Journal of Nursing Education

Educational Innovations 

Resolving Bottlenecks: Converting Three High-Enrollment Nursing Courses to an Online Format

Ken-Zen Chen, PhD; Jeff Anderson, MA, RRT; Elizabeth Lyon Hannah, DVM, MS, MPH; Christine Bauer, PhD; Corinna Provant-Robishaw, MS

Abstract

Background:

Converting large undergraduate classes from the classroom to online has been an effective way to increase enrollments in high-demand courses in undergraduate education. However, challenges exist to maintaining students’ high-quality learning interaction and engagement in large online courses. This article presents a collaborative model between faculty in health sciences and instructional designers to redesign and redevelop three high-enrollment courses to online at Boise State University.

Method:

Health studies course faculty and eCampus instructional designers conducted this study to reflect the collaborative online course development process at Boise State.

Results:

The offering of high-enrollment nursing courses met enrollment demand and maintained student retention. Challenges related to instruction were addressed by using a careful course redesign process and continuous improvement.

Conclusion:

Implications of this educational innovation for health science educators, instructional designers, and lessons learned are provided. [J Nurs Educ. 2015;54(7):404–408.

Dr. Chen is Research & Retention Analyst, Dr. Bauer is Assistant Director, and Ms. Provant-Robishaw is Instructional Design Consultant, eCampus Center, Mr. Anderson is Associate Professor and Director of Clinical Education, Department of Respiratory Care, and Dr. Hannah is Associate Professor, Department of Community and Environmental Health, Boise State University, Boise, Idaho.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Ken-Zen Chen, PhD, Research & Retention Analyst, eCampus Center, Boise State University, 220 E. Parkcenter Blvd., Boise, ID 83706; e-mail: kenzenchen@boisestate.edu.

Received: May 22, 2014
Accepted: February 18, 2015

Abstract

Background:

Converting large undergraduate classes from the classroom to online has been an effective way to increase enrollments in high-demand courses in undergraduate education. However, challenges exist to maintaining students’ high-quality learning interaction and engagement in large online courses. This article presents a collaborative model between faculty in health sciences and instructional designers to redesign and redevelop three high-enrollment courses to online at Boise State University.

Method:

Health studies course faculty and eCampus instructional designers conducted this study to reflect the collaborative online course development process at Boise State.

Results:

The offering of high-enrollment nursing courses met enrollment demand and maintained student retention. Challenges related to instruction were addressed by using a careful course redesign process and continuous improvement.

Conclusion:

Implications of this educational innovation for health science educators, instructional designers, and lessons learned are provided. [J Nurs Educ. 2015;54(7):404–408.

Dr. Chen is Research & Retention Analyst, Dr. Bauer is Assistant Director, and Ms. Provant-Robishaw is Instructional Design Consultant, eCampus Center, Mr. Anderson is Associate Professor and Director of Clinical Education, Department of Respiratory Care, and Dr. Hannah is Associate Professor, Department of Community and Environmental Health, Boise State University, Boise, Idaho.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Ken-Zen Chen, PhD, Research & Retention Analyst, eCampus Center, Boise State University, 220 E. Parkcenter Blvd., Boise, ID 83706; e-mail: kenzenchen@boisestate.edu.

Received: May 22, 2014
Accepted: February 18, 2015

As a result of recent financial cuts, public higher education institutions are facing decreases in governmental funding, while simultaneously coping with increased enrollments. With fewer resources, many faculty—both novice and experienced—are facing increasing numbers of students in their classrooms (Stanley & Porter, 2002). The number of both online and on-campus students at Boise State University has grown approximately 40% over the past decade. To better allocate limited instructional resources, converting high-enrollment courses, especially at the undergraduate level, to an online format is a plausible solution for colleges and universities such as Boise State University. According to the “Distance Education at Boise State 2000–2010 Report” (2010, p. 21), the number of on-campus student enrollments nearly doubled (from 4,805 to 9,207) between the 2009 and 2010 school years.

Bottleneck courses can be defined as required courses with enrollment caps. By virtue of simultaneously imposing high need and limited access, bottleneck courses interfere with student progression and with faculty resources, potentially increasing costs for both students and the offering institution. The rapid growth in on-campus enrollments created tension when allocating instructors, classroom space, and proper scheduling. In Idaho, health care professions have been increasing in demand, and undergraduate health programs’ enrollments have been undergoing significant growth due to the demand (“Distance Education at Boise State 2000–2010 Report,” 2010; eCampus Strategic Plan, 2012; Eduventure, 2011). The problem of insufficient seats postpones students’ application to nursing or other health sciences majors and increases both cost and duration of their college education. To help address this increasing student demand with existing faculty and staff capacity, the eCampus Center and the Health Sciences departments collaborated to redesign three bottleneck courses for online delivery.

The purpose of this article is to portray a collaborative course development action that converted bottleneck high-enrollment health science courses to an online format in fall 2012. In this article, the authors define a high-enrollment online course as an online class section, with more than 100 registered students (Scholl & Thomas, 2012). A formal redesign took place in summer 2012 for HLTHST 101 (Medical Terminology), HLTHST 300 (Pathophysiology), and HLTHST 304 (Public Health). These courses were specifically targeted because they are required courses in the health science curriculum, and large enrollment waitlists prevented departments from meeting the demands of students needing these courses. In addition, this project enabled instructional collaboration between academic departments and supporting units to maintain the quality of online nursing education.

Literature Review

Nurse educators have delivered courses to distance students for more than three decades (Billings, 2007). Large online classes pose multiple specific challenges, such as maintaining student engagement and allowing for timely student–instructor communications (Diekelmann & Mendias, 2005). A critical aspect of university education is the facilitation of students’ professional socialization through student–teacher mentorship (Mancuso-Murphy, 2006), and a realistic concern in moving courses into an online setting, especially large online classes, is the fact that it may become unmanageable for the instructors to maintain a professional mentorship with each student. Furthermore, students are likely to feel isolation in Internet environments, compared with face-to-face classroom settings (Thiele, 2003). An online course setting can worsen such scenarios. Therefore, Raines (2007) argued that fostering interaction and collaboration is critical to online nursing students’ learning success. Researchers reinforce that interactive instructional designs, such as collaboration through a wiki page (Ciesielka, 2008), peer review (Little, 2009b), podcasts (Greenfield, 2010), and audio feedback between instructors and students (Wood, Moskovitz, & Valiga, 2011), have positive effects on the success of online nursing education.

In terms of course development, a survey (Ryan, Hodson, & Ali, 2005) revealed that providing administrative and technological support, learning new pedagogies and communication methods, adjusting faculty workload, bringing in external experts, and providing faculty development and mentoring, are factors to successfully develop an online course. The authors reviewed the experience of offering high-enrollment online courses from scholarly works (e.g., Elison-Bowers, Sand, Barlow, & Wing, 2011; NC State, 2012) and then leveraged the redesign principles from the National Center for Academic Transformation (NCAT, http://www.thencat.org/). Because nursing faculty may have varying experience teaching online and may not receive enough resources from academic departments in developing online courses (Little, 2009a), a collaboration between faculty members and instructional designers can not only fast-track the development process but also ensure the quality of online courses through activities that keep students engaged. With prior research findings in mind, the steps of online course transformation proposed by Anderson and Tredway (2009)—identify desired results, determine acceptable evidences, and plan learning experiences and instruction—were followed, and then the authors sought to increase the threshold of class size, while continuing to maintain high-quality learning experiences for the students.

Course Redevelopment

The design of high-enrollment online courses was staffed with faculty developers and teaching assistants from the academic department and instructional design consultants from the eCampus Center (Table 1). The Center invested a total of $12,000 in faculty stipends for the development of the three courses. Instructional design consultants collaborated with faculty weekly from May through mid-August. Three courses were offered to students in the fall 2012 semester, and Quality Matters Peer Reviews were conducted to improve course quality before reoffering them in spring 2013. A Blackboard specialist from Academic Technologies was also invited to ensure platform stability for the foreseeable high volume of user access.

Teamed Faculty and Instructional Designers of High-Enrollment Online Course Development

Table 1:

Teamed Faculty and Instructional Designers of High-Enrollment Online Course Development

Identify Desired Result

For the Medical Terminology course, the main course objective was for students to be able to construct medical terms by using root words to translate medical terminology into lay words. Prior to the design tasks, an “Analysis of Situational Factors” (Fink, 2005, p. 7) was used to describe learning situations of the courses. The design team for the Pathophysiology course focused on increasing interaction with students, reorganizing course content, chunking chapter lectures, building interactive questions with automated feedback, and eventually creating department standard master course shells for online faculty that are appropriate for the course level in Blackboard. The Public Health course was previously developed to be a self-paced online course. The instructor had developed course content, assignments, examinations, and discussions in previous courses. In this regard, the major task for the redesign team was to reshape the course into scheduled learning modules.

Develop Assessment and Learning Activity

After identifying the desired results in the three courses, the development team reevaluated the appropriateness of assessments to be acceptable outcomes and then planned learning experiences and instructions in the redevelopment course shells. For the Medical Terminology course, three redesign foci (Anderson & Provant-Robishaw, 2013) were achieved to:

  • Increase student-to-content interaction: A publisher’s Web site was integrated to the course so that students could explore a virtual hospital, practice annunciation of medical terms by repeating the words, and participate in interactive games in the setting of a virtual hospital. A tutorial was created for students as a job aid.
  • Provide immediate feedback: The instructor recorded case studies through chunked lecture-capture videos for students. Students were provided with directions to pause the video in sections to practice and to complete a study guide on the translation of medical terms to lay terms. The student would then continue the video to hear the correct response and have immediate feedback from the instructor.
  • Offer flexible participation: After reading the assigned journal articles, students could either interact with classmates and their teaching assistants on the asynchronous discussion board or join a live discussion with their professor on Blackboard Collaborate. This allowed the instructor to add interesting content, illustrate concepts, and provide immediate feedback to students synchronously. These live sessions were recorded and able to be reviewed on Blackboard.

To help manage instructors’ workloads teaching Pathophysiology, quizzes, study guides, and discussion boards were set up to be automatically graded or self-graded. Hence, the instructors and teaching assistants would be able to use their time on student-to-teacher interactions. In the Public Health course, two major tasks stood out in the development phase: the alignment of scheduling and creating chunked lecture videos. Initial communication with students was also rewritten to emphasize that this course was not a self-study course. For each of these three large-section online courses, a course design map was used to align assessments, learning activities, and course and module objectives. Concerning the redesign, the same Web site appearance was applied as the students moved through each weekly module and eventually became the standard online course template for the College of Health Sciences.

Results and Discussion

Enrollment and Retention

The most significant impact of offering high-enrollment online courses is to help meet student demand for bottleneck courses. The enrollment cap of regular online courses at Boise State University is 20 to 25 students and 45 students for on-campus lecture. In the beginning of fall 2012, the HLTHST 101, 300, and 304 courses attracted 262, 370, and 111 students, respectively (743 in total) (Table 2). Within these enrollments, 565 students earned their credits across these three courses. The retention rates for the three courses were 74.4%, 82.7%, and 82%, respectively (79.7% on average). Among the students completing each course, the pass rate was 94.9%, 95.8%, and 95.6%, respectively (95.4% on average).

Enrollment Numbers of the First-Offering of Three High-Enrollment Online Courses in Fall 2012

Table 2:

Enrollment Numbers of the First-Offering of Three High-Enrollment Online Courses in Fall 2012

Comparing the original capacity in spring 2012, an additional 182 students were enrolled by the three high-enrollment online courses in fall 2012. Enrollment numbers of the three courses in the following semesters also showed that three bottleneck courses were relieved because of the expanded capacity from the new high-enrollment online sections. Departments in the College of Health Sciences boosted enrollments without adding instructors and became more flexible to reallocate faculty resources to other research, teaching, and service tasks.

Instructor Reflections After Delivery

Instructor feedback was obtained during and after the delivery of three online courses. In the Medical Terminology course, many students did not participate in the Collaborate sessions. By reviewing the course evaluation, possible reasons were identified, such as being afraid of technology, having no built-in microphones on their computer, being afraid of being called on, and having conflicting schedules. To remedy the situation based on the feedback, corresponding technical support information was included in the syllabus, and a noncredit survey was used to determine the optimal times for Collaborate sessions. In spring 2013, students had all the necessary information at the beginning of the class, and the attendance of Collaborate sessions increased. In addition, students enjoyed the chunked lecture video. Students who had chances to attend the Collaborate sessions responded that the instructor was good at lecturing and that they were attracted to his charisma. It was suggested to enhance the benefits of the instructor videos in the course announcements, module summaries, and frequently asked questions. The instructor wanted to give students choices to complete the activities that were suitable for them. However, students were confused about required activities and assignments. Therefore, a communication plan was needed to help students consider “doing online activities that you think are valuable,” rather than “filling in the blanks to get grades.”

For the Pathophysiology course, the instructors and teaching assistants reflected that students had a better understanding of the material because they could revisit the course materials online. Adding more personal stories and case studies may help to increase students’ engagement with the course material and understanding of the course concepts. In addition, a workflow of corresponding contacts among instructors, teaching assistants, instructional designers, and technical support staff should be considered to prevent instructors from being flooded by students’ e-mails and telephone calls regarding technical concerns. Finally, clear alignment between the textbooks, study guides, discussions, assignments, and examination questions was addressed over the first three modules to set up expectations of student learning patterns successfully.

For the Public Health course, the instructor reflected that many of the course activities were mostly “read this,” “watch that,” and “tell me about” when the course was self-paced. An opportunity to review activities the instructor had used previously and revised for use in the high-enrollment online setting was critical. Moreover, the first-time teaching of the high-enrollment online course was still challenging and demanding, but the instructor perceived benefits when teaching the course, in which the content, activities, and assignments have been aligned and clearly laid out.

Lessons Learned

Based on the experience and reflection of transferring and delivering three high-enrollment online courses, recommendations from faculty and instructional designers are as follows:

  • Form a sustainable course development workflow. When the design team of a high-enrollment course is formed, a lead faculty member and a lead instructional designer should work together to establish an effective workflow and create clear channels of communication during the course design and delivery process.
  • Use both technology and instructional design to facilitate instructor presence. When the instructors and teaching assistants use most of their time grading individual students’ assignments or replying to individual students’ problems, less time is available for instructors to convey information and communicate to the whole cohort. Solutions such as automatic grading activities, a flipped classroom approach (e.g., Schwartz, 2014), and self- and peer-assessment tools (Scholl & Thomas, 2012) have proven useful to relieve the instructors’ routine workloads in high-enrollment online courses. These solutions enable online instructors to refocus on conveying teaching and social presence.
  • Set up communication guidelines. Although providing frequent instructor presence is important in the online setting, faculty still need to declare boundaries on their availability to prevent exhaustion during the teaching process (Magnussen, 2006). The syllabus should clearly identify communication channels (e.g., teaching assistant, technical help, instructor, writing center) when students seek different kinds of assistance. Assignment start and end dates and times should be carefully thought-out to ensure support for students during high-stress times, such as close to examination dates.
  • Allocate interactive learning activities in the redesign process. To compensate for student disengagement in online courses, interactive learning activities should be taken into account during the course redesign process (Schullery, Reck, & Schullery, 2011). Instructors and teaching assistants need to carefully monitor these activities and provide necessary interventions when students have problems.
  • Provide road maps, study guides, and test-taking tips to novice learners. Students in both the Medical Terminology and Pathophysiology courses complained about too much content. For early college courses, such as Medical Terminology, Diekelmann (2002) explained that the current knowledge system of nursing education favors hospital-based, banking epistemologies instead of case-based health promotion. To better help students, instructors may consider providing real cases, study guides, and test-taking tips as cognitive scaffolds (Stavredes, 2011) to motivate students. For the Pathophysiology course, the key to content management has been to clearly identify key learning outcomes and focus content and activities to ensure these key learning outcomes are achieved. Pathophysiology course students are primarily upper division, so focusing study and reading time and communicating that via the lesson and unit objectives helped the students to manage content concerns. In addition, a road map indicating the importance of the information would be helpful for students who are novices in the field.

Conclusion

This article provides a comprehensive description of converting three high-enrollment courses to an online format at Boise State University since fall 2012. The authors’ intent was to address the collaborative accomplishments between faculty from the Health Sciences departments and instructional design consultants from the eCampus Center. The results demonstrate that the three high-enrollment online courses were successful overall and that challenges were addressed by careful course redesign and continuous improvement. Future investigations needed for high-enrollment courses at Boise State University include identifying the optimal high-enrollment online class size; comparing effectiveness among online, on campus, and hybrid delivery format; and identifying proper online training and teaching strategies for faculty involved in online course delivery.

References

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Teamed Faculty and Instructional Designers of High-Enrollment Online Course Development

CourseNo. of Faculty DevelopersNo. of Instructional DesignersNo. of Teaching Assistants
HLTHST 101 Medical Terminology132
HLTHST 300 Pathophysiology234
HLTHST 304 Public Health121

Enrollment Numbers of the First-Offering of Three High-Enrollment Online Courses in Fall 2012

CourseInitial EnrollmentsDrop-OutsRemaining EnrollmentsStudents Passed the ClassRetention Rate (%)
HLTHST 101 Medical Terminology2626719518574.4
HLTHST 300 Pathophysiology3706430629382.7
HLTHST 304 Public Health11120918782

10.3928/01484834-20150617-09

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