Educating for Quality Healthcare: Improving Outcomes through Innovative Applications of Internet-based Technology Professor J C Taylor Deputy Vice-Chancellor (Global Learning Services) The University of Southern Queensland Presentation to the Educating for Quality Healthcare International Symposium 28 July 2003 Presentation to the Educating for Quality Healthcare International Symposium 28 July 2003

Joseph Schumpeter (1934) predicted that every 50 years or so, technological revolutions would cause "gales of creative destruction” in which old industries would be swept away and replaced by new ones.

Technological Changes  Steam Power s to the 1840s  The Railways s to the 1890s  Electric Power s to the 1930s  The Motor Car s to the 1980s  Information Technology s to ?

Pace of Change 1. Radio: 50 million users in 38 years 2. Television: 50 million users in 13 years 3. The Internet: 50 million users in 5 years Common Prediction: One billion users by the year 2003

Internet Access Population (millions)  USA  Japan56.1  China 45.8  UK34.3  Germany32.1  South Korea25.6  Brazil13.9  Australia10.6  Netherlands 9.7  Sweden 6.1 Source: A C Nielsen, June 2003 Total global population estimated at 580 million

e-Readiness Rankings: Leaders 1Sweden Denmark (tie)Netherlands (tie)US (tie)UK8.43 6Finland8.38 7Norway8.28 8Switzerland8.26 9Australia (tie)Canada (tie)Hong Kong Singapore Germany8.15 Source: The Economist Intelligence Unit eBusiness Forum, March 2003 e-Readiness ranking Country e-Readiness score

e-Readiness Rankings: Contenders 14Austria Ireland South Korea (tie)Belgium (tie)New Zealand France Taiwan Italy Portugal Spain Japan Israel6.96 Source: The Economist Intelligence Unit eBusiness Forum, March 2003 e-Readiness ranking Country e-Readiness score

The Knowledge Explosion Over 90% of the relevant literature in many technical fields, such as biotechnology, astronomy, computers and software, and environmental sciences, has been produced since J B Quinn (2001) Traditional programmatic approaches to education simply cannot keep up………...

The Knowledge-based Economy There are increasing signs that our current paradigms for higher education, the nature of our academic programs, the organization of our colleges and universities, and the way that we finance, conduct and distribute the services of higher education may not be able to adapt to the demands of our time. J J Duderstadt (2001)

Prediction 'The death of distance as a determinant of the cost of communications will probably be the single most important economic force shaping society in the first half of the 21st century'. Cairncross (1997)

Thesis Interaction between Internet systems and educational processes will revolutionize traditional approaches to higher education and continuing medical education.

Leadership Challenge A market-driven restructuring of continuing medical education as an industry – while perhaps both alien and distasteful to the academy – is an important perspective from which to view the future.

Annotated list of worthwhile CME links to more than 230 Online CME sites offering more than courses and more than hours of CME credit. This site is managed by Bernard M Sklar, M.D., M.S.

Why you should bother …Online CME is always there, waiting for you, 24 hours a day, 7 days a week, at home or at the office You can proceed at your own speed No travel costs Very inexpensive

Family Practice A family doctor might start at the Family Practice Section Family Practice Section of the CME List, and go from there to the American Academy of Family Physicians site or to American Academy of Family Physicians FamilyPractice.com, sponsored by the American Board of Family Practice FamilyPractice.com

Internist An internist might start at the Internal Medicine section of the Online CME List, and go from there toInternal Medicine Clinical Problem Solving Cases, sponsored by ACP/ASIM, or to Clinical Problem Solving Cases Johns Hopkins Advanced Studies in Medicine Johns Hopkins Advanced Studies in Medicine

Cardiologist A cardiologist could start at the Cardiology section of the Online CME List and go to Cardiology section of the Online CME List CardioVillage (University of Virginia) or CardioVillage Baylor University’s extensive list of cardiology offerings Baylor University’s

The transition from the Industrial to the Information Age was encapsulated by Dolence and Norris (1995), who argued that to survive organisations would need to change from rigid, formula driven entities to organisations that were “fast, flexible and fluid”. Fast, Flexible and Fluid

What type of institutions will survive? Will your institution survive? The Global Lifelong Learning Economy

Increasing Competition Cambridge University’s business school has joined forces with FT Knowledge, part of the global communications group Pearson plc, to offer this new degree from September The Cambridge e-MBA

791 years ago Cambridge University passed a rule Requiring all students to reside in the town of Cambridge, England. In 2000 that rule was revoked. The 800 year-old rulebook had to be altered to make way for the university’s first Internet-enabled program, the global e-MBA. Fast, Flexible and Fluid?

reply received from University of Cambridge MBA Office on 13 March “Thank you for your enquiry concerning the Cambridge MBA course. We do not have on-line learning or distance learning, we have considered this but decided not to pursue this.”

Increasing Competition AllLearn (an e-learning partnership between Oxford University, Stanford University and Yale University) is offering 75 short courses in a dozen disciplines in the Fall Semester, starting 7 th October,

Future Projections  A recent IBM report forecasts a threefold (US$4.5 trillion) jump in global education expenditure during the next 13 years. (Source: Richard Gluyas, New Nabs e-School Deal 22 April 2000).   The World Bank expects the number of higher education students will more than double from 70 million to 160 million by 2025.

Future Projections  By 2005, e-learning will be the single most used application on the web. (Source: Harris, Logan & Lundy, Gartner Research, 2001).   Corporate investment in e-learning will grow from US$2.1 billion in 2001 to US$33.4 billion in 2005.

The Big Picture   Change is the only constant.   Growth is the only certainty.

Five Generations of Distance Education Technology  The Correspondence Model  The Multimedia Model  The Telelearning Model  The Flexible Learning Model  The Intelligent Flexible Learning Model

HIGHLY REFINED MATERIALS HIGHLY REFINED MATERIALS ADVANCED INTERACTIVE DELIVERY ADVANCED INTERACTIVE DELIVERY CHARACTERISTICS OF DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES Yes Yes Yes Yes No FLEXIBILITY Time Place Pace INSTITUTIONAL VARIABLE COSTS APPROACHING ZERO THE CORRESPONDENCE MODEL THE CORRESPONDENCE MODEL Print First Generation No

HIGHLY REFINED MATERIALS HIGHLY REFINED MATERIALS ADVANCED INTERACTIVE DELIVERY ADVANCED INTERACTIVE DELIVERY CHARACTERISTICS OF DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES Yes Yes Yes Yes No FLEXIBILITY Time Place Pace Yes Yes Yes Yes Yes INSTITUTIONAL VARIABLE COSTS APPROACHING ZERO THE MULTIMEDIA MODEL Print Audiotape Videotape Computer-based learning (eg CML/CAL) Interactive video Print Audiotape Videotape Computer-based learning (eg CML/CAL) Interactive video Second Generation No

HIGHLY REFINED MATERIALS HIGHLY REFINED MATERIALS ADVANCED INTERACTIVE DELIVERY ADVANCED INTERACTIVE DELIVERY CHARACTERISTICS OF DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES No No No No Yes FLEXIBILITY Time Place Pace No No No Yes Yes INSTITUTIONAL VARIABLE COSTS APPROACHING ZERO THE TELELEARNING MODEL Audio-teleconferencing Videoconferencing Audiographic communication Broadcast TV/Radio and Audio-teleconferencing Audio-teleconferencing Videoconferencing Audiographic communication Broadcast TV/Radio and Audio-teleconferencing Third Generation No

THE FLEXIBLE LEARNING MODEL Interactive multimedia (IMM) Internet-based access to WWW resources Computer mediated communication (CMC). Interactive multimedia (IMM) Internet-based access to WWW resources Computer mediated communication (CMC). HIGHLY REFINED MATERIALS HIGHLY REFINED MATERIALS ADVANCED INTERACTIVE DELIVERY ADVANCED INTERACTIVE DELIVERY CHARACTERISTICS OF DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES Yes Yes Yes Yes Yes FLEXIBILITY Time Place Pace Yes Yes Yes Yes Yes INSTITUTIONAL VARIABLE COSTS APPROACHING ZERO Yes No Fourth Generation

HIGHLY REFINED MATERIALS HIGHLY REFINED MATERIALS ADVANCED INTERACTIVE DELIVERY ADVANCED INTERACTIVE DELIVERY CHARACTERISTICS OF DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES MODELS OF DISTANCE EDUCATION AND ASSOCIATED DELIVERY TECHNOLOGIES Yes Yes Yes Yes Yes FLEXIBILITY Time Place Pace Yes Yes Yes Yes Yes INSTITUTIONAL VARIABLE COSTS APPROACHING ZERO THE INTELLIGENT FLEXIBLE LEARNING MODEL THE INTELLIGENT FLEXIBLE LEARNING MODEL Interactive multimedia Internet-based access to WWW resources CMC, using automated response systems Campus portal access to institutional processes & resources Interactive multimedia Internet-based access to WWW resources CMC, using automated response systems Campus portal access to institutional processes & resources Fifth Generation Yes

Incoming “new” admin question from student Previous Questions USQAssist: Self-service Knowledge Base Previous Answers “Immediate” admin feedback to student NO YES Search / Match Trigger Ask a question/ send an USQ staff member – “New Answer” 5th Generation Application

Incoming “new” academic question from student Previous Questions Previous Questions Reusable Learning Objects Database Previous Answers Previous Answers “Immediate” academic feedback to student NO YES New Answer Search / Match Duty Tutor Trigger Metadata Schema Model 5th Generation Application

Patient search screen – Patient name is typed in and the search button is pressed.

Screen showing results of a search for “Tom”. Patient is selected from the list.

Patient details are displayed. Extra details are selected from tabs at top.

This screen shows the history of the the patient. Details can be reviewed and updated on this screen.

This screen lists the seizure details for the patient. These can be reviewed and updated from this screen.

This screen displays current and past medications on the left hand side, with details for the selected one listed on the right hand side.

Screen where notes can be entered in an unstructured manner about the patient and their treatment.

Upload to Web Site Collected details are uploaded to the central website on a regular basis. Updates for medication and side-effects are downloaded to the client. Once the details are uploaded, analysis can be performed and reports produced and made available. 110 system CDs have been distributed – with the assistance of Novartis, a further 1000 CDs are to be distributed.

 All students22,908  On-campus 5,720  Off-campus (Australia)12,606  Off-campus (Overseas) 4,582 Note: Students studying solely online 887 Enrolled Students USQ 2003

USQ’s International Students 2003  Singapore 1,598  Malaysia 2,327  Hong Kong 565  South Africa 288  United Arab Emirates 114  Japan 93  Pacific Islands 180  India 18  Canada 98  China 195  Germany 188 Total, incl. students from 67 other countries 6,976

The GOOD System provides a simple way to Create, Manage & Re-purpose content

XML (eXtensible Markup Language) RENDITIONS: STYLE SHEET: CONTENT REPOSITORY: INPUT: Print Web CD DVD XSLXSLXSLXSLXSLXSLXSLXSL XML DTD (Document Type Definition) XML Editor

Incoming “new” admin question from student Previous Questions USQAssist: Self-service Knowledge Base Previous Answers “Immediate” admin feedback to student NO YES Search / Match Trigger Ask a question/ send an USQ staff member – “New Answer” 5th Generation Application

During the first half of 2003 the system received:   an average 9,075 hits per week;   95, 322 student contacts;   61,579 answers viewed;   23,079 searches performed;   3,566 questions using the “Ask a Question” facility. During S1, the e-CRM also managed a further 37,755 queries. During the first half of 2003 the system received:   an average 9,075 hits per week;   95, 322 student contacts;   61,579 answers viewed;   23,079 searches performed;   3,566 questions using the “Ask a Question” facility. During S1, the e-CRM also managed a further 37,755 queries. USQAssist Self-Service Knowledge Base USQAssist Self-Service Knowledge Base

Student support staff also save 25% of their time through the use of the knowledge-base for the automatic generation of suggested answers to , phone and face-to-face enquiries USQAssist Self-Service Knowledge Base USQAssist Self-Service Knowledge Base

The PC-ePhone

Using the Internet as a mode of delivery will not automatically improve student learning.

Laurillard (2002)…..“ The academic world has called each new technological device – word processing, interactive video, hypertext, multimedia, the Web- into the service of the transmission model of learning.”

The Potential of e-Learning  From transmission to transaction  From the independent learner to the inter-dependent learner  From transmission to transaction  From the independent learner to the inter-dependent learner

Content Areas Communication Areas Student Areas Group Areas

Computer Mediated Communication (CMC) There is a fundamental qualitative difference between a traditional on- campus tutorial and asynchronous written communication online.

Important Qualitative Difference Compared to the spontaneous and less structured nature of oral discourse, asynchronous discussion online engenders a disciplined and rigorous form of thinking based on the reflective and explicit nature of the written word.

Brown & Duguid (2000) emphasised the importance of regarding learning as a social act: “Practice is an effective teacher, and community of practice an ideal learning environment.”

Lave & Wenger (1991) emphasised the importance of the social context in which the learner is immersed, and learning as legitimate peripheral participation in a community of practice.

In the online context, legitimate peripheral participation has become associated with the term “Lurker”. “One of the “silent majority” in an electronic forum; one who posts occasionally or not at all but is known to read the group's postings regularly.” (The Jargon dictionary, 2002)

Student Participation Profiles  Proactive  Peripheral  Parsimonious Workers Lurkers Shirkers

Overview of Participation and Performance Student Sub- Groups The Workers The Lurkers The Shirkers Average Number: Discussion Board Hits Average Number: Messages Posted Average: GPA

The academic performance of the lurkers was on average not much less than that of the workers, thereby supporting the notion of learning as legitimate peripheral participation. Outcome

The success of the lurkers augurs well for the use of e-learning facilitated by intelligent databases and the flexibility inherent in interacting with virtual cohorts of students. The success of the lurkers augurs well for the use of e-learning facilitated by intelligent databases and the flexibility inherent in interacting with virtual cohorts of students. The Future

Incoming “new” academic question from student Previous Questions Previous Questions Reusable Learning Objects Database Previous Answers Previous Answers “Immediate” academic feedback to student NO YES New Answer Search / Match Duty Tutor Trigger Metadata Schema Model 5th Generation Application

In effect, fifth generation distance provides students with better quality tuition and more effective pedagogical and administrative support services at lower cost. 5th Generation

“Any new technology environment eventually creates a totally new human environment”. Marshall McLuhan The e-Revolution