Enhancing Learning in the Clinic and the Classroom
Laurie J. Posey, EdD and Laurie B. Lyons, MA
CHAPTER OBJECTIVES
After reading this chapter, the reader will be prepared to:
- Use a systematic approach to design and implement effective technology-based learning experiences in the clinic, the classroom, and the community.
- Motivate diverse learners by engaging them in multisensory e-Learning experiences.
- Apply principles of multimedia design to maximize learning.
- Ensure clear and accessible e-Learning experiences for all learners, including those with special needs.
- Apply technology-based teaching and learning strategies to optimize learning for the lifelong learner, teacher, patient educator, clinician, and student.
STOP AND REFLECT
Take a minute to reflect on all that you have learned in previous chapters about the multiple teaching and learning roles you may play as a physical therapy practitioner and educator. How might technology facilitate teaching and learning in support of these different roles?
How can technology support teaching and learning in the clinic and classroom? You will remember from the discussion in the very first chapter of this text that teaching and learning are fundamental to physical therapy practice. Physical therapists cannot be effective clinicians without being good educators. Physical therapists are involved in teaching every day. Whether you are teaching your patients, colleagues, students, various community members, or even yourselves, becoming truly expert at what you do requires effective teaching and learning strategies. So, how can technology be used to support all aspects of your teaching and learning? Consider the following:
- As a lifelong learner, you stay abreast of the latest evidence to guide physical therapy practice, and continually reflect on your experiences to broaden your perspectives and hone your knowledge and skills. You value reflective practice; but you are a busy clinician. How can you use technology to help you?
- As a teacher, you design and implement strategies to foster the development of new knowledge and skills. How can technology best support the achievement of different kinds of learning objectives for different types of learners, including students in the clinical setting?
- As a patient educator, you provide essential health information to your patients and their families. Are there more creative and more effective ways to provide patient education materials using technology? How might technology help to facilitate behavior change?
- As a clinician, you participate in communities of practice, communicate information, and share your experiences with colleagues. Perhaps you are a practice owner with a team of physical therapists and physical therapy assistants. How can you use technology to present information effectively or enhance communication across the team to prevent conflict?
- As a student, you strive for deep, meaningful learning experiences, value diverse perspectives, are open to feedback, are proactive in reflecting on your own learning process, and seek additional help and resources when needed. How can technology support you in maximizing your own learning and collaborating with others in the learning process?
- As a clinician, you participate in communities of practice, communicate information, and share your experiences with colleagues. Perhaps you are a practice owner with a team of physical therapists and physical therapy assistants. How can you use technology to present information effectively or enhance communication across the team to prevent conflict?
The range of available teaching and learning technologies is expanding every day. Your options are as far-reaching as your imagination, and your technology toolkit is at your fingertips. In this chapter, we explore practical approaches for applying technology-based teaching and learning strategies and tools to a range of teaching and learning challenges. We will use the term e-Learning to refer to any kind of electronic media or tool used for educational purposes, on or off of the Internet.
SYSTEMATIC APPROACH TO E-LEARNING DEVELOPMENT
With so many options to choose from, where do you begin? What technologies should you consider? When should you consider using them? Why bother? Should you look for existing materials or create something new? What is the best way to present your message? How can you be sure that your time and money are well invested? The prospect of tackling a new e-Learning project or even selecting an e-Learning project or tool may seem overwhelming and time consuming. Fortunately, as a health care practitioner, you are better equipped than most to tackle this new challenge. Your diagnostic abilities will serve you well.
In Chapter 5, you learned a systematic process for designing effective instruction for different learners that incorporated a needs assessment, development of learning objectives, motivational hooks, content boosters, teaching strategies including active learning strategies, formative assessments, summative assessments, and summaries. Most educational technologists use a similar approach to guide the development of e-Learning materials. Often referred to as ADDIE, the process includes 5 phases: Analysis, Design, Development, Implementation, and Evaluation (Figure 13-1). Working through each phase in a systematic fashion helps to ensure an efficient, top-down process resulting in an end product that achieves the intended outcomes.
Figure 13-1. ADDIE framework for instructional systems design.
Analysis
As you have learned in this text, conducting a needs assessment to understand the learning styles, level of expertise, and expectations of your audience is the first step in planning any educational intervention. When planning an e-Learning project, it is also important to consider the benefits, challenges, and technical considerations associated with different delivery formats, as well as the technical capabilities of the target audience. Above all, it is essential to analyze the educational need that the product is intended to fill. Begin with the end in mind. Why do you need this e-Learning project? What are you hoping to achieve?
Consider this example. You work with an elderly population for whom falls are a significant risk, and you would like to develop an educational program about falls prevention. Think about your audience. What factors would you need to consider in planning an educational program that best meets their needs? What, if anything, do they already know about falls prevention? What is the most common cause of falls in this population? Are there particular behaviors that you are trying to correct? What educational formats are likely to be most appealing and usable for this audience? These are some of the questions that you would need to answer in planning an effective program, and you would probably need to do a good bit of research to answer them. What does the literature say about falls and falls prevention in this population? What types of educational interventions have been most effective in the past? In addition to reviewing existing evidence, it would be useful to conduct surveys or focus groups with representative members of your specific target audience to learn more about their learning needs. You can see how the information you gather through this analysis process would help to guide your educational approach.
Design
The design phase includes defining goals, learning objectives, instructional strategies, and assessments to address the needs and requirements defined during the analysis phase. Just as in designing other teaching and learning experiences, learning objectives are the backbone of instructional design and provide the framework for everything that follows, so it is important to define them carefully. Learning objectives are central to a key instructional design principle referred to as alignment, which means that learning goals, objectives, instructional strategies, and assessments are consistent with one another. The learning objectives inform learners of the learning target, the instructional strategies are designed to support learners in meeting the objectives, and the assessments ensure a fair and accurate measurement of whether the objectives were achieved. Typically, the overarching instructional design is documented for review by key stakeholders, such as administrators, subject-matter experts, and multimedia developers. This instructional design plan provides a foundation for further content development.
An instructional design plan for the falls prevention program would begin with a summary of the analysis, a description of the problem, a description of the audience, and a description of how the proposed educational program will help to reduce falls in this population, which would be followed by a statement of educational goal(s). The following is an example of an educational goal statement:
- The goal of this program is to reduce the incidence of falls in the elderly by increasing their awareness of common causes of falls and strategies to prevent them.
Next, you would write learning objectives designed to enable learners to achieve the stated goal. The following is an example:
- After participating in this educational experience, learners will be able to do the following:
- Recognize common causes of falls.
- Apply falls prevention strategies in their daily lives.
- Recognize common causes of falls.
These objectives would provide a framework for developing a more detailed content outline.
With the objectives stated and content outlined—and having a good idea of the types of educational experiences that would be most appealing and effective for your target audience—you are ready to begin to think about instructional strategies. Continuing with our falls prevention example, imagine you decide to create a self-paced, interactive e-Learning program that would be set up in a waiting room and also available for patients’ use at home. To engage learners, you might begin the program with a montage of video clips showing different types of falls (ie, a motivational hook). To teach your first objective, you might present the learner with a list of common fall incidents that they could click on to learn about common causes of falls in the elderly through case examples. To teach the second objective, you might present a list of falls prevention strategies and challenge learners to identify a strategy that could have prevented the fall in each case. You might wrap up the program with a summary of common causes of falls and falls prevention strategies, presented using a combination of narration, still or video images of active, healthy seniors, and text to highlight key points. The instructional design plan would include a high-level description of the e-Learning format, instructional strategies, and delivery media in narrative form.
Creating e-Learning products such as the example described previously requires careful, upfront planning of media elements and navigational flow. For these kinds of programs, the high-level design is followed by a more detailed design that includes a flowchart illustrating the structure of the different scenes in the program and how a learner can navigate through them and a storyboard that details the visuals, audio, and navigational options available for each scene (Figure 13-2). Storyboards for the falls prevention program would detail the narration, images, text, and interactivity for each scene in the program. When working in a team setting, all of the flowcharts and storyboards are reviewed, revised, and agreed upon by all stakeholders. Given the expense that may be associated with developing e-Learning products, this review is critical.
Development
In the development stage, digital media artists and audiovisual producers compile all of the graphics, photos, audio, and/or video that are defined in the storyboards. These program assets may be newly created for the project or obtained from a stock media library. To produce the opening montage for the falls prevention program, for example, you might be able to find and edit together existing footage of real falls; if not, you would need to hire actors, a professional video crew, and stage and record a series of fall incidents. You can see how a simple idea can quickly become costly, and you might need to revisit your instructional approach. Using one of many available development programs, a programmer or author assembles the media according to the flowchart and storyboard specifications. The product is tested and any programming bugs are corrected. The final product is then reviewed by the project team and prepared for dissemination.
Figure 13-2. Flowchart and storyboard.
Alternatively, for projects that make use of existing e-Learning products, the development stage includes selecting materials that meet the goals and objectives defined during the design phase and creating any printed learner and instructor materials needed to guide the use of these materials.
Implementation and Evaluation
Once developed, the e-Learning program is implemented, and, as with any educational presentation, outcomes must be evaluated. For the falls program, you might ask some of your elderly patients, your grandparents, or an elderly neighbor to review the program, report any problems that they encounter, and provide feedback about its usability and content. Based on this evaluative process, materials may be revised or new materials selected. Notably, the process is cyclical, inferring an ongoing continuous improvement process.
The ADDIE process has been used for many years to provide training development teams with a common, systematic framework that results in the efficient design and production of high-quality instructional products. The process has been detailed by many authors and is the foundation for a professional discipline called instructional design. There are several variations on the ADDIE model, but all share the key characteristics of following a systematic phased approach, iterative formative evaluations to ensure quality along the way, and design with the end in mind. An expanded model that provides detailed guidance for all phases of the instructional design process is provided in The Systematic Design of Instruction,1 and an Internet search using the key words instructional design will yield many more resources. If you are working on a small e-Learning project independently, you may not need to delve too deeply into this area; just follow the basic steps outlined above. If you decide to tackle a more complex e-Learning project, however, it may be in your best interest to consider hiring a professional instructional design and development team.
In addition to making the process manageable, following this systematic approach will help to ensure that the technology solutions you create or choose are appropriate and meet the learning needs of your target audience. Educational technologies can be dangerously alluring—it is all too easy to be swept away by a flashy presentation or the latest gadget. Remember, even the most fabulous e-Learning program will be useless to a patient who does not own, know how to use, or want to use a computer.
STOP AND REFLECT
Think about some of the learning needs of your patients or coworkers. Consider the following:
- Can you translate these needs into measurable learning goals and objectives?
- What types of educational experiences would best support these goals and objectives?
- How, if at all, might technology enhance these learning experiences?
You are the architect of your patient’s educational technology experience, and, as every architect knows, “form always follows function.” For an architect, this means that the form (ie, structure and features) of a building must be based on its function (ie, intended purposes). For example, consider the differences between a residential and commercial kitchen. To plan its features effectively, an architect would need to know the function of the kitchen—who will use it, how it will be used, and with what desired outcomes. Similarly, when designing e-Learning, you must be clear about the purpose of the application before determining what form it will take. To ensure that form follows function, again, a thorough needs assessment is critical. Ask yourself, Who is my audience? What do I want them to know or do? Where and when will they be learning? Thinking through and answering these questions thoroughly will prepare you to determine how to use technology to deliver an effective educational message.
KEY POINTS TO REMEMBER
- Instructional systems design is a process that does the following:
- Provides a systematic approach for managing the selection or development of technology-based learning products.
- Ensures alignment or consistency among learner needs, learning objectives, and technology-based learning solutions.
- Fosters continuous improvement through ongoing evaluation.
- Provides a systematic approach for managing the selection or development of technology-based learning products.
- Form follows function. Effective technology solutions must address real learning needs.
CONSIDER YOUR LEARNERS IN DEVELOPING EFFECTIVE E-LEARNING PRODUCTS
Motivating Diverse Learners
If you have practiced physical therapy for any length of time or have worked in other people-oriented professions, you know that people come in many shapes and sizes. From earlier chapters, you will recall the importance of knowing your audience and recognizing the influence that individual filters have on learning. Differences in culture, language, attitude, disposition, motivation, expertise, age, experience, learning style, literacy, and comorbid conditions can all impact how an educational message is received. How can you create messages that are appealing and effective for such diverse audiences? How can technology help you to meet this challenge?
As we have discussed before, the best way to appeal to a diverse audience is to provide a variety of learning options. The more you can vary the teaching-learning strategies, media, and modes of delivery you use, the more likely you are to meet the needs of everyone in your audience—whether that audience is live or sitting behind some electronic medium. Meeting the needs of your audience in a virtual community becomes even more challenging and may be limited by the time and resources you have available. You may not be able to please all of the people all of the time, but, as in systematic effective instruction, it is important that you make an effort to include a number of strategies to appeal to a variety of individuals with differing learning preferences.
Keeping diversity in mind during the planning process can have the added benefit of maximizing your investment. For example, if you were planning to produce an exercise video, developing complementary materials based on the content you are already developing would require little additional time and money. You might decide to create a spiral-bound, laminated booklet including exercise plans and instructions for each exercise, along with illustrative photos taken during the video production. You might even be able to take the same script you created to support your exercise video and create an audio recording or podcast that patients can listen to using a mobile device while exercising in the gym, rather than when they are at home in front of the computer or television. The key point here is to think about delivery options early in the process with an eye toward providing multiple media formats for different kinds of learners while streamlining the design and development process.
In addition to maximizing the use of different media formats, embracing a learner-centered approach to teaching will help to ensure that the educational experiences you create or facilitate will meet the unique needs of diverse learners. Learner-centered education requires learners to take ownership over their own learning. By reflecting on their individual learning needs, relating instructional objectives to personal goals, and taking an active role in the learning process, learners become coauthors of the educational experience. This makes it possible for diverse individuals to come away from a common educational experience having met the established objectives, yet having connected differently with the material, allowing it to become more personally relevant.
For example, if you were facilitating an online support group for teens with spinal cord injuries, rather than simply presenting general information about community resources and support, you might encourage discussion and interaction by asking participants to find and share resources from their own communities. In addition to providing participants with meaningful, useful connections, this experience would also be more empowering than a “spoon-fed” approach (ie, providing all of the information). As an added benefit, others in the group would be exposed to a richer array of examples that may relate to their own needs and settings.
Simply considering different modes of delivery may not be sufficient to motivate and meet the needs of diverse learners. Keller2 developed a useful model for planning educational experiences based on research related to human motivation. The ARCS model includes the following 4 categories: Attention, Relevance, Confidence, and Satisfaction. As illustrated in Table 13-1, each of these categories includes 3 components that can be used to guide the selection of instructional strategies that engage and motivate learners.
The ARCS model can be applied to the design of any instructional project. It is particularly useful when thinking through the different types of learning experiences that you may wish to include in an e-Learning program. For example, to build confidence, designers of an e-Learning program may decide to organize practice activities from simple to complex and allow learners to repeat the activities as many times as needed to succeed.
The ARCS model is intended to complement, rather than replace, the instructional design process previously described. Like instructional strategies, the selection of motivational strategies is based on a thorough understanding of your audience and the instructional objectives that you are trying to achieve. Armed with an analysis of audience characteristics, knowledge of what motivates people to learn, and insight into instructional strategies that enhance motivation, we are well positioned to plan learning activities and experiences that are both motivational and instructionally effective. There is no prescribed formula for using the model, and the sample strategies provided are not intended to be comprehensive. The ARCS model simply provides additional factors to consider and possible strategies that you can use to enhance your learner’s motivation to learn.
Although you do not need to address every component of ARCS in every e-Learning project, it is worthwhile to consider each one within the context of your audience and project goals. The third column of Table 13-1 illustrates how one e-Learning project might integrate all of the different components of ARCS. Keller3 provides more information about designing instruction using ARCS, along with additional resources, on the ARCS website.
CRITICAL THINKING CLINICAL SCENARIO
You have been asked to create an online workplace wellness program for the physical therapy aides in your department. You just learned about the ARCS model and would like to use it to ensure that you have optimized learner motivation.
Reflective Question
What strategies would you use to address each of the following 4 components of the ARCS model?
- Attention
- Relevance
- Confidence
- Satisfaction
Integrating different motivational strategies and modes of delivery into the e-Learning experiences you design will help to ensure that your instructional designs appeal to learners with different learning preferences and different motivations to learn.
STOP AND REFLECT
Think back to Chapter 1, where you learned about various learning preferences or styles.
How can technology support the various learning preferences described by Kolb,4 including the following:
- Divergers?
- Assimilators?
- Convergers?
- Accommodators?
Table 13-2 summarizes some possibilities.4 Can you think of others?
Engaging Learners With Different Learning Preferences
Note that many of the different technology supports can be applied in different ways to support different kinds of learners. In addition to selecting appropriate technologies, it is important to apply them in ways that appeal to different kinds of learners. For example, an effective design for an educational setting such as an online course that allows for different types of learning experiences over time might integrate virtual field trips, multimedia and text presentations of concepts, problem-based assessments with feedback, online dialogue or blogs about thought-provoking situations or dilemmas, and case-based learning with guided feedback. Although less flexible in terms of delivery options, a self-directed e-Learning module could also be designed with different learning styles in mind. For example, an e-Learning module might integrate a menu-driven hierarchical navigation system and online prompts to guide learning with the option for learners to move freely among sections, didactic content using different kinds of media, click-to-explore interactions that enable learners to discover different perspectives related to a concept, structured case- or problem-based learning with feedback to guide and remediate learning, and simulations to enable experimentation or experiential learning with multiple possible outcomes.
KEY POINTS TO REMEMBER
- Different technology supports can be applied in different ways to support different kinds of learners.
- In addition to selecting appropriate technologies, it is important to apply them in ways that appeal to different kinds of learners.
- Consider the ARCS model and various learning style preferences in designing your e-Learning experiences.
Adapting Technology-Based Teaching for Individuals With Special Needs
Diverse audiences include individuals with special needs. This is especially true in a field focused on helping people overcome physical challenges. According to the United States Census Bureau, approximately 56.7 million (19%) of people living in the United States have at least one type of disability.5 There is a wide range of assistive technology products that can help to bridge the learning divide for these learners, such as telecommunications devices for the deaf, computer screen readers, and voice recognition programs. Microsoft provides a useful description of the different types of assistive technologies at www.microsoft.com/enable/at/types.aspx.6 Technology may also enable some people to take advantage of education that they were previously unable to access.
From a planning and design perspective, it is important to consider the special needs of your audience—known and unknown. This means making sure that education is both effective and accessible for those with disabilities or other special needs. These are related, but distinct, considerations. Providing education that is effective for all requires attention to instructional content and teaching strategies as they relate to limitations, disabilities, and differences that may impact an individual’s ability to learn. These may include cognitive, sensory, or physical disabilities; language barriers; literacy issues; emotional problems; or lack of interest and motivation. Providing education that is accessible involves ensuring that people with physical, sensory, or cognitive impairments can successfully use a technology-based educational offering. Thus, accessibility is a subset of effectiveness; for a learning application to be effective, it must be accessible to all learners.
Researchers at the Center for Applied Special Technology (CAST) have developed a framework called Universal Design for Learning (UDL)7 to guide the design of educational experiences that are effective for all learners. UDL principles focus on providing learners with multiple options for achieving educational goals, representing information and knowledge; expressing or demonstrating what learners know, and engaging learners’ interests and motivations. These principles are consistent with the concept of providing diverse learning options to meet the needs of diverse learners. Technology is widely used in UDL because it offers an alternative to traditional instruction. The UDL website7 (www.cast.org) is rich with guidelines, strategies, and examples of how UDL principles can be applied in different educational settings. One example of a commercial product that applies the principles of UDL is the iLit program by Pearson8, which augments e-Books with dynamic audio, pictures, and video elements as well as pop-up definitions to assist diverse learners (Figure 13-3). Research has demonstrated that achievement improved significantly among students who used the iLit program for 1 year.8
While UDL’s primary focus has been to equalize traditional education for students with diverse learning styles, its principles are also applicable to website and e-Learning design. Well-designed e-Learning programs incorporate principles of universal design by integrating options for different kinds of learners. A simple example would be to supplement a paragraph of text with a video or graphical explanation. Notably, providing content in different formats is beneficial to all learners, not just to those with special needs. Features such as closed captioning to assist people with hearing loss may also be helpful to learners who learn better by reading than watching.
MULTISENSORY TEACHING WITH INTERACTIVE MULTIMEDIA
STOP AND REFLECT
Think about a time when you were completely engaged in some type of learning experience. Perhaps you were immersed in an IMAX film with surround sound, participating in a workshop presented by a gifted facilitator, working through a collaborative simulation, or just walking through an art museum. What was it about the experience that captured and held your attention? How did your mind and senses interact to create a memorable learning experience?
Something as simple as text on a page can create an engaging and effective educational experience, particularly if it makes readers think. It is likely, however, that your most memorable experiences have involved something more than the written word. Multimedia-based e-Learning materials that engage learners in multisensory experiences can be powerful teaching tools. By adding the element of interactivity, multimedia e-Learning can move beyond the passive delivery of knowledge and engage your audience in active learning experiences.
Learning Preferences
Fleming and Mills9 describe learners as having different perceptual preferences: Visual, Aural/auditory, Read/write, and Kinesthetic. The acronym VARK categorizes these preferences. The authors also describe a fifth category, multimodal, noting that most learners prefer some combination of the VARK categories, with some having a preference for all. Multimodal learners may either base their preferences on the learning context or use all 4 learning modes in every learning situation. It is important to note, there is controversy in the literature surrounding the use of learning preferences or styles in teaching and learning, particularly when considering matching teaching approaches to these preferences.10 While targeting instruction to individual learning preferences does not appear to enhance academic performance, it is safe to say that multimodal approaches are most likely to engage all types of learners.
How does this relate to the learning process and the design of technology-based instruction? We know that multisensory experiences are engaging, whether online or in person. The challenge is to engage the senses in a way that most effectively enhances motivation and produces learning. When carefully designed, a multisensory or multimodal approach may be most effective in both engaging and motivating the learner.
Multimedia Modalities
Designing interactive multimedia-modal e-Learning involves combining audiovisuals, animations, and interactivity in ways that most effectively teach the intended learning objective(s). To begin, it is important to know a bit about different multimedia elements.
Digital Images
Images can be used to illustrate concepts or procedures, augment text, or audio communications, display data, or communicate a mood or meta phor. Visuals are powerful in aiding learning and retention. Images are also foundational to the look, feel, and functionality of e-Learning. A program’s user interface is also comprised of visual elements.
Figure 13-3. Example of universal design for learning features: Pearson’s iLit program. (Reprinted with permission from Pearson Intervention, ELL.)
There are many good sources for royalty-free images on the Internet. Table 13-3 provides some examples, along with important information about copyright related to using images from the Internet. You can use these, and/or your own digital photography, to illustrate concepts and examples or to tell a story. For example, in an educational program targeting falls prevention, seeing pictorial examples of variables in the home that could contribute to falls rather than just reading about them would likely be more memorable and impactful. Similarly, a home exercise program with illustrations showing the proper mechanics of an exercise would be more useful than a text description.
Audio
Audio may include narration, music, or sound effects. The spoken word is essential to many e-Learning programs. Simply adding narration to a slide presentation can engage the senses further, motivate the learner, and enhance memory and learning. Sound effects can be used to enhance or add realism to a story or other communication. Music can convey emotion and is often used to introduce and close a program, or to transition between sections.
Video
Digital video can add a real-world dimension to your e-Learning presentation that is difficult—but not impossible—to achieve in other ways. Digital video can be used to tell a story, demonstrate a process, document real events, or whenever both audio and action are important. Video production involves skills in video and audio recording, lighting, and editing that may require the help of a professional, depending on the level of quality that you are looking for. With this in mind, it is relatively easy to record high-quality video using a smart phone or digital camera, and edit it using a variety of software tools that are available. It is not uncommon to have a physical therapist take video of a patient doing an exercise on a smart phone and then send it to the patient as part of his or her patient education. A video can be a very powerful reminder of how to perform an exercise correctly, especially if the therapist adds audio, talking through proper technique as he or she records.
Text
The written word is essential to most educational communications. Although some e-Learning makes appropriate use of long text passages, as a rule, text used in e-Learning should be succinct. Short phrases, paragraphs, or bulleted lists may be used to highlight key points. Labels or captions may be used to add meaning to images. Text-based interface elements, such as menu items on a Web page, hyperlinks, or labels on a button, provide navigational aids.
TABLE 13-3
COPYRIGHT FOR DIGITAL IMAGES
Important Copyright Considerations
How Can You Get Images and Other Media to Use Legally?
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