Alternative Learning Methods: Computer-Assisted Learning
(Part 4 of 5) (December 2001)

Rapid changes in technology have made the computer an integral part of our personal and professional lives. Concurrent with changes in computer technology have been major changes in how the computer is being used to enhance education and training. In many schools, it is now commonplace to find students using multimedia computers as an integral part of the learning process. Clinicians can take online continuing education courses or learn new information from a CD-ROM. Clearly, learning with the aid of a computer is here to stay. But what are the implications of using computer-assisted learning (CAL) for training reproductive health professionals? CAL means using computer technology to assist with, augment or deliver part or all of the instruction and to evaluate participant progress along the way. There are several terms commonly used in CAL:

• Multimedia. Multimedia simply means a variety of media together. On the computer, the media can be text, sound and still or moving pictures. Multimedia instruction can simulate a real-life experience, such as decision-making on the job, thereby allowing the learner to progress through training by interacting with realistic situations. Interactive multimedia are those that require the participant to interact with the computer by completing exercises, answering questions and solving problems.
• Computer-based training. Computer-based training, also known as computer-assisted instruction (CAI) or computer-assisted learning (CAL), is instruction delivered by a computer. Originally, it was text-based, but most computer-based training programs now encompass many multimedia elements.
• Internet or Web-Based Training. Many organizations are beginning to provide multimedia training materials on Internet websites so that training will be more accessible and materials can be more easily modified.
• Distance Education. Distance education (also known as distance learning or open learning) is instruction in other than the traditional face-to-face or instructor-led format, often at a time and place of the individual's choosing. It can be in the form of self-study materials, CAL modules, Internet materials or some combination of these or other media.

Many of the terms used above have come to be used interchangeably. Multimedia instruction, for instance, can be delivered via the Internet or via a CD-ROM on a computer. The use of the Internet and CD-ROM can also be combined. In this type of learning, instructional content on the Internet can refer to related information on an individual's CD-ROM. The common element in these computer-assisted approaches is the use of technology.

Why Use Technology to Assist Learning?

CAL and traditional, group-based learning have the same purpose: transferring information and skills. In many ways, delivering instruction using computer technologies is similar to delivering it in a face-to-face format. Good instruction fulfills the desired learning outcomes, whether instructor-led or technology-based. As with any alternative learning approach, there are advantages and limitations to consider:

Advantages

• Improves access to instruction
• Complements a wide variety of learning styles
• Is non-threatening, allowing participants with varying knowledge and skills to obtain instruction in a more comfortable manner
• Enables individuals to choose a convenient time and place for learning
• Increases instructional effectiveness, because learners can review each topic as much as they need to, and do not have to progress to the next topic until they feel ready
• Results in increased retention because each learner has the same level of participation in the learning process
• Provides immediate feedback to participants
• Allows consistent, standardized presentation of material
• Allows easy updating of materials
• Reduces training time and costs

Limitations

Some of the limitations of CAL are that it involves:

• Initial development time and high cost
• Access to computers and, for online learning, the Internet
• Technical support for computers
• Training of trainers to facilitate CAL
• Security for computers

Possible CAL Scenario in IUD Counseling and Clinical Skills Using ModCal(r) for IUD Services

Preliminary Activities

1. Print and multimedia materials are developed and a system for implementing, supervising and evaluating the program is designed.
2. A facility is identified and equipped with computer(s) and technical support. A clinical site for skills practice is identified. Learning materials provided to the site include CD-ROM(s) containing the CAL course, a video and anatomic models.
3. An experienced trainer is oriented to the CAL method and responsibilities of a CAL facilitator.
4. A proficient clinician who is interested in becoming an IUD service provider is selected for training.
5. The clinician as participant meets with the trainer to discuss the program structure, schedule, objectives, assignments, and knowledge and skill evaluations.
6. The participant receives a set of materials including an IUD reference manual and participant's handbook that describes each of the steps in the CAL process. The participant is also shown how to turn on and use the computer.

Transfer of Knowledge

1. The participant enters the first module and completes a precourse questionnaire based on content in the CAL course. The computer scores the questionnaire and presents the results to the participant.
2. The participant and trainer use the questionnaire results to identify topics the participant has some background in and those where more study will be required.
3. The trainer observes the participant's counseling and clinical skills through role play and performance using the pelvic model. Clinical skill assessments may include performing a pelvic examination, loading the Copper T 380A IUD in the sterile package, and IUD insertion and removal.
4. The participant begins the individualized process of information transfer (i.e., learning the content) by working through the CAL modules (similar to chapters in the reference manual), completing practice exercises and taking brief module assessments to ensure understanding of the information presented in each module--all on the computer.
5. Upon completion of all modules and/or assignments, the participant takes the midcourse questionnaire.
6. The computer scores the questionnaire and presents the results to the participant.
7. If the participant scores at least 85% correct, s/he is considered to have mastered the knowledge portion of the course. If the score is less than 85%, the computer (for CAL) identifies the topics requiring further study. The participant studies these topics and repeats the knowledge assessment until s/he achieves a score of at least 85%.

Transfer of Clinical Skills

1. At the point indicated in the participant's handbook, the participant meets with the trainer for a demonstration of the IUD counseling process. The trainer and participant review the steps outlined in the counseling learning guide and view a video of a counseling session--if one is available. Following the demonstration, the participant practices the counseling steps during a series of role plays, either with the trainer or with another staff member. The trainer functions as a coach and observes and provides feedback as the participant practices.
2. When the participant feels comfortable with the counseling process, the trainer uses a checklist to evaluate competency in counseling during a role play.
3. After the trainer determines that the participant is competent during the role play, the participant observes the trainer counseling a client in a clinic setting. The participant then counsels several clients as the trainer (now serving as a coach) observes and provides feedback.
4. When the participant feels comfortable counseling clients, the trainer evaluates these counseling skills to determine if the participant is competent.
5. At the point indicated in the participant's handbook, the participant meets with the trainer for a demonstration of IUD insertion and removal using an anatomic model. The trainer and participant review the steps outlined in the learning guide and view a video showing the procedures--if one is available. Following the demonstration, the participant practices insertion and removal using a model. The trainer functions as a coach and observes and provides feedback.
6. When the participant feels comfortable with the insertion and removal procedures using a model, the trainer evaluates these skills with a checklist to determine competency.
7. After the trainer determines that the participant is competent with models, the participant observes the trainer working with a client in a clinic setting. The participant then inserts and removes IUDs with several clients while the trainer, as coach, observes and provides feedback.

Assessment

1. When the participant feels comfortable with the process, the trainer uses a checklist to evaluate these skills to determine if the participant is competent.
2. When the participant has demonstrated mastery of the required information and skills, the participant receives a statement of qualification that identifies the knowledge and skills mastered during the course.

The next installment will review the advantages and limitations of structured on-the-job training as an alternative learning method.

For more information about alternative learning methods, contact Rick Sullivan.

Go to JHPIEGO TrainerNews