- Email: [email protected]
Computer mediated conferencing – A hope or hype for healthcare education in higher learning?: A review of the Literature
Nurse Education Today (2007) 27, 318–324
Nurse Education Today intl.elsevierhealth.com/journals/nedt
Computer mediated conferencing – A hope or hype for healthcare education in higher learning?: A review of the Literature C.F. Loke Jennifer
*
Faculty of Health and Social Care, University of Hull, Foss Building, West Campus, Cottingham Road, Hull HU6 7RX, England, United Kingdom Accepted 30 May 2006
KEYWORDS
Summary Aims and objectives: In view of the increase use of computer mediated conferencing (CMC) by nurses with other health care professionals in health care education, this literature review provides insights into the experiences and issues surrounding the use of the technology by nursing students and their use with other health care students. It is an important initial step in designing and developing strategies in the use of CMC. This literature review also aims to structure the available research findings of needs and experiences of other health care students and students from disciplines other than health care to provide the best approximation of what nursing students will experience in diverse groups for inter-professional learning. Method: Literature review. Results: The literature review indicates a substantial amount of students’ experiences and expectations in CMC. The problems thus far, are more complex than access and use of the technology, and emerged as six different, but related issues associated with technology and reflective and collaborative online learning in a constructivist learning environment. Relevance to practice: Priority needs should be central in the preparation of student in the constructivist learning environment. Concerted efforts should not be just about increasing students’ technological competence, but on addressing the socio-psychological dimensions in CMC. c 2006 Elsevier Ltd. All rights reserved.
Computer conferencing; Nurses; Health care students
Introduction * Tel.: +44 1482 463460. E-mail address: [email protected].
When merged with web technologies, computer mediated conferencing (CMC) uses text-based dia-
0260-6917/$ - see front matter c 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2006.05.012
Computer mediated conferencing – A hope or hype for healthcare education in higher learning? logue to enable asynchronous communication (Hiltz and Wellman, 1997) and creates the kind of learning community needed for collaborative learning (Hiltz, 1998). Although underpinning CMC is Vygotsky’s social constructivist approach (Vygotsky, 1978) to learning, CMC is predominantly a written environment (McConnell, 2000). In effect, CMC provides a permanent record of participants’ contributions which enhances reflective and hence deep learning (McConnell, 2000). CMC is desired by educators and stakeholders in education, that it is now an integral part of elearning (Chetty, 2005). When the shift to learner-centeredness in education coincides with the expansion of inter-professional education (Cook, 2005), it is likely that the increased use of CMC in health care education is within an environment of heterogenous groups of health professionals. Potentially, there is not only an increase use of CMC by nursing students, but also, their increased use of the technology involved students from other health care disciplines. Since CMC as a learning environment mediated by technology has become and remains a popular online learning tool (Jones, 1998), it is important to appreciate that CMC produces very different challenges and demands for users. It is thus, critical to design and develop effective strategies for students’ use of CMC. However, this cannot be achieved, unless one has insights to students’ experiences and the issues surrounding their use of the technology. This paper is a literature search about experiences of students with CMC in higher learning. Papers are mostly about students and professionals from the disciplines of nursing and medicine, learning in homogeneous professional groups, as well as experiences of students in disciplines other than healthcare. This provides the best approximation of what nursing students will experience, when they work with diverse groups.
Methodology and classification of the existing research Medline and CINAHL search systems were first used with a combination of key words, ‘computer mediated conferencing’, ‘constructivism’, ‘e-learning’, collaborative learning, ‘higher education’, ‘students’ experiences’ or ‘students’ needs’ and ranged from 1980, because much of the pioneering work in educational use of CMC was no earlier than that. The search resulted in 64 hits, but only 10 papers were relevant. All 10 were case studies exploring the experiences of health care students – five on nurses undertaking post-registration courses or
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post-graduate courses, two on medical doctors undertaking continuous professional development programmes and three on baccalaureate student nurses. The search was repeated using SwetsWise, one of the library’s major providers of papers of many disciplines. This search resulted in 98 hits. Abstracts of the papers were read to examine their relevance. Twenty-six papers which have foci on theoretical concepts underpinning CMC as an educational tool were read in depth. Of the 26 papers, 25 were case studies to explore students’ experiences and expectations in CMC, and one was an anecdotal record of students’ experiences. Research studies ranged from 1987 to 2004. Of these 26 papers, 17 were done on post-graduate and graduate students (one on nursing; one on health care professionals; 15 on students from other disciplines) and nine were on undergraduate students (one on medical students; two on nursing students; one on health care students; five on students from other disciplines). The literature review includes a substantial amount of students’ experiences and expectations in CMC, all of which emerged as six different but related issues associated with technology, and reflective and collaborative online learning in a constructivist learning environment.
Needs and experiences of students Technological When Cochrane (2000) reflected on his 20 years of distance learning experience, the results demonstrated that the less than satisfactory conferencing system was due to the lack of sufficient training and the reluctance of most students to participate regularly. This may be explained by the reflective account of a graduate student (Maor, 2003) in an online unit about familiarising practicing teachers with the available technologies. The student revealed how he had first assumed that the use of CMC technology was simple, but later discovered how complicated it can be, even preventing him from participating in the conference. Students registered for online courses did not necessarily possess the minimum prerequisite technology skills (Lynch, 2001) and technological preparation of students has been demonstrated to be important pre-class planning to prepare them for online collaborative learning (Ge et al., 2000; Harasim, 1987). Nevertheless, in a paper by McGugan (2002) to evaluate the instructional models for CMC alongside Salmon’s five stage model
320 in a tourism course, the undergraduate students who had already logged online to participate in conferencing claimed that they had no problem with the technology, but these findings were obtained in the first stage of ‘‘access and motivation’’, where students were at an early stage of learning in that online module. Frustrations from technical problems (Cartwright, 2000; Cragg, 1994a,b; Farrell and McGrath, 2001; Wisenberg and Hutton, 1996) and anxiety in using computers (Saunders and Heyl, 1988) due to lack of familiarity (Cooper et al., 2004) were commonly reported in the literature.
Teacher-led approach A study by Murphy and Coleman (2004) involving 20 students working towards a master of education in information technology, explored their experiences of challenges in online asynchronous discussions. Frustrations were vented continuously by the graduate students in some courses on the lack of direction and organisation. In the students’ opinion, there was no useful purpose for doing the courses. Students entered the flexible learning sphere with the presence of other students and social networks, still preferred traditional forms of learning with the presence of a teacher and the security of a teacher-led environment. In fact, the results of a study by Oliver and Shaw (2003) supported the view that tutors’ expertise and tutors’ enthusiasm are the major factors stimulating student participation. In a case study (Maor, 2003) based on three learners’ own stories, affective support from the facilitator was a critical motivating environment, and this was particularly so in the initial period when the online experience was still new and isolating. One learner even claimed that it was the moderator who had helped her in making the discussions relevant to her practice, and without such support, she would have ended up becoming a spectator rather than a participant. This finding supported Mason’s conclusion (1991) during a study on interactivity in distance education that tutors played a major role in directing the online classes, where only one third of the students were actively providing and receiving online feedback. In a similar vein, Kearsley et al. (1995) found that there was a general concern about the slow response time of e-moderators amongst students at graduate level education. This was despite their findings indicating that CMC worked very well compared with traditional classes. Students’ satisfaction, their level of critical thinking and problem solving skills in online courses was found to be higher. The general lack of feedback from e-moderators as a student concern (Kearsley et al., 1995;
C.F. Loke Jennifer Murphy and Coleman, 2004) had been reported as more than a concern but a cause for student frustrations in other studies (Farrell and McGrath, 2001; Sturgill et al., 1999).
‘Retrievable’ asynchronous and text-only messages In the study by Maor (2003), one student felt that the permanent nature of the conference reduced her sense of isolation because the student felt that the class was open ‘24/7’ and everyone was ‘always’ present. Nurses shared similar positive views and appreciated the proficiency with computers for asynchronous networking with colleagues (Cragg, 1994a,b; Landis and Wainwright, 1996). In another study (McGugan, 2002), it was clear that students liked the permanence of online posting as students felt that it allowed them to go over what other learners said, yet they were uncomfortable and felt that they were constantly being ‘‘watched’’, and the mistakes they made (including spellings) could not be deleted in CMC. The graduate students in the study by Murphy and Coleman (2004) reported that the inability to delete posted messages had forced them to respond to their own messages for revision, and students felt that this not only disrupted the flow of discussion but had created a lot of confusion and frustration in their learning experience. Computer communication difficulties were commonly reported in a survey of graduate students (Ross et al., 1994). The difficulty of having to commit thoughts to writing, gave rise to discomfort in a group of health care professionals in a case study by Saunders and Heyl (1988). Students felt that CMC, by its nature allowed them to express their opinions and ideas in no other way except text increased the risks of easily misinterpreting or be misinterpreted (Murphy and Coleman, 2004). Students from a Master of Education course expressed that lack of feedback, specifically from visual and aural cues in text-based communication, led them to feeling out of synchronisation with discussion (Burge, 1994). According to these students, this form of feedback was a challenge. However, it was not so thought by a group of graduate students (Tiene, 2000), who considered it a disadvantage. This may explain why there were some students who were still not convinced of the benefits of technology and were sure that the rapport in a classroom would never be replicated on screen (McGugan, 2002). Students struggled to articulate/create their own ‘‘theory-in-use’’ in relation to each topic (Wisenberg and Hutton, 1996).
Computer mediated conferencing – A hope or hype for healthcare education in higher learning? Students thought that the difficulty was not only expectations of their intellectual ability but also excitement from having to think about whether they agreed or disagreed with what had been posted by others. In some situations, just to avoid taking comments the wrong way, students admitted that they might not respond to postings by others (Murphy and Coleman, 2004). This, in turn, heightened the anxiety level amongst learners (Murphy and Coleman, 2004). According to the students, students tend to attribute the lack of responses from peers to them being offended by the messages (Murphy and Coleman, 2004).
Community of learning In a study to investigate, the effectiveness of CMC in replacing face-to-face collaboration amongst 43 graduate students who enrolled in the core information systems class required of all Master of Business Administration and Master of Science/ Information Sciences students (Ocker and Yaverbaum, 1999), it was found that students were less satisfied with the asynchronous learning experience. Dissatisfactions were in terms of group interaction process and the quality of group discussion. Undergraduate students (Farrell and McGrath, 2001; McGugan, 2002) had also expressed that they disliked facing screens at all time and wanted constant feedback. Some students were sceptical that CMC would replace face-to-face interaction (McGugan, 2002) and as in other studies (Schutte, 1996; Tiene, 2000), students had indicated their preference for face-to-face experiences. Similarly, there were concerns about the perceived lack of real communication amongst students in the study by Wisenberg and Hutton (1996). While some students wanted face-to-face contact, others used telephones to establish voice connections with the teacher and each other delivering online learning. Schutte (1996) attributed online students’ scores of 20% higher than the traditional class to two examinations to extra peer interactions, because students from the virtual class who were frustrated at the lack of classroom interaction with the professor and other students had formed study groups to make up for the slack of not having a real classroom (Schutte, 1996). While concerns of the inability for a community of learning in CMC to develop remains, Maor (2003), found that one of the learners who was the only one with a computing background instead of a teaching background like the rest of the learners, felt that CMC provided space for her to develop a sense of belonging. In a study (Clarke, 2002) on student teachers who were pursuing a post-
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graduate degree in education, it was found that the conference, which was open to all members of the educational community, not only provided an avenue for reflective learning, but also allowed a community of practice to develop. Such positive findings were reflected in studies on baccalaureate nursing students, where students’ responses were found to grow in length and depth as the course progressed (Buckingham, 2003; Witucki et al., 1996). Nursing students generally felt that CMC provided them with the equal opportunity to participate (Cooper et al., 2004; Witucki et al., 1996). Similarly, in a qualitative study by Cragg (1994a), exploring the experiences of a group of seven nurses who completed a post-registration university course, nurses reported that they were able to function as a group and actively participated. When Wisenberg and Hutton (1996) taught a CMC course (Master of Continuing Education), it was found that students who tend to prefer the traditional classroom were those who appreciated most the democratisation of the CMC classroom. Students generally felt freedom to participate as fully and felt that their contributions were valued on an equal level. Unfortunately, this was not the case for every online student (Murphy and Coleman, 2004). Twenty graduate students expressed a domination of discussion by a particular group of students and such domination had created the feelings of exclusion and frustration.
Quality of conferences Students felt that the fear of offending others inevitably resulted in a decline in quality of responses in CMC to superficial comments that contributed little to general discussion and to particular learning (Murphy and Coleman, 2004). Students had associated the decline in quality with forced contributions to meet course requirements. They felt that responses were made for ‘point grabbing’, rather than interactions useful for learning (Murphy and Coleman, 2004). This finding was mirrored in another study, when Oliver and Shaw (2003) investigated strategies for encouraging student participation in online medical education. They discovered that contributions were not strongly interactive, medical students were simply playing the game of assessment and only making postings that would earn marks, but they rarely contributed. In a recent study (Curran et al., 2003) that used transcript analysis tools to analyse the nature of discourse that took place in four different webbased continuing medical education courseware programmes, it was found that the nature of participation programmes consisted primarily of
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C.F. Loke Jennifer
independent messages with a minimal learner-tolearner interaction. In addition, Hallett and Cummings (1997) on an undergraduate psychology course demonstrated that interactivity among students was an illusive goal, as students did not postadditional comments beyond required assignments. Student teachers were seen to use CMC to exchange emotional support and not for reflecting on their teaching or exchanging pedagogical content knowledge (Admiraal et al., 1998). In contrast, the opinion that CMC was most suited for information transfer was put forward in a case study of 25 health care students in a graduate level professional healthcare programme (Saunders and Heyl, 1988). However, these students’ ratings for the appropriateness of computer conferencing reflected their views on conferencing as being more appropriate for exchanging information, displaying agreements, requesting suggestion and information and exchanging opinions, rather than bargaining, persuading others and displaying disagreements and frustrations. CMC health care education may be valued as a medium only to gain insights of global heath care issues (Iwasiw et al., 2000) or to seek collaborative information sharing amongst health care professionals (Curran et al., 2000, 2003; Moen et al., 2000). In a study to explore the role of CMC in creating interdisciplinary practice amongst a heterogeneous group of health care students, students did not see any value in conferencing (Becker et al., 2000). They felt that the project should be discontinued owing to limited computer access, as well as to their experience of conferencing failure. In contrast, graduate nurses (Andrusyszyn et al., 1999) perceived meaningful interactions in conferences.
mation overload, passive interaction, no socialisation, the cost and the time involved in downloading and technical malfunctions (Gee, 2000). Negative feelings associated with the use of CMC to upload and download files and to send messages, were also shared by health care students (Saunders and Heyl, 1988). There was a general feeling amongst students that CMC was more time consuming (Cartwright, 2000; Saunders and Heyl, 1988), simply because students felt that reading text took longer than listening to voices (Murphy and Coleman, 2004). There was also a common feeling that the amount of electronic information generated was huge, simply because of a shift in emphasis on increasing the quantity of contributions. As a consequence, students felt pressurised to contribute to the discussion forum continuously to meet course requirements, and more so to keep up with others (Burge, 1994; Murphy and Coleman, 2004). Students felt that the amount of electronic information generated can be huge, that it can become so overwhelming that they lost track with the flow of conversations on a particular topic (McGugan, 2002; Murphy and Coleman, 2004). This may explain why it was generally felt that discussions were relevant only if students responded within a narrow time frame (Burge, 1994). Otherwise, students were frustrated that they were forced to spend time on deciphering the huge amount of information generated, when messages were not of value to discussions (Murphy and Coleman, 2004).
Practicality – flexibility versus demands
When students were more technologically competent and when teacher support was felt to be adequate, students tend to have positive experiences (Maor, 2003). However, problems faced by many students in CMC are far more complex than just the lack of confidence in the technology and the lack of teacher support. Many problems encountered by students seemed to have emerged from the text-based and asynchronous nature of CMC, which was originally designed on the promise that these features would add advantages to online learning, in which interactivities were expected to surpass those that occurred in a traditional classroom (Kaye, 1989). The problems, being mostly socio-psychological in nature, gave rise to even more complex problems and upset the balance between flexibility and demands in CMC. Positive experiences of having a sense of community of learning were commonly reported in studies which
Nurses generally appreciated the ability to participate in discussion without being in a specific place and time (Andrusyszyn et al., 1999; Cragg, 1994a; Landis and Wainwright, 1996; Iwasiw et al., 2000; Moen et al., 2000), as learning could fit around their shift-work patterns. Like nurses, the postgraduates appreciated the asynchronous nature of CMC for they could participate when it was convenient to their work and family schedules (Burge, 1994; Curran et al., 2000). However, the majority of students’ experiences were not so positive. In a study by Gee (2000), although two different perspectives were reported, only one student felt that online learning permitted a good balance of university, family and work commitment, while another felt that more work was required than ‘regular’ classes, and still, many others complained of infor-
Discussion and conclusions
Computer mediated conferencing – A hope or hype for healthcare education in higher learning? involved homogenous groups of students, such as nurses (Cooper et al., 2004; Witucki et al., 1996). Even then, nurses’ positive experiences were about the flexibility of CMC (Andrusyszyn et al., 1999; Cragg, 1994a; Landis and Wainwright, 1996; Iwasiw et al., 2000; Moen et al., 2000) as a tool for networking (Iwasiw et al., 2000). In most cases, the socio-psychological dimension of students’ need could have been underestimated, and the need for building of a community of learning for groups with diversity was perhaps, masked by the need for technological competence. When preparation of students in the constructive learning environment was skewed towards pre-class planning, students’ insecurity multiplied and students were therefore seen to increase their demand for the presence of a teacher (Murphy and Coleman, 2004). In conclusion, experiences of both general and health care students are not always positive and many students do not value CMC as a learning tool. Hence, despite the claim that CMC offers revolutionary capabilities not available with traditional educational approaches, students’ experiences with CMC may not always coincide with the oft-cited benefits of learning in this medium. The features of CMC designed to enhance collaborative learning inhibits as much as, or perhaps more than, it facilitates students in their adaptation to online learning. It seems then, instead of responding to problems at surface value there is a need for indepth evaluation and critical analysis to be part of the culture of the viable teaching and learning. This review has summarised knowledge of students’ perspectives, which is important for insights into decision-making. However, the full potential of the text-based and asynchronous nature of CMC and its underpinning theoretical concepts from the context of group dynamics in a community of learning amongst nurses in a heterogeneous group of health professionals are difficult to ascertain. Future research is needed to create an environment that draws on the inherent and learned competencies in nurse teaching staff, particularly those who have been involved as online students with other health professionals. Studies could derive from the use of interviews and anecdotal records to the examining of health professions students’ online behaviour via the analysis of students’ interactive conversations. In effect, the social context in which students’ responses are generated can be better understood. When awareness of issues surrounding learning in an authentic inter-professional learning environment is raised in the provision of collaborative online health care education in higher education, there will be better
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guidance for the development of health care educational strategies.
Acknowledgements I thank Professors Watson R and Shields L for their thoughtful review of this paper.
References Admiraal, W.F., Lockhorst, D., Wubbels, T., Korthagen, F.A.J., Veen, W., 1998. Computer-mediated communication environments in teacher education: computer conferencing and the supervision of student teachers. Learning Environments Research 1 (1), 59–74. Andrusyszyn, M.A., Iwasiw, C., Goldenberg, D., 1999. Computer conferencing in graduate nursing education: perceptions of students and faculty. The Journal of Continuing Education in Nursing 30 (6), 272–278. Becker, E.A., Scott, A.H., Gutman, S., Zelski, L., JaffeeGropack, S., Kiefer, C., Riquelme, L., McManus, M., Nieves, E., 2000. Creating interdisciplinary team practice through computer conferencing. Respiratory Care Education Annual 9 Spring, pp. 19–33. Buckingham, S., 2003. Perspectives on the experience of the learning community through online discussions. Journal of Distance Education 18 (2), 74–91. Burge, E., 1994. Learning in computer conference contexts: the learners’ perspective. Journal of Distance Education 9 (1), 19–43. Cartwright, J.C., 2000. Lessons learned: using asynchronous computer mediated conferencing to facilitate group discussion. Journal of Nursing Education 39 (2), 87–91. Chetty, G. 2005. The role of computer mediated communication (computer conferencing) in online learning – its benefits and problems. An introduction to digital environments for learning. (accessed 13.03.06.). Clarke, L., 2002. Putting the ‘C’ in ICT: using computer conferencing to foster a community of practice among student teachers. Journal of Information Technology for Teacher Education 11 (2), 163–179. Cochrane, C., 2000. The reflections of a distance student 1977– 1997. Open Learning 15 (1), 17–34. Cook, D., 2005. Models of interprofessional learning in Canada. Journal of interprofessional Care 19 (1), 107–115. Cooper, C., Taft, L.B., Thelen, M., 2004. Examining the role of technology in learning: an evaluation of online clinical conferencing. Journal of Professional Nurse 20 (3), 160–166. Cragg, C.E., 1994a. Nurses’ experiences of a post-RN course by computer mediated conferencing: friendly users. Computers in Nursing 12 (5), 221–226. Cragg, C.E., 1994b. Distance learning through computer conferences. Nurse Educator 19 (2), 10–14. Curran, V.R., Hockman, T., Gulliver, W., Landells, I., Hatcher, L., 2000. Web-based continuing medical education (II): evaluation study of computer-mediated continuing medical education. Journal of Continuing Education for Health Professionals 20 (2), 106–119. Curran, V., Kirby, F., Parsons, E., Lockyer, J., 2003. Discourse analysis of computer-mediated conferencing in World Wide Web-based continuing medical Education. Journal of Continuing Education in the Health Professions 23 (4), 229–302.
324 Farrell, M., McGrath, I., 2001. Online learning in an undergraduate nursing program: the perceptions of the learning technology mentors. ASCILITE 2001 conference proceedings. (accessed 07.07.05.). Ge, X., Yamashiro, K.A., Lee, J., 2000. Pre-class planning to scaffold students for online collaborative learning activities. Educational Technology and Society 3 (3), 159–168. Gee, L., 2000. Log on to learn, impulse-inflight, November– December in Choy S, McNickle C, Clayton, B 2002. Learners expectations and experiences. NCVER. (accessed 22.07.05.). Hallett, K., Cummings, J., 1997. The virtual classroom as authentic experience: collaborative, problem-based learning in a WWW environment. In: Competition–Connection–Collaboration – Proceedings of the Annual Conference on distance Teaching and learning, University of WiconianMadison, Mason WI, pp. 103–107. Harasim, L., 1987. Teaching and learning on-line: issues in computer mediated graduate courses. Canadian Journal of Educational Communication 16 (2), 117–135. Hiltz, S.R., 1998. Collaborative learning in asynchronous learning networks: building learning communities, invited Address at ‘‘WEB98’’ Orlando, Florida November 1988. (accessed 22.07.05.). Hiltz, S.R., Wellman, B., 1997. Asynchronous learning networks as a virtual classroom. Communication of the Association for Computer Machinery 40 (9), 44–49. Iwasiw, C., Andrusyszyn, M.A., Moen, A., Ostbye, T., Davie, L., Stovring, T., Buckland-Foster, I., 2000. Graduate education in nursing leadership through distance technologies: the Canada–Norway Nursing Connection. Journal of Nurse Education 39 (2), 81–86. Jones, C., 1998. Evaluating a collaborative online learning environment. Active learning 9 December, pp. 31–35. (accessed 22.07.05.). Kaye, A., 1989. Computer-Mediated Communication and Distance Education. In: Mason, R., Kaye, A. (Eds.), Mindweave: Communication, Computers and Distance Education. Pergamon Press, Oxford, pp. 50–62. Kearsley, G., Lynch, W., Wizer, D., 1995. The effectiveness of impact of computer conferencing in graduate education. Educational Technology 35 (6), 37–42. Landis, B.J., Wainwright, M., 1996. Electronic education. Computer conferencing: communication for distance learning. Nurse Educator 21 (2), 9–14. Lynch, M.M., 2001. Effective student preparation for online learning. The Technology Source. (accessed 20.01.05.). Maor, D., 2003. Teacher’s and student’s perspectives on on-line learning in a social constructivist learning environment. Technology, Pedagogy and Education 12 (2), 201–218.
C.F. Loke Jennifer Mason, R., 1991. Analyzing computer conferencing interactions. International Journal of computers in Adult Education and Training 2 (3), 161–173. McConnell, D., 2000. Implementing Computer Supported Collaborative Learning. Kogan Page, London. McGugan, S., 2002. Asynchronous computer mediated conferencing to learning and teaching: An action research approach. Journal of Hospitality, Leisure, Sports and Tourism Education 1 (1), 29–42. Moen, A., StØvring, T., Andrusyszyn, M., Iwasiw, C., Østbye, T., Davie, L., Buckland, F.I., 2000. ICT and international collaboration; experiences with internet based computer conferencing as part of studies in nursing science. Vard I Norden Nursing Science and Research in the Nordic Countries 20 (4), 42–45. Murphy, E., Coleman, E., 2004. Graduate students’ experiences of challenges in online asynchronous discussions. Canadian Journal of Learning Technology 30 (2). (accessed 11.04.05.). Ocker, R.J., Yaverbaum, G.J., 1999. Asynchronous computermediated communication versus face-to-face collaboration: Results on Student learning, quality and satisfaction. Group Decision and Negotiation 8 (5), 427–440. Oliver, M., Shaw, G.P., 2003. Asynchronous discussion in support of medical education. Journal of Asynchronous Learning Network 7 (1), 56–67. Ross, J.A., Crane, C.A., Roberston, D., 1994. Computer-mediated distance education. Journal of Distance Education 9 (1), 1–13. Saunders, C.S., Heyl, J.E., 1988. Evaluating educational computer conferencing. Journal of Systems Management 39 (4), 33–37. Schutte, J.G., 1996. Virtual teaching in higher education: the new intellectual superhighway or just another traffic jam? (accessed 11.04.05.). Sturgill, A., Martin, W., Gay, G., 1999. Surviving technology: a study of student use of computer-mediated communication to support technology education. International Journal of educational Telecommunications 5 (3), 239–259. Tiene, D., 2000. Online discussions: a survey of advantages and disadvantages compared to face to face dimension. Journal of Educational Multimedia and Hypermedia 9 (4), 371–384. Vygotsky, L.S., 1978. Mind in Society: The Development of Higher Psychological Processes. Harvard University Press, Cambridge, MA. Wisenberg, F., Hutton, S., 1996. Teaching a graduate program using computer-mediated conferencing software: distance education futures. Journal of Distance education 11 (1), 83– 100. Witucki, J.M., Hodson, K.E., Malm, L.D., 1996. Electronic education: integrating electronic conferencing to enhance problem solving in nursing. Nurse Educator 21 (4), 8–11.
Nurse Education Today intl.elsevierhealth.com/journals/nedt
Computer mediated conferencing – A hope or hype for healthcare education in higher learning?: A review of the Literature C.F. Loke Jennifer
*
Faculty of Health and Social Care, University of Hull, Foss Building, West Campus, Cottingham Road, Hull HU6 7RX, England, United Kingdom Accepted 30 May 2006
KEYWORDS
Summary Aims and objectives: In view of the increase use of computer mediated conferencing (CMC) by nurses with other health care professionals in health care education, this literature review provides insights into the experiences and issues surrounding the use of the technology by nursing students and their use with other health care students. It is an important initial step in designing and developing strategies in the use of CMC. This literature review also aims to structure the available research findings of needs and experiences of other health care students and students from disciplines other than health care to provide the best approximation of what nursing students will experience in diverse groups for inter-professional learning. Method: Literature review. Results: The literature review indicates a substantial amount of students’ experiences and expectations in CMC. The problems thus far, are more complex than access and use of the technology, and emerged as six different, but related issues associated with technology and reflective and collaborative online learning in a constructivist learning environment. Relevance to practice: Priority needs should be central in the preparation of student in the constructivist learning environment. Concerted efforts should not be just about increasing students’ technological competence, but on addressing the socio-psychological dimensions in CMC. c 2006 Elsevier Ltd. All rights reserved.
Computer conferencing; Nurses; Health care students
Introduction * Tel.: +44 1482 463460. E-mail address: [email protected].
When merged with web technologies, computer mediated conferencing (CMC) uses text-based dia-
0260-6917/$ - see front matter c 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2006.05.012
Computer mediated conferencing – A hope or hype for healthcare education in higher learning? logue to enable asynchronous communication (Hiltz and Wellman, 1997) and creates the kind of learning community needed for collaborative learning (Hiltz, 1998). Although underpinning CMC is Vygotsky’s social constructivist approach (Vygotsky, 1978) to learning, CMC is predominantly a written environment (McConnell, 2000). In effect, CMC provides a permanent record of participants’ contributions which enhances reflective and hence deep learning (McConnell, 2000). CMC is desired by educators and stakeholders in education, that it is now an integral part of elearning (Chetty, 2005). When the shift to learner-centeredness in education coincides with the expansion of inter-professional education (Cook, 2005), it is likely that the increased use of CMC in health care education is within an environment of heterogenous groups of health professionals. Potentially, there is not only an increase use of CMC by nursing students, but also, their increased use of the technology involved students from other health care disciplines. Since CMC as a learning environment mediated by technology has become and remains a popular online learning tool (Jones, 1998), it is important to appreciate that CMC produces very different challenges and demands for users. It is thus, critical to design and develop effective strategies for students’ use of CMC. However, this cannot be achieved, unless one has insights to students’ experiences and the issues surrounding their use of the technology. This paper is a literature search about experiences of students with CMC in higher learning. Papers are mostly about students and professionals from the disciplines of nursing and medicine, learning in homogeneous professional groups, as well as experiences of students in disciplines other than healthcare. This provides the best approximation of what nursing students will experience, when they work with diverse groups.
Methodology and classification of the existing research Medline and CINAHL search systems were first used with a combination of key words, ‘computer mediated conferencing’, ‘constructivism’, ‘e-learning’, collaborative learning, ‘higher education’, ‘students’ experiences’ or ‘students’ needs’ and ranged from 1980, because much of the pioneering work in educational use of CMC was no earlier than that. The search resulted in 64 hits, but only 10 papers were relevant. All 10 were case studies exploring the experiences of health care students – five on nurses undertaking post-registration courses or
319
post-graduate courses, two on medical doctors undertaking continuous professional development programmes and three on baccalaureate student nurses. The search was repeated using SwetsWise, one of the library’s major providers of papers of many disciplines. This search resulted in 98 hits. Abstracts of the papers were read to examine their relevance. Twenty-six papers which have foci on theoretical concepts underpinning CMC as an educational tool were read in depth. Of the 26 papers, 25 were case studies to explore students’ experiences and expectations in CMC, and one was an anecdotal record of students’ experiences. Research studies ranged from 1987 to 2004. Of these 26 papers, 17 were done on post-graduate and graduate students (one on nursing; one on health care professionals; 15 on students from other disciplines) and nine were on undergraduate students (one on medical students; two on nursing students; one on health care students; five on students from other disciplines). The literature review includes a substantial amount of students’ experiences and expectations in CMC, all of which emerged as six different but related issues associated with technology, and reflective and collaborative online learning in a constructivist learning environment.
Needs and experiences of students Technological When Cochrane (2000) reflected on his 20 years of distance learning experience, the results demonstrated that the less than satisfactory conferencing system was due to the lack of sufficient training and the reluctance of most students to participate regularly. This may be explained by the reflective account of a graduate student (Maor, 2003) in an online unit about familiarising practicing teachers with the available technologies. The student revealed how he had first assumed that the use of CMC technology was simple, but later discovered how complicated it can be, even preventing him from participating in the conference. Students registered for online courses did not necessarily possess the minimum prerequisite technology skills (Lynch, 2001) and technological preparation of students has been demonstrated to be important pre-class planning to prepare them for online collaborative learning (Ge et al., 2000; Harasim, 1987). Nevertheless, in a paper by McGugan (2002) to evaluate the instructional models for CMC alongside Salmon’s five stage model
320 in a tourism course, the undergraduate students who had already logged online to participate in conferencing claimed that they had no problem with the technology, but these findings were obtained in the first stage of ‘‘access and motivation’’, where students were at an early stage of learning in that online module. Frustrations from technical problems (Cartwright, 2000; Cragg, 1994a,b; Farrell and McGrath, 2001; Wisenberg and Hutton, 1996) and anxiety in using computers (Saunders and Heyl, 1988) due to lack of familiarity (Cooper et al., 2004) were commonly reported in the literature.
Teacher-led approach A study by Murphy and Coleman (2004) involving 20 students working towards a master of education in information technology, explored their experiences of challenges in online asynchronous discussions. Frustrations were vented continuously by the graduate students in some courses on the lack of direction and organisation. In the students’ opinion, there was no useful purpose for doing the courses. Students entered the flexible learning sphere with the presence of other students and social networks, still preferred traditional forms of learning with the presence of a teacher and the security of a teacher-led environment. In fact, the results of a study by Oliver and Shaw (2003) supported the view that tutors’ expertise and tutors’ enthusiasm are the major factors stimulating student participation. In a case study (Maor, 2003) based on three learners’ own stories, affective support from the facilitator was a critical motivating environment, and this was particularly so in the initial period when the online experience was still new and isolating. One learner even claimed that it was the moderator who had helped her in making the discussions relevant to her practice, and without such support, she would have ended up becoming a spectator rather than a participant. This finding supported Mason’s conclusion (1991) during a study on interactivity in distance education that tutors played a major role in directing the online classes, where only one third of the students were actively providing and receiving online feedback. In a similar vein, Kearsley et al. (1995) found that there was a general concern about the slow response time of e-moderators amongst students at graduate level education. This was despite their findings indicating that CMC worked very well compared with traditional classes. Students’ satisfaction, their level of critical thinking and problem solving skills in online courses was found to be higher. The general lack of feedback from e-moderators as a student concern (Kearsley et al., 1995;
C.F. Loke Jennifer Murphy and Coleman, 2004) had been reported as more than a concern but a cause for student frustrations in other studies (Farrell and McGrath, 2001; Sturgill et al., 1999).
‘Retrievable’ asynchronous and text-only messages In the study by Maor (2003), one student felt that the permanent nature of the conference reduced her sense of isolation because the student felt that the class was open ‘24/7’ and everyone was ‘always’ present. Nurses shared similar positive views and appreciated the proficiency with computers for asynchronous networking with colleagues (Cragg, 1994a,b; Landis and Wainwright, 1996). In another study (McGugan, 2002), it was clear that students liked the permanence of online posting as students felt that it allowed them to go over what other learners said, yet they were uncomfortable and felt that they were constantly being ‘‘watched’’, and the mistakes they made (including spellings) could not be deleted in CMC. The graduate students in the study by Murphy and Coleman (2004) reported that the inability to delete posted messages had forced them to respond to their own messages for revision, and students felt that this not only disrupted the flow of discussion but had created a lot of confusion and frustration in their learning experience. Computer communication difficulties were commonly reported in a survey of graduate students (Ross et al., 1994). The difficulty of having to commit thoughts to writing, gave rise to discomfort in a group of health care professionals in a case study by Saunders and Heyl (1988). Students felt that CMC, by its nature allowed them to express their opinions and ideas in no other way except text increased the risks of easily misinterpreting or be misinterpreted (Murphy and Coleman, 2004). Students from a Master of Education course expressed that lack of feedback, specifically from visual and aural cues in text-based communication, led them to feeling out of synchronisation with discussion (Burge, 1994). According to these students, this form of feedback was a challenge. However, it was not so thought by a group of graduate students (Tiene, 2000), who considered it a disadvantage. This may explain why there were some students who were still not convinced of the benefits of technology and were sure that the rapport in a classroom would never be replicated on screen (McGugan, 2002). Students struggled to articulate/create their own ‘‘theory-in-use’’ in relation to each topic (Wisenberg and Hutton, 1996).
Computer mediated conferencing – A hope or hype for healthcare education in higher learning? Students thought that the difficulty was not only expectations of their intellectual ability but also excitement from having to think about whether they agreed or disagreed with what had been posted by others. In some situations, just to avoid taking comments the wrong way, students admitted that they might not respond to postings by others (Murphy and Coleman, 2004). This, in turn, heightened the anxiety level amongst learners (Murphy and Coleman, 2004). According to the students, students tend to attribute the lack of responses from peers to them being offended by the messages (Murphy and Coleman, 2004).
Community of learning In a study to investigate, the effectiveness of CMC in replacing face-to-face collaboration amongst 43 graduate students who enrolled in the core information systems class required of all Master of Business Administration and Master of Science/ Information Sciences students (Ocker and Yaverbaum, 1999), it was found that students were less satisfied with the asynchronous learning experience. Dissatisfactions were in terms of group interaction process and the quality of group discussion. Undergraduate students (Farrell and McGrath, 2001; McGugan, 2002) had also expressed that they disliked facing screens at all time and wanted constant feedback. Some students were sceptical that CMC would replace face-to-face interaction (McGugan, 2002) and as in other studies (Schutte, 1996; Tiene, 2000), students had indicated their preference for face-to-face experiences. Similarly, there were concerns about the perceived lack of real communication amongst students in the study by Wisenberg and Hutton (1996). While some students wanted face-to-face contact, others used telephones to establish voice connections with the teacher and each other delivering online learning. Schutte (1996) attributed online students’ scores of 20% higher than the traditional class to two examinations to extra peer interactions, because students from the virtual class who were frustrated at the lack of classroom interaction with the professor and other students had formed study groups to make up for the slack of not having a real classroom (Schutte, 1996). While concerns of the inability for a community of learning in CMC to develop remains, Maor (2003), found that one of the learners who was the only one with a computing background instead of a teaching background like the rest of the learners, felt that CMC provided space for her to develop a sense of belonging. In a study (Clarke, 2002) on student teachers who were pursuing a post-
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graduate degree in education, it was found that the conference, which was open to all members of the educational community, not only provided an avenue for reflective learning, but also allowed a community of practice to develop. Such positive findings were reflected in studies on baccalaureate nursing students, where students’ responses were found to grow in length and depth as the course progressed (Buckingham, 2003; Witucki et al., 1996). Nursing students generally felt that CMC provided them with the equal opportunity to participate (Cooper et al., 2004; Witucki et al., 1996). Similarly, in a qualitative study by Cragg (1994a), exploring the experiences of a group of seven nurses who completed a post-registration university course, nurses reported that they were able to function as a group and actively participated. When Wisenberg and Hutton (1996) taught a CMC course (Master of Continuing Education), it was found that students who tend to prefer the traditional classroom were those who appreciated most the democratisation of the CMC classroom. Students generally felt freedom to participate as fully and felt that their contributions were valued on an equal level. Unfortunately, this was not the case for every online student (Murphy and Coleman, 2004). Twenty graduate students expressed a domination of discussion by a particular group of students and such domination had created the feelings of exclusion and frustration.
Quality of conferences Students felt that the fear of offending others inevitably resulted in a decline in quality of responses in CMC to superficial comments that contributed little to general discussion and to particular learning (Murphy and Coleman, 2004). Students had associated the decline in quality with forced contributions to meet course requirements. They felt that responses were made for ‘point grabbing’, rather than interactions useful for learning (Murphy and Coleman, 2004). This finding was mirrored in another study, when Oliver and Shaw (2003) investigated strategies for encouraging student participation in online medical education. They discovered that contributions were not strongly interactive, medical students were simply playing the game of assessment and only making postings that would earn marks, but they rarely contributed. In a recent study (Curran et al., 2003) that used transcript analysis tools to analyse the nature of discourse that took place in four different webbased continuing medical education courseware programmes, it was found that the nature of participation programmes consisted primarily of
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independent messages with a minimal learner-tolearner interaction. In addition, Hallett and Cummings (1997) on an undergraduate psychology course demonstrated that interactivity among students was an illusive goal, as students did not postadditional comments beyond required assignments. Student teachers were seen to use CMC to exchange emotional support and not for reflecting on their teaching or exchanging pedagogical content knowledge (Admiraal et al., 1998). In contrast, the opinion that CMC was most suited for information transfer was put forward in a case study of 25 health care students in a graduate level professional healthcare programme (Saunders and Heyl, 1988). However, these students’ ratings for the appropriateness of computer conferencing reflected their views on conferencing as being more appropriate for exchanging information, displaying agreements, requesting suggestion and information and exchanging opinions, rather than bargaining, persuading others and displaying disagreements and frustrations. CMC health care education may be valued as a medium only to gain insights of global heath care issues (Iwasiw et al., 2000) or to seek collaborative information sharing amongst health care professionals (Curran et al., 2000, 2003; Moen et al., 2000). In a study to explore the role of CMC in creating interdisciplinary practice amongst a heterogeneous group of health care students, students did not see any value in conferencing (Becker et al., 2000). They felt that the project should be discontinued owing to limited computer access, as well as to their experience of conferencing failure. In contrast, graduate nurses (Andrusyszyn et al., 1999) perceived meaningful interactions in conferences.
mation overload, passive interaction, no socialisation, the cost and the time involved in downloading and technical malfunctions (Gee, 2000). Negative feelings associated with the use of CMC to upload and download files and to send messages, were also shared by health care students (Saunders and Heyl, 1988). There was a general feeling amongst students that CMC was more time consuming (Cartwright, 2000; Saunders and Heyl, 1988), simply because students felt that reading text took longer than listening to voices (Murphy and Coleman, 2004). There was also a common feeling that the amount of electronic information generated was huge, simply because of a shift in emphasis on increasing the quantity of contributions. As a consequence, students felt pressurised to contribute to the discussion forum continuously to meet course requirements, and more so to keep up with others (Burge, 1994; Murphy and Coleman, 2004). Students felt that the amount of electronic information generated can be huge, that it can become so overwhelming that they lost track with the flow of conversations on a particular topic (McGugan, 2002; Murphy and Coleman, 2004). This may explain why it was generally felt that discussions were relevant only if students responded within a narrow time frame (Burge, 1994). Otherwise, students were frustrated that they were forced to spend time on deciphering the huge amount of information generated, when messages were not of value to discussions (Murphy and Coleman, 2004).
Practicality – flexibility versus demands
When students were more technologically competent and when teacher support was felt to be adequate, students tend to have positive experiences (Maor, 2003). However, problems faced by many students in CMC are far more complex than just the lack of confidence in the technology and the lack of teacher support. Many problems encountered by students seemed to have emerged from the text-based and asynchronous nature of CMC, which was originally designed on the promise that these features would add advantages to online learning, in which interactivities were expected to surpass those that occurred in a traditional classroom (Kaye, 1989). The problems, being mostly socio-psychological in nature, gave rise to even more complex problems and upset the balance between flexibility and demands in CMC. Positive experiences of having a sense of community of learning were commonly reported in studies which
Nurses generally appreciated the ability to participate in discussion without being in a specific place and time (Andrusyszyn et al., 1999; Cragg, 1994a; Landis and Wainwright, 1996; Iwasiw et al., 2000; Moen et al., 2000), as learning could fit around their shift-work patterns. Like nurses, the postgraduates appreciated the asynchronous nature of CMC for they could participate when it was convenient to their work and family schedules (Burge, 1994; Curran et al., 2000). However, the majority of students’ experiences were not so positive. In a study by Gee (2000), although two different perspectives were reported, only one student felt that online learning permitted a good balance of university, family and work commitment, while another felt that more work was required than ‘regular’ classes, and still, many others complained of infor-
Discussion and conclusions
Computer mediated conferencing – A hope or hype for healthcare education in higher learning? involved homogenous groups of students, such as nurses (Cooper et al., 2004; Witucki et al., 1996). Even then, nurses’ positive experiences were about the flexibility of CMC (Andrusyszyn et al., 1999; Cragg, 1994a; Landis and Wainwright, 1996; Iwasiw et al., 2000; Moen et al., 2000) as a tool for networking (Iwasiw et al., 2000). In most cases, the socio-psychological dimension of students’ need could have been underestimated, and the need for building of a community of learning for groups with diversity was perhaps, masked by the need for technological competence. When preparation of students in the constructive learning environment was skewed towards pre-class planning, students’ insecurity multiplied and students were therefore seen to increase their demand for the presence of a teacher (Murphy and Coleman, 2004). In conclusion, experiences of both general and health care students are not always positive and many students do not value CMC as a learning tool. Hence, despite the claim that CMC offers revolutionary capabilities not available with traditional educational approaches, students’ experiences with CMC may not always coincide with the oft-cited benefits of learning in this medium. The features of CMC designed to enhance collaborative learning inhibits as much as, or perhaps more than, it facilitates students in their adaptation to online learning. It seems then, instead of responding to problems at surface value there is a need for indepth evaluation and critical analysis to be part of the culture of the viable teaching and learning. This review has summarised knowledge of students’ perspectives, which is important for insights into decision-making. However, the full potential of the text-based and asynchronous nature of CMC and its underpinning theoretical concepts from the context of group dynamics in a community of learning amongst nurses in a heterogeneous group of health professionals are difficult to ascertain. Future research is needed to create an environment that draws on the inherent and learned competencies in nurse teaching staff, particularly those who have been involved as online students with other health professionals. Studies could derive from the use of interviews and anecdotal records to the examining of health professions students’ online behaviour via the analysis of students’ interactive conversations. In effect, the social context in which students’ responses are generated can be better understood. When awareness of issues surrounding learning in an authentic inter-professional learning environment is raised in the provision of collaborative online health care education in higher education, there will be better
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guidance for the development of health care educational strategies.
Acknowledgements I thank Professors Watson R and Shields L for their thoughtful review of this paper.
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