Pedagogy, Technology and eLearning

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Pedagogy, Technology and eLearning

• Jeannette Murphy
• Senior Lecturer in Health Informatics
• CHIME
• j.murphy_at_chime.ucl.ac.uk

Kalmar, Sweden, Sept 2005
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Overview

• Setting the Scene
• Using technology to support learning and teaching
• Brief history
• Changes in Health Science education
• Pedagogy proceeds Technology
• Need for new learning resources
• Clinical Skills and eLearning
• Key Concerns
• Case Study Methodology
• Net-based Examinations
• Monitoring Student Progress
• eSeminars
• Interesting Initiatives (Time permitting)
• Reflections

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Using Technology to Support Learning Teaching

• In my life time
• Chalk, blackboards
• Banda machine
• Gestener machine
• Video player
• White Boards
• Overhead Projector, acetates
• Computer not networked
• Internet

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Computers early days

• CAL, CBL, CAI
• Programmes on floppy discs
• Interactive video disc
• Compact disc, multimedia
• Networked machines
• Internet, browsers, search engines

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Computers Clinical Skills Labs

• St Bartholomews Hospital Medical School, London
• First clinical skills lab in the UK
• Collaboration between Clinical Skills
  Co-ordinator and professor of medical informatics
• Developed own software
• Installed computers in the skills lab
• Explored use of computers for assessment
• Online testing using QuestionMark
• OSCEs with computer stations

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Early Pioneers in UK

• David Ingram
• Simulation software MacPuf, MacPee - with
  McMaster Medical School
• Medical Images Database
• Cancer Patients and their Families
• Tropical Medicine Resource (with Welcome Trust)
• Tim de Dombal
• Acute Abdominal Pain
• Ali Mansour
• Simple Linctus

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Changing ParadigmsHealth Science Education

• Conceptions of Education and Training have
  shifted over last 50 years
• Learning Knowing about
• Acquisition of facts, information
• Didactic methods Teacher-led
• Learning Knowing how
• Emphasis on clinical skills
• Learning Knowing where
• Ability to locate and evaluate information

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New Educational Approaches

• Self-Directed Learning
• Problem Based Learning
• Clinical Skills Labs
• Simulators
• Simulated Patients
• Use of Mannequins
• Objective Structured Examinations (OSCEs)
• Videos of common procedures techniques
• Communication Suites

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Need for New Educational Resources

• Changes in educational methods and philosophy
  require new types of learning resources
• Books, charts, lecture notes, videos not enough
• Need resources to support independent study,
  self-directed learning
• Must not be linear need to be multimedia and
  interactive

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Challenges

• Ensuring learning resources underpinned by sound
  pedogogy
• Need to avoid technology-driven solutions
• End users - must be able, motivated to use
  resources
• Resources must be cost effective
• Need to be able to deliver the resources to
  targeted audience

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Pedagogy

• Before start to design the resource
• Start from assessment of learning needs
• Understand needs of learners
• Whats wrong with traditional resources and
  delivery methods?
• Specify Learning Outcomes
• Plan for Interactivity
• Devise Assessment Strategy

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Wheres the Evidence?

• Given recency of elearning, not many systematic
  studies of what does / does not work
• Mostly anecdotal and case studies of programmes
• Greenhalgh (2003) did a systematic review of the
  literature
• She and her colleagues developed first post
  graduate course in primary health care

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Greenhalgh Findings

• Found only one randomised controlled trial
  examining what works in online education (in
  primary health care)
• Eriksson in Scandinavian J Public Health, 2000
• Identified 15 guidelines for online education
  (undergrad medical education)
• Validity hard to assess
• Sensible, but no clear evidence base

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Topics to Consider

• Case study methodology on distance courses / via
  e-learning
• Net-based examination
• How to best monitor student progress during case
  study work
• Holding extended on-line seminars

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Case Study - Methodology

• In clinical domain, use of case studies very
  popular
• From earliest days of CAL, interest in using
  computer to present case material
• Many projects funded by health services,
  universities, professional groups
• Baud book, The Challenge of PBL, spelled out key
  issues eg how select suitable problems, how
  write cases

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Problem Based Learning

• Many clinical schools have adopted PBL
• Common Problem tutors revert to traditional
  teaching methods
• Especially when teaching clinical skills
• Using virtual patients presented online -- a way
  of supporting PBL

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Electronic Presentation of Case Studies

• Much material online some free
• Examples
• Family Practice
• CyberPatient Simulator
• Trauma Scenarios (New Zealand)
• Geriatric Cases

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http//familypractice.com/cases/casesframe.htm
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(No Transcript)
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CyberPatient Simulator - A case of a 54 year old
female with an a traumatic swollen leg
http//www.mdchoice.com/cme/case5/frame.asp
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User Makes Decisions receives immediate feedback
10 Decisions relating to case
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Trauma Scenarios
http//www.adhb.govt.nz/trauma/scenarios.htm
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Basic Case Details
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Another Trauma Site
http//www.trauma.org/resus/moulage/moulage.html
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Resources Topic Outline Drug List Glossary
Post Test Annotated Bibliography
http//medinfo.ufl.edu/cme/geri/
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Index of Patient Simulation Sites
http//www.mic.ki.se/MEDCASES.html
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Maastricht PBL Cases
http//www.unimaas.nl/pbl/
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Online Presentation of Cases

• Learning technologists seek to exploit multimedia
  possibilities of the WWW
• More realistic, more engaging than paper-based
  cases
• Use artificial intelligence so that the students
  responses influence how case unfolds
• Interactive student types in information and
  receives feedback on decisions, actions

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Virtual Learning Environments(VLEs)

• By start of 21st century, many universities
  implemented virtual learning environment (aka
  managed learning environments MLEs)
• Commercial Packages now available
• Blackboard
• WebCT
• Challenge find ways of introducing elearning, or
  blended learning

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Method for Producing High Quality Cases

• Choosing right health problems
• What important enough to be in the curriculum?
• In PBL curriculum, problems chosen for study
  define the basis of the curriculum
• Way problems are studied defines the curricular
  emphasis (eg organ based, system based)
• Indices of educational importance
• McMaster staff emphasise prevalence of problem

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Selecting Problems

• Educational Priorities must also be taken into
  account
• E.g. clinical logic, prototype value, urgency,
  treatability, interdisciplinary input
• MacDonald at McMaster has developed a method for
  assessing problems to determine whether to
  include in the curriculum

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Method of Weighting

• Criteria include
• Priority of the Problem common, uncommon, rare
• Priority Health Problem Indices
• Severity Score
• Effectiveness Score
• Produced a list of priority health problems for
  use by medical curriculum planners

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Free to academics but you must first register to
use it http//www.jclinpbl.org/high/index.htm
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Questions to Audience

• What are key features of high quality case study?
• What problems do you face in developing cases to
  use in distance learning?
• Can existing cases be adopted?
• How much work involved? How much time required?
• Opportunities to collaborate? Can same case be
  used for different groups? Different levels?
• Role of Tutor?

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Topic 2 Student Assessment

• Purpose determine if students have met course
  learning objectives
• Formative and summative assessment
• Formative may be continuous
• Both may be online
• Norm-based and criterion-based

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Student Assessment

• Traditional approaches, face-to-face teaching
• Quizzes
• Essays, term papers, reports
• Projects
• Portfolios
• Student Presentations
• Peer Evaluations
• Interviews, Vivas
• Participation in Seminars, Group Discussions
• Examinations

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On-line Assessment

• Some traditional methods transfer readily
• Web-based learning also offers some new
  opportunities e.g. design web site, access
  on-line resources during test, prepare e-folios
  or web-based journal
• Problems arise in conduct of on-line examinations

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Net-Based Examinations

• Advantages
• Immediate test score feedback to learner
• Immediate statistical evaluation of objective
  test question quality
• Concerns
• Plagiarism
• How do identify checks?

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Net-Based Examinations

• Issues to address
• Security
• How validate the identity of person taking the
  test
• Possible Solutions
• Live video-conferencing with proctors
• Students sit exams on campus, or other sites,
  under supervised conditions
• Students sit exams at home with approved proctors
• Regional test centres established

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Net-Based Examinations

• Issues to address
• Academic Standards
• Making sure test same range of skills, knowledge,
  competencies as with traditional programme
• Creating interesting, valid, reliable exams
• Not just objective, multiple choice
• How test clinical skills?
• How test knowledge management?
• How assess communication skills?

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Questions to Audience

• Your experiences?
• Your concerns?
• Views of your students?

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Topic 3 Monitoring Student Progress

• Purpose of monitoring to identify
• Weak students, those who are struggling, liable
  to fail
• Advanced students, who need to be stretched
• Dysfunctional group dynamics
• Deficiencies in course materials
• Problems with course design
• Common problems and those specific to
  individuals, groups

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Moderating Case Studies

• Tutor most active at start (eg weeks 1 and 2)
• Tutor Roles
• Group facilitator
• Mentor, Guide
• Quality Assurance
• Moderator

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Monitoring Student ProgressOn-line

• Various Approaches
• email contact
• Reflective learning logs
• eFolios
• eSeminars
• Teleconferencing, video conferencing
• Discussion boards
• Mini surveys
• Quizzes

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Monitoring Student ProgressOn-line

• Pulse Checks
• Students asked on regular basis (e.g. every 4
  weeks or 3 times during the semester) to post or
  email their pulse
• Where they are
• How they are doing in the course
• What improvements or changes they think should be
  made
• Office Hours

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Types of Monitoring

• Synchronous v Asychronous
• Real-time e.g. virtual chat, teleconferencing
• Time delayed - e.g. discussion boards
• Groups v Individuals
• Keeping track of progress of individuals
• Keeping track of group progress, group dynamics

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Monitoring of Case Study Work

• Basics ensure able to access material and
  understand how organised and what expected to do
  explain assessment methods
• Decision - work alone or work in groups,
  syndicates, teams
• Set timetable, deadlines what expected to be
  done, by what date

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Monitoring of Case Study Work

• Set ground rules for communicating email,
  attachments, e-seminar, student common room
• What to monitor?
• Monitor log in, access etc (software tools
  available)
• Monitor contributions frequency, quality
• Monitor reflective learning logs, e-folios
• Monitor output, presentations e.g. video
  conferences

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Cautions

• Must be careful not to overload learners or
  tutors
• Students must be told in advance what aspects of
  performance being monitored, for what purpose
• Issues of privacy, confidentiality need be
  addressed (Freedom of Information Act, data
  protection, retention of information)
• Students may need to give explicit consent

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Questions to Audience

• Providing Feedback
• How much feedback?
• How frequently?
• Balance between general and specific?
• How much time should tutor devote to providing
  feedback?
• Should students be asked to provide feedback to
  one another?
• In your experience, what methods of monitoring
  do/do not work?

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Topic 4 eSeminars

• On-line seminar vital part of online course
• Require planning
• Moderators (seminar leaders) need to be trained
• E-Moderators preside over electronic meetings or
  conferences or seminars

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E-Moderating

• Skills Needed
• Management
• Coaching
• Observing
• Mentoring
• Facilitating

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Getting Started

• Getting Started
• Introducing participants, welcoming them, setting
  ground rules, making clear what expected

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Goals for e-Moderators

• Assist learners to feel confident in
  communicating online on unfamiliar topics
• Increase online comfort by starting informal
  and non controversial discussion
• Start with topics which are not too daunting
• Set clear goals
• Promote trust, sharing

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Extended On-line Seminars

• Make clear aims and objectives
• Make sure all participants know one another
• Announce start time and end time
• Provide ground rules for seminar
• Brief yourself before hand about participants
  (create mental pictures)
• Do not dominate the session

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Extended On-line Seminars

• Be clear on your role what you will and will
  not do
• Consider appointing one participant to act as
  scribe or reporter
• Provide information, feedback, guidance to
  participants before and after the event
• Summarise discussion midway and at the end

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Extended On-line Seminars

• Try ensure everyone participates
• Do not allow individuals to dominate the
  discussion
• With large groups, may consider setting up
  syndicates or learning sets
• Allow time for questions
• Make students feel they are part of a class
• Try to foster a sense of community

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Questions to Audience

• How time consuming is it to moderate eSeminars?
• Has your approach altered as you gained
  experience?
• How much help and support do new students need?
• Does this method of learning suit some types of
  students more than others?

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Interesting Initiatives - University of Sydney

• Developed Problem-based Learning Cases for
  medical students
• Site recognises where each student is up to in
  the program and which PBL group they are in
• Essential case material links for the week are at
  top of the window and are timed for individual
  release so dont preempt students weekly PBL
  discussion
• All materials available retrospectively

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University of Sydney

• Each case contains
• Student online assessment (formative) and staff
  tutor guide
• Student evaluation forms
• Essential case materials needed to guide thinking
  about the weeks basic and clinical science
  issues
• Trigger, Results, Patient Data

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http//www.medfac.usyd.edu.au/showcase/pbl/index.p
hp
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Case Summary Mr Sarichs chest pain

• John Sarich is a 55 year-old newsagent who has
  been brought to the Emergency Department of a
  city hospital by his wife with a half hour
  history of continuing chest pain. He is
  overweight and smokes 20 cigarettes a day.
  Investigations showed an ECG consistent with
  anterior myocardial infarction. He underwent
  successful urgent coronary angioplasty and
  stenting, and his subsequent in-hospital course
  was unremarkable.

Mr Sarich was discharged on long-term drug
treatment to reduce his risk of future heart
attack, and was referred to a comprehensive
cardiac rehabilitation program to establish and
maintain lifestyle modification (diet, exercise,
smoking cessation).
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Interesting Initiatives - MATADOR

• MATADOR Trauma team training in a virtual
  emergency room. 2003
• Nordic research project to explore use of
  distributed virtual environments to enhance
  quality of training in emergency medicine.
• Developed a multi-user simulator
• Tested by 24 medical students and professionals
• Won silver medal in Swedish IT competition

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MATADOR Project

• Training tool designed to assess leadership,
  teamwork and communication within a trauma team
• Participants collaborated to save a trauma victim
• Allowed geographically remote participants to
  train and collaborate as a team in a clinically
  realistic environment

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Interesting Initiatives - Glasgow Simulation Lab

• School of Nursing has PBL curriculum
• Teachers inclined to revert to traditional
  methods when teaching clinical skills
• Decided to embed learning objects within web
  pages as substitute for lecturers providing
  instruction and demonstrations
• Aim was to encourage students to explore, analyse
  and make decisions

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Student-Centred Learning

• Both PBL and eLearning put students in charge of
  the learning process
• Share common problems
• Role of educationalist similar facilitator
• In clinical skills lab, must achieve balance
  between giving instruction and promoting enquiry

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ICU Learning Environment

• Mannequin attached to equipment (monitor,
  ventilator)
• Simulate and display clinical data
• Students nursed George Morgan for 6 weeks
• Adopted a minimum instruction approach
• Students had to investigate, explore, learn from
  one another
• Provided scenario resources, email links and
  online multimedia quizzes

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UK Health Education Partnership

• Royal College of Nursing collaboration with
  several universities in UK to produce elearning
  materials
• Hosted by University of Ulster
• Aimed at nurses who do not have a degree
• Students pay for modules
• Modules delivered through WebCT

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UKHEP - modules

• Commission authors to write material
• Work with learning technologist
• 8 Modules currently available
• Site provides all learning materials, online
  discussion, assessment

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http//www.ukhep.co.uk/
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Issues to Consider

• Increased Staff work-load
• Time to design course
• Time to participate, monitor, give feedback
• Time to update course
• Time to redesign course in light of feedback
• Time to evaluate course
• Time to evaluate students

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Dangers Potential Losses

• Human contact
• Key part of education, meeting other people
  faculty members and other students
• Students talk about loneliness of lost distance
  learner
• Social Interaction
• Direct, unmediated communication important to
  developing good social and communication skills

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References

• Baud D Feletti G (eds) (1991)The Challenge of
  Problem Based Learning, Kogan Page
• Cotterill SJ et al (2005) Design, implementation
  and evaluation of a generic e-portolio the
  Newcastle experience. On ePortfolios website
• www.eportfolios.ac.uk

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References

• Devlin M (2002) On-line assessment in James, R,
  McInnis C Devlin M (eds) Assessing Learning in
  Australian Universities
• Doherty C et al (2004) Using ELearning Techniques
  to Support Problem Based Learning Within a
  Clinical Simulation Laboratory. MEDINFO
  proceedings.
• Eriksson in Scandinavian J Public Health, 2000

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References

• French D et al (1999) (eds) Internet Based
  Learning An Introduction and Framework for
  Higher Education and Business, Kogan Page.
• Greenhalgh T et al (2003) Transferability of
  principles of evidence based medicine to improve
  educational quality. BMJ.
• Hovenga EJS Mantas J (eds) (2004) Global Health
  Informatics Education, IOS Press.

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References

• Kenny NP Beagan BL (2004) The patient as text
  a challenge for problem-based learning, Medical
  Education38,no10, pp 1071-1079
• Maier P Warren A (2000) Integrating Technology
  in Learning and Teaching a practical guide for
  educators, Kogan Page.
• ONeil CA, Fisher CA Newbold SK (eds) (2004)
  Developing an Online Course Best Practices for
  Nurse Educators, Springer

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References

• Orange G Hobbs D (eds) (2000) International
  Perspectives on Tele-Education and Virtual
  Learning Environments, Ashgate.
• Royal College of Nursing (2003) Electronic
  learning An RCN guide for nurse educators
• http//www.rcn.org.uk/members/downloads/electroni
  c-learning.pdf
• Salmon G (2000) E-Moderating The Key to Teaching
  and Learning Online. Kogan Page.