IIMS 1994: Lee - A comparison of the cost effectiveness of traditional lectures with interactive computer assisted learning packages

A comparison of the cost effectiveness of traditional lectures with interactive computer assisted learning packages

Harry B Lee
Curtin University of Technology, Western Australia

To compare the educational cost effectiveness of traditional lectures with a computer managed learning environment (CMLE), the activities of staff and students in the School of Physiotherapy at the Shenton Park campus of Curtin University have been recorded for the Past four years. These data compare the cost effectiveness of interactive computer assisted learning packages (ICALP) with lectures for the teaching and learning of anatomy. These data provide models of cost effectiveness which can be applied to the administration, maintenance, development of software, and the use of work stations in a CMLE. A Student Operated Computer Controlled Educational Resource (SOCCER) is described which provides continuous assessment of the learning environment. The educational cost effectiveness of SOCCER is shown to compare the results of lecture and computer learning groups. Techniques are described which score, store and retrieve results for instant review by learners and administrators. Usage has been audited to appropriate its share of the total running costs of the CMLE. A formula is shown to rate the cost per hour of each student at a work station when learning and being tested. These formulae are applied to compare the time spent in the preparation of lectures with the development of software. Estimates of the time taken to prepare lectures, assignments, written and practical examinations, as well as to grade these procedures is compared with that taken to develop ICALP's, test and feedback items, and the tracking, recording and retrieval of results. The educational cost effectiveness of these models is measured in units per hour to compare the effectiveness of students attending lectures with their counterpart at computer workstations. The effectiveness of CBL is validated by comparison of pre and post-tests with the retention of the knowledge in delayed post-tests at 60 and 120 day intervals. This information is collated to demonstrate the relative cost effectiveness of computer based learning with lecture methods.

Information explosion

For more than two decades there has been an exponential growth in computer software to supplement traditional methods of teaching and learning, using meta-analysis to compare CAL with traditional methods of instruction (Kulik, Kulik & Cohen, 1980; Kulik & Kulik, 1986; McNeil & Nelson, 1991). Mitrani and Swan (1990) assert that CAL differs from traditional education media because it is interactive for the presentation of abstract ideas. Reeves (1992) defined learning as the processing of knowledge construction tuned to the situation in which it takes place, advocating the benefits of a problem based approach to computerised learning.

Information overload

To reduce the information overload created by the continuing explosion of medical knowledge, CBL programs have been incorporated into the curriculum of many medical schools (Starkweather, 1986; Hannan, 1991; McCracken & Spurgeon, 1991). With evidence to affirm the efficacy of CBL in the education of health care professionals (Prentice & Kenny, 1986; Fincher, Abdulla & Sridharan, 1988; Lee & Allison, 1992), there is a risk that these techniques may be used without proper research into their development and the mental processes of learners. The precise mechanisms by which learners absorb information from hypermedia is still poorly understood, which, according to Kidd, Cesnik, Connoley & Carson (1992), may emulate the diagnostic processes used by clinicians.

Intuitive links

The education of health care professionals requires the ingestion and assimilation of detailed information from a wide variety of contrasting sources (Shortliffe & Perreault, 1990). Because this information is stored at a conceptual level, the aim of medical education is to create 'intuitive' links between disparate pieces of information (Kidd, Hutchings, Hall & Cesnik, 1992). Nevertheless, despite considerable evidence in support of computers in undergraduate medical education, Lambert (1992) identified a Luddite Mentality Factor as a barrier to learning by computers at the postgraduate medical level.

CAL in nursing and dentistry

Computer assisted learning (CAL) has been used to educate health care professionals since Bitzer pioneered computer assisted instruction (CAI) for nurses in 1963 and 1966, followed by other computerised modalities applied to nursing (Bitzer & Bitzer, 1973; Paulanka, 1986; Belfry & Winne, 1988; Hebda, 1988). CAL is well represented in dental education by computers in the Flexible Dental Curriculum at the University of Kentucky in 1971 (Mast & Watson, 1976), and comparison of CAL with tutorials in dentistry at the University of Manchester (Levine, Jones & Morgan in 1987).

CAL in medical schools

Evidence of computerised learning in medical schools is shown by Holley and Heller (1984), who compared computers with tutorials to teach anaesthesiology and by Harkin, Dixon, Reid and Bird (1986), who used computers to present pathology by microfiche and slide transparencies. In a survey of CAL in British medical schools, Florey (1988) recommended intermedical school collaboration for the development and use of these resources to rationalise their costs. Wigton, Poses, Collins and Cebul (1990), reported the effectiveness of CAI to improve the diagnostic skills of experienced student health physicians. Branch, Ledford, Robertson and Robinson (1987) validated interactive videodiscs as a teaching technique in biomedical education, whilst Boyle (1985) demonstrated the value of computers to teach respiratory physiology. Ashwood, Fine, Beherens and Adams (1986) emphasised the importance of visual information in CAI, enhanced by video images, declaring this combination to have great potential in all areas of medical education. Despite these advances, Andrews, Schwarz and Helme (1992) claim that little has changed in medical education during the past half century, contrasted by the Luddite Mentality Factor identified by Lambert (1992).

CAL and anatomy

For the teaching and learning of anatomy, Richards, Sawyer and Roark (1987) created 3-D images of anatomical structures to teach gross anatomy, reporting positive reactions and responses from 91 first year medical students. Jones, Olafson and Sutin (1978) compared the results of freshmen medical students with those in traditional classes to show that they could learn gross anatomy equally well by computers without lectures or dissection. In a comparative investigation of a group of 48 medical students sequestered from a class of 151, Walsh and Bohn (1990) used CAL to teach gross anatomy, finding no significant difference between the two groups.

ICALP and anatomy for physiotherapy students

Applied, functional and clinical . anatomy is fundamental to the practice of physiotherapy. By tradition, anatomy is presented by lectures, demonstrations, and laboratory sessions, reinforced by prosected cadavers, and other materials. Because the study of anatomy is a visual and descriptive science, observation of new students suggests that some experience difficulty with the transmission of visual, verbal and written constructs into a third dimension (Arons, 1984; Meals & Kabo, 1980; Rochford, 1985). It appears that those with well developed written and verbal skills are more likely to overcome this difficulty sooner (Lee & Allison, 1992 & 1993). Lee and Allison (1992 & 1993) clarified the need to investigate the proportional relationship of ICALP modules with other educational techniques, reinforcing the views of Richards, et al, 1987; Jones, et al, 1978; Walsh and Bohn, 1990.

Questions raised

Despite support from the literature and empirical observations, reservations remain about its use (Richards, 1989). Although the efficacy of CAI is substantiated in medical education (Ashwood, et al., 1986; Harkin et al, 1986; Levine, et al, 1987; Branch, et al, 1987; Florey, 1988; Hmelo, 1989) and its value verified by meta-analysis (Kulik, et al, 1986), questions are raised about its educational validity, the mere availability of interactive multimedia does not guarantee learning (Clark, 1992, Reeves, 1992; Romiszowski, 1992). Clark (1992) declared 'books to be better', countered by Looms (1992), who quoted Karpatschof (1991) to define computers as "the ability to solve tasks which could neither be solved by computers without people, nor by people without computers".

Learning curve and cost effectiveness

Offir and Katz (1990), provided a learning curve model to evaluate the cost effectiveness of computerised learning programs. Thew authors suggest that educators use philosophy and theory in their decision making process, whereas educational administrators and economists base their decisions upon cost effectiveness. Lee and Allison (1993), compared the cost effectiveness of traditional lectures with computer assisted learning, to confirm that ICALP equates with lectures, enhancing them to seminar discussion sessions with problem based learning sooner than may otherwise be expected.

The relative cost effectiveness of CBL with traditional methods

Niemiec, Sikorski and Walberg (1989) combined meta-analysis and costing techniques to investigate the cost effectiveness of CAI with tutoring. A model was described to determine that CAI is three times more cost effective than tutoring. This contrasts markedly with Dean (1989), who applied a cost model of computer software against a group of faculty members in a university environment. Dean's model was based on suggestions by Levin (1984), with a detailed examination of the financial transactions of a computer environment over a period of four years. The overall costs were reduced to a formula which identified the cost per hour of student time at each work station. These costs were offset against an analysis of the costs of faculty time between control and experimental groups of faculty members. Dean concluded that the faculty costs of the experimental group were 21 % greater than those of their traditional counterpart. However, because the CAI component was one of enrichment , it is obvious that it is likely to be more expensive.

In a study of the continuing education of paramedics, Porter (1991), compared the relative effectiveness of lectures, video, and CAI. Analysis of post-test scores shows that CAI subjects performed significantly better (79.6%) than the lecture (70.5%) and video (68.9%) groups. Of greater interest, was that when the same test was repeated 60 days later, the differences between the groups were maintained, with retained scores of 70.9%, 59.4% and 59. 1% respectively. Lee & Allison (1993), conducted a comparative study of the presentation of identical neuroanatomical information to 41 students by lectures and to 37 students by ICALP. At pre-test, the mean for each group was 43.58 and 44.81, with a standard deviation of 8.67 and 6.54 respectively. At post-test, the lecture group achieved a mean of 73.19, with a 7.76 SI), whilst the ICALP group achieved a mean of 75.42, with a SD of 6.76. The same test was unexpectedly administered after delayed periods of 60 and 120 days. The lecture group obtained 68.04, with a SD of 8.49 after 60 days, and 68.06 and 8.24 after 120 days. The ICALP group achieved 70.34, with a SD of 9.58 after 60 days, and 69.68 and 9.02 after 120 days. See Table 2.

SOCCER in a CMLE

Research has shown that a CMLE can be most effective when designed to provide pathways and freedom of choice to empower learners to become self paced by access to materials to meet their own needs. Rates of progress can be accelerated by the opportunity to monitor individual levels of competence by instant feedback prior to admission to test procedures under controlled conditions. To meet these requirements, a Student Operated Computer Controlled Educational Resource (SOCCER), funded by a grant from the Committee for the Advancement of University Teaching (CAUT), was developed for the teaching and learning of anatomy by physiotherapy students in a CMLE. As an educational facility, SOCCER provides data for research to validate the performance of learners and educators in discrete areas of anatomy. SOCCER empowers learners to become self paced and self directed in a platform of entry to register, monitor and track activities to validate performance in anatomy. SOCCER can be converted to a colour format, when it is referred to as ScoLar (Student Operated Learning and Assessment Resource).

Results summary

An important component of SOCCER is that it provides learners and administrators with instant information about their rate of progress. A click on the results summary shows an individualised review of activities undertaken from the commencement of any learning period. This information is continuously updated in a personal file available to the learner at any time. In the same way, this information enables administrators to track the reactions and rate of progress of individuals throughout the CMLE.

Test items

Pre and post-test items provide learners and administrators with data from the point of entry to later progression. Levels of concentration and success are continuously tracked and recorded for self review by learners and evaluation by administrators.

Problem based learning

The results of this study validate the effectiveness of SOCCER as a navigational instrument to track and store information, and verify that ICALP and test items can be used to replace formal lectures 'm anatomy. Research has shown that the time spent by learners in the CMLE is equivalent to that normally spent in the library and home based study. Because of this, lectures in the fourth semester have been converted to seminar discussion sessions in a climate of problem based learning at a more advanced rate of progress than would otherwise be expected.

Instant reinforcement

SOCCER dispenses ICALP, Test and Feedback Item to enable students to track, test and control their own rate of progress. The last screen of ICALP and Test Items provides instant reinforcement by summary to the learner. The summary shows the time taken with the score achieved, expressed as a percentage. This information is stored in the results summary for instant review by the learner and administrators. These data provide an invaluable tool for the ran" and investigation of the mechanisms of learning, for direct comparison of the interaction of individual learning strategies with practice and test situations.

Tests

ICALP modules are converted to test items by the selection of text and diagrams into strings of screens, each of which incorporates a question, scored by a click on a prescribed target. Once a learner has explored ICALP modules and is satisfied with the results summary, test items are available to measure performance under controlled conditions.

Feedback

To gain insight into learner reaction to strategies used within the CMLE, feedback items have been developed with an inventory of over forty items. Learners directly type in responses to questions, clicking radio buttons to register views. These data are stored via XCMDs and XFCNs in Excel but invisible to learners.

Cost effectiveness

Although not available for public scrutiny, these data were assembled to relate the cost effectiveness of lecture and computer items used in this project. The task was completed by continuous assessment of the learning environment by all participants. Budgetary and salary information was recorded for correlation with student results. Feedback items were used to measure student effort and response to methods of learning. Modification of the methods outlined by Levin (1984), Niemiec et al, (1989) and Dean (1989) were incorporated into the following model.

Computer network costs

Pro-rated initial costs

Network Administrators salary
Network software costs
Printer costs
Total costs of hardware at computer work stations

Pro-rated recurrent annual costs

Annual maintenance costs
Support staff costs
Consumable costs
Depreciation and replacement costs

Pro-rated usage by students

For learning
For being tested

Pro-rated costs per hour of sections 1 - II - III

Total annual costs (I and II)
Hours per week learning anatomy at work stations
Costs per hour at work stations when learning anatomy
Weeks per annum of availability of work stations
The life expectancy of equipment in years
The number of work stations available

C = A
B x D x E x F

This formula was applied to compare the pro-rated staff time and salaries per unit hour between the presentation of identical anatomical information by lectures versus SOCCER. Assessments were made of the time spent in the preparation and presentation of lecture materials, and the grading and marking of testa and examinations. In the same way, amount was kept of the time spent in the development and presentation of SOCCER, ICALP, Test and Feedback items per unit hour of effort in the CMLE. To evaluate educational cost effectiveness, account was taken of student activities and achievements per unit hour, comparing the time spent in lectures and post lecture learning and revision by one group, with that spent at computer workstations and time spent in revision ad learning elsewhere.

Educational and administrative cost efficiency and cost benefits

Accepting that the provision of a CMLE is an essential resource to facilitate learning at the tertiary level, its comparative cost benefits with traditional lectures are somewhat esoteric. Nevertheless, a comparison of the educational and administrative cost efficiency of learning anatomy by traditional lectures with the opportunities of learning, testing and feedback within SOCCER become self evident.

Comparative cost effectiveness

In a time sequence, Conyer (1992) studied the progress of eleven professionals in the development of computerised learning modules, finding them to be in a ratio of 200: 1. In a comparative study, Lee and Allison (1992) defined the ratio of time spent in the development of ICALP to time spent by its users, to vary between 50: 1 and 100: 1 dependent upon the complexity of the package. This may be empirically offset by the 'rule of thumb' which suggests that it takes one hour of research and experience to fill each minute of a lecture.

Time taken to prepare written and practical examinations

The time spent by lecturing staff to prepare, mark and grade tests in anatomy is significant. Whilst m experienced lecturer may prepare a 2 hour Written examination paper in about 2 hours, the same person is likely to take between 4 and 6 hours to prepare questions for computer workstations. Unless acquired from a commercial source, the time taken to develop a bank of quality assured multiple choice and true-false questions is immeasurable.

Time taken to prepare computerised examinations

Using the facilities of SOCCER, the time spent by academic staff to prepare computerised tests in anatomy is rigorous. Using images from ICALP learning materials, 100 questions take an average of six hours to prepare. Once developed, or acquired, the same constraints apply to the use of quality assured multiple choice and true false questions for the lecture stream.

Time taken to grade and record results by traditional methods

Research has shown, that the time spent by academic staff to grade and mark a two hour examination paper is between 12 and 20 minutes. This represents between 20 and 33 academic staff hours for every two hour examination per 100 students, which may be considerably more when marking and grading detailed practical examination papers.

Time saved to access and grade computerised results

Using SOCCER, 100 students can undertake a diagrammatic challenge test with a further 100 MCQ test questions in less than two hours. More importantly, the results are available for instant reinforcement by the candidates, and are marked, graded and stored for retrieval and printing directly after completion of the last workstation.

Consumable costs of traditional methods

Traditional methods incur immeasurable costs by provision of photocopied materials, lecture notes, handouts, study directives, examination papers, invigilation and examination booklets.

Consumables saved by computerised learning and testing

The costs of consumables used by traditional methods are totally eliminated by SOCCER and a CMLE. Furthermore, not only does each ICALP contain specific lists of references used for its construction, it provides instant access to accumulated results, with options to print problem based questions at the learners expense!

Educational cost benefits

In contrast to learning by lecture, individuals using SOCCER gain a self paced, self directed style of learning, with freedom of access to all materials, which may be repeated at any time.

ICALP versus lectures

A comparative study of results achieved by randomly selected ICALP and Lecture learning groups of the anatomy of the lower limbs show no significant difference between the two groups. See figure 1.

Figure 1: Comparison of mean raw scores of ICALP and Lecture groups
Pre and post-tests differences show a significant improvement ( df=78, 1 p <0.001 ) with
no significant difference between the ICALP and Lecture groups ( F=0.023, df=78, 1 p <0.001)

Replication of ICALP versus lectures

In a further study to quantify and compare the results of randomly selected ICALP and Lecture groups whilst learning cardio-pulmonary anatomy, the same controlled methods were applied to a different group of second year students. These groups were pre and post-tested, with a mean improvement of 37%, but no significant difference between the two groups. See Table 1.

Group n Pre-test Post Test +Improvement

Mean SD Mean SD Mean SD

ICALP 38 44.99 6.09 82.7 7.71 37.07 6.33

Lecture 36 42.35 6.06 80.00 7.38 37.65 4.52

Table 1: Mean and standard deviations of replication study

ICALP versus lectures and the retention of knowledge

To investigate the effectiveness of learning the anatomy of the central nervous system by ICALP and Lectures, group n was randomly subdivided into groups of 37 and 41 respectively. The ICALP group were denied admission to lectures, with free access to SOCCER, whilst the Lecture group were given identical information via lectures and OHP, but denied admission to SOCCER. The same computer test was repeated under controlled conditions throughout. At pre-test, the ICALP group achieved a mean score of 44.81% with a SD of 6.54%, whilst the Lecture group scored 43.58% with a SD of 8.67%. To quantify learned information, both groups were tested again at the end of a five week learning period. To measure the decay of knowledge, the test was unexpectedly re-administered at 60 and 120 day intervals. For detailed results, see Table 2 and Figure 2.

Group	n	Pre-test		Post Test		Days		+ 120 Days
Group	n	Mean	SD	Mean	SD	Mean	SD	Mean	SD
ICALP	37	4.81	6.54	75.42	6.76	70.34	9.58	69.68	9.02
Lecture	41	43.58	8.67	73.19	7.76	68.04	84.9	68.06	8.24

Table 2: Mean and Standard Deviations of the groups in Figure 2

Figure 2: Mean pre-test and delayed post-test scores
A comparison of the relative scores and retention rates of learning by ICALP and
lecture groups at pre, post and delayed re-tests at 60 and 120 day intervals.

Summary and conclusions

This paper has reviewed the literature associated with the information explosion and overload initiated by computer based learning. Intuitive links are related to. learning in medicine, with discussion of CBL in schools of nursing and dentistry. The teaching and learning of anatomy by physiotherapy students is debated, as well as the transfer of 2-D information into a 3-D domain. The cost effectiveness of CBL with traditional lectures is described, comparing obtained from several reputable studies. The principles of SOCCER and a CMLE are outlined, with its ability to register, record and retrieve information for instant learner reinforcement.

Evidence is given to verify how these techniques are used to advance the rate of learning, replacing lectures with seminar discussion sessions to facilitate problem based learning. A pro-rated cost effectiveness model is shown to support the educational and administrative cost benefits of CBL.

Information is also given about the costs of the time taken by traditional academic staff to prepare lectures and examinations, as well as to mark and grade them, with a review of consumable costs whilst doing so. The disadvantages of time commitment for the development of ICALP and test items are offset by the advantages of its flexibility for rapid modification, as well as time saved in marking and consumable expenditures. Details of studies are given to relate the cost effectiveness of ICALP with lectures in anatomy, showing a mild advantage to ICALP groups by retained information when post-tested after 120 days. In review, the administrative and educational cost benefits of SOCCER as a facility to record data from test and feedback items becomes self evident. The acquirement of knowledge can be tracked, assessed and measured, with the reactions and responses of individual learners constantly evaluated for further analysis. From the paradigms described, it is clear that SOCCER, ICALP's, Test and Feedback Items can be used with confidence to replace formal lectures in anatomy. Furthermore, that these facilities can be used to empower learners to become self paced and self directed, giving educational administrators an ability to monitor and rate progress during practice and test situations. This research shows that some topics are best suited to ICALP alone and that others can be integrated with lectures, placing responsibility for the acquisition of knowledge firmly upon the student in a climate of problem based learning at a more advanced level than could otherwise be expected.

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Author: Harry B Lee, Senior Lecturer in Anatomy, School of Physiotherapy, Curtin University of Technology, Western Australia. Tel: 09 351 6643
Please cite as: Lee, H. B. (1994). A comparison of the cost effectiveness of traditional lectures with interactive computer assisted learning packages. In C. McBeath and R. Atkinson (Eds), Proceedings of the Second International Interactive Multimedia Symposium, 264-272. Perth, Western Australia, 23-28 January. Promaco Conventions. http://www.aset.org.au/confs/iims/1994/km/lee1.html

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© 1994 Promaco Conventions. Reproduced by permission. Last revision: 8 Feb 2004. Editor: Roger Atkinson
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