MOOCs in Health Professions Education Hype or Hope

MOOCs in Health Professions Education: Hype or Hope? Catherine R Lucey MD Professor of Medicine Vice Dean for Education UCSF School of Medicine Medbiquitous 5/19/14 1

Conclusions In 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 Productivity Health professions educators are in the perfect position to serve as change leaders for the adoption of technology enhanced learning. 2

Learning is a social endeavor Teachers Engage Inform Challenge Coach Motivate Inspire Learners Engage Inquire Inform Challenge Share Inspire 3 3

Faculty have always embraced new technologies to help 4 4

And students have always been one step ahead in their adoption of tools 5 5

The Spectrum of On Line Content Delivery High Tec h Khan Academy MOOCS Minerva University based distance learning Low Tec h Asynchronous Semi-synchronous Synchronous 6

MOOCS: A High Quality Disruption • Recruited Elite Institutions • Platform allowed for up to 100, 000 users • Semisynchronous • Course constructed of short videos with quizzes • Scale allows Crowd Sourced TA role • Computer or Peer Reviewed Assignments 7

The Push Back 8

Questions We at UCSF Asked 1. Feasibility: Can computer assisted instruction teach Clinical Problem Solving? 2. Interest: Who would want to learn about a topic that would not lead to credit towards a degree? 9 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 probability Module 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. 10

Adapted Blended Learning Principles to Facilitate Design of the Course Establish a Teaching Relationship purpose driven reason for the course eye contact with the viewer encouragement Design with Explicit Cognitive Strategies skills, not content alone short videos, immediate quizzes with answers cliff hangers to keep people coming back prioritize graphics over text begin and end the week with summaries Support the development of Learning Communities short answer homework with peer review chat rooms and office hours 11 Garrison, D. R. , & Vaughan, N. (2008) Blended Learning in Higher Education: Framework, Principles, and Guidelines. San Francisco: Jossey-Bass

29000 Dabblers 4000 Experimenters 1500 Completers 12

40% 30% 20% 10% 0% H h S/ Sch < o 4 4 y ol ye rs ar C C ol M olle leg e as g e t D ers oc Pr tor of al es si on al ig H < Current Education ✔ Would you recommend? Yes No ✔ ✔ ✔ 13 13

Student and Resident Testimonials “. . this course taught me more about how to study than the three years I’ve been spending in medical school. ” “…It has shaped the way I study and I can’t 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 R 3 talk on the subject…” 14

Faculty and Practitioner Testimonials “…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 expected—”it has completely changed the way I look at clinical problems. ” 15 15

Five challenges that Computer Assisted Instruction can help us meet 16 16

1. Create flexible educational paths Students can use web based instructional tools to take a different approach to their learning. 17 17

2. Facilitate authentic workplace learning experiences • Students 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 18

3. Enable inter-professional and international education • Mitigates the academic schedule problem • Study groups can expand to include – Employed professionals – Professionals from different institutions or countries 19 19

4. Rapidly disseminate new advances to broad audiences • Emerging 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 Life 20 20

5. 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 review • Peer review of actual teaching will be enhanced and the field will continue to improve. 21 21

Five Challenges that Computer Assisted Instruction Alone Won’t Help Us Meet** **AT THIS TIME 22 22

1. Truly Individualized Learning • Flexible learning paths are not individualized paths. • True individualization requires faculty and learner interaction 23 23

2. Foster Innovation and Inquiry requires give and take exchange between learners and mentors. 24 24

3. Facilitate Professional Identity Formation • Professional identity formation requires personal interactions between role models and learners, in authentic practice environments, with critical reflection. 25 25

4. Decrease educational expense • Excellent computer assisted instruction is expensive. • Faculty time • Instructional design time • Production infrastructure • Teaching Assistant support • Possible economies of scale? ? ? 26 26

5. Increase Efficiency of Learning • Time on task remains critical to success. • Failure to incorporate time for CAI in blended learning environments is a common error. • Student motivation is also critical 27 27

Health Professions Educators as the Explorers of the Slope of Enlightenment Strong Incentives Expert Learners Faculty Resiliency Culture of continuous improvement and change 28

It is 2030. What will the plateau of productivity look like? 29

“Online education is not an enemy of residential education but an inspiring and liberating ally. ” Susan Hockfield, Ph. D President, MIT 30

Conclusions In 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 Productivity Health professions educators are in the perfect position to serve as change leaders for the adoption of technology enhanced learning. 31