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Wiki for Health Professions Education

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__Introduction__
A wiki is a web 2.0 collaborative tool which allows users to participate in a virtual learning environment, collectively developing, creating, and constructing knowledge. The learners (members) are active contributors to the wiki, and therefore become part of the virtual community of practice. As such, each participant is actively participating throughout the process, with the learners sharing knowledge, asking questions, and reflecting on edits and postings. As the wiki revolves around a common theme, in this case wikis in HP Ed, the participants (lavenderteam) are engaged in learning about this topic as a group (the community of practice). There are many medical based wikis, examples of which include Ask Dr.Wiki, Webhealth, and WikiHealthCare. Applications of wikis to health professions education and analysis of their use in the context of learning theories will be explored and developed for this group project.

__Advantages and Disadvantages of the Wiki__
The advantages of the Wiki approach include the fact that group members may have complementary skills and knowledge and therefore the document they create collaboratively will be more complete and accurate. A second advantage is that the wiki can be continuously updated as information changes. However, there are also a number of limitations. Inaccurate information may be incorporated into the Wiki and, without expert help or novice contributors willing to do research, it is difficult to insure accuracy. Also, with this approach to writing, it is difficult to monitor and understand the rationale for edits. Although this wiki site (WikiSpaces) does log when changes to the document are made, it doesn't identify the exact changes, nor ask the editors for a rationale. Unless there is careful monitoring of the wiki and a plan for updating, the information could become outdated. Finally, wikis can become unwieldy if additions are made without attention to readability. More is not necessarily better.

__Applications to Health Professions Education__
Wikis can have many applications to health professions education. The wiki can provide examples of how theory can be put into practice in the classroom. For instance, a page could be established where ideas are shared identifying how social learning theory is applied to health professions education. Unique issues relevant to health professions education may also be discussed. For instance, best practices in being a "culturally competent teacher" for students in health professions could be discussed with best practices from the literature identified.

Here are some examples of current health professions wikis: [|Ganfyd] This site has a similar format to wikipedia, but the subject matter is diseases. [|Fluwiki] This is a wiki devoted to influenza. [|List of Medical Wikis] David Rothman has assembled a list of medical wikis.

Here are 2 links to relevant articles about wikis:

__Analysis in the context of learning theories__

 * 1) Constructivism - Constructivism states that knowledge is personal and doesn't exist outside the minds of people. One constructs new knowledge upon previous knowledge in the process of interacting with the world and other people by perceiving and acting. This is an active process that is enhanced by appropriate arousal and the sense of self-efficacy. In a sense, the process of creating a wiki could be likened to an external simulation of the process of learning as espoused by the constructionists. The process of modifying the scaffolding upon which new knowledge is incorporated is similar to the process of modification of the wiki as it takes shape. Moreover, this section could be considered new knowledge built upon the introductory sections which are derived from previous knowledge. However, there are some clear differences. The wiki is not just a reflection of personal knowledge, but the collaborative knowledge of the group creating it. Clearly, also, it is external and could be directly observed and incorporated by others.
 * 2) Cognitive Load Theory (CLT) - This theory proposes that learning happens best under conditions that are aligned with human cognitive architecture. The architecture assumes a limited working memory capacity and an unlimited long term memory capacity holding cognitive schemas that make up an individual's learning base (Sweller 1988) . Learning is described as the construction and automation of such schemas, and is enhanced when extraneous load is decreased, intrinsic load managed and germane load (motivation) optimized (van Merrienboer & Sweller, 2010) . The CLT can be used to explain the utility of wikis as a collaborative instructional tool: being easily accessible, relatively user friendly and not requiring extra software, it reduces extraneous load so that the working memory is not overloaded by the "technological aspects" and can be freed for productive learning. Conversely, the availability of too many features and enhancements hinders the actual task of doing the course activities, since by having to learn the various features (and thus increasing the intrinsic load, especially for less technically adept learners), the limited working memory capacity is diverted from the key tasks at hand. In one study, a simpler, less-feature-rich version was actually preferred (Raman et al., 2005) . Finally, the advantages of social interaction, collaboration and information sharing within a community (beyond just learning as individuals) can be harnessed as a means to motivate learners to invest cognitive resources ("germane cognitive load") in schema construction and automation, such that the externalization of knowledge results in internalization and the creation of emergent knowledge (Kok, 2009).
 * 3) Situated Learning - Situated learning, or situated cognition, is a subset of constructivist learning theory that describes well the learning that occurs for students and novices in the clinical environment. In the clinic (the authentic environment), the novice practices the skills he or she has learned with real patients.What has also been found to be essential for significant learning, however, is that the novice is accepted into the “culture” of the clinic. In order to best learn how to “use the tools in the toolbox”, the novice has to be exposed to and have access to more experienced clinicians, as well as access to the clinical environment. The learning is situated in the practice community.The more experienced health professionals are mentors for the health professional students and novices. Situated learning theorists emphasize the learning that occurs in the context of “…apprenticeships,coaching, repeated practice, reflection,and collaboration.” (Wolfson & Willinsky, 1998) These theorists would argue that learning how to build this wiki (our product) represents a collaborative construction of understanding, which leads to new knowledge for the participants. Web 2.0 technologies, including wikis, promote the collaborative development of knowledge, and it is in this environment that the lavender team is learning as members of this learner community.
 * 4) Social Learning - Social learning theory, proposed by Albert Bandura, is applicable to understanding the process of a novice creating a wiki. Bandura proposed that, in addition to direct reinforcement of behavior, we learn new information and behaviors by watching others. Specifically, we are able to observe others’ behavior (live or symbolic) and imitate the behavior. In creating a wiki, we can observe the additions made by others, as well as how the edits and comments are made, and imitate those behaviors that we perceive are reinforced (well received). Bandura also postulated that intrinsic reinforcement is important to learning. That is, after we contribute to the wiki, we may feel proud/satisfied that we are learning a new technology, interacting with a community of like-minded learners, and becoming proficient. Bandura also theorized that learning involves certain steps including attention to the modeling process, retaining the learning process, reproducing what was learned, and being motivated (through reinforcement or punishment). In creating the wiki, a learner reads about wikis, retains that information, actually creates or adds to the wiki, and hopefully receives reinforcement on the work (or negative feedback if done incorrectly).
 * 5) Experiential Learning - Carl Rogers coined 2 types of learning: "cognitive" or "experiential". Cognitive learning is considered unimportant or insignificant, whereas experiential learning is significant and "experience is... the highest authority... No other person's ideas, and none of my own ideas, are as authoritative as my experience." With that in mind, how does this apply to the creation of a wiki? The process of researching, discussing and creating this wiki has been an experience. The end product will be a script of all our ideas which according to the above definition is not authoritative enough for another person. It will only serve as a reference point for the reader to create another experience. The challenge remains to create a wiki that allows for experiential learning!

__Analysis in the context of Clark and Mayer eLearning Principles__
Feedback on same screen as question || Integrated presentations had higher scores on knowledge acquisition || Yes. One could place text next to a graphic, although I am not sure how much you could integrate the text into the graphic. || Keep text if words are technical or need to be learned/ remembered. || Maybe. This would be challenging. For example, Pongy could have described a graphic in her video. ||
 * **Principle** || **Definition** || **Evidence** || **Can a Wiki do this?** ||
 * Multi-media principle || Integrates graphics with text || Learn better with both; novice learners do better with this || Yes. It is possible to add graphic files. ||
 * Contiguity principle || Text next to graphic/ audio with graphic;
 * Modality principle || Audio better than text with graphics if possible || Visual/pictorial channel may get overloaded if user has to attend to text at same time (pg118); reduces demands on visual processing.
 * Redundancy principle || Explain visuals with audio or text; NOT both || See pg 128: cognitive theory of multimedia: //learners actively attempt to build pictorial and verbal models from material & build connections between them.// || Yes. It is possible to explain visuals with audio or text alone. ||
 * Coherence principle || Avoid lessons with extraneous audio, graphics, words || Simple is best; more complex or sophisticated graphics or works makes the user work harder, cognitive load || Yes, it is possible to stream audio and graphics . Use with discretion. ||
 * Personalization principle || Use conversational style (1st & 2nd person language) & virtual coaches (pedagogical agents) || Works best for less experienced learners & when amount of personalization is modest so as not to detract. When authors are visible the user may see them as a guide, a sense of social presence. || This is dependent on the authors. With multiple contributors on a wiki, the style may not be consistent. ||
 * Segmenting & pre-training principle || Break a continuous lesson into bite-size segments || Learner can absorb each element before moving on to next level;allows learner to manage/ control the material || Yes, the display can be arranged so it is visually pleasing and into manageable segments. ||

__Evaluation of the outcomes of this tool__
The SECTIONS framework can be utilized to evaluate the outcomes of our wiki tool.  S - Students  E - Ease of use  C - Cost structure  T - Teaching and Learning  I - Interactivity  O - Organizational issues  N - Novelty  S - Speed

 Application of SECTIONS framework to this wiki:  The **Students** in the course were adult learners and had the ability to access and use technology.  The lavender team (Students) found the tool relatively **Easy**, although there were some difficulties formatting the document.  There was no direct **Cost**.  **Teaching and learning** principles were appropriate for the learners and helped to guide the wiki development.  The members were able to be **Interactive** with the learning technology, as evidenced by frequent email and discussion board postings, as well as edits on the wiki itself.  **Organizational issues** did come up, with several different members taking the lead at different times during the project. <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> The **Novelty** of the tool was appealing as many members of the group have not used these technologies in the past. <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> **Speed** in creating the wiki page, though probably slower for our group of relative novices, was definitely faster than working on the project separately, and then trying to merge and edit different drafts. <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> Taken together, the SECTIONS framework allows for a comprehensive evaluation of the wiki as a learning tool for the Lavender team.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">__Best Practice Consensus Statement: Criteria necessary for evaluation of educational technologies__
<span style="font-family: arial,helvetica,sans-serif; font-size: 90%;">In considering the best practices for evaluation of technology in educational programs, one must consider the various stakeholders and resources that are involved. It is not sufficient to measure just one aspect of the program, and it may not be a good idea to apply one of the many surveys that are readily available as they may not fit the purpose. <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> According to the authors in the flashlight project, 3 major categories should be considered: <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> 1. //Outcome//: graduates who knew how to find and critically evaluate information (in print or electronic form) <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> 2. //Activity// that fosters the outcome: students working on projects using primary source materials <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> 3. //Technology// that supports the activity: print and electronic materials

<span style="font-family: arial,helvetica,sans-serif; font-size: 110%;"> __<span style="font-family: arial,helvetica,sans-serif; font-size: 90%;">Outcome __ <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> The graduates, or the learners in the program, will be able to utilize a variety of technology and apply them in various programs. <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> The faculty should also be included in the evaluation process. <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> Measurements of the variety of technologies used as they relate to various learning theories <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> Talk about robustness, sustainability, scalability, and generativity

<span style="font-family: arial,helvetica,sans-serif; font-size: 110%;"> __<span style="font-family: arial,helvetica,sans-serif; font-size: 90%;">Activity __ <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> The activities that engaged the learners can also be measured, such as the variety of technology tools, the ability by which learners are able to apply to different projects <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> Quantitative and qualitative data on learner satisfaction

<span style="font-family: arial,helvetica,sans-serif; font-size: 110%;"> __<span style="font-family: arial,helvetica,sans-serif; font-size: 90%;">Technology __ <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> Evaluate types of technology support – website, audio, intervention/ guidance by faculty <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> Barriers to using various forms of technology <span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> SECTIONS framework is an easy way to evaluate the technology (as seen above)

<span style="font-family: arial,helvetica,sans-serif; font-size: 90%;"> The Flashlight Approach of Stephen C. Ehrmann also provides some __practical guidance__ with regard to assessing educational uses of technology. The first rule is not to do assessment unless you plan on making use the of findings. In fact, the assessment should be designed to discover how to improve the results of a use of technology. Regardless of the outcome of the evaluation, the process should inform and influence stakeholders. It is worth adding here a theme from the Harvard Macy Course on Assessment, that one should not design a learning activity without simultaneously designing the assessment method. Another practical aspect emphasized by Ehrmann is that one should study not what you intended the learners to do, but the activities that they did repeatedly and attempt to determine why they did these activities. He suggests that the control for the study of a new application of an education technology be the best existing technology rather than no technology. Variation in how a technology performs is to be expected and outcomes will vary based on individual learners and individual teachers. One can take the approach of looking for uniform impact by assuming the same outcomes for all participants and/or be open to unique uses of the technology. The latter approach is more akin to qualitative research with inductive reasoning.

<span style="font-family: arial,helvetica,sans-serif; font-size: 13px;"> Norcini et al identified seven criteria that are necessary for good assessment in any teaching/learning situation.. These are (1) validity/coherence (2) reproducibility/consistency (3) equivalence (4) feasibility (5) educational effect (6) catalytic effect and (7) acceptability. The stakeholders involved, the context to which assessment is applied, and the importance of the criteria in different situations are all explored. The authors described these criteria and the relative importance of each of them depending on the purpose of the assessment. In formative assessment, the criterion that is most evident is the catalytic effect (the results of the assessment drive continued and future learning). The educational effect and the validity criteria are also of greater importance for formative assessment. Conversely, validity, reproducibility and equivalence (the same assessment results in equivalent scores when given at different institutions or at different times) are of more significance for summative assessment. Applying these criteria to assessment of outcomes from the use of educational technologies would take into account many of the same factors that the SECTIONS method promotes.

<span style="font-family: arial,helvetica,sans-serif; font-size: 13px;"> Increasingly, technology has found greater application in the area of assessment in health professions education, including computer-based assessments, simulation and simulators (e.g. assessment of crisis events and team skills), and management of assessment procedures. Potential validity threats associated with technology enabled assessment (TEA) include assessment of wrong construct, deviation from real-life experiences, tension between learner assessment and technology evaluation, as well as inappropriate levels of fidelity. The Ottawa consensus also provides recommendations regarding the use of **technology-enabled** assessment (TEA). The recommendations include: (1) Principles of quality assessment should be observed when using TEA, (2) Contextual considerations such as educational needs, resource efficiency, and relevance should be the primary deciding factors in choosing the appropriate technologies, (3) TEA needs to be integrated within the larger ecosystem of health professions education, (4) Capitalize on available technologies for the entire life-cycle of management of assessment processes including examination development, administration, data acquisition, analysis, reporting, storage, and quality assurance, (5) To ensure validity, attention should be given to the constructs being measured, and selection of appropriate scenarios and activities, (6) Assessors and test developers should actively devise assessment strategies to include broader competencies such as team-work, monitoring of performance, and patient-safety. Again, many of these considerations are consistent with the SECTIONS framework.