Shifting the Emphasis from Teaching to Learning: Process-Based Assessment in Nurse Education

Shifting from an emphasis on teaching to learning is a complex task for both teachers and students. This paper reports on a qualitative study of teachers in a nurse specialist education programme meeting this shift in a distance education course. The study aimed to gain a better understanding of the teacher-student relationship by addressing research questions in relation to the students’ role, the learning process, and the assessment process. A didactical design comprising three phases focusing on distinct learning outcomes for the course was adopted. Data were collected through in-depth interviews with teachers and were analysed using inductive thematic analysis. The results indicate a shift towards a problematising and holistic approach to teaching, learning, and assessment. This shift highlighted a teacher-student relationship with a shared responsibility in the orchestration of the learning experience. The overall picture outlines a distance education experience of process-based assessment characterised by the imposition of teachers’ rules and a lack of creativity due to the limited role of ICT merely as a container of content.


Introduction
Shifting the emphasis from teaching to learning involves a complex process of changing structures in the education system (Barr & Tagg, 1995).One catalyst for changing structures is the use of information and communication technologies (ICT) in education and society (Brown, 2006).In Sweden, ICT was introduced to the policy agenda in 1994, following the political initiative from the USA in 1993 (Karlsson, 1996).The introduction of ICT was also a starting point for the increased use of ICT in education and particularly in

Peter Bergström
Umeå University, Sweden or the students' style of talking and understanding of their practice (Winther Jørgensen, 2000).The instructional discourse creates what Bernstein refers to as specialised skills (Bernstein, 2000, p. 32).From an interview study with in-service nurse students, Bergström (2010) reported on the diversity of skills when students start to focus on the learning process through process-based assessment.The diversity of skills was illuminated through the students' shift of thinking from desk teaching to self-regulated learning, from reproductive learning to productive learning, and from norm-referenced marks to self-reflective assessment.However, the regulative discourse is regarded as teachers' rules of order, in other words what is tolerable or not in the teacher-student relationship.The regulative discourse is the dominant discourse in relation to the instructional discourse.
In this study, the focus is turned onto the teachers' perspective as representative of the teacher-student relationship.Therefore, the aim was to understand the teacher-student relationship in the regulative discourse contextualised within a changing emphasis from teaching to learning in distance education.Thus, the following research questions were addressed in relation to the expectations of and beliefs about teaching, learning, and assessment from the teachers' perspective: • How does the students' role change in relation to traditional approaches to teaching and learning?
• How does the learning process change in relation to traditional approaches to teaching and learning?

Background
At the time of this study in 2007, the teachers involved had experienced two significant turning points during a five-year period.The first turning point was the increased use of ICT that became a catalyst for distance education, and the second was the Bologna reform of higher education.
The teachers in this study worked at a department for specialist nurse education in Sweden.
In 2002, a strategic decision was taken at the department to move to distance education.
This new approach to teaching and learning was regarded as a turning point in each of the teachers' careers.The decision to adopt distance education as the main approach to teaching and learning resulted in the integration of ICT into distance education courses.This created a bottom-up response (Richards, 2004) in the process of shifting the emphasis from teaching to learning.This prompted change in both the learning environment and the pedagogy, which was a result of limiting the regular face-to-face course meetings and shifting towards communications through e-mail and an online approach.The online learning environment is based on a learning management system (LMS) that is used for archiving and displaying assignments and for communication between teachers and students.A webbased video conference tool was used for synchronous communication and collaboration in base groups amongst the students and the teachers.As a result, the students visited the university at the beginning and end of the semester.Through this approach, the number of face-to-face course meetings has decreased by 50%.Moreover, the increased use of ICT can be seen as an example of Richard's (2004) notion of a changed rhetoric towards new ideas and models for developing this kind of practice and context.For these teachers, the rhetoric was characterised by increased demands for developing flexible courses every year and also for alternative approaches to assessment.Recruitment has developed from enrolling students in the neighbouring counties of the university to recruiting students from other parts of Sweden.This development has created pedagogical demands in terms of meeting student needs without having them travel to the university.However, the changed rhetoric is also part of curriculum reforms towards outcome-based models of education.
In Europe, the Bologna process is considered as the most important reform (Eurydice, 2009), which was introduced in Sweden in 2007 (Ministry of Education and Science, 2006).Accordingly, the teachers rewrote the learning outcomes in the syllabus according to the Bologna model.Changing the curriculum has been part of the change in emphasis from teaching to learning (Karseth, 2006).The key challenges for higher education are still considered to be shifting from an instructional paradigm towards a learning paradigm by addressing diversity in learning (TRENDS, 2010) and by recognising the needs for greater flexibility (TRENDS, 2005).A curriculum according to the Bologna model outlines the shift from content-based learning to outcome-based learning (Biggs & Tang, 2007).The teach-

The Didactical Design
The figure below (Bergström, 2010) illustrates the didactical design of process-based assessment for a course of study.The didactical design takes its starting point from the three phases that aimed at covering and capturing the students' learning process during the course.112 The teachers used a template developed in a teacher education programme, which was a 10-page document covering all of the phases.The students started by writing about themselves, on topics such as experiences from higher education and work in relation to the theme of the course, child health and school health service.In the first phase-based on previous knowledge-the students were asked to describe their previous knowledge in relation to each learning outcome.In the second phase, the students' task was to reflect on the learning outcomes in relation to the course assignments, the literature, and the lectures.In the final phase, the teachers asked the students to analyse their learning in relation to the learning outcomes and reflections.

Theoretical Framework
In order to understand the regulative discourse, the material was analysed through the lens of the message system: curriculum, pedagogy, and evaluation (Bernstein, 1977(Bernstein, , 1990)).
These three concepts are only used as analytical concepts.In this analysis, Bernstein's key concepts of classification and framing were applied.In order to understand the conditions and reproduction of the teacher-student relationship, the message system was analysed from the perspective of educational codes, in other words elaborated code and restricted code (Bernstein, 1990).

Curriculum in Relation to Classification
Bernstein used the concept of curriculum with a theoretical and symbolic meaning similar to that of Stenhouse, cited in Ruddock and Hopkins (1985).Stenhouse explains the symbolic meaning of the curriculum as having "a physical existence but also a meaning incarnate in words or pictures or sound or games or whatever" (Ruddock & Hopkins, 1985, p. 67).
Accordingly, curriculum is interpreted with a broad understanding covering the teachers' practice.In this analysis, curriculum is analysed through the concept of classification (Bernstein, 1977(Bernstein, , 1990)), which informs us about the relationship between categories.Classification is a relative concept and is either strong or weak.However, classification can be applied to an analysis at different levels, such as the relationship between the external and the internal value of classification.For example, the external value of classification can consider an educational reform in relation to the internal value of classification, which considers elements of content in a course's syllabus.These values inform us about the power relationship between categories.Strong classification signifies a hierarchical power relationship, while the opposite pertains to weak classification.Bernstein (1990) argues that strong classifications reproduce relationships among categories.

Pedagogy in Relation to Framing
The concept of pedagogy highlights the pedagogical practice from a theoretical perspective, which is perceived through the relative concept of framing, creating the notion of a message (Bernstein, 1977(Bernstein, , 1990)).This message is derived from the relative nature of framing that informs us who is in control, for example in the teacher-student relationship.If the analysis has a purpose of understanding something external, for example a reform, in relation to 113 the internal pedagogical practice, two values need to be considered.An educational reform with a value of weak external framing carries a message of teacher control.In the pedagogical practice, a study guide with low structure has a value of weak internal framing and the students are in control, such that they could have, for example, influence on the learning environment.Thus, understanding pedagogy through the concept of framing, Bernstein (1990) argues that the notion of control creates a message in the external-internal relationship.

Evaluation as a Function of Classification and Framing
According to Bernstein (1977), evaluation is a function of curriculum and pedagogy and is understood as the relationship between classification and framing.In practice, evaluation is understood as the teachers' assessment.Accordingly, the assessment practice depends on the syllabus and the teachers' approach to teaching and on how the learning environment is arranged.
Educational Codes Bernstein (1990) explains an educational code as something tacitly received by taking part in education.The meaning of the code (its orientation) communicates two themes: an elaborated code derived from the principle of keeping things apart or a restricted code derived from the principle of keeping things together.In this paper, the educational code is considered to be the symbolic relationship between policy and practice.The analytical tool for investigating the code concerns the relationship between the internal and external values of the relative concepts of classification and framing.For example, if a policy reform is mandatory for the institution, external classification is strong.If the message of the reform aims to tell the teachers how to teach and assess, external framing is strong.Depending on the relationship between the external and internal values, the analysis points towards a specific meaning as either an elaborated or a regulative code (Bernstein, 1990).

Methodology
A qualitative approach was adopted in order to understand the regulative discourse in the shift in emphasis from teaching to learning.The regulative discourse in the teacher-student relationship was studied from the teachers' narratives of process-based assessment.
A strategy for reading and analysing the texts is outlined, which addresses the trustworthiness of the interpretations of the empirical material.

The Qualitative Interviews
The two teachers (N = 2) who taught in the course were chosen for in-depth interviews.
They are above the age of 50 and have worked with distance education for between four and five years.Because the study was conducted over one semester, the model for interviewing the teachers was through four semi-structured, in-depth, face-to-face interviews.The interviews followed the occasions for teacher-student interaction in the didactical design.
Before they were interviewed, the interview themes were tested with two other teachers.

Ethics
At the outset, the teachers agreed to a statement of research ethics.This followed the guidelines from the Swedish Research Council ( 2001) and addressed the aspects of beneficence, non-malfeasance, informed consent, and confidentiality/anonymity.

Thematic Analysis
The empirical material was analysed through inductive thematic analysis influenced by Boyatzis (1998) and Malterud's (2009) approaches.The empirical material was read and re-read several times, ultimately interpreting what the interviewees were implicitly or explicitly saying.In this process of understanding the essence of the interviews, a strategy was followed in which important signs (Malterud, 2009), episodes, comparisons, and contrastive thinking (Coffey & Atkinson, 1996) were searched for in the written transcriptions.An analytical process of searching for a relationship in the captured essences of the empirical material then followed.As a result of this process, three descriptive themes could be coded to a majority of the empirical material.The reliability and validity of the coding was considered in the subsequent reading of the material in light of the strategy for capturing the essence.Text of the chosen learning outcomes in the syllabus with regard to meaningbearing concepts was analysed in relation to the interviews.However, as the purpose of my research was to better understand the teacher-student relationship in process-based assessment, taking the analysis a step further was necessary.This step moved from the descriptive level to a higher analytical level by integrating theory into the analysis in order to investigate what underpinned process-based assessment.The themes were interpreted through Bernstein's (1977) message system of curriculum, pedagogy, and evaluation by using the relational concepts of classification and framing.The results from the analysis of the message system in the form of the educational code were outlined in order to understand the regulative discourse.

Results
The results are structured and presented in two stages, with the aim of understanding the teacher-student relationship in light of the research questions regarding the student role, the learning process, and the assessment process from the teachers' perspective.In the first stage, the teachers' practice was analysed.In this process of analysing the empirical material, five descriptive categories were found: the organisation of the course, the confusion of working in the LMS, the teachers' criteria for assessment, difficulties in assessing the students, and a contextualised learning process.The five categories were developed into three themes covering most of the empirical material.The three themes are the teachers' relationship with the students, the teachers' interaction with the content, and the students' interaction with the content.These results were analysed through Bernstein's (1977) message system of curriculum, pedagogy, and evaluation.The teachers' voices were frequently quoted from the interviews.Furthermore, in this study the teachers' narratives about their feedback, actions, and ideas were important sources for understanding the themes according to the message system of curriculum, pedagogy, and evaluation.The names of the teachers are replaced with pseudonyms.
In the second stage of the analysis for understanding the teacher-student relationship, the focus turned to the relationship between policy and practice.By applying Bernstein's (1990) educational codes through a theoretical lens, the social relationship from practice could be analysed in relation to educational reforms.
The Teachers' Relationship with the Students In the teachers' relationship with the students, the relative concept of classification highlighted the relationship between valid content from the learning outcomes and less valid content from the students' process.Moreover, the relative concept of framing outlined the teachers' mode for communication in the teacher-student relationship.

Curriculum.
In the students' previous knowledge, a curriculum of weak classification was expressed.In practice, the weak classification was seen when the teachers encouraged the students to use Changing the feedback involved another approach to the students' content in practice, which was a move from feedback of confirmation and summaries towards a problematising approach.The wish for a changed approach in practice outlines a strengthened perspective of a curriculum of weak classification.Caryn said, "I will try to think more from a reflective and problematising approach."

Pedagogy.
The teachers' approach in practice highlighted the difficulties of bringing the students' skills and experiences to a predefined course structure.The teachers' approach highlighted tacit communication with the students in the syllabus and in the instructions of the template but also explicit communication in the teachers' feedback to the students.In the document files, the template showed a method of strong framing through signals of non-negotiation with the students in which the learning outcomes were chosen in advance.However, the format of the questions in the template indicated weak framing: the students had the freedom to write about their skills and experiences in relation to the learning outcomes.The teachers' approach to the students was not to take a standpoint.Ellen argued, "The students have what they have as previous knowledge." The teachers saw their own reflections and analyses about their feedback as repetitive, the majority of their comments as too general, and their questions not sufficiently open.Ellen In the students' reflections (phase 2), framing became stronger when the teachers used the learning outcome as a point of reference for validating the students' element of content.
Caryn explained, "Firstly, I encourage them . . .and then I give support or express if something is missing."

Evaluation.
The function between the strengths of classification and framing reflected a shift in assessment.The teachers argued for a move towards a problematising approach through weak classification and framing.Thus, the assessment condition did not highlight a question of right or wrong in the student-teacher relationship.Instead, the teachers' feedback outlined encouragement by confirmation, as Caryn explained, "To confirm the students' writing . . .they shall feel themselves confident in their creative process.I think this is very important," and by questions in which the students self-regulate their learning.Ellen said, "I thought when the students got these questions back they should reflect a bit more without replying to me." The Teachers' Interaction with the Content In this theme of the teachers' relationship to the content, the learning outcomes were explic-

Curriculum.
For process-based assessment, the teachers chose three learning outcomes in the syllabus that raised different expectations of learning.The three learning outcomes contained the verbs "to analyse," "to identify," and "to describe."In the students' learning, they encountered content that yielded a variety of answers reflecting the nurse practice in clinic.The teachers found that the learning outcome in the syllabus gave different categories of answers, from diverse to predefined.The three verbs highlighted to what extent the formal

Figure 1 .Vol
Figure 1.The figure illustrates the didactical design of process-based assessment.
to a modification of the interview themes and the follow-up questions.For the teachers in this study, the first interviews were conducted between June and August 2007, focusing on the teachers' background as teachers.The second interview took part three weeks after the course started in September, focusing on the work of the students' previous experiences.In December, a third interview focused on the students' reflections.In January and February 2008, a fourth interview took place focusing on students' learning.The interviews followed a structure of themes according to the didactical design and areas of teaching, learning, assessment, and use of ICT.The interviews were recorded digitally and transcribed, and notes were taken during the interviews.The recorded material from the interviews amounted to 11 hours and 35 minutes.
content outside of formal education, for example the students' professions or lives.Ellen explained, "I ask . . .if they don't think that they have learned somewhere else [in another situation]."Moreover, a shift towards strengthened classification was highlighted in the second phase of the process-based assessment by using the learning outcomes in the syllabus.Ellen reflected, "I repeated more of what they said [in Phase 1] . . .but [in Phase 2] I use the learning outcomes, which I take as a starting point."Overall, the teachers expressed a curriculum in the process of change-from strong to weak classification with regard to the students' content.
said, "By giving summaries of what has been said . . .and maybe an open question."The teachers' approach indicated weak framing because of the students' right to create content.
itly discussed and valued in relation to process-based assessment.Classification informs us about the insulation of content in relation to the learning outcome.Framing, the issue of control in the teacher-student relationship, was derived from the teachers' reasoning about the philosophy in the course design and for process-based assessment.
Shifting the Emphasis from Teaching to Learning: Process-Based Assessment in Nurse Education Bergström Shifting the Emphasis from Teaching to Learning: Process-Based Assessment in Nurse Education Bergström