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 the two most important historical events were probably the creation of the Open University (1969),creation of the Open University (1969), its emphasis on its emphasis on quality,quality, and the introduction of on-line learning through the and the introduction of on-line learning through the internet (early ’90s) internet (early ’90s) making internationalisation possiblemaking internationalisation possibleopen and distanceopen and distance learning (ODL) and e-learning have learning (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 in early 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’s purpose of this study is to identify lessons from ODL’s experience in general which can guide and maximise impact experience in general which can guide and maximise impact of its use for health-education in futureof its use for health-education in future

Pedagogical, theoretical concerns: Pedagogical, theoretical concerns: how adults learn at-a-distance how 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

current issues in the development of ODLcurrent issues in the development of ODL

1.1. ever-changing nature of information and communication technologies ever-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-campus a 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 education the growing internationalisation, or globalisation, of tertiary education whereby programmes, courses and qualifications can be shared across whereby programmes, courses and qualifications can be shared across international boundariesinternational boundaries

4.4. the expected widening of successful access to tertiary education through the expected widening of successful access to tertiary education through ODL has not been fully realised and the consequent expected economies ODL 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

Changes in availabilityChanges in availabilityof media/technologiesof media/technologies

From print/post thru radio/TV and audio/video-cassettes, telephone From print/post thru radio/TV and audio/video-cassettes, telephone tutorials to audio/video teleconferencing, on-line delivery and group tutorials 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 over Common-sense guidance about particular advantages of one medium over another: e.g. immediacy of feedback on-line or by telephone compared to another: 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 and Significant 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

Student support and Student support and interaction centre-stageinteraction centre-stage

effective ODL/e-learning depends primarily on effective student-support effective ODL/e-learning depends primarily on effective student-support student support needed at all stages of study: before, during and after; it student support needed at all stages of study: before, during and after; it

takes many forms and serves many purposes: cognitive, affective and takes many forms and serves many purposes: cognitive, affective and systemicsystemic

possible by via traditional correspondence as well as thru face-to-face possible 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 essential immediacy of feedback essential face-to-face and on-line student support inevitably increases cost, but also face-to-face and on-line student support inevitably increases cost, but also

increases effectiveness and probably success/through-put rates increases effectiveness and probably success/through-put rates

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 small dual-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 blurred But 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 and especially advantageous for professional training…but expensive and limits intakeslimits intakes

consortia: can bring teaching, subject-matter and ODL specialisms together consortia: can bring teaching, subject-matter and ODL specialisms together for particular courses (e.g. health worker training)… but v. hard to manage for 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

Globalisation: cross-border Globalisation: cross-border learninglearning

and internationalisation and internationalisation internet and on-line delivery have hugely facilitated internet 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 to at 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 and it 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 support 1. quality management 2. curriculum relevance 3. student support 4.accreditation 5. recognition of qualifications 6. contractual and 4.accreditation 5. recognition of qualifications 6. contractual and financial arrangementsfinancial arrangements

it’s here to stay, especially in health-worker training; but the it’s here to stay, especially in health-worker training; but the dangers remain also, and caution must be exercised: hence dangers remain also, and caution must be exercised: hence this study! this study!

ConclusionConclusion

as Perraton and others have pointed out, all our earlier as Perraton and others have pointed out, all our earlier hopes about increased access and economies of scale hopes about increased access and economies of scale have not always been realisedhave not always been realised

ODL/e-learning can be used effectively generally and ODL/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 the to 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-you Thank-you