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June 15, 2015

Open versus Closed Learning

Research Paper Outline: Open versus Closed Learning

Susan Koch

Thompson Rivers University

EDDL 5151

Abstract Hypothesis:

Is an online open learning system appropriate for healthcare students who will be practicing person-centered practice instead of the traditional merit-based approach that has been followed by most universities in the past?

Can both online open and traditional methods of instruction exist and complement each other well in healthcare education? I think they are both needed to balance recent developments in simulated (SIM) learning and changes in attitude and compassion. This paper will examine the pros and cons of online open learning for healthcare students.

Definition of Open Learning

Open learning is defined in “as a system of further education on a flexible part-time basis”. ( Bates states open education can also be described as education that is free for all; gives open access to courses or programs that are for credit or not for formal credit; or open/online textbooks that are free of charge. (Bates, 2015) This would mean that many more people would have entrée to educational opportunities they would previously not have had the opportunity to access. Bates goes on to say that merit-based admittance to universities has been the norm for a long time and high academic standards have been the standard (Bates, 2015).

I have found that high academic standards does not necessarily create a good, focused health care student. I have often seen people more interested in high marks than person-centred caregiving or actual emphasis on curiosity, communication and learning to provide care using best-practice to their clients. In this instance, I believe traditional instruction may be a better fit to modify attitudes toward seniors and others in need of care. Learning how to communicate effectively with patients, families and others is difficult if it is not practiced with real individuals.

Highly competent, compassionate people are needed in healthcare as many experienced healthcare personnel will be retiring. I am in favour of open access and open textbooks to decrease costs to students and increase accessibility to education for all but I am concerned that open learning may not be as focused as it needs to be in the area of providing competent, compassionate care for seniors and other vulnerable people.

The Pros of Open Learning in Healthcare

Rabkin (2002) as cited in Herrington, Reeves and Oliver (2007) states simulators (SIMS) provide realistic and accurate initial education in healthcare and acquisition of medical knowledge. Performing procedures on SIMS which can even provide tactile similarity to humans does make sense as a practice environment which is not harmful to human beings. I question whether the ability to engage with clients/patients can also be taught in this setting. Ulrich & Mancini (2013) support the use of SIMS to “change (improve) a learner’s behavior in applied clinical practice. The two primary factors that influence behavior in applied practice are confidence in the ability to perform what is required and competence to accurately perform what is required. Simulation-based instruction supports each of these factors and has the potential to significantly improve the acquisition and maintenance of competence beyond current training systems” (pgs. 27-28). Learners can, in a safe environment, practice their skills, attitude development and communication skills with the other members of their healthcare team. Does this method of interacting with SIMS produce the necessary circumstances to develop a warm manner of communicating with families and patients? I am not sure it does. The Khan Academy (Khan, n.d.) provides excellent information on a variety of topics including specific healthcare subjects. I have used some of their videos and teaching tools in my own classes on the cardiac system and have not been disappointed.

Tony Bates (2015) notes some of the other options of online open learning are MERLOT, OER Commons, and for k-12, Edutopia. He suggests when researching the sites you should look for a Creative Commons license to ensure they are using the information in the format for which it was intended. The ‘cons’ for online open education generally is in the section below.

Cons to Open Learning in Healthcare

Ingerslev refers to Cooper, (2008) when he states “innovation literature describes various strategies for killing ideas. In the stage-gate innovation model, the purpose of the gates is to decide whether an idea should be recycled, continue to next stage or be killed” (2014). Traditional methods of providing instruction in healthcare are, I believe, still viable options. Many ideas are used and discarded when new innovations arise. Some instructors will not use the online or multimedia methods of instruction that are available. I think they do not consider the information presented in enough depth to be useful in their nature of teaching.

I am not sure open education is always the correct course of action. Is open education the correct choice when it comes to providing the information, skills and attitude needed in present-day healthcare? I believe some traditional activities are required to make ‘a good, compassionate healthcare individual.’ Practice with real people will always be the most important part of education in healthcare. It is important to see students in ‘action’ in the clinical setting to be able to assess their learning and skill.

“Communication with others is an innate skill that is variably developed in all human beings. Students must be introduced to the exploration of the communication that occurs between health professionals and patients. ‘Communication Skills for Adult Nurses’ aims to provide students with a basic understanding of different modes of communicating and to enable critical analysis of health professional– patient interactions.” (Kraszewski, 2010)

I believe communication skills with families, patients and peers cannot be effectively mastered by SIM experience alone. It must be practiced with real people in real situations in order to be able to respond to the individual and unique personalities and difficulties. When it is practiced face-to face, the nurse/practitioner nuances can be seen, body language can be read and so on.

Apparently, the material that is available is not always of the highest quality. Bates (2015) notes “Power Point slides, lecture notes are poorly done and…text with no interaction or PDFs that cannot be modified easily. If the material is not scrutinized prior to use, a poor presentation can be apparent.

Pedagogical Use of Open Learning in Healthcare

The definition of pedagogy is “the principles, practice, or profession of teaching” ( There is also andragogy or “the methods or techniques used to teach adults: ( As post-secondary education involves both of these, there must be an overlap of what adult learners already know and how they learn more effectively.

Beard (2013) speaks of the “contrast between two kinds of systems that affect the way that our cities evolve: the open ‘a system in unstable evolution’ – and the closed – ‘a system in harmonious equilibrium”. Closed system development plays to our desire for planning and stability. The underlying assumption is that we collectively have the capacity to generate a single vision and construct a future environment that will be to the benefit of all. Open systems on the other hand challenge our desire for control” Beard (2013).

Beard (2015) maintains the method for determining if inequality is still present:

This possibility though depends on 5 key tests for equality:

  • Connection – is there universal connectivity?
  • Platform – does every person have access to a platform to get online?
  • Content – is the best and most effective content is available free or at low cost?
  • Teacher – is there a skilled teacher mediating the experience for the learners?
  • Learner – does the learner having sufficient competence and motivation to log on and do the learning?”

    Again, Beard (2015) states if you look at each of the categories you will still see some difficulties in all areas. Each potential student may not have connectivity or be able to access the necessary platforms to participate in an open online educational presentation. They may have language difficulties or not understand the content that is being taught. A competent teacher/instructor is still a vital component of the process and the learner must be able to log on and open the information in order to contribute to their own learning and their colleagues.

    (Baillie, 2015)


        I have many questions unanswered in my determination of open, online learning and whether it is the best method in all situations in healthcare education. I need to dig deeper into the resources and possibilities of open versus traditional learning practices. As this an outline for my future paper I will save more of my questions for the final paper. I am, as yet, uncertain what I will decide.


(n.d.). Retrieved June 13, 2015, from

Bates, T. (2015, February). What do we mean by open in education. Retrieved June 11, 2015, from

Beard. (2015). Can education technology solve the problems of inequality of access or is it a raise in this elitism of resources? Retrieved June 13, 2015, from

Beard, A. (2013, September). Education: An open or closed system? Retrieved from

Herrington, J. R. (2007). Immersive learning technologies: Realism and online authentic learning. Journal of Computing in Higher Education, 19(1), 80-99. Retrieved June 2015, from

Ingerslev, K. (2014). “The Killing Fields” of innovation How to kill ideas. The Innovation Journal: The Public Sector Innovation Journal, 19(3). Retrieved June 13, 2015, from


Khan, S. (n.d.). Khan Academy. (S. \khan, Producer) Retrieved June 13, 2015, from

Kraszewski, S., & McEwen (2010) A.Communication skills for adult nurses. Berkshire, GBR: McGraw-Hill Education, 2010. ProQuest ebrary. Retrieved June 14, 2015.

McCormick, T. (2015). The future of opensource in health IT. Retrieved June 11, 2015, from

Ulrich, B. &. (2013). Mastering Simulation : A Handbook for Success. Sigma Theta Tau International. Retrieved June 13, 2015, from

unknown. (2014). Immersive learning of design (ILD): A new model to assure the quality of learning through flipped classrooms. Open Journal of Social Sciences, 11(2), 212-223. doi:doi:10.4236/jss.2014.211027

unknown. (n.d.). What is open education? (opensource, Compiler) Retrieved June 11, 2015, from

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