September 2001

A case study in instructional design, for inclusion in Peg Ertmer and Jim Quinn, Eds., ID Casebook 2^nd edition, to be published by Merrill/Prentice-Hall.

Background

State Medical University trains doctors, nurses, and health professionals in a variety of specialties. The training of doctors is fairly traditional, with two years of basic science instruction followed by third- and fourth-year clinical experiences. The primary teaching strategy for clinical experiences has been apprenticeships in hospital settings. However, due to a changing health care environment, fewer than 5% of all pediatric interactions result in hospitalization, and hospital stays have been greatly shortened. Therefore, increasing numbers of medical students do their required rotation in pediatric offices around the state.

The pediatrics department is considered to be among the top 10 in the country with a strong history of pediatric research. There are many older faculty members known to be excellent teachers and mentors. The Chair reports, "The faculty on this campus wrote the textbook on pediatrics." All medical students are required to take the pediatric clerkship in their third year. Thus year-round, the pediatric department gets between 15 and 18 new third-year students every 6 weeks.

Dr. Jean Fallon is eager to begin a new project that will use technology to change how the pediatrics clerkship is taught. She has called a planning meeting to gather ideas so she can apply for a pilot grant through a recently released request for proposals (RFP) from the Office of the President.

Main Characters

• Pat Kelsoe–Medical educator. A doctoral level instructional designer, Dr. Pat Kelsoe is a new (two months) assistant professor in Pediatrics accustomed to collaborating on development teams. She has been an instructional designer for the last six years with all of her experience in academic medicine. She has helped two other medical schools transition to problem-based learning. She worked full-time while she completed her doctoral degree in instructional technology a year ago. "I dragged my family across the country to accept this position; there’s no way I’m going to take this job lightly."

• Sam McConnell–Senior colleague. Dr. Sam McConnell, a senior faculty leader, was also asked to attend this meeting to discuss potential changes to the pediatric clerkship. Dr. McConnell thinks the new clerkship director had the potential to be a star given the research she was doing, and was upset that she did not wait until after she was tenured to take this educational position. He has heard some of the grumbling from other faculty about the medical educator position and he, too, wonders why she was hired and what she will do to help the department’s already excellent teachers.

• Harry Lipsitz, Department chair: Though he has received a lot of heat from some senior faculty members for creating a medical educator position and appointing a junior faculty member as clerkship director, Harry Lipsitz is excited about the potential of these young professors. He sees that there are many research questions in education to be asked and is anxious for his department to be a leader in this area. He believes that he has two very talented and hard-working faculty members, who share his vision for the clerkship. Harry is concerned, however, about their interest in technology. He recalls a colleague who took a sabbatical to create an educational software program. This colleague worked very hard on the project, but nothing ever came of it. Harry is afraid that ventures into educational technology could take a lot of time and money and end up being unproductive. His most important job is to get these two junior faculty promoted under the new evaluation system. They will be some of the first faculty to attempt to get tenure under these new guidelines. While it’s true that educational innovations are a risky venture for untenured professors, these two could have some interesting studies and research findings.

The Planning Meeting

Faculty members begin arriving in the Department Conference Room. After several minutes of friendly banter, Harry begins discussion.

You have indicated previously that Jean Fallon has called the meeting. This being the case, we would expect her rather then Harry to open the meeting. Please rewrite to be consistent.

Jean, the SME: Thank you all for making the meeting. I know it’s a busy time of year, but I want to get this project off the ground. There are a lot of great things already in place with the clerkship, but there seems to be some room for trying out new ideas. The President’s office just came out with a grants program, and I thought we could compete for some of that money.

Sam, the Colleague: Always happy to take someone else’s money!

Jean: That’s right, and I think this project could be worth the investment. I’ve been thinking: Our clerkship students often have great experiences out in the field, but they sometimes don’t see any critical cases. It’s a bit risky out there: You can get a great education, but we leave a lot to chance. So I’ve been playing around with this idea: What if we developed a set of cases, like computer-based case studies, covering some cases we think everyone should see? Like, say, an urgent case of abuse. Then we’d be giving students something that’s very close to real life, but we can be sure they will actually encounter it in their rotation.

Harry: You mean, show some video on the computer?

Jean: Yeah, show some video, either actors or real patients, depending on what we’re thinking of. Give students a look at some symptoms and a situation, and let them ask questions, order tests, somehow leading to a diagnosis. Then we could give some feedback.

Harry: Wouldn’t that be kind of expensive? Putting all that into the computer?

Pat, the Medical Educator: Yes, a project like this could easily run up a budget. But I see the President’s Fund as a way to get it started. It could lead to some new ways to think about the clerkship.

Sam [shifting in his seat]: Hold on a second. After having directed the clerkship for 12 years prior to your arrival here, Jean, I have to say that it’s one of the most respected in the country. Our students come out very well-versed in pediatrics. We get a good number of them deciding to specialize in pediatrics after their rotation.

Jean: That’s important; we want students to be attracted to our department. I’m just thinking–maybe some video cases could even increase the attraction.

Harry: I’m still worried about the scope and cost of this kind of project.

Pat: Video production is getting cheaper and easier, but it’s still a lot of work. We don’t have a production facility here within the university; we would have to hire some of this work out. And we’d need to develop some expertise among ourselves.

Sam: That’s just what I need, some fancy new technology to learn. I remember taking a HyperCard class once–never again!

Pat: I don’t think faculty members should have to do all the authoring. We could get a couple of interns or part-time help to do most of the production. Your expertise, though, would be very helpful in determining how to approach a case, Sam.

Sam: I don’t want to do any of the authoring. It will take far too much of my time and time is money.

Pat: Maybe I should clarify. We would have a team working on the case. The design and technical aspects would be handled by the interns and me. But we need experts to review the cases to ensure that they are realistic. This is what I mean when I say authoring.

Sam: Oh, well I could do that. Of course, you’d need some expert advice since you’re not a physician or pediatrician.

Chair: Tell me more about your ideas for the video case. Would it be like a tape that you watch?

Jean: Pat, why don’t you share the ideas you were telling me about PBL?

Pat: As you know, problem-based learning is heavily used in medical schools, but I’m not aware of very many problems or cases being presented online. Here is what Jean and I were talking about. You present a video case, with some footage and some background information. Make it interactive so that students can explore some information, order tests and ask questions. That part is kind of standard, like an interactive case or problem online. The part that I’m excited about is somehow connecting the students together online. Get students and a faculty member on the Internet talking to each other about the case. Students won’t be so isolated in their different field sites; they will be able to watch each other and learn from each other. It’s from talking about the case that people learn the most.

Harry: Wow, that sounds exciting. You’re trying to get the best of both worlds–Video on the computer, but then having people connect and talk about it from different locations.

Jean: That’s right. You get the benefit of field experience, but some assurances that key learning experiences will be shared. That’s important for us to have confidence that they’re all learning something similar. Not only would they have the lectures on-campus, they would stay connected throughout their field experiences.

Harry: It can get kind of isolated out there. Having some way to work together would be good.

Preliminary Analysis Questions

Implications for ID Practice

Decisions within organizations happen within a context of limited resources–limited time, money, and expertise. An organization’s history also constrains present choices. This case explores how two risk-willing innovators might articulate and promote their innovation within an organization facing these constraints. The innovators must be sensitive and respectful of constraints and risks, while carefully cultivating their plan to increase its likelihood of success.

Objectives

After studying and responding to this case, the instructional design student will be able to:

1. Analyze conditions to determine appropriate use of technology in a learning setting. Given a detailed scenario, develop a well-reasoned rationale for a technology-based solution where appropriate.
2. Differentiate the change agent role from others who might be inclined to resist an innovation. Understand the needs and interests of each of these groups.
3. Develop 2-3 cautions that change agents should heed if they are to see their work successfully implemented within their organization.
4. Understand and appreciate the need for commitment, leadership, and expertise if technology-based solutions are to be successfully adopted in organizations.

Debriefing Guidelines

The case presents a situation that is generally favorable to the use of technology. Cases could be presented using multimedia that would bring some standardization to field experiences that may vary dramatically across site and time. Email and conferencing technologies could profitably be used to reduce the isolation of students in remote parts of the state. Web resources could become part of an inquiry process in responding to cases. In spite of these potentials, however, the project presents considerable risks to the young professors. This problem space–the potential value of technology-based solutions; the different positions and values of participants; and the risks associated with innovation–constitutes a fairly common environment faced by instructional designers on the job. It is good for novice designers to navigate these hazardous waters in safe learning environments such as classes, where the consequences of failing are relatively manageable.

The case is designed like an unfinished play, with clearly drawn characters and an initial plot direction. It’s up to the learner to determine where the case will go. Because of this, we encourage in-class or online completion of the role-play exercise and/or the proposal-writing activity.

Students should be able to respond to the activities without formal introduction to the underlying theories of technology adoption, change agency, and appropriate use. Supporting theory bases include:

See the reference list for more information on each of these ideas. Students may be directed to these resources as they participate in case activities.

The case can also be valuable as a window into the tenure process for university professors. Many departments tend to under-value teaching in favor of research. Instructional design, in fact, can sometimes play a role in bridging these polarities.

Additional Comments

The rest of the story: Sam and Jean did get a $45,000 grant from the President’s office. After building the prototype virtual PBL program, they received a three-year grant from the Fund for the Improvement of Post-Secondary Education (FIPSE) to build more cases using a CD-ROM/web hybrid program developed in the initial grant. The cases have been distributed to more than 30 other medical schools. The physician-assistant and nursing programs at their university have plans to include the cases in their curriculum. An extensive evaluation was conducted of the program’s effect on student performance and attitudes, as well as the impact of distance and case modality. Sam and Jean recently received a second three year grant from FIPSE to disseminate their case authoring tool to six additional medical schools and conduct extensive faculty development. Both Sam and Jean were promoted to associate professor!