Melanie Keep is an early career researcher at the University of Sydney. Her focuses include eHealth, technology to improve healthcare, and supporting the student experience. In this interview, Mel highlights her experiences in teaching eHealth to undergraduate students, with tips for those interested in branching out into this area.
Interviewer: Thanks for taking the time to do this interview. Could you introduce yourself and provide a little background?
Mel: I’m Mel Keep. I’m a lecturer at the University. I have an interest in e-health research and e-health teaching and also teaching more broadly, and I feel that my role as a teacher– so someone who designs curriculum and then delivers it– is to prepare students to be able to navigate the work force that they enter. Whether they’re a clinician or whether they go into policy or practise or even somewhere a little bit left of centre of health. To be able to problem-solve, to think laterally, to critically evaluate problems and identify solutions that are appropriate to that, whether those solutions are tech-based or not.
Interviewer: Okay, and what units of study are you currently teaching?
Mel: I currently coordinate two e-health units of study. One is Foundations in E-health. That’s a sampler of the different components of e-health and some of the key skills in e-health for first year students. So this is an elective that’s open to all students who are studying health. The majority of our enrollments are Bachelor of Health Sciences students. So it’s sort of the liberal arts of health. And we have a few occupational therapy students do that unit as well. The numbers are between 160 and 200 of a given year.
The other unit I coordinate is much smaller. It’s an elective for 30 physiotherapy units who’ve just come back from placement. It runs for five weeks and it’s intensive and that unit is, again, an introduction to e-health, but specifically for physiotherapy. And what we’ve done … So in the past couple of months we’ve also spoken to physio on the e-health map project and identified where they’re currently teaching e-health to their students and embedding it into their curriculum. So what that gives me the chance to do is to further refine the unit to the physio students so it becomes more like a capstone unit, an intro to health unit, rather than an intro unit because they’re getting an intro elsewhere.
Interviewer: I’m just curious with the foundations in e-health unit of study, without going through the entire unit of study, what are the general foundations that are offered or are seen as essential in e-health for the students in that unit?
Mel: When I was creating the unit, what I really wanted was for the students to feel brave enough to explore things. Because I think what we find in the work place is that people gravitate toward the new shiny tool ’cause it’s the new shiny tool, without really thinking through why it’s being used and whether it’s actually that much more effective than what’s currently being done, while other things are out there. So I wanted to instil that into the students. But also, I explain to them that if I teach them how to use a particular piece of software or hardware now, that might be obsolete by the time they graduate, so what’s more important for them is to be brave enough to go “Hey I don’t know how to use that, but let me find out.” And to be proactive in their learning, and I explain to them that if they can do that, it doesn’t matter what comes in front of them. They’ll be able to overcome it and they’ll be able to learn it and evaluate it appropriately. So we apply that way of thinking to a different range of contexts so we learn about the remote delivery of e-health provided by teleconferencing, email, chat, or even online self-help programmes, where you don’t have a clinician that guides you through it and you do it on your own.
We talk about Dash and how Dash can be used in decision making. We talk, also, about the impact of technology on well-being so it’s a little bit about … For instance, we take social media … How we can use social media as a tool to help people with chronic health conditions. But we also look at the impact of social media on every day people. What’s it’s impact on well-being, even things like ISI from using different pieces of technology. So there’s the impact of technology on our health in addition to how we can use it as a tool.
We look at a range of different types of technology, so there’s a week where we talk about games. Digital games, and things like brain training, virtual reality games and so on. We talk about social media … We have an electronic limitation in evaluation and its very … basic. But it’s to get them aware of what some of the things are that they’ll have to encounter and think about how they might respond to getting people on board. You can’t just design something and say, “Here. Do it.” You gotta bring people on board, and how to assess impact as well.
Interviewer: Yeah, that’s really important. That’s a very comprehensive unit.
Mel: We try to.
Interviewer: It must be a challenge to try to fit it all into one term! Alright, my next question would be, what do you think are the implications of teaching people e-health or why is this important, I suppose, for the future and for the work force that we’re training students to be a part of?
Mel: I think it makes them better health consumers, at the very least. We talk about online health information and being there to assist the quality of that and how that plays out and, perhaps, exacerbates health inequity. Online health information is usually written at a literacy level of 12 or above and the average literacy level for Australians is grade five. People make claims, “Oh this information is online, it’s going to completely revolutionise the way patients interact with their clinicians.” And it might for some, but for most, there are other barriers to even accessing that information, let alone using it and engaging in a different way with your health professional. So I think an awareness of the different things that are available for students, for consumers, and an awareness of the very quality of the things that are available makes them better consumers, and, I think, bringing in to the unit the social determinants of health helps them be advocates for consumers in the development of new tools and processes that when we’re bringing in a new app or a new process or a new website that we consider the people who might not have the resources to engage with those tools.
I think it brings us to a place where we have graduates who are more aware and with their critical analysis and with the safe space they have at University to try different things and to fail at different things. We could have a series of graduates who are more engaged with their own health, more aware of the different things that are out there, the various qualities. But also more willing to try, and to learn and be open to being wrong or things not working as well.
Interviewer: That’s a huge part of it, especially with technology. Being adaptable when things don’t always go the way you want them to. Now, my next question would be, in your experience teaching and designing courses and working with students, all of those things, what are some of the biggest challenges that you’ve faced so far?
Mel: I think it’s hard– sometimes it feels hard with e-health because it’s not the sorts of skills that students need to be able to learn and demonstrate and not as tangible as clinical skills, for instance. Doing a prac test on some of these skills doesn’t seem sensible. And the challenge we negated the first years is … At least persons in Australia, they’re used to a particular way of learning in high school that is sometimes reinforced in their early subjects. The bridge between “instead of learning content, we want you to learn to be brave and we want you to learn to problem-solve,” can be a bit challenging. So we’re working on the communication piece with the students a little bit more and bringing them along on that journey. We don’t have a test, for example, because a test makes absolutely no sense in e-health. So what they do instead is they create an e-portfolio that brings together all the different pieces of work that they’ve created during that semester. Perhaps an infographic for someone with low literacy or a video that they created to evaluate a particular product. Or a Wiki page that they’ve edited so it’s more appropriate to a particular community.
I think it’s a tension between students seeing themselves as students versus seeing themselves as professionals-in-training. When they see themselves as students they want a clear list of the things they have to do so they can check that off and get the marks. But when you see yourself as a health professional-in-training, then the exam is not as important. The e-portfolio brings together all your skills and starts you off for adding to it later on. I think that’s one of the bigger challenges.
Interviewer: That’s interesting. It’s a much different approach from the traditional exam and that sort of thing, but, yeah. A lot more creative I think.
Mel: I think so, and it means that students who aren’t good at exams, not good at long essays and so on, a little bit more creative, to have a chance, to put those skills to be recognised. And I just couldn’t hand-on-heart put an exam question in when I feel that it might not be relevant in six months down the road, information that they should be able to Google and evaluate on their own.
Interviewer: Definitely. That makes sense. Great. On that note, have you had any unexpected things that you’ve discovered in your experiences teaching in e-health or surprises along the way or maybe things that you maybe didn’t anticipate going in this field or, I don’t know, in your unit of study design, just anything that made you think “Ah, okay, I didn’t think that would happen?”
Mel: The first year we ran this intro unit, it was run across Cumberland and Camperdown campuses. We ran the lectures at the same time via video conference. One week I would be live at Camperdown the other I’d be live at Cumberland and there’d be a shooter who would be present at the alternate campus. What I found– and this is something we share with the students as well– was how much we rely on feedback from the other person with whom we’re communicating. We were able to apply that example to telehealth. For instance, I rely so much on being able to hear students’ feedback and I adjust my lectures. But when you’ve got one set on video conference and you’re talking to another set and you’re just trying to … I felt like I was deaf because I couldn’t get what their reactions were to be, how to adapt accordingly.
Sometimes the technology failed and the students were sitting outside and I’m there on the phone to AV saying “I have two hundred students waiting to get into this class to [inaudible 00:12:37] Can you set it up, please?” It was three to five on Friday afternoon and the students were really patient when they had every opportunity to be extremely annoyed. To be able to explain that to them and to role model that to them as well that, “things go wrong, that’s all right. This is what you can do in the meantime. This is how you can get started in the lecture. What I’m going to do is carry on with AV. You’ve got to deal with this in the background. Let’s work on this now.” And then we found a way to, in our own way, to make it work even across the two campuses without the video conferencing. And so teaching students things like “it’s okay if things go wrong. Always have backup plan. Work on how to communicate with people in different places.” All those things they can take and put into their own experiences when they do their telehealth role play.
Those sorts of teaching moments were unexpected, but I think they made for a richer experience for the students just to go “I was half an hour late just because the technology didn’t work. How am I going to cope when this is a patient sitting [crosstalk 00:13:44] with their family member?”
Interviewer: That’s right. Oh, that’s interesting.
Mel: It did become a bit of a joke by the end of it.
Interviewer: It’s good you can make a learning experience out of it, though, too. Because it’s true; Those are the things that you miss sometimes when you’re not actually doing practise or clinical placement and that sort of thing. It’s that critical thinking on the spot that really prepares you for the real world.
Interviewer: So my final question would be, what advice would you have for anyone who is interested in this field of e-health? I know it’s quite broad, but any sort of guidance that you would offer to something who is interested in this area whether it’s teaching or research or any sort of resources that you would recommend for people with an interest in e-health?
Mel: The people who are interested in developing e-health curriculum, I’d say just talk to other people who are doing the same. I’ve found that everybody is very generous with their thinking and their resources and their time, so if you’ve got an idea of what you want to do with your students or what sorts of learnings that you want them to experience, have a chat to other people teaching the same. People are very generous with that and there’s point recreating the will and vice versa. It’s not just you learning from the people who have already got an established curriculum but they will learn from your fresh insights as well.
People interested in doing research in e-health … I think I would say find the questions that you’re really interested in. What is it that you’d be doing if you … What is it that you want the answer to even if no one was paying you money to find that answer? That will sustain you through your research. All the stressful moments become less stressful because you still want that answer.
Interviewer: That’s very good advice.
Mel: And people who are looking for e-health as a career, I think, in the workplace, as it is now, if you’re not a clinician, just to be broad-minded about the different things that you could do. Our graduates have gone on to do lots of different things even without doing a masters degree or doing clinical practise. We have a graduate who’s now working for E-health News South Wales developing training materials and online educational resources about their products. We have students who have created and designed an app in the unit and are looking towards developing it in the real world as well. I think it’s just about being open-minded about the different types of job labels that you come up with.
One of our other graduates started off as a social media manager for one of the big mental health research groups and has since then moved onto the department of education in importing social media policy and some procedures for them. So there’s a lot of things that you can go into. We just don’t have a set list of positions with names that you can give to people. It’s just about being open-minded.
Interviewer: That’s very good advice. Well thank you so much. I don’t know if you have any other final points to add, but I think that was very informative, and thank you so much for your time and your expertise.
Mel: Thank you for having me!
Dr Keep is an early career researcher with a focus on eHealth, the use of technology to improve healthcare, and supporting the student experience. Underpinning Dr Keep’s research is a motivation to facilitate access to healthcare and enhance the training of future health professionals using technology. In particular, she is interested in examining the role of communication between patients and health practitioners for better outcomes and how this changes in the eHealth context.