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Can an email-prompted web-based e-learning platform aimed at undergraduates in the UK with moderate to persistent asthma improve compliance to their prescribed preventer drugs to 80%?

Fig. 1 Preventer, Reliever and volumetric. With good adherence the ‘brown one’ is taken as prescribed and the ‘blue one’ rarely needed. With poor adherence there is no brown on and there is dependence on the blue one. In this example a QVAR easibreather and a Venotlin inhaler. Mine. 

By presenting these ideas here I asking for support on how to make this research happen.

The medical profession is replacing the term ‘adherence’ with the term ‘compliance’. This reflects the desire to encourage self-management of prescribed drugs in concordance with health care providers (HCPs). For the purposes of this paper the terms should be considered interchangeable.

Asthma is a chronic and complex condition affecting the lungs that can be managed but not cured. (NHS Choices, 2013) (See Appendix 1 for a definition of ‘moderate to persistent asthma’). The World Health Organisation estimates that 300 million people globally are asthmatic (Web, 2001) while in the UK in 2010 5.4 million people were receiving treatment for asthma and there were 1,143 deaths. (Asthma, UK. 2013) An estimated 75% of hospital admissions for asthma are avoidable and as many as 90% of the deaths are preventable. (Asthma, UK. 2013) 80% compliance is the minimal level required for treatment to be effective (Lasmar et al., 2009).

Research construct

Asthmatics form a heterogeneous group that shows great diversity of triggers, effective medication, management strategies and outcomes. Research clusters asthmatics into four to six groups based on how they present and the drug regime they are on (Webb, 2011). Isolating a participant’s conditions and being confident that their medication is correct will be a challenge. For this reason, thorough in-depth interviews with participants, potentially with an HCP present, will be vital in order to set a benchmark.

A team at Harvard Medical School designed Qstream, the proposed e-learning platform (Kerfoot et al., 2008). Qstream (Fig.1.) takes its approach from an understanding of Ebbinghaus (Ebbinghaus, 1913) and how we forget and remember to provide a spaced-learning response that uses a combination of email alerts and interactive content to build knowledge. Its use has been researched with junior doctors in relation to their formal medical training and assessment (Kerfoot et al., 2008; Kerfoot et al., 2012) and in applied settings with healthcare practitioners to support informed decision-making. (Kerfoot et al., 2010)

Fig.1. Screengrab from Qstream homepage. (www.qstream.com)

On the basis of their research, Dr B Price Kerfoot says that ‘educational games work’ (Kerfoot et al., 2008. Kerfoot suggests that the next step is to use this approach with patients and ‘clinical decisions of greater complexity’ Kerfoot (2010:477). Research using Qstream involving people with chronic illnesses is planned to take place in North America in the Fall of 2013 (Vernon and Kerfoot, 2013).

What is the problem?

Too many people with a chronic illness, such as asthma, fail to take their medication as prescribed (Royal Pharmaceutical Society (RPS) of Great Britain, 1997; Hayes et al., 1979). This can lead to an exacerbation of the disease, risks hospitalization and even death. Non-compliancy rates are between 10-60% (Cochrane, 1992. Rand,1994), 30–50% (Horne, 1999), 50% (Di Matteo, Giordani, Lepper & Croghan, 2001; Kyngas, 2007 in Wales et al., 2011:148).

Reasons for non-compliance include medication side effects, expense of treatment, personal value judgments or religious or cultural beliefs about the proposed treatment, age–related debility, not having an action plan prescribed by an HCP, the patient not following the adequate treatment prescribed (Cerveri et al., (1999:288) or the presence of a mental disorder (e.g., schizophrenia, personality disorder).  American Psychiatric Association [DSM-5], (2013:726).

What is the opportunity?

According to McGavock et al., (1996) efforts to improve compliance have been unsuccessful; it is hoped that efforts using e-learning will be successful. The healthcare community – manufacturers, prescribers and frontline carers, recognise that education offers a way to reduce hospital admissions and deaths (Cerveri et al.,1999:288). The opportunity exists to increase compliance to 80% and therefore improve the health of millions of people with asthma.

A variety of programmes have tested a potential solution to non-adherence. (Byer & Myers, 2000; Hand, 1998; Tettersell, 1993), while Hacihasanoğlu and Goözuöm (2011) showed that patient education on medication adherence is effective. A variety of studies on e-learning in healthcare have used emails linked to multiple-choice questions and answers to improve patients’ knowledge and behaviours (Volpp et al. 2009; Kato et al. 2008).

The hypothesis

The hypothesis is that as a result of greater compliance through a ‘spaced learning’ e-learning education programme, non-compliant moderately persistent asthmatics will show changes in measurements of their illness and changes in their medication beliefs. (Based on Petrie et al., 2012:76).

Desired outcomes / results

Having completed a programme of e-learning using Qstream people with moderate to persistent asthma who had been noncompliant (under 80% compliant) should show changes in their illness and medication beliefs, improved compliance to their preventer inhaler and measured improvement across a range of physiological measures. (Based on Petrie et al., 2012:76) As a result of what they learn, the research will address patient perceptions, such as beliefs (Horne & Weinman, 2002), worries about long term use of steroids (Apter et al., 2003), fears and other concerns (Kaptein, Klok, Moss-Morrs & Brand, 2010). For example, 28% of asthma patients think that drugs are bad and not necessary while 12% think that drugs may not be not bad but aren’t necessary. Cerveri et al., (1999:292).

Achieving a reasonable level of compliance with treatment regimes has been shown to improve the health outcomes of patients undergoing treatment and reduce demands on health resources (Bender, Milgrom, Wamboldt & Rand, 2000; Dunbar-Jacob, Burke & Puczynski, 1995).

The long-term and broader opportunity exists to reduce hospitalizations, reduce costs, improve and extend lives.

Learning Theories

The learning theories that form the basis of Qstream are behaviourist (Skinner, 1974) and cognitive (Wenger, 1987; Hutchins, 1993; Anderson, 1983; Piaget, 1952) with problem solving, explanations and re-combinations. In line with this behaviourist approach early versions of Qstream worked best in formal learning contexts, for example first year medical students needing to pass an exam on anatomy. (Kerfoot et al., 2008) and practical clinical guidelines (Kerfoot et al., 2009). By complementing traditional medical training, with clear goals and the motivation to pass, the attraction of the platform are clear in this context. This stimulus-response approach, builds on the work of Ebbinghaus (1913) (Fig. 2)

Fig. 2. A typical forgetting curve for newly learned information. After Ebbinghaus (1913)

Through association, the learner takes a number of steps to build a composite skill. (Skinner, 1984; Gagné, 1985) (Fig.3) An accurate reproduction of knowledge can be assessed or demonstrated in drill and practice.

Fig.3. Screengrab from Qstream showing how a participant receives feedback on their response to a multiple-choice question.

Later and current versions of Qstream include components of peer competition, participant interaction and collaboration. This constructivist approach takes the view that learners build their own structures (Piaget, 1954). It also suites task orientated learning (Bruner, 1993) and assimilative learning. This constructed and socio-constructed approach to learning is less suited to assessment simply by looking at exam grades, therefore in-depth interviews or comprehensive self-reporting surveys are required to elicit what took place and the level of knowledge attained especially as evidence of learning by people with asthma won’t be elicited through formal assessment.

Why undergraduates?

The research shows that younger asthma patients in the age 14-25 years are less likely to use their preventer medication than older patients (Diette et al., 1999; Legorreta et al., 1998), which makes ‘young people an important group to target for improving adherence and reducing their underuse of preventer-inhaler corticosteroids’, (Pertie et al., 2012:75). For this reason, and to exploit study parameters of population size and geography, a university undergraduate population is proposed.

METHODOLOGY/METHODS

A mixed-method approach will be adopted with qualitative and quantitative components. In-depth pre and post intervention interviews will form the qualitative element, while the quantitative component will be based on several hundred student participants taking part in a randomized controlled trial and use analytics generated by the Qstream platform. The aim is to interview approximately 30 students in-depth within the parameters of a single university. For example, Adams, Pill & Jones, (1997) favoured in depth interviews with a carefully selected and eligible number of patients before and after intervention. For quantitative analysis the far larger pool of participants will be drawn from a UK wide undergraduate student population using platforms such as The Student Room (www.thestudentroom.com. The Student Room, 2013) and Asthma UK to recruit participants. According to Kerfoot & Baker (2012) an individual randomized control trial is preferable were there is a large sample size. Extending to a sample of four UK universities might increase the potential number of participants to 9000+ (See Appendix 2). Self-reporting screening would be used to ensure that only those in the desired group took part.

Based on UK statistics on asthma in the population, it can be calculated that at, for example, the University of Southampton from a total undergraduate population of 17,000 there are likely to be between 485 and 586 students with moderate to severe asthma. (This intentionally excludes those likely to have a mild form of the disease, and those with a profoundly severe form of the condition). (See Appendix 2 for break down of likely respondents). Asthma UK (2013) suggests that amongst asthmatics 48% consider themselves to be at risk. If this percentage of potential participants volunteered then the starting population for the proposed research is likely to be around 250. It is reasonable to suggest that by working with four different universities of a similar size the total population for a randomized control trial would increase to 1,000.

Identifying those who are moderate to severe asthmatics and agreeing criteria has confounded asthma studies in the past, therefore great care will be required to set parameters, the simplest being that where an asthmatic has been prescribed only two medications, a preventer inhaler (known as the ‘brown one’) and the reliever inhaler (the ‘blue one’) that their condition is considered to be ‘moderate to severe’.

Having a sound basis for giving a person’s baseline, for both compliance and knowledge of asthma and how it is treated, will indicate if an improvement in adherence has been made and whether this e-learning approach has been effective.

To have a physical measure you can audit the prescriptions issued or weigh the inhalers to establish how much has been expelled, however Spector (1985) found cases of both miss-application and trial firing.  A blood test is definitive, but this could only be carried out by an HCP. The alternative is to ask patients how they got on, however patients are thought to overestimate their actual drug use by between 30 and 50% (Spector, 1985; Sacket and Snow, 1979). In the case of people with asthma, Horn (1992:126) found that 11% who claimed to have inhaled salbutamol in the preceding four hours had no detectable drug in their urine.

Whilst therefore there are advantages in conducting interviews, patients are giving a subjective measure of their treatment compliance (Sawyer, Rosier and Phelan, 1995). This method suffers from being the most inaccurate of any available (Horn, 1999:126), however the alternative requires a series of tests that need to be administered by an HCP.

This ethnographic investigation would be open and exploratory  (RPS, 1997). A system of meanings would be taken either from transcripts (Scherman and Löwhagen, 2004:4) or preferably from audio recordings as current best practice in medical market research favours working from the audio as nuances of meaning are more likely to be apparent (Kazmer & Xie, 2008).

Given the complexity of influencing compliance and the desire to use this as a measure of effective learning, structured and semi-structured in depth interviews will take place. In addition physiological improvements to lung functionality need to be measured for a sample of the participants to offer an objective indicator that a change of behaviour has occurred.

Other influences on outcomes that should be revealed in a semi-structured interview include issues of identity in relation to learning (Kirkup, 2001; and Hughes, 2007) and motivation, what Resnik (2008) describes as ‘passion based learning’.

The text from these interviews will be analysed for clusters of meaning, aiming to pick out nuanced responses, potentially from video but at least from audio recording of interviews (Kazmer & Xie, 2008), which according to Webb (2011) is preferable to working from text alone

The aim would be to reveal the experiences of those interviewed and so come to a view of ‘understandings and misunderstandings’ about their condition, the role their prescribed ‘preventer’ medication plays and the value of Qstream.

Qstream offers a variety of ways to monitor and measure activity on the platform (fig. 4) . This is how data and metadata from several hundred participants would be analysed. (Appendix 3 lists the affordances of using a Qstream private site)

Fig. 4. Screengrab showing example of analytics available on a group of 356 learners.

TIME LINE CHART


Fig. 5. Simplified model of research. Punch (2006: KL 487 )

Phase One

  1. Submit Proposal

  2. Seek and secure funding

  3. Purchase UK license for Qstream.

  4. Undertake training on the Qstream platform

  5. Seek approval from appropriate ethics committee

  6. Speak to and engage subject matter experts and HCPs: consultant, GP, practice nurse, welfare office and disability officer.

  7. Consider the merit of ‘reversibility testing’ which involves taking measurements of asthmatics’ breathing before and after the Qstream ‘trial’.

  8. Prepare content for Qstream: text, images, multiple-choice questions. Contents to include: bite-size video, interactive notes and legalese.

  9. Prepare recruitment communications (posters, email campaign, university and student websites, the student rooms, Asthma UK.)

  10. Test platform on university server

  11. Email links to online survey

  12. Screen potential participants to under 1000 and divide for randomized controlled trial. See Kerfoot et al. 2010:332 Flowchart of a randomized controlled trial.

  13. Filter the sample for in-depth interviewing from those enquiring about respiratory symptoms, attacks of asthma, use of asthma allergies, together with questions on how they have or usually gain knowledge on the disease, its treatment and their diagnosis and compliance behaviours. This is likely to be kept to one geographical and healthcare region based on the population of a single university.

  14. Conduct initial interviews from this filter group to establish eligibility.

Eligibility for interviews and physiological testing would be based on patients with the indicated symptoms though excluding patients with serious social problems and severe learning difficulties. (Franklin et al., 2006)

  • Who?

  • How many?

  • Age?

  • Gender?

  • Where referred?

  • How long diagnosed for?

  • Smoking or not?

Aim to recruit 30+ students for in-depth interviews and <1000 for a randomized controlled trial using the Qstream platform.

Confirm participants, ensure that they understand the terms and nature of the research and request that they read and agree to these and that participation is voluntary, information will be confidential and their written consent is required.

Invite all or some to complete either an asthma Journal or, as they have been shown to be effective, an audio log. Patient-reported outcomes would help us understand the impact of drugs on patients’ lives and activities. “Are patients really doing better? Can they sleep through the night rather than waking up with a sense of shortness of breath?” Bohen (2013: 863)

Phase Two

Pre-Qstream Interviews

  • Conduct in-depth interviews to establish baselines for compliance as well as knowledge of asthma as a chronic illness with responses given on a Likert Scale. (Horne, 1999).

  • Video or audio record.

  • Horn’s ‘Offer Self Image Questionnaire’ (1977) will be used as part of the in-depth interview to Horn (199:126) considered this a central part of compliance assessment strategy. The chronic disease compliance instrument (CDCI) (Kyngas, Skaar-Chandler, and Duff, 2000) will be adapted and its use considered.

  • Complete physiological measurements: blood test, skin test and assessment of lung function and spirometry and airway challenge. Cerveri et al., (1999:289)

Run Qstream e-learning programme for 12 weeks

Phase Three

Post-Qstream Interviews

  • Conduct in-depth interviews to re-assess compliance. Aim to gauge how and if this has changed and why amongst the 30 selected for this purpose. Assess verbally for knowledge of asthma. Include questions on the Qstream platform itself. According to Van Dijik, 2005) questions after the intervention should include operational skills, managing the software on different platforms and how they got on with the multiple-choice process skills.

  • Video or audio record.

  • Repeat of physiological measures to understand if there have been improvements in, for example, lung function.

Analyse data and metadata generated by the Qstream platform

  • Listen through interviews and undertake cluster analysis of ideas and issues in order to establish patterns of meaning.

  • Is there a correlation between compliance and reduction in the severity of asthma?

  • Is there a correlation between increased compliance and completing the Qstream e-learning module?

Write up and report findings.

Follow up a year later to see if the impact of the learning is maintained over time through changing behaviours.

Limitations

No study of a therapeutic regime can be considered fully valid without some documentation of whether the patients took their treatment. Horn (1992:127) Establishing valid data on whether people take their medication as prescribed will be a challenge.

No single method of assessment of compliance with (anti-asthma) therapy is ideal nor does any one method give a full picture of the pattern of compliance. Usually the chosen method(s) will require to be validated specifically for the particular circumstances under investigation.

An issue arises with using an Internet and mobile alert system where potentially limited or broken Internet access or paid-for Wi-Fi impinges on the student’s access to the resources. Care will be taken both over how content is scripted and produced, as well as securing a robust platform. Kerfoot and Baker (2012:13) had problems in relation to: ‘server errors’,  ‘attrition’ (Kerfoot & Baker, 2012:4), ‘fatigue’ (Kerfoot et al., 2010) and technical hitches due to spam blockers (Shaw et al., 2011) as well as the challenging nature of the content. (In Vernon, 2013)

It is also reasonable to suggest that those who are noncompliant to regularly taking their prescribed medicine could also be ‘noncompliant’ to the features of Qstream – a twice or thrice weekly prompt to take a few minutes to answer some questions.

A UK license for up to 1,000 participants to use the Qstream platform is $15,000 per annum.

In research carried out by ZoRA et al. (1989). Only 1 in 17 diary sheets completed by asthmatic children (under age 14) were accurate to within 10% of the number of puffs used. Whilst the participants in this research are older, any completion of a dairy sheet will include errors and inaccuracies.

Overestimation in self-reporting is well known and probably due to a desire to please. (Cochrane, 1995. Cochrane 1998)

Failure of a therapeutic regime can only be ascribed to poor compliance if appropriate drugs are being prescribed in adequate dosage that historically has tended not to be the situation in the management of asthma. (Horn, 1992:127)

The population using the Internet is diverse. This impacts on research in relation to access and having a representative group of participants. (Eynon, 2009). The use of Qstream in a student population favours use of a mobile device for ease of response to email prompts. It is suggested that 53.7% of people in the UK will be using smartphones by 2014 with those aged 18-25 by far the largest group followed by teenagers (New Media Trend Watch, 2013) whilst it is estimated that nearly 38% will have tablets by this time. (eMarketer, 2013).

Ethics

For ethical reasons an institutional review board would be approached for approval to perform this study. (Kerfoot & Baker, 2012:2)  (In Vernon, 2013)

  • A standardized form will be used to obtain informed consent from participants.

  • Well Being, confidentiality and anonymity will be stressed.

  • Rights will be clearly explained

  • The personal safety of those conducting the research will be considered.

  • Conflicts of Interest will be declared, for example, Dr Kerfoot is on the board of Qstream.

  • Unintended consequences will be considered.

  • People have to have the freedom to make mistakes in relation how they elect to adhere, or not, to the prescription drugs they are prescribed. Mental Healthcare Act.

Validity and reliability

If one hope is to correlate a physiological change with improved knowledge an array of factors need to be isolated and measured. Data from both a qualitative and a quantitative approach, the clusters of issues and ideas from analysing what is said in pre and post interviews and the activity on the Qstream platform will offer some indication of what is taking place and why.

Implications for future policies, practice and further research

1) Socio-constructed learning and connectivism

It is further hypothesized that effective compliance is most likely to be achieved where in addition to the patient, the related HCPs engage in the proposed e-learning programme. Social interaction has an important role to play in learning. (Vygotsky, 1978) Donath (2002) shows how through exchanging information a person gains recognition and that social learning of this kind provides affiliation. This suggests value in having HCPs, even family, especially parents and guardians, of younger people with asthma taking part in a Qstream learning programme and exploiting how we connect in networks (Kit Yee et al., 2011) Wang (2008:05) considers the importance in learning of both the student and instructor. HCPs would play the role of ‘intermediaries’ (Laurillard, 1993).

This not only invokes ideas of values relating to communities of practice (Lave and Wenger, 1991) but also, in our digital age, to ‘connectivism’ (Siemens, 2006; Calvani, 2009: de Waard, 2011) – where ‘nodes of readily available information’ are linked to and shared between learners. (Edudemic, 2013) The asthmatic as a learner can question their own knowledge and understanding by connecting with others, as part of a ‘community of practice’ (Lave and Wenger, 1991), from the periphery (Brown, 2002; Brown, 2007) and vicariously (Cox, 2006). Connecting with other people with asthmatics online is supported by the Asthma UK website (Asthma UK, 2013)

2) Use of narrative and creative content

Fig. 5 Screengrab introducing a series of animated videos on design. Open Learn (2013)

The quality and style of scriptwriting using the Qstream platform will impact on effectiveness. (Laurillard, 2000 and Jewell and Hooper, 2011) understand the role of narrative in learning. Resnik and Chang (2008) talk about the need for e-learning to be self-revealing, pleasurable and fun, with a ‘low threshold and high ceiling, supporting collaboration, plugins and making it iterative’ and ‘tinkerable’. The Open University, through Open Learn, often use rich video content to engage audiences, for example with a series of short video in ‘Design in a nutshell’. (Open Learn, 2013)

3) Further personalisation of e-learning

Intelligent Web pages that can adapt themselves to a person’s linguistic and other competence are examples of more ambitious applications that we might look forward to in coming decades. (Hara et al., 2006:352)

4) Extend duration of study period

This study would initially be restricted to a single term or academic year, though it could be extended, for example, to include first year undergraduates through the 3 to 4 year duration of their undergraduate studies. Ostojic et al.,  (2005) carried out a 4-month trial, whilst trials run by Kerfoot (2008-2012) have run for as long as 45 weeks.

5) Include other chronic illnesses:

Allergic rhinitis is comorbid with asthma (Bousquet at al., 2013) warranting its inclusion in future research alongside studies on asthma. Other chronic illnesses that may benefit from Qstream’s use by patients includes diabetes, epilepsy, Parkinson’s and Alzheimer’s.

6) Consider ‘Big Data’, Web 2.0, Pedagogy 2.0

There is the potential of automatic real-time data gathering relating to inhaler use with a microchip and the use of wearable technology even an ingestible smart pill (Engineer Online 2012; Arnold, 2013) in medicine. Supported by enhanced patient knowledge of their illness. Armed with this data, analysed automatically, and read by the patient or an HCP, the drug regimen and response to it is closely monitored. Such patient analytics are akin to student performance analytics (Koller, 2012) providing HCPS and educators with the potential for gathering and analysing data and metadata from hundreds of thousands of participants.

Conclusion

The opportunity exists to develop an e-learning programme that change lives – that improves the health of those with moderate to persistent asthma. Research suggests that greater knowledge and understanding of a chronic medical condition and personal medical and lifestyle responses and self-management improves compliance. However, the way the illness presents are complex, the triggers and symptoms vary greatly. The approach suggested here also offers the chance to establish if learning brings about a change in behaviour that can be measured in a physiological response – improved lung function and the role an e-learning platform can play. In due course, if a reasonable percentage of the 300+ million asthmatics who are online engage with an e-learning programme such as this significant insights and improvements to health can be made.

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Picard, R, Papert, S, Bender, W, Blumberg, B, Breazeal, C, Cavallo, D, Machover, T, Resnick, M, Roy, D, & Strohecker, C (2004) ‘Affective learning – a manifesto’, Bt Technology Journal, 22, 4, pp. 253-269, Science Citation Index, EBSCOhost, (viewed 24 June 2013).

Perlin, K. and Fox, D. (1993) Pad: An Alternative Approach to the Computer Interface, Proceedings of SIGGRAPH ’93:20th Annual Conference on Computer Graphics and Interactive Techniques, 2-6 August 1993, Anaheim, California, USA, 93:57-64.

Petrie K.J., Perry, K., Broadbend, E., Wienman, J (2012) A text message programme designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer medication’.

Punch, K.F. (2006) 2nd Edition. Developing Effective Research Proposals.

Resnik, M and Chang, A (2008) Tinkering Together: enabling synchronous creativity and distributed collaboration for kids, MAS 712 Technologies for creative learning.

Royal Pharmaceutical Society (RPS) of Great Britain. (1997) From compliance to concordance: achieving shared goals in medicine taking. London: Royal Pharmaceutical Society of Great Britain

Sawyer, S., Rosier, M. J., & Phelan, P. (1995). The self-image of adolescents with cystic fibrosis. Journal of Adolescent Health, 16(3), 204–208.

Sharples, M., Corlett, D. and Westmancot, O. (2002) The design and implementation of a mobile resource, Personal and Ubiquitous Computing, 6: 220-34.

Soloway, E, Norris, C, Blumenfeld, P, Fishman, B, Krajcik, J, & Marx, R 2001, ‘Handheld Devices are Ready-at-Hand’, Communications Of The ACM, 44, 6, pp. 15-20, Business Source Complete, EBSCOhost, (Accessed 24 June 2013).

Stenhouse, L. (1981) ‘What counts as research?’, British Journal of Educational Studies, vol. 29, no. 2, pp. 103

Scherman, M, & Lawhagen, O (2004), ‘Drug compliance and identity: reasons for non-compliance : experiences of medication from persons with asthma/allergy’, Patient Education & Counseling, 54, 1, pp. 3-9, CINAHL, EBSCOhost, (viewed 12 March 2013).

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Vernon, J.F. (2011) Practice-based research in e-learning (H809). Tutor Marked Assignment 1 (TMA01)

Vernon, J.F., and Kerfoot, B.P. (2013) Skype conversation on the use of e-learning in healthcare in relation to people with chronic illnesses. Considered H809 TMA01. (Unrecorded)

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Wokasch, M. (2010) Pharmaplasia. Wokasch Consulting LLC.

APPENDIX ONE

How to define asthma

MODERATE PERSISTENT – IN THE RESEARCH GROUP (aboutasthma.com)

Your asthma severity is classified as moderate persistent asthma when:

  • You have asthma symptoms daily.

  • You wake up from your asthma more than one night per week, but not every night.

  • You use your rescue inhaler daily.

  • Your asthma moderately interferes with your daily activities.

With moderate persistent asthma, you will need daily asthma medication with anti-inflammatory properties, as well as a second medication.

You are able to gain control of your asthma with two medications, what we call the ‘blue one’ and the ‘brown one’.

The brown one, the inhaled steroid, you take a couple of puffs in the morning and a couple at night.

The blue one, the reliever, or what in North America they call the ‘rescue’ inhaler, you take as required

Source:

National Heart, Lung, and Blood Institute. Accessed: May 20, 2010. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma

APPENDIX 2

% =/-5% too ill to attend ‘profound’

SOTON 17000 undergraduates

First years 5,000 – 5,500

Total Soton

9.5%

Total

Soton 11.5%

First Years

9.5%

First

Years

11.5%

Across4 UK

universities

Approx: students with asthma in the undergraduate population

1,615

1,955

475

575

64,500

Describing themselves as:

41% very mild

662

801

195

234

26,445

27% mild

436

528

128

155

17,415

19% moderate

307

371

90

109

12,255

11% severe (Wales et al., 2011)

178

215

52

63

7,095

Moderate to severe likely to be:

485

586

142

172

19,350

48% think they are at risk (Asthma UK)

232

263

68

82

3,405

53.7% smartphones by 2014

125

141

37

44

1,829

less 4% self exclude from digital devices

120

135

36

42

1,756

University of Southampton

Of an undergraduate population at the university of Southampton of 17,000 UK asthma statistics (Asthma UK, 2013) would suggest that between 1 in 10 and 1 in 12 are asthmatic (in a school population 1 in 12 has asthma, while there are 1 in 10 in the general population). Of these 5% have severe asthma and are unlikely to be attending university. This would suggest that between 9.5% and 11.5% as asthmatic. So between 1,615 and 1,955 asthmatic, of whom 662 to 801 likely to say that they are very mild and from 436 to 528 mild so have no medication, or a reliever at most (if they’re right). Between 307 and 371 moderate and 178 to 215 severe – so likely to be on a reliever at least at one end of the spectrum and a preventer too towards the more persistent or severe levels. i.e from 485 to 586. Of these 232 to 263 are likely to think they are ‘at risk’ (Asthma UK). Horn (1992) suggests that patients who admit to poor compliance may be more amenable to compliance modifying strategies; EU funded research into asthma has shown a significant willingness of those with this troublesome disease to take part in research (Cerveri et al., 2013) Whilst use of a smartphone does not define a person as digitally literate a self-reporting interview will isolate those who are … which might be, given use of e-learning in higher education, most of this group. A further reduction is given to exclude some who will not use these devices.

Potentially conducted across four universities:

  • University of Southampton. 17,000 students.
  • City University, Finsbury, London. 17,000 students. Urban
  • University of Cumbria in Lancaster and Newton Rigg, Penrith. 10,500 students. Rural
  • University of Oxford. 20,000 students.

APPENDIX THREE

Benefits of a private site using Qstream

User admin

Batch invite

Batch enroll

History – invite, enroll

Delete

Email issue mgmt

User registration report

Access to learner email addresses

Reporting & analytics

User tagging

Management roles & reporting

Management summary engagement emails (weekly)

Engagement summary

Engagement detail & export

Learner performance summary

Learner performance detail & export

Snapshot analytics

Trend analytics

Question performance report

Question performance answer matrix

Question performance analytics

Site admin

Monitor site activity

Monitor comment activity for site

Site branding (logo, tagline, home page, Dashboard, URL)

Site localization (site branding translations)

Email branding (sender name, organization logo)

Private site publishing privileges

Course admin

Manage comment activity for course

Shut down courses

Basic course branding (course logo, course title)

Adv course branding (sender name, organization logo)

Private course catalog

Public course catalog listing

Private, closed courses

Open enrollment courses

Control course ‘operations’ (spacing, locked/unlocked)

Completion management (%, certificate, messaging)

Assign authors, co-authors

Assign moderators

Learner experience

Customized leaderboard gaming (email display, online display, invid, team, monthly, rollilng)

Localization

Mobile

Native app with notifications

Mobile interface

Course authoring

Course catalog description/listing

4 question types (MC, MCA, T/F, FIB)

Preview/validation of questions

Security

Auto login

Data security

Social & collaboration

Assign course moderator

Learners can post private or public comments

Comment management tools

Advertisements

Notes on inclusion in open learning

INCLUSION

Inclusion/Case Study : John, an engineering Postgrad PhD student with Cerebral Palsy.

Inclusion/Multimedia Demo: Xerte.

Inclusion/Workshop: Creative Problem Solving: YouTube

Loads of ideas in VanGundy’s book: VanGundy, A.B. (1988) Techniques of Structured Problem Solving, 2nd ed, Van Norstrand Reinhold. Techniques 4.01, 4.06, 4.57

INNOVATION

Innovation/Paper: Spaced-Ed, now QStream. A platform initially designed to support junior doctors as they revised for formal knowledge assessments. Paper (Paper available in OU Library)

Innovation/demo: QStream 90 day trial.

Innovation/Workshop: Creative Problem Solving:

TAGS: c

Reflections of a post-post graduate – the no-man’s land before a PhD

 

Fig. 1. How the eBrain looks – everything’s tagged. (Lost property, London Underground)

I’m delighted to say the Open University’s student blog upgrade is an enhancement. The improvements are seamless without any loss of what we had before … a ‘bulletin-board-cum-blog-thingey’.

Become an OU student to see this for yourself.

I will get Internet access in my ‘office’ – a studio down the road, away from home and family, DIY, the garden … but not the dog. She’s allowed.

All that it requires from me is something I lack – self-discipline NOT to get distracted by email, which includes updated postings from forums and the likes of Linkedin (let alone a gaggle of family members on Facebook). AOL is the worst as I innocently go to check email and find 20 minutes later I am still clicking through the inviting gobbets of news and sensation that is offered.

I had hoped to behave like the smoker trying to give up – I’ll only smoke other people’s fags. A very, very, very long time ago … I can honestly say I have never smoked a cigarette since I turned 20.

Back to the Internet. Like Television.

Or diet. We are living in an age where self-control is vital. Having not had a TV for several months I was eventually pushed to buy one. Courtesy of Which? we now have a TV so Smart that it probably tells my brother in South Africa who is watching what …. we can Skype sofa to sofa. I just wonder if our antics could be recorded and posted on YouTube? Not my doing but any of the teenagers with the wherewithal just hit a record button somewhere.

In all this hi-tech I DO have a tool I’d recommend to anyone.

I’ve invested in an hour-glass. In runs for 30 minutes. While that sand is running all I may do is read and take notes. This might be an eBook, or a printed book, either way they are on a bookstand. I take notes, fountain pen to lined paper. What could be easier? The left hand may highlight or bookmark and turn a page, while the right writes?

This works as the filtering process of the knowledge that I am reading and want to retain needs to go through several steps in any case. The handwritten notes will be reduced again as I go through, typing up the ideas that have some resonance for me.

My current task has been ‘How Europe went to war in 1914’ by Christopher Clark.

I doubt my second thorough read will be the last. From notes I will start posting blogs and going into related social platforms to share and develop thoughts and in so doing be corrected while firming up my own views. I need this social interaction, to join the discussion if not the debate.

Meanwhile I will revisit Martin Weller‘s book on Digital Scholarship.

However swift the age of the Internet may be he suggests it will still take a person ten years to achieve the ‘scholar’ level … whereas John Seely Brown recently reckoned this was now down to five years. i.e. through undergraduate and postgraduate levels and popping out the other end with a PhD in five years.

DIdn’t an 18 year old who was home schooled just get called to the Bar?

She graduated with a law degree while contemporaries did A’ Levels and finished High School and then did a year of pupilage I suppose.

The intellectual ‘have’s’ of the future will, by one means of another, achieve degree status at this age. The Internet permits it.

School is far, far, far, far, far too lax.

It tends to the median if not the mediocre. Long ago it found a way to process kids as a genderless year group instead of treading each student as an individual … so let them skip a year, let them stay back a year … allow them to expand and push subjects that appeal to them.

Reading ‘Red Nile: a biography of the world’s greatest river’ – a gem

At times you laugh out loud, always informative, great stories, full of well-known facts with a twist, as well as a myriad of gems. The kind of book I would have bought and sent to people for the pleasure of it … not sure how that works with an eBook. If Michael Palin had got stuck in Egypt for six years, without the film crew, he might have made a stab at it. I described Robert Twigger to my wife as Michael Palin’s mischievous younger brother. (I know Robert, though I’ve not seen him for twenty years). He’s exceedingly bright but very modest, even humble. A boffin you might find going through second-hand books in a pile at a charity shop.

There’s an intimacy, cleverness and a flash of British funniness throughout. Encyclopedic whilst as readable as an unputdownable novel.

For me this is the very best travel writing. I’ve bounced into it via a need to take an interest in ethnography in H809 Practice-based research in e-learning. I found myself watching ‘Seven Years in Tibet’ then reading the book by Heinrich Harer. ‘The Red Nile’ is written in a similar vein, though Robert’s relationship is with the river and not the Dalai Lama. The book touches on a good deal of anthropological study of the peoples of the Niles (blue and white). It’s value is how easy it is to read after all the academic papers, and how quotable and informed it is too.

‘It seems peculiar to me that specialisation should involve developing a point of view that obscures the very subject you wish to study’.

This is I will take as a warning as I venture towards doctoral study. My interest is in learning, and e-learning in particular. Learning can apply to many, many fields. We all do it whether we want to or not.

Why skiing is my metphor for life and learning

Fig.1.   Mont Turia from the summit of Aiguille Rouge, Les Arcs at 3250m

On the last day, on the last run of my first week’s skiing I broke my leg rather badly. I was 13. I was in hospital for a week. In a wheelchair for two months and had the leg re-broken as it wasn’t setting properly. I spent six months at home. Idiot. But most 13 year old boys are.

I missed the next season.

For the following 20 years skiing mattered – a gap year working in the Alps (Val D’Isere in the Sofitel Hotel working 13 hours a day 7 days a week), a decade later researching a TV documentary and book  (Oxford Scientific Films, Skieasy Ski Guides), falling in love with a fellow skiing enthusiast (we’ve been married 20 years), a honeymoon on the slopes and ten years later, on the slopes with a 4 and 6 year old, then again when they were 10 and 12. 

I miss it.

(See above – the last week of the season, Tignes. The only people on the slopes are the ‘seasoniers’ who have worked since December. It is like being on the beach. A stream that flows above Val Claret melts and various ponds form. We ski it.)

Early in the afternoon I’d asked my girlfriend if she’d marry me. I was feeling cock-a-hoop.

We’ve been back twice in the last decade. There have been other priorities. I’ll be taking my 14 year old son out later this month or in April. Is that wise? At this age teenagers really are prone to take risks and can lack the physique.

Reasons to celebrate and look forwards

37 months to the day after starting the Masters in Open & Distance Education (MAODE) I got the final result, for H810: Accessibility in Open Learning – supporting students with disabilities, today. 84.

It has been so worth it and such a better, engaging, effective, experience than my undergraduate degree in a traditional university some decades ago. I feel as if I have earned it for a start. I have survived disasters rather than succumbed to them.

I am a reading, thinking, writing machine.

I feel like someone who has come to skiing late in life and has caught the bug. My mother started skinning in her mid 40s … and in her 50th year (unencumbered by her husband who was with wife three by then) sold the house and did a belated ‘gap year’ working a season in the Alps. The equivalent for me has to be the intellectual challenge of doctoral research.

More reading, thinking and writing – with research and teaching too I hope.

Onwards.

Tutor Marked Assignment One  (TMA01) for H809 (Practice-based research in educational technology) is due on Monday.

Why more?

‘Practice-based research in educational technology’, to use skiing as a metaphor, is like learning to ski ‘off-piste’. Apt, as the tracks I make are ones I have planned, rather than keeping to the groomed, signed and patrolled ‘safety’ of the regular runs.

And my reward?

Fig. 2. Mont Blanc – From the Ski Resort of La Plagne,  Above Montchavin. Les Arc on the right . The road to Val d’Isere clinging to the mountain in the middle distance Bourg St. Maurice in the bottom of the Valley

Skiing en famille.

We’ve not been out for five years so it should be a treat. It has to be on a shoestring, so short of hitching to Bulgaria can anyone recommend ways to keep the cost down?!!

 

Blogging breached the guidelines a bunch of us followed in 2002 – now anything comes and goes on e-folded origami paper we call a blog

Fig. 1 Blogging brings like minds together – through their fingertips

I did a search in my own blog knowing that somewhere I cited an academic who described blogging as ‘whatever you can do on electronic paper’.

Chatting about this at dinner my 14 year old son trumped my conversation with his mother as I tried to define a blog and what can go into one with one word ‘anything’.

For me there has been a slow shift from text (the weblog-cum-dairy journal thingey), to adding pictures (which have become photo / image galleries, photostreams of Flickr and concept boards of Pinterest), to adding video … to adding ‘anything’ – apps, interactivity, grabs, mashups, music …

My starting place is here.

This ‘eportofolio, writers journal, aggregating, dumping ground, place for reflection and course work’.

You see, is it a blog at all? This platform, I’m glad, has its design roots in a Bulletin board.

The limitations of our OU Student Blog platform works in its favour.

I can only put in two search terms. In Google I might write a sentence and get a million links, in my wordpress blog it might offer have the contents.

Less is more.

Here I search ‘blog paper’ and get 112 posts that contain both words.

I’ll spin through these an add a unique tag. My starting place.

But to study blogging would be like researching the flotsam and jetsam that floats across our oceans – after a tsunami.

RESEARCH

Starting with a book published in 2006 ‘Use of Blogs’ I want to read a paper ‘Bloggers vs. Journalists’ published in 2005. A search finds richer, more up to date content. Do I even bother with this first paper? (ironic that we even call them papers).

I can’t read everything so how do I select?

  • Toggle through the abstract, check out the authors, see where else such and such a paper has been cited.
  • Prioritize.
  • Use RefWorks rather than my habit to date of downloading papers that MIGHT be of interest.

Whilst storage space is so inexpensive it is virtually free there is no need to clutter my hard drive, Dropbox or Google Docs space.

Which makes me think of one of my other favourite metaphors – kicking autumn leaves into the breeze. That or drowning in info overload, or as the Robert de Nero character in Brazil, Archibald ‘Harry’ Tuttle, who vanishes in a pile of discarded paper … my mind wanders. We do. It does.

I stumble in the OU Library as I find I am offered everything under the sun. I am used to being offered academic papers only. So far all I’m getting are scanned images of articles in newspapers on blogging. All feels very inside out.

Where’s the ‘turn off the printed stuff’ button?

I fear that just as I have never desired to be a journalist, preferring the free form of your own diary, letters, and of course blogging and forums online, I will struggle to write within the parameters of an academic paper. I’m managing assignment here, so I guess I’m learning to split the two. A useful lesson to have learnt.

Serendipity

Is this a research methodology?

I am looking at a book on blogging, ‘Use of Blogs’ (Bruns & Jacobs, 2006). I have it open on p.31 Notes (i.e. references) for the chapter Journalists and News Bloggers.

As I pick through these articles, papers and reviews written between 2002 and 2005 I find several of the authors, a decade on, are big names in the Journalism/Blogger debate. It’s as if I am looking at a tray of seedlings.

It strikes me as easier to start in 2006 with 27 starting points when the field of debate was narrow, rather than coming in from 2013 and finding myself parachuting into a mature Amazonian jungle of mixed up printed and digital, journalism and blog content.

Courtesy of the OU Library and RefWorks I have nailed this article after a decade of searching:

Druckerman, P (1999) Ellen Levy Has Got The Write Project For the Internet Age — It’s a Year of Scribbling Down Almost Everything; Ah, Yes, It Was a Raisin Bagel, New York, N.Y., United States, New York, N.Y.

Reading this around 23rd /24th September 1999 prompted me to start blogging

Then I’d been reading blogs for a few months but had a mental block with uploading HTML files and then along came the first ‘ready made’ DIY blogging platforms.

The last 12 years makes amusing reading – particularly the battle between journalists and bloggers. And who has won? Is there a difference anymore? Journalists blog and bloggers are journalists and entire newspapers are more blog-like from The Huffington Post to the FT … which within three years will close all its print operations.

To be used in learning and to be a genre to study blogging needs to be part of formative assessment

A blog therefore becomes ‘an active demonstration of learning’ with cumulative feedback. I’ve only received ONE Tutor comment in my OU blog and that was to say why was I blogging and not getting on with my TMA. This person had their head so stuffed inside primary school education of the 1960s it made me feel like tossing my cap in the air.

Why MAODE students blog (Kerawella et al, 2009) depends on their perceptions of, and for:

  1. an audience
  2. community
  3. the utility of and need for comments
  4. presentational style of the blog content
  5. overarching factors related to the technological context
  6. the pedagogical context of the course

Cited x30

REFERENCES

‘Bloggers vs. journalist: The next 100 year War?’ 2011, Public Relations Tactics, 18, 4, p. 17, Business Source Complete, EBSCOhost, viewed 18 February 2013.

Bruns, A. Jacobs, J. (2006) Use of Blogs.

Kerawalla, L, Minocha, S, Kirkup, G, & Conole, G (2009) ‘An empirically grounded framework to guide blogging in higher education’, Journal Of Computer Assisted Learning, 25, 1, pp. 31-42, Academic Search Complete, EBSCOhost, viewed 18 February 2013.

Rosen, J. (2007) ‘Web Users Open the Gates’, Washington Post, The, n.d., UK & Ireland Reference Centre, EBSCOhost, viewed 18 February 2013.

How to visualise learning – think Lava Lamps!

Fig. 1. Lava Lamps – and how we learn – on a rising thermal and in coloured, slimy blobs …

There is a physiological response to the first moments of a new module – I am nervous. This is like meeting the cast for a student play for the first read through. Intrepidation and expectation. As ever, I know no one, not the tutor or fellow students, though many of us have surely crossed paths on previous MAODE modules. We certainly have all of that in common so will have a set of themes and authors, favourite moments and gripes to share.

Visually I see this as my ‘Lava Lamp’ year!

The blob is starting to stretch and will at some stage take me away from the Master’s Degree – now complete – and onwards either returning to learning and development in the multinational / government department arena of my past, or into research.

Fig. 2. Lava lamp inspired quilt – illustrates this idea of the thermal. Is this how we learn? It’s how I visualise it.

If you want the wordy, academic response then read Kolb.

Fig. 3. How I see learning occuring – as expressed during H808 – The e-learning professional

Making swim coaching a tad easier with SwimTag

Fig. 1. A plethora of session plans – what a year of elite swimming training looks like

Swimtag today, skitag tomorrow

Serendipity had me click on Swimtag and I’m hooked – as a swimmer and coach, but for the purposes of this note as a prospective PhD student looking for a research project for the next three years.

Fig. 2 . Swimtag

My interest is in e-learning, sport and virtual assistants / augmented learning.

Armed with a set of swimtags I’d like to research their use with a range of swimmers: masters, elite athletes, learn to swim and swimmers with disabilities. We have all of these in our 1000+ member swimming club Mid Sussex Marlins SC. Early days – I have only just completed a Masters in Open & Distance Education and am tentatively speaking to potential supervisors at the Open University, Oxford Internet Institute and Web Sciences at Southampton University with a view to submitting a doctoral research project in the next couple of months.

My vision is how swimtag becomes as commonplace as swim goggles, then translates into other sports and other fields, including business, but also as a potential prosthesis for people suffering from dementia or memory loss so potentially tied into other data capture devices.

I am seriously looking at funded PhD research for the next 3/4 years.

I am interested in e-learning, so Learning & Development particularly for v. large organisations. There is a groundswell of interest in devices/software that enhance or support memory and learning. There is a fertile crossover between health – providing support say to those who would benefit from cognitive support, what we call ‘lifelogging’ – so gathering pertinent data about the world around you, then using this in an artificially edited form (using Artificial Intelligence algorithms) to supplement memory loss or to enhance learning potential as a virtual companion. Those recovering from a stroke or with dementia included.

It may sound like science fiction but people have been working on these ideas for a decade or more.

I appreciate that simply tagging vulnerable people who may wander off and not know how to find their way home is one way to support but I’m thinking about quality of life and facilitating memory and communication too.

 

Authoring a PhD

20130116-124704.jpg

This is what I am up to next. It seems right, though I would never have thought it a year ago. Currently reviewing the papers of some dozen academics to find potential supervisors, funded research or a research topic. My interests in relation to e-learning are broad: mobile, augmented, collaboration and networked learning … workplace but also visitors to galleries, museums, battlefields and historic castles and homes.

The e-learning professional – H800 (Masters in Open and Distance Education)

The podcast H808 e-learning SMEs.

(Makes them sound like a prog rock band of the 1960s. Perhaps they were?)

[V. Long version here. 4,000 words +. 1,000 or under in H808 Tutor Forum.

Edited versions in the next 24 hours/couple of days in EduBlogs at www.mindbursts.edublogs.org]

Week One

I may be a professional swimming coach (amongst several things), but my head coach told me ‘I think too much.’ Think less and get the athletes to do more. Keep it simple. If there is any context however where thinking is the currency, literally if we are talking professionalism, then the more I think the more professional I become.

(Or not).

Many would say that a 3,000 word blog entry is ‘unprofessional.’

I call it shared reflection, the ‘uncut version.’ It is the outcome of over five hours thinking on the topic. Hours banked. Ideas turned into cash. By definition when I have made two years worth of regular deposits I may call myself and even be defined as an ‘e-learning professional’ with the MA to suggest I have joined that club, and a job that for the remuneration I receive makes me a professional rather than a wishful thinking wannabe.

It is unprofessional as a post-graduate student to be flippant and/or verbose.

A professional would keep this down to 500 words, yet I am stretching it to 3,000. The uncut version. Reflection in action. My mind at work. Not the athlete sharing a few ‘mots justes’ after a successful race, but the race itself and all the training before hand. The choice words, bullet point form only with an abridged commentary goes into my Tutor Group Forum. Under 250 words there, is my targert. Under 1,000 words per OU blog had been my thinking too. Blown that then.

Watching the TV I fall asleep.

Listening to the radio (i.e. any audio) I do something else – I’d be distracted anyway, I have to.

In an effort to get into my head the points being made by OUr E-learning Subject Matter Experts (SMEs) I first read the transcripts provided and then listened to the podcast while reading the text.

What shocked me was how much I had missed.

I do less than skim read it appears, all I must do is to look at patterns and shapes. No wonder I learn so little when I do nothing more than read.

Lesson learnt?

This isn’t an ‘airport thriller’ I can read at break-neck speed chaisng the protagonist as he is in turn chased; this requires a different kind of reading.

It requires effort.

I must work with the text, make notes. Just highlighting choices words and sentences isn’t enough either. Effort I can do. It is consistent effort unless I am working under exam conditions where I struggle. There is always something more interesting to read.

Historically, when successful academically, it has been a huge effort and very time consuming for me. I have to take notes (long hand). Then I have to take notes on the notes. I have to make lists, take quotes and re-order the material. I may still not make sense of it. I need to chase up a few references. I need to find my own patterns. I need to discuss it. Argue about it, agree and disagree. And then, gathering up a wad of papers and scraps of paper the whole lot needs to compost for a few months. Then, and only then, might I start to ‘get it,’ and have something constructive and original to say.

Do any of us have this kind of time anymore? Did we ever?

(My late father, my daughter and a friend, a partner in one of the world’s leading law firms, all have/had photographic memories. They would have read the transcript and been able to pick out its salient points after the first swift reading. Not so me, not so us?)

The process you see playing out here is an attempt to mulch the content, slow cook it and hope that I can achieve something in five hours that would normall require five months.

Keep cooking.

The second time round with the SME podcast I first worked with the text, highlighting points and generally trying to get my head around it. If you’ve come across Jakob Nielsen’s ‘Writing for the Web,’ this is what I did – isolating sentences and ideas, creating headings, sub-headings and bullet points, in a word ‘chunking. In fact, I begin to get close to doing what Richard Northridge recommends in the ‘OU Guide to Studying’ (1990) note taking, creating concept cards and then even looking for links and patterns in the text itself.

Lesson learnt?

This takes time and requires effort. I’m not great on effort. My modus operandi is (or has been) to take in volumes of material, but if this is only at a surface level no wonder I am often more frustrated than informed.

Lesson learnt?

Less is more. Rather than chasing a reference, another report or book, I need, at first, to ensure that the text I have in front of me has been dissected, not consumed, not afforded nothing more than a passing glance, but pulled apart, then reconstructed.

Lesson learnt?

Effort

Not the expected outcome of this simple task – my faltering approach to learning laid bare, but a valuable lesson at the start of the module.

At last I’m listening to the podcast.

I made myself think, made myself listen, I ‘sat forward’ (the technical term for interacting, for engagement.) I made myself read and take notes, made me list the contrasting ideas, the arguments for and against, the justifications … and to cluster these ideas and adjust my own thoughts accordingly based on my experience.

I had something to think about as I listened.

Do I have anything in common with these e-learning professionals in relation to assumptions and aims?

  • Do I have different understandings of what it means to be an ‘elearning professional’?
  • Is there a distinct elearning profession, or is elearning simply an aspect of other professions?
  • The profession of teacher?
  • The profession of a university lecturer or academic?
  • The profession of a trainer or staff developer or a human resources developer in private corporate bodies?
  • Is there an elearning professional?
  • And should I be describing my job as that of an elearning professional?

My short reply, given my background in sports coaching, is simple.

  • If you are paid you are a professional.
  • If you are the athlete and not paid you are an amateur.
  • If you’re the coach and not paid you are a volunteer.

Therefore, if someone is good enough and experienced enough (or simply good at selling themselves and their ideas) – and they are remunerated for their efforts, then they are a professional.

Rebecca Addlington is a professional athlete. Bill Furness, her coach, is a professional too.

At my swimming club all the swimmers are amateur, though some through bursaries to pay for County and Regional development training are by definition quasi-professional as they are receiving benefits if not in cash, then in kind. Some of the coaches and I do not define myself as a swimming coach; it’s a hobby that’s got out of hand.

I have ‘put in the hours.’

(Which I can qualify by saying I have put in the appropriate hours. i.e. time will not make you a professional, the enduring focus of your efforts will)

One of the key themes of the podcast made by each of the speakers is that a professional has put in the time.

They have put in the effort, gained experience that is directly or indirectly relevant to their e-learning expertise – and by dint of this expertise (and being paid by the OU, for books and reports, lectures and workshops too perhaps) they are all professionals.

At the swimming club many of us (its the biggest club in the South of England) have earned our places through years of experience, gaining qualifications and attending regular courses (CPD) to retain a licence to teach or coach aquatics. Many of us, paid or not, can call ourselves ‘professionals.’

Just as I’ve reduced my core thought to that of the contract between a professional and an amateur, by picking out the ideas of each speaker and doing something similar a number of interesting points regarding what it means to be an ‘e-learning professional’ emerge.

In this see-saw of ideas the protagonists have a habit of changing places.

By defining professional we should also think what it means to be unprofessional.

I’ve allowed this dance to play out as it leaves me with an image of a professional being circled by the professional wannabe, the unprofessional (as yet), the layperson, the naive, virgin student. A mass of non-professionals clamoring around the few.

The points and arguments frequently fall into another diametrically opposed set: the qualitative vs. quantitative, an objective point vs. the subjective, a value judgment vs. the facts. Everything overlaps – a Venn Diagram of the points would show sets within sets.

Adrian Kirkup

· Amateur vs. Professional (there are many highly ‘professional’ amateurs)

· Ineffective vs. effective.

Robin Mason

· Hasn’t done it for long vs. been doing it for a long time

· Undergraduate vs. PhD (A sub-set of the above)

· Hasn’t put in the hours vs. has put in the hours (more of the same)

· Immature vs. Mature (a variation of the same. Though professionalism is not a consequence of maturity)

· Inexperienced vs. Experienced.(Experience that takes time to acquire, and a certain manner to be effective)

Gill Kirkup

· A new field vs. an established field. (Disagree. Though a new field of subset of a professional activity would be definably professional).

· New vs. Established. (as above)

· No established standards vs. abides by general and specific received standards.

· Acting alone or part of a professional association.

· Part of the UK Higher Education Academy or not. (a subset of the above)

· Part of a legitimate community or not. (as above)

· Committed vs. Uncommitted.

· Respectful vs. Disrespectful.

· Respect for the individual learner, incorporating research and scholarship, the development of learning communities online is a hugely strong component in professional elearning practice. (successfully combines the subjective and unquantifiable with the quantifiable and objective)

· Juvenile and professional vs. professional only if matured. (as Robin Mason)

· Unlicensed vs. Licensed.

Robin Goodfellow

· Genuine vs. not genuine.

· Unrecognised vs. Recognised.

· Inexperienced vs. Experienced.

· Independent vs. tied (to government or a business).(disagree)

· Technical foundation vs. no technical foundation

· No need for a label, e-learning professional vs. professional enhancer. (strongly agree)

Chris Jones

· Takes time vs. no time.(as Robin Mason and Robin Goodfellow. You have to put in the time to become a professional. Which I guess applies as much to the professional criminal, as the Professional lawyer. Little p, Big P- see below)

· Part of the mainstream vs. Specialist. (disagree)

· ‘Lone Ranger’ and early stages of innovation … vs. early majority and established (themes of Rogers)

· Enthusiasts vs. the not interested. (strongly agree)

· Society and the professionalisation of modern life (quotable)

· Sport in the 20th century and professional vs. amateurs in sport

· Traditional and modern professionals

· Autonomous vs. dependent

· Trustworthy vs. (spin/PR/Branding/Agenda)

· Not part of a trade association or governing body vs. part of such an association

· Generalist vs. specialist

· An outside vs. part of something

· Formalised standards vs. none

· Unmonitored vs. monitored

· Is there a distinct elearning profession, or is elearning simply an aspect of other professions?

· Little ‘p’ pr big ‘P.’

Jonathan Vernon (moi)

· Doesn’t look the part vs. looks the part.

· Lacks form vs. has form.

· Self-taught vs. ‘done a course.’

· Qualified (with the piece of paper to prove it) vs. Unqualified (however expert they may be).

Some thoughts on the points identified above

It is worth reflecting on Robin Mason’s point about ‘putting in the hours.’

The suggestion that genius and expertise requires 10,000 hours of effort is no urban myth. A study carried out at the Berlin Music Conservatoire identified three groups of graduates. Asked to estimate how many hours of practice and playing each student had put in since picking up an instrument they were then divided into three distinct categories: up to 4,000 hours, up to 8,000 hours and up to 10,000 hours. The first became teachers, the second category got places in orchestras whilst the tiny number who had put in 10,000 hours (takes around 10 years to do this) were most likely to be the solo artists, the concert pianists, the mavericks, the Vanessa Maes and Mozarts. Whilst all these categories are professionals, they are paid for their skills, the use of the word ‘professional’ to distinguish those who are expert, who have attained a certain standard, would in my view apply to the musicians who have made it into a top orchestra – with the soloists in a category beyond the ‘professional.’ Our ‘OU H808 E-learning SME professionals’, given the decades of thought they have put into what we now define as ‘e-learning’, have been part of this ‘orchestra’ of professionals for some time, and who knows, we may have a Mozart amongst them. Personally, I’ve not read enough from any of them yet to know any better. I look forward to hearing what they have to say and how they say it.

Interestingly, Robin Mason returns repeatedly to a theme of time passing, of gaining, requiring or acquiring maturity of thought. Though I feel as if I am clutching at ideas in an amorphous cloud here, my sense is that whether it is professional with a big P or a little p, that the word ‘maturity’; might say it all.

What does maturity imply?

Growing up, lessons learnt, age, growth, adult hood, a way of behaving, able to fit in and contribute to a community and so on.

I disagree with Gill Kirkup

If I have understood her correctly regarding her suggesting that only in an established field is something professional whilst in a new field this is not possible. We can all think of (or at least imagine) an unprofessional ‘professional.’ The corrupt lawyer, the doctor struck off the medical register, the TV food expert who is not a doctor at all (and so a sham professional).

In 2000 I would have defined myself, as some of the panel here would have done, as what is now termed an ‘e-learning’ professional. After fifteen years in corporate communications, training and learning, creating linear, then non-linear and ultimately web-based materials the companies and government department for whom I worked through various production companies had to see me as ‘professional.’ I hadn’t done the post-graduate studying, but I’d learnt through observation and experience (first carrying video kit into the changing rooms of a nuclear power plant age 17 assisting with a training film for BNFL at Sellafield).

Interestingly, I don’t currently consider myself to be an e-learning or a learning professional and even with the MA I hope to gain in 2011 I will by my own definition not be a professional until I am being paid for my expertise.

To use a horse-racing term I lack ‘form.’

I’m literally out of the race (for now).

Being studious here and building my confidence is part of the plan to regain the ‘professional’ tag.

Does a barrister on retirement cease to be a professional lawyer?

Socio-econonmically he/she would still be defined as a ‘professional’ would they not?

I agree however, very much, with Gill Kirkup’s views regarding ‘respect’ and her definition of an e-learning professional within the academic community.

Respect for the individual learner, incorporating research and scholarship, the development of learning communities online is a hugely strong component in professional elearning practice.’

(This, for me, successfully combines the subjective and unquantifiable with the quantifiable and objective. i.e. you can be a professional Professional).

I disagree with Robin Goodfellow’s view that a professional must be independent vs. tied (to government or a business). If we look beyond e-learning professionals and academia it would be quite wrong to say that someone is not professional simply because they represent the interests of an organisation or government department, let alone are being paid to take a certain stance or have a strongly held view (left or right wing politically, religious or atheist and so on).

If nothing else, I believe I have shown above that there is a natural dichotomy, if not a debate even an implicit conflict, between views on whether a person, or institution, or field of study, can be defined as professional or not, worthy of study or not.

It is engagement in such a debate where a professional proves their credentials.

A professional is a match for anyone, whilst the unprofessional would not play by the rules, make excuses, bow out…

Dare I imply that all the above are differentiating between the educated and uneducated?

Is it so black and white? Students at school, scholars as Edwardian’s would have defined them, and undergraduates, graduates too, in terms of education can never be defined as ‘professional.’

Or can they?

The government pays students to go to college, to stay on in secondary school after the age of 16 – does not this make them pros, like a boy of a similar age getting paid to play football in an academy, they literally ‘turn pro.’

I agree with Robin Goodfellow that there is ‘need for a label’, that what is currently the e-learning professional may be the ‘professional enhancer ‘of the future if the UK HE Academy has their way (though I doubt the term will stick). Just as Robin was (we were) once web-based learning professionals, or learning professionals, or professionals in education…

Big P, little p (Chris Jones) is the most memorable expression of an idea in relation to the professional Professional that I take from this and a worthy talking point. And 2,500 words in I could sum it up with a Twitter count.

Professional is an adjective and a noun.

Anyone can be described as ‘professional,’ (adjective) by dint of their behaviour and experience, however to be a ‘professional’, (noun), various criteria should be met. Depending on how your measure up, by Chris Jones’s definition, you are either Big or Little P.

(I can think of other categories where a similar way of looking at things could be applied, for example, ‘engineer’. The person who fixes my washing machine may call himself an ‘engineer,’ but Isambard Kingdom Brunel was an ‘Engineer’. A sports psychologist is no longer allowed to call themselves such, they are sports scientists. So Psychologist, if not professional, not has a legally binding form of expression and use).

I disagree however with Chris Jone’s view that Professionals (big P you notice) have to be specialists whilst implicitly, if they are professional at all (little p) they are not, or unlikely to be so if they are part of the mainstream.

Or do I?

(I’m changing my mind as I write this, reflecting on a matter tends to do this. You twist yourself in so many knots and then find you are looking in the opposite direction – and happy to do so)

Onwards

Is there an implicit elitism here that makes me uncomfortable, an obvious them and us?

As a Professional I am not ‘part of the mainstream’ ?

Yes, that’s it.

You see the ‘mainstream’ is the population, everyone, in the universe that we are discussing. Professionals are of the mainstream, of society, even if they are a subset community within the broader community.

The likes of Richard Dawkin and Stephen Hawkings are ‘professional Professionals’ by their engagement with the world, not because of an elitist, hide-themselves away hermit like attitude to knowledge acquisition. Do Simon Schama and Neil Ferguson fall into the same category of professionalism?

Be published and damned, broadcast and be damned even more?

But you don’t have to be famous to be Professional (though I dare say you’d cease to be professional if you became infamous).

Or have I been making a mistake through-out this internal debate … this reflection – that we have always only been discussing Big P professionalism ONLY as part of ‘the whole thing,’ i.e. the specific category of the ‘e-learning Professional’ and just as this time round I haven’t given a moment’s thought to ‘e-learning’ as a term, I have nonetheless unnecessarily dissected the term ‘professional.’

I’m yet to click through the OED online.

I daren’t. It may be my undoing.

Back to my idea of a Venn Diagram.

If ‘professionals’ is the universe then we have two subsets, Professionals (Big P) and professionals (little p) (the noun only). Far smaller, and intersecting both these sets, we have ‘e-learning.’ There are in e-learning little P and Big P professionals.

Still with me?

But there are also non-professionals, and even  the unprofessional to consider. Can they also be defined as Non-professionals (Big N) and Unprofessionals (Big U).

Final thoughts

Might a professional be defined as someone with ‘qualified confidence in their field?’

Not finished yet

I’ve got a Venn Diagram to draw, some visualising to do.

Can a loner be a professional?

I enjoyed Chris Jones’s point about the ‘Lone Ranger’ that in early stages of innovation there are maverick, loners having a go at something new way ahead of anyone else – think Dr Emmett Brown in ‘Back to the Future’ tinkering away at the construction of a time-travelling automobile. Are such people professionals or even professional? Does this ‘odd-ball’ behaviour disenfranchise you from the professional community, even if you have the mind the size of a planet?

A consultant escapes the hospital ward for a couple of years to undertake research. Just because they are beavering away on their own, being a ‘Lone Ranger’ doesn’t disqualify them from the category of ‘Professional,’ (Big P), or even ‘professional Professional’ (little p, Big P).

Dare I suggest that our panel of e-learning experts are ‘professional e-Professionals’ ?

I don’t even begin to delve into the thinking behind innovation diffusion. This is an entire module in its own right. It is called ‘Innovations in E-learning’, or H807 for short.

For more read ‘Diffusion of Innovations’ E.M.Rogers. (2005) 5th edition.

Nor am I going to teach the definition ‘e-learning.’

Is there a professional ‘look.’

Forgive me if I make a comparison here between the need for barristers to put on the appropriate garb in court and so look Professional with a big p, compared to those wishing to be called professional and seen as Professional who don’t look the part. Poolside as coaches it is expected that all teachers are appropriately dressed in the club colours and well groomed – this looks professional. There was once a time when teachers wore a jacket and tie, so looked professional like fellow professionals such as lawyers and doctors. Don’t academic look the part, ‘look professional’ in their gowns and mortar-boards?

And having addressed ‘looks’ can someone sound ‘professional?

Think how a director chooses actors to play a role. Look at Michael Cane in ‘Educating Rita,’ is this the stereotypical professional Professor?

Another discussion, but coming from corporate communications we have been through exercises of using authentic presenters (people who work at the place) compared to buying in ‘professional’ presenters. To do justice to the message in the TV medium the professional broadcasters were far better at putting over the points the client wanted to make.

As I said, another discussion, a different thread.

P.S. It would be unprofessional to post such a long entry into a tutor forum, where a 500 word, even a 250 word version will be posted (the bullet points, or just my thoughts on the key bullet points … or just where I strongly agree or disagree).

Lesson Learnt ?

Professionals put in the time and effort, and follow rather than ignore guidelines for the community in which they operate.

It strikes me that academics, like creatives, are more interested in reputation and recognition than money.

Is it not striking that not one of our panel mention it?

Can you be a professional without it?

And what about spelling and grammar?

The ability to communicate. Have I mentioned that. Can the professional spell?

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