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Engaging Health Professionals and Trainees in Online Learning Graham McMahon MD MMSc

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1 Engaging Health Professionals and Trainees in Online Learning Graham McMahon MD MMSc

2 The World of Medicine is Changing Fast  Hard to anticipate how this generation of learners will be practicing?

3 Our learners have changed: Some Characteristics of Millenials  have never known a life without computers and the Internet  generally began using computers between the ages of 5 and 8; almost all used computers by age 16  are more accustomed to using keyboards rather than pens or pencils  generally prefer to read information from computer screens or mobile devices rather than from printed texts  have more friends in social networking sites than in person  have spent more time playing games than reading books

4 More standardization?  Create new standards  Raise standards

5 Standardization  Conformity

6 vs.

7  Engage the heart  Goal that is meaningful (task vs. knowledge orientation)  Engage the mind  Interesting achievable task  Personalized feedback over time  Engage with others  Nurture collaboration

8 Information is Ubiquitous and Easily Accessible

9 Challenges

10 The Challenge  Millenials don’t need information; they need  Prioritization  Context  Understanding  Feedback  The Challenge: Engage Learners  Variety  Style  Interactivity

11 Unique Issues  The technological forces that have affected this generation necessitate  digital multitasking and  interaction in online communities  Individuals raised with computers deal with information differently compared to previous cohorts: “They develop hypertext minds, they leap around.”  Efficiency is very important

12 Issues for Learning  learn better through discovery and experiential learning rather than by being told  want an immediate response  have the ability to shift their attention rapidly from one task to another and may choose not to pay attention to things that don’t interest them — attentional deployment  believe multitasking is a way of life and are comfortable when engaged in multiple activities simultaneously  respond to visual cues and stimuli

13 The Decline of Experts  Millenials are interactors – creating and consuming information  Old Model:  Reputation  Experience  Access  New model:  Crowd  Someone with experience  Anyone with an opinion

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15 What are gamers getting good at?  Urgent optimism  Ability to engage immediately with a problem where there is a reasonable hope of success  “always worth trying, and trying now”  Tight social fabric  Takes a lot of trust to play a game with someone  Blissful productivity  Happier working hard gaming than relaxing

16 Emotion and Learning  Students retain what they learn when the learning is associated with strong positive emotion.  Dulay & Burt, 1977; Krashen, 1982  Stress, boredom, confusion, low motivation, and anxiety individually, and more profoundly in combination, interfere with learning  Christianson, 1992

17 Attributes of Engaging Games  Clear and consistent rules  Clear goal  Clear rationale  Mission connected to and dependent on your ability  Plenty of support  Lots of positive feedback  Shared experience

18 Task-Based Learning is Promoted when learners  have a clear goal  activate prior knowledge or experience  observe a demonstration  engage in deliberate practice  receive feedback  apply the new knowledge  integrate their new knowledge into their everyday world

19 Educational technologies are advantageous in providing:  safe, controlled environments that eliminate risk to patients  enhanced, realistic visualization  authentic contexts for learning and assessment  documentation of learner behavior and outcomes  instruction tailored to individual or group needs  learner control of the educational experience  repetition and deliberate practice  uncoupling of instruction from place and time  standardization of instruction and assessment  perpetual resources and new economies of scale

20 Creating Engagement  Individualize the offering  Relevant and important  Build on prior learning  Personalized comparative feedback  Develop and maintain a longitudinal relationship  Curriculum for personal growth  Make it rewarding  Goal oriented  Fun  Positive  Engage the social instinct  Collaborative models

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22  Learning is facilitated when the learner  is engaged in solving a real-world problem.  is engaged at the problem or task level, not just the operation or action level.  solves a progression of problems.  is guided to an explicit comparison of problems  Learning is facilitated when the learner  is engaged in solving a real-world problem.  is engaged at the problem or task level, not just the operation or action level.  solves a progression of problems.  is guided to an explicit comparison of problems

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24  Learning is facilitated when the learner  is directed to recall, relate, describe, or apply knowledge from relevant past experience that can be used as a foundation for the new knowledge.  is provided relevant experience that can be used as a foundation for the new knowledge.  Learning is facilitated when the learner  is directed to recall, relate, describe, or apply knowledge from relevant past experience that can be used as a foundation for the new knowledge.  is provided relevant experience that can be used as a foundation for the new knowledge.

25  Learning is facilitated when  the learner is shown rather than told.  the demonstration is consistent with the learning goal.  the learner is shown multiple representations.  the learner is directed to explicitly compare alternative representations.  the media play a relevant instructional role.  Learning is facilitated when  the learner is shown rather than told.  the demonstration is consistent with the learning goal.  the learner is shown multiple representations.  the learner is directed to explicitly compare alternative representations.  the media play a relevant instructional role.

26  Learning is facilitated when  the learner is required to use his or her new knowledge to solve problems.  the problem solving activity is consistent with the learning goal.  the learner is show how to detect and correct errors.  the learner is guided in his or her problem solving by appropriate coaching that is gradually withdrawn.  Learning is facilitated when  the learner is required to use his or her new knowledge to solve problems.  the problem solving activity is consistent with the learning goal.  the learner is show how to detect and correct errors.  the learner is guided in his or her problem solving by appropriate coaching that is gradually withdrawn.

27  Learning is facilitated when the learner  can demonstrate his or her new knowledge or skill.  can reflect-on, discuss, and defend his or her new knowledge.  can create, invent, and explore new and personal ways to use his or her new knowledge  Learning is facilitated when the learner  can demonstrate his or her new knowledge or skill.  can reflect-on, discuss, and defend his or her new knowledge.  can create, invent, and explore new and personal ways to use his or her new knowledge

28 Rationale: Learning Theory  Learning can be optimized if the material  Activates prior knowledge  Is  engaging  relevant  Integrative  interactive  Facilitates elaboration Page 28

29 Online Simulations

30 Rationale  Learning is greatest when  The materials meet the learner’s needs  Relevant  Sufficient detail  The learning process is active  Problem solving  Making choices  Feedback is provided

31  20 cases across many specialties  Flash environment  Recreate the physician-patient encounter  History  Physical Exam  Relevant clinical decisions  Real patient cases, actual data & media  Reinforce learning and retention  Make decisions and receive feedback  “Learn more” links Simulation to Enhance the Learning Experience Page 31

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36 Questions with Feedback Page 36

37 Learn More Page 37 Article

38 More Questions with Feedback Page 38

39 Learning Element Page 39

40 Learning Element Page 40

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43 Learning Element Page 43

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46 Total IMCs Initiated and % Completed Page ,175 initiations

47 N=10,353Ratings of 4 & 5Mean score (of 5) Overall learning experience96%4.70 Ease of use95%4.71 Visual design95%4.69 Quality of the questions95%4.61 Level of detail94%4.59 Interactivity93%4.62 Rating of Interactive Cases

48 Amount of Information Page 48 N=10,329

49 N=10,123 All To test my clinical decision-making80% To learn about a topic outside my specialty area58% To learn generally about a topic in my specialty area44% As a teaching tool29% To obtain CME credits28% How they will be used?

50 PhysiciansNon-Physicians Physicians involved in clinical practice 91%72% Residents or trainees 83%75% Medical students 69%82% Fellows 60%50% Physicians involved in research & teaching 48%49% Physician Assistants 32%35% Nurses or Nurse Practitioners 20%28% Recommend to Whom?

51 How Often?

52 96% selected Very or Somewhat valuable How Valuable is the Comparative Score?

53 Adaptive Education

54 Hermann Ebbinghaus ( ) In 1885, he published "On Memory” Forgetting curves Learning curves Spacing effect

55 Forgetting Curve for Web-Based Teaching Modules

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57 Spaced Education: the basics  Spacing effect  spaced  repeated  repeated at increasing intervals - Increased efficiency of learning - Reduction in the slope of the forgetting curve ► Improves neuronal longevity in the hippocampus of rats ► Phosphatase mediator identified in Drosophila Sisti et al, Learn Memory 2007;14(5): Pagani et al, Cell 2009; 139, 186–198.

58 Testing Effect Interactive Spaced Education (ISE) harnesses both the testing effect & the spacing effect. Roediger & Karpicke. Test-enhanced learning: taking memory tests improves long-term retention. Psychol Sci, 2006; 17: 249. Karpicke & Roediger. The critical importance of retrieval for learning. Science 2008; 319:

59 How to Structure Spaced Education Answer & Explanation Question Curriculum to be Covered

60 Spaced Education on GU Pathology 77%; 580/583

61 SEPT: Study Structure University of Virginia School of Medicine University of Pittsburgh School of Medicine Harvard Medical School University of Alabama School of Medicine

62 SEPT: CONSORT Flow Chart

63 SEPT: 40-item assessment of retention

64 Adaptive Spaced Education Personalizes the content and spacing of the spaced education course for each physician Example – 932 urology residents in US & Canada – Residents receive two spaced education questions every day. – Incorrect → repeated 2 weeks later. – Correct → repeated 6 weeks later. – Correct twice in a row → item is retired & is no longer repeated. – Residents complete the program when all are retired. Advantages: – reduces the unnecessary repetition of mastered material. – turns the spaced education course into a game. – measures not only what physicians know, but how well they learn. 38%

65 Spaced Education Works  Increases knowledge & retention - Medical Education 2007: 41: UGME - Journal of General Internal Medicine 2008; 23(7): UGME - Journal of Urology 2007; 177, GME  Journal of Urology 2009; 181, GME  Annals of Surgery 2009; 249: 744– CME  Improves self-assessment of knowledge  American Journal of Surgery 2009; 197(1):89-95  Changes behavior  American Journal of Surgery 2009: 197(2),  Academic Medicine 2010  Is well-accepted by learners - Demonstrated in all trials to date

66 Online Lectures

67 Traditional vs. Online Class Activity Traditional Class Online Class Lecture In-class lectures Lecture recorded and stored online Discussions In person discussion Online blog Discussion board Assignments Paper submissions Electronic submission Tests & Exams Written, person proctored Online, digitally proctored Group Work In class or in a room together Virtual meetings Collaborative google documents Training Follow along to an onscreen demo. Students complete a guided self-completion exercise Office Hours In-office appointments Online anonymous questions Grading Grades released on each paper Grades released instantaneously online Demos Talk about your materials and work Video vignette

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70 Online Tutorials

71 “Headache & Heartache”  Learning Objectives:  Understand the role of pituitary hormones in growth and development  Appreciate the emotional and physical effects of sex hormones  Recognize the challenges in providing care to financially disadvantaged individuals and minorities  Case: 19yo woman with headache and primary amenorrhea  Problem: Supra-sellar tumor, ultimately leading to pan- hypopituitarism

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73 Student Preference for Learning n = 658 surveys

74 Tutor Preference for Teaching Strongly prefer paper 0% Prefer paper 0% n = 62 surveys

75 Student Data *p<0.05 ** p< Stimulation Learning Time Usage 5-point Likert Rating (  SEM) ** * Video Paper ** p<0.01 * p<0.05 vs paper n = 658 surveys Strongly Disagree Strongly Agree Neutral Scale Used:

76 VideoPaper

77 Critical Thinking Ratio by Video and Paper Cases VideoTextP Problem Identification Problem Description Problem Exploration <0.001 Applicability NS Integration NS

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79 1.Mobile technologies are omnipresent, technology is mobile-first 2.Seamless integration and synchronization across devices and platforms 3.Systems are user-experience driven – more human, less technical, highly user-friendly 4.Smarter adaptive programs with instant feedback 5.Higher-fidelity simulations 6.Collaborative social learning and immersive experiences using seamless communication Happening Today “No matter how sophisticated or robust the delivery, the content must fundamentally inspire (people) to learn” Source: MIT RELATE Current and future technologies impacting learning

80 Current and Future Technologies Impacting Learning Interactive web based learning Learning On The Go Seamless Synchronicity Predictive Suggestions Serious Games Collaborative learning in social networks Advanced, Simulations Visual Data Analysis Augmented Reality Improving cognitive performance Happening TodayFuture Horizon Electronic Books Mobility Intelligence Content Delivery Case-based learning Ubiquity? Predictive Competence AI Tutor? Mind reading of commands Advanced 6 th Sense Devices Holographic devices Direct connection to the brain

81 Key Messages from Online Learning Experiments  Online learning is  Acceptable  Effective  Efficient  Online learning is best when it is  Relevant  Interactive  Uses a variety of programs  Is spaced  Is adaptive  Provides feedback

82 Summary  The principals of gaming apply to learning the complexities of medical practice online  Physicians and medical students welcome the opportunity to learn online, and welcome  High-fidelity decision-making simulations  Personalized feedback & comparative performance  Multimedia interactive learning elements Page 82

83 QUESTIONS? Graham McMahon MD MMSc

84 Systemic approaches to creating engaging learning and teaching experiences LearningTeaching The Power of Taking Breaks The Power of Setting High Expectations The Power of Visualization & Visual Association The Power of Deferring Critical Judgment The Value of Expert Coaching The Value of Structured Sequencing The Value of Progressive Add Ons The Value of Anchored Instruction The Value of Fusing Content with Process The Power of Being Observed The Value of Adaptive Teaching Styles The Power of Removing Hierarchical Boundaries

85 Barriers to Physician Participation  Lack of motivation  Fatigue  Lack of time  Competing demands  Lack of awareness of knowledge deficit  Personal reluctance to change  Ambivalence  Group mentality  The “Dirty Dozen” of Human Factor Errors: Lack of Communication Lack of Communication Complacency Complacency Lack of Knowledge Lack of Knowledge Distraction Distraction Lack of Teamwork Lack of Teamwork Fatigue Fatigue Lack of Resources Lack of Resources Pressure Pressure Lack of Assertiveness Lack of Assertiveness Stress Stress Lack of Awareness Lack of Awareness Norms Norms

86 EXAMPLE: NEJM INTERACTIVE CASES

87 Focus Group Feedback  Learners want efficiency (permit saves)  Learning mindset vs. challenge mindset (range of difficulty)  Welcome mobile usage and ‘take home’ summary  Dependent Outcomes Model  Next outcome depends on your decisions  Learners worry it creates too much opportunity to fail; want earlier feedback for incorrect paths  Probabilistic Outcomes Model  Outcome in case reflects likelihood of that outcome in actual practice  Learners concerned they’ll miss the learning point with rare outcomes; they want to know what’s common Page 87

88 Image Challenge

89 Image Challenge Votes  Over 200 images in directory  2006: ~2 million votes  2007: ~3 million votes  2008: ~4 million votes  2009: ~6 million votes  Most popular link from e-table of contents

90 30 videos 30 videos Popular learning tool Popular learning tool 4 of top 10 downloads from site in were videos 4 of top 10 downloads from site in were videos Avg. 20,000 impressions/month) Avg. 20,000 impressions/month) Videos in Clinical Medicine

91 For the savvy, connected physician Audio Summaries #3 most useful podcast for professional purposes -- and the only journal cited (Manhattan Research ePharma Physician® v8.0)

92 Thank You!

93 Utility of NEJM.org Features 93

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95 Who Professional Profile Where does he/she work?  Works in a small practice or community health center/hospital, may have teaching/research responsibilities  May work in a technologically-forward practice or employing institution (i.e. already utilizing EMR) What does he/she value in his/her professional and personal life?  Cares about patient-centered approaches to medicine and patient education: educates the patient through websites, handouts and images  Values structure and advance planning to ensure preparedness when meeting patients  Enjoys interacting with co-workers or peers during everyday interactions or at conferences  Values and makes time for family and/or outside interests  Values practicality and real-world applications of learned knowledge (e.g., acknowledging different approaches to medicine, allowing for medical uncertainty or workflow management teachings)  Busy schedule, may take work home with him when needed Task-Oriented Clinicians

96 What Behaviors Related to Learning What are his/her preferences for learning?  Prefers information and learning to be convenient and concise  Wants to learn through information that is contextual and focused on practical tasks  Enjoys listening to experts in his/her field, even if they do not always have the time  Does not subscribe to NEJM because it is too scientific or is not relevant to his/her everyday practice  Does not have sufficient time to extensively read journals  Occasionally reads journals or specialty relevant information to review articles that discuss guidelines or practice changing information* How does he/she choose to complete formal learning requirements?  Likes the convenience of online activities and events given by the hospital  Attends conferences put on by major industry players, societies and boards  Is price-conscious (e.g. goes to conferences that are closer, or does not subscribe to NEJM due to price)  Adheres to CME and MOC requirements as needed, but views them strictly as requirements*  Relies on societies/boards to tell him where to go to complete MOC and CME*  Puts off study for CME and then works intensively to acquire sufficient credits before the deadline* Task-Oriented Clinicians * Denotes statements articulated by a minority of individuals within the segment

97 What is the context in which unstructured, informal learning occurs?  Researches information at the time it is needed (e.g. for patients, other doctors calling with questions)  Learns while doing - at bedside, while patient is getting dressed, in between patients  Looks up diagnostic and treatment information to refresh memory or to confirm beliefs  Looks up drug information for specific medications (i.e. dosages, interactions, etc.)  Completes further research when faced with unusual situations  Completes research when receiving incoming consult calls or patient s  With “spare” time will look further into unusual or interesting cases What is the context in which formal learning occurs?  Tries to fit bites of learning when possible in the day (e.g. listens to a CD while commuting, completes15-20 minute Epocrates sessions)*  Due to busy schedule, needs to plan ahead or set commitments to ensure formal learning gets done* Task-Oriented Clinicians When & Where Context in which Learning Takes Place * Denotes statements articulated by a minority of individuals within the segment

98 What types of electronic resources, tools and devices does he/she value?  Likes multimedia sources such as video content, CDs or information posted after presentations*  Enjoys ability to do minute CME courses on a handheld device*  Prefers Epocrates for drug information, and utilizes iPhone app for immediate access*  Uses EMR for drug information* What factors influence his/her choice of electronic resources, tools, devices?  Utilizes UpToDate to look up information when under time pressure  Relies on familiarity and reputation to ensure sources are trustworthy  Uses computer to access PubMed for more in-depth and academic searches  Uses computers in patient rooms to look up information with the patient*  Uses Google to search for more specific questions regarding patients and cases*  Accesses websites and journals through free hospital access or free websites* Task-Oriented Clinicians How Materials / Media / Technology Usage * Denotes statements articulated by a minority of individuals within the segment

99 What are his/her frustrations with unstructured, informal learning?  Too busy to devote extra time to establishing a consistent schedule of reading journals  Feels that there is an overload of information and would prefer sources to summarize relevant, practical findings  Finds it difficult to take the time to focus on professional growth or to reflect on informal learning opportunities on a daily basis* What are his/her frustrations with formal learning?  Feels CME activities (e.g. question formats, topic choice, content) and curricula can be poorly designed  Finds it difficult to evaluate the quality of a CME activity or provider without the aid of a medical association or peers  Believes that completing MOC/CME requirements can be expensive  Believes that CME and MOC impose requirements on learners that conflict with his/her own or employers’ goals* Task-Oriented Clinicians Why Frustrations around Learning * Denotes statements articulated by a minority of individuals within the segment

100 Where does he/she work?  Works in an academic setting, or has additional, non-clinician responsibilities  Works within a technologically forward practice, or institution (i.e. utilizes EMR)* What does he/she value in his/her professional and personal lives?  Feels responsible for educating patients through handouts, discussion and citing information in medical records  Creates his/her own informational material, if he/she feels what is available is insufficient (e.g. uses patient websites, guidelines, diagnosis templates)  Distrusts biases and sponsored studies/courses  Values communications with peers/co-workers  Is overloaded with clinician work and additional responsibilities  Ends up bringing work home Knowledge-Oriented Clinicians Who Professional Profile * Denotes statements articulated by a minority of individuals within the segment

101 What are his/her preferences for learning?  Likes to listen to, or see information visually (e.g. images, video content, podcasts)  Interested in building awareness of broader issues, but prefers materials that are focused on his/her specialty  Refreshes knowledge, or learns something new in preparation for presentations and/or lectures  Consults experts/specialists/peers to gain consensus, learn new information, or feel confident with a course of action  Cares about the quality of articles and sources when researching information, takes note of study methodology and/or looks at article references*  Reads or shares articles with practice group and peers* How does he/she choose to complete formal learning requirements? When studying for boards and doing CME activities, relies mainly on certifying board/specialty society/academic institution for review materials  Meets some CME/MOC requirements through institutional events or fulfilling institutional requirements  For CME activities, gets credit for current research efforts and/or likes to prep with questions (e.g. UpToDate, journal articles, pre-tests)  Likes learning through case studies or conferences Knowledge-Oriented Clinicians What B ehaviors Related to Learning * Denotes statements articulated by a minority of individuals within the segment

102 What is the context in which unstructured, informal learning occurs?  Reads journals when he/she can squeeze it in (e.g. during lunch, or at night time)  Due to busy schedule, will spend personal time preparing for presentations and on research projects outside of working hours  Shares information with peers/colleagues when it is interesting, or is needed to inform a diagnosis/treatment (e.g. printing out interesting articles, consulting specialists, recommending a new medication)  Prefers to wait until the patient has left to follow up on relevant issues, or until he/she can sit at a computer* What is the context in which formal learning occurs?  May study for multiple board exams*  Likely to begin preparing for MOC and/or boards early* Knowledge-Oriented Clinicians When & Where Context in which Learning Takes Place * Denotes statements articulated by a minority of individuals within the segment

103 What types of electronic resources, tools and devices does he/she value?  Utilizes many different websites for learning new information and research (e.g. UpToDate, Medline, Medscape, PubMed and specialty websites or journals)  Currently involved, or was involved in forums for sharing experiences and answering questions  Looks up drug information on Epocrates smartphone application  Receives electronic alerts from journals and other websites to keep up to date Knowledge-Oriented Clinicians How Materials / Media / Technology Usage * Denotes statements articulated by a minority of individuals within the segment

104 What are his/her frustrations with unstructured, informal learning?  Feels that he/she cannot always access information quickly enough  Frustrated by his/her inability to complete an effective literature search with current online resources* What are his/her frustrations with formal learning?  Believes that preparing for boards/recertifications is a tedious process or a waste of time*  Believes CME activities are not aligned with his/her interests and learning needs* Knowledge-Oriented Clinicians Why Frustrations around Learning * Denotes statements articulated by a minority of individuals within the segment

105 Enhancing the offline with the online The Financial Times offers broad suites of learning tools that augment classroom learning. Materials include short assignments, semester-long project, materials, and guides for instructors to assist learners in undertaking them. Bloomberg Businessweek offers learners online access to its network of experts. The interactivity inherent in online activities means that students participate in a “lean-forward” learning experience. This has empowered a shift from instructor-centric teaching, to student-centric learning Click-through training with audio & text narration Vermont’s Law Enforcement Online Training Center allows users to click- through a training module, accompanied by audio and text narration. It is simple, intuitive, and straightforward. Visual, interactive simulations of science phenomena PhET is a fun, interactive, and research-based simulation of physical phenomena from the University of Colorado. These simulations, click-and-drag-manipulation enabled, have been extensively tested and evaluated, and have turned out to be highly effective. Happening TodayFuture Horizon Interactive Web-Based Learning

106 Growing ubiquity across classrooms The adoption of mobile devices as learning tools is increasing, based on their use in all other facets of everyday life. Campus-wide pilot programs using mobile devices and/or software-enabled mobile learning and assessment abound, e.g. at Abilene Christian University, Ball State University, University of Texas, and Franklin & Marshall college The development of the multi-touch screen, improved graphic displays, and higher processor speeds contribute to a user experience that is simple, intuitive, and interactive Computers on the move The Motorola Atrix is a cell phone in size but computer in function. It has a powerful processor and has integrated mobility tools that are always available to record, track, and teach. Tablets as learning devices Following the success of touch-enabled smartphones, tablets represent the next generation of devices, led by the iPad. These devices offer a different kind of experience, placing less emphasis on typing, and written content, and more on interactivity, based on kinesis. Happening TodayFuture Horizon Learning on the Go: Mobile Devices

107 Simultaneous classroom ‘backchats’ Hotseat – designed at used at Purdue University – is a micro-discussion platform that allows students to ask questions, contribute to discussions, and respond to teacher prompts during a class in session. Facebook and Twitter are also used as alternative channels. There has been a demonstrated positive effect on student participation and overall learning. Learning on the Go: Mobile Apps Happening TodayFuture Horizon Mobile apps are an emerging delivery model. In time, developers will understand and master the unique qualities of learning on the go, and create apps that harness the enormous potential the technology presents Mobile higher education Blackboard Mobile Learn is a suite of integrated learning tools that can be configured by universities for their students to use. Blackboard allows students to access and comment on course content, hand in homework assignments, take part in communities, and even find their way around campus. Capsule program with incentives, performance & improvement tracking The Steer Clear app helps young drivers stay safe on the roads. Young drivers who complete the program may be eligible for a discount on their State Farm auto insurance. The app makes it easy to record driving experience and tracks improvement over time.

108 Immediate access to the text’s impact & context A prototype application provides numerical scores of each book based on their impact on popular opinion and debates. It also visualizes the book’s referencing connections. Technology is changing the way written content is consumed. Reading matter will soon be served up through our social networks; prose will be interactive; and text will link instantly to contextually relevant information Reading as a collective, social experience An application that serves up reading materials based on the readers’ professional networks. It offers recommendations from colleagues, allows users to join reading groups and discussions, and if enough employees buy the same book, it becomes part of a collectively accessible library Interactive narratives that are unique to each reader A book that actively engages with the reader and determines the ending of the story. The possible endings are multiple. Embedded in the story are certain plot twists and turns that are unlocked by performing physical actions, i.e. visiting a specific location. The story becomes unique to the reader. Happening TodayFuture Horizon Source: IDEO Electronic Books

109 Solve puzzles for science Foldit enables players to contribute to important scientific research simply by folding proteins. Players are awarded points based on the internal energy of the 3D protein structure. Serious games are effective as learning tools - they induce a desire to act, optimism about the outcome, trust and cooperation between players, a state of “blissful productivity”, and motivate with awe-inspiring missions Practice operational tactics Full Spectrum Warrior, is a “first person shooter” game used to train U.S. army recruits. It allows users to practice military tactics in simulated real life scenarios. Develop collective solutions Urban Science and Land Science, are “epistemic” games,” in which players solve real-life problems. The game seeks to bring together “ways of knowing, ways of doing, ways of being, and ways of caring” and apply them to the world around us. Happening TodayFuture Horizon Serious Games

110 Communities of teachers Skype in the classroom is a free community that helps teachers to use Skype. Teachers create profiles that allow them to connect with others, find partner classes, or guest speakers for a specific learning activity at very low cost. Community platforms are making it easier for teachers and providers to collaborate with others, while learners get to identify like-minded learning partners Visualizing and actualizing your career path LinkedIn Career Explorer gives students the opportunity to explore different career paths. In addition to visualizing possible career paths, it provides relevant opportunities, top companies, salary ranges, and access to professionals who can offer a helping hand. Open access to renowned experts & universities iTunes University uses the iTunes player to distribute open source educational content. There are +800 universities with active iTunes University sites, mostly providing their content publicly, and in many cases for free. Happening TodayFuture Horizon Collaborative Platforms for Teaching & Learning

111 Global learning classroom Inquus’ OpenStudy is a social learning network in which students ask questions, give help, and connect with other students studying similar things. Its aim is to create “one large study group, regardless of school, location, or background” Collaborative learning experiences bring together large numbers of participants to share knowledge. The advantage of community learning is the quantity of long-tail information created Solution improvements from patient contributions Cure Together, and PatientsLikeMe allow patients to share quantitative information, talk about their symptoms, and compare which treatments work best for them. New research discoveries have been made based on the patient- contributed data. Community problem solving Open IDEO is an online platform to create a global community that draws on “optimism, inspiration, ideas and opinions of everybody to solve design problems together for the collective social good” Happening TodayFuture Horizon Collaborative Learning in Networks

112 The emergence of cloud computing means that individuals can construct a personalized digital world. The points of entry to this world – PCs, tablets, smartphones – provide different options for interaction Happening TodayFuture Horizon Seamless Synchronicity and Your Private Digital World Synching the same content on my different devices Whispersync synchronizes bookmarks on Amazon’s Kindle devices registered to the same account. Netflix allows users to do the same with its films. This allows the users to and pick up where they left off and switch between devices My private world, accessible anywhere MobileMe is a subscription service that provides access from any device anywhere to , photos, and important files. MobileMe stores information in the cloud, and automatically syncs it with the device used. A software suite in the cloud Google’s products span and VoIP, to a suite of collaborative productivity tools. Google’s entire consumer-facing offering exists in the cloud making access easy and consistent.

113 Advanced simulators offer highly realistic verisimilar situations that are multi- dimensional and recreate unpredictable events. The effect is a high degree of sensory engagement in the simulations, while keeping the learner safe A physical crime-ridden street with professional actors Hogan’s Alley is a mock town in which the FBI conduct their training. New agents learn the latest techniques by investigating crimes and pursuing criminals. Professional actors play the criminals, and the town was created by Hollywood set designers. Simulated actual driving / flying conditions Lexus has developed a driving simulator that features a Lexus LS 460 mounted on a turntable on a 15-foot-high domed structure that can move in all directions. A track system allows the vehicle to simulate cornering, handling, and high speeds. Pilot training goes one step further in using satellite imagery, weather and lighting effects, to recreate unpredictable conditions. Happening TodayFuture Horizon Advanced Simulations Interactive, multimedia-enabled hands-on training CommandSim Fire Department Edition is an interactive, multimedia environment that assists firefighters in performing collaborative, hands-on training of command and control, radio communication, and incident command strategy. Users create scenarios from their own digital photos, video, and audio, and then overlay realistic smoke, fire, and vapor cloud effects.

114 Direct transduction The Emotiv EPOC is a neurosignal acquisition and processing wireless neuroheadset. It uses a set of sensors to tune into electric signals produced by the brain to detect player thoughts, feelings and expressions and connects wirelessly to most PCs. Advances in our understanding of the brain and technology may lead to a machine that is able to read the brain. The next step would be for the machine to communicate back to the brain, feeding information – opening vast, new possibilities for learning Motion Control The ultimate in motion recognition technology will be a set of sensors that provide spatial navigation in 3D, using human motion to provide six degrees of navigational control. Some examples of this are already available but it still lacks the standardization necessary for mass market. Artificial intelligence IBM are developing “Watson,” an AI machine that is able to make subjective judgments based on the reliability of available information. Experts suggest that future AI machines will be both self-aware and human in their intelligence, and capable of greater cognitive performance than humans. Happening TodayFuture Horizon Improving Cognitive Performance

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116 1.Current and Future Technologies Impacting Learning 2.Systemic Approaches to Effective Learning and Teaching 3.Teaching & Training Methods in Other Life Critical Professions (Aviation, Military, Firefighting) Contents

117 Learning opportunities can be made more effective by setting appropriately high expectations at the outset – both in terms of learning goals and teaching standards Individuals with poor expectations internalize their negative label, while those with positive labels succeed accordingly. This is known as the Pygmalion Effect (also, Rosenthal Effect). Experiments have shown that expectations about the competency level of a teacher, or one’s own ability to learn, and learners’ assessment of how difficult it is to assimilate the material can all positively and negatively influence learners’ test performance. For this reason, the greater the expectations instilled in learners, the better they perform. The Power of Setting High Expectations Upfront Source : Rosenthal, Robert and Jacobson, Lenore. Pygmalion in the Classroom: Teacher Expectation and Pupils' Intellectual Development. Irvington Publishers: New York, Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

118 Adults have a tendency to self-edit their thoughts. They fear embarrassment and the judgment of their peers. This fear causes them to be conservative in their thinking. To improve problem-solving, Tim Brown, the CEO and president of design firm IDEO, suggests that we must find ways to lessen self-editing and feel free to experiment, and be more ‘playful.’ Problem solving consists of two very distinctive modes of operation: Divergence, a generative mode where we explore and create many ideas, and Convergence, where we look back for solutions. The Divergence mode is where we most need experimentation ad playfulness. Freedom to think, without fear of judgment, can improve one’s ability to generate better solutions The Power of Deferring Critical Judgment & Self Editing Source: TED Talks, Tim Brown on Creativity and Play Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

119 Visualization enhances our ability to memorize After surviving a tragic collapse of a banquet hall and being able to remember where each of the guests was sitting, Simonides of Ceos, a fifth century Greek, reasoned that anything could be memorized by imagining a “memory palace,” containing imagery of what needed to be recalled. The tale of Simonides has been the basis for memorization techniques of the modern professional memorizers. MRI scans of professional memorizers reveal that they rely on regions of the brain known to be involved in spatial memory, in order to remember large quantities of information. This principle has been applied by Rosetta Stone, the popular language learning program whose learning tools encourage learners to remember by visual association. The Power of Visual Association Source: The New York Times, Secrets Of A Mind-gamer Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

120 The Power of Being Observed People improve or modify an aspect of their behavior that is being experimentally measured simply in response to the fact that they are being studied, and not in response to any particular experimental manipulation. This is known as the Hawthorne effect. Productivity gains can be the mere result of the motivational effect of the interest being shown in the people observed. Knowing that one is being observed can increase performance and productivity Source: Roethlisberger, F. Jules and W.J. Dickson. Management and the Worker. Cambridge, MS: Harvard University Press, Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

121 Removing hierarchical constraints creates more effective sharing of knowledge and ideas Employees are often reluctant to share knowledge due to their fears of loss of control over the ideas. Equally, bosses are reluctant to accept those ideas because of the fear of becoming useless, and consequentially loss of position. Thus, French CPG firm, Danone has recognized that and has developed “Knowledge Marketplaces” – events at which ideas are freely exchanged as products for “sale” at “idea stands,” and participants must dress in such a manner that there is no visible way of distinguishing their hierarchical rank. The Power of Removing Hierarchical Boundaries Source: Story-telling At Danone : A Latin Approach To Knowledge Management Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

122 Companies have embraced the power of time-off: 3M and Google allocate their employees “personal time” – time out from everyday work, which they are free to invest in their own projects. This enlightened approach to employee management has driven many of the innovations that have emerged from these two organizations. Ferran Adrià, the executive chef of world-renowned El Bulli in Spain would close his restaurant for half the year to experiment and discover new ways of cooking. The result has been three Michelin stars and recognition as the best restaurant in the world by Restaurant magazine. Every seven years, the two-time Grammy Award winning graphic designer Stefan Sagmeister, closes his New York studio for a yearlong sabbatical to rejuvenate and refresh its creative outlook. The result: “everything that we've done in the seven years following came out of thinking that took place in the sabbatical year.” Time out and freedom to invest in personal interests can play an important role in raising motivation, and inspiring creative problem-solving. The Power of Taking A Break Sources: The New York Times: The Google Way: Give Engineers Room; Wired Magazine: The 15 Percent Solution; TED Talks, Stefan Sagmeister: The power of time off; The New York Times, Ferran Adrià Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

123 Knowledge coaching allows the wisdom of experts to be transferred to others. Effective coaching comprises: ‘Deeply smart’ people and experts in a particular field have been shown to make intuitive decisions fast, and are able to spot problems and possibilities others miss. Their wisdom is crucial to any organization’s success and can be an institutional loss when the knowledge is not passed on. To ensure knowledge transfer and retention, experts should be empowered to act as coaches. Effective coaching spurs transfer and retention of vital wisdom, yields better solutions and more efficient processes. To maximize the degree to which novices absorb this wisdom, knowledge coaching should comprise a blend of guided practice, observation, debriefing, collective problem solving, and experimentation. The Value of Teaching Through Expert Coaching Guided Practice Guided Observation Guided Problem Solving Guided Experimentation Source: Harvard Business Review, Deep Smarts Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

124 Sequencing – aligned with natural cognitive processes – can create more effective learning Gagne posited that teaching actions should follow a precise sequence, to ensure alignment with the cognitive processes that allow us to learn new intellectual skills. The sequence of teaching actions is ( illustrated with an example sequence of teaching actions for the skill “recognize an equilateral triangle ”): 1.Gain attention Show a variety of different triangles 2.Identify the objectivePose the question: "What is an equilateral triangle?“ 3.Recall prior learningReview the definitions of triangles 4.Present stimulusProvide the definition of an equilateral triangle 5.Guide learningShow an example of how to create an equilateral triangle 6.Elicit performanceAsk students to create five different examples of equilateral triangles 7.Provide feedbackIndicate whether the examples are correct or incorrect 8.Assess performanceProvide scores and remediation 9.Enhance retention Show students various pictures and ask students to pick out equilaterals Source: Gagne, R., Briggs, L. & Wager, W. Principles of Instructional Design (4th Ed.). Fort Worth, TX: HBJ College Publishers, The Value of Teaching Through Structured Sequencing Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

125 According to elaboration theory, instruction should be organized in increasing order of complexity for optimal learning. A key idea of elaboration theory is that the learner needs to develop a meaningful context into which subsequent ideas and skills can be assimilated. Elaboration theory proposes seven major strategy components: Elaborative sequence – by adding successive layers of complexity Learning prerequisite sequences – via conceptual, procedural, or theoretical structures Summary – through content reviews presented in rule-example-practice format Synthesis – via presentation devices, diagrams, procedural flowcharts, or decision tables Analogies – by relating the content to learners' prior knowledge Cognitive strategies – by using a variety of cues (pictures, diagrams, mnemonics, etc.) needed for appropriate processing of material Learner control – by clear labeling and separation of instructional strategy components Source: English, R.E. & Reigeluth, C.M. Formative research on sequencing instruction with the elaboration theory. Educational Technology Research & Development, 44(1), 23-42, The Value of Teaching with Progressive Add-Ons For optimal learning, allow learners to develop meaningful understanding before moving on to the next step Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

126 Cognitive styles refer to the preferred way an individual processes information, a person's typical mode of thinking, remembering, or problem solving. There are many contrasting styles organized around context, content, and structure. Some examples of cognitive styles are: Field Independence vs. Field Dependence – Field independent learners tend to approach the problem- solving in an analytical fashion, whiles field dependent learners approach it in a global fashion. Serialist vs. Holist – Serialists prefer to learn in a sequential fashion, whereas holists prefer to learn in a hierarchical manner. Leveling versus sharpening – in sharpening individuals tend to exaggerate selected characteristics of the original memory and in leveling minimize the same. This affects a person’s account of what actually happened and may not be the same as what actually did occur. The Value of Teaching By Adapting to Cognitive Learning Styles Source: Kearsley, G. (April 19, 2011). The Theory Into Practice Database. Retrieved from To achieve greatest effectiveness, teaching approaches need flexibility to adapt to different cognitive learning styles Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

127 Component Display Theory (CDT) classifies learning along two dimensions: content type and performance. It also specifies nine presentation forms that are unique to each material and learner. A complete lesson would consist of objective followed by some combination of rules, examples, recall, practice, feedback, helps and mnemonics appropriate to the subject matter and learning task. To teach most effectively, consider both content dimensions and applicable forms of presentation/interaction Source: Merrill, M.D. Instructional Design Theory. Englewood Cliffs, NJ: Educational Technology Publication, The Value of Fusing Content with Process Performance Find Use Remember FactConceptProcedurePrinciple Types of Content RulesExamplesRecall PracticePrerequisitesObjectives HelpsMnemonicsFeedback Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way

128 Anchored instruction theory requires putting the students in the context of a problem-based story. The students "play" an authentic role while investigating the problem, identifying gaps to their knowledge, researching the information needed to solve the problem, and developing solutions. Anchored instruction is comprised of five principles: 1.Realistic task or event is presented in which the problem is anchored or focused 2.Students take ownership based on relatedness to problems and goals seen everyday 3.Deep development of knowledge structure that is highly transferable to other situations 4.Complex content presented in a narrative format 5.Generative learning context is created in which students identify with problem and become actively involved in generating solution Source: Bransford, J.D. et al. Anchored instruction: Why we need it and how technology can help. In D. Nix & R. Sprio (Eds), Cognition, education and multimedia. Hillsdale, NJ: Erlbaum Associates, The Value of Providing Contextual Anchors Adding contextual “anchors” in teaching improves learner assimilation and problem-solving Applicable to? Progressive Learning Make the Most of My Time Make it Rewarding for Me Help Me Through the Professional Development Process Make it Real Drawing upon the Wisdom of Others Patient- centered Learning Learning while Doing Learning it in My Own Way


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