Thursday, February 07, 2013


MOOCs and Clinicals

This week I had one of those “duh” moments when I realized that I had been missing something basic.

The dean of the Health division -- which includes nursing -- and I took a field trip to a local health care provider to talk about working together to give nursing students some exposure to what goes on there.  These wouldn’t be full-fledged clinical placements -- we already have those -- but a sort of structured introduction to a part of the health care system that isn’t always top-of-mind for nursing students.  The meeting went well, and I think there’s potential for something good to happen.

In the course of the meeting, though, the dean and the director of the facility got to talking about the difference between the ways that they were taught when they went to school, and the way the health field actually works.  When they went through, they had “lectures” which taught “theory,” and “clinicals” that taught “practices.”  Students who were relatively good at one weren’t always good at the other, and the connections between the two weren’t always obvious.  

Now, largely due to technology, theory and practice are all mixed up, and students are better for it.  

We have increasingly and incredibly complex simulators in class, to create the clinical situations the professor wants, on cue.  To make time for those simulations in class, lectures have been largely displaced to out-of-class time, online.  By the time the students are loosed upon actual people, they’ve already had to bring theory to bear on situations repeatedly.  Even better, a student can make and learn from a harrowing medical mistake on a simulator without harming an actual person.  (Last year, apparently, some students made a dosage mistake with a simulator, and nearly “killed” the “patient.”  After that, those students got religion in a significant way.)   

In this model, MOOCs and their variants aren’t threats to our business model or our usefulness; they make us better.  They let us focus on where we can add the most value, and they pick up the part of instruction that was least custom.  

To the extent that we use online resources this way, I see our business model doing just fine.  MOOCs and similar expedients can pick up some of the most rote, least interesting elements of what we do, leaving us free to tend to the integrative, interactive, more applied stuff that often gets neglected.  Used well -- that is, integrated thoughtfully into a curriculum -- they can actually help students learn more effectively than they did in the older style.  

Nursing lends itself to this kind of blending particularly well, but I could see other disciplines doing something similar.  Let the online tool take the students through “Congress is divided into the House and the Senate,” and use class time to have students work on a constitution for a society on a desert island.  (I always enjoyed that one.)  Let the online tool illustrate the layout of the audience in the Globe theatre, and use class time to show how Shakespeare wrote for each section.  

The choice to be made is to re-imagine class time as a scarce resource.  Given new and alternative ways to “deliver” information, can class time be used to help students actually wrestle with the information and make it their own?

That should have been obvious -- a “duh” moment -- but it’s largely missing from the public discussion.  Can we use the new online tools to offload the least interesting parts of the classroom experience, precisely so we can upgrade the classroom experience?

I was told that the simulators actually will "die", flat line and all, in a very realistic fashion.

I like your analogy. Class time is valuable, if you are serious about it being only 1/3 of the time students spend on the class each week. What I have had to do is learn that putting them to work in class is not the same as having them do their homework in class.
Unfortunately, the ideas floating around aren't that MOOCs will be supplemental, or replace the rote parts. Instead, they are being looked at as low-cost alternatives to real instruction.
In this model, what are MOOCs providing that a textbook doesn't, except a different (and usually less convenient) multimedia format?
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I have yet to hear a reason why MOOCs are better at blended learning than regular online courses.
Isn't that the "flipped-classroom" idea? Video lectures at home on the students' own time, instructor spends class time working on applied aspects and problem solving.

I don't know if it is a fad or not, but some professors really seem to believe in it.
@ Anonymous 9:13:
Yes, MOOCs in this instance are replacing books. There are both upsides and downsides to this: upside is that students who resist reading for long stretches will watch video lectures (at least some of them will). Downside: less chance to "own" the material by having to work harder to access it and no ability to use the textbook for review in a time-efficient way (re-viewing a MOOC in its entirety in order to review a section that you're not sure happened at 20 minutes or 28 minutes). And, some students might take notes during a MOOC but many do not, so still a great need for in-class review and reinforcement. Books are much more useful in study-group situations Having said all that, Nursing is one program where this format can be really useful. Nursing students are above average in motivation, conscientiousness, ability to capture detail from the spoken word, etc.

One final advantage: MOOCs can be updated and revised more easily than textbooks can be.
What Stu said - some of us have done this for years, but now it's been given a name "flipped classroom" and getting lots more traction.
Sadly, this all relies upon the students to both read/view and process the material before we run class. Discussions can stall suddenly because nobody's gotten through the work due to a time crunch OR a key part became unavailable without warning, etc., etc.
Entirely unrelated to the post but in 8th grade my civics class did the "create your society/rules/bill of rights" on a remote island type of thing. We were a ruthless bunch of 13 year olds. Death penalty out the ying yang.

Although maybe it explains a lot about my graduating class...
I, too, was thinking that this *is* part of the public conversation, under the rubric of the "flipped" classroom.

Of course, those of us who have been teaching in "flipped" classrooms for some time (have students read literature outside the classroom; work together in a relatively small discussion-based class to arrive at possible interpretations during class) point out that students often aren't as good as we'd like at actually doing outside-of-class assignments (and, since this is at least partly a function of how many hours they work for pay to afford tuition, I assume this problem is at least as bad at a CC as it is at my state R2).

I'd guess that nursing is something of a special case in this regard, for several reasons: the stakes *are* high (witness those flatlining simulators), and for that reason, the program has a very real reason to be rigorous, and insist that the students accept said rigor; students are facing a licensing exam (another support for rigor); and the students (whether accurately or not) expect to be able to find decently-paid jobs fairly easily when they graduate. Somehow, even though employers care a great deal about good writing (in all its aspects, from sentence-level correctness and grace to structure to evidence), expecting the same level of out-of-class work, or imposing the same penalties for substandard work, is a bit harder in English classes (which, you know, are supposed to be easy, or at least to rely on subjective grading which is all about whether the instructor likes the students and hir opinions).

So, yes, a worthy idea, but not, perhaps all that new a one, and one needs to be careful about assuming that what is true in nursing (or, say, accounting -- another field with licensing exams) can be expanded to other fields, for a variety of reasons.
When I introduced this style of learning into my course, the student's first reaction was that I was not doing my job (being the sage on the stage) and that I was expecting them to do all the work. "We shouldn't have to teach ourselves and teach eachother," was the basic attitude.

We went back to lectures for the most part and only used in class assignments at the end of large sections. I wish I could have found a way for them to take more responsiblity for their own learning - or could have presented this in a way that didn't make them feel like I was refusing to "work". Creating in-class exercises to meet all of our learning objectives was no picnic but they didn't see that.
@ Anon 1:49

To present a course in this style has only worked for me in small groups of students.

I have some students complain that I do not "set homework", that I "do not mark all assigments", that I do not "go over" the quiz questions. The sage on stage avoids this type of situation.

Sometimes the reason why students do not do this work is because they have mild forms of learning difficulties and in my environment there is very little support for this situation so they linger on until the gpa becomes sufficiently low.

The online mini lectures and videos are beneficial mainly to those students who would learn well from a book otherwise.
The good part about this post is that it shows that the real thinking about how to do a good job at Community Colleging is to avoid thinking about ending tenure or Baumol's Cost Disease at any time.

Anonymous@5:50AM writes:
"but many do not, so still a great need for in-class review and reinforcement."
and others make the same point about students failing to do required homework.

That is what I meant about whether we are serious about 2/3 of their time "in" class being done outside of the class ROOM. (The ratio increases to 8/9 if you have a hybrid class that only meets f2f once each week.) There have to be consequences, sometimes enforced with a start-of-class quiz, but the consequence can't be that you go back to lecturing (or do their homework during class, etc).

There is more time for learning to apply what would be "given" (and bounce off) during lecture if they come to class prepared.

My view about video lectures and textbooks is that using a video lecture might change your choice of textbook. Some of the more verbose textbooks read like a good lecture turned into a bad one by excessive additions and emendations. What textbooks do really badly are examples. You can't see the drawing being made or the equation being developed.

With video, your text choice might be more like a reference book.
PS - Hope MR aka DD is out having fun in a half meter of snow! I still fondly remember a few storms like what you got this week.

PPS - It fascinates me to notice which topics generate a much larger response here than on IHE, and vice versa.
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