Christal Ramanauskas

Assistant Clinical Lecturer, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Canada

Interviewed September 2020 by Martina MacFarlane

MM Welcome Christal. Can you say who you are?

CR I am an assistant clinical lecturer in the Department of Occupational Therapy at the Faculty of Rehabilitation Medicine at the University of Alberta. I teach a variety of different courses, but my main emphasis is on mental health and clinical field work. We have a satellite campus in Calgary, and we have distance learning as part of those classes, but online teaching is brand new to me.

MM Through this transition, what is the biggest challenge that you’ve experienced in moving to remote teaching?

CR I would say the biggest challenge that seems to be ongoing is student engagement. One of the things that I have found really challenging and, frankly, exhausting at some points, is trying to facilitate the same type of quality interactions that would typically be had in the face-to-face classroom. The experience of having to transition to teaching online has really demonstrated how much learning is facilitated through students and instructors sharing the same physical space. It takes a lot of energy to create something that’s similar in terms of engagement experiences. With COVID, we’ve lost the hallway chats, the questions in between breaks, students dropping by in office hours just to say hi, and just all of those interactions that automatically occur when we’re all sharing the same space together.

MM Have you come across any ways to creatively deal with the challenge of student engagement?

CR Previously in the Winter term, I was holding virtual office hours by keeping the Zoom call open, and that was successful to some extent. Another thing I do is if there’s correspondence happening over e-mail, I ask to hop on a Zoom or Google Meet call so that we’re still trying to have some semblance of a personal connection. When it comes to doing a synchronous lecture and I’m rolling through a shared screen, it’s really hard to have that sense of engagement. I’m relying on the chat box “blowing up” or for people to be “chiming in.” I do try to encourage students to put themselves out there and just holler at me, because if not I’ll just keep ripping through the slides. That tends to work okay, but again, that ability to gauge where my audience is at is almost impossible unless students are really putting it out there and letting me know whether or not what I’m saying is landing.

One of the cool things with our occupational therapy (OT) cohort is that they’ve been very proactive in organizing a professional development month, where faculty and other external lecturers are coming in and doing talks and workshops on a variety of topics. The goal is to bring in more practice and opportunity for clinical skills development. In the spring, clinical fieldwork placements had to be cancelled, so this is a way to bridge the learning that otherwise would have been happening in clinical fieldwork. The professional development month is receiving good engagement from students and faculty alike and in terms of engagement issues, this has been a big way to help.

There is also another significant element that is impacting clinical skills, instruction, and practice, which is that there’s so much communication that happens through real-life interactions that’s implicit and non-verbal and that is what really makes your learning experience. For example, when I’m practising interviewing skills or mindfulness exercises with OT (Occupational Therapy) students, it’s a whole body-mind experience that a student is engaging in and learning from. Doing this online reduces and strips a lot of that communication, and it simply doesn’t get transferred. You don’t see my whole body and vice versa, and you’re not getting the full read on someone.

MM What are some of the opportunities that are created by digital education?

CR Oh man, that’s where things get really exciting. So, there’s the whole phenomenon where the non-verbal communication is reduced, but it also creates opportunities. For example, I taught a module that incorporated an interviewing tool that the students had to learn and facilitate themselves, and one of the things I noticed is that because it took some of the emotional charge away from the role play with me as their interviewer, students consistently did a better performance than I had previously observed when we did this exercise in person. It actually helps grade the activity a bit, and it frees up some of that cognitive load that comes with learning something new and putting something into practice. I would say that this is especially great for students who have concerns around performance anxiety. This might be a nice way of helping people work up to doing these interactions in person. Another example that’s been really interesting for occupational therapists in particular is that this time online has shown us how much of our practice is actually language-based, and the extent to which we as occupational therapists can help our patients through an effective and productive therapeutic conversation.

I also really like that I’m able to do asynchronous lecturing, because it enables me to have more control over my content. I’m able to hit on my key points and give the comprehensive overview of the topics that I’m teaching, and the product is more of what I wanted it to be. I get to do more with visual and design elements in my slides and video footage and I can go back and edit too. I’m better able to incorporate elements such as pop culture references and jokes, turns of phrase—little things that make your lectures more engaging and fun to listen to. I’ve received consistently positive feedback from students that my lectures were enjoyable to watch and learn, and in those we’re talking about four or five hours of lecture content. So, when it comes to some pretty dry content, there are great opportunities in simply learning how to jazz it up and make it entertaining. I think it’s really important to exercise or develop your design skills, and I see this as an opportunity to enhance student learning. In a live lecture, you’re more or less beholden to your audience for a particular amount of time where you’re hoping that you have your speaking points down—and that’s fine; that stuff is really important. But for me, knowing that there’s so much more that can be said about a topic than what is said in lecture, I get to be more comprehensive through online teaching, and I think that has been really good. Basically, I get to cram in more information.

There’s also another opportunity, and I think this applies across the board for all students regardless of what they’re learning. I believe that digital education is going to help students learn to be more adept digital content creators so that we learn how to use communication technology, assistive technology, software, social media, and all those things more effectively. We’re recognizing that learning how to design more elegant interfaces can actually improve the connection and accessibility for people, and that this in and of itself is health promoting. It really challenges and pushes students who are eventually going to be health providers to engage in things like app development, which has tremendous potential for health promotion. I know that we have some OT students who are working on app development projects, and they have exciting potential to make clinical practice more efficient and effective.

And then, my goodness, in terms of the opportunities for the field of occupational therapy, one of the big things with digital education is that it’s really helping us to realize the possibilities of telerehabilitation, which is an exciting enterprise for OTs. Usually, telerehabilitation is more of a subspecialty that happens outside of the classroom, or it might be a module of additional learning, but it’s something that we’re starting to integrate as being more of a core component of our curriculum, just by virtue of everything going online. Basically, what this is enabling us to do is to refine our clinical interviewing skills, which has been a strong and ongoing interest for me, in particular as a practitioner and educator. It’s been really cool to see how students are developing their relational skills over the online platforms we use, and how one of the fieldwork sites that I supervised has successfully transitioned to a telerehabilitation service provision. So, a number of students are learning how to do telerehabilitation, and that’s one opportunity that I think is pretty neat.

MM It is indeed very exciting to think about all of the opportunities that may come from an increased knowledge and awareness of online platforms in healthcare, especially those opportunities for accessibility. Could you tell us a little more about telerehabilitation?

CR Telerehabilitation is an occupational therapy service provision that takes place over an online video conferencing platform such as Zoom, or a dedicated piece of telerehabilitation software. It can involve a variety of occupational therapy evaluations, interventions, or follow-ups. It can be used to facilitate an intake session or an initial interview to identify client priorities; it can be used for things such as cognitive or psychosocial screening; and it can be used to do physical assessments just by observing the patient carry out the instructions to help with their range of motion, strength and balance.

One great thing about telerehabilitation is that you get to see the patient or the client in their own home, and that makes it more accessible. For people who have mobility concerns, difficulty accessing a service, or complications arising out of lockdown or physical distancing, all of these things make it more difficult for patients to access health care services. Opportunities in terms of accessibility for these types of things are fantastic. I know that one of the hospitals in Edmonton that offers a cancer education group that’s run by occupational therapists has been able to continue it by doing it through Zoom. Rather than having to cancel this education group, they’ve been able to successfully continue it in an online platform.

MM Absolutely. These are extremely valuable takeaways from the switch to emergency remote education. What is your favourite resource for teaching online?

CR My colleagues! Typically, we’ll debrief a class and have a conversation about what went well, what could be improved, how was the balance of synchronous versus asynchronous content delivery, and things like that. I’ve also been actively consulting with students about their learning experiences over the past five months to get a sense of what it’s like to be on the receiving end of online learning, and what’s working for them. I would say more than anything, my favourite resource is talking to students and hearing about the level of success in their learning facilitated through different software. The feedback on the type of delivery is really useful, I would say, more than anything else.

MM What do you expect higher education to look like in ten years’ time?

CR I expect that higher education is going to keep moving more and more to online delivery. Given the changes to higher education that we’re currently seeing in the province of Alberta, I don’t think that online education is going away. I think that what we are experiencing right now in the switch to emergency remote education is going to change the way in which education and higher learning is going to function. I see it putting more pressure and expectation on teaching programs and departments to offer some edge or value, or something that really conveys to potential students why it is that they should come and study at that particular institution. With online delivery, it means you can have people from all over the world come in and start to access your program, and if it frees people up from having to be in a particular geographical location, then those potential students are going to be looking at different criteria to base their educational choices on. I also think that with things moving more and more toward digital learning, there is an opportunity to free up class time and to make prep work more engaging because really, how many students actually do the required reading? When I think of OT skills and OT learning, I see there being more skills practice, more opportunities to have those higher-level discussions and to engage in scholarly practice. Making and crafting the learning experience to be more of an enriching experience will have more of an emphasis in the future.

Overall, information delivery will be more engaging and information dense; at least, I think it should be. Well-designed content is more engaging, and we know that people like to learn when things are fun and interesting. If we can make our learning more fun and interesting, we’re going to come out knowing more, as well as with an increased reasoning capacity. And that’s going to free us up, so that we have more time as educators and students to have interesting conversations and good dialogue and to start to do more innovative things.

MM Are there any final points you’d like to add to the conversation before we wrap up?

CR I have seen really positive outcomes in student performance. In my experience with teaching a module on mindfulness and clinical interviewing where most of the content is largely asynchronous lecture material, and also where the students are in their first year of their education without any prior field work experience, the quality of performance that I have witnessed has been very impressive. I could see that there were learning outcomes that I hadn’t encountered before.

Lastly, one of the things that we could all do with is better software. I think, especially for telerehabilitation, there are platforms being used that are not as elegant as they could be in the user interface. Engaging and usable software is especially important when working with patient populations that aren’t computer savvy because online platforms can be confusing, and that detracts from the experience you’re giving those people. So, if there’s anybody out there who’s working on a platform that’s as smooth as a Mac OS type of interface, I’m really excited to see that come through. It feels like a lot of learning is detracted by clunky, cumbersome, buggy interfaces, and it doesn’t have to be that way. Remote platforms are here to stay, and they’re obviously a work in progress, but I’m curious to see how things evolve.

Reflection

Since the interview, and with eight months of digital teaching experience to reflect on, I’ve come to appreciate how important it is to manage digital learning fatigue. Fatigue has a significant impact on student performance and wellness. One of the realities of digital learning is that we are always limited by fatigue, and the best way to address fatigue is to prevent it. On the one hand, I’ve experienced some of the strongest performances from students via digital learning, with respect to their ability to articulate clinical reasoning and engage in complex theory, which I attribute to the efficiency of learning via engaging in digital content. On the other hand, I’ve learned that this learning fatigue can quickly spiral into students feeling overwhelmed, and at times becoming demoralized. Prioritizing student wellness is central to optimizing the digital learning environment, and student wellness is best addressed through a time-efficient, less-is-more approach. I’ve had to consider the most efficient ways of delivering information and clarifying the objectives of my lectures and learning activities. The demands of digital learning have challenged me to be more succinct and clearer in my delivery:

• Speak slowly and clearly: Slower speech makes it easier for students to follow along and engage in the learning material.
• Enthusiasm energizes: It’s important to offer positive energy to engage students in material.
• Vary the media sources for self-study/prep: I now use a mix of reading, podcasts, and pre-recorded lectures.
• Less is more: Less content to cover makes the task of teaching and learning less overwhelming for everyone involved.
• Be directive with time use: I tend to specify when I want to lecture without interruption from students, when I will facilitate discussion, and when I will take questions.
• Learning activities go a long way: Anything you can do to incorporate student engagement in the digital classroom helps. Sprinkling in brief discussion questions or experiential exercises helps translate lecture content.
• Offer a generous time cushion for lectures and discussions in synchronous sessions. If I get through the synchronous session with time to spare, I consider that the class has finished done early. These extra time cushions are important for students who are doing 8+ hours of online learning.
• Use flexible due dates: For example, I have an assignment that can be submitted at any time in the term.
• Create engaging content: To encourage engagement in learning, I made “scribble vids” using the Concepts App to draw out ideas and recorded clinical interviewing role plays, etc. all of which received positive feedback from students who had to rely on digital content for their learning.

About

Christal Ramanauskas is an assistant clinical lecturer in the Department of Occupational Therapy in the Faculty of Rehabilitation Medicine, at the University of Alberta, in Canada. She teaches a variety of different topics with a primary focus on mental health and clinical field work. Christal is a certified acceptance and commitment therapy matrix facilitator and an administrator of the ACBS (Association for Contextual Behavioural Science) OT Special Interest Group.