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					                                       Practice Standard Review
                                 University of Medicine and Pharmacy, Bucharest
                                  Department of Public Health and Management

    Practice or procedure being reviewed

        Use of Instructional Design to Implement an Effective Distance Learning Programme

    Reasons for selecting this topic, institutional history, etc.

        Implementing a Distance Learning Programme in Public Health and Health Services
        Management is a very challenging issue for our University. This is the first DL Programme
        implemented in a Medical University in Romania, and it started as World Bank/Ministry of
        Education grant.
        According to the definition of the University of Maryland, College for the University System of
        Maryland Institute for Distance Education:
        “The term distance education represents a variety of educational models that have in common
        the physical separation of the faculty member and some or all of the students. As with all types
        of education, the various distance education models are built around the central components of
        the instructional process: presentation of content; interaction with faculty, peers, and resources;
        practical application; and assessment. Each distance education model uses technologies in
        various ways to address some or all of these components.
        Each distance education model uses technologies in various ways to address some or all of these

•      An Romanian application for Course Management in DL (E-Learn) was installed on our server,
       and the courses in Public Health and Health Services Management began to be loaded. A training
       programme in Distance Learning was attended by 2 persons from the Department at the
       University of Kentucky in June 2002. At the University of Kentucky, having a good tradition
       and experience in implementing DL Programmes, the Romanian trainees have understood the
       vital importance of using the Instructional Design methods for building an effective training
       programme. This is why we have chosen the present topic of our PSR.

    Search strategy:
    Strategy for identification of studies (including keywords and databases searched)

        Keywords: Distance Learning / Instructional Design
        Databases searched: Google, OVID Journals, documents provided by the University of
        Kentucky staff available in our library.
Summary of search results:
Methodological quality of included studies. Summarize the quality of studies available on this subject

   We obtained the following findings by searching the INTERNET:
   - using Google search engine: a big amount of citations, out of which we have retained 11,
        proving to be very adequate for our purpose.
   Being in an early stage of DL Programme development, all these materials proved to be
   extremely helpful for our staff in order to establish some standards for developing good DL
   courses. We all understood the role of Instructional Design in order to meet the instructional
   needs of our clients.

Results of review:
What does the evidence show? Compare the effectiveness of treatment options considered.

   Evidence show that mainly the American and Canadian Universities have a good tradition in
   implementing DL Programmes, and are ready to share their experiences with other universities.
   We could notice a tendency of standardizing the Instructional Design models, as well as the
   software for Course management like BlackBoard which tends to become the standard in USA.
   Looking at the University of Idaho experience ( we have
   found the following basic concepts of Instructional Design:
   “Instructional development provides a process and framework for systematically planning,
   developing, and adapting instruction based on identifiable learner needs and content
   requirements. This process is essential in distance education, where the instructor and students
   may share limited common background and typically have minimal face-to-face contact.
   Although instructional development models and processes abound (see Dick & Carey, 1990;
   Gustafson & Powell, 1991), the majority follow the same basic stages of design, development,
   evaluation, and revision.
                                            -Determine need
                                           -Analyze audience
                                             -Establish goals

   Revision                                                Development
   Develop and implement revision plan             - Create content outline
                                                   - Review existing materials
                                                   - Organize and develop content
                                                   - Select/develop materials and delivery methods

                                     -Review goals and objectives
                                     -Develop evaluation strategy
                                       -Collect and analyze data

   Quite a similar model we have found at , a model developed by the
   University of Colorado, at Denver.
This figure highlights the importance of evaluation and feedback throughout the entire training
program. It also stresses the importance of gathering and distributing information in each of the
five phases and shows the training process is NOT a static (waterfall) model, but a iterative flow
of activities (dynamic or spiral).
The five phases are ongoing activities that continue throughout the life of a training program.
After building a training program, the other phases do not end once the training program is
implemented. The five phases are continually repeated on a regular basis to see if further
improvements can be made.
University of Illinois ( has
developed a very interesting Instructional design model based on learning styles. Because
learners have different learning styles or a combination of styles, online educators should design
activities that address their modes of learning in order to provide significant experiences for
each class participant. In designing online courses, this can best be accomplished by utilizing
multiple instructional strategies. Below is a table of the most common learning styles. These
descriptions reflect different channels of perception (seeing, hearing, touching/moving):

Learning Style          Preference for information acquisition
Visual/Verbal           Prefers to read information
Visual/Nonverbal        Uses graphics or diagrams to represent information
Auditory/Verbal         Prefers to listen to information
Tactile/Kinesthetic     Prefers physical hands-on experiences

Below are ten instructional strategies which have been effectively used in the traditional
classroom and can likewise be used in the online learning environment:
Learning Contracts; Discussion; Lecture; Self-Directed Learning; Mentorship; Small Group
Work; Project; Collaborative Learning; Case Study; Forum

A very similar model was described by Katy Campbell from the University of Alberta, Canada
(“Learner Characteristics and Instructional Design” – a link from
As stated in “A Case Study in Instructional Design FOR WEB-BASED COURSES”, BARKER,
ANNE M. (found in OVID Journals) “The Basis for Instructional Design: The classic principles
of adult learning, mutuality and collaboration, underpin Web-based design. In fact, Web-based
courses may be more effective in supporting these principles than traditional classroom courses.
SPECIFICALLY, four basic principles were used for designing the Foundations course (1):
* Adults do not generally respond to lecturing, the traditional method of teaching.
* Adults bring life experiences to the learning situation that influence what they learn.
* Adults learn best if they actively participate in the learning experience.
* Adults are more motivated to learn when they understand the usefulness of the learning and
can apply the content to immediate life situations.
Since adults may be anxious about their ability to succeed (1), faculty must be available for
support, coaching, and providing feedback. With a method of course delivery that switches from
real time, face-to-face interactions to asynchronous, distant interactions, faculty responsibilities
for keeping in touch with individual students and groups - publicly and privately - are complex.”

A useful material with some mistakes to avoid when implementing a DL Programme, we have
found at
Top Ten Web Design Mistakes
Nielsen's Top Ten Web Design Mistakes are adapted from Nielsen's Alertbox (Nielsen, 1996).
These design guides will be used to evaluate the user interface of the WBI. Note: The following
is an succinct explanation of each item.
      Using Frames. Frames are not to be used as frames make it hard to correctly set a
      Gratuitous Use of Bleeding-Edge Technology. Like avoiding to many fonts, new
         technology, such as three- dimensional designs should only be used if the content
         dictates use, such as a web site for maps. Scrolling Text, Marquees, and Constantly
         Running Animations. Do not include any element that constantly is moving because
         this distracts the reader.
      Complex User Resource Locations (URLs). Users may want to type in a URL directly
         within their browser or may use the URL as bookmark. Therefore URL should make
         sense and use lower case characters to make entering the data easier. Orphan Pages.
         Each page should have a link to the home page (index page). A page that does not
         allow you to navigate from the page is considered orphaned. Or a page that causes the
         Web Browser to display a message stating the link is no longer valid.
      Long Scrolling Pages. Nielsen (1996) states that "Only 10 percent of users scroll
         beyond the information that is visible on the screen when a page comes up." Therefore,
         if a page must be longer than one page, then the most important information must be
         displayed at the top of the page.
      Lack of Navigation Support. A map must be provided of how to access information on
         a web site and also each page should include a link to get to the next page or the
         previous page. Additionally, a search engine should be provided to enable users to
         search any page on a web site.
      Non-Standard Link Colors. Nilesen (1996) states that: "Links to pages that have not
         been seen by the user are blue; links to previously seen pages are purple or red.". This
         is typical throughout the World Wide Web community.
      Outdated Information. Information must be kept updated as information on the World
         Wide Web is often outdated, within days. Information considered 'old' by users may
         lead the user's to believe all of the information is outdated. Overly Long Download
         Times. Nielsen (1996) states that: "Traditional human factors guidelines indicate 10
         seconds as the maximum response time before users lose interest. On the web, users
         have been trained to endure so much suffering that it may be acceptable to increase this
         limit to 15 seconds for a few pages."

And last, but not least, we have also found some useful hints for a very hot debate in our
   Department: the copyright issue, also developed by the University of Idaho:
   Suggestions for Distance Education
   There are several precautionary steps that may be taken in order to avoid copyright
   infringement. This is not a complete list, but rather highlights that will assist in avoiding illegal
   copying of materials (Bruwelheide, 1994):
         Utilize the copyright policy adopted by your governing agency.
         Provide instructor and staff training in current copyright law and institutional policy.
         Do not hesitate to request permission. When in doubt, ask.
         Be aware of the law, but realize that a great deal of educational copying is legitimate.
         If you are copying to avoid purchase of a text, you are probably in violation of the law.
         Give proper copyright credit.
         Label equipment that may be used for unauthorized copying with a restriction.

What other factors (e.g. financial factors) need to be considered at your institution? Where is your review
lacking? Does your review accurately reflect the evidence available?

   As compared with foreign universities, our University has not yet a support Department for DL,
   even this is stated by the law. To apply all these concepts in our programme, means a very
   concerted work from our staff, which is very few as number of teaching staff and has many
   other tasks to perform. In order to follow the copyright laws, we have to use only free of charge
   links for readings due to financial constraints.

Reviewers' conclusions
         Implications for practice:
         Is a change in practice at your institution warranted? Does the evidence support your current

           At present, the courses loaded in our application do not meet the Instructional Design
           criteria. They look more like e-readings rather than web-courses. They have to be
           completely reviewed to match the international standards of Instructional Design. The 2
           persons who attended the training sessions at the University of Kentucky have prepared a
           material with Instructional Design principles, and are ready to work with the staff to
           completely review the courses. But this means a huge effort of all our staff, and a clear
           commitment of the University in creating the support department.

         Implications for research:
         What further research is required? Can you conduct a trial at your institution?

             It would be extremely useful to conduct a research to review in-depth the methods for
             using effective assignments methods and student evaluation.
Provide citations for information reviewed

    Distance Education Clearinghouse – University of Wisconsin
    University of Idaho, with links:
       Learner Characteristics and Instructional Design (Katy Campbell – University of
    Tools for Developing Interactive Academic Web Courses – University of Manitoba
    Distance Education & WWW Design, with links:
       Instructional Design Models - University of Colorado at Denver
       Case Studies in Instructional Design and Technology – University of Virginia
       Instructional Design Theories and Models
       TopTen Web Design Mistakes
       Designing Effective Research Assignment – University of Minnesota
    Instructional Design for Online Course Management – University of Illinois
    BARKER, ANNE M., A Case Study in Instructional Design FOR WEB-BASED
      COURSES (OVID Journals), Nursing Education Perspectives, vol. 23(4), July/August 2002

Names of reviewers:
Provide names of participants and contributors for this review - colleagues, partners, committee members,
information coordinators, etc.

   Adriana Galan, Information coordinator
   Dr. Carmen Moga, EBP specialist

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