A asks “how did theory drive the delivery of the group?”
Connection to content within the curriculum code when the instructor relates the topic under observation to content from other points in the curriculum	Proximity of content: Previous or concurrent content in current course the instructor explicitly relates the day’s topic to prior content in the current course	Instructor D says “I know we dealt with this question earlier this semester”
	Proximity of content the instructor explicitly refers students to how the day’s topic relates to content they had in prior courses or concurrent courses	Instructor D asks about the Portney and Watkins text that they used in stats
	Proximity of content: Content in upcoming courses the instructor explicitly refers students to how the day’s topic relates to content they will have in future semesters	Instructor mentions that “we’ll get into this in more detail in Biomechanics II”
Connection to research code when the instructor uses research to explain a topic or relates the class topic to research principles/terminology	Nature of reference to research: Terminology the instructor infuses research terminology with the current class topic
	Nature of reference to research: Principles the instructor uses principles of research to explain current class topic. Seems to assume that research vocabulary is familiar to students	Instructor explains the reliability issues associated with an assessment Instructor D. explains what a p value of .0001 means
	Nature of reference to research: Evidence the instructor uses specific research articles/data to support the class topic or to engage students in evaluating and critiquing a class topic or practice situation	Instructor explains research on intervention outcomes for people with cognitive impairments Instructor A asks “how did evidence drive what you did with the group?” Refers to well-elderly study Instructor A. offers suggestions on how to link observations with documenting evidence
	Nature of reference to research: Other the instructor makes a connection to research that is not identified in the above modifiers. Note the type of connection in the comments. May include a discussion of the state of knowledge development in the field	Instructor D. talks about the state of knowledge development in SI and the reasons for OT knowledge not getting developed more quickly
Connection to external influences outside the curriculum code when a topic is linked to external factors that gave rise to and continue to shape the topic, e.g. legislation, practice acts, non-research professional literature, marketplace demands, reimbursement, etc.		Instructor starts with Federal Legislation as the source of the definition of AT Student mentions article he or she read Instructor discusses how reimbursement limits the time and therefore the selection of assessments for clients
Connection to occupation code when the instructor facilitates a direct connection between the topic and human occupation. Or when the students explore their own occupations in order to learn about occupation more generally. Distinguish from Connection to Practice by explicit statement or question about occupation. May or may not be in the context of a practice situation
Connection to thinking process code when instructor seeks to help students gain a metacognitive awareness of their reasoning. E.g. the instructor explicitly highlights the reasoning/thinking processes process that a student is using, or that the instructor hopes they will use		Instructor A asks questions about students’ assumptions about older people