Alternatives to Traditional Classrooms
ABSTRACT. The Internet is one of a number of alternatives to full-time attendance in traditional education programs for midcareer professionals seeking information about occupational safety and health (OSH) for immediate use or in pursuit of an advanced degree. Distance education and distance training are examples of means of instructional delivery that afford the learner the opportunity to engage in learning experiences away from the traditional classroom. They are planned and structured means of learning that use electronic technology-based media including audio, print, video, and the Internet, alone or in combination. Limited but impressive data on the popularity and effectiveness of distance education in preparing physicians for occupational medicine board certification examinations point to its potential as a means of facilitating education and certification of the many practicing OSH personnel without formal specialty training in the area. The committee concludes that, although traditional approaches remain indispensable for some types of instruction, the National Institute for Occupational Safety and Health (NIOSH) should develop incentives to promote the use of distance education and other nontraditional approaches to OSH education and training. An essential part of these innovative programs should be thorough evaluation of both the program content and the performance of their graduates in relation to the performance of graduates of traditional programs in job placement and on measures like certification examinations.
As noted in Chapters 2 and 7, doctors and nurses often discover occupational medicine and occupational health nursing only after graduation and experience in another field. Occupational safety professionals may also discover the field only after considerable experience in another job,
very often in a high-risk industry. In all of these cases, return to school for formal education as a full-time student is generally not a feasible option. Innovations like “executive” master’s degree programs that pack course work into a series of all-day weekend meetings have been one response. The On-the-Job Off Campus Program at the University of Michigan is one example of this approach to training working professionals. Students attend classes at the University for four days once per month for 22 months. Other concentrated programs, like the North Carolina Education and Research Center’s Winter and Summer Institutes, offer industrial hygiene technician and safety technician certificates for completion of six 1-week or half-week courses over a 3-year period. For people who are responsible for health and safety as an ancillary duty or who are contemplating a career change this may be a more appealing alternative than pursuing a degree or CIH/CSP certification.
The Internet offers another approach to the information needs of OSH personnel, and employers as well as those of workers. Both NIOSH and the Occupational Safety and Health Administration (OSHA) have been working hard to take advantage of the Internet’s vast potential for providing ready access to information, data, and tools for improving occupational safety and health. The OSHA website (www.osha.gov) has thousands of pages of regulations, publications, and other documents online, including the latest versions and updates of all health and safety standards. A huge advantage of accessing this information via the Internet is that ever more powerful and user-friendly search engines can be used to rapidly pull out all the documents of interest. An “expert adviser” is interactive diagnostic software that asks the user a series of questions and follow-up questions to determine whether, how, and which specific parts of an OSHA standard apply to the user’s activities. On the basis of the answers that the user gives, the adviser determines what information the user needs to know about the standard’s application to the user’s activities. The NIOSH website (www.cdc.gov/niosh) is also packed with useful information for the busy OSH professional. Searchable publications and databases such as the Pocket Guide to Chemical Hazards (National Institute of Occupational Safety and Health, 1997b) and the Manual of Analytical Methods (Cassinelli and O’Connor, 1994) are supplemented by Health Hazard Evaluations, notices of upcoming meetings and conferences, descriptions of research and training grant programs, and links to a myriad of other websites. Listservers such as the Duke University Occupational Environmental Medicine Mail List Health (http://gilligan.mc.duke.edu/oem/occ-env-.htm) can be used to query hundreds of other subscribers on their experience with any aspect of OSH.
Another alternative to traditional classrooms is distance learning or distance education. Distance education and distance learning modalities
offer flexibility for reaching individuals beyond the traditional classroom and campus or large corporate training programs, and many organizations, public and private, have already begun to incorporate computer technology into worker training. Distance learning is used at many education levels, ranging from workplace training for specific preventive measures related to a hazardous substance to certificate, associate, baccalaureate, and graduate degree programs and continuing professional education. Technology-based education is expanding rapidly, with the expansion spurred by both the job needs and higher education institutions’ efforts to meet the needs of a changing workforce and student population. Distance learning programs in higher education programs initially focused on part-time students and nontraditional students located at a distance from the campus. These programs are now expanding and are being integrated into more traditional campus-based programs (National Center for Education Statistics, 1997).
Many state education systems have active distance education programs, including the states of Maine, Colorado, and Kansas. The governors of 15 states are developing a “virtual university” that will have no physical campus but will use computers and interactive video to provide instruction (National Center for Education Statistics, 1997). The Western Interstate Commission for Higher Education has developed a cooperative arrangement for educational telecommunications that has 12 participating institutions, including Pennsylvania State University, Ohio State University, and the Universities of Iowa, Minnesota, Wisconsin, and Illinois (National Center for Educational Statistics, 1997). The National Institute of Environmental Health Sciences (NIEHS) held a workshop in April 1999 to assess the potential use of “advanced training technologies” for hazardous substance training. The ensuing report (National Institute of Environmental Health Sciences, 1999) included a comprehensive analysis of existing and emerging technologies and concluded that NIEHS’s call for fiscal year 2000 hazardous materials training grants should include encouragement of applications for programs that pilot the use of advanced training technologies.
With the need for expanded training of workers in OSH, many of whom work in small establishments, and the need for professionals at every level, increased use of distance learning can help fill many of the currently unmet education and training needs. Distance learning is explored here as a potential means of facilitating lifelong learning by OSH professionals and more specifically as an alternative to traditional graduate training in occupational medicine and occupational health nursing, two professions with large numbers of practitioners without formal specialty training in the area.
DISTANCE EDUCATION MODALITIES
A number of different technologies, alone or in combination with other modalities, can provide distance education. The oldest form of distance learning is the correspondence course. The following are current technology-based delivery media:
Virtual training is used to enhance and support real-world training. It replicates real-life situations by appearing lifelike and three-dimensional, but it trains the learner without risking potential dangers. A well-known example is the aircraft simulator, which is routinely used to train pilots in emergency procedures. High-voltage training simulators, mining simulators, vehicle simulators, and medical laboratory simulators are used to train individuals safely, allowing for errors, eliminating casualties and saving revenue by avoiding destruction of property.
Internet video conferencing allows the transmission of digital voice and video through the Internet. The strengths of this medium include its convenience, high degree of accessibility, economy, and interactivity. Participants have the ability to receive video conferencing broadcasts at their desktop computers and also have the ability to communicate synchronously. It does require student participation at specific times, however.
CD ROM is an advanced upgrade of the audio compact disc (CD). It stores computer-readable programs, images, and digital audio data. CD ROMs have large storage capacities, are fast, and if properly handled, will last indefinitely. Students can use them at their own convenience. Their shortcomings include an inability to erase, modify, and update the information on the disk.
Interactive videodiscs (IVD) is the CD laser version of the earlier 16-and 35-mm training films. IVDs include features of CD technology such as long life and high data storage capacity. IVDs can store as much as 54,000 frames on each side of the disc and each frame may be viewed individually or in forward motion and reverse. They share the same strengths and weaknesses as CDs.
Teleconferencing describes the interaction between instructors and learners. Teleconferencing includes audio, audiographics, video, and computer interaction. Audioconferencing connects participants through telephone calls and is relatively inexpensive. Audiographics adds a visual component (via fax or copier) to support instruction. Videoconferencing transmits voices and images through telephone lines and allows an immediate synchronous interaction between all participants. Computer conferencing connects through computer networks. Instructors and learners interact, primarily through electronic mail, and their interaction can be
synchronous or asynchronous. Like Internet videoconferencing, the methods demand student attention at specific times.
Computer managed instruction (CMI) allows the learner to gradually work through training modules. On the basis of their performance and skill mastery, learners can move forward or backward through the training module. CMI instruction is self-paced for optimal understanding and does not require travel or absence from work (Stephens, 1999).
DISTANCE EDUCATION AND WORKFORCE RELATIONSHIPS: POTENTIAL BENEFITS AND COSTS
Distance education expands the ability to offer education toward a certificate or degree, continuing education, and work site education and to expand the pool of professionals and on-site employees and employers in OSH. The different techniques provide individuals with the flexibility, depending on the modality, to learn at the work site, at home, or in local community facilities at specially established network sites. Distance learning modalities have and can be used in degree programs like the Master’s in Public Health offered by institutions such as the Universities of Wisconsin and Kansas or to provide specific instruction like that being developed by NIEHS in the handling of hazardous materials and the United Auto Workers’ demonstration of the online Right to Know computer network or refresher and continuing education training (National Institute of Environmental Health Sciences, 1999).
The OSH workforce, on average, is technically-adept, well-educated, and has a low unemployment rate. In many respects, OSH professionals are typical, or even ideal, “adult learners.” The adult learner views education as a mechanism that can be used to reach specific career goals that can include specific skill enhancement, continuing education, and degree and advanced degree education. Most adult learners are employed full-or part-time, have family responsibilities, and cannot readily participate in traditional classroom-based education. With the flexibility of the training capabilities and sites of training, distance education can significantly build the skills of employees, managers, and students at various academic levels. Health professionals can also participate in continuing education in almost any environment (Stephens, 1999).
Distance education requires careful planning and matching of the education and student requirements with the different modalities. For example, if part of the training requires hands-on exercises or preceptorships with a mentor, the distance learning can fulfill only part of the teaching needs and augmentation will be needed to either bring the students to mentors or mentors to the students. Curricula need to be carefully designed for the particular modality, evaluated, and modified. With
methods like videoconferencing and teleconferencing, faculty usually require some training to use the medium effectively.
Distance leaning alone cannot always substitute for traditional classroom or onsite hands-on experiences. Many distance learning programs are augmented by periodic meetings of students and faculty mentors to encourage interpersonal interaction and dialogue. For certain skill training, including industrial hygiene analytic techniques and patient care in medicine and nursing, hands-on work in the presence of faculty or preceptors is still required. For some students and trainees, particularly younger students, interaction with other students and faculty on the campus or at the work site remains important.
Determination of the costs of distance learning and who should bear the costs is often difficult and confusing, primarily because of the complexity of the technology. It is necessary to distinguish among technologies with costs that vary widely between one-way and two-way technologies. With one-way technologies, consideration needs to be given to the additional costs of tutorial support, in contrast to two-way technologies, for which the tutorial costs are factored into the base cost. Costs will vary with the student numbers and with the need to develop new course materials or adapt or adopt existing ones.
The initial capital costs of the technologies also vary. For example, if computers are available to all students the costs will be quite different than if computers need to be purchased or upgraded. There are substantial costs of installing telecommunications lines and video equipment. Certain costs are one-time capital investments or fixed costs like developing the education materials and courses. Other costs like faculty time for teaching and mentoring, grading examinations and papers, and evaluating the content and outcomes of the course, telephone costs, and costs maintenance of equipment are ongoing, and again the unit cost will vary with the number of students and whether some costs are no longer incurred with the new education or training technique. For example, if distance learning reduces the number of faculty previously needed to teach students in different locations or times of day, these savings will offset some of the costs of the new teaching modality.
Cost efficiency is related to program goals, objectives, and outcomes and how they are matched with the most appropriate technology. These technologies, as will be seen in some of the examples that follow, take advantage of economies of scale. Without careful planning, however, costs can become inefficient. Because distance education can be developed to meet very specific criteria and “one size will not and does not fit all” there is no standard pricing. Choices of media include CD-ROM, virtual reality, teleconferencing, World Wide Web-based courses, and satellite broadcast, with the initial and ongoing costs varying with the media selected.
Compared to traditional face-to-face modes of instruction in the classroom, distance education has potential cost-savings advantages including the indirect costs incurred by students in travel, travel time, lost wages, and so forth. Although there may be high initial costs in establishing distance learning infrastructures, the long-range cost savings of open learning (no qualifying academic requirements) may be attractive alternatives for companies. For example, a traditional face-to-face training course with 1,000 participants that met for 2 days at a conference center can cost considerably more than the same conference deployed electronically and with less productivity loss.
Costs can also be affected by such things as shared networks or courses, where multiple institutions collaborate on joint educational and training activities and either use existing sites for the distance learning or establish decentralized education networks as in the case of the Kansas universities discussed later or the virtual universities referred to earlier. Infrastructure costs are substantially reduced with broad-based cross-institutional collaboration (Stephens, 1999).
Described below are examples of education and training programs delivered by distance education methods. These programs are using a variety of technologies shaped by the audiences they are trying to reach and other factors.
The University of Kansas
The School of Nursing at the University of Kansas (KU) has been a pioneer in developing distance learning master’s-level programs. There are two types of programs: one that is entirely KU based and another that is collaboration with other nursing programs across the state.
Using KU’s Virtual Classroom, the School of Nursing is bringing the classroom to students’ homes. The term virtual classroom describes an Internet website on the KU computer network. This website houses courses for Schools of Nursing, Medicine, Allied Health, Pharmacy, Graduate Studies, and Continuing Education. A virtual classroom does not require a student to have a physical presence in a traditional classroom. Students can then choose when, where, and how to learn within a prescribed set of criteria. The School of Nursing has the following programs available through the virtual classroom:
A Master of Science in nursing with a major in family nurse practitioner or adult/geriatric nurse practitioner for Bachelor of Science in Nurs-
ing-prepared nurses who have already completed certificate programs in these fields. The courses are offered entirely on the World Wide Web.
A Master of Science in nursing with a major in family nurse practitioner at sites in Kansas City and Garden City, Kansas. This program is geared for nurses not currently prepared as nurse practitioners. Because this program combines World Wide Web-based courses and interactive television, some classroom work is required in one of the cities mentioned above.
The School of Nursing has also developed master’s level nurse practitioner programs with other nursing schools in the state including Pittsburg State University, Fort Hays State University, and Wichita State University. There is a single faculty with faculty members based at the different institutions and courses presented through teleconferencing, mainly from the KU campus. Students take courses through the televideo at their home campus, and the clinical clerkship requirements are met locally.
The same philosophy underpinned the joint Master of Public Health program that is a collaborative program between the University of Kansas Medical School and the College of Health Professions at Wichita State University. An off-site campus for the convenience of state personnel was established in Topeka. Faculty from both universities teach courses on all campuses by televideo, with KU specializing in epidemiology and biostatistics and Wichita State specializing in social and behavioral science and administration. The two universitites are planning an expansion of the joint program to provide access to certificate-level courses statewide for public health personnel who have no formal training using distance learning.
The KU Medical School has developed network education sites in six locations in Kansas. These sites are equipped with computers and televideo capacity and compressed video. Combined with the efforts of the Area Health Education Centers, these sites are designed to provide distance education for numerous health professionals who either are taking clinical preceptorships in the area or want to enroll in continuing education or in degree and certificate programs. A master’s-level occupational therapy program in collaboration with Pittsburg State University is currently offered at one site. (For more information, see the program description at http://www2.kumc.edu/son/prospective.htm.)
Medical College of Wisconsin
The Medical College of Wisconsin (MCW) provides nationwide access to a distance education Master of Public Health program for physi-
cians. The mission of the program is to provide didactic courses that may be adjunct to clinical training programs and that may partially satisfy prerequisites for board certification in preventive medical specialties including OSH. Occupational health students were first accepted in 1986, with the Master of Public Health program accredited in 1991. The entire curriculum is based on distance learning using computer technology. Each course has a set of goals and objectives, an introduction to each module, required and supplemental reading lists, activity assignments, computer quizzes, and report forms for activity assignments. A final examination is administered by a local (to the student) proctor at one of the 600 local institutions with which MCW has contracted. There is an 8-hour on-campus orientation on the mechanics of the program; the only other time that students are required on the campus is for the graduation ceremony. The completion of 10 courses is required for the degree. The courses are intended to be 4 months in length, and are generally taken one at a time. The program is self-paced, and although at least one student has graduated in a year, the average time to graduation is 4.5 years. As of June 1999 there were 347 graduates of the program, and 250 students were currently taking a course. As noted in Chapter 7, MCW graduates have an exceptionally high rate of passing the occupational medicine certification examination (“boards”) of the American College of Preventive Medicine (For more information, see http://instruct.mcw.edu/prevmed/).
University of North Carolina at Chapel Hill
The University of North Carolina School of Public Health at Chapel Hill has a Master of Public Health Leadership degree program that aims to provide access to higher education for professionals and health-related organizations via the Internet and Internet-based conferencing. The project uses cohorts of students to eliminate the lone student approach. Most courses are taught by using a combination of videoconferencing and World Wide Web-based instruction. Groups of learners gather each Thursday evening at seven sites in North Carolina for two-way interactive videoconferences with professors and students at other sites. Professors give lectures and lead group discussions within and across the sites. Students also receive readings and lectures over the web and interact with the professors and other students by electronic mail and computer-based discussion forums. The School of Public Health also offers a master’s degree (MPH) in public health nursing with a concentration in occupational health nursing. Beginning in August 1999, the program has included a distance learning option that is Internet-based and requires only 2.5 weeks of campus coursework each year (The program can be com-
pleted in 2 years, but students are allowed up to 5 years). (For more information, see http://cdlhc.sph.unc.edu/phl).
The National Technological University
The National Technological University (NTU) is a consortium of institutions that share courses and that offer a large variety of degrees. Courses are delivered directly to the work site (coupled with the ability for recording of broadcasts for student viewing at home). NTU students are employees of organizations that have installed equipment that receives signals from the NTU satellite. The downlink equipment allows employees to access NTU’s course offerings via satellite.
By means of instructional television, engineers, scientists, and managers at their job sites can tune in to technical and managerial courses offered by top faculty and experts at the nation’s leading engineering schools and other organizations selected for their expertise. More than 500 academic courses are offered. NTU offers 14 master’s degree programs designed specifically for technical professionals (see http://www.ntu.edu).
There are numerous additional examples such as the associate degree program in occupational health and safety at Trinidad State Junior College that has recruited workers who have been injured on the job and return to their industries as OSH workers. The U.S. Army Corps of Engineers has developed an 8-hour World Wide Web-based hazardous waste operations and emergency response refresher training program. Tulane University School of Public Health has announced plans for a new Internet-based Masters in Public Health degree program in Occupational Health that is designed for physicians, nurses and other health professionals who work in occupational health programs or clinics. The two-year, part-time program will provide the academic year required for board certification in preventive medicine/occupational medicine. The course content in this real-time interactive program will be the same as the oncampus program, but students will attend class over the Internet by logging onto the course website and receiving an audio broadcast from the instructor, delivered through a combination of pre-recorded lectures and live instructor-led class sessions.
EDUCATION OUTLOOK FOR OCCUPATIONAL SAFETY AND HEALTH
Distance learning technologies have the capability of meeting the educational needs at all levels for the field of OSH. From short training modules at the workplace or home to full graduate degree programs, the distance learning technologies can be used alone or in tandem. The advantages of distance learning include the flexibility of the sites of learning, the ability to draw on expertise from multiple institutions to tailor the education content to the need, the ability to use multiple modalities to reinforce traditional classroom-type activities, economies of scale, and replicability. Disadvantages include infrastructure costs for techniques such as teleconferencing, absence of hands-on skill instruction, potential isolation of students, faculty resistance and the need to train faculty to use distance learning modalities, lack of capability for informal “corridor consultation,” and potential high direct costs depending on the technology used and the number of students enrolled.
With the dramatic changes that have occurred and that will occur in the workplace and in the composition of the workforce, flexible new methods of training workers and professionals in occupational health and safety need to be considered for all environments. Distance education techniques can be used not only to transmit discrete modules on specific toxic substances but also to provide access to degree programs and ongoing continuing education for busy OSH professionals. The learning can take place in the home, at the work site, at local community sites, or on college and university campuses.
The committee concludes that although traditional approaches remain indispensable for some types of instruction, NIOSH should develop incentives to promote the use of distance education and other non-traditional approaches to OSH education and training. An indispensable part of these innovative programs should be the thorough evaluation of both the program content and the performance of their graduates in relation to the performance of graduates of traditional programs in such areas as credentialing examinations and job placement.