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I. Mastery learning: an approach to individualizing learning
E APPROACHES TO NURSIM EDUCATION I.
Mastery Learning: An Approach to Individualiiing Learning byEve!ynHort. C.N.M., M.S.N.. M.Ed and TeereroMarrico. C.N.M.. M.Ed. Ms. Her1 is direcling the Basic Certiffcatioo NuweMidwifery EducoLlon Program. New Jersey Medical School. Newark. New Jersey KS Morsicois Director. Division of Nurse-Mfdwilery, Deportment of Obrtetrlcr and Gynecology. New Jersey Medical School, Newark, New Jersey
Mastery learning, a concept which offers an appoach to Z~Udent learning based upon the prop osition that all or almost all students can master what they are taught, ts enjoyfog a resurgence today. It is seen by some educators as a new. trmovatlve allrnoach to learning but. In fact, Its-6egirmings In the Untted States 40 back to the early 19!2ok Today. mastery learning currlcw la utllirlng modular (self-contained units of iearningj approacha to achieving, cd” be famd oat only In general oducatton but also to health ~ofesslo~iol education. An ovrvtew ofone such program domonstrrtor the edaptatlon and
assimilation of concepts from earher mastery learning strategies. This program with a masterj learning curriculum is a basic certification program preparing Nurse.Midwwes to manage medically and obstetncally uncomph. cated women and their babies within. on interdependent team framework during the antepxtal. intrapartzl. puerperal-neonatal and famliy plzn&g~phases of the re. prdwtlveperiod Rior knowledge and *kills in nursing and pertinent physical. biological. social and be. havioral sriences are utilized as foundation for developing the thee. retical andpractice content needed to assist the student in acquiring theadd!tlonal knowledgeand skills essential for competenl Nurse-Mid. wtfery praehce. It Is.ar.ticipated that most students can complete this program tn one year. Pre&us knowledge and skills and individual abiltties can modify the total time needed to complete the pro. gram. Mastery ln this program is de. fined in main objectives which specify the level of achievement
needed to successfully
dolla, thertudent is provided with a k&g of achievement and NCces; e&y I” the prgram. Many InstructIonal strategies sue 1 ss smali.yrosp iearning se3 510”s. seminars, case pfesentatio”s, tutorial help and pro. and post.cllnlcal practice er.nfere”ces are wlized to aecomac&te the differing needs of studcn!:. Varied lristructlonal materiais such as worksheets. programedinstruetion ““its, audlovis”al resourcee and alternative texts and learning guides are utilized to accommo. date differences in students’ ability to respond to and understand iw 5truct:on.
evduation
Ona3ins Is used to l”dlca& h-w stw!ents are changing wfth rerpea to theft attainment of the instructional goeb. SPgrrre feedback about each student’s learning progress 1s emential I” ader to lxovide information us& for dlreciingwltrecti~ individual study and pactlee. Weaknesses in learning can be ldentifled early and student and teacher jointly can re. direct learning-teaching in c&r to strengtheo idontffied weak areas. Tbls tmplles that with mastery learning. the student Is ultimately reqxmslble for her-hlr own learnlng. Dally clinical pfactlce conferences and weekly rvmmary
post
Tmbfe 1: Ssqu?“ce of C:urrioulum Modules
:o”fmences protidetfme fa review sd evaluation of :wdy and pat:ice by student and teacher. In add!!io2. ~,+a~~a student con:ludes that tiieory and-a pactice ?as hen, malered, wItton or oral testsbased upon all dthemodulds oblectives are used to confim7 m&!ery or to identify remaining content weaknesses. A clinical evaluation tool incorporating all clinical objectives, rubobjectives and tasks is utilized to confirm mastery of clinical practice. A student does not “fail” these evaluation exams but rather with her instructor identifies and discusses content areas which need further study andbr practice. Suggested additional learning guides. reading and/& audiovisual references and practice are offered to the student as a means of strengthening identified unmastered areas of learning. Re. evaluation at Ihe student’s rewest is orovided to demonstrate mastery of remaining u”mas. tewd areas of theory/practice. When all content has boon mastered, the stude”t mows on to the next module. As illustrated in Table 1, a student starts the program with the Basic Skills Module. Upon completion of this module, two additional modules are taken: Communication/lntnvieurlng and Community Life Styles. Either of these two modu!es mnv be taken first. Upon complatlo~ of theComm”nlcatlon~ntewlewing and Canmunlty Ufe Styles Modules, a student may then take the History/Physical Assessment or the Pelvlc/G~ynocologieaI Screoning Module. The remalnb~g module is then mastered. For ox. ample. if a student elects to take Pelvic/C;ynecdoglcal Screening first. she/he then takes the Hlrtory/Physlcal Assessment Mdule before moving on to the next level of modules. Upon completion of the F’hy~cal As. aessment and Pelvic~yneccdog~ ical Screening Modules. a stu-
.
Baw Skills; Com~nunicat~onlInteNIaW; Community Life Styles: History TaklnglPhysical Assessment; Pelvi~IGynecol~l~aI Scrwnlng plus either (a) two major praotlce modules fAP, IP. Neonatology) e”d one minor practlcw modules (PP, Challenges In Nurse-Mldwlfew. F&My Plsnnlng)or Ib) one major module a?d Iwo minor modules)-aver&-a complaflon time-23 weeks w4h cut-off pol,‘t at 28 weaka. 2. The allamate of the above major and ml”Dr practloe modules-average aompletlon time-13 weeks ..I,,, cut-off point af 17 weeks. 3 Hemalnlng modules-averege point at 18 weeks.
completion
time-15
weaka with a cut-off
.
dent may the,, elect to next take one of &v. mduler: Antepartal Nurse-Midwifery Practice, Postpartal NurseMidwifery Practice, Neonatology and Family Planning. It does not matter in what sequence these five modules are taken. Sometime while moving thrcjugh these five modules, all students will simultaneously take the Challenges In Nurse.Mldwifery Module. These five mod. Jes must be completed before moving into the Parent Education and Family Study Modules. While the start of the Parent Education and Family Study Module is prerequisite to the Antepartal-Intrapartal Complicattons Module, theParent Education and Family Study (because of the extended follow-through with families) continues throughout the Antepartal-lntrapartal G2mpllcations Moduleand ends some(ime during the Integration Module. The Into gratton Module ts the last module t&&n bu the stu&ent. It 1s benun upon c&j&tkm d the A&pa& lntrawrtal Comdlcations Module and Lws to integrate all learning in the program. Its objectives are theobjectives of total program. As rsn be seen. students entex and Ibxve modules at varying time perk&. Because of !hls. broad time limitations which are based up~l learning-teaching time need. ed to bring all or almost all st”. dems to unit mastery have been set. Tnese parameters concur tith those ol other slmliar txwlarns and haw been found td be-valid based on waluatlon d student learning-teachlng needs wlthln these pagrams over a period oi yean. Erceptiom to the deftned ttme Iimitattons are evaluated on an individual basis and modiflca~ tions msda accwJlngly. Most students will complete thlc pogram in months. Be cause students learn at dlffererr rates and come this prograrr with ~ryine edixattonal and PI~C tlc4 ba&gKwb. same rtudew will finish wont and some Iota
the
tdw
to
tt
,a”
0
thetwelve months.
f fun&g
orientation within this program. teacher-student ratio Is low. In some modules (such as the Pbplcal Assessment or Pelvic~Gvneco~ logical Screening) the teach&stu. dent ratlo Is one to one. As the student’s theoretical and practice base Increase, the ratio may change to an average teacher-student ratio ofor,e teacher to three or four students. This low ratio is parslble hcpws.! of the varied number of students within an” one module any one time. . It 1snot possible within the limits of this paper to elaborate “pea all the details included in such a pmgram, but It Is hoped that by sharing the Mastery Learning strategies utilized in this health professional educatiou program, other educators will be stimulated to try new approaches to student learnlng ,n an effort to increase rewarding learnlng expcrlences far all students.
Bscause
and availability of facul-
I end clinical facllltles. the maxl13 IT
Prcgram is Rfteen months..nls exmslon may be made with special : xulty permission Students must sc!iae that self-pacing throughout leormr;mmustbeaccomdlshed d&In ;he tlme framework &cessl. atedhyfinanclal, faculty and clinl. al p:actlce IimItatIons and In no ray would be construed to mean a .?isurelypace. The faculty 1s cornnitted to facilitating the efforts of ach student to achieve the pro[ram objectives and complete all equirements withln the &ated ime framework. Challenge mechanisms have wen built into each module to ac:ommodate those students coming o this program with selected theeetical-cllnlcal expe:tise. Success. ul challenge of a module(s) there‘y shortens the total time spent tithin the pogram. Graduation fav varies for each student and ,a!& place Individually as each student has mastered the content ti all fourteen modules. Because of the cllnical practice
at
Recommended reading: Block, James H., Ed. Mastery Learning: Theory and Ructice. New York: Holt, Rinehart and Winston, it+.. i971.
II. Designing and Implementing Modules: A Guide for the Educator ByLlndo U’heeler,C.N.M.,hf.N. Lhda Wheeler Formerly Ass,~cl. ate DIrector, Nurse-Midwifery I’ro. gram and Director, Family Rtin. n,ng Nurse Ractitloner Frcgnzm. Ur~lverslt~ of Mlsslsrl~~l Medical Center. Jockson. Missi&pl. Cur. rer.tly Doctoral Student, Highland Urwerslty, Moryullle, Tennessee. Modular InstructIon, an old teachlng4eaming method reborn It1 today’s quest for humanism In education, attempts ta lndlvldualizelnstructlonro that students may
“tlhze their most effective learning patterns, move through a prcggram at their own pace, and build on &sting knowledge and skills. Also known as mlnl-courses and audio. tutorial packages, modular iwtruc. tlon supports the belief that edwa. tlon should be goal.alented rather than tlme4ented and changes the roleofthe Instructor from giver of Information to “dlagnoctir.lan aeserlbn. motivator. and resource
, 7
porSOIl.“l
The Ilterature lndlcate
that the
Mastery Learning: An Approach to Individualiiing Learning byEve!ynHort. C.N.M., M.S.N.. M.Ed and TeereroMarrico. C.N.M.. M.Ed. Ms. Her1 is direcling the Basic Certiffcatioo NuweMidwifery EducoLlon Program. New Jersey Medical School. Newark. New Jersey KS Morsicois Director. Division of Nurse-Mfdwilery, Deportment of Obrtetrlcr and Gynecology. New Jersey Medical School, Newark, New Jersey
Mastery learning, a concept which offers an appoach to Z~Udent learning based upon the prop osition that all or almost all students can master what they are taught, ts enjoyfog a resurgence today. It is seen by some educators as a new. trmovatlve allrnoach to learning but. In fact, Its-6egirmings In the Untted States 40 back to the early 19!2ok Today. mastery learning currlcw la utllirlng modular (self-contained units of iearningj approacha to achieving, cd” be famd oat only In general oducatton but also to health ~ofesslo~iol education. An ovrvtew ofone such program domonstrrtor the edaptatlon and
assimilation of concepts from earher mastery learning strategies. This program with a masterj learning curriculum is a basic certification program preparing Nurse.Midwwes to manage medically and obstetncally uncomph. cated women and their babies within. on interdependent team framework during the antepxtal. intrapartzl. puerperal-neonatal and famliy plzn&g~phases of the re. prdwtlveperiod Rior knowledge and *kills in nursing and pertinent physical. biological. social and be. havioral sriences are utilized as foundation for developing the thee. retical andpractice content needed to assist the student in acquiring theadd!tlonal knowledgeand skills essential for competenl Nurse-Mid. wtfery praehce. It Is.ar.ticipated that most students can complete this program tn one year. Pre&us knowledge and skills and individual abiltties can modify the total time needed to complete the pro. gram. Mastery ln this program is de. fined in main objectives which specify the level of achievement
needed to successfully
dolla, thertudent is provided with a k&g of achievement and NCces; e&y I” the prgram. Many InstructIonal strategies sue 1 ss smali.yrosp iearning se3 510”s. seminars, case pfesentatio”s, tutorial help and pro. and post.cllnlcal practice er.nfere”ces are wlized to aecomac&te the differing needs of studcn!:. Varied lristructlonal materiais such as worksheets. programedinstruetion ““its, audlovis”al resourcee and alternative texts and learning guides are utilized to accommo. date differences in students’ ability to respond to and understand iw 5truct:on.
evduation
Ona3ins Is used to l”dlca& h-w stw!ents are changing wfth rerpea to theft attainment of the instructional goeb. SPgrrre feedback about each student’s learning progress 1s emential I” ader to lxovide information us& for dlreciingwltrecti~ individual study and pactlee. Weaknesses in learning can be ldentifled early and student and teacher jointly can re. direct learning-teaching in c&r to strengtheo idontffied weak areas. Tbls tmplles that with mastery learning. the student Is ultimately reqxmslble for her-hlr own learnlng. Dally clinical pfactlce conferences and weekly rvmmary
post
Tmbfe 1: Ssqu?“ce of C:urrioulum Modules
:o”fmences protidetfme fa review sd evaluation of :wdy and pat:ice by student and teacher. In add!!io2. ~,+a~~a student con:ludes that tiieory and-a pactice ?as hen, malered, wItton or oral testsbased upon all dthemodulds oblectives are used to confim7 m&!ery or to identify remaining content weaknesses. A clinical evaluation tool incorporating all clinical objectives, rubobjectives and tasks is utilized to confirm mastery of clinical practice. A student does not “fail” these evaluation exams but rather with her instructor identifies and discusses content areas which need further study andbr practice. Suggested additional learning guides. reading and/& audiovisual references and practice are offered to the student as a means of strengthening identified unmastered areas of learning. Re. evaluation at Ihe student’s rewest is orovided to demonstrate mastery of remaining u”mas. tewd areas of theory/practice. When all content has boon mastered, the stude”t mows on to the next module. As illustrated in Table 1, a student starts the program with the Basic Skills Module. Upon completion of this module, two additional modules are taken: Communication/lntnvieurlng and Community Life Styles. Either of these two modu!es mnv be taken first. Upon complatlo~ of theComm”nlcatlon~ntewlewing and Canmunlty Ufe Styles Modules, a student may then take the History/Physical Assessment or the Pelvlc/G~ynocologieaI Screoning Module. The remalnb~g module is then mastered. For ox. ample. if a student elects to take Pelvic/C;ynecdoglcal Screening first. she/he then takes the Hlrtory/Physlcal Assessment Mdule before moving on to the next level of modules. Upon completion of the F’hy~cal As. aessment and Pelvic~yneccdog~ ical Screening Modules. a stu-
.
Baw Skills; Com~nunicat~onlInteNIaW; Community Life Styles: History TaklnglPhysical Assessment; Pelvi~IGynecol~l~aI Scrwnlng plus either (a) two major praotlce modules fAP, IP. Neonatology) e”d one minor practlcw modules (PP, Challenges In Nurse-Mldwlfew. F&My Plsnnlng)or Ib) one major module a?d Iwo minor modules)-aver&-a complaflon time-23 weeks w4h cut-off pol,‘t at 28 weaka. 2. The allamate of the above major and ml”Dr practloe modules-average aompletlon time-13 weeks ..I,,, cut-off point af 17 weeks. 3 Hemalnlng modules-averege point at 18 weeks.
completion
time-15
weaka with a cut-off
.
dent may the,, elect to next take one of &v. mduler: Antepartal Nurse-Midwifery Practice, Postpartal NurseMidwifery Practice, Neonatology and Family Planning. It does not matter in what sequence these five modules are taken. Sometime while moving thrcjugh these five modules, all students will simultaneously take the Challenges In Nurse.Mldwifery Module. These five mod. Jes must be completed before moving into the Parent Education and Family Study Modules. While the start of the Parent Education and Family Study Module is prerequisite to the Antepartal-Intrapartal Complicattons Module, theParent Education and Family Study (because of the extended follow-through with families) continues throughout the Antepartal-lntrapartal G2mpllcations Moduleand ends some(ime during the Integration Module. The Into gratton Module ts the last module t&&n bu the stu&ent. It 1s benun upon c&j&tkm d the A&pa& lntrawrtal Comdlcations Module and Lws to integrate all learning in the program. Its objectives are theobjectives of total program. As rsn be seen. students entex and Ibxve modules at varying time perk&. Because of !hls. broad time limitations which are based up~l learning-teaching time need. ed to bring all or almost all st”. dems to unit mastery have been set. Tnese parameters concur tith those ol other slmliar txwlarns and haw been found td be-valid based on waluatlon d student learning-teachlng needs wlthln these pagrams over a period oi yean. Erceptiom to the deftned ttme Iimitattons are evaluated on an individual basis and modiflca~ tions msda accwJlngly. Most students will complete thlc pogram in months. Be cause students learn at dlffererr rates and come this prograrr with ~ryine edixattonal and PI~C tlc4 ba&gKwb. same rtudew will finish wont and some Iota
the
tdw
to
tt
,a”
0
thetwelve months.
f fun&g
orientation within this program. teacher-student ratio Is low. In some modules (such as the Pbplcal Assessment or Pelvic~Gvneco~ logical Screening) the teach&stu. dent ratlo Is one to one. As the student’s theoretical and practice base Increase, the ratio may change to an average teacher-student ratio ofor,e teacher to three or four students. This low ratio is parslble hcpws.! of the varied number of students within an” one module any one time. . It 1snot possible within the limits of this paper to elaborate “pea all the details included in such a pmgram, but It Is hoped that by sharing the Mastery Learning strategies utilized in this health professional educatiou program, other educators will be stimulated to try new approaches to student learnlng ,n an effort to increase rewarding learnlng expcrlences far all students.
Bscause
and availability of facul-
I end clinical facllltles. the maxl13 IT
Prcgram is Rfteen months..nls exmslon may be made with special : xulty permission Students must sc!iae that self-pacing throughout leormr;mmustbeaccomdlshed d&In ;he tlme framework &cessl. atedhyfinanclal, faculty and clinl. al p:actlce IimItatIons and In no ray would be construed to mean a .?isurelypace. The faculty 1s cornnitted to facilitating the efforts of ach student to achieve the pro[ram objectives and complete all equirements withln the &ated ime framework. Challenge mechanisms have wen built into each module to ac:ommodate those students coming o this program with selected theeetical-cllnlcal expe:tise. Success. ul challenge of a module(s) there‘y shortens the total time spent tithin the pogram. Graduation fav varies for each student and ,a!& place Individually as each student has mastered the content ti all fourteen modules. Because of the cllnical practice
at
Recommended reading: Block, James H., Ed. Mastery Learning: Theory and Ructice. New York: Holt, Rinehart and Winston, it+.. i971.
II. Designing and Implementing Modules: A Guide for the Educator ByLlndo U’heeler,C.N.M.,hf.N. Lhda Wheeler Formerly Ass,~cl. ate DIrector, Nurse-Midwifery I’ro. gram and Director, Family Rtin. n,ng Nurse Ractitloner Frcgnzm. Ur~lverslt~ of Mlsslsrl~~l Medical Center. Jockson. Missi&pl. Cur. rer.tly Doctoral Student, Highland Urwerslty, Moryullle, Tennessee. Modular InstructIon, an old teachlng4eaming method reborn It1 today’s quest for humanism In education, attempts ta lndlvldualizelnstructlonro that students may
“tlhze their most effective learning patterns, move through a prcggram at their own pace, and build on &sting knowledge and skills. Also known as mlnl-courses and audio. tutorial packages, modular iwtruc. tlon supports the belief that edwa. tlon should be goal.alented rather than tlme4ented and changes the roleofthe Instructor from giver of Information to “dlagnoctir.lan aeserlbn. motivator. and resource
, 7
porSOIl.“l
The Ilterature lndlcate
that the