Voices from Afar: Building the Academic-Practitioner Bridge

Higher education and its flag bearers—traditional graduate degrees—have long sat on their laurels, controlling knowledge creation and transmission and guiding students through a discipline's foundations, while delegating the responsibility of building workplace skills to on-the-job training and professional development. But changes in the work world are knocking on the doors of the ivory tower, challenging its long-held traditions and definitions of knowledge; as a result, higher education is facing criticism for inadequately preparing its pupils to meet the demands of the current workplace.¹

Reeling under pressure, higher education rallied its forces and, with its endorsement, numerous massive online open courses (MOOCs) and certificates began popping up on popular platforms such as Coursera and edX. Although unaccredited, MOOCs soon became an accessible medium for working professionals and in-school graduates to earn credentials without disrupting their work or school life, heralding an era of lifelong learning.

The popularity of MOOCs encouraged universities to create accredited applied graduate programs for in-demand areas, reifying the academic–workplace handshake. Before long, accrediting agencies started redesigning their credentialing criteria to include authentic assessments and evidence-based learning. Higher education is treading gingerly in this shifting landscape, hoping to maintain its footing by redefining high-level goals, while steadfastly sticking to tradition where the rubber meets the road—that is, in course design that fulfills the curriculum and program goals.

At this intriguing juncture, our institution launched a set of applied graduate programs targeting working professionals. In designing and developing these new-wave programs, we faced a blank canvas and had the freedom to explore styles and ideas that might have encountered resistance at a different time. We started with two key questions:

• How does such a course look in practice?
• What successes can we garner that can be embraced across similar programs aimed at working professionals?

Here, we share our experiences in designing and developing the course, "Managing Health Across the Continuum," which is part of the Master of Applied Science in Population Health Management (PHM) graduate program at the Johns Hopkins Bloomberg School of Public Health. We began by brainstorming design ideas a few months before the course's initial offering. In addition to teaching the foundations, we decided to craft a course that integrates applicability in the workplace and exposure to current practices. With a great deal of excitement in trying something new, we got started.

Our design recipe centered on being authentic: offering content relevant to the learner's academic and professional context, activities that simulated workplace experiences, and assessments that challenged the learner with close-to-real workplace problems. The approach—which we trademarked A:CELA (Authentic: Content, Experiences, and Learning Assessments)—is granular enough for individual course design yet can scale up as a standard for designing applied programs in any discipline. Here, we chronicle our experiences with integrating authentic content and explore the themes that evolved in our qualitative case study.

Content, Content, Everywhere

Imagine how much information we are exposed to daily and the variety of ways it reaches us—TV, YouTube, Twitter, Facebook, Khan Academy, MOOCs, and so on. Clearly, learners today have myriad content resources, yet they also live in a "fake news" world. As educators, we are in a unique position to introduce authenticity, validity, and reliability to the knowledge and experiences gained via a degree program.

With so many information sources, learners have clear expectations for the format and quality of their learning experiences. But how is content typically distributed in academia? A vision of teachers offering lectures and presentations from behind lecterns immediately springs to mind. In this exemplar course, we hoped to improve on this traditional method by

• including multiple perspectives and practitioner experiences, and
• structuring the lessons as a mixture of presentations and conversational interviews.

Further, while a handful of existing courses have included guests or experts, these experts were often from academia and their lessons were incorporated into the course as stand-alone lectures. For students of an applied program, such an approach is not ideal as it does not adequately expose the content's practical elements.

The fundamental challenge in adopting the A:CELA approach to content is this "how" factor, with distance, time, and cost emerging as critical constraints, and logistics acting as a roadblock. However, with today's technologies and their potential to mitigate space and time constraints, bringing practitioner viewpoints into the classroom to bridge the academia–workplace gap is an achievable goal.

The Scene

In the spring of 2018, a cohort of thirty-two students signed up for our course and embarked on this journey with us; all of them were working professionals balancing jobs with the demanding course requirements of an eight-week term. The program was fully online to accommodate students from all over the world seeking to expand their breadth of experience and improve their marketability.

Energetic discussions in the forum and enthusiastic participation in videoconferences illuminated the depth of student engagement in the course. At various points in the term, we administered anonymous surveys to gather student response and decide whether our strategies needed reevaluation.

In terms of course content, the term's first quarter covered the conceptual foundations of the area. After covering foundational topics, the course focus shifted to interviews with practitioners to discuss their experiences in putting theory into practice. Ten speakers, in distant locations and various time zones, recounted stories from the field. One of us (Ashwini Davison) was the course instructor and guided the discussion, tying it to the course objectives. The recorded video interviews, or vodcasts, used an informal, conversational style. We also invited experts to participate via live videoconferences. Davison hosted three sessions, with guests joining in to talk about their experiences and answer student questions.

Ever mindful of our workload and time constraints, we aimed to simplify the logistics of integrating expert voices into the course. Many of our guests were remote and needed to record the vodcasts at a time that suited their schedule using accessible technologies and a presentation format that required minimal preparation time. Moreover, we needed a production strategy that would accommodate regular updates to the recordings to keep up with current practices in the field. We therefore decided to use readily available technologies such as Skype for the vodcasts, and Zoom or Adobe Connect for the videoconferences. Meticulous preplanning—which took copyright provisions and universal design into account, among other things—allowed us to finalize the recordings with minimal post-production effort.

Authentic Content—The Case of the Four Themes

Now that we have introduced the A:CELA model, outlined our philosophy for authentic content, and unveiled our canvas, an astute reader might ask a few questions, including

• What makes authentic content indispensable to course design?
• Do existing learning theories support a design incorporating authentic content?
• How did the students respond to the course's authentic content elements?

The following four themes aim to both capture the essence of authentic content and answer these questions along the way.

Faculty and Content: Me or We?

Content needs to work its magic on students, engaging them with the field, binding them as a community of learners, and inspiring them in their practices. The Community of Inquiry (CoI) framework argues that a deep and meaningful learning experience in online courses requires careful selection and crafting of content that anchors the learning space's two pillars: teaching presence and cognitive presence.²

In many educational courses, these key presences are often enacted by a single faculty member delivering content through lectures. Course content is curated based on a synthesis of the instructor's area of expertise or research, and it is delivered as such. As knowledge and practice in a field grows and diversifies, however, a single instructor will struggle to do justice to a field's breadth and scope.

Designing a teaching strategy aligned with the A:CELA model entails a transition in the educator's role from a single source of expertise to that of a director, leveraging various actors to show the interplay of theory and practice. As the field expands, this approach allows the faculty member to respond nimbly, weaving in content relevant to the times and as dictated by the degree program's goals.

Because our course was part of an applied program, we designed content to introduce concepts, models, and frameworks, and brought in practitioner viewpoints to illustrate successes and challenges during implementation. Although the bulk of the performance was by practitioners, Davison served as the conductor, choosing the content composition and shaping the sound of the practitioner ensemble; as a result, her audience came away with a deep understanding of the content music by the end of the term.

Anonymous feedback from students included several emotive comments illuminating the strong presence of the faculty member in the course, while also acknowledging the practitioner contributions.

Featured course comments include the following:

• The "real world" experiences you bring to us with the videocast are educational and complete our education. Relevant and thank you!!
• These are some of my favorite parts of the curriculum. It is exciting to be exposed to people doing cutting-edge work in healthcare transformation.
• My organization just went through a Care Management NCQA [National Committee for Quality Assurance] certification, and I am very curious to know about that process. Maybe in the future, have NCQA talk about a few case studies of organizations who succeeded with certifications and what they did, or maybe even "failed" the first attempt and then built a program around the standards and succeeded. Thank you for continuing to bring great speakers to us!
• Dr. Davison's courses are some of my favorite. I love her approach, delivery, and application of course material.
• As always, Dr. Davison's presentation style is engaging and enjoyable. Presentation style maintains interest and attention. I appreciate that this is a true example of a tool that can be used to make PHM a reality. Presentation was clear and concise and transitions from presenter to video were well done.
• She [Davison] presents the material in new, exciting, engaging, and innovative ways.
• Dr. Davison's purposeful "connecting the dots" is helpful in assimilating the big picture (increases consciousness) versus completing modules. Thanks.
• Another amazing prevention [of opioid dependence using technology]. Thank you! This is going to be a game changer for many individuals. Including this interview in the curriculum really helps in continuing to put all of the pieces of the puzzle together from previous classes, i.e., health informatics.

Let's Party! Awakening the Social Aspect of Content

Although learners need private space to contemplate and process information, learning is, in its essence, social in nature. The social construct as a catalyst in the educational experience has been studied extensively, emerging from Soviet psychologist Lev Vygotsky's theories and evolving to the more recent social presence aspect of the CoI model.³ Great thinkers, for time immemorial, have used a combination of stories, conversations, question-answer sessions, and debates as a means of communication to stimulate this social facet of learning.⁴ In today's technology-mediated learning space, the social and personal learning experience can be enhanced by presenting information using multiple media, as expounded by Richard Mayer's Cognitive Theory of Multimedia Learning.⁵

An online learner interacting with the content has an isolated existence, with only a pair of headphones for company. Moreover, the content is typically delivered by a faculty member furnishing information from a single perspective and expecting students to effectively transfer the knowledge to the workplace milieu. A course design that aligns with the A:CELA model's vision for authentic content calls for the educator to highlight learning's social aspect in a natural and entertaining way. We accomplished this using vodcasts and live videoconferences. Through the vodcasts, Davison was able to show the application of theory in practice through practitioner stories, while the videoconferences let learners interact with and query the experts. Content delivery was infused with multiple media—including slides, video, and data—to stimulate the learner's dual channels of information processing.

So, how does authentic content improve on a typical online course's social aspect of learning? First, it allows students to engage with practitioners and experts in the field in addition to interacting with their academic peers, which immediately enhances the course's educational value. Moreover, the course exposes the learner to professional communication that is authentic and unique to the practitioner's social context. Each field has a code of communication—from a lawyer's arguments, to a data analyst's plots, to a social worker's activism— that binds practitioners with the approaches, procedures, and styles characteristic of specialists in the field. The element of practitioner social presence, missing in most courses, becomes an essential part of an applied course or program designed using the A:CELA model.

Vodcasts and videoconferences triggered animated student discussions in the forum and influenced their work on assignments as the effect of class concepts in real-world situations became increasingly apparent.

The following comments reveal student enthusiasm for this hands-on-the-ground approach to learning:

• [T]his program is a paradigm shift for me because of the wonderful opportunity to collaborate and learn from people other than [those in] the nursing discipline. The variety of audience and speakers made this program valuable to me.
• This was another really helpful vodcast for me. I really like that the PHM program is now integrating social determinants work more tightly, including by interviewing subject matter experts who work at organizations dedicated to these solutions. I liked the use of intermingled slides, videos, Skype in a seamless format. Ash [Davison] is really pioneering more modern approaches to online learning at JHU that should be emulated in other courses and programs. This helps me synthesize various data sources in a more conversational style using all of my senses (audio, video, text).
• The use of multimedia sources has really helped to make me feel connected and more engaged. This is especially true since we are long-distance learners. I particularly like Ash's video "touch points," shall we call them, as we transition from one topic of study to the next. It is a great way to personalize our "electronic" relationship.
• I prefer this type of presentation to just looking at slides! It is [so] much smoother to follow and stay engaged with the content.
• Great to hear the perspective of governmental expert on tackling complex issues [such as homelessness].
• Very exciting to see how the concepts we are learning are being put to use in corporate environment.
• I love these real life examples of [population] health in action. Interesting to hear from the perspective of an insurance company.

Widening the Content Net

Today, topic-area knowledge and applications can expand into newer realms and branches at a pace that the ponderous steps of academia cannot match. How do we provide a comprehensive learning experience that facilitates exposure to the rapidly evolving spectrum of knowledge in a field? The Theory of Multiple Intelligences posits that providing opportunities within the curriculum that builds on a learner's "preferred intelligences" helps the student better grasp the intricacies of content.⁶ Students need well-rounded knowledge to navigate varied perspectives, supplement their practice, and explore opportunities for innovation and entrepreneurship; therefore, one goal of applied programs should be to expose learners to the ever-broadening scope of topics, frameworks, approaches, and practices in a field. Content design that meets this lofty goal ably supports the cognitive-presence pillar of the learning space as explained in the CoI framework.

In contrast to a conventional course with a solo perspective, our course offered multiple perspectives by introducing practitioners who exposed learners to different facets of the subject and encouraged them to explore areas of interest. Structured around vodcasts, videoconferences, and other authentic elements, the course developed learners in multiple areas and expanded their minds, thereby enabling them to solve problems or create products valuable to present times.

Exploring the subject of "Managing Health Across the Continuum" using current topics of significance—including data analytics, technology, and practical models—allowed students to gain a broader perspective, as the following comments show:

• I liked the way the bold goal was linked to social determinants and the need to show ROI. [I] work for a for-profit entity and trying to convince leadership that a good thing can be profitable is important.
• [G]reat [to] hear about an example of machine learning and advanced data analytics providing guidance to identify risk associated with SDOH [social determinants of health].
• The innovation was explained clearly. It is interesting to hear of all the technology around health and will be interested to see collectively how the technology drives down medical costs.
• [G]reat to have exposure to applied technology in dealing with a significant threat to public/population health. I envision that much of what we do will occur in this way in the future.
• The content exposed me to application uses for my work. For example, the hub and spoke model; the pathways and SDOH questionnaires. The resources that we were exposed to were excellent.
• Not only did I like the presentation, I found it relevant to the work I do, and parts of it can be applicable to a faith-based initiative I am currently working [on].
• Another really strong vodcast in this course. I have become increasingly interested in the work of [company name] as a result of this course. I previously didn't see them as doing much around social determinants but now can see they are making real efforts. I found the speaker's style to be very calm and data driven. In particular, it seems that large numbers-driven organizations like this can play a role in crunching mass quantities of data. [I]n particular, I found it rather interesting to learn about some of the gaps they'd found around people's awareness of social services.

Content, Thou Art My Engagement!

What does engagement have to do with creating a satisfying learning experience? It seems everything! Jennifer Fredricks and her colleagues have emphasized the importance of learner engagement as a key prerequisite for influencing learner attitudes and motivating learners in the educational space.⁷ Although learner engagement can be analyzed as a multidimensional construct, our course concentrated primarily on the emotional and cognitive aspects of engagement. Using Situated Learning Theory as the basis, we investigated whether presenting knowledge in authentic contexts through practitioner interviews improved these aspects of engagement.⁸

Surprisingly, the perceived disadvantage of online learning—the learner's isolated existence in the educational space—turned out to be our ally in building learner engagement. Similar to how a quiet environment helps to create an engaging movie experience, the isolated existence of online learners allows them to be immersed in the practitioner stories. Over the eight-week term, learners became the Padawans, working with the Jedi masters in the vodcast or videoconference holograms. They vicariously faced the same problems, drew on the available knowledge base, made difficult decisions, and planned their improvisations; along the way, Davison became the voice of Yoda saying, "connect this story to that concept, you must" and "explore this new path, we will," to effect an engaging learning experience.

The practitioner stories mimicked a natural setting for learning in which the learners could engage mentally with workplace challenges; this let students observe the causal factors of real-world problems, acquaint with the practitioner's methods of problem solving, and summarize lessons learned, all of which eased the transfer of knowledge and improved its long-term retention. Using carefully crafted questions, Davison molded the educational value of the practitioner interviews, either tying them to concepts covered previously or segueing into new topics. The resulting cognitive engagement facilitated a deeper understanding of the content, helping learners build toward the expertise that working professionals need, as highlighted in the comments below.

• I really like your use of the vodcast. It helps to make a deeper connection with you as the teacher and me [as] the student. I found everything in the video very relevant/applicable to the quest for knowledge that I am on. I am very much looking forward to learning more about the AHC [accountable health communities].
• Looking forward to the next session to hear more about the specific determinants that were selected. I could have listened to more of the lecture in one sitting.
• Believe it [or] not, with certain vodcasts and interviews I was so interested in the content that [I] thought there could have been more information or the interview could have been longer.
• Thank you for providing this exciting and engaging interview. It make[s] me hopeful for the future of American healthcare and primary care in general to hear providers discussing with such enthusiasm the way we will continue to transform care delivery.
• I really like how you incorporate "real life" interviews in the [curriculum]. It continues to spur my mind, opening up new possibilities of how much there is to do for the communities in which we serve. Very exciting for me. Thank you!

Introducing the perspectives of leaders and practitioners in the field, constituted a "learning in the trenches" approach to building emotional engagement with the course content, as captured vividly in the following comments:

• Another excellent interview regarding what insurance companies are starting to do. I really liked that you have included that as part of the curriculum. It is very refreshing to see. This is especially true because I think I am somewhat jaded regarding insurance after living in the trenches of primary care practice management for over five years, being an advocate for my patients, doctors and advanced providers, and my team. It has been very frustrating at times.
• I have had some programs/initiatives that have only been visions. With knowledge from this class I am beginning to see the practical implications in communities of color. I am also gaining some understanding of how to measure social determinants and show the economic value.
• Another really great vodcast which integrated social determinants of health, a subject I've long been seeking to study in public health and a major reason I entered the program. It was very interesting to me in particular to see the way that the threats of homeless people to the quality of life of wealthier people as well as their mental health challenges, which were becoming disruptive [and] were driving urgent change in this community. It is sad it has to come to this but if there is one thing we have learned is that economic and health disparity eventually reaches everyone.
• The way you present information is really engaging, your passion comes through, and, as a result, continues to inspire me to be the best I am able to be and gain as much knowledge and new tools for my tool belt. Thanks!

"ALEXA, How Do I…?"

The A:CELA model provided the basis for achieving our course design goals and creating a standardized approach to applied program design. Working professionals enrolled in applied programs have a distinct outlook and distinct expectations for their learning experience. Although the four themes can provide strategies for faculty members to ponder in the evolving educational landscape, we also offer the following practical considerations for course design, layout, and organization to reduce the learner's cognitive load and provide an efficient learning experience.⁹

Elements of Design

Often, working professionals are familiar with the field and may have foundational knowledge that you can build on. Appropriate introductions to concepts and theories can provide the necessary scaffolding for tying academic fundamentals to practical applications; meanwhile, by including prefaces on how a topic fits into the bigger course context and real-world practices, you can help segue your teaching from an academic to a practical perspective. Following are a few tips for achieving this.

First, it helps to map out topics to include in the course and identify potential practitioners that you can invite to be your partners in teaching. One way to find practitioners is to tap into your department or college's alumni network. While alumni are typically contacted for financial giving, sharing their practitioner experiences with learners can be an even more rewarding experience for them. Leading a course or joining as a guest speaker gives alumni an opportunity to maintain relationships with their alma mater.

Second, we found that a conversational interview format required less preparation time for practitioners than an out-of-context lecture presentation. Further, this format lets you, as the instructor, do the following:

• Guide the discussion based on the course's needs
• Weave in visual elements to support the discussion
• Simulate professional discourse etiquette
• Keep your course up-to-date using the same discussion structure and questions as a foundation for updating the interviews in the future.

Finally, introducing practitioners and experts to the learning hub provides a great opportunity for project collaborations and networking, which students can leverage for future career opportunities.

Elements of Structure

The four themes highlight the evolving nature of the faculty member's role in education; from course director to entertainer to change agent, you have big shoes to fill. Further, the course itself becomes a manifestation of your personality. Putting your best foot forward is essential and easily accomplished when you pay attention to the details. Do the content recordings seem professional? Have you addressed the universal design and copyright aspects of content? You do yourself no favors by letting orthographical, grammatical, or typographical errors run wild.

Think of content as an opportunity to tell a story, whether through slide presentations or interviews. If some parts of the content can be best learned through hands-on experience, discard the lecture and insert a learning activity. Use myriad openly accessible resources—from images to YouTube videos to readings—to present your content and engage learners.

Today, many technological solutions available through your institution enable you to create an engaging student experience. Examples include Skype for recording guests at a distance, Zoom for live videoconferencing sessions, Camtasia for showcasing a process, and VoiceThread for creating interactive presentations. Utilize these resources wisely to create engaging content for your course.

Elements of Consistency

In designing our course, we focused on the themes of ease of use and consistency:

• The intuitive layout allowed students to find course materials and instructions easily.
• Using a consistent layout for all courses in the program removed confusion regarding site navigation.
• Streamlining instructions gave students clear, concise information about the course elements.
• Posting course materials and instructions in only one place avoided duplication and potential errors.

We used a weekly format for all program courses. This approach was incredibly helpful in aligning the course elements with credit hours (defined as the number of hours a student spends on the course per week), while also providing a consistent framework across all courses in the program. We also found that the format allowed our students to manage their time better as the term progressed. Moreover, the weekly structure will save time during reaccreditation of the program—the consistent format visibly connects each element to the course and program goals, and helps the accreditor to easily evaluate the pacing, assessment structures, and adherence to credit requirements.

We posted the requisite content and related course elements on Sunday each week. Given that our students were all working professionals and busy during the week, this incremental strategy provided a considerate and unvarying schedule around which they could organize the rest of their week.

Moving Forward

Based on the design approaches in this course, in summer 2018, the school's Center for Teaching and Learning (CTL) was awarded a DELTA grant of $75,000 through the Office of the Provost to procure resources for introducing global perspectives into public health teaching and learning. We hope to continue this action research journey, exploring and writing about our shared passion—education in practice. We also plan to collaborate with external agencies to establish the A:CELA approach as a formal standard for developing applied graduate programs in online settings.

Acknowledgments

Many thanks to our course guests for sharing their stories with us. We also thank CTL's video production team, led by David Toia and Kevin Brennan, for their assistance throughout.

Notes

1. Dianne F. Harrison, "The Role of Higher Education in the Changing World of Work," EDUCAUSE Review 52, no. 6 (November/December 2017). ↩
2. D. Randy Garrison, Terry Anderson, and William Archer, "Critical Inquiry in a Text-based Environment: Computer Conferencing in Higher Education Model," The Internet and Higher Education 2, nos. 2–3 (Spring 1999): 87–105. ↩
3. L. S. Vygotsky, Mind in Society: The Development of Higher Psychological Processes (Cambridge, MA: Harvard University Press, 1980). ↩
4. Brian Boyd, On the Origin of Stories: Evolution, Cognition, and Fiction (Cambridge, MA: Harvard University Press, 2010). ↩
5. Richard E. Mayer, Multimedia Learning (Cambridge, UK: Cambridge University Press, 2009). ↩
6. Howard Gardner, Frames of Mind: The Theory of Multiple Intelligences (New York: Basic Books, 2011). ↩
7. Jennifer A. Fredricks, Phyllis C. Blumenfeld, and Alison Paris, "School Engagement: Potential of the Concept, State of the Evidence," Review of Educational Research 74, no. 1 (2004): 59–109. ↩
8. Jean Lave and Etienne Wenger, Situated Learning: Legitimate Periperal Participation (Cambridge, UK: Cambridge University Press, 1990). ↩
9. Ruth C. Clark, Frank Nguyen, and John Sweller, Efficiency in Learning: Evidence-Based Guidelines to Manage Cognitive Load (New York: Pfeiffer, 2006). ↩

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Rohini Vanchiswaran leads the design and development of online applied graduate programs at the Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health.

Ashwini Davison is a faculty member at Johns Hopkins University School of Medicine with appointments in General Internal Medicine, Health Sciences Informatics, and Health Policy & Management.