Characteristics of teaching assistants who support teaching of APB
The main findings can be summed up under three themes: One is that the teaching assistants are academically confident and enthusiastic, the second is that they created a good learning atmosphere, and the third is that they used creative learning methods.
Academic assurance and enthusiasm
The nursing students described the teaching assistants as academically competent. They got help in working with the difficult topics. If the teaching assistants did not have the answer at hand, they worked with the students to find it.
The teaching assistants were felt to have a good understanding of the curriculum and detailed insight into APB: ‘The teaching assistants have been very clever. They know a lot about anatomy, and are very good at providing answers to all the things we have been uncertain about’, (written feedback 35).
The teaching assistants demonstrated academic enthusiasm and genuine interest in APB, which inspired the students and bolstered their belief that they too could succeed. They got help in sorting and prioritising and had confidence in the teaching assistants’ advice, both academic and with respect to how to work: ‘They've been there themselves, haven’t they? And they gave their own examples of what they have been through, and what it was like for them’ (student 16).
Good learning environment
The nursing students emphasised that the social aspect of the seminars was important for learning APB. One student said: ‘They pushed us to get to know one another better” (student 20), and maintained that this was important for learning such a tough subject.
‘You’re comfortable with the person you get to know, or the class you get to know. So you can ask about school things you are uncertain about; even if there is no study gathering that day, you aren’t afraid to send a message: “Hi, there's something I’m not sure about” (student 18).
The fact that the teaching assistants were of a similar age and were themselves students made it easy to ask about ‘everything’.
The fact that the teaching assistants were of a similar age and were themselves students made it easy to ask about ‘everything’ without being afraid of not being clever enough: ‘I think it's great with students who sort of talk the same language as us, because the generation above, the ones who are our teachers, haven't learned in quite the same way’ (student 9). The teaching assistants also participated in a joint Facebook group, where students were able to ask one another questions.
The nursing students found that the teaching assistants had insight into what they struggled with, and were able to relate to the students’ situation: ‘Great having students as guides. I feel you understand us better because you’re students yourselves. Anatomy study groups have been very good, because anatomy is both important and difficult’ (written feedback 32).
Creative learning methods
‘We learned in a way that was great fun and enjoyable’, wrote one student (written feedback 5). A lot of humour and laughter in the seminars helped to ‘make the gatherings fun’. The teaching assistants were creative, and invented competitions and games that capptured the students’ interest:
‘Now that we have got activated and involved in this [...] I find I learn so much more if I’m involved in doing it myself, not just hearing it, because then I think for myself and understand it in my own way, and can try and pass it on’ (student 11).
The students were encouraged to use many different sides of themselves to learn APB, such as singing and drawing.
The students were encouraged to use many different sides of themselves to learn APB, such as singing and drawing. The encouragement to use multiple teaching resources, and not just textbooks, was stressed as liberating and creating confidence – that the students were allowed to learn APB in a way that worked for them.
Challenges associated with using teaching assistants
The students singled out as challenging aspects of having teaching assistants that the programme could be too slack, and that the teaching assistants spent a lot of time on trial and error and asking the students what they wanted. Another point was that the topics they worked on in the seminars were not coordinated with their lectures. Students who had not prepared by doing their own reading therefore lacked the necessary preliminary knowledge for working in depth on themes in groups.
In the following, we discuss the qualities of teaching assistants that we found helped to dismantle barriers to learning science and to increase students’ ability to tackle their aversion to learning difficult academic material, so that it was easier for nursing students to learn APB.
Help to dismantle barriers to science
Nursing students find APB more difficult to learn than other subjects (1, 4). APB are classified in nursing educations as ‘medical subjects’, a classification that is underpinned by the fact that the lecturers and textbook authors are often doctors (3). The absence of teachers with solid APB knowledge from their own profession makes it difficult for nursing students to develop ownership of and familiarity with the science subjects (2).
One clear finding of the study is that nursing students found the teaching assistants to be academically competent. They knew APB at a high enough level to be able to explain the details and relationships to the students and to guide them in the curriculum. In the teaching assistants, the nursing students met other nursing students who were going to become registered nurses like themselves. The teaching assistants were perceived as genuinely interested in science, and they put across the importance of learning APB in order to become a competent nurse.
One clear finding of the study is that nursing students found the teaching assistants to be academically competent.
‘They spoke the same language as us’, said several of them. Closeness in age and status may have made it easier to understand what the teaching assistants were explaining (9, 11).
Creative learning methods such as the “forehead game”, where students stuck anatomical terms onto the foreheads of fellow students and then reasoned their way to the right answers, created enthusiasm and familiarity with the concepts. The students got to investigate the material together and say the words themselves, and even draw on their own bodies and those of others. Learning methods that activate and engage the students encourage ownership and familiarity with the academic material (10).
The expression ‘they were us before’ can be understood as meaning that the teaching assistants appeared as competent ideals, something that was attainable also for the nursing students. They were living proof that nursing students can master APB at a high level.
At the same time, the teaching assistants came across as ‘humble’ and ordinary students, whom the nursing students could identify with. Being able to identify with the instructor can lead to identifying with the subject (13, 19, 22). In this way the teaching assistants may have broken down some of the barriers to science and paved the way for the nursing students to be able to experience APB as ‘their subject’, thereby making learning it more achievable.
Help in tackling the psychological barrier to learning difficult academic material
Learning new things is challenging, because it's a matter of stepping out of the known and stretching towards something new and foreign (21). In a subject such as APB, with many unfamiliar terms and relationships that are not immediately comprehensible, part of the challenge is tackling the insecurity associated with not understanding and not having an overview. The psychological barrier and insecurity lead to many nursing students lowering their ambitions and giving up learning APB more than superficially (3).
The nursing students described the seminars with the teaching assistants as ‘fun’. Creative learning activities, with elements of games, song and competitions, stood out in the findings. The students described a youthful form of communication in the teaching, with a lot of laughter and playfulness. Having fun while one learns reduces anxiety and negative pressure (10, 111).
The teaching assistants had the social milieu in the class constantly in mind. The students reflected over this, and pointed out that the teaching assistants ‘pushed’ them to get to know one another, and that this pressure was perceived as positive.
The teaching assistants had the social milieu in the class constantly in mind.
The students worked a lot in small groups. The formation of new small groups at each seminar led to them all getting to know everybody. Many of the students also held study-related gatherings outside the seminars. One student described the sense of community in their seminar group as ‘we took up a whole row in the auditorium’. Social support and recognition make the students feel safe and release energy for concentrating and using their capacity to investigate the unknown (9, 21).
In a secure learning atmosphere, students can test out reasonings and present interpretations that are incomplete, and still not fully comprehended (7, 13, 21). Fellow students can function as ‘scaffolding’ (10) for one another, and support each other in getting over the psychological barrier to learning difficult material, until they achieve a breakthrough to new insight and understanding.
The students also found the teaching assistants supportive, both in the seminars and in the Facebook group, where they gave advice to and encouraged the students. Because the teaching assistants were students themselves, and had recently experienced the challenges of learning the academic material, they were able to understand what the students were asking for help with (12, 18).
At the same time, the teaching assistants applied pressure to the students. They made it clear what was required to pass exams, and set up programmes that required the students to work hard and prioritise APB. The students had to explain concepts and relationships to their fellow students, both in small groups and at the board. A mock exam was also arranged. Some found this fun and stimulating and that it helped them to work in a focused way and obtain good grades. Others found it too demanding, and not being able to keep up was demotivating.
Finding the balance between support and reassurance on the one hand and pace and direction on the other is a key principle of sociocultural learning theory (10, 21). There is reason to believe that the approaches and qualities of the teaching assistants helped to reduce negative anxiety and thereby helped the nursing students to make better use of their learning potential.
Strengths and weaknesses of the study
The strength of this study is that teaching assistants, who were themselves nursing students, took part in identifying problems and implemented an intervention. The teaching assistants planned and conducted interviews. This is an advantage, because they are on an equal footing with the informants and speak the same language.
The challenge is that they lacked training in conducting focus group interviews, and thus missed information that might have been picked up by a more experienced moderator (24).
The teaching assistants’ combination of academic competence, social engagement and creative learning methods reduced the nursing students’ barriers to learning science and gave them ownership of APB. The teaching assistants created safe learning environments and set pace and direction, which helped to reduce the psychological barrier to learning complex academic material and improved the nursing students’ opportunity to exploit their learning potential.
Although the teaching assistants lacked pedagogical training, and had only come a short way in their own studies, the study showed that they can be a resource that the nursing educations should use to meet the challenge of a low level of APB knowledge among nursing students.
The participants in the research group and invaluable contributors to the article in the form of intervention and collection, processing and analysis of our data were:
- Melissa Lindfield Solberg, registered nurse, Akershus University Hospital Trust
- Hanna Kvinge Augustin, registered nurse, Oslo University Hospital Trust
- Lars Peder Kolås Henriksen, registered nurse, Oslo University Hospital Trust.
The authors also wish to thank the Institute of Nursing and Health Promotion at OsloMet – Pilestredet for help in setting up the project and for financial support.