Wikis are best known through Wikipedia (Boulos et al, 2006), the online repository of shared knowledge which can be updated by anyone at any time through the internet. The term ‘wiki’ means ‘to hurry’ in Hawaiian, and wikis have been part of the web landscape for over fifteen years. In health care, wikis have been used to share and develop clinical knowledge, but contribution tends to be restricted (Sandars and Schroter, 2007). For example, the Ganfyd website is a repository of medical information, where contributors must be registered medical practitioners (Ganfyd, 2011).
Wikis have been embraced in the educational sector as providing an exciting new means of promoting collaboration and shared learning through the development of joint materials (Elgort et al, 2008). The key feature of the wiki is that it provides students with the capacity to write a shared document, allowing them to write, edit and rewrite material.
At first brush, the wiki seems like an ideal way in which to promote cooperative learning; it provides the technological platform to promote sharing of ideas and the joint development of an artefact. It permits students to integrate other online resources as well as their own understandings and has been linked with Wenger's concept of building a ‘community of practice’ (Wheeler et al, 2008).
However, a range of limitations exist with wiki's, such as the potential for propagation of unfounded and unreliable information, which is largely unregulated, is exposed to online vandals that promote misinformation, and is a potential source of student plagiarism (Greenstein and Devereux, 2009).
Different types of wikis
Furthermore, a range of empirical studies in the use of wikis in higher education indicate a somewhat more complex picture. In 2006, Bower and Richards compared two different types of wikis in two different masters of information technology units (Bower and Richards, 2006). They studied both a wiki used to provide weekly class extensions and a wiki that acted as an overarching e-learning space where administrative matters were discussed as well as group projects created.
They drew a number of conclusions that can be summarized as: the effective use of wikis was dependent on appropriate educational task design such as authentic meaningful activities, appropriate technical guidance, and feedback and assessment should be considered in wiki design. Wheeler et al (2008) indicated that Bachelor of Education students perceived their writing skills and critical skills improving and enjoyed the public nature of their work but also reported difficulty with respect to working with the technology and sharing ownership of writing materials.
A recent 2010 study by Judd et al (2010) examined the use of a wiki in a first year psychology unit, measuring contribution and collaboration using text and time-based metrics rather than perceptual measures such as surveys and focus groups. This indicated some key issues: a small proportion of the students did the bulk of the work; and many students’ contributions were minimal. Judd et al (2010) note:
‘Many students were probably more concerned with simply meeting the task contribution requirements, which would require minimal cooperation or collaboration then developing a comprehensive and coherent group submission’
This is at odds with Elgort et al's (2008) study that concluded that wikis did support individual participation.
Case-based learning
The Bachelor of Emergency Health (BEH) is a paramedic pre-employment undergraduate degree, offered full-time on-campus over three years at Monash University. Each of the clinical units within the BEH is guided by the teaching and learning approach of case-based learning (CBL). CBL is considered a derivative of problem-based learning (PBL), which has been used in the medical and health sciences for over forty years (Savin-Baden, 2000).
The CBL process is argued to be well suited for healthcare education as it is designed to mimic future professional practice and encourages increased search for independent knowledge and self-discovery (Bowen, 1998). While variations of CBL exist, the fundamental principle is developing students’ knowledge through solving problems based on authentic clinical scenarios. In the BEH, students are provided with relevant information, followed by the small group facilitated discussions with expert tutors to develop solutions and answers to the clinical problems.
In previous papers, CBL has been reported via a blended teaching approach, using a combination of face-to-face and e-learning asynchronous communication strategies via Blackboard (Williams, 2006). Paramedic undergraduate students report high satisfaction levels with this approach (Williams, 2009). The CBL process requires students to engage in self-directed, self-discovery, and peer-and self-engaged learning practices. These learning characteristics are central to wiki learning sites.
In 2009, we piloted the use of wikis instead of Blackboard via an independent management system (Wikispaces). To our knowledge, this is the first study of this type involving paramedic undergraduate students. The aim of this article is to report students’ perceptions and attitudes towards wikis used in association with case based learning. We describe a contemporary teaching and learning opportunity and a pragmatic evaluation regarding the use of wikis in the BEH degree, which may be useful to other paramedic programmes internationally.
The pedagogical context
In this article, the e-learning component is described through the use of wikis instead of Blackboard via an independent management system (Wikispaces). Wikispaces was chosen for this pilot study as it offered a clear interface, good resource support and well-priced for an academic semester. Unfortunately, the platform was not able to be merged into Monash's designated learning management system (LMS) (Blackboard), and therefore a separate web page link was created for student login, plus an added username and password in addition to their standard Monash student account.
At the commencement of each week, students were provided with new theoretical content, which was followed by an accompanying case to support the content for that teaching week. Each CBL wiki group was limited in numbers (12–15 students) and quarantined from each other group, to avoid repetition and potential for some students to dominate discussion postings.
During week 1 of the semester, a brief overview, orientation and educational rationale of wikis and Wikispaces was provided to students, including new passwords, how to edit, user requirements, netiquette and other related wiki tools.
Each clinical case was provided at the conclusion of the main face-to-face lecture and was uploaded into wikispaces. Students were allocated to their wiki tutorial groups within Wikispaces and were expected to de-construct the clinical case as a collaborative group, which were regularly moderated by faculty staff. It is important to note that student participation in wiki tutorials was not compulsory, nor were any marks given for participation or quality of discussion.
This collaborative learning was undertaken at a time that suited individual students (generally off-campus and after hours). As with similar LMS, Wikispaces allows faculty staff to provide students with an authentic and interactive method of presenting realistic clinical cases and often includes supporting video and audio files, for example lung sounds or electrocardiograms that are essential for paramedic clinical practice.
Students were given three days in which to collaborate and develop answers/solutions to the case. The final wrap-up and closure to the weekly case took place later in the week in a face-to-face lecture which included work undertaken by each wiki group. While previous examples of e-tutorial groups allowed group discussions, these were largely constrained to threaded discussion postings, without the capacity to directly modify or edit peer work.
This capacity to edit fellow peers’ work is one of the central characteristics of a wiki. In other words, students (and moderators) have the capacity to over-write work that is incorrect, perhaps debatable, or requires further analysis. Of note, all edited work by peers was evident in the editing history page that could be accessed by students and moderators at any time. In other words, any modification or editing of work was completely transparent, further emphazising the peer-based learning basis to wikis.
Methods
Design
A cross-sectional study using a short paper-based self-reporting questionnaire was administered to second year students in the BEH undergraduate paramedic course.
Participants
Participants in the study were students enrolled in second year of the BEH studying BEH2031: foundations of paramedic clinical practice. Inclusion criteria for the students were providing consent to take part in the study and being enrolled in the BEH at Monash University on a full-time basis.
Instrumentation
The self-report questionnaire used was an adapted subset of the instrument published by Elgort et al (2008) and included 7 items measuring student attitudes towards wikis and was assessed using a Likert-type scale: 1 (strongly agree) to 5 (strongly disagree). Two open-ended questions such as ‘what did you enjoy about wikis’ and ‘what did you not enjoy about wikis’ were used to allow students to provide greater alternative responses. A brief set of demographic questions (2 items) were also included.
Ethical considerations
Ethics approval for the study was granted by the Monash University Standing Committee on Ethics in Research Involving Humans. Students were invited to take part in the project by one of the investigators at the conclusion of a lecture. The purpose of the study was explained to students and that their participation in the project was voluntary.
Data analysis
For the questionnaire data, statistical analysis was undertaken using the Statistical Package for the Social Sciences (Version 18.0, SPSS Inc). Since the data were ordinal, non-parametric statistics were used based on medians and interquartile ranges (IQR). Mann-Whitney U Test was performed to compare between genders and age. The results were considered statistically significant if the P-value was < 0.05.
Results
A total of 29 second year paramedic students participated in this study, 49% of the total eligible to participate. Overall the vast majority of participants were female n=20 (69%). This finding is consistent with previous BEH intakes since the inception of the programme in 2004.
The majority of participants were 25 years or less 72% (n=21). Again, this result is consistent with previous BEH age distributions. No statistically significant differences were found between gender and age variables, when comparing medians and inter-quartile ranges. Table 1 displays an overview of results.
| Item | % (n) favourable | % (n) neutral | % (n)unfavourable |
|---|---|---|---|
| I found the group wiki useful in completing the team task | 100% (29) | 0% (0) | 0% (0) |
| I found the group wiki easy to use | 52% (15) | 31% (9) | 17% (5) |
| Using wiki encouraged better participation of each group member in the case. | 2% (15) | 38% (11) | 10% (3) |
| Group wiki worked well as a tool for collecting and organizing information for the case | 31% (9) | 31% (9) | 38% (11) |
| Group wiki worked well as a tool for presenting the results and findings of the group | 41% (12) | 31% (9) | 28% (8) |
| Did you experience technical problems when using wiki pages for cases? | 28% (8) | 52% (15) | 21% (6) |
| Would you like to see group wikis incorporated into other Bachelor Emergency Health (BEH) units? | 41% (12) | 1% (12) | 14% (4) |
Responses of ‘agree’ or ‘strongly agree’ have been grouped as ‘favourable’. Responses of ‘disagree’ or ‘strongly disagree’ have been grouped as ‘unfavourable’.
Several open-ended questions were also provided to elicit students’ perceptions on what they enjoyed or did not enjoy about wikis. A sample of typical responses from second year students is shown below discussing what they enjoyed about wikis.
‘Having a chance to consider other options and thoughts prior to expressing own. The chance to research and refect prior to contributing…not feeling like being put on the spot to have the right answer’
‘You can see everyone's individual opinions’
‘A very useful study tool, particularly for topics linked to in-class learning: great for comparisons and extra info’
‘The fact that it was group response related— some students brought up interesting points I would not have considered otherwise’
‘Further expanded on information and ideas learnt in class therefore encouraging you to put the information into context and forces you to extend your knowledge base as much or as little as you want’
A sample of typical responses from second year students is shown below discussing what they did not enjoy about wikis.
‘There needs to be a commitment that all group members will contribute’
‘I had to change my password every time I tried to login to wiki. It was very annoying!’
‘To start off with I found using wiki extremely frustrating and whilst I eventually got the hang of it, I’m not convinced of its benefts’
‘I didn't like how everyone gave their opinions/answers and there was no way of knowing whether or not the answers were correct. Also, I felt some groups were disadvantaged as not all groups put as much into it as others’
‘I do think that wikis are yet ANOTHER tool to add to the myriad of things we have to check each day, which can tend to shorten the amount of time we have for actually studying/actively learning/researching. It can be fiddly too. If everything could be located at one online location that would be preferable!’
‘I really liked the idea of wikis but stopped using it after a few weeks as all other assessment tasks took priority. I couldn't justify spending an evening on wikis when I had other assignments to do, even though I know it was designed to improve my understanding of the course material’
Discussion
The results of this study add to the body of work describing mixed outcomes for the use of wikis to support teaching and learning. The majority of students found the group wiki useful in completing the team task, the group wiki was easy to use, and the wiki encouraged better participation of each group member in the case.
On the other hand, there was more equivocation regarding the wikis value as a tool for collecting and organizing case information, or presenting results and findings of the group. It is fair to say that, in general, the students were positive about the use wikis in their educational setting but there were some perceived drawbacks as indicated by the qualitative comments.
When this study is considered in context of other recent studies, some interesting observations can be made. First, that the pedagogical purpose of the wiki may be highly instrumental in perceptions of its usefulness. In this instance, the clinical format of case-based learning may be a very good ft for wikis, as opposed to tasks, as noted by Wheeler et al (2008) which are less ‘authentic’. This may in turn lead to different perceptions of the intrinsic value of completing the exercise.
Second, the individual cohort may also be better or worse suited to these type of group work activities. Judd et al (2010) note that students on a first year undergraduate psychology course may be less suited to responsible group work than those on other courses, as it can be suggested these undergraduates are more extrinsically motivated. Certainly the perception of the cohort that group work was shared is very much in contrast to Judd et al's (2010) metric-based findings.
It would be very interesting to measure participation against perception of participation. It is also unclear what the impact of various instructional design choices are on the particular student experience. For example: publishing the wiki to the wider web vs keeping the documentation in house; or anonymity vs identification of particular students.
Limitations
A consequence of using convenience sampling is that there no data on those students who declined to participate is available. The final sample (n=29) while adequate for conducting the statistical analysis, is not large enough to produce results that are generalisable to larger groups. Although the survey instrument is based on a previous version, no formal validation or psychometric testing has taken place. Some caution is, therefore, advised in interpreting the results of this study. It should also be underlined that students were not required to participate in the wiki activity.
Conclusion
Although findings from this study are preliminary, it appears that wikis may be a useful addition to CBL in paramedic clinical units. Further research is warranted using a larger sample size, and integrated and compared across both clinical and non-clinical units. The impact of instructional design choices as well as understanding actual vs reported practices is worth further exploration, particularly with the increasing use of educational technology being used throughout higher education.