Planning to Practice: Developing Partnership-Building Skills Across the Curriculum

Abstract

The ability to work in effective collaborations has long been a foundation of health promotion and environmental health practice and, more recently, has been explicitly identified in international accreditation competencies. While limited evidence is available on strategies to teach these skills within single courses, there are no guidelines on best practice, or how to develop the skills across a curriculum. In this article, we demonstrate the scaffolding of partnership building knowledge and skills across an undergraduate public health curriculum through the application of the cognitive apprenticeship model. Using a fading concept, students move from staff-directed to independent practitioners in the development and demonstration of partnership building skills. The model offers an example of cross-program scaffolding for skills that could be adapted to other competencies, disciplines, and contexts.

Keywords

curriculum partnership public health scaffolding

Working in partnership with individuals, communities, and governments has been a core principle in health promotion and environmental health, and public health more broadly, since the development of the Ottawa Charter in 1986 and its subsequent declarations (Scriven, 2012). Competency in partnerships is a core professional skill internationally (Environmental Health Australia, 2014; International Union for Health Promotion and Education, 2016). The ability to form partnerships and collaborate with key business and industry and community partners is essential in public health. Teamwork and the ability to work collaboratively, across sectors, among various types of organizations, and in diverse settings, is a highly desired skill for entry-level health promotion or environmental health graduates (Hart Research Associates, 2010). It is surprising, therefore, that teaching teamwork and partnership building skills is not more evident in the literature.

The skill set required to work in partnership is extensive and cannot reasonably be taught to students in a single course or two (Coleman & Lang, 2012). Partnership skill development occurs over time through opportunities to experience, reflect, and plan future action (Coleman & Lang, 2012. This article outlines an Australian undergraduate curriculum in public health that scaffolds partnership building across the entirety of the 3-year program delivered in mixed mode (distance and on campus). We first examine the benefits and challenges of teamwork and partnership building in an online environment. We then present the curriculum model we use to guide embedding partnership building across the program and to provide examples of how this is accomplished. Throughout this article, we argue that partnership building skills and knowledge need to be scaffolded over time to enable students to graduate and practice with confidence in initiating and nurturing effective public health partnerships.

Literature Review

Developing partnership skills and knowledge within a university context is primarily based on group work (collaborative learning) within individual courses. Many students understand the value in undertaking group work and recognize the potential benefits (Chang & Kang, 2016); indeed, previous studies have reported how group work can be transformational in changing perspectives and enhancing cognitive skills (Bass, 2012; Chang & Kang, 2016). Others have highlighted how group work prepares students for team-based work environments and contributes to relationship building and assertiveness skills (Fadzli, Joyes, & Ellison, 2013; Jackson, Sibson, & Riebe, 2014; Lindsay & Orton, 2014). However, while not as widely reported, there is enough evidence that such benefits can be overshadowed by negative teamwork experiences (Chang & Kang, 2016; Fadzli et al., 2013).

In recent years, a growing body of literature aimed at enhancing group work experience and outcomes has emerged (Tucker & Abbasi, 2016). Espey (2010) found that attitudes to group work can change (even throughout a semester); other studies have shown that those who enjoyed group work had relationships built on trust, familiarity, and commitment to producing quality work and team cohesion (Ku, Tseng, & Akarasriworn, 2013; Tseng & Yeh, 2012). Unsurprisingly, several authors support the view that high levels of collaboration do not happen naturally; that is, students need to learn how to work in groups (Häkkinen et al., 2017; Salas, Lazzara, Benishek, & King, 2013). Despite high levels of advocacy for teamwork to be embedded as a generic skill within universities and industry, there is remarkably little research into how collaborative learning takes place in our formal education settings (Doyle, Kelliher, & Harrington, 2016).

Adding to this challenge, undertaking group work in an online environment can be particularly challenging for both instructors and students. As noted by Saghafian and O’Neill (2017), while there are similarities between online and face-to-face teamwork, there are naturally notable differences. Online and face-to-face teamwork both require effective leadership, fair distribution, and equal effort in completing assigned work between team members, and knowledge of each team member’s commitment and approach to assessment work to support good collaboration and communication (Saghafian & O’Neill, 2017). Differences also include the establishment of communication channels with every team member, managing hidden identities, and handling asynchronicity (Chang & Kang, 2016; Saghafian & O’Neill, 2017). While these issues relate to incorporating group work into specific courses, if we are serious about developing partnership skills, we must also consider how students use group work opportunities across an entire program. Scaffolding generic skills, such as teamwork across a program, is an ideal but is not well explored in the literature (Coleman & Lang, 2012).

As part of Collins, Brown, and Newman’s cognitive apprenticeship model (1989), strategies including scaffolding are implemented to support student learning through a guided experience approach. The basic model situates learning in context and includes the following strategies: (1) modeling thought processes, (2) coaching and supporting students through scaffolding, (3) reflective activities, (4) articulation of the reflective process, and (5) exploration that involves formation and testing a personal hypothesis associated with the pursuit of learning. Scaffolding, as defined by this model (Collins, Brown, & Newman, 1989), refers to support structures put in place to assist students to reach skill levels beyond their current abilities. The process is one of progressively moving through stages of coaching in which the teacher provides guidance and feedback, to scaffolding where the student carries out a task with support. Over time, the scaffolding is gradually removed as the student begins to work independently.

Jackson et al. (2014) emphasize the importance of constructive alignment of skills with pedagogical practices and actively advocating for scaffolding such skill development across a degree. A scaffolding approach ensures consistency of delivery and may increase “buy-in” from students who struggle to understand why such skills are being developed. Pinahs-Schulz and Beck (2016) use scaffolding in the development of signature assignments across their public health curriculum, an approach aimed at equipping students with knowledge and skills relevant to real-world settings. In this article, we outline how scaffolding is used to build partnership skills and knowledge across an online undergraduate public health program.

Setting

The context for the program outlined here contains several challenges regarding partnership skills and knowledge development. As a regional university that has multiple campuses across Australia, our public health team is located on four geographically dispersed campuses. Our undergraduate Bachelor of Public Health students complete a 3-year full-time or part-time equivalent degree. Students are enrolled in mixed mode, in one of two specializations (Environmental Health or Health Promotion), and are scattered across the whole of the country, only having opportunities to meet with one another personally at periodic residential schools. Students range in age from 19 to 59 years; however, the majority of students (73%) are over 30 years of age and studying part time. While there is a small cohort of students who are full time, and work their way together through the curriculum (predominantly those under 25 years), for the majority of students, they are often unlikely to find familiar names. Rather, they meet with a wide mix of students from a variety of programs taking the course as a core or an elective.

As a program delivered in mixed mode, there is extensive use of an online learning management system. Online, synchronous opportunities for students to meet with teaching staff and other students are offered in most courses in either day-time or evening sessions. However, participation in these courses are often low due to various competing priorities for students. Students consequently tend to undertake few planned offerings, thereby limiting connection to their peers and lecturers via real-time channels and rely mostly on asynchronous opportunities across the teaching semester. In scaffolding partnership across the curriculum of this program, these challenges needed to be considered.

Scaffolding Partnership Across Curriculum

The Bachelor of Public Health was developed using three core principles; partnership, participation, and prevention scaffolded across the curriculum as a sound foundation for praxis (Figure 1). These principles are developed in the core courses and then augmented in courses taken by environmental health or health promotion students separately. In line with the cognitive apprenticeship model, learning activities and assessments are guided by academic staff to varying degrees, ensuring that the cognitive processes of teamwork and partnership are visible and accessible to novice learners. Students are exposed to the theory behind successful teams and partnerships, and they are provided with the opportunity to experience teamwork and partnership processes through scaffolded activities in both face-to-face and virtual environments. These experiences and cognitive understandings become deeper and more extensive, and decision making becomes more independent as students progress through their study program. The involvement of the academic correspondingly becomes less evident, applying the fading concept described by Brown, Collins, and Duguid (1989).

Figure 1.

Bachelor of Public Health Scaffolding Model.

The focus in first year is on developing an understanding of oneself and learning to work with other students through the sharing of ideas, personal experiences, and resources. Students are introduced to the concept of emotional intelligence, specifically self-awareness, social awareness, self- management, and relationship management. They are given the opportunity to put this theory into practice through group assessment tasks around the location and evaluation of scholarly information, the discussion of the application of information to public health problems, and the sharing of relevant lived experience to develop mutual understanding of public health concepts. These activities are supported by theory relating to the value of contributions from professional peers, the worth of different perspectives in problem solving, individual responsibilities within a team, purposeful contribution toward agreed aims, and the ways in which public health problems cross discipline boundaries.

In the second year, students continue to engage with one another through discussion and residential schools. There is a greater emphasis on theory to support the more advanced tasks and activities that they will experience. The focus shifts the students’ understanding from teamwork to partnerships and how they form and function outside the university context. The differences between community participation, action, and empowerment are explored within a community action framework. Students are introduced to partnerships within industry and the community through a variety of authentic activities and cover the theory of team role preferences, identifying their own and then get the opportunity to function in these roles during residential school. Such tasks provide students with an opportunity to practice team skills in a safe environment in advance of their professional placement in the third year, undertaken in a professional context that is less forgiving of the novice. Such activities also encourage students to consider how they can make partnerships work within public health, at least theoretically.

The focus shifts from the theoretical to the experiential in the third year, as students undertake a year-long industry placement. They are encouraged to identify community and industry partners necessary for solving complex public health problems in a variety of contexts, including environmental change and disaster situations. The holistic approach taken in several of the third-level courses allows students from other disciplines such as sociology, psychology, and allied health to enroll, providing an opportunity to work in multidisciplinary teams, mimicking the diverse nature of real-world professional partnerships.

Experiences, theory, and scaffolding at each level of the curriculum are outlined in Table 1.

Table 1.

Scaffolding Partnership Experiences and Theory Across Bachelor of Public Health.

Level	Experiences	Theory	Scaffolding
First year	• Sharing scholarly information • Sharing of lived experiences • Developing a wiki • Problem-based learning activities • Tutorials • Discussion	• Value of different perspectives • Individual responsibility within a team • Public health problems cross boundaries of discipline • Emotional intelligence • Value of contributions from professional peers • Purposeful contribution toward shared aims	• Lecturer-led tutorials • Lecturer-initiated discussion topics • Regular feedback on team activity • Explicit guidelines on expectations for participation
Second year	• Simulations of public health investigations and data collection • Public health program planning • Tutorials • Discussion	• Individual team role preferences • How agencies work in partnership • Community-based interaction • Appropriate community and intersectoral partnerships • Differences between community participation, action, and empowerment	• Team role quiz • Structured simulations facilitated by lecturer • Lecturer-moderated discussion forums • Community action framework for public health planning
Third year	• Discussion • Student-led seminars • Q&A seminars with subject “experts” • Self and peer assessment • Reflective blogs/journals • Problem solving and reporting in multidisciplinary teams • Professional practicum • Applied research project	• Development of intersectoral partnerships • Intersectoral partnerships in complex problem solving • Incorporating public health perspectives across government policy • Community partnerships to achieve change	• Lecturer moderates student seminars and facilitates discussion • Approval and oversight of practicum by lecturer • Self and peer assessment of team activities

Note. Q&A = question and answer.

While this article has been written from a theoretical perspective, and does not seek to demonstrate effects on student attitudes, scaffolding teamwork and partnership in this way appears to have had a positive effect on the attitudes students report about teamwork. Previously, students would routinely report that they disliked team assessment tasks, with comments such as “I don’t like group projects!,” “disliked the group work component,” and “one group member was able to ruin the grade of the rest of our group” regularly appearing in course evaluations. Since the introduction of a scaffolded approach to learning teamwork and partnerships, team activities have elicited a much more positive range of responses, including “you have taught me to love group work,” “the challenge of the group assessment was the best aspect,” “the group seminar was really fun and I highly recommend keeping it,” “the [group tasks] were a great opportunity to benefit from the learning of other students.” Further research is needed, however, to provide empirical evidence on the effectiveness of this approach on changing student attitudes.

Although not without its challenges, especially when students and staff are geographically dispersed, partnership-building skills and knowledge can be scaffolded across an entire curriculum, allowing students to gradually build these into their practice.

Conclusion

The capacity to work effectively in team environments is a requirement of most graduates entering the workforce. It is also explicitly identified as a core skill in health promotion and environmental health accreditation requirements. Partnership building knowledge and skills need to be scaffolded across undergraduate degree programs to enable students to develop and master the ability to initiate and nurture effective public health partnerships. Despite this need to embed collaborative learning within undergraduate public health courses, there is little published evidence to identify how this can occur across a degree program rather than within a single course or two. Achieving this in a challenging mixed-mode (on campus and distance) environment with students who often experience structural barriers to their education presents further challenges. We applied the cognitive apprenticeship model to address this through the scaffolding of partnership theory and experiences across the Bachelor of Public Health Program curriculum using a fading concept that moves students from staff-directed to independent practitioners. This model provides an example of cross-program scaffolding of skills that could be adapted for other competencies beyond partnership building skills. The model could also be adapted for other health promotion, public health, or community service programs to suit different contexts and cultural needs.

Footnotes

Authors’ Note

Wendy Madsen is principal author; other authors are listed alphabetically.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Erika Langham

Catherine O’Mullan

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