Abstract Title | Student resistance to new technology


  1. Vicki Langendyk
  2. Glenn Mason
  3. Shaoyu Wang




University of Western Sydney


The University of Western Sydney School of Medicine (UWSSoM), established in 2007, is one of the newest Australian undergraduate medical schools.

Personal and Professional Development (PPD) is one of the four major curricular themes.  Method of delivery was small group tutorials and lectures.

We inherited responsibility for the PPD Theme in 2012.

Problems we inherited

1) Critique of original PPD curriculum

  • PPD considered "soft" and "fluffy" by our students
  • No explicit learning objectives
  • No scholarly articles for tutorial preparation
  • Minimal tutor development
  • Limited formal feedback provided to students
  • Limited requirement for reflection and critical thinking
  • Assessed by short answer and MCQs in the end of semester science examination 


2) Existing content management system does not allow students to:

  • Maintain a continuous record of their work from one year to another
  • Facilitate the provision of continuous and timely formative feedback as student work develops
  • Reflect and develop their work in response to teacher and peer feedback
  • Work collaboratively on joint projects

As a result

Neither the curriculum nor the technology supported the educational philosophy which underpins our preferred approach to teaching and learning PPD; transformative learning theory (Mezirow, 1990)

What we did

  • Curriculum now all tutorial based (no lectures)
  • Redevelopment of PPD curriculum and assessment 
  • Introduced an online portfolio system called Pebblepad (see details for more information)
Summary of Work

What is PebblePad and how we introduced it

  • Online portfolio system (with private learner and institutional spaces)

  • Integrated with curriculum and assessment development
  • Tutor and student instruction (face to face and online instructions)
  • Coincided with pebblepad trial by UWS in 3 schools


Redesigned curriculum and assessment

  • Clear learning objectives
  • Student centred
  • Emphasis on scholarship and critical thinking
  • Align with the graduate outcomes  
  • Progressive assessment (written essay, creative responses, student presentations, debates, peer and self-assessment)
  • Emphasis on formative rather than summative assessment

Tutor development programme

  • Discussions on philosophy of teaching and learning (especially professionalism) and teaching strategies
  • Tutor participation in simulated PPD tutorial as students
  • Tutor handbooks developed to guide tutoring
  • Tutor feedback used for curriculum development



Evaluation of PebblePad

 As part of a University trial of the new technology, Pebblepad, feedback was sought from students across the 3 participating schools.

1. Is Pebblepad user friendly?

2. How much support was provided to students to learn to use Pebblepad?

3. How are students using pebble for their learning and assessment activities (individual and collaborative)?

Summary of Results

PebblePad - some student feedback


Table 1: Student Evaluation of Pebblepad

Theme Issues
Interface and navigational
  • Interface unintuitive and overly complex
  • Difficult to navigate and unsure about what interface items mean
Process and navigating between personal learning space and the institutional space
  • Difficulty in navigating required processes such as getting templates and using them in personal learning space - this confusion creates complexity for tutors


How do we understand the critical reception by medical students of Pebblepad? 

  • Students in other schools who used Pebblepad had some technical issues but were much more positive than our students
  • Our students reported that they were better supported to learn to use Pebblepad than students from other schools
  • Our students had more practice with Pebblepad
  • Our tutors (in general not technologically savvy) embraced Pebblepad
  • Is there something else going on?

Acknowledging complexity: the origins of our current research project

We have not only introduced a new technology which by itself will have complex effects on the learning environment, but we have also revised the curriculum and assessment content and process and undertaken an intense tutor development programme. And these multiple changes were made in response to a pressing issue in medical education: how to teach professionalism to medical students?

We cannot understand student attitudes to the new technology without investigating how the other significant variables are impacting on their learning of PPD.

Research Question

What is the relationship between students' attitudes to Pebble, the introduction of a new curriculum and assessment, and the subordinate status of PPD to the basic and clinical sciences in the medical curriculum?

Possible hypotheses

The negative discourse of PPD mediates student negativity with PebblePad, (eg. the rigorous assessment now required and operated via Pebblepad is colliding with the student concept of PPD as soft and common sense).

Student resistance to the new technology represents a reluctance to engage in the reflective mode of learning that Pebblepad facilitate, (eg. technology should be fun and Pebble is the means by which they are required to engage in reflective practice).

Framing our research question


Activity Theory (Kaptelinin & Nardi, 2006) was selected as a framework that provides the conceptual tools to combine an analysis of the technological issues arising from the use of the PebblePad with the broader discourse of the place of PPD within a medical curriculum.


 Figure 1: 2nd generation Activity Theory (Engestrom, 1987)








The model below is a ‘populated’ version of the schema in figure 1



Following Daniels (Daniels, 2004) the discourse that we have introduced as a mediating artefact provides a further level of complexity to the model. 

Future research activities:

  • Focus group with PPD tutors to understand the perspectives and practices of the tutors to the renewed curriculum and Pebblepad and the impact on their students experiences
  • Survey of students to explore the impact of the new curriculum and assessment on student conceptions of PPD as "soft"
  • Literature review and interviews with relevant stakeholders to explore the forces that contribute to the negative discourse of PPD
  • Evaluation of trial implementation of Pebblepad in the basic and clinical science component of the curriculum  




Background: Pre-existing major contradiction in PPD learning: students see PPD as "irrelevant", "common sense", "soft"!

Action: Redevelopment of PPD curriculum (including and facilitated by the introduction of Pebblepad)

Results: Pebblepad facilitated the construction of a new curriculum and assessment process, generating expansive transformation of PPD learning and teaching. From this perspective, Pebblepad has been highly successful!

YET: It has also resulted in a new tension: student resistance to new technology.

Activity theory:The adoption of a new technology may result in new tensions or contradictions by colliding with another element of the learning environment. 

New Research Question: What is the relationship between student attitudes to Pebblepad, the revised PPD curriculum and assessment and the subordinate status of PPD in the medical curriculum?

Take-home Messages

1. Activity theory is a useful tool to analyse how technology operates in complex ways in the learning environment of a contested part of the medical curriculum.

2. Educators should maintain a focus on the effects of technology on student attainment of educational outcomes. Technology is a means to this end, not an end in itself.


Arntfield, S. L., et al. (2013). "Narrative medicine as a means of training medical students toward residency competencies." Patient Education and Counseling 91(3): 280-286.

Bakhurst, D. (2009). Reflections on activity theory. Educational Review, 61(2), 197-210.

Daniels, H. (2004). Activity theory, discourse and Bernstein. Educational Review, 56(2), 121-132. DeVane, B., & Squire, K. (2012). Activity Theory in the Learning Technologies. In D. H. Jonassen & S. M. Land (Eds.), Theoretical foundations of learning environments. New York: Routledge.

Engestrom, Y. (1987). Learning by Expanding: an activity-theoretical approach to developmental research Helsinki, Orienta-Konsultit.

Engeström, Y. (2001). Expansive Learning at Work: Toward an activity theoretical reconceptualization. Journal of Education and Work, 14(1), 133-156.

Kaptelinin, V., & Nardi, B. (2006). Acting with Technology : Activity Theory and Interaction Design: MIT Press.

Mezirow, J. (1990). Fostering Critical Reflection in Adulthood. A guide to transformative and emancipatory learning. San Francisco, Jossey- Bass.

Waldstein, S. R., Neumann, S. A., Drossman, D. A., & Novack, D. H. (2001). Teaching psychosomatic (biopsychosocial) medicine in United States medical schools: survey findings. Psychosomatic Medicine, 63(3), 335-343.

Yamagata-Lynch, L. C. (2003). Using Activity Theory as an Analytic Lens for Examining Technology Professional Development in Schools. Mind, Culture, and Activity, 10(2), 100-119.



Pebblepad is a fully web-based electronic portfolio which  provides a private space for learners to plan, record and reflect on their activities, and an institutional space for learners to reveal their work to teachers for feedback.

Students can store their reflections/work in Pebblepad across their undergraduate education and beyond, encouraging a view of learning as a continuous and lifelong process.

Transformative learning theory (Mezirow):  Perspective transformation based on critical analysis of prior assumptions and interpretations.


Mezirow, J. (1990)

Summary of Work


The negative discourse of PPD in medical schools

The medical school curriculum is dominated by the scientific paradigm which exerts a powerful influence on students’ conceptualisation of what medicine is and the formation of their professional identity (Waldstein, Neumann, Drossman, & Novack, 2001). The PPD curriculum theme offers another perspective to science, emphasising the personal, the subjective and the socio- cultural dimensions of medicine.  Frequently denigrated as “soft” and “subjective,” PPD struggles for legitimacy in the medical curriculum not only amongst students but also the staff of the medical school community. We call this the negative discourse of PPD.

The Workbook in PebblePad


An example of a PebblePad webfolio


Summary of Results

 The negative discourse of PPD in medical schools

The medical school curriculum is dominated by the scientific paradigm which exerts a powerful influence on students’ conceptualisation of what medicine is and the formation of their professional identity (Waldstein, Neumann, Drossman, & Novack, 2001). The PPD curriculum theme offers another perspective to science, emphasising the personal, the subjective and the socio- cultural dimensions of medicine.  Frequently denigrated as “soft” and “subjective,” PPD struggles for legitimacy in the medical curriculum not only amongst students but also the staff of the medical school community (Arntfield, 2013). We call this the negative discourse of PPD.


Activity Theory in a nutshell

  • Activity Theory based on Vygotksy’s early work in learning and psychology (Bakhurst, 2009; DeVane & Squire, 2012)
  • Activity is the basic unit of analysis
  • Activity takes place in a complex environment of interrelated layers through which activity is constituted and mediated.
    • In 2nd generation Activity Theory (DeVane & Squire, 2012) these layers are schematically represented in figure 1
  • There are 5 basic principles of AT: Activity system as a unit of analysis, multi-voicedness of activity, historicity of activity, contradictions as a driving force of change in activity units and expansive cycles as possible froms of transformation in activity (Engeström, 2001).
  • AT has been adopted as a conceptual framework to aid in the analysis of complex domains such as schools (Yamagata-Lynch, 2003) and hospitals (Engeström, 2001)






Take-home Messages
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