MOOCs in Health Professions Education: Hype or Hope?

MOOCs in Health Professions Education:Hype or Hope?Catherine R Lucey MDProfessor of MedicineVice Dean for EducationUCSF School of Medicine

Medbiquitous5/19/14#ConclusionsIn all change initiatives (including MOOCS), Hype is a necessary precursor to Hope: it creates interest and momentum that sustains innovation.In all disruptive innovations, disagreement and disillusionment is necessary to drive iteration and the identification of the best strategy.Enlightenment comes from experimentation in the midst of disillusionment and leads to the Plateau of ProductivityHealth professions educators are in the perfect position to serve as change leaders for the adoption of technology enhanced learning.#Technology in learning is here to stay. Our job is to figure out how to use it to truly enhance learning.Technology disruptions may stimulate improvement in non technology teaching. The belief that MOOCS will be an inexpensive replacement for institutions of higher education is hype.Health professions education may be the ideal place to experiment with new forms of technology enhanced learning.The education professions response to MOOCs can provide insights into necessary change management strategies.2Learning is a social endeavor3

Engage Inform Challenge Coach Motivate InspireTeachersEngage Inquire Inform Challenge Share InspireLearners#Universities are responsible for creating an environment in which learning occurs not just transmission of facts from teacher to student but actual learning students mastering the material, and using it to solve problems in their environs.

Whether working in a large lecture hall or a small lab, Teachers focused on learning engage their students, inform them of existing facts and paradigms, challenge them to use those facts and build on them, coach them to excellecne, motivate them to do better and inspire them to reach for the stars.

Similarly, learners in these ideal environments also engage with their teachers and with each other, asking questions, sharing knowledge, challenging their professors and each other and motivating all in the environment to do better.

No where is this more true than in medical education3Faculty have always embraced new technologies to help 4

#Since Socrates and the tree, faculty have always used tools and techniques to aid them in their role as guiders of learning. And those tools have evolved as technology has evolved witness the blackboard giving way to the powerpoint slide, audience response systems replacing raise your hands instructions and Ipads and other computers elminating the piles of paper that used to represent class handouts and syllabi.4And students have always been one step ahead in their adoption of tools5

#Students have been ahead of us, using or forcing us to use podcasting of lectures, watching videotapes on youtube uncurated or supervised by faculty, and even sharing their faculty members work on student orchestrated websites, like scholar locker.5AsynchronousSynchronousLow TechHigh TechKhan AcademyMOOCSMinervaSemi-synchronousUniversity based distance learningThe Spectrum of On Line Content Delivery

#MOOCS: A High Quality DisruptionRecruited Elite InstitutionsPlatform allowed for up to 100,000 usersSemisynchronousCourse constructed of short videos with quizzesScale allows Crowd Sourced TA roleComputer or Peer Reviewed Assignments

#The Push Back

#Questions We at UCSF AskedFeasibility: Can computer assisted instruction teach Clinical Problem Solving?Interest: Who would want to learn about a topic that would not lead to credit towards a degree?9

#When coursera approached UCSF in 2012 to ask us to participate, we saw this as an opportunity to move to the slope of enlightenment.We asked to questions:Can CAI be used to teach a topic that typically is taught in small groups andWould anyone be interested in taking a medical school course, without any promise for credit towards a degree.9

Module 1: How experts understand diseases and how to read like an expert to form disease based illness scripts.Module 2: How experts analyze their patient' problems: processing and the patient illness script.Module 3: Using disease and patient illness scripts to prioritize differential diagnostic possibilities into tiers of probabilityModule 4: Understanding how diagnostic tests can be appropriately used to improve diagnostic accuracy.Module 5: Diagnostic Mistakes: how they happen, how you can avoid them and how to find them once they occur.Module 6: How our clinical problem solving strategies can be used to write good test questions, perform well on tests, and teach others to do well too.#In January of 2013, we launched a six week course on coursera.Each week consisted of 4-5 15minute video modules designed specifically for web use10Adapted Blended Learning Principles to Facilitate Design of the CourseEstablish a Teaching Relationshippurpose driven reason for the courseeye contact with the viewerencouragement Design with Explicit Cognitive Strategiesskills, not content aloneshort videos, immediate quizzes with answerscliff hangers to keep people coming backprioritize graphics over textbegin and end the week with summariesSupport the development of Learning Communitiesshort answer homework with peer reviewchat rooms and office hoursGarrison, D. R., &Vaughan, N. (2008) Blended Learning in Higher Education: Framework, Principles, and Guidelines. San Francisco: Jossey-Bass #

DabblersExperimentersCompleters#13

#Almost 2/3rds of participants were college graduates or greaterMost took the course because it was relevant to their studies, work or career1/3 also stated that they were taking the course to see how others used on line tools or taught clinical problem solving

98% of those completing the course would recommend it to their peers13Student and Resident Testimonials

..this course taught me more about how to study than the three years Ive been spending in medical school.It has shaped the way I study and I cant wait to bring many of the lessons forward with me to clerkship next year.I took your course and thought it was fantastic. I was inspired to give my R3 talk on the subject#The testimonials were particularly rich.Students, residents from around the world stated that they found the course useful in their medical studies some more so than what they had been taught thus far14Faculty and Practitioner Testimonials15

was a transformative learning experience. As an educator in a clinical skills course, I thought this would be excellent for our students. Is there a way to make it available?I am working as a physician in Poland. The course changed my way of thinking in all day clinical practice. I am convinced patients and students will profit tremendously. I am a pulmonologist/internist working in the UK. The feedback I have been getting is as I expectedit has completely changed the way I look at clinical problems.#Similar praise came from faculty and practicing physicians who learned a different way to approach a common medical cognitive skills15Five challenges that Computer Assisted Instruction can help us meet16

#So, what conclusions have we drawn from the literature and our experience with this MOOC?

CAI is a tool that, when used by a skilled teacher in a manner compatible with the objectives that the professor is trying to achieve, can accomplish important goals. It is not a replacement for face to face experience but it can complement face to face experiences.

In comparing CAI with the elements of high quality teaching that Cooke, Irby and OBrien put forth in their outstanding book on medical education, here are five challegne that cai, in the form of MOOCS or elsewsie, can help us achieve.161. Create flexible educational paths Students can use web based instructional tools to take a different approach to their learning.

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#Computer modules, unlike professors, are available 24 hours a day, 7 days a week and can be repeated endlessly slowing up areas that are hard to master and speeding up through areas that are already known. Computer Assisted instruction may be very useful for the increasingly heterogeneous classes we admit- and for those students who might need some remedial attention. Rather than sending your student away, you might assign a MOOC for summer school172. Facilitate authentic workplace learning experiencesStudents can be freed up to engage in workplace learning experiences at different sites or during prime class time.Face to face activities can occur via computer or at the workplace.18

#The flexibility of computer administered lessons can shift formal presentations to times other than the middle of the workday. This allows students to participate in authentic workplace learning experiences. Similarly, small group activities can occur via the internet, perhaps with a local professors, thus freeing students from the burden of always traveling back to the mothership for group encounters.183. Enable inter-professional and international educationMitigates the academic schedule problemStudy groups can expand to includeEmployed professionalsProfessionals from different institutions or countries

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#The flexibility of web based courses can overcome the academic schedule problems that plague many interprofessional initiatives.With their broad reach around the world, MOOCs can provide a much more diverse learning community with whom the students can engage. If you dont have all medical professions represented at your institution; MOOCs can provide other professionals for learningeither from other schools or from the workplace. If you are interested in a global perspective on topics under discussion, MOOCS can provide a platform for bidirectional global learning in real time.194. Rapidly disseminate new advances to broad audiencesEmerging topics taught to this generation of students can be disseminated to current generation of practicing professionals, thus shortening the time from discovery to implementation in practice.Relationships with our graduates: Learners for Life20

#MOOCs constructed for one set of learners can easily be disseminated to others. The potential for rethinking continuing education by disseminating current lessons to alumni is strong. Similarly, if new content comes along that all professionals should know, it would be relatively simple to construct a MOOC and disseminate to all professionals in the comfort of their own home, rather than waiting for them to go to a continuing ed course.205. Demonstrate the quality & impact of excellent teachers beyond their institution. Promotion/Tenure requires dissemination, peer review and national/international impact. Educators whose work requires them to be at their home institution may be challenged to meet this requirement.Disseminating actual teaching may allow for broad based peer reviewPeer review of actual teaching will be enhanced and the field will continue to improve.21#Finally MOOCS can provide an avenue for dissemination of the actual products of teaching gifted educators can now demonstrate their ability to impact a national and international audience using their medium of choice, rather than the proxy of a static curriculum

Peer review can be outsourced to experts, thus serving to raise the quality of all teaching.21Five Challenges that Computer Assisted Instruction AloneWont Help Us Meet**

**AT THIS TIME22

#But MOOCs and other forms of Computer assisted instruction are not a panaceaHere are five challenges that cai wont help us meet221. Truly Individualized LearningFlexible learning paths are not individualized paths.True individualization requires faculty and learner interaction23

#Although MOOCs provide flexible options for students different paths for them to choose, they do not truly individualize learning. That would come from a trusted teacher who works with the student to analyze their strengths and suggest a different approach to learning.232. Foster Innovation and Inquiry 24Inquiry requires give and take exchange between learners and mentors.

#MOOCs are good at presenting introductory concepts (not simple) and frameworks for understanding. They dont allow the give and take between learned faculty and motivated students that is required for true innovation and inquiry.243. Facilitate Professional Identity FormationProfessional identity formation requires personal interactions between role models and learners, in authentic practice environments, with critical reflection.

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#MOOC instructors can be inspiring and can demonstrate what it looks like to be a good teacher. They cannot demonstrate what it means to be a great doctor that requires authentic workplace mentorship experiences.25

4. Decrease educational expenseExcellent computer assisted instruction is expensive. Faculty timeInstructional design timeProduction infrastructureTeaching Assistant supportPossible economies of scale???26#MOOCs will not decrease the expense of medical education or provide more revenue for struggling schools. A deep infrastructure is needed to produce these courses not only technology but also people who have a better understanding of web based design than do most university faculty.

It is possible that schools uniting around a common core can find ways to share computer assisted instruction tools and thus offset some costs through collaboration. This requires further exploration265. Increase Efficiency of LearningTime on task remains critical to success.Failure to incorporate time for CAI in blended learning environments is a common error.Student motivation is also critical27

#Finally, it is critically important to recognize that no study exists that supports the notion computer assisted instruction increases learning efficiency. Students still need dedicated time on task to master the material. Furthermore, it is essential that if MOOCs and other CAI are used in blended learning environments, time must be assigned for the students (whether they are faculty or students) to engage with the computer material. Finally, student motivation is paramount. 27

Health Professions Educators as the Explorers of the Slope of EnlightenmentStrong IncentivesExpert Learners Faculty ResiliencyCulture of continuous improvement and change

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It is 2030. What will the plateau of productivity look like?

#Use platforms , like MOOCs and Like29Online education is not an enemy of residential education but an inspiring and liberating ally.Susan Hockfield, PhD President, MIT#ConclusionsIn all change initiatives (including MOOCS), Hype is a necessary precursor to Hope: it creates interest and momentum that sustains innovation.In all disruptive innovations, disagreement and disillusionment is necessary to drive iteration and the identification of the best strategy.Enlightenment comes from experimentation in the midst of disillusionment and leads to the Plateau of ProductivityHealth professions educators are in the perfect position to serve as change leaders for the adoption of technology enhanced learning.#Technology in learning is here to stay. Our job is to figure out how to use it to truly enhance learning.Technology disruptions may stimulate improvement in non technology teaching. The belief that MOOCS will be an inexpensive replacement for institutions of higher education is hype.Health professions education may be the ideal place to experiment with new forms of technology enhanced learning.The education professions response to MOOCs can provide insights into necessary change management strategies.31