Individual face-to-face tutorials: the value in nurse education Martina Nathan
The individual, face-to-face tutorial is one means by which academic support can be provided to students in higher education. This mode of tutorial support has been deemed effective but it can be considered labour-intensive, which is a concern in the UK with the recession currently impacting on higher education institutions. Nevertheless, with increasing student fees come higher student expectations. With all UK pre-registration nursing study programmes at degree level and with the emphasis on widening access, students may require additional academic support to ensure success. This study aimed to examine the value of individual, face-to-face tutorials for academic support in nurse education. A descriptive and exploratory design was used, mixing qualitative and quantitative methods. The survey approach employed a web-based, self-completion questionnaire, which was distributed to lecturers and pre-registration student nurses in a UK university. Following analysis of the questionnaire results, students were invited to attend a group interview. Findings highlighted the importance of individual, face-to-face tutorials with qualitative data supplying detailed accounts regarding their value. Key words: Nursing education ■ Nursing education research ■ Academic support ■ Face-to-face tutorial
A
cademic support is vital in higher education (HE). Although adult-centred learning can be considered as self-directed, guidance is required to meet the academic achievement of HE students (Gopee, 2011). Students come from a variety of backgrounds and have diverse learning styles and needs. Academics are in a position to provide opportunities to encourage development. This is relevant in nurse education, which has grown from apprenticeship training to being based in HE, with all preregistration programmes at degree level in the UK. Tutorials are one form of academic support. There are many types of tutorials ranging from group to individual, and delivery can be face-to-face or electronic. Palfreyman (2008) questions whether one-to-one, tutor/student tutorials are a thing of the past. The current recession is placing pressures on HE institutions. Tuition fees have increased since 2012, with all universities now charging £6000 to £9000 annually. Simultaneously, funding has Martina Nathan, Lecturer, School of Healthcare Sciences, Cardiff University. Accepted for publication: January 2015
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been cut to universities: in England, for 2012–13 there was a total spending cut of £1296 million in comparison with 2011–12 (Evans, 2012; Higher Education Funding Council for England, 2012a). This further accentuates the concerns of the Russell Group (2010) that the quality of academic support will be difficult to maintain. For pre-registration nursing in Wales, even though tuition fees are paid, bursaries have been reduced since 2012. However, the benefit of such individual, face-to-face tutoring is established in the literature (Price et al, 2007; Duers and Brown, 2009). It is important to take into account students’ expectations for a quality educational experience. The National Student Survey (NSS) is a powerful tool for gathering feedback from students completing undergraduate programmes. Regarding academic support in 2012 only 77% of full-time students in England claimed they were satisfied with the support (Higher Education Funding Council for England, 2012b). Therefore, there appears a major tension between reduced funding in HE, an increase in fees and student expectations. Stemming from these issues, it is timely to consider the value of individual, face-to-face tutorials for academic support in nurse education. This question needs addressing as it poses a problem for academic staff and students. Academics need to consider the best means to ensure efficient and effective student support. As the Quality Assurance Agency aims to safeguard quality in HE institutions, the Agency needs to know that students are receiving the best possible academic support. Low rates of student satisfaction could lead to high rates of withdrawal (Tomlinson, 2014). However, confounding this issue is the need for HE institutions to ensure student support is cost-effective. Tutorials are deemed to be expensive, due to their impact on resources. Hence, the benefit of tutorials should outweigh the cost implications. The value of individual, face-to-face tutorials consequently needs to be questioned, as valuable money could be spent on these tutorials under the assumption that they are the most effective way to offer academic support. By seeking students’ views within the study, current and potential students could be reassured that the students’ voice is heard. Students should be given the choice of how to access tutorial support but knowledge of the most effective means may aid their decision making.
Literature review An electronic literature search was undertaken using online health-related and educational databases. The findings are presented here according to the main themes emerging from the literature: the value of academic support; the student-tutor
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Abstract
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RESEARCH relationship in individual, face-to-face tutorials; and dialogue in individual, face-to-face tutorials.
Value of academic support Gidman et al (2000) believed that the mode of academic support should be dictated by the student rather than the programme. With the growing emphasis on student-centred learning, students are encouraged to take responsibility for their own learning. Nevertheless, students still require guidance and direction, particularly in the first year of study (Nolan and Nolan, 1997). Potolosky et al (2003) examined the association of tutoring services and academic performance of first-year nursing students. Support was offered by group or individual tutorials with tutors interacting with students via email or a website. A convenience sample of 37 students was used in 2 modules Results were not significant with regard to success and the number of tutorial sessions students attended, but on analysis of qualitative data, students were positive about the tutorials. McGann and Thompson (2008) also found the positive impact of academic support on failing students. Attrition is estimated to cost UK taxpayers £99 million a year, with a 26% attrition rate in pre-registration programmes (Waters, 2008). Simpson (2000) while recognising student support as vital for retention, stated that factors such as the course and policy have greater influence on attrition rates. Relating to academic support, Sayer et al (2002) justified the need for remediation programmes to prevent wastage of resources from student attrition due to failure. Ecclestone and Pryor (2003) concurred, stating that if institutes want to retain students, individual student goals need addressing and a plan needs to be put in place to enable achievement.
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Student-tutor relationship Following the move into HE for nurse education, Akinsanya (1992) emphasised the need for tutors to get to know students individually, to gain a better understanding of their needs. He added that the face-to-face nature of the tutorial leads to a ‘close relationship’ with the tutor. Although this literature is dated, with many changes occurring in nurse education since then, Malik’s (2000) study still recognises the importance of the student–teacher relationship. He found the nature of the relationship will distinguish whether a student accesses a tutor for academic advice. The approachability of the tutor is highlighted by students as being vital to the relationship (Stephen et al, 2008). Students in Owen’s (2002) action research study stated the personal characteristics of the tutor were not important but the availability and approachability of the tutor were important. Another factor that enhances the student–tutor relationship is regularly meeting (McGann and Thompson, 2008). For individual, face-to-face tutorials, developing a trusting relationship with the students is imperative to elicit any misconceptions regarding academic support (Price, 2003). This should be achieved through encouragement of a one-toone dialogue.
Dialogue in individual, face-to-face tutorials The benefit of interaction with face-to-face tutorials
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in comparison to online tutoring in a distance learning programme was highlighted in a study by Price et al (2007). Students undertaking the programme were offered the choice of face-to-face tutorials with telephone support or online support by email and computer conferencing. The only area of statistical significance between students undertaking face-to-face tutorials and students tutored online was in the ‘good tutoring scale’, with students tutored online awarding lower scores for their assessment of the tutoring. In exploring feedback, Higgins et al (2001) produced similar results. They concluded that the discussions between student and tutor in individual, face-to-face tutorials will clarify what is expected as the student prepares for assessments. Figure 1. Questionnaire used to obtain quantitative data
Face-to-face individual tutorials for academic support Please read the information sheet about the research before completing this questionnaire. All responses will be kept strictly confidential and only the researcher has access to the data. Please return the completed questionnaire by [date] 1. Are you a lecturer or a student? * Please select correct response ■■ Lecturer ■■ Student 2. Have you ever participated in individual face-to-face tutorials for academic support? If yes, please continue. ■■ Yes ■■ No 3. What was the primary purpose of the face-to-face individual tutorials? Please tick all relevant answers ■■ Supervision ■■ Feedback ■■ Academic writing ■■ Other: 4. Do you consider individual face-to-face tutorials for academic support valuable? ■■ Yes ■■ No ■■ No opinion Please list the two main reasons to support your answer .................................................................................................................................. 5. In comparison to the face-to-face individual tutorial, how would you rate the following: (More) (Less) (Equal) ■■ Information and communication technology; e.g. email. — ......... ........ ......... ■■ Group tutorial — ......... ........ ......... 6. Would you like more opportunity to participate in face-to-face individual tutorials for academic support? ■■ Yes ■■ No ■■ No opinion If you have answered ‘Yes’ to the previous question, please list the two main factors that limit you partaking in more face-to-face individual tutorials for academic support. ....................................................................................................................................... Thank you! Thank you for taking the time to complete this survey. The second strand of this study is a group interview to further explore the subject. If you are a STUDENT, and would be interested in partaking, please supply the following details Email address:
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3% Supervision Supervision and feedback
30%
Supervision, feedback and academic writing Supervision and academic writing Supervision, feedback, academic writing and other
37%
Academic writing and other
22%
Figure 2. Primary purpose of face-to-face individual tutorials (from questionnaire responses)
In comparison to the value of individual, face-to-face tutorials, how would you rate tutorials via information and communication technology? 40 36 35 30 26
Frequency
25 20 15 10 5 0
4 More valuable
Less valuable
Equally valuable
Figure 3 Results from questionnaire (actual numbers of respondents)
In comparison to the value of individual, face-to-face tutorials, how would you rate group tutorials? 40
37
35
Frequency
30
27
25
15 10
0
2 More valuable
Less valuable
Figure 4. Results from questionnaire (actual numbers of respondents)
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Methods For this mixed methods research, the approaches were sequential, with the quantitative survey first. Leading from the analysis of the survey data, an exploratory approach followed as qualitative methods further explore quantitative findings and provide more depth. The research method employed for the survey approach was the self-completion questionnaire. The self-administered questionnaire was deemed a suitable research method for this study as it reached students and lecturers at one time and allowed respondents to answer at their own convenience. To reduce the possibility of respondent burden and missing data only six questions were formulated (Figure 1).The questionnaire was piloted with lecturers and students to gain both perspectives: no changes to the tool were required following the pilot. The qualitative strand was a group interview, which allowed questions to be posed to each group member in turn. A purposive sampling strategy was employed for the two types of data collection. The population targeted was student nurses and lecturers in nurse education from a school of nursing and midwifery studies in a Welsh university. Although this sampling technique is deemed weak as bias may be introduced (Moule and Hek, 2011), the sample is easily accessible. Regarding the composition of the quantitative sample, all lecturers in the school were included and a year 3 adult undergraduate cohort. As the researcher was a lecturer in a different field of nursing, adult nursing students were chosen to prevent researcher bias. Students who completed the questionnaire were invited to attend the group interview through the questionnaire. As a lecturer was conducting the interview, only the student cohort were invited for interview. Only 5 students requested to participate in the interview from the invitation on the questionnaire. The researcher met with the cohort again faceto-face to invite them again to take part in the interview and distribute the information sheets and consent forms to those interested. No further interest was shown. Ethical approval was granted by the university’s ethics committee.
Results
20
5
Duers and Brown (2009), in exploring student nurses’ experiences of formative assessment, found that students preferred verbal to written feedback, as by communicating with the tutor, questions could be posed and non-verbal signs observed gaining a clearer understanding of the feedback. Weaver’s (2006: 384) findings concur, with the quantitative results of a multi-method design indicating that more guidance is required in interpreting and using feedback as students may not understand ‘academic discourse’.
Equally valuable
The questionnaire’s quantitative data were analysed using SPSS (v 18.0). The questionnaire’s qualitative comments were analysed and common themes emerged. The questionnaire was sent out via email to 90 academic staff with a lecturer’s role and to 76 year 3 adult undergraduate students. A total of 166 questionnaires were distributed. The response rate was 40% (n=67); 75% of responses came from lecturers. Results are shown for answers to question 3 (Figure 2) and question 5 (Figure 3 and Figure 4). Five students who responded to the questionnaire
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6%
2%
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RESEARCH participated in the group interview. Common themes stemming from the questions posed in the survey helped plan the interview schedule and structure the analysis (Table 1), which Tappen (2011) refers to as concept-driven. The interview was recorded and subsequently transcribed. Participants were informed that their names would be changed when findings were analysed to ensure anonymity. It was sent to each participant for verification. Only two out of the five students verified the transcribing.
Discussion Participation in individual, face-to-face tutorials All respondents in the study participated in individual, faceto-face tutorials. The combination of ‘supervision, feedback and academic writing’ emerged as the primary purpose of the tutorial in results from the questionnaire (37%). Although academic writing is included in this category, none of the students in the interview claimed that they had face-to-face support for academic writing, which they felt would have been beneficial. One respondent, Liz, stated that ‘on line’ resources were not sufficient: ‘I found it quite hard as I came from a Welsh background and I had nobody showing me how to reference, it was all on line …’
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This aligns with Baratta (2010) who recognises that webbased resources cannot replace contact teaching. As 75% of respondents to the questionnaire were lecturers, they may view ‘academic writing’ as part of supervision. Wisker et al (2008) recognise the importance of a one-toone relationship for supervision, where tutors enable students to develop skills. They also suggest that supervision involves negotiation and dialogue. Therefore, face-to-face tutorials for supervision could be deemed more appropriate. This was recognised by one student interviewee, who claimed that he preferred supervision face-to-face, as questions can be asked and ‘proper’ feedback can be given. Feedback was considered one of the main purposes of individual, face-to-face tutorials in 66% of questionnaire responses, which was explored further in the interview, with all participants recognising the benefit of formative feedback. Sally expressed the belief that tutors can direct her regarding what she ‘should be doing next’. However, on further probing, participants only accessed tutorials for summative feedback if they ‘didn’t do well’ commenting that feedback through email was sufficient. This is surprising as the value of dialogue and questioning are recognised by participants’ with regard to supervision and formative feedback. This would imply that students do not require face-to-face feedback if they are satisfied with their summative mark. However, Higgins et al (2001) advised the need for discussion between tutor and student, to apply lessons from feedback to future work.
The value of individual, face-to-face tutorials All respondents within the study considered individual, faceto-face tutorials valuable. Clarification was given as a reason by 26% of respondents. This was reinforced in the interview with Stacy stating:
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‘With face-to-face normally if you don’t understand what they are getting at, you can ask.’ These findings marry with those of Chi et al (2008), which showed that the interaction in individual, face-to-face tutorials encouraged learning. From the tutor’s perspective, it would be easier to detect if a student is struggling with understanding during a meeting face-to-face. Stewart (2007) when discussing critical pedagogy, added that students will therefore be encouraged to speak and ask questions. Responses in the interview also highlighted the benefit of questioning in the tutorial. Sally stated: ‘If they [lecturers] have said something and you have not really understood it, you can question them.’ Kerri concurred, stating that questioning can continue until understanding is gained. Interviewees identified the benefit of questioning but moreover the overarching dialogue in face-to-face, individual tutorials. Sally explained this dialogue as ‘building’ on issues between the tutor and student. Keesing-Styles (2003) appreciated that dialogue is not just discussion, which was identified by 8% of questionnaire respondents in free text comments relating to ‘meaningful discussion’. The importance of ‘building’ working relations in face-to-face, individual tutorials was also recognised by 11% of questionnaire respondents in free text comments. Stewart (2007) believed that if relationships are maintained with students it will encourage Table 1. Schedule for student group interview Theme
Questions
Reason to access individual, face-to-face tutorials
■■ Have all of you participated in face-to-face, individual
tutorials for academic support? ■■ Why have you accessed individual, face-to-face tutorials
for academic support? The value of individual, face-to-face tutorials
■■ Do you consider individual, face-to-face tutorials valuable
or beneficial? ■■ Consider understanding of ‘valuable’? ■■ Why? Give examples. ■■ Have you experienced both individual, face-to-face tutorials
and tutorials via information technology (such as e-mail) ■■ Following from the previous question; comparing
individual, face-to-face tutorials to tutorials using information technology, which would you consider the most valuable and why? ■■ Do you think one benefited you more than the other? ■■ Give examples—written/verbal ■■ Have you experienced group tutorials? ■■ Would you prefer individual or group tutorials for academic support and why? ■■ Consider: are there situations where one is better than the other? ■■ Consider: giving examples from questionnaire results Opportunity to participate in individual, face-to-face tutorials
■■ Would you like more opportunity to participate in
Other areas to consider
■■ Would you consider individual, face-to-face tutorials a
individual, face-to-face tutorials? Why? What limits you partaking in more (consider giving examples)? form of teaching? ■■ Is the academic support what you expected when you
commenced your programme?
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‘When I have an email it sometimes does not open and when I have the comments back I can’t really understand what he or she is saying and then you have to wait for them to get back to you.’ Kerri concurred, highlighting the barriers in interpreting each other’s electronic communications. Mutch (2003) stressed this can be particularly problematic for a weaker student who cannot understand the tutor’s language, and concluded that discussion is required to prevent misunderstanding. In relation to this, 54% of respondents rated tutorials via information technology as less valuable than face-to-face, 38% rated them of equal value, with 6% rating information technology more valuable. Students outlined in the interview, the problems they encountered with tutorials via email relating to being unsure if the tutor had received their email. This issue emerged within Price et al’s (2007) study with findings showing the students’ need for immediate interaction and feedback. Therefore, it appears that by meeting face-to-face with the tutor, students’ anxiety would be lessened. Nevertheless, Kerri appreciated the need for email comments: ‘I have quite a bad memory and the last supervisor was really helpful but I was trying to write down what he was saying and then I got home and leaving it 48 hours, I thought … I don’t know where it fits so I think you need the email to make it all fit together.’ This highlights that written comments are required, so feedback can be referred to later. This may account for the 38% of respondents that rated the tutorial by information technology as equal to face-to-face or higher, though again it must be considered that 75% of respondents were lecturers who may feel they supply detailed, written comments through email. However written academic language needs to be clear. Chanock (2000) recommended that if terms such as ‘analysis’ are used, they need to be followed up with an explanation. However, students in a study by Duers and Brown (2009) related that verbal feedback is preferred to written, as body language can be observed allowing easier interpretation. Results from the questionnaire were that 55% considered group tutorials less valuable than one-to-one tutorials, though 40% stated they were of equal value. Students in the group interview agreed that they would prefer one-to-one over group tutorials, however, they recognised the benefits of group tutorials. Sally related to ‘bouncing ideas off each other’ with Kevin stating: ‘A group tutorial is nice as someone in the group can ask the supervisor the question you want to ask and if you don’t think of any questions you will get answers to things like you wouldn’t have asked before.’
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Therefore students recognise they can use their peers as a learning resource (Higher Education Academy, 2010). Nevertheless, as Stacy conveyed, she feels uncomfortable asking questions in a group, with other interviewees agreeing. Freire (2007) relates to the need for an environment of mutual trust to allow learning to take place. It is difficult to elicit the size of the groups Stacy has experienced, but being in the adult branch, students may be referring to a large group. Smaller groups may produce a less intimidating climate and develop the students’ self-confidence (Higher Education Academy, 2010). In accordance with Wisker et al’s (2008) beliefs that one-toone contact is a ‘learning conversation’, Kevin identified the disadvantage of group tutorials is that the focus is not on one individual, but on a group of students.
Limitations to face-to-face, individual tutorials From questionnaire results, 57% stated they would like more opportunity to partake in face-to-face, individual tutorials with 27% stating they would not. Findings from the student interview were that all participants wanted more opportunity to partake in them. However, as the majority of questionnaire respondents were lecturers, the results are not surprising, due to time and resources. Regarding the limitations in partaking in more face-to-face, individual tutorials, Sally expressed: ‘[The] only barrier is that I think you are only supposed to have a set number of tutorials.’ This is consistent with qualitative questionnaire results, where 14% of comments acknowledge that school regulations limit participation in tutorials. As Stacy stated this could be related to ‘being fair’ to all students, which students in Gidman et al’s (2000) study deemed important. However, the issue of parity could be connected to time, workload and resources, which made up 41% of the question comments. Currently, with a 5% decrease in funding for Welsh HE institutions compared to 2010 (Higher Education Funding Council for Wales, 2011) and Pricewaterhouse Cooper’s (2011) recommendations of a reduction in investment in nonmedical healthcare education, the impact on staff workload and resources in nurse education needs attention. Nevertheless, the restrictions on tutorial time can cause stress, with Kerri remarking there needs to be ‘someone to refer to’, if students are having problems with understanding. The clinical component of undergraduate nursing programmes can also prove an obstacle to accessing tutorials. From the questionnaire, 13% stated ‘availability of students/ staff ’ as a problem, with concord in the interview. This issue needs recognition in contrast to other HE degree programmes, which do not have a clinical component. This may hinder nursing students’ opportunities for face-to-face dialogue within the HE institution. Conversely, having a clinical component where theory and practice combine should encourage a questioning and reflective approach leading to what Freire (2007) terms ‘transformation learning’.
Limitations of the study A purposive sampling strategy was employed for the study from a school of nursing and midwifery studies within a Welsh university.The findings cannot be given the same regard as those
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dialogue. Freire (2007) added that this relationship should be based on mutual trust and partnership between the educator and student. Liz commented on the difficulty in deciphering tutor’s language in email feedback:
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RESEARCH based on probability sampling. However, if the composition of the sample is considered, the descriptive data may lead to generalisations to the wider population (Sim and Wright, 2000). Nevertheless this is limited because of the sample size. A 40% (n=67) response rate was achieved from the questionnaire, with only 25% of the responses from students. This was disappointing after several reminders. Questionnaires are known for their low response rate and as Fincham (2008) acknowledged, email response rates may only approximate 30% without follow up.As 75% of respondents were lecturers, students were under-represented, which is a flaw in the overall results. Results show that individual, face-to-face tutorials are more valuable than other forms of tutorials. Respondents accessed individual, face-to-face tutorials primarily for supervision, feedback and academic writing. Just over half of the respondents (57%) would like more opportunity to partake in these tutorials. Participants in the student group interview highlighted the value of individual, face-to-face tutorials, stressing the benefit of dialogue and interaction which encourages learning. However they also appreciated the value of written email comments. The group interview could be criticised as respondents may feel they should give similar answers to the other participants (Bryman, 2008). Therefore in-depth individual interviews may be more trustworthy, though this method may cause additional difficulties with recruitment. Furthermore, the researcher’s presence in the group interview may have lead participants to supply the answers that they felt the researcher wanted (Tappen, 2011).
Conclusion This research could be deemed a pilot for a more robust, rigorous study, posing the same research question. The target population could remain lecturers and students in nurse education, or be extended to health-related education, in HE institutions. The composition of the sample could include undergraduates, postgraduates and post-registration students. The same research design could be used but it would be beneficial to also include lecturers within the exploratory stage to build on results from the descriptive stage. Further questions could to be considered in relation to the questionnaire: more meaningful data could be gathered if the relationship between individual, face-to-face tutorials and academic results were examined. Also, having a larger sample would allow comparisons to be made between lecturers’ and students’ responses, which was not possible within this study. Considering the current climate in HE institutions, where workload is increasing and resources are reducing, tutorials need to be efficient and effective. Therefore, further research is needed in this area to inform policy and procedures, as student experiences should be recognised for quality BJN assurance and enhancement.
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Conflict of interest: none Akinsanya CY (1992) Tutorials in nurse education; a survey of its use in district nursing training. Nurse Educ Today 12(4): 303-9 Baratta A (2010) Mandatory academic writing classes: they’ll thank you for it later. Times Higher Education, 5 August. http://tinyurl.com/lbdkxx5 (accessed 20 January 2015) Bryman A (2008) Social Research Methods. 3rd edn. Oxford University Press, Oxford Chanock K (2000) Comments on essays: do students understand what tutors write? Teaching in Higher Education 5(1): 95-105. doi:10.1080/135625100114984 Chi MT, Roy M, Hausmann RG (2008) Observing tutorial dialogues collaboratively: insights about human tutoring effectiveness from vicarious learning. Cogn Sci 32(2):
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KEY POINTS n Individual,
face-to-face tutorials are beneficial to students when receiving academic formative feedback
n Lecturers
and students would like more opportunity to partake in individual, face-to-face tutorials for academic support
n To
further examine the value of individual, face-to-face tutorials for academic support, a larger study, including undergraduate and postgraduate nursing students within the sample, is recommended
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Nurs Stand 22(31): 12-5 Weaver MR (2006) Do students value feedback? Student perceptions of tutors written responses. Assessment and Evaluation in Higher Education 31(3): 379-94 Wisker G, Exley K, Antoniou M, Ridley P (2008) Working One-to-One with Students. Routledge, New York
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The individual, face-to-face tutorial is one means by which academic support can be provided to students in higher education. This mode of tutorial support has been deemed effective but it can be considered labour-intensive, which is a concern in the UK with the recession currently impacting on higher education institutions. Nevertheless, with increasing student fees come higher student expectations. With all UK pre-registration nursing study programmes at degree level and with the emphasis on widening access, students may require additional academic support to ensure success. This study aimed to examine the value of individual, face-to-face tutorials for academic support in nurse education. A descriptive and exploratory design was used, mixing qualitative and quantitative methods. The survey approach employed a web-based, self-completion questionnaire, which was distributed to lecturers and pre-registration student nurses in a UK university. Following analysis of the questionnaire results, students were invited to attend a group interview. Findings highlighted the importance of individual, face-to-face tutorials with qualitative data supplying detailed accounts regarding their value. Key words: Nursing education ■ Nursing education research ■ Academic support ■ Face-to-face tutorial
A
cademic support is vital in higher education (HE). Although adult-centred learning can be considered as self-directed, guidance is required to meet the academic achievement of HE students (Gopee, 2011). Students come from a variety of backgrounds and have diverse learning styles and needs. Academics are in a position to provide opportunities to encourage development. This is relevant in nurse education, which has grown from apprenticeship training to being based in HE, with all preregistration programmes at degree level in the UK. Tutorials are one form of academic support. There are many types of tutorials ranging from group to individual, and delivery can be face-to-face or electronic. Palfreyman (2008) questions whether one-to-one, tutor/student tutorials are a thing of the past. The current recession is placing pressures on HE institutions. Tuition fees have increased since 2012, with all universities now charging £6000 to £9000 annually. Simultaneously, funding has Martina Nathan, Lecturer, School of Healthcare Sciences, Cardiff University. Accepted for publication: January 2015
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been cut to universities: in England, for 2012–13 there was a total spending cut of £1296 million in comparison with 2011–12 (Evans, 2012; Higher Education Funding Council for England, 2012a). This further accentuates the concerns of the Russell Group (2010) that the quality of academic support will be difficult to maintain. For pre-registration nursing in Wales, even though tuition fees are paid, bursaries have been reduced since 2012. However, the benefit of such individual, face-to-face tutoring is established in the literature (Price et al, 2007; Duers and Brown, 2009). It is important to take into account students’ expectations for a quality educational experience. The National Student Survey (NSS) is a powerful tool for gathering feedback from students completing undergraduate programmes. Regarding academic support in 2012 only 77% of full-time students in England claimed they were satisfied with the support (Higher Education Funding Council for England, 2012b). Therefore, there appears a major tension between reduced funding in HE, an increase in fees and student expectations. Stemming from these issues, it is timely to consider the value of individual, face-to-face tutorials for academic support in nurse education. This question needs addressing as it poses a problem for academic staff and students. Academics need to consider the best means to ensure efficient and effective student support. As the Quality Assurance Agency aims to safeguard quality in HE institutions, the Agency needs to know that students are receiving the best possible academic support. Low rates of student satisfaction could lead to high rates of withdrawal (Tomlinson, 2014). However, confounding this issue is the need for HE institutions to ensure student support is cost-effective. Tutorials are deemed to be expensive, due to their impact on resources. Hence, the benefit of tutorials should outweigh the cost implications. The value of individual, face-to-face tutorials consequently needs to be questioned, as valuable money could be spent on these tutorials under the assumption that they are the most effective way to offer academic support. By seeking students’ views within the study, current and potential students could be reassured that the students’ voice is heard. Students should be given the choice of how to access tutorial support but knowledge of the most effective means may aid their decision making.
Literature review An electronic literature search was undertaken using online health-related and educational databases. The findings are presented here according to the main themes emerging from the literature: the value of academic support; the student-tutor
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Abstract
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RESEARCH relationship in individual, face-to-face tutorials; and dialogue in individual, face-to-face tutorials.
Value of academic support Gidman et al (2000) believed that the mode of academic support should be dictated by the student rather than the programme. With the growing emphasis on student-centred learning, students are encouraged to take responsibility for their own learning. Nevertheless, students still require guidance and direction, particularly in the first year of study (Nolan and Nolan, 1997). Potolosky et al (2003) examined the association of tutoring services and academic performance of first-year nursing students. Support was offered by group or individual tutorials with tutors interacting with students via email or a website. A convenience sample of 37 students was used in 2 modules Results were not significant with regard to success and the number of tutorial sessions students attended, but on analysis of qualitative data, students were positive about the tutorials. McGann and Thompson (2008) also found the positive impact of academic support on failing students. Attrition is estimated to cost UK taxpayers £99 million a year, with a 26% attrition rate in pre-registration programmes (Waters, 2008). Simpson (2000) while recognising student support as vital for retention, stated that factors such as the course and policy have greater influence on attrition rates. Relating to academic support, Sayer et al (2002) justified the need for remediation programmes to prevent wastage of resources from student attrition due to failure. Ecclestone and Pryor (2003) concurred, stating that if institutes want to retain students, individual student goals need addressing and a plan needs to be put in place to enable achievement.
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Student-tutor relationship Following the move into HE for nurse education, Akinsanya (1992) emphasised the need for tutors to get to know students individually, to gain a better understanding of their needs. He added that the face-to-face nature of the tutorial leads to a ‘close relationship’ with the tutor. Although this literature is dated, with many changes occurring in nurse education since then, Malik’s (2000) study still recognises the importance of the student–teacher relationship. He found the nature of the relationship will distinguish whether a student accesses a tutor for academic advice. The approachability of the tutor is highlighted by students as being vital to the relationship (Stephen et al, 2008). Students in Owen’s (2002) action research study stated the personal characteristics of the tutor were not important but the availability and approachability of the tutor were important. Another factor that enhances the student–tutor relationship is regularly meeting (McGann and Thompson, 2008). For individual, face-to-face tutorials, developing a trusting relationship with the students is imperative to elicit any misconceptions regarding academic support (Price, 2003). This should be achieved through encouragement of a one-toone dialogue.
Dialogue in individual, face-to-face tutorials The benefit of interaction with face-to-face tutorials
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in comparison to online tutoring in a distance learning programme was highlighted in a study by Price et al (2007). Students undertaking the programme were offered the choice of face-to-face tutorials with telephone support or online support by email and computer conferencing. The only area of statistical significance between students undertaking face-to-face tutorials and students tutored online was in the ‘good tutoring scale’, with students tutored online awarding lower scores for their assessment of the tutoring. In exploring feedback, Higgins et al (2001) produced similar results. They concluded that the discussions between student and tutor in individual, face-to-face tutorials will clarify what is expected as the student prepares for assessments. Figure 1. Questionnaire used to obtain quantitative data
Face-to-face individual tutorials for academic support Please read the information sheet about the research before completing this questionnaire. All responses will be kept strictly confidential and only the researcher has access to the data. Please return the completed questionnaire by [date] 1. Are you a lecturer or a student? * Please select correct response ■■ Lecturer ■■ Student 2. Have you ever participated in individual face-to-face tutorials for academic support? If yes, please continue. ■■ Yes ■■ No 3. What was the primary purpose of the face-to-face individual tutorials? Please tick all relevant answers ■■ Supervision ■■ Feedback ■■ Academic writing ■■ Other: 4. Do you consider individual face-to-face tutorials for academic support valuable? ■■ Yes ■■ No ■■ No opinion Please list the two main reasons to support your answer .................................................................................................................................. 5. In comparison to the face-to-face individual tutorial, how would you rate the following: (More) (Less) (Equal) ■■ Information and communication technology; e.g. email. — ......... ........ ......... ■■ Group tutorial — ......... ........ ......... 6. Would you like more opportunity to participate in face-to-face individual tutorials for academic support? ■■ Yes ■■ No ■■ No opinion If you have answered ‘Yes’ to the previous question, please list the two main factors that limit you partaking in more face-to-face individual tutorials for academic support. ....................................................................................................................................... Thank you! Thank you for taking the time to complete this survey. The second strand of this study is a group interview to further explore the subject. If you are a STUDENT, and would be interested in partaking, please supply the following details Email address:
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3% Supervision Supervision and feedback
30%
Supervision, feedback and academic writing Supervision and academic writing Supervision, feedback, academic writing and other
37%
Academic writing and other
22%
Figure 2. Primary purpose of face-to-face individual tutorials (from questionnaire responses)
In comparison to the value of individual, face-to-face tutorials, how would you rate tutorials via information and communication technology? 40 36 35 30 26
Frequency
25 20 15 10 5 0
4 More valuable
Less valuable
Equally valuable
Figure 3 Results from questionnaire (actual numbers of respondents)
In comparison to the value of individual, face-to-face tutorials, how would you rate group tutorials? 40
37
35
Frequency
30
27
25
15 10
0
2 More valuable
Less valuable
Figure 4. Results from questionnaire (actual numbers of respondents)
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Methods For this mixed methods research, the approaches were sequential, with the quantitative survey first. Leading from the analysis of the survey data, an exploratory approach followed as qualitative methods further explore quantitative findings and provide more depth. The research method employed for the survey approach was the self-completion questionnaire. The self-administered questionnaire was deemed a suitable research method for this study as it reached students and lecturers at one time and allowed respondents to answer at their own convenience. To reduce the possibility of respondent burden and missing data only six questions were formulated (Figure 1).The questionnaire was piloted with lecturers and students to gain both perspectives: no changes to the tool were required following the pilot. The qualitative strand was a group interview, which allowed questions to be posed to each group member in turn. A purposive sampling strategy was employed for the two types of data collection. The population targeted was student nurses and lecturers in nurse education from a school of nursing and midwifery studies in a Welsh university. Although this sampling technique is deemed weak as bias may be introduced (Moule and Hek, 2011), the sample is easily accessible. Regarding the composition of the quantitative sample, all lecturers in the school were included and a year 3 adult undergraduate cohort. As the researcher was a lecturer in a different field of nursing, adult nursing students were chosen to prevent researcher bias. Students who completed the questionnaire were invited to attend the group interview through the questionnaire. As a lecturer was conducting the interview, only the student cohort were invited for interview. Only 5 students requested to participate in the interview from the invitation on the questionnaire. The researcher met with the cohort again faceto-face to invite them again to take part in the interview and distribute the information sheets and consent forms to those interested. No further interest was shown. Ethical approval was granted by the university’s ethics committee.
Results
20
5
Duers and Brown (2009), in exploring student nurses’ experiences of formative assessment, found that students preferred verbal to written feedback, as by communicating with the tutor, questions could be posed and non-verbal signs observed gaining a clearer understanding of the feedback. Weaver’s (2006: 384) findings concur, with the quantitative results of a multi-method design indicating that more guidance is required in interpreting and using feedback as students may not understand ‘academic discourse’.
Equally valuable
The questionnaire’s quantitative data were analysed using SPSS (v 18.0). The questionnaire’s qualitative comments were analysed and common themes emerged. The questionnaire was sent out via email to 90 academic staff with a lecturer’s role and to 76 year 3 adult undergraduate students. A total of 166 questionnaires were distributed. The response rate was 40% (n=67); 75% of responses came from lecturers. Results are shown for answers to question 3 (Figure 2) and question 5 (Figure 3 and Figure 4). Five students who responded to the questionnaire
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6%
2%
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RESEARCH participated in the group interview. Common themes stemming from the questions posed in the survey helped plan the interview schedule and structure the analysis (Table 1), which Tappen (2011) refers to as concept-driven. The interview was recorded and subsequently transcribed. Participants were informed that their names would be changed when findings were analysed to ensure anonymity. It was sent to each participant for verification. Only two out of the five students verified the transcribing.
Discussion Participation in individual, face-to-face tutorials All respondents in the study participated in individual, faceto-face tutorials. The combination of ‘supervision, feedback and academic writing’ emerged as the primary purpose of the tutorial in results from the questionnaire (37%). Although academic writing is included in this category, none of the students in the interview claimed that they had face-to-face support for academic writing, which they felt would have been beneficial. One respondent, Liz, stated that ‘on line’ resources were not sufficient: ‘I found it quite hard as I came from a Welsh background and I had nobody showing me how to reference, it was all on line …’
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This aligns with Baratta (2010) who recognises that webbased resources cannot replace contact teaching. As 75% of respondents to the questionnaire were lecturers, they may view ‘academic writing’ as part of supervision. Wisker et al (2008) recognise the importance of a one-toone relationship for supervision, where tutors enable students to develop skills. They also suggest that supervision involves negotiation and dialogue. Therefore, face-to-face tutorials for supervision could be deemed more appropriate. This was recognised by one student interviewee, who claimed that he preferred supervision face-to-face, as questions can be asked and ‘proper’ feedback can be given. Feedback was considered one of the main purposes of individual, face-to-face tutorials in 66% of questionnaire responses, which was explored further in the interview, with all participants recognising the benefit of formative feedback. Sally expressed the belief that tutors can direct her regarding what she ‘should be doing next’. However, on further probing, participants only accessed tutorials for summative feedback if they ‘didn’t do well’ commenting that feedback through email was sufficient. This is surprising as the value of dialogue and questioning are recognised by participants’ with regard to supervision and formative feedback. This would imply that students do not require face-to-face feedback if they are satisfied with their summative mark. However, Higgins et al (2001) advised the need for discussion between tutor and student, to apply lessons from feedback to future work.
The value of individual, face-to-face tutorials All respondents within the study considered individual, faceto-face tutorials valuable. Clarification was given as a reason by 26% of respondents. This was reinforced in the interview with Stacy stating:
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‘With face-to-face normally if you don’t understand what they are getting at, you can ask.’ These findings marry with those of Chi et al (2008), which showed that the interaction in individual, face-to-face tutorials encouraged learning. From the tutor’s perspective, it would be easier to detect if a student is struggling with understanding during a meeting face-to-face. Stewart (2007) when discussing critical pedagogy, added that students will therefore be encouraged to speak and ask questions. Responses in the interview also highlighted the benefit of questioning in the tutorial. Sally stated: ‘If they [lecturers] have said something and you have not really understood it, you can question them.’ Kerri concurred, stating that questioning can continue until understanding is gained. Interviewees identified the benefit of questioning but moreover the overarching dialogue in face-to-face, individual tutorials. Sally explained this dialogue as ‘building’ on issues between the tutor and student. Keesing-Styles (2003) appreciated that dialogue is not just discussion, which was identified by 8% of questionnaire respondents in free text comments relating to ‘meaningful discussion’. The importance of ‘building’ working relations in face-to-face, individual tutorials was also recognised by 11% of questionnaire respondents in free text comments. Stewart (2007) believed that if relationships are maintained with students it will encourage Table 1. Schedule for student group interview Theme
Questions
Reason to access individual, face-to-face tutorials
■■ Have all of you participated in face-to-face, individual
tutorials for academic support? ■■ Why have you accessed individual, face-to-face tutorials
for academic support? The value of individual, face-to-face tutorials
■■ Do you consider individual, face-to-face tutorials valuable
or beneficial? ■■ Consider understanding of ‘valuable’? ■■ Why? Give examples. ■■ Have you experienced both individual, face-to-face tutorials
and tutorials via information technology (such as e-mail) ■■ Following from the previous question; comparing
individual, face-to-face tutorials to tutorials using information technology, which would you consider the most valuable and why? ■■ Do you think one benefited you more than the other? ■■ Give examples—written/verbal ■■ Have you experienced group tutorials? ■■ Would you prefer individual or group tutorials for academic support and why? ■■ Consider: are there situations where one is better than the other? ■■ Consider: giving examples from questionnaire results Opportunity to participate in individual, face-to-face tutorials
■■ Would you like more opportunity to participate in
Other areas to consider
■■ Would you consider individual, face-to-face tutorials a
individual, face-to-face tutorials? Why? What limits you partaking in more (consider giving examples)? form of teaching? ■■ Is the academic support what you expected when you
commenced your programme?
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‘When I have an email it sometimes does not open and when I have the comments back I can’t really understand what he or she is saying and then you have to wait for them to get back to you.’ Kerri concurred, highlighting the barriers in interpreting each other’s electronic communications. Mutch (2003) stressed this can be particularly problematic for a weaker student who cannot understand the tutor’s language, and concluded that discussion is required to prevent misunderstanding. In relation to this, 54% of respondents rated tutorials via information technology as less valuable than face-to-face, 38% rated them of equal value, with 6% rating information technology more valuable. Students outlined in the interview, the problems they encountered with tutorials via email relating to being unsure if the tutor had received their email. This issue emerged within Price et al’s (2007) study with findings showing the students’ need for immediate interaction and feedback. Therefore, it appears that by meeting face-to-face with the tutor, students’ anxiety would be lessened. Nevertheless, Kerri appreciated the need for email comments: ‘I have quite a bad memory and the last supervisor was really helpful but I was trying to write down what he was saying and then I got home and leaving it 48 hours, I thought … I don’t know where it fits so I think you need the email to make it all fit together.’ This highlights that written comments are required, so feedback can be referred to later. This may account for the 38% of respondents that rated the tutorial by information technology as equal to face-to-face or higher, though again it must be considered that 75% of respondents were lecturers who may feel they supply detailed, written comments through email. However written academic language needs to be clear. Chanock (2000) recommended that if terms such as ‘analysis’ are used, they need to be followed up with an explanation. However, students in a study by Duers and Brown (2009) related that verbal feedback is preferred to written, as body language can be observed allowing easier interpretation. Results from the questionnaire were that 55% considered group tutorials less valuable than one-to-one tutorials, though 40% stated they were of equal value. Students in the group interview agreed that they would prefer one-to-one over group tutorials, however, they recognised the benefits of group tutorials. Sally related to ‘bouncing ideas off each other’ with Kevin stating: ‘A group tutorial is nice as someone in the group can ask the supervisor the question you want to ask and if you don’t think of any questions you will get answers to things like you wouldn’t have asked before.’
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Therefore students recognise they can use their peers as a learning resource (Higher Education Academy, 2010). Nevertheless, as Stacy conveyed, she feels uncomfortable asking questions in a group, with other interviewees agreeing. Freire (2007) relates to the need for an environment of mutual trust to allow learning to take place. It is difficult to elicit the size of the groups Stacy has experienced, but being in the adult branch, students may be referring to a large group. Smaller groups may produce a less intimidating climate and develop the students’ self-confidence (Higher Education Academy, 2010). In accordance with Wisker et al’s (2008) beliefs that one-toone contact is a ‘learning conversation’, Kevin identified the disadvantage of group tutorials is that the focus is not on one individual, but on a group of students.
Limitations to face-to-face, individual tutorials From questionnaire results, 57% stated they would like more opportunity to partake in face-to-face, individual tutorials with 27% stating they would not. Findings from the student interview were that all participants wanted more opportunity to partake in them. However, as the majority of questionnaire respondents were lecturers, the results are not surprising, due to time and resources. Regarding the limitations in partaking in more face-to-face, individual tutorials, Sally expressed: ‘[The] only barrier is that I think you are only supposed to have a set number of tutorials.’ This is consistent with qualitative questionnaire results, where 14% of comments acknowledge that school regulations limit participation in tutorials. As Stacy stated this could be related to ‘being fair’ to all students, which students in Gidman et al’s (2000) study deemed important. However, the issue of parity could be connected to time, workload and resources, which made up 41% of the question comments. Currently, with a 5% decrease in funding for Welsh HE institutions compared to 2010 (Higher Education Funding Council for Wales, 2011) and Pricewaterhouse Cooper’s (2011) recommendations of a reduction in investment in nonmedical healthcare education, the impact on staff workload and resources in nurse education needs attention. Nevertheless, the restrictions on tutorial time can cause stress, with Kerri remarking there needs to be ‘someone to refer to’, if students are having problems with understanding. The clinical component of undergraduate nursing programmes can also prove an obstacle to accessing tutorials. From the questionnaire, 13% stated ‘availability of students/ staff ’ as a problem, with concord in the interview. This issue needs recognition in contrast to other HE degree programmes, which do not have a clinical component. This may hinder nursing students’ opportunities for face-to-face dialogue within the HE institution. Conversely, having a clinical component where theory and practice combine should encourage a questioning and reflective approach leading to what Freire (2007) terms ‘transformation learning’.
Limitations of the study A purposive sampling strategy was employed for the study from a school of nursing and midwifery studies within a Welsh university.The findings cannot be given the same regard as those
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dialogue. Freire (2007) added that this relationship should be based on mutual trust and partnership between the educator and student. Liz commented on the difficulty in deciphering tutor’s language in email feedback:
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RESEARCH based on probability sampling. However, if the composition of the sample is considered, the descriptive data may lead to generalisations to the wider population (Sim and Wright, 2000). Nevertheless this is limited because of the sample size. A 40% (n=67) response rate was achieved from the questionnaire, with only 25% of the responses from students. This was disappointing after several reminders. Questionnaires are known for their low response rate and as Fincham (2008) acknowledged, email response rates may only approximate 30% without follow up.As 75% of respondents were lecturers, students were under-represented, which is a flaw in the overall results. Results show that individual, face-to-face tutorials are more valuable than other forms of tutorials. Respondents accessed individual, face-to-face tutorials primarily for supervision, feedback and academic writing. Just over half of the respondents (57%) would like more opportunity to partake in these tutorials. Participants in the student group interview highlighted the value of individual, face-to-face tutorials, stressing the benefit of dialogue and interaction which encourages learning. However they also appreciated the value of written email comments. The group interview could be criticised as respondents may feel they should give similar answers to the other participants (Bryman, 2008). Therefore in-depth individual interviews may be more trustworthy, though this method may cause additional difficulties with recruitment. Furthermore, the researcher’s presence in the group interview may have lead participants to supply the answers that they felt the researcher wanted (Tappen, 2011).
Conclusion This research could be deemed a pilot for a more robust, rigorous study, posing the same research question. The target population could remain lecturers and students in nurse education, or be extended to health-related education, in HE institutions. The composition of the sample could include undergraduates, postgraduates and post-registration students. The same research design could be used but it would be beneficial to also include lecturers within the exploratory stage to build on results from the descriptive stage. Further questions could to be considered in relation to the questionnaire: more meaningful data could be gathered if the relationship between individual, face-to-face tutorials and academic results were examined. Also, having a larger sample would allow comparisons to be made between lecturers’ and students’ responses, which was not possible within this study. Considering the current climate in HE institutions, where workload is increasing and resources are reducing, tutorials need to be efficient and effective. Therefore, further research is needed in this area to inform policy and procedures, as student experiences should be recognised for quality BJN assurance and enhancement.
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Conflict of interest: none Akinsanya CY (1992) Tutorials in nurse education; a survey of its use in district nursing training. Nurse Educ Today 12(4): 303-9 Baratta A (2010) Mandatory academic writing classes: they’ll thank you for it later. Times Higher Education, 5 August. http://tinyurl.com/lbdkxx5 (accessed 20 January 2015) Bryman A (2008) Social Research Methods. 3rd edn. Oxford University Press, Oxford Chanock K (2000) Comments on essays: do students understand what tutors write? Teaching in Higher Education 5(1): 95-105. doi:10.1080/135625100114984 Chi MT, Roy M, Hausmann RG (2008) Observing tutorial dialogues collaboratively: insights about human tutoring effectiveness from vicarious learning. Cogn Sci 32(2):
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KEY POINTS n Individual,
face-to-face tutorials are beneficial to students when receiving academic formative feedback
n Lecturers
and students would like more opportunity to partake in individual, face-to-face tutorials for academic support
n To
further examine the value of individual, face-to-face tutorials for academic support, a larger study, including undergraduate and postgraduate nursing students within the sample, is recommended
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