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Literature Review
Many resources are available discussing blended-learning and the implementation of it.  These are the sources that I reviewed.  I tried to research the sources that were specific to health sciences.

Introduction

          The intended goal for any effective health science program is to produce graduates that are self-directed, life-long learners that are well-versed in the theory of the profession.  We are experiencing curricula that continue to impart the same expectation of content with shorter semesters therefore leaving an extraordinary amount of processing and theory on the learner to decipher.  The sheer quantity of information cannot be delivered effectively with the current practice of face-to-face only curriculum.  Radiologic technology is a health science field that is in constant motion with new advancements in technology occurring at a record setting pace but gaps are forming as we rush to get our graduates into the field. Further, any great radiologic technologist knows that the goal is to continue the path of knowledge indefinitely.  Creating a significant learning experience using blended learning fits the mold of best practice to produce a graduate that does not have gaps in their learning but is also motivated to continue the process of learning on their own to achieve mastery. There is a clear trend toward highly interactive, self-directed learning environments to support the concept of life long independent learners. (Zafar et al.,2014)

            Significant learning experiences are defined as ones that engage students, make them enthusiastic about the subject, promote long-term learning, and help students see the value of material in the world around them. (Fink, 2013, pp.8-9) Blended learning has been defined in a variety of ways.  For our purposes, we will define blended learning as courses that thoughtfully integrate different instructional methods such as: lecture, discussion group, self-paced activity; and contain both face-to-face and computer-mediated portions.  (Alammary et al., 2014, Bonk &Grahaml,2006)

The aim of this review is to demonstrate the effective practice of using blended learning to create self-directed significant learning environments for radiography students.   Blended learning has proven to be a useful tool in closing the gap for students by increasing student engagement, creating learner efficiency by increasing student learning outcomes and by providing both time flexibility and management as compared to face-to-face only courses. 

 Increased Student Engagement

          “The need to provide more engaged learning experiences is at the core of the interest in blended learning.” (Garrison & Vaughan,2008, p.4) Thibodeaux, Harapniuk and Cummings evaluated the proposition  that if you engage students in their own journey by giving them choice and ownership and a voice in the learning process then authentic learning can happen because they feel empowered to control their learning and their outcomes. (2019, pp.55-57). The research shows that if we turn over the ownership to the learners, then they are more likely to continue on a path of self discovery.  Ultimately, we must  shift our focus to long-term learning and promote  multiple kinds of learning as a way to increase the likelihood that students will keep learning after the course is over. (Fink,2013,p.63) This is authentic and significant learning.

            We also have an obligation to bring the classroom into the current century. Today’s generation of students are more comfortable than ever using technology.  Radiologic science is already heavily technology based. Many students enter the field because of their love of technology and the constant change that comes with it. (Wertz et al, 2014, Martino & Odle, 2008) Using technology to promote interest in the learning aspect is a great place to begin with student engagement.  Bonk and Graham (2006) also stated that “students who enter colleges and universities today embrace and welcome technology as an expected part of their learning experience.” (p157) Although adding technology is only one piece of creating a blended learning environment, creating authentic and creative learning happens when the learner feels enthusiastically engaged.  No one loves technology more than the current generation.

  Increased student learning outcomes

        The most important item to measure is the student learning outcomes.  If we cannot demonstrate that the method of delivery results in improved outcomes for our students, then there is no justification for the time and effort it takes to alter the curriculum to a blended format. Although a much-debated topic, the research has shown that although not much of a difference happens in learning between online learning versus face-to-face learning, blended learning models do show stronger learning outcomes.  We do understand that the current practice of lecturing alone does not produce good outcomes. (Bergmann & Sams, 2012, p.109)

          The overall finding of a meta-analysis of empirical literature is that online learning (the combination of studies of purely online and of blended learning) on average produces stronger student learning outcomes than learning solely through face-to-face instruction.(Means, et al, 2013, p.35). 

         Research indicates that blended learning outcomes work across disciplines. In another meta-analysis for health professions, it demonstrates that blended learning has a large consistent positive effect on knowledge acquisition compared with no intervention, which suggested that blended learning was very effective and educationally beneficial in health professions. (Liu et al, 2016), “More specifically, utilizing blended learning in a radiology model also shows an improvement in student outcomes.”(Zafar et al, 2014 p.2)

 Time flexibility and management.

         We should not discuss adapting curriculum if we do not consider the time, or more accurately, lack of time that the current generation faces.  Radiography curriculum is already time intensive, and shortened semesters without a decrease in the amount of content leaves the student time locked if their best exposure is within the confines of a face-to-face course.  A blended learning environment is more conducive for learning content that requires continuous exposure for retention.  Course materials can be accessed 24/7 in a blended learning environment.  Although course materials are readily available in an online format also, we must keep the possibility of high-energy interaction that the blended learning affords.  Opportunities are created for students to engage in the material at any time or place.Students indicate that a blended learning model provides them with greater time flexibility and improved learning outcomes. (Vaughn,2007) Online learning has become popular because of its potential for providing more flexible access to content and instruction at any time, from any place.(Means, Toyama, Murphy, Bakia, & Jones, 2009).  Blended learning also provides an opportunity for students to value sort their content.  Learners can spend less time in areas that they are confident in and target learning objectives and activities they are not as confident in. (Bonk and Graham,2006, p24)

 Conclusion

          Research supports blended learning as a useful tool in closing the gap for students by increasing student engagement, creating learner efficiency by increasing student learning outcomes and by providing both time flexibility and management as compared to face-to-face only courses.  Creating a significant learning environment through high energy student engagement that results in a long lasting change and provides value for their life is the goal for true learning. (Fink, 2013,p.8) This philosophy also mirrors what we hope to see in all healthcare professions, a love of learning that impacts their life and career. Creating a deep love of learning that propels a learner to continue to explore and experience within their field is a win/win for everyone. With the ever-changing demands and time constraints, creating this type of authentic learning environment with the blended learning model will be a giant leap in the right direction. 



 

 References

Alammary, A., Sheard, J., & Carbone, A. (2014). Blended learning in Higher Education:     Three                        different design approaches. Australasian Journal of Educational Technology, 30(4).                                 https://doi.org/10.14742/ajet.693 

Bergmann, J., & Sams, A. (2012). Flip your classroom: Reach every student in every class every day.                   International Society for Technology in Education. 

Bonk, C. J.& Graham,C. (2006). The Handbook of Blended Learning: Global Perspectives, local                         designs. Pfeiffer. 

Fink, L. D. (2013). Creating significant learning experiences: An integrated approach to designing                    college courses. Jossey-Bass. 

Garrison, R., & Vaughan, N. D. (2008). Blended learning in higher education: Framework, principles                   and guidelines. Wiley. 

Hattie, J. (2012). Visible learning for teachers & students: Maximizing impact on learning. Routledge. 

              Institute, B. C., & Christensen Institute. (2020, December 16). Disrupting CollegeHow                             disruptive innovation can deliver quality and affordability to postsecondary education.                           Christensen Institute. Retrieved September 29, 2022,                                                                                    from https://www.christenseninstitute.org/publications/disrupting-college/ 

Liu, Q., Peng, W., Zhang, F., Hu, R., Li, Y., & Yan, W. (2016). The effectiveness of blended learning in                     Health Professions: Systematic review and meta-analysis. Journal of Medical Internet                            Research, 18(1). https://doi.org/10.2196/jmir.4807 

Martino, S., & Odle, T. (2008). New Models, New Tools The Role of Instructional Technology in                             Radiologic Sciences Education. American Society of Radiologic Technologists.                                         https://doi.org/https://www.asrt.org/docs/default-                                                                                        source/research/whitepapers/acad_whtppr_nweddelmthds.pdf?sfvrsn=8d5011f8_8 

Means, B., Toyama, Y., Murphy, R., & Baki, M. (2013). The effectiveness of online and blended                               learning: A meta-analysis of empirical literature. Teachers College Record: The Voice of                         Scholarship in Education, 115(3), 1–47. https://doi.org/10.1177/016146811311500307 

Thibodeaux, T., Harapnuik, D., & Cummings, C. (2019). Student Perceptions of the Influence of                          Choice, Ownership, and Voice in Learning and the Learning Environment. International Journal Of Teaching And Learning In Higher Education, 31(1), 50-62. https://eric.ed.gov/?                                    q=choice+ownership+and+voice+in+learning &id=EJ1206966.

Vaughan, N. (2006, December 31). Perspectives on blended learning in higher education.                                      International Journal on E-Learning. Retrieved September 29, 2022,                                                          from  https://eric.ed.gov/?id=EJ747810 

Wertz, C. I., Mickelsen, W., & Hobbs, D. L. (2014). Integrating technology into Radiologic Science                         Education. Radiologic technology. Retrieved September 25, 2022, 

                 from https://pubmed.ncbi.nlm.nih.gov/25224084/ 

Zafar, S., Safdar, S., & Zafar, A. N. (2014). Evaluation of use of e-learning in Undergraduate Radiology                     Education: A Review. European Journal of Radiology, 83(12), 2277–2287.                                                   https://doi.org/10.1016/j.ejrad.2014.08.017 

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