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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

We forget, it’s only natural – what can we do about it?

Fig.1. The Forgetting Curve. Ebbinghaus (1885)

‘The psychological conclusion demands a distribution of repetitions such that some of them should be produced at a later time, separated from the first repetition by a pause’. (Vygotsky, 1926)

More recently, in the last ten years in fact, Dr B Price Kerfoot of Harvard Medical School (2006) created a platform called SpacedEd (now Qstream) that uses multichoice questions, typically and most successfully with first year medical students, where sets of questions are randomised then sent out as text or email to tackle, I suppose, what Ebbinghaus (1885) identified with his ‘Forgetting Curve’. An evidence based paper on the effectiveness of ‘spaced learning’ showed how there was better retention three months, six months and a year down the line.

REFERENCE

Ebbinghaus, H (1885) Memory: A contribution to experimental psychology.

Kerfoot, B, P (2006) SPACED EDUCATION. Interactive Spaced-Education to Teach the Physical Examination: A randomized Controlled Trial.

Vygotsky, L (1926) Educational Psychology

FURTHER LINKS

Formative Tests Aid Retention

We are all the people we have ever been


What image should we use to portray ourselves?

Is there such as thing as best practice? Ought it to be like joining a gym, we have a snapshot taken on a webcam and this current image, no matter how it comes out, becomes who we are?


Do so few of us dislike or distrust what we see when we look at our faces in the mirror each morning?

It has been the subject of research, role play in online education; I’d like to do some of my own.

I began a year ago with this.

I liked the picture, felt it was healthy, robust and confident and confident.

I should have looked at the date on it. August 2004. Happy and sunny days. You age under stress and from the mid-40s it doesn’t take much to add ten years -all that sun in the past, being unwell.

As I write below, his spirit, like mine (I hope) remains that of an enthusiastic twenty-something.

The same occurred with the Elluminate session we had in H800 the other day, the tutor on the webcam (initially in a scratchy black and white image) is not the person who goes by in the General Forum. Are we all guilty of this. Men included? We go with something in our late thirties or early to mid-forties?


I then went with this.

An image I long ago used in my eleven year old blog. I wanted something that was indicative of the content and would last. I’m still inclined to run with this. It is indicative of what I think blogging is all about – the contents of your mind, what you think i.e. you ‘mind bursts’ as I call them on numerous blogs.

Facebook personas sees me in a number of guises

While on Skype I use a image taken with the webcam on the day of an online interview – this is a month ago, so as contemporary as it gets.


I have this image fronting Tumblr taken 21 years ago.

In moments of euphoria having just successfully negotiated a 15m pond of slush on a pair of skis in front of a crowd of early May skiers below the Tignes Glacier, France. The day I proposed to my wife. We’d be ‘going out together’ for three days … we’ve now been together, well 21 years.

In my original diary we could create banner ads to publicise what we had to say to fellow writers. One of these has a spread as long as the contents of my diaries and blog: they run from a 13 year old Head Chorister in cassock and ruffs, though gap, undergrad, to add exec, video director, with four woman I didn’t marry.


Increasingly, I am thinking of using a self-portrait, that this attempt to capture myself through my minds eye is more telling that a photograph.


I could use the drawing I did of a 14 year old

What amuses me most here is how I superimpose these attachments as if I were in a school play, the beard is clearly on the soft face of a pubescent boy – I should have looked at my grandfather for the face I’d get, with the more bulbous nose and pronounced chin.

Talking of which, I find it intriguing that I am the spitting image of my grandfather, that my own children see images of him age 20 and think it has to be me. All that changes as he ages into a 40 and 50 year old is he goes bald, whereas I am thus far limited to a thinning of the crown.

This I’m afraid, if the age of my children in the rest of the picture is something to go by, is some seven years ago 🙁

My only reason for picking it is that I haven’t renewed my contact lenses and am inclined, after twenty years wearing them to give up. Maybe laser surgery when I have the cash?
This is contemporary. It doesn’t say who I am, just ‘what’ I am. Wearing a child’s hat (he’s a dad), the headset to record notes onto a digital recorder (for a podcast), a coat he bought for honeymooning in the Alps (we went skiing) 18 years ago …


I have of course not changed much since 1977

It takes me back to the original point – who are we? how do we representative ourselves online in a single image when we are all a sum of a complex of parts?

Is it any wonder that we present multiple selves online, the more so the longer we’ve lived?

I don’t remember my father being around to take this picture. though clearly he did. I do remember the great-big wellies though and the joy of water spilling over the top if I could find a puddle or pond deep enough. And the jumpers knitted by my granny (sleeves always too long). And the trees in the garden I climbed behind. And my sister and brother …

How set in were the learning process by then?

The Dracula Spectacula, People’s Theatre, Newcastle.

The teeth were made from dentine and fitted by an orthodontist.I rather foolishly sharpened the fangs and bit through my own lip on the last night. I had to sing while gargling my own blood. The joy of memories.

  • Could a daily snap taken when looking in the bathroom mirror be used to tag memories from that ‘era’ of your life?

Spaced Ed

SpacedEd is a platform designed to allow learners and teachers to harness the educational benefits of spaced education.

Spaced education is a novel method of online education developed and rigorously investigated by Dr. B. Price Kerfoot (Associate Professor, Harvard Medical School).

It is based upon two core psychology research findings:the spacing effect and the testing effect.

In more than 10 randomized trials completed to date, spaced education has been found to:

  1. Improve knowledge acquisition
  2. Increase long-term knowledge retention (out to 2 years)
  3. Change behavior
  4. Boost learners’ abilities to accurately self-assess their knowledge.
  5. In addition, spaced education is extremely well-accepted by learners.
  6. The spacing effect refers to the psychology research finding that information which is presented and repeated over spaced intervals is learned and retained more effectively, in comparison to traditional bolus (‘binge-and-purge’) methods of education.
  7. The testing effect refers to the research finding that the long-term retention of information is significantly improved by testing learners on this information.
  8. Testing is not merely a means to measure a learner’s level of knowledge, but rather causes knowledge to be stored more effectively in long-term memory.
  9. The spaced education methodology is content-neutral and thus can be utilized to learn most anything.
  10. Potential applications range from teaching chemistry concepts to high school students to reinforcing Arabic language skills among health workers in the Middle East.
  11. It can also be used to reinforce educational material which was initially presented in the classroom.
  12. The full multi-media capabilities of the Internet can be harnessed to create a rich and effective learning experience.

Asynchronous Spaced Education becomes synchronous and game-like

I might have interviewed Dr Price Kerfoot of Spaced-Ed for H807, ‘Innovations in E-learning’ a year ago.

I finally caught up with him this afternoon two weeks into the Spaced-Ed transmogrification that is Qstream.

We used Skype. Clear barely broken sound. Sharp video in colour. It worked.

It was a fascinating discussion.

I should have asked to record and done so.

Next time. I’m sure the conversation has only just begun.

Though armed with a set of questions used in TMA02 of H807 non were necessary. I’d prepared them to follow a narrative flow, and that is what we did.

We have something in common, we were both at Balliol College, Oxford.

I was there as an undergraduate 1984, he was there five years later as a Rhodes Scholar taking a BA in Medicine. Dr B P Kerfoot is now an Associate Professor of Harvard Medical School. He is also a passionate educator and e-learning entrepreneur. I suspect we will continue to hear a great deal about him – he has a passion for education, reminding me of the late Randy Pausch, even the Robin Williams character from Dead Poets Society; there is an unstoppable, engaging warmth backed by a profound intellect.

The narrative

Price had finished his surgical training when he went into education, an odd elective he admits, but one that through circumstances and surely an innate interest has proved fruitful.

What is the problem?

I didn’t need to make this prompt. You strive to fix something when you see it isn’t working. Learning outcomes from first year medical students were poor. Why, in US terms, spend $1000 dollars on a course only to find a year later that the traditional methods of acquisition and retention of knowledge has failed.

No problem, no fix.

Price looked to web-based teaching to create learning modules. Two concepts were devised, the spacing of questions proved successful. This is from one of a dozen papers authored by Kerfoot and his team; each one, naturally, a worthy, academic, professional appraisal.

Two reports are cited as we talk, one on the effect on the hippocampus of rats, another on phosphate levels in fruit flies. As an OU student these reports are readily available.

There is physiological evidence that ‘spaced learning works’.

This matters:

a) you want something that works,

b) you want something that will justify the investment.

We give it away, academics in the US are commercially savvy.

Its as if in the UK academics (individuals and institutions) are like bachelors and spinsters, whereas in North America they are eager to marry.

More importantly the research has shown that the Spaced-ed approach improves patient outcomes the goal it was found that cancer screening of patients improved by 40% for the year spaced-education was introduced.

In 2006 the methodology was submitted by Harvard for a patent application. Entrepreneurs and venture capital companies were also approached.

It’s a shame the Spaced-Ed blog hasn’t been maintained, though you’ll get some further insights here.

What began as continual education in medicine has expanded. If you go to the Spaced-Ed website there are all kinds of courses you can take, typically 20-30 questions of the multi-choice type fed to your laptop, SmartPhone or iPad. Writing these multiple choice questions is an effort and requires skill to get right,, indeed I can admit to wanting to create what I thought would be a simple set of questions relating to teaching swimming … but the correct construction of the questions, let alone the creation of appropriate images has held me back. It isn’t as easy to get this right as it looks. You don’t want to feed your audience lame questions, nor do you want to overstretchthem. There is also some negative feelings about Multi-choice, perhaps we have all had negative experiences at school … I personally remember what we described as ‘multi-guess’ that was so often used in Chemistry classes. Though clearly effective, not enough people have been persuaded to pay for these sets of questions, even a dollar or so.

The challenge, has been to move on from asynchronous to synchronous, real time learning, including video and other rich media. The new platform promoted as Qform is an Facebook App and Twitter-like in its approach. People elect to follow a Qstream which goes out to everyone. You join in collectively, rather than alone, which creates a sense of participation and competition. If I understand this correctly, as I’m yet to give it a go, you pose a response to an open question that others read. You then vote on the various responses given. As Price, engaging as Robin Williams in Dead Poets Society enthused about the platform I thought about Skype and Elluminate, even forum threads. Indeed, I wonder if we could all organise to be online and go to one of these threaded conversations to turn an asynchronous environment into a synchronous one. Harvard is also the home of Rotisserie, which rotates a threaded conversation between online learners to ensure that everyone has a turn… and of course Facebook.

Gameification is the key. You respond in a way that other s like and you get points for it and your name appears on a leader board.

Rich content and a range of responses is what’s new. And its live And its competitive

And so Qstream delivers synchronicity and a sense of community Price also talked about how to make it possible for answers to questions to become searchable in Google – I guess with the inclusion of the right metadata. I didn’t need to say it to find I’m told the more controversial responses would generate the most responses. Now it’s starting to sound like the format of the Oxford Union Debating Society – I guess Price went along there at some stage too. By listening to two sides battle it out you form your own opinion.

One final statistic – 85% of those studying urology in North America (that’s the US and Canada) are using Dr B Price Kerfoot’s 23 question Spaced-ed multi-choice Q&A.

The competitors are Quora, Stackoverflow and FormSpring or some such … I’ll go take a look.

REFERENCES

REFERENCE

J Gen Intern Med 23(7):973–8

DOI: 10.1007/s11606-008-0533-0

© Society of General Internal Medicine 2008

12 Reasons to used spaced learning, Q&A sent to a mobile to reinforce recollection of vital facts

SpacedEd is a platform designed to allow learners and teachers to harness the educational benefits of spaced education.

Spaced education is a novel method of online education developed and rigorously investigated by Dr. B. Price Kerfoot (Associate Professor, Harvard Medical School).

It is based upon two core psychology research findings:the spacing effect and the testing effect.

In more than 10 randomized trials completed to date, spaced education has been found to:

  1. Improve knowledge acquisition
  2. Increase long-term knowledge retention (out to 2 years)
  3. Change behavior
  4. Boost learners’ abilities to accurately self-assess their knowledge.

In addition, spaced education is extremely well-accepted by learners.

The spacing effect refers to the psychology research finding that information which is presented and repeated over spaced intervals is learned and retained more effectively, in comparison to traditional bolus (‘binge-and-purge’) methods of education.

  • The testing effect refers to the research finding that the long-term retention of information is significantly improved by testing learners on this information.
  • Testing is not merely a means to measure a learner’s level of knowledge, but rather causes knowledge to be stored more effectively in long-term memory.
  • The spaced education methodology is content-neutral and thus can be utilized to learn most anything.
  • Potential applications range from teaching chemistry concepts to high school students to reinforcing Arabic language skills among health workers in the Middle East.
  • It can also be used to reinforce educational material which was initially presented in the classroom.
  • The full multi-media capabilities of the Internet can be harnessed to create a rich and effective learning experience.
REFERENCE
Kerfoot,B,P (2008) Interactive Spaced-Education to Teach the Physical Examination: A Randomized Controlled Trial. Armstrong,E.G., O’Sullivan,P.M.,JOURNAL OF GENERAL INTERNAL MEDICINE Volume 23, Number 7 Harvard Medical International.
Spaced Repitition. definition: https://sites.google.com/site/elearningsnippets/a-wiki-page/spaced-repetition
Journal of General Internal Medicine: http://springerlink3.metapress.com/content/0884-8734/

Where old meets new: paper and handwriting vs e-learning

Paper Assignments

I have in-front of me an Amateur Swimming Associations (ASA) paper for the Level III Senior Club Coach certificate. There are 12 sheets, facing side only. The paper is waxed, copyrighted and stamped with the ASA logo. Having attended a day long workshop on the topic, done some reading and from my own experience I complete these assignment and submit. It ought to be submitted as is; this is in part a test of authenticity. I have handwritten my responses. My habit and way of doing things is to have it in a word document, so I load the text and tables, complete the required questions/tasks, print off and submit both parts. Invariably I get a note about the typed up/printed off version being so much better … it takes skills that even I lack to write something in some of the minuscule boxes.

I was discussing on Monday with the ASA how to avoid plagiarism with e-assessments.

I mentioned Nottingham University medical students attending a computer-based assessment. I mentioned software that can spot plagiarism. I struggled however with the kind of forms the ASA uses as these tests seem to be have written with the EXAMINER in mind … i.e. to make them easy to mark. Which also makes it easy to cheat. The answer is the same, not open to interpretation. More or less. This isn’t strictly fair … papers are returned covered in red ink – I have redone one paper.

There has to be a sign in process that is used to identify a person.

How many people cheat? Is it such a problem?

Apparently so. Even with certificates and qualifications it appears easy to falsify documents. And often, these determined people are excellent teachers/coaches who have learn their trade as competitive swimmers and/or on the job, so they know what they are doing, they simply don’t have the piece of paper.

Memory Cards

I also have in front of me a set of handwritten cards given to me by a colleague who has just taken her Level II Coaching certificate. She failed the written paper. She used these cards to test herself. My intention is to put these into Spaced-Ed, as an exercise, possibly to create or to begin to create a useful learning tool.

I like the way Space-Ed prompts you over the week, tests you on a few things, then leaves you alone. You have time to assimilate the information. Is it easy learning? It is easier learning … nothing beats a period of concerted effort and self-testing to verify that you know something or not.

Whether electronic, or paper … or the spoken word, there is always a bridge to gap, a translation, as it were, of the information a person wants or needs to assimilate and this assimilation process.

Common to all is EFFORT.

Do you work hard at it for longer periods of time … or divide the task up into smaller chunks? Which works best? For you, or anyone? Is there a definitive answer? No. It will vary for you, as with anyone else. It will vary by motivation, inclination, time available, the nature and importance of the topic, the degree to which this topic is covered in print or online, or in workshops and in the workplace. In deed, my contention, would be that the greater the variety of ways to engage with the information the better it will be retained and the more useful it will be when required in a myriad of ways to be applied or is called upon.

On reflection

I learn from writing something out by hand. I learn again when I type it up. I may not be engaging with it ‘in the workplace;’ but there is engagement non the less through my eyes, hands and fingers. Similarly the person who wrote out this pack of 71 cards (both sides written up) was preparing themselves, afterall, for a written exam. She knows her stuff poolside, her struggle (as I know is the case for many) is translating this into exam-like responses in a highly false setting, away from a pool, from swimmers, having to read words to respond in text, rather than reading an athlete (observation) and responding with a fixing drill or exercise.

Learn – Repeat – Learn

 

Fig. 1. Spaced education randomised trial. Kerfoot (2008)

‘The psychological conclusion demands a distribution of repetitions such that some of them should be produced at a later time, separated from the first repetition by a pause’. (Vygotsky, 1926:Location 2686)

So wrote the educational psychologist Lev Vygostsky over 80 years ago. Putting this into practice using email (and now Smart Phone apps and eventually Facebook), the team at Spaced-Ed have created a learning system that works.

SPACED EDUCATION – DR B PRICE KERFOOT

Interactive Spaced-Education to Teach the Physical Examination: A randomized Controlled Trial

BACKGROUND/PROBLEM

Several studies have documented that physical examination knowledge and skills are limited among medical trainees.

OBJECTIVES:

The objective of the study is to investigate the efficacy and acceptability of a novel online educational methodology termed ‘interactive spaced education’ (ISE) as a method to teach the physical examination.

DESIGN:

Randomized control trial.

PARTICIPANTS:

170 second year medical students.

MEASUREMENTS:

  • Spaced-education items (questions and explanations)
  • Validated by two experts
  • Piloted and 36 items selected for inclusion
  • 6 spaced-education e-mails each week for a 6 week cycle.
  • Students submitted answers to the questions online and received immediate feedback
  • An online end-of program survey was administered.

RESULTS: Successful 85% participants recommended the ISE programme for students the following year.

CONCLUSIONS: ISE can generate significant improvements in knowledge of the physical examination and is very well-accepted by students.

While many studies have documented the dearth of physical examination knowledge and skills among trainees, ISE has the potential to remediate these deficiencies across the spectrum of medical education’. (p977)

Why necessary?

Students do the training, but may still have poor recall a year later. Spacing works.

The spacing effect is the psychological finding that educational encounters that are spaced and repeated over time (spaced distribution) result in more efficient learning and improved learning retention, compared to massed distribution of the educational encounters (bolus education). (P973)

As Vygotsky expressed it 80 years previously:

‘It should also be emphasized that every person has his own customary rate of response, and that any change in this rate, either speeding it up or slowing it down, weakens the force of recall’. (Vygotsky, 1926:Location 2686)

And so here students can tailor the timing of questions they are fed – spacing them out or bunching them as they see fit and circumstances change. Go try it, there are courses you can do on topics that a far less demanding that second year physical examinations. Try world history in maps, for example, or getting the most out of your iPhone.

A distinct neurophysiologic basis for the spacing effect has been identified

‘Spaced education’ refers to online educational programs that are structured to take advantage of the pedagogical benefits of the ‘spacing effect’.

Interactive spaced-education (ISE) combines the pedagogical merits of both the ‘spacing effect’ and the ‘testing effect. (974)

Each spaced-education item consists of an evaluative component (a multiple choice question based on a clinical scenario) and an educational component (the answer and explanation)

Psychometric analysis of the questions was performed using the Integrity test analysis software (http://integrity.castlerockresearch.)

Based on item difficulty, point-biserial correlation, and Kuder–Richardson 20 score, 36 of the questions were selected for inclusion in the ISE program.

  • Students receive spaced-education e-mails at designated time intervals which contain a clinical scenario and question (evaluative component).
  • Upon clicking on a hyperlink in this e-mail, a web-page opens which displays pertinent images and allows the student to submit an answer to the question.
  • Upon downloading this answer to a central server, students are then immediately presented with a webpage displaying the correct answer to the question and an explanation of the curricular learning point (the educational component).
  • By having the provider submit a response before receiving the correct answer and an explanation, this process requires greater interactivity, which educational theory argues may improve learning outcomes.
  • The submitted answers of students were recorded using the MyCourses™ web-based education platform

The survey was constructed and administered online using the SurveyMonkey web-based platform.

Future developments and assimilation of spaced-education alongside traditional medial school teaching methods

For example, as ISE utilizes traditional web-pages for the submission of answers and for the presentation of learning points, it should be possible to use all of the functionalities of web-pages within the ISE program to meet the training needs of care providers. For example, physician trainees learning how to auscultate the heart can be presented with ISE items which contain an audio recording of an unknown heart sound, and then, trainees can be asked to identify the murmur.

LESSONS LEARNT

Micro-learning is favoured over more substantial time being given to this. I can imagine many applications.

This finding is in stark contrast to the strong resistance we encountered when conducting a recent trial of web-based teaching modules among 693 medical residents and students. In this trial focusing on systems based practice competency education, trainees were expected to spend 20 minutes per week over 9 weeks completing web-based teaching modules (interactive web-pages and online narrated slide presentations). (p977)

This high acceptability also likely reflects the ease of use of the spaced-education delivery system, the immediate relevance of the content, and the importance that students attribute to learning the physical examination. (p977)

Some items to cover if you are thinking of being a professional and thorough as the team at Harvard and Spaced-Ed:

  • · Conflict of Interest:
  • · Funding/Support:
  • · Financial Disclosures:
  • · Author Contributions:
  • · Conception and design:
  • · Acquisition of data:
  • · Analysis and interpretation of data:
  • · Drafting of the manuscript:
  • · Critical revision of the manuscript for important intellectual content:
  • · Statistical analysis:
  • · Obtaining funding:
  • · Ethical Approval to Perform the Study:
  • · Corresponding Author:

And a finaly word from Lev Vygotsky.

‘Rhythm plays a decisive role in the learning process, unifying some of the material, conferring on it a sequential symmetry, and, finally, organizing the various elements into a unified whole’. (Vygotsky, 1926)

REFERENCE

Kerfoot . B. P (2006) SPACED EDUCATION. Interactive Spaced-Education to Teach the Physical Examination: A randomized Controlled Trial.

Kerfoot. B. P (2008) Interactive Spaced-Education to Teach the Physical Examination: A Randomized Controlled Trial. Armstrong,E.G., O’Sullivan,P.M., JOURNAL OF GENERAL INTERNAL MEDICINE Volume 23, Number 7 Harvard Medical International.

Vygotsky, L (1926) Educational Psychology

Serendipity took me to Space Ed when I had just started H807 ‘Innovations in E-learning.’

English: The front of Balliol College as viewe...

English: The front of Balliol College as viewed from Broad Street, looking west. (Photo credit: Wikipedia)

Dr Price Kerfoot is an alumni of Balliol College and he was featured in the College Magazine.

This Balliol and Harvard trained doctor had considered ways to improve the way in which medical students learn. A great deal must be learnt rote, you have to know your anatomy (to start with). This means dissecting a cadaver, making the information stick, then testing yourself relentlessly so that exams can be passed.

Here is a professional educator using e-technology to solve a problem.

As an innovation in e-learning nothing compares. It may not use second life or 3D animation, but is addresses a learning problem and offers an effective solution – good-bye factoids on Rolodex cards, hello 21st century email and text alerts probing you to answer multi-choice questions correctly. If you get it wrong, you receive the right answer and an explanation. This question will be resent in due course and sent repeatedly until it is self-evident that you now know the correct answer.

I’m signed up for Core Anatomy.

I haven’t a clue but using Google and go into research mode. It is staggering the wealth of visual materials to support learning, beautifully rendered images of the human body, podcasts from doctors, definitions of the terminology with audio so you learn how to pronounce these things. I still get the first couple of questions wrong, but never mind. I understand what the right answer is, I am building a corpus of knowledge that will in time enable me to answer 100 questions rather than only 25.

Give it a go.

Better still, build your own Space Ed programme. The platform is free to use and you are free to offer the results of your endeavour for free … or for a fee.

REFERENCE

TESTING NEW INSTRUCTIONAL METHODS

Interactive Spaced-Education to Teach the Physical Examination:

A Randomized Controlled Trial

B. Price Kerfoot, MD EdM1,2,3, Elizabeth G. Armstrong, PhD2,3, and Patricia N. O’Sullivan, MD3,4

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