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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.)

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