A journal dedicated to allied health professional practice and education
http://ijahsp.nova.edu      Vol. 2 No. 1     ISSN 1540-580X 

Correspondence and requests for reprints should be directed to:

Lynda Thomas Goodfellow, Ed.D., RRT.
Assistant Professor
Department of Cardiopulmonary Care Sciences
Georgia State Universtiy
Atlanta Georgia USA
email: lgoodfellow@gsu.edu

.
Citation:
Goodfellow, L., Patil, M;  Assimilating intensive writing into respiratory therapy instruction: One baccalaureate program's experience. The Internet Journal of Allied Health Sciences and Practice. January 2004. Volume 2 Number 1.

Introduction

Writing is an important tool for communication and an inherent part of learning.  In broadly based pedagogical practice, the assumption is that writing is at the center of the academic experience in all disciplines.  Traditionally, writing in universities and colleges has been limited to English composition classes.  Faculty members in professional programs tend to believe that the time allotted for teaching in their disciplines is already insufficient and that writing is an unwanted additional duty.  So how can we in allied health education encourage and promote writing in our curriculums? 

Writing Across the Curriculum (WAC) is one such program that has incorporated writing through various forms in college-level courses.  It is based on the principle of writing-to-learn (WTL) and students do write more than in a traditional class.  WTL can be defined as the process of developing expressive skills that are useful in discovering, processing, and analyzing information through language.¹  The WAC method encourages sequenced writing assignments that builds bridges between formal and informal types of communication, during the teaching-learning process.  Writing stimulates the thinking process and in effect also helps improve the communication process.¹ The goal of WAC is not to eradicate the problems of poor writers, but to foster the development of critical thinking strategies.² Ultimately, a WAC program can improve literacy and intellectual capacity across the board, thus helping students to be more competent and equipped with better writing skills when they enter their respective professional fields.³  WAC’s basic premise is that writing plays a vital part in learning no matter what the subject matter.

WTL and writing in the disciplines are two related activities influencing each other greatly. While WTL stimulates discovery thinking, writing in a discipline targets critical thinking.^4,5  Writing in the discipline acknowledges the benefits of an expert in the field teaching writing techniques because various fields involve different writing styles and requirements.  Classes within a given discipline can have numerous writing assignments and the expert/instructor provides feedback on the writing to improve professional communication.  Through the formality of writing and editing, writers can learn to differentiate concepts that they understand from those not fully understood. 

A review of the literature offered only a few strategies for writing and reflection in nursing and allied
health.^6-9   No articles were found for respiratory therapy education. In this article, a brief overview of how writing was developed and assimilated in an undergraduate respiratory therapy course will be presented, some of the lessons learned will be discussed, and writing strategies to encourage learning and critical thinking will be provided.

History of WAC

WAC programs were conceptualized and developed in England in the 1960s and 1970s as a language for learning movement.  In the 1970s many American universities and colleges were criticized for poor verbal scores of students on standardized tests. The industry and business world expressed their dissatisfaction over the inept literacy skills of the graduates. Thus to meet these challenges, WAC programs were started in the mid 1970s in colleges and universities in the U.S. These programs began very slowly in the beginning but with increased government and corporate funding, they continue to grow and develop today.^4,10 

WAC programs are not new to healthcare education.  Writing assignments were developed as a core of two undergraduate nursing courses at a mid-western university.⁶  Researchers evaluated the program across two years and observed an improvement in the reflective practice and critical thinking among the students. They also observed an increase in the willingness of the faculty to integrate writing in clinical education and a satisfaction among the faculty as the students not only learned the practical skills but also evaluated them critically. However, it is not always easy to implement intensive writing in clinical fields like nursing as many students disregard the importance of writing in clinical practice.⁷  Although the implementation of a two year WAC program in the nursing department did face numerous challenges in the beginning, a sense of improvement in teaching skills was felt by the faculty and an improvement in the skills and outlook of students as professionals was observed at the end of two years.  A WAC program and critical reading have also been implemented successfully in a clinical laboratory science curriculum with a focus on WTL activities.⁸

In 1995, a WAC program was approved by this large urban university and has since been instituted in various disciplines across the University.  The purpose of the program was to integrate WTL into the courses, initiate clear thinking, aid in organization and presentation of thoughts, and thus improve communication skills of the students.³  The goal of the program was to enhance the marketability of the university’s graduates by improving their knowledge and increasing their communication skills.  If a person can explain in writing how something works, or how to do something, then he or she is perceived to understand the concepts and processes involved.  Therefore, better-prepared students have an advantage in their respective professions.

Implementation

The Respiratory Therapy Department incorporated these principles into their curriculum in Spring semester 2002 by designating a senior level capstone course called “Trends and Professional Issues in Respiratory Care” as a Writing Intensive (WI) course.  The WAC Standing Committee approved the course as WI because the course focused on writing assignments both in and out of class and a substantial percentage of the grade was based on these assignments.  This was a mini-mester course (seven weeks) taught to the seniors who were graduating from the program the same semester. The primary objective of this course was to enable students to begin to think of themselves as practicing respiratory therapists.  Funding was obtained in 2001 for the assigned instructor to attend a faculty workshop sponsored by the English Department and also for a graduate teaching assistant (GTA).  The instructor was asked to secure a graduate student who was familiar with the respiratory care profession.  A graduate physical therapy student was interviewed  and employed for a two-year term to assist in assimilating WTL into the curriculum.  This WI course has been taught twice now, both times during Spring semester in 2002 and in 2003.

The GTA was introduced to the respiratory therapy students at the beginning of the WI course as she attended all class sessions.  The GTA responsibilities included assisting students with difficulty in writing, structuring papers and use of reference/ citation styles for their papers.  Apart from the class hours, the GTA also held office hours twice a week during which the students were encouraged to meet and solve their difficulties. The students were also informed about the online and on-campus resources available i.e., the writing lab conducted by the English Department.

The instructor and GTA taught the capstone course as co-facilitators.  The class was composed of graduating seniors with the course objectives focusing on various professional issues and improving communication skills for entry into the respiratory therapy profession.  Various writing assignments were developed to enhance the learning opportunities for students both in and out of class assignments for which the students were awarded a total of 500 points. There were five in-class writing assignments worth 50 points each.  Examples of these assignments included writing a paragraph during the last 10 minutes of class on professional organizations related to respiratory care, writing a paragraph at the beginning of class stating why they entered the profession, and their thoughts on a particular topic discussed during the class. The rationale of these short-writing assignments was to have the students reflect on a lecture previously presented so that any gaps in their understanding of the content could be seen. 

During the seven weeks, the students were shown two 20-minute videos; one on end-of-life matters regarding terminally ill patients and the other on prolonging life support for an infant with multiple birth deformities. At the end of each video the students were assigned to write on their viewpoints. The aim of these assignments was to stimulate critical thinking and brainstorming as the writings were short (one completed in class at the end of the video and the other as an overnight homework assignment).  The students were encouraged to be creative and to use humor as appropriate. Table 1 includes two examples of student writings in poetry form to express their final healthcare wishes in the aftermath of an unfortunate catastrophic occurrence.

Table 1.  Two examples of student writings. 

Assignment was to write a poem on one’s last wishes.  The first two lines were provided.

Other forms of writing were also assigned such as writing a resume for a prospective employer, a take home mid-term and final exam, which were in an essay format, and preparing a brochure to promote good respiratory health. Each out-of-class writing assignment was worth 100 points and the take-home final exam was worth 200 points.  Fifty points were awarded for class participation and attendance.

Apart from the in-class sessions, the course was made available to the students through WebCT, an online course management tool that allows the faculty and students to make course related information accessible through a web based educational environment. The instructor posted the course syllabus, grading criteria and class presentations on WebCT. The students were also encouraged to send their assignments via email to the WebCT mailbox. In another use of technology, the instructors experimented with the online grading system using the “track changes” feature in Microsoft Word.TM The corrected paper was then sent back to the student via email. This process was found to be timesaving and extremely easy.

The grading criteria were outlined on the syllabus, explained to the students at the beginning of the course, and restated again before assigning the writing tasks. They were encouraged to be creative in their work.  The university policy on plagiarism was also provided and made clear that it would result in serious consequences. Concentration on spelling and grammar were emphasized as essential aspects to writing clearly for understanding and learning. The GTA would read the assignments first for spelling and grammar, as well as style, and the respiratory therapy instructor evaluated content. The instructors limited their comments on the papers to a minimum as it was thought that since these assignments were aimed towards learning, it was essential not to discourage the students. The GTA did not mark any comments on the student papers, instead, comments were written on a post-it to avoid confusion between the comments of the GTA and instructor. The respiratory therapy instructor assigned the overall grade of the writing task.  Some assignments were graded while others were simply passed to the student across the aisle to discuss as peers.  The students were instructed on the process of peer-review such that they could focus only on the thoughts and opinions of their peers on certain issues discussed in the writings and avoid deviation from the purpose of peer review. The students did not know which writings were to be handed in for a grade and which were to be used for discussion only.   For those assignments graded, revisions were allowed and even encouraged to improve the student’s explanation and analysis of the writing assignment.  This was done because research on writing indicates that students learn the best when they revise their writing using feedback.3

Evaluation And Lessons Learned

Overall, both students and instructors were pleased with the course.  Formal student’s course evaluations over the two-year period were not helpful in evaluating the course.  In the first year, the students were given the evaluations to do in class without the instructors present and a class member gathered the forms for the appropriate office.  In the second year the university went to an on-line course evaluation system and students were asked to complete their evaluation during the last week of class.  The responses were 11 of 22 students for a 50% return in year 1 and 0 response in year 2.  The ratings of year one of the instructor and course were 3.6/3.5 respectively in year 1 on a 4-point scale.  Qualitative comments in year one included a suggestion to better spread the homework assignments and one student stated that there were too many writing assignments.  The instructor felt that the quality of the writings from the students was very good considering this was the first time a writing designated course was emphasized. 

In an attempt to solicit feedback from the students to evaluate the effectiveness of assimilating writing into the course, an optional question on the final exam in year two asked the students to provide an assessment of the course.  This question, “In your opinion should this class be a required course and share any thoughts on the subjects and content covered, delivery of materials and the effectiveness of the instructors,” proved to be a popular question to answer with 72% of students responding.  Excerpts of their opinions are listed in Table 2.

Table 2. Examples of student's opinions in evaluating the effectiveness of a writing intensive course.

Cowles et al.,⁶ suggested that it might be necessary to blend the writing assignments with the course objectives and design them in a manner that the students perceive as being meaningful and useful in the process of learning.  This was found this to be true and the varied use of non-traditional teaching methods and assignments was well received by the students.  In fact, they seemed to welcome the opportunity to be imaginative and artistic in their assignments as opposed to the machine graded multiple-choice exams given in other courses.  Finally, the instructors were very impressed with the creativeness of the students and their ability to express themselves in the written form.  The most popular time in class was before returning graded papers when the instructor would read aloud anonymously several poems and memos.  This actually generated some excitement for writing and rewarded those who took the writing assignments seriously.

Writing Strategies and Overcoming Barriers

The use of multiple short in-class writings was observed not only to improve the thinking and thought compilation process but also provided the practice necessary to improve writing.  It was viewed as an essential tool in developing writing skills. Brainstorming was another process that was employed with the short writing exercise. This process could be used by the students especially in composing long papers.  Noting down thoughts as they come to the mind is particularly helpful as the chances of missing a particular point are reduced. The writing can then be revised several times before submitting the final paper. This process greatly improves the quality of the papers submitted. Sequencing writing assignments stimulates thinking in an organized manner to improve the composition of thoughts thus improving the overall writing skills.⁶

Many faculty members in clinical sciences hesitate to integrate writing assignments in their courses, as they are viewed as not only tedious to read and grade but also irrelevant in clinical practice. They may not perceive implementation of writing to be a personal responsibility as educators or may simply feel incompetent to grade the writing assignments.^6,8  However, lessons learned from incorporating WAC into this respiratory therapy baccalaureate program was that no unreasonable amount of additional time was required to process papers.  Neither the GTA nor lead instructor had to be a grammar expert to teach writing.  The point of whether to comment on each error in the paper has been long debated in the academic circles. Teachers sometimes tend to be overly critical and scornful of student writings.  Marking all the surface errors not only makes the process of grading lengthy but also irritating.  It also tends to create an overload of information and possible confusion in the minds of the students.¹¹  It was observed that providing the students a clear explanation of expectations before the assignments improved the quality of writing and reduced marking on the papers during grading by the end of the course. By understanding the expected style of writing and paying attention to the quality of writing, the students could easily focus on the content of the papers. It was felt that along with negative comments it was necessary to provide positive comments on innovative ideas and thought compositions so that the students were motivated to improve their writing in the following assignments. Positive feedback was also helpful in maintaining the interests of students. While returning the graded papers back to the students, the instructors pointed out certain commonly seen errors in the writings of the class in general. This was found to be an efficient method of providing feedback.

The use of peer-review method for one or two of the in-class writing assignments was particularly useful as the students provided comments/suggestions to each other on improving their writing. It was observed that students act as better proofreaders while reviewing their peers rather than their own writings. It also stimulated a healthy discussion on a few controversial topics promoting critical reflection and understanding.

Using WebCT in the course was viewed to be particularly helpful as it was easy to disseminate course information to the students. Both the instructors had faculty access to the WebCT account thereby reducing any confusion among the students in sending  assignments electronically.  WebCT made it easier to respond to any questions from the students as access to WebCT could be obtained from virtually any computer on campus. Similarly, the instructors found the online grading method to be particularly efficient as quick feedback could be provided.  It allowed the instructor to view and grade the paper from any computer having Microsoft Word.^TM  Overall, the use of innovative educational technology in the form of WebCT was found to cut down the burden of printing reams of paper to distribute information to the class and thus in several ways proved to be timesaving.

Summary

In Spring 2002, the faculty of  an undergraduate respiratory therapy program made a concerted effort to integrate WAC into the curriculum in response to interests internal to the university.  The incentive to do so, apart from the satisfaction of using innovative pedagogical strategies and creating a valuable learning experience, included possible recognition by the University for teaching excellence, and improved support and training for teaching assistantships.  Several benefits were recognized from this experience that included an improvement in the students’ awareness of writing and making them critical consumers of the information being taught. Apart from promoting creativity, a dedicated effort was made to improve professional communication skills among the new respiratory therapy graduates.

Following the experience in this particular capstone course, other respiratory therapy instructors began assimilating writing into their courses.  The faculty now acknowledges that incorporating writing assignments into the content positively enhances learning opportunities.  It is believed that if a student can communicate effectively, he or she will have a distinct edge on others in any environment, corporate or academic.  For further information on WAC programs at colleges and universities across the US, the web sites for these programs are listed in Appendix A.  These listings are not inclusive but are provided as examples of how WAC programs are tailored to meet the needs of their faculty and students.

References

1. Heifer K. An Introduction to Writing Across the Curriculum. Colorado State University. 2000 [cited 2002 Nov 8]; Available from: URL: http://aw.colostate.edu/reference/wac-faq/page2.htm

2. Herrington, AJ. Writing to learn: Writing across the disciplines.  College English 1981;43:379-81.

3. Georgia State University, What is Writing Across the Curriculum? 2002 [cited 2002 Nov 8]; Available from: URL: http://www.gsu.edu/~wwwwac/

4. Young A. Writing Across the Curriculum. 3rd ed. (NJ). Prentice Hall Resources for  Teaching Writing; 1999.

5. Remerge J. Writing Across the Curriculum and Writing in the Disciplines.  2000 [cited 2002 Nov 8]; Available from: URL: http://owl.english.purdue.edu/handouts/WAC/

6. Cowles KV, Strickland D, Rodgers BL. Collaboration for teaching innovation: Writing across the curriculum in a school of nursing. J Nurs Educ 2001;40(8), 363-7.

7. Rooda L A, Nard DA. A curriculum self-study of writing assignments and reflective practice in nursing education. J Nurs Educ 1999;38(7), 333-5.

8. Wright MS, Miller SA. Critical reading and writing across the curriculum in clinical laboratory science. Clin Lab Sci 1999;12(3):161-6.

9. McCarthy D. Implementing writing to learn in a program of nursing.  Nurs Educ 1994;19:32-5.

10.  Tillotson G. A short history of WAC. 1996 [cited 2002 Nov 8]; Available from: URL: http://www.engl.niu.edu/wac/histwac.html

11.  Haswell RH. Minimal Marking. College English 1983;45(6):600-4.

Appendix A

 For Further Information
WAC Programs at Other Universities

·        American University
http://www.american.edu/academic.depts/cas/lit/writeweb.htm

·        Amherst College
http://www.amherst.edu/~writing/

·        Boise State University
http://www.boisestate.edu/wcenter/owl.htm

·        Bowdoin College 
http://academic.bowdoin.edu/writing_project/

·        California State University - Los Angeles
http://web.calstatela.edu/centers/write_cn/index.htm

·        Colorado State University
http://aw.colostate.edu/index.html

·        The Citadel
http://www.citadel.edu/citadel/otherserv/wctr/

·        Cornell University
http://www.arts.cornell.edu/knight_institute/

·        Dartmouth College
http://www.dartmouth.edu/~compose/

·        East Tennessee State University
http://www.etsu.edu/writing/

•    Eastern Illinois University

http://www.eiu.edu/%7Ewriting/

·        Eastern Washington University
http://www.ewu.edu/StudentServ/writers/

·        George Mason University 
http://wac.gmu.edu/

·        Georgetown University
http://www.georgetown.edu/departments/english/writing/writprog.htm

·        Harvard University
http://www.fas.harvard.edu/~wricntr/

·        Indiana University - Bloomington
http://www.indiana.edu/~cwp/

·        Iowa State AgComm
http://www.ag.iastate.edu/grants/strategies.html

·        Kapiolani Community College
http://leahi.kcc.hawaii.edu/org/wac/

·        Malaspina University-College 
http://www.mala.bc.ca/www/wac/proj.htm

·        Marshall University
http://www.marshall.edu/wac/

·        Maryland Community College Consortium for Teaching Reasoning
http://academic.pg.cc.md.us/~wpeirce/MCCCTR/

·        Massachusetts Institute of Technology
http://web.mit.edu/writing/writereq/

·        Northern Illinois University 
http://www.engl.niu.edu/wac/

·        Princeton University
http://webware.princeton.edu/Writing/

·        Purdue University
http://owl.english.purdue.edu/

·        Rice University
http://www.ruf.rice.edu/~riceowl/

·        Samford University
http://www.samford.edu/schools/artsci/english/wac.htm

·        Swarthmore College
http://www.swarthmore.edu/Humanities/wa/

·        Temple University
http://www.temple.edu/english/uwp.html

·        Tufts University
http://www.tufts.edu/as/wac/wacweb.html

·        University of Arkansas at Little Rock
http://www.ualr.edu/%7Eowl/

·        University of Florida
http://web.nwe.ufl.edu/writing/

·        University of Hawaii-Manoa 
http://alaike.lcc.hawaii.edu/writing/WAC.htm

·        University of Illinois--Urbana-Champaign
http://www.english.uiuc.edu/cws/wac/wacmain.html

·        University of Missouri - Columbia
http://cwp.missouri.edu/index.html

·        University of Maryland - College Park
http://www.umuc.edu/ewp/

·        University of Minnesota
http://composition.cla.umn.edu/instructor_web/index.htm

·        University of Pennsylvania 
http://www.sas.upenn.edu/writing/

·        University of Richmond 
http://www.richmond.edu/~wac/

·        University of South Dakota
http://www.usd.edu/engl/writingcenter.html

·        University of Texas - Austin
http://uwc.fac.utexas.edu/

·        University of Toledo
http://writingcenter.utoledo.edu/wacweb/newhome.htm

·        Virginia Tech  
http://www.uwp.vt.edu/

·        Washington State University Writing Programs
http://owl.wsu.edu/

·        Wright State University
http://www.wright.edu/academics/wac/wac1.htm

·        Youngstown State University  
http://cc.ysu.edu/wac

 Source: (WAC website, GSU, 2002)