The presentations in this session cover three different aspects of health professions education and how technology is transforming these systems. First, Katherine McKnight, senior manager at the Research Triangle Institute’s Center for Evaluation and Study of Educational Equity, talked about the kindergarten through 12th grade (K–12) system, which lays a foundation of knowledge and skills for more specific health professions education. George Siemens, associate director of the Technology Enhanced Knowledge Research Institute at Athabasca University in Canada, discussed technology
in health professions education, and how it is changing the traditional roles of student and teacher. Finally, Catherine Casserly, formerly vice president of Learning Networks at EdCast, told participants about the use of technology to diffuse knowledge, and how tools such as open-access educational resources are transforming how knowledge is built and shared around the world.
TECHNOLOGY IN K–12 EDUCATION
“Great technology can’t replace poor teaching,” said McKnight, noting that integrating technology into education is not as easy as simply adding laptops or apps to the classroom. However, when solid pedagogy is aligned with how humans learn, technology can transform education and facilitate a learner-centered approach, she said. McKnight said that education is undergoing a transformation from a teacher-centered “sit and get” approach to a learner-centered active learning approach. An active learning approach involves a few key features, said McKnight. First, the educator seeks to personalize the learning so it is challenging and relevant to the student’s interests. Personalizing learning materials so they are challenging but not overwhelming is called targeting the “zone of proximal development.” Educating a classroom full of students using the zone of proximal development is nearly “impossible to do without technology,” said McKnight.
The second feature of active learning is enabling personal choice and control of the learner. Rather than instructing the student, the teacher facilitates his or her learning through an inquiry-driven approach that follows the student’s interests. Third, using multiple pathways to knowledge is essential to active learning; the teacher uses various sources of information and different methods of learning, rather than simply covering material in a textbook. Fourth, active learning requires that students be enabled and encouraged to be responsible for their own learning and to learn the answers to the questions that interest them. The fifth and final feature involves an active learning approach using collaborative learning. Humans are social beings, said McKnight, and learning is a social enterprise.
McKnight told workshop participants about a study she and her colleagues performed in seven K–12 school districts that were “known for pushing the envelope in terms of integrating technology into learning” (McKnight et al., 2016). The researchers observed classrooms, talked with teachers and students, and reviewed lesson plans to see how teachers were leveraging technology to enhance learning. The study found that integrating technology affected five domains: access, communication and feedback, teacher time, teacher and student roles, and purpose and audience for student work. These changes, in turn, increased student engagement and deepened and improved student learning (see Figure 2-1).
McKnight discussed each of these domains and the effect that technology had on them. First, students had improved access to a wider variety of educational resources, and they could select video, reading, and other materials that were interesting and appropriate for the individual student. McKnight said that textbooks tend to be outdated by the time they are printed—particularly in the fields of science and technology—and that using other resources provides a richer and deeper array of information. Students who have unique challenges in learning are able to use technology to find accessible material. For example, a student who struggles with reading—and therefore cannot read the science assignment—can use a technology that will read the text to them so they can learn the material.
Communication and feedback were also improved by technology, said McKnight. Technology allows students and teachers to communicate with anyone at any time; for example, students in a rural area can “beam in” a teacher from across the world to teach subjects they would not normally have access to. In addition, technology enables immediate feedback to students, which is “critical for learners,” said McKnight. Online quizzes, assessments, and feedback-oriented tasks allows students to immediately discover and disabuse misconceptions or misunderstandings as well as track their learning progress.
The integration of technology into education helped teachers use their
time more efficiently. Teachers used technology to keep track of students’ absences, to monitor their progress on homework, and to provide immediate feedback. The time this freed up could be used for planning, integrating technology, and instructional time. McKnight said that one of the best predictors of quality learning is the proportion of classroom time spent on instruction; using technology to allow for more instructional time is an enormous benefit to students.
The study found that technology was being used to extend the audience and the relevance and authenticity of the students’ learning tasks. McKnight said that teachers and students were using technology to share student work with others, and that this sharing encouraged students to take ownership of their learning. For example, students who wrote blog posts and discovered that people around the world were reading the posts became invested in checking their spelling and grammar and in writing material that would interest others. This type of ownership and engagement is “foundational for learning,” said McKnight.
Finally, technology facilitated a restructuring of teacher and student roles, in which students shifted from passive to active learners and teachers shifted from the “sage on the stage” to the “guide on the side.” The “flipped classroom” model for education serves as a good example of this shift in teacher and student roles, allowing students to drive their own education, while teachers teach students how to learn, rather than simply conveying information. McKnight said that this is an area in which technology can be the “biggest game changer,” although she noted that the role change can be difficult for some teachers to accept.
In response to a question from the audience, McKnight emphasized that integration of technology into the classroom does not mean that K–12 teachers are teaching students how to use technology—in fact, she noted that students are likely to know more about technology than their teachers. Rather, teachers are using the technology in order to further the general aims of education. Aligning the capabilities of the technology with what students are expected to know and be able to do is “the Holy Grail,” McKnight concluded.
TECHNOLOGY IN HIGHER EDUCATION
Siemens started with a story about when Red River College in Winnipeg, Manitoba, brought laptops into the classroom in the late 1990s. Siemens said that the switch had very little effect on teaching—professors simply put old transparencies into PowerPoint, but those same computers changed the students’ experience dramatically. Students used the laptops to message with each other, and used messaging to discuss the answers to online tests. This experience demonstrated to Siemens that technology has an uneven
effect on a population, based on their existing expertise and comfort with technology and their intent of how to use the technology. Since that time, Siemens has focused his research on the question: “How do technologies influence how we create networks, and develop and share knowledge?”
In recent years, there has been a fundamental shift in the population of health professions students, said Siemens, and this shift has affected how technology is used in education. Students are not a homogenous group—a student may be a recently graduated 18-year-old, a health professional with a long career who is returning to learn new skills, or a professional from another field who is changing course mid-career. Students come from all around the world, and the average entrance age is increasing (OECD, 2013). Many students and faculty are now digital natives, who are comfortable with and accustomed to using technology in every aspect of their lives. Owing in part to these changes, higher education is moving away from the traditional didactic model (see Figure 2-2) into a more complex and interconnected model of learning (see Figure 2-3).
There is increasing emphasis on self-regulated, self-selected, and self-directed learning, said Siemens, and on the use of social media, massive open online courses (MOOCs), and community knowledge spaces. Students and faculty are growing more comfortable with online and distance learning. Siemens said that nearly half of professors have taught online courses, and as the percentage of professors teaching online rises, so does the percentage of professors who believe that online outcomes can be at least as good as face-to-face learning (Inside Higher Ed, 2017). However, Siemens also noted a need for faculty to be trained on how to teach and interact in the digital
environment, and he commented on the lack of digital pedagogical models to draw on. Courses cannot seamlessly be shifted from in person to digital without an investment of resources to design the course appropriately.
Students and professionals are accustomed to taking ownership of their education by seeking out TED Talks, MOOCs, and other self-directed learning, said Siemens. For example, 59 percent of employed data scientists have learned skills on their own or via a MOOC, in addition to or instead of taking traditional classes (Jansen and Konings, 2017). These shifts have resulted in faculty becoming “a node among an overall knowledge network” rather than the sole source of knowledge, said Siemens. As part of this change, faculty need to be prepared for a role change; when professors are no longer the sole source of information, they must be prepared to serve as facilitators, collaborators, and communicators.
Another way in which technology has affected health professions education, said Siemens, is the advent of technology that can perform tasks better than humans. For example, it has been shown that artificial intelligence systems can more accurately and consistently diagnose the presence of cancerous tissue in a mammogram than a human being (Bahl et al., 2018). If this is the case, asked Siemens, why should universities be teaching students how to perform these types of tasks? It is ineffective to bring up to scale through humans what should be brought up to scale through technology or vice versa. Instead, technology can help free up humans to do what they
do best. For example, humans have the capacity for combinatorial creativity, focusing on collaboratively developing knowledge and understanding the implications of connections. Siemens said that his organization, along with Smart Sparrow and Arizona State University, are working together to change science instruction away from a model of learning facts toward a model of learning as a system of exploration, relationship building, and creativity. This type of approach, said Siemens, can help to break down the silos within science and health care, and to improve the ability to answer questions and solve problems by connecting people and knowledge from multiple disciplines and fields of thought.
Moving forward in this new world of online learning, personalized education, and interconnected and creative problem solving will require overcoming some challenges, said Siemens. First, educational institutions need to understand the diverse and complex student population, and what their needs, interests, and aptitudes are. Second, institutions need to provide scaffolded support for students, and design curricula in a way that supports learners in their individual journeys. Siemens noted that certain groups may be in particular need of assistance. For example, adding technology and digital learning to education may negatively affect students of lower socioeconomic status because they may not have access to or know how to use certain technologies, and they may lack access to a social network that can help them. Third, systematic integration among technology, education, and health care systems is needed in order to move forward in a meaningful and sustainable way. Fourth, said Siemens, there are the inevitable technological limitations. Particularly in a global context, many people lack access to technologies or fast Internet. However, Siemens said, “We should not lower our expectations of what is possible because there are some technology limitations.” To demonstrate this point, he gave an example of people who have been displaced and are living in refugee camps using social media and MOOCs to further their education.
TECHNOLOGY TO DIFFUSE KNOWLEDGE
Before speaking about using technology for knowledge diffusion, Casserly emphasized that the most important aspect of technology is that it is focused on the needs of the user. Whether the technology is used for education, knowledge diffusion, or health care practice, a user-centered design helps ensure the technology meets a need and gets adopted. Casserly noted that many devices and technologies are developed that only work effectively for a small percentage of the population. She specifically urged participants to think about the needs of populations in different parts of the world when developing new ideas.
Casserly said that knowledge has often been “recreated again and
again,” particularly in the pre-Internet era. Instead, Casserly said the focus should be on sharing information and building on knowledge that already exists: “If we share, we all gain.” There are limited time and resources, she said, and these should be spent distributing and teaching the knowledge rather than recreating content. In addition, resources and knowledge are often locked “behind walls”—there are fee structures and permissions required to access information, which creates barriers to learning rather than facilitating diffusion of ideas. A key goal of health professions education should be to promote innovation and collaboration—two things that cannot be accomplished when knowledge is “locked up.”
One way to share knowledge is through open educational resources and Casserly gave workshop participants an overview of this topic. Open resources, said Casserly, are content that have free and unfettered access, and free copyright permissions. This permits people to access, use, adapt, and redistribute content—including teaching, learning, and research materials—at no cost. Open resources can either be in the public domain or be available through an open license. Open licensing—such as Creative Commons—allows creators of content to share their work on their own terms, with attribution. For example, a creator may allow users to adapt the content and redistribute it, but may not allow commercial use. This type of licensing is available for both individuals and institutions and allows content to be translated and reproduced.
Casserly highlighted two platforms as exemplars for knowledge distribution. One is called EdCast, a Silicon Valley startup that focuses on facilitating peer-to-peer learning and personalized education. EdCast has designed its product to be accessible on mobile phones, since many people have smartphones but may not have access to a computer. Another platform is called Osmosis, which was created to spread health information around the globe. Osmosis offers open access to nearly 500 videos on various health topics, including schizophrenia, hepatitis, and tuberculosis. Health professionals around the world use these videos to supplement and inform their classroom learning.
Allowing open access to high-quality educational resources, said Casserly, encourages people to repurpose and reuse content to develop “creative and innovative solutions.” This type of innovation demonstrates the “power of the Web that we should all be harnessing.” Casserly concluded with a few principles of success regarding technology and knowledge diffusion. First, content should be free and open so resources can be used to innovate and collaborate, rather than to recreate content. Second, designs should be inclusive and user centered, considering the user’s situation, opportunities, and constraints. Third, technologies should harness the power of the community and encourage collaboration and peer-to-peer learning and sharing.
Preparing Faculty for New Roles
Drawing on both McKnight and Siemens’s comments about how integrating technology into education can result in a shifting of teachers’ and students’ roles, Loretta Nunez asked how faculty can learn the new roles and the new competencies that will be required. She noted that particularly in higher education, professors have traditionally been hired based on their content knowledge, which may not be as important under a new system. McKnight concurred, saying that the incentive structures in higher education reward content knowledge and research ability, rather than teaching skill. Shifting these incentives at an institutional as well as individual level will be necessary to ensure that faculty are prepared to inhabit their new roles. In K–12 schools, teachers are largely incentivized based on student test scores. While this is not a perfect measure, test scores do convey some evaluation of what a student has learned. Eventually, she said, professors should also be evaluated based on what students have learned and what they can do, but it is unclear how higher education will accomplish this. McKnight identified methods that could potentially help teachers learn how to educate based on evidence. For example, the science of e-learning looks at how people learn in a virtual environment. It could be applied along with dual channel learning theory—use of multiple senses for maximizing learning—to improve education and student engagement in the learning process.
George Thibault, a forum member and president of the Josiah Macy Jr. Foundation, said, “When we think about faculty development in this domain, we often think about teaching the faculty about the technology and how to use it.” However, he said, when technological innovations mean that the primary goal of faculty is no longer transmitting knowledge, faculty development can take an entirely different course. Faculty can focus on developing high-quality assessments and ensuring that learners are comprehending and developing new skills. Ruth Nemire added that in this new world, the “human values” are really what is going to be valued in faculty, including teaching, critical thinking, and problem solving.
Ensuring Competencies in Learner-Based Education
Patricia Hinton Walker, forum representative of the Uniformed Services University of the Health Sciences, asked McKnight how competencies and progression can be assessed in a learner-driven education model. McKnight responded that in order to assess competency, we need to understand exactly what mastery of the content looks like: What does the learner need to know and be able to do? Once this is understood, learning trajectories are
mapped out, with smaller competency markers along the way. She said that using this competency-based system means that instead of students passing or failing a specific grade level, students are assessed on whether they have mastered a specific content area (e.g., algebra), whether they do so in 4th grade or 10th grade. This system harkens back to the “one-room school house where every kid was learning their own content at their own pace.” Once a student has mastered the knowledge, skills, and abilities, they move on. The difficulty comes in defining these competencies and trajectories, said McKnight. In some content areas—math and reading—these competencies are well-defined, whereas in other parts of education like science and the arts, it is more of a challenge.
Economic Implications of Open Access
Hinton Walker asked panelists about the economic implications of open access. She noted that institutions must somehow generate money in order to pay faculty, and wondered how providing free access to content affects this reality. Siemens responded that he believes that curriculum should not be a value point. If a lecture can be recorded and shared digitally with thousands of people, the ease of duplication “eliminates the opportunity for economic resources to be generated.” Siemens reiterated his earlier point about using technology to let humans do what humans do best, and said that if content can be learned via free and open digital access to lectures—instead of lectures being viewed as income generation—it opens up the opportunity for classroom time to be used for engaging dialogue and discussion. MOOCs, such as the Massachusetts Institute of Technology’s open courses, have demonstrated that content does not have to be a value point for a university. Furthermore, Siemens believes that content that is developed using public funds should be free to access. It is “ludicrous” that public funds are used to create knowledge (e.g., taxpayer-funded research) that is then given to a journal and sold back to the public at a cost. Bringing a global perspective into the conversation, Siemens noted that most higher education institutions in the world do not use the same economic models that the United States and the United Kingdom use, and therefore do not face the same economic pressures to generate income from content.
Casserly agreed with Siemens that content should not be seen as a source of income, and said that platforms such as Osmosis use value-added services to pay for the cost of providing open access to content. For example, students can pay for a content deck that is personalized for the student’s needs and sent directly to their mobile phone. Casserly added that “the unique value proposition of higher education” is not content, but interaction, synergy, and collaboration. Making content freely available furthers these aims of education. The model of open access can also affect
the traditional model of “publish or perish” tenure decisions, said one workshop participant. Casserly responded that she has seen a recent shift in norms in academic institutions; institutions are beginning to recognize the “power of knowledge diffusion as part of their mission” and are changing incentive structures to allow faculty’s open access work to be considered as part of the promotion and tenure process. The economic model of the future for academic institutions, said Casserly, is in flux and will likely be quite different in the future. She said that institutions increasingly serve a wide variety of students, and serve students over the life of their careers, so the economic model may need to be more flexible and more differentiated than it is currently.
Brenda Zierler, a forum member representing the American Academy of Nursing, asked panel members about the use of crowdsourcing to develop and assess knowledge and create content. Siemens responded that in his opinion, crowdsourcing can play different roles in different settings. He said that creation of content and curriculum is best done with an expert-oriented approach, whereas crowdsourcing can be quite useful for solving problems. Siemens relayed his concerns about the “diminishment of the idea of expertise” in society, where “all opinions are equal and all opinions are valid.” While crowdsourcing is valuable, he said that it is not a solution to all problems, particularly knowledge creation. Casserly added that when expert-created content is made open, it provides the opportunity for other experts to build on the content—in effect, crowdsourcing by experts.
Christoph Pimmer, senior researcher and lecturer at the University of Applied Sciences and Arts in Northwestern Switzerland, relayed his experience in rural African communities (see Chapter 3) and said that the local health workers used crowdsourcing principles to solve patient-oriented problems, particularly complex cases, in that they consulted larger groups of colleagues by using mobile social media. By connecting health workers, this kind of crowdsourcing can work very well. However, he said, the results of crowdsourcing “can only be as good as the crowd being sourced.” There is a danger for misinformation and rumors to spread in this environment, so ensuring that participants are educated—and perhaps moderated by experienced professionals—is critical to success.
Bahl, M., R. Barzilay, A. B. Yedidia, N. J. Locascio, L. Yu, and C. D. Lehman. 2018. High-risk breast lesions: A machine learning model to predict pathologic upgrade and reduce unnecessary surgical excision. Radiology 286(3):810–818.
Inside Higher Ed. 2017. Faculty buy-in builds, bit by bit: Survey of faculty attitudes on technology. https://www.insidehighered.com/news/survey/faculty-buy-builds-bit-bit-survey-faculty-attitudes-technology (accessed April 12, 2018).
Jansen, D., and L. Konings. 2017. MOOC strategies of European institutions. Status report based on a mapping survey conducted in November 2016–February 2017. European Association of Distance Teaching Universities. Maastricht, the Netherlands.
McKnight, K., K. O’Malley, R. Ruzic, M. K. Horsley, J. J. Franey, and K. Bassett. 2016. Teaching in a digital age: How educators use technology to improve student learning. Journal of Research on Technology in Education 48(3):194–211.
OECD (Organisation for Economic Co-operation and Development). 2013. Education at a glance 2013. http://www.oecd.org/education/eag2013.htm (accessed March 5, 2018).