Videconferencing is as good as being there

Does being face-to-face make a difference for learning?  Is there something different about learning at a distance?

You may be in a position, like I am, where people ask these questions and worry that learning with a distance modality is going to be inferior.  In most situations though, there just doesn’t appear to be an advantage for learning face-to-face.  

That’s not only true for learning, research is starting to suggest that it’s true for other kinds of interactions too.   

Therapy works just as well when it’s delivered using video conferencing

A group from Hong Kong University compared outcomes for a cognitive intervention delivered to one group in a traditional face-to-face method and to another group using videoconferencing technology.  The intervention was a cognitive therapy designed for older adults who had memory complaints and problems with declining memory.  Each group got 12 sessions of therapy and their scores on standard memory tests and dementia scales were measured before and after the intervention.  

The results for groups were about the same.

This finding is not unusual.  A recent review article on delivering therapies at a distance found that people got similar results in-person and using videoconferencing T hey concluded that:

“Across studies, telehealth technologies were found to provide roughly equivalent clinical outcomes ... and process variables … as traditional in-person treatments.”

 How you deliver training doesn’t seem to be important

It’s not surprising that therapy delivered over a distance works just as well as it does in-person, that’s the same finding that educational research has been reporting for over a decade.

Two recent reviews sum it up.  

The Department of Education says that:

“Students in online conditions performed modestly better, on average, than those learning the same material through traditional face-to-face instruction”

And a review of internet learning from JAMA (The Journal fo the American Medical Association) concluded that training over the internet appeared to be equally effective effective as training delivered in-person.  

What you have people do is important, how you connect with them isn’t.  

1. Poon, P., Hui, E., Dai, D., Kwok, T., and J. Woo (2004). Cognitive intervention for community-dwelling older persons with memory problems: telemedicine versus face-to-face.  International Journal of Geriatric Psychiatry, 20:285-286.  

2. Gros, DF; Morland, LA; Greene, CJ; Acierno, R; Strachan, M; Egede, LE; Tuerk, PW; Myrick, H; and BC Frueh (2013).  Delivery of evidence-based psychotherapy via video telehealth.  Journal of Psychopathological Behavioral Assessment, 35:506-521.

3. Means, B., Toyama, Y. Murphy, R., Bakia, M., & Jones, K. (2010). Evaluation of evidence-based practice in online learning: A meta-analysis and review of online learning studies.  A Report prepared for the US Department of Education, Center for Technology in Learning.

4, Cook, D. A., Levinson, A. J., Garside, S., Dupras, D. M., Erwin, P. J., & Montori, V.M. (2008). Internet based learning in the health professions: A meta-analysis.  JAMA, 10, 1181-96. 

Spreading learning over time may be an old idea but it's very effective. 

We can use what we know about learning and memory to design better learning experiences.  One of the strongest principles of learning is that learning takes time.  If we can divide our training into several sessions instead of a using a single longer session, our training will be more effective and our students will be better able to remember and use the new information.    

Here’s an example of how that might work; Carlos is a nurse manager who needs to help his team learn a new procedure.  When he’s needed to do training in the past, Carlos has blocked off a large chunk of time to demonstrate new procedures and let his nurses practice them.  This is not a bad strategy, having people learn about, then practice a new technique is often an effective way to help them learn.  

But Carlos can do something that will make his training sessions even more effective.  Instead of a single session where he shows his nurses how to do the new procedure and then gives them a chance to practice it, he can spread the same amount of instruction over two or three shorter daily sessions.  

Why is it important to divide the learning sessions?  Spreading learning out over time, sometimes called spaced learning or spaced practice, is one of the most effective ways to improve learning and memory.  

Interestingly, it works not just for humans, but it is a general property of learning for different species.  For instance, researchers, examining the effects of spacing on memory have taught honeybees to react to certain odors by extending their proboscises.  Bees have been taught to react to odor A, but not to Odor B, and they’ve been taught more complex reactions like reacting to odors a and B together, but not A or B by itself.  These memories are stronger if the learning sessions have been spaced out over time.1

This spacing effect is not a new idea; it was first described by Herman Ebbinghaus, a psychologist who did groundbreaking work on memory starting in 1879.  Ebbinghaus discovered many basic features of memory including the spacing effect.  Ebbinghaus used himself as a subject, memorizing many individual items and tracking his ability to remember them.  He discovered that he could improve his ability to remember items by spacing spacing his learning sessions over time, instead learning them in a single session.  

Carlos can use these principles to improve the training he’s giving to his nurses.  Spacing the learning sessions over time will improve the chances that his nurses will remember the new procedure and be able to use it effectively with patients.  Instead of using a single hour or two to learn the procedure, Carlos could break the up the learning into shorter 15 or 20 minute sessions over several days.  It might take a little more work on Carlos’ part to arrange this training but his benefit because they will have a much better chance of using the new procedure successfully.  

1. Menzel, R., Maz, G., Menzel, R., and U. Greggers (2001), Massed and spaced learning in honeybees: The role of CS, US, the interval, and the test interval.  Learning and Memory, 8:198-208.  

Designing Better Slides

Jennifer is getting ready for a presentation on a new surgical technique. She's going to be talking to fellow physicians and she wants them to understand the significant advantages of the new technique. She wants her slides to be effective; she's been to too many presentations where speakers sped through one page of bullet points after another.

What can she do to make her presentation more effective?

A recent study published in Medical Education can help her design her slides in ways that will help people better understand and remember her presentation.

The Study

The researchers compared the effectiveness of traditional bullet point slides to slides develop using principles of multimedia (Mayer, RE. ,2001, Multimedia Learning. Cambridge University Press).

Multimedia in this study means presenting information in different channels (visual and verbal), so instead of simply using text, the multimedia slides also used diagrams and pictures to help the audience understand the concepts. The pictures weren't just decorations, they were intended to help the learners from mental models of the information.

Medical students got either a lecture with the multimedia slides or a lecture with the traditional bullet point slides. Retention and transfer were measured immediately after the lecture, 1 week later, and 4 weeks later.

The slides designed using principles of multimedia resulted in significantly better retention and transfer at all time points.

Issa, N, Mayer, RE, Schuller, M, Wang, E, Shapiro, MB, and DA DaRosa, (2013) Teaching for understanding inmedical classrooms using multimedia design principles. Medical Education, 47:388-94.

What it means

We can use what we know about designing multimedia learning modules to make slide presentations more effective too. Lectures and slides are widely used for teaching in medical school and continuing medical education, increasing their effectiveness could have a big impact.

This study is particularly interesting because it looked at two different kinds of learning – retention and transfer – and measured that learning after a significant amount of time had passed. This gives us a lot more confidence about the effects of these changes than simply looking at retention immediately after the lecture.

How can you use this information?

You can revise your own slides in the same way the researchers did. They first looked at each slide to determine the key point, or message. Then, they used multimedia design principles to help each slide present information more effectively.

For instance, slides that used bulleted text were replaced by slides with diagrams or pictures. Important principles were highlighted with color and larger fonts. Graphs had explanatory text moved as close to them as possible so that people didn't have to spit their attention between a graph and a caption.

Learning from Cases Online

Medical cases can be very effective teaching tools.  Sometimes, though, it’s hard to know exactly what to include in a teaching case, especially when it’s presented online.  

For a good resource on developing cases, you can look through a recent paper in Teaching and Learning Medicine (1). 

The authors looked at online case-based presentations and scored each one on a series of features that make for a “good” case:

• Relevance
• Engagement
• Challenge
• Instructional strategies

Only a few of the online cases they reviewed scored well on their metric, which shows that many online cases aren't as good as they could be.  

This framework/checklist is a good way to look at cases and it’s worthwhile looking at the examples they present.  

The paper is worth taking a look at if you’re in the process of trying to develop case-based learning materials, or you want to review existing cases.



1. Kim, S., Phillips, W.R., Huntington, J., Astion, M.L., Keerbs, A., Pinskey, L., Dresden, G., Sharma, U., and D.W. Shearer (2007). Medical case teaching on the web.  Teaching and Learning in Medicine, 19(2), 106-114.  


http://www.tandfonline.com/doi/abs/10.1080/10401330701332169

Online Learning Works Teaching a Complex Subject using PBL

Distance Learning is as Effective as Classroom Learning

In general, many studies have shown that online learning is as effective as classroom learning.    The most common finding when comparing classroom to online learning is that they’re essentially equivalent if they’ve been carefully designed.  This has been shown to be true for many different kinds of learning experiences, but what about a highly interactive kinds of learning?  

A New Study Compares Online to Classroom Learning of Statistics

Does online learning work for learning statistical methods using a highly interactive methods like problem-based learning (PBL)?  That’s the question asked in a new paper published in Advances in health Sciences Education. (1)

The learners were enrolled in a Master’s degree program in public health and were learning multilevel and exploratory factor analysis.  

The classroom version of the course consisted of lectures, guided practice using statistical software, and PBL tutorials.  

Online learning used video lectures, individual practice with statistical software, and asynchronous PBL using discussion boards.  

Students’ experiences (positive or negative) were elicited after the course and their scores on the class final exam were compared.  

Measures indicated no significant differences between the two groups on examination scores.   

Some Advantages to Asynchronous PBL Discussions

Tutors and students noted some advantages of the asynchronous PBL discussions.  Tutors found that the online PBL took a little more time, to write feedback rather than delivering immediate verbal feedback.

Tutors like having the ability to monitor what students were doing and who was contributing the most to each discussion.  

Overall, the results of the study are consistent with many other studies showing that online learning can be as effective as classroom-based learning, even for a highly complex subject. 




de Jong, N., Versteen, D.M.L., Tan, F.E.S., and O'Connor, S.J., 2012, A comparison of classroom and online asynchronous problem-based learning for students undertaking statistics training as part of a Public Health masters degree. Advances in health Sciences Education (epublication).  

Practice is Important for Learning - How we Practice may Also Be Important

I miss your heartbeat.  Uploaded to Flickr by digitalnoise

Wired.com recently ran an article called “Everything You Thought You Knew About Learning is Wrong.”  The article was popular and was re-posted by many different people interested in learning and education.  The article focused on an interview with Robert Bjork, a UCLA psychology professor and the Director of the UCLA Learning and Forgetting Lab.  

One of Bjork’s main themes was the importance of “interleaving,”  that is working on several skills at once rather than focusing on a single skill.  

“First, he told me, think about how you attack a pile of study material.

“People tend to try to learn in blocks,” Bjork said. “Mastering one thing before moving on to the next.”

Instead of doing that Bjork recommends interleaving. The strategy suggest that instead of spending an hour working on your tennis serve, you mix in a range of skills like backhands, volleys, overhead smashes, and footwork.

“This creates a sense of difficulty,” Bjork said. “And people tend not to notice the immediate effects of learning.”

Instead of making an appreciable leap forward with your serving ability after a session of focused practice, interleaving forces you to make nearly imperceptible steps forward with many skills. But over time, the sum of these small steps is much greater than the sum of the leaps you would have taken if you’d spent the same amount of time mastering each skill in its turn.”

Numerous studies support the positive effects of practicing different skills, rather than simply practicing a single skills then moving on.  


Interleaving (mixed) practice also works for learning in medicine
A paper in Advances in Health Sciences Education looked at the effect of mixed practice (interleaving) in learning to electrocardiogram (ECG) diagnosis.  


To diagnose an ECG, students have to be able to correctly identify the the features on the ECG and to know the rules for each cardiac diagnosis (for instance left ventricular hypertrophy).  

Traditionally, students have learned and practiced these diagnoses one at a time.  Once they had mastered a diagnosis, they moved on to a new one, with a new learning and practice cycle.  


Study Design - groups differ in timing of practice
The study used a 2 hour learning session for both groups.  Each of the groups got the same instruction on five different ECG diagnoses, but they differed in the timing and presentation of the practice materials.  
 

Control Group	Contrastive Practice
Topic 1 Instruction Practice Topic 2 Instruction Practice Topic 3 Instruction Practice Topic 4 Instruction Practice Topic 5 Instruction Practice	Topic 1 Instruction Topic 2 Instruction Topic 3 Instruction Topic 4 Instruction Topic 5 Instruction Topics 1-5 Mixed Practice  Students encouraged to compare and contrast patterns  across diagnoses.

Study outcomes - mixed practice works
Students were tested on a six-item diagnostic test.  The group receiving contrastive practice had an over 50% increase in accurate diagnoses (1.8 for the control group v. 2.8 for the contrastive practice group).



Hatala, R.M., Brooks, L.R., and Norman, G.R. (2003).  Practice makes perfect: The critical role of mixed practice in the acquisition of ECG interpretation skills.  Advances in Health Science Education, 8:17, 17-26.