Can you imagine a more challenging group of individuals to reach with an e-Learning application than medical residents? Long shifts, sleep deprivation, and tremendous competing demands for attention add up to one tough group of obstacles for e-Learning. This is the challenge we are tackling with an unusual system that provides exactly the same content across multiple media.
After doing some front-end analysis of our learners and their needs, we designed this system to offer physicians a choice of formats to match their situation, without compromising on results. This approach has been highly successful. In this article we will show you our development process, and share the key workarounds we discovered along the way.
Established in 1999, MEBN is a medical education company that delivers accredited continuing education to medical professionals. Our objective is to help busy clinicians improve performance and patient health outcomes. MEBN’s expertise is in creating courses that blend the latest technology with proven adult learning models. These courses assist medical professionals in translating evidence-based medicine and guidelines into their clinical practice. We believe we are at the forefront in this regard.
Traditionally, MEBN produces a journal with a companion CD of interactive and audio courses. This combination allows the learners to choose the style of learning that best suits their needs. The courses printed in the journal and the courses on the CD address various aspects of the same topic and work together to form a complete educational program. We recommend that the learner read the journal courses and then proceed to the website or CD to take the interactive courses, including a case based course. Lastly, the medical professional has the opportunity to participate in a live Webcast. In this Web Workshop learners are able to put the knowledge gained from the other formats into practice while interacting with thought leaders and peers.
In 2004 MEBN began a
project to enter the graduate medical education market. According to The Accreditation
Council for Graduate Medical Education (ACGME), there are approximately 8000
residency programs in the
MEBN partnership with
Rush
University
In order to ensure a
minimal level of acceptance, MEBN forged a partnership with
Doing front-end analysis of course requirements
MEBN held a focus
group in early September 2004 with residents and program directors at
MEBN reviewed many sources of time-efficient learning, both print- and computer-based, looking for examples. We found that there is a growing movement in the e-Learning industry toward smaller, less time-intensive courses. Print courses are becoming increasingly shorter so that learners may read them during a lunch break or on an airplane. Many computer- based courses now take the form of Web sessions, or a series of short sessions.
A new design emerges
Based on critiques of these sources and feedback from residents and program directors, MEBN decided on a 15-20 minute modular format with light text and a high-quality graphic style. We made the printed journal small enough to fit into a resident’s lab coat pocket. We would offer the interactive courses in audio-only mode, and as a PDA version. It was clear that the key to this product, and to getting residents to use this program, was to have the same exact content in all formats. This would be a break from MEBN’s traditional style, in which each course provides a building block to a complete program. With this new product, a resident would be able to read a journal course while eating lunch, continue the course on PDA while waiting for the elevator, and finish the course from their home computer. Learners would see the same content in all formats.
Armed with this new course design, MEBN proceeded to the development and production phase in late 2004. We chose the development firm of Engage Interactive (www.engageinteractive.com, (Editor's Note: As of January 25, 2010, this website appears to have been removed from the Web.) ) to produce the new format. Engage Interactive already had experience with MEBN’s traditional format, as well as knowledge of PDA development. Earlier in the year, they had in fact taken a traditional MEBN course and converted it to the PDA format in order to demonstrate the possibilities and the limitations of the PDA.
Content design
The first challenge in any project is getting the entire team to have the same vision for the new product. The MEBN team consists of managing editors, writers, editors, course production managers, and developers and print designers. Medical education can be very content-heavy, and the team members are used to providing maximum knowledge on every screen for each course. However, if MEBN was going to produce the same content on the PDA, in print, and on the desktop, the content had to be written first for the smallest denominator, the PDA.
This new format required cutting the traditional content in half, and then in half again. In order for everyone to visualize the new content, a content prototype was created from the first draft. This prototype stripped all unnecessary text from each screen. Production managers set narration word count limits and text limits for the screen. Still, it was difficult to visualize exactly how limiting the PDA is.
A Learning Solutions Magazine article suggested creating a PowerPoint template based on a 3x5 index card, and this idea proved to be our turning point (Editor’s Note: See Stolen Moments for Learning: An Overview of Wireless e-Learning Development, by David Metcalf, March 19, 2002.) Once the writers and editors were able to see just how little space was available on the PDA, the project began to fall into place.
Design of the user interface began at the same time as content development. There is consensus in the e-Learning industry about what the key elements of a user interface are and how they should function. For instance, a course should have a navigation bar with forward and back buttons to allow sequential navigation through the content. The interface should also have a menu to allow non-sequential navigation. Generally accepted conventions such as these buffers, the user from having to understand the underlying technology. The focus is directly on content, as opposed to understanding the mechanism for delivering that content.
With PDA-based courseware, however, screen size limitations require re-thinking the basic precepts of usability:
- 90-95% of the PDA screen must be reserved for the display of content, as opposed to ~75% on a desktop
- Fonts on the PDA tend to get fuzzy at smaller sizes so fonts and graphics must be reduced in size, yet still be legible
- On a PDA device, the color resolution is lower than on desktop computers
- There is no mouse over event on a PDA, so it is essential that interface elements such as buttons clearly imply their functionality
- Interface elements that would normally be visible on a desktop course, such as a search textbox, must be hidden by default; display them only within a dialog box at the user’s request
- A PDA cannot open multiple browser windows simultaneously, so the user must exit a course altogether to perform actions such as visiting a Web page or other resource that is external to the course
Workarounds for these problems included a minimalist presentational style, since crowded screens on a PDA appeared significantly less legible than a corresponding layout on the desktop. Content needed to be more succinct, and displayed in smaller chunks than one would see in traditional desktop courseware.
Another workaround involved font sizes. Although 9- or 10-point fonts would have been optimal to allow more on-screen text, 11- or 12-point fonts had to be used. The quality of certain font styles was inferior at smaller sizes. Rather than use traditional Arial or Helvetica font, we settled on Tahoma — the default system font for a Pocket PC — because it appeared to be more highly optimized for display. (Editor’s Note: Similar PDA-optimized fonts are available to developers for Palm devices through third-party applications such as FontBucket from Hands High Software at http://www.handshigh.com.)
Finally, we found that highly contrasting colors for graphics ensured sharper definition. Certain color combinations of text and graphics simply did not work well — such as white text on a dark background.
PDA memory issues also played a major role in design. A PDA has miniscule memory capacity compared to today’s powerful desktop computers. Courseware designed for a desktop computer rarely has issues with playability of processor-intensive elements such as sound and video. However, when a PDA attempts to deliver media that exceeds its memory capacity, some of the following problems can occur:
- Sound in video can become choppy and out of synch, emit clicks and screeches, or drop out altogether
- The device may slow down or stop altogether while its processor attempts to manage the overload
- The device may freeze completely, requiring restart
Workarounds for these problems included paying closer attention to the size of sound, video, and graphics files. We compressed these files as much as possible without noticeable reduction in quality. We re-wrote the underlying courseware engine to optimize the system of resource management. The engine, after modification, delivered content “just-in-time” or “on-demand” — only when it was absolutely needed — rather than trying to retain large amounts of content in memory. It also anticipated which content was likely to be needed next, and would preload that content into a buffer.
Another effective technique was pausing audio and video — extremely resource intensive processes — every time the user interacts with a secondary interface element such as a menu or dialog box. We override the default loading mechanism of Macromedia Flash by placing all operations in a “queue,” and ensuring that content is loaded in sequence, rather than simultaneously. Finally, we designed a “transcript-only” mode whereby a user with limited memory can opt to take the course in a streamlined, non-audio format.
