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Transforming the Delivery of a Translational Medicine Program Tim Bulger MDE 621_F13 Athabasca University
TRANSFORMING TRANSLATIONAL MEDICINE Transforming the Delivery of a Translational Medicine Program Introduction Translational Medicine is the complex process of taking knowledge gained from pure medical research out of the lab into the research where it is translated into tools, processes, or even pharmaceuticals that are used to treat diseases in humans. Translational medicine is an emerging field. At present there are few institutions that provide graduate programs to credential individuals. The Department of Medicine at the University of Alberta (UofA) recently launched a graduate program in Translational Medicine. This program is offered in person at the UofA but there is interest in expanding the program to office campus students through the use of distance education technology and computer mediated communication. This paper will provide a summary of the Translational Medicine Program and discuss the opportunities, along with the challenges, of using CMC to deliver this program via distance education technology. Translational Medicine Program Translational Medicine is the term given to the activities required to take knowledge gained from laboratory research through regulatory processes to become new interventions that are used to prevent, diagnose, and treat diseases (Woolf, 2008). The successful development of novel medical interventions occurs in two domains. The first domain is the basic science laboratory, often situated in a large research university, where extensive supporting infrastructure and cutting edge technology is available. Extensive experimentation using methods drawing from molecular biology, genetics, vascular biology and other specialty areas creates new knowledge regarding disease processes. The other domain is in the “real world� of hospitals, regulatory systems, government policy, funding limitations, and people. If the knowledge gained in the lab is to be implemented, i.e., used to prevent, diagnose, or treat diseases, it has to be implemented.
TRANSFORMING TRANSLATIONAL MEDICINE The research skills required for implementation include epidemiology, public policy, study design, regulatory submissions, qualitative research, and an understanding of systems theory. Medical researchers are typically trained in one of these two domains, the intention of the Translational Medicine Program (TM Program) offered by the Department of Medicine is to provide basic scientists with the skills of the real world scientist, and vice versa, enabling them to take knowledge from the bench to the bedside (Department of Medicine, 2013). At present the program is delivered in a traditional face-to-face classroom setting, but there is a desire to introduce CMC into the program for on campus participants as part of a broader goal of developing the program to be delivered by distance education allowing off campus participants to obtain a graduate credential in Translational Medicine. Computer Mediated Communication Computer Mediated Communication (CMC) is the communication between two or more individuals via separate computers, typically using social software (Edutech Wiki, 2013). CMC is a generic term which applies to a range of online technologies that make distance education possible. CMC makes it possible for individuals to interact with course material, other learners, and instructors.The benefits of using CMC include facilitating collaborative learning and enabling a community (Fahy, 2013). A common way that CMC is used to support collaborative learning is the use of online forums where learners are guided to provide written response on a topic specific to the course material. In this instance CMC is not only providing a replacement for traditional classroom discussion but, due to the asynchronous text based nature of forums, can enhance the discussion by giving participants a chance to review and contemplate the responses of others before responding. Jonassen et.al., (1995) identify that CMC allows learners to â€œâ€Ś negotiate with each other over the correct meaning of ideas and events.â€? Supporting
TRANSFORMING TRANSLATIONAL MEDICINE collaboration is one way that CMC fosters constructivist learning. Schunk (2008) describes how collaborative learning, such as classroom discussion is an important element of constructivist learning as it allows the learners to discuss and debate the various aspects of the course material. CMC facilitates collaborative learning by creating an environment which supports constructivist learning. Collaboration among individuals or groups of learners is an essential component of distance education. Another benefit of CMC is the ability to enable what Jonassen et. al. (1995) describe as a “community of inquiry� built upon the collective goal of learning. They identify that a community of inquiry is developed by constructing a shared understanding and knowledge of the subject matter through discussion and critical reflection. While collaboration can be facilitated by having participants use online discussion forums, community cannot be mandated. Rovai (2002) provides a summary of dimensions which define community in the context of distance education, these are: spirit, trust, interaction, and common goals. Understanding the need for these dimensions it is possible for designers and instructors of distance education courses to aid the growth of a community of inquiry. Spirit is there term used to describe the connectedness and inclusion in a group. The second dimension, trust, must be developed so that course participants feel able to express their thoughts and feelings. The third dimension of community is interaction. Learning is a social action where people learn from and with each other, therefore interaction needs to be incorporated into the application of CMC. The fourth dimension identified by Rovai is the existence of a collective educational or learning goal which the community is striving to achieve. CMC can enable collaboration and facilitate the development of a community of inquiry, both of which are critical elements for learning, and are essential for distance education.
TRANSFORMING TRANSLATIONAL MEDICINE Briefly examined in the following section are the opportunities that CMC can provide to augment the existing structure of the TM program. CMC and the Translational Medicine Program The TM Program is presently offered in a face-to-face setting at the University of Alberta. Participants attend weekly lectures and are required to complete assigned readings outside of the classroom. In addition, the TM program uses a seminar structure where participants review a real world clinical case and, during a 15 minute presentation on the case, provide answers to prepared questions. Recognizing that there are few institutions around the world that offer graduate level courses in Translational Medicine, there is interest in enabling the delivery of the TM program by distance education technology. The distance education resources available to deliver the TM program include an online LMS and a MOOC system via Coursera. The University of Alberta makes extensive use of a Learning Management System called eClass, which is a collection of online applications. The primary application of eClass is moodle (University of Alberta, 2013), in addition eClass offers Respondus for online examinations and StudyMate, which provides games to enhance studying. Presently eClass is used by on campus students for course management, content delivery and online discussion forums. Recently the University of Alberta begun working with Coursera to offer Massive Online Open Courses (MOOC) offered via Coursera is Dino 101. Students enrolled at the UofA can take Dino 101 free of charge for credit, off campus students can get a form or credit which their home university or college can review to determine if formal credit towards their undergraduate degree will be provided (Coursera, 2013b). A first step in moving the TM program online is to utilize eClass to augment the current face-to-face structure of the course by using CMC to enable collaboration and facilitate the development of community. The understanding gained from the work of Rovai, Jonassen and
TRANSFORMING TRANSLATIONAL MEDICINE others can be used to help design the use of CMC for the TM program. The next section will discuss how CMC could be implemented and identify some potential challenges. Implementation of CMC The TM program is designed to be highly interactive with the participants directly involved in leading the learning through case presentation and in-person discussion. Knowing that collaboration and community are critical elements of learning the goal of using CMC technology is intended to enable collaboration and facilitate building of a community. The resources available to the course instructors via eClass include Moodle which can be used to continue discussion of course presentation outside of the classroom. This allows participants time to think about what was presented in the class and provide their feedback after the fact thereby extending learning beyond the walls of the classroom. As discussed by Fahy (2013, p. 237) the use of CMC requires a change in the role of the instructor to become a guide and moderator for the online discussion. Recognizing this, it is suggested that the TM program establish a faculty member to moderate online discussion by providing support, keeping the conversation on topic, and encouraging participation (Fahy, 2013 p. 228). Using CMC to facilitate a community of inquiry may be enabled by ensuring support is in place for the four dimensions of community (spirit, trust, interaction, and common goals) discussed by Rovai (2002). In his paper, Rovai identifies seven factors that correlate with the presence of community. These factors are: transactional distance, social presence, social equality, small group activities, group facilitation, teaching and learning style, and community size. Each of these is briefly extrapolated on in relation to the context of CMC and the TM program. Transactional distance is highest when a course is highly structured and provides little opportunity for interaction between learners and instructors (Moore, 1993). If the the open structure of the TM program and the focus on discussion can be retained
TRANSFORMING TRANSLATIONAL MEDICINE with the use of CMC then the transactional distance should remain low. The second factor, social presence is built by participation of the instructor(s) online, which reinforces the importance of participation and moderation of the online community. The third factor, social equality, relates to ensuring participants behave respectfully towards each other and that one voice does not overshadow or intimidate the involvement of others. The fourth factor, small group work, helps enable a feeling of community by giving an opportunity for participants to connect. Group facilitation is the fifth factor and relates to the need for the instructor(s) to actively support the development and maintenance of small and large groups. The sixth factor, teaching style and learning stage identifies that it is necessary to adjust how the instructor interacts with the participants according to their collective, and in some cases individual, progression through the four stages of leaner dependency (Fahy, 2013 p. 89). The final factor identified by Rovai is community size, at present the number of participants in the TM program is quite small, a small community can be risky as it could result in too low a volume of online interaction, therefore it will be important for the instructor(s) to monitor participation and encourage involvement by all. In summary, the recurring suggestions coming from the work of Rovai, Jonassen and others is that successful collaboration and facilitating development of online community is dependent on the supporting structures provided by the instructor(s). Moving the TM program into eClass will provide an opportunity to develop structures, processes, and faculty involvement that support these factors as well as enable evaluation of the ability of CMC to enhance the TM program. Evaluation of CMC within the Program The primary goal of using CMC for the TM program is to ensure participants gain skills and experience related to the application of Translational Medicine. The goal of using CMC for the TM program is to enable collaborative learning and facilitate the development of a community.
TRANSFORMING TRANSLATIONAL MEDICINE Therefore, evaluation will focus on if these goals were met, rather than on the learning outcomes of participants. Evaluation will focus on three areas: did CMC facilitate collaborative learning?, was collaboration a valuable component of the course?, did CMC enable a community to develop? From each of these broad questions a series of specific questions can be explored (refer to Appendix 1 for more details of a possible evaluation framework). Conclusion Translational Medicine is the complex process of taking knowledge gained from medical research out of the lab into the research where it is translated into tools, processes, or even pharmaceuticals that are used to treat diseases in humans. The Department of Medicine at the University of Alberta recently launched a graduate program in Translational Medicine and desires to expand this deliver this course using distance education technology for current on campus participants in the course. In addition, recognizing the lack of institutions offering graduate and undergraduate courses in TM, there is an interest in developing the course for online delivery in a MOOC format via Coursera. The goal of using CMC for the TM program is to enable collaborative learning and build a community of inquiry. This will be enabled by ensuring the course is designed to foster a common spirit, trust among instructors and participants, regular interaction, and working towards a common learning goal. Significant participation in the online environment by instructors and tutors (if applicable) to moderate and guide course participants will be critical. Evaluation will be used to confirm the goals of collaborative learning and community are achieved. The outcomes of this evaluation will provide guidance for furthering enhancing the TM program so that it can be delivered to a massive online community of learners.
TRANSFORMING TRANSLATIONAL MEDICINE
References Coursera. (2013). Coursera Blog | Welcoming the University of Alberta to Coursera. Retrieved from: http://blog.coursera.org/post/56843037897/welcoming-the-university-of-alberta-tocoursera Coursera. (2013). Dino 101: Dinosaur Paleobiology. Retrieved from: https://www.coursera.org/course/dino101 Department of Medicine (2013). Translational Medicine Program. Retrieved from: http://www.medicine.med.ualberta.ca/GraduateStudies/TranslationalMedicine.aspx Edutech Wiki. (14 May 2013). Computer-Mediated Communication. Retrieved from: http://edutechwiki.unige.ch/en/Computer-mediated_communication Fahy, P. J. (2013). Online Teaching in Distance Education and Training. Athabasca, Alberta: Athabasca University. Garrison, D. R., Anderson, T., & Archer, W. (2001). Critical thinking, cognitive presence, and computer conferencing in distance education. American Journal of distance education, 15(1), 7-23. Jonassen, D., Davidson, M., Collins, M., Campbell, J., & Haag, B. B. (1995). Constructivism and computer�mediated communication in distance education. American journal of distance education, 9(2), 7-26. Moore, M. G. (1993). Theory of transactional distance. Theoretical principles of distance education, 22. Rovai, A. P. (2002). Building sense of community at a distance. The International Review of Research in Open and Distance Learning, 3(1).Schunk, D. H. (2008). Learning theories: An educational perspective (5th ed.). Upper Saddle River, New Jersey: Pearson Education. University of Alberta (2013). eClass. Retrieved from: http://ctl.ualberta.ca/technologyservices/eclass. Wong, G., Greenhalgh, T., & Pawson, R. (2010). Internet-based medical education: a realist review of what works, for whom and in what circumstances. BMC medical education, 10(1), 12. Woolf, S. H. (2008). The meaning of translational research and why it matters. JAMA: the Journal of the American Medical Association, 299(2), 211-213.
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Appendix 1 - A Possible Evaluation Framework
Goal
Theme
Potential topics for evaluation questions
Collaboration
Did CMC facilitate collaborative learning?
• • • •
Collaboration
Was collaboration a valuable component of the course?
• Is collaboration an important element of your learning? • Did the use of computer mediated communication make it possible for you to collaborate with others.
Community
Did CMC enable a community to develop?
• Did you develop a feeling of trust towards instructors? • Did you develop a feeling of trust towards fellow participants? • Did you interact with the other participants • Did you independently initiate interaction with other participants in the course • Did you feel you were able to provide honest feedback and responses to the posts other participants made in the discussion forums? • Were you contacted directly by any other participants? If yes was the contact outside of the mandated discussion in the online forums? • Can you describe a learning goal that all participants in this course share?
Frequency of use of online forum Frequency of use of email with instructors Frequency of use of email with fellow participants Did reading the viewpoints of others in the online forum result in you re-thinking your own thoughts on that element of the course?