Local Coverage Determinations (LCDs) - Office of Inspector General
Ivory Tower to concrete jungle: Will LCDs light the way?
description
Transcript of Ivory Tower to concrete jungle: Will LCDs light the way?
Ivory Tower to concrete Ivory Tower to concrete jungle: Will LCDs light the jungle: Will LCDs light the
way?way?Philip C CandyPhilip C Candy
National Director of ETDNational Director of ETDNHS Connecting for HealthNHS Connecting for Health
[email protected]@nhs.net
A cautionary tale about the A cautionary tale about the promise...promise...
Far away in the heavenly abode of the great god Indra, there is a wonderful net which has been hung by some cunning artificer in such a manner that it stretches out indefinitely in all directions. In accordance with the extravagant tastes of deities, the artificer has hung a single glittering jewel at the net's every node, and since the net itself is infinite in dimension, the jewels are infinite in number. There hang the jewels, glittering like stars of the first magnitude, a wonderful sight to behold. If we now arbitrarily select one of these jewels for inspection and look closely at it, we will discover that in its polished surface there are reflected all the other jewels in the net, infinite in number. Not only that, but each of the jewels reflected in this one jewel is also reflecting all the other jewels, so that the process of reflection is infinite. Cook, F H (1977). The Avatamsaka Sutra. In Hua-yen Buddhism: The jewel net of Indra. University Park and London: Pennsylvania State University
… … and the performanceand the performance
• Error 404 File Not Found• Connection Refused• Connection Terminated• Connection Failed• Enter Login Name and Password• and, on one memorable occasion,• Congratulations, you've broken the Internet
Overview of presentationOverview of presentation
• Background• Some assumptions about learning and
about elearning• Some pedagogical challenges and their
elearning ‘solutions’• Conclusion
Background to the title of the Background to the title of the presentationpresentation
• In 1991, Candy and Crebert undertook a study of the learning skills required of the new graduate. In their paper 'Ivory tower to concrete jungle: The difficult transition from the academy to the workplace as learning environments' (Journal of Higher Education, vol. 62, no. 5, pp. 570-92), they identified a number of radical discontinuities between the workplace and the academy as learning environments. These were then explored in terms of the skills required to navigate the shift.
Ivory Tower to Concrete JungleIvory Tower to Concrete Jungle
• This was followed a few years later by a major study on behalf of the Australian Government into the development of skills for self-directed learning through undergraduate education (Candy, P. C., Crebert, G., & O'Leary, J. (1994). Developing lifelong learners through undergraduate education. (Commissioned Report 28). Canberra: National Board of Employment, Education and Training Australian Government Publishing Service).
• Has the advent of the World Wide Web changed either the challenge or the way of approaching it?
Looking backwards to move forwards: Implications Looking backwards to move forwards: Implications of fifty years of elearning research and of fifty years of elearning research and
developmentdevelopment
We need to avoid the narrow pedagogies that are predisposed by available technologies, such as those dictated by currently available VLEs, and instead impose broader and more sophisticated pedagogies that address the necessary relationships between community, communication and cognition. Or, putting this another way, if we want to ‘put the learning into e-learning’ then we have to treat technology as a mediator of what are, essentially, social learning processes.
(Ravenscroft, 2002)
A few starting assumptionsA few starting assumptions• Learning is a conversational act: how can we support
various kinds of conversations?• Learning is an individual act which may not be caused by
teaching and may not coincide with a teaching event• Campus and ‘beyond the campus’ – the challenge
(imperative) of supporting lifelong learning• Elearning is not the same as e-training, e-tutoring or e-
mentoring. The focus of elearning should be directly and unambiguously on learning and in particular on self-directed or autonomous learning
• Our focus should be on solving enduring pedagogical problems: not just ‘e-mimicking’ (or, worse still, on ‘e-shovelling’)
So, what are some of these So, what are some of these enduring pedagogical problems?enduring pedagogical problems?
1. The time- and place-bound nature of most formal education
2. The fact that learning involves qualitative changes in meaning not quantitative accretions to a stock of information
3. Developing an anticipatory or futures-oriented frame of reference
4. Understanding whole systems, models and possibilities
5. The artificial divide between the classroom or lecture theatre and ‘real world’ situations and applications
And their solutions…And their solutions…1. The time- and place-bound nature of most formal
education: Open learning and distance education2. The fact that learning involves qualitative changes in
meaning not quantitative accretions to a stock of information: Constructivist – not instructivist - approaches to learning and assessment
3. Developing an anticipatory or futures-oriented frame of reference: Learning for about the future – possible, probable and preferable futures
4. Understanding whole systems, models and possibilities: Games, simulations and experiential learning
5. The artificial divide between the classroom or lecture theatre and ‘real world’ situations and applications: Learning from real life settings, practitioners and resources
Learning beyond the CampusLearning beyond the CampusOpen learning and distance
education
Constructivist – not instructivist - approaches to
learning and assessment
Learning for and about the future
Games, simulations and experiential learning
Learning from real life settings, practitioners and
resources
Open education and distanceOpen education and distancelearninglearning
• The long tradition of correspondence education
• Advances in open education and distance learning
• Increased use of multimedia and eventually of telecommunications
• But beware of pedagogic trajectories from the past – transmission-based approaches
Digital developments in open education Digital developments in open education and distance learningand distance learning
• Convergence of various modalities: words, pictures, video and audio-streaming
• Synchronous and asynchronous communications with tutors and with other learners
• Increased use of forums, blogs, wikis and other user generated content
• Advances in the sophistication and functionality of Managed Learning Environments
• Rapid elearning; content authoring• Leicester’s ‘Media Zoo’
Constructivist – not instructivist - Constructivist – not instructivist - approaches to learning and assessmentapproaches to learning and assessment
• Constructivist approaches – how people make sense of their realities
• Personal constructs and socio-grids• Diaries, journals and reflective essays• Tracking learning journeys over time• Drafts, revisions and final versions• Concept maps and schemata
Digital developments in constructivist approaches Digital developments in constructivist approaches to learning and assessmentto learning and assessment
• All of the above plus:• Video diaries• Software that tracks and reflects changes over
time• Software that allows users to reflect and test
their mental models of phenomena• Software applications that allow for varying
some parameters and testing ‘hypotheses’ or ‘hunches’
• Software that prompts reflection and internal conversations
Learning about events that haven’t Learning about events that haven’t happened yethappened yet
In a broadcast on the BBC in 1932, H G Wells stated:It seems an odd thing to me that though we have thousands and thousands of professors and hundreds of thousands of students of history working upon the records of the past, there is not a single person anywhere who makes a whole-time job of estimating the future consequences of new inventions and new devices. There is not a single Professor of Foresight in the world.
Learning about events that haven’t Learning about events that haven’t happened yet – possible, probable and happened yet – possible, probable and
preferable futurespreferable futures• Futures studies are about possibilities, not
predictions• …Not in Utopia, subterranean Fields,
Or some secreted Island, heaven knows where! But in the very world, which is the world Of all of us,-- the place where in the end We find our happiness, or not at all!
(William Wordsworth, 1805, The French
Revolution as It Appeared to Enthusiasts at Its Commencement)
Learning about events that haven’t Learning about events that haven’t happened yethappened yet
• As Toffler observed, essentially all education is about the future. Resources include:
• Artists’ impressions; paintings and drawings• Art installations; ‘Found objects’ from the future• Imaginative literature; sci-fi; alternative or
conjectural histories• ‘What if…’ scenarios (e.g., the Mont Fleur
Scenarios)• Moderated discussions• Films, videos and ‘mocumentaries’
Digital developments in learning about Digital developments in learning about events that haven’t happened yetevents that haven’t happened yet
• All the above, available instantly and conveniently• Online forums and summits• Blogs and online discussion forums• Web-based ‘Open space’ forums• Websites devoted to all kinds of futures discussions
and tracking projections (e.g., Long Now Foundation)• Access to authors, thinkers, dreamers• The availability of radically different views and visions
can be a stimulus to forming personal values about desirable futures
Games, simulations and Games, simulations and experiential learningexperiential learning
• Flight and other simulators• Role-playing and role-taking• War Games; TEWTs• Model offices; atelier studios; moot courts• Games and simulations (e.g., Tango – Sveiby)• Standardised patients and OSCE (Objective
Structured Clinical Examinations)• Microteaching• Practice interviews (clinicians; social workers)• … in fact any simulation for any career,
occupation or job
Digital developments in games, Digital developments in games, simulations and experiential learningsimulations and experiential learning
• MUDs, MOOs and Dungeons• Digital simulations of any environment, context
or setting• Virtual reality (e.g, Wii; THOTH)• Second Life: "Real Learning in a Virtual World“• Eilif Trondsen (2006) Virtual Worlds for Learning
and Training• (see: http://www.sric-bi.com/LoD/summaries/2006-12virtualworlds.shtml)
Improving the ‘real world’ relevance Improving the ‘real world’ relevance of formal educationof formal education
• Apprenticeships; atelier methods • Sites visits, field trips, observational
studies • Sandwich courses• Internships, placements, practicums• Visiting lecturers, adjunct appointments• Industry mentors• Resource Based Learning
Digital developments inDigital developments in improving the improving the ‘real world’ relevance of formal ‘real world’ relevance of formal
educationeducation• The university's value, we claim, lies in the
complex relationship it creates between knowledge, communities, and credentials. Changes contemplated in either the institutional structure or technological infrastructure of the university should recognize this relationship. In particular, any change should seek to improve the ability of students to work directly with knowledge-creating communities.
• Universities in the Digital Age (John Seeley Brown and Paul Duguid, PARC Xerox)
Digital developments inDigital developments in improving the improving the ‘real world’ relevance of formal ‘real world’ relevance of formal
educationeducation• Increasing use of the same software and even
the same platforms by students and practitioners• Shared access to the same learning resources
and modules (e.g., Doctors.net; Clinical Knowledge Summaries)
• Seamless linkages between work and learning (e.g., MOCOMP in Canada)
• Discussion forums and online mentoring• Ability for learners to access experts directly and
in real time
Some (provisional) conclusionsSome (provisional) conclusions• Elearning should not be used to substitute for
methods and approaches that are demonstrably better in face-to-face mode
• Elearning should not be used simply to replicate existing pedagogical approaches or assumptions
• Elearning should be utilised for its potential to meet learning challenges and solve problems not addressed by other approaches
• Elearning is quintessentially about learning, and this provides some important insights into what we should be doing as educators
But the biggest challenge of allBut the biggest challenge of all
• is trying to support self-directed learning and build capacity for it…
Learning beyond the CampusLearning beyond the CampusOpen education and distance
learning
Constructivist – not instructivist - approaches to
learning and assessment
Learning for and about the future
Games, simulations and experiential learning
Learning from real life settings, practitioners and
and resourcesBuilding the capacity and infrastructure for self-directed learning
Some possible lessons…Some possible lessons…
• … for software design AND for facilitating learning (and, by the way e-literacy)
• Based on a study of self-directed learning• “What people do when no-one is telling
them what to do”
www.dest.gov.au/research/publications/linking_www.dest.gov.au/research/publications/linking_thinking/thinking/
Why choose self-directed learning?Why choose self-directed learning?
• self-directed learning occurs without the ideological or pedagogical overlay of teaching in formal education and training settings, and may accordingly provide a more direct route to a more direct route to understanding the relationship(s) between learning understanding the relationship(s) between learning and technologies;and technologies;
• self-directed learning is the prototype of all learning and, since it has been extensively researched and extensively researched and documented in the pre-digital offline worlddocumented in the pre-digital offline world it should be possible to make some claims about whether and how digital technologies are affecting learning;
Why choose self-directed learning?Why choose self-directed learning?
• there is a close and growing relationship close and growing relationship between self-directed learning and that which between self-directed learning and that which occurs in formal education and trainingoccurs in formal education and training settings, in the sense that self-directed learning is commonly a precursor to, and even more often a consequence of participation in formal courses of study.
Why self-directed learning? Why self-directed learning? (continued)(continued)
• in the context of lifelong learning, self-directed learning is a principal way in which people keep up with changeprincipal way in which people keep up with change, and since we are currently experiencing unprecedented change on a global scale, the demands of a changing world are likely to impact on the nature and extent of self-directed learning that people engage in; and, finally,
• evidence suggests that at least some forms of self-some forms of self-directed learning are particularly suited to the online directed learning are particularly suited to the online environmentenvironment and there is merit in exploring the linkage.
A timeless insight about self-A timeless insight about self-directiondirection
The truth is that even those who enjoy to the greatest extent the advantages of what is called a regular education must be their own instructors as to the greater portion of what they acquire, if they are ever to advance beyond the elements of learning. What they learn at schools and colleges is comparatively of small value, unless their own after reading and study improve those advantages.
Craik, G (1830). The Pursuit of Knowledge Under Difficulties. London: Charles Knight and SDUK.
Towards a model based on Towards a model based on studying self-directed learnersstudying self-directed learners
1. Engaging with the technology for learning2. Locating, retrieving and utilising resources3. Evaluating sources and resources4. Assimilating new information and insights5. Reconceptualising - transforming understandings6. Networking - contributing to the community of
learners• For each: Claim and Counter-claim
Engaging with the technology: ClaimsEngaging with the technology: Claims
• Convenience - available 24*7• Suits a range of learning styles• Fewer (or different) impediments to participation• User anonymity or protected identity • “On the Internet, no one knows you’re a dog”• Inexhaustible patience of the technology• Possible to exit from difficult or awkward situations• Opportunity to contribute to others’ learning• Highly addictive - engages curiosity-driven inquirers• Requires high degree of self-discipline• 4Es:Effectiveness, Ease of Use; Engagement; Environment
Engaging with the technology: CEngaging with the technology: Counter-ounter-claimclaimss• Costs and connectivity may preclude some
• There is an overwhelming amount of information• Some sources too complex or require high levels of literacy• Impatience with breakdowns/slow connections• Learners may not believe in the technology• Phenomenon of ‘computerphobia’ (gender?)• Many people have a fear of looking stupid• People may lack awareness of ‘netiquette’• Concerns about the ‘presentation of self’• Lack of feedback or context to contributions• Search engines may militate against serendipity
Locating, retrieving and utilising Locating, retrieving and utilising resources: Claimsresources: Claims
• Search engines facilitate plain language inquiries• Not all located resources will be digital• Not all finding aids will be digital either• Portals and specialised search engines can
facilitate the identification of relevant sources• ‘Push’ technologies (including personal web
watchers) can customise searching• Being part of a community of learners can
increase a learner’s ‘reach’ (but not his or her ‘grasp’?)
Locating, retrieving and utilising Locating, retrieving and utilising resources: Cresources: Counter-claimounter-claimss
• Many useful resources are on the ‘deep web’• Some resources are ‘pay-per-view’• ‘If it’s not on the web, it doesn’t count’• English is the dominant medium• Some material takes too long to download• Mutable resources are impermanent• Problem of non-enduring locators • Evolving nature of each inquiry• The challenges of navigating in hyperspace
Evaluating sources and resources: ClaimsEvaluating sources and resources: Claims
• Potential to evaluate original digitised resources• The lack of ‘rigid canonical thinking’ frees
learners to make independent judgements • Many search engines provide a relevance rating• Reputable institutions, publishers and
organisations provide a ‘seal of approval’• Potential to obtain ‘expert’ input from others
Evaluating sources and resources (contd.)Evaluating sources and resources (contd.)
• Move towards ‘refereed’ sites and electronic publications
• Range of useful web evaluation guides– Coverage– Currency– Objectivity– Accuracy– Authority– Audience
Evaluating sources and resources: CEvaluating sources and resources: Counter-ounter-claimclaimss
• The overwhelming volume of information• Screen-based nature of the web militates against ‘study’• The appearance of websites is not always a guide to quality• Lack of comparability between offline and online sources• Links do not always bear the imprimatur of the referring site• Understanding how search engines and portals rate
sources• Lack of ‘narrative structure’ leads to decontextualised
knowledge claims• The dynamic nature of digital spaces affects evaluation• Information literacy itself is an evolving capability
Assimilating new information and Assimilating new information and insights: Claimsinsights: Claims• Learning involves more than the accumulation of
isolated ‘factoids’• Learners have access to diverse information sources
and forms, and hence to various perspectives• The creation of concept maps that mirror understanding• Software can facilitate the capture and management of
large amounts of information (Lynx, Storyspace, e-gems etc)
• Dynamic nature of the domain accommodates evolving development of understandings
• Considerable potential to request help from others
Assimilating new information and Assimilating new information and insights: Cinsights: Counter-claimounter-claimss
• Non-linear nature of hypertext• Sheer number of sources to be integrated
(‘Infoglut’ or ‘Data Smog’)• Evolving nature of learner’s understandings• Inconsistencies between sources• Decontextualised nature of many resources• Mutability or volatility of sources
Reconceptualising - transforming Reconceptualising - transforming understandings: Claimsunderstandings: Claims
• Seeing things from a new perspective lies at the heart of all learning (Piaget)
• Technologies can support transformation and visualisation of digital information
• The web as a metaphor for cognitive functioning (the ‘interbrain’)
• Knowledge can be co-constructed through a learning community
• Reconceptualisation through ‘vicarious learning’
Reconceptualising - transforming Reconceptualising - transforming understandings: Cunderstandings: Counter-claimounter-claimss
• Technologies can pre-ordain knowledge structures
• High degree of technological proficiency may be needed to use certain software
• Possibility of misconstruing important concepts without correctives
• Time for reflection may be in short supply in the online world
Networking - contributing to the Networking - contributing to the community of learners: Claimscommunity of learners: Claims
• Provides a human aspect to online learning• Essentially a democratic, self-regulating environment • Unprecedented opportunities to ‘publish’ ideas and
findings (see, e.g., ornithology; genealogy)• Requests for help have exceptionally wide reach• Information may be shared in a variety of formats (text
and non-text)• Communities of learners may be virtual or real (eg
companies or communities)• Knowledge can be co-created e.g., through tools such
as ‘Answer Garden,’ blogs and wikis
Networking - contributing to the Networking - contributing to the community of learners: Ccommunity of learners: Counter-claimounter-claimss
• Ability to participate is dependent on connectivity (may be controlled by employer)
• Lack of quality control over information • In unmoderated lists, ignorance can be amplified• Moderated lists can exert a censoring or
silencing of contributions• The willingness to share requires both technical
competence and personal confidence
Elements of a model of e-learningElements of a model of e-learning• EEngaging with the technology• LLocating, retrieving and utilising resources• EEvaluating sources and resources• AAssimilating new information and insights• RReconceptualising - transforming understandings• NNetworking - contributing to the community of learnersIn the context of:• 6 Cs6 Cs: Connectivity; Competence; Content; Credibility
and confidentiality; Capturing information; and Collaboration
ConclusionConclusionHigher education is not a factory…a business…or a bureaucracy…. We need to develop more humane and organic analogies and models. The relevant analogies are biological, ecological, organic, psychological, sociological and philosophical. A…university is a habitat, a society, a community, an environment, an ecosystem. It should be judged by the quality of life that it fosters, the opportunities for experience and exploration it provides, the concern for growth, for enrichment and for culture that it exemplifies. The question is not just ‘What does your machine produce?’ but also ‘How does your garden grow?’
Pace, C R (1971). Thoughts on Evaluation in Higher Education.