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Competency-Based Medical Education – The Basics

Introduction

Like all fields, healthcare is engaging with the characteristics and consequences of our digital society. Data with varying degrees of contextualization pours in from diverse sources.  Knowledge changes fast. Problems are complex.  In this new age, healthcare professionals (like everyone else) must not only be technical experts, but also team workers, lifelong learners, creative thinkers, and great communicators.

Additionally, medical education is engaging with the same wicked problems and reform movements as the rest of higher and professional education. Competency gaps have been documented at every transition from undergraduate (UME) to graduate (GME) to postgraduate environments.  Like others, medical school faculty and program directors experience overwork, conflicting priorities, and a lack of faculty development and support around teaching and learning. A stubborn hidden curriculum chips away at the intentional approaches and lessons of the classroom.  Buzzwords like accountability; evidence-based practice; inclusivity; and active, social, and applied learning design approaches are just as dominant in the healthcare literature as they are elsewhere in educational research.

In the “Beyond-Flexner” era, the trend in medical education is to move towards competency-based education as a way to enhance program and student accountability, flexibility, and performance.

The purpose of this blog post series (and I promise – it will be a series) is to provide a little background for individuals who need an introduction to competency-based medical education (CBME).  It will review basic vocabulary: What are competencies?  Milestones? Domains? It will try to make sense of the relationships between and best uses of competency domains and EPAs while comparing these new frameworks to more traditional instructional and assessment frameworks found in medical education.  It will describe how some institutions have chosen to implement CBME and how it might manifest itself at different levels of study (e.g. pre-clerkship UME versus GME).

A blog post is a blog post. It is not a reviewed (peer, if you believe that in that sort of thing, or otherwise) article. This particular blog post introduces the basics as well as one of the best-documented examples of CBME available in the form of Vanderbilt University School of Medicine’s UME pre-clerkship curriculum.  The blog post is not meant to be comprehensive.  Rather, it represents me thinking through the articles I’ve been reading for the last week in an effort to put together a cohesive account.  It is a preliminary effort and should be considered as such.

Initiatives to Know

Highlights:

ACGME Core Competencies (US). A set of competencies (e.g. professionalism, interpersonal communication, medical knowledge) developed for graduate medical education.  Specialty-specific milestones that support the competenices have been created in colloboration with the American Board of Medical Specialities (ABMS).  Now the competencies and their milestones are being used in U.S. graduate medical education and ABMS-mandated Maintence of Certification (MOC) efforts.

Core Entrustable Professional Activities (US). Guidelines published by the Association of Medical Colleges (AAMC) for undergraduate medical education.  Currently, they are being piloted by ten medicals schools across the US. The thirteen EPAs (observable, workplace-based activities that all medical students should be able to perform successfully and with consistency when they matriculate into any residency training program) are meant to interface with the AGME’s core competencies and milestones.

CanMeds (Canada). A role-based (e.g. communicator, professional, scholar) competency framework developed by the Royal College of Physicians and Surgeons of Canada for residency training and specialty practice.  As of 2015, the Royal College is moving towards the development of milestones to support the use of CanMeds at the postgraduate continuing education level.

ACGME Core Competencies

In an effort to address the competency gap between GME requirements and the changing needs of the workforce, the Accreditation Council for Graduate Medical Education (ACGME) partnered with the American Board of Medical Specialities (ABME) in 1999 to create the six domains of clinical competency. These domains included:

  • Patient Care
  • Medical Knowledge
  • Interpersonal and Communication Skills
  • Practice-Based Learning and Improvement
  • Professionalism
  • Systems-Based Care

Over the next ten years, GME programs worked closely with the relevant ABMS-certifying boards to specialty-specific develop milestones (defined in more detail later).  The milestones provide definition around the core competencies, attributing specialty-specific activities to each competency.  These milestones assist in developing curriculum, resident assessment tools, and residency training program evaluation strategies Nasca et al., 2012).

AAMC Core Entrustable Professional Activities

In 2014, the Association of American Medical Colleges (AAMC; the accrediting arm of AAMC, in collaboration with the Amercian Medical Association, is the Liasion Committee on Medical Education – LMCE) followed in the footsteps of GME and created 13 Entrustable Professional Activities (EPAs) which will serve as a framework for assessing the readiness of medical students for graduate medical training.  They are defined as the point when a learner has demonstrated an activity at the level that they no longer require direct supervision.  They differ from traditional competencies because they address performance within distinct workplace expectations that demand trustworthiness as well as expertise (Englander et al., 2016).

As of Spring 2015, the EPAs include:

  • Gathering a history and performing a physical examination;
  • Prioritizing a differential diagnosis following a clinical encounter;
  • Recommending and interpreting common diagnostic and screening tests;
  • Entering and discussing orders and prescriptions;
  • Documenting a clinical encounter in the patient record;
  • Providing an oral presentation of a clinical encounter;
  • Forming clinical questions and retrieving evidence to advance patient care;
  • Giving or receiving a patient handover to transition care responsibility;
  • Collaborating as  a member of an interprofessional team;
  • Recognizing a patient requiring urgent or emergent care, and initiating evaluation and management;
  • Obtaining informed consent for tests and/or procedures;
  • Identifying system failures and contributing to a culture of safety and improvement; and
  • Performing general procedures of a physician (e.g. IV line insertion, phlebotomy, BVM ventilation, CPR).

The AAMC launched the Core EPA initiative: a feasibility pilot study of ten schools that aims to explore curriculum development, assessment, the path to entrustment, faculty development and ongoing development of the EPAs.

Learning Objectives: A primer

Best source for learning more: 

Thomas, P. A., Kern D.E., Hughes, M.T., & Chen, B.Y (Eds.). (2015). Curriculum development for medical education: A six-step approach (3rd ed). Baltimore, MD: Johns Hopkins University Press

There are certain terms everyone should know before entering into a conversation about competency-based education.  These conversations typically start with a discussion of learning goals and objectives. Although goals and objectives can be defined in different ways, they are typically distinguished from each other by their level of specificity.  Goals or outcomes speak to broad educational outcomes while objectives relate to specific measurable actions or concepts.

According to Thomas et al. (2016), objectives can be divided into learner, process and outcome objectives:

  • Learner Objectives.  These objectives address knowledge, attitudes, and skills at the individual student level.  More specifically
    • Knowledge (aka Cognitive) Objectives relate to a spectrum of mental skills relevant to curricular goals ranging from factual knowledge to problem-solving, and clinical decision making.
    • Affective Objectives involve attitudes, values, beliefs, biases, emotions or role expectations that can impact performance.
    • Skill (aka Psychomotor)  Objectives relate to specific actions involving hand or body movements, vision, hearing, speech, or the sense of touche.  Medical interviewing, interpersonal communication, examination, and procedural skills fall into this domain (Thomas et al. (2016), p. 55-6).
  • Process Objectives. These objectives address achievement at the program level and are often expressed as aggregations of learner objectives.
  • Outcome Objectives.  Thomas et al. (2016) points out that ‘outcome’ is not used consistently in the literature or in the world.  Sometimes these relate to patient care while at other times they relate to learner objectives.  The authors recognize that it is unreasonable to suggest that undergraduate medical schools should be held accountable for patient outcomes as their interactions are indirect or their care peripheral and/or secondary.  However, they suggest that some health outcome objectives should be included to emphasize the big picture and potentially influence curricular design choices.

CBME: The Overview

Best source for learning more: 

Carraccio, C., Wolfsthal, S.D., Englader, R., Ferentz, K., Martin, C. (2002). Shifting paradigms: From Flexner to competencies. Academic Medicine. 77(5):361-367.

Competencies are “learner outcomes which are observable behaviors that result from the integration of knowledge, attitudes, and psychomotor skills” (Thomas et al. 2016, p. 58).  These competencies are often grouped into domains.  CBME emphasizes learner objectives for the purpose of ensuring learners are progressing from novice to expert with a framework of essential competencies (Harris et al., 2010).

Some key points worth remembering:

  • CBME focuses on learner objectives. It does not specify particular learning strategies or formats (Harris et al., 2010).
  • CBME establishes a trajectory rather than a baseline for minimal competence (Pettepher, Lomis, and Osheroff, 2017).
  • CMBE requires a commitment to formative assessment, self-regulation, and personalized learning.
  • CBME can provide seamless transitions across educational levels if it is designed with each other in mind  (Harris et al., 2010).

Carraccio et al (2002) published a useful table for distinguishing between traditional and competency-based education – the following table is directly from Carraccio:

Educational program
Variable Structure- and process-based  Competency-based
Driving force for curriculum Content—knowledge acquisition Outcome—knowledge acquisition
Driving force for process Teacher Learner
Path of learning Hierarchical (teacher → student) Non-hierarchical (teacher ↔ student)
Responsibility for content Teacher Student and teacher
Goal of educational encounter Knowledge acquisition Knowledge application
Typical assessment tool Single subjective measure Multiple objective measures (“evaluation portfolio”)
Assessment tool Proxy Authentic (mimics real tasks of profession)
Setting for evaluation Removed (gestalt) “In the trenches” (direct observation)
Evaluation Norm-referenced Criterion-referenced
Timing of assessment Emphasis on summative Emphasis on formative
Program completion Fixed time Variable time

Assessment: Milestones and trajectories

Best source for learning more: 

Swing, S.R., Beeson, M.S., Carraccio, C., Coburn, M., Iobst, W., Selden, N.R., Stern, R.J., & Vydareny, K. (2013). Educational milestone development in the first seven specialties to enter the next accreditation system. Journal of Graduate Medical Education. 5(1) 98-106.

Assessment in CBME is formative, personalized, and based in the language of milestones and trajectories. Milestones describe the typical developmental pathway for a given competency.  They are best used to describe competencies that develop and must be demonstrated over time under increasingly complex clinical circumstances (Thomas et al (2016).

Milestones are defined by the following criteria:

  • Criterion-referenced. They offer a common set of benchmarks that are applicable across courses.  Milestones are standardized across a program to help students identify their personal learning trends and provide stronger evidence to support change, remediation, or growth (Lomis et al., 2017).
  • Performance-driven. Milestones are driven by performance rather than time. There may be a window of time in which – given equal opportunity and practice – most students will achieve expertise (similar to developmental milestones for children), but achievement is not dictated by time alone (Nasca et al., 2012).
  • Escalating behavioral anchors. The trajectory towards expertise is described in terms of incremental improvements in performance. The milestones described in much of the CBME literature is based on the Dreyfus Model of Learning Progression  (Novice, Advanced Beginner, Competence, Proficiency, Expertise) or Miller’s Pyramid of Clinical Skills (Knows, Knows How, Shows How, Does).
  • Indicates current status AND what behaviors are required to progress. (Schumacher et al, 2013 and Swing et al., 2013).   Swing et al. (2013) offers an annotated example of a milestone graphic designed to support the assessment of a student for a sub-competency.

Example: Vanderbilt University School of Medicine

Sometimes it’s easiest to explain something through an example.  Several years ago Vanderbilt redesigned its UME curriculum and assessment to support the development of four of the six ACGME competencies.  It is also a pilot school for the AAMC Core EPA Initiative (more to come on this in later blog posts).

This section draws from the articles that Vanderbilt has published since 2010 about their curriculum and assessment reform and the lessons they learned along the way.

Why did they do it?

Best source for learning more:

Miller, B.M., Moore, D.E., Stead, W.W., & Balswer, J.R. (2010). Beyond Flexner: A new model for continuous learning in the health professions.  Academic Medicine. 85(2): 266-272.

In 2008, Vanderbilt University School of Medicine proposed the following principles for a new model of health workforce development:

  • Learning is competency-based and embedded in the workplace.
  • All workers learn; all learners work.
  • Learning is undertaken by individuals, teams, and institutions and is linked to patient needs.
  • Learning activities are modular; the system allows multiple entry and exit points.
  • Learning is interprofessional, with shared facilities, common schedules, and shared foundational coursework.
  • A rich information technology infrastructure supports the healthcare/learning system.
  • Health outcomes and educational outcomes are directly linked (Miller et al., 2010).

As part of this larger initiative, the school decided to transition away from a traditional curriculum and assessment profile (one based primarily on medical knowledge and content-only exams) to one that was directly connected to four of the six ACGME competency domains.  They focused on the pre-clerkship years (Medical School Year 1 & 2) because they felt that the lecture-driven nature the curriculum was not allowing students to benefit as they might from the collective clinical and professional experience of the faculty.

Who actually did the work?

An interdisciplinary leadership team spearheaded the Foundations of Medical Knowledge (FMK; Years 1&2) redesign, a process which included significant research, piloting, interprofessional collaboration, and faculty training.  The team included an anatomist (PhD), biochemist (PhD), pathology (MD-PhD), and pediatric neurogenetics (MD; Pettepher et al. 2016).

What did they do?

Best source for learning more: 

Vanderbilt University School of Medicine Office of Undergraduate Medical Education. (2018). Competencies for Leaners Across the Continuum. Retrieved from: medschool.vanderbilt.edu/ume/competencies-learners-across-continuum

The leadership team worked with faculty to diversify the curriculum to include active learning (described in detail below) and small group activities which would allow for more faculty-student interaction.

They also created a new approach to assessment that was based on the four competency domains and definitions as follows: (Miller et al., 2010 and Pettepher et al. 2016):

  • Medical knowledge. Demonstrate deep knowledge of the sciences essential for one’s chosen field of practice.  Approach to learning: collect, analyze, interpret and prioritize new information to enhance one’s knowledge in the various disciplines related to medicine.
  • Practice-based learning and improvement.  Compare data about current performance at the individual, team, and/or systems level with expected outcomes, and identify and implement the learning strategies needed to improve performance. They emphasized critical reflection and self-assessment here (through group and personalized learning plans).
  • Systems-based practice. Because students are early in their training, they framed the systems-based practice domain around each student’s role in the learning (rather than care delivery) system. They emphasized interpersonal communication and teamwork skills here.  Discuss the elements of effective team building and utilize appropriate techniques to create, participate in and lead effective teams.
  • Professionalism. Demonstrate a commitment to the duties and obligations of the medical profession, its healthcare institutions and its individual practitioners to patients, communities and society. Demonstrate honesty and transparency in all dealings with patients, learners, and colleagues. Demonstrate compassion and respect for all persons regardless of differences in values, beliefs, and experiences.

For detailed sub-competencies, see the Vanderbilt webpage on competency-based education.

How…did they design and evaluate milestones?

Best source for learning more: 

Lomis, K.D., Russell, R.G., Davidson, M.A., Fleming A.E., Pettepher, C.C., & Cutrer, W.B. (2017). Competency milestones for medical students: Design, implementation, and analysis at one medical school.  Medical Teacher. 39(5), 494-504.

As outlined in Pettepher et al. (2016), the leadership team created milestones for the four ACGME competencies.

They started by using the following sources of information to define core behaviors that should be continually re-assessed throughout a student’s training: 

  • Faculty judgment of importance
  • Priorities represented in existing assessments
  • Consideration of areas in which students historically struggle
  • Areas amenable to measurement starting in the first year.

After applying a Modified Delphi technique to their findings, the leadership team established work groups to work on writing milestones for each competency domain.  They based their work on the modified Delphi results as well as grading forms from multiple UME courses, GME milestones, and GME entry-level expectations.

Next, they piloted their milestones for construct alignment and validated their construct through:

  • Expert review
  • Interrater reliability (including between student and assessor)
  • Qualitative evidence of feasibility
  • User satisfaction

Continuous quality improvement cycles are being implemented (Lomis et al., 2017).

How…did they design their curriculum?

Best source for learning more:

Pettepher, C.C., Lomis, K.D., & Osheroff, N. (2016). From Theory to Practice: Utilizing competency-based milestones to assess professional growth and development in the foundational science blocks of a pre-clerkship medical school curriculum. Medical Science Educator. 26(3). 491-497.

Vanderbilt redesigned their pre-clerkship curriculum to provide ample opportunities to practice and demonstrate competency-related behaviors. First, they rearranged coursework to create a highly integrated block schedule curriculum:

  • Introduction to the profession (1 week)

  • Foundational interdisciplinary science blocks 

    • Human Blueprint and Architecture (6 weeks)

    • Microbes and Immunity (6 weeks)

    • Homeostasis (12 weeks)

    • Endocrine, Digestion, and Reproduction (12 weeks)

    • Brain, Behavior, and Movement (12 weeks)

  • Concurrent longitudinal blocks
    • Physical Diagnosis
    • Foundations of Healthcare Delivery
    • Learning Communities and Research
      • All students are assigned a clinic-based learning community consisting of providers and postgraduate trainees who oversee the care of a population of patients and serve as teachers, advisors, and mentors  (for more information specific to learning communities, see Miller et al., 2010 and Fleming et al., 2013).

Examples of integration across the interdisciplinary science and longitudinal blocks:

  • The genetics content of Human Blueprint and Architecture took place at the same time as an ethics section in the Learning Communities
  • Chest examinations and heart sounds in Physical Diagnosis coordinated with the cardiovascular unit of Homeostasis
  • Pediatric and adult neurological examinations in Physical Diagnosis coordinated with the Brain, Behavior, and Movement block (Pettepher et al., 2016).

Then the school introduced case, team, and experiential learning activities throughout the year.  In fact, they built courses around a similar weekly template of learning activities in order to implement consistent assessment events across the FMK phase.

Case-based learning sessions were student-run, problem-based learning sessions. Groups were crafted intentionally so that they included students from diverse academic backgrounds.  Groups re-formed every twelve weeks to help students practice transitioning in and out of new teams (Pettepher et al. 2016).

Team-based learning sessions were differentiated from case-based learning sessions, but the details were not evident from available publications (for the general differences between case-based and team-based learning see Koles et al., 2005).

Experiential learning was promoted through dissection teamwork (integrated into all basic science blocks) and patient-focused activities.  As described by Miller et al. (2010):

“Whereas most medical schools now include clinical experiences in the preclinical years, this model eliminates the “preclinical” and “clinical” distinction by giving students real responsibility for clinic operations and patient care from the start of their professional education  and by making the learning-working team the focus of their educational experience.” (p. 4)

How…did they design their assessments?

Best source for learning more:

Pettepher, C.C., Lomis, K.D., & Osheroff, N. (2016). From Theory to Practice: Utilizing competency-based milestones to assess professional growth and development in the foundational science blocks of a pre-clerkship medical school curriculum. Medical Science Educator. 26(3). 491-497.

The leadership team sought to design competency-based assessments that facilitated the collection of many low-stake data points for every student.  These touchpoints included self-, peer, and faculty feedback collected through standardized rubrics with qualitative milestone assessments.

Digital milestone forms included six observable behavioral anchors for each competency and described escalating levels of performance from unacceptable to aspirational. Over the course of the phase, minimally acceptable levels of performance were raised to parallel the maturation of the students. Identical milestone descriptors were utilized across the entire four-year curriculum and shift as the student level and experience progresses (Pettepher et al. 2016 includes real examples).

Self-, peer-, and faculty feedback were sought at scheduled intervals.  This included initial self-assessment exercises, standardized rubric assessments, and qualitative “global” questions:

  •  What is at least one valuable contribution this person has made to your team?
  • What is at least one important thing this person could have done to more effectively contribute to your team?

Assessment of the medical knowledge competency domain includes weekly low-stakes assessments consisting of multiple choice questions (autograded by the learning management system) and brief online essays (graded by the case-based learning facilitators).  End-of-block examinations consist of NBME shelf exam questions (autograded on the NBME website) and online essays/short answer questions (graded by block faculty).

All blocks are graded on a pass/fail basis.  Competency domains are weighted equally. Students achieving target scores in all domains pass, while those who receive a threshold score in one competency generally pass, but must set additional learning goals for the weak domain.  Learning goals were established and assessed with the student’s portfolio coach (described below).  

Students with received one sub-threshold score in any domain or multiple threshold scores across domains are handled on a case-by-case basis. Sub-threshold scores in the medical knowledge domain resulted in students passing a remediation exam (at minimum).  Deficiencies in the other domains were remediated through ongoing targeted coaching and monitoring of peer and faculty milestone assessments (Pettepher et al. 2016).

How…did they personalize learning and assessment (beyond remediation)?

Best sources for learning more:

Vanderbilt University School of Medicine Office of Undergraduate Medical Education. (2018). Personalized Learning.  Retrieved from: medschool.vanderbilt.edu/ume/personalized-learning

Spickard, A., Ahmed, T., Lomis, K., Johnson, K. & Miller, B. (2016). Changing medical school IT to support medical education transformation. Teaching and Learning in Medicine 28(1), 80-87.

As described above, the leadership team was interested in providing students with a multitude of low-stakes data points across standardized milestones so that they could follow their trajectory over time and make adjustments as necessary.  These data points are collected at the individual student level in longitudinal e-portfolios. The data collected in these portfolios are reviewed regularly by students and their personal learning coaches who work together to create and monitor a personalized learning plan.  An illustration of the portfolio-user interface can be found in Lomis et al., 2017.

Portfolios are linked to other digital platforms for streamlined data integration and visualization.   This includes the student clinic digital platform, which allows for seamless integration of patient-care skills assessment.

There is more to come on personalized learning, and medical school IT in future blog posts (coming soon). Also additional examples of how different institutions are implementing CBME.

Featured Image by jesse orrico on Unsplash

Syndicated, Virginia Group

My Digital and Medical Education Mash-up

It’s been almost a year since I joined the iDesign team as a learning architect and nine months since I was promoted to senior learning architect.  For much of that, I have worked with Mayo Clinic School of Medicine on the creation of a flipped classroom experience for first- and second-year medical students.  We designed templates, iconography, workflows, material tracking systems, organizational and file naming structures, transition policies and procedures, and change management strategies even as we designed courses at a remarkable pace. It’s been an intensely creative experience and I am so grateful to Mayo and iDesign for giving me the opportunity to learn from and contribute to this project.

Our task was to design a new digital component for the pre-clerkship (undergraduate medical education Y1 and Y2) learning experience.

Learning to be a doctor is hard. An unprecedented amount of content must be committed to memory with a fluency that is not interchangeable with being information literacy.  Don’t get me wrong – the information literacy is important for lifelong learning, problem-solving,  communication, and collaboration.  The best physicians are digital thinkers, but their capacity for connected learning is situated in a larger context characterized by the ability to manage massive amounts of data in their own heads. 

The face-to-face learning experience at Mayo Clinic already includes the best teaching and learning practices of our times: case-based and team-based learning, interactive whole group sessions, simulations, early clinical and patient interaction, integrated curriculum.   It is a lively, rigorous, multifaceted, active learning program with a lot of moving pieces as well as a lot of course content.  However, from my viewpoint as an educated observer, I think it might be easy for students (and maybe some faculty) to get caught in the busy weeds and lose sight of the big picture.

Our vision for the digital learning space was to provide a deceptively simple map that organizes course logistics, materials, activities, assessments, and resources through motifs that repeat themselves across all courses. If successful, the map would work to strip away cognitive clutter and convey information so clearly that pedagogical meaning and relationships reveal themselves without additional words.

My medical background facilitated an intuitive understanding of how the learning activities fit together (and to what end). However, I leaned heavily on information sciences to inspire design. I read cartography texts.  I studied maps and infographics as influencers and storytellers. I referenced Edward Tufte almost every day.  I placed it all in the pedagogical context of Vannevar Bush, George Siemens and my previous experience with designing connected courses.

As I transition away from the Mayo Clinic Project, I am thinking about writing an article about what it means to design a course site as a map. If anyone thinks that might be of interest, please let me know.

 

Featured Image by rawpixel on Unsplash

 

 

Syndicated, Virginia Group

The Professional Ethos

Australian_Capital_Territory_Legislative_Assembly_and_the_statue_Ethos

By Bidgee – Own work, CC BY-SA 2.5 au, https://commons.wikimedia.org/w/index.php?curid=12857136

Although Open Learning ’18 has come and gone, the questions and issues linger in my mind. I continue to think about faculty development, and more widely, professional development. I wonder about the routine and damaging separation of skills and content, teaching and research, computers and pedagogy. During the thirteen years I worked in faculty development, as I worked with colleagues to foster deeper and more intellectually stimulating varieties of professional development, I saw organizational and cultural barriers of all kinds; and while I did my best to identify, address, and overcome those barriers, I feel that I failed more often than I succeeded.

Lately I’ve been thinking about how to frame professional development as an ethical project–which of course leads me to think about the ethos of the contemporary university, which is not a happy thinking spot. Still, it’s interesting to think not about programs or outcomes or assessment or any of those useful but secondary things, but about ethos, and ethics. I understand that trying to identify one ethos in the contemporary multiversity is probably a fool’s errand. I wonder, though, if we can talk about ethical higher education without asking about the ethos of the university.

In this regard, I find Jerry Z. Muller’s definition of “the professional ethos” very interesting.

The professional ethos is based on mastery of a body of specialized knowledge acquired through an extended process of education and training; autonomy and control over work; an identification with one’s professional group and a sense of responsibility toward colleagues; a high valuation of intrinsic rewards; and a commitment to the interests of clients above considerations of costs….  (The Tyranny of Metrics)

Mastery. Processes that take time. Self-regulation. Responsibility. Intrinsic rewards. Commitment to the interests of clients (not mere “customers”). It’s hard to think of what professionalism might mean without these commitments. It’s hard to watch such commitments being eroded, or forgotten, or forsaken.

When I hear vapid and damaging talk about how the university is a “business” (as if there’s only one kind of business in the world, the kind focused on making as much money as possible) or about how we need to “give the students what they want, not what we think they need,” I hear a refusal of this idea of the professional ethos.

When smart and perceptive experts feel they must problematize the idea of expertise as what I can only assume is a sincere but misguided egalitarian gesture, I hear a refusal of the idea of the professional ethos. As should be clear by now, putting the word expert in scare quotes can result in a truly frightening and harmful rejection of knowledge itself. To see any part of this rejection in higher education is to see a process of self-consumption that cannot end well.

I wonder if the assumptions underlying much (not all) professional development in contemporary higher education reflect a similar erosion of the professional ethos. Expertise is not simply a quantity or something to be certified. Expertise is a practice emerging from, and reflecting, an ethos. A professional ethos.

Food for thought.

Syndicated, Virginia Group

Faculty Development in the Open

What does it mean to do faculty development in the open? How is it different than typical faculty development experiences?

For me, faculty development in the open allows me to connect with learners I might not otherwise encounter. My professional development tends to focus on library conferences where I get to talk and network with other librarians and learn about things that are relevant to my day to day work. Faculty development in the open allows me to encounter colleagues from other areas of higher education that I might not otherwise have a chance to meet. We explore issues that are relevant in higher education on a broader scale than any of our respective “day jobs.” I have conversations with economists, literature scholars, education experts, historians, instructional designers, educational technologists and others. We can find connections that cross disciplines, areas of expertise, regions, and even continents. Language barriers are minimized and connections are formed over shared excitement about the possibilities of working in the open. Perhaps even collaborations emerge. I may never meet some of these colleagues face to face, but I feel a kinship having traveled on a journey with my co-learners.

OpenLearning17 and 18 have been rich experiences for me and I look forward to future iterations! I hope you will join us!

Syndicated, Virginia Group

“The Moral Crisis of the University”

Michael B. Katz is a new discovery for me (h/t Roving Librarian). His scholarship on the history of public education in the U.S.is fascinating, troubling, and revelatory. I’m sure his conclusions are contested–whose aren’t?–but at times the clarity and forcefulness of his insights take my breath away.

“The Moral Crisis of the University,” reprinted in Katz’s last book, Reconstructing American Education (1987), is full of such insights. The essay doesn’t make for happy reading, but every time I read it I come away with a renewed understanding of what will be lost if  higher education centered on the life of the mind and nurtured by a strong sense of civic obligation disappears. In many cases, this has already happened. The change Katz describes in 1987 has accelerated in ways that may go beyond his worst nightmare. Along with that acceleration, of course, is a great deal of business as usual, as there always is. We look here when the real erosion is happening there. It’s hard to know where to look, even when there are no distractions–and there are always distractions.

There’s an old joke about going broke, credited to Hemingway: Q: “How did you go bankrupt?” A: “Little by little, then all at once.” During the little by little stage, people who sound various alarms risk being called cranks, or worse. And it’s true: a premature or mischievous cultivation of outrage may damage or destroy what little semblance of community may be left.

And yet, the little by little becomes greater every year. Michael Katz gives me a way to see that. With that clarity also comes hope, the hope that recognizing problems really is the first step toward addressing them, managing them, perhaps even solving them.

Here, then, for Week 7 of Open Learning ’18, my last week as hub director, is some Michael Katz for us to consider together.

[W]hat is it exactly that makes a university distinct from other social institutions? [Robert Paul] Wolff offered a compelling definition based on a conception of the ideal university as a “community of learning.” The ideal university, he argued, should be “a community of persons united by collective understandings, by common and communal goals, by bonds of reciprocal obligation, and by a flow of sentiment which makes the preservation of the community an object of desire, not merely a matter of prudence or a command of duty.” Community implies a form of social obligation governed by principles different from those operative in the marketplace and state. Laws of of supply and demand lose priority; wage-labor is not the template for all human relations; the translation of individuals into commodities is resisted. The difficult task of defining common goals or acceptable activity is neither avoided nor deflected onto bureaucracy….

For all their problems, universities and their faculties remain immensely privileged. They retain a freedom of activity and expression not permitted in any other major social institution. There are two justifications for this privilege. One is that it is an essential condition of teaching and learning. The other is that universities have become the major source of moral and social criticism in modern life. They are the major site of whatever social conscience we have left…. If the legitimacy of universities rested only on their service to the marketplace and state, internal freedom would not be an issue. But their legitimacy rests, in fact, on something else: their integrity. Like all privileges, the freedom enjoyed by universities carries correlative responsibilities. In their case it is intellectual honesty and moral courage. Modern universities are the greatest centers of intellectual power in history. Without integrity, they can become little more than supermarkets with raw power for sale. This is the tendency in the modern history of the higher learning. It is what I call the moral crisis of the university.

I firmly believe that these large questions are essential foundations for any effective change or conservation in higher education. For always some new things must be invented, some things will benefit from change, and some things must be conserved. Some core principles must remain non-negotiable. I agree with Katz: tenured faculty in higher education are the last, best hope for addressing these large questions of common goals and acceptable activities.

It may not yet be too late.

Syndicated, Virginia Group

Faculty Development

I want to take a moment to emphasize the value of faculty development in an open environment.  Both OpenLearning17 and OpenLearning18 provided opportunities to explore open pedagogy “in the open.” They also created a space for connecting with other faculty members and administrators with an interest in open education. I value my time in both OL17 and OL18—the topics I’ve explored, the people I’ve met— and I look forward to future iterations!

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What Makes a Compelling Faculty Development Opportunity?

This post is going to be short and I hope sweet. The best faculty development opportunities I’ve experienced in my career haven’t been designed primarily (or explicitly?) for faculty development:  Examples include UMW’s Faculty Academy, ELI Annual Conferences, at least in the early years, the SERC project, and OpenEd Conferences, to name just a few.   What have they had in common? They were rich scholarly experiences, rather than training per se. That workshop on Excel may have taught me a few tricks with the software, but they didn’t fundamentally change the way I teach or think about teaching. The best faculty development opportunities were framed in a way that drew me in, that made me think the question they were exploring was interesting, even if I came in thinking the opposite. (I could name some of these, but I don’t wish to upset any of my friends.  What you should remember is that I ended up in the right place.) These opportunities became intellectually compelling so that for a while (an hour, a day, a few days—whatever the length of the event) I forgot about real life and immersed myself in the problem at hand. And then, much to my surprise, I found myself thinking of ways this exploration could be applied to my teaching.  In short, these activities were about scholarly learning rather than training.

That’s what I’ve found rewarding about #OpenLearning17-18.  There were several topics in #OpenLearning17 that I didn’t think would interest me, but somehow I was carried along by the interest of my co-learners, and then found that I was interested as well.  Part of it was the journey–the fact that I was studying a topic with a group of colleagues who, in the process, became friends.  I wanted to contribute to our collective learning, so I had to take the process seriously.  This is especially true in an open learning environment.  Part of it was the conference effect–that what was happening was occurring outside of my normal work.  That’s why going away, either literally or virtually, matters.  With open learning, the colleagues I worked with included people I might never have had a chance to meet in real life.  Yes, non-economists! 😉  That diversity (of place, of discipline) made the experience much richer for me.  And it continues to do so.

 

Syndicated, Virginia Group

Tolstoy, Economics and OER

OpenStax - $ Contribution page

David Wiley wrote a recent blog post that had me scratching my head. In the post, David argued that OER is in a feature of the resource, not who is providing it and whether the provider is offering it for free. This whole thing got me thinking about OER, commercial publishers and non-profit providers.

I know there are people who are opposed in principle to publishers who charge for their products in order to make a profit. I don’t have a problem with profit. If a chef opens a restaurant in my community and offers good food at a reasonable price, I am happy if they make a profit with the business, because that means they are likely to stay around. What I do have a problem with is excess profit. My favorite example, which some of you will remember, is Blockbuster Video. Blockbuster offered lousy service and charged too much. But they were the only game in town, so if you wanted to watch a video that night, you pretty much had to go to Blockbuster.

The first rule of economics is that nothing is produced for free; if it’s free to use, someone else is paying. This is not a moral judgment. Rather, it’s a fact of life. Everything (or almost everything) has a cost to produce. Image of Leo Tolstoy dressed in peasant clothing

Leo Tolstoy gave up the copyright to his early novels, and adopted a peasant lifestyle.   I can’t imagine what his family thought of that. Most of us are not like Tolstoy. We all need to provide for ourselves, and our families. When I helped write OpenStax’ Principles of Economics, I was paid a reasonable stipend to compensate me for the time. It didn’t make me rich, but it was enough. If I was one of those heroic authors, like my colleague Caitie Findlayson, who writes an open textbook without the support of any publisher, I would be able to do it only because I had the luxury of time as part of my professional responsibilities as a tenured faculty member. In other words, I would be implicitly compensated by my institution, but the cost would be the other scholarly work I wasn’t able to do in that time. There is always an opportunity cost. If I was working 9 to 5 somewhere, I wouldn’t be able to do the project at all.

OpenStax is a nonprofit organization. Where did they get the money to pay me, and to pay the other expenses of producing the book? The answer is grant funding. Grants are great, but they run out. Then what? How does OpenStax pay for the servers on which the book resides? How do they pay for updates and corrections? How do they pay for new editions? This is a perpetual challenge for non-profits. As far as I can tell, OpenStax has a four-pronged approach:

  1. They ask for donations. I don’t know how successful this us, but I suspect it’s not much.
  2. Ten percent of their adoptions are in print form. They sell these at slightly over cost, which means those copies generate some revenue.
  3. They look for more grants, but granting agencies prefer to fund new books to maintaining existing ones.
  4. They find commercial partners to work with, like Sapling Learning. Sapling offers the OpenStax text with online end-of-chapter problem sets and quizzes. In return, Sapling gives OpenStax a modest kickback, and then OpenStax markets the Sapling option. (I mention Sapling because I used their product after I adopted OpenStax. OpenStax has many more partners than Sapling.)

Do people criticize OpenStax because of their affiliation with Sapling who charges a fee for the book plus ancillaries? I may be wrong, but I don’t think so. Do they criticize OpenStax for openly allowing Sapling to use their open texts? I’ve not heard that criticism. Have people criticized Sapling for exploiting the open license of OpenStax? I haven’t heard that either.

The elephant in the room is commercial publishers who are beginning to offer OER wrapped in a package for a price. Traditional proponents of OER are rightly suspicious of commercial publishers who are new to the OER field. Commercial publishers have a long history of charging very high prices for textbooks, higher than can be justified by costs.

Take “Inclusive Access” for example. If you’re not familiar, Inclusive Access is a marketing venture by commercial publishers to rent digital texts to an entire class for a discounted price. Students are on the hook to their university for the bill, unless they opt out, so the “nudge” is in the wrong place. Inclusive Access strikes me as akin to OpenWashing. While the digital text is cheaper than a new print edition, at my school at least it’s not very cheap, coming in a bit under $100. It’s a pretty good deal for the commercial publishers, since the marginal cost of a digital copy is about zero. And Inclusive Access is certainly not OER since the access goes away at the end of the term.

When is it legitimate to charge for OER? Like any product, charging is appropriate if the product adds value, in this case to the OER. Sapling added value to OpenStax Principles of Economics because it offered a feature that OpenStax didn’t have. The problems & quizzes helped students learn better than just with the text alone. Similarly, Lumen Learning adds value in its Waymaker platform for the same reason.

Of course, one can argue that the value added isn’t worth the price. In the older model of commercial publishers, they charged for the book and then offered the ancillary products, including online quizzes and problems for free. But the package was pricey. Cengage is currently charging over $200 for their market leading Principles of Economics book.  That price has come down from its original $385.  Sapling charged about $40 for its product, which included OpenStax Principles of Economics. Lumen Learning charges $25 for its Waymaker Principles of Economics. Sapling struck me as a bargain for what it offered my students. Waymaker, which I’ve used for the last three years, is even better, especially since my own statistical analysis has shown that the average student does at least as well with Waymaker as with the previous commercial text I used. Perhaps more importantly, Waymaker seems to help weaker students more than stronger ones.

Commercial publishers have traditionally charged too high a price for their books two reasons: First, because they have a higher cost structure (due to their large sales force). Second, they have exploited their market power to charge more than a reasonable price for their products. Netflix mailing envelope w/DVD insideMonopolies often fall when a technological improvement creates better alternatives. Thus, Netflix supplanted Blockbuster.  Only when OER came on the scene did cracks appear in the commercial textbook oligopoly. (For non-economists, an oligopoly is an industry dominated by a small number of firms that exploit their joint monopoly power.) Newcomers like Sapling brought textbook prices down to under $50. And Lumen Learning brought them down to $25. Is $200 too much to ask a student to pay for a textbook? In my opinion it is, especially given the alternatives. Is $25 too much to ask? I’ve asked my students that question every semester that I’ve used Waymaker, and no student has ever said yes.

Lumen Learning deserves some kudos: For every course for which they offer their Waymaker value-added OER, they also offer a free version of the Waymaker content without the added features. This free version is openly licensed to include the 5Rs. It’s hard to ask more than that.

Disclosure: I’m the lead subject matter expert for Waymaker Principles of Economics and I’ve taught with Waymaker for the last three years.

 

Image credits:

OpenStax website

Image By Ilya Repin – ugFXC9F7-NWM9Q at Google Cultural Institute maximum zoom level, Public Domain, https://commons.wikimedia.org/w/index.php?curid=21854099

Image Netflix courtesy of Abhijit Bhaduri via flickr.com

Syndicated, Virginia Group

Beautiful Study

Elaine Scarry,

Elaine Scarry’s On Beauty and Being Just has long been food for the journey for me. Yesterday Scarry’s insights emerged yet again at an important moment, both for me and for my students in ENGL 325, Early Modern Literature, as we met for a second time to consider Aemilia Lanyer’s brave, complex, and intense poem Salve Deus Rex Judaeorum (1611). Lanyer’s poem is vitally concerned with beauty, truth, and justice. They’re central topics in her retelling of Christ’s Passion, but they’re also linked on multiple levels to Lanyer’s own biography and proto-feminist arguments. I wanted my students to get a feel for how deep, complex, and important Lanyer’s thoughts on beauty are–why beauty mattered for her, and in what ways, and how those ways might be relevant to us as learners, too.

I knew Scarry would be a vital part of the context for our discussion, so I read a longish excerpt aloud to set the tone for the class. What I read was so resonant at that moment for me, too (this always happens on good teaching days), that I wanted to share it with you all. For me, Scarry’s words go deeper, and are more vital, than much or even most of what I read about “higher education” these days. I think her words are especially interesting in light of Open Pedagogy week in Open Learning ’18.  For me, open learning seeks to reveal, and by revealing stimulate, insight and love. Or, as Scarry writes, “to place oneself in the path of beauty is the basic impulse underlying education.” At its best, open learning shares and encourages the placement Scarry describes. Open pedagogy, then, leads by example.

I also think that “studying,” a neglected term in many contemporary conversations about learning, involves a version of the “staring” that Scarry celebrates below. One older sense of “study” used to mean something like that. When I was a child, my father would perceive me lost in a reverie and ask, “what are you studying?”   I hope such staring does not become lost in all the laudable “experiential real-world problem-based” approaches to learning celebrated so widely today, valuable as they certainly are. Contemplation, musing, mulling: these too are modes of active learning, no less important for the rapt stillness they inhabit.

So here’s Elaine Scarry, who begins by thinking about the way “beauty prompts copies of itself”:

This phenomenon of unceasing begetting sponsors in people like Plato, Aquinas, Dante the idea of eternity, the perpetual duplicating of a moment that never stops. But it also sponsors the idea of terrestrial plenitude and distribution, the will to make “more and more” so that there will eventually be “enough.” Although very great cultural outcomes such as the Iliad or the Mona Lisa or the idea of distribution arise out of the requirement beauty places on us to replicate, the simplest manifestation of the phenomenon is the everyday fact of staring. The first flash of the bird incites the desire to duplicate not by translating the glimpsed image into a drawing or a poem or a photograph but simply by continuing to see her five seconds, twenty-five seconds, forty-five seconds later–as long as the bird is there to be beheld. People follow the paths of migrating birds, moving strangers, and lost manuscripts, trying to keep the thing sensorily present to them. Pater tells us that Leonardo, as though half-crazed, used to follow people around the streets of Florence once he got “glimpses ot it [beauty] in the strange eyes or hair of chance people.” Sometimes he persisted until sundown. This replication in the realm of sensation can be carried out by a single perceiver across time (one person starting at a face or listening to the unceasing song of a mockingbird) or can instead entail a brief act of perception distributed across many people. When Leonardo drew a cartoon of St. Anne, for “two days a crowd of people of all qualities passed in naive excitement through the chamber where it hung.” This impulse toward a distribution across perceivers is, as both museums and postcards verify, the most common response to beauty: “Addis is full of blossoms. Wish you were here.” “The nightingale sang again last night. Come here as soon as you can.”

Beauty is sometimes disparaged on the ground that it causes a contagion of imitation, as when a legion of people begin to style themselves after a particular movie starlet, but this is just an imperfect version of a deeply beneficent momentum toward replication. Again beauty is sometimes disparaged because it gives rise to material cupidity and possessiveness; but here, too, we may come to feel we are simply encountering an imperfect instance of an otherwise positive outcome….

This willingness continually to revise one’s own location in order to place oneself in the path of beauty is the basic impulse underlying education. One submits oneself to other minds (teachers) in order to increase the chance that one will be looking in the right direction when a comet makes its sweep through a certain patch of sky. The arts and sciences, like Plato’s dialogues, have at their center the drive to confer greater clarity on what already has clear discernibility, as well as to confer initial clarity on what originally has none. They are a key mechanism in what Diotima called begetting and what Tocqueville called distribution. By perpetuating beauty, institutions of education help incite the will toward continual creation. Sometimes their institutional gravity and awkwardness can seem tonally out of register with beauty, which, like a small bird, has an aura of fragility, as when Simone Weil in Waiting for God writes:

The love of the beauty of the world … involves … the love of all the truly precious things that bad fortune can destroy. The truly precious things are those forming ladders reaching toward the beauty of the world, openings onto it.

But Weil’s list of precious things, openings into the world, begins not with a flight of a bird but with education: “Numbered among them are the pure and authentic achievements of arts and sciences” To misstate, or even merely understate, the relation of the universities to beauty is one kind of error that can be made. A university is among the precious things that can be destroyed.