Communication and proximity effects on outcomes attributable to sense of presence in distance bioinformatics education.

BACKGROUND: Online learning is increasingly popular in medical education and sense of presence has been posited as a factor contributing to its success. Communication media influences on sense of presence and learning outcomes were explored in this study. Test performance and ratings of instruction and technology, factors influenced by sense of presence, are compared under four conditions involving different media and degrees of student physical presence: 1) videoconference co-located, 2) webcast co-located, 3) videoconference dispersed, and 4) webcast dispersed. METHODS: Eighty one first to forth year medical students heard a lecture on telemedicine and were asked to collaboratively search a telemedicine website under conditions where the lecture was delivered by videoconference or one way streaming (webcast) and where students were either co-located or dispersed. In the videoconference conditions, co-located students could use the technology to interact with the instructor and could interact with each other face to face, while the dispersed students could use the technology to interact with both the instructor and each other. In the webcast conditions, all students could use chat to communicate with the instructor or each other, although the co-located students also could interact orally. After hearing the lecture, students collaboratively searched a telemedicine website, took a test on lecture-website content and rated the instruction and the technology they used. Test scores on lecture and website content and ratings of instruction and technology for the four conditions were compared with analysis of variance and chi-square tests. RESULTS: There were no significant differences in overall measures, although there were on selected ratings of instruction. Students in both webcast conditions indicated they were encouraged more to follow up on their own and felt instruction was more interactive than co-located videoconferencing students. Dispersed videoconferencing students indicated the highest levels of interaction and there was evidence they interacted more. CONCLUSION: Results do not strongly support proximity as a sense of presence factor affecting performance and attitudes, but do suggest communication medium may affect interactivity.

An exploratory study of co-location as a factor in synchronous, collaborative medical informatics distance education.

BACKGROUND: This study determined differences in learning, judgments of teaching and technology, and interaction when videoconferencing was used to deliver instruction on telemedicine to medical students in conditions where they were co-located and dispersed. A lecture on telemedicine was given by videoconference to medical students at a distant site. After a question and answer period, students were then given search problems on the topic and encouraged to collaborate. Half the students were randomly assigned to a co-located condition where they received the presentation and collaborated in a computer lab, and half were assigned to a dispersed condition where they were located in different rooms to receive the presentation and collaborate online using the videoconferencing technology. Students were observed in both conditions and they individually completed a test on presentation content and a rating scale about the quality of the teaching and the technology. FINDINGS: There were no differences between the two groups in the learning outcomes or judgments about the teaching and technology, with the exception that more students in the dispersed condition felt more interaction was fostered. The level and patterns of interaction were very different in the two conditions and higher for dispersed students. CONCLUSIONS: Synchronous communication at a distance via videoconference may give sufficient sense of presence that the learning experience may be similar to that in actual classrooms, even when students are far apart. The technology may channel interaction in desirable ways.

Societal drivers in the applications of telehealth.

The application of telemedicine and e-health tools and the integration of these tools in healthcare is no longer a demonstration, pilot project, or idea. The changing landscape of humanity dictates that new solutions be implemented to address old problems. The landscape is changing with diminishing resources of fossil fuels, aging population, a shortage of skilled labor in healthcare (doctors, nurses, and allied health professionals), and emerging technologies for the personal space, culture, and consumer demand. All are key drivers in altering healthcare delivery, access, and education. The very foundation of medicine needs to change to meet these demands. Access using telehealth will widen and enable our ability to respond to public health issues. This paper addresses the many societal issues facing healthcare delivery and demonstrates how telehealth solutions are key components of the future of healthcare delivery across the globe.

Assessing physician job satisfaction and mental workload.

Physician job satisfaction and mental workload were evaluated in a pilot study of five physicians engaged in a telemedicine practice at The University of Texas Medical Branch at Galveston Electronic Health Network. Several previous studies have examined physician satisfaction with specific telemedicine applications; however, few have attempted to identify the underlying factors that contribute to physician satisfaction or lack thereof. One factor that has been found to affect well-being and functionality in the workplace-particularly with regard to human interaction with complex systems and tasks as seen in telemedicine-is mental workload. Workload is generally defined as the "cost" to a person for performing a complex task or tasks; however, prior to this study, it was unexplored as a variable that influences physician satisfaction. Two measures of job satisfaction were used: The Job Descriptive Index and the Job In General scales. Mental workload was evaluated by means of the National Aeronautics and Space Administration Task Load Index. The measures were administered by means of Web-based surveys and were given twice over a 6-month period. Nonparametric statistical analyses revealed that physician job satisfaction was generally high relative to that of the general population and other professionals. Mental workload scores associated with the practice of telemedicine in this environment are also high, and appeared stable over time. In addition, they are commensurate with scores found in individuals practicing tasks with elevated information-processing demands, such as quality control engineers and air traffic controllers. No relationship was found between the measures of job satisfaction and mental workload.