The many faces of interaction

The many faces of interaction IN BRIEF • P. A. Reynolds,1 R. Mason2 and J. Harper3 • VERIFIABLE CPD PAPER • Explores how people in general, and teachers and students in particular, interact with ICT when learning. Describes the ICT-human interfaces that currently occur in education. Describes the use of mobile technology and portable digital assistants in a clinic to help in decision making and administration. The interactive opportunities for developing e-portfolios using social software are highlighted. During the process of learning teachers and/or students interact with each other on a personal level. However, in e-learn­ ing the process is achieved through the intermediary of an information and communication technology (ICT) system or service. Descriptions of these ICT-human interface devices are given in this paper. Successful interaction depends not just on personal relationships, but also on understanding and the ability to use computers and communications equipment ef­ fectively. Interactivity, when using ICT, may as a result be different from that in a traditional classroom. The computer is the main man-machine interface and modulates people’s ability to interact. Newer, mobile technology will extend the ability to interact in terms of time and place, as is illustrated by the use of portable digital assistants for dental teaching in clinics. The paper concludes that it is very important that both teachers and students should understand how to interact optimally with current and future ICT systems and devices. E-LEARNING IN DENTISTRY Section A: Teaching and technology 1. A description of the new technologies used in transforming dental education 2. Seeing is believing: dental education benefits from developments in videoconferencing 3. Webcasting: casting the web more widely 4. Top of the pops – CD-ROM and DVDs in dental education Section B: Informatics: better informed by systems and services 5. Better informed: an overview of health informatics 6. Better informed in clinical practice ­ a brief overview of dental informatics 7. Digital clinical records and practice administration in primary dental care Section C: Impact of e-learning in dental education 8. Remember the days in the old school yard: from lectures to online learning 9. An intricate web – designing and authoring a web-based course 10. The many faces of interaction 11. Supporting the learner and teacher online 12. Making a mark – taking assessment to technology 13. Continuing professional development and ICT: target practice 14. Assuring quality Section D: A connected future 15. Nine years of DentEd: a global perspective 16. A vision of dental education in the third millenium INTRODUCTION Previous papers in this series have sug­ gested that, in a successful e-learning scenario, interactivity is a vital ingre­ dient. There is always an important relationship between all those involved in the teaching and learning process, even if that relationship is mediated by a machine. In many respects it is the bedrock of education, for as Mason1 observes – ‘Interaction between learn­ ers and teachers has continuously been shown to provide cognitive benefits, as well as to assist in the effective and motivational aspects of learning’.1 However, it cannot be assumed that interactivity is purely concerned with personal relationships. In e-learn­ ing most of the relationships will be 1* Professor of Dental Education, Centre for Flexible Learning in Dentistry, King’s College Dental Institute, Floor 3, Strand Bridge House, 138-142 Strand, London, WC2 1HH; 2Professor of Educational Technology, Insti­ tute of Educational Technology, The Open University, Walton Hall, Milton Keynes, MK7 6AA; 3IT Manager, The Dental Institute at Guy’s, King’s and St Thomas’ NHS Hospitals, King’s College Hospital, Denmark Hill, London, SE5 9RW *Correspondence to: Professor P. A. Reynolds Email: P.A.Reynolds@kcl.ac.uk Refereed Paper DOI: 10.1038/sj.bdj.2008.409 © British Dental Journal 2008; 204: 565-570 BRITISH DENTAL JOURNAL VOLUME 204 NO. 10 MAY 24 2008 mediated through ICT systems and serv­ ices, in a situation that depends on the often-criticised man-machine interface. Interactivity obviously exists in a traditional classroom setting and it is face-to-face and personal. Teachers teach and ask questions, students learn, give answers and interact amongst themselves. Some would see this as the strength of the traditional pedagogical methodology and its apparent lack as a weakness of its e-learning counterpart. However, writing about online univer­ sity degree programmes at a university in the United States, Cannings and Tol­ ley (2000) 2 state: ‘online encourages a degree of community of practice and the level of reflection well beyond that found in students who participate in graduate school by attending weekly face-to-face classes’.2 Their reason for this claim is the ongoing value of edu­ cation which they characterise as ‘the continuation of the dialogue in between any official synchronous online classes or occasional face-to-face meetings… a sort of 24/7 (twenty-four hours a day, seven days a week) type of presence that has not existed in education before.’2 Four types of communications have been delineated.3 They are: 565 © 2008 Nature Publishing Group EDUCATION • EDUCATION • • • • Teacher-to-student group Teacher-to-individual student Student-to-teacher Student-to-student. The author also states that ‘it is cus­ tomary… to distinguish between “pub­ lic” modes of interaction such as bulletin boards, emails or “open” chat environments; and “private” one-to-one exchanges such as individually addressed email messages’. The author then claims that the traditional classroom favours the teacher-student group model in which the limited opportunities for communi­ cations between teacher and an individ­ ual student are compromised by a ‘lack of privacy and confidentiality’. Student-to-student communication is also limited by constraints of ‘time and place at which this type of interaction can take place.’ There are both differences and similarities between the interaction inherent in face-to-face situations when compared with those mediated through ICT systems. It has been pointed out that: ‘Even people we “know” in other circumstances may not interact with us in the same way within computer-medi­ ated contexts. It is possible to change your identity online, and even your gen­ der.’3 Furthermore, electronic learning spaces often encompass a greater range of participants than is customary within traditional classrooms.4 Further comments describe the way we represent ourselves in the physical world as including ‘aspects of our appearance, our voices, our facial expressions, our clothes and other possessions, our cho­ sen companions, and so on.’4 On the other hand, ‘where the self is revealed solely through electronic mediated text this richness of information is obviously not available.’4 This observation does not take account of visual ICT media such as videoconferencing, where these personal traits and accoutrements can be seen and experienced, albeit at a distance. Experience with videoconferencing suggests that any initial reservations about such a teaching method are quickly dispelled. In a report on the use of video in the delivery of continuing profes­ sional development for dentists, it was observed that ‘students in the larger lec­ ture group did… feel camera shy at fi rst, but as the presenter moved amongst the audience with a microphone, the discussion improved.’5 It was also noted that ‘The students were obviously interested and concentrated well. An attention span of more than 16 minutes was timed which compares well with the face-to­ face lecture span of 9 minutes.’5 Some will argue that web-based distance learning causes persistent frustrations that inhibit educational opportunities,6 such as: • Too many emails, not all of which are read • Difficulties interacting with technol­ ogy and the web • Lack of feedback and help from tutors. This is a situation that has to be addressed by both teachers and learn­ ers through course design, training and support, all subjects which will be cov­ ered in future papers in this series. TALKING TO TECHNOLOGY Although there may be a debate about the nature of relationships within e­ learning, there is no doubt that both teachers and students have to interact with technology. The use of pen and paper – perhaps the historic technologies – may well appear simple, but are they, in reality, any different from the use of a computer? We might be more at ease reading a book rather than reading off a screen, but this may well be a cultural and generational factor, ie older people may be likely to be happier in a paper­ based world than younger generations who have grown up with ICT. For both teachers and students the ICT system that they most frequently inter­ act with is the computer, although the use of internet-connected mobile devices is becoming pervasive. It may seem less natural and more complicated than putting pen to paper; as they have to have confidence in their abilities to use the intermediaries – the keyboard, screen and mouse. The importance of these man-machine interfaces is demonstrated in the words: ‘At a more practical level, even factors such as the lack of exper­ tise at keyboarding can have a marked effect on choice of words and structure of sentences, giving an “impression” of 566 the writer which might be significantly at odds with that obtained during a face­ to-face conversation.’4 There is still debate as to whether or not the QWERTY keyboard is the best method of inputting text into a compu­ ter. Since 1874, this has formed the nor­ mal model for no better reason than it was the optimum arrangement to reduce typebar clashes on the first – manual – typewriters. Now it is the ‘universal user interface.’7 The only other mode of inputting that has been tried is voice recognition. This has to some extent been the ‘holy grail’ of the ICT industry; much has been prom­ ised, but delivery has been difficult with the user having to ‘train’ the system, often talking like a robot to ensure accu­ racy of recognition. However, a voice response system in a call centre can be satisfactorily responsive to simple words like ‘yes’ and ‘no’ and numbers. Voice or speech recognition is the abil­ ity of a machine or program to receive and interpret dictation, or to understand and carry out spoken commands. The human voice’s analogue signals have to be converted into digital signals; to deci­ pher these a computer has to have a dig­ ital database, ie a vocabulary of words and syllables, and a fast method of com­ paring this data with the incoming sig­ nals. The size of this vocabulary depends upon the computer’s RAM (random access memory) capacity and the best systems have all words, syllables etc stored in the RAM rather than having to search the hard disk for some of the matches. Nevertheless, total accuracy cannot be guaranteed. Extraneous noises such as coughs and barking dogs can lead to false input and there are problems with simi­ larly sounding words such as ‘here’ and ‘hear’. Despite these drawbacks voice rec­ ognition has some applications, notably as a security device for authorising access to banking services, and to buildings. Other uses have mainly been for ‘repetitive data entry operations. This includes dictation of medical notes and case histories in the health sector, for which there is a bur­ geoning market (our italics).’8 Given that it enables hands-free opera­ tion of computers and other ICT systems and, in time, mobile equipment such as personal digital assistants and increas­ BRITISH DENTAL JOURNAL VOLUME 204 NO. 10 MAY 24 2008 © 2008 Nature Publishing Group EDUCATION • Controlling the computer • Controlling the software programmes on the computer. A typical PC mouse system has the following parts: • Sensors (eg opto-mechanical move­ ment detectors) • A mouse controller which reads the state of sensors and records the cur­ rent mouse position • A communication link • A data interface • A driver • Software. Fig. 1 Touch screen smart phone with the functionality of a PDA and mobile communications with internet connectivity Fig. 2 Dental student interacting with flat screen monitor and keyboard in combination with more traditional media such as books ingly smartphones (Fig. 1), chairside applications in both dental education and practice can be foreseen. Notwithstand­ ing this, the question of whether voice recognition will replace the QWERTY keyboard as the main method of compu­ ter inputting remains open to doubt, par­ ticularly in the short and medium-term. OF MICE AND SCREENS The ubiquitous mouse, in conjunction with the graphical user interface (GUI), has made the control of and access to software programmes far more user­ friendly than in the days when users had to remember the correct ‘F’ number. Similarly to the use of the QWERTY key­ board, it is the best option until voice recognition becomes more pervasive and user-friendly. Then this may well take over the control functions that are cur­ rently the preserve of the mouse. The mouse has two functions, which are: BRITISH DENTAL JOURNAL VOLUME 204 NO. 10 MAY 24 2008 When information changes, the mouse controller sends a packet of data to the computer data interface controller. The mouse driver in the computer receives the data packet and decodes the infor­ mation and directs the application soft­ ware or operating systems. Recent mouse developments are offer­ ing different data transmission tech­ niques to reduce desk top cable clutter. Wireless – also used for keyboards – laser and even optical versions are now avail­ able, as are Bluetooth® models which can operate over longer distances.* e-Learners spend a considerable amount of time staring at a screen, with the potential danger of eye-strain. Fortunately, most modern screens have eliminated the annoying ‘fl icker’ and with larger screen sizes and much improved text and pictorial display and background, user experience is much improved. In addition, monitor fi lters, such as privacy and antiglare fi lters, help to decrease computer screen glare and reduce viewing from the side. Despite emanating from television, the more common computer display tech­ nology is the CRT (cathode ray tube), distinguished by its bulky importance.9 Newer techniques such as liquid crystal display have led to the development of flat screens, which are rapidly replacing the CRT versions (Fig. 2). They also take up less space on a desk. *Bluetooth® is a short-range wireless specification that allows radio connection between devices including computers, printers, headsets and mobile phones as well as mice, within a 10-metre range of each other. Up to seven compatible devices can communicate simultaneously using Bluetooth. 567 © 2008 Nature Publishing Group EDUCATION A number of standards have been introduced for the resolution offered by monitors. These started with VGA (video graphics array), since when various ver­ sions have been developed to improve the screen resolution. VGA had a reso­ lution of 640 × 480 pixels* whereas the latest – UXGA (ultra-extended graphics array) offers up to 1,600 × 1,200 pixels. The resolution of a screen is expressed as the number of pixels arrayed hori­ zontally and vertically; thus, as stated above, the UXGA standard has a reso­ lution of up to 1,600 × 1,200 depend­ ing on the number of colours displayed. Obviously the higher the resolution, the better the quality of the picture, but the perception of this naturally depends on the user’s visual acuity with or without glasses. Screen sizes are normally measured in inches diagonally from one corner to the other; the key factor in choosing a moni­ tor is the viewable area, not necessarily the quoted screen size. It is also worth noting that the size of the viewable area affects the resolution. A low resolution on a larger screen will produce a fuzzy image, so large-size screens should have a higher resolution. APPEARANCE MATTERS It may not be generally known that it is possible to change the settings of the interfaces to suit personal preferences and situations. This is particularly use­ ful for disabled people, although altering the touch and feel of the computer can improve the man-machine interface for all users. As one website observes: ‘Every computer user is an individual… Yet the computer we may spend many hours on each day is set up to meet the needs of an amorphous average person.’8 The website goes on to list typical changes that can be made to make the screen, keyboard and mouse more suita­ ble for the user.9 Included in the list are: 1. Making the text easier to see on the screen by imposing a preferred text size on any website visited 2. Changing the screen background colour or reversing text out of a black background *A pixel is the basic unit of programmable colour on a computer display. Fig. 3 Screenshot of Second Life avatar page 3. In Microsoft’s Windows XP there is a feature that makes locating the mouse much easier. The standard mouse pointer, the website advises, ‘isn’t very easy to see and many people find that they can’t spot where it is located, or they lose it as they move it across the screen.’ LOCATION, LOCATION, LOCATION The other question that e-learning poses is where does the interaction take place? By its very nature it is unlikely to take place on a single site where everybody is co-located. More likely it will take place as various forms in cyberspace – virtual classrooms, bulletin boards, chatrooms and videoconferencing sessions. These impersonal methods may appear to lack the interactive advantages of a face­ to-face situation. However, one opinion based on personal experience is that this possible downside ‘has been partly overcome by the availability of chat­ rooms, emails and bulletin boards.’10 In fact, research has shown that ‘shrinking violets, who in normal circumstances rarely open up, often blossom in the Internet gardens.’11 In support of this, one commentator makes the point that ‘online discussion can potentially be more engaging, more inclusive and perhaps more democratic than in face-to-face situations. Shy, less verbally articulate, slight of voice or slower responders can spend time 568 considering their responses before sub­ mitting them and have equal access when being displayed online.’12 This is supported by an evaluation of online learning amongst undergradu­ ates in which it was suggested that ‘cyberspace provided an easier mode for expressing one’s feelings about a learn­ ing experience generally, and about online learning in particular.’13 MOBILE INTERACTION We have placed our emphasis on the com­ puter as the main method for interfacing. However, the penetration and applica­ tion of mobile technology means that the location may not have a desk. Evidence of this comes from a trial at a UK dental school, the aim of which was to evaluate the use of PDAs amongst undergraduate students. In this trial the point of inter­ action was at the chairside.14 The dental school’s academic network was linked to a secure encrypted wire­ less network which connected to the PDAs. This allowed students to access a virtual learning environment (VLE) and, through it, appropriate teaching resources and material. These included text-based documents featuring teaching notes, illustrative images and textural extracts, PowerPoint presentations, PDF documents, instructional images, simple animations such as clinical procedures or patient safety/emergency procedures, and viewable webcasts. The WebCT BRITISH DENTAL JOURNAL VOLUME 204 NO. 10 MAY 24 2008 © 2008 Nature Publishing Group EDUCATION interface enabled students to send emails, post notes to a bulletin board and enter personal or clinical details. As the PDA is a mobile device, all the interaction can take place at the chair­ side, allowing the students to receive guidance while undertaking clinical practice. This also has major implica­ tions with the introduction of electronic patient records (EPRs) for these too can be accessed, consulted and updated via the mobile device. The PDA proved to be a highly accept­ able mode of access to online education; their small size and mobility enabled students to use them in a variety of learning activities such as note-tak­ ing, downloading materials and receiv­ ing ICT-based information. Positive responses from students, even those with limited ICT experience, and the time saved in record-keeping and note-tak­ ing indicate that a PDA-based approach to mobile computing is highly applicable in healthcare environments. A mobile solution is also being sought in the completion of e-portfolios on- and offline using the ‘m-portfolio’15 The inter­ active potential of e-portfolios – the new digital identity – is discussed below. A MORE CONNECTED FUTURE There is now an emerging literature on the socio-cognitive interactions and their assessment that will allow fur­ ther evaluation of this new and clearly acceptable way of mobile interaction.16 The authors make no distinction between technology and people but explore the dynamic interaction between those who are advancing ‘knowing’. This ‘conver­ sational’ process has a snowball effect between those in the dialogue as they grow their understanding within their own context.17 With mobile learning there are new relationships between tra­ ditional and mobile learning in which global conversation has a central role. This is especially important as the new, more connected Web 2.0 facilitates such mobile communications.18 The emer­ gence of more social software such as ‘Facebook’, ‘YouTube’ and ‘Second Life’ is providing new interactive domains. The latter (http://secondlife.com) creates 3D personalised worlds where the play­ ers choose embodiments of themselves (avatars) (Fig. 3).19 Emerging immersive worlds will inevitably offer ever-new opportunities for interacting with peo­ ple and places where the only limitation is the bandwidth, the software and the user’s own imagination. Furthermore, the development of hap­ tic devices (gloves or jigs) will enable even more senses to be involved in this interaction. Virtual reality is discussed later in this series, but one key issue is the disorientation that can occur when using these devices. Motion sickness can also occur as part of this disorientation and this is well documented in 3D view­ ing.20 However, whether it is pen and paper media or a human interface device of a computer mediating the interaction, once this interface becomes automatic or unconscious, the communication can occur freely. Assistive technology* will inevitably help those users with disabili­ ties and the world will become an ever smaller place.21 media can now benefit from interactive social software such as blogging, wikis, podcasting and multimedia tools. ‘E­ portfolios help you to become the person you are to be.’25 Even though there are challenges in interoperability between the many systems available, there is no doubt that interactive, student-focused log books will become essential in reas­ suring future employers and patients that the professional has a well thought­ out and proven track record. CONCLUSION For the successful use of ICT in dental education, it is essential that the impor­ tance of the factors influencing interac­ tions between teachers, students and the different forms of ICT are understood and that the lessons that have been learned in this area are applied. 1. 2. REWINDING THE STORY e-Portfolios are the latest, somewhat poorly-defined concept that has cap­ tured the imagination of educational­ ists. One general definition suggests that ‘an e-portfolio is an electronic space for learners to store their work — to share with others and to show to teachers (and, sometimes) employers.’22 Another, in the healthcare context states ‘the ePortfolio is a purposeful collection of information and digital artefacts that demonstrates development or evidences learning out­ comes, skills or competencies.’23 The potential to create a portfolio offers an interactive process, that allows the learner to ‘collect, select, reflect, connect and project and present’.24 Pro­ jection in this sense is the direction of the next steps to be taken and presenta­ tion of the e-portfolio can be submitted for assessment purposes. Creating a personally-owned learn­ ing record through the use of multiple 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. *Assistive technology (AT) is a generic term that includes assistive, adaptive and rehabilitative devices and the process used in selecting, locating and using them. AT promotes greater independence for people with disabilities by enabling them to perform tasks that they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to or changed methods of interacting with the technology needed to accomplish such tasks. 21 BRITISH DENTAL JOURNAL VOLUME 204 NO. 10 MAY 24 2008 14. Mason R. Using communications media in open and flexible learning. London: Kogan Page, 1994. Cannings T A, Tolley S G. Online university degree programmes. In Watson D M, Downes T (eds) Communciations and networking in the networked society. pp 149-156. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2000. Turkle S. Life of the screen: identity in the age of the Internet. London: Weidenfield and Nicolson, 1996. Dowling C. Social learning within electronic envi­ ronments. Current perspectives and future direc­ tions. In Nicholson P, Barrie Thompson J, Ruohonen M, Multisilta J (eds) e-Training practices for profes­ sional organizations. pp 205-212. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2005. Reynolds P A, Mason R D. Online videomedia for the continuing professional development in dentistry. Comput Educ 2002; 39: 65-98. Hara N, Kling R. Students’ frustrations with a web-based distance education course. First Monday 1999; 4(12). http://firstmonday.org/issues/issue4_ 12/hara/index.html (accessed 30 March 2008). The QWERTY connection website. http://home. earthlink.net/~dcrehr (accessed 30 March 2008). AbilityNet. My computer my way website. http://www.abilitynet.org.uk/myway (accessed 30 March 2008). Howstuffworks website. http://www. howstuffworks.com (accessed 30 March 2008). Reynolds P A. e-Learning gets results for Europe’s largest dental school. Br J Healthc Comput Inf Manage 2005; 22: 30-32. McDougall A, Clark T, Campbell L .Taking the e-train in university education. In Nicholson P, Barrie Thompson J, Ruohonen M, Multisilta J (eds) e-Training practices for professional organizations. pp 85-92. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2005. Hellstén M. Anybody out there a real expert? In Nicholson P, Barrie Thompson J, Ruohonen M, Multisilta J (eds) e-Training practices for profes­ sional organizations. pp 51-60. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2005. Dowling C. Social interactions and the con­ struction of knowledge in computer-mediated environments. In Watson D M, Downes T (eds) Communciations and networking in the networked society. pp 165-174. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2000. Reynolds P A, Cox M J, Dunne S, Myint Y K, Harper J. Portable digital assistants (PDAs) in dentistry: Part II – pilot study of PDA use in the dental clinic. Br Dent J 2007; 202: 477-483. 569 © 2008 Nature Publishing Group EDUCATION 15. Cotterill S J, Angarita M, Horner P et al. Towards the m-portfolio. Proc ePortfolios 2006. Oxford, 2006. http://www.eportfolios.ac.uk/fdtl4_ docs/47_mPortfolio_paper_for_ePortfolio_2006. doc (accessed 1 April 2008). 16. Sharples M, Taylor J, Vavoula G A. Theory of learn­ ing for the mobile age. In Andrews R, Haythorn­ thwaite C (eds) The Sage handbook of e-learning research. Thousand Oaks, CA: Sage Publications Ltd, 2007. 17. Laurillard D. A conversational framework for indi­ vidual learning applied to the ‘learning organisa­ tion’ and the ‘learning society’. Syst Res Behav Sci Res 1999; 16: 113-122. 18. Science learning opportunities in Second Life. Dental Information and Library Innovation weblog, University of Michigan, 2007. http://mblog.lib. umich.edu/dentlib/archives/resources/education/ index.html (accessed 31 March 2008). 19. O’Reilly T. What is Web 2.0? Design patterns and business models for the next generation of soft­ ware. http://www.oreillynet.com/pub/a/oreilly/ tim/news/2005/09/30/what-is-web-20.html (accessed 30 March 2008). 20. Smith S P, Marsh T. Evaluating design guidelines for reducing user disorientation in a desktop vir­ tual environment. Virtual Reality 2004; 8: 55-62. 21. Wikipedia. Assistive technology. http:// 570 View publication stats 22. 23. 24. 25. en.wikipedia.org/wiki/Assistive_technology (accessed 30 March 2008). Mason R. Handbook of research on e-portfolios – Ali Jafari & Catherine Kaufman. Br J Educ Technol 2007; 38: 174. (Review). Cotterill S J. What is an e-portfolio? http://www. eportfolios.ac.uk/definition (accessed April 1 2008). Mason R, Pegler C, Weller M. ePortfolios: an assessment tool for online courses. Br J Educ Technol 2004; 35: 717-727. Cotterill S J, White A, Currant B. Using Web 2.0 to support PDP. PDP-UK Newsletter 2007; 12: 7-8. http://www.recordingachievement.org/down­ loads/PDP%20UK%20Dec%20Issue%2012.pdf BRITISH DENTAL JOURNAL VOLUME 204 NO. 10 MAY 24 2008 © 2008 Nature Publishing Group