MOOCs in Health Professions Education: Hype or Hope?

1. 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

2. 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.

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

4. Faculty have always embraced new technologies to help

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

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

7. 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

8. The Push Back

9. Feasibility: 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? Questions We at UCSF Asked

10. 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.

11. 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 Garrison, D. R., & Vaughan, N. (2008) Blended Learning in Higher Education: Framework, Principles, and Guidelines. San Francisco: Jossey-Bass

12. Dabblers Experimenters Completers

13. ✔ ✔ ✔ ✔

14. 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 R3 talk on the subject…”

15. 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.”

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

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

18. 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. 2. Facilitate authentic workplace learning experiences

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

20. 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 4. Rapidly disseminate new advances to broad audiences

21. 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. 5. Demonstrate the quality & impact of excellent teachers beyond their institution.

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

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

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

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

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

27. 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 5. Increase Efficiency of Learning

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

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

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

31. 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.