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Collaborative Activities for Online Students of Allied Health
Paul S. Roche
Liberty University
EDUC 639- D01

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Book Summary:

The purpose of E-LEARNING IN THE 21ST CENTURY: A Framework for Research and
Practice, (Garrison, 2013) is to provide an understanding of a theoretical framework introduced
by an author who contributes many years of experience and research to the field of distant
education. This is the second edition and includes updated research, pedagogical, and educational
technology best practice information for the new concept of distant education, eLearning. It
includes, but is not limited to, new topics about mobile learning and the use of social media in
eLearning, (Garrison, 2013).
The book explains the theoretical framework of the Community of Inquiry (CoI) as the
most up to date model for distant learning. A CoI has its foundational theories in John Deweys
(1938) principle of interaction between an individual and society. In an educational application
of this theory, Dewey believed in the concept education as a transaction. The main points are
first, that this transaction of a collaborative/constructivism approach eLearning, including
blended learning, can provide deep levels of understanding that are meaningful and lasting to the
learner, her/his environment, and ongoing. Second, in the application to eLearning , assessment
and evaluation takes on a much different approach in light of expected learning outcomes.
This need for change to an eLearning environment meets expected organizational challenges and
future considerations for research.
Critique:
The author of the book, E-LEARNING IN THE 21ST CENTURY: A Framework for Research and
Practice, (Garrison, 2013) breaks down the CoI framework into consists of three interacting
components: cognitive presence, social presence, and teaching presence. I believe this helps the

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educational stakeholders understand how to instruct, create curriculum, and gain support on an
organizational level. The reader can easily gain a deep understanding of how Garrisons (2013)
ideas are best played out and support learning from his discussion of technologies of today and
how they can be used in distant and blended learning environments. In addition, he provided
helpful teaching-learning guidelines and various types of assessments with rubric examples
applicable to online and blended courses. I was enlightening to know that many institutions of
education are considering and making preparations for eLearning adaptation as they move
forward. I have a deeper understanding of how the predictions of the new permeating educational
structure of eLearning changed the scene of the traditional university. It once was the only place
where communities of inquiry were established and deep lasting education occurred. Now, the
university is a place where the use of new tools for information access and collaboration properly
utilizing these tools in a blended on-line\on-campus learning environment or strictly on-line
environment utilizing technology that creates the same synchronous level of an inquiring
community. The difference is that there is an access now available to so many more students.
Now the focus of research is more to the use of technology in light of learning needs and
not just the technology, as was just two decades ago.
Many expensive technologies were created without considering improvement of learning, tried,
and did nothing, at the least, to improve the learning experience. Research was more on
technology, than how its use can make a better learning experience. The author portrays the
Community of Inquiry as a theory which has evolved out of research supporting best practices of
learning which begat what enlightened education stakeholders describe todays learning
transaction as collaborative/constructivism. I expect there to be a third edition of Garrisons

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(2013) work or he has stimulated research in the direction of improvement of Communities of

Inquiry.
Reference:
Garrison, D. &. Anderson, T. (2013). E- learning in the 21st century: A framework, second
edition, London: Routledge Falmer.
Journal Article Summary 1
The authors of the article, Using wikis to Stimulate Collaborative Learning in Two
Online Health Science Courses, (Zitzelsberger, Campbel, & Sanchez, 2015), discussed their
evaluative research on a pilot project of the implementation of wikis tools available in the
colleges Blackboard Learning Management System (LMS).This research consisted of two
samples of nurses in two different undergraduate allied health science online courses for third
and fourth year students. Training on the use of wikis was provided to the students via a power
point presentation. The project had two phases the first taking place in the fall of 2013, and the
second in the winter of 2014. Direct observation was performed during each step of the
assignments in the wiki environment. Observation of the two phases was done to find patterns,
areas of weakness, benefits, and commonalities. During the two separate semesters each group
broke down into self-appointed subgroups and completed group projects related to health
science. Prior to the use of the chosen wiki space, the authors performed informal testing of the
wiki tools with other wiki tools from other LMSs. They found the schools Blackboard LMS to
be most beneficial to use, though of equal value to the ones studied.

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The main reasons for using the chosen wiki source was because of the familiarity with it
amongst faculty and students and having the ability to extrapolate them for other courses taught
by the authors.
The study revealed that meaningful and productive interaction occurred during the
students work on assignments. Also, it was revealed that some students applied self-learning of
the use of wikis and worked with other students directly on the wiki project while other students
preferred to work outside the wiki and submit their work when completed to share with the other
students in the group. The use of wikis found favor amongst faculty who, welcomed training or
had previous training on their use because of the ability to examine progress early and therefore
provide guidance where necessary.
Critique:
I found that this article was weak in the use of graphs and needed more description of the
study. However, it did provide supporting insight in the use wikis, an evolving source of
collaborative activity for the blended learning nature of allied health studies. The second phase of
the study did include a project developer dedicated for the sole purposes of wiki project design
and assisting students. This addition of this resource as well as sample wikis notably brought
forth greater student support. I suspect having this support was a direct result of faculty
knowledge of student needs from the previous phase. An idea for further research would be using
the same type of study, more descriptively as mentioned, with and without the addition of
nursing student coaching by those in a graduate program.
Using wikis in future curriculum is a step forward into the eLearning environment
researchers are seeking to accommodate. Technology that supports learning and is not created

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simply for the purpose of fascination with technology (those motivations have a place for
contributing to society technological knowledge) should keep education learning needs as the
primary goal. The authors of this article support one of the most important factors in eLearning;
the need for effective collaboration in an information-rich on line and/or blended learning
environment. The contribution of this research does have a valid place in the quest for bridging
the digital divide. It should also be mentioned that the authors addressed the importance for
faculty to be knowledgeable in the use of new and effective educational technology. An
unintended part of this research was the modeling of another important research-based practice.
The authors carefully facilitated the courses in allowing student choice within the projects
themselves. In the practice of these researchers, it was made apparent to the reader that they
value the effective on learning that student choice, within the parameters of learning objectives,
makes. I believe, if the article included elements such as sources of measuring the findings in
order to contribute to research of the same nature and graphical illustrations it can add a greater
reliability.
Reference:
Zitzelsberger, H., Campbell, K.A., & Sanchez, O., (2015) Using wikis to stimulate collaborative
learning in two online health sciences courses, Journal of Nursing Education 54(6) 353355, doi:http://dx.doi.org/10.3928/01484834-20150515-08

Journal Article Summary 2:

In their article, Improving the Learning of Clinical Reasoning Through Computer-Based
Cognitive Representation, (Wu, Wang, Johnson, & Grotzer, 2014) the authors reported the

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findings of their research on the effect computer-based cognitive representation has on clinical
reasoning. The sample used was twenty-nine third year or higher medical students in East China.
Each student used the suggested approach applied to an eLearning system. They individually
completed four learning cases in four weeks. They also used a computer-based cognitive
representation software tool to articulate and denote important elements and their interactions in
the learning process. An end of course survey was completed by each student. The findings were
supportive of formative assessment showing a significant improvement in learning throughout
the duration of the study. The improvements were in learning how to measuring students clinical
reasoning in two areas, problem solving and knowledge construction. The findings did not
support summative assessment.
Critique:
When considering social presence in eLearning, it is important to measure how
collaboration contributes to deeper levels of learning. Equally as important is the measuring
teaching and cognitive presence. In this article the authors discuss the findings on the
effectiveness of a software learning tool, computer based cognitive representation to measure
clinical reasoning. They found results that share in the assessment of the learning experience.
Assessment of learning is a key area of research towards best practices in eLearning as well as
learning in general. Without understanding how learning is achieved course development and
instruction would be lacking greatly. One can only imagine the potential affect improper clinical
reasoning would have on patient care. There is much study on how the brain is affected under
certain learning activities and their effects on the reasoning centers of the brain. However, much
of this research does little to impact curriculum development because it does not include
researchers, such as the authors of this article, as part of the research team. This would be an

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important contribution to future research. I believe the most significant implication was the
ability to measure cognitive processes. Cognitive process are difficult to measure when not able
to see the results of lesson planning. It was within the setting where students worked individually
without collaboration. Another idea for future research comes to mind, having read this article,
would be a more realistic setting where students are able to collaborate as is common practice in
healthcare. Although this research was on medical students clinical reasoning skills, future
research may also include this type of model adapted to other areas of healthcare such as allied
health. Because the authors offer several years of research article on learning beginning in the
early nineties (Wang), I believe this is a good resource to follow for future findings that will
impact eLearning, blended learning, and learning in general. Maintaining good clinical reasoning
skills is of vital importance which can get lost in the evolution of education technology. Research
such as this article shares can assist in developing a more effective curriculum in medicine and
allied health education.
Reference:
Wu, B., Wang, M., Johnson, J. M., & Grotzer, T. A. (2014). Improving the learning of
clinical reasoning through computer-based cognitive representation. Medical Education
Online, 19 doi:http://dx.doi.org/10.3402/meo.v19.25940 ference:

Journal Article Summary 3:

The samples of this evaluative study on the development, implementation, and evaluation
on the activity involved in the use of a virtual patient (VP).

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The study examined the development, implementation, and evaluation of a software using virtual
patient software. It consisted of two separate groups of advanced registered nurses in the Health
and Social Care Sciences program at Kingston University/St Georges University of London
(KU/SGUL). There were two equally important purposes for researching the two separate
groups. The first was to examine the usefulness of a VP software for online activity involving
realistic patient care scenarios to train advanced nursing students for patient assessment. The
second purpose was for examining the usefulness of the same software for preparing the nurses
in prescription writing from a limited formulary approved by United Kingdom Department of
Health according to the Prescription by Nurses Act (Parliament, 1992). The results revealed that
the use of a VP was perceived as useful for helping nurses to learn the skills of patient
history/assessment, decision-making, and prescription writing as well as being helpful in
developing their confidence. The study implied that the use of an online VP for training
registered nurses in patient assessment and prescription writing can be an effective tool with low
risk of patient harm.
Critique:
Preparing allied health students (nurses, physical therapist, occupational therapists,
respiratory therapists, and their support staff) through software which allows for virtual patient
care practice entails much lower risks of patient harm than in real practice. The research
conducted by the authors of Using a Virtual Patient Activity to Teach Nurse Prescribing, Hurst &
Marks-Moran, 2011) addressed this issue using technology that proved to be effective in several
ways. Most important, was the low risk of patient harm by unskilled critical decision making.
Another important issue was that the use of this software improved the confidence of the
students. I commend these authors for the work done and published.

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As a healthcare worker/clinical instructor, it is difficult to keep from the technology demands and
patient care needs one is presented with on any given day. Students need the type of software
discussed here implemented in their curriculum now more than ever as we care for the
generation of baby-boomers in the midst of downsizing staff. It is extremely demanding and very
well impacting clinical decision making. I believe the authors of this article were very much
aware of the importance to address the clinical training needs in the blended learning of allied
health curriculum. Many programs are done online without students ever making direct contact
with a seasoned practitioner until they step foot in a hospital. It is important to mention that this
article did not emphasize that the software was not a replacement for actual patient practice
which needs to happen while still a student and overseen by a knowledgeable trained instructor.
Also not mentioned was at which part of the program the VP practice was done. It is an
important consideration as to how close to actual exposure is the virtual practice done. The right
timing can have a direct impact on knowledge retention and further develop critical decision
making skills of the student. Future examination on the development, implementation, and
evaluation of similar Virtual Patient software adapted to other allied health programs students
would also be beneficial.
Reference:
Hurst, H. M., & Marks-Maran, D. (2011). Using a virtual patient activity to teach nurse
prescribing. Nurse Education in Practice, 11(3), 192-8.
doi:http://dx.doi.org/10.1016/j.nepr.2010.08.008

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Journal Article Summary 4:

In their article, Creation of Medicinal Chemistry Learning Communities through

Enhanced Technology and Interdisciplinary Collaboration, (Henrikson & Roche, 2012)
discussed their findings in the assessment of the impact of clinician involvement in the chemistry
classroom. Although this research did not involve an eLearning or blended learning environment
it raised the question to me of how can the authors findings apply to scheduled synchronous
meetings online for courses in allied health. A voluntary self-reported, aggregate, de-identified
survey instrument was distributed to 180 students taking a Chemical Basis of Drug Action II
course. The survey was on the clinician involvement in the previous Chemical Basis of Drug
Action I course. 30.9% of the students responded. The authors explained the low response may
have been due to the timing of the students receiving the survey. The survey results revealed a
high percentage (80-832%) agreed or strongly agreed that the presence of a clinician during the
course had a positive impact on their learning and preparation to enter the pharmacy field. The
implication of these findings suggest that the presence of a seasoned professional in course
lesson planning for pharmacy students should be a part of their curriculum.
Critique:
For an eLearning environment this research adds to an important element in curriculum
development which adaptable to other areas of allied health or medicine. I believe that is a
worthwhile area of future research. Many Allied health programs are now done in a blended
learning environment of didactic experience and clinical experience. As part of the preparation of
these students, according to this survey, it appears that a new area of research was sparked. Since
research on best practices in eLearning demonstrates that collaborative activities amongst distant
learners supports a deeper and richer learning experience, allied health and medical students

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would benefit from the exposure of experienced professional clinicians during their course
activities. This could mean identifying with the professional as a future staff member. Students
can collaborate via a blog on their new insights from a scheduled Q/A sessions with guest
professional in their future careers during a synchronous meeting online. Another worthwhile
study would be on collaborative activities with allied health professionals and the knowledge
gained from their individual an interview with a professional and shared with fellow students via
a discussion blog.
I believe the research the authors presented was a valid contribution to best practices in
eLearning. I have seen, in my experience as a clinical instructor for respiratory therapy students,
the need for much collaborative activity similar to what this article presents to in preparation of
students for their future role in healthcare. This article presents some limitations to the reliability
of the findings applicable to a larger population of pharmacy students due to the small amount of
response to the survey, but overall the authors were precise in their measurement and use of
graphic illustrations to prove a valid degree of reliability. It sheds light on the clinical relevance
of clinician involvement in the learning experience for certain, at least in pharmacy courses, and
would seem to be a helpful learning experience if adapted to other areas of healthcare especially
for eLearning environments.
Reference:
Henriksen, B., & Roche, V., (2012). Creation of medicinal chemistry learning
communities through enhanced technology and interdisciplinary collaboration. American
Journal of Pharmaceutical Education, 76(8), 1-158. Retrieved from

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