David Schleich, PhD

Back in the early 1990s, it had already long been going on, but hardly massively. In those days, “distance education” actually spawned professional degree titles for those who used that methodology (e.g., master of distance education, from accredited public sector institutions such as Athabasca University in Canada or Deakin University in Australia). Today, we have “massive open online courses” [MOOCs], and a lot of institutions are doing it (Google “Coursera” to see what I mean). In 1991, when I was the VP academic of a public sector college in Canada, we overhauled continuing education offerings into a kaleidoscope of certificates and course series, credentialing like never before and offering them in evening and weekend formats, and less often by “correspondence.” Nevertheless, our part-time population rose from 1,000 annual registrations to 25,000 in less than 3 years. Everywhere, in those days, there was lots of ink [and now megabytes] about “innovation,” “transformation,” and “change,” and the conversation included, but did not emphasize, non–time/place-bound curriculum delivery. During that time, I was seconded to the role of “VP transformation.” We did our best to shift that unionized system into something attuned to a future that favored the convenience and access of the student over the schedules of teachers, which were embedded in collective agreements that prescribed when, how, and where delivery could occur. We noted how abruptly students flocked to convenient curriculum, designed in nontraditional formats. We were worried about capital costs for the equipment to support that delivery; we were also concerned about rigor and assessment. The Internet was barely a factor in the equation at the time. That ship (so-called electronically mediated instruction or “EMI”) had no trim tab then, but it sure does now. Almost 2 decades later, the same challenges are before us: institutional priorities, the cost of delivery, methodology out of whack with technology, and institutional accreditation and governance habits. There are shifts under way to address these facts of postsecondary institutional life that naturopathic medical education must take notice of. Those shifts include MOOCs.

Some things are different, however; maybe this time the abundant literature about how to shift what we do in higher education, including taking note of how our learners choose to access and process information, has more to tell us before we jump in budget first. The Innovation University: Changing the DNA of Higher Education From the Inside Out, by Clayton Christensen and Henry Eyring (2011), is a good read for every dean and every provost in the naturopathic medical education system in North America. A close second is Reinventing Higher Education: The Promise of Innovation, by Ben Wildavsky and his colleagues (2011). In these books and in many others, the story is the same: change or become quickly redundant. However, our curriculum structures (design and delivery) and our accreditation standards (predicated on what some would insist are threadbare assumptions that conducted learning with the taskmaster present is the only reliable platform for assuring learning outcomes) demand transformation. And no wonder we are stuck; the alternatives are not clear, and the margin for error is razor thin.

These academic problems are much older than my 1990s reference. Case Western Reserve University School of Medicine (Cleveland, Ohio), for example, was the exemplary model of medical education in America back in 1952. Case Western Reserve had the gumption, resisted intensely by the academic establishment both inside the university and elsewhere at the time, to integrate basic and clinical sciences. The legendary Joseph Wearn, T. Hale Ham, and John Caughey led the charge. They designed the learning of medical students around these core ideas:

• Teaching should be based on problem solving.
• Students should accept responsibility for their own education.
• Basic principles of medicine should be emphasized.
• Curriculum should be designed as a continuum by faculty subject committees, not by departments; teaching should be interdisciplinary.
• Basic sciences should be integrated with clinical sciences.

Sound familiar? Have we inched away from those middle-aged ideas? Not much and maybe not yet. But with the onslaught of online learning (Coursera, anyone?), the meter is running. In the biology and life sciences category alone are free offerings such as Drugs and the Brain (CIT) and at Duke University (Durham, N.C.) Introductory Human Physiology, Medical Neuroscience, and Introduction to Genetics and Evolution, to name a few. Coursera already has almost 2 dozen universities in its arsenal, including CIT, Duke, GIT, Johns Hopkins (Baltimore, Md.), Princeton (N.J.), Rice (Houston, Texas), Stanford (Calif.), California (Berkeley and San Francisco), Edinburgh (Scotland), Illinois at Urbana-Champaign, Michigan (Ann Arbor), Pennsylvania (Philadelphia), Toronto (Ontario, Canada), Virginia (Charlottesville), Washington (Seattle), and the Ecole Polytechnique Fédérale de Lausanne (Switzerland). More every quarter join the family. Coursera is a “social entrepreneurship” company whose purpose is to give everyone access to world-class education free of charge. Their funders are John Doerr (of Kleiner Perkins Caufield & Byers) and Scott Sandell (of New Enterprise Associates fame). Not sure who they are? A Google will let you know this is the big leagues. They back what is next.

Even so, let us not take Doerr’s and Sandell’s word for it. Back in September 2010, the U.S. Department of Education’s Office of Planning, Evaluation and Policy Development published its benchmarking study Evaluation of Evidence-Based Practices in Online Learning: A Meta-analysis and Review of Online Learning Studies. This remarkable document, a quantitative meta-analysis, is number three in my suggested “have a read” list for ND medical education leaders. Part of a broader study of online learning being conducted by SRI International for the Policy and Program Studies Service of the U.S. Department of Education, this is a systematic search (1996-2008) of more than 1,000 empirical studies of online learning. Although focused on the K-12 public school sector, the implications for higher education are riveting because the search also included career technology, medical and higher education, and corporate and military training. Keeping in mind that meta-analysis combines the results of many experiments to pull together a composite estimate of the depth, range, and breadth of the effect, what we do know is that the number of articles per square inch emerging in this field is leaping, especially since 2004. The investigators discovered that “students in online conditions performed modestly better, on average, than those learning the same material through traditional face-to-face instruction” (Evaluation of Evidence-Based Practices in Online Learning, 2010, p. xiv). They also discovered these further trends:

1. Instruction combining online and face-to-face elements had a larger advantage relative to purely face-to-face instruction than did purely online instruction.
2. Effect sizes were larger for studies in which the online instruction was collaborative or instructor-directed than in those studies where online learners worked independently.
3. The effectiveness of online learning approaches appears quite broad across different content and learner types.
4. Online learning can be enhanced by giving learners control of their interactions with media and prompting learner reflection. (Evaluation of Evidence-Based Practices in Online Learning, 2010, pp. xv-xvi)

So far there is no definitive evidence. The authors of the Evaluation of Evidence-Based Practices in Online Learning concluded: “Despite what appears to be strong support for blended learning applications, the studies in this meta-analysis do not demonstrate that online learning is superior as a medium” (2010, p. )

Shucks. What is a dean to do? S/he can not ride off in all directions fund-raising and publicly promoting the college and profession brands; there is work to do with new cohorts and soon-to-graduate NDs wondering how to pay back six figures. The dean, the provost, and the president must, in addition to all that advancement work, reengineer the very programs and institutions they run. We can not turn to our regional and programmatic accreditors for much help because they are, by their very design, apologists for the status quo or else. After all, only we can issue the real ND degree, the ticket to ride as a professional naturopathic physician, and an accredited credential is our bread and butter. The ultimate threat is not that ND students will abandon ND programs in droves for online alternatives (there are none so far). Rather, they will turn to open-source learning networks (such as Coursera) to prove their competency, especially as the so-called integrative medicine bandwagon hijacks modalities and therapies long nourished by NDs without government aid, thank-you very much.

There is a path through all this mist and fuss. Next month, Part II, What I Learned That Day in Siberia, may take the sting out of any concerns accompanying the rise of the MOOCs.

David Schleich, PhD is president and CEO of NCNM, former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Other previous posts have included appointments as vice pres-ident academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd) and the University of Toronto (PhD)

References

Christensen, C. M., & Eyring, H. J. (2011). The innovation university: Changing the DNA of higher education from the inside out. San Francisco: Jossey-Bass.

Means, B., Toyama, Y., Murphy, R., Bakia, M., & Jones, K. (2010). Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies. Washington: Office of Planning, Evaluation and Policy Development, U.S. Department of Education.

Wildavsky, B., Kelly, A., & Carey, K. (2011). Reinventing higher education: The promise of innovation. Cambridge: Harvard Education Press.