YNEDT-02955; No of Pages 7 Nurse Education Today xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first year undergraduate nursing students Linda Sheahan a,⁎, Alison While b, Jacqueline Bloomfield c a b c
Waterford Institute of Technology, Ireland, Ireland King's College London, United Kingdom The University of Sydney, Australia
a r t i c l e
i n f o
Article history: Accepted 1 May 2015 Available online xxxx Keywords: Clinical skills learning and teaching MITA Nursing students Learning preferences
s u m m a r y Background: The teaching and learning of clinical skills is a key component of nurse education programmes. The clinical competency of pre-registration nursing students has raised questions about the proficiency of teaching strategies for clinical skill acquisition within pre-registration education. Objectives: This study aimed to test the effectiveness of teaching clinical skills using a multiple intelligences teaching approach (MITA) compared with the conventional teaching approach. Design: A randomised controlled trial was conducted. Participants were randomly allocated to an experimental group (MITA intervention) (n = 46) and a control group (conventional teaching) (n = 44) to learn clinical skills. Setting: Setting was in one Irish third-level educational institution. Participants: Participants were all first year nursing students (n = 90) in one institution. Methods: The experimental group was taught using MITA delivered by the researcher while the control group was taught by a team of six experienced lecturers. Participant preference for learning was measured by the Index of Learning Styles (ILS). Participants’ multiple intelligence (MI) preferences were measured with a multiple intelligences development assessment scale (MIDAS). All participants were assessed using the same objective structured clinical examination (OSCE) at the end of semester one and semester two. MI assessment preferences were measured by a multiple intelligences assessment preferences questionnaire. The MITA intervention was evaluated using a questionnaire. Results: The strongest preference on ILS for both groups was the sensing style. The highest MI was interpersonal intelligence. Participants in the experimental group had higher scores in all three OSCEs (p b 0.05) at Time 1, suggesting that MITA had a positive effect on clinical skill acquisition. Most participants favoured practical examinations, followed by multiple choice questions as methods of assessment. MITA was evaluated positively. Conclusion: The study findings support the use of MITA for clinical skills teaching and advance the understanding of how MI teaching approaches may be used in nursing education. © 2015 Elsevier Ltd. All rights reserved.
Introduction Clinical skills education is a core component of nursing education internationally. The role of nurse educators is to prepare nursing students, both theoretically and clinically, for professional practice (Stayt, 2011). The most common approach to teaching clinical skills has been the didactic approach with the lecturer providing the theory in relation to the skill followed by a demonstration of the skill to a large group of students (Jeffries et al., 2002; Khan et al., 2012). Didactic teaching and demonstration may leave a void in relation to the cognitive and affective
⁎ Corresponding author. Tel.: +353 51306170 E-mail addresses: [email protected] (L. Sheahan), [email protected] (A. While), jacqueline.bloomfi[email protected] (J. Bloomfield).
domains of learning, which collectively constitute competency in skill and theory acquisition. The didactic approach is considered teacher focused and does not always accommodate the diverse learning styles or learning needs of the students (Khan et al., 2012). Further, the didactic approach may result in a lack of consistency in how the skills are demonstrated and how the theoretical information is provided by lecturers (Corbally, 2005). The multiple intelligences teaching approach (MITA) presents a unique opportunity to enhance the learning experience based on unique abilities and characteristics of the learner (Weber, 2005). MITA has five phases comprising question, target, expect, move and reflect (Table 1) and is based on Gardner's (1983) Multiple Intelligences theory (Table 2) (Weber, 2005). MITA techniques are shown to enhance critical inquiry and discussion for problem-solving (Weber, 2005; Denny, 2007). It is intended to stimulate the students' interest and abilities
http://dx.doi.org/10.1016/j.nedt.2015.05.002 0260-6917/© 2015 Elsevier Ltd. All rights reserved.
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
2
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
Table 1 MITA phases. MITA phases
Education
Assumption
Phase 1. Question possibilities. Pose meaningful questions Phase 2. Target improvements. Identify objectives Phase 3. Expect quality. Create rubrics Phase 4. Move resources. Move students to learn using all their MIs Phase 5. Reflect for growth. Reflect to adjust new learning
An opening question describes the lesson topics and relates content to learners' interests and abilities.
High quality questions help motivate learners to explore new meanings.
Use clearly defined objectives for each lesson to ensure deeper understanding of content topic.
When learners know exactly where they are going it is more likely they will arrive there successfully.
Expectations provide a tool to guide evaluation of learners' work by adding precision about specific criteria used for evaluating learner work. Assessment tasks match related learning approaches, cover content, solve real life problems, create meaningful challenges, and motivate learners to explore related issues using MI approaches. Reflective tasks are given to students at the end of the lecture to give closure to topic.
When given specific signposts learners are guaranteed to reach their destination.
and provides an opportunity for probing content more deeply. Finally, it presents an opportunity for reflection on the learning experience with these reflections forming a platform for future learning. MITA asks the question, “How am I smart?” as opposed to “how smart am I?” (Weber, 2005). The use of MITA in teaching clinical skills to undergraduate nursing students is not well researched. It is thought that MITA has the capacity to improve the competency of nursing students regardless of their ability and to encourage independent, self-directed and active uptake of knowledge in the skills laboratory, classroom and beyond (Weber, 2005; Denny et al., 2008). It is claimed that MITA can help nursing students to engage with learning by engaging their differing intellectual strengths, abilities or dispositions (Weber, 2005; Denny, 2007). Therefore, the study aimed to conduct a randomised controlled trial (RCT) to assess whether MITA is an effective method of teaching clinical skills to first year undergraduate nursing students. Methods Study Hypotheses It was hypothesized that there would be an increase in Objective Clinical Skills Examination (OSCE) scores as a result of teaching clinical skills using MITA.
MITA activates learner resources to ensure multiple approaches to learning. Reflection is a regular commitment that encourages the learner to critically evaluate.
Design and Sample Population The RCT was conducted between September 2011 and May 2012 at one nursing school located in the South of Ireland. All students enrolled on a first year BSc nursing degree were eligible for inclusion. Students were invited to participate on a voluntary basis, and were informed of their rights as a participant, including the right to withdraw from the study at any time (LoBiondo-Wood and Haber, 2010). All participants were then provided with detailed information, in verbal and written format. Following recruitment each participant was asked to give written consent and were then assigned an individual code to ensure confidentiality. In total 90 students agreed to participate which represented the entire enrolled cohort (Fig. 1). Students were randomly assigned to either the experimental (n = 46) or control (n = 44) group. This was achieved using computer generated number sequence (each student was identified by a number and discipline, for example, G1, P5, ID7). Blinding was not possible for operational reasons and each participant was aware of their assignment into either the experimental or control group. Control group participants were taught by a team of six lecturers while participants in the experimental group were taught by the researcher who was trained in MITA techniques (Table 3).
Table 2 Multiple intelligences (Gardner, 1983). Intelligence
Description of intelligence
Linguistic intelligence
The ability to use words effectively whether orally or in written format. This intelligence also relates to the ability to learn languages and to an understanding of spoken and written language. The ability to use numbers effectively, to solve and analyse problems and use analytical skills. It is the ability to think of cause and effect connections. The ability to appreciate music, song, tone, pitch. This also relates to the capacity to hear and recognise patterns. It considers active listening with a connection between music and emotions. The ability to perceive the visual world. It includes the capacity to visualize and to graphically represent visual ideas. It includes the use of visual aids and colour to aid learning and the ability to work with objects effectively. Having an awareness of others and the ability to respond effectively to those cues in a pragmatic way. This also relates to peer and co-operative learning. It involves interacting effectively with one or more people in familiar or working circumstances. This intelligence involves the ability to think about and understand one's self, to have an awareness of self-knowledge and have the ability to act on the basis of that knowledge. It also involves being aware of one's own capacities and to use such information effectively. The ability to control body movement that includes co-ordination, dexterity and speed for goal directed activity. This involves having a sense of timing. This intelligence relates to recognition of an individual's environment and to have the ability to understand patterns and sequences in everyday life. (Gardner added this intelligence in 2000.)
Logical–mathematical intelligence Musical intelligence Spatial intelligence Interpersonal intelligence Intrapersonal intelligence
Bodily-kinesthetic intelligence Naturalistic intelligence
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
3
Literature Review Methodology and Methods
Participants recruited to the study (n=90)
Baseline data collection ILS, MIDAS IS, MI assessment preferences, OSCE scores semester 1
Participants recruited into one of two groups
Experimental Group (n=46)
Control Group (n=44)
General (n=21) Psychiatry (n=14) ID (n=11)
General (n=23) Psychiatry (n=15) ID (n=6)
MITA Intervention 12 weeks
Conventional Teaching 12 weeks
OSCE Scores Semester 2 MI assessment Preferences Time 1
Data Analysis Findings Discussion Implications
Fig. 1. Study design and sample size.
Intervention: Teaching of Clinical Skills Clinical skills were taught over 12 weeks in the second semester (January to May 2012). All participants attended a mandatory one hour lecture, based on the theoretical component of each skill being taught. This ensured that all students had a reasonable level of knowledge prior to the practical skills session. Participants then attended a mandatory one hour clinical skills session in their dedicated groups of five or six. The control group was taught using traditional teaching methods and learning approaches. This included DVDs from a Clinical Skills Website, developed by City University London. A demonstration of the skill took place and participants practiced the skill and received
feedback on their performance. Skills sheets were available to the participants and lecturers prior to class, through an open source course management system. The content of the skills sheets was based on up to date literature and policies from local clinical sites and depicted key steps to be undertaken for each skill. The experimental group was taught clinical skills using MITA techniques. Teaching methods were principally the same as for the control group. However, a teaching plan, specific to MITA using the five-phase strategy, was devised (Table 4). A rubric was created for each teaching plan specific to the particular skill being taught. At the end of the semester (May 2011) all participants were assessed by an OSCE on the same three unrelated practical skills namely handwashing, sub cutaneous injection and nebuliser therapy.
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
4
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
Table 3 Demographic profile of student and lecturer participants. Characteristic
% (n)
Students
Characteristic
% (n)
Lecturers
Gender Female Male Age 17–20 years 21–24 years 25–28 years 29 + years
76.6 (69) 8.8 (8) 10 (9) 4.4 (4)
Level of qualification Diploma Degree
3.3 (3) 1.1 (1)
88.9 (80) 11.1 (10)
Inclusion criteria All students registered on nursing programme in one institute
Gender Female Male Age 30–39 years 40–49 years Length of time employed as lecturer 6–10 years 11–15 years Level of qualification Post graduate diploma Master's degree Nurse tutor Doctoral degree Inclusion criteria Teaching clinical skills in undergraduate programme
71.4 (5) 28.6 (2) 14. 29 (1) 85.71 (6) 42.86 (3) 57.14 (4) 100 (7) 100 (7) 57.14 (4) 28.57 (2)
Data Collection
Results
Data were collected between September 2011 and May 2012 at different time points during the study. Baseline data were collected in September and October 2011 and included that generated from the pre-validated Index of Learning Styles Questionnaire and the Multiple Intelligences Development Assessment Scale (MIDAS IS) to identify learning styles and MI preferences. Data were collected using the MI assessment preferences questionnaire pre-test (October 2011) and post-test (May 2012) to identify any change of preference and Objective Structured Clinical Examination (OSCE) pre-test (December 2011) and post-test (May 2012) (Table 5). Experimental group participants completed an evaluation of MITA using a survey (May 2012).
A total of 90 first year nursing students were enrolled in the study. Most of the sample were females 88.9%, (n = 80). The age of the participants ranged from 18 to 51 years (mean 21.73; SD 5.331).
Data Analysis A database was created in Predictive Analytics Software (PASW) version 19 to manage and analyse the data from the four instruments (Table 6). A one-way between-groups analysis of variance (ANOVA) with planned comparisons was conducted to explore the impact of learning style preference, MI preference and MI assessment preference across the groups. Mann–Whitney U tests were used to compare the medians of the hand washing OSCE scores between the groups for statistically significant differences (95% CI). MITA was evaluated using a nine-item questionnaire and was analysed using thematic analysis.
Table 4 Teaching interventions for the study. Conventional teaching method
Teaching intervention using MITA
Participants attended 1-hour mandatory theory class. Participants attended 1-hour mandatory skills laboratory session in groups of 5 or 6. Video demonstration Lecturer demonstration Repeated practice Feedback from lecturer Skills sheet developed for each skill
Participants attended 1-hour mandatory theory class. Participants attended 1-hour mandatory skills laboratory session in groups of 5 or 6. Video demonstration Lecturer demonstration Repeated practice Feedback from lecturer Skills sheet developed for each skill MITA teaching plan Reflection time – personal and group Picture board available on the college virtual learning environment
Index of Learning Styles The learning style preference with the highest score was sensing (M = 1.68; SD 0.95) and the learning style preference with the lowest score was intuitive (M = 0.20; SD 0.64). An independent t-test found no significant difference between gender for each of the eight learning style preferences (p N 0.05). A one-way between-groups analysis of variance (ANOVA) with planned comparisons was conducted to explore the impact of the ILS on the three disciplines in the study (Group 1: General Nursing; Group 2: Psychiatric Nursing; Group 3: Intellectual Disability nursing). There was no statistically significant difference between disciplines (p N 0.05) or experimental and control groups (p N 0.05) in learning styles. MIDAS The strongest multiple intelligence was interpersonal (M = 62.58; SD 13.454) and the weakest intelligence was naturalistic intelligence (M = 39.58; SD 20.185). An independent two-sample t-test found no significant differences between the experimental and control groups regarding MIDAS MI (p N 0.05). A one-way between-groups analysis of variance (ANOVA) with planned comparisons was conducted to explore the impact of the MIDAS MI on the three disciplines. There was no statistically significant difference between disciplines (p N 0.05) or experimental and control groups (p N 0.05) regarding any of the eight MIs. MI Assessment Preferences Questionnaire This questionnaire was completed at Baseline (n = 61; response rate 67.7%) and Time 1 (n = 86; response rate 95.5%). The following was identified: Most participants ranked written assessments which encouraged the practical application of practice experiences as their first preference in relation to written assessments at Baseline (61%) and at Time 1 (65%). In relation to practical assessments participants identified the ability to demonstrate personal knowledge as their first preference at Baseline (61%) whereas at Time 1 participants (48%)
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
5
Table 5 Instruments used in the study. Instrument
Description
Validity
Reliability
ILS (Felder and Silverman, 1988)
44-item self-scoring instrument Preferences along four bipolar continua active–reflective; sensing–intuitive, verbal–visual and sequential–global MIDAS is an objective assessment of multiple intelligences or intellectual dispositions. Data are compiled from the perceptions of a knowledgeable observer or person completing the test This tool was used to identify student preferences for assessment and was based on the eight multiple intelligences identified by Gardner (1983) An assessment method that is based on objective testing and direct observation of student performance during planned clinical encounters.
The Web based version of the ILS is taken over 100,000 times a year with content validity supported.
Test re-test reliability of this instrument is considered satisfactory with p b0.05 after 7 months
The mean internal consistencies of each MIDAS scale fall in the high-moderate to high range, with alpha coefficients ranging from 0.78 to 0.89 (median = 0.86).
The test–retest reliability shows a two-month stability coefficients ranging from 0.69 to 0.86 (M = 0.81) across the various intelligence scales.
All items were above the recommended level of 0.7 for Cronbach's alpha.
Used for first time in this study.
Content validity of the OSCE checklists, in this study, was established by having four members of the module team review the criterion-based checklists.
Reliability was strengthened by a good assessment schedule design and appropriate training for examiners
MIDAS (Shearer, 1994)
MI Assessment Preferences Questionnaire
OSCE
identified the ability to demonstrate attitudes as their first preference. Continuous assessment was identified as the most preferred assessment method at Baseline (46%) and at Time 1 this increased to 55%. There was a strong preference for multiple choice questions (MCQs) (56%) and short answer questions (57%) at Baseline rising to 77% and 70% at Time 1. Participants had a strong dislike of examinations that had essay type questions at Baseline (35%) rising slightly to 39% at Time 1. OSCE Scores at Baseline All participants completed an OSCE examination at the end of semester 1 (December 2011) with three skills assessed, namely: hand washing, TPR and BP. OSCES scores were computed by combining individual scores based on the number of items from the scoring sheet. No statistical significance (p N 0.05) was found between the control and experimental groups.
purpose of this study hand washing was the only skill assessed at all timelines. There was a statistically significant difference between the scores of the experimental and control groups (p b 0.05). Hand Washing Scores All participants (n = 90) were assessed for the skill of hand washing at Baseline and Time 1. There was an improvement in scores for both experimental and control groups between Baseline to Time 1 (Table 7). At Time 1 the experimental group's mean score was 3.56 points above that of the control group (p = 0.01). The Wilcoxon signed rank test was also used to compare the hand washing scores at Baseline and Time 1. The difference between the two sets of scores was statistically significant at Time 1 as the scores for the experimental group were higher than the scores achieved at Baseline, z = 4.941, p b 0.001 with a large effect size (r = 0.52).
OSCE Scores at Time 1
MITA Evaluation
Three skills were assessed at Time 1 (May 2012) namely: hand washing, subcutaneous injection and nebuliser therapy but for the
The experimental group (n = 46) completed a questionnaire in relation to their experiences of MITA for clinical skills teaching (response
Table 6 Summary of data analysis. Objective
Outcome measure
Type of data
Test used
To explore the effect of MITA compared with the conventional teaching approach
OSCE scores
Continuous Categorical
To compare the scores of hand washing OSCE scores between the control and the experimental group To explore the differences of ILS scores based on gender/discipline/control and experimental group
OSCE scores
Continuous Categorical Continuous Categorical
To explore the differences of MIDAS IS scores based on gender/discipline/control and experimental group
Participant questionnaire
Continuous Categorical
To explore the influence of MI on OSCE scores
Participant questionnaire OSCE scores Participant questionnaire
Continuous Categorical Continuous Categorical
Independent t-test Mann–Whitney U test Independent t-test Independent t-test 1 way ANOVA Independent t-test Chi-square test 1 way ANOVA Kruskal–Wallis test
Participant questionnaire OSCE scores
Continuous Categorical
To explore the differences of MI assessment preferences questionnaire based on gender/discipline/control and experimental group To explore the influence of MI assessment preference on OSCE scores
Participant questionnaire
Independent t-test Chi-square test 1 way ANOVA Kruskal–Wallis test
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
6
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
Table 7 OSCE hand washing scores at Baseline and Time 1 for experimental and control groups. Study phase
Group
n
Mean (SD)
Range of scores (%)
P value
Baseline
Experimental Control Experimental Control
46 44 46 44
92.17 (7.60) 90.15 (7.53) 98.41 (4.70) 94.85 (8.84)
73–100 73–100 80–100 53–100
0.20
Time 1
0.01
rate 95.7%). Participants rated the use of MITA positively by either strongly agreeing (90.9%) or agreeing (9.1%) with all the statements. The positive features of MITA included the enablement of clinical skills learning, MITA as a diverse learning method, environmental factors such as the use of music that helped to reduce stress and an approachable instructor. The negative features included a lack of practice time and the amount of information provided. Discussion The study aimed to compare the effectiveness of MITA to a conventional teaching approach for clinical skills. In this study the experimental group achieved statistically significant higher scores for the three OSCEs (p b 0.01) which support the use of MITA as an alternative to conventional teaching approaches. These results echo those of Denny (2007) who investigated the use of MITA for teaching nursing practice theory to undergraduate nurses in Ireland and found that the experimental group achieved higher examination results in their summative assessment. The focus of the MITA five phase approach is on active student learning and participation and consequently differs from the educatorcentred approach (Weber, 2005; Denny et al., 2008). The emphasis of the MITA approach is on designing an active, constructive and goal directed learning environment appropriate for the students' cognitive abilities (Weber, 2005). Each student brings their own unique abilities and characteristics to the classroom and this must be taken into consideration when planning teaching activities (Beghetto, 2007). The educator provides subject knowledge while creating an atmosphere and a context for learning to take place (Tan and Grigorenko, 2010). In addition, Weber (2005) suggested that collaboration, content (integrated curriculum tasks) and criteria (suggestions for assessment) promote brain-based learning. The experimental group was provided with reflection, individually and as a group, to explore their clinical skills development and to enhance self-awareness (Weber, 2005). Driscoll's Model of Structured Reflection (2000) was used at this time to probe the participants' understanding of their learning, analyse their performance, provide strategies for improvement and set new learning goals. Reflection is essential to nursing practice and if it is not facilitated, both in education and practice, then a nurse's ability to reflect critically on practice issues may result in incompetent performance (Funnell et al., 2008). Using a reflective process encourages engagement in the learning process, improves understanding and promotes problem solving (Rose and Best, 2005). Another explanation for the higher scores may have been that the researcher identified the participants' learning style preferences and MI preferences at Baseline and the MITA lesson plans were developed accordingly. The integration of MI theory and learning styles theory may help the educator understand the learning disposition of the students and as a result the teaching approach can encourage student engagement for learning and teaching (Baeten et al., 2010). The use of visual aids, which is one of the many teaching and learning strategies used with MITA may also have increased the OSCE performance scores of the experimental group. The experimental group was provided with picture boards, posters and illustrations from a whiteboard, developed specifically for each skill. The use of visual aids, such
as the picture boards, posters, photographs or illustrations has been found to enhance mental representations or schemata (Piaget, 1981; Arguel and Jamat, 2009). It is suggested that visual imagery has lasting effects on learning, particularly in relation to recall of information and critical thinking ability (Mayers, 2001). Limitations of the Study This study took place in one site only with a small sample size (n = 90) and, therefore, only reflect nursing students in this one site in Ireland. The small sample size could be considered to lack statistical representation. However, with no other reported studies using MITA for the teaching of clinical skills, this study can be considered a useful exploratory trial. The researcher conducted all the MITA teaching to the experimental group which may have had an effect on the experimental group, known as the ‘Halo effect’ or the participants knowing they were under observation, known as the ‘Hawthorne effect’ (Cruise et al., 2006). The variability of lecturer teaching styles and engagement with the students in the control group was not explored. Implications for Practice This study will be of particular interest to educators who prepare nursing students with the knowledge, skills and attitude necessary for the complex world of clinical practice. MITA, as a method of teaching and learning, offers an innovative approach for teaching clinical skills. Students can benefit from the use of MITA because it is a systematic approach to teaching that can create a positive and motivating environment for learning with its strong student focus. Conclusion This study found that when educators are aware of the students' learning style preferences and multiple intelligence preferences, they can assist the student to achieve their maximum potential by adapting teaching approaches. This exploratory trial supports the use of MITA, as a means of drawing upon the students' individual strengths and abilities so that they can achieve greater personal and academic success (Weber, 2005). This study provides a strong basis for further investigation within nursing education. The cost effectiveness of MITA was not assessed in this study and should be addressed in future studies. Acknowledgements Ms. Michelle Foley has been acknowledged for her statistical advise. References Arguel, A., Jamat, E., 2009. Using video and static pictures to improve learning of procedural contents. Comput. Hum. Behav. 25 (2), 354–359. http://dx.doi.org/10.1016/j. chb.2008.12.014. Baeten, M., Kyndt, E., Struyven, K., Dochy, F., 2010. Using student-centred learning environments to stimulate deep approaches to learning: factors encouraging their effectiveness. Educ. Res. Rev. 5 (3), 243–260. http://dx.doi.org/10.1016/j.edurev.2010.06. 001. Beghetto, R.A., 2007. Does creativity have a place in classroom discussion? Prospective teachers' response preferences. Think. Skills Creat. 2 (1), 1–9. Corbally, M.A., 2005. Considering video production? Lessons learned from the production of a blood pressure measurement video. Nurse Educ. Pract. 5 (6), 375–379. http://dx. doi.org/10.1016/j.nepr.2005.04.003. Cruise, S., Lewis, M., Alan, C., McGuckin, C., 2006. Test-retest reliability of self-estimated intelligence: temporal stability over four time periods. S. Behav. Personality 34 (10), 1179–1187. Denny, M., 2007. Exploring how Teaching for Multiple Intelligence Affects Student Achievement in an Undergraduate Nursing Education Programme in Ireland. (PhD Thesis). University College Cork. Denny, M., Redmond Stokes, O., Wells, J., Weber, E., McMaster, R., Taylor, M., O' Sullivan, K., 2008. The learning experience: a new approach to optimise student learning. In: Callara, L. (Ed.), Nursing Education Challenges in the 21st Century. Nova Science Publishers Inc., New York, pp. 23–48. Driscoll, J., 2000. Practising Clinical Supervision. Balliére Tindall, Edinburgh.
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx Felder, R.M., Silverman, L.K., 1988. Learning and teaching styles in engineering education. Eng. Educ. 78 (7), 674–681. Funnell, R., Koutoukidis, G., Lawrence, K. (Eds.), 2008. Tabbner's Nursing Care: Theory and Practice. Elsevier, Chatswood Sydney. Gardner, H., 1983. Frames of Mind. Basic Book Inc., New York. Jeffries, P.R., Rew, S., Cramer, J.M., 2002. A comparison of student-centred versus traditional methods for teaching basic nursing skills in a learning laboratory. Nurs. Educ. Perspect. (ISSN: 1536-5026) 23 (1), 14–19. Khan, B.A., Ali, F., Vazir, N., Barolia, R., Rehan, S., 2012. Students' perceptions of clinical teaching and learning strategies: a Pakistani perspective. Nurse Educ. Today 32 (1), 85–90. http://dx.doi.org/10.1016/j.nedt.2011.01.016. LoBiondo-Wood, G., Haber, J. (Eds.), 2010. Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. Mosby Elsevier, St. Louis. Mayers, R.E., 2001. Multimedia Learning. Cambridge University Press, New York.
7
Piaget, J., 1981. Intelligence and Affectivity: Their Relationship during Child Development. Annual Reviews, Palo Alto. Rose, M., Best, D., 2005. Transforming Practice through Clinical Education, Professional Supervision and Mentoring. Churchill Livingstone, London. Shearer, B., 1994. The MIDAS: A Professional Manual. MI Research and Consulting, Inc., Kent. Stayt, L.C., 2011. Clinical simulation: a sine qua non of nurse education or a white elephant? Nurse Educ. Today 32 (5), e23–e27. http://dx.doi.org/10.1016/j.nedt.2011. 06.003. Tan, M., Grigorenko, E.L., 2010. Where creativity and curriculum meet. New Horiz. Learn. J. 5 (2), 15–22. Weber, E., 2005. MI strategies in the Classroom and Beyond: Using Roundtable Learning. Pearson Publishers, New York.
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first year undergraduate nursing students Linda Sheahan a,⁎, Alison While b, Jacqueline Bloomfield c a b c
Waterford Institute of Technology, Ireland, Ireland King's College London, United Kingdom The University of Sydney, Australia
a r t i c l e
i n f o
Article history: Accepted 1 May 2015 Available online xxxx Keywords: Clinical skills learning and teaching MITA Nursing students Learning preferences
s u m m a r y Background: The teaching and learning of clinical skills is a key component of nurse education programmes. The clinical competency of pre-registration nursing students has raised questions about the proficiency of teaching strategies for clinical skill acquisition within pre-registration education. Objectives: This study aimed to test the effectiveness of teaching clinical skills using a multiple intelligences teaching approach (MITA) compared with the conventional teaching approach. Design: A randomised controlled trial was conducted. Participants were randomly allocated to an experimental group (MITA intervention) (n = 46) and a control group (conventional teaching) (n = 44) to learn clinical skills. Setting: Setting was in one Irish third-level educational institution. Participants: Participants were all first year nursing students (n = 90) in one institution. Methods: The experimental group was taught using MITA delivered by the researcher while the control group was taught by a team of six experienced lecturers. Participant preference for learning was measured by the Index of Learning Styles (ILS). Participants’ multiple intelligence (MI) preferences were measured with a multiple intelligences development assessment scale (MIDAS). All participants were assessed using the same objective structured clinical examination (OSCE) at the end of semester one and semester two. MI assessment preferences were measured by a multiple intelligences assessment preferences questionnaire. The MITA intervention was evaluated using a questionnaire. Results: The strongest preference on ILS for both groups was the sensing style. The highest MI was interpersonal intelligence. Participants in the experimental group had higher scores in all three OSCEs (p b 0.05) at Time 1, suggesting that MITA had a positive effect on clinical skill acquisition. Most participants favoured practical examinations, followed by multiple choice questions as methods of assessment. MITA was evaluated positively. Conclusion: The study findings support the use of MITA for clinical skills teaching and advance the understanding of how MI teaching approaches may be used in nursing education. © 2015 Elsevier Ltd. All rights reserved.
Introduction Clinical skills education is a core component of nursing education internationally. The role of nurse educators is to prepare nursing students, both theoretically and clinically, for professional practice (Stayt, 2011). The most common approach to teaching clinical skills has been the didactic approach with the lecturer providing the theory in relation to the skill followed by a demonstration of the skill to a large group of students (Jeffries et al., 2002; Khan et al., 2012). Didactic teaching and demonstration may leave a void in relation to the cognitive and affective
⁎ Corresponding author. Tel.: +353 51306170 E-mail addresses: [email protected] (L. Sheahan), [email protected] (A. While), jacqueline.bloomfi[email protected] (J. Bloomfield).
domains of learning, which collectively constitute competency in skill and theory acquisition. The didactic approach is considered teacher focused and does not always accommodate the diverse learning styles or learning needs of the students (Khan et al., 2012). Further, the didactic approach may result in a lack of consistency in how the skills are demonstrated and how the theoretical information is provided by lecturers (Corbally, 2005). The multiple intelligences teaching approach (MITA) presents a unique opportunity to enhance the learning experience based on unique abilities and characteristics of the learner (Weber, 2005). MITA has five phases comprising question, target, expect, move and reflect (Table 1) and is based on Gardner's (1983) Multiple Intelligences theory (Table 2) (Weber, 2005). MITA techniques are shown to enhance critical inquiry and discussion for problem-solving (Weber, 2005; Denny, 2007). It is intended to stimulate the students' interest and abilities
http://dx.doi.org/10.1016/j.nedt.2015.05.002 0260-6917/© 2015 Elsevier Ltd. All rights reserved.
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
2
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
Table 1 MITA phases. MITA phases
Education
Assumption
Phase 1. Question possibilities. Pose meaningful questions Phase 2. Target improvements. Identify objectives Phase 3. Expect quality. Create rubrics Phase 4. Move resources. Move students to learn using all their MIs Phase 5. Reflect for growth. Reflect to adjust new learning
An opening question describes the lesson topics and relates content to learners' interests and abilities.
High quality questions help motivate learners to explore new meanings.
Use clearly defined objectives for each lesson to ensure deeper understanding of content topic.
When learners know exactly where they are going it is more likely they will arrive there successfully.
Expectations provide a tool to guide evaluation of learners' work by adding precision about specific criteria used for evaluating learner work. Assessment tasks match related learning approaches, cover content, solve real life problems, create meaningful challenges, and motivate learners to explore related issues using MI approaches. Reflective tasks are given to students at the end of the lecture to give closure to topic.
When given specific signposts learners are guaranteed to reach their destination.
and provides an opportunity for probing content more deeply. Finally, it presents an opportunity for reflection on the learning experience with these reflections forming a platform for future learning. MITA asks the question, “How am I smart?” as opposed to “how smart am I?” (Weber, 2005). The use of MITA in teaching clinical skills to undergraduate nursing students is not well researched. It is thought that MITA has the capacity to improve the competency of nursing students regardless of their ability and to encourage independent, self-directed and active uptake of knowledge in the skills laboratory, classroom and beyond (Weber, 2005; Denny et al., 2008). It is claimed that MITA can help nursing students to engage with learning by engaging their differing intellectual strengths, abilities or dispositions (Weber, 2005; Denny, 2007). Therefore, the study aimed to conduct a randomised controlled trial (RCT) to assess whether MITA is an effective method of teaching clinical skills to first year undergraduate nursing students. Methods Study Hypotheses It was hypothesized that there would be an increase in Objective Clinical Skills Examination (OSCE) scores as a result of teaching clinical skills using MITA.
MITA activates learner resources to ensure multiple approaches to learning. Reflection is a regular commitment that encourages the learner to critically evaluate.
Design and Sample Population The RCT was conducted between September 2011 and May 2012 at one nursing school located in the South of Ireland. All students enrolled on a first year BSc nursing degree were eligible for inclusion. Students were invited to participate on a voluntary basis, and were informed of their rights as a participant, including the right to withdraw from the study at any time (LoBiondo-Wood and Haber, 2010). All participants were then provided with detailed information, in verbal and written format. Following recruitment each participant was asked to give written consent and were then assigned an individual code to ensure confidentiality. In total 90 students agreed to participate which represented the entire enrolled cohort (Fig. 1). Students were randomly assigned to either the experimental (n = 46) or control (n = 44) group. This was achieved using computer generated number sequence (each student was identified by a number and discipline, for example, G1, P5, ID7). Blinding was not possible for operational reasons and each participant was aware of their assignment into either the experimental or control group. Control group participants were taught by a team of six lecturers while participants in the experimental group were taught by the researcher who was trained in MITA techniques (Table 3).
Table 2 Multiple intelligences (Gardner, 1983). Intelligence
Description of intelligence
Linguistic intelligence
The ability to use words effectively whether orally or in written format. This intelligence also relates to the ability to learn languages and to an understanding of spoken and written language. The ability to use numbers effectively, to solve and analyse problems and use analytical skills. It is the ability to think of cause and effect connections. The ability to appreciate music, song, tone, pitch. This also relates to the capacity to hear and recognise patterns. It considers active listening with a connection between music and emotions. The ability to perceive the visual world. It includes the capacity to visualize and to graphically represent visual ideas. It includes the use of visual aids and colour to aid learning and the ability to work with objects effectively. Having an awareness of others and the ability to respond effectively to those cues in a pragmatic way. This also relates to peer and co-operative learning. It involves interacting effectively with one or more people in familiar or working circumstances. This intelligence involves the ability to think about and understand one's self, to have an awareness of self-knowledge and have the ability to act on the basis of that knowledge. It also involves being aware of one's own capacities and to use such information effectively. The ability to control body movement that includes co-ordination, dexterity and speed for goal directed activity. This involves having a sense of timing. This intelligence relates to recognition of an individual's environment and to have the ability to understand patterns and sequences in everyday life. (Gardner added this intelligence in 2000.)
Logical–mathematical intelligence Musical intelligence Spatial intelligence Interpersonal intelligence Intrapersonal intelligence
Bodily-kinesthetic intelligence Naturalistic intelligence
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
3
Literature Review Methodology and Methods
Participants recruited to the study (n=90)
Baseline data collection ILS, MIDAS IS, MI assessment preferences, OSCE scores semester 1
Participants recruited into one of two groups
Experimental Group (n=46)
Control Group (n=44)
General (n=21) Psychiatry (n=14) ID (n=11)
General (n=23) Psychiatry (n=15) ID (n=6)
MITA Intervention 12 weeks
Conventional Teaching 12 weeks
OSCE Scores Semester 2 MI assessment Preferences Time 1
Data Analysis Findings Discussion Implications
Fig. 1. Study design and sample size.
Intervention: Teaching of Clinical Skills Clinical skills were taught over 12 weeks in the second semester (January to May 2012). All participants attended a mandatory one hour lecture, based on the theoretical component of each skill being taught. This ensured that all students had a reasonable level of knowledge prior to the practical skills session. Participants then attended a mandatory one hour clinical skills session in their dedicated groups of five or six. The control group was taught using traditional teaching methods and learning approaches. This included DVDs from a Clinical Skills Website, developed by City University London. A demonstration of the skill took place and participants practiced the skill and received
feedback on their performance. Skills sheets were available to the participants and lecturers prior to class, through an open source course management system. The content of the skills sheets was based on up to date literature and policies from local clinical sites and depicted key steps to be undertaken for each skill. The experimental group was taught clinical skills using MITA techniques. Teaching methods were principally the same as for the control group. However, a teaching plan, specific to MITA using the five-phase strategy, was devised (Table 4). A rubric was created for each teaching plan specific to the particular skill being taught. At the end of the semester (May 2011) all participants were assessed by an OSCE on the same three unrelated practical skills namely handwashing, sub cutaneous injection and nebuliser therapy.
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
4
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
Table 3 Demographic profile of student and lecturer participants. Characteristic
% (n)
Students
Characteristic
% (n)
Lecturers
Gender Female Male Age 17–20 years 21–24 years 25–28 years 29 + years
76.6 (69) 8.8 (8) 10 (9) 4.4 (4)
Level of qualification Diploma Degree
3.3 (3) 1.1 (1)
88.9 (80) 11.1 (10)
Inclusion criteria All students registered on nursing programme in one institute
Gender Female Male Age 30–39 years 40–49 years Length of time employed as lecturer 6–10 years 11–15 years Level of qualification Post graduate diploma Master's degree Nurse tutor Doctoral degree Inclusion criteria Teaching clinical skills in undergraduate programme
71.4 (5) 28.6 (2) 14. 29 (1) 85.71 (6) 42.86 (3) 57.14 (4) 100 (7) 100 (7) 57.14 (4) 28.57 (2)
Data Collection
Results
Data were collected between September 2011 and May 2012 at different time points during the study. Baseline data were collected in September and October 2011 and included that generated from the pre-validated Index of Learning Styles Questionnaire and the Multiple Intelligences Development Assessment Scale (MIDAS IS) to identify learning styles and MI preferences. Data were collected using the MI assessment preferences questionnaire pre-test (October 2011) and post-test (May 2012) to identify any change of preference and Objective Structured Clinical Examination (OSCE) pre-test (December 2011) and post-test (May 2012) (Table 5). Experimental group participants completed an evaluation of MITA using a survey (May 2012).
A total of 90 first year nursing students were enrolled in the study. Most of the sample were females 88.9%, (n = 80). The age of the participants ranged from 18 to 51 years (mean 21.73; SD 5.331).
Data Analysis A database was created in Predictive Analytics Software (PASW) version 19 to manage and analyse the data from the four instruments (Table 6). A one-way between-groups analysis of variance (ANOVA) with planned comparisons was conducted to explore the impact of learning style preference, MI preference and MI assessment preference across the groups. Mann–Whitney U tests were used to compare the medians of the hand washing OSCE scores between the groups for statistically significant differences (95% CI). MITA was evaluated using a nine-item questionnaire and was analysed using thematic analysis.
Table 4 Teaching interventions for the study. Conventional teaching method
Teaching intervention using MITA
Participants attended 1-hour mandatory theory class. Participants attended 1-hour mandatory skills laboratory session in groups of 5 or 6. Video demonstration Lecturer demonstration Repeated practice Feedback from lecturer Skills sheet developed for each skill
Participants attended 1-hour mandatory theory class. Participants attended 1-hour mandatory skills laboratory session in groups of 5 or 6. Video demonstration Lecturer demonstration Repeated practice Feedback from lecturer Skills sheet developed for each skill MITA teaching plan Reflection time – personal and group Picture board available on the college virtual learning environment
Index of Learning Styles The learning style preference with the highest score was sensing (M = 1.68; SD 0.95) and the learning style preference with the lowest score was intuitive (M = 0.20; SD 0.64). An independent t-test found no significant difference between gender for each of the eight learning style preferences (p N 0.05). A one-way between-groups analysis of variance (ANOVA) with planned comparisons was conducted to explore the impact of the ILS on the three disciplines in the study (Group 1: General Nursing; Group 2: Psychiatric Nursing; Group 3: Intellectual Disability nursing). There was no statistically significant difference between disciplines (p N 0.05) or experimental and control groups (p N 0.05) in learning styles. MIDAS The strongest multiple intelligence was interpersonal (M = 62.58; SD 13.454) and the weakest intelligence was naturalistic intelligence (M = 39.58; SD 20.185). An independent two-sample t-test found no significant differences between the experimental and control groups regarding MIDAS MI (p N 0.05). A one-way between-groups analysis of variance (ANOVA) with planned comparisons was conducted to explore the impact of the MIDAS MI on the three disciplines. There was no statistically significant difference between disciplines (p N 0.05) or experimental and control groups (p N 0.05) regarding any of the eight MIs. MI Assessment Preferences Questionnaire This questionnaire was completed at Baseline (n = 61; response rate 67.7%) and Time 1 (n = 86; response rate 95.5%). The following was identified: Most participants ranked written assessments which encouraged the practical application of practice experiences as their first preference in relation to written assessments at Baseline (61%) and at Time 1 (65%). In relation to practical assessments participants identified the ability to demonstrate personal knowledge as their first preference at Baseline (61%) whereas at Time 1 participants (48%)
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
5
Table 5 Instruments used in the study. Instrument
Description
Validity
Reliability
ILS (Felder and Silverman, 1988)
44-item self-scoring instrument Preferences along four bipolar continua active–reflective; sensing–intuitive, verbal–visual and sequential–global MIDAS is an objective assessment of multiple intelligences or intellectual dispositions. Data are compiled from the perceptions of a knowledgeable observer or person completing the test This tool was used to identify student preferences for assessment and was based on the eight multiple intelligences identified by Gardner (1983) An assessment method that is based on objective testing and direct observation of student performance during planned clinical encounters.
The Web based version of the ILS is taken over 100,000 times a year with content validity supported.
Test re-test reliability of this instrument is considered satisfactory with p b0.05 after 7 months
The mean internal consistencies of each MIDAS scale fall in the high-moderate to high range, with alpha coefficients ranging from 0.78 to 0.89 (median = 0.86).
The test–retest reliability shows a two-month stability coefficients ranging from 0.69 to 0.86 (M = 0.81) across the various intelligence scales.
All items were above the recommended level of 0.7 for Cronbach's alpha.
Used for first time in this study.
Content validity of the OSCE checklists, in this study, was established by having four members of the module team review the criterion-based checklists.
Reliability was strengthened by a good assessment schedule design and appropriate training for examiners
MIDAS (Shearer, 1994)
MI Assessment Preferences Questionnaire
OSCE
identified the ability to demonstrate attitudes as their first preference. Continuous assessment was identified as the most preferred assessment method at Baseline (46%) and at Time 1 this increased to 55%. There was a strong preference for multiple choice questions (MCQs) (56%) and short answer questions (57%) at Baseline rising to 77% and 70% at Time 1. Participants had a strong dislike of examinations that had essay type questions at Baseline (35%) rising slightly to 39% at Time 1. OSCE Scores at Baseline All participants completed an OSCE examination at the end of semester 1 (December 2011) with three skills assessed, namely: hand washing, TPR and BP. OSCES scores were computed by combining individual scores based on the number of items from the scoring sheet. No statistical significance (p N 0.05) was found between the control and experimental groups.
purpose of this study hand washing was the only skill assessed at all timelines. There was a statistically significant difference between the scores of the experimental and control groups (p b 0.05). Hand Washing Scores All participants (n = 90) were assessed for the skill of hand washing at Baseline and Time 1. There was an improvement in scores for both experimental and control groups between Baseline to Time 1 (Table 7). At Time 1 the experimental group's mean score was 3.56 points above that of the control group (p = 0.01). The Wilcoxon signed rank test was also used to compare the hand washing scores at Baseline and Time 1. The difference between the two sets of scores was statistically significant at Time 1 as the scores for the experimental group were higher than the scores achieved at Baseline, z = 4.941, p b 0.001 with a large effect size (r = 0.52).
OSCE Scores at Time 1
MITA Evaluation
Three skills were assessed at Time 1 (May 2012) namely: hand washing, subcutaneous injection and nebuliser therapy but for the
The experimental group (n = 46) completed a questionnaire in relation to their experiences of MITA for clinical skills teaching (response
Table 6 Summary of data analysis. Objective
Outcome measure
Type of data
Test used
To explore the effect of MITA compared with the conventional teaching approach
OSCE scores
Continuous Categorical
To compare the scores of hand washing OSCE scores between the control and the experimental group To explore the differences of ILS scores based on gender/discipline/control and experimental group
OSCE scores
Continuous Categorical Continuous Categorical
To explore the differences of MIDAS IS scores based on gender/discipline/control and experimental group
Participant questionnaire
Continuous Categorical
To explore the influence of MI on OSCE scores
Participant questionnaire OSCE scores Participant questionnaire
Continuous Categorical Continuous Categorical
Independent t-test Mann–Whitney U test Independent t-test Independent t-test 1 way ANOVA Independent t-test Chi-square test 1 way ANOVA Kruskal–Wallis test
Participant questionnaire OSCE scores
Continuous Categorical
To explore the differences of MI assessment preferences questionnaire based on gender/discipline/control and experimental group To explore the influence of MI assessment preference on OSCE scores
Participant questionnaire
Independent t-test Chi-square test 1 way ANOVA Kruskal–Wallis test
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
6
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx
Table 7 OSCE hand washing scores at Baseline and Time 1 for experimental and control groups. Study phase
Group
n
Mean (SD)
Range of scores (%)
P value
Baseline
Experimental Control Experimental Control
46 44 46 44
92.17 (7.60) 90.15 (7.53) 98.41 (4.70) 94.85 (8.84)
73–100 73–100 80–100 53–100
0.20
Time 1
0.01
rate 95.7%). Participants rated the use of MITA positively by either strongly agreeing (90.9%) or agreeing (9.1%) with all the statements. The positive features of MITA included the enablement of clinical skills learning, MITA as a diverse learning method, environmental factors such as the use of music that helped to reduce stress and an approachable instructor. The negative features included a lack of practice time and the amount of information provided. Discussion The study aimed to compare the effectiveness of MITA to a conventional teaching approach for clinical skills. In this study the experimental group achieved statistically significant higher scores for the three OSCEs (p b 0.01) which support the use of MITA as an alternative to conventional teaching approaches. These results echo those of Denny (2007) who investigated the use of MITA for teaching nursing practice theory to undergraduate nurses in Ireland and found that the experimental group achieved higher examination results in their summative assessment. The focus of the MITA five phase approach is on active student learning and participation and consequently differs from the educatorcentred approach (Weber, 2005; Denny et al., 2008). The emphasis of the MITA approach is on designing an active, constructive and goal directed learning environment appropriate for the students' cognitive abilities (Weber, 2005). Each student brings their own unique abilities and characteristics to the classroom and this must be taken into consideration when planning teaching activities (Beghetto, 2007). The educator provides subject knowledge while creating an atmosphere and a context for learning to take place (Tan and Grigorenko, 2010). In addition, Weber (2005) suggested that collaboration, content (integrated curriculum tasks) and criteria (suggestions for assessment) promote brain-based learning. The experimental group was provided with reflection, individually and as a group, to explore their clinical skills development and to enhance self-awareness (Weber, 2005). Driscoll's Model of Structured Reflection (2000) was used at this time to probe the participants' understanding of their learning, analyse their performance, provide strategies for improvement and set new learning goals. Reflection is essential to nursing practice and if it is not facilitated, both in education and practice, then a nurse's ability to reflect critically on practice issues may result in incompetent performance (Funnell et al., 2008). Using a reflective process encourages engagement in the learning process, improves understanding and promotes problem solving (Rose and Best, 2005). Another explanation for the higher scores may have been that the researcher identified the participants' learning style preferences and MI preferences at Baseline and the MITA lesson plans were developed accordingly. The integration of MI theory and learning styles theory may help the educator understand the learning disposition of the students and as a result the teaching approach can encourage student engagement for learning and teaching (Baeten et al., 2010). The use of visual aids, which is one of the many teaching and learning strategies used with MITA may also have increased the OSCE performance scores of the experimental group. The experimental group was provided with picture boards, posters and illustrations from a whiteboard, developed specifically for each skill. The use of visual aids, such
as the picture boards, posters, photographs or illustrations has been found to enhance mental representations or schemata (Piaget, 1981; Arguel and Jamat, 2009). It is suggested that visual imagery has lasting effects on learning, particularly in relation to recall of information and critical thinking ability (Mayers, 2001). Limitations of the Study This study took place in one site only with a small sample size (n = 90) and, therefore, only reflect nursing students in this one site in Ireland. The small sample size could be considered to lack statistical representation. However, with no other reported studies using MITA for the teaching of clinical skills, this study can be considered a useful exploratory trial. The researcher conducted all the MITA teaching to the experimental group which may have had an effect on the experimental group, known as the ‘Halo effect’ or the participants knowing they were under observation, known as the ‘Hawthorne effect’ (Cruise et al., 2006). The variability of lecturer teaching styles and engagement with the students in the control group was not explored. Implications for Practice This study will be of particular interest to educators who prepare nursing students with the knowledge, skills and attitude necessary for the complex world of clinical practice. MITA, as a method of teaching and learning, offers an innovative approach for teaching clinical skills. Students can benefit from the use of MITA because it is a systematic approach to teaching that can create a positive and motivating environment for learning with its strong student focus. Conclusion This study found that when educators are aware of the students' learning style preferences and multiple intelligence preferences, they can assist the student to achieve their maximum potential by adapting teaching approaches. This exploratory trial supports the use of MITA, as a means of drawing upon the students' individual strengths and abilities so that they can achieve greater personal and academic success (Weber, 2005). This study provides a strong basis for further investigation within nursing education. The cost effectiveness of MITA was not assessed in this study and should be addressed in future studies. Acknowledgements Ms. Michelle Foley has been acknowledged for her statistical advise. References Arguel, A., Jamat, E., 2009. Using video and static pictures to improve learning of procedural contents. Comput. Hum. Behav. 25 (2), 354–359. http://dx.doi.org/10.1016/j. chb.2008.12.014. Baeten, M., Kyndt, E., Struyven, K., Dochy, F., 2010. Using student-centred learning environments to stimulate deep approaches to learning: factors encouraging their effectiveness. Educ. Res. Rev. 5 (3), 243–260. http://dx.doi.org/10.1016/j.edurev.2010.06. 001. Beghetto, R.A., 2007. Does creativity have a place in classroom discussion? Prospective teachers' response preferences. Think. Skills Creat. 2 (1), 1–9. Corbally, M.A., 2005. Considering video production? Lessons learned from the production of a blood pressure measurement video. Nurse Educ. Pract. 5 (6), 375–379. http://dx. doi.org/10.1016/j.nepr.2005.04.003. Cruise, S., Lewis, M., Alan, C., McGuckin, C., 2006. Test-retest reliability of self-estimated intelligence: temporal stability over four time periods. S. Behav. Personality 34 (10), 1179–1187. Denny, M., 2007. Exploring how Teaching for Multiple Intelligence Affects Student Achievement in an Undergraduate Nursing Education Programme in Ireland. (PhD Thesis). University College Cork. Denny, M., Redmond Stokes, O., Wells, J., Weber, E., McMaster, R., Taylor, M., O' Sullivan, K., 2008. The learning experience: a new approach to optimise student learning. In: Callara, L. (Ed.), Nursing Education Challenges in the 21st Century. Nova Science Publishers Inc., New York, pp. 23–48. Driscoll, J., 2000. Practising Clinical Supervision. Balliére Tindall, Edinburgh.
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
L. Sheahan et al. / Nurse Education Today xxx (2015) xxx–xxx Felder, R.M., Silverman, L.K., 1988. Learning and teaching styles in engineering education. Eng. Educ. 78 (7), 674–681. Funnell, R., Koutoukidis, G., Lawrence, K. (Eds.), 2008. Tabbner's Nursing Care: Theory and Practice. Elsevier, Chatswood Sydney. Gardner, H., 1983. Frames of Mind. Basic Book Inc., New York. Jeffries, P.R., Rew, S., Cramer, J.M., 2002. A comparison of student-centred versus traditional methods for teaching basic nursing skills in a learning laboratory. Nurs. Educ. Perspect. (ISSN: 1536-5026) 23 (1), 14–19. Khan, B.A., Ali, F., Vazir, N., Barolia, R., Rehan, S., 2012. Students' perceptions of clinical teaching and learning strategies: a Pakistani perspective. Nurse Educ. Today 32 (1), 85–90. http://dx.doi.org/10.1016/j.nedt.2011.01.016. LoBiondo-Wood, G., Haber, J. (Eds.), 2010. Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. Mosby Elsevier, St. Louis. Mayers, R.E., 2001. Multimedia Learning. Cambridge University Press, New York.
7
Piaget, J., 1981. Intelligence and Affectivity: Their Relationship during Child Development. Annual Reviews, Palo Alto. Rose, M., Best, D., 2005. Transforming Practice through Clinical Education, Professional Supervision and Mentoring. Churchill Livingstone, London. Shearer, B., 1994. The MIDAS: A Professional Manual. MI Research and Consulting, Inc., Kent. Stayt, L.C., 2011. Clinical simulation: a sine qua non of nurse education or a white elephant? Nurse Educ. Today 32 (5), e23–e27. http://dx.doi.org/10.1016/j.nedt.2011. 06.003. Tan, M., Grigorenko, E.L., 2010. Where creativity and curriculum meet. New Horiz. Learn. J. 5 (2), 15–22. Weber, E., 2005. MI strategies in the Classroom and Beyond: Using Roundtable Learning. Pearson Publishers, New York.
Please cite this article as: Sheahan, L., et al., An exploratory trial exploring the use of a multiple intelligences teaching approach (MITA) for teaching clinical skills to first ..., Nurse Educ. Today (2015), http://dx.doi.org/10.1016/j.nedt.2015.05.002
