Second-Phase Virtual Patient Literature Review

We are returning focus to case-based online content and how 'virtual patient' encounters may be developed and integrated into curriculum. A comprehensive review was undertaken a few years ago and revealed how a number of national and international medical schools were making use of various virtual patient authoring tools available at the time. The study brought a number of pedagogic principals to light and suggested a basis on which to develop a system. The full review can be accessed here.

However, the perceivable changes in the development of software and devices since then have given cause to re-evaluate how case-based online resources are being developed and delivered. For example, the advent of HTML5 and increasing use of smartphones may have dictated some degree of change in approach to development and deployment of content.

A new review will firstly conduct a review of widely used authoring systems and the gathering of information relating to the success of their use within various settings across different medical education institutions. If you have any thoughts or experience of the implementation of current clinical scenario-based study resources, then please do comment and share.

School of Medicine E-Learning Team

What is CORTEX?

Cardiff University School of Medicine
The School of Medicine is one of the largest Schools within Cardiff University, featuring numerous postgraduate courses and the largest undergraduate course in the University.

The undergraduate curriculum now has over 1500 students taught over two main campuses, and numerous clinical locations. To address many of the logistical problems associated with large student numbers and the pseudo-distance learning nature of the course, the current undergraduate curriculum is evolving to make increasing use of technology to deliver educational experiences and resources to students.

CORTEX and the C21 Project
In conjunction with the evolution of the current curriculum, the School is developing a new curriculum to go-live in Septbember 2013 for the new first year in-take. The new curriculum will be developed with technology as a much more integrated part of the curriculum and pedagogy from the off. This programme is know as the C21 project.

To facilitate the appropriate uptake of technology within both curricula the School of Medicine eLearning Team are running the CORTEX project. The CORTEX project aims to provide web-based resources to staff to enable them to select and implement technology appropriate for their teaching. The project is a corner stone of the eLearning Strategy, which aims to enable and empower staff to implement as much eLearning as necessary with as little direct involvement from the eLearning Team as possible. This prevents the eLearning Team from becoming a bottle neck, and allows the eLearning Team to focus on areas such as infrastructure, specialist technical developments, and quality assurance.

While the main focus for the project is to support the undergraduate curriculum, the School of Medicine also delivers numerous postgraduate, distance learning courses, which also make heavy use of eLearning. Many staff supporting these courses are also struggling with the adoption of technology, and so the planned CORTEX website will be developed in conjunction with PGT to ensure we cater for the School’s overall eLearning requirements as far as possible.

Wider Collaboration
A similar degree of collaboration is also required with University Learning and Teaching Support team, to ensure that we are well aligned with the University’s Technology Enhanced Education strategy, and that the resources we produce are as widely applicable across the University as possible.

Enhancing Content Accessibility

MEDIC e-learning are to invest in a resources upgrade enabling the access to module content from platforms such as the iPad. The increased use of non-Adobe Flash enabled devices means focus has been directed on adapting development whilst maintaining the level of interactivity previously only possible through use of the Adobe Flash Player plugin. Students using the self directed learning area in the new Cochrane building have been making extensive use of the Clinical Skills modules for OSCE revision, with many frequently using iPads to do so.

Virtual Patients at Cardiff; A Review

Virtual Patients are computer-based simulations of fictitious patients presenting with a complaint. The complaint is analysed by the learner and encourages thinking processes surrounding history taking, examination, diagnosis, treatment and discharge, without the obvious risks associated with a student treating a real patient case. The cases can focus on important common condition but can also be used to cover important conditions that it may be difficult for students to gain experience of, such as domestic abuse.

Main Points...

• Allows self-directed learning opportunities
• Narrative/didactic style of delivery for earlier years students
• Branched/exploratory style of learning for later years where knowledge can be applied
• Focus is on applying clinical knowledge to diagnostic thinking and management
• Cognitive realism - that is that the challenge posed to the learner seems real - is more important than visual realism - that is that real photos or video clips are used
• Communication/social skills for patient dialogue can be exercised Opportunity to familiarise with patient dialogue
• Continual focus on learning objectives is key for maintaining relevance
• Regular self-assessment opportunities allows the learner to evaluate their own progress
• Promotion of clinical reasoning is arguably the most important distinguishing feature of VP delivery and purpose

Read more about the comprehensive literature review conducted at Cardiff University School of Medicine...

Access the full literature review here.

Wikis

A wiki is an editable web page which enables many-to-many communication – it is essentially a database created by a group rather than an individual (e.g. Wikipedia). Wikis are similar to blogs but allow the text on the website to be edited by others, with the creation of a common document that can be shared between individuals. One of the big advantages of collaborating with wikis is that it should reduce email traffic.

Wikis can be used to share dialogue and information among participants in group projects, or to allow learners to engage in learning with each other, using wikis as a collaborative environment to construct their knowledge or to be part of a virtual community of practice. Wikis show the evolution of thought processes as students interact with the site and its contents.

As users can modify the content of a wiki, allowing such manipulation carries some risks. Thus wikis are often monitored to ensure that inappropriate language or content are not allowed; however, this can be time-consuming.

How to do it
There are many different wiki creating and hosting services available. Wikimatrix provides a comparison of the key features offered by a variety of services. There are also plenty of other non-wiki collaborative editing tools such as googledocs. Most wiki-hosting services have a built-in search system for you to find wikis of interest, and there are some general wiki-search engines such as wikiindex.


Incorporating wikis

• To create multimedia presentations and simple digital stories as they are able to incorporate sounds, movies and pictures
• As e-portfolios illustrating their utility as a tool for collection and reflection of current thoughts
• To form groups around specific topics and might also prove to be an ideal vehicle for soliciting ongoing input for research or projects where community input can help inform and direct subsequent investigation
• As repositories for meeting notes. Agenda items are contributed prior to a meeting; notes added during the meeting are saved in a public archive

Considerations
In an open and collaborative web environment, anyone can very easily post copyrighted material without the permission of copyright holders (e.g. patient anonymity when clinical data and images are posted), post otherwise unsuitable or misleading content

A lack of clear and complete authorship/editorship information attached to each wiki entry, including authors’/editors’ affiliations and credentials, is a serious quality issue. Wiki author anonymity also poses questions for higher education institutions where assessment and grading are still typically based on individual efforts

Wikis are sometimes prone to vandalism and, as a result, to serious quality issues, because of their free form nature and the (relative/potential) lack of control over their content (e.g. edit in a way that reduces its accuracy, or even delete a good wiki entry)

Wikis do not have the functionality expected on more traditional web sites, such as the use of highly visual dynamic backgrounds that are integrated with various multimedia. However, they are highly useful pedagogically as a low technology approach to providing an online presence with the ability to have links to other online resources or to store a variety of files


Solutions
Monitoring and moderation: Wiki software packages have built-in ‘Administrator’s functionalities’ to support monitoring and moderation. However, these tasks can be very time-consuming and may prove to be too great a challenge to ask of educators who already lack time and resources

The ‘closed environment’ scenario: e.g. Learning Central – The wiki owner(s) /Administrator(s), enforce, check, and limit wiki and blog registration and editing privileges to selected, well-defined, and verifiable special interest groups or communities of users. Everyone else will still be able to access/read the wiki and, if desirable to also post limited (moderated) comments (to build a community)

Obtaining Patient Permission: Permission must be sought when posting clinical photos/videos, and all efforts should be made to preserve individuals’ privacy. Clinical wikis may also be password protected if necessary to further preserve patient confidentiality. The software also makes it a simple matter for an editor to delete/revert or modify material that violates patient privacy. Refer to patient consent and copyright policies

Web 2.0

Web 2.0 is commonly referred to as a second generation of services available on the web, allowing users to do more than just retrieve information. Social software is considered a key web 2.0 development, since it encompasses services which facilitate collaborating, sharing, meeting and communicating with others online. Although much of this activity is currently social, there is a huge education potential in these tools, particularly with students who are not campus-based.

While there is no set definition of Web 2.0, the phrase generally refers to the use of interactive and collaborative web applications as social media platforms, where users participate by generating their own content alongside the content provided by the websites themselves. This characteristic is often stated as being the primary difference between Web 2.0 and the original World Wide Web (Web 1.0).

Web 2.0 applications allow students to easily create their own content and also to actively share information, opinion and support across networks of students. They are relatively easy to use requiring little or no technical expertise and there are many free an Open Source versions availble that offer flexibility and convergence options with a number of systems. In addition, they provide educational opportunities for students ‘any time, any place’. The collaborative and engaging nature of these tools can then be used to support a number of educational processes such as reflection, knowledge building and encouraging student participation and discussion.

Web 2.0 Terminology
Web 2.0 literacy is increasingly important, so here is a glossary of social media terminology to help you get the ‘gist’ of the jargon.

• Tags - The categorization of content by users adding tags (short, usually one-word descriptions or keywords to facilitate searching). As opposed to a classical taxonomy-based categorization system (e.g. MESH), they are usually non-hierarchical, and the vocabulary is open
• Tag Clouds – Give you a visual idea of tag frequency for a blog or other social media site. The more popular a tag, the bigger the text appears in the cloud.
• Folksonomies – These are collections of tags created by many users within a single system
• Syndication – allows websites to ‘push’ new content to users. RSS (Really Simple Syndication) is a family of web feed formats used to publish frequently updated works, such as blog entries, news headlines, audio and video in a standardized format. RSS benefits users who want to subscribe to multiple feeds using a feed reader. To provide a single point of access for updates to content from multiple sources. An increasing number of medical journals have RSS feeds available
• Mashup – involve the merging of information from multiple sources. For example, Google maps and BBC traffic data
• Open Source – Open Source refers to software that is available to the general public at no monetary cost. However, there may still be restrictions on what you can and cannot do with the software

Web 2.0 Software Tools
An outline of different social software tools follows. However, it is important to note that there is a growing trend for services which combine different features in one package, such as services which enable you to join online communities, set up blogs and wikis and share photographs all via one website.

Blogs
Blogs (short for ‘weblogs’) are personal websites that allow rapid updating by the author and can be most easily described as a web-based diary. Content can be easily created (listed in date order) and shared. They are designed to be interactive, allowing others to post comments about the blog entries; however, it is usually not possible for anyone to alter the content except the owner. Syndication options enable users to subscribe to blogs and digests. Increasingly, blogs incorporate multimedia, and you can also upload and read them via mobile devices. Examples of blog platforms include: Learning Central, edublogs. Microblogging – allows users to send brief text updates e.g. Twitter.

Wikis
Wikis are similar to blogs but allow the text of the website to be edited by others, with the creation of a common document that can be shared between individuals. Examples of wiki platforms include: Learning Central,  MediaWiki (the platform that wikipedia is based upon). wikis give an opportunity for users with different types of knowledge, confidence and communication to contribute equally to a joint publication. Collaborators who lack confidence to argue a case in a ‘live’ face-to-face debate can feel more comfortable making the same points in a wiki environment where the pace of discussion is slower and the quality of the thinking is more significant than force of personality.

Podcasts
Podcasts are audio recordings made available on the internet, which can be played on computers or downloaded to hand-held devices such as MP3 players, providing the potential for ‘anytime, anywhere’ mobile learning experiences. Users can subscribe to podcasts using RSS feeds, so that any new broadcast in a series is automatically downloaded to their PC or device. Podcasts have been embraced by the education sector, since they offer a lively method of communicating with different audiences – whether for lectures, discussions, audio guides etc…

Social Bookmarking
Social bookmarking allows users to save online resources as bookmarks, which can be accessed from any device with an Internet connection, both by the bookmarker and by the wider community. Most  bookmarking sites also allow bookmarks to be tagged to make finding them easier later. In these systems, bookmarks represent ‘links’ to web resources (they do not attach a copy of them). Examples of social bookmarking platforms include: digg, diigo

Media Sharing – Visual media can be uploaded and stored on a website and shared with please ensure that you refer to consent and copyright policies. Examples of media sharing platforms include: Flickr , You Tube

Social Networking – Involves the process of building online communities, often accomplished both through ‘groups’ and ‘friends lists’ that allow greater interaction on websites. Several approaches can be combined in these sites to make them extremely versatile e.g. blogging and file sharing. Examples of social networking platforms include: Cardiff University Connections Service, My Space, Facebook
Social software tools can provide significant support to both traditional teaching and distance education programs by facilitating interaction, collaboration, and the formation of
social networks among students.

Further Resources
Cardiff University Learning and teaching support
Learning Central
JISC e-Learning Programme
Donald Clarke “Don’t lecture me”
JISC Report “Higher Education in a Web 2.0 World”
www.jisc.ac.uk/media/documents/publications/heweb20rptv1.pdf
HEA e-Learning Programme
JISC Advance – Guide to Digital Media
7things you should know about… Podcasting
7 things you should know about… Blogs
7 things you should know about… Wikis

Technology & Pedagogy

Exemplary teaching combines skilful use of pedagogy with content expertise and innovative uses of technology, embedding key elements into course design. Wilson (2003)

As educational technologies continue their rapid evolution and the effectiveness of traditional educational techniques are brought into question (Bligh, 2000), it would be easy to become overly enamoured and forget that the technology is fundamentally dependent on the underlying pedagogy and learning principles employed to deliver the educational programs themselves; indeed “pedagogies before technologies” is a commonly touted phrase (Watson, 2001; Ascough, 2002; Mayes and De Freitas, 2004).

Beetham and Sharpe (2007) suggest that far from trying to create pedagogy anew, we should be in the business of locating new technologies within proven practices and models of teaching, where the focus is on educational issues or problems that might possibly be solved, at least partially, by the provision of learning arrangements that make a deliberate and effective use of technology. Unfortunately, there is no one simple approach to using technology to support learning that will succeed. Instead the starting point is not the technology per se, but the educational process itself.

Pedagogical Perspectives
Pedagogy is a term that generally refers to strategies of instruction or a style of instruction (Stephenson, 2002). A number are often quoted in e-Learning literature and can be mapped into broad theoretical educational perspectives that govern the good practice of teaching (JISC 2004). These perspectives are not mutually exclusive, but within each, it is possible to identify a key set of assumptions, that have in turn generated a large number of pedagogical approaches and models that can be used to encourage specific aspects of learning (Insert Table 1).

Table 1: Defining approaches to learning from the Effective Practice with e-learning Guide

e-Learning Pedagogy
Although a number of reviews of learning theories and their relevance to e-Learning have been carried out (Conole et al., 2003; Mayes and De Freitas, 2004; Beetham and Sharpe, 2007; Dyke et al., 2001) it would appear that there is currently little evidence of how these models or theories are applied consistently to effective pedagogically driven e-Learning. Research indicates that most implementations of e-learning include blended elements that emphasise all three pedagogical perspectives: learning as behaviour, learning as the construction of knowledge and meaning, and learning as social practice. However, the literature also suggests that the emerging pedagogical consensus centres around constructivism – collaborative learning, authentic tasks, reflection and dialogue and to do so in a way that addresses both identity and community (Bangert, 2004; Mayes, 2004; Windschitl, 2002). Weller (2003) also cites constructivism as the dominant teaching pedagogy applicable to the Internet, but while advocating that there are opportunities for new pedagogies he also admits that they should be used “in conjunction with more traditional approaches”.

e-Learning also places additional emphasis on several key features including the ‘individualisation’ of learning, with each student making their own learning pathways at a speed that is appropriate to them, and ‘just-in-time’ learning where students have timely access to relevant and useful knowledge. Moreover the steady growth in mobile device ownership enables mobile learning (m-learning) where students are able to learn at ‘any time and in any place’. These features demonstrate students increasing reliance on an eclectic mix of personal and institutionally-based technologies and illustrate that much of this e-learning is not developing as conventional pedagogy – but as ‘informal learning’. This is facilitating the bottom-up development of learning communities by combining one-to-one (email and instant messaging), one-to-many (discussion tools, blogs and podcasts), and many-to-many (wikis) communication modes.

Technologies Identified
The tools used to support and deliver learning cover a wide range of different applications including:

• Virtual Learning Environments (VLEs) – Many institutions have now adopted VLEs which incorporate collaboration and communication tools such as wikis, blogs, forums and chat. However, research suggests that while VLEs may have enhanced learner access to online resources, the associated communication tools have been little used JISC (2003).
• Reusable Learning Objects (RLOs)
• Self-paced Computer Aided Instruction (CAI)
• Web 2.0 Tools – Technology can provide a medium for conversing and collaborating within the learning environment (Jonassen et al. 1999; McConnell, 2006). The growing interest in social dimensions of learning and the availability of more open-source web-based social networking tools have been adopted in learning and teaching (Dron, 2007). Web 2.0 social technologies include: social network services, social bookmarking, folksonomies, social search engines, file sharing and tagging, mashups, instant messaging an online multi-player games. More popular in education appear to be wikis, blogs and podcasts (Boulos et al., 2007). Wikis – enact knowledge building, where the focus is on the community itself rather than on the individual learner (Holmes et al, 2004). Wikis are based upon a principle of non-exclusive authority, anyone and everyone gets to decide what will be said (content), how it will be said (organization), and whether it will be said (dissemination). Blogs – are useful teaching and learning tools because they provide a space for students to reflect and publish their thoughts and understandings. As blogs allow comments, they also provide opportunities for feedback and potential scaffolding of new ideas. Podcasts – can be released episodically to ‘push’ content to students that want to listen when they want, where they want and how they want.
• Multimedia – In its most straightforward role, multimedia can be used to present the subject matter. There are many different ways of integrating graphics into tutorials, ranging from simple stick figures to sophisticated simulations using virtual reality applications. However, at no time should a desire for sophistication and look outweigh the pedagogical value of the item itself, especially not when functionality might be compromised. Video – is by far one of the most powerful and expressive non-textual media that can capture and present information. A number of e-Learning systems present integrated and synchronized instructional materials in different media such as video, presentation slides, and lecture notes to users.
• e-Portfolios
• Formative Assessments

An instructor is therefore faced with choosing from a plethora of tools and learning theories in order to create specific learning activities which can be confusing. JISC (2004) suggest that these technologies reflect the pedagogical perspectives listed below (Table 2).

Table 2: Pedagogical Perspectives and Technology

Summary
The use and understanding of technology in teaching is often viewed as a separate issue to that of teaching in itself. If the primary focus of teaching is on pedagogy, and technology is merely viewed as another mode of delivery, then technology and pedagogy can be seen as existing separately, with one having minimal impact on the other. However, if elements of technology and pedagogy can be seen as mutually supportive and interdependent, then it should be possible to construct new meaning about teaching online that is integrative and serves to bring about a bridging of the gap between pedagogy and technology (Maor, 2004 and Wilson 2003).

Alexander and Boud (2001) argue that much of the potential for online learning is being lost because too much of the pedagogy of online learning has been transferred unreflectively from didactic traditional teaching where the computer substitutes for the teacher and textbook as a conveyer of information. It has been argued that many of the digital learning objects created to-date simply translate existing lectures into a digital format, with no change in the pedagogy used (Donald Clarke – Don’t lecture me).

Recommendations in the literature point towards technologies specifically designed to provide interactivity that guide students towards online collaborations (Crook, 1994). This in turn promotes, among other things, skills such as articulation, justification and negotiation (Crook, 1994), shared responsibilities (Laurillard, 1997; Goodyear, 2001), scaffolding (Salmon, 2000), setting hypotheses (Valdez et al., 2000), reflection (Schon, 1992; Laurillard, 1997; Goodyear, 2002), knowledge activation and knowledge application (Gagne, 1965; Bruner, 1997; Goodyear, 2001) and individualized learning and motivation (Goodyear 2002). Advice and guidance is available to institutions as there is no blueprint for implementation of technologies, and each is currently deciding its own path (JISC, 2003)

References

Alexander, S. and Boud, D. (2001) Learners still learn from experience when online. In: Stephenson, J. (Ed.) Teaching and learning online: pedagogies for new technologies. London, Kogan Page.

Ascough, R.S. (2002) Designing for Online Distance Education: Putting Pedagogy before Technology. Teaching Theology and Religion: 1; p.p. 17-29.

Bangert, A. W. (2004) The Seven Principles of Good Practice: a framework for evaluating online teaching. The Internet and Higher Education. 7 (3), 217-232.

Beetham, H. and Sharpe, R. (2007) Rethinking Pedagogy for a Digital Age – Designing and Delivering e-Learning. Routledge, London.

Beetham, H. (2004) Initial Positioning Report. JISC programme on pedagogies for e-learning.

Bligh, D.A.  (2000) What’s the Use of Lectures? Exeter: Intellect.

Boulos, M.K. and Wheelert, S. (2007) The emerging Web 2.0 Social Software: an enabling suite of sociable technologies in health and healthcare education.

Bruner, J. (1997) The culture of education (Cambridge, MA, Harvard University Press).

Conole, G.  Dyke, M. Oliver, M. and Seale, J. (2004) Mapping pedagogy and tools for effective learning, Computers and Education, 43, 17–33.

Crook, C. (2009) Web 2.0 technologies for learning: the current landscape – opportunities, challenges and tensions. Becta, 2008

Dron, J. (2007). Designing the Undesignable: Social Software and Control. Educational Technology and Society, 10 (3), 60-71.

Dyke, M. (2001) Reflective learning and reflexive modernity as theory practice and research in post-compulsory education

Gagne, R. M. (1965) The conditions of learning (New York, Holt, Rinehart & Winston Inc.).

Goodyear, P. (2001). ‘Effective networked learning in higher education: notes and guidelines.’ Centre for Studies in Advanced Learning Technology, Lancaster University. Networked Learning in Higher Education Project, Deliverable 9, Volume 3 of final report to JCALT.

Goodyear, P. (2002) Psychological foundations for networked learning. In: Steeples, C. and Jones,C. (eds.), Networked Learning: Perspectives and Issues. London: Springer, 49–75.

Holmes, B. and Gardner, J. (2006) E-learning :concepts and practice. Sage : London.

Jarvis, P. (1987). Adult learning in a social context. London: Croom Helm.

JISC (2003)  Effective Practice with e-learning Guide (Managed Learning Environment Activity in Further and Higher Education in the UK.

Jonassen, D. H. (1999). Designing Constructivist Learning Environments. In Reigeluth, C.M. (ed.), Instructional-Design Theories and Models: A New Paradigm of Instructional Theory. Volume II (pp. 115-140). Lawrence Erlbaum.

Kolb, D. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ:

Prentice-Hall.

Laurillard, D. (2002). Rethinking University Teaching-a conversational framework for the effective use of educational technology. London, Routledge Farmer.

Laurillard, D. (1999) Learning formal representations through multimedia, in: N. Entwistle (Ed.)The experience of learning (London, Academic Press).

Maor, D. (2004). Pushing beyond the comfort zone: Bridging the gap between technology and pedagogy. In R. Atkinson, C. McBeath, D. Jonas-Dwyer & R. Phillips (Eds), Beyond the comfort zone: Proceedings of the 21st ASCILITE Conference (pp. 572-576). Perth, 5-8 December.

Mayes, T. and de Freitas, S. (2004) Review of e-Learning Theories, Frameworks and Models

Mayes, T. (2004) Learner-centred pedagogy: individual differences between learners, report for JISC Elearning

Models Desk Study,

McConnell, D. (2006) E-Learning Groups and Communities. Maidenhead, SRHE/OU Press.

Papert, S. (1980). Mindstorms. Sussex, The Harvester Press Limited.

Piaget, J. (1971) Biology and Knowledge: An essay on the relations between organic regulationsand cognitive processes. Edinburgh: Edinburgh University Press.

Salmon (2000) E-Moderating: the key to teaching and learning online (London, Kogan Page).

Schon, D. (1992) Educating the reflective practitioner: towards a new design for teaching and learning in the professions (London, Jossey-Bass).

Stephenson, J. (2002) Teaching and Learning Online: Pedagogies for New Technologies, Kogan Page Ltd. London.

Valdez, G. McNabb, M. Foertsch, M. Anderson, M. Hawkes, M. Raack, L. (2000) Computer based technology and learning: evolving uses and expectations.

Vess, D. L. (2006). History to go: Why iTeach with iPods. History Teacher,39(4), 479-492.

Vygotsky, L. S. (1978) Mind in Society. Cambridge, MA: Harvard University Press.

Watson, D. (2001) Pedagogy before technology: Re-thinking the relationship between ICT and teaching. Education and Information Technologies, 6 (4), 251-266.

Weller, M. (2003) Delivering Learning on the Net, Routledge Falmer

Wenger, E. (1998) Communities of Practice: learning, meaning and identity. Cambridge. Cambridge University Press.

Wilson, W. (2003) Faculty Perceptions and Instructional Uses of Technology. Educause Quarterly (2003)

Windschitl, M. (2002) Framing constructivism in practice as the negotiation of dilemmas: an analysis of the conceptual, pedagogical, cultural, and political challenges facing teachers. Review of Educational Research 72 (2): 131–175.

Step 4: Install, Maintain & Develop Prototype (Rapid Prototyping - 4 Step Instructional Design Model)

Once you have implemented your amendments, the learning episode should be installed and appropriately maintained.

A logical directory structure is required to keep all of the graphics, text, audio clips organised into folders in such a way that you know where to find them when they need updating. Documentation should also be developed such as user guides and any further information.

Your evaluation should continue as part of an iterative process, in particular feedback from students. This will allow you to improve the effectiveness of your tutorial.

Click here to repeat Step 3 – Utilize Prototype.
Click here to repeat Step 2 – Construct Prototype.
Click here to repeat Step 1 – Analyze.

Step 3: Utilise Prototype (Rapid Prototyping - 4 Step Instructional Design Model)

A crucial part of the prototyping process is the utilization of the design with peers and potential learners. During utilization, the strengths and weaknesses of the prototype can be discovered. This needs to be done in a structured and timely way. There are three stages to the evaluation and ideally, each stage would occur in sequence, with a revision step between each stage where amendments to the prototype are made.

• Expert/Peer Review – Competent experts in the field check the content for validity, relevancy and currency
• Student Review – At this stage ideally a small number of learners work through the materials (four to eight selected from the student audience)
• e-Learning Review – The e-learning team proof, apply quality standards, evaluate instructional design, ease of navigation, screen design layout, technical performance

Ideally you should gain feedback on the following elements:

• Content
• Sequence and layout
• Media chosen
• Graphics/animations
• Navigation
• Assessments
• Objectives and Outcomes
• Overall comments

Click here for more information on Step 4 – Install, Maintain and Develop Prototype.
Click here to repeat Step 2 – Construct Prototype.
Click here to repeat Step 1 – Analyze.

Step 2: Construct Prototype (Rapid Prototyping - 4 Step Instructional Design Model)

The rapid prototyping process continues with the parallel processes of design and review, or construction and utilization. It involves:

• Incorporating your chosen pedagogical approach such as problem-based, collaboration, self instructional
• Deciding what content should be contained and how it should be structured and sequenced
• Preparing review and/or assessment questions, learner assignments
• Deciding what multimedia you require
• Deciding what is the proper ratio of text to audio, graphics, and interactivity

Structure and Sequence
The learning content should follow a simple, logical structure with clear sequence and instructions. The structure should include:

• Prerequisite knowledge requirements – this allows students to be able to put the learning episode into context
• Clearly stated learning objectives – both at the start and end of the learning episode. This allows the student to reflect on the knowledge that they have gained and provide closure by relating it to other learning episodes
• Sequenced content – ideally in increasing order of complexity, that matches specified learning objectives. Content should be relevant, meaningful practical and supportive, but unnecessary content should be made available in a downloadable document or perhaps into a wiki. If there is still a substantial amount of content then consider smaller learning episodes, rather than one big one.
• Formative assessment
• Summary of the key concepts
• Further reading resources
• Employ clear navigation which is consistent and accessible from anywhere within the session
• Employ real-world examples and scenarios where possible

Creating Assessments
A number of factors can determine how you assess or measure learners’ performance including your philosophy as an educator, the types of students you are dealing with and the delivery system you are using. However, the biggest consideration has to be the content you are teaching, particularly the levels of learning it represents and the performance objectives you have specified during the analysis phase of the process. Formative assessments enable the learner to test their knowledge, and to modify it or fill in gaps if necessary. A diversity of measures can be incorporated into your design either embedded or at the end of the module. These range from:

• Multiple choice, matching, or fill in the blanks (Bloom’s knowledge lower order content) to …
• Online discussions and simulations for performance objectives (Bloom’s higher levels of analysis, synthesis and evaluation)
• Performance measures that encourage critical reflection, are open-ended, practical, and provide opportunity to contextualize learning, are often more valuable and relevant than formal testing based on right or wrong answer

 If your assessment is robust enough, those who understand the content will pass, while those who don’t will fail. Ask a colleague to bluff their way through your assessment. If they pass, it’s obviously too weak. However, in every instance provide rich feedback.

Multimedia Options
All of us learn differently: some of us need to physically manipulate objects, others require auditory stimulus to reinforce key concepts, and still others require graphs, charts, diagrams, and photographs to create understanding. Few of us are either one way or the other. Rather, most of us learn best when a combination of learning styles are engaged to deliver concepts.

One of the key characteristics of e-Learning is its capability to integrate different media to create effective multimedia instructional material. Each medium offers unique opportunities to deliver instructional methods that others cannot. To exploit each medium fully, the unique capabilities of the technology should be used in ways that effectively support learning. However, a note of caution, be selective as too much unnecessary multimedia may distract learners and actually decrease learning performance. It can also prove to be impracticable and very costly to re-edit content with a short life expectancy.

Instructional Design Guidelines
This is where the learner interacts with the content by listening, reading, manipulating, and viewing the instructional content. Your choice of words, images, sounds, content flow, variety, and novelty all affect the success of a lesson. A balance of each ensures you are meeting the learning styles of diverse learners while creating an engaging and entertaining user experience. The five elements of the instructional component to consider are:

Text – Reading from a computer screen is around 25% slower than from paper; therefore as a guide text should:

• Be set into narrow columns rather than allowed to stretch across the entire webpage
• Have 50% of the word count of its paper equivalent
• Be written in a way that is easy to read and digestible
• Be used in conjunction with graphics, photographs, animations, audio and video to add meaning where appropriate
• Have a minimum font 10pt/line height 12pt and stick to one font type where possible
• Have enough whitespace
• Be mindful of using coloured text and backgrounds
• Have limited bold text – generally key terms, headings and subheadings
• Be enclosed in a box to make it easier to digest when necessary

Graphics/Photographs
Graphics in the form of illustrations, photographs, charts, graphs etc… can be an effective way to describe concepts and add visual interest. However, avoid bright decorations that compete with the substantive content for the learner’s attention. In addition, the overuse of graphical elements can be distracting and reduce the speed at which pages will load, given that good quality images can be large and require additional wait time for the user as they download, their effectiveness must be carefully weighed against this reality. Where possible use real photos rather than cartoons or illustrations to highlight key concepts. Be mindful of the School’s copyright and consent policy.

Audio – By no means should you use audio to read the entirety of a lesson to a learner. Nevertheless, audio done the right way can greatly enhance your e-learning materials because you are directing information to both the auditory and visual channels, distributing the mental workload. Audio can assist with humanizing the content by having a voice either welcome the learner to the course or give an introduction to a lesson. Audio can also be effective for providing auditory interest to simulations and to add authenticity to your content via subject matter experts. Users, however, must have a soundcard and speakers installed in their computers to benefit from audio.

Interactivity/Simulation – Animations can provide much needed interaction where appropriate and include: flip books, rollovers, click-ons etc… Again, avoid bright decorations and looped animations that compete with the content for the learner’s attention. Formative Assessments are also vital and can include: drag and drop, True/False, single best answer, multiple correct answer or hotspot. Simulations are time consuming to build but provide a powerful means for bringing content to life.

Video – Has long been accepted as a valuable teaching resource. It can provide a clarity and explicitness not possible with words or still pictures alone and it is an easily reusable/ shareable resource. Video is great for simulations and demonstrations. However, using video doesn’t guarantee effective learning, and it can create a passive experience if used inappropriately. Although it is true that digital video can now be produced on desktop equipment, there are still some important issues to consider including: very large file-sizes, quality, cost and content re-editing factors.

Once you have completed the design step and are happy with your prototype, again, please talk through your session progress with one of the e-learning team. This way we can:

• Review your chosen multimedia
• Provide any requested assets
• Provide further instructional design advice
• Proof read and apply specific quality standards
• Answer any questions and offer advice and guidance on best practice

 Click here for more information on Step 3 – Utilize Prototype.
Click here for more information on Step 1 – Analyze.

Step 1: Analyse (Rapid Prototyping - 4 Step Instructional Design Model)

In essence, the first step of the Rapid Prototype process is to conduct a focused and structured analysis of the students and their needs and requirements. The following elements should be considered.

Learning Needs
An assessment of student needs and the identification of any potential problems at this stage will allow you to make some general goal statements. Any analysis should consider:

• The task and conditions
• Current performance levels
• Potential problems/s or potential causes
• Desired performance outcomes and the associated expectation of your learning episode as related to the outcomes

This analysis is vital in order to identify the best way to achieve those needs and check your interpretation.

Student Audience
Students will not buy in to you tutorial unless it suits their needs, interests and motivations. Without this information it would be possible to end up with a learning episode that is either too easy or difficult. Five categories of audience characteristics can be considered including:

• Instructional preference - The type of presentation, the need for practice, the type and amount of feedback, the time available and the likely location when reviewing content
• General characteristics – Student demographics, IT skills
• Affective characteristics – Motivation, self-concept, attitudes, interests
• Entry skills – Existing knowledge, skills and abilities
• Personal/Physical characteristics – Geographic location, sensory, motor or mental conditions

Resources
When choosing the right delivery system – or combination, you must consider your students resources such as financial, time, facilities, equipment, materials, institutional characteristics and existing instructional resources.

This is also an opportunity to expose your students to new media and methodologies and to demystify technology; however, do not assume too much prior knowledge. At this point you should be able to:

Identify the delivery methods most conducive to learning and any associated learning constraints
Check accessibility elements
Use self-study materials and distance learning methodologies that allow learners to study independent of time and space (however, it is important that learners do not feel isolated)

Content
Essentially, what the learning episode should contain in order to achieve the instructional goal/s. Content analysis considers what learners need to do to perform and what learners need to know to perform. Your analysis should discover:

• What the lesson should contain in order to achieve the instructional goal
• How you will organise and sequence the content in easily completed chunks
• How you will balance self-direction carefully with more structured learning
• What level of learning each piece of content represents (e.g. does the content require the simple recall or recognition of facts, or more abstract mental processes and intellectual activity?) This is crucial because it determines how you will write your performance objectives, and how you will assess performance based on those objectives

Learning Outcomes
These will describe what students will be able to do upon completion of the instruction and should be stated in terms of precise, measurable, and observable actions. Conducting an analysis of learning outcomes allows you to formulate a general aim and establish the associated objectives. At this stage a statement of objectives is simply the definition of a plan for the design and as a plan, it serves two functions:

1. To communicate to everyone involved the purpose of instruction
2. To delineate tasks the learner will pursue

Establish Learning Objectives
Clearly defined learning objectives lead the learner into the learning episode. They drive the lesson and inform learners of what they will be able to do upon completion of the lesson. Improperly stated objectives are frustrating to the learner and will ultimately mislead. It is important to explain up-front why the learner should bother.Having already established through your content analysis the level of learning your lesson represents, Bloom’s Taxonomy and corresponding list of verbs may be helpful at this stage (Table 1).

Level of Learning	Associated Verbs
Knowledge	Arrange, define, duplicate, label, list, memorize, name, order, recognize, relate, recall, repeat, reproduce, state
Comprehension	Classify, describe, discuss, explain, express, identify, indicate, locate, recognize, report, restate, review, select, translate
Application	Apply, choose, demonstrate, dramatize, employ, illustrate, interpret, operate, practice, schedule, sketch, solve, use, write
Analysis	Analyze, appraise, calculate, categorize, compare, contrast, criticise, differentiate, discriminate, distinguish, examine, experiment, question, test
Synthesis	Arrange, assemble, collect, compose, construct, create, design, develop, formulate, manage, organize, plan, prepare, propose, set-up, write
Evaluation	Appraise, argue, assess, attach, choose, compare, defend, estimate, judge, predict, rate, core, select, support, value, evaluate

Table 1: Bloom’s level of learning taxonomy

Once you are happy with the analysis you have conducted and are ready to move forward and develop your prototype, please talk through your session requirements with one of the e-learning team. This way we can establish:

What multimedia you may need to use
What graphics, illustrations, animations etc… you require
Answer any questions and offer advice and guidance on best practice

Click here for more information on Step 2 – Construct Prototype.

Rapid Prototyping: 4 Step Instructional Design Model

The rapid prototyping instructional design model offers a systematic approach to aid you in the creation of learning materials for the web. It allows you to develop a prototype, which gives you and others the opportunity to visualise and evaluate your lesson design early in the process, ultimately saving you time and costly revisions.

The design model itself is a four step process. The overlapping boxes represent the fact that the various processes do not occur in a linear fashion. In other words, the analysis of students and their needs, content requirements and resources depends in part upon the knowledge that is gained by actually building and using your prototype.

Step 1 Analyse
In essence, the first step of the process is to conduct a focused and structured analysis of the students, their needs and requirements.

Learning Needs
Assessing student needs and any potential problems allows you to make general goal statements. Analysis is needed of the task and conditions as well as the current and desired performance outcome requirements.

Student Audience
Students will not buy in to you tutorial unless it suits their needs, interests and motivations. Without this information it would be possible to end up with a learning episode that is either too easy or difficult.

Resources
When choosing the right delivery system – or combination, you must consider your students resources, constraints, facilities, materials, equipment, institutional characteristics and time availability.

Content
What the learning episode should contain in order to achieve the instructional goal/s. Content analysis should consider what learners need to do to perform and what learners need to know to perform.

Learning Outcomes
These will describe what students will be able to do upon completion of the instruction and should be stated in terms of precise, measurable, and observable actions.

Establishing Learning Objectives
Clearly defined learning objectives lead the learner into the learning episode. They drive the lesson and inform learners of what they will be able to do upon completion of the lesson.

Click here for more information on Step 1 – Analysis.

Step 2 – Construct Prototype
The rapid prototyping process continues with the parallel processes of design and review, or construction and utilization. It involves:

Incorporating your chosen pedagogical approach such as problem-based, collaboration, self instruction
Deciding what content should be contained and how it should be structured and sequenced
Preparing review and/or assessment questions, learner assignments
Deciding what multimedia you require
Deciding what is the proper ratio of text to audio, graphics, and interactivity

Click here for more information on Constructing your prototype.

Step 3 – Utilise Prototype
A crucial part of the prototyping process is the utilization of the design with peers and potential learners. During utilization, the strengths and weaknesses of the prototype can be discovered. However, this needs to be done in a structured and timely way. Ideally you should gain feedback on the following elements:

• Content
• Sequence, layout and navigation
• Media chosen
• Graphics/animations
• Assessments
• Objectives and Outcomes
• Overall comments

Click here for more information of utilizing your prototype.

Step 4 – Install, Maintain and Develop
Once you have implemented your amendments, the learning episode should be installed and appropriately maintained.

Your evaluation should continue as part of an iterative process, in particular feedback from students. This will allow you to improve the effectiveness of your tutorial.

Click here for more information on installing, maintaining and developing your prototype.

Selecting an Instructional Design Model

Effective instruction, whether occurring via conventional face-to-face methods or e-Learning should be the result of careful planning that follows a transparent process. Instructional Design (ID) models aim to provide conceptual and communication tools that can be used to visualize, direct and manage processes for generating episodes of guided learning. The better the instruction is planned and developed, the better learning experiences and outcomes it will bring to learners. There are numerous instructional design models which can be broadly incorporated into two main theoretical approaches:

The systematic approach – has a behaviourist foundation, ID is viewed as a process consisting inputs, processes and outputs, very precisely predicted and predetermined prior to instruction
The constructivist approach – is based on epistemological and psychological aspects of constructivist learning views. Here, there is no emphasis on predetermined design steps, just principles (e.g. to include learning in related and authentic contexts)

The application and value of a particular model is dependent on the instructional situation, problem or task and the true value of a model can only be determined within the context of its use. A taxonomy of ID models can help clarify the underlying assumptions of each model, and help identify the conditions under which each might be most appropriately applied. For example, Gustafson’s taxonomy is based on a set of assumptions that each creator of an ID model has made about the conditions under which the development and delivery of the instruction will take place. While many of the models are similar, each take a slightly different approach to the design of instruction. Some are more systematic and/or prescriptive than others, some are a step-by-step process, while others are more open-ended and allow the designer to take a looser path through the model. Most of them have some sort of graphical representation of the model to make following it relatively easy and they vary in the amount of expertise required by individuals to apply the model.

Research tends to suggests that at the root of many popular ID models is a systematic process to the design task, that breaks it down into discrete and manageable units. This encourages the setting of a design objective and provides a way to know when that objective has been met. It also emphasizes the idea of the process being an interdependent group of items that form a unified whole. In this case the outcomes of each component directly or indirectly impact on every other component of the ID process to some degree.


ADDIE
Most models today tend to be a variation of the basic ADDIE model (Analysis, Design, Development, Implementation, and Evaluation). Developed for engineering projects in the 1950′s, ADDIE provides a mainstream approach for designing and developing e-Learning resources. The phases sometimes overlap and can be interrelated. ADDIE provides a dynamic, flexible guideline for developing effective instruction; however, a key criticism often leveled at the approach is that it was never designed to take into account today’s rapid application tools.

Rapid Prototyping
Tripp and Bichelmeyer’s Rapid Prototyping model originated in manufacturing with a focus primarily on development. A variation of the ADDIE model, rapid prototyping borrows from the most valuable aspects of the systemic approach. Learners, subject matter experts and peers interact with prototypes in a continuous review and revision process. It is a four stage process. The overlapping boxes represent the fact that the various processes do not occur in a linear fashion. In other words, the analysis of students and their needs, content requirements and resources depends in part upon the knowledge that is gained by actually building and using your prototype. Developing a prototype so early in the design phase, enables all those who have invested in it to visualize and evaluate what the final product truly needs to resemble. This approach helps by developing a possible product while not investing a large amount of time and money. More emphasis can then be placed on the evaluations of the prototypes to help ensure good sound instructional content.

Click here for more information on each of the rapid prototyping steps.

Mobile Learning (mLearning)

Today’s students live in a world enveloped by the Web. News can be read from online publications, blogs can be used to publish student’s own content and they can share up-to-the minute updates using Twitter – and for the last few years students have been doing this on their phones. The computing world is rapidly going mobile with a plethora of devices and a maze of operating systems and applications (apps) (Prensky (2005, 2010).

Mobile learning (m-Learning) is based on utilizing the functionalities of mobile phones, hand held computers and other mobile devices to enhance learning. If appropriately facilitated, m-Learning can benefit students by providing instructional materials and interaction wherever and whenever they need it providing “just-in-time, just enough, and just for me learning” Traxler 2007. This increases the flexibility for students studying at a distance (Rekkedal, 2002) and potentially increases student retention (Fozdar and Kuma, 2007).

To accompany the latest mobile hardware, computer technology companies are researching and developing ever-increasing mobile communications software adapted for the small screen. Microsoft, Apple, Blackberry, and Google have all created their own mobile operating systems and are developing long lists of software applications as the use of smartphones becomes more widespread (Tapscott, 2009).

Considerations

Some of the key things to consider when considering using mobile devices in the learning environment include:

• Learning content – just enough, brief content – ‘nuggets’ Metcalf and De Marco (2006) noted that mobile devices are beneficial in making small amounts of knowledge available when we are not otherwise occupied
• Portability of the device – e.g. phones are carried everywhere, frequently used
• The mobility and flexibility of the student

Benefits of m-learning

• Mobile learning is great for people on the go as it allows anywhere, anytime, access to content -  enabling just-in-time learning
• There is a social media focus, facilitatating collaborative learning experiences that can enliven or add variety to conventional lessons or courses
• Mobile learning can also help combat ICT resistance by providing a bridge between mobile phone and PC literacy as well as appealing to tech-savvy students because of the media-rich environment
• There is a social media focus, facilitating rapid communication. This can be very beneficial for students and educators alike (e.g. feedback could be provided at a much faster rate). Such communication also enhances interaction and collaboration between and among students enabling peer-to-peer learning and support
• Using such devices can also reduce cultural and communication barriers between faculty and students by using communication channels that students like

Challenges of m-Learning

As with all forms of technology, integrating mobile learning into your teaching programme offers potential challenges including:

• The possibility that tech-savvy students will have an unfair advantage over non-technical students creating a feeling of isolation or of being ‘out-of-the-loop’. Additional learning resources may be required
• The requirement that certain media be reformatted or offered in multiple formats
• Design content restrictions because of the limited display capacity (small screen sizes) in mobile devices. The interface should convey the message using the smallest amount of text, and navigation must be built into the system to allow learners to move between screens and sections of the lesson
• It may make it easier for some students to cheat in assessments

Integrating Mobile Devices

Here are a few examples of how mobile devices can be integrated within your teaching programme:

• Record lectures or parts of lectures
• Contribute to a course blog and/or wiki
• Listen to instructor-generated podcasts
• Create narrated slide shows with your photos

Click here for some tips on constructing mobile learning

References

Metcalf, D. S., & De Marco, J. (2006). M-learning: Mobile learning and performance in the palm of your hand. Amherst, MA: HRD Press.

Prensky, M. (2005). What can you learn from a cell phone? Almost anything! Journal of Online Education, 1(5). Fischler School of Education and Human Services at Nova Southeastern University.

Prensky, M. (2010). Teaching digital natives: Partnering for real learning. Thousand Oaks, CA: Corwin Press.

Tapscott, D. (2009). Grown up digital: How the net generation is changing your world. New York, NY: McGraw-Hill.

Traxler, J. (2005). Defining mobile learning. Proceedings IADIS International Conference Mobile Learning 2005, Malta, (pp. 261-266).