Introduction and backgroundIntroduction and background
 learning-at-a-distance has been around a long time:learning-at-a-...
Pedagogical, theoretical concerns:Pedagogical, theoretical concerns:
how adults learn at-a-distancehow adults learn at-a-d...
current issues in the development of ODLcurrent issues in the development of ODL
1.1. ever-changing nature of information ...
Changes in availabilityChanges in availability
of media/technologiesof media/technologies
 From print/post thru radio/TV ...
Student support andStudent support and
interaction centre-stageinteraction centre-stage
 effective ODL/e-learning depends...
Programme design:Programme design:
organisational options:organisational options:
a blurring of the edgesa blurring of the...
Globalisation: cross-border learningGlobalisation: cross-border learning
and internationalisationand internationalisation
...
ConclusionConclusion
 as Perraton and others have pointed out, all our earlieras Perraton and others have pointed out, al...
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Distance Learning for Health Workshop: Open and distance learning for health worker training: Learning from experience - Tony Dodds, ODL specialist

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  • Good morning. I have been asked to speak briefly to my paper,* ‘Open and distance learning for health workers: learning from experience’. *Learning at a distance has a long history, under many different names, from correspondence education to e-learning and on-line learning. Perhaps *the two most influential events in its history were the launching of the Open University in the UK in 1969, because of its great emphasis on quality, and the invention of the world-wide web and internet, which has made internationalisation possible. These methods* of education have been used for most levels and kinds of education and *were introduced into medical education in the mid ’60s with an enormous proliferation from the mid ’90s. I hope* this study will enable some of the main lessons learnt from ODL in general to guide its further development for health worker training in the future.
  • *Over the decades, ODL has stimulated considerable pedagogical and theoretical debate. The following are some of the recurrent concerns.* One of its greatest attractions is its ability to increase access for large numbers of previously excluded or isolated learners. But how can this be done while catering for their individual needs? Quality learning at-a-distance requires specialist skills in developing learning materials and administrative and support structures. *Quality learning also entails dialogue and interaction between learners and between them and their teachers: how can this be provided in ODL? *Adult learners, especially thos learning on their own, need continuous motivation: this can be provided by making the learning continuously relevant to their lives and jobs. *Quality also entails a combination of cognitive, affective and psychomotor learning: *how can practical and application learning be provided and supervised in ODL? *Adult learners, especially in in-service training, want a sense of control over their learning; at the same time they need continuous interaction with their peers and support from their teachers. Can this combination be achieved in ODL? *A recent contribution to this debate is the idea of ‘communities of practice’ through creating communities of learners and their tutors, possibly by on-line technologies.
  • I believe* there are four main issues currently dominating the development of ODL. First,* since it all began there has been a constant and ever increasing change in the media and technologies available, due to continue at mind-boggling speed. *This has led to a blurring of the distinctions between ODL and campus-based learning and *made possible a growing globalisation of ODL through e-learning. Finally,* the ambitious expectations of many practitioners concerning economies and hugely increased access through ODL have not always, dare we say often, been realised.*
  • Many media* have been used over the years and are still being used today, from the simplest to the most high-tech. The speed of change will increase. *But common sense and pedagogical concerns must determine the choice of media, not the technology itself. Evidence from research continues to suggest that we can learn effectively from any or all media available to us and there is little or no significant difference in learning quality arising from the media used.*It’s quite clear that printed materials continue to be very important to students as tools for learning, even if delivered on-line…which adds significantly to the cost borne by students. * It is very important that planners and course designers do not underestimate the value of more other more traditional media also, such as audio and video cassettes and telephones. *Clearly there are seriouys cost implications for both students and institutions related to the choice of technologies. It seems from the evidence available that the use of online technologies adds significantly to the cost for both. * At the end of the day, the crucial consideration must be the access of the intended audience to the technology.
  • *The experience of most people who work in ODL is that student support structures are crucial to effective learning. This clearly applies to on-line learning also. *Students need support throughout their studies: counselling before starting, encouragement, advise and feedback as they study and even counselling where they can go next when they have finished. It must relate to support in their learning itself, both cognitive and practical, encouragement and continuing motivation and effective administrative and information management systems. *Such support can be provided in various ways. Good correspondence education provides it through feedback on assignments; face-to-face tutorials and on-line tutoring and tele-conferencing have the advantage of immediacy and personalisation. *Such immediacy of feedback and interaction are especially important for practical learning and therefore for medical training *where clinical practice is involved. *Both face-to-face and on-line tutoring obviously increase costs but if they increase effectiveness and success rates, they are almost certainly worth it.
  • *Since the creation of the Open University in Britain, the debate as to whether such single-mode institutions dedicated exclusively to ODL or dual-mode institutions which teach both on-campus and by ODL are preferable. Certainly single mode provides opportunities for the development of ODL specialisms and expertise in ODL design, delivery, support and administration, which are all necessary for quality courses. They are however expensive to set up and are only justified for very large numbers of potential students. Dual-mode institutions on the other hand can maximise the use of existing resources and can therefore be used economically for small student intakes and limited numbers of courses. But it is much harder to provide the ODL specialisms and expertise needed and to ensure that ODL students are treated with equal emphasis and that the courses are given equal academic status. * The coming of on-line learning facilities, however, both to ODL and to on-campus learning has led to a blurring of the distinction between them and to a questioning of the need for specialist ODL units. *The need for ODL/e-teaching specialist expertise remains at the heart of quality provision, however. But there is a possibility that this blurring will lead to a growing potential for mixed-mode programmes where learners spend significant time studying on-campus as well as at-a-distance. This could be especially relevant and beneficial for health-worker training but it is expensive and limits intakes. * A fourth organisational model is available from experience, the consortium model where several institutions combine to develop and offer ODL programmes. This allows bodies with specialist skills in education, in selected subjects or disciplines and in ODL to combine to ensure high quality courses. This might be particularly relevant for health-worker training on an international basis. Consortia, however, are notoriously difficult to manage and even more difficult to sustain. It seems likely in many situations that the last three models will be most appropriate for health-worker training though both the UKOU and the Indira Gandhi National Open University of India show this is not universally the case.
  • With the development of the internet, on-line learning has become possible across national and even continental borders. This has led to the proliferation of attempts to spread the coverage of courses, materials and qualifications internationally, sometimes in collaboration with national institutions, sometimes independently by institutions in industrialised countries.*The potential of such sharing and the provision of access anywhere to any potential student to the best courses is theoretically immense. It has led to open access to such courses both to institutions and individuals where no such local courses are available. It is an ideal to be aimed at.* But there are serious questions to be asked about how this ideal can be realised. There is an equal potential for the worst courses to be made available to unsuspecting students at exploitative costs. It can also, sometimes unintentionally, lead to irrelevant learning and to undermining the development of local courses and expertise. This leads to the conclusion that a variety of forms of control need to be put in place about quality assurance, about national and local relevane, about ensuring that the necessary student support and advisory services are in place, about accreditation and recognition of qualifications and about the nature and regulation of inter-institutional partnerships.* There is no doubt that the existence and increase of cross-border learning is unstoppable. It is very evident in health-worker training by ODL. It has great potential advantages, but only if caution is exercised and quality controls are put in place. That is the purpose of this study.
  • When I was young and starting out on a career in ODL, we were full of optimism and confidence that ODL, whatever we called it would hugely increase equity in learning at home and in what we still referred to as developing countries. As my colleague of those days, and our key-note speaker, Hilary Perraton, has pointed out, those hopes of increased access at cheaper costs have often not been achieved.* There is no doubt that ODL/e-learning can be used to great effect to increase access to quality learning of all sorts, including health worker training. *For this to happen there are important lessons to be learned from past experience. I hope this paper has drawn attention to some of them. * Thank you.
  • Distance Learning for Health Workshop: Open and distance learning for health worker training: Learning from experience - Tony Dodds, ODL specialist

    1. 1. Introduction and backgroundIntroduction and background  learning-at-a-distance has been around a long time:learning-at-a-distance has been around a long time: correspondence ed., ed. broadcasting, distance education,correspondence ed., ed. broadcasting, distance education, ODL, supported open learning, e-learning, etc.ODL, supported open learning, e-learning, etc.  two most important historical events were probably thetwo most important historical events were probably the creation of the Open University (1969),creation of the Open University (1969), its emphasis onits emphasis on quality,quality, and the introduction of on-line learning through theand the introduction of on-line learning through the internet (early ’90s)internet (early ’90s) making internationalisation possiblemaking internationalisation possible open and distanceopen and distance learning (ODL) and e-learning havelearning (ODL) and e-learning have been used and are being used for most levels of education.been used and are being used for most levels of education. early examples of their use for health-worker training inearly examples of their use for health-worker training in mid-’60s and on; proliferation from mid-’90s.mid-’60s and on; proliferation from mid-’90s. purpose of this study is to identify lessons from ODL’spurpose of this study is to identify lessons from ODL’s experience in general which can guide and maximise impactexperience in general which can guide and maximise impact of its use for health-education in futureof its use for health-education in future
    2. 2. Pedagogical, theoretical concerns:Pedagogical, theoretical concerns: how adults learn at-a-distancehow adults learn at-a-distance  Learning en masse: how to cater for all the individualsLearning en masse: how to cater for all the individuals  Quality learning: specialist materials and support structuresQuality learning: specialist materials and support structures  Bridging the distance by dialogue, interaction and feedbackBridging the distance by dialogue, interaction and feedback  Maintaining motivation by relevance to life/jobsMaintaining motivation by relevance to life/jobs  Combining learning by reading/seeing, doing and applyingCombining learning by reading/seeing, doing and applying  Providing for/supervising hands-on practical learningProviding for/supervising hands-on practical learning  Independence/interaction; student control/student supportIndependence/interaction; student control/student support  Creating communities of learners at-a-distanceCreating communities of learners at-a-distance
    3. 3. current issues in the development of ODLcurrent issues in the development of ODL 1.1. ever-changing nature of information and communication technologiesever-changing nature of information and communication technologies (ICT) their use, and effectiveness(ICT) their use, and effectiveness 2.2. a blurring of the distinctions between ODL and traditional on-campusa blurring of the distinctions between ODL and traditional on-campus teaching and learning (because of ICT)teaching and learning (because of ICT) 3.3. the growing internationalisation, or globalisation, of tertiary educationthe growing internationalisation, or globalisation, of tertiary education whereby programmes, courses and qualifications can be shared acrosswhereby programmes, courses and qualifications can be shared across international boundariesinternational boundaries 4.4. the expected widening of successful access to tertiary education throughthe expected widening of successful access to tertiary education through ODL has not been fully realised and the consequent expected economiesODL has not been fully realised and the consequent expected economies of scale have not always been realised eitherof scale have not always been realised either
    4. 4. Changes in availabilityChanges in availability of media/technologiesof media/technologies  From print/post thru radio/TV and audio/video-cassettes, telephoneFrom print/post thru radio/TV and audio/video-cassettes, telephone tutorials to audio/video teleconferencing, on-line delivery and grouptutorials to audio/video teleconferencing, on-line delivery and group tutoring and mobile phones…what next?tutoring and mobile phones…what next?  Common-sense guidance about particular advantages of one medium overCommon-sense guidance about particular advantages of one medium over another: e.g. immediacy of feedback on-line or by telephone compared toanother: e.g. immediacy of feedback on-line or by telephone compared to postal tutorials/ of visual media over audio for certain subjects etc….but:postal tutorials/ of visual media over audio for certain subjects etc….but:  The theory of media equivalence/no-significant differenceThe theory of media equivalence/no-significant difference  Continuing importance/predominance of print, even if delivered on-lineContinuing importance/predominance of print, even if delivered on-line  Continuing potential/effectiveness of traditional media not to be ignoredContinuing potential/effectiveness of traditional media not to be ignored  Significant cost implications of certain technologies…both for students andSignificant cost implications of certain technologies…both for students and institutions…especially of on-line technologiesinstitutions…especially of on-line technologies  Most crucial concern is student access to the technology proposedMost crucial concern is student access to the technology proposed
    5. 5. Student support andStudent support and interaction centre-stageinteraction centre-stage  effective ODL/e-learning depends primarily on effective student-supporteffective ODL/e-learning depends primarily on effective student-support  student support needed at all stages of study: before, during and after; itstudent support needed at all stages of study: before, during and after; it takes many forms and serves many purposes: cognitive, affective andtakes many forms and serves many purposes: cognitive, affective and systemicsystemic  possible by via traditional correspondence as well as thru face-to-facepossible by via traditional correspondence as well as thru face-to-face meetings and on-line: a mixed approach probably desirablemeetings and on-line: a mixed approach probably desirable  especially important for practical learningespecially important for practical learning  even more crucial in medical training; where clinical practice is included,even more crucial in medical training; where clinical practice is included, immediacy of feedback essentialimmediacy of feedback essential  face-to-face and on-line student support inevitably increases cost, but alsoface-to-face and on-line student support inevitably increases cost, but also increases effectiveness and probably success/through-put ratesincreases effectiveness and probably success/through-put rates
    6. 6. Programme design:Programme design: organisational options:organisational options: a blurring of the edgesa blurring of the edges  single-mode: specialisation of design, delivery, support and management…single-mode: specialisation of design, delivery, support and management… but expensive, only justified by large numbersbut expensive, only justified by large numbers  dual-mode: capitalises on existing resources, can work for smalldual-mode: capitalises on existing resources, can work for small numbers…but harder to develop specialisms and achieve equal statusnumbers…but harder to develop specialisms and achieve equal status But the distinctions between ODL and on-campus learning are being blurredBut the distinctions between ODL and on-campus learning are being blurred thru use of new ICTs in boththru use of new ICTs in both  mixed-mode: allows experience of both ODL and on-campus learning,mixed-mode: allows experience of both ODL and on-campus learning, especially advantageous for professional training…but expensive andespecially advantageous for professional training…but expensive and limits intakeslimits intakes  consortia: can bring teaching, subject-matter and ODL specialisms togetherconsortia: can bring teaching, subject-matter and ODL specialisms together for particular courses (e.g. health worker training)… but v. hard to managefor particular courses (e.g. health worker training)… but v. hard to manage and sustainand sustain  Last three options most likely to be suitable for health-worker trainingLast three options most likely to be suitable for health-worker training
    7. 7. Globalisation: cross-border learningGlobalisation: cross-border learning and internationalisationand internationalisation  internet and on-line delivery have hugely facilitatedinternet and on-line delivery have hugely facilitated international sharing of courses/programmesinternational sharing of courses/programmes  at best and in theory this allows hugely expanded access toat best and in theory this allows hugely expanded access to quality learning and to potential economies…and can do soquality learning and to potential economies…and can do so  BUT:BUT: it can also lead to the opposite and to exploitation andit can also lead to the opposite and to exploitation and very bad quality sharingvery bad quality sharing  essential that controls be put in place by all ‘partners’ on:essential that controls be put in place by all ‘partners’ on: 1. quality management 2. curriculum relevance 3. student support1. quality management 2. curriculum relevance 3. student support 4.accreditation 5. recognition of qualifications 6. contractual and4.accreditation 5. recognition of qualifications 6. contractual and financial arrangementsfinancial arrangements  it’s here to stay, especially in health-worker training; but theit’s here to stay, especially in health-worker training; but the dangers remain also, and caution must be exercised: hencedangers remain also, and caution must be exercised: hence this study!this study!
    8. 8. ConclusionConclusion  as Perraton and others have pointed out, all our earlieras Perraton and others have pointed out, all our earlier hopes about increased access and economies of scalehopes about increased access and economies of scale have not always been realisedhave not always been realised  ODL/e-learning can be used effectively generally andODL/e-learning can be used effectively generally and for high quality health worker trainingfor high quality health worker training  to achieve this, lessons from the past, including theto achieve this, lessons from the past, including the cautions raised in this paper, should be noted.cautions raised in this paper, should be noted.  Thank-youThank-you

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