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Learning to be at a distance: structural and educational change in the digitalization of medical education
Umeå University, Faculty of Social Sciences, Department of Education.ORCID iD: 0000-0003-3985-7848
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

As an expression of current challenges faced by contemporary societies, past decades have witnessed heavy demands for higher education to change and transform. One key question here has been the increased digitalization of higher education. Within this wider setting, this thesis deals with an attempt to handle the increasing shortage of physicians in Sweden by way of digitalizing medical education. The aim of this explorative and longitudinal thesis is to describe and analyze structural and educational transformation work in medical education during the digitalization of the program and the transition from face-to-face to distance education. This thesis focuses on teachers, students and management, who are all heavily involved in this transition of the medical program. Two questions guide the research: (1) what are teachers’ and students’ expectations pending the transition, and what are the influences of already established tools and activities on the program and (2) in what ways do conflicts and changes occur over time, and how do teachers, students, and management deal with these as part of the transition? Cultural-historical activity theory (CHAT) serves as the theoretical framework of the thesis. In particular, the concepts of dominant and non-dominant activities, conflicts, transitional actions, and levels of learning inform the analysis. The data are generated by surveys (N = 108), logging of actors’ activity patterns (N = 100 teachers and 100 students), field studies (65 hours), and interviews (N = 62). The data cover teachers’, students’ and management’s roles in the transition. The analysis shows that the way of theoretically understanding the transition – from a dominant face-to-face activity to a new and unproven non-dominant distance activity – have proved to contribute to deeper understanding of the process of digitalizing medical education. The analysis further displays how the transition from face-to-face to distance education creates considerable conflicts that over time force teachers, students and management into structural and educational transformation work. This type of work successively renders new educational design solutions and new flexible ways of organizing distance medical education. This thesis discusses how the structural and educational transformation work forces actors to collectively engage in the transition by experimenting with new suitable methods and designs, as digital technologies and technology-enhanced learning (TEL) could make sense to teachers and students when they are at a distance.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2015. , 89 p.
Series
Akademiska avhandlingar vid Pedagogiska institutionen, Umeå universitet, ISSN 0281-6768 ; 115
Keyword [en]
Distance education, medical education, medical program, regionalized medical program, rural clinical school, digitalization, digital technologies, technology-enhanced learning, TEL, cultural-historical activity theory, CHAT, transition, transformation, conflicts, contradictions, dominant- non-dominant activities, levels of learning
National Category
Pedagogy
Research subject
Education
Identifiers
URN: urn:nbn:se:umu:diva-110740ISBN: 978-91-7601-356-4 (print)OAI: oai:DiVA.org:umu-110740DiVA: diva2:865286
Public defence
2015-11-20, Hörsal E, Humanisthuset, Umeå, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2015-10-29 Created: 2015-10-27 Last updated: 2017-06-02Bibliographically approved
List of papers
1. Medical education through the use of digital technologies: The implementation of a Swedish regionalized medical program
Open this publication in new window or tab >>Medical education through the use of digital technologies: The implementation of a Swedish regionalized medical program
2013 (English)In: The University of the Fraser Valley Research Review, ISSN 1715-9849, Vol. 4, no 3, 16-30 p.Article in journal (Refereed) Published
Abstract [en]

In 2011, the first regionalized medical program (RMP) started in Sweden. The Swedish RMP means that students are distributed in groups while doing their five clinical clerkship semesters. To enable the medical students' theoretical studies when being regionalized, digital technologies are used for educational and administrational purposes. This paper explores medical teachers' and administrators' understanding of faculty preparations, their own preparedness and expectations related to the implementation of the RMP supported by digital technologies. A survey was distributed to teachers and administrators before the first regionalized semester was conducted. Findings indicate that the use of digital technologies began at a small scale, but that there is potential for increased development. It is concluded that although teachers and administrators have limited experience of distance education, the faculty has been able to create a feeling of being prepared.

Place, publisher, year, edition, pages
University of the Fraser Valley, 2013
Keyword
Digital technology implementation, faculty preparedness, medical education, regionalized medical program, technology enhanced learning
National Category
Pedagogy
Identifiers
urn:nbn:se:umu:diva-66956 (URN)
Conference
ICICTE 2011
Available from: 2013-03-12 Created: 2013-03-08 Last updated: 2017-06-02Bibliographically approved
2. Implementing a Swedish regionalized medical program supported by digital technologies: possibilities and challenges from a management perspective
Open this publication in new window or tab >>Implementing a Swedish regionalized medical program supported by digital technologies: possibilities and challenges from a management perspective
2013 (English)In: Rural and remote health, ISSN 1445-6354, Vol. 13, no 2, 2173Article in journal (Refereed) Published
Abstract [en]

Introduction:  In 2011, Umeå University in Sweden was facing its first attempt to transform the existing medical program into a regionalized medical program (RMP), supported by the use of digital technologies. The Swedish RMP means that students are distributed in geographically separated groups while doing their five clinical clerkship semesters. To provide medical students with ways of undertaking their theoretical studies when geographically distributed, digital technologies are used for educational and administrative purposes. In this article, the Swedish RMP will be described and related to previous international research on educating medical students in rural settings. The aim of this article was, from a management perspective, to understand if and how contradictions arise during the implementation process of the Swedish RMP, supported by digital technologies. Based on this analysis, a further aim was to discuss, from a management perspective, the possibilities and challenges for improvement of this medical educational practice, as well as to provide implications for other similar changes in medical programs internationally.

Method:  To identify possible contradictions during the implementation process, ethnographically inspired observations were made during management work meetings, before and during the first regionalized semester. In addition, in-depth follow-up interviews were held in May and June 2011 with six management executives of the Swedish RMP, concerning their expectations and experiences of the implementation process. The qualitative and activity theory (AT)-inspired analysis resulted in the emergence of two main themes and seven sub-themes.

Results:  The analysis suggests that a number of contradictions arose during the implementation process of the Swedish RMP. For instance, a contradiction constituted as a conflict between the university management and some teachers concerning how digital technologies and technology enhanced learning (TEL) could and should be used when educating medical students. In addition, due to the use of digital technologies the implementation process helped to reveal existing problems and tensions in educational practice, not previously visible to management. These included contradictions such as a lack of alignment in how course goals, teaching practices, and examinations should be carried out. Further, obsolete course content and overlap between courses and subjects were identified, leading to an overhaul of all semesters, not only those regionalized.

Conclusion:  This study showed how contradictions in educational practice arose when the Swedish RMP, supported by digital technologies, was implemented. These contradictions involve both possibilities and challenges for management to improve how and with what quality the Swedish RMP is conducted. A challenge for management is to find the most effective way to enhance up-take and use of the more interactive and innovative TEL-solutions. However, a possibility is that the regionalization process and implemented improvements may also influence non-regionalized semesters, with the potential to eventually increase the quality of the entire program.

Keyword
activity theory, contradictions, digital technologies, ICT, implementation, management, medical program, regionalized medical program, rural clinical school, technology enhanced learning.
National Category
Pedagogy
Identifiers
urn:nbn:se:umu:diva-71561 (URN)000322365600018 ()23574374 (PubMedID)
Note

Published: 10 April 2013

Available from: 2013-06-03 Created: 2013-06-03 Last updated: 2017-12-06Bibliographically approved
3. Implementing distance teaching at a large scale in medical education: a struggle between dominant and non-dominant teaching activities
Open this publication in new window or tab >>Implementing distance teaching at a large scale in medical education: a struggle between dominant and non-dominant teaching activities
2013 (English)In: Education and Information Technologies: Official Journal of the IFIP technical committee on Education, ISSN 1360-2357, E-ISSN 1573-7608, Vol. 20, no 2, 359-380 p.Article in journal (Refereed) Published
Abstract [en]

This paper examines possibilities and challenges when implementing distance teaching of theoretical content in a regionalized medical program (RMP). It will be argued that Cultural-Historical Activity Theory (CHAT) and the concepts of dominant and non-dominant activities, including conflicts and transitional actions, can lead to an understanding of the distance teaching implementation process. The concepts further provide a theoretical lens through which one can understand the complex relationship between the established and historically rooted, face-to-face teaching activity and the new non-dominant distance teaching activity introduced in the educational setting. Data in the study was collected through an online survey, log data, observations, and in-depth interviews. During the analysis, conflicts between the dominant face-to-face teaching and non-dominant distance teaching activity were identified, and they partly inhibited medical teachers at the program from adopting and developing distance teaching. By illustrating transitional actions as small, innovative bottom-up solutions, further analysis revealed how medical teachers tried to overcome those conflicts to facilitate the adoption and development of distance teaching. The non-dominant distance teaching activity, even if not fully adopted, actually influenced and facilitated change in educational practice. The discussion argues that understanding the implementation of a non-dominant teaching activity in medical education in terms of mere success or failure is not fruitful. Instead, we should strive for sensitivity by closely analyzing the implementation process as interplay between dominant and non-dominant teaching activities. Such sensitivity will make it possible to cultivate future educational development and change.

Place, publisher, year, edition, pages
New York: Springer Science+Business Media B.V., 2013
Keyword
Cultural-Historical Activity Theory, Dominant and non-dominant activities, Distance teaching, Regionalized medical program
National Category
Pedagogy
Identifiers
urn:nbn:se:umu:diva-83387 (URN)10.1007/s10639-013-9289-1 (DOI)
Available from: 2013-11-22 Created: 2013-11-22 Last updated: 2017-12-06Bibliographically approved
4. A longitudinal study of facilitating medical students’ stepwise transformation from face-to-face to distance learners
Open this publication in new window or tab >>A longitudinal study of facilitating medical students’ stepwise transformation from face-to-face to distance learners
2015 (English)In: Transformative curriculum design in health sciences education / [ed] Colleen Halupa, Hershey, PA: IGI Global , 2015, 235-247 p.Chapter in book (Refereed)
Abstract [en]

This chapter focuses on medical students’ experiences in transforming from faceto-faceto distance learners in a Swedish regionalized medical program (RMP).One group of students (n=100) were followed during six semesters through surveys,log data, observations, and in-depth interviews. A research model built on theCultural-Historical Activity Theory (CHAT), including the notion of dominant andnon-dominant activities, was used in order to identify factors that influence students’stepwise transformation from face-to-face to distance learners. The analysis containsthe investigation of pedagogical, institutional, and historically grounded conflictsthat seem to inhibit medical students from making a complete transformation todistance learners. By going deeper into the analysis of transitional actions, whichseems to help in solving conflicts, the chapter discusses implications to facilitatingmedical students’ future transformation from face-to-face to distance learners.These implications are examples of curriculum redesigns, such as new educationaldesigns and integration of technology and pedagogy in the curriculum.

Place, publisher, year, edition, pages
Hershey, PA: IGI Global, 2015
National Category
Pedagogy
Identifiers
urn:nbn:se:umu:diva-104532 (URN)10.4018/978-1-4666-8571-0.ch009 (DOI)9781466685710 (ISBN)
Available from: 2015-06-11 Created: 2015-06-11 Last updated: 2017-06-02Bibliographically approved

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