overview of geriatric distance education for academic courses and continuing education
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This article was downloaded by: [Texas A&M University Libraries]On: 12 November 2014, At: 22:56Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK
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Overview of Geriatric DistanceEducation for AcademicCourses and ContinuingEducationHelen Arleen Johnson PhD aa Ohio Valley Appalachia Regional GeriatricEducation Center , University of Kentucky Sanders-Brown Center on Aging , 658 South LimestoneStreet, Lexington, KY, 40506-0442, USAPublished online: 25 Sep 2008.
To cite this article: Helen Arleen Johnson PhD (2004) Overview of Geriatric DistanceEducation for Academic Courses and Continuing Education, Gerontology & GeriatricsEducation, 24:4, 9-22, DOI: 10.1300/J021v24n04_02
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Overview of Geriatric Distance Educationfor Academic Courses
and Continuing Education
Helen Arleen Johnson, PhD
ABSTRACT. Distance education technologies may be applied to aca-demic settings, continuing education/continuing medical education set-tings or in combination to both. This article provides an overview ofwhat we have learned about academic and continuing education/continu-ing medical education in geriatrics and gerontology. It includes informa-tion on the scope of distance education, the strengths and challenges ofdistance education, and discusses issues related to technology, intellec-tual property, instructional design and curriculum development, collabo-rative effort, marketing, evaluation, and research. [Article copies availablefor a fee from The Haworth Document Delivery Service: 1-800-HAWORTH.E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2004 by The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Geriatric, gerontology, continuing education, continu-ing medical education, academic, distance education, distance learning,cyber technology, distance technology, on-line learning, Internet-basedlearning, web-based learning
Helen Arleen Johnson is Director for the Ohio Valley Appalachia Regional Geriat-ric Education Center, University of Kentucky Sanders-Brown Center on Aging, 658South Limestone Street, Lexington, KY 40506-0442 (E-mail: [email protected]).
Gerontology & Geriatrics Education, Vol. 24(4) 2004http://www.haworthpress.com/web/GGE
2004 by The Haworth Press, Inc. All rights reserved.Digital Object Identifier: 10.1300/J021v24n04_02 9
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In the 1920s, distance education began in the United States of Amer-ica with college courses being taught via radio. It was expanded in the1960s to include continuing medical education made possible by two-wayradio and the transmission of medical documents by slow-scan videos(Whitten, Ford, Davis, Speicher, & Collins, 1998). In the 1980s and1990s, satellite teleconferencing was the choice (Moore, 1988; Zemke,1986). According to Levine (1992), from 1979 to 1990, United Statescolleges and universities utilizing DE increased from about 600 to about2,000 classes each year, with classes serving about half a million adults(Wiley, 1991). As of 1997, it was projected that approximately 1,107four-year colleges and universities in the United States were providingDE courses for more than a million students (Gubernick & Ebeling,1997). Additional documentation for the increase in DE is provided byCarrillo and Renold (2000), who report that Internet courses have dou-bled every semester since 1998 at Maricopa Community College in Ari-zona, that San Francisco University expects 15% of all its students to beserved by online courses by 2008, and that Washington State Universityexpects to provide DE to 5,000 students by 2010.
Distance education has been defined by the U.S. Department of Edu-cation, Higher Education Act, Final Rule as “an educational processthat is characterized by the separation, in time or place, between instruc-tor and student” (Sec. 602.3). It may include classical correspondencecourses and technologies such as satellite televisions, cable and instruc-tional television, fiber optics, microwave, audiotapes, video, CD-ROM,and computer Web-based technologies that stand alone or are combinedwith other modalities and/or classroom experiences.
DISTANCE EDUCATION FOR GERIATRICSAND GERONTOLOGY EDUCATION
Mulcare (2000) suggests that there are five contemporary trends inhigher education: “. . . the expansion of gerontology, the use of distanceeducation, an information explosion, increased recognition of the im-portance of student active learning, and the assessment of the utility ofgerontology programs” (p. 91). Although we do not know the extent ofDE in gerontology (Poon, 2001), it appears that these trends are movingin concert as the field expands for both academic and CE/CME programofferings.
In 1998, a survey of 287 Association for Gerontology in Higher Edu-cation member institutions was conducted to determine the use of DE
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technologies for coursework in gerontology, which included under-graduate and/or graduate certificates in gerontology and/or undergradu-ate, masters, or doctoral degrees in gerontology (Tompkins & Siegel,2000). Of the 122 respondents, 42 institutions (35%) were utilizing dis-tance learning in their coursework. The majority of these programs(79%) had utilized distance learning for five years or less.
It is possible to get undergraduate and graduate degrees and gradu-ate certificates in gerontology and to take a variety of geriatricscourses that utilize CD-ROM, interactive video, and Web-based tech-nologies (McBride, Kuder, & Gamel, 2000; Schneider, 2000; Segrist,2000; Weaver, Kovacich, & Gugliucci, 2000; Wood, Miller, & Test, 1998).There also are hybrid courses that utilize a combination of face-to-face anddistance technologies (Burdick, 2000). In geriatrics/gerontology, DEtechnologies are especially useful because they lend themselves to theinclusion of interdisciplinary content that provides a holistic approachto the multiple needs of older persons. Coogle, Parham, Welleford, andNetting (2002) describe a graduate-level geriatrics course that success-fully utilized interactive television, videotapes, and on-line computer in-struction for an interdisciplinary audience of health-care providers.
Distance education for geriatrics and gerontological CE/CME is a rela-tively new field with great potential for diverse audiences (McBride et al.,2000; Teaster & Roberto, 2000; Tompkins & Siegel, 2000; Wood &Parham, 1996). During the 1980s, satellite teleconferencing began to be ac-tively utilized for professional continuing education in geriatrics/gerontol-ogy (Wood & Parham, 1996; Wood, Teitleman, Parham, & Saidman,1988), and two-way interactive television technology became an available,albeit generally underutilized, resource for many geriatric education pro-grams across the USA (McBride et al., 2000; Whitten et al., 1998). Sincethe 1990s, there has been growth in the number of geriatric CE/CME pro-grams offered to a variety of disciplines. Examples of programs can befound for extension services (Teaster & Roberto, 2000), medicine (Malay &Moore, 2002; Whitten et al., 1998), nursing (Dawes, 1998), rehabilitation(Wood et al., 1998), and social work (Rooney, Hollister, Freddolino, &Macy, 2001; Teaster & Blieszner, 1999).
The hallmark of DE is its flexibility and convenience. There is agrowing demand for just-in-time learning which focuses on identifica-tion of what is needed and quick access to an assortment of educationalproviders who can meet that need (Asynchronous Learning Network,1997). Distance education via the Internet, CD-ROM, videos, and au-diotapes enables learning to take place anywhere at any time, which isespecially important for non-traditional students who have multiple re-
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sponsibilities related to work and family. These modalities, plus satel-lite-transmitted teleconferencing, increase access to experts and to Weblinks and current information, and offer additional options for academicand CE/CME that enable learners to remain at home or on the job site,reducing their need to travel, time away from home and/or the office,and expenses in pursuit of education.
In addition, there is evidence that indicates that DE formats are costefficient (Malay & Moore, 2002), as effective as traditional classroomsfor student learning, retention, and achievement (Braun, Dubanoski,Smith, & Kijak, 2000; Carrillo & Renold, 2000; Whitten et al., 1998);encourage critical thinking skills (Huff, 2000) and may enhance auton-omy, self-directed learning, creativity, and class diversity and participa-tion (Wood, 2001). For an expanded overview of the research on DE,see Rooney et al. (2001), and for a summary of strengths and weak-nesses of surface mail correspondence, audiotape, videotape, cable tele-vision, closed-circuit interactive television, websites, and e-mail, seeBraun et al. (2000, pp. 20-21).
Although more has been written extolling the strengths of DE than thechallenges, two reports in the 1999 Chronicle of Higher Education indicatethat a survey by the Institute for Higher Education Policy of 300 publica-tions resulted in serious questions about the lack of original research on theeffectiveness of DE and that a report by the College Board raised concernsabout the effect of DE on students without access to computers and theInternet (Blumenstyk & McCollum, 1999). The need for further research issupported by Burdick (2000); McBride et al. (2000); National GeriatricEducation Center Network (2002); Poon, (2001); and Rooney et al. (2001).
ISSUES IN DISTANCE EDUCATIONIN GERIATRICS AND GERONTOLOGY
Some areas for further study and research related to institutional, fac-ulty and student issues are discussed in the following section as theyrelate to technology, intellectual property, instructional design and cur-riculum development, collaborative research, marketing, evaluation,and research.
Technology
DE technology should be selected to match the needs of the studentand the instructor and enhance the delivery of course material. The utili-
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zation of technology may involve increased institutional costs for thenecessary technical infrastructure as well as increases in faculty timeand effort (Carrillo & Renold, 2000; Poon, 2001; Wood, 2001). In satel-lite-transmitted teleconferencing, there are additional costs associatedwith marketing, program development, and technology that must betaken into consideration (Wood & Parham, 1996).
There also is a need for faculty and student training in the technology(Connelly, 2000; Tompkins & Siegel, 2000). Unless they receive ade-quate technical training and support, faculty, students, and profession-als participating in DE feel increasing frustration and concern regardingthe operation of the technology and their role as distance teachers/learn-ers with every technological problem they encounter.
For media such as interactive television (ITV), training is neededprior to broadcast for presenters, learners, and technical coordinators atremote sites to increase confidence and to reduce system errors. Thistraining component often is neglected due to time constraints, fundinglimitations, or unavailability of equipment; however, technology failureresults in decreased instructional time, student interaction time, andtrust in the modality (Burrow & Glass, 2001; Teaster & Blieszner,1999) and may be avoided in many cases with better planning and prep-aration. Remote site equipment must be tested, back-up plans must be inplace to facilitate rescheduling in the event of transmission failure, andrelationships must be established with remote location technical coordi-nators to assure their availability during the broadcast.
For Internet-based DE, it is important to consider system compatibilityamong producers and end-users. Software platforms should be chosenthat are user friendly and match agency/university systems, and plansshould be in place for training or tutorials that enable faculty, students,and providers to utilize the navigation systems and software formats.
Most states have computer networks and ITV systems in placethrough their State Department of Education. These technologies are of-ten underutilized, especially by CE/CME programs, and universities,hospitals, mental health agencies, public schools, Area Health Educa-tion Centers, and public libraries could prove to be valuable partners fordeveloping and transmitting programs.
Intellectual Property
There is a high level of concern regarding ownership of intellectualproperty (Armatas, 2002; National GEC Network, 2002). Traditionally,faculty have been the owners of their course content; however, in an
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Internet-based course, ownership becomes an issue. Copyright ques-tions may be raised regarding whether the author or the university is theowner of original material presented online. In some cases, when fac-ulty are paid to develop a DE course and/or if university resources areused in the development of the product, the university may claim own-ership; in other cases, if faculty are not paid or if they are underwork-for-hire contracts, they may own their work. When two or morefaculty work together to produce DE courses, concerns may arise overjoint ownership.
Many universities have outdated copyright, fair use, work-for-hire,and intellectual property/ownership policies. These should be reviewedand revised in light of the growing field of DE and the passage of theTechnology, Education and Copyright Harmonization (TEACH) Act(Copyright and Digital Media in Education, 2003; Federal RelationsLegislative Report, 2002).
Faculty time and payment through incentives, royalties, and in-creased pay for the development of DE courses are important areas ofdiscussion. Whereas DE has been found to reduce costs for course en-rollees, the cost benefit to faculty still remains in question (Poon, 2001;Bucur, 2000). The cost and time involved in developing, teaching, andadministratively managing distance education courses is addressed byBurrow and Glass (2001) who report:
A basic Internet course takes three to six months to develop if thereis released time for faculty; longer, if not. . . .The amount of facultytime needed to administer a course with a significant Internet de-livery component may well be two to three times more than acomparable face-to-face course in the first few semesters of the of-fering. This is due to the need to address both technical and contentissues with students, a greater need for attention on the part of stu-dents with limited Internet course experience, and the increasedamount of one-on-one interactions with each student throughe-mail, discussion groups, and chat rooms. (p. 691)
Questions are being raised regarding the appropriateness of requiringfaculty to develop new DE courses or to convert existing courses to DEformats when they were hired under a traditional classroom system.Such redirection often requires new skills and a greater investment oftime and may not best utilize the strengths that faculty originallybrought to the position.
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Instructional Design and Curriculum Development
A great deal of discussion has centered around the technological andapplied aspects of DE; however, little is written regarding the theoreti-cal basis for the field which would provide a conscious and method-ological explanation of why events occur (Hooyman & Kiyak, 1988).Moore’s transactional distance theory and Mezirow’s transformationtheory are being explored, but this area has received limited attention(Chen & Willits, 1999; Stanberry & Azria-Evans, 2001).
In academic courses, there are concerns regarding faculty training forcourse development, resources for implementation and delivery, and re-lease time. To address some of these issues, course development guide-lines and resources for lectures, content and interactive simulations areavailable (Bucur, 2000; Henke, 2000), as are models for designing dis-tance learning programs (Braun et al., 1998; Carrillo & Renold, 2000;Renold, 2000) and suggestions for improved communication and stu-dent participation (Mulcare, Silverstein, Walgreen & Spencer, 2000;Piercy, 2000). Specific hints for instructors are offered for interactivevideo and Internet courses (Burrow & Glass, 2001; Lane, 2000) that arevery useful for inexperienced faculty or CE/CME presenters designingDE courses. It is important to ensure that, before they begin teaching,instructors receive hands-on training to familiarize them with the equip-ment that they will be using in their classes and with the best format forconstructing and/or revising PowerPoint presentations, overhead trans-parencies, and slides.
There are major questions regarding standards for curricula whenapplying distance learning course credits across disciplines and de-partments in the same university or across universities in separate set-tings. Faculty are expected to develop comprehensive courses thatinclude the most current and complete information available on a cho-sen topic and are provided with the academic freedom to design thecourses in ways that they determine best meet the needs of students.However, there are no methods to certify across universities that evena minimum standard of content is provided in DE courses. The Univer-sity of Georgia Gerontology Center has begun to address the curricu-lum standardization issue through the development of the DistanceLearning Partnership in Gerontology that includes eight universitiesin Georgia and provides a model for establishing standards and collab-orative partnerships (Malone, Schmidt, & Poon, 1998).
Institutions must determine whether it is cost effective to offer a DEclass for 24-40 students when the same class could be offered in a tradi-
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tional classroom for over 100 students. In addition, there is the question ofwhether students living on campus should be allowed to use Internet-basedDE course spaces when the same courses are available on site.
Attention must be paid to student issues such as the higher dropoutrates for tele-courses than for traditional classroom courses (Braun et al.,2000; Burrow & Glass, 2001) and the limited interaction between facultyand students and among the students enrolled in the classes (Piercy, 2000;Carrillo & Renold, 2000). Students may inaccurately expect distance ed-ucation courses to be easier and take less preparation time than traditionalcourses (Burdick, 2000) and may not realize the effects of havingslow-speed computer equipment and limited computer skills (Wood,2001). The degree of student maturity, family responsibility, autonomy,adaptability, organization, and communication skills should also be con-sidered (Carrillo & Renold, 2000; Connelly, 2000; Poon, 2001).
In CE/CME, formatting issues for Internet-based courses also need tobe addressed. Courses may range in format from a PowerPoint slide pre-sentation with a post-test to interactive curricula that incorporate theI-CARE (introduction, connect, apply, reflect, and extend) model devel-oped by Hoffman and Ritchie (2001). Although both of these formatsmay be accepted by CE/CME accrediting bodies, they offer very differ-ent levels of student involvement. There also are questions regarding towhat extent one should use the available technology for Internet-basedcourses. While the inclusion of audio, video, games, interactive exer-cises, and multiple Web-links are entertaining and may enhance learningfor many, these options are best enjoyed on a high-speed computer with adirect DSL line hookup. Students with older, slower, dial-up computersystems are less likely to enjoy the benefits of these options, and the moreexciting technology actually may interfere with learning due to the timelag and frustration of trying to access information.
Collaborative Efforts
Collaborations allow for the efficient and effective use of resourceswhile providing an enriching environment for academic inquiry. In Au-gust 2002, representatives from 45 Geriatric Education Centers fromacross the USA, funded through the USDHHS, HRSA, Bureau forHealth Professions (Koenig, Gleich, & Zwick, 1988), attended the Na-tional Geriatric Education Centers (GEC) Network Meeting (2002),where issues related to national collaborations were discussed at length.
The proceedings from that meeting outline challenges and benefits,collaborative models, potential partnerships, and a suggested work plan
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for developing geriatric educational partnerships (National GEC Net-work Meeting, 2002). They concluded that in order for collaborations toresult, there must be a commitment on the part of all parties, appropriatefunding, compatible computer hardware and software, provisions fortargeting local and/or nationwide audiences, and standardized policiesand procedures across agencies and universities.
Marketing
The need for marketing applies both to academic and CE/CME offer-ings in DE. According to Renold (2000), as distance education geriat-ric/gerontology courses become more prolific, they will require mar-keting efforts by faculty and administrators. He recommends directmail, advertising in trade magazines, conferences and conventions, anddeveloping web sites that provide institutional information while pro-moting courses. Examples of existing Web sites that market their DEprograms via the Web are provided (p. 27).
In CE/CME, there appears to be an increasing market for DE pro-grams that are targeted toward professionals who are in need of earningcredit to apply toward licensure/certification. Opportunities such asthese will expand for-profit and not-for-profit institutions as onlinecompetition grows. Issues related to the development and provision ofCE/CME include lack of standardization in the process utilized for ap-proving DE programs, concerns regarding limitations on the number ofhours that DE courses can be applied to certification requirements, thethe need for establishing reciprocal CE/CME credits across state lines,and need to develop a process for determining equitable cost and in-come sharing for CE/CME programs within institutions and across mul-tiple institutions.
Workforce estimates for the next 20 years indicate that there will be acritical shortage of qualified faculty and professionals who are preparedto work with older persons (Kovner, Mezey, & Harrington, 2002; U.S.Health Resources and Services Administration, 1995). It is expectedthat both public and private-for-profit industries will increase DE op-tions to meet the growing demand for knowledge and skills to serveolder persons better. As the concept of the university without walls at-tracts a global market, competition for online students will increase(Henke, 2000). Private for-profit virtual universities are expected to re-spond, and programs may develop such as the one offered by HarborsideHealthcare Corp in Boston that provides DE for employees throughoutits 55 facilities (DeGeorge III, 2002). The increased interest by private
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industry enhances the opportunity for creative collaborations that couldbenefit both public and private entities.
The need to maximize funding, faculty, and technological options willbring partnerships, and with it the need to develop inter- and intra-agencyagreements that are equitable for all concerned. Mulcare et al. (2000)provides an example of the partnership between UMass Dartmouth andUMass Boston gerontology programs that share Internet-based and ITVcourses for academic and continuing education and provides a costanalysis model for the conversion of traditional classroom courses thatsuggests cost savings and beneficial exchanges for faculty and students.
Evaluation
We must address the long-term efficacy of DE for geriatrics and ger-ontology and document the types of educational modalities that maxi-mize learning and result in changed behavior. Standardized tools areneeded for measuring primary, secondary, and tertiary outcomes result-ing from DE. There is a need to document the influence of DE on insti-tutions, students, faculty, and professionals and to develop a betterunderstanding of the fit between traditional and DE styles of learning.We must demonstrate the relationship of DE to learning theories and de-termine the types of educational modalities that result in learning andchanged behavior. In addition, we need outcome data that documentsfaculty and institutional DE costs.
In order for such research to be conducted, evaluation activities mustbe recognized as a priority. Funding must be forthcoming to supportthese initiatives and to enable the application of findings along with thereplication of evidence-based best practices.
CONCLUSIONS
Distance education provides great potential for addressing the chal-lenges of academic education for non-traditional students and for meet-ing future geriatric/gerontological workforce needs. We are aware ofthe currently documented strengths and weaknesses of DE and the needfor additional research.
Many issues related to technology, intellectual property, instruc-tional design and curriculum development, collaborative efforts, mar-keting, and evaluation are surfacing for institutions, faculty, students,and professionals in the field of aging. As we wrestle with these issues,
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we need to remember that in any new field, there are opportunities toembrace and challenges to be met. Our ultimate goal is well stated byPoon (2001), who says, “Finally, the most significant influence on thequality and effectiveness of distance education will not be faster orbetter technology, but an understanding of how to teach on the part ofthe teachers, and how to learn on the part of the students” (p. 119).
NOTE
The author gratefully acknowledges Geriatric Education Center funds provided fromthe Health Resources and Services Administration (HRSA), US Department of Healthand Human Services (DHHS), Bureau of Health Professions (BHPr); the support of theAssociation for Gerontology in Higher Education (AGHE) Geriatric Education Commit-tee; and the participants at the Pre-Conference Institute entitled “Expanding Business:The Realities of Internet-Based Courses and Continuing Education Programs in Ger-ontology,” conducted at the Twenty-Ninth Annual Meeting and Educational Leader-ship Conference of the Association for Gerontology in Higher Education (AGHE)which was held at the Hilton St. Petersburg in St. Petersburg, Florida on March 6, 2003.
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