Online Education Technology: What We Have, What We Need

By Rick E. Sevier, CPed, ROPA

Traditionally, healthcare workers receive their education while sitting in a classroom. In the 1999-2000 school year, about 43 percent of students enrolled in post secondary programs were non-traditional students 24 years old or older. A total of 82 percent of these students held jobs while attending college.

In general, non-traditional students make up roughly one-third of the undergraduate population. The majority of non-traditional students have a family and a lifestyle to support. Using time in a family/work-friendly and efficient way is very important to these individuals. Distance learning is a tool that fits this criterion.

How can distance learning be most successfully utilized in allied healthcare education to best serve these nontraditional students' needs? This is the basis of the following exploration into distance learning. The purpose of this article is to allow the reader to gain insight and understanding of the current technologies used in distance learning and how these can be incorporated to provide a truly useable, cost-effective learning opportunity.

Review of Current Computer-Based Technology

Several technologies are used in distance learning today. They include CD-ROM, web-based training, PC chat, desktop video conferencing, classroom video conferencing, and web-based synchronous systems. These technologies fall into one of two different categories: "asynchronous learning" and "synchronous learning."

Asynchronous learning is defined as "any learning event where interaction is delayed over time." This allows learners to participate according to their schedule, and be geographically separate from the instructor.

CD-ROM based distance learning tools are asynchronous in nature. This technology is traditionally non-interactive and provides no student-instructor interaction. CD-ROM based distance learning technology is a good add-on for the web-based training technology, which we will be discussing next, but is not very effective as a standalone technology.

Web-based training technology is also asynchronous in character, but may incorporate a basic synchronous component, such as PC chat. This technology is also non-interactive and provides no student-to-instructor or student-to-student interaction. The exception to this is a text-based PC chat which provides a primitive level of interaction within the learning group. This technology is a very popular solution as a class enhancement in many universities. This technology is considered to be a good model, but as we will see next, synchronous learning has many more advantages.

Synchronous learning is defined as "any learning event where interaction happens simultaneously in real time." This requires that learners attend class at its scheduled time. It commonly includes multimedia components and provides for interactivity as well as effective student assessment.

PC chat generally refers to real-time, text-based discussions between two or more individuals linked via the Internet. As you type, everything you type is displayed to the rest of the chat group. Some applications provide for private communications between individuals, and most applications provide for a group chat where everyone sees everything. Some chat applications now feature voice chat. The advantages of PC chat are that it is readily available, inexpensive, and an interface commonly used by people who use the Internet.

Desktop video conferencing is an application on a personal computer equipped with a fast Internet connection, a microphone, and a video camera. This application allows two-way or multiway video and audio, depending upon the hardware and software of the members. One advantage is that the interface is another that is commonly used by people who use the Internet.

Classroom video conferencing technology allows two or more people at different locations to see and hear each other at the same time. Classroom video conferencing technology requires expensive audiovisual equipment in the form of monitors, cameras, microphones, and speakers. It also requires a means to transmit data between sites. This technology does allow for greater student-to-instructor and student-to-student interaction. A downside to this technology is that the student is once again required to take time to travel to a remote-access class site.

Web-based synchronous technology is a distance learning system based solely upon the Internet. It differs from desktop video conferencing in that it incorporates multimedia and is managed similarly to classroom video conferencing. It uses an existing and comfortable interface of the standard web browser. The student can participate from the comfort of his or her own home or place of business. Setup is inexpensive at less than $30 for each student. Most will already have the appropriate equipment to participate. This technology provides the best mix of all technologies at an affordable price.

The Problem

There is a need for a cost-effective, easy-to-use and easily implemented distance learning system that is tailored to the needs of the healthcare education system. This system would need to be secure, allow for a mix of technologies, be low maintenance, and provide for interactive assessment. The system would need to turn the standard web browser into a tool for healthcare communication and collaboration. It would need to merge communication with data access. Finally, it would need to provide remote tools for display and manipulation.

One Possible Solution

First, there needs to be a standard model to serve as a foundation. Advanced Distributed Learning, also known as the ADL initiative, originally established by the US Department of Defense, is now in collaboration between government, industry, and educational institutions. The purpose of the ADL initiative is to ensure access to high-quality education and training materials that can be tailored to individual learner needs and made available whenever and wherever they are required.

ADL uses the SCORM standards model. SCORM (Sharable Content Object Resource Model) defines a web-based learning content aggregation model and runtime environment for learning objects and references interrelated technical specifications to bring together diverse and disparate learning content and products to ensure reusability, accessibility, durability, and interoperability.

Web-based synchronous technology would provide a suitable and efficient framework for a healthcare distance learning system solution. Its major advantage is that it would be based upon infrastructure already in place. This would allow for ease of implementation and maintenance. The web browser would be a familiar interface and would create a reduced learning curve for students and instructors alike.

Web-based synchronous technology would allow for the mix of multimedia and technology required to appropriately explore healthcare-related objects. It would allow the use of cost-effective development tools such as Java, Flash, and HTML. It would also facilitate the use of existing computer applications by integrating them into the interface. It would allow for interactive assessment by instructors in a live environment. It would also allow students to interact with other students in a schedule-friendly environment. Finally, web-based synchronous technology would provide the security needed for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) confidentiality requirements when dealing with patient matters.

Asynchronous and synchronous virtual labs could be integrated into the system. These virtual labs would be developed in Macromedia Flash®. Several virtual chemistry Labs have already been developed. Oklahoma State University-Okmulgee has developed a Foot Anatomy CD that is entirely based upon Macromedia Flash® technology. The Macromedia Flash development language was designed for integration into the Internet. It is an object-oriented language that would facilitate integration with a new entity - Healthcare Learning Objects.

Healthcare Learning Objects would be based upon the concept of Learning Objects. According to the National Learning Infrastructure Initiative website ( www.educause.edu/nlii), Learning Objects are defined as: "...digital resources, modular in nature, that are used to support learning. They include, but are not limited to, simulations, electronic calculators, animations, tutorials, text entries, websites, bibliographies, audio and video clips, quizzes, photographs, illustrations, diagrams, graphs, maps, charts, and assessments. They vary in size, scope, and level of granularity, ranging from a small chunk of instruction to a series of resources combined to provide a more complex learning experience."

Thus Healthcare Learning Objects would consist of Terminology Objects, Diagnostic Imaging Objects, Pathology Objects, Drug Data Objects, Treatment Objects and Patient Case Study Objects.

The Terminology Objects database would be less of a dictionary definition, and more of an encyclopedic database. Each object would be cross-referenced to related objects via the use of hyperlinks. The entire database would contain all common healthcare terminology. In essence, it would be a very intelligent medical dictionary. The contents of the database would be stored in HTML format, so as to accommodate access and linkage from any web-based system.

Likewise, Diagnostic Imaging Objects database would contain images from CAT, MRI, X-ray, ultrasound and endoscopic procedures. These would be stored and accessed as streaming video files. This would allow virtual labs to integrate simulated real-time procedural graphics into their content.

The Pathology Objects database could consist of pathological data and images and be cross-referenced to a treatment and drug database.

The Treatment Objects database would contain data and streaming video of surgical and non-surgical treatments. These treatments could span from simple exercises to surgical procedures. This too could be integrated into the virtual labs.

The Drug Objects database would contain standard drug data in HTML "drug data cards" that would serve as a reference to the rest of the system. A deal could more than likely be struck with drug manufacturers to keep this portion of the database updated. This could also serve as a partial financial support system for the system as a whole.

Finally, Patient Case Study Objects would contain actual patient case studies. It would become the driving data for the virtual lab. Each case would contain links to appropriate Terminology Objects, Diagnostic Imaging Objects, Pathology Objects, Drug Data Objects, and Treatment Objects. Student assessment would be centered on an actual case in these virtual labs. As a student chose a course of diagnostics and treatments, the patient would either respond favorably or not. This would give the student a feel for real-world consequences to action or inaction.

All of these Healthcare Learning Objects would reside in a central database to be accessed by the healthcare distance learning system and used in the appropriate venue. The thought behind this is to reduce the redundancy of information and centralize its use and storage.

We Can Do This Now

The technology exists today to create a distance learning system for healthcare education using existing technology infrastructure, development tools and instructional modalities. The system could be created and implemented cost-effectively, possibly with financial assistance from pharmaceutical companies.

Much of the information that is needed for the databases already exists. Many institutions have gathered similar information for years. If all of this information were pooled into a central resource, the amount of potential knowledge would be astounding. With the right interface, the data could be categorized and turned into a truly powerful learning tool.

As our society in general moves towards a goal of "standardization" in everything from electronics to personal information, it is our task to standardize the way we educate our future healthcare workers. The use of web-based distance learning achieves this standardization. The Internet has become as big a part of everyday life as our cell phones. The interface is user-friendly and non-intimidating. The Internet is THE standard choice for any future healthcare distance learning system.

By pooling the vast knowledge and resources of the best healthcare system in the world, we can rest assured that we will not only have the tools needed to train the next generation of healthcare workers, but that the training will be accessible to all individuals, regardless of their traditional or non-traditional status. This should logically promote more individuals from the nontraditional pool to consider pursuing healthcare careers because of the sheer convenience of the education.

We owe it to ourselves as insurance of our own futures to provide user- and worker-friendly modes of healthcare education to tomorrow's healthcare workers.

Rick E. Sevier, CPed, ROPA, worked as a licensed college instructor for nearly seven years and has worked with computer graphic applications for over 20 years. He is currently finishing his last semester for a bachelor of science degree in technical education at Oklahoma State University. He serves as lead developer and instructor for Pedorthics Education Technologies Ltd. (PET). Contact him via e-mail: rsevier@sbcglobal.net  

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