Dr. Natalie Voigt, PhD, MPhil, MSN, RN
Assistant Professor of Nursing at Columbia University School of Nursing
Dr. Voigt teaches “The Science of Nursing Practice with Adults II,” a medical surgical nursing course in the Masters Direct Entry Nursing program at CUIMC. This 5-week course is part of the larger MDE program, a 15-month accelerated graduate nursing program that recruits students from various undergraduate and professional backgrounds. With the shift to remote teaching in Spring 2020, what began as a pilot to update a few units in the course became a full course restructuring out of necessity. Dr. Voigt met the moment by rethinking her class format to incorporate more interactivity and case-based learning, reimagining her role in the classroom, and leveraging partnerships with her students, TAs, and colleagues. Read on to learn more about what Dr. Voigt did in her course, what lessons and experiences she’s carrying forward, and the advice she has for other instructors at Columbia. To hear more about Dr. Voigt’s innovations, watch her 2022 Celebration of Teaching and Learning Symposium panel presentation.
Rethink Class Format with Case-Based Learning
After my first year of pandemic teaching, I recognized areas of the course that I wanted to change. I applied for and was awarded an Office of the Provost Innovative Course Module Design Grant in Spring 2021. The purpose of this grant was to institute case-based learning modules in my course. I wanted to move away from a traditional lecture-based format to incorporate case-based learning and more small group work. Nursing requires lifelong learning, and so the purpose of the grant was to create more of an active learning environment to support the lifelong learning needs of the nurse. These cases can help hone students’ critical thinking skills and their clinical reasoning ability.
The cases follow a similar format, regardless of their topic: there’s an opening stem where students identify their priorities. Then there’s an evolution in the case, and students have to rethink their priorities: Based on this evolution, now what are your priorities? And the case always ends with some sort of psychosocial aspect; it might be that the family has a question, or there’s an end-of-life scenario, or the patient is concerned about returning to work. These are the things you just won’t find in a textbook. These are the real-life things that are important for students to roleplay and think about in a safe space, like the classroom. Because really, it’s all about how they can relate to people.
I found that this small group, case-based focus really worked. We have such a diverse learning environment, and this format allowed students to grasp what they could from the case. Some students would elect to be the recorder so they would type things out and that helped them learn. Some students would go back to the aspects of the recorded lecture I shared to help the group answer the questions. Some people liked to talk things out more than others, some were more quiet. It really allowed everybody to tap into the way that they learn best, but still contribute to the group.
With this case-based approach, I want to bring humanity back into it for students – this isn’t just about being in the classroom, getting a grade. This is a class about learning about what ails people and doing your best to care for people with dignity. It’s important to remember that patients are people. I remind students that we’re here to learn, but I try to use humor, and keep things low stakes where I can. There’s just so much anxiety among students, so I try to keep it calm and light as much as possible. The cases are graded, worth 15% of students’ grades, but they feel lower-stakes because they’re facilitated. Students work in small groups, and there’s an opportunity for me and my TAs to talk with each group and to facilitate their thinking by asking probing questions and for clarification.
Reimagine Roles: Educator as Facilitator
I feel the role of educator as facilitator is really important; it’s why I wanted to move away from a lecture-based, top-down, very formal format where there’s less interaction unless you open for questions. Recording the lectures allows students to listen, re-listen, stop, and focus on specific areas; and they can do this on their own. Then, I can use the synchronous, in-person time to take questions, give examples, do demonstrations, do case studies; and I feel like that’s where the real learning happens.
I also try to model for my students the values I want them to bring to patient care. Healthcare is constantly evolving. I can’t teach them everything, because I don’t know everything. It’s important in healthcare to stay curious, stay involved, and stay engaged; I hope to start that process in the classroom. I also want my students to learn non-judgement, and I model that in the classroom by making sure that every student sees they have something to give, something to contribute. Everybody has value, regardless of their experience or background entering the class, and likewise, so do the patients in which we provide care.
It was also important for me to engage in reflection while I was incorporating the case studies and making these changes; it was important to stay flexible as the professor. Just because I wanted a specific outcome, I was okay sometimes not achieving that, because the cases took root in different students in different ways. Students were able to draw from their own experience and personalize their education. In this space, because it’s a shared space, it’s a collaborative space with my students, I have to allow for things not to go exactly as planned. No matter what, it’s still going to be okay.
Leverage Partnerships: Students, TAs, Colleagues
Student Partnerships
The class feels like a collaborative experience with my students. Rather than leaving surveys for the end of the course, where changes can only come for the next group of students, I solicit weekly feedback. I really partner with my students and ask them if there is something they want to share, something we can fix in real time that they will benefit from. And this works! I found out that my recordings were helpful but too long; students asked for more manageable chunks. And I was able to edit those recordings to meet those needs. My pre-class quizzes tended to be more open-ended questions, but students wanted more practice with NCLEX-style questions, so I updated those questions. I was able to invite this feedback and find those comments that are constructive, that I could really build on to help facilitate students’ learning.
TA Partnerships
My TAs have been so helpful in implementing case-based learning into the class. They help facilitate the student groups, and with the return to in-person classes, they help act out the cases and scenarios with me. Having the TAs involved is really important. It helps build rapport in the classroom; there’s less of that intimidating power dynamic. Power dynamics are always going to be there, but with my TAs, I can create an environment where students feel like they can approach me and the TAs, and they feel it really is a collaborative learning environment. It really is sort of the best scenario.
Colleague Partnerships
I found that being able to do the simulation and cases in the classroom really partnered with what students were seeing in the lab. It was really fluid. There was no longer a separation between just a straightforward, top-down passive lecture that might synch or align with the lab. Instead, I talked to my colleagues in the simulation lab and shared what I was going to do for this unit. Students could then come up and practice in class. It was an experience of learning together.
I also learned from another colleague about the impacts of the changes I was making. I shifted some of the structure of the course, moving the introduction of particular topics around so students would have more dedicated time to focus on harder material. I found out that students were actually doing better on NCLEX practice exams.
Dr. Voigt shares her course innovations.
Advice for Instructors and the Future of Teaching at Columbia
Envision what it’s like to be your own student.
Put yourself in the space of your audience, and imagine: what would it be like to listen to two hours of a recorded lecture and then be in a space for another three hours? I remember from my graduate school training it was always about the “so what”: Why am I here? Make good used of class time. It’s important to have empathy and recognize what the student experience is like, while also keeping in mind your curriculum and program. I teach in an accelerated program, so I have five weeks to teach students this material. I’m always thinking about: what’s the best way I can deliver this and make this effective? Knowing that, in five weeks, I can’t possibly teach them everything I ask myself: what are the most important takeaways they need in these five weeks?
Stay flexible.
I ask for students’ feedback weekly, so it’s important to be able to read that student feedback with a critical eye and tease out the constructive comments. In my course, I found that it was okay when certain things didn’t go as planned, and although they were unintentional, wonderful things happened as a result. The prep work I put in beforehand was done thoughtfully and carefully, and it worked its own way through everybody a little differently.
Change one small thing.
Choose one aspect to change, one that might affect several things in the course, rather than setting out to overhaul the whole course itself. The module design grant I received allowed me to focus on the case studies, but just doing the case studies did so much – it changed the entire learning environment. It forced me to move my lectures out of the synchronous space, allowing space for discussion and engagement. This one thing made such an impact on the entire course.