Author Archives: Peter Asman

About Peter Asman

Peter Åsman, MD, PhD Senior Lecturer / Senior Consultant Dept of Ophthalmology Malmö University Hospital

Concluding week – future perspectives

The ONL course has (according to my current opinion) fostered an understanding of online learning in it´s higher definition from simple pdf downloads. At least at my programme many teacher would place equal signs beetween e-learning and the use of an LMS full of word processor documents and powerpoint type of files. In my own use I have previously added instructional videos and interactive flash media. As the ONL course has continued It has become more and more apparent that there is much more than that to be utilized. I had made some hurting and crippled attempts in setting up AdobeConnect meetings before this course but was so frustrated by tons of technical issues that I gave up – until now when I have learnt how to schedule and set up Google+ video hangouts (a small step for man – a giant leap for me). I have also learnt to appreciate the value of short instructional videos at a higher level than before. A pretty well packed toolbox has also been presented and a few of those have been very inspiring – diigoo probably most and padlet but many more as well.

I sense that the ONL course will have a major impact on my teaching in the future especially in terms of providing student groups the opportinity to meet with the facilitator online outside of campus. Escpecially handy for periods of extended self study and for the convenience of campus students unable to attend class. Also I might try out some of the collaboration tools prezis and padlets for student use. Need to figure out easy ways to integrate those into our Moodle structure. Im also more inclined to use Mahara as an online portfolio tool for my students to allow students to more easily select materials for presentation against summative assessment and also to provide a way to accommodate an online portfolio across individual Moodle courses.

I’ve always been very keen on using technology in my teaching and the ONL course has offered me some new tweaks that I hadn’t payed any attention to earlier. Most of all I’ve seen the major possibility to use collaborative tools – indeed very interesting.

A specific short term goal is to power up our Moodle page with some better instruments for collaboration – a paddle link maybe Google+ and hangout additions and much more. It would be especially interesting to try out a full scale online sub-course as a replacement to the current blended learning environment.

When I think back on the ONL course and where I learnt the most I end up in the numerous videos, good readings and interesting asynchronous communications. The synchronous tools, however gave me experience on using the tools but theoretical contents probably not so much. I’m therefore still in the mode of thinking where synchronous tools are for planning learning rather than learning per se.

So, in conclusion, I’ve experienced a very intense, content packed, friendly course that has been a great joyful learning experience despite the fact that, at times, time has not been available. Hope that there will be opportunities for future collaborations with the very relaxed, creative, and wonderful PBL peers.

Supportive learning envoironments

Supportive learning environments are very important. With an increasing diversity of students these environments need to accomodate various needs and various learning styles. This is true for online education, as well as blended learning environments and campus courses. In my perspective running a blended learning module support in the online world has posed some specific problems that I’ve yet to solve. More on that below.

Support could be many things. I would foremost think of support as the availability of on demand feedback in relation to intended outcomes (10.1037/0033-295X.100.3.363).  Online, that could mean immediate automated feedback on online quizes (24003913), a route to a mentor, tutor, facilitator when topics are difficult to understand – could be by means of (e-mail) or instant messaging och video calls. The latter is much more time consuming than predefined quiz feedback. Supplementary to that, at least in blended learning, the physical availability of the teacher is valuable so that students can engage in short face to face meetings either for cognitive support and to reassurance or for support in psychomotor skills training (24458338).

Similar support could also be obtained from peers during video-conferences, discussion forums, chats or by formal student-led teaching. Such support seems to function well for learning both for the student “learner” and the student “teacher” (10.2147/AMEP.S14383).

An entirely different kind of supportive environment relates to support in operating the digital tools necessary for engagement in the learning environment. This includes support in setting up tools in one’s own computer in the initial phase of a course or possible also in the pre-admission phase. This requires that the course organizer or individual facilitator collects enough information about and from the new learner on skills (digital litteracy) as well as providing information on prerequisites. During a course such support could include technical support from facilitators participating in video-meetings, by providing instructional videos or even simple FAQ boards.

A third kind is the support needed for dysfunctional online groups. This requires careful monitoring of activities and I would suppose that efficient routines need to be set up to prevent excess in instructor workload.

Finally support also need to be targeted towards specific individual needs such as vision disorders where specific measures are needed. A good webpage on how this can be done is found on American Foundation for the Blind webpage. Screen readers labelling images and typefont sizes are options among others. Color blinds would have difficulties collaborating on shared documents if color is used to identify individual contributors.

In conclusion a supportive environment is a very multifaceted construct where several pieces of the puzzle need to fall in place.


Open educational practices

During the past couple of years I have thought much about openness in terms of my own educational resources. From being very protective having everything behind secure passwords I have gradually open up. The way my students, and myself work before and during group meetings depends on availability of online resources. Since the course list provides options rather than necessities in my teaching other resources are crucial. I have thus come to the conclusion that I can’t justify keeping my material hidden if I’m demanding access to others. So, a few years ago I was approached by the local iTunes-U group who needed material to reach a critical mass on the university level. A lecture series was uploaded in this way. So far, I have not faced a situation were I needed to regret this and it has also made my life as a teacher a bit easier. Students have encouraged me to proceed and now everything in my undergraduate teaching is public.

I have been wondering why there is such a general resistance towards this culture of open resources and there are several reasons, in my own domain of medicine, that may be important.


, Argument, Possible solution

1, Lack of time, Allocation of budget

2, Lack of knowhow, University and/or programme level education

3, Images and resources used are not open resources, Allocation of budget to make own / to find open resources

4, Images of patients may violate legislation, Tricky – photo model contracts for patiens?

5, ‘My material needs to be hidden for pedagogical reasons’ , University and/or programme level education


I asked my students to suggest reasons as well and they came to similar alternatives besides the last which probably is a reason only in the head of the teacher. Regardless, they felt it was unacceptable that materials were unaccessible merely because of legislative perspectives patient security (reasons 3 & 4) and that actions need to be taken to resolve this issue. I’m more prone to back up student opinion now than before engaging in the ONL course. The OER Evidence Report 2013-2014 forwarded by Ebba Ossiannilsson provided a reasonable research foundation for continued efforts along this route.

From the experiences of the ONL course so far I see a need for massive education in the use of and creation of open educational resources as well as of online learning pedagogy. I envisage courses and seminars at a faculty and programme level to facilitate the late migration into the new century. Apart from that I also feel that my own teaching is at a major turn at the moment and it’s definitely a feeling i like making it even more fun and challenging to act in undergraduate teaching.

Flexible learning

The week has been devoted to understanding flexible learning. I was curious to look into my own practice to see if there were elements of flexible learning and wether these were beneficial, detrimental, or didn’t matter. I’ll take a closer look on previous semester. I’m responsible for the education of eye diseases at the medical programme in Malmö. The clinical rotation involving theory and work place practice is 6 weeks together with ear nose throat education so about half time for six weeks. I’m using a flipped classroom model since several years based on a complete replacement of all my lecture hall lectures into 48 short home made video screencasts partitioned into 6 discrete topics. Students are encouraged to view the appropriate movies before class. At our face to face group meetings (3 hours per week) we start out with a short quiz to be completed individually and then in small teams. After that we work together with a number of clinical case scenarios which have been available to the students beforehand including interactive real time patient simulations. Students have been asked to prepare solutions to the cases in their teams before class.

Resources for learning are structured in Moodle-books and are avilable free in swedish at our Moodle site. Flexibility comes into play with the availability of online lectures – an inflexible part of this is that the lectures are tailored but alternative resources may, on the other hand, well be found. This allows students to go back and forth in the lecture and to repeat it. Team work around case solutions also include a great deal of flexibility in that student groups are free to plan their activities timewise even though times decided to meet by team members may not always fit well for everyone. No restrictions are set for how teams work with their cases.

Suggested readings is another area where my teaching offers flexibility. Two text books are indicated as “course litterature” and students are generally supposed to buy one of them. My way of dealing with this issues is having several different text books on display and available for students to read at their leisure in a combined skills lab/study room at the department. Litterature is then viewed as sources of information needed to discuss and understand clinical management of our patients. The source can thus be any combination of books, journal articles, web pages, lecture notes, etc.

Parallell to learning theoretical parts students have their own patients under supervision of a mentor in small groups. This part is fairly inflexible just like working hours for professionals, i.e. you need to be there or else you have to call in sick or provide acceptable excuse in advance.

Skills training also occur without tutor but with the help of peers in the skills lab. Students have to learn a few moderately complicated motor skills and they have digital tools to aid this training. Flexibility is offered in that students arrange their training at their own pace by collaborating and using the numerous blank areas in the time schedule. They are also encouraged to ask for help when needed and either myself or the clinical mentor are usually available for coaching as needed. I’ve summarized flexible learning in my own practice in the table

Part, Flexibility, Inflexibility, Pros, Cons
Lectures, Online 24/365, My content, Always available, Production ‘cost’
Group acitivities, Students plan timing, Cases predefined, Collaboration training, –
Litterature, Student’s choice, -, Fits the individual needs, Can be difficult to choose
Skills training, Students plan timing, skills predefined, Collaboration training + Time abundance, Students may plan inefficiently
Real patient work, -, Need to show up and work, Professional training for all + Immediate professional formative feedback, –

So, my impression is that my practice offer a fair amount of flexibility which is very uncommon at our programme which usually falls back on heavily packed time schedules with lectures and full time teacher planned activities. I’m also quite happy with the amount of flexibility but I can easily imagine and understand the fear that many teachers would have that content might not be covered appropriately by many students. Adequate assessment is one way to ensure quality.

What I would like to try, based on the experiences from this ONL course so far, is to implement digital environments for that group or team work that is now face-to-face with me. An introduction for this might be using hangouts, or Adobe Connect to include students that for some reason couldn’t attend, and also to possibly record the group sessions for the sake of those.

Collaborative learning and communities

An interesting week covering issues I have been struggling with in my own practice. Running a blended learning course with students in the vicinity most of the time has introduced some obstacles to online collaborative learning. I’m using a slightly modified mode of team based learning (moving from a PBL oriented approach) so collaboration is an integral part of the learning process. For long and in periods I have tried to facilitate digital collaboration by adding forums and chat rooms with next to zero impact. Having read Asynchronous & Synchronous E-Learning by Stefan Hrastinski I have realised that there needs to be more specific reasons for the students to engage with the tools than just collaboration per se. There is an intense use of other online learning objects posted on the LMS with the intention of illustrating problems or scenarios that calls for investigation and solutions. They’re also used in such a way that students collaborate in groups to present such solutions. However, collaboration occurs in the classroom and moving it out of the classroom into online spaces requires critical rethinking of the actions needed in my role as a facilitator in the team work process. Based on the suggestions by Hrastinski I would start out by adding tools in the LMS for synchronous communication with the intended use for planning preparation for the classroom face to face activities. Proper preparation must be dependent on online collaboration e.g. by instructing students to produce a padlet for each group illustrating their basic understanding of the topic to be covered in the face to face meeting. If that works out well, the next step might be to replace the face to face meeting as well. The only thing holding me back at this point is an uncertainty that every student in fact is in possession of the required digital skills and tools.

Another problem I have been thinking about relates to intended learning outcomes. Teaching in a fairly strict outcomes based curriculum ending in a certificate for a profession I’m relying on a shared agreement between students and faculty that what is happening in the various venues (lecture hall, group room, clinical ward attachment online quiz etc) somehow acts in the direction of a common outcome with minimum criteria for achievement, in the best of worlds understood by all involved individuals. In this sense collaboration could be seen in the light of a common goal. From my understanding, so far admittedly being a complete novice in the field, of open networked learning, this may be an assumption at times or even frequently violated and individuals more likely have individual goal as the primary focus. I challenge other course participant to disprove me on this one. Some insights in how the asynchronous collaboration can be enhanced and become more meaningful are given by Randy Garrison in Elements of quality online education: Practice and direction 2003. The importance of creation of and reflection on learning outcomes as well as deliberate actions in relation to those outcomes are stressed.

Digital litteracy

Digital literacy seems intuitively to be a generic skill, applicable irrespectively of context. On second thought digital literacy has both generic and context specific components. In the field of medicine digital literacy is at the heart of competencies required for carrying out the most basic tasks. The system for patient records is a good example of how digital literacy surrounds everyday routine practice. The patient record previously consisted of a folder including masses of typewriter-filled paper documents, sometimes shared with framed 35 mm slides for image purposes. One folder securely kept at each hospital department. Today, the retrieval of information relies on using digital interfaces to search databases from various hospitals and departments for key information. Thus, an enormous overflow of information is available and skills to selectively find the relevant information is required. In analysing the information retrieved, some systems may provide computer-based decision making programs of applications for better organising the visual output for better overview. The extent to which an individual physician could benefit from such add-ons depends deeply on the appropriate skills. Finally dissemination of information comes when new findings and new interpretations of these are digitally put into the database for coming health staff, or other relevant agents (insurance companies etc) to retreive when needed. The way such information is packaged and entered critically affects the possibility of others to efficiently retrieve it and use it. Oftentimes mandatory digital instruments (e.g. patient record systems) are launched by enthusiastic ICT units only to become subject of the deepest of frustration when facing the end user (which in many instances is not only staff but also students walking along their path into a profession). This leads to the question of how we reason around the need to define digital literacy in concrete terms in relation to generic and specific components. If such concrete skills are eventually defined then comes the need to insure, on an individual as well as organisational level, that required skills are mastered. Assessment tools are indispensable in this process and many variations are presented on various web-pages, some of which can be easily used for self assessment. For a certain organisation or unit such assessment tools must be tailored for it’s specific needs. If ICT systems are to be efficiently used at all levels it is, however, a requirement that assessment occurs and that adequate remediation is at hand when needed.

Here’s a web-based questionnaire which is very software/hardware oriented. In contrast a much more in depth method is described by Irvin R Katz in 2007.  Looking at my own education programme such assessment is very scarce both for student evaluation and for teacher evaluation. An interesting report from Deakin University can be found here where it is pointed out that surveys like the first of these two tools may not be sufficient since they provide little evidence of true literacy while portfolios and genuine tasks like the second tool may well be better suited for this purpose.

I’m now eager to dig into my own environment for a needs assessment


First topic done?

Finished off the first topic, at least almost. Spotted a few problems. Seemed to be difficulties in getting the PBL-group together. Several reasons may be at hand but one thing that strikes me is that communication is a bit confusing. Many areas on the web to scan, not easy to find e-mail-adresses and I guess if you get lost in the beginning it may be hard to keep up with the course pace. I’m still to get familiar with the layout of the Google+ area. It’s not ordered in the way I would like but can’t yet put my finger on where the problem is.

On a very positive note I’ve got to learn a bit on a wonderful cork board “padlet”. Entirely new to me but will certainly come in handy in many situations in my future teaching. Also, the short videos posted have been really instructive and I’m eager to produce a number of such into my programme.

Another aspect important to my teaching is how to best mix online learning with campus and workplace learning. This is a real challenge for educational programs for professions like medicine, nursing, teaching etc since students may well be on campus for long periods.