Multi-discipline, Web-based healthcare orientation.

Abstract

A multidisciplinary team of health program educators collaboratively changed the presentation of clinical orientation content (HIPAA, universal precautions, etc.) from face-to-face to asynchronous online. The successful transition required no additional fiscal resources and caused minimal difficulties for faculty or students. The new orientation process provides flexibility for individual program needs.

Introduction

What is an effective method to ensure that health care students acquire information on blood borne pathogens, standard precautions, and other information needed to begin clinical education? Faculty of four programs in Western Carolina University's (WCU) College of Applied Sciences (CAS) responded to changing conditions with a cost and time effective process for faculty and students. Faculty converted a face-to-face orientation session that students attended before their first clinical experiences to an asynchronous, Web-based format during three months in the summer of 2002.

The CAS offers seven nationally-accredited health care programs. Annually, the CAS provided a mandatory, face-to-face orientation session for students just prior to the fall semester before their first clinical experiential activities. The goals of the five-hour orientation were to: 1) prepare students for success in clinical facilities; 2) meet the intent of multiple governmental and accrediting agencies' requirements to protect healthcare workers, patients, and the public; 3) provide new, standardized content while reviewing previously covered content; and 4) reduce the time and resources that healthcare facilities' staffs needed to provide their own orientation for our students. Speakers included healthcare professionals from local facilities and faculty members. Handouts were provided and students completed a comprehensive written test to verify their understanding and ability to apply the orientation content. Because of increasing problems and technical options, the CAS's faculty began considering other, more effective methods for providing the required content.

Impetus for Change

New, mandatory orientation information increased the duration of the session. Students were unhappy about returning to campus before the start of classes to attend the required session. Local healthcare professionals' time constraints limited their availability. A logistical problem was scheduling adequate campus meeting space as the healthcare student population increased. The Physical Therapist (PT) Department coordinated the face-to-face orientation program. After the Fall 2001 session, the PT Clinical Coordinator initiated a committee to consider alternatives for more efficient delivery and improved quality of the orientation content. She proposed that the orientation session content become self-learning modules in an asynchronous, Web-based format. Due to strong support, the committee met in March 2002 to determine the unique needs of each program, the advantages of a format change, and related technical support issues. Change in organizations and their people's roles results when an institution of higher education uses asynchronous, online learning resources. "The successful adoption and effective use of any innovation in an organization requires five interrelated stages. These are; (1) introducing, (2) implementing, (3) adopting/adapting, (4) diffusing, and (5) integrating the innovation into the organization's tasks, structure, culture, and people" (Mueller, 2001, p. 29). The collaborative change process described in this article follows these stages.

Planning Process

The clinical coordinators for Emergency Medical Care (EMC), Health Information Management (HIM), PT, and Nursing agreed to serve on the Orientation Committee. Team members decided that a Web-based orientation program would resolve issues of space, scheduling, and increases in required content. Because of their varied experience in developing and teaching in Web-based education, each realized that experience, limited resources, and time constraints seriously limited alternatives to the traditional face-to-face orientation session. Faculty members of the healthcare profession programs at WCU are "committed to quality ... teaching, which encourages the development of critical thinking and an appreciation of the concept of life long learning" (WCU Department of Health Sciences, 1992, p. 1). Since program graduates will need to learn throughout their careers, students must be exposed "to different learning environments in order to extend and challenge their habitual preferences" and gain experience in self-directed professional learning during their pre-professional education (Kell & van Deursen, 2002, p.38). Another force increasing the need to change the orientation process is "the development of a global economy, [which] strongly supports the need for e-training." ... "As economic globalization continues, the workforce will become more diverse, and training will need to accommodate cultural differences among learners. Because e-training is self-directed, it is uniquely adaptable to learners with different learning styles, interests, and cultural beliefs. In addition, e-training affords flexible pacing, which is ideal for instruction aimed at both new and experienced workers" (Loos & Diether, 2001, pp. 231, 232).

Team members also realized the work settings students enter during clinical experiences and after graduation are part of the e-Health environment. E-Health organizations are those "in which health care information is accessed, processed, stored, and transferred using electronic technologies to facilitate the business of healthcare" (e-Health Task Force, 2001, p. 7). Two recent studies (as cited by Overheul) indicate "Internet-based or online training is seen as the emerging delivery vehicle for ... training programs" (2002, p. 100). A study by Aragon, Johnson, and Shaik (2002) found that "learners can be just as successful in the online environment as they can in the face-to-face environment, regardless of their learning style preferences." However, "online courses must be developed using adult learning theory and principles as well as sound instructional design guidelines appropriate to the content and level of instruction" (p. 243). Student appreciation for ease of access to materials and flexibility in completing the program is related to learner ownership in knowledge acquisition. Goldsmith's qualitative study (2001) found that students were particularly pleased with the flexibility offered by an online course.

However, "computer-based delivery cannot compensate for inaccurate or ineffective Content" (Overheul, 2002, p. 101). A qualitative study on self-directed learning (SDL) found that "although SDL has positive outcomes, the process of becoming a self-directed learner can be painful" (Lunyk-Child, et. al 2001, p. 119). This study also "demonstrated a dichotomy in student thinking, between [the] role of self-directed learner with responsibility and accountability for learning, and their need for assurance from faculty that they are achieving the necessary outcomes" (p. 120). A study of an online nutrition course by Beffa-Negrini, Miller, and Cohen (2002) "demonstrated the importance of positive interaction between the learners and the instructor." They also found that "contact with the instructor during online learning is more important to course quality than interaction with the technology" (p. 8). Therefore, the team wanted to provide a positive learning experience and introduction to e-training for the healthcare profession students while still in the familiar environment of WCU, where they could receive feedback and validation of their individual learning processes. After considering a variety of solutions, the committee decided to create an asynchronous, Web-based orientation by Fall 2002.

The team agreed that: 1) they should focus on developing accurate, current content modules; 2) modules should meet requirements of healthcare facilities that accept WCU students; and 3) faculty members who taught in the previous sessions would develop the modules, based on personal areas of expertise. Also, each program would decide: 1) which modules are mandatory for their students; 2) the method of test administration in the format of their choice (i.e., paper, electronic); and 3) the completion timeframes for their students. The Orientation Committee next met with the CAS Webmaster to discuss technology alternatives. Two Web-based formats were available. WebCT (the course management system at WCU) advantages included password protection and a test-grading component. Disadvantages were the need to create a special course with constant updating of student registration and the students' additional learning curve to access the WebCT page. Advantages of a Website linked to the college Webpage included minimal protection by a generic password, fewer access issues for the students, and fewer administrative requirements for the clinical coordinators. A disadvantage was that the test could not be automatically administered and graded within the site.

Given the WebCT disadvantages and the limited preparation time, the team decided on the Webpage and to use PowerPoint modules. The CAS Webmaster indicated that by using PowerPoint, no additional resources were required and that his time and effort would be minimal. The Information Technology department and the college Webmaster collaborated to assign the user name and password for students and clinicians who served as preceptors/clinical instructors for WCU students. The CAS Webmaster agreed to manage the technical components of the online orientation program. These included creating homepage with password protection; developing links to the clinical orientation homepage from department homepages, uploading each module, and solving access and other problems that might occur.

Development Process

Committee members began developing modules. Although some PowerPoint presentations already existed, additional content was needed to meet the current needs of the students and the healthcare facilities providing clinical experiences. The 2001-2002 WCU session included blood-borne pathogens, radiation and fire safety, and back care. After reviewing current topics in orientation programs at area healthcare facilities, the team added new topics. Team members volunteered to develop and produce new modules based on their areas of expertise. A total of 14 modules formed the basis of the Web-based program, including: Advance Directives, Bloodborne Pathogens, Communication Aids, Corporate Compliance, Electrical Safety, Ergonomics (Body mechanics), Ethics, Fire Safety, Hazard Communication, JCAHO, Public Safety, Radiation Safety, Risk Management, Tuberculosis. The team members e-mailed draft modules to all members for content and format review. Final versions incorporated their suggestions. The PT Coordinator, as committee chair, received the PowerPoint modules by June 2002 and forwarded them to the college Webmaster for posting to the Website. Then she revised the assessment test. Then she revised the assessment tool, by adding questions for the new content areas to the existing comprehensive test. She sent the test to each clinical coordinator for review, then beta-tested it with a second-year cohort of physical therapist graduate students. The class took the test, noted any unclear questions, and suggested improvements.

Implementation Process

Programs selected the orientation components that met specific needs of their students and their affiliated healthcare facilities. As the Fall 2002 semester began, each program established an orientation timeline for its students. Clinical coordinators provided the Website address, user name, and access password to students during a fall class. Students received program-specific information about completing the modules and test, and the importance of the orientation content for success during their clinical experiences. The coordinators reported any difficulties to the committee chair. Problems with a few test answers were reported and corrected. Minor technical access problems were quickly resolved by the college Webmaster.

While all students accessed the same site, each program used different assessment processes, varying in testing, grading, and feedback. For example, the HIM program administered the test in class on paper with faculty grading. The EMC program used an electronic exam in WebCT, which provided immediate grading. Other variations included take-home exams and peer grading. As in the past, a certificate was issued to each student who successfully completed the test. The wording of the completion certificate slightly changed from "attended" to "completed." Information packets sent to the clinical experience facilities included copies of the certificate, valid for one year.

Evaluation

Team members evaluated the new orientation in November 2002. Test questions determined to be unclear or irrelevant were revised. Qualitative feedback from students and faculty noted satisfaction with the following expected benefits. Students appreciated not attending an afternoon of lectures on campus before the beginning of the fall semester. Students required minimal time in orientation programs at their clinical sites. The opportunity to learn material with less stress and fewer complaints occurred because students were able to determine their own location, time, and pace for reviewing the modules. Faculty reported more time efficiency in their busy fall semesters, since the program was asynchronous and student complaints were significantly reduced. The faculty appreciated the flexibility in choosing a testing format. Faculty reported no complaints about learning through the online course. Each program coordinator reported satisfaction with the flexibility in the required completion time and the opportunity to customize the set of modules for each program. In this first iteration of the process all programs used all modules. Clinical coordinators expressed great satisfaction in the individualized approach to testing. "WOW! I'm very impressed. You covered everything I could hope that a student would need to have prior to a visit at [my facility]" (HIM Clinical Instructor). The local medical center's health education manager greatly appreciated the ability to demonstrate the modules during a JACHO visit.

Additionally, several unexpected or potential benefits were identified. Students received positive reinforcement of their personal responsibility to annually update competencies and knowledge throughout their professional careers. Based on individual experiences, committee members believed the new format improved learning. This belief was confirmed in July 2003, when the PT students completed a second annual competency examination. Students could work together and use the online modules as a resource. All students completed the examination with a score of 88 or better in less than 50 minutes. Additionally, the committee believed that student access to orientation modules during clinical experiences was an advantage. During the 2003-2004 academic year, the faculty will track the number of times students use the information. Previously, each student was provided handouts with information on the units. The Web-based format eliminated the need for paper copies of the content, saving each department time and duplication costs. Faculty learned that the online format allows quick and easy updating. The committee will share the orientation information with all health professions faculty because the modules can serve as adjunct material for curriculum needs or as a reinforcement of program content in some courses. When WCU's Speech and Language Pathology program asked to use the orientation, allowing their students access to the course was simple and inexpensive, although this program is not part of the CAS and was not involved in the original development.

Future Additions/Improvements

The CAS Orientation committee members believe that the change from a face-to-face to an asynchronous, Web-based delivery method is beneficial. However, they know that "Interactive online training should be more than a Power Point presentation offered over the Web; it should engage ... and reinforce learning through creative questions and exercises, ... quizzes, [and] e-mail communication between workers and managers" (Overheul, 2002, p. 101). Since the online orientation modules are one example of a learning object as defined by Wiley (as cited by Bratina, Hayes, & Blumsack,)-"any digital resource that can be reused to support learning," they can be continuously modified to meet evolving content needs and to further increase their value in self-directed learning (2002, p. 1). During Summer 2003, several modules were added (HIPAA), and the ethics module was revised. Using the PowerPoint modules' content, various team members will integrate interactive self-assessment activities into the program. The HIM coordinator is developing several scenarios with related questions to assess the students' application of the orientation content in situations they may encounter in healthcare facilities. The 2002 CAS students did not formally evaluate the orientation delivery method. The Orientation Committee members will insure that students evaluate the Orientation process on a yearly basis, beginning with the 2003-2004 academic year. The Committee will also continue collecting feedback from clinicians who accept and work with CAS students.

Conclusion

The Orientation committee members are very satisfied with the results of the change to a Web-based format. Students had increased flexibility and experienced a Self-Directed Learning environment, while still in a familiar and comfortable setting. Program benefits of this staged development process for transitioning to an e-Health training environment included no additional costs, increased flexibility, and customized content. Faculty involvement during the Fall 2002 semester was reduced, but overall time commitment was unchanged due to developing new procedures. However, team members anticipate a further reduction of time and effort in future years. The authors recommend staged implementation of a Web-based, asynchronous orientation process, guided by an interdisciplinary faculty team. However, technical support is essential for successful, efficient development and implementation of an online orientation program. Other healthcare programs can adapt the described development process to meet their students' needs.

References

Aragon, S. R., Johnson, S. D., & Shaik, N. (2002). The influence of learning style preferences on student success in online versus face-to-face environments. American Journal of Distance Education, 16(4), 227-244.

Beffa-Negrini, P.A., Miller, B., & Cohen, N.L. (2002). Factors related to success and satisfaction in online learning. Academic Exchange Quarterly, 6(3), 105-114.

Bratina, T. A., Hayes, D., & Blumsack, S. L. 2002. Preparing teachers to use learning objects. Faculty and Staff Development, The Technology Source. Available at: http://ts.mivu.org/default.asp?show=article&id=961 Accessed: December 3, 2002.

e-Health Task Force. (2001). Report on the roles and functions of e-health information management. Chicago, IL: American Health Information Management Association.

Goldsmith, D. J. (2001). Communication, humor, and personality: Student's attitudes to learning online. Academic Exchange Quarterly, 5(2), 108.

Kell, C. & van Deursen, R. (2002). Student learning preferences reflect curricular change. Medical Teacher. 24(1), 32-40.

Loos, G. & Diether, J. W. (2001). Occupational safety and health training on the Internet. AAOHN Journal. 49(5), 231-234.

Lunyk-Child, O.I., Crooks, D., Ellis, P. J., Ofosu, R. C., O'Mara, L., & Rideout, E. (2001). Self-directed learning: Faculty and student perceptions. Journal of Nursing Education. 40(3), 116-123.

Mueller, I. L. E. (2001). Faculty development for electronic technology-based distance education in public two-year institutions of higher education with allied health programs. Unpublished doctoral dissertation, Montana State University.

Overheul, V. (2002). Does online training live up to its promises? Occupational Health & Safety. 71, 100-106.

Western Carolina University, Department of Health Sciences. (1992). Statement of philosophy and purpose.

Irene L. E. Mueller, Western Carolina University Linda Eargle, Western Carolina University

Mueller, EdD, RHIA, is WCU HIM Director with experience in online Distance Education. Eargle, PT, MIn Ed, is WCU PT clinical education coordinator with 36 years in physical therapy, including 15 in higher education.