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January 10, 2005

Way Outside of Class
By Beth W. Orenstein
Radiology Today
Vol. 6 No. 1 Page 17

El Centro College’s distance education program teaches echocardiography over the Internet.

Ginger Madden, RT(R)(M), RDMS, RVT, RDCS, was hired to manage the cardiovascular department at Wadley Regional Medical Center in Texarkana, Tex., in February 2003. When she arrived, she learned that only one person on her staff was registered. “She was dual-licensed in echo and cardiovascular and had learned what she needed strictly on her own,” Madden recalls.

Madden immediately began searching for ways to provide her technologists with more formal training, hoping they would become credentialed. The problem was that although Wadley is a major regional medical center, the 400-plus-bed acute-care facility is roughly three hours from Dallas in a rural area where no college-based allied health programs are available to help prepare people for their registry exams.

Pilot Program
In summer 2003, Madden was preparing to send a staffer to Arizona for a year of study. That’s when she came across a program in echocardiography that could be taken over the Internet.

While a pilot program, the distance education course meant the student she chose—Mike Brown, a cardiac registered nurse—could remain in Texarkana and learn what he needed to sit for his registry. Brown, who has an associate’s degree in nursing and has worked at the hospital for 18 years, was thrilled at the opportunity to learn new skills without having to leave his home or work.

Having completed the distance education program in cardiovascular ultrasound the first week in September, Brown is now an echo tech at Wadley, and he had planned to take the first part of his credentialing exams by the end of 2004. He was the first distance education student to complete the echocardiology technology specialty program offered by El Centro College in Dallas.

One reason Catherine Carolan, RDMS, RDCS, RVT, coordinator of the echocardiology technology program at the Dallas County community college, had started the distance program was to bring education to more rural areas of the state. Brown’s enrolling in what was then a pilot program was ideal for them both.

Thanks to a variety of hardware and software programs and Web cameras, students can take all the echo program’s didactic course work from the comfort of their own computers. Using interactive software called Tegrity, Carolan has recorded all her lectures and posted them on a secure Web site that enrolled students can access with their given code. Using the Blackboard learning system and eCampus technology, Carolan also provides the students with a weekly calendar telling them what lectures and assignments they must complete and by what date.

“What I have done over the last 21/2 years is put all the course content online,” Carolan says. The distance education students check the schedule she posts online to see what notes they have to print, lectures they have to watch, readings they have to complete, and tests they have to take. Carolan’s online course material is identical to what she offers in the classroom. “My philosophy is for the distance education program to be completely comprehensive and of the same quality as on-campus students would have,” she says.

24-Hour Access
Students have 24-hour access to the lectures and can view them at their convenience and at their own pace. Taking the courses at home, Brown found that he had to be extra disciplined. But, he says, by following the calendar Carolan outlined, “I prioritized what I needed to do and it worked fine.”

Carolan has found that students access the lectures in ways that best fit their learning styles. Some students watch the lectures all the way through and then go back over any material they are not sure they totally comprehend. Others rewind along the way, replaying sections to make sure they understand the point before going on to the next. “From an educator’s point of view, that’s just gold,” she says with a smile.

Brown found that he rarely had to stop and rewind. “For the most part, it was very clear to me the first time,” he says. “I did on rare occasions have to stop and go back.”

Carolan also sets up online question-and-answer sessions for her students. They sign on at designated times and, using Tegrity Live software, they conduct class and have conversations with her as if they were all in the same room. If Brown had a question and couldn’t make the scheduled question-and-answer session, he would e-mail Carolan and she would respond or arrange another session, he says.

Students can also access earlier lectures in preparation for exams. “If we don’t have an exam on that content for three weeks and a student wants to know, ‘What did Miss Carolan say about that?’ they can go back to that particular spot in the lecture and rewatch it,” she says.

Long-Distance Labs
Lab demonstrations and exams are computer-based as well. Carolan finds it advantageous to record the labs using video cameras and have the students access them at their convenience. The cameras capture what she’s doing from every angle, making it easier for the students to see and follow. In the classroom, it’s not unusual for students’ views to be obstructed.

“When you have 10 students crowded around equipment in a lab,” Carolan says, “my head may be in their way. This way I had a camera on everything that the operator sees, and this means that the students get this same bird’s-eye view. It’s proven very effective when you recorded the lecture and played it back. That to me is just huge.”

One of Carolan’s distance education students from Wichita Falls, Kan., was worried that she was missing something by watching the demonstrations over the Internet rather than in person. “So one day, she came down and watched us record one of the sessions,” Carolan recalls. “When she saw what I was doing, she said, ‘Oh, that’s exactly what’s online.’”

Students also reverse the process, sending Carolan videotapes of their scanning skills every few weeks. Carolan finds that it’s easier for her to critique the students’ work that way. “I can play it back while they are online with me and I can go through it with them and draw on it and show them where the diagnostic angle they used might not have been quite right. I can do it one-on-one and they can have a permanent record of that.”

After watching her critique, the students can rerecord the scan and send it back to Carolan for verification that they have indeed learned the proper techniques.

Carolan has found that recording assignments works so well that she is planning to incorporate this technique for her on-campus students as well. “I’ve gotten a lot more accuracy getting students to where they need to be this way.”

Using Web cameras, Carolan is able to proctor her online students’ exams as if she were in the room with them.

Minor Drawbacks
Carolan finds some drawbacks to distance learning, but all seem relatively minor and easily overcome, she says. One drawback is that to enroll, students must have high-speed broadband Internet access and basic computer skills. However, Carolan says students who don’t have access can often find it at the local library as one of her students did. Also, Brown says, the technology has to be up and running. Of course, the occasional computer glitch always comes at the worst time and can be very frustrating.

From the professor’s perspective, the biggest drawback is that it is very time-consuming to set up the equipment, record the labs, and put them online. “I have to say it is hard work to build the program,” Carolan says. “Also, you have to tweak your policies and procedures to include distance education concerns.”

Carolan says many people assume that because she doesn’t have to be in the classroom to lecture, her life is much easier. They forget, she says, “with technology, everything you touch seems to take longer than you think it’s going to.”

Eventually, Carolan hopes to record hundreds of lab demonstrations on everything she can think of, “but it will take time,” she says.

From the student perspective, the biggest drawback of distance education is the lack of camaraderie. “With distance ed, you didn’t have the sense that there were other people out there going through the same as I was,” Brown says.

However, Brown and Madden visited El Centro several Fridays, “so he got to know the other students,” Madden says. Brown also did a two-week rotation at Parkland Hospital in Dallas, where he worked directly with his teachers and mentors and a two-week rotation at a pediatric clinic to get exposure to pediatric echocardiography.

“The students do miss each other’s company,” Carolan says. However, she adds, that’s more of a social than an academic issue. Besides, she often found that by the end of the classroom program, some students would start to get on each other’s nerves. “It’s just that when you’re there for eight hours a week and you’re tired and just want to go home, someone asks another question, and you can’t go until you hear the answer, it can be annoying. But I didn’t see any of that friction with the students this year.”

Carolan believes she spends enough time with the distance education students to get to know their needs and personalities. She has a phone conversation with them at least once per week. She also schedules a Webcam conference every second week and regular classroom question-and-answer sessions.

Reduced Exposure, Of a Sort
The flip side to connecting online vs. in person, Carolan says, “is the students don’t suffer from overexposure to me as their main instructor, and therefore our time together is always quality.”

Students who have taken courses both in the classroom and online tell Carolan that they like the computerized learning option very much—and, in most cases, better than the traditional classroom.

Carolan says because her program has limited enrollment, it is highly selective, and her students have always been tops in their class to start and done well. She has found that both her classroom and online students continue to get excellent grades.

Carolan knew the distance education program was a tremendous success when a cardiologist walked into Madden’s department in Texarkana and asked for a proximal isovelocity surface area (PISA) measurement. An alternative way of measuring the severity of a stenotic lesion on a patient, PISA is not widely known. Right away, Brown, who had watched Carolan’s lecture on PISA, said, “I think I can do that for you.” He went to the Web site and reviewed her lecture and then produced what the cardiologist had requested. To Carolan, the incident “speaks volumes about what we have accomplished.”

Madden and Carolan also worked together to set up a distance education program for the members of her staff who needed physics training to pass the registries. Today, eight of nine technologists on Madden’s staff are licensed.

Carolan began developing El Centro’s online program and using technology to its fullest almost three years ago when a colleague received a grant, securing technology funds for the community college. After purchasing the technology, that colleague subsequently left the college, but not before helping Carolan implement the technology in the echocardiography program.

The year-long echocardiology technology specialty program at El Centro is open to approximately 10 students per year. By offering it online, Carolan hopes to double enrollment, which could help ease the sonographer shortage that is hitting some rural areas especially hard.

— Beth W. Orenstein is a freelance writer based in Northampton, Pa. She is a frequent contributor to Radiology Today.

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