Nurse Education in Practice 9 (2009) 372–376
Contents lists available at ScienceDirect
Nurse Education in Practice
journal homepage: www.elsevier.com/nepr
Podcasts and videostreaming: Useful tools to facilitate learning of
pathophysiology in undergraduate nurse education?
Aidín A. McKinney 1, Karen Page *
School of Nursing and Midwifery, Queens University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom
a r t i c l e
i n f o
Article history:
Accepted 16 November 2008
Keywords:
Podcasts
Pathophysiology
Nurse education
Videostreaming
s u m m a r y
Nurses require an understanding of pathophysiological processes to support safe practice in the clinical
area. A review of the literature indicates that nursing students have traditionally found this to be a challenging element of the course. The increasing availability of newer technology in higher education such
as videostreaming and podcasting provides the opportunity to utilise a variety of approaches to cater for
a wider range of learning styles. In view of this, lecturers developed multimedia resources to incorporate
into a pathophysiology module. An evaluation of students’ views on the use of ICT to facilitate understanding of pathophysiology was undertaken. The majority of students appeared to welcome the incorporation of alternative teaching approaches into the module. Interestingly despite the opportunities
which technology offers to enhance learning many of the students also highlighted the importance of
maintaining significant face-to-face contact with lecturers. This supports the findings of the literature
which indicates that students find hybrid learning strategies that combine traditional teaching with more
innovative methods particularly beneficial.
Ó 2008 Elsevier Ltd. All rights reserved.
Introduction
The biological sciences are viewed as an important aspect of the
undergraduate curriculum and seek to empower nurses with the
scientific knowledge and understanding to inform their decision
making and underpin safe clinical practice. Indeed Eraut et al.
(1995) and Clark (1995) have commented that as practice becomes
more complex the need for nurses to understand and apply their
knowledge in the clinical area increases. However studies continue
to provide evidence that nursing students commonly acknowledge
problems in learning biological sciences (McKee, 2002; Dorthe,
2004; King, 2004; Fleming and McKee, 2005). Traditionally this
subject has been taught using key lectures followed by small group
tutorials however both the student population and the resources
available to lecturers have changed dramatically with the development of information and communication technology (ICT) in higher education. There is an emerging appreciation that the use of ICT
may assist students’ understanding of many of the complex concepts associated with science learning by providing multimedia
learning experiences (Sloan et al., 2006). This paper reports on an
evaluation of the introduction of multimedia resources alongside
* Corresponding author. Tel.: +44 0 28 90975834.
E-mail addresses: a.mckinney@qub.ac.uk, k.page@qub.ac.uk.
1
Tel.: +44 0 28 90975835.
1471-5953/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nepr.2008.11.003
traditional teaching methods in the delivery of pathophysiology
within a pre-registration nursing programme.
Background
Within higher education curriculum formal lectures have long
been the cornerstone of teaching strategies and despite their
acknowledged pedagogical limitations they remain the pre-eminent method of teaching large classes (Bligh, 2000). Lectures are
viewed as a cost effective method of introducing new topics, providing students with key facts and concepts or establishing an
overview of the relationship between topics (Davies et al., 2000;
Quinn, 2000; Foertsch et al., 2002). Yet Collins (2000) noted that
students attending formal lectures are exposed to a wide variety
of stimuli that can distract them from the learning process including the behaviour of other students, the pace of delivery of the
material, fatigue and other environmental factors. In addition to
this, it must be recognised that today’s students face many outside
pressures which may make attending lectures more difficult such
as domestic and childcare responsibilities and other family and
financial commitments (Glackin and Glackin, 1998; Hughes,
2005; Kevern and Webb, 2004; Lauder and Cuthbertson, 1998).
There is growing recognition that the use of ICT can facilitate an
alternative approach to the delivery of traditional lectures (Boyle,
2004). Sloan et al. (2006) also take the view that effective use of
multimedia offers a way of enhancing the learning experience
and can support the understanding of difficult scientific concepts.
A.A. McKinney, K. Page / Nurse Education in Practice 9 (2009) 372–376
Moreover Maag, (2006c) would argue that many of today’s students are from the ‘net generation’ and learn from digital materials
rather than from more traditional sources of information. They expect to access a variety of learning resources and consequently the
introduction of technological innovations is more pertinent than
ever. However the literature highlights that some students continue to value the lecture as a way of providing an overview of
key concepts to guide their private study which would suggest that
this format should not be totally dismissed in the teaching of science subjects (Davies et al., 2000, Foertsch 2002). The challenge
for nurse education is therefore to develop innovations which will
not only enhance teaching provision within the nursing curriculum
but which will consider all students learning styles and preferred
teaching methods.
Literature review
Videostreaming
The advent of new technological innovations in recent years
such as videostreaming has created unprecedented opportunites
and challenges to explore new ways to deliver education to students. Video streaming, or webcasting, combines videoconferencing and the internet so that a live or recorded event can be
distributed via the web (Robin et al., 2001). Using this technology
to video lectures means that students can view the streams on
their own computers whenever it suits them rather than having
to take part in a face-to-face lecture (Garrison, 2001). This technology is increasingly being used in higher education, including the
area of nursing (Bennett and Glover, 2008; DiMaria-Ghalili et al.,
2005; Green et al., 2003) and there would appear to be much support for this innovation. An evaluative study on the inclusion of video streaming into an engineering course was conducted by
Foertsch et al. (2002) and reported that 59% of the students felt
that placing the lectures online in this format had a ‘‘positive” effect on their learning. While it is difficult to ascertain what the students meant by ‘‘positive”, the evaluation did also report on
advantages such as students feeling that this afforded them the
opportunity to learn from lectures at their own pace. However it
is evident that 41% of the students did not share this ‘‘positive”
view and therefore caution should be exerted when considering
these results. A study by Dimaria-Ghalili et al. (2005) where more
than 64% of students participated in the first webcast from home
again highlighted positive comments including that the students
enjoyed the convenience of not having to travel into lectures.
Unfortunately Dimaria-Ghalili et al. (2005) study is of limited value
since it only consisted of 27 participants. A more recent and larger
scale study however by Bennett and Glover (2008) reported on the
implementation and evaluation of videostreaming in an undergraduate nursing programme. In this case, the results reported that
91% of respondents stated that videostreaming assisted their learning although unfortunately 46% also highlighted that they had difficulty with accessing the video streaming resource. A limitation
however of this study is that of the students surveyed (n = 703),
the response rate was only 15%. Nevertheless, it would appear that
there was genuine interest in this strategy with Bennett and Glover
(2008) commenting that there were 8440 ‘‘hits”(number of times
video streaming website was accessed) during the video streaming
trial period demonstrating students enthusiasm for this technology. Although this may be the case it must also be acknowledged
that the use of video streaming as a sole teaching strategy essentially remains a non interactive medium and may therefore have
certain disadvantages that are comparable to traditional lectures.
Nevertheless it is apparent that while the studies reviewed do have
some limitations, there would seem to be support from students
373
for the introduction of these innovative teaching and learning resources. Indeed Bennett and Glover (2008) also comment that
there is further scope for developing video streaming to include
the downloading of lectures to portable multimedia devices such
as iPods and MP3 players.
Podcasting
It is apparent that today’s generation of student have an increased need for more flexible learning (Maag, 2006a). As noted
by Billings and Kowalski (2007) it would appear that many nurses
do not even seem to have enough time to sit at the computer to address educational issues. Recently the advent of more accessible
and better supported mobile technology is making mobile learning
(or m-learning) more achievable than ever (Boulos et al., 2006). A
quick ‘‘on the go” educational method that could be used is a podcast. Podcast can be defined as a method of distributing multimedia files such as audio or audio/video programmes over the
Internet for playback on mobile devices and personal computers.
More specifically audio files are referred to as podcasts and
audio/video files are called vodcasts (Billings and Kowalski,
2007).What distinguishes it from videostreaming is that not only
can information be listened to or watched on a computer but it
can also be transferred quite easily to a mobile device such as
the iPod or MP3 player for an audience that wants to listen not just
when they want but also where they want and how they want
(Boulos et al., 2006). As an emerging technology it is easy to appreciate why it may be of value in education. Maag (2006a) purports
that there are multiple advantages for the use of this technology
including that it can allow content such as a lecture to be accessed
easily more than once and in a convenient manner and therefore
should assist students to understand complex material. The literature would contend that mobile learning will become more a norm
than an expectation in the near future and indeed reports that this
technology is already being used in healthcare curricula (Boulos
et al., 2006; Maag, 2006a). However as this is very much an emerging learning tool there is little research available that considers its’
use. Only one study to date conducted by Maag (2006b) was identified that looked at students’ satisfaction with the introduction of
podcasting into a nursing course. Results highlighted that overall
student satisfaction was favourable and a significant number of
students thought listening to podcasts assisted their learning.
However it is important to note that this was a small study carried
out in America and the author reports that the majority of students
in the study owned a MP3 player and felt comfortable using computer technology. This may not necessarily be the case for all students and therefore some caution should be exerted when
considering these results. Furthermore this study does not consider
whether this approach is suitable for the teaching of pathophysiology particularly since it does not support the inclusion of visual
images which could be considered to be beneficial to the understanding of this subject.
Aims
The purpose of this paper is to report the outcomes of one
pilot project which evaluated nursing students views on the
inclusion of a variety of multimedia resources alongside more
traditional teaching approaches to facilitate the learning of
pathophysiology.
Sample
A convenience sample of a cohort of students (n = 125) were recruited from those undertaking an Applied Biomedical Sciences
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module in their final year of the undergraduate nursing sciences
programme.
Methodology
This module has been traditionally taught using lectures and
small group tutorials and is designed to enhance students understanding of pathophysiology. However the literature reviewed suggests that the introduction of more innovative technologies may be
useful to support student learning. The use of multimedia resources to enhance the learning of pathophysiology is a relatively
new intervention that requires evaluation. Consequently a team
of lecturers from the School of Nursing and Midwifery at Queen’s
University Belfast in collaboration with media services proposed
introducing multimedia resources including mobile technologies
into a traditionally taught pathophysiology module as a small pilot
project. Two lectures from the module were selected and made
available to students in a videostreaming format and also in a format which enabled them to download these as a vodcast or podcast onto iPods or MP3 players. The students were also provided
with handouts containing the powerpoint slides to enable them
to visualise the images that were discussed during the lecture if
they chose to use an audio only format. These two lectures replaced the delivery of the traditional didactic lecture. Students also
attended a follow up tutorial in which any issues of concern could
be clarified. The remaining lectures and tutorials in the module
were delivered using the traditional format.
Ethical considerations
Students and staff were informed about the proposed introduction of the educational initiative at the commencement of the
module. The initiative was then implemented following their
agreement. Consent to take part in the evaluation of the project
was obtained from the students and they were informed of their
right to withdraw at any time, although none did. Consent was also
obtained to their evaluation comments being used in the event of
any future publication. Anonymity was preserved by the absence
of identifying markers on the evaluation forms.
Data collection and analysis
Questionnaires were issued to students on completion of the
module. These questionnaires contained both qualitative and
quantitative questions and were completed and returned by 125
students. Quantitative data was analysed using SPSS. Qualitative
data was amalgamated and required content analysis to identify
recurring categories/themes.
Findings and discussion
The data analysis indicated a number of advantages and disadvantages that were grouped into various themes. The predominent
themes to emerge from the advantages were that of enhanced
understanding and convenience. The main disadvantages were
themed under the areas of lecturer contact issues and IT difficulties.
Enhanced understanding
The majority of the 125 participants (89%) reported that multimedia resources assisted their understanding of pathophysiology.
A prominent advantage that was highlighted by students in the
evaluation was the opportunity to revisit the material on a number
of occasions. Comments reported by the students included ‘‘I could
go back over the pathophysiology and pharmacology areas that I
found most difficult” and ‘‘ you could download the lecture onto
the MP3 format to use continuously so I was able to go back over
the parts I did not understand.” These comments appear to concur
with the findings of Maag (2006b) whose study on the introduction
of Podcasts noted that students reported that they learnt better by
hearing the material more than once and that this tool assisted
them to retain information. A number of students particularly
commented that this would be useful around exam time and felt
that this would aid their revision. Students were also generally
very positive about the information being produced and presented
in house by their own lecturers. As one student said ‘‘I found the
online lecture very clear and easy to listen to”. This appears to be
in keeping with the findings of Phillimore (2002) who reported
on the introduction of an online electronic lecture. In this case
when the students were questioned about the home produced econtent 70% of students seemed to prefer the voice of the lecturer
known to them with 30% identifying that they were happy with
any voice as long as it was clear. This seems to suggest that e-learning material does not necessarily have to be professionally produced as long as clarity and relevance to the module is ensured.
Convenience
Another significant advantage to emerge from the evaluations
was in relation to convenience. The majority of students identified
that they were able to access the lecture off campus. The most
common online resource employed by the students was the videostreaming format with only 5 students acknowledging that they
did not access any of the online resources. Most students appeared
to appreciate the fact that they could access the online lectures
from home and didn’t have to travel into university to attend class.
Several students made this point which was articulated particularly well by the following statement ‘‘ the online lectures were
so convenient it meant that you could access the lecture whenever
you wanted”. This is in keeping with the findings of Bennett and
Glover (2008) who also reported that students appreciate the flexibility to learn within their own schedule rather than being constrained by the university timetable. A significant number of
students in the evaluation also specifically commented on accessing the lecture podcasts and reported favourably on the ability to
listen to the lecture on their iPod or MP3 player. In particular they
seemed to appreciate the value of learning becoming more mobile.
As one student commented ‘‘I could listen to the lecture on my
MP3 player at the same time as doing the housework”. This highlights the potential for these technologies to support the busy lifestyles of today’s learners. However in this evaluation it must be
acknowledged that only 35 out of the 125 students identified that
they had downloaded the lecture onto their MP3 players or iPods.
The reasons for this as acknowledged by some students in the evaluations were due to the fact that they did not own iPods or MP3
players and would not feel comfortable using these technologies.
This differs from the study by Maag (2006b) conducted in America
in which the majority of students appeared to own MP3 players. It
is therefore important not to assume that all students are as technologically competent as others nor that they have ready access to
mobile technologies and thus points to the necessity of not assuming that one learning tool will facilitate all. Consequently it is
essential to ensure that all students are able to access learning
material in a format that is suitable for them and that they are adequately trained in the requisite technical skills.
IT difficulties
One of the main disadvantages that was reported by students
was in relation to IT difficulties. In particular many students
A.A. McKinney, K. Page / Nurse Education in Practice 9 (2009) 372–376
indicated that it appeared to take a long time to download the
material to their own computer. Reasons identified for this included that not all students reported having access to Broadband
connections particularly if they lived in more rural areas of Northern Ireland. This was highlighted by the following comment ‘‘It
took ages to download. We don’t have broadband so the download
took forever”. This is similiar to Green et al. (2003) findings who reported that a limited uptake of the videostreaming facility was due
to slow band and modem speeds. Other IT difficulties appeared to
stem from some students lack of knowledge or confidence with regard to computers with a small number indicating that they did
not know how to download onto an iPod. A small number of students also indicated that their home computer was quite dated
and could not support this technology or as reported by one student they did not even have a computer at home. This concurs with
Wakefield et al. (2008) study in which it was reported that restricted access to computing facilities may be a difficulty when
attempting to implement e-learning strategies.
Lecturer contact issues
Another disadvantage that students highlighted regarding the
introduction of these technologies was the fact that they were unable to gain immediate feedback to questions. As one student reported ‘‘there were no lecturers to go over the bits that I didn’t
understand”. However it is interesting to note that students also
identified that the follow up tutorials were useful to clarify any difficulties with 117 out of 125 students agreeing with the view that
there is a need for a group tutorial following an online session.
Comments to support this included ‘‘tutorials were another way
of going over aspects of the lecture that I didn’t understand” and
‘‘tutorials are vital following online teaching as if you have a problem you can ask for information and it allows us to bounce ideas off
each other”. Other studies have also identified that students miss
the opportunity to ask questions in class and receive instant clarification when online resources such as videostreaming are used
(Bennett and Glover, 2008; Foertsch et al., 2002). This indicates
that students appear to wish to maintain some contact with teachers and indeed their peers to reinforce their learning and therefore
it would seem to be beneficial to include followup tutorials to support the online learning resources. Indeed Boulos et al. (2006)
would contend that it is not enough to consider ways of introducing new innovative technologies into the practice of teaching without also considering whether the learning resources are
educationally sound and will match the learning needs and styles
of the students. It is apparent that sophisticated technology may
be a useful method of transmitting content but it is limited if a student does not understand a concept and there is no opportunity to
ask questions. As this project has identified students need interaction with tutors to clarify their understanding of a subject and adjust this understanding if need be. Thus hybrid or blended learning
which combines the convenience of technology without the complete loss of face-to-face contact may deliver the best of both
worlds. This concept is also supported by a study conducted by Salamonson and Lantz (2005) who evaluated the use of hybrid learning to aid students understanding of pathophysiology. In this case
the new hybrid format reduced the number of face-to-face contacts per week and included more online content that involved students undertaking additional reading and worksheets. The results
identified that students had a highly positive attitude toward a hybrid course delivery format although it must also be noted that a
number of students reported that they still preferred the traditional format. Indeed our evaluations would also support this
viewpoint with 104 out of 125 students clearly indicating that they
would not like to change from one approach to the other but that
375
they enjoyed the combination of both. Although Salamonson and
Lantz’s (2005) study did not focus on how the use of multimedia
mobile technologies can be combined with traditional teaching
methods their results together with the findings of our evaluations
further contribute to an understanding that blended learning may
be a useful teaching and learning strategy.
Limitation
Overall the evaluation of this module highlights some positive
and indeed negative points regarding the introduction of multimedia resources to facilitate the learning of pathophysiology. However it is important that the authors acknowledge that this is not
a research study but simply a small pilot project that was undertaken to consider whether the introduction of innovative technology would enhance the learning experience for the students. In
view of this it is essential to recognise that the evaluation comments cannot be generalised. Nevertheless it could be proposed
that the information obtained further adds to the findings of the
studies and the literature reviewed in this article.
Conclusion
It is acknowledged that learning science is difficult for many
students and requires repeated rehearsal of complicated ideas
and concepts. This is not necessarily ensured by the use of traditional didactic teaching strategies. This article has considered
how the introduction of multimedia resources such as the use of
videostreaming, iPods and MP3 players can enhance students
understanding of scientific concepts. Moreover these e-learning
strategies attempt to address the requirements of today’s busy
learners and are more compatible with the need to promote mobile
learning (m-learning) which Maag (2006c) indicates will become
more a norm than an exception in the near future. Nevertheless
it is evident that the use of these tools alone is not necessarily
the way forward. As our evaluations have highlighted it is apparent
the sole use of ICT approaches does not facilitate learning for all
students particularly those not yet comfortable with broadcast
technologies. Indeed Haigh (2004) would also take the view that
simply providing high quality resources is not enough to ensure
that learning takes place. Such resources would be perhaps more
beneficial if they were effectively integrated into programmes of
learning that involve dialogue with tutors and peers as proposed
by Twomey (2004).Thus the hybrid or blended learning approach
that combines new technological innovations with traditional
teaching methods may provide the optimum learning experience
for science subjects such as pathophysiology. Ongoing evaluations
and further research is required in order to guide the best approach
to take during this era of rapid technological change.
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