Lessons from a rural hospital in Uttar Pradesh for Higher Education and MOOC in the US

MOOC is the latest of many four letter words.  Ok, it is not a word.  But, it has all the potential to become a cherished curse word.

As much as I am into using technology as much as I can--in my professional and personal worlds--and as much as I am disgusted with the pathetic outcomes delivered by the current higher education structure, I am far from supporting MOOC.

MOOC--“massive open online course"--delivers courses online to a gazillion students. Well, thousands of students.  Any rational person's first question would be this: "how can one instructor teach thousands of students at the same time?"  The answer is simple: there is no "teaching" involved.

Step back for a second.  Think about a C-Span book discussion program. Or a PBS Nova piece on string theory.  I can watch them at home. I can learn from them.  And I do. This C-Span or Nova program simultaneously goes out to hundreds of thousands of viewers.   (Ok, that is an exaggeration. Maybe ten other people watch the C-Span discussions with me!)  Both these programs have immense learning materials, and provide phenomenal education.  Right?

So, does it mean that we can use these as formal higher-educational materials?  Yes, we certainly can.  But, will that work for the typical undergraduate student?  Now, that is a different question, wouldn't you think so?

The PBS Nova or C-Span examples work as educational materials for me because by now I have learnt how to learn.  It has taken me years of formal schooling to figure out how to listen to a lecture, or watch a program, and think through it.  Learning how to learn might be intuitive for some, but I think that "some" is a minuscule number.  The rest of us need a structured way to learn how to learn.

MOOC is not about that deeper sense of learning. Not even close.  What a typical MOOC class is nothing but:

What you can do over the Internet this way is deliver information, but that's not education. Education, as any real teacher will tell you, involves more than just transmitting facts. It means teaching students what to do with those facts, as well as the skills they need to go out and learn new information themselves.

How do they know whether or not MOOC helps students learn?  How are students assessed?

the most common way to assess learning in the MOOCs offered by the largest providers is a single multiple-choice question after approximately five-minute chunks of pre-taped lectures. 

The reason why MOOC appeals to people, in addition to the obvious labor-saving cost advantages, is that most faculty's classes even now are nothing but the same MOOC in the real world.  I.e., students go to classes, listen to the faculty lecture on and on, and then they take multiple-choice tests.  If that is how it is in the real world even now, then why not get rid of that and replace it with MOOC, right?

The problem lies with what faculty do in the classrooms.  It is not a place to lecture and put students to sleep.  It is not a place to conduct multiple-choice tests.  Classrooms ought to be the places where students come to learn. More importantly, classrooms are places where students come to learn not merely about the contents of courses but also to learn how to learn.

However, over the years, faculty have, by and large, abandoned the task of helping students learn in that larger sense, and have merely focused on simplistic measurements via multiple-choice tests. Faculty have abandoned the Socratic questioning and discussing, and have favored the sage-on-the-stage lecturing.  And lecturing from the same notes. Using texts written by somebody else.  One can, therefore, easily see why people want to throw this out and replace with MOOC that would save a whole lot of money.

MOOC will do a typical undergrad worse service than even the horrible system we now have in place.   A C-Span or PBS program is not what a typical undergrad student watches.  A MOOC would do no better for this demographic.

In the New Yorker,  Atul Gawande discusses how some ideas seem to catch on really fast, while others are not adopted.  His article, which is about medical practices, especially in the primary health centers in rural India, has some important lessons for this MOOC discussion too.

Sister Seema Yadav, a twenty-four-year-old, round-faced nurse three years out of school, was one of the trainers. (Nurses are called “sisters” in India, a carryover from the British usage.) Her first assignment was to follow a thirty-year-old nurse with vastly more experience than she had. Watching the nurse take a woman through labor and delivery, she saw how little of the training had been absorbed. The room had not been disinfected; blood from a previous birth remained in a bucket. When the woman came in—moaning, contractions speeding up—the nurse didn’t check her vital signs. She didn’t wash her hands. She prepared no emergency supplies. After delivery, she checked the newborn’s temperature with her hand, not a thermometer. Instead of warming the baby against the mother’s skin, she handed the newborn to the relatives.
When Sister Seema pointed out the discrepancy between the teaching and the practice, the nurse was put out. She gave many reasons that steps were missed—there was no time, they were swamped with deliveries, there was seldom a thermometer at hand, the cleaners never did their job. Sister Seema—a cheerful, bubbly, fast talker—took her to the cleaner on duty and together they explained why cleaning the rooms between deliveries was so important. They went to the medical officer in charge and asked for a thermometer to be supplied. At her second and third visits, disinfection seemed more consistent. A thermometer had been found in a storage closet. But the nurse still hadn’t changed much of her own routine.

You see how difficult it is to make sure that learning happens?  And that the lessons learnt will be practiced?  Despite the hand-holding teaching by a qualified teacher?  All those practices--from washing hands to noting the temperature to everything else--can be instructed via a video, right?  Make those rural hospital staff watch the videos and problem solved?  It does not happen that way.

In the era of the iPhone, Facebook, and Twitter, we’ve become enamored of ideas that spread as effortlessly as ether. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.
But technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.

Learning is a complex process that requires us to change our thinking and behavior in so many different ways.  Whether it is learning about the diverse cultural practices in Papua New Guinea or the Big Bang Theory or about hand-washing and germs, learning requires us to shed what might have previously been our gut-instincts and routines.  We humans are, naturally, resistant to changes.  Learning forces us to change.  Very rarely does that not require change agents.  MOOC is no active change agent.

We are approaching the challenge in education from a messed-up perspective.  The challenge is to figure out how to make the faculty change their practices in the classroom, similar to how the thirty-year old nurse in the rural hospital was taught to change her practices.  Otherwise, whether it is the current system or MOOC, the patients--students--will not benefit.