The pedagogy of phlebotomy

October 14, 2011, 7:30 am

When we moved to Michigan from Indiana over the summer, my wife moved to a sort of “standby” status with her employer, a conglomerate of medical labs based in South Bend. They are considering opening up a new lab nearby, and if they do, my wife would not only work in the area in which she was trained — cytotechnology — but she would also be the general do-it-all lab worker for clients. To prepare my wife for her possible new duties, her employer is paying for her to take a class in phlebotomy this semester at a local college. That means she’s learning how to draw blood.

I joke with my students that if they think Calculus 2 is bad, then they should try taking a class that consists of sticking each other (and being stuck) with needles — literally, bloodletting — for 4 hours every week. But all jokes aside, there happens to be some pretty interesting pedagogy that takes place in my wife’s class.

The teacher employs an inverted or “flipped” classroom model for the class. There are PowerPoint lectures posted to Blackboard each week, and learners are supposed to go through them and then take a quiz (also on Blackboard) before coming to class. During class, there’s some Q&A followed up with, well, lots of sticking each other with needles. Doesn’t this make sense? There is important basic knowledge that needs to be absorbed (patient privacy rights, technical specs about different kinds of tubes and needles, etc.) but it’s crazy to think about taking time away from supervised practice of phlebotomy to talk about that stuff. Phlebotomy students don’t need help reading about HIPAA. They do need help in the form of supervision and coaching by an expert when sticking a needle in someone else’s veins. Having been subjected to bad phlebotomists in the past, I can unequivocally say that more practice time is a Good Thing, and please get that lecture out of class as much as possible to make room for it.

The assessment, like the pedagogy, is also focused on practice. Aside from quizzes and attendance, students are assessed with something resembling standards-based grading. Apparently, there are five different kinds of needle sticks that a phlebotomist needs to know how to perform. Students have to perform five successful attempts at each kind of stick during the semester. Every class meeting gives the students chances to perform successful sticks, and if they don’t get some of them right one week, they can try again the next. On the final exam, students have to perform each of the five kinds successfully (and they get a couple of chances for each kind). If a student tries to get a sample from a person’s arm and misses on the first try, then — just like on the job in real life — they’ll get a second chance. (A third chance? That’s pushing it, at least when we’re talking about taking blood samples from my arm.)

Not all subjects are like phlebotomy, of course, which is all about performing a physical task (getting blood out of a person in an organized way). But there are important similarities. A well-designed course in any subject is going to have clear, explicit, and measurable learning objectives. These are often in the form of action verbs — Explain the Fundamental Theorem of Calculus in plain English, Critically analyze the differences between Shakespeare and John Donne, etc. — and so those objectives are in some sense like skills. Do we design our courses specifically to give learners time and space in class to practice those skills and receive guidance and feedback on them? Or do we fill the class time with information transfer (whether it’s lecture or something else) instead? And does our assessment similarly focus on students demonstrating mastery of clearly-defined learning objectives? I think there could be some things to learn here if we stick to it.

(I only partially apologize for that last line.)

This entry was posted in Education, Grading, Inverted classroom, Teaching and tagged Flipped classroom, Inverted classroom, learning, Phlebotomy, SBG, Standards based grading, Teaching. Bookmark the permalink.

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mkt42

I’d never thought about this before, but I now know The Class That I Would Least Like To Take.

http://chronicle.com/blognetwork/castingoutnines Robert Talbert

I had a hard time even finding an image for this post that doesn’t creep me out.

Guest

Interesting that the Army has eliminated the IV needle training as a part of Basic Combat Training (at least the BCT I went through.) Their conclusion was that people with a little bit intravenous training are more dangerous than people who know they can’t do it and find other ways to administer combat first aid.
riosalado

Anyone who has taught Calculus to freshmen knows what it is like to get blood from things, at least metaphorically.
http://www.facebook.com/kimber.palmer Kimber Palmer

Wow. When I was in college I worked part time at a major big-city hospital as a phlebotamist. My training consisted of following someone around for a few shifts learning the correct tubes and paperwork, then being observed for shift while I jumped in and started sticking people. I had no idea to some people it is akin to rocket science. Sounds to me like someone is making a lot of money teaching something that is rather simple.
5768

“Do we design our courses specifically to give learners time and space in class to practice those skills and receive guidance and feedback on them?”

Depends on the class, depends on the students. The phlebotomy model under discussion is similar to most good laboratory courses in the sciences. Good laboratory courses require advance reading on the part of the student outside of class, with accountability in the form of a pre-laboratory quiz over the reading material before the hand-on laboratory is begun. No expectation of a quiz held by the teacher, no reading on the part of the student, and lots of wasted lab time. It’s that simple.

The trick is how to implement a similar model not in the laboratory but in the classroom, a model in which out-of-class accountability for content-based knowing in advance of lecture is the expectation on a daily basis. The sole way I have ever found this possible is to structure the classroom for quizzes (both individual and group) over the readings themselves. Individual quizzes demonstrate individual responsibility and group quizzes afford communications processing coupled with a measure of forgiveness (I average the two and the latter are always higher in scores). At one extreme, if we do nothing but lecture, the students default to us to tell them everything they are to know and don’t do sufficient outside work required for drill and deep learning. A perverse incentive that catches up with them by the first exam of the semester. If on the other hand we structure the classroom with group work that doesn’t require students first do their part out of class, the lack of accountability for the material will do nothing but lead to an infinitesimally small kinetic rate constant–to their advantage since less has to be learned and they then expect to be tested on less, another perverse incentive.

“Or do we fill the class time with information transfer (whether it’s lecture or something else) instead?”

(1) Fill class time with information transfer if you are at an institution where students are intrinsically motivated, attend class, hang on your every word and have respect for that spoken word, and take an excellent set of notes. Does such a place exist anymore??? (2) Fill it with information transfer by lecture if you are in a discipline where excellent textbooks have yet to be published, where solutions manuals don’t exist, and where your gifted oratory is being recorded for posterity, which today means YouTube.

Ultimately we find ourselves faced with issues of extrinsic motivation necessary to structure learning where intrinsic motivations appear to be increasingly lacking. A teacher can do only so much in either case and today’s forces conspire teachers and students alike to do too less and less, only exacerbating the problem.
catbertie

Laboratory services now require all employees to be certified at the job they are performing. This means whether we wish to be a cytotech or phlebotomist, education is a requirement in order to sit for certification. OTJ training does not exist anymore….
http://twitter.com/ToddR29 Todd R

Its not that hard.
I was taking the practice test at
http://phlebotomytrainingonlinecertification.com/
and it isnt so hard mkt42
vceross

It surely would be nice if our professors, at least, were factual, balanced, civil. Why are so many people in the US bound and determined to act like yahoos? Is it because we’ve been educated by schools of Fish?

seattlenerd

The thought process that leaps from disapproval of Fish to a surplus of yahoos to indoctrination in yahooness by professors leads me to conclude that all people who disagree with Fish are incorrigible infinitive splitters.

vceross

just kidding.
dank48

“infinitive splitters”? Where? And what’s wrong with that, anyway?

mkni4658

Bravo for the fact checkers! — who are also reality checkers, bringing us back down to earth. Analysis or claims that are not built on a firm foundation of supportable evidence reeks of mendacity and malice at worst, irresponsibility at best. For many of us, media representation is not only visual and auditory via print and TV, but also olfactory (although the mass dulling of this vital sense in an election year is phenomenal). I also appreciate the citation of sources in the piece that provide grounds for the claims and multiple perspectives on the points raised — practicing, not just preaching. Ah, Balance, be it in facts and analysis (political discourse), or received teachings and actual usage (split infinitives).
marcleavitt

The nonsense about the split infinitive is simply a real world example of a sure business practice – get there first. That’s why Coca Cola is still the empty calorie drink of choice for millions, no matter how hard Pepsi tries to catch up. It’s also a fine example of the Joseph Goebbels rule: “If you repeat a lie often enough, it becomes the truth.”
MedfordBugbee

You seem to have gone from 0-60 in less than 5 seconds here. “Lying” is a bit over the top.

Where’s your evidence for deliberate deceitfulness — in both instances that you cite?
blog21

“I realize you may say, “Oh, where’s your sense of humor? It was just a joke.”” — it’s called hyperbole, and it’s a construct used to make a point. It’s not meant as a joke, nor a lie.

Shame on George Will for perhaps not doing his homework, though he could just as easily be mistaken, as opposed to lying.

I am sorry, but this entry isn’t worth the electrons beaming it to my screen.

faculty_developer

Given George Will’s political agenda, I think it’s safe to say that his statement was NOT hyperbole. He either failed to check his facts, or his statements have been deliberately deceitful.

And I respectfully disagree with you about this entry. I think that exposing lies/hyperbole/errors for what they are is always important.
Larry_Darrell

But it is worth taking your time to type out and submit a comment? I think your statement wonderfully backs up what the author is saying.
blog21

This is a two part comment. The first part about hyperbole is about the comment ” I have not seen a “whole” infinitive in years” — you don’t think that is hyperbole??

The George Will thing was point two. I tend to give people the benefit of the doubt, but you could be just as correct.

But what a humorless world some people live in, when they can’t accept hyperbole.

svoorhies

Curious — I rarely agree with George Will, but I had the same impression that Obama used “I” instead of “we” more often than other presidents — or other leaders. This was based on hearing random sound bites on the news, rather than going over the full text of his speeches. It was, as I say, an impression. I don’t think I was lying when I mentioned it to my wife. Maybe George Will should be held to a higher standard, but I still think calling him a liar is unjustified. My impression is that he’s more of a pompous conservative know-it -all.

jrulfo

This has been going on since early June 2009! As a commenter on LLog’s latest entry said: “Language Log gets a lot of citations these days, and it’s SEO ranking is quite amazing. I doubt that George Will himself has read any of Mark’s posts on this topic, but it seems likely that one of his interns (or whoever does his grunt work) HAS run across it and maybe even brought it to his attention. This is an OLD topic.Bottom line. I think Mark is probably spot on when he calls Will a liar. He really knows better and says this crap anyway.”

studentteacher

I have had to back down my own desire to hyperbolize (infinitive not split) about the current seeming inability to use (ins) apostrophes correctly until my significant other has been rerunning tv shows from the 50′s and 60′s– SO many apostrophe mistakes in the signage– hiLARious
mtyler

A well substantiated argument. Warms the cockles of my heart.
paxton

I am neither a linguist nor a psychologist, but I just heard a program on NPR about what our use of pronouns say about us. The conclusion, in that piece, was that in any given email exchange the person with less power actually used “I” more.

“We use “I” more when we talk to someone with power because we’re more self-conscious. We are focused on ourselves – how we’re coming across – and our language reflects that. ”

Whether or not that also applies to presidential speeches is another question. But nonetheless, it suggests that not only the facts but the logic might be faulty.

Link to the article:

http://www.npr.org/blogs/health/2012/04/30/151550273/to-predict-dating-success-the-secrets-in-the-pronouns

nordicexpat

I’ve heard of that research, but haven’t read it, so this is a response just based on the NRP report. I don’t find the email exchange very convincing evidence for the idea that a person with lower status uses “I” more often than a person with higher status. The problem is that in each instance, the person with supposedly lower status 1) initiates an exchange and 2) makes a request. Given there are three different factors involved (status, initiation of communicative exchange, request), it is different to single out one as the decisive factor. Maybe people initiating communicative exchanges use “I” more often than people responding to them (make sense, as you have to explain why you are contacting the person in the first place). Or maybe people making requests use “I” more often than people responding to them (again, makes sense, as you may have to explain why you are making a request from them). Or maybe low status speakers use “I” more frequently.

As I said, I haven’t read the actual study, so he may have other evidence to support the claim, but the letters on NPR aren’t really conclusive.

emwhitephd

This is just one more example of how the right wing has redefined argument lately. You start with your hypothesis and then invent facts that purport to prove it. Look at Romney’s entire campaign.
luigi

This is an old gimmick, In 1963, in the “McLandress Dimension,” JK Galbraith wrote an anonymous parody calculating how often celebrities used the first person. Very frequent users included Richard Nixon and Gore Vidal. Infrequent users included Nikita Krushchev and Elizabeth Taylor.
refranck

I confess to being a bit confused. Apparently George Will has stated that President Obama uses the word “I” with remarkably high frequency in public statements.

Did he continue that pattern of commentary after evidence to the contrary appeared? Was the baseline other Presidents (apparently) or the general population? (BTW, how does the current President look relative to the general population?)

But assuming that Will was wrong, did he continue that Presidential egomania theme? There’s no indication whatsoever about that in Professor Pullum’s essay. This isn’t trivial. If George Will made his I-statements once, he might have been mistaken. If he continued the commentary when his contention had been publicly disproven, that’s another matter. If he continued the commentary after knowing his contention was wrong, there’s some reason to believe he was lying (or unaware of his surroundings).

My point here is that the posting does nothing to inform us of the pattern of George Will’s behavior.
I don’t know, and am not better informed by the posting. In any case, it’s generally not right to assume malicious intent without considering error, ignorance, or incompetence.

Therefore, I also confess to being massively unimpressed. Prof. Pullum apparently makes the same subjective leaps (without bothering to present supporting facts) of the sort he finds so distasteful in George Will.

magyar

Perhaps you should read the evidence presented in the links.
jrulfo

Please read the article above that you are commenting on before you comment on it!

http://who-will-kiss-the-pig.blogspot.com Richard Grayson

I have a mom with advanced Alzheimer’s disease, and while I love her totally, I don’t really pay attention to the nonsense sentences she says these days when I visit her at the nursing home.

I’m astonished to discover that otherwise sensible people read George Will’s columns.
widder4

Can one know from use of language if another person is lying or just careless? I think both cases are instances of the latter. In neither do I see much evidence for the former. Still I would not want to accuse the writer of the column of lying about language. Merely suggest that alternatives exist: Infinitive splitting seems too minor a concern to warrant putting a ton of research into it. Accusing Obama of egotism may be too serious a matter to base on a statement that can so easily be proven wrong. In either case people who really care about the issue will check the facts and not believe something based on a statement without reference to any data…
widder4

Admittedly there are instances of incorrect uses of language that do not require research to suspect the author was less than honest. For example in this head-line;
6 cups a day? Coffee lovers less likely to die, study finds
http://vitals.msnbc.msn.com/_news/2012/05/16/11704493-6-cups-a-day-coffee-lovers-less-likely-to-die-study-finds?lite
Given that we all have the same likelihood [100%] to die no matter what we do, JoNel Aleccia hardly could have believed the claim made was true…
http://www.facebook.com/RoughAcres Rough Acres

Let’s just call it what it really is: a lie.
jamescurrin

I would like to suggest a new word to Prof. Pullum—”mistaken”. This piece displays a seething anger at people,who at worst are merely mistaken, by repeatedly calling them “liars”. I would go further to say that to disagree with Pullum is to risk the full force of his rage.

magyar

Might I suggest a new word for you? -”accuracy”. The word liar doesn’t appear at all in the piece, so to accuse the writer of “repeatedly calling [people] liars” is untrue, a lie, or, if you prefer, a mistake. If the writer calls no one a liar, it is also hard to see how you are not mistaken in assuming his calling people liars (repeatedly) is evidence of “a seething anger”.

What is true is that Prof. Pullum characterises the telling of a demonstrable untruth as lying. One could argue that one man’s lie is another’s mistake. For me the blatant disregard for easilly checkable evidence moves it out of the mistake category.

nomentanus

Hyperbole, to be ethical, has to be sufficiently extreme that it is clearly false as stated, for most or almost all readers. But to be hyperbole it has to be an exaggeration of a truth, not 180 degrees in the other direction, as in the above, sloppy, split infinitive example.

There’s always someone who doesn’t get the memo, (but a swallow doesn’t make a summer).

The greater question is the use of irony as humor. I’m going to take a wild guess that the author of this article is an American (I’m not but I do read the Washington Post, so I’m not going by that). Americans, from the point of view other nationalities, are notoriously insensitive to irony; in fact foreign writers are often strictly warned NEVER to use irony humorously for American audiences because they will always take it literally and either become confused, or explode with fury and start writing articles in vaguely academic journals about the impending end of civilization as we know it. (PS, that last was an attempt to use ironic hyperbole to create humor.)

I like Americans. I admire Americans. I just try not to be spontaneously funny around them. (Or light my underwear in their airplanes.) I suspect the writer criticized above may be someone who has only been exposed to humorous irony through the internet, and just doesn’t have the melody down yet.

propergramma

“Americans, from the point of view other nationalities, are notoriously insensitive to irony”

I think this means, people in other countries believe that Americans are insensitive to irony.
It’s just a national stereotype, I suppose; but there is no evidence for it at all.

lairdwilcox

I would think that a lie has to be deliberate. Perhaps George Will’s claim was simply a mistake. He should have researched the subject more thoroughly. Nevertheless, I suspect that most U. S. Presidents are egoists. I don’t absolutely know that, however, but I’m not lying. It’s simply my opinion.

magyar

And if George Will had said, “I suspect that Obama uses first person pronouns more than other presidents. I don’t absolutely know that. It’s simply my opinion,” rather than asserting it as a fact, and if he had said it only once, rather than repeating it as a fact on many occasions, I might agree with you that he was mistaken rather than lying…

CatoJr

You are all too eager to call something a lie. The author’s statement may have been an error, a negligent exaggeration, etc. What proof do you have that it was a lie?
dank48

My respect for Will’s intelligence thus leads me to believe he’s gone down the primrose path of “all’s fair.”

No, it isn’t.
seattlenerd

One should not miss Karl Rove’s comments about creating reality, see

http://en.wikipedia.org/wiki/Reality-based_community .
big_giant_head

”I know you are but what am I” is not generally considered a valid argument strategy around here, but nice try.
emwhitephd

Thank you, Crunchycon, for so neatly illustrating my point. As long as we have wholly different data sets, we cannot have rational conversation. As Karl Rove told the NYT reporter, “We create our own reality.”
crunchycon

No giant head (and emwhitphd), what I am pointing out is that this has been standard operating procedure for decades for dems. Now that a republican has used the tactic, it is being decried. Didn’t say I agreed with it, just pointing out the obvious.

The pedagogy of phlebotomy

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