Texas Tech University Health Sciences Center El Paso (TTUHSC EP) is a small health sciences university located in far West Texas on the US-Mexico border. It consists of four schools (medical, nursing, graduate school and dental) with approximately 400 full- and part-time faculty members. Approximately 93% of our faculty members are clinicians . Our institution has a robust Information Technology (IT) department and numerous academic solutions for technology-assisted learning but does not have an institutional-level office that supports the delivery of curricula through eLearning methods.
The Office of Faculty Development (OFD) consists of six team members (four staff and two faculty) with different but complementary skills, and serves the faculty of all four schools. The associate dean is a clinician-scientist (M.D., Ph.D.) and the assistant dean is an epidemiologist (Ph.D.). Every year the OFD conducts multiple faculty development programs; from the Institutional Faculty Development Course, Leadership Development Academy, Institutional Faculty Mentoring Program, writing interest group and the continuous faculty development program, leading to approximately 1000 contact hours per year. To better serve the diverse needs of our faculty, during the last 3 years the OFD was systematically building curriculum in a learning management system (LMS) to complement our face-to-face learning activities .
Emergency transition to eLearning
As the leadership of clinical services at TTUHSC EP was mobilizing healthcare workers to prepare for an influx of patients with coronavirus disease 2019 (COVID-19), the OFD was working in the background preparing the contingency plans for academic and faculty development resources that would be available in 100% eLearning formats. An intense effort to reformat the face-to-face sessions for teaching, research, clinical skills/simulation and leadership modules to eLearning solutions began in early March 2020. Simultaneously, the OFD assisted faculty and staff in the transition of course materials into eLearning formats and into an LMS, as well as creating guides and instructional videos on how to use our LMS and how to create and upload the learning material and quizzes for their learners. This was followed by providing assistance to the nursing and medical school faculty in the creation of an eLearning course on COVID-19, and the use of personal protective equipment.
The OFD team also collaborated with our institution’s Director of the Office of Clinical Informatics and Digital Health on the creation of a comprehensive, institution-specific 4 Continuous Medical Education (CME) hour online course on the initiation of a telehealth visit. The OFD lead analysts created two videos for patients (in English and Spanish) on how to schedule a visit with providers at our institution. Production of these eLearning materials enabled us to implement telemedicine at our institution successfully. Through the creation of this course we improved not only individual competency of our faculty, but also our collective capacity.
The creation of a quality eLearning program is a high-input operation, requiring time and expertise to design and develop, and significant investments to run, monitor and report on its outcomes. Educational institutions with a tradition of online education have well-structured offices for pedagogy and solution support. Due to the rapid transition to eLearning during the COVID-19 crisis, we believe that many educational institutions with limited or no experience in eLearning experienced problems with instructional design and lack of interactivity (faculty to student, and student to student), technical and connectivity problems, threatening the best practices of eLearning which require time to implement and refine , , , , . Table 1 reviews the advantages and limitations of synchronous and asynchronous eLearning processes.
Advantages and limitations of synchronous and asynchronous eLearning.
|Interaction||Real-time interactions between instructors and students and students-to-students||Advanced organization and coordination of all learning activities required to ensure that the synchronous sessions achieve learning outcomes||Instructors and students can initiate interaction 24/7 via multiple solutions – email, discussion forum, chat||Delay in timing of responses, dialogue is written or recorded, responses occur over time and sometimes there are lapses in the dialogue|
|Technology||Live sessions with audio, video and content sharing options||Inadequate internet connection, webcam and/or audio functions may undermine student experience and satisfaction||Reduced bandwidth required for compressed files in audio and video sharing. Less disruption in delivery. Access to the course 24/7||Technical problems with course delivery during non-working hours require support staffing that may or may not have been provided or contracted. This may postpone the learner’s participation|
|Learning management system||LMSs include many options for content delivery, learning activities and assessments, as well as synchronous course meetings||Unless staff support is available, instructor knowledge of LMS may be limited and interfere with the learning experience||The institution-approved LMS provides a consistent learning environment that students can master to minimize disruption in learning||Instructor, instructional designer and student efficacy in eLearning environments, as well as the usability of the LMS|
|Instructors||Instructors schedule interactions with students in group and individual sessions||As with F2F instruction, the instructor must be prepared and knowledgeable of the topic to respond to students’ questions and perspectives||Flexibility: Material is delivered and prepared in advance||Detailed instructions are required, so the learners are supported to accomplish their tasks|
|Learners||Learners plan for class meetings, can be assigned individual and team-based learning and teaching roles, can share their content||Students need to attend sessions to benefit from the learning experience. Learners may review content from recorded sessions, but interaction is undermined by non-attendance||Flexibility: Connection from most locations at any time||Consistent attendance and engagement require learner self-regulation that may not have been developed|
|Assignments||Assignments are delivered, submitted and evaluated in the LMS with the opportunity for significant written and/or audio feedback||Feedback can be accomplished via LMS, phone, or email but depends upon the instructor to arrange||Assignments can be scheduled and made available in advance at scheduled times. Rubrics can be designed, grading can be automatized and rapid feedback available to learners||Automatized assignments may limit the quality of the instructor’s feedback and knowledge assessment|
|Time||Both synchronous and asynchronous courses are high-input operations, requiring instructor’s expertise, time and familiarity with course development and design; significant investment in the LMS; expense of the technical support staff necessary to run, monitor and report on the outcomes of the eLearning courses|
At TTUHSC EP, institutional leadership had implemented policies but they were in the process of being updated and required rapid deployment to create an eLearning Committee that provides a point of engagement as well as learning about best practices to support student learning in the eLearning environment and related regulatory requirements. Figure 1 illustrates the recommended process of the emergency transition to eLearning, emphasizing the role of faculty development, from providing the information about the institutional resources and regulations for transitioning to eLearning, through faculty training, technical support, video production, instructional design services, assessment suggestions to the dissemination of crash courses.
In the post-pandemic world, face-to-face instructional activities should be selected based upon student learning assessment that demonstrates that this form of delivery (face-to-face) is the most likely to advance learning. These environments might be a small group discussion, or simulation-based activity. Face-to-face learning should be complemented with novel eLearning experiences, from synchronous instruction, to asynchronous delivery of course materials, and then hybrid learning environments where higher-order thinking skills are developed .
eLearning experiences should always be created with the learner at the center, focusing on promotion of the efficient use of all pedagogical opportunities and based upon evidence related to the highest student learning outcomes. Such experiences are dependent upon significant support for faculty development as well as support for student self-regulation in eLearning environments . Despite the opportunities to create rich eLearning environments, there are limitations on its utilization, particularly in clinical environments where it is critical for students to interact with patients in face-to-face settings. Consideration of the social, emotional and psychological development of learners is vitally important to ensure acquisition of the requisite clinical knowledge, communication skills, as well as professional behavior, compassion, empathy and resilience. Providing structured, individualized feedback in the eLearning environment is challenging. This challenge may be especially acute for faculty members who have not acquired pedagogical skills in eLearning prior to the rapid deployment of eLearning solutions during the pre-pandemic period.
Role of the OFD in the emergency transition to eLearning
TTUHSC EP did not have an office for eLearning. This gap was bridged using the talents of two lead analysts in the OFD who have strong instructional design skills and keen LMS knowledge. The lead analysts were engaged to form the first institutional-level eLearning support unit. The starting point of a successful transition to eLearning in our institution was the identification of and collaboration with key collaborators in each department and every program. The great majority of our collaborators were current or past participants of our faculty development programs. Partnering with these enthusiastic faculty and working in synergy with the Office of the Provost were equally important for the successful continuation of the OFD’s academic services and our productivity.
Faculty development in the post-pandemic world
There is a saying that with crisis comes opportunity. In the past, the OFD was providing courses and engaging our faculty in the benefits of eLearning. Although we had numerous early adopters, we also had faculty who were resistant to transitioning from face-to-face instructional practices. What the OFD could not accomplish earlier, the novel coronavirus changed overnight. During the COVID-19 crisis, educators realized the advantages and limitations of eLearning solutions. Despite many advantages, eLearning must be coupled with face-to-face instruction in clinical environments for our learners in the health sciences. In our view, in the post-pandemic world, the first portion of the faculty development process will predominantly occur within the eLearning environment where faculty development program participants will learn new skills and new roles and engage in highly interactive assignments .
The OFD envisions sessions where faculty will be engaged in the same interactive learning activities that are part of a well-designed eLearning course. This would be facilitated through discussion forums. The second portion of the development process, the application of knowledge and skills, will predominantly occur at the workplace. This precious in-person teaching time will be more productively utilized for individual learning, small group discussions, debates, writing groups, simulation-based activities and guided practice in the work setting.
eLearning implies distance, but at the same time, and in the global world, it implies connectivity. Additionally, we appeal to the major publishers of scholarly content to have equivalent author copyright transfer agreements. Having uniform copyright agreements between scholars and journal publishers that allow authors more flexibility in sharing their published material, in a responsible manner, will support effective eLearning. Finally, educators, academic leaders and learners should not be discouraged as we believe that all of us will emerge from this crisis stronger, wiser and more experienced in the use of eLearning and implementation of digital health.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Kupesic Plavsic S, Mulla ZD. The essentials of a faculty development program in the setting of a new medical school. J Investig Med 2020, in press.
Moore MG. Theory of transactional distance. In: Keegan D, editor. Theoretical principles of distance education. New York: Routledge; 1993. p. 22–38.
Barnard-Brak L, Lan WY, Paton VO. Profiles in self-regulated learning in the online learning environment. Int Rev Res Open Distance Learning 2010;11:61–80.
Twigg CA. Improving learning and reducing costs: models for online learning. Educause review. https://blendedtoolkit.wisc.edu/wp-content/uploads/2014/04/twigg.pdf.
Hillman DCA, Willis DJ, Gunawardena CN. Learner-interface interaction in distance education: an extension of contemporary models and strategies for practitioners. Am J Distance Educ 1994;8:30–42.
Taylor DCM, Hamdy H. Adult learning theories: implications for learning and teaching in medical education: AMEE Guide No. 83. Med Teach 2013;35:e1561–72.
Anderson LW, Krathwohl DR, editors. A taxonomy for learning, teaching, and assessing: a revision of Bloom’s Taxonomy of educational objectives (Complete edition). New York: Longman; 2001.
Kupesic Plavsic S. Faculty Development Roles During the COVID-19 Crisis. J Investig Med 2020, https://soundcloud.com/bmjpodcasts/faculty-development-roles-during-the-covid-19-crisis?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bmjj%2Fpodcasts+%28Latest+talk+medicine+podcasts%29.