Running Head: INCORPORATING TECHNOLOGY IN TRADITIONAL 1

Incorporating Technology in
Traditional Instructional Design
Models for Clinical Education
Bret Wydysh

University of Utah

EDPS 6430
INCORPORATING TECHNOLOGY IN TRADITIONAL INSTRUCTIONAL DESIGN MODELS FOR CLINICAL
2EDUCATION

Incorporating Technology in Traditional Instructional Design Models for Clinical

Education

Introduction:

Instructional design (ID) is a systematic process by which education and training

programs are developed to engage, inspire, and efficiently deliver content. Also known as
Instructional Systems Design (ISD), designers use a variety of methods including, audio, video,
simulations, online course and instructional strategies to effectively engage the learner. While
instructional design is not a new concept, its implications in today’s world are increasingly far
more apparent than they ever have been before. The need to educate many individuals effectively
in a wide array of topics and applications extends to academics, industry and beyond. I will
review the historical roots of ID and then discuss how ID models can serve the everchanging
educational landscape of today especially in medical education.

History of Instructional Design:

Instructional design has its roots from World War II (WWII) (Reiser 2007). The need to
train vast numbers of men to serve in the nations military to help with the war effort was
identified, and the fathers of instructional design went to work developing the basis for what we
know ID to be today. Most notably Gagne, Briggs, and Flannagan led the push to develop these
principles. One early example of work done by Gagne was the testing of entry skills for
individuals entering a flight training program. By testing their skills prior to entry, the candidates
who performed well were able to move on while those who scored poorly were sent to other
programs (Reiser 2007). This highlights a very important aspect of any ID model of identifying
the entry skills of the learner prior to instruction.

B.F. Skinner in 1954 penned an article called “The Science of Learning and the Art of
Teaching”. In it he outlined a method of instruction relying on small steps and frequent responses
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to questions which would provide feedback to the learner immediately, thus allowing for a self-
paced environment. Similar to modern models the Skinner and others used a systematic process
for developing programmed instruction (Reiser 2007). By evaluating the data with respect to the
effectiveness of the instruction, weak elements were identified, and improvements were made to
the materials. Today this process is known as the formative assessment.

The concept of behavioral objectives became popular in the 1960’s with the introduction
of Robert Mager’s book Preparing Objectives for Programmed Instruction (1962). Behavioral
objectives dictate the conditions for which the learner(s) are to perform the desired behaviors. To
this day the criteria, conditions, and behavior are contained in performance objectives (Dick and
Carey, from Reiser 2007). Even though the concept of behavioral objectives were made popular
by Mager, they were described as early as 1934 by Ralph Tyler (Reiser 2007). In 1956 Benjamin
Bloom published the Taxonomy of Educational Objectives. In it he suggested that there are
various types of learning outcomes within the cognitive domain. He went on to suggest that the
design of tests should be made to measure these outcomes (Reiser 2007). The 1960’s bought
about “Criterion-Referenced testing” which replaced “norm-referenced tests” and focused on the
performance of behaviors as they applied to the individual being tested.

One of the most pivotal development’s in the timeline of instructional design is the
publishing of Gagne’s The conditions of Learning in 1965. The book outlined the 5 domains of
leaning outcomes: verbal information, intellectual skills, psychomotor skills, attitudes and
cognitive strategies (Reiser 2007). Modern ID models like the SDI model emphasize the use of
these domains (Dick &Carey, from Reiser 2007).

The need to assess the effectiveness of instructional materials wasn’t realized until the
late 1960’s. After losing the space race to the USSR in 1957 the US government committed
millions of dollars into improving math and science education. The resulting materials were
found to be ineffective. Michael Scriven showed the need to perform try-outs of the drafts of the
instructional materials. This allows the designers to revise the materials if necessary before
they’re distributed for mass consumption. Scriven developed the terms formative assessment to
describe this revision process and summative assessment for the process of assessing the
instructional materials once they’re finished (Reiser 2007).
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The earliest ID models appeared in the 1960’s, Gagne, Glaser, and Silvern were some of
the first individuals to describe the systematic design of instructional materials. In the 1970’s
more ID models came to fruition, most notably the Dick & Carey model, which is a mainstay of
graduate education. Industry, academics and the military got on board using ID models to
develop training curricula (Reiser 2007). In the 1980’s ID continued to gain popularity in the
business and industry sectors, however it sagged in the public-school system. With the advent of
the personal computer in the 1980’s many in the ID field began to focus on computer-based
learning (Reiser 2007). This led some to think that new models were needed. In my opinion
many models are capable of working in harmony with evolving technology. However, Hannafin
(1993) argued that the shortcomings of traditional models have become more evident due to
advances in educational technology (Goksu et al. 2017).

Modern Application of ID models:

There are at least 50 different ID models that can be employed in the development of
instruction. Generally speaking, they are used in to develop instruction in the fields of science,
mathematics, and computer and instructional technologies (Goksu et al. 2017). In medicine, very
few studies have been conducted however, several authors have evaluated how certain ID models
can affect medical education. Multimedia design (Issa, 2013), Cognitive load theory (van
Merrienboer & Sweller 2010), Problem-based learning (Ntyonga-Pono 2006), Gagne and Briggs
(Goksu et al. 2017) and Simulated Interaction (Dotger et al. 2010) are examples of models used
in medical/clinical education. It is important to remember that in any medical field that the 5
domains of learning outcomes are all expressed in some form. Therefore, when designing
instruction, it is essential to use a model that can support the needs of the learner given that the
outcomes of learning may be very complex (Cheung 2016).

In the realm of modern learning, technology as a facilitative agent is becoming

ubiquitous. Multimedia, simulations and educational games are just a couple examples of
common pedagogical tools (Onyrua 2016, Issa 2013). Multimedia learning is not a new concept
to instructional design, it’s applications date back to WWII (Reiser 2007). More recently Richard
Mayer has shown how the incorporation of multimedia into clinical education can improve
learning (Mayer 2010). In his paper he explored multiple principles for decreasing extraneous
processing (improving instructional design), managing essential processing (decrease intrinsic
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load) and fostering generative processing (making the material easy to understand) through the
use of multimedia. Cognitive load theory suggests that using multimedia can decrease extrinsic
cognitive load and optimize germane load, thus leading to better learning outcomes (van
Merrienboer & Sweller 2010). Issa et al (2013) showed that by using multimedia-based lectures,
with Mayer’s design principles, learners were able to perform better in testing than those without
the use of multimedia.

Simulations can provide and “authentic” learning experience with can allow a clinician
learning a skill to be immersed in a situation that is similar to the work environment (Onyura et
al. 2016). This type of model is very consistent with the constructivist ideas that grew in
popularity in the 1990’s (Reiser in 2007). There are multiple ways a simulation can be provided,
computerized mannequins, virtual patients and virtual reality are several examples. In reviewing
outcomes in the use of these different models, Onyura et al. (2016) found improvements in
knowledge, confidence, skill acquisition, and skill execution as well as professionalism,
communication, and ethical reasoning (2016). Dotger et al. (2009) evaluated a live simulation
model where the models are standardized, such that the learners could experience the most
common problems for a given context. While this method doesn’t utilize technology per se this
method could potentially be employed through a virtual simulation paired with an artificial
intelligence (AI).

Experiential learning is a pedagogical tool that lets students apply concepts learned in the
classroom and apply them to the real-world (Anderson et al. 2016). Educational games can be a
type of experiential learning. Onyura et al., looked at several instances of educational games for
medical education. They found that games may improve learner satisfaction, knowledge and
motivation. Their review, while limited, shows that educational games may support traditional
classroom learning and gains in knowledge.

Perhaps the most classic and ubiquitous method of instruction in modern medical
education is problem-based or case-based learning (Ntyonga-Pono, 2006). Onyura et al., 2016
separates them as to separate pedagogical tools, but their execution and results are quite similar.
Traditionally these two methods provide the learner with a problem that has implications in
clinical practice. The instructor then facilitates a student or group of students through the
problem, guiding with questions and additional information. This method helps to improve
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clinical reasoning, interpersonal relationships, knowledge, problem-solving abilities, and clinical

skills (Onyura et al. 2016). In the analysis by Goksu et al, Problem-based learning was associated
with an increase with academic success. While the problem-based model typically enhances
learning through situated cognition (Ntyonga-Pono, 2006), Mounsey and Reid, (2012) explored
the effectiveness of computer-based scenarios. In their study they looked at power-point based
computer modules, one of which had case-based scenarios, and compared testing outcomes
between the case-based and non-case-based instruction. Their study reinforced the efficacy of
computer-based learning, and further showed that applying a case-based approach can improve
learning. In addition, Onyura et al. (2016) review of e-learning showed improved course
satisfaction when compared with print, and knowledge gains were better or at least equivalent to
traditional methods.

Conclusion:

The use of instructional design models has been shown to improve many aspects of
learning. In the realm of clinical education, the use of technology when combined with
instructional design has been shown to improve knowledge, motivation, skill acquisition,
decision making skills, confidence, ethical reasoning, professionalism, communication skills,
problem-solving, and academic success. As instructional technology advances, instructional
design will remain as the ever-important back bone allowing for the instruction to be delivered
effectively and for the learners to benefit. Improving our measurement techniques will allow for
improved data collection on the effectiveness of instruction and thus for better instructional
materials. Even though Gagne developed his 5 domains of learning outcomes in 1965, there is no
doubt that they are just as relevant today. In fact, many of the original design models including,
ADDIE, PBL, SDI, ARCS, and Gagne & Briggs, all hold up in the face of modern technology.
With this in mind the designer should choose which model to use based on the front-end
analysis, so the needs of the learner can be met appropriately.
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References:

Anderson, S., Hsu, Y., Kinney, J. (2106) Using Importance-Performance Analysis to Guide
Instructional Design of Experiential Learning Activities. Online Learning, 20(4).
Cheung, L. (2016) Using an Instructional Design Model to Teach Medical Procedures.
Medical Science Education, 26, 175-180.
Goksu, I., Ozcan, K. V., Cakir, R., Yuksel, G. (2017) Content Analysis of Research Trends
in Instructional Design Models: 1999-2014. Journal of Learning Design, 10(2), 85-
109.
Issa, N., Mayer, R., Schuller, M., Wang, E., Shapiro, M.B., DaRosa, D.A. (2013) Teaching
for Understanding in Medical Classrooms Using Multimedia Design Principles.
Medical Education, 47, 388-396.

Mayer, R.F. (2010) Applying the Science of Learning to Medical Education. Medical
Education, 44, 543-549.

Mounsey, A., Fied, A. (2012) A Randomized Controlled Trial of Two Different Types of
Web-Based Instructional Methods: One with Case-based Scenarios and One Without.
Medical Teacher, 34, e645-e658.

Ntyonga-Pono, MP. (2006) Problem-Based Learning at the Faculty of Medicine of the

Universite de Montreal: A Situated Cognition Perspective. Medical Education
Online, 11-21.

Onyura, B., Baker, L., Cameron, B., Friesen, F., Leslie, K. (2016) Evidence for Curricular
and Instructional Design Approaches in Undergraduate Medical Education: An
Umbrella Review. Medical Teacher, 38, 150-161.

Reiser, R. A. (2007) A history of instructional design and technology. In R. A. Reiser & J. V.

Dempsey (Eds.), Trends and issues in instructional design and technology (pp. 17-
34). Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

van Merrienboer, J.J.G., Sweller, J. (2010) Cognitive Load Theory in Health Professional
Education: Design Principles and Strategies. Medical Education, 44, 85-93.