Many educators have experienced the unpleasantness associated with end-of-course summative evaluations by students. As nurse educators, we strive to provide a stimulating educational environment using various pedagogies that incorporate experiential learning activities. But inevitably, some of the strategies we use are noneffective, poorly received, or even demotivating to student engagement in the classroom.
Midterm formative evaluations are helpful in providing insight into what is or is not working for students. Unfortunately, by that point in the quarter or semester, educators are overwhelmed with course content, student interactions, grading, research, and service commitments. We say to ourselves, "I cannot do anything about this course right now, but I will make changes the next time I teach it."
It is essential that students have opportunities to provide frequent formative course feedback and see that the feedback is used to make course adjustments (Chen & Hoshower, 2003). It stands to reason that educators should provide frequent opportunities for meaningful feedback to bring about change at the "point-of-care," the classroom. We would not take a patient's blood sugar at the bedside and react with a dose of insulin without also investigating the circumstances and environment that led to the hyperglycemic event. Instead of being reactive, we need to be responsive, purposeful educators.
OUR SOLUTION: YOUR VOICE COUNTS
Our team had been interested in finding ways to engage students in meaningful, constructive, and reflective feedback. Initially, we relied almost entirely on end-of-course feedback to guide the development of subsequent courses. We were frustrated by not receiving this important feedback until the end of the quarter, when it was too late to make changes. We decided to implement a more student-centered learning environment and began asking students to provide us with rapid and informal feedback, using methods such as email and in-class comments. This seemed to work well, and we were proud of our innovation, but many students said that they felt intimidated at the prospect of providing instructors with feedback, especially in front of their peers. The feedback was usually superficial and not very helpful.
We then began asking for anonymous feedback that students could turn in at the end of the course and offered a box for comments. This method helped improve the quality and quantity of the feedback, but also resulted in some inappropriate and not very helpful venting. It also did not solve the problem of feedback that came too late.
Finally, the lightbulb went off, and we decided to experiment with seeking continuous formative feedback during the course. We began using Your Voice Counts as a strategy for student feedback in a prelicensure course for returning students seeking a pathway to a nurse practitioner license. We then used it in the Senior Synthesis Capstone course and the following year with undergraduate students in an adult health course.
The idea was to provide students a means of feeling empowered and part of the process, as opposed to passive recipients of knowledge. The feedback loop would be created on a continuous consistent basis - our goal was weekly - and the feedback would be used to immediately implement changes that had a significant functional impact on the direction and delivery of the course content. Your Voice Counts sought to create a highly flexible and highly responsive learning environment that had, as one of its unique properties, the ability to meet the different needs of successive student cohorts, with recognition that the classroom is a variable, rather than a fixed environment, in which each group of students shares certain similarities with and has certain differences from those who have gone before.
Several simple steps were instituted. With some minor variation among us, we begin the first day of class explaining to students our learner-centered approach to teaching, and we provide instruction on giving reflective and constructive feedback. We use a simple, hardcover, spiral-bound notebook with a picture on the cover of a student using a megaphone with the caption Your Voice Counts. Students are given the book at the beginning of class and are free to pass it around. The last student to have the notebook returns it to one of the instructors.
Students are encouraged to write down what comes to mind during the class and what questions, concerns, or suggestions they may have. The ground rules are simple. Students are asked to provide feedback that is anonymous, respectful and professional, constructive and thoughtful, reflective, and realistic. They are asked to provide a solution or an alternative way of doing something.
LESSONS LEARNED
We have found this method to be extremely helpful in shaping our courses and addressing the needs of the students. We are able to be responsive instead of reactive. The method leads to dialogue and creates a culture of inclusivity and trust, where learners feel respected and connected to one another and the teacher. Comments regarding the use of this method appear numerous times on our end-of-course evaluations as something students really value.
Our belief is that learning happens best in a safe and inclusive environment that fosters respect and trust. Once the environment is "safe," you can develop positive attitudes that enhance meaning and ways of engendering competence. Our philosophy is framed in the work of Wlodkowski (2008), which emphasizes the importance of creating an inclusive learning environment, developing positive attitudes about learning, establishing meaning in the material, and engendering competence.
At the end of each class session, we review the responses, look for common themes, and make necessary adjustments. Sometimes this involves emailing the class about a change or concern, changing something for the following week, or making a major change to the course timeline or structure. The students always see the results from their feedback. If we cannot make a change, we discuss why this is the case during the next class. The majority of comments are positive.
Our end-of-course student evaluation form does not ask for specific measures of student empowerment or engagement, but we have detected an increase in positive narrative comments offered by students. Actual comments include the following:
* "Instructor encouraged student feedback with every class and took time to address our concerns at the beginning of each class, which greatly reduced our stress levels."
* "Professor treated the students respectfully and sought our regular feedback after each class asking us to describe what was going well or needed improvement."
* "This professor is amazing - always seeking feedback from students in an anonymous manner so she is constantly improving herself and the class."
Others have commented on "a safe and trusting environment," the quick feedback received, and the fact that the class is about student needs. Students have noted that we "changed teaching styles based on what worked for our class" and thanked us for listening. Very rarely do we receive disrespectful or uncivil feedback. We believe that, because the students have so many opportunities to have their voices heard, their frustration level is kept to a minimum.
IMPLICATIONS FOR NURSING EDUCATION
Using the feedback from Your Voice Counts created an opportunity for us to address student issues in a timely manner. Flush with success, we wanted to extend our communication effort. Using the content of the notebook as well as the course assignment structure, we created a weekly posted announcement dubbed Sunday Check-Ins on our course learning management system.
Students in the early weeks of the course expressed feelings of being overwhelmed as they worked through complex assignments. The Sunday Check-Ins had three purposes: a) to offer clarity about upcoming assignments and course expectations for the week, b) to address any concerns or suggestions presented in Your Voice Counts, and c) to offer encouragement and reassurance. The feedback has been positive and consistent. Comments include:
* "The Sunday Check-Ins really help me to keep things straight."
* "I really like the way we know what is coming up, it helps me to stay organized and reduces my stress level."
* "Even though I use the course calendar, I really like how Sunday Check-Ins keep me on track."
As a result of the Sunday Check-Ins, the number of questions for faculty posted via email, in person, or by telephone has been significantly reduced, enabling us to make more effective, more efficient use of our time. Students rarely need to seek clarification and rarely experience frustration. The end result has been enhanced communication, role modeling of professional behaviors, and an increased level of accountability regarding assignments and interactions.
Several strategies have been incorporated into our classrooms based on student feedback, including the following:
* Each class begins with a review of important concepts and content. Rather than our presenting concepts to the class, we use a whiteboard to explore concepts and have students come to the board to list priority interventions.
* Students are given guided quizzes that focus on concepts and prioritization to take prior to the class. These replace PowerPoints.
* Students, supported by input from their peers, take the classroom lead in articulating priority interventions.
* Students are given participation credit for completing the guided quizzes and group case studies.
We let the students know that we continually learn from them. We say things such as, "In this classroom, everyone is a teacher and everyone is a student." We encourage them to see learning as a fluid interaction with constantly shifting roles; sometimes we will be the teacher, other times they will teach themselves or their peers. In this way, we are engaged in a cycle of mutual learning. We believe that managing students' expectations while offering a means of continuous formative feedback sets the stage for active learning.
As it became apparent that Your Voice Counts was an effective strategy to improve the learning environment and enhance students' sense of empowerment, we casually discussed this method of continuous feedback with colleagues. Recently, we introduced Your Voice Counts and Sunday Check-Ins during a faculty educational in-service, and several faculty members asked us to assist them in implementing these strategies in their classes.
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