Implementing Quality Corporate HealthCare Continuing Education Utilizing the TPACK Model of Instruction. by David M. DeLaire A DISSERTATION PROSPECTUS Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, in the Program of Instructional Leadership, in the Graduate School of The University of Alabama TUSCALOOSA, ALABAMA 2014 Table of Contents Contents CHAPTER 1 - INTRODUCTION ................................................................................................................ 3 Introduction ........................................................................................................................................... 3 Statement of the Problem ...................................................................................................................... 3 Statement of Purpose ............................................................................................................................ 4 Significance of the Problem .................................................................................................................. 5 Theoretical Framework ......................................................................................................................... 6 Research Questions ............................................................................................................................... 7 CHAPTER 2 - REVIEW OF THE LITERATURE ...................................................................................... 7 Introduction ........................................................................................................................................... 7 Defining the Six Individual and Blended TPACK Knowledge Areas .................................................. 8 Defining TPACK ................................................................................................................................ 11 TPACK Challenges ............................................................................................................................. 12 Applying TPACK ............................................................................................................................... 13 Measuring TPACK ............................................................................................................................. 14 Technology in Healthcare Training .................................................................................................... 15 Summary ............................................................................................................................................. 16 CHAPTER 3 - METHODS ......................................................................................................................... 17 Introduction ......................................................................................................................................... 17 Setting of the Study ............................................................................................................................. 17 Instrumentation ................................................................................................................................... 17 Data Collection ................................................................................................................................... 18 Data Analysis ...................................................................................................................................... 18 REFERENCES .......................................................................................................................................... 19 CHAPTER 1 - INTRODUCTION Introduction The Technological Pedagogical Content Knowledge TPACK framework consists of seven components that represent the expertise required to successfully implement technology into instructional settings. The TPACK idea was an extension to the Pedagogical and Content Knowledge concept originally founded by Lee Shulman (Koehler, 2011). The three primary pillars of TPACK consist of Technology Knowledge, Content Knowledge, and Pedagogical Knowledge. TPACK is complex and requires the interaction of many moving parts. It is when all three of these knowledge domains converge that TPACK is realized. The fundamental theme behind TPACK is essentially Gestalt theory. When we examine TPACK it important to concentrate on the whole, which in the case of TPACK is the centralized merger of knowledge. The individual separate knowledge pillars should be understood but fundamentally TPACK is an example of the Gestalt’s premise that “The Whole is More Than the Sum of Its Parts” (Hufnus, 2014 – better source needed). Statement of the Problem The educational landscape has changed a great deal in the past three decades as new technologies have been introduced at an amplified rate. The implementation and integration of technology into educational strategies has become increasingly important. TPACK looks at the integral perquisite knowledge components: Pedagogical, Technological, and Content along with their various levels of synthesis (Koehler, 2011). The idea of synthesis has become an increasingly important requirement and it is often difficult for instructors to achieve the integration of technology into their instruction. Healthcare is a 24, 7, and 365 day environment, which requires flexible technological based solutions for fulfilling educational requirements. Most major healthcare facilities have entire departments devoted to developing education and training. However the potential application and examination of TPACK on the corporate healthcare training and education backdrop is missing from the current research body. It is unclear which forms of TPACK knowledge components currently exists among healthcare trainers. Additionally the levels of their existing knowledge and whether or not they are achieving the synthesizing effects of these knowledge areas needed to achieve TPACK has yet to be explored. This study will look into the educational settings that are being implemented in healthcare, including those that are mandated by the federal and state governments. This study will focus specifically in the areas of delivery by instructors and eLearning to assess whether or not there is a blending of technology, pedagogy, and content knowledge. Statement of Purpose This study will seek to explore the existing practical applications of the TPACK model and incorporate key findings into a model that could be applied to the unexplored educational area of TPACK and healthcare training. This new potential application of TPACK will take into account the fact that continuing education in healthcare faces many challenges including government mandates, challenging student schedules, and robust content. A feasibility assessment on TPACK’s applicability into healthcare training is the primary motivation and deliverable from this study. TPACK has many viable applications beyond the traditional classroom setting. Most research incorporating the TPACK model to date has focused predominantly on primary, secondary, and higher education environments. This study will investigate the applicability and potential value that TPACK can add to a healthcare training model. This exploration into applying the TPACK into the healthcare education setting will also investigate how well technological, pedagogical, and content knowledge are being synthesized and utilized in integrating quality educational solutions to the challenges faced by healthcare education departments. Clarity on the current and potential application of TPACK in healthcare will be investigated by looking at healthcare education program directors’ and instructors’ knowledge of the core components of the TPACK model and their proficiency to accurately blend these knowledge areas into quality educational solutions. Significance of the Problem Very little research exists on TPACK’s specific applications to corporate learning and eLearning initiatives. The trend of continuing education is growing and becoming very common place in many job settings. It is required by government mandates in some situations. In particular, healthcare requires that personnel fulfilling roles in nursing, pharmacy technician, electronic health records, billing and coding, patient care assistants, medical administrative assistances, EKG technicians, and Phlebotomy technicians all continue to stay current in their chosen skillsets through required education. Analyzing the potential merger of the TPACK method to both the corporate training and healthcare domains will fill a significant gap in education research, which has primarily focused on these knowledge areas and synthesizing concepts with traditional K12 and higher education programs. Information and findings will be focused on learning about the level and channels of knowledge acquisition as it relates to the main pillars of TPACK. These findings will also help improve healthcare education and training programs by identifying knowledge gaps and providing guidance in improving education and technology integration within healthcare. This study explores the Pedagogical Knowledge, Content Knowledge, and Technological Knowledge in the corporate healthcare education sector. Healthcare education and training departments will be investigated using the TPACK model to gain insight into how prepared and successful educational decision makers in healthcare training are with TPACK concepts. An assessment on their background knowledge and capability to implement TPACK enriched solutions will also be included in the evaluation of this study. Theoretical Framework This study will utilize the conceptual framework known as Technological, Pedagogical, and Content Knowledge or TPACK. TPACK was formerly referred to as “TPCK” in the literature until 2008, when the research community shifted to using the more easily spoken TPACK (Thompson, 2008). This model was derived from Lee Shulman’s concept of pedagogical knowledge blended with applicable and specific content knowledge. Shulman’s work in this area began in the 1980’s and has evolved out of necessity since the late 1990’s to include technology. The TPACK model’s foundation relies on a new and complex knowledge that is achieved only after the effective integration of technology with pedagogy occurs for a specific subject matter. This blend of disciplines results in a higher order knowledge that will result in effective teaching and learning (Koehler, 2011). At the core of this idea is the notion that instructors must have obtained the prerequisite proficiency in these three pillars of the model. This is needed in order to properly merge the knowledge areas and teach towards the idealistic TPACK target area of these cornerstones. The TPACK model is evolving quickly with the fast pace of new technology, this progressive model is applicable to a variety of areas of modern teaching and learning. Research Questions The primary research question for this study is: Is the TPACK model applicable to corporate healthcare continuing education initiatives? Secondary research questions consist of the following: 1. What obstacles exist to implementing TPACK in corporate healthcare environment? a. Are the lessons learned from traditional educational applications applicable to corporate Healthcare? 2. Are corporate healthcare educators capable of providing TPACK? a. What knowledge areas are insufficient? b. How do we fill gaps, in particular, core knowledge areas? c. Is it possible to fill gaps in the blended knowledge areas? 3. What role does eLearning play in corporate healthcare education? a. Can the role of eLearning be expanded? b. Is TPACK present and or achievable in eLearning in the healthcare environment? 4. Does corporate healthcare training have the motivation and desire to implement and promote a successful TPACK centric training environment? CHAPTER 2 - REVIEW OF THE LITERATURE Introduction This literature review will focus on TPACK and how it has been applied to real world situations. Furthermore a look into measurement methods for TPACK will be conducted in an attempt to see if it is plausible to take the ideas of this theoretical framework and make it applicable to various areas of instruction, such as healthcare training. The majority of TPACK literature is focused on pre-service teachers and programs of study. TPACK by its very nature is a fluid notion that requires immense creativity to measure. There are multiple variations of the knowledge area mix that can result in reaching TPACK and this has caused discrepancy among reaching scholarly consensus as to the proper measurement of TPACK. Additionally, TPACK has been exclusively focused on traditional K-16 teaching and learning environments and the personal development of those that are being trained to work in K-16 settings. There is a void in TPACK feasibility as well as application focused research among educators in non-traditional settings, such as corporate training, coaching, and other professional organizational development areas. It is the identification of this void that highlights the value to be added to the research body by this study. Defining the Six Individual and Blended TPACK Knowledge Areas In 2006 TPACK gained widespread popularity with Mishra & Koehler’s introduction of the model. In this introduction they outlined each of the central constructs, which is what we will focus on in this section (Thompson, 2008). At the heart of good teaching with technology are three core components: content, pedagogy, and technology, plus the relationships among and between them (Koehler & Mishra, 2009). The TPACK framework utilizes these three foundational knowledge sectors and three blends of these knowledge segments. The three foundational knowledge sectors are depicted in figure 1 below by pink, yellow, and blue circles and they include technological knowledge (TK), pedagogical knowledge (PK), and content knowledge (CK). Pedagogical knowledge (PK) is teachers’ deep knowledge about the processes and practices or methods of teaching and learning (Koehler & Mishra, 2009, p.64). Examples of PK include how students learn, general classroom management skills, lesson planning, and student assessment (Koehler & Mishra, 2009). PK involves teaching and learning that spans across content areas (Doering, Veletsianos, Scharber, & Miller, 2009). Technology knowledge (TK) is in a constant state of flux. It requires that persons understand information technology broadly enough to apply it productively at work and in their everyday lives, to recognize when information technology can assist or impede the achievement of a goal, and to continually adapt to changes in information technology (Koehler & Mishra, 2009, p.64). Finally, content knowledge (CK) or subject matter knowledge is the depth and breadth of knowledge in a specific content area (Doering, Veletsianos, Scharber, & Miller, 2009), for this study it would be healthcare competencies and training. To proceed towards TPACK it is fundamental that practitioners are affluent with these three primary pillars of knowledge. This simple model represents the interaction between these three major knowledge domains (Graham, 2011) which we will be the next focus. Figure 1 Integrating the three pillar knowledge areas to enhance instruction by operating in the areas where they overlap is the gateway to TPACK. These areas of overlap or blended knowledge domains include technological pedagogical knowledge (TPK), technological content knowledge (TCK), and pedagogical content knowledge (PCK) they are predecessors to achieving TPACK. Pedagogical content knowledge is the oldest of these notions and has been around since 1986 and were introduced in literature by Lee Shulman. PCK is fundamental to the TPACK framework. Researchers must clearly understand PCK before they can productively understand and effectively measure TPACK constructs (Graham, 2011, p.7). This area is the most commonly focused on among traditional professional educator curriculum because it traverses generational differences and technological ability. In summary PCK is knowledge of pedagogy that is applicable to the teaching of specific content. Technological content knowledge (TCK) is the understanding of how technology and content influence and constrain each other (Koehler & Mishra, 2009). Literature on TCK focuses on the ability of technology to both enhance and limit an instructors content knowledge application, experienced instructors achieve TCK when they are able to selectively apply technology to key content to enhance retention as well as teaching and learning. TCK is the area that integrating technology is a very visible medium, such as slides on a projector to display content. It is important to remember that this is just one component of TPACK yet this type of technology and content integration is often the most confusing area and where many get to and feel that they have achieved the elusive TPACK goal. Technological pedagogical knowledge (TPK) involves developing skills to look beyond the common uses for technologies and repurposing them for customized pedagogical purposes (Koehler & Mishra, 2009). The evolution of the internet from a defense department initiative to a business and corporate device and later into an educational tool is an example of this. A point of great debate among TPACK research centers on the lack of concrete definitions and boundaries for the knowledge areas. Many see TPACK research as loosely established and difficult to apply outside of theoretical dialog and practice. This stems from the argument that precise definitions are essential to a coherent theory. Promoters of this idea call on the need for researchers to clarify the boundary conditions that enable various elements in the framework to be distinguished from adjacent elements (Graham, 2011, p.20). The complexity of these knowledge domains and mergers grows exponentially as instructors move towards the targeted TPACK region. The vagueness inherent in the TPACK components seem to be this way by design. This allows the framework to be dynamic and one that evolves. Now that a thorough definition of the individual components of TPACK has been established it is time to look at the elusive blend of these knowledge domains and the instructors use of their skills and past experiences that create TPACK. Defining TPACK At this point we have established working and commonly accepted definitions among the research body for the six components or prerequisites rather of TPACK. TPACK is found in the figure 1 above at the centralized overlapping point where TPK, TCK, and PCK all complement each other and create the synthesized effect of a utopian teaching and learning experience. This occurs by establishing a dynamic equilibrium that changes in nearly each unique teaching and learning encounter and among all components. A large range of factors influences how this equilibrium is reached (Koehler & Mishra, 2009). This makes creating and recreating TPACK very challenging, technology integration is after all a complex and wicked problem (Mishra & Koehler, 2007, p.2214). The TPACK framework’s value is a combination of its broad appeal and potential in our fast paced technologically changing educational landscape (Graham, 2011). Instructors must not only be well versed in each of the key types of knowledge but instead they must go the extra step and grasp how these knowledge’s interact and how and when to apply them. Teaching with technology is a complex, ill-structured task (Koehler & Mishra, 2009, 62), to handle this TPACK is very complex, but was designed to also be flexible because of the broad and loosely defined constructs which must be integrated (Graham, 2011). Some criticism of TPACK has surfaced with a focus on these loosely defined constructs and the ambiguous borders between them. However the literature seems to indicate that this has been done intentionally in order to allow the model to shift and be molded over time as new technological educational milestones are reached, generational gaps are narrowed, and fields such as instructional technology and educational technology continue to mature. TPACK Challenges Literature on TPACK has highlighted several challenges that will potentially resurface in this study. In many publications, the term TPACK could be substituted with the words technology integration without significantly changing any meaning (Graham, 2011). This results in oversimplification when attempting to apply this model to diverse and complex situations. Instructors’ backgrounds and experiences can be very diverse. Technology integration courses are taught with a focus on being generalists and do not attempt to provide integration with content-specific methods courses (Keeler, 2008), which is at the core to TPACK. This is also a contributing factor to the confusion associated with this model as it relates to instructors past experiences and perspectives (Graham, 2011). Another challenge that instructors and administrators interested in TPACK face is the fact that instructors may have earned degrees, certifications, and experience at a time when educational technology was at a very different stage of development than it is today (Koehler & Mishra, 2009, p.62). At the same time there is a demand and push in teaching and learning to incorporate technology and the notion that our instructional bodies have the knowledge needed to be successful with this is often ill-conceived. Ultimately the development of TPACK by teachers is critical to effective teaching with technology (Koehler & Mishra, 2009). The vast majority of literature focuses on simply technology integration and not the holistic approach that TPACK stands for. Simply pursuing technology as an add-on rather than looking for a synthesized approach in which the whole is greater than the parts is perhaps the most difficult ideal to change in practice. Applying TPACK TPACK literature indicates that there are challenges in moving from the theoretical framework towards practical applications and measurement of the model. The majority of the studies and articles available to this point in time have focused primarily on both theoretical discussion and analyzing pre-service teacher professional development programs to see how well they are preparing instructors at TPACK in the K16 setting. Literature on the successful practical applications of TPACK are limited as are applications of TPACK outside of the traditional K16 setting are scarce. Measuring TPACK The limited research available on the practical applications of TPACK mentioned above can most likely be directly contributed to lack of a unified and accepted measurement protocol. With the complexity and interdependence of the types of knowledge represented by the TPACK constructs, well-triangulated ways to assess demonstrated technology integration knowledge are needed (Hofer, Grandgenett, Harris, & Swan, 2011, p. 4352). Instructors achieve TPACK through a varied mix of knowledge, the TPACK model depicted in figure 1 above shows all three knowledge areas as being equal in size. However, in order to accurately measure TPACK across individual instructors I believe that we must vary the size of the circles to show varied skill and knowledge levels. This idea is not new and calls into question whether someone with vast knowledge in all three areas truly has a better chance at realizing TPACK or does the sweet spot where TPACK occurs remain constant and roughly the same size no matter how vast a person’s knowledge depth is. This would be demonstrated by a simple variation in the distance of the circles that would equalize the size of the TPACK area. The most widely used TPACK measurement methods involve survey data, self-report interview instruments with items keyed to each of the seven knowledge areas, reviews of documents and artifacts such as lesson plans, and observed behavior. These techniques are demonstrated in a recently revised version of TIAI Technology Integration Assessment Instrument called Technology Integration Assessment Rubric (Harris, 2010), which was used to assess pre-service teachers’ lesson plan documents. It was also noted that this rubric could be expanded to interviews (Harris, 2010). Additionally another study (Doering, Veletsianos, Scharber, & Miller, 2009) on in-service teachers provided a mixed method approach with an interview, survey, and TPACK diagram similar to figure 1 above. It allowed them to evaluate their TPACK and place themselves on the diagram were they see fit. This mixed method approach provides and interview protocol and sample survey with a blend of Likert scale questions and a place for open ended explanations totaling a manageable six questions. The goal of the quantitative section is to present aggregate information regarding teachers’ perceptions of their TPACK, while the qualitative section provided a deeper analysis of the meaning behind the quantitative results (Doering, Veletsianos, Scharber, & Miller, 2009). Similar variations of these examples have also been presented and if TPACK scholars should unite to develop a unified measurement protocol it will need the ability remain fluid as the pillars of knowledge grow and change and traditional validity and reliability evidence will need to be presented. Technology in Healthcare Training Quality education in healthcare contributes to quality of patient care and patient safety in health systems. The healthcare industry requires continuing education among its population to provide validation of specialty knowledge, experience, and clinical decision making. Since by its nature healthcare is an around the clock venture, technology has become a key driver in the way that continuing education and organizational development related to teaching and learning occurs. It is common place in healthcare in this day and age to have systems in place such as learning management systems and computer based training to assist in reaching a broad set of students over a diverse timeframe. The better healthcare trainers are at teaching and learning the safer a hospital will be, which contributes to the overall quality of care. Assessing the feasibility of incorporating the TPACK framework into healthcare training has the potential to add value to healthcare training and ultimately quality of care in health systems. Summary Current TPACK literature has focused on detailing and theorizing the knowledge constructs and their interactions with each other. According creators Matt Koehler and Punya Mishra (2009, p. 66), TPACK is the basis of effective teaching with technology and it requires the following: An understanding of the representation of concepts using technologies Pedagogical techniques that use technologies in constructive ways to teach content Knowledge of what makes concepts difficult or easy to learn and how technology can help redress some of the problems that students face Knowledge of students’ prior knowledge and theories of epistemology Knowledge of how technologies can be used to build on existing knowledge to develop new epistemologies or strengthen old ones The synthesizing of all three of these knowledge areas through concepts such as those listed above are what forms the complex TPACK concept (Koehler & Mishra, 2009). Other areas of TPACK that have received less research focus include the practical applications of the framework, challenges the framework both faces and creates, and standards on unified measures for calculating the effectiveness levels of TPACK in an instructor population. This proposed study will fill research gaps in both the practical applications and measurement area through building on existing concepts. CHAPTER 3 - METHODS Introduction The purpose of this study is to explore the practical application of the TPACK model to an unexplored educational area of corporate healthcare learning and education. This will help add to the limited research body of practical TPACK applications while investigating a new untapped area beyond the common boundary of K16 literature that currently exist. The measuring and applying of TPACK in the healthcare education setting will provide useful insight into how well technological, pedagogical, and content knowledge are being integrated and utilized among instructors healthcare education departments. This study’s purpose is to provide clarity to the current and potential level of the TPACK framework in healthcare education and instructor proficiency. This study will use quantitative data collection and analysis techniques. Setting of the Study This study will take place with nationally operated and accredited hospitals and healthcare systems in the United States, which have a minimum of 200 beds and a department dedicated to training, development, and instruction. Participants will be department heads and immediate training staff responsible for the development and delivery of healthcare education. Instrumentation Quantitative data will be collected through online surveys. Self-reported proficiency in TPACK will be employed by requesting instructors to evaluate their levels of proficiency in the technology, content, and pedagogy by drawing their own custom TPACK diagram. They will be instructed to vary the size of these three overlapping circles according to their own proficiency and indicate where on the diagram they feel that they operate most frequently while instructing. Survey items will be aligned with the core components and their integration with each other. Existing research models and their application to pre-service teaching and other K16 areas will be modified and adapted if applicable to fit this practical healthcare focused look into TPACK. Data Collection Data collection will occur through online surveys created utilizing Qualtrics software solutions and other apparatuses designed to capture TPACK expertise through self-assessment. Participants will be contacted via email and regular postal service correspondence. 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