Why should I be in the same room with these people?
That’s one of the many smart questions participants posed at a Stanford Medical School meeting I attended last weekend. If I had been daydreaming (I’d never do that), I might have thought the question was for me. You see, the participants were a handpicked set of national medical education experts, folks nominally from the status quo medical-education-industrial complex—the very thing we’re trying to change.
You might think that they embodied that dreaded status quo. I’m happy to report they did not—not even close. I’m also relieved to tell you that the question (in spite of my paranoia) wasn’t for me. Instead, it was one of many challenges these thoughtful, passionate teachers tossed at each other.
“Why are we in the room?” was a challenge to each other. Why and when should teachers be in the same room with the learners?
When you think about it, that’s actually a central question if you’re attempting to use online education to flip the medical education experience. It’s also a brave one if you’re a teacher: justify the time you spend with your students.
Over the last month, journal headlines have been heralding the death of massive online open courses (MOOCs). You could almost hear the sigh of relief from the academy. With Sebastian Thrun himself acknowledging the “lousy” quality of the MOOC product, told-you-so skeptics have been giddily pointing out that Udacity, in its failure to disrupt higher education, is now moving on to vocational training.
Sadly, what audiences are missing is that Thrun’s shift to workforce training is precisely what has the potential to disrupt and severely impact traditional postsecondary education. We at the Christensen Institute have already written extensively about how MOOCs were not displaying the right markers for disruption (see here, here, here, and here), but we became more hopeful as they started to offer clusters of courses. Coursera announced Foundations of Business with Wharton, while edX and MITX introduced the Xseries in Computer Science as well as Supply Chain & Logistics.
These moves appeared to map better to employer needs and what we describe as areas of nonconsumption. In their turn away from career-oriented training, colleges and universities have unwittingly left unattended a niche of nonconsumers—people over-served by traditional forms of higher education, underprepared for the workforce, and seeking lifelong learning pathways.
What most people forget when they bandy about the term “disruptive innovation” is that disruptive innovations must find their footholds in nonconsumption. McKinsey analysts estimate that the number of skillsets needed in the workforce has increased rapidly from 178 in September 2009 to 924 in June 2012. Unfortunately, most traditional institutions have not adapted to this surge in demand of skillsets, and as a result, the gap has widened between degree-holders and the jobs available today.
Coursera, the popular massive open online course (MOOC) platform, intrigues. With over 5 million students served and $85 million raised—both numbers are first among the “MOOC platforms”—it’s the type of company that captures the imagination of people in Silicon Valley who dream of transforming sectors.
Its reach and emerging focus on K–12 professional development were prime reasons that we at the Clayton Christensen Institute, along with the Silicon Schools Fund and the New Teacher Center, recently offered a MOOC on blended learning through Coursera.
But Coursera has always given me reason to pause as well. It’s never felt to me like its initial incarnation could possibly disrupt higher education. Why? As I’ve told its team, offering courses from the top universities online and claiming that at last, anyone anywhere can access the best learning in the world isn’t correct.
The reason is that the top universities do not offer the best teaching and learning experiences. Instead, their faculty members are incentivized heavily to focus on research at the expense of teaching. If a professor seeking tenure at one of these institutions receives a teaching award, it is often said that that professor has just received the kiss of death for her tenure hopes. If students learn at these institutions, it’s often not because the teaching is so good, but because the students are so talented that they can absorb anything thrown at them (and it’s worth noting that just because a professor is entertaining, does not mean it’s a good learning experience).
Putting these courses online often makes them worse. Not only do professors not know how to teach well in person, but also their lack of understanding of the basic principles of sound learning design causes them to exacerbate these problems as they put these experiences online, which can become more problematic as students from all walks of life with many different learning needs are now theoretically able to take these courses.
The educational world is becoming flat.
A quiet revolution is underway in the way teachers and students interact using recorded lectures, YouTube, and the internet. In 2004, financial analyst turned online educator Sal Khan began tutoring his niece in math using an online drawing program. As he uploaded these lectures to YouTube, their popularity grew into a social phenomenon.
Today, Khan Academy has provided over 240 million online lessons around the world in over 4000 topics. Stanford, MIT, and other universities now offer massive open online courses (MOOCs) by top professors to all comers. In fact, Harvard Business School no longer offers an introductory accounting class due to the availability of an exceptional online course from Brigham Young University. With high-quality content readily available online, the student-teacher dynamic is changing. Students are expecting excellent instruction and teachers are expecting students to be increasingly knowledgeable about subjects from online viewing. These reciprocal heightened expectations have the potential to create a more dynamic and interactive classroom experience.
These innovations can also transform patient education by bringing patients into the circle of learning. Patients already leverage YouTube and other online sources for health purposes. For example, PatientsLikeMe was started in 2004 by the family and friends of Stephen Heywood who had been diagnosed with amyotrophic lateral sclerosis. This online community helps connect patients with other similarly affected patients and aims to educate patients about the illness experience and potential treatment options. This encourages patients to think synergistically about complex problems such as outcomes, decision-making and ethics. Today, PatientsLikeMe covers more than 1200 health conditions with over 100,000 members.
Given these broad ranging developments, we need to rethink the patient–doctor encounter. The typical encounter follows the traditional pedagogic paradigm of “banking” – in which the teacher, who has the power and the knowledge, seeks to deposit knowledge assets into the learner’s bank (1). Unfortunately, though this approach induces passivity and disempowerment it is the dominant mode of patient education. Instead, imagine encounters where patients are prepared to engage in shared decision-making, allowing the office visit to center on activities that promote patient-centeredness and engagement such as confirming patient comprehension, ascertaining values, and establishing goals.
From SFO, I carefully followed my Droid Navigator’s directions off Highway 101 into a warren of non-descript low-slung office buildings—non-descript except for the telltale proliferation of Google signs and young adults riding colorful Google bikes. I drove around to the back of several of those complexes and finally found the correct numbered grouping. It really could have been any office or doctors’ office complex in the U.S. The Khan suite is on the second floor. There’s a simple brass plate saying “Khan Academy” on what looked like oak double doors. I let myself in and immediately encountered a large, central open space—with long dining tables, food, an ample sitting area with couches conducive for group discussions—and a friendly greeting by programmers and staff. Oh, and computers—there were lots of computers. As far as I could tell, nobody had their own office—though maybe Sal does. Everyone was also open, friendly and passionate about the great work happening there.
After some trial and error, Rishi and I found an unused office and huddled around his Mac for a Google Hangout interview with a Bay Area reporter about the Khan/RWJF health care education project. Later, I met with Shantanu, the Khan COO and former “math jock” high school friend of Sal, as well as Charlotte, external relations, and Matt, software engineer. They’re all long termers at Khan—that means they’ve been there for about two years. Overall, the energy was pretty electric. One other small thing—do not be fooled—these incredible people are, how should I put it—ferociously—intense and focused.
Pioneers in flipping the med school classroom
The next morning, Rishi and I met at Stanford Medical School—in the Li Ka Shing Center for Learning and Knowledge—an enormous and beautiful building off Campus Drive near the hospital that did not exist back in my days as an earnest Stanford law student. We were there to observe some pioneers in medical education attempt to use Khan-like videos to flip the medical school classroom. This work at Stanford is part of the current Khan Academy and RWJF collaboration. We’re trying to understand what happens when a medical school attempts to use the Khan-style videos to change the classroom interaction.
If you follow the world of higher education, you have heard of MOOCs—massive online open courses. Open to anyone, anywhere, these free classes can attract tens of thousands of students whose hunger to learn outweighs the fact that no credits are typically awarded. With many elite universities now offering MOOCs, it’s a movement that is worth following as a potential model for affordable, accessible education in the future.
From an educator’s perspective, it’s also worth trying out. Beginning June 3, I will be teaming up with Cheryl Dennison Himmelfarb, a patient safety expert and associate professor at the Johns Hopkins University School of Nursing, to lead a five-week-long MOOC, “The Science of Safety in Healthcare.” Through the course, participants will explore fundamental topics in the science of safety, patient safety culture, teamwork and communication, patient-centered care, and strategies for assessing and improving care. The course workload is two to five hours per week, which includes up to two hours of video instruction, as well as readings and assignments.
Clinicians, hospital administrators, students, patients—indeed anyone with an interest in this topic—should consider enrolling. Students receive a statement of accomplishment upon passing the course.
Increasing patient safety requires that all frontline health care workers understand the basic concepts and language of health care, and that they develop the lenses to identify the hazards that face their patients. It will be interesting to see, through this course, if the MOOC model can help to efficiently deliver that kind of education on a broad basis. Certainly, becoming a patient safety leader at your unit, department or hospital requires more in-depth training.
The new darling of the online educational community is Massively Open Online Courses (MOOCs). The example which figures most prominently in the popular imagination is the Khan Academy, though its founder says otherwise, noting that MOOCs are merely online transplantations of traditional courses, while Khan Academy offers something different.
Others would take issue with his conclusion, or characterization. A “connectivist” MOOCis based on four principles:
- Aggregation. The whole point of a connectivist MOOC is to provide a starting point for a massive amount of content to be produced in different places online, which is later aggregated as a newsletter or a web page accessible to participants on a regular basis. This is in contrast to traditional courses, where the content is prepared ahead of time.
- Remixing, that is, associating materials created within the course with each other and with materials elsewhere.
- Re-purposing of aggregated and remixed materials to suit the goals of each participant.
- Feeding forward, sharing of re-purposed ideas and content with other participants and the rest of the world.
Sounds great, but is it working? Can it work? A piece in the current issue of The Washington Monthly took a look and concluded:
Given the current 90 percent dropout rate in most MOOCs, an 8-point gap in completion rates between traditional and online courses offered by community colleges, the 6.5 percent graduation rate even at the respected Western Governors University, and the ambiguity of many other higher education reform ideas, there’s good reason to think that an unbound future might not be so great.
The best American innovations in education were the Land-Grant College Act of 1862, which helped create a system of public universities, and the GI Bill of 1944, which ensured that an entire generation had the money to attend college. This widespread access to the college experience enabled people from working-class backgrounds to advance en masse into professional jobs that required reasoning and logic and extensive knowledge of the world. The question is whether or not we will continue this trend or simply give up and say that a few online classes and specialized training are good enough for the majority of Americans.
In other words: Democratization of higher education – good; MOOCs – not so much.
Why is this relevant to you, gentle reader?
The question is whether the promise of MOOCs, or their inability to deliver, will characterize MOOM — Eric Topol’s neologism, “Massively Open Online Medicine,” used in his HIMSS 2013 keynote.
In health care, a perfect implementation of big data and data analytics, combined with open access for clinicians and patients, would yield a success in MOOM along the lines of a connectivist MOOC.