Learning Online: One Year Later

Thomas A. Marino, Ph.D.
Temple University School of Medicine
Philadelphia, PA

Last year, two of my students and I wrote a paper for the National Teaching and Learning Forum (vol. 9, No.4 pp. 4 - 6). We discussed the embryology course I put online and taught as a hybrid course. The didactic material from lectures was put online in a series of PowerPoint presentations with recorded narration. The presentation was converted into a real audio file and streamed so it could be listened to and viewed over the Internet. The face-to-face component of the course became problem-solving sessions that focused on using the student's understanding of the normal embryology to figure out what went wrong in cases of clinically relevant congenital defects.

Student progress was measured by a series of online quizzes given for each segment of the course. Students had two attempts at the quizzes for each section and they were able to use the higher score toward their final grade. The attempt was to reduce fear and cramming for each of these quizzes and to help the students take ownership of their own learning progress. The final exam was designed to give the students a time to put all the material together and integrate their learning of the many segments of the course. The final, however, remained a multiple-choice exam.

In the paper, the student coauthors made recommendations for improving the course. They wanted more focused tasks to help them prepare for the problem-solving workshops. They also said there needed to be built-in incentives for the students to spend time on the course. I heard the desire to make the course more task oriented. I also said then that exams had to be reorganized and overall there was a need to help guide the students early on as they were trying to adapt to this new learning paradigm.

In this paper I would like to update the readers on what changes were made to the course. I would also like to give a sense of how the course progressed both from my viewpoint as a teacher and from the students' viewpoint. As course management tools become ubiquitous on campuses and faculty use them to place all or part of their courses online, they might consider some of the lessons learned during these experiments in teaching and learning that my students and I have attempted.

The New Course

There were two major objectives for my revising the embryology course. The first objective was to help my students become better life-long, independent learners. The second was to help them approach learning in an authentic way where higher order learning took place and where they constructed their learning rather than just memorized facts for recitation later in the course. I have often said that when you teach medical students you teach some of the most sophisticated and successful educational bulimics - a group of individuals that can binge and purge facts better than most. My goal was to try to get them to learn in different ways so that what they learned stayed with them and became part of their permanent educational background.

I started out with the following course goals

1. To learn how the structures of the body develop from the time of fertilization.

2. To learn some of the factors involved in developmental processes.

3. To understand the embryological basis for abnormal development.

4. To become familiar with and to learn how to access outside sources dealing with normal and abnormal human development.

In order to achieve these goals, one of the course's major objectives was to promote learning through the interaction of individuals in the class. The medical community is comprised of people who consistently share information in order to solve problems. As a learning community, every member of this class had the responsibility of learning from the available resources and sharing his/her understanding with other members of the community. A final objective of the course was to develop lifelong learning habits. Students were expected to use the tools that were provided and also to look for other resources that would help to solve clinically relevant cases.

The students were provided with a detailed schedule that outlined their tasks along with a completion date. A recommended set of daily tasks for the course was designed to help them keep pace with the course materials. An influential reference on this topic is Extending the Classroom Walls Electronically a wonderful web site (http://www.users.csbsju.edu/~tcreed/osu/index.html) by the late Tom Creed.

For each section of the course, the tasks included:

1. To read the handout for the system under study.

2. Next to read the noted sections of the text for the system under study.

3. To listen to the online presentations. Listening to the presentations resulted in 3 points per section of the course for a total of 18 points toward the final grade.

4. Following the presentations, a pre-workshop writing assignment was available online. Students received 3 points per writing assignment for each section of the course for a total of 18 points. The writing assignment had three questions and each was worth one point.

5. The problem-solving workshops consisted of question and answer sessions on the basic embryology and clinical cases related to the topic under study. Understanding the pertinent embryology would be sufficient to solve these cases. Those concepts that were identified as unclear in the pre-workshop writing assignments were explained during the workshop. Students received 3 points per workshop attended for each section of the course for a total of 18 points.

6. The next step was to take an online assessment. For each section of the course, students had two assessments. These were closed book exams. The first one was online for two days and the second was online for the next two days. They received a maximum of 3 points per online exam for each section of the course for a total of 18 points. The highest online assessment score is the one the students get credit for. The grading of these assessments was 3 points for a score of 90 - 100, 2 points for a score of 80 - 89, 1 point for a score of 70 - 79 and zero points for scores under 70.

7. Finally, a final examination provided an authentic testing situation was worth 28 points toward the final grade. In this assessment the students were required to examine four cases of congenital abnormalities from the literature, much as though they were examining their own patients. They were then to describe the normal development of the structure that developed abnormally and then explain what went wrong that led to the described abnormality.

Evaluation

Over the past 10 years, the embryology course has undergone several changes. However, the recent attempts to use technology to help the students learn began in 1998. The students' perception of the course improved this year compared to last year and the addition of the more directed tasks seemed to be one of the major reasons. Students found the structure provided them with a better understanding of tasks to accomplish. Course evaluations, competed by 76.2% of the class, were done anonymously and were done online. In the fall 1999 survey, no one rated the course at the highest level and almost 30% of the class gave it one of the lowest ratings. This year the results improved with 12% of the class rating the course at the highest level and only 11% giving it one of the lowest ratings.

Last year, when asked whether lectures would have been a better way to deliver the course, over 55% agreed that it would be and less than 20% disagreed. This year, 43% thought lectures would have been better while 25% did not. In trying to understand this result it was clear there are still a significant number of the students that react negatively to the course based on their preference for a lecture/study/test paradigm. For example one student said "I disagree with Dr. Marino's philosophy of education. His view is that "fear in education" should be eliminated. However, like in all aspects of life, a little bit of stress/fear gives people an extra motivation to push ourselves and excel. I'm sorry to say that a class "full of fear" … was a much more enriching educational experience. I can't believe how much I learned in that (type of class) class. I appreciate an appropriate level of stress/fear that helped me to push till the wee hours of the night. This has been my personal experience." Another student wrote eloquently, "Your aim to see students embrace the material out of enthusiasm for the concept and an anticipation of its application in their clinical careers, has unfortunately been greeted with widespread inability for most students to perform at this higher level of learning. Your charge to students is rooted in fundamental principles which students do embrace at a basic level but they, as a whole, have been so ill-prepared for the task and unfamiliar with self-motivated instruction that even the first steps towards this superior educational strategy were not taken. The educational system in America has allowed students to succeed with sporadic bursts of pressure-driven motivation to complete a task immediately before them and simply move on to the next. Self-motivated learning is not fostered in American schools and neither is self-discipline to study the material in hopes of understanding and retention of the knowledge so it can be applied in the distant future. Students are not taught these fundamental skills and few are fortunate enough to have the insight or instruction to develop them on their own. So often motivation for learning is a means to an end, viewing learning opportunities merely as the task at hand and another step to climb and leave behind rather than a piece of the complex puzzle of knowledge required at the end of the path to be successful in the next."

Yet this year's changes did have the effect of improving the course. The students, liked the freedom to study at their own pace and appreciated the cases as motivating and helpful in seeing the relevance of their learning. A student commented, "The format of the course was very innovative. This was the first course that I took that was based mainly online. I loved the flexibility of learning everything at my own pace. The supporting case presentations were very helpful to see if the material was retained."

Another student wrote, "I liked the innovative way this course was taught. I really appreciated that the online presentations gave me the flexibility to listen to them on my own. I thought that the course respected the students' maturity and gave us more independence and trust than many other courses. I appreciate Dr. Marino's effort to listen to the concerns of the students and his effort to try and do things differently instead of just sticking to old, unchanging methods. I also appreciated the emphasis on ideas and themes instead of tiny details. Also, I liked the emphasis on clinical application of the embryology. It was always tough to picture the fetuses as actually representing human babies. It was nice to get that perspective. I felt there was a mutual respect between the students and the professor that I rarely see."

In the end the course still has a way to go. The efforts to build structure into the course were successful, but there was still something missing. Perhaps one of the students was very perceptive when commenting, "Ask no multiple-choice questions, ever, in any manner, as an evaluation of the course material. Multiple-choice questions play to the fact-cramming talents of medical school students. Minutia is their game and they are good. Concepts are not their game and they are lousy at them." While this may be the case, a compromise might be to still have online multiple-choice assessments as a means for students to assess their own progress and then to move toward more authentic testing more often than just for the final.

The cases were excellent ways to motivate the students to think and learn for clinical application and they could be used more during the workshops. Some of the students commented they would have preferred to have a chance to attempt the authentic testing that was done on the final during the semester. In addition, there was an expectation that the students would be able to approach this type of exercise based upon the verbal examples used in the workshops. However, the ability to be able to think in solitude and then write out your approach to solving the problem really does take a different set of skills and so more attempts at this type of writing will be employed more in the future.

In summary, this approach to teaching and learning, and the application of technology to give students ownership of their learning, still needs to be refined. As the technology becomes seamless in our educational systems we will be able to spend more time is think about learning. Hopefully, this will permit us to move toward more authentic teaching methods that are embedded in safe, humanistic learning environments that permit students to learn not from fear of failing but for the joy of learning.

Contact:
Thomas A. Marino, Ph.D.
Department of Anatomy and Cell Biology
Temple University School of Medicine
3400 North Broad Street
Philadelphia, Pennsylvania 19140
215-707-3704 (office phone)
215-707-2320 (fax)
marino@temple.edu
http://isc.temple.edu/marino/tom