Amanda Thomas Community Based Education/ Practice Entry and Support Program Coordinator

1. East Texas Geriatric Education Center + East Texas AHEC = Successful Health Professions Distance EducationCollaborative Amanda Thomas Community Based Education/ Practice Entry and Support Program Coordinator Brazos Area Health Education Center (AHEC) Tony DiNuzzo, PhD Director, Easy Texas Geriatric Education Center

2. Objectives • Provide an overview of the ETAHEC / ETGEC partnership and activities • Describe the use, strengths and weakness of distance learning (DL) to reach multiple sites • Describe steps taken to strength the ETGEC-ETAHEC relationship and improve effectiveness of DL

3. ETAHEC • Helps with Health profession shortage problem • Health work force development • Facilitate and plan continuing education events

4. Geriatric Education Centers • In existence since 1980’s at part of Title VII Program • Funded by Department of Health & Human Services (DHHS) - Health Resources & Services Administration (HRSA), Bureau of Health Professions (BrHP) • Program eliminated in 2006 due to HRSA budget cuts • Massive lobbying effort led to reinstating GEC funding for 2007 • 50 GECs funded in 2007 for 3 yrs (9/07 – 6/30/10) • 2 options: • consortia ($400,000/yr) single entity ($200,000/yr) • 3 others funded in Texas • Texas Consortium GEC – Baylor College of Medicine • SWAP-C GEC – UTHSC San Antonio • Houston GEC - UTHSC-Houston School of Medicine

5. Purpose of GECs • Improve training of health professionals in geriatrics • Develop & disseminate curricula • Provide opportunities for continuing education • Provide geriatric clinical training to students Required: training involving 4 or more health professions – at least one must be allopathic or osteopathic

7. East Texas Geriatric Education Center (ETGEC) • Single institution • Headquarters in UTMB • East Texas Area Health Education Center (AHEC) primary partner • Affiliations with other institutions • Funded by Department of Health & Human Services (DHHS) - Health Resources & Services Administration (HRSA), Bureau of Health Professions (BrHP) • $200,000/yr. for each of 3 years, supplemented with existing funds

8. ETGEC Service Area Coastal AHEC Piney Woods AHEC Pecan Valley AHEC Brazos AHEC Legend: l - MUA whole or partial V - HPSA whole or partial p - Both HPSA & MUA whole or partial  - University of Texas Medical Branch at Galveston 1 – Lamar University 2 – Stephen F. Austin University 3 – Baylor University 4 – Victoria College

9. Administrative Structure Affiliate consultants: Wilma Cordova, MS, LCSW – SFA Eileen Durgess Curl, PhD, RN – Lamar James Ellor, PhD – Baylor U. Barbara Orantes, RN – Victoria Jim Mann, PhD - Lamar Oma Morey, PhD - OED

10. ETGEC Project /Requirements • Huge assessment, tracking, dissemination, evaluation and outcome reporting component • Massive web and distance education presence • Collaboration w/other Texas and national GECs • Interprofessional, interprofessional • Regional collaboration w/ affiliates, AHEC and TDCJ/CMC

11. ETGEC Programmatic Focus HP Disciplines • Allopathic Medicine • Nursing • Social Work • Allied Health Professions – OT, PT, PA Special Target Populations • Minority elderly • Rural elderly • Older prisoners

12. ETGEC Programmatic Focus Program Features No registration Fees Free CE credits (CME, CNE, CEUs - SW, OT, PT) Modalities/venues: • Distance learning technologies • Web-based curricula • Clinical training • Multiple ambulatory sites

13. Teleconferencing Sites Victoria College - Victoria Baylor University - Waco

14. ETGEC Training Focus • 30-hour program in health literacy • the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions • Live and on-line Continuing Education credits for CME, CNE, SW, OT & PT • Convene major symposiums with affiliate institutions • Alzheimer’s Disease • Long Term Care: Residents and Their Families • On-line Continuing Education • Establish 3 clinical interdisciplinary training sites in geriatrics

15. Nurturing the Partnership

16. Interactive Video Distance Learning (IVDL) Compression video involving exchange of audio and video between two or more sites Characterized by separation of student(s) and teacher by space and/or time

17. Background • Mid ’90s, K-12 level (Fulford & Zhang, 1993; Klesius, Homan, & Thompson, 1997; Smith, 1996; Zirkin & Sumler, 1995) • Increasing use and value on IVDL – adopted at many major Universities, medical settings, telemedicine, Interactive Teledermatology(East Carolina University Brody School of Medicine, 2005) • Becoming more affordable • Improved technologies – eg. ↑ frame speed

18. IVDL as Effective Learning Tool Early studies: • IVDL cannot achieve degree of interaction compared to a non-distance environment • Smith (1996, May) - 30% of 400 respondents would never choose distance learning (DL) courses compared to face-to-face courses • Miller and Webster (1997) - no significant difference in assessment of interaction • Horn (1994); Hirumi and Bermudez (1996) - with proper instructional design, courses using IVDL can be more interactive than traditional ones

19. IVDL at UTMB • Telemedicine widely used – Pediatrics, Endocrinology, TDCJ, ENT, Family Medicine, Geriatrics, Nursing etc… • UTMB commitment to establishing DL education • 2003-06 Institutional Plan for Distance Education and Off-Campus Instruction • Evaluation of IVDL limited to evaluating system software, hardware setup, operation procedures. • No formal instruction available developing courses involving IVDL • Assistance available through UTMB Telehealth Center Distance Education Program

20. Purpose • Determine which interactive video distance learning (IVDL) activities are most effective for learning • Provide additional guidelines for developing IVDL-based courses

21. Methods • Survey developed to assess: • Effectiveness of various learning strategies and activities • Level of satisfaction with interaction • Professionalism • IRB approval of survey instrument • Distributed to health care providers via e-mail - participants of East Texas Geriatric Education Center (ETGEC) programs: • 2004-05 Scholar of Aging Program • 2005-06 Lecture and Case Study Series in Advanced Geriatrics

22. Study Sites • 4 remote sites • Stephen F. Austin State U. (Nacogdoches) • Lamar University (Beaumont) • UTHC at Tyler • McLennan Community College (Waco)

23. Methods (continued) • Activities queried: • Didactic lecture (q & a) • Didactic lectures w/group activities • Written case studies w/general discussion • Written case studies w/group discussion • Video cases w/general discussion • Video cases w/group discussion • Pre-session activity - assignments • Scoring: 5= Very effective - 1=not effective • ~90 surveys sent - 30 surveys completed -representative of all 4 sites

24. Question #1What IVDL activities are considered most effective for learning?

25. Survey Results (N=30) Figure 1. Distribution of average effectiveness score by activity type Avg. score=3.55 Avg. Score Max=5

26. Question #2Does the technological level of DL system used by remote sites affect impact of activities?

27. System characteristics • Frame speed, availability of technician, monitor size, connection difficulties • Stephen F. Austin State U. (Nacogdoches) – High level • Lamar University (Beaumont) – Moderate level • UTHC at Tyler – Low level • McLennan Community College (Waco) – Low level • Average effectiveness score for all activities for each subject based on location

28. Survey Results (N=30) Figure 2. Distribution of total average effectiveness score for each subject by site Total average score Max=5

29. Survey Comments • Use of handouts – very helpful • Interaction – dependent on instructor, involving sites throughout presentation • Need for professionalism – strong agreement Major Concern When should IVDL courses be considered? - Cost vs. Benefit issues - Demand for courses not available in specific sites - Time needed for training, acquiring IVDL techniques, course development

30. Conclusions Data analyses indicated the use of group, team-based activities and case studies as providing the most effective means for learning. Learning effectiveness was also impacted by the technical level and system used by remote sites.

31. Discussion and Suggestions • Course development & delivery • Incorporate activities that are “active” • Group activities work best (if well planned) • Supply handouts • Videoconferencing Professionalism • Pay attention to how others will be seeing and hearing you • Speak clearly & directly; be polite • Establish “eye contact” with remote site • Acknowledge their presence; get them involved • Be kind if something goes wrong • Muting is tricky

32. Limitations • Small sample (n=30) • Representative, low response (30%) • Survey reliability and validity • How do effectiveness scores compare to host site (UTMB)?

33. New Challenges • Different remote sites, new technical requirements • Hurricane Ike • Personnel changes • Need for consistent communication • Problems with: • Consistent connection capacity • Speaker cancellations • Obtaining CE Certificates

34. Addressing New Challenges • Communication • Regular meetings with AHEC Executives • Develop new processes to assure communication • Test runs to assure connection capability • Program Fidelity • Improved evaluation methods • Improved participant tracking • Back-up plan if speakers cancel, cancelling activity (avoid at all cost) • Follow-up measures to determine long term program impact

35. Contact Information East Texas Geriatric Education Center c/o Tony DiNuzzo, Ph.D., Program Director Sealy Center on Aging, Route 0460 301 University Blvd. University of Texas Medical Branch Galveston, TX 77555-0460 Telephone: 409.772.5367 Toll-free number: 800.298.7015 Fax: 409.772.8931 E-mail:adinuzzo@utmb.edu Website:http://etgec.utmb.edu