Traveling in Cyberspace: Web-Based Instruction
J. Philip Craiger and R. Jason Weiss
University of Nebraska at Omaha
In our last installment of Traveling in Cyberspace we discussed computer-based training (CBT): computer programs developed and used to deliver training and education to end-users. In this installment we discuss a type of CBT that delivers training over the World Wide Web (WWW). First, we describe the best implementation of web-based training we've found, the Interactive Patient. Next, we describe some current web sites that provide information on developing testing web-based training sites.
The Interactive Patient
The best implementation of web-based training we have found is located at the Marshall University School of Medicine (URL: http://medicus.marshall.edu/medicus.htm). Developed by Cristoph Lehmann, M.D. (now at the Johns Hopkins School of Medicine) and Kent Hayes, The Interactive Patient is a realistic, interactive computer simulation of a patient's visit to a physician's office. The educational goals of the Interactive Patient include increasing students', interns', and physicians' knowledge of illness and disease; enhancing communication, examination, and clinical problem-solving skills; as well as augmenting risk/benefit analysis and professional behavior (Lehmann, Lehmann, & Freedman, 1997).
The main menu presents the user with four choices, reflecting the typical sequence of an office visit: obtain an oral history from the patient; give the patient a physical exam; order lab tests and x-rays; and perform a diagnosis and treatment based on the results of the findings. Figure 1 is a screen shot of the initial encounter as the physician collects an oral history of the patient's ailment.
The interface for the oral history section of the simulation employs natural language understanding (NLU). NLU has been studied for quite some time by researchers in artificial intelligence (AI), and is generally considered to be one of the most difficult problems in AI. The NLU capabilities of the Interactive Patient are quite sophisticated. The user types in a question in the space provided (see Figure 1), and then clicks on the "Ask-Question" button. The question is then sent to the remote computer program which parses the question (i.e., attempts to "understand" it), retrieves the relevant answer from a database, and responds to the user electronically. Although we are not physicians, our questions seemed to elicit appropriate responses.
Users may also perform a (virtual) physical exam on the patient. The physical exam section allows users to (virtually) inspect, palpate, or ausculate (i.e., use a stethoscope to listen to the heart and lungs) the patient. For example, if the patient claims lower back problems, the user/physician would use the mouse to point to a picture of the portion of the back that he/she would like to inspect (see Figure 2). After clicking on the relevant area, the user/physician receives feedback as to what, if anything, was found.
The lab and x-ray section allows the user/physician to request any combination of 21 possible lab tests (e.g., electrolyte panel, blood count, urine analysis, etc.) and five sets of possible x-rays (e.g., chest, abdominal, lumbar, etc.) of the patient. As in real life, the results of the x-rays are actual x-ray films of the patient, which the physician must inspect and interpret. Figure 3 shows a lumbar x-ray.
Finally, based on the oral history, physical exam, and lab/x-ray results, the physician selects from approximately 30 diagnoses, and one or more of 22 possible treatment plans. The diagnosis and treatment plan are then submitted electronically to be graded. The user then receives, via e-mail, a response indicating whether the diagnosis and treatment plan were correct.
The reason we chose to describe the Interactive Patient is that it is a sophisticated and realistic training device used by real students in a complex domain. The Interactive Patient has won numerous awards, and students' evaluations have been overwhelmingly positive (Lehmann, et al., 1997). The Interactive Patient was planned and produced in accordance with the Accreditation Council for Continuing Medical Education, and physicians successfully completing the Interactive Patient receive continuing education credits through Marshall University School of Medicine. Dr. Cristoph Lehmann, co-developer of the Interactive Patient, is in the process of developing an "improved" version at the Johns Hopkins School of Medicine (C. Lehmann, personal communication, August 14, 1997).
Advantages and Disadvantages of Web-Based Instruction
Web-based instruction (WBI) is essentially a meshing of computer-based instruction and the WWW. Therefore, it offers an interesting hybrid of benefits and pitfalls that are related in a fairly complex fashion. The choice of moving to WBI should not be a "no-brainer," since there is much to consider. We describe some of the most common considerations below.
Cost. It seems that cost is inversely proportional to the amount of effort it will take to get the WBI system on-line. Authoring systems such as Authorware and Asymetrix Toolbook used to cost many thousands of dollars for a single license. Recently, prices have dropped drastically and companies are bundling additional useful software with their authoring systems. Nonetheless, a full-blown WBI set-up with authoring, server, and tracking software can cost a daunting amount of money-even before considering the time and expense of developing and maintaining the system. In contrast, one can program a reasonable WBI less expensively using simple HTML (HyperText Markup Language, the formatting language of the World Wide Web). However, such an endeavor could quickly become unmanageable depending on the complexity of the WBI under development.
When pursuing WBI, it is helpful to think in terms of costs per learner. If the course is highly amenable to WBI, it can be economically delivered to a far greater audience than previously feasible, reducing per-learner costs to a fraction of other instructional delivery methods. In addition, if learners pay for the instruction, an established WBI system could represent a powerful source of income with little ongoing expense to the organization.
Instructional effectiveness. The main issue is to find a method by which course material can be efficiently delivered to a student while maximizing the likelihood that the student will actually learn and retain the information. An optimistic approach finds many advantages to WBI, most of which are associated with computer-based instruction. These include the power of self-paced, experiential learning, the assurance of uniform delivery, and the richness of multimedia. In addition, the use of the WWW promises the availability of the course from anywhere on the planet. Although it's hard to imagine a student working on a statistics tutorial while lying on a beach in the south of France, the technology will be there should the inclination strike.
Aside from some case studies (see Khan, 1997), it is too soon to expect much systematic research evaluating the effectiveness of WBI. Although computer-based instruction is generally well-regarded, use of the WWW essentially turns it into a new form of distance learning. A recent review of research on distance education held that it can be as effective as face-to-face learning, provided that proper support and feedback are provided (Threlkeld & Brzoska, 1994). On the other hand, the flexibility of self-paced distance learning may also be detrimental. Classrooms and set class times create a separation between learning and non-learning activities, which in turn helps students concentrate on the task at hand. Students taking WBI instruction at home may potentially be distracted by other demands and therefore concentrate less than in a more traditional setting. Clearly, empirical research is necessary to confirm that WBI's potential is met in practice.
Logistics. In theory, WBI should be easier to implement widely than CBI, given that CBI typically relies on CD-ROMs or in-house networks, thus making widespread distribution somewhat difficult. The ubiquity of the Web means that access to course material is simple and instantaneous. However, simple access does not necessarily mean quick access. The Internet can be very slow in the evenings, especially when accessed via modem. Consequently, when WBI systems include large sound, graphics, and animation files, the effect might be a very useful WBI system that is also effectively unusable at certain times of the day. While technologies such as streaming (in which the client computer plays content while it is being delivered by the server) reduce this problem, burgeoning use of the Internet and perennial bandwidth issues suggest that it will remain a concern.
Another logistical issue concerns student tracking and testing. So far, only one WBI system (Asymetrix Librarian) could be found which tracks student progress in a database. Other authoring systems permit deployment over the Internet, but offer no convenient ways to monitor student progress. Further, testing as it is commonly employed in academic settings is all but impossible. The former challenge will inevitably be met in future generations of software. The latter will simply require course designers to develop different ways to evaluate students in courses that require student grading.
WBI is still in its infancy. However, we have found an increasing number of Web-based courses, reflecting not only growth in the technology but also a widespread appreciation of its potential as an instructional tool. We invite readers to send us URLs of interesting and innovative Web-based courses. We can be reached via e-mail at pcraiger@unomaha.edu and weiss@unomaha.edu. Happy surfing!
References
Khan, B. H. (Ed.). (1997). Web-based instruction. Englewood Cliffs, NJ: Educational Technology Publications.
Lehmann, H.P., Lehmann, C.U., & Freedman, J.A. (1997). The use of simulations in computer-aided learning over the World Wide Web. Unpublished manuscript.
Threlkeld, R., & Brzoska, K. (1994). Research in distance education. In B. Willis (Ed.), Distance education: Strategies and tools (pp. 41-66). Englewood Cliffs, NJ: Educational Technology Publications.