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And then there’s this – 12 grabs of an Activity System looking like Toblerone.
One per month, one per hour.
This is the point. The thing is
a) a grab in time
c) a construct or model (as well as a theory).
A theory because it can be re-applied (for now).
Fig.1. Its image explains itself.
Engestrom and others go to great lengths to remind us that the model/theory of an Activity System is a snap shot in time – that even as we look at it things are moving on, that the relationships don’t simply change as a result of the interactions with each other – but because the whole thing shifts.
OK. Take a chocolate triangle of activity Theory and visualise it in sequence. Better still, drop what you are doing and go and buy some.
Now take a piece and eat it.
The logic remains equally sound when I suggest that by consuming a moment of the Activity System in its last iteration you are enacting what the Internet has done and is doing.
This is what the connectivity of the Web does – the degree and scale of connections is overpowering and consuming.
One step more.
That triangle of chocolate, nougat, almonds and honey that I see as a multi-sensory expression of an Activity System may be digested in the stomach, but its ingredients hit you in the head.
It’s a brain thing.
Which explains my interest in neuroscience.
It happens. It should be visible. It can be measured.
Just reading this a million Lego Characters are kicking a few more million molecular bricks along a dendrite in part because they must, then again just to see what happens (yes, I have just read ‘Neuroscience for Dummies’). So some stick in odd places. Some will hit the mark (whatever that is) while another will remind you of the very moment you first nibbled on Toblerone.
I LOVE the way the brain will throw you a googlie. (as a fraction of the planet know cricket other metaphors are required. I never even played the game as I was deemed rubbish – actually, though no one spotted it in five years of prep school, I needed glasses).
On the one hand, my interest is to take a knife to all of this, chop it off and put it in the compost bin so that I am left with something that is ‘tickable’, on the other hand I want to indulge the adventure of the composting process.
When I think if learning, I think of the minuscule intricacies of the component parts of the brain and at the same time the immense vastness of the known universe.
As humans we are eager to understand everything.
It seems appropriate to marry neuroscience with astrophysics, like brackets that enclose everything. From a learning point of view then ask as you look at a person or group of people, ‘what is going on?’ specifically, ‘what is going on in there? (the brains) and between them to foster insight, understanding, innovation and advancement.
The best interface for this, a confluence for it all, is the Internet and the connectedness of it all.
What has the impact of the Internet been and based on everything we currently know, where do we presume it is going?
Martin Weller, in ‘The Digital Scholar’ looks forward to the time when there will be such people – a decade hence. I suggested, in a review of his book in Amazon, that ’10 months’ was more likely given the pace of change, to which he replied that academia was rather slow to change. That was 18 months ago.
Are there any ‘digital scholars’ out there?
How do we spot them? Is there a field guide for such things?
I can think of a few candidates I have come across, people learning entirely online for a myriad of reasons and developing scholarly skills without, or only rarely, using a library, attending a tutorial or lecture, or sitting an exam. But can they ever be considered ‘scholarly’ without such things? They’ll need to collaborate with colleagues and conduct research.
In this study, the authors assessed the educational impact of weekly Fast Facts and Concepts (FFAC) e-mails on residents’ knowledge of palliative care topics, self-reported preparedness in palliative care skills, and satisfaction with palliative care education.
The more papers I read, like learning a foreign language, the thinner the blur between mystery and comprehension in terms of judging a paper and its contents. My goal is to be able to conduct such research and write such papers. I understandably feel that a first degree in medicine and a second masters degree in education is required at this level. At best I might be able to take on psychology or neuroscience. My preference and hope would be to become part of a team of experts.
Purpose: Educational interventions such as electives, didactics, and Web-based teaching have been shown to improve residents’ knowledge, attitudes, and skills. However, integrating curricular innovations into residency training is difficult due to limited time, faculty, and cost.
What – A clear problem:
Integrating palliative care into residency training can be limited by the number of trained faculty, financial constraints, and the difficulty of adding educational content with limited resident duty hours. (Claxton et al. p. 475 2011)
Who – Participants
Beginning internal medicine interns
Why – Time- and cost-efficient strategies for creating knowledge transfer are increasingly important. Academic detailing, an educational practice based on behavioral theory, uses concise materials to highlight and repeat essential messages. Soumerai (1990)
How – We designed this study to assess the educational impact of weekly e-mailed FFAC on
internal medicine interns in three domains: knowledge of palliative care topics, satisfaction with palliative care education, and self-reported preparedness in palliative care skills.
This randomized, controlled study of an educational intervention included components of informed consent, pretest, intervention, and posttest.
Fast Facts and Concepts
FFAC are 1-page, practical, peer-reviewed, evidence-based summaries of key palliative care topics first developed by Eric Warm, M.D., at the University of Cincinnati Internal Medicine Residency Program in 2000.6
One e-mail containing two FFAC was delivered weekly for 32 weeks to interns in the intervention group.
All participants completed a pretest that assessed knowledge of palliative care topics, self-rated preparedness to perform palliative care skills, and satisfaction with palliative care education.
Method: Internal medicine interns at the University of Pittsburgh and Medical College of Wisconsin were randomized to control and intervention groups in July 2009. Pretests and post-tests assessed medical knowledge through 24 multiple choice questions, preparedness on 14 skills via a 4-point Likert scale and satisfaction based on ranking of education quality.
The intervention group received 32 weekly e-mails.
No e-mails were sent to the control group.
Respondents completed a post-test 1 to 8 weeks after the
All study participants were informed of the content and the online availability of FFAC during recruitment. At the conclusion of the study, both control and intervention groups were given a booklet that contained all the e-mailed FFAC.
Descriptive statistics and t tests were used to compare the demographic data between the control and intervention groups. Medical knowledge, preparedness, and satisfaction were compared pretest and post-test within groups by Wilcoxon tests and between groups via Mann-Whitney U tests. The data did not meet assumptions for multivariate analysis due to the small sample size. Only univariate analysis was performed.
Although traditional academic detailing techniques include educational outreach visits and distribution of printed graphic materials, e-learning techniques such as e-mail delivery of educational content, listservs and Web-based tutorials can also be considered rooted in this behavioral theory given their focus on repeated, concise content.
Pain assessment and management, breaking bad news, communicating about care goals, and providing appropriate medical care for a dying patient are necessary skills for surgery, family medicine, pediatric, obstetrics and gynaecology, physical medicine and rehabilitation, emergency medicine, neurology, radiation oncology, anesthesiologist, and psychiatry residents.
Studies that focus on e-mail education interventions have shown that weekly e-mails change the behavior of e-mail recipients, improve learner retention of educational content and that retention improvements increase with the duration over which e-mails were received. (Kerfoot et al. 2007 ) (Matzie et al. 2009)
Results: The study group included 82 interns with a pretest response rate of 100% and post-test response rate of 70%. The intervention group showed greater improvement in knowledge than the control (18% increase compared to 8% in the control group, p = 0.005).
Preparedness in symptom management skills (converting between opioids, differentiating types of pain, treating nausea) improved in the intervention group more than the control group ( p = 0.04, 0.01, and 0.02, respectively).
There were no differences in preparedness in communication skills or satisfaction between the control and intervention groups.
Conclusions: E-mailed FFAC are an educational intervention that increases intern medical knowledge and self-reported preparedness in symptom management skills but not preparedness in communication skills or satisfaction with palliative care education.
Claxton, R, Marks, S, Buranosky, R, Rosielle, D, & Arnold, R 2011, ‘The Educational Impact of Weekly E-Mailed Fast Facts and Concepts’, Journal Of Palliative Medicine, 14, 4, pp. 475-481, Academic Search Complete, EBSCOhost, viewed 25 February 2013.
Matzie KA, Price Kerfoot B, Hafler JP, Breen EM: (2009) Spaced education improved the feedback that surgical residents given to medical students: A randomized trial. Am J Surg 2009;197:252–257.
Price Kerfoot B, DeWolf WC, Masser BA, Church PA, Federman DD: (2007) Spaced educational improves the retention of clinical knowledge by medical students: A randomized controlled trial. Med Educ 2007;41:23–31.
Soumerai SB, Avorn J: (1990) Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA 1990;263:549–556.
- Palliative care: knowing when not to act (oup.com)
I just watched Daphne Koller’s TED lecture on the necessity and value of students marking their own work. (for the fifth time!)
Whilst there will always be one or two who cheat or those who are plagiarists, the results from ‘Big Data’ on open learning courses indicate that it can be a highly effective way forward on many counts.
- it permits grading where you have 1,000 or 10,000 students that would otherwise be very expensive, cumbersome and time consuming
- as a student you learn from the assessment process – of your work and that of others
- student assessment of other’s work is close to that of tutors though it tends to be a little more harsh
- student assessment of their own work is even closer to the grade their tutor would have given with exceptions at opposite ends of the scale – poor students give themselves too high a grade and top students mark themselves down.
- it works
- it’s necessary if learning reach is to be vastly extended
- isn’t human nature a wonderful thing?! It makes me smile. There’s an expression, is it Cockney? Where one person says to another ‘what are you like?’
‘What are we like?’ indeed!
Philip M. Sadler & Eddie Good (2006): The Impact of Self- and Peer-Grading on Student Learning, Educational Assessment, 11:1, 1-31
- Online university giant gets bigger (bbc.co.uk)
- To be told when you are right or wrong is essential to student learning (mymindbursts.com)
- Massive online education: Daphne Koller at TEDGlobal 2012 (ted.com)
- Who would you invite to an e-learning dinner party? (mymindbursts.com)
- TED Talk: What we’re learning from online education (ezrasf.com)
- Technology brings classroom experience to distance learners (guardian.co.uk)
- What we’re learning from online education by Daphne Koller (bluesyemre.com)
Even a well-designed quasi-experimental study is inferior to a well-designed randomised controlled trial.
In favour of randomized control trials
Torgerson and Torgerson (2001)
The dominant paradigm in educational research is based on qualitative methodologies (interpretive paradigm). Torgerson and Torgerson (2001. p. 317)
Despite fairly widespread use of quantitative methods the most rigorous of these, the randomised controlled trial (RCT), is rarely used in British educational research. Torgerson and Torgerson (2001. p. 317)
Even a well-designed quasi-experimental study is inferior to a well-designed randomised controlled trial. Torgerson and Torgerson (2001. p. 318)
Something I’ll need to get my head around – again!
The first problem is the statistical phenomenon of regression to the mean (Cook and Campbell, 1979; Torgerson, C.J., 2000) All groups studied need to have the same regression to the mean chances. Torgerson and Torgerson (2001. p. 318)
Non-randomised quantitative methods are nearly always inferior to the randomised trial. Torgerson and Torgerson (2001. p. 319)
Nearly 40 years ago Schwartz and Lellouch described two types of randomised trial: the ‘explanatory trial’ and the ‘pragmatic trial’ (Schwartz and Lellouch, 1967).
The explanatory trial design is probably the one with which most people are familiar.
This type of study is tightly controlled and, where possible, placebo interventions are used.
Thus, one may take a large group of children all from a similar socio-economic background and attainment and randomly allocate them into two groups. One group receives the intervention under investigation whilst the other receives a dummy or sham intervention. Torgerson and Torgerson (2001. p. 320)
The pragmatic trial : the environment in which the trial is conducted is kept as close to normal educational practice as possible.
The children, or schools, are allocated the new intervention at random. A disadvantage of the pragmatic approach is that the trials usually have to be much larger than the explanatory approach but the pragmatic trial approach is probably the most feasible and useful trial design for educational research. Because the trial mimics normal educational practice, there is a greater variation that can make it harder to detect a small effect. To cope with this the sample size needs to be increased accordingly. Torgerson and Torgerson (2001. p. 320)
The underlying idea of a randomised trial is exceedingly simple.
Two or more groups of children, identical in all respects, are assembled. Clearly, the individual children are different but when groups of children are assembled by randomisation, and with a large enough sample size, they will be sufficiently similar at the group level in order to make meaningful comparisons. In other words, the differences are spread equally across both groups, making them essentially the same. Torgerson and Torgerson (2001. p. 321)
The analysis of a randomised trial is actually simpler than other forms of quantitative research because we know the two groups are similar at baseline. Torgerson and Torgerson (2001. p. 321)
Randomisation creates groups with the same proportion of girls, with the same proportion of pupils from various socio-economic and ethnic groups, with the same distribution of ages, heights, weights etc. – this is the simple elegance of randomisation! Torgerson and Torgerson (2001. p. 323)
To avoid observer bias blinded outcome assessment must be undertaken. Torgerson and Torgerson (2001. p. 324)
Qualitative methodologies are well suited to investigating what happens with individuals; RCTs are appropriate for looking at the larger units relevant to policy makers. Torgerson and Torgerson (2001. p. 3264)
SCHWARTZ, D. and LELLOUCH, D. (1967) Explanatory and pragmatic attitudes
in therapeutic trials. Journal of Chronic Diseases 20, 637–648.
Torgerson, C, & Torgerson, D 2001, ‘The Need for Randomised Controlled Trials in Educational Research’, British Journal Of Educational Studies, 3, p. 316, JSTOR Arts & Sciences IV, EBSCOhost, viewed 13 February 201
- Effects of the Endpoint Adjudication Process on the Results of a Randomised Controlled Trial: The ADVANCE Trial (plosone.org)
- RCTs, skeptics, and evidence-based policy (errorstatistics.com)
- Smith and Pell: Parachute Use and Randomised Controlled Trials (delong.typepad.com)