By Virginia E. Hall, M.D.
In 1999, annual data from the Accreditation Council for Continuing Medical Education had approximately 79,000 physicians participating in Internet education programs. Just one year later, the council’s reported figure was more than doubled, at nearly 182,000.
As products of at least a decade of formal postgraduate education, physicians would seem to be prime candidates for traditional as well as innovative educational experiences. But we are not likely to be immune from the high dropout rates (one study found more than 40 percent) cited by educators in their general studies of online learning.
Increasingly, educators are seeking to identify the type of student who is the best “match” for online education-the one most likely to successfully complete the online course of study. For physicians, there are three areas to consider: personal qualities, professional characteristics and the reality of the unexpected.
Sometimes we may tend to feel that our training and our profession have shaped us more than other factors in our lives, but it’s good to remember that we are dealing at some level with the basic personality tendencies and characteristics we’ve been dealing with all of our lives.
In this area, we can look at the general characteristics of successful online students and see where we find ourselves. Note that these results have been gleaned from a number of small studies, often focused on college students, and are not intended to be comprehensive. This field is still very new and data are evolving. With that caveat, here are some of the characteristics researchers have found to be important in successful completion of general online education programs.
Internal “locus of control.” This concept espoused by Julian B. Rotter, Ph.D. (http://psych.fullerton.edu/jmearns/rotter.htm) is based upon the notion that people relate differently to their environment depending upon how much influence they believe they have over it. Those who feel that outcomes depend upon their own behavior have been shown to be more likely to finish an online program. Those who feel that matters tend to be outside of their control (whether they attribute that to something like luck, or to family pressures, or the environment itself), seem less likely to take online work to its conclusion.
“Autonomous-type” learning style. There are a number of different models seeking to identify how a range of student characteristics affect successful learning. One relevant model shows how students prefer to interact with their instructor and peers. Work with this model has suggested that students with an “Independent” learning style may do better in online work. Some characteristics of this style are a preference for self-paced instruction and for working on their own.
Thomas E. Anderson, M.D., an emergency medicine physician in Chambersburg, successfully completed an eight-month online program in medical leadership and management. His advice? “To be successful in an on-line course the physician has to have the time available to dedicate to the project. Before starting a course physicians should look closely at their routine schedules and decide where there is room to devote to the course on a regular basis. In my case, since I work many evenings, I was able to devote a couple of hours almost every morning to the course. Having flexibility in one’s schedule is also important so you can adjust as needed to keep up with assignments.”
Comfort with a learner-centered asynchronous environment. Some learners depend on the instructor as the primary source of guidance and prefer working closely with the perceived “expert” in the class. Others thrive on competition and gain their sense of accomplishment by performing better than their peers. These preferences are likely not to be well-served in an online program where response is not immediate and where learners are often asked to serve as collaborators in mutual learning rather than as receivers of information from an expert source.
Good written communication skills. In the online environment, most of the work and interaction is likely to require writing. Students will submit papers electronically. They will post discussions or participate in “chat” sessions through their computer keyboards. If they prefer oral communication, they will have to adjust to the limited opportunity for this kind of exchange in online education. If they never learned to type, as many of us didn’t, they should factor in some extra time until they become more proficient.
As physicians we have a sense of certain characteristics that either led us to the profession in the first place or that have been ingrained in us by our education, training and the nature of our work. Many of us think of ourselves as perfectionists. We have an overriding sense of responsibility toward our professional obligations, often at the sacrifice of our personal lives and even family time. We are problem-solvers and we reprioritize throughout the day, as necessary, to respond to crises and unanticipated needs.
How do these characteristics affect our success at online learning?
Let’s extrapolate a bit by examining some of the research into physician learning in general. Henry B. Slotnick, Ph.D., a prominent researcher in the field, has developed a model for explaining when physicians determine to take on learning something new, how they go about it, and when they stop.
In brief, Dr. Slotnick concludes that physicians choose to learn by scanning for potential problems, deciding whether the problem is solvable within their own situation and proceeding to learn the required knowledge and skills.
For purposes of this article, we will focus on the next topic in Dr. Slotnick’s physician learning process, “When do physicians stop learning?”
These times include situations when (1) the physician has no further time to continue learning (for instance, in an emergency); (2) the physician believes he or she has taken advantage of all available, unique or relevant learning resources; (3) the physician has identified a clear answer to the problem; or (4) the physician has developed a reasonable plan of action and feels further learning will not affect this plan significantly.
In an online course, time-pressed independent physician learners may very well choose to judge independently when they have obtained the information they needed. For some, this point may come as early as receipt of the textbook or reading materials. For others, it may come midway through the scheduled course, before the instructor or the educational institution considers the course to have been completed.
Does this matter? At the moment, the answer to this question is the personal prerogative of the physician learner. If the cost of the tuition has led to the desired knowledge, the physician could be said to be successful, despite the truncated timeframe. In such a case, loss of CME or academic credit would be a personal choice.
In the larger world of online education, this question is challenging educators to consider how the nature of online education may have long-term effects on such matters as course schedules, deadlines and the instructor-student relationship.
Reality of the Unexpected
You’ve mastered your computer keyboard. You’ve signed up for an online course, logged in and posted your first assignment. Then—your practice partner leaves. A child develops problems in school. A parent becomes ill. You are asked to take on more responsibilities at the hospital. Suddenly, that window of time you thought you had between 10 p.m. and midnight is gone, along with your energy, and you are left with incomplete course work and the professional frustration of not performing at the level you expect of yourself.
You have made a conscious decision to postpone the work for a time, what Joseph R. Ferrari, Ph.D. (http://condor.depaul.edu/~jferrari/) has described as “functional” procrastination, when a delay may be good or necessary. Some online adult courses assume this will happen and build in a “grace period” for completion of assignments.
If enough time passes, though, you may find yourself further frustrated by anxiety-related procrastination. Those who study academic procrastination have identified several “cognitive distortions,” including underestimating the time required to complete a task, overestimating the fact that you will feel more motivated or better able to tackle the task in the future, and relying too heavily on the fact that you need to feel a certain way about a task before you can accomplish it successfully.
“Telling a chronic procrastinator to ‘just do it’ is like telling a clinically depressed person to cheer up,” Dr. Ferrari has noted. Rather, he suggests dealing with procrastination with a series of steps, including writing down tasks, breaking them down into components and being realistic.
Finally, online education can seem to promise the ability to telescope time—to accomplish in one hour at home in front of your computer what would have taken three hours in a traditional classroom. In fact, you may find you need more time to adjust to the new online environment.
Dr. Ferrari’s recommendation regarding general time allotment for tasks? Estimate how much time you believe something will take, then increase the number by 100 percent.
Virginia E. Hall, M.D., is an associate professor in obstetrics and gynecology at Penn State Hershey Medical Center. She also serves as Chair of the Physician Education Advisory Committee for The Foundation of the Pennsylvania Medical Society.