Fig.1 H809 EMA Mindmap (for fellow H809 / MA ODErs I've added a PDF version in the TMA Forum) Created using Simpleminds.
- H809 - Practice-based research in e-learning
- MA ODE - Masters in Open and Distance Education
- TMA - Tutor Marked Assignment
- PDF - PDF
Yonks ago I realised for me the best time to study was v.early in the morning. 4.00 am to breakfast isn't unusual, 5.00 am is more typical. All it costs is an early night. This is easy too - no television. Its move from the shed to the dump is imminent.
A week ahead of schedule I find I have an EMA to complete - this'll give me a three hour, exam like run of it. Even the dog knows not to bother me.
For those on the same path the mindmap of my H809 EMA is above.
Ask if you're interested in a legible PDF version.
This gorse bush off density has patterns within it that I can decipher. The net result ought to come out somewhere around the 4,000 word mark too. This approach could not be more different to my earliest TMAs and EMAs three years ago - they were too often the product of what I call 'jazz writing' (this kind of thing), just tapping away to see where it takes you. This process used to start on scrolls of backing wallpaper taped to my bedroom wall. Now it goes onto a whiteboard first.
As always this blog is an e-portfolio: most notes, moments in student forums and references are in here.
I recommend using a blog platform in this way. You can default to 'private', or share with the OU community ... or 'anyone in the world'. One simple addition to this would be a 'share with your module cohort'.
By now I have clicked through some 165 posts taggeed H809 and can refer to H809ema for those picked out for it.
One split occured - I very much wanted to explore the use of augmented reality in museum visits, but found instead a combination of necessity and logic taking me back to the H809 TMA 01 and a substantial reversioning of it. Quite coincidentally this proposed research on adherence to preventer drugs amongst moderate to severe asthmatics had me taking a very close interest on a rare visit to a hospital outpatient's. Nasal endoscopy must look like a circus trick to the casual observer as the consultant carefully 'lances' my skull through the nose with a slender and flexible rod on which there is a tiny camera and light. 'Yes, I can see the damage from surgery' he declares (this was 33 years ago), 'but no signs of cancer'.
There's a relief.
An unexplained nose bleed lasting the best part of 10 weeks was put down to my good-boy adherence to a steroid nasal spray that had damaged the soft tissue. And the medical profession wonder why drug adherence can be so low? 20% to 60% 33 years on and courtesy of the OU Library I found a wholly convincing diagnosis - allergic rhinitis. The 'paper' runs to over 80 pages excluding references and has some 20 contributors (Bousquet, 2008). I'll so miss access to the online library as most papers appear to cost around the £9 to download. This desire to remain attached by a digital umbilical chord to such a resource is one reason I wish to pursue yet more postgraduate studying and potentially even an academic career. I get extraordinary satisfaction browsing 'stuff' to feed my curiosity.
When I stop diddling around here I'll pick off this mindmap in a strick clockwise direction from around 1 O'Clock.
Simpleminds is great as a free App. It's taken me a couple of years to get round to paying £6 for a version that can be exported into a word file though I rather enjoy the slower, more considered 'cut and paste' which adds another opportunity to reflect, expand or ditch an idea.
Bousquet, J, Khaltaev, N, Cruz, A, Denburg, J, Fokkens, W, Togias, A, Zuberbier, T, Baena-Cagnani, C, Canonica, G, Van Weel, C, Agache, I, Aït-Khaled, N, Bachert, C, Blaiss, M, Bonini, S, Boulet, L, Bousquet, P, Camargos, P, Carlsen, K, & Chen, Y (2008) 'Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization, GA2LEN', Allergy, 63, pp. 8-160, Academic Search Complete, EBSCOhost, viewed 19 June 2013.
I might have interviewed Dr Price Kerfoot of Spaced-Ed for H807, 'Innovations in E-learning' a year ago.
We used Skype. Clear barely broken sound. Sharp video in colour. It worked.
It was a fascinating discussion.
I should have asked to record and done so.
Next time. I'm sure the conversation has only just begun.
Though armed with a set of questions used in TMA02 of H807 non were necessary. I'd prepared them to follow a narrative flow, and that is what we did.
We have something in common, we were both at Balliol College, Oxford.
I was there as an undergraduate 1984, he was there five years later as a Rhodes Scholar taking a BA in Medicine. Dr B P Kerfoot is now an Associate Professor of Harvard Medical School. He is also a passionate educator and e-learning entrepreneur. I suspect we will continue to hear a great deal abot him - he has a passion for education, reminding me of the late Randy Pausch, even the Robin Williams character from Dead Poets Society; there is an unstoppable, engaging warmth backed by a profound intellect.
Price had finished his surgical training when he went into education, an odd elective he admits, but one that through circumstances and surely an innate interest has proved fruitful.
What is the problem?
I didn't need to make this prompt. You strive to fix something when you see it isn't working. Learning outcomes from first year medical students were poor. Why, in US terms, spend $1000 dollars on a course only to find a year later that the traditional methods of acquisition and retention of knowledge has failed.
No problem, no fix.
Price looked to web-based teaching to create learning modules. Two concepts were devised, the spacing of questions proved successful. This is from one of a dozen papers authored by kerfoot and his team; each one, naturally, a worthy, academic, professional appraisal.
Two reports are cited as we talk, one on the effect on the hippocampus of rats, another on phosphate levels in fruit flies. As an OU student these reports are readily available.
There is physiological evidence that 'spaced learning works'.
a) you want something that works,
b) you want something that will justify the investment.
We give it away, academics in the US are commercially savvy.
Its as if in the UK academics (individuals and institutions) are like bachelors and spinsters, whereas in North America they are eager to marry.
More importantly the research has shown that the Spaced-ed approach improves patient outcomes the goal it was found that cancer screening of patients improved by 40% for the year spaced-education was introduced.
In 2006 the methodology was submitted by Harvard for a patent application. Entrepreneurs and venture capital companies were also approached.
It's a shame the Spaced-Ed blog hasn't been maintained, though you'll get some further insights here.
What began as continual education in medicine has expanded. If you go to the Spaced-Ed website there are all kinds of courses you can take, typically 20-30 questions of the multi-choice type fed to your laptop, SmartPhone or iPad. Writing these multiple choice questions is an effort and requires skill to get right,, indeed I can admit to wanting to create what I thought would be a simple set of questions relating to teaching swimming … but the correct construction of the questions, let alone the creation of appropriate images has held me back. It isn’t as easy to get this right as it looks. You don’t want to feed your audience lame questions, nor do you want to overstretch them. There is also some negative feelings about Multi-choice, perhaps we have all had negative experiences at school … I personally remember what we described as ‘multi-guess’ that was so often used in Chemistry classes. Though clearly effective, not enough people have been persuaded to pay for these sets of questions, even a dollar or so.
The challenge, has been to move on from asynchronous to synchronous, real time learning, including video and other rich media. The new platform promoted as Qform is an Facebook App and Twitter-like in its approach. People elect to follow a Qstream which goes out to everyone. You join in collectively, rather than alone, which creates a sense of participation and competition. If I understand this correctly, as I’m yet to give it a go, you pose a response to an open question that others read. You then vote on the various responses given. As Price, engaging as Robin Williams in Dead Poets Society enthused about the platform I thought about Skype and Elluminate, even forum threads. Indeed, I wonder if we could all organise to be online and go to one of these threaded conversations to turn an asynchronous environment into a synchronous one. Harvard is also the home of Rotisserie, which rotates a threaded conversation between online learners to ensure that everyone has a turn… and of course Facebook.
Gameification is the key. You respond in a way that other s like and you get points for it and your name appears on a leader board.
Rich content and a range of responses is what’s new. And its live And its competitive
And so Qstream delivers synchronicity and a sense of community Price also talked about how to make it possible for answers to questions to become searchable in Google – I guess with the inclusion of the right metadata. I didn’t need to say it to find I’m told the more controversial responses would generate the most responses. Now it’s starting to sound like the format of the Oxford Union Debating Society – I guess Price went along there at some stage too. By listening to two sides battle it out you form your own opinion.
One final statistic – 85% of those studying urology in North America (that’s the US and Canada) are using Dr B Price Kerfoot’s 23 question Spaced-ed multi-choice Q&A.
The competitors are Quora, Stackoverflow and FormSpring or some such … I’ll go take a look.
J Gen Intern Med 23(7):973–8
© Society of General Internal Medicine 2008
'The psychological conclusion demands a distribution of repetitions such that some of them should be produced at a later time, separated from the first repetition by a pause'. (Vygotsky, 1926:Location 2686)
So wrote the educational psychologist Lev Vygostsky over 80 years ago. Putting this into practice using email (and now Smart Phone apps and eventually Facebook), the team at Spaced-Ed have created a learning system that works.
SPACED EDUCATION – DR B PRICE KERFOOT
Interactive Spaced-Education to Teach the Physical Examination: A randomized Controlled Trial
Several studies have documented that physical examination knowledge and skills are limited among medical trainees.
The objective of the study is to investigate the efficacy and acceptability of a novel online educational methodology termed ‘interactive spaced education’ (ISE) as a method to teach the physical examination.
Randomized control trial.
170 second year medical students.
- Spaced-education items (questions and explanations)
- Validated by two experts
- Piloted and 36 items selected for inclusion
- 6 spaced-education e-mails each week for a 6 week cycle.
- Students submitted answers to the questions online and received immediate feedback
- An online end-of program survey was administered.
RESULTS: Successful 85% participants recommended the ISE programme for students the following year.
CONCLUSIONS: ISE can generate significant improvements in knowledge of the physical examination and is very well-accepted by students.
While many studies have documented the dearth of physical examination knowledge and skills among trainees, ISE has the potential to remediate these deficiencies across the spectrum of medical education (p977)
Students do the training, but may still have poor recall a year later. Spacing works.
The spacing effect is the psychological finding that educational encounters that are spaced and repeated over time (spaced distribution) result in more efficient learning and improved learning retention, compared to massed distribution of the educational encounters (bolus education). (P973)
As Vygotsky expressed it 80 years previously:
'It should also be emphasized that every person has his own customary rate of response, and that any change in this rate, either speeding it up or slowing it down, weakens the force of recall'. (Vygotsky, 1926:Location 2686)
And so here students can tailor the timing of questions they are fed - spacing them out or bunching them as they see fit and circumstances change. Go try it, there are courses you can do on topics that a far less demanding that second year physical examinations. Try world history in maps, for example, or getting the most out of your iPhone.
A distinct neurophysiologic basis for the spacing effect has been identified
‘Spaced education’ refers to online educational programs that are structured to take advantage of the pedagogical benefits of the ‘spacing effect’.
Interactive spaced-education (ISE) combines the pedagogical merits of both the ‘spacing effect’ and the ‘testing effect. (974)
Each spaced-education item consists of an evaluative component (a multiple choice question based on a clinical scenario) and an educational component (the answer and explanation)
Psychometric analysis of the questions was performed using the Integrity test analysis software (http://integrity.castlerockresearch.)
Based on item difficulty, point-biserial correlation, and Kuder–Richardson 20 score, 36 of the questions were selected for inclusion in the ISE program.
- Students receive spaced-education e-mails at designated time intervals which contain a clinical scenario and question (evaluative component).
- Upon clicking on a hyperlink in this e-mail, a web-page opens which displays pertinent images and allows the student to submit an answer to the question.
- Upon downloading this answer to a central server, students are then immediately presented with a webpage displaying the correct answer to the question and an explanation of the curricular learning point (the educational component).
- By having the provider submit a response before receiving the correct answer and an explanation, this process requires greater interactivity, which educational theory argues may improve learning outcomes.
- The submitted answers of students were recorded using the MyCourses™ web-based education platform
The survey was constructed and administered online using the SurveyMonkey web-based platform.
Future developments and assimilation of spaced-education alongside traditional medial school teaching methods
For example, as ISE utilizes traditional web-pages for the submission of answers and for the presentation of learning points, it should be possible to use all of the functionalities of web-pages within the ISE program to meet the training needs of care providers. For example, physician trainees learning how to auscultate the heart can be presented with ISE items which contain an audio recording of an unknown heart sound, and then, trainees can be asked to identify the murmur.
Micro-learning is favoured over more substantial time being given to this. I can imagine many applications.
This finding is in stark contrast to the strong resistance we encountered when conducting a recent trial of web-based teaching modules among 693 medical residents and students. In this trial focusing on systems based practice competency education, trainees were expected to spend 20 minutes per week over 9 weeks completing web-based teaching modules (interactive web-pages and online narrated slide presentations). (p977)
This high acceptability also likely reflects the ease of use of the spaced-education delivery system, the immediate relevance of the content, and the importance that students attribute to learning the physical examination. (p977)
Some items to cover if you are thinking of being a professional and thorough as the team at Harvard and Spaced-Ed:
- · Conflict of Interest:
- · Funding/Support:
- · Financial Disclosures:
- · Author Contributions:
- · Conception and design:
- · Acquisition of data:
- · Analysis and interpretation of data:
- · Drafting of the manuscript:
- · Critical revision of the manuscript for important intellectual content:
- · Statistical analysis:
- · Obtaining funding:
- · Ethical Approval to Perform the Study:
- · Corresponding Author:
And a finaly word from Lev Vygotsky.
'Rhythm plays a decisive role in the learning process, unifying some of the material, conferring on it a sequential symmetry, and, finally, organizing the various elements into a unified whole'. (Vygotsky, 1926)
Kerfoot, B, P (2006) SPACED EDUCATION. Interactive Spaced-Education to Teach the Physical Examination: A randomized Controlled Trial.
Vygotsky, L (1926) Educational Psychology
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