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Teaching Health Professionals Online: Frameworks and Strategies

Teaching Health Professionals Online


Sherri Melrose, Caroline Park, and Beth Perry

To our students, who teach us to be better teachers and better people

To our colleagues, who inspire us with their dedication to teaching excellence

To our university, for giving us the freedom to be innovators

To our families, for providing us with encouragement and purpose




1 Instructional Immediacy: The Heart of Collaborating and Learning in Groups

2 Invitational Theory: Developing the Plus Factor

3 Constructivism: Building on What Learners Know

4 Connectivism: Learning by Forming Connections

5 Transformational Learning: Creating Attitudinal Shifts in Online Learners

6 Quantum Learning Environments: Making the Virtual Seem Real in the Online Classroom [by Katherine Janzen]

CONCLUSION: Rethinking Online Course Design and Teaching


The inspiration for this book came first from our students, who challenge us to become better teachers and often serve as a test population for new teaching strategies. Their criticisms and suggestions have helped us refine many of the ideas presented here.

We are also grateful to our colleagues in the Faculty of Health Disciplines at Athabasca University—inspiring educators who continually refine their teaching approaches. Many of them responded generously to our call for information about teaching techniques and activities that they have found to be productive and that we might include in this book. We extend our sincere thanks to Carol Anderson, Diana Campbell, Cheryl Crocker, Sharon Moore, and Joyce Springate for their contributions. Finally, a special thanks to Katherine Janzen, with whom the theory of quantum learning originated and who graciously agreed to write a chapter for the book on that topic.


You are a teacher at heart. Your goal is to inspire students to excel professionally in one of the many health disciplines. Your students may be nurses, social workers, dietitians, physiotherapists, occupational therapists, chiropractors, dental hygienists, or radiation therapists, or they may be learners who have not yet entered their chosen health care profession. You teach at least some of your courses online, and you find it challenging to be effective, personally engaging, and “real” to students when teaching via the Internet. If this is your story, this book is for you.

Our aim is to equip health care educators, whether they are new to teaching online or already have some experience in that area, with a variety of effective (and proven) online teaching strategies and learning activities. The book offers teaching techniques that can be put into practice immediately and generally demand little by way of technological skill, the investment of time, or other resources. Teachers who find themselves at a loss for inventive ways to challenge their students can flip through these pages, scan the activities, and find an idea to suit their purpose.

This book is both practical and theoretical. It is often helpful to understand why certain teaching strategies are effective in engaging learners. The teaching activities and techniques included in this book are therefore presented in the context of contemporary educational theory, supported by scholarly literature. Teachers often struggle to understand how theories such as constructivism or connectivism or transformative learning apply to actual learning situations. By linking specific theories to concrete examples of teaching activities, this book aims to demystify theory. It is our hope that after reading this book, instructors will be comfortable discussing educational theory and may even be inspired to develop their own teaching activities based on educational theories that align with their personal teaching philosophy. Educational theory kindles ideas and inspires us to improve our teaching.

The teaching strategies and learning activities presented in this volume are drawn from the practice of many professors, instructors, and tutors who currently teach online in the Faculty of Health Disciplines at Athabasca University. Athabasca University was Canada’s first open university, and, today, most of its courses are taught online. The Faculty of Health Disciplines boasts about 2,000 undergraduate and 1,500 graduate students, as well as some forty professors, instructors, and tutors who have a combined total of many years of experience with online teaching. (Many of the courses offered in the Faculty of Health Disciplines have been taught online for a decade or more.) When we set out to write this book, we solicited input from colleagues in the Faculty of Health Disciplines, asking them to share their most successful online teaching strategies and activities. We also included techniques that we have developed and found effective in our own teaching. Once we had an assemblage of activities, we grouped them according to the educational theory with which they were most closely aligned. Of course, in developing teaching techniques, instructors often integrate elements drawn from a variety of theories. For the purposes of this book, however, we assessed the “best fit” in order to illustrate the relationship between practice and theory.

This book is very much a collaborative effort. However, we chose to divide up the primary responsibility for specific chapters according to our individual areas of interest and theoretical expertise. Thus, chapter 1, on instructional immediacy, is principally the work of Sherri Melrose. As she explains, the theory of instructional immediacy holds that demonstrating availability, projecting warmth and friendliness, and taking time to get to know students as individuals all play a major part in an instructor’s effectiveness. Her discussion of the theory is followed by suggested ways in which teachers can encourage collaboration while also supporting individual learners as they progress through the expected stages of development in class groups.

Invitational theory is the focus of chapter 2. In it, Beth Berry discusses “the plus factor,” a way of thinking and being with students that creates a warm and welcoming online educational environment. She examines how trust, respect, optimism, and intentionality exert a positive influence on educational outcomes.

In chapter 3, Sherri Melrose reviews constructivist thinking, a teaching approach that builds on what learners already know. She describes ways in which teachers can provide learners with the scaffolding, or support, that they need in order to progress toward competence and independence.

The theory of connectivism stresses the role of networks in learning. As Caroline Park explains in chapter 4, in a connectivist approach, teachers and students use digital technology to create complex and diverse networks of people who can help them find the information they need. She offers connectivist techniques that can help learners to create informal and perhaps unexpected connections that support their specific learning needs and interests. In addition to locating information, however, students must learn to organize the information they gather and evaluate it critically.

In chapter 5, Park turns to the concept of transformational learning, which she describes as a process of changing learners’ attitudes and deeply entrenched beliefs and assumptions. When teachers provide learners with opportunities for critical reflection and challenge them to question commonly accepted truths, exciting new perspectives can be gained.

Chapter 6, contributed by Katherine Janzen, concerns the theory of quantum learning. Janzen draws from principles of quantum physics to illustrate how the basic elements of virtual classrooms—teachers, students, and course content—are connected and entangled, just as electrons are. She explains how teachers in quantum learning environments can create virtual classrooms that feel real and alive.

In the concluding chapter, we describe the six principal lessons we have learned about how to make online courses more engaging. Fundamentally, we acknowledge that wonderful online teaching strategies alone do not inevitably lead to success. The teacher matters. Online teachers, however, face special challenges. How can online teachers ensure success? How can they transcend the emptiness of cyberspace to become real to students and create learning environments in which classmates become as tangible to one another as they would be if they were sitting side by side? This final chapter addresses these questions and provides online teachers with important take-away messages.

We acknowledge that online education changes at a breathtaking pace. With each new technology, fresh teaching approaches become possible. To be on the cutting edge in the dynamic world of online education, we focus here on the most contemporary of learning theories, theories that are likely to remain relevant as Web 3.0 technologies continue to emerge. The importance of social media in online education is also given consideration throughout the book. Some of the teaching strategies described use social media as the primary platform for learning, and many of the suggested activities can be adapted to employ social media as needed.

Future online learning will undoubtedly be more open, mobile, and flexible than it is today. Open educational resources, the adoption of mobile devices, free online tools and courses, and the rise of cloud computing are four trends that will propel changes in online teaching and learning. This book provides a foundation that will enable you to make optimal use of these and other transformations that will shape online learning in the years ahead.

If you are a novice online teacher, this book is a place to start. If you are a seasoned educator who has just been asked to convert some of your face-to-face courses to online courses, read this book first. If you have been teaching online for years and feel that you are “rusting out” and getting stuck in your old ways, our theory-based techniques and activities may refresh your teaching. If you are a highly regarded online teacher emulated by others, we hope that you will find some hidden gems in this book that will help you to continue to be a leader in online education.

In sum, the purpose of this book is to inspire great teaching by providing you with theory-informed techniques and activities to help make you an exemplary online educator. The end result will be enhanced quality of education, increased student success and satisfaction, and, ultimately, the best possible health care professionals.


Instructional Immediacy: The Heart of Collaborating and Learning in Groups

Exemplary teachers generally have one thing in common: their classes bustle with activity as students connect and interact with one another. As teachers who love what we do, we want students to share our excitement and to become fully engaged members of our class community. We know how connections among students can sustain motivation and deepen understanding of course material. But we also know how full life can be for students and how stretched their time is as they juggle family, work, and study commitments. Looking through the eyes of adult learners, we can see that carving out time to collaborate with classmates in an online course may not stand out as a priority. How, then, can we begin to foster the kind of collaboration that our students need in order to fully engage in online courses?

Albert Mehrabian’s explanation of the construct of immediacy, together with theories of how groups work, offers important directions. This chapter explains instructional immediacy, provides a primer on how groups work, and suggests ways to invite students to collaborate in groups by modelling their achievements. Instructional immediacy is at the heart of collaborating and learning in groups. Teachers must demonstrate what intentional commitment to collaboration actually looks like before they can expect students to interact in meaningful ways with their classmates.


An Explanation of Instructional Immediacy

Understanding the construct of instructional immediacy is foundational to effectively fostering collaboration among students. Encouraging learners to engage in collaborative activities with one another begins with communicating our own availability, friendliness, and willingness to connect in personal ways with our students. As technology offers increasing possibilities for electronic communication, teachers must not lose sight of the basic feelings and responses that we know exist within the teacher-student relationship. Teachers who demonstrate immediacy in their classrooms, whether face to face or online, engage students and invite them to risk looking at the world in new ways.

The construct of immediacy was introduced in the 1960s by social psychologist Albert Mehrabian, who defined immediacy as an affective expression of emotional attachment, feelings of liking and being close to another person (Mehrabian, 1967, 1971; Wiener & Mehrabian, 1968). Immediacy, in other words, is a sense of psychological closeness. In the context of face-to-face university classrooms, the definition of instructional immediacy was further developed to include nonverbal manifestations of high affect such as maintaining eye contact, leaning closer, touching, smiling, maintaining a relaxed body posture, and attending to voice inflection (Andersen, 1979). Verbal expressions of immediacy include using personal examples, engaging in humour, asking questions, initiating conversations, addressing students by name, praising students’ work, and encouraging students to express their opinions (Gorham, 1988). Links among teacher immediacy, student motivation, and affective learning have consistently been documented (Baker, 2010; Christophel, 1990; Christophel & Gorham, 1995; Gitin, Niemi, & Levin, 2012; Witt, Wheeless, & Allen, 2004).

However, in electronic learning spaces, where nonverbal cues may be less clear or even nonexistent, establishing instructional immediacy, or psychological closeness, can be challenging, but it is not impossible: research has demonstrated links in online learning environments between instructors’ immediacy behaviours, on the one hand, and student satisfaction and instructional effectiveness, on the other (Arbaugh, 2001; Hutchins, 2003; Walkem, in press; Woods & Baker, 2004). The experience of liking and feeling close to instructors can lead to positive effects in online classrooms (Hess & Smythe, 2001), and correlations between immediacy and affective learning have been identified (Baker, 2004; Russo & Benson, 2005).

In essence, instructional immediacy online refers to the extent to which teachers are able to project an affect of warmth and likeability in their communication with students (Melrose, 2009). In online learning environments, one-way immediacy can be demonstrated through word choice. For example, online teachers who refer in their messaging to “our” class and indicate a willingness to work “with” learners through their word choices signal qualities that may prompt immediacy. Words that communicate a genuine interest in getting to know each class member as a unique individual can create a feeling of safety. This equips instructors with the foundation needed to encourage learners to extend that teacher-student immediacy toward collaboration in the class group.

Research with online health care graduate students that explored their perceptions of instructional immediacy showed that learners value instructional behaviours that model engaging and personal ways of connecting, that maintain collegial relationships, and that honour individual learning accomplishments (Melrose & Bergeron, 2006). Examples include instructors posting self-introductions that include pictures and appropriate personal and professional information, creating a course document incorporating biographical information for each member of the class, and choosing words with gentle connotations (Melrose & Bergeron, 2006). By projecting an affect of warmth and immediacy in our own communication, we can begin the process of creating an engaged and appealing online learning environment where learners feel recognized as individuals and experience a sense of belonging to a vibrant class group.

A Primer on Groups and How They Work

In addition to intentionally projecting an affect high in warmth to strengthen individual relationships with learners, instructional behaviours that communicate immediacy also set the stage for nurturing student-to-student relationships within the learning community. Here, an appreciation of how well-functioning groups work is important. Individuals who join together in a group for a specific purpose such as engaging in a learning activity can be expected to progress through predictable stages. Social psychologists Bruce Tuckman, David Johnson, and Frank Johnson provided seminal frameworks. Tuckman (1965) and Tuckman and Jensen (1977) assert that functional groups move through five stages: forming (characterized by anxiety and uncertainty about belonging), storming (characterized by competition, individuality, and conflict), norming (characterized by attempts to resolve earlier conflicts and clear expectations of behaviours and roles), performing (characterized by cooperation and productive work), and adjourning (characterized by termination and disengagement from the group). Johnson and Johnson (1997, 2009) identify seven stages through which functional groups progress: defining and structuring procedures and becoming oriented, conforming to procedures and getting acquainted, recognizing mutuality and building trust, rebelling and differentiating, committing to and taking ownership of the goals of other members, functioning maturely and productively, and, finally, terminating.

In online classroom environments, functioning groups are expected to progress through similar stages (Jaques & Salmon, 2007). Gilly Salmon (2000) identifies five stages of online group development: access and motivation (characterized by welcoming and encouraging), online socialization (characterized by familiarizing and providing bridges between cultural, social, and learning environments), information exchange (characterized by facilitating tasks and supporting use of learning materials), knowledge construction (characterized by facilitating process), and development (characterized by supporting and responding). In addition, Salmon emphasizes that the ability to guide online groups is more important than making polished instructional presentations.

Melrose and Bergeron (2007) link the three overarching stages of group development, beginning/engagement, middle/encouragement, and ending/closure, and suggest specific online instructional approaches to facilitate progress at each stage. For example, in the beginning/engagement stage, learners value knowing that their instructors are available “if you need me” and that it is “safe” to contact them. In the middle/encouragement stage, learners appreciate personal help with networking and with managing conflict, particularly in relation to participation and marking. In this middle stage, students also value individual private feedback from instructors. And, in the ending/closing stage, learners need opportunities to debrief and reflect.

Implementing teaching actions at the most opportune time, such as intervening promptly when the expected conflict emerges once a group has entered its working phase, offers important reassurance to students. In contrast, implementing a teaching action at an inopportune time can have the opposite effect. For example, during the beginning phase of group work, introducing activities that encourage over-long reflection (which leads to inaction) can inadvertently communicate teacher abandonment. Knowing that learners value debriefing time in the ending stage of their group work leads educators to consider ways to ensure that this time is available. Furthermore, introducing supplementary content or tasks not required for course credit is more meaningful in the beginning rather than the middle or ending stages of a class group’s developmental trajectory.

No primer on groups and how they work would be complete without considering the seemingly obvious point that a group is a collection of individuals. Group members each bring their own distinct needs to any collaboration in which they participate. In efforts to support interaction and collaboration among students, educators must bear in mind that each student is an individual learner as well as a member of a learning group.

Individual Support of Learners in Groups

Learning groups differ substantively from other groups in that the designated formal leader, the teacher, ultimately determines learners’ grades. Given the critical importance of grades in higher education, working collaboratively and sharing the same grade can be perceived as threatening. During course activities when students work in groups, learners need continued assurance that the teacher will remain present and attentive to their needs as individuals.

If we empathize with students, we can easily appreciate how the threat of achieving poor grades or even failing might have a dramatic effect on their willingness to collaborate with fellow students in group projects. Abraham Maslow’s (1982) well-known “hierarchy of needs” indicates that an individual’s survival needs (physiological needs for air, water, and food, and safety needs for security and protection) must be fulfilled before the psychological needs for esteem, belonging, and self-actualization can be met. In the high stakes environment of higher education, learners need passing grades in order to survive. Given that students need to feel safe individually before they can be expected to engage in social activities such as belonging to a group, maintaining one-to-one communication with students takes on new significance. Simply sending regular private emails to each student, addressing students by name in written communication, and offering timely evaluative feedback on submissions can unobtrusively communicate the instructor’s presence. This sense of presence provides learners with reassurance and feelings of security that are foundational to full group participation.

Group members have varying needs that their group can help satisfy (Beebe & Masterton, 2011). While some learners may have a high need for safety within a group, others may have a strong need for esteem and respect from the group. When specific individual needs are not met by the group, participants may dominate conversations, withdraw from participating, or introduce distractions. These dysfunctional behaviours slow the group’s progression through the expected stages. Members may feel uncomfortable and dissatisfied with the collaborative process. Negative past experiences with groups can leave students reluctant to risk working together in future projects.

Online educators can play important roles in preventing negative group experiences. For example, intervening promptly and efficiently when the needs of an individual begin to interfere with a group’s functioning is critical (Bergeron & Melrose, 2006). By monitoring collaborative work and requiring groups to attend to their own group process, teachers can remain well prepared to intervene when necessary. For instance, requiring groups to establish and submit their own “rules of engagement”—ground rules or guidelines—at the first meeting ensures that these will be available when needed. Contingency plans delineating consequences for not attending sessions, not submitting contributions, and not respecting members’ time need to be clearly articulated in these group rules. Some groups may want group members to be graded individually. Others may wish to have input into the grades that their colleagues receive. Opportunities for progressive self-evaluation need to be built into the group’s task timelines. The exercise of creating these rules, consequences, and self-evaluations, coupled with the formal requirement to submit a document that explains the rules, emphasizes the importance of group process in collaboration. In turn, this emphasis on process can communicate further assurance to students that they will be respected for their individual accountability during their involvement with collaborative work.

William Schutz’s (1958) classic theory of interpersonal behaviour postulates that when individuals form and interact in groups, they all have needs for inclusion (feeling recognized and included, and reaching out to make others feel included), control (feeling in control, contesting issues, vying for leadership, and resolving conflicts), and affection (giving and receiving emotional support). Teaching actions that foster a sense of belonging, such as communicating that participation in group work is essential and ensuring that students are competent in the use of required tools such as the Internet and the learning management system, will begin to project a message that inclusion is important. Similarly, instructions phrased in a welcoming manner (“Let’s make sure no one misses the chance to join a group”) will invite students to pay attention to principles of inclusion.

Teaching actions such as allocating marks for participation, requiring group guidelines, and normalizing the experience of conflict as a natural part of a group’s progress will help learners feel that

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