illustration of the side of a building; in one window, a professor lectures; in other windows, with different shapes suggesting different countries, students watch computer screens

Global Classroom

Technology and pedagogical savvy are revolutionizing public health education. LiveTalk, anyone?

By Mike Field

It’s just after 7 p.m. on a Wednesday night in Baltimore, and from a recording studio on the second floor of the Bloomberg School’s Wolfe Street building, John McGready is on the air. Wearing a DJ’s headset and working from notes jotted on a small green cheat sheet, McGready has the easygoing banter of a drive-time radio host. The content of his monologue, however, is anything but drive-time.

“This is complicated material,” he says, reaching out with his left hand as if toward an imaginary blackboard. “You can’t hear it once and ‘get it.’ You have to ruminate on this material.”

His listeners—there are currently 70 signed in from as far away as Abu Dhabi—seem to agree. They are texting questions that appear on a large flat screen display mounted on the wall opposite where McGready is sitting, asking him to clarify issues of z scores and degrees of freedom and other subject matter covered in his class, “Statistical Reasoning in Public Health.”

Thanks to “LiveTalk” technology, McGready can respond verbally, and write and draw on a tablet that transfers the images to his and his students’ screens during the session.

McGready, PhD, is an instructor and assistant scientist in Biostatistics. He is also an Internet pioneer, having taught this and other online classes in the School’s distance education program for the past 10 years. He says tools like LiveTalk are very useful in helping him gauge how well students are following the material—something that’s easy to do in a traditional classroom lecture but trickier when teaching online.

“When we began this effort in 1997, there was no existing model, so it was largely a matter of saying, ‘Let’s try something entirely new.’ We ended up creating features that have helped to change teaching and pedagogy across the School.”  —James Yager, senior associate dean for Academic Affairs

The sessions, which McGready holds weekly, are one of several feedback loops built into the Bloomberg School’s distance education program. Other tools include hours of pre-recorded lectures; direct email contact with faculty; a threaded, content-rich bulletin board discussion system that encompasses polls, private work spaces, document sharing and DED Messenger—a live-streaming audio conferencing capability that allows small groups to work collaboratively on group assignments and faculty to hold virtual “office hours.” Taken all together they represent, not so much a different way of doing the same old thing, but a new and improved way of teaching and learning, say faculty proponents.

“When we began this effort in 1997, there was no existing model, so it was largely a matter of saying, ‘Let’s try something entirely new,’” says James Yager, PhD, senior associate dean for Academic Affairs. “We ended up creating features that have helped to change teaching and pedagogy across the School, and have greatly improved it, in my opinion.”

By removing the geographic constraints of the traditional classroom, the Bloomberg School has also vastly increased access, redefining the profile of the School’s typical MPH student. Currently there are 210 students enrolled in the full-time, 11-month-long MPH program in Baltimore and more than 430 students in the part-time program, which is generally completed in two and a half to three years. The number of students matriculating in the part-time program has increased by 50 percent over the past five years.

“These programs have grown so rapidly because of need,” says Marie Diener-West, MPH program chair and the Helen Abbey and Margaret Merrell Professor in Biostatistical Education. “We saw that our part-time programs could be more widely available through distance education, and new technologies opened up the opportunity for students to take classes throughout different parts of the world. Many of our part-time Internet-based students are only in Baltimore or other onsite locations for several two-week periods, and the rest of the program is done over the Internet.” The availability of the distance education option for students around the world has been increased significantly over recent years by the addition of a wide range of online courses, and face-to-face instruction has extended from the School’s summer and winter institutes in Baltimore to locations such as Hong Kong and Barcelona, where students can fulfill some of the curricular requirements of the degree.

Experts say this expansion of access to top-flight public health pedagogy can’t come soon enough: A critical shortage of public health workers—across the country and around the globe—is looming, due to years of declining public health budgets and an oncoming tidal wave of retirements. (See Public Health’s Looming Workforce Crisis.)

The Association of Schools of Public Health (ASPH) estimates that it will be necessary to find 250,000 more public health workers by the year 2020 in order to return the U.S. to its former ratio of 220 public health workers per 100,000 of population—a not unrealistic goal in the age of global pandemics and a simultaneous explosion in chronic diseases like diabetes and asthma.

“There is a need for more and better-trained public health workers,” says David Trump, MD, MPH ’85, director of the Peninsula Health District within the Virginia Department of Health. “Local health departments have evolved from a clinical focus to a community health focus, which means we need workers who can work effectively in the community. That’s a different set of demands on the practitioner than even 10 years ago.”

Many, but not all, will need at least certificate-level training, while the demand for leaders with MPH and other advanced degrees will be acute. And this staggering number does not even begin to address the critical global shortage in public health workers, where, for instance, in sub-Saharan Africa, 11 percent of the world’s population carries 24 percent of the burden of disease—yet commands less than 1 percent of the world’s health expenditures.

Against this backdrop, distance learning and the Internet are likely to loom large in meeting the need for more and better training of public health professionals. The ASPH lists a dozen member schools that offer online MPH degrees, with many more schools offering continuing education and certificate training in public health online.

If now more than twice as many Johns Hopkins MPH students are enrolled online as on campus, how does that impact the meaning of the degree? And how can distance learning students be assured their educational experience—in classes, in their interactions with the faculty and other students—has the same breadth, depth and caliber as the more traditional classroom experience available to those who have the time and resources to come to Baltimore? These are not inconsequential challenges.

“This was a real concern when we first started these programs,” says Dean Michael J. Klag, MD, MPH ’87. “Will people be inculcated with the ethos and spirit of the Bloomberg School if they are not physically present? Will they look at this as a calling to a higher purpose or just an efficient way to transfer knowledge?” That underlying uncertainty was in part responsible for the decision to create a program that incorporates onsite visits so the distance-learning students have some direct personal contact with key faculty members and program directors. “We did not want to just put a video camera in a classroom, tape the lecture, and call that an online class,” Klag says. “But we decided from the start to spend a lot of time in design and planning our distance education program to make sure those students came away feeling part of the community. One thing that tells me we have succeeded is the surprising number of online students who travel to Baltimore to receive their diplomas in May at graduation—there are many each year.”

“As faculty, we are very cognizant that these aren’t correspondence courses,” says Diener-West, PhD. “One of the ways in which we deliver an online education comparable to what our students experience when they come to Baltimore is by fostering synchronous communities where students and faculty can chat in real time through LiveTalk or by other modes such as a bulletin board. I would say that the level of engagement of our online students was the main surprise that I experienced when I started teaching in this format.”

She notes that when her colleague John McGready compared outcomes in his online and onsite biostatistics classes, he discerned no significant differences in learning based on evaluations between the two groups. “The great advantage online is that everyone experiences the lecture on a one-to-one basis with the instructor and can move at their own pace,” she says.

At the Bloomberg School, turning subject matter knowledge into a best practices education is the responsibility of Sukon Kanchanaraksa, PhD, and his team of 26 professional instructional designers, technical writers, web developers, medical graphic illustrators, audio producers and editors, and others in the Bloomberg School’s Center for Teaching and Learning with Technology. Kanchanaraksa serves as the Center’s director and has taught online since the School’s first distance education courses premiered a dozen years ago, back when faculty recorded their lectures in a second-story walk-up studio in a Monument Street rowhouse.

The Internet is generations advanced since then, and the Bloomberg School now employs a state-of-the-art digital recording studio, but the focus has remained the same, he says: facilitating the learning that has to happen in each course. “It’s not about the technology per se,” says Kanchanaraksa. “We have instructional designers who can help find the appropriate tools and approaches to improve pedagogy in all situations.” Rule number one for the Center is that the tools don’t come first. “You don’t start a course because you have Twitter. You start with the educational objective and make choices from there.”

But even something as seemingly straightforward as identifying the educational objective for a course can be a fraught exercise for faculty who have no prior experience in pedagogical analysis. In medicine the “see one, do one, teach one” instructional tradition relies on students seeing a skill (such as suturing) modeled, doing it themselves, and then teaching someone else to do the same. The use of three different learning modalities—observing, practicing, teaching—is an age-honored educational practice; it’s how most university faculty learn to teach as they advance from undergraduate to graduate to doctoral studies. But learning by doing does not necessarily impart the sound theoretical underpinnings that are so necessary when adapting teaching to the oftentimes unfamiliar milieu of the online world. For that, Bloomberg School faculty members have a staff of professional instructional designers at hand.  (See The Art and Science of "Webagogy.")

Says Kanchanaraksa: “It’s the quality and attention to detail that makes all the difference. We focus on the learning that has to happen, and we have a team of experts who can help an instructor improve the teaching in a class.”

For their part, students have great flexibility in choosing how to learn the material. Each online class is divided by the audio engineers into discrete “chapters” that are labeled with a total running time and can be individually downloaded in MP3 format. Students can choose to view chapters with all slides and related materials on their computers or, if they wish, they can use the MP3 format to simply listen to the lecture as they drive to the lab or work out at the gym. (“So you never have to be without me,” McGready jokingly tells his students.)

“It’s a really good way to make it work for you,” says David Williams, MPH ’09, who lived and worked a demanding job in Rockville, Maryland, editing technical journals while earning his degree. After working from 8:30 a.m. to 5:45 p.m. he would have dinner at home and then “jump online and spend two to three hours listening to lectures or doing the other work.” It was, he says, the only way he could have earned his degree—plus it came with some unexpected insights that enriched the experience. “I took several classes with [International Health Professor] William Brieger including one called Training Methods and Continuous Education for Health Workers,” he says. “And while that course was going on, Professor Brieger was actually out in the field in Africa doing his work. It was pretty neat to hear from someone who was working on the issues he was talking about.”

The online learning format is sometimes referred to as the classroom without walls, and the ability to hear from and interact with faculty and fellow students engaged in public health activities around the globe presents unparalleled educational opportunities. But it also offers another, more prosaic advantage that is especially important in an era of critical public health workforce shortages. A classroom without walls is a classroom that can accommodate—theoretically at least—an unlimited number of additional students. The potential this technology offers for filling the urgent need for more and better trained specialists was evident when McGready casually announced at the start of his first LiveTalk session that the class had reached a new record of “upwards of 180” enrollees.” In online learning, take 18 enrollees or 180 and the class experience should remain largely the same.

“Onsite courses are limited by the number of seats in a classroom, but in an online course you effectively accommodate many more students,” says Diener-West, the MPH chair. “Sukon Kanchanaraksa and I went from having about 35 students in 1998 to over 150 students in 2009 in our Fundamentals of Epidemiology course, and we have adapted by adding additional teaching assistants and forming small working groups of students.”

The Center for Teaching and Learning with Technology reports that as of the new academic year, the Bloomberg School offers a total of 73 courses online, with another 10 in development. Faculty are encouraged to keep their courses fresh and up-to-date by going back to the studio to revise the lectures every three years. To date, this approach has worked well, and Center director Kanchanaraksa predicts the School will have no fewer than 100 online offerings within the next year or two. “I think the use of this technology will only grow in the future,” he says. “Yes, we have students who can come to Baltimore and take face-to-face full-time courses because they have the opportunity to do so. But there are a body of students who can’t—and that’s a large portion of the population.”

One such student is Jessica Knupp, a clinical science liaison representative for Celgene Corporation, who covers nine states in the southern U.S. “This is the only way I could earn this degree,” she says of a schedule that commonly involves 12 hours of travel time for a single 30-minute meeting. “I am in the hotel room, at the airport, in the plane, and what’s great is that I can take class everywhere. Not long ago I had a flight delayed for two hours—and that was two hours of studying.” It is, she says, ideally suited for busy, but focused professionals. “The only challenge from my perspective is that I sometimes talk to older people who ask me, ‘Is that a real degree?’ But I have no doubt this will take hold. It’s the wave of the future.”

For Dean Klag, the proof-of-concept for the School’s distance learning program lies in the numbers. “I think it’s extremely significant that about a quarter of our online enrollments come from our students who are here onsite in Baltimore,” he says. “That says something important about the quality of these courses. I’m bullish that our distance education efforts will continue to develop new technologies that will improve teaching across the entire School, both online and in the classroom.”

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