Facilitator Guide: Rural and Remote Practice Module

Contents

    • Before the Online Module Starts
    • At the Beginning of the Module
    • Throughout the Module
    • At the End of the Module
    • Session 1: Life in Northern Rural and Remote Communities
    • Session 2: The Nature of Living and Practicing in Rural and Remote Communities
    • Session 3: Models of Professional Practice and Learning in Rural and Remote Communities
    • Session 4: When Professional Life and Personal Life Intersect
    • Overview
    • Online Participation
    • Evaluation Activities
    • Style Guide Requirements

Introduction

Welcome to the Rural and Remote Practice Module!

This Facilitator’s Guide has been designed to support you in facilitating this online module. It includes your roles and responsibilities as an online facilitator, some important information and suggestions for managing the module, and tips on creating a positive climate for learning.


Module Overview

This module has been developed for:

  1. learners in health professional programs who will be undertaking clinical placements or other clinical experiences in rural and remote areas, and/or
  2. health care practitioners who are relocating to rural or remote communities for the first time.

The content of this module is also applicable to learners and practitioners in human service professions who will be learning or practicing in rural and remote areas for the first time.

The purpose of this module is to help learners prepare for a clinical learning or practice experience in a rural or remote community. The unique nature of these communities allows for clinical practice that can be complex, rich, challenging, and deeply rewarding.

This module includes four sessions, which span five weeks. In the first two sessions, learners will examine some of the factors that make living and practicing in rural and remote communities different from that of an urban setting. They will also have a chance to explore their own assumptions and questions about what rural practice and life is like. In the third session, learners will explore models of practice that can help to address the unique challenges of rural and remote professional practice and learning, with a particular focus on generalist practice, sole practice, interprofessional collaborative care and learning, and the use of technology. In Session Four learners will have a chance to explore the benefits and challenges that can arise when personal and professional lives intersect in rural and remote communities, along with the resulting ethical and practical considerations. In this final session learners will also review their learning from the module as a whole, and complete an evaluation activity.

In each of the sessions, there are readings and activities to help learners engage with the realities of practice in rural and remote communities before they begin their clinical experience. Resources such as quotes, photos, and videos help to provide a sense of the lived experience of learners and practitioners in these communities. There will be an opportunity in each session for learners to reflect on their learning and to interact with fellow participants through discussion forums. Each week will require a commitment of about four to five hours total to complete. At the beginning, this time may vary slightly depending on learners’ familiarity with utilizing online learning tools.


Tailoring the Module to Your Audience

This module has been designed specifically for health care professionals/learners preparing for clinical experiences in Rural and Remote Northern Ontario; however much of the content is relevant for many health or human services workers/learners preparing for a service-related experience in any rural or remote area. If you are facilitating a group that is different from the target group for which the module was developed, you may wish to customize some of the resources or activities to your group. Tips for tailoring to your group are included in the Session Notes.


Preparation

The following instructions are meant to help you get organized so that you can feel well prepared to facilitate the module, as well as create an optimal learning experience for participants. Your institution may have specific guidelines and standards for facilitating an online module. Please ensure that you are aware of these, and follow your institution’s guidelines in the event that there is a discrepancy with those provided below.

Before the Online Module Starts:

  1. Ideally, facilitators will have the opportunity to complete the module themselves prior to facilitating. If this is not possible, review the module in its entirety to understand the content, structure, and requirements for participation and completion. Ensure that resources and learning activities are relevant to your specific group of learners.
  2. Review the Session Notes for Facilitators for each session.
  3. Check that all links work, and are current.
  4. Understand the technology used for the module, including the site/online platform and how to use it effectively. You may be using a platform that is specific to your institution. The module has been developed so that it can be used on various online learning platforms, however there are sometimes a few bumps along the technology road. You may wish to identify a technology support person in your school that you can access if needed both before and during the module.
  5. Develop an online delivery plan. The module is divided into four sessions related to content themes:
    • Session 1: Life in Northern Rural and Remote Communities
    • Session 2: The Nature of Living and Practicing in Rural and Remote Communities
    • Session 3: Models of Professional Practice and Learning in Rural and Remote Communities*
    • Session 4: When Professional Life and Personal Life Intersect
  6. Schedule your Facilitation: Review the module schedule and assignments and place important dates in your calendar. Block off time in your calendar to enable you to get feedback to learners in time to inform their work in subsequent sessions.
  7. Familiarize yourself with effective facilitation of online modules through available resources (see Resources section).
  8. Contact the learners, welcome them to the module, provide them with your preferred contact information, and provide clear instructions to access the online platform.

*Session 3 is particularly content heavy, and is best spread out over two weeks. Session 4 includes learning content and activities, as well as the final evaluation for the module. Content and learning activities in the module span 5 weeks, and it is recommended that learners be given extra time to complete the evaluation activities at the end. See facilitator notes for Sessions 3 and 4 for specific suggestions on dividing the content.

At the Beginning of the Module:

  1. Ensure that learners can access the online platform and provide support as needed.
  2. Set clear expectations for learners. Provide learners with guidelines for online participation (see Resource section for sample guidelines)
  3. Clarify expectations around facilitator response times for learner questions/concerns.
  4. Understand your audience. You may wish to survey participants to identify their background, expectations, and comfort with online learning.
  5. Facilitate introductions and community building using the online platform e.g. have everyone introduce themselves.
  6. Emphasize the importance of online interactions for community building and module outcomes, as well as the goals of online communication within the module, and any expectations around etiquette.

Throughout the Module:

The Facilitator’s Role during the module:

  1. Contribute to the online discussions
  2. Ensure that discussions are properly opened (e.g. welcoming, encouraging with clear expectations) and closed (e.g. reinforce the learners’ participation)
  3. Ensure that learners are aware of timelines for expected online participation each week, e.g. all learners should post their own responses by mid-week, and add to discussions by the end of the week
  4. Provide timely feedback when learners complete learning activities.
  5. Monitor and evaluate learner participation in the discussions/learning activities.
  6. Ensure that participants’ roles and expectations for learning activities are clearly defined
  7. Ensure that the group is running smoothly.
  8. Make direct contact with learners who are not present in the discussions/learning activities to assess the reasons for the lack of participation and where appropriate, assist in resolving barriers to participation.

Weekly check-ins and brief reminder emails to all learners can help to ensure that everyone is on the same page and that issues are addressed as they arise.

Recommendations for Ongoing Contact and Availability of the Facilitator:

  1. Identify and maintain contact hours (i.e. ‘office hours’/specified times) when learners can contact you with questions or concerns.
  2. Be present in your virtual classroom.
  3. Answer learner inquiries (email, or phone) within 48 hours but preferably the same day.

Normally email is used for individual communication on issues relevant only to a specific learner.

Keeping Track of Learners’ Participation in Online Interactive Activities:

It is suggested that you keep notes about the quality and quantity of learners’ online participation on a weekly basis. Usually it is helpful to include a brief note about the learner’s participation to date with their first evaluation. A private email can also be sent to a learner who may not be performing to expectations in their discussion postings. Alerting them early gives them a chance to improve.

Protecting Learners’ Privacy and Intellectual Copyright in Module Work:

Learners’ assignments and other evidence of their work (e.g. discussion transcripts) cannot be shared, copied or displayed for presentations without written permission from the learner. If you wish/need to obtain such permission it is recommended that you use a consent form for this purpose that is explicit in stating what materials will be used, when and for what purpose, and the author(s). Such consents should be signed by all authors and witnessed by someone other than you.

At the End of the Module:

  1. Wrap up the module and thank learners for their participation.
  2. Ensure that all evaluations/marks have been submitted according to your institution’s guidelines.
  3. If your institution requires learners to evaluate the module, direct learners to your institution’s appropriate evaluation form.
  4. Take time to reflect on your own experience as facilitator, and consider future learning goals and plans for your personal development in the facilitator role.

Session Notes for Facilitators

The following facilitator notes for each session include a session overview, tips for managing the session, and ideas for tailoring the session to groups other than health care learners/practitioners undertaking experiences in rural and remote Northern Ontario.

Note: Prior to beginning Session One, learners will watch a Welcome slide show providing an overview of the module, as well as a short video created by previous learners in rural northern communities highlighting recreational outdoor activities, to begin to give learners a sense of the experience of living in such a community.

Session 1: Life in Northern Rural and Remote Communities

Session Overview:

In this introductory session, learners will explore the concepts of rural, remote, and northern communities in Canada. They will have the opportunity to become more familiar with what it means to live in rural and remote communities and how this can impact health and wellness. They will also begin to examine their own experiences and perceptions around life and practice in rural and remote northern communities.

Main Topics:
Intended Learning Outcomes:
  1. Explain the following concepts in reference to Northern Ontario communities: rural, remote, urban, northern, Aboriginal, Francophone. Identify and explore communities from each of these categories in Northern Ontario.
  2. Describe the geographical and cultural diversity of Northern Ontario and consider the implications for lifestyle and health care.
  3. Explain the role and impact of the social determinants of health in rural, remote, northern, and Aboriginal communities.
Session Tips:

As in each session, learners will review readings and resources and complete the learning activities. There are five learning activities in this session, the first of which learners are instructed to complete prior to reviewing readings and resources, in order to allow them to examine their own experiences, perceptions, and questions they may have around living and practicing in a rural or remote community. As learners begin posting online, your role as facilitator will be to open discussion topics where necessary, provide constructive feedback and probing questions to encourage learners to engage with the topics at an appropriate level of depth, and to provide support and answer questions learners may have.

Tailoring to Your Group:

Although designed primarily for health care learners and practitioners, the material in this session should apply broadly to learners and workers in many areas of the health and human services sector. It is important to review the resources and learning activities to ensure a proper fit for groups other than health care learners/practitioners.

The readings and resources for this section are specific to rural and remote areas of Canada. Some of the resources and learning activities focus specifically on rural and remote Northern Ontario, particularly with respect to geography, culture, language, and health status. For groups who will be having clinical experiences in areas other than rural and remote Ontario, you may choose to direct learners to comparable and appropriate resources for your area. Learning activities can be modified to correspond to the identified geographical area.


Session 2: The Nature of Living and Practicing in Rural and Remote Communities

Session Overview:

What is it like to live, practice and learn in rural and remote communities? In this session learners will have the opportunity to examine their own thoughts and perceptions around this topic, and compare them to the perceptions of those who have spent time practicing and learning in this environment.

Main Topics:
Intended Learning Outcomes:
  1. Identify challenges and benefits of living, practicing and learning in a rural or remote community, and reflect on how this may relate to you personally
  2. Describe factors that influence healthcare professionals’ decisions to practice in rural and remote communities
Session Tips:

As in Session One, learners are asked to complete the first learning activity prior to engaging with the resources, in order to examine their own thoughts and feelings around their upcoming practice experience in a rural or remote community. Included in this week’s resources is a video of an interview with an Occupational Therapy learner describing her clinical experience in a rural community. Learners will also begin small group activities (pairs) this week. Consider how you would like students to pair up and guide them appropriately at the beginning of this session.

Tailoring to Your Group:

This week’s resources are tailored to learners and workers in health care. Much of the content will be relevant to other human service learners and workers, however you may wish to identify resources specific to your group, or to ask learners in the learning activities to compare/contrast the information to their own profession.

In terms of geographic location of practice, this session focuses more broadly on rural and remote areas in general, and includes resources from both Canada and Australia.


Session 3: Models of Professional Practice and Learning in Rural and Remote Communities

Session Overview:

This session, which spans two weeks, focuses on models of healthcare practice that help to address the challenges of delivering care in rural and remote communities. Learners will explore the nature of practice and learning in rural and remote communities in greater detail, including the concepts of generalist practice, rural and remote practice as a specialty, sole practice, interprofessional collaboration and learning, and the use of technology in supporting rural and remote practice.

Main Topics:
Intended Learning Outcomes:
  1. Define generalist practice; Identify the challenges and rewards of generalist practice.
  2. Explain the concept of the rural and remote generalist specialist. Identify the skillset potentially required by generalist practitioners across health care professions, and your profession specifically.
  3. Identify the challenges and rewards of being a sole practitioner in a rural or remote community.
  4. Define and explore the concepts of interprofessional collaborative practice (IPCP) and interprofessional learning (IPL), particularly as they relate to rural and remote settings.
  5. Identify the attitudes and skills necessary for successful IPCP and IPL, and relate them to your own experiences and learning needs.
  6. Explore innovative ways of using technology to support rural and remote practice.
Session Tips:

As this session is spread over two weeks due to the volume of resources and activities, you will need to clearly indicate to your learners what you would like them to accomplish each week. It is suggested that learners complete all of the readings in the first week before beginning the learning activities. You may wish to have learners complete at least one of the learning activities online in the first week of this session to ensure continuity of engagement with content and fellow learners, and to continue with the rest of the activities over the next week.

Learners will be working individually and in pairs this week. You may wish to provide encouragement and regular input/feedback at this point, keeping in mind that this session is a bit more demanding, and online learning can be somewhat isolating at times.

Tailoring to Your Group:

This session’s resources are taken from the health care field, however as in previous sessions, much of it is applicable to human service professions, including the concepts of generalism, interprofessional practice, and use of technology to address challenges in providing service in rural and remote areas. If you are working with a group other than health care learners/workers, upon reviewing the resources you may wish to identify resources specific to your profession.

In terms of geography, most of the resources and learning activities are applicable to rural and remote practice broadly rather than in a specific area, and resources are taken from Canada and Australia. The exceptions to this general approach are resource # 11 (the Ontario Telemedicine Network website), and Learning Activity #4, which focuses specifically on a clinical scenario in remote Northern Ontario. If your learners will be undertaking clinical experiences in areas other than Ontario, you may wish to modify these resources/activities to suit your region.


Session 4: When Professional Life and Personal Life Intersect

Session Overview:

Healthcare practice in rural and remote communities presents unique challenges with regards to ethics. The close-knit nature of small communities leads to inevitable overlap of relationships, with resultant challenges and rewards. Additionally, communities that are rural or remote may present other issues that can be ethically challenging and potentially distressing for healthcare learners and practitioners. In this session learners will explore the nature of healthcare ethics in rural and remote communities, as well as strategies to manage potential issues. They will also have the opportunity to review their learning from all of the sessions in this module.

Main Topics:
Intended Learning Outcomes:
  1. Identify the challenges and rewards of overlapping professional and personal lives in rural and remote communities
  2. Explore strategies for managing issues arising from intertwined professional and personal lives
  3. Develop an understanding of potential unique situations in rural and remote northern communities that may be difficult at an emotional level, and identify strategies for managing this in a healthy way
  4. Describe the experiences of learners and practitioners in rural and remote northern communities and explore your own responses to their advice.
  5. Review your expectations, hopes, and concerns regarding your upcoming learning or practice experience in a rural/remote northern community. Explore strategies you can implement to make the most of this unique and potentially rich experience.
  6. Demonstrate your learning by identifying and linking major concepts explored in the module.
Session Tips:

It is important to identify timelines for your learners in this session. Review of resources and completion of Learning Activities 1-4 should occur within the week. Extra time will be required to complete the Evaluation Activities (Learning Activities 5 and 6), and this should be considered in setting deadlines. You will also want to remind learners how their work will be graded, and the value of the evaluation activities in this session toward the final evaluation (e.g. pass/fail, letter grade, specific mark, and percentage toward overall evaluation, including participation and online contributions). Clarify with learners how you would like Learning Activity 6 submitted to you, and be specific in any expectations you have around the completion of the Evaluation Activities. See the “Evaluation” section in the guide for support in evaluating learner activities.

Once the module draws to an end, be sure to go back and review the Facilitator’s Guide section “At the End of the Module”.

And don’t forget to give yourself a pat on the back. You did it!

Tailoring to Your Group:

The resources in this section are taken from health care literature, but again are broadly applicable to human service professions in terms of overlapping personal and professional lives, ethical concerns in small communities, and the humanity of practice. If your group is from an area other than health care, you may wish to direct learners to resources appropriate to their professions, or ask them to compare/contrast the ideas presented in the resources with their own field of practice/work.

This week’s resources are applicable to rural and remote practice in any geographic area. One exception to this is resource #8, which provides a brief history of residential schools in Canada, and their impact on Aboriginal peoples and communities. If you are outside of Canada, you may wish to find a comparable resource appropriate to your region if applicable.

It is recommended that if your learners are not in health care or undertaking clinical experiences in Ontario, you review the learning activities for this module, including the evaluation activities, which may require small changes to best suit your learners. Ensure that you clearly communicate with learners regarding any changes in activities or expectations, particularly to the Evaluation Activities.


Learner Evaluation

Overview:

Learner evaluation in the Rural and Remote Practice online module is based on the learner’s online participation and completion of Evaluation Activities in the final session. Depending upon the requirements of your program and in consultation with your institution, you may choose to determine successful completion of the module under evaluation models of pass/fail, a letter grade, or a percentage mark.

Online Participation:

Online participation is an important element of the module. If your institution has guidelines for evaluation of participation in online courses, you may apply these and share expectations with your learners.

In the case that you do not have appropriate guidelines available to you, a sample guideline is included in the following article by David L. Baker: Designing and Orchestrating Online Discussions.

Useful information regarding evaluation of online participation is also available in the chapter, Teaching in an Online Learning Context, by Terry Anderson for Athabasca University.

Examples of rubrics for grading online participation can be found at https://topr.online.ucf.edu/index.php/Discussion_Rubrics.

Learners may also complete a self-evaluation of online participation for consideration in their overall grade, based on the criteria determined for instructor evaluation of learner online participation.

Evaluation Activities:

There are two evaluation activities in this module, both in the final session: Session 4, Activities 5 and 6. In Activity 5, learners complete a concise creative endeavor of their choice within the specified guidelines. In Activity 6, learners choose one of three options to complete a more in-depth demonstration of their understanding of the module material. It is recommended that you share grading criteria (see below for each activity) with learners to clarify expectations. Grading criteria is not included in the online sessions, and may be modified to suit your group prior to sharing with learners.

Below is a list of some of the major concepts that are explored in this module as they relate to health care practice in rural and remote communities in Northern Ontario:

Evaluation Activity #1 (Session 4, Activity 5)

Putting It All Together

In Evaluation Activity #1, based on their learning in the “Health Care Practice in Rural and Remote Communities” module, learners will complete one of the following creative activities so that it captures one or more unique features of learning or practicing in a northern rural or remote community (see list above of major concepts for ideas). The purpose of this activity is not to produce a great piece of art, but rather for learners to challenge themselves in a creative way to express what they perceive to be a part of the essence of northern rural and remote practice, and to share that with their colleagues. Learners will post their submissions online.

Suggestions for creative activities are as follows:

Grading Criteria:

Evaluation Activity #2 (Session 4, Activity 6)

One of Three Options: Story Telling/Future Telling/Concept Map

In Evaluation Activity #2, learners choose one activity from the three activities listed below to demonstrate their understanding of rural and remote health care practice. Learners submit completed evaluation activities directly to the facilitator.

Option #1 - Story telling: Choose a community in rural or remote Northern Ontario and create a story about a client’s possible health care experience. Incorporate at least 4 of the major concepts from this course. (1000-1300 words)

Grading Criteria:

Option #2 - Future telling: It is a number of years from now and you have been working in a northern rural or northern remote region for at least one year. Describe a day in your practice life that incorporates at least 4 of the major concepts from this course. (1000-1300 words)

Grading Criteria:

Option #3 - Create a Concept Map: Create a concept map of major concepts from the module using the online tool identified by your instructor. Write an accompanying narrative (800-1200 words) examining your learning by elaborating on links between concepts, and what actions you’ll take as a result of your learning and/or to further support your learning.

Information for Concept Map Activity: Concept maps are learning tools that help you organize information and identify the inter‐relationships between concepts. Because a concept map reflects your own ideas and way of thinking, everyone’s concept maps will be very individual ‐ both in content and presentation.

Your concept map should contain the elements outlined in the following approach:

Grading Criteria:

Concept Map

Narrative

Style Guide Requirements

Assignments should contain correct spelling and grammar, and are expected to be original and referenced appropriately. Learners should follow the assignment and reference guidelines indicated in the assignment section of course content. Learners are expected to use a style guide- for example the 6th edition of the American Psychological Association (APA) manual (2009).

American Psychological Association. (2009). Publication Manual of the American Psychological Association (6th ed.). Washington, DC: Author.

Quick on-line reference for most aspects of APA: https://owl.english.purdue.edu/owl/resource/560/01/


Resources

Online resources cited in the guide:

Anderson, T. (2004 ). Teaching in an online learning context. In T Anderson and F Elloumi (Eds.), Theory and practice of online learning. Athabasca University. Retrieved August 10, 2015 from http://cde.athabascau.ca/online_book/ch11.html

Baker, D.L. (2011). Designing and orchestrating online discussions. MERLOT Journal of Online Learning and Teaching, 7(3), 401-411. Retrieved August 10, 2015 from http://jolt.merlot.org/vol7no3/baker_0911.pdf

Chen, B., DeNoyelles, A., Thompson, K., Sugar, A., & Vargas, J. (2014). Discussion rubrics. In K. Thompson and B. Chen (Eds.), Teaching online pedagogical repository. Orlando, FL: University of Central Florida Center for Distributed Learning. Retrieved August 10, 2015 from https://topr.online.ucf.edu/index.php?title=Discussion_Rubrics&oldid=3649

Other resources for effective online facilitation:

Abrami, P. C., Bernard, R. M., Bures, E M., & Tamim, R. M. (2011). Interaction in distance education and online learning: Using evidence and theory to improve practice. Journal of Computing in Higher Education, 23, 82-103.

Clark Green, M. (2005). Factors influencing critical thinking among health professionals during computer conferencing: A case study. Available from AU Digital Thesis and Project Room http://hdl.handle.net/2149/527.

Kanuka, H., Rourke, L., & Laflamme, E., (2007). The influence of instructional methods on the quality of online discussion. British Journal of Educational Technology, 38(2), 260-271.

Kanuka, H. (2011). Interaction and the online distance classroom: Do instructional methods affect the quality of interaction? Journal of Computing in Higher Education, 23, 143-156.

Lou, Y., Abrami, P, C., & d'Apollonia, S. (2001). Small group and individual learning with technology: A meta-analysis. Review of Educational Research, 71(3), 449-521.


References

Components of this guide were adapted from McMaster University’s MSc (RS) Course-Based Online Program, Instructor’s Guide, by Joyce Tryssenaar. This guide also includes online facilitation tips adapted from Matthew Guyan’s article for the website eLearning Industry, cited below.

Tryssenaar, J. (2012). MSc (RS) Course-Based Online Program, Instructor’s Guide. Rehabilitation Science Program, School of Rehabilitation Science, Faculty of Health Sciences, McMaster University.

Guyan, M. (2013, June). 25 Tips for Successful Online Course Facilitation. eLearning Industry. Retrieved Aug. 10, 2015 from http://elearningindustry.com/25-tips-for-successful-online-course-facilitation