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The use of interactive multimedia to facilitate speech pathology students' learning of the dynamic swallowing process.
By Ingrid Sholten and Alison Russell
Flinders University of South Australia
By Ingrid Sholten and Alison Russell
Flinders University of South Australia
ABSTRACT
The management of swallowing problems is the largest recognised sub specialty in the field of speech pathology. Speech pathologists require a comprehensive understanding of the normal swallowing process and how this may be affected in an individual with a swallowing problem.
Students therefore need to develop an understanding of the normal integrated swallow and how it can be affected in order to appreciate the assessment or treatment of dysphagia. Whilst students are well-motivated to learn this material, assimilating knowledge of the dynamic nature of the swallow has typically been problematic because of its complex character.
The Dynamic Swallow, an interactive multimedia program that includes integrated presentation of text, graphics, voice over, video and animation sequences to highlight various aspects of the swallowing process, was developed to overcome the limitations of currently available teaching resources.
Students are able to direct their own learning of this complex material by selectively manipulating parts of an animated swallow in order to understand the normal swallow and simulate different aspects of dysfunction. In this way they are able to appreciate the integrated nature of the swallowing process and evaluate the consequent effects of dysfunction on swallow safety and efficiency.
Feedback from students suggests that this unique delivery of material greatly facilitates their understanding of the complex normal swallow as well as the links between related aspects of course content, such as aetiology, assessment and treatment techniques, by offering a way of investigating the swallowing mechanism in a safe environment.
Introduction
Speech pathologists working with clients of all ages have a leading role in the management of people with swallowing problems, with over 50% of speech pathologists regularly treating swallowing difficulties (Janota, 1997). Swallowing problems can be life threatening, and graduates should possess the necessary skills to approach this area of their clinical caseload with optimum competency and confidence.
Students need to develop an understanding of the normal integrated swallow and how it can be affected in order to appreciate the assessment or treatment of swallowing problems. Until very recently this material was learned in the clinical setting, after graduation, but there has been a recent move towards inclusion of this teaching at the undergraduate level in university speech pathology programs, most often through the delivery of formal lectures.
Given the recency of dedicated teaching in the area of swallowing and its disorders, it is not surprising that there have been no published studies that examine students' learning in this field of practice. There are studies in related fields however, including head and neck anatomy, that can inform us about student learning in this area.
Speech pathology students performed with less than 50% accuracy, on an assessment of their learning of head and neck anatomy following traditional classroom teaching (Reimers Neils, 1994). This supports the findings of researchers in related fields of medical training that lectures are not especially effective when they are the sole learning method used (Squire, 1989).
More importantly, even if students demonstrate recall of information, this is not translated into a working understanding when they are faced with real situations involving patient care. There is evidence to suggest that students require direct personal experience in order to achieve long term recall (Gonnella et al., 1970; Templeton, 1985).
Eizenberg (1988) has described that medical students find anatomy and related subjects complex and this is the same for even the most able speech pathology students. Several factors contribute to this. The material is often presented in a language that is new to students, and at the same time students have heavy schedules and demands on study time.
Typically students cope with the demands of learning such vast amounts of knowledge by assuming a very superficial approach to learning, resulting in poor understanding and little retention. The challenge is to shift students from a surface approach to a deep approach to learning, (Eizenberg, 1988) incorporating strategies that require students to make links between facts, relate new ideas to existing knowledge and to then apply fundamental principles to solving complex problems (Marton et al., 1988).
The available teaching materials do not represent the dynamic character of the swallowing process and this is almost certainly a contributing factor to poor learning in this area.
The development of an interactive multimedia CD-ROM, The Dynamic Swallow, arose from our concern that students had difficulty in developing a meaningful understanding of the dynamic nature of the swallowing.
Our task was to create a teaching resource that would provide students with a representation of the dynamic swallowing process to enhance their understanding of the complexity and coordination of the normal swallowing process and develop an understanding of the consequences of dysfunction.
In doing so, we aimed to improve students' understanding of the connections between the external signs of swallowing dysfunction seen during clinical assessment and an illustration of internal function.
Development of The Dynamic Swallow
Academic speech pathologists responsible for teaching in the area of swallowing disorders at each of the six university speech pathology programs in Australia, together with two senior speech pathology students, formed the project team.
The team leaders (Ingrid Scholten and Alison Russell) presented an initial concept for the program and then worked cooperatively with the team to finalise the overall concept for The Dynamic Swallow.
Upon completion of the planning phase of the project the team leaders worked closely with the interactive media designers and maintained regular contact with the project team. Student input and feedback was critical to the success of this project, as indicated by the student representation on the project team.
In addition, informal focus testing was conducted throughout the evolution of the project and students were consulted for their views about many aspects of the program, as well as how well the material addressed their learning needs.
A key feature of The Dynamic Swallow was the development of a series of distinctive stylised animations of the swallowing process for morsels of both liquids and solids. This complex task required accurate depiction of anatomy, correct sequence and timing of movements, and authentic illustration of the effects of dysfunction.
In order to ensure the accurate visual representation of the physiology essential to the understanding of the swallowing process, close collaboration with the interactive media designer was essential. The interactive media design team provided the technical and production support for this phase of the project including the development of flow charts and screen designs, computer coding, digitisation of video images.
Technical Aspects of The Dynamic Swallow
The instructional platform for this project included interactive multimedia design because of its capacity to support a variety of different media including animations, video images, text, diagrams and voice-overs. Using this platform resources can be arranged in many different structures and sequences which are immensely different from those which can be provided by text based material (Hedberg et al., 1996; Oliver, 1996).
The interactivity feature of this format gives users many options for working through the program. By allowing the student to access the information in the way that best suits their learning style, the learner's active involvement is promoted and decision making, problem solving, and reflection is facilitated (Hedberg et al., 1996; Oliver, 1996; Laurillard, 1993; Keller et al., 1993).
The project was created using Macromedia Director 6.0, a cross platform multimedia authoring environment, on a Macintosh 8500/120 Power PC.
The QuickTime movies and images created for this interactive multimedia package were also produced on the same computer. The movies and animations were digitised using the standard audio visual capabilities of the 8500. The animation sequences were composited and compressed in Adobe After Effects.
Still images were created and composited in Adobe Photoshop version 4.0. Illustrations were created using Adobe Illustrator 7.0. The final package is one cross platform CD-ROM playable on Windows or Macintosh computers.
The base requirements are a Macintosh Power PC or Windows Pentium computer with 16 megabytes of RAM, a 14" colour monitor set to thousands of colours, and high quality external speakers. A Quad Speed CD-ROM is also necessary.
Description of The Dynamic Swallow
The primary aim of The Dynamic Swallow is to help students to develop an understanding of the normal swallowing process and the disordered swallow by helping to create internal visual models of the swallowing process.
The Dynamic Swallow allows students to manipulate the animations which supports experiential learning, provides scope for qualitative reasoning and permits problem-solving in context (Laurillard, 1993). One of the features of the program is that learning is enhanced because the form of presentation (animation) matches the content of the material (dynamic bio-mechanical swallowing process) (Svensson et al., 1988). This project provides students with a safe environment in which to examine concepts that would be hazardous with real clients.
There are five main menu selections that can be accessed from any part of the program by students in the sequence that best meets their learning needs. The five components are described below:
Introduction
A brief introduction to the program is provided in the form of vocal commentary and video collage of people eating and drinking.
Swallow
The Swallow section is the main focus of The Dynamic Swallow (Figure 1) and is designed to facilitate understanding of the integrated and dynamic nature of the swallowing process. It uses stylised animations of both liquid and solid material as well as authentic X-ray videos to highlight aspects of the normal swallow and variations of the swallowing act.
The user is able to "damage" specific elements of the swallowing process by clicking on the feature, and in doing so, investigate the consequences of dysfunction.
The animations and videos can be paused and repeated as many times as desired, or played in slow motion using an animation controller.
Oral Cavity and Pharynx
It is important that students understand the anatomy related to swallowing. Both the oral cavity and the pharynx are illustrated in The Dynamic Swallow using simple coloured diagrams that can be either fully annotated (Figure 2) or interactive. In the fully annotated mode, the colored diagram is shown, with all elements labelled. In the interactive mode, the diagram is presented in black and white.
The user can activate the colour, labels, and voice-over describing the component and its function in swallowing, by rolling the cursor over the section of interest.
Glossary
The glossary includes an alphabetical listing of definitions of terms used within the program. Students can access these definitions from any part of the program allowing them to move freely between the two whenever they need clarification of terms.
In addition there are hot links to other parts of the glossary from within most definitions. The glossary can also be viewed and printed by accessing the relevant file from the Glossary folder located on the CD-ROM.
Evaluation
Evaluation of whether or not The Dynamic Swallow meets the learning objective of helping students to understand the physiology of both the normal and disordered swallowing process, is ongoing. To date it has been evaluated by students at Flinders University of South Australia and the University of Newcastle, by academic staff teaching swallowing and its disorders in Australia, and by international experts.
Student's Questionnaires
Thirty-seven students provided written feedback about the program after using The Dynamic Swallow in conjunction with their lectures. They were asked to respond to questions using a 5 point Likert-type equal appearing interval scales, with 1 being strongly disagree and 5 being strongly agree.
Most students (80.6%) described themselves as being inexperienced computer users. All students believed that the learning objectives of the program had been completely (89.8%) or partially (10.2%) met and they all agreed that the material from The Dynamic Swallow had complemented lecture material. As can be seen from the responses to the attitude scales summarised in Table 1, the majority of the students were positive about the program and their learning using The Dynamic Swallow.
Student feedback has been extremely positive, with the most common response for all questions being "strongly agree". The wide range of responses to the question about the usefulness of the glossary may have reflected the fact that not all students felt the need to access it.
The students consistently reported that they liked those features of the program that were felt by the authors to be critical to its success. These included the high level of interactivity, especially the ability to slow down and replay the animations and videos, user friendly format, ease of navigation, variety of media, clear commentary and detailed explanations, stylised animations, diagrams, interesting X-rays, and the glossary.
The very few negative responses to aspects of the program reflected students'; inexperience using multimedia. For example, one student suggested that the sections could have been presented in a different order, when in fact the order of access is not prescribed.
Questionnaires from Academic Staff
Feedback was received from five academic staff. Overall, they responded favourably to the same features as the students, including navigability, interactivity, flexibility and the program's visual appeal (Table 2). There was less agreement about the clarity of the objectives of the program, although respondents felt that the implied goals had been achieved.
The academic staff all agreed that The Dynamic Swallow was an excellent supplement to formal class presentations and clinical work. They also observed that the program would be valuable in a clinical setting, either for review of the clinician's knowledge base or for client education. They concluded that other health professionals, such as nurses, allied health and medical staff, would also find the program useful.
Feedback from International Experts
Reviews have been sought from people with international reputations in the field of swallowing disorders. Although all have not yet been returned, most have been received and are very positive, containing comments similar to those made by the Australian academic staff. Observations included: "very instructive and informative", "it is really excellent for students", "the beauty is that it has something for everyone", "provides an extra dimension to learning", "nice features for learning basic anatomy" and "under direction it would be great for clients".
Direct Observation
Two pairs of students from Flinders University volunteered to be video taped while using The Dynamic Swallow for the first time to allow the team leaders to evaluate how students approached the task of learning using interactive multimedia. This proved to be a very informative process.
Despite the high level of interactivity of the program, the students all approached the task in a very linear fashion, starting with the first option on the menu bar and proceeding sequentially from left to right and top to bottom, and rarely deviating from this approach even for the simple purpose of clarifying a definition from the glossary.
The students' limited exploration of the potential of the program diminished their access to deeper learning. This was the first time the students had used the program and their later feedback indicated that they were much more interactive in accessing the information on subsequent encounters. Their limited flexibility in accessing information using this technology should not have been surprising given that the majority of students described themselves as novice computer users.
Discussion and future directions
The Dynamic Swallow is an innovative development in the teaching of normal and disordered swallowing. Speech pathology students, academic staff and expert reviewers have been positive about the program and its application for teaching. The academic staff responsible for teaching in the area of dysphagia in all undergraduate speech pathology programs throughout Australia are now using The Dynamic Swallow in conjunction with other teaching methods as advocated by Laurillard (1993) in order to maximise the effectiveness of student learning.
Although students will use The Dynamic Swallow outside of normal lecture times, lecturers may demonstrate it in class and make reference to the material and its application to encourage students to refer back to it in their subsequent studies. The program could also be used for revisiting previously learned material in the context of later clinical practice.
The Dynamic Swallow assists students in learning about the complex nature of swallowing by providing unlimited repetition and exploration of a potentially life threatening aspect of speech pathology practice in a safe environment.
The Dynamic Swallow has potential applications in other fields, including medicine and nursing, and may also be of benefit for use with clients in explaining the complexities of the swallow, and the consequences of dysfunction.
Evaluation of the nature of student learning and the impact of the introduction of The Dynamic Swallow in courses around Australia is ongoing.
Acknowledgement
This project was supported by a National Teaching Development Grant (CUTSD).
Table i. Student responses to attitude scale questions
Table ii Academic staff responses to attitude scale questions
Figure 1. The Swallow section showing the liquid bolus animation.
Figure 2. The oral cavity in annotated mode.
Reference List
Eizenberg, N. (1988). Approaches to studying anatomy: improving teaching by investigating learning. ANZAME Bulletin, 15, 3-17.
Gonnella, J.S., Goran, M.J., Williamson, T.W., & Cotsonas, N.J. (1970). Evaluation of patient care: An approach. Journal of the American Medical Association, 214(11), 2040-2043.
Hedberg, J.,& Harper, B. Interactive educational technologies: Effective design and application in the classroom. In Anonymous. Perth: Paper presented at the Third International Interactive Multimedia Symposium.
Janota, J. Omnibus survey results. (1997). ASHA.
Keller, B.,& Keller, J. Beyond the novelty effect: designing motivating multimedia instruction. In Anonymous. New Orleans: Paper presented at the annual meeting of the Association for Educational Communications and Technology.
Laurillard, D. (1993). Rethinking university teaching: A framework for the effective use of educational technology. London: Routledge.
Marton, F., & Ramsden, P. (1988). What does it take to improve learning? In P. Ramsden (Ed.), Improving learning: New perspectives. London: Kogan Page.
Oliver, R. Interactions in educational multimedia: The things that matter. In C. McBeath & R. Atkinson (Eds.), The learning superhighway: New world. New worries.: Perth: Proceedings of the Third International Interactive Multimedia Symposium.
Reimers Neils, L. (1994). Effects of perceptual training on students diagnostic skills: implications for a training model. Northwestern University;
Squire, L.F. (1989). On teaching radiology to medical students: challenges for the nineties. American Journal of Roentgenology, 152(3), 457-463.
Svensson, L., & Hogfors, C. (1988). Conceptions as the content of teaching: improving education in mechanics. In P. Ramsden (Ed.), Improving learning: New perspectives. London: Kogan Page.
Templeton, A.C. (1985). Videodisc - computer technology in the teaching of pathology. Physiologist, 28(5), 432-434.
Contact Details
Ingrid Scholten
Speech Pathology Department
Flinders University of South Australia
GPO Box 2100
Adelaide 5001
South Australia
Phone: +61 8 8204 5953
Fax: +61 8 8204 5935
Email: ingrid.scholten@flinders.edu.au
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The management of swallowing problems is the largest recognised sub specialty in the field of speech pathology. Speech pathologists require a comprehensive understanding of the normal swallowing process and how this may be affected in an individual with a swallowing problem.
Students therefore need to develop an understanding of the normal integrated swallow and how it can be affected in order to appreciate the assessment or treatment of dysphagia. Whilst students are well-motivated to learn this material, assimilating knowledge of the dynamic nature of the swallow has typically been problematic because of its complex character.
The Dynamic Swallow, an interactive multimedia program that includes integrated presentation of text, graphics, voice over, video and animation sequences to highlight various aspects of the swallowing process, was developed to overcome the limitations of currently available teaching resources.
Students are able to direct their own learning of this complex material by selectively manipulating parts of an animated swallow in order to understand the normal swallow and simulate different aspects of dysfunction. In this way they are able to appreciate the integrated nature of the swallowing process and evaluate the consequent effects of dysfunction on swallow safety and efficiency.
Feedback from students suggests that this unique delivery of material greatly facilitates their understanding of the complex normal swallow as well as the links between related aspects of course content, such as aetiology, assessment and treatment techniques, by offering a way of investigating the swallowing mechanism in a safe environment.
Introduction
Speech pathologists working with clients of all ages have a leading role in the management of people with swallowing problems, with over 50% of speech pathologists regularly treating swallowing difficulties (Janota, 1997). Swallowing problems can be life threatening, and graduates should possess the necessary skills to approach this area of their clinical caseload with optimum competency and confidence.
Students need to develop an understanding of the normal integrated swallow and how it can be affected in order to appreciate the assessment or treatment of swallowing problems. Until very recently this material was learned in the clinical setting, after graduation, but there has been a recent move towards inclusion of this teaching at the undergraduate level in university speech pathology programs, most often through the delivery of formal lectures.
Given the recency of dedicated teaching in the area of swallowing and its disorders, it is not surprising that there have been no published studies that examine students' learning in this field of practice. There are studies in related fields however, including head and neck anatomy, that can inform us about student learning in this area.
Speech pathology students performed with less than 50% accuracy, on an assessment of their learning of head and neck anatomy following traditional classroom teaching (Reimers Neils, 1994). This supports the findings of researchers in related fields of medical training that lectures are not especially effective when they are the sole learning method used (Squire, 1989).
More importantly, even if students demonstrate recall of information, this is not translated into a working understanding when they are faced with real situations involving patient care. There is evidence to suggest that students require direct personal experience in order to achieve long term recall (Gonnella et al., 1970; Templeton, 1985).
Eizenberg (1988) has described that medical students find anatomy and related subjects complex and this is the same for even the most able speech pathology students. Several factors contribute to this. The material is often presented in a language that is new to students, and at the same time students have heavy schedules and demands on study time.
Typically students cope with the demands of learning such vast amounts of knowledge by assuming a very superficial approach to learning, resulting in poor understanding and little retention. The challenge is to shift students from a surface approach to a deep approach to learning, (Eizenberg, 1988) incorporating strategies that require students to make links between facts, relate new ideas to existing knowledge and to then apply fundamental principles to solving complex problems (Marton et al., 1988).
The available teaching materials do not represent the dynamic character of the swallowing process and this is almost certainly a contributing factor to poor learning in this area.
The development of an interactive multimedia CD-ROM, The Dynamic Swallow, arose from our concern that students had difficulty in developing a meaningful understanding of the dynamic nature of the swallowing.
Our task was to create a teaching resource that would provide students with a representation of the dynamic swallowing process to enhance their understanding of the complexity and coordination of the normal swallowing process and develop an understanding of the consequences of dysfunction.
In doing so, we aimed to improve students' understanding of the connections between the external signs of swallowing dysfunction seen during clinical assessment and an illustration of internal function.
Development of The Dynamic Swallow
Academic speech pathologists responsible for teaching in the area of swallowing disorders at each of the six university speech pathology programs in Australia, together with two senior speech pathology students, formed the project team.
The team leaders (Ingrid Scholten and Alison Russell) presented an initial concept for the program and then worked cooperatively with the team to finalise the overall concept for The Dynamic Swallow.
Upon completion of the planning phase of the project the team leaders worked closely with the interactive media designers and maintained regular contact with the project team. Student input and feedback was critical to the success of this project, as indicated by the student representation on the project team.
In addition, informal focus testing was conducted throughout the evolution of the project and students were consulted for their views about many aspects of the program, as well as how well the material addressed their learning needs.
A key feature of The Dynamic Swallow was the development of a series of distinctive stylised animations of the swallowing process for morsels of both liquids and solids. This complex task required accurate depiction of anatomy, correct sequence and timing of movements, and authentic illustration of the effects of dysfunction.
In order to ensure the accurate visual representation of the physiology essential to the understanding of the swallowing process, close collaboration with the interactive media designer was essential. The interactive media design team provided the technical and production support for this phase of the project including the development of flow charts and screen designs, computer coding, digitisation of video images.
Technical Aspects of The Dynamic Swallow
The instructional platform for this project included interactive multimedia design because of its capacity to support a variety of different media including animations, video images, text, diagrams and voice-overs. Using this platform resources can be arranged in many different structures and sequences which are immensely different from those which can be provided by text based material (Hedberg et al., 1996; Oliver, 1996).
The interactivity feature of this format gives users many options for working through the program. By allowing the student to access the information in the way that best suits their learning style, the learner's active involvement is promoted and decision making, problem solving, and reflection is facilitated (Hedberg et al., 1996; Oliver, 1996; Laurillard, 1993; Keller et al., 1993).
The project was created using Macromedia Director 6.0, a cross platform multimedia authoring environment, on a Macintosh 8500/120 Power PC.
The QuickTime movies and images created for this interactive multimedia package were also produced on the same computer. The movies and animations were digitised using the standard audio visual capabilities of the 8500. The animation sequences were composited and compressed in Adobe After Effects.
Still images were created and composited in Adobe Photoshop version 4.0. Illustrations were created using Adobe Illustrator 7.0. The final package is one cross platform CD-ROM playable on Windows or Macintosh computers.
The base requirements are a Macintosh Power PC or Windows Pentium computer with 16 megabytes of RAM, a 14" colour monitor set to thousands of colours, and high quality external speakers. A Quad Speed CD-ROM is also necessary.
Description of The Dynamic Swallow
The primary aim of The Dynamic Swallow is to help students to develop an understanding of the normal swallowing process and the disordered swallow by helping to create internal visual models of the swallowing process.
The Dynamic Swallow allows students to manipulate the animations which supports experiential learning, provides scope for qualitative reasoning and permits problem-solving in context (Laurillard, 1993). One of the features of the program is that learning is enhanced because the form of presentation (animation) matches the content of the material (dynamic bio-mechanical swallowing process) (Svensson et al., 1988). This project provides students with a safe environment in which to examine concepts that would be hazardous with real clients.
There are five main menu selections that can be accessed from any part of the program by students in the sequence that best meets their learning needs. The five components are described below:
Introduction
A brief introduction to the program is provided in the form of vocal commentary and video collage of people eating and drinking.
Swallow
The Swallow section is the main focus of The Dynamic Swallow (Figure 1) and is designed to facilitate understanding of the integrated and dynamic nature of the swallowing process. It uses stylised animations of both liquid and solid material as well as authentic X-ray videos to highlight aspects of the normal swallow and variations of the swallowing act.
The user is able to "damage" specific elements of the swallowing process by clicking on the feature, and in doing so, investigate the consequences of dysfunction.
The animations and videos can be paused and repeated as many times as desired, or played in slow motion using an animation controller.
Oral Cavity and Pharynx
It is important that students understand the anatomy related to swallowing. Both the oral cavity and the pharynx are illustrated in The Dynamic Swallow using simple coloured diagrams that can be either fully annotated (Figure 2) or interactive. In the fully annotated mode, the colored diagram is shown, with all elements labelled. In the interactive mode, the diagram is presented in black and white.
The user can activate the colour, labels, and voice-over describing the component and its function in swallowing, by rolling the cursor over the section of interest.
Glossary
The glossary includes an alphabetical listing of definitions of terms used within the program. Students can access these definitions from any part of the program allowing them to move freely between the two whenever they need clarification of terms.
In addition there are hot links to other parts of the glossary from within most definitions. The glossary can also be viewed and printed by accessing the relevant file from the Glossary folder located on the CD-ROM.
Evaluation
Evaluation of whether or not The Dynamic Swallow meets the learning objective of helping students to understand the physiology of both the normal and disordered swallowing process, is ongoing. To date it has been evaluated by students at Flinders University of South Australia and the University of Newcastle, by academic staff teaching swallowing and its disorders in Australia, and by international experts.
Student's Questionnaires
Thirty-seven students provided written feedback about the program after using The Dynamic Swallow in conjunction with their lectures. They were asked to respond to questions using a 5 point Likert-type equal appearing interval scales, with 1 being strongly disagree and 5 being strongly agree.
Most students (80.6%) described themselves as being inexperienced computer users. All students believed that the learning objectives of the program had been completely (89.8%) or partially (10.2%) met and they all agreed that the material from The Dynamic Swallow had complemented lecture material. As can be seen from the responses to the attitude scales summarised in Table 1, the majority of the students were positive about the program and their learning using The Dynamic Swallow.
Student feedback has been extremely positive, with the most common response for all questions being "strongly agree". The wide range of responses to the question about the usefulness of the glossary may have reflected the fact that not all students felt the need to access it.
The students consistently reported that they liked those features of the program that were felt by the authors to be critical to its success. These included the high level of interactivity, especially the ability to slow down and replay the animations and videos, user friendly format, ease of navigation, variety of media, clear commentary and detailed explanations, stylised animations, diagrams, interesting X-rays, and the glossary.
The very few negative responses to aspects of the program reflected students'; inexperience using multimedia. For example, one student suggested that the sections could have been presented in a different order, when in fact the order of access is not prescribed.
Questionnaires from Academic Staff
Feedback was received from five academic staff. Overall, they responded favourably to the same features as the students, including navigability, interactivity, flexibility and the program's visual appeal (Table 2). There was less agreement about the clarity of the objectives of the program, although respondents felt that the implied goals had been achieved.
The academic staff all agreed that The Dynamic Swallow was an excellent supplement to formal class presentations and clinical work. They also observed that the program would be valuable in a clinical setting, either for review of the clinician's knowledge base or for client education. They concluded that other health professionals, such as nurses, allied health and medical staff, would also find the program useful.
Feedback from International Experts
Reviews have been sought from people with international reputations in the field of swallowing disorders. Although all have not yet been returned, most have been received and are very positive, containing comments similar to those made by the Australian academic staff. Observations included: "very instructive and informative", "it is really excellent for students", "the beauty is that it has something for everyone", "provides an extra dimension to learning", "nice features for learning basic anatomy" and "under direction it would be great for clients".
Direct Observation
Two pairs of students from Flinders University volunteered to be video taped while using The Dynamic Swallow for the first time to allow the team leaders to evaluate how students approached the task of learning using interactive multimedia. This proved to be a very informative process.
Despite the high level of interactivity of the program, the students all approached the task in a very linear fashion, starting with the first option on the menu bar and proceeding sequentially from left to right and top to bottom, and rarely deviating from this approach even for the simple purpose of clarifying a definition from the glossary.
The students' limited exploration of the potential of the program diminished their access to deeper learning. This was the first time the students had used the program and their later feedback indicated that they were much more interactive in accessing the information on subsequent encounters. Their limited flexibility in accessing information using this technology should not have been surprising given that the majority of students described themselves as novice computer users.
Discussion and future directions
The Dynamic Swallow is an innovative development in the teaching of normal and disordered swallowing. Speech pathology students, academic staff and expert reviewers have been positive about the program and its application for teaching. The academic staff responsible for teaching in the area of dysphagia in all undergraduate speech pathology programs throughout Australia are now using The Dynamic Swallow in conjunction with other teaching methods as advocated by Laurillard (1993) in order to maximise the effectiveness of student learning.
Although students will use The Dynamic Swallow outside of normal lecture times, lecturers may demonstrate it in class and make reference to the material and its application to encourage students to refer back to it in their subsequent studies. The program could also be used for revisiting previously learned material in the context of later clinical practice.
The Dynamic Swallow assists students in learning about the complex nature of swallowing by providing unlimited repetition and exploration of a potentially life threatening aspect of speech pathology practice in a safe environment.
The Dynamic Swallow has potential applications in other fields, including medicine and nursing, and may also be of benefit for use with clients in explaining the complexities of the swallow, and the consequences of dysfunction.
Evaluation of the nature of student learning and the impact of the introduction of The Dynamic Swallow in courses around Australia is ongoing.
Acknowledgement
This project was supported by a National Teaching Development Grant (CUTSD).
Table i. Student responses to attitude scale questions
| Question | Mean | Range |
| Effective means for learning normal swallow | 4.8 |
|
| Effective means for learning disordered swallow |
|
|
| Increased confidence in interpreting aspects of swallowing process |
|
|
| Easy to navigate |
|
|
| Screen design aesthetically pleasing |
|
|
| Level of interest |
|
|
| Suitability of animations for students |
|
|
| Suitability of videos for students |
|
|
| Usefulness of diagrams |
|
|
| Usefulness of the glossary |
|
|
Table ii Academic staff responses to attitude scale questions
| Questions |
|
|
| Objectives were clear |
|
|
| Content consistent with stated objectives |
|
|
| Format is effective for achieving objectives |
|
|
| Sound principles of adult learning |
|
|
| Easy to navigate |
|
|
| Allows the user to work at their own pace |
|
|
| Allows the user to select their own sequence |
|
|
| Animations suitable for students |
|
|
| Animations suitable for novice clinicians |
|
|
| Animations suitable for experienced clinicians |
|
|
| Animations suitable for clients |
|
|
| Different media are well integrated |
|
|
| Screen design aesthetically pleasing |
|
|
Figure 1. The Swallow section showing the liquid bolus animation.
Figure 2. The oral cavity in annotated mode.
Reference List
Eizenberg, N. (1988). Approaches to studying anatomy: improving teaching by investigating learning. ANZAME Bulletin, 15, 3-17.
Gonnella, J.S., Goran, M.J., Williamson, T.W., & Cotsonas, N.J. (1970). Evaluation of patient care: An approach. Journal of the American Medical Association, 214(11), 2040-2043.
Hedberg, J.,& Harper, B. Interactive educational technologies: Effective design and application in the classroom. In Anonymous. Perth: Paper presented at the Third International Interactive Multimedia Symposium.
Janota, J. Omnibus survey results. (1997). ASHA.
Keller, B.,& Keller, J. Beyond the novelty effect: designing motivating multimedia instruction. In Anonymous. New Orleans: Paper presented at the annual meeting of the Association for Educational Communications and Technology.
Laurillard, D. (1993). Rethinking university teaching: A framework for the effective use of educational technology. London: Routledge.
Marton, F., & Ramsden, P. (1988). What does it take to improve learning? In P. Ramsden (Ed.), Improving learning: New perspectives. London: Kogan Page.
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Contact Details
Ingrid Scholten
Speech Pathology Department
Flinders University of South Australia
GPO Box 2100
Adelaide 5001
South Australia
Phone: +61 8 8204 5953
Fax: +61 8 8204 5935
Email: ingrid.scholten@flinders.edu.au
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