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A gap analysis of course directors’ effective implementation of technology-enriched course designs: An innovation study

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A gap analysis of course directors’ effective implementation of technology-enriched course designs: An innovation study

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Content Running head: TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION
A Gap Analysis of Course Directors’ Effective Implementation of Technology-enriched Course
Designs: An Innovation Study
by
David Patrick James Green
A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
May 2018
Copyright 2018 David P. J. Green
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION
Dedication
I dedicate this dissertation to my wife, Tania, and to my son, Gavin (who was only one
year old when I began this academic journey). Their unwavering support allowed me to
successfully complete this professional opportunity, while balancing (to the best of my abilities)
the roles of husband and father. I am humbled and forever grateful for their endless love and
enthusiasm.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 2

Acknowledgements
Many people directly contributed to this study’s success and to my development
throughout the Organizational Change and Leadership (OCL) program at the University of
Southern California’s Rossier School of Education. First, Dr. Melora Sundt, my Dissertation
Committee Chair, receives special recognition for her passionate guidance throughout the entire
process. She understood my needs as a student and was a perfect match to help me exceed my
own expectations for success. I hope that my research adequately reflects her dedication to
innovative and excellent education. Three years was not enough time, and I hope to find
meaningful ways to collaborate in the future. Next, Dr. Ken Yates served as one of my
committee members. I am grateful for his conversations (even on early Saturday mornings via
online collaborative documents across multiple time zones) that helped me streamline my
thoughts, arrange the framework of the study, and stimulate me to truly test my capabilities. And
of course, Dr. Monique Datta served as both a committee member and as a faculty member
during one of my initial courses. She inspired me throughout this entire program. Aloha!
Given the intertwined nature of this dissertation program, I wish to sincerely thank all of
the faculty members I had in classes for their honest feedback, tireless guidance, and dedication
to my profound academic growth. Specifically, these were the professors who led my academic
experiences: Dr. Monique Datta, Dr. Patrick Crispen, Dr. Mark Pearson, Dr. Darline Robles, Dr.
Holly Ferguson, Dr. David Cash, Dr. Ravneet Tiwana, Dr. Katherine Hanson, Dr. Esther Kim,
Dr. Ken Roth, Professor Randle Mell, Dr. Alexandra Wilcox, Dr. Holly Shim-Pelayo. The
names are listed in the order of the program’s class schedule. You all are superb professionals
and educators. I also extend my gratitude to Rossier’s OCL support staff and to the Rossier
School of Education administration for fostering the conditions needed for its students to be
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 3

creative, chase dreams, and innovate.
One of the many highlights of the OCL program was learning alongside a truly
remarkable group of professionals. I am indebted to my cohort members for the thought-
provoking discussions and friendships. In so many ways, my interactions with each of you
helped make this entire program stimulating and exciting. Your contributions to my professional
development cannot be discounted.
I wish to sincerely thank this study’s participants, who volunteered their time and openly
shared their perspectives, gave tremendous feedback, and engaged in meaningful conversations
with me. This all contributed to make this study a fascinating journey and exploration. As a
researcher, I tried my absolute best to let their words tell this story. I genuinely hope that this
dissertation articulates a true reflection of their voices. Likewise, I wish to extend my gratitude
to the study site’s administration, colleagues, and staff for supporting this study. I wish they
could each be named, but anonymity must be maintained.
Finally, I thank my mom and brother for their lifetime of love and support. We did it and
this is for you, too! We started this academic journey together as Jenks Trojans in Kindergarten,
and finished it as USC Trojans! Fight on!

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 4

Table of Contents

List of Tables 7
List of Figures 8
Abstract 9
Chapter One: Introduction 11
Introduction of the Problem of Practice 11
Background of the Problem of Practice 13
Importance of the Organizational Innovation 15
Organizational Context and Mission 16
Organizational Performance Need 17
Description of Stakeholder Groups 17
Stakeholders’ Performance Goals 18
Stakeholder Group for the Study 19
Purpose of the Project and Project Questions 20
Conceptual and Methodological Framework 21
Definitions 21
Organization of the Dissertation 23
Chapter Two: Literature Review 24
Review of the Literature 24
Faculty Ambivalence to Next Generation Medical Education 24
The Clark and Estes (2008) Gap Analytic Conceptual Framework 26
Stakeholder Knowledge, Motivation, Organizational Influences 27
Knowledge and Skills 27
Knowledge Influences 28
Motivation 38
Expectancy Value Theory 39
Self-Efficacy Theory 41
Emotions 43
Attribution Theory 44
Organizational Influences 48
Challenges to Organizational Culture Change: Leadership 49
Cultural Models and Settings 50
Conclusion 59
Chapter Three: Methodology 61
Purpose of the Project and Questions 61
Site 61
Conceptual and Methodological Approach 62
Assessment of Performance Influences 64
Knowledge Assessment 69
Motivation Assessment 71
Organization/Culture/Context Assessment 74
Participating Stakeholders 75
Data Collection 76
Survey 77
Interview 79
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 5

Data Analysis 81
Survey 82
Interviews 83
Data Integration 85
Reliability and Validity 85
Trustworthiness of Data 86
Role of Investigator 86
Positionality and Biases 87
Ethics 89
Chapter Four: Results and Findings 91
Introduction 91
Creativity, Innovation, and Stakeholder Social Identity 92
Findings for Assumed Knowledge Needs 95
Synthesis of Findings for Knowledge Causes 115
Results and Findings for Assumed Motivation Needs 115
Survey Results 116
Interview Findings 124
Synthesis of Results and Findings for Motivation Causes 146
Results and Findings for Assumed Organizational Needs 147
Survey Results 148
Interview Findings 155
Analytic Memo 169
Synthesis of Results and Findings for Organizational Needs 174
Summary 175
Chapter Five: Solutions, Implementation, and Evaluation 178
Recommendations for Practice to Address KMO Influences 178
Knowledge Recommendations 178
Motivation Recommendations 184
Organization Recommendations 191
Integrated Implementation and Evaluation Plan 198
Implementation and Evaluation Framework 198
Organizational Purpose, Need, and Expectations 199
Level 4 Results and Leading Indicators 199
Level 3: Behavior 201
Critical Behaviors 201
Required Drivers 202
Organizational Support 204
Level 2: Learning 205
Learning Goals 205
Program 206
Components of Learning 208
Level 1: Reaction 210
Evaluation Tools 212
Data Analysis and Reporting 213
Summary 215
Limitations and Delimitations 217
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 6

Future Research 217
Broader Implications 218
Conclusions 218
References 220
Appendices 238
Appendix A: Survey 238
Appendix B: Interview Protocol 243
Appendix C: Survey Recruitment Script 246
Appendix D: Information Sheet for Exempt Non-medical Research 248
Appendix E: Level 1 and Level 2 Evaluation Tools 250
Appendix F: Delayed Blended Evaluation Tools 253

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 7

List of Tables

Table 1. Organizational Mission, Global Goal, and Stakeholder Performance Goals 18
Table 2. Summary of Course Directors’ Assumed Needs and General Literature
for Knowledge Gap Analysis 36
Table 3. Summary of Course Directors’ Assumed Needs and General Literature
for Motivation Gap Analysis 47
Table 4. Summary of Course Directors’ Assumed Needs and General Literature
for Organization Gap Analysis 58
Table 5. Summary of Assumed Needs for Knowledge, Motivation, and
Organizational Influences 67
Table 6. Summary of Course Directors’ Assumed Knowledge Needs Aligned With
Validation Strategies 70
Table 7. Summary of Course Directors’ Assumed Motivation Needs Aligned With
Validation Strategies 72
Table 8. Summary of Course Directors’ Assumed Needs for Organizational
Influences Aligned With Validation Strategies 74
Table 9. Course Director Reactions to Educational Technologies 94
Table 10. Criteria Used to Classify Assumed Knowledge Needs as “Not Validated” 96
Table 11. Knowledge Patterns Frequencies 97
Table 12. Criteria Used to Classify Assumed Motivation Needs as “Not Validated” 116
Table 13. Self-Efficacy Aggregate Mean Values 117
Table 14. Self-Efficacy Results 118
Table 15. Motivation Patterns Frequencies 124
Table 16. Criteria Used to Classify Assumed Organizational Needs as “Not Validated” 148
Table 17. Course Director Perceptions of Cultural Model 154
Table 18. Course Director Perceptions of Cultural Setting 155
Table 19. Organization Patterns Frequencies 155
Table 20. Validated and Prioritized Needs to be Used to Present Recommendations
for Solutions 176
Table 21. Summary of Knowledge Influences and Recommendations 178
Table 22. Summary of Motivation Influences and Recommendations 185
Table 23. Summary of Organization Influences and Recommendations 191
Table 24. Outcomes, Metrics, and Methods for External and Internal Outcomes 200
Table 25. Critical Behaviors, Metrics, Methods, and Timing for New Reviewers 201
Table 26. Required Drivers to Support New Reviewers’ Critical Behaviors 202
Table 27. Components of Learning for the Proposed Faculty Development Program 209
Table 28. Components to Measure Reactions to the Proposed Faculty Development
Program 211

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 8

List of Figures

Figure 1. Model of Assumed Knowledge Motivation, and Organizational Influences
That Impact Stakeholder Adoption of Next Generation Medical Education
Initiatives 26
Figure 2. Gap Analysis Process Conceptual Framework 62
Figure 3. Interactive Conceptual Framework That Depicts Course Directors’
Needs Analysis 64
Figure 4. Course Directors’ Creative Identities 95
Figure 5. Percentage of Course Directors Scoring in Self-Efficacy Categories
of Low, Medium, and High 119
Figure 6. Course Director Perspectives on Traditional Lectures (Value, Emotion,
and Attribution) 121
Figure 7. Course Director Perspectives on Learner-centered Blending Learning
Design (Value, Emotion, and Attribution) 122
Figure 8. Course Director Perspectives on Appropriate Educational Technologies
(Value, Emotion, and Attribution) 123
Figure 9. Perceptions of Organizational Support (Time, Human Capital, and
Financial Support) for Redesigning Learner-centered Courses 150
Figure 10. Perceptions of Organizational Support (Time, Human Capital, and
Financial Support) for Developing Technology-enriched Learning
Environments 151
Figure 11. Perceptions of Organizational Support (Policies and Procedures) for
Redesigning Learner-centered Courses and Developing
Technology-enriched Learning Environments 152
Figure 12. Proposed Faculty Development Initiative 208
Figure 13. Proposed “Ibis Academy Organizational Outcomes Dashboard” 215

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 9

Abstract
Efficient and effective student-centered instructional elements could potentially streamline
educational processes and still produce competent professionals. However, successful
implementation of technology-enriched courses that exceed course design standards and meet
learners’ needs is limited by contextual interactions of the course designer’s knowledge,
motivation, and organizational influences. The purpose of this project was to conduct a needs’
analysis in the areas of knowledge, motivation, and organizational resources necessary for
preclinical medical education course directors to perform two critical behaviors related to
redesigning courses using learner-centered approaches and developing technology-enriched
learning environments. This study answered two research questions. First, what are the
knowledge, motivation, and organizational barriers to course directors implementing technology-
enriched approaches during preclinical medical education modules as represented in their critical
behaviors and performance goal? Second, what are the recommended knowledge, motivation,
and organizational solutions to those barriers/needs? For this study, the Clark and Estes (2008)
gap analysis was adapted for a needs analysis as the conceptual framework, and an explanatory
sequential mixed methods approach was used for the methodological framework. Twenty-seven
preclinical medical education course directors, from a private, east-coast medical school,
completed the online survey, and eleven voluntarily participated in the follow-up face-to-face
interview. Twenty-five literature-based assumed knowledge, motivation, and organizational
influences were investigated through the lenses of the two critical behaviors. Using the New
World Kirkpatrick model as a guide, an integrated implementation and evaluation plan of a novel
faculty development program was proposed as a solution to help course directors achieve their
performance goals and facilitate organizational change. Data-driven communication strategies
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 10

were incorporated into the integrated plan to enhance communication amongst key stakeholders
and improve accountability relationships. This study contributes to the organizational change
literature, and the broader implications of this research are applicable to the current medical
education paradigm shift, higher education and educational technology initiatives, evaluation of
novel faculty development programs, and gap analysis application research.

Keywords: active learning; blended learning; technology-enriched learning environments; needs
analysis; program evaluation

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 11

CHAPTER ONE: INTRODUCTION

Introduction of the Problem of Practice
The need for more physicians is a pending societal concern because the United States
faces a shortage of 46,000 – 90,000 physicians as early as 2025 (IHS Report, 2015). In response,
new, competency-based strategies are attempting to streamline the medical education process
since it can take over a decade to properly train a doctor (Mehta, Hull, Young, & Stoller, 2013;
Prober & Khan, 2013). In medical education, assessing national physician competencies (called
“entrustable professional activities,” or EPAs) is driving mastery-based curricular overhauls
(Chen, van den Broek, & Cate, 2015; Hurtubise, Hall, Sheridan & Han, 2015). Consequently,
current medical education reforms are trying to link nontraditional and experiential classroom
strategies (Hurtubise, et al., 2015; Mehta, et al., 2013) with accepted national physician
competencies earlier in the undergraduate medical education curriculum (Prober & Heath, 2012;
Prober & Khan, 2013). These types of educational reform efforts forge culture changes that
necessitate transformations in faculty instructional behavior and student buy-in (Ruiz, Mintzer,
& Leipzig, 2006). However, traditionalism within the medical education ecosystem creates
enduring challenges that negate potential successes with medical education reform and make
such complex culture changes uncertain (White, et al., 2014). This study focused on analyzing
an organizational intervention at a private medical school, where segments of the preclinical
medical education curriculum were being re-engineered to include technology-enriched and
student-centered solutions.
Recent calls for medical education reform highlight the worth of collaborative, learner-
centered approaches by using blended classrooms and nontraditional teaching strategies
(Hurtubise, et al., 2015;
Prober & Heath, 2012; Prober & Khan, 2013). Current medical
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 12

education practices are characterized by a lack of appropriate, well-designed learner-centered
strategies (Mehta et al., 2013). For example, Howley and Wilson (2004) reported that of 345 3
rd

year students interviewed via a survey tool, 51% responded that a faculty member had never
observed them while taking a patient history and 81% responded that a faculty member had
never observed them when conducting a complete physical examination. These results point to
an inefficient educational system where students are not being provided assessment and feedback
in what is supposed to be a learner-centered environment. Prober and Khan (2013) conclude that
the rigid traditionalism of the medical education system does not cater to the needs of today’s
medical education students.
Next generation digital learning ecosystems include hypermedia-driven environments
that adapt to meet individual needs based upon neuroscience research and metacognitive
strategies (Anguera, et al., 2013; Berman, Fall, Maloney, & Levine, 2008; Brown, Dehoney, &
Millichap, 2015; Domagk, Schwartz, & Plass, 2010). Transformational learning experiences in
medical education can be created by properly incorporating hypermedia-driven environments
(Kalet, et al., 2012). Instructional design shortcomings, however, yield persistent obstacles that
influence potential successes with next generation digital education reform and make such
multifaceted culture changes uncertain (Song, et al., 2014).
Transformational medical education using technology to deliver content can create
academic successes when those responsible for creating the curriculum and courses—faculty
members—understand how to best deploy the technology (Green, 2016). The improper
implementation of next-generation hypermedia-driven learning environments diminishes the
likelihood that students will benefit from self-regulated learning (SRL) processes (Azevedo,
Cromley, Moos, Greene, & Winters, 2011). Berman, et al. (2008) identified that poor
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 13

communication between educators and designers, who can help faculty integrate technological
learning tools effectively into their course designs, leads to insufficient incorporation of
computer-based learning environments. This divide generates inadequate student experiences
within the learning process.
Other concerns, such as faculty apprehensions about a potential loss of student
relationships, fear of not succeeding, a lack of confidence with creating computer-assisted
learning environments, and fear of potential disruptive impacts, manifest into cultural hesitation
and resistance (Mitchell, Parlamis, & Claiborne, 2015). Reducing faculty resistance to next
generation modes of instruction in medical education is important to address because using
properly-designed hypermedia with appropriate interactive features has yielded successful
learning outcomes (Domagk et al., 2010; Song et al., 2014), yet the research is thin when
describing the situational contexts and student types for which this pedagogical strategy is most
valuable (Homer, Plass, & Blake, 2008; Yavner et al., 2014).
Overcoming such resistance creates new paradigms for undergraduate medical education
that, potentially, could be used to train future physicians faster and effectively (Mehta et al.,
2013). Ultimately, the reform efforts will fail if faculty members continue to thwart the use of
time-saving technology-enriched learning environments (Mitchell, Parlamis, & Claiborne, 2015).
Eliminating faculty resistance to generating efficient, effective, and properly-designed next
generation medical education learning environments is an important problem to address because
medical education reform can help alleviate societal impacts associated with the imminent
shortage of physicians.
Background of the Problem of Practice
Without a culture change in medical education, non-lecture classroom sessions may not
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 14

fully engage students in the learning process (White et al., 2014; White et al., 2015). It is
important to point out that engagement alone does not equate to learning (Rodgers, 2002) and not
all medical students respond favorably to nontraditional forms of teaching and learning. Only
when medical students see the critical match between using higher-order thinking skills in
activity-based curricula with increased performance on exams, will they appreciate the value of
collaborative learning processes delivered by medical educators (White et al., 2015). Thus, to
foster the conditions necessary for a paradigm shift, improved understanding of barriers that limit
faculty implementation of nontraditional approaches based on established best practices is an
important investigation.
Fostering organizational cultures that promote creativity and experimentation yield
disruptive opportunities to innovate with competency-based curricula in medical education
(Berman et al., 2008; Christenson & Horn, 2011; Kalet et al., 2012; Wolfe & Andrews, 2014,
Yavner et al., 2014). Digital learning environments, competency-based approaches, and
frameworks utilizing entrustable professional activities are guiding recent undergraduate medical
education enhancement initiatives. These types of curricular overhauls rely on self-directed
student learning, metacognitive self-regulated learning strategies, instructional design based on
accepted best practices linked to neuroscience research. Therefore, organizations must identify
and remove barriers that negatively impact preclinical medical education reform initiatives to
help faculty create successful experiential learning opportunities that map to national physician
competencies.
Organizational strategies that reduce ambivalence to next generation medical education
could ensure that mastery-based pedagogical reform efforts are successful. Efficient, effective,
and sound student-centered instructional elements could potentially streamline the educational
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 15

process and still produce competent physicians. But successful implementation of technology-
enriched courses that exceed course design standards and meet learners’ needs is limited by
contextual interactions of knowledge, motivation, and organizational influences. Medical
education programs are launching novel computer-assisted instruction initiatives, but
understanding barriers that limit faculty implementation is required to ensure that effective
interface designs are aligned with cognitive theory. Furthermore, research is needed that
specifically links technology-enriched learning environments with competency-based medical
education. By implementing organizational solutions that reduce barriers to faculty
participation, overcoming medical education’s rigid traditionalism could become a reality and
complex culture changes might be successfully navigated.
Importance of the Organizational Innovation
Implementing organizational strategies that reduce ambivalence to next generation
medical education is important for a variety of reasons. Society’s well-being depends upon an
adequate supply of knowledgeable, well-trained physicians. But a pending shortage of
approximately 46,000 – 90,000 physicians by the year 2025 requires improved efficiency in
training doctors, since this process currently consumes at least a decade (IHS Report, 2015).
Efforts to streamline and enhance quality include assessing physician competencies earlier in the
medical education curriculum as part of a greater reform effort (Hopkins et al., 2015; Mehta et
al., 2013; Prober & Heath, 2012; Prober & Khan 2013). Implementing such a broad overhaul to
current medical education curricula, however, results in a culture change to the traditional system
since faculty, students, and administrators are affected when didactic sessions are replaced with
competency-based pedagogical strategies, technology-enriched learning environments, and
blended learning approaches.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 16

During such a paradigm shift, the medical educator’s role changes (Doherty et al., 2015;
Robin, McNeil, Cook, Agarwal, & Singhal, 2011; Wiecha et al., 2003). Thus, overcoming
faculty resistance during the transition phase is a component of the culture change (Ruiz,
Mintzer, & Leipzig, 2006). Further, students will likely respond positively to nontraditional
forms of education, such as collaborative learning opportunities that result from the use of
hypermedia, only when assessment exercises adequately map to their use of higher-order
thinking skills (White et al., 2014). However, if resistance remains, then transformational
learning experiences will fall short of anticipated goals and well-intentioned efforts by the
organization to enhance medical education will likely fail. Efficient and effective opportunities
to streamline medical education while improving competency-based training will be lost, and the
pending physician shortfall will remain.
Organizational Context and Mission
The Urban School of Medicine
1
, the site for this study, is located in a large, urban
environment in the southeastern United States and serves multicultural populations in education,
research, patient care, and community service. The Ibis Academy is an initiative at the Urban
School of Medicine that fosters teaching and learning environments where self-guided mobile
learning is blended with enhanced face-to-face opportunities that promote deeper learning and
high-impact educational practices (Ibis Academy, 2016). According to their website, the mission
of Ibis Academy is “to lead next generation medical education reforms by featuring student-
centered learning strategies to train world-class physicians” (Ibis Academy, 2016).
Ibis Academy, initiated in October 2014, is housed within the medical education
department and collaborates with both pre-clinical and clinical faculty members through a

1
Pseudonyms are used to replace all names, organizations, and associated initiatives.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 17

partnership with the Educational Enhancement Office. The staff includes a senior instructional
designer and a medical education fellow who serves as a faculty liaison. The primary role of
these staff members is to serve as faculty support resources for the design, delivery,
implementation, and assessment of course content that features embedded videos and
supplemental resources. Several Executive Deans oversee different aspects of the initiative. The
Ibis Academy serves 200 medical students per academic year who are pursuing either a M.D. or
a Joint M.D. and Master’s in Public Health.
Organizational Performance Need
Ibis Academy’s organizational goal is that 100% of Ibis Academy courses will exceed
thresholds for all internal metrics, as defined by the Executive Faculty Curriculum Steering
Committee, used to evaluate medical education courses by May 2019. The Director of
Instructional Technologies for Ibis Academy established this goal after three pilot course
redesign efforts demonstrated moderate successes and identified several key opportunities for
improvement. Opportunities exist to increase Ibis Academy’s footprint within the two-year
preclinical medical education experience.
Description of Stakeholder Groups
Stakeholders for this effort include administrators, faculty members, and students.
Administrators are stakeholders who support Ibis Academy projects by providing logistical,
material, and financial resources. These administrators include the Executive Dean for
Education and Policy, the Senior Associate Dean for Undergraduate Medical Education, the
Senior Associate Dean for Educational Development, the Assistant Dean for Clinical
Curriculum, the Associate Dean for Preclinical Curriculum, university information technology
personnel, and Ibis Academy support staff. The administrative stakeholders are primarily
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 18

concerned with facilitating the culture change needed to grow the initiative and reach
performance goals. Faculty members are stakeholders who use Ibis Academy resources for
course improvements and redesigns. These faculty members are affiliated with both pre-clinical
and clinical experiences. Course Directors are faculty members who are responsible for
implementing actual projects that relate to the performance goals. Students are stakeholders who
participate in Ibis Academy courses during their undergraduate medical education (UME)
experience. UME refers to the first two years of medical school (typically didactic sessions) and
to the final two years (clinical experiences). Student satisfaction, perceptions, and learning gains
will be measured to help determine if Ibis Academy performance goals are met. Table 1
summarizes the organization’s mission and goal, and the key stakeholders’ goals.
Stakeholders’ Performance Goals
Table 1
Organizational Mission, Global Goal, and Stakeholder Performance Goals
Organizational Mission
The mission of Ibis Academy is to lead next generation medical education reforms by featuring
student-centered learning strategies to train world-class physicians.
Organizational Performance Goal
By May 2019, 100% of Ibis Academy courses will exceed thresholds for all internal metrics,
as defined by the Executive Faculty Curriculum Steering Committee, used to evaluate
preclinical medical education modules.
Faculty – Course Directors’
Goal
By May 2019, 100% of
course directors will
implement student-centered
teaching strategies by using
Ibis Academy approaches for
Medical Students’ Goal

By August 2018, 100% of Ibis
Academy students will
complete a “self-regulated
learning strategies” reflection
exercise before their first Ibis
Ibis Academy
Administrators’ Goal
By August 2018, 100% of
Ibis Academy administrative
staff and team members will
complete “The Playbook”
training program by the end
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 19

technology-enriched course
designs.
Academy course is launched.

of their first week involved
with the initiative.

Stakeholder Group for the Study
A complete analysis of Ibis Academy’s organizational goal of exceeding thresholds for
all internal metrics used to evaluate medical education courses would have involved all
stakeholders. However, course directors are the faculty members most responsible for creating
organizational change. Therefore, the stakeholders of focus for this study were all Course
Directors involved with undergraduate medical education at the Urban School of Medicine.
This stakeholder group’s first aspirational performance goal, supported by the Ibis
Academy’s Director of Instructional Technologies, is that 100% of course directors will
implement student-centered teaching strategies by using Ibis Academy approaches for
technology-enriched course designs by May 2019. To achieve this aspirational performance
goal, course directors will need to demonstrate several critical behaviors. First, they will
redesign their modules based on educational best practices for learner-centered blended learning
course design. “Redesign” includes mapping student outcomes to measureable learning
objectives, course goals, and national physician competencies, while identifying appropriate
technologies and teaching strategies. Second, they will develop their modules by using
appropriate educational technologies that support cognitive process and effective delivery.
“Developing modules” includes replacing traditional lecture sessions and implementing
technology-enriched learning solutions. Third, and outside the scope of this study, they will
implement and evaluate courses that provide both student and instructor support based on best
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 20

practices.
To date, no course directors are meeting the stakeholder goal, as described by
observations of the critical behaviors outlined above. Given that this is a new initiative, the
performance gap is not entirely unexpected, and this innovation study investigated factors
contributing to the gap. Previous pilot projects indicated that mapping student learning outcomes
to objectives, developing courses using educational best practices for blended design, and
implementing technology-enriched courses were opportunities for faculty growth and
development. Additionally, 100% of course directors are expected to achieve student
satisfaction scores of 85% for each new course redesign for Ibis Academy course redesigns.
This value exceeds the mandatory threshold of 80% set by the Executive Curriculum Steering
Committee. Existing surveys, which gather feedback from students, document performance
metrics, and collect satisfaction with instruction data, are used to evaluate course directors.
When the course directors fail to reach these goals, improper course designs, poor
communication, and substandard outcomes materialize. Collectively, these factors lead to
increased resistance to organizational change and likely jeopardize the long-term sustainability
of the Ibis Academy initiative. Thus, Ibis Academy’s ability to lead next generation medical
education reforms that feature student-centered learning strategies to train world-class physicians
is negatively impacted.
Purpose of the Project and Project Questions
The purpose of this project was to conduct a needs’ analysis in the areas of knowledge,
motivation, and organizational resources necessary for the course directors to perform their
critical behaviors and thus reach their performance goal. This analysis thereby assists the
organization with meeting its organizational performance goal of exceeding thresholds for all
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 21

internal metrics, as defined by the Executive Faculty Curriculum Steering Committee, used to
evaluate preclinical medical education modules.
As such, the questions that guided this study were the following:
1. What are the knowledge, motivation, and organizational needs for course directors
implementing Ibis Academy approaches during preclinical medical education modules as
represented in their critical behaviors?
2. What are the recommended knowledge, motivation, and organizational solutions to those
needs?
Conceptual and Methodological Framework
The Clark and Estes (2008) gap analysis, which is a diagnostic process that helps clarify
organizational performance goals by identifying stakeholder performance gaps within an
organization, will be adapted for a needs analysis as the conceptual framework. Throughout the
upcoming academic year, faculty focus groups, interactive workshops, course redesign projects,
academic performance metrics, and both qualitative and quantitative student perception surveys
will be used to monitor the achievement of Ibis Academy’s organizational goal. For this study,
an explanatory sequential mixed methods approach was used for the methodological framework.
Assumed knowledge, motivation and organizational needs were generated based on stakeholder
perspectives and related literature. Surveys, face-to-face interviews, and literature reviews were
used to validate these needs. Following data analysis, evidence-based solutions were
recommended.
Definitions
Active learning: Learner-centered instructional approaches that promote student engagement and
inquiry inside the classroom, which facilitate ownership of the learning process and
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 22

meaningful learning experiences (Prince, 2004).
Blended learning: An educational approach that carefully fuses the best elements of computer-
assisted learning environments with the best elements of face-to-face sessions (Garrison
& Vaughan, 2008; Garrison & Vaughan, 2013; VanDerLinden, 2014).
Competency-based learning: Generating a learning environment where the instructor assesses
observable and measureable abilities to ensure mastery of core concepts and skills
(Englander, Cameron, Ballard, Dodge, Bull, & Aschenbrener, 2013; Mehta et al., 2013).
Computer-assisted instruction: A modality where course instructors deliver supplemental
academic content via digital means to support teaching practices (Kalet et al., 2012). In
such a circumstance, an educator would create and implement a technology-enriched
course design. A student would participate in a technology-enriched learning
environment.
Course director: A faculty member who oversees medical education course logistics, scheduling,
supervises the lecturers, and reports student performance metrics to executive curricular
committees.
Experiential learning theory: “The process whereby knowledge is created through the
transformation of experience. Knowledge results from the combination of grasping and
transforming experience” (Kolb, 1984: 41).
Hypermedia: Computer-assisted learning environment where the learner has choice, autonomy,
and control because multiple representations of information are connected via hyperlinks
(Moos, 2014).
Self-directed learning: Adult learners demonstrate autonomy in situational contexts by
employing personalized goals and processes to be lifelong learners (Merriam, 2001).
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 23

Self-regulated learner: Student who is actively engaged in metacognitive practices where they
modify behaviours, settings, and attitudes during the learning process to achieve self-
selected measurable learning goals (Zimmerman, 2001).
Organization of the Dissertation
Five chapters are used to organize this study. This chapter provided key concepts and
terminology commonly found in a discussion about paradigm shifts, medical education reform,
and stakeholder apprehension. The organization’s mission, goals, and stakeholders as well as the
initial concepts of gap analysis adapted to needs analysis were introduced. Chapter Two
provides a review of current literature surrounding the scope of the study. Topics of competency-
based pedagogical solutions, blended learning approaches, and assumed knowledge, motivation,
and organizational influences that yield barriers to implementation of such nontraditional
medical education solutions will be addressed. Chapter Three details the assumed needs for this
study as well as methodology when it comes to choice of participants, data collection and
analysis. Chapter Four conveys the results and findings from the mixed methods study.
Stakeholder perspectives and emergent themes are summarized and aligned with this study’s
assumed knowledge, motivation, and organizational needs. Chapter Five outlines specific,
contextually relevant recommendations. Using the New World Kirkpatrick Model as a
framework, an integrated implementation and evaluation plan is presented that aligns
stakeholders’ critical behaviors with organizational goals (Kirkpatrick & Kirkpatrick, 2016).

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 24

CHAPTER TWO: LITERATURE REVIEW
Review of the Literature
This literature review will explore root causes of performance gaps in the realization of a
novel medical education initiative. Chapter Two identifies the assumed influences on a faculty’s
ability to implement student-centered teaching strategies. It begins by outlining the progression
of medical education reform literature leading to the emergence of faculty resistance as a
contributing factor to performance issues with next-generation medical education. The first
section defines next generation medical education by focusing on an overview of best practices
for technology-enriched learning environments and blended learning pedagogical strategies.
This segment also addresses the emergence of competency-based learning solutions that utilize
blended learning strategies and hypermedia as instructional solutions for medical education
reform efforts. The chapter ends with an analysis of barriers to faculty participation through the
lens of educational psychology literature by utilizing the Clark and Estes (2008) gap analysis
model to examine knowledge, motivation, and organizational dimensions.
Faculty Ambivalence to Next Generation Medical Education
Recent calls for medical education reform recommend that competency-based learning
activities should replace traditional didactic approaches that characterize the current system
(Chen, van den Broek, & Cate, 2015; Hurtubise et al., 2015; Mehta et al., 2013; Prober & Heath,
2012; Prober & Khan, 2013). Next-generation medical educators construct innovative digital
learning ecosystems by carefully blending appropriate instructional design features with
pedagogical practices grounded in the neuroscience research behind cognitive control and
neural-plasticity (Anguera et al., 2013; Plass, Homer, & Kinzer, 2015). Hypermedia-driven
learning environments connect academic content via hyperlinks to promote learner control of the
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 25

progression through the academic journey (Moos, 2014). These types of technology-enriched
solutions can be used as mechanisms to replace didactic content with blended-learning strategies
that promote self-directed student learning (Azevedo, Cromley, Moos, Greene, & Winters, 2011;
Song et al., 2014). Thus, digital learning ecosystems are evolving to provide personalized,
adaptable, and collaborative experiences that rely on analytics to drive student learning and
promote the use of self-regulated learning strategies (Brown, Dehoney, & Millichap, 2015;
Doherty, Sharma, & Harbutt, 2015; Plass, Homer, & Kinzer, 2015).
Nevertheless, barriers during paradigm shifts influence implementation of novel
approaches to teaching and learning (Mitchell, Parlamis, & Claiborne, 2015; Porter, Graham,
Bodily, & Sandberg, 2016). A model that graphically describes the three assumed influences
(knowledge, motivation, and organizational) currently impacting implementation of next
generation medical education initiatives is illustrated in Figure 1. In 2014, the Urban School of
Medicine launched an initiative called Ibis Academy
2
as a response to calls for medical
education reform. Contemporaneous barriers plague Ibis Academy performance, which limits
broader implementation. Consequently, properly-designed technology-enriched learning
environments, where medical students are provided sufficient opportunities to practice
metacognitive self-regulation learning strategies, are not being delivered by Ibis Academy.
Thus, reform efforts to scale-up effective next-generation medical education exemplars lag
behind expectations and conventional didactic sessions endure.

2
Pseudonyms are used to replace all names and organizations.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 26

Figure 1. Model of assumed knowledge, motivation, and organizational influences that impact
course director adoption of next generation medical education initiatives

Figure 1. This model describes the six components of next generation medical education.
Furthermore, it illustrates the array of assumed influences that impact stakeholder adoption of
nontraditional pedagogical approaches.
The Clark and Estes (2008) Gap Analytic Conceptual Framework
The Clark and Estes (2008) gap analysis technique presents a framework for methodical
and comprehensive investigations that diagnose root causes of divergences between stakeholder
performance goals and substantive performance lags. This yields a diagnostic tool for probing
knowledge, motivation, and organizational factors that potentially limit stakeholder performance
(Clark & Estes, 2008). First, knowledge and skills are classified into four subclasses, which are
factual, conceptual, procedural, and metacognitive (Krathwohl, 2002). These four knowledge
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 27

types help to interpret the proficiency of a stakeholder who is attempting to realize a
performance goal. Next, motivation refers to a stakeholder’s disposition toward actively
choosing to achieve goals, staying focused on the task of achieving goals, and expending the
necessary mental effort to realize goals (Clark & Estes, 2008; Rueda, 2011). Expectancy value
theory, cost/benefit value constructs, and self-efficacy theory are motivational principles that can
be employed when analyzing stakeholder performance gaps (Bandura, 2000; Eccles, 2006;
Rueda, 2011). Finally, leadership, vision, accountability, culture, and climate are examples of
assumed organizational influences that impact stakeholder capacity to achieve performance goals
(Clark & Estes, 2008).
Each component of the Clark and Estes’ (2008) gap analysis will be explained in terms of
course directors’ knowledge, motivation, and organizational needs to meet their performance
goal of implementing student-centered teaching strategies by using Ibis Academy approaches for
technology-enriched course designs by May 2018. To begin, consideration of the influences on
the stakeholder performance goal through the lens of fundamental knowledge and skills will be
discussed. Then, explaining progress toward the stakeholder performance goal through the lens
of motivational influences will be reviewed. Lastly, probing the stakeholder performance goal
through the lens of organizational factors that influence stakeholder capacity to achieve
performance goals will be described. The methodology used to investigate each of the
knowledge, motivation, and organizational influences on stakeholder performance is outlined in
Chapter Three.
Stakeholder Knowledge, Motivation, Organizational
Influences
Knowledge and Skills
The goal of this knowledge analysis was to determine the knowledge and skills,
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 28

according to the research that Ibis Academy course directors need to have to implement student-
centered, Ibis Academy-supported teaching strategies for technology-enriched course designs.
Sound instructional design is characterized by minimizing extraneous cognitive load for the
learner that results from inappropriate instructional assets (Kirschner, Kirschner, & Paas, 2006).
The review of the literature focused on the critical knowledge and skills that Ibis Academy’s
course directors need to create blended learning environments. When Ibis Academy’s course
directors gain the knowledge and skills that are necessary to create technology-enriched blended
learning environments, they will be able implement student-centered teaching strategies. The
purpose of this literature review was to identify the knowledge influences needed to meet the
stakeholder’s goals.
Knowledge influences. Advances in cognitive psychology research have led to
describing four categories of knowledge types (Krathwohl, 2002). Factual and conceptual types
focus on the “what,” the procedural type focuses on the “how,” and the metacognitive type
focuses on the “self” (Krathwohl, 2002). Knowledge influences are important because they
provide perspectives to help course directors understand expected knowledge and skills needed
to influence next generation medical education reforms when generating student-centered
learning environments. Factual knowledge provides information course directors need to create
blended-learning course designs and compare these novel strategies with traditional approaches
used in teaching and learning. Conceptual knowledge assists course directors with knowing
relationships between educational best practices and student outcomes. Procedural knowledge
gives course directors the capacity to use appropriate skills when creating technology-enriched
learning environments that are based on established best practices. Metacognitive knowledge
provides course directors with the skills and strategies needed to self-assess their own
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 29

effectiveness in creating blended-learning environments. The specific knowledge influences
identified by the research are described below and summarized in Table 2.
Course directors need to know the goal of Ibis Academy and what is expected of them
with respect to course redesign (Factual). Unclear communication and lack of information
creates confusion during change initiatives (Kotter, 2007). Pincus (2006) suggested that open
and direct communication strategies enrich stakeholder commitment. To increase performance,
stakeholders should collaboratively align accountability mechanisms and performance metrics
with a common goal, or shared vision (Bender & Schuh, 2002; Doerfel & Ruben, 2002; Kotter,
2007). Thus, course directors could benefit from knowing the initiative’s goal for innovative
medical education during Ibis Academy course design projects (Elmore, 2002; Kotter, 2007).
Likewise, this shared goal could be accompanied by a clear set of policies, procedures, and
accountability mechanisms that guide adherence to educational best practice, enhance feedback,
and promote reflection-in-practice. Without this factual knowledge, course directors will likely
encounter challenges when collaborating with Ibis Academy personnel during course design
projects.
Course directors need to know educational best practices for learner-centered blended
learning design (Factual). Blended learning is defined as the careful integration of face-to-face
and digital experiences that create student-centered learning environments where students can
demonstrate mastery of learning objectives (Garrison & Vaughan, 2008; Garrison & Vaughan,
2013; VanDerLinden, 2014). Course directors need foundational knowledge of blended-learning
pedagogy when creating student-centered learning environments that incorporate academic
technologies. This factual knowledge will allow course directors to write measurable learning
objectives, identify appropriate technologies, and choose teaching strategies in the early stages of
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 30

their course redesign projects. Garrison and Vaughan (2008, 2013) state that transformational
structural and instructional redesigns are necessary when employing blended learning strategies
to enhance student learning. However, unclear understandings of blended-learning definitions,
rationales for use, and resources needed for implementation limit course director involvement in
course redesign projects (King & Boyatt, 2015; Mitchell, Parlamis, & Claiborne, 2015;
VanDerLinden, 2014; van Rooij & Zirkle, 2016). Furthermore, blended learning environments
are enhanced with the inclusion of measurable learning objectives, formative assessment
opportunities, and deeper-learning strategies (Mayer, 2011; Shute, 2008). Yet, many faculty
members lack the required knowledge, skills, and creative potential to design such instructional
assets (Dailey-Hebert, Carbonell, & Gijselaers, 2013). Blended learning strategies attempt to
maximize student performance by fusing the best elements of face-to-face and online learning,
but require that course directors understand their new role and have the needed knowledge and
skills to succeed (VanDerLinden, 2014). Without this factual knowledge, course directors will
likely encounter challenges when implementing student-centered teaching strategies by using
Ibis Academy approaches for technology-enriched course designs.
Course directors need to know appropriate educational technologies that support
cognitive process and effective delivery (Factual). Appropriate educational technologies are
those that effectively enhance student outcomes because they are grounded in cognitive
neuroscience research (Homer et al., 2008; Plass et al., 2015). Course directors need
foundational knowledge of appropriate educational technologies when creating technology-
enriched student-centered learning environments. This factual knowledge will allow course
directors to align technology choices with learning objectives and teaching strategies in the
initial phases of their course redesign projects. Kalet et al. (2012) stated that properly-designed
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 31

computer-assisted learning environments could form the foundation of a paradigm shift in
medical education. However, vague understandings of educational technologies and resources
needed for effective implementation under situational contexts limit course director commitment
to course redesign projects (Yavner et al., 2014). Thus, many medical educators lack the
required knowledge and skills to independently design such instructional assets (Green, 2016).
Delivering effective technology-enriched learning environments potentially maximizes student
performance when properly-designed, but this necessitates that course directors recognize the
alignment of appropriate educational technologies under specific situational contexts with
supporting cognitive processes. Without this factual knowledge, course directors will likely face
barriers when implementing student-centered teaching strategies by using Ibis Academy
approaches for technology-enriched course designs.
Course directors need to know the relationship between best practices for learner-
centered blended learning design and student outcomes (Conceptual). Relevant student
outcomes in preclinical medical education include developing self-regulated learning skills,
using higher order thinking skills, and improving long-term retention of academic content
(White, 2007). Course directors need conceptual knowledge of educational best practices that
improve student outcomes when designing student-centered learning environments. This
conceptual knowledge will allow course directors to implement impactful instructional
approaches during their course redesign projects. Self-regulated learners are those that take
control of their learning by approaching tasks with mastery-based mindsets (Zimmerman, 2001).
Learner-centered environments enrich the opportunities for students to develop such a mindset
and navigate away from extrinsic performance-driven motivators (Land, Hannafin, & Oliver,
2012). However, an overreliance on automated and unconscious knowledge limits course
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 32

director commitment to these types of course redesigns (Clark, 2009). Thus, medical educators
may lack the foundational knowledge and skills needed to promote self-regulated learning
behaviors in non-lecture based environments, which could impact student outcomes (White,
2007). Without this conceptual knowledge, course directors will likely confront obstacles when
implementing student-centered teaching strategies by using Ibis Academy approaches for
technology-enriched course designs.
Course directors need to know the relationship between appropriate educational
technologies and student outcomes (Conceptual). Homer et al. (2008) state that sufficient
evidence exists to demonstrate that educational technologies are effective mechanisms to support
learning. They argue that identifying the specific situational contexts in which appropriate
educational technologies are most effective for individual learners is the new challenge.
Consequently, course directors need conceptual knowledge of relationships between utilizing
appropriate educational technologies and student outcomes. This conceptual knowledge will
allow course directors the capacity to implement personalized and autonomous learning
opportunities for students, where appropriate educational technologies are aligned with effective
teaching strategies. Guided instruction, or scaffolding, enhances technology-enriched learning
environments, promotes self-regulated learning behaviors, and improves student outcomes
(Devolder, van Braak, & Tondeur, 2012; Moos & Bonde, 2016). However, educators struggle
with embedding appropriate scaffolds in traditional instruction (Moos & Bonde, 2016). These
struggles could amplify into significant challenges for educators who are new to technology-
enriched learning environments (Zheng, 2016). Thus, course directors may lack the foundational
knowledge and skills needed to use educational technologies effectively and generate
autonomous learning opportunities, which could impact student outcomes (Devolder, van Braak,
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 33

& Tondeur, 2012; Homer et al., 2008; Zheng, 2016). Without this conceptual knowledge, course
directors will likely encounter barriers when implementing student-centered teaching strategies
by using Ibis Academy approaches for technology-enriched course designs.
Course directors need to know how to redesign courses based on educational best
practices for learner-centered blended learning design (Procedural). In educational settings,
best practices are interventions that typically generate enhanced learner outcomes and are
generally accepted as the community standard. When converting instructor-centered lecture-
based courses to student-centered blended learning experiences, course directors need procedural
knowledge to know how to redesign their courses based on established best practices. In
addition to modifying face-to-face sessions, this requires that medical educators know proper
implementation of appropriate educational technologies, interact with digital content as a student
would, recognize which lessons are suitable for blended learning, and evaluate exemplar courses
to identify successful characteristics (Graham, Woodfield, & Harrison, 2013). Although the
contemporaneous paradigm shift in medical education promotes learner-centered course designs,
faculty skepticism of nontraditional educational practices often impedes change initiatives
(VanDerLinden, 2014). For example, Yavner et al. (2015) highlight how faculty biases
negatively impact student perceptions of their learning environments. On the other hand, with
enhanced knowledge and increased experiences leading nontraditional learning environments,
faculty perceptions of innovative learning practices tend to improve over time (Fink, 2013;
Porter et al., 2016). Thus, when designing next generation medical education experiences,
course directors require procedural knowledge in learning how to create student-centered
opportunities based on accepted educational best practices.
Course directors need to know how to develop the course by using appropriate
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 34

educational technologies that support cognitive process and effective delivery (Procedural).
Thoughtful consideration to cognitive neuroscience research and instructional design must be
given when developing courses that use appropriate educational technologies (Anguera et al.,
2013; Plass et al., 2015). Course directors need procedural knowledge to know how to create
online learning modules for technology-enriched learning environments based on established
best practices. Technology-enriched learning environments use educational technologies that
connect web-based content via hyperlinks to promote self-directed student learning (Moos,
2014). These learning environments rely on neuroscience research and metacognitive strategies,
and adapt to meet individual learner needs (Anguera et al., 2013; Berman et al., 2008; Brown et
al. , 2015; Domagk et al., 2010). In preclinical medical education, these types of computer-
assisted instructional techniques are replacing traditional didactic content so that competency-
based educational strategies can be employed (Green, 2016). Analytics are typically used in
technology-enriched learning environments to help instructors shape personalized, adaptable,
and collaborative experiences to enhance student learning (Brown et al., 2015). In these types of
learning experiences, students learn at their pace and on their terms (Wolfe & Andrews, 2014).
With poor instructional design and lack of instructional knowledge, however, learners spend
more cognitive resources on understanding poorly-designed interactive features than they do on
actually learning content (Kalet et al., 2012; Kirschner et al., 2006). Thus, when designing next
generation medical education experiences, course directors require procedural knowledge in
learning how to properly develop their courses by using appropriate educational technologies
that support cognitive process and effective delivery.
Course directors need to reflect on their progress toward redesigning courses based on
educational best practices for learner-centered blended learning design (Metacognitive).
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 35

Course directors need metacognitive knowledge that enables them to reflect on their instructional
design effectiveness. To design courses that align measurable learning objectives with
appropriate student-centered instructional strategies and technology choices, course directors
need to know reflection strategies to self-assess their own effectiveness in creating blended-
learning environments. At its most basic level, metacognition is thinking about thinking (Mayer,
2011). Just like their students in the classroom, instructors who are learning new pedagogical
approaches also need to be aware of their own learning and how to control it (Mayer, 2011).
This will facilitate the transfer of knowledge and help course directors develop mastery of
blended learning best practices, building hypermedia-driven learning environments, and
increasing self-regulated learning behaviors form their students. Consistent with Schraw and
McCrudden (2006), course directors who wish to develop mastery in creating novel medical
education learning environments will need time to acquire knowledge and skills, practice
implementing rapid prototypes, and self-reflect on their effectiveness over time. Indeed, lack of
knowledge, skills, and confidence has previously been shown to limit the adoption of computer-
assisted teaching practices (King & Boyatt, 2015). Self-reflective instructors can overcome
those challenges when implementing on new instructional design practices, like blended
classrooms.
Course Directors need to reflect on their progress toward developing the course by
using appropriate educational technologies that support cognitive process and effective
delivery (Metacognitive). When developing technology-enriched learning environments, course
directors need to reflect on their progress. Metacognitive behaviors enhance performance within
challenging cognitive situations, where self-regulation is necessary (Mayer, 2011). When
educators increase their metacognitive skills, they will be able to connect prior knowledge to
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 36

new content, organize information via schema for long-term storage, automate information
retrieval processes, and facilitate transfer of knowledge (Mayer, 2011; Schraw & McCrudden,
2006). Reflection strategies are important during course development for enhancing student
outcomes. For example, Berman et al. (2008) identified that poor instructional design by
educators leads to unsatisfactory implementation of technology-enriched learning environments,
which yields poor student experiences. Situational contexts, like the absence of structured
scaffolding within computer-assisted curricula, might limit the effectiveness of developing self-
regulated learners (Azevedo et al., 2011). Consequently, reflecting-on-practice could help
educators generate effective technology-enriched learning environments for their students. Thus,
for preclinical medical education course redesigns to be effective, course directors need
metacognitive knowledge to reflect on their progress toward developing their courses, which
incorporate appropriate educational technologies that support cognitive process and effective
delivery.

Table 2

Summary of course directors’ assumed needs and general literature for knowledge gap analysis

Assumed Needs for
Reducing Ambivalence
General Literature
Knowledge
Course directors need to know the goal
of Ibis Academy and what is expected
of them with respect to course redesign.
(Facutal)

(Bender & Schuh, 2002; Doerfel & Ruben,
2002; Elmore, 2002; Kotter, 2007; Pincus,
2006)
Course directors need to know
educational best practices for learner-
centered blended learning design.
(Factual)

(Dailey-Hebert, Carbonell, & Gijselaers, 2013;
Garrison & Vaughan, 2008; Garrison &
Vaughan, 2013; King & Boyatt, 2015; Mayer,
2011; Mitchell, Parlamis, & Claiborne, 2015;
Shute, 2008; VanDerLinden, 2014; van Rooij
& Zirkle, 2016)

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 37

Course directors need to know
appropriate educational technologies
that support cognitive process and
effective delivery. (Factual)

(Green, 2016; Homer, Plass, & Blake, 2008;
Kalet, Song, Sarpel, Schwartz, Brenner, Ark,
& Plass, 2012; Plass, Homer, & Kinzer, 2015;
Yavner, Pusic, Kalet, Song, Hopkins, Nich, &
Ellaway, 2014)

Course directors need to know the
relationship between best practices for
learner-centered blended learning
design and student outcomes.
(Conceptual)

(Clark, 2009; Land, Hannafin, & Oliver, 2012;
White, 2007, Zimmerman, 2001)
Course directors need to know the
relationship between appropriate
educational technologies and student
outcomes. (Conceptual)

(Devolder, van Braak, & Tondeur, 2012;
Homer, Plass, & Blake, 2008; Moos & Bonde,
2016; Zheng, 2016)
Course directors need to know how to
redesign courses based on educational
best practices for learner-centered
blended learning design. (Procedural)

Fink, 2013; Graham, Woodfield, & Harrison,
2013; Porter, Graham, Bodily, & Sandberg,
2016; VanDerLinden, 2014; Yavner, Pusic,
Kalet, Song, Hopkins, Nick, & Ellaway, 2015)

Course directors need to know how to
develop the course by using appropriate
educational technologies that support
cognitive process and effective
delivery. (Procedural)

(Anguera et al., 2013; Berman, Fall, Maloney,
& Levine, 2008; Brown, Dehoney, &
Millichap, 2015; Domagk, Schwartz, & Plass,
2010; Green, 2016; Kalet et al., 2012;
Kirschner, Kirschner, & Paas, 2006; Moos,
2014; Plass, Homer, & Kinzer, 2015; Wolfe &
Andrews, 2014)

Course directors need to reflect on their
progress toward redesigning courses
based on educational best practices for
learner-centered blended learning
design. (Metacognitive)

(King & Boyatt, 2015; Mayer, 2011; Schraw &
McCrudden, 2006)

Course Directors need to reflect on
their progress toward developing the
course by using appropriate educational
technologies that support cognitive
process and effective delivery.
(Metacognitive)
(Azevedo et al., 2011; Berman et al., 2008;
Mayer, 2011; Schraw and McCrudden, 2006)

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 38

Motivation
Motivation explains the drive behind an individual’s willingness to actively achieve
goals, stay focused on tasks, and expend energy to demonstrate mastery (Pintrich, 2003).
Motivation is important because performance increases when individuals actively devote internal
interest to tasks they find value in, thereby increasing their confidence, efficacy, and willingness
to demonstrate mastery (Clark & Estes, 2008; Eccles, 2006; Pajares, 2006; Schraw & Lehman,
2009; Yough & Anderman, 2006). The primary goal of the motivation gap analysis is to
determine whether course directors are motivated to implement student-centered teaching
strategies by using Ibis Academy approaches for technology-enriched course designs. Table 3
summarizes the motivation types, motivation influences, and general literature for the motivation
gap analysis.
The focus of the literature review is to describe potential sources of faculty apprehension
toward nontraditional teaching strategies. Eccles (2006) describes perceived cost of time and
effort as a belief-driven influence that limits task value and decreases motivation. The goal of
this section is to explain the motivational influences that adequately describe Ibis Academy
course director motivation. Motivational influences will be investigated through the lenses of
expectancy value theory, self-efficacy theory, emotions, and attribution theory.
Expectancy value theory and the perceived cost/value benefit construct describe two key
motivational influences. First, course directors need to value redesigning courses to reflect best
practices for learner-centered blended learning. Second, course directors need to value
developing courses that use appropriate educational technologies that support cognitive process
and effective delivery. Next, self-efficacy theory describes two key motivational influences
(Pajares, 2006). First, course directors need to be confident that they can design courses based
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 39

on educational best practices for learner-centered blended learning design. Second, course
directors need to be confident that they can develop courses that use appropriate educational
technologies that support cognitive process and effective delivery. Then, affect, or emotions,
describes two key motivational influences (Clark & Estes, 2008). First, course directors need to
feel positive about redesigning courses based on educational best practices for learner-centered
blended learning design. Second, course directors need to feel positive about developing courses
that use appropriate educational technologies that support cognitive process and effective
delivery. Finally, attribution theory describes two key motivational influences (Anderman &
Anderman, 2009). First, course directors need to believe that improved student outcomes are the
result of their efforts in redesigning courses based on educational best practices for learner-
centered blended learning design. Second, course directors need to believe that improved
student outcomes are the result of their efforts in developing courses that use appropriate
educational technologies that support cognitive process and effective delivery.
Expectancy Value Theory. Understanding an individual’s expectancy of success and
value of tasks provides context for performance indicators (Eccles, 2006). The expectancy value
motivational model describes how motivation increases with task-value (Eccles (2006). The four
constructs that drive an individual’s motivation are intrinsic interest, attainment value, utility
value, and perceived cost (Eccles, 2006; Pintrich, 2006). Intrinsic interest describes an
individual’s pleasure or expected pleasure with task commitment (Eccles, 2006). Attainment
value describes how a task matches an individual’s identity and inclinations, while utility value
describes how a task matches future ambitions (Eccles, 2006). Perceived cost is influenced by
an individual’s beliefs about the cost of involvement with a task (Eccles, 2006). Time and effort
spent on a task that diminish potential opportunities to participate in other life experiences is one
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 40

example of how perceived cost can limit an individual’s motivation (Eccles, 2006). Expectancy
value theory and the perceived cost/value benefit construct can be used as a framework to
explore motivational issues that affect Ibis Academy course directors.
Course directors need to value redesigning courses to reflect best practices for learner-
centered blended learning (Expectancy-Value and cost/benefit value construct). The
expectancy value theory has been used as a framework for investigating faculty members’ values
toward change and innovation in education (Matusovich, Paretti, McNair, & Hixson, 2014).
Intrinsic value is linked to faculty persistence, willingness to change teaching strategies, and
innovation (McCrickerd, 2012). Johnson, Stewart, and Bachman (2015) report that faculty
member motivation is driven by an intrinsic predisposition to choose innovative teaching tasks.
However, attribution differences exist between individual faculty members in relation to their
degree of innovativeness, creativity, and willingness to gain new knowledge and skills, which
minimizes their willingness to explore new teaching strategies, like the blended classroom
(Jaskyte, Taylor, & Smariga, 2009).
Course directors need to value developing courses that use appropriate educational
technologies that support cognitive process and effective delivery (Expectancy-Value and
cost/benefit value construct). Given the up-front increased time and effort required to redesign
courses using innovative teaching strategies that incorporate educational technologies, Ibis
Academy course directors must balance the expectancy to succeed with their intrinsic values of
engaging in these type of novel tasks. McCrickerd (2012) points out that without an inherent
drive toward risk-taking, faculty members will elect not to modify their pedagogical practices.
In terms of choosing to use new technologies or pedagogical strategies, faculty members rely on
their awareness (knowledge), adoption (motivation), and implementation (organization), and
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 41

have self-classified along an innovator-laggard continuum (Graham, 2013; Moore, 2002; Porter,
2016; Rogers, 2003). Thus, choosing to develop courses that use educational technologies could
be a potential barrier or facilitator to course directors’ decision-making processes when they
weigh expectancy to succeed against exceeding criteria used to evaluate their performance.
Self-Efficacy Theory. Self-efficacy refers to the degree of confidence and perceptions of
abilities individuals have about their task-related competencies (Bandura, 2000; Pajares, 2006).
Higher self-efficacy tends to be related to increased motivation (Pajares, 2006). Furthermore,
Pajares (2006) explains that self-efficacy helps individuals regulate choice, persistence, and
mental effort invested during challenging tasks. In the higher education arena, resistance to tasks
can be linked to self-efficacy theory. For example, Mitchell, Parlamis, and Claiborne (2015)
identified fear of the unknown, fear of failure, and concerns about change as primary factors that
drive resistance. Since self-efficacy has also been linked to persistence in computer-based
instruction, the self-efficacy theory can be used to explore motivational issues of Ibis Academy
course directors (Horvitz, Beach, Anderson, & Xia, 2015).
Course directors need to be confident that they can design courses based on
educational best practices for learner-centered blended learning design (Self-Efficacy). Self-
efficacy theory will help identify motivational factors that determine whether or not Ibis
Academy course directors choose to participate, persist, and invest mental effort in blended-
learning course redesign projects (Pajares, 2006; Pintrich, 2003). Efficacious course directors
are likely to demonstrate increased motivation toward designing learner-centered blended
courses (Pajares, 2006). Ibis Academy course directors are experts in their medical disciplines,
yet may not field the same levels of expertise with designing innovative educational practices.
Habitual classroom management strategies, like delivering traditional lectures, is an automated
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 42

process that relies on unconscious knowledge and behaviors, which limits the degree to which an
individual is willing to change (Clark, 2009). Clark (2009) further suggests that individuals will
need to unlearn the old and dedicate significant mental effort toward automating new behaviors,
which leads to motivational conflicts. In addition to expending significant mental effort to
design blended learning environments, these course directors may also be limited in their desire
to risk failure. These fears of the unknown, fears of negative professional assumptions, and fears
of failure are consistent with sources of faculty resistance to change, as identified by Mitchell et
al. (2015). These types of fears could manifest into diminished self-efficacy, and thereby
negatively impact motivation. Consequently, choosing to design learner-centered courses could
be a potential barrier to course directors’ willingness to change when they weigh automated
behaviors and fear of failure against their personal confidence levels with nontraditional teaching
approaches.
Course directors need to be confident that they can develop courses that use
appropriate educational technologies that support cognitive process and effective delivery
(Self-Efficacy). Early-adopters are faculty members who actively choose to incorporate
computer-assisted strategies into their teaching and learning activities (Porter et al, 2016).
Efficacious faculty members are more likely to innovate in the classroom and participate in
blended-learning environments (Moore, 2002; Porter et al., 2016; Rogers, 2003). Horvitz et al.
(2015) identified that satisfaction with computer-assisted teaching and perception-of-learning
were both significant predictors of faculty member self-efficacy. Likewise, King and Boyatt
(2015) explained that confidence in skills and technology use determined faculty adoption of
technology in their teaching strategies. Lee and Tsai (2010) found that instructors with more
experience with web-based teaching experience displayed higher self-efficacy. Thus, self-
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 43

efficacy theory should reveal motivational issues that potentially limit participation of course
directors in actively choosing to develop student-centered learning opportunities that use Ibis
Academy approaches for technology-enriched course designs.
Emotions. Motivation increases when organizational environments promote positive
emotions and enthusiastic settings (Clark & Estes, 2008). Emotions, which are different from
moods, generally are of a shorter duration and are linked to a particular provocation, or stimulus
(Lord & Kanfer, 2002). When stakeholders encounter professional tasks that decrease negative
emotions and intensify positive emotions because organizations commit to creating positive
settings, motivation and morale increase (Clark & Estes, 2008; Lord & Kanfer, 2002). Thus,
when faculty members are confronted with educational change initiatives, they will demonstrate
behavioral responses aligned with how they regulate their emotions (Lord & Kanfer, 2002).
Positive emotions should elicit behavioral modifications that increase motivation (Clark & Estes,
2008; Lord & Kanfer, 2002). Furthermore, cognitive and neuroscientific research indicate that
emotions are correlated with learning and growth (Pekrun, 2011). Therefore, exploring faculty
members’ emotions is an essential consideration when identifying motivational issues that affect
Ibis Academy course directors.
Course directors need to feel positive about redesigning courses based on educational
best practices for learner-centered blended learning design (Emotions). Incorporating new
pedagogical approaches into established courses introduces a range of emotions for educators,
which influences their engagement and behavioral responses (Pekrun, 2011). Negative
deactivating emotions will likely yield undesirable outcomes for educators, while positive
activating emotions will likely generate enjoyment and gratitude (Pekrun, 2011). In a study
where 145 educators responded to an online survey that asked about emotions and teaching
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 44

environments, Kordts-Freudinger (2017) found a correlation between positive emotions and
teaching in learner-centered settings. These positive emotions most frequently felt by educators
included contentment, enjoyment, and pride (Kordts-Freudinger, 2017). In a mixed methods
study, where participants were new faculty members, Stupnisky, Pekrun, and Lichtenfeld (2014)
also found that positive-activating emotions, like enjoyment and pride, were correlated with
perceived success. Thus, investigating the emotions and associated behavioral responses
surrounding choices to participate in blended-learning course design projects could lend insight
into motivational barriers that Ibis Academy course directors might face.
Course directors need to feel positive about developing courses that use appropriate
educational technologies that support cognitive process and effective delivery (Emotions).
Actively choosing to develop courses using educational technologies necessitates a team
approach to completing tasks (Green, 2016). Positive emotional environments typically enhance
individual and team motivation (Clark & Estes, 2008). However, Matusovich, Paretti, McNair,
and Hixson (2014) found that transforming engineering educational practices was not always
straightforward because personal educator emotions succumbed to cultural traditionalism and
collective values. Furthermore, faculty members engaged in digital education often feel
negative-deactivating emotions early in the process (Baran & Correia, 2014; Lee, 2001). Yet,
Bunk, Li, Smidt, Bidetti, and Malize (2015) surveyed 152 university-level faculty members and
found that excitement and fear determined emotional responses to developing courses that
feature educational technologies. Thus, exploring the individual and group emotions that
determine behavioral responses surrounding choices to developing technology-enriched courses
could lend insight into motivational barriers Ibis Academy course directors potentially face.
Attribution Theory. Environmental and personal variables contribute to sense-making
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 45

when understanding successes and failures of tasks (Anderman & Anderman, 2009; Weiner,
2005). Attribution theory suggests that an individual’s perceived cause of an outcome is
important and will determine their future motivation toward task engagement (Anderman &
Anderman, 2009; Weiner, 2005). Such attributions can be perceived as internal or external to the
individual, stable or unstable across time and contexts, and manageable or uncontrollable
(Weiner, 2005). Under the educational context, Anderman and Anderman (2009) state that
attributing success or failure to effort expended rather than natural ability should improve
motivation and task completion. Varieties of intrinsic and extrinsic motivators have been shown
to either increase or decrease a faculty member’s willingness to engage in utilizing educational
technologies (Johnson, Stewart, & Bachman, 2015). Thus, understanding if medical educators
attribute student outcomes to their effort spent in redesigning courses is potentially an important
factor to explore when identifying motivational issues that affect Ibis Academy course directors.
Course directors need to believe that improved student outcomes are the result of their
efforts in redesigning courses based on educational best practices for learner-centered blended
learning design (Attribution). Once a course director makes the decision to adopt a new
teaching approach, they must evaluate whether the effort spent redesigning the educational
experience is attributed to improving student performance and experience (Anderman &
Anderman, 2009; Weiner, 2005). Rogers (2003) described faculty members depending upon
their willingness to adopt new strategies, and found that sound data demonstrating impact on the
effectiveness of learning was a significant driver that separated innovators from cautious
implementers. In a study that interviewed 37 faculty members, more than half of the
interviewees reported that evaluation data demonstrating improved learning outcomes for
students would encourage them to adopt blended learning approaches (Porter et al., 2016). Thus,
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 46

when weighing effort costs of redesigning courses using blended learning approaches against
educational benefits, attribution theory suggests that Ibis Academy course directors could face
motivational barriers in the absence of data-driven or evidence-based solutions.
Course directors need to believe that improved student outcomes are the result of their
efforts in developing courses that use appropriate educational technologies that support
cognitive process and effective delivery (Attribution). When course directors actively choose to
adopt new educational technologies, they must assess whether the effort they spend developing
educational experiences is attributable to improving student outcomes. Faculty motivation to
adopt educational technologies is driven by complex interactions of internal and external
motivators (Johnson et al., 2015). For example, in a qualitative study where 37 faculty members
participated in focus groups and 11 individuals participated in interviews, King and Boyatt
(2015) found that in addition to knowledge of technological resources, perceived student
outcomes was a primary emergent theme that explained whether or not faculty members were
motivated to adopt educational technologies. Additionally, Mitchell et al. (2015) identified that
faculty attributing student outcome failures in digital environments was a significant factor that
limited their participation with adopting educational technologies. Consequently, attribution
theory suggests that Ibis Academy course directors could face motivational barriers when
assessing effort costs of developing courses using educational technologies against student
benefits and outcomes.
Motivation summary. In sum, application of the expectancy value theory and the
perceived cost/value benefit construct, self-efficacy theory, emotions, and attribution theory will
help identify motivational factors that determine Ibis Academy course director choice,
persistence, and mental effort (Eccles, 2006; Matusovich, Paretti, McNair, & Hixson, 2014).
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 47

Using Matusovich et al. (2014) as a guide for applying these motivational theories, four
predictions can be made. First, motivated course directors will value the effort spent on blended
course redesign projects and on using appropriate educational technologies. Second, motivated
course directors will feel confident with their abilities to effectively design blended courses using
educational best practices and with their abilities to develop courses that use appropriate
educational technologies to support cognitive process and effective delivery. Third, motivated
course directors will feel positive about their learner-centered course redesigns that feature
educational technologies. Fourth, motivated course directors will believe that improved student
outcomes are a result of their efforts in redesigning courses using blended learning approaches
and with incorporating appropriate educational technologies. These motivational theories theory
will likely distinguish motivational drivers of course directors who actively choose to implement
student-centered teaching strategies by using Ibis Academy approaches for technology-enriched
course designs (Eccles, 2006; Johnson et al., 2015; Matusovich et al., 2014).

Table 3

Summary of course directors’ assumed needs and general literature for motivation gap analysis

Assumed Needs for
Reducing Ambivalence
General Literature
Motivation
Course directors need to value
redesigning courses to reflect best
practices for learner-centered blended
learning. (Expectancy-Value and
cost/benefit value construct)

(Jaskyte, Taylor, & Smariga, 2009; Johnson,
Stewart, and Bachman (2015; Matusovich,
Paretti, McNair, & Hixson, 2014; McCrickerd,
2012)
Course directors need to value
developing courses that use appropriate
educational technologies that support
cognitive process and effective
delivery. (Expectancy-Value and
(Graham, 2013; McCrickerd, 2012; Moore,
2002; Porter, 2016; Rogers, 2003)

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 48

cost/benefit value construct)

Course directors need to be confident
that they can design courses based on
educational best practices for learner-
centered blended learning design (Self-
Efficacy)

(Clark, 2009; Mitchell, Parlamis, & Claiborne,
2015; Pajares, 2006; Pintrich, 2006)

Course directors need to be confident
that they can develop courses that use
appropriate educational technologies
that support cognitive process and
effective delivery. (Self-Efficacy)

(Horvitz et al., 2015; King and Boyatt, 2015;
Lee and Tsai, 2010; Moore, 2002; Porter et al,
2016; Rogers, 2003)
Course directors need to feel positive
about redesigning courses based on
educational best practices for learner-
centered blended learning design.
(Emotions)

(Kordts-Freudinger, 2017; Pekrun, 2011;
Stupnisky, Pekrun, and Lichtenfeld; 2014)
Course directors need to feel positive
about developing courses that use
appropriate educational technologies
that support cognitive process and
effective delivery. (Emotions)

(Baran & Correia, 2014; Bunk, Li, Smidt,
Bidetti, and Malize, 2015; Clark & Estes,
2008; Green, 2016; Lee, 2001; Matusovich,
Paretti, McNair, and Hixson, 2014)
Course directors need to believe that
improved student outcomes are the
result of their efforts in redesigning
courses based on educational best
practices for learner-centered blended
learning design. (Attribution)

(Anderman & Anderman, 2009; Porter et al.,
2016; Rogers, 2003; Weiner, 2005)
Course directors need to believe that
improved student outcomes are the
result of their efforts in developing
courses that use appropriate educational
technologies that support cognitive
process and effective delivery.
(Attribution)
(Johnson, Stewart, & Bachman, 2015; King
and Boyatt, 2015; Mitchell, Parlamis, &
Claiborne, 2015

Organizational Influences
Organizational influences impact medical education by promoting or inhibiting paradigm
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 49

shifts (Berman et al., 2008; Mehta et al., 2013; Prober & Heath, 2012; Prober & Khan, 2013).
For example, assets are organizational features that support change. Conversely, organizational
barriers interfere with successful change efforts. While knowledge and motivation are important
for a stakeholder’s ability and willingness to complete tasks, organizational resources are also
required to facilitate task completion (Clark & Estes, 2008; Rueda, 2011). Aligning
organizational influences with performance goals requires foundational understanding of cultural
models and settings that characterize an organization (Clark & Estes, 2008; Schein, 2004). The
focus of this literature review is to reveal organizational influences that promote or inhibit Ibis
Academy’s capacity of achieving its organizational goal of exceeding thresholds for all internal
metrics, as defined by the Executive Faculty Curriculum Steering Committee, used to evaluate
preclinical medical education modules. Resources, policies, cultural model, and cultural setting
are the specific organizational influences that are examined in this literature search, through the
lens of course directors at Ibis Academy. The purpose of this literature review is to reveal the
organizational assets, barriers, and circumstances that influence the ability of course directors to
effectively implement student-centered teaching strategies by using Ibis Academy approaches for
technology-enriched course designs.
Challenges to organizational culture change: leadership. Visionary leadership
promotes transformational organizational change (Eisenbach, Watson, & Pillai, 1999; Kotter,
2007). Articulating a germane shared vision creates purpose for stakeholders, stimulates a
performance strategy, and inspires an innovative organizational culture (Lipton, 1996;
McDonald, 2007). Schein (2004) explains that through charismatic leadership abilities and
actions, followers are guided into a shared organizational engagement around the vision.
Leaders engage diverse groups of constituents through building relationships and forming
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 50

coalitions (Clifton, 1999; Kezar, 2000a; Kezar, 2000b). This forms a foundation for
communication, acceptance of evidence-based decision-making practices, and performance
assessment (Lakos & Phipps, 2004; Pincus, 2006). A trustworthy culture with shared
accountability values promotes open processes where climates are characterized by transparent
assessment strategies linked to performance goals (Earl & Fullan, 2003; Lakos & Phipps, 2004).
Therefore, transformational leaders effectively enact cultural changes by integrating shared
mental values with visible and measureable contextual practices that are experienced by
stakeholders within social settings (Eisenbach, Watson, & Pillai, 1999; Kotter, 2007).
Cultural models and cultural settings. Schein (2004) explains that artifacts, values,
and underlying assumptions are the three strata that comprise an organizational culture. In
organizational arenas, group interactions that require problem solving, evolve over time, and
spawn artifacts, values, and shared assumptions that are conveyed to new group members as
integrative norms or rules, exemplify culture (Erez & Gati, 2004; Schein, 2004). Cultural norms
are influenced by contextual macrocultures, subcultures, and microcultures that function both
globally and independently (Schein, 2004). These shared norms involve additional contextual
complexities due to dynamic processes that exist within nested cultural levels, such as individual,
group, organizational, national, and global dimensions (Erez & Gati, 2004). In terms of cultural
strength, novel or innovative organizations that are operating within spaces of creative tension
may lack homogeneity of shared assumptions and subsequently be characterized as fragile
cultures (Erez & Gati, 2004; Senge, 1990; Schein, 2004). Therefore, deeper understanding of
cultural models and settings is required to evaluate stakeholder perceptions, organizational
norms, and shared assumptions.
Cultural models and cultural settings will be explored in this literature review to help
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 51

assess how organizational influences impact achievement of stakeholder performance goals.
Cultural models are automated and predominantly invisible values, beliefs, and attitudes that are
revealed through cultural habits (Gallimore & Goldenberg, 2001; Rueda, 2011; Schneider, Brief,
& Guzzo, 1996). These shared mental conceptions include behavioral, cognitive, and affective
responses or perceptions (Gallimore & Goldenberg, 2001). Examples of such shared mental
schema include acceptance of lack of accountability, resistance to change, pessimistic attitudes,
lack of trust, and conflict avoidance. Cultural settings are the contextual and visible revelations
of cultural models in social or interactive environments (Gallimore & Goldenberg, 2001; Rueda,
2011; Schneider et al., 1996). Lack of organizational strategic plans, vague performance goals,
lack of communication, lack of credible role models, and restrictive policies are examples of
cultural settings. Evaluating the dynamics of cultural models and cultural settings on stakeholder
goal achievement facilitates an investigation into leadership’s role and influence in
organizational change. Table 4 summarizes the organization influences subdivided into cultural
settings and cultural models, and general literature for the organization gap analysis.
Course directors need to have the resources (time, human and financial support) to
redesign courses based on educational best practices for learner-centered blended learning
design (Resources). While institutional policies and procedures are necessary, adequate support
resources are also required. To understand faculty perceptions of innovative teaching, Jaskyte,
Taylor, and Smariga (2009) surveyed 48 faculty members and found that simply introducing new
techniques does not guarantee faculty participation. Instead, multiple factors emerged that drove
faculty decisions to adopt innovative teaching practices, which included collaboration,
interactions, and flexibility (Jaskyte et al., 2009). In a qualitative study using semi-structured
interviews, Porter et al. (2016) found that faculty members who were late-adopters of online
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 52

teaching approaches responded that technological support, pedagogical support, course load
reductions, and incentives were primary factors that increased their adoption of nontraditional
teaching methods. These types of support mechanisms and incentives should be linked to
performance expectations and aligned with critical behaviors throughout the change process
(Eisenbach et al., 1999)
Course directors need to have the resources (time, human and financial support) to
develop the course by using appropriate educational technologies that support cognitive
process and effective delivery (Resources). Successful culture change initiatives often require
aligning institutional resources with an inspirational shared vision (Bender & Schuh, 2002;
Bolman & Deal, 1994; Doerfel & Ruben, 2002). This vision serves to define novel
accountability relationships and new stakeholder performance metrics, which unite
organizational stakeholders around a common purpose (Doerfel & Ruben, 2002; Dowd, 2005).
Transformational leaders champion organizational change by assembling resources, amassing
constituents, motivating the group, and implementing changes that are aligned with a clearly-
articulated shared vision of the future (Bolman and Deal, 1994; Eisenbach et al., 1999; Lipton,
1996; McDonald, 2007). Collaborative, ongoing, and strategic planning processes foster cultures
where substantive organizational change occurs (Hill, Thomas, & Keller, 2009). Eisenbach et al.
(1999) state that working toward realizing the organizational vision necessitates alignment of
strategic plans with stakeholder performance metrics, implementation of change initiatives, and
follow-through via evidence-based decisions. Thus, accountability procedures must be
established where all parties participate in ethical transactional relationships, where defined
performance measurements are agreed upon, transparent assessment protocols are implemented,
and stakeholders answer for consequences (Hentschke & Wohlstetter, 2004). Unification of
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 53

stakeholders around shared visions and providing them with the necessary resources creates a
strategic culture built on trust, collaboration, and accountability.
In sum, two resources influences are established. First, course directors need to have the
resources (time, human and financial support) to redesign courses based on educational best
practices for learner-centered blended learning design. Second, Course directors need to have
the resources (time, human and financial support) to develop the course by using appropriate
educational technologies that support cognitive process and effective delivery. By allocating
necessary resources and incentives for nontraditional teaching, innovative educational practices
can be institutionalized that would likely expand course director participation and simultaneously
develop quality (Green, 2016).
Course directors need to have the org policies and procedures aligned with their efforts
to redesign courses based on educational best practices for learner-centered blended learning
design (Policies). Institutional support is a necessary bridge to encourage adoption of blended
learning strategies by late adopters (Porter et al., 2016). Educational organizations that provide
policies, procedures, and support increase the likelihood that their blended course redesign
initiatives will be effective and sustainable (Dailey-Hebert, Bohle, Carbonell, & Gijselaers,
2013; McCrickerd, 2012; Porter et al., 2016; Schein, 2004; Schneider et al., 1996; Senge, 1990).
Carefully integrating workplace settings and proper developmental support with a shared
purpose is consistent with how Eisenbach et al. (1999) encourage innovative leaders to increase
constituent participation during transformational change initiatives.
Course directors need to have the organizational policies and procedures aligned with
their efforts to develop the course by using appropriate educational technologies that support
cognitive process and effective delivery (Policies). A cultural setting that features sound
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 54

accountability policies and procedures necessitates involvement of course directors and
alignment of a shared vision via strategic planning (Lipton, 1996; McDonald, 2007; Schein,
2004; Senge, 1990). In such a setting, open and direct communication between leader and
followers maximizes shared organizational commitment (Pincus, 2006). In successful data-
driven learning organizations, all stakeholders collaboratively establish novel accountability
relationships and generate performance metrics to increase performance (Bender & Schuh, 2002;
Doerfel & Ruben, 2002; Dowd, 2005; Marsh, 2012; Marsh & Farrell, 2015). Thus, a shared
vision mapped to measurable performance goals via a clearly communicated strategic plan
increases collective decision rights for all Ibis Academy stakeholders, which thereby is
consistent with suggestions for improved accountability procedures as outlined by Elmore
(2002).
In sum, two policies influences are established. First, course directors need to have the
organizational policies and procedures aligned with their efforts to redesign courses based on
educational best practices for learner-centered blended learning design. Second, course directors
need to have the organizational policies and procedures aligned with their efforts to develop the
course by using appropriate educational technologies that support cognitive process and effective
delivery. By aligning a clearly articulated shared vision with strategic plans, policies, and
procedures that serve as mechanisms for holding course directors accountable, Ibis Academy
initiatives can be institutionalized, which would increase participation and promote excellence.
Course directors need to believe that they are part of an organization that supports
their efforts to redesign courses based on educational best practices for learner-centered
blended learning design (Cultural Model). Institutional traditionalism impacts stakeholder
perceptions of organizational value for pedagogical creativity, experimentation with teaching
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 55

methods, and curricular innovation. Cognitive development research indicates that
nontraditional learning environments incorporating educational technologies should be used to
enhance, and not impede, social learning environments (Immordino-Yang, Christodoulou, &
Singh, 2012). Creativity research indicates that creativity is a time-consuming, iterative process
that requires collaboration and organizational support for risk-taking and failures (Sawyer,
2012a; Sawyer, 2012b). Therefore, organizations bear the responsibility of properly supporting
stakeholders associated with designing blended learning environments, where initial failures are
expected (King & Boyatt, 2014; McCrickerd, 2012).
Course directors need to believe that they are part of an organization that supports
their efforts to develop the course by using appropriate educational technologies that support
cognitive process and effective delivery (Cultural Model). In order to demonstrate value,
organizational commitment to innovation must modify cognitive processes, behaviors, and
affective responses from course directors. Darling-Hammond, Wilhoit, and Pittenger (2014)
suggest that organizations that hold value for innovative learning should vigorously support
“meaningful learning accountability, resource accountability, and professional accountability”
(p. 11). This type of infrastructure exhibits systems thinking and demonstrates organizational
value for innovation (Senge, 1990). Furthermore, executive leadership is encouraged to
understand the psychology of faculty choices during the innovation process, which lends itself to
committed reciprocity within accountability relationships (Darling-Hammond et al. 2012).
Indeed, using results from a qualitative study where 37 faculty members were interviewed,
Porter et al. (2016) recommend that organizations must evolve into nurturing, data-driven
learning organizations where multiple modes of support and interventions are made available to
improve faculty performance. These types of interventions influence stakeholder views,
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 56

interpretations, and perceptions of organizational commitment to and value for innovation (King
& Boyatt, 2014; Schein, 2004; Schneider et al. , 1996; Senge, 1990; Tellis, 2013).
In sum, two cultural model influences are established. First, course directors need to
believe that they are part of an organization that supports their efforts to redesign courses based
on educational best practices for learner-centered blended learning design. Second, course
directors need to believe that they are part of an organization that supports their efforts to
develop the course by using appropriate educational technologies that support cognitive process
and effective delivery. Once executive leadership demonstrates organizational support and value
for innovative educational practices, course directors will gain the needed foundation for risk-
taking and creativity, which enhances the likelihood of expanding nontraditional teaching
practices.
Course Directors need to believe that they are part of a team that works together to
redesign courses based on educational best practices for learner-centered blended learning
design (Cultural Setting). Physical workspace design and organizational commitment to
innovative teams are important considerations when recruiting course directors to participate in
nontraditional teaching initiatives. Increased collaboration and occupational performance are
correlated with innovative workplaces (Waber, Magnolfi, & Lindsay, 2014). Although research
is limited that directly links physical workspace settings with increasing the capacity of creative
teams, Malinin (2015) presents a conceptual framework that fuses the creative process with
workplace settings, where cognitive processes are linked to physical space, social space, and
behavioral actions. Emerging research indicates the importance for organizations to create
physical workplace settings that are conducive for creative and collaborative practitioners
(Malinin, 2015; Waber et al., 2014). Therefore, purposefully designing workplace environments
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 57

to encourage stakeholder collaboration aligns organizational innovation with shared aspirations.
Course directors need to believe that they are part of a team that works together to
develop the course by using appropriate educational technologies that support cognitive
process and effective delivery (Cultural Setting). Effective leaders model expected behaviors
for followers and empower stakeholders to participate in shared communication efforts (Berger,
2014). McCrickerd (2012) recommends that leaders of organizations wishing to minimize
traditionalism need to establish nurturing cultures for resistant stakeholders, where risk-taking is
celebrated and evidence-based improvements are incrementally incorporated. Additionally,
Schneider et al. (1996) report that implemented changes are effectively sustained when the
organization’s leadership sends robust messages about the value for innovative cultures and
climates. Replacing traditionalism requires organizational commitment to sustained change by
broadcasting its strong value for challenging the status quo via empowered collaborative
mechanisms.
In sum, two cultural setting influences are established. First, course directors need to
believe that they are part of a team that works together to redesign courses based on educational
best practices for learner-centered blended learning design. Second, course directors need to
believe that they are part of a team that works together to develop the course by using
appropriate educational technologies that support cognitive process and effective delivery. By
nurturing a setting where all stakeholders engage in collaborative team-building efforts,
participation in Ibis Academy initiatives could increase and a shared sense of purpose would
unite the community.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 58

Table 4
Summary of course directors’ assumed needs and general literature for organization gap
analysis

Assumed Needs for
Reducing Ambivalence
General Literature
Organizational
Course directors need to have the
resources (time, human and financial
support) to redesign courses based on
educational best practices for learner-
centered blended learning design.
(Resources)

(Jaskyte, Taylor, and Smariga, 2009; Porter,
Graham, Bodily, and Sandberg, 2016)
Course directors need to have the
resources (time, human and financial
support) to develop the course by using
appropriate educational technologies
that support cognitive process and
effective delivery. (Resources)
(Bender & Schuh, 2002; Bolman and Deal,
1994; Doerfel & Ruben, 2002; Dowd, 2005;
Eisenbach, Watson, & Pillai, 1999; Hentschke
& Wohlstetter, 2004; Hill, Thomas, & Keller,
2009, Lipton, 1996; McDonald, 2007)

Course directors need to have the org
policies and procedures aligned with
their efforts to redesign courses based
on educational best practices for
learner-centered blended learning
design. (Policies)

(Dailey-Hebert, Bohle, Carbonell, &
Gijselaers, 2013; Eisenbach, Watson, and
Pillai, 1999; McCrickerd, 2012; Porter,
Graham, Bodily, & Sandberg, 2016; Schein,
2004; Schneider, Brief, & Guzzo, 1996; Senge,
1990)
Course directors need to have the
organizational policies and procedures
aligned with their efforts to develop the
course by using appropriate educational
technologies that support cognitive
process and effective delivery.
(Policies)

(Bender & Schuh, 2002; Doerfel & Ruben,
2002; Dowd, 2005; Lipton, 1996; Marsh, 2012;
Marsh & Farrell, 2015; McDonald, 2007;
Pincus, 2006; Schein, 2004; Senge, 1990)
Course directors need to believe that
they are part of an organization that
supports their efforts to redesign
courses based on educational best
practices for learner-centered blended
learning design. (Cultural Model)
(Immordino-Yang, Christodoulou, & Singh,
2012; King & Boyatt, 2014; McCrickerd,
2012; Sawyer, 2012a; Sawyer, 2012b)

Course directors need to believe that
they are part of an organization that

(Darling-Hammond, Wilhoit, & Pittenger,
2014; King & Boyatt, 2014; McCrickerd,
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 59

supports their efforts to develop the
course by using appropriate educational
technologies that support cognitive
process and effective delivery.
(Cultural Model)

2012; Porter, Graham, Bodily, and Sandberg,
2016; Schein, 2004; Schneider, Brief, &
Guzzo, 1996; Senge, 1990; Tellis, 2013)
Course Directors need to believe that
they are part of a team that works
together to redesign courses based on
educational best practices for learner-
centered blended learning design.
(Cultural Setting)
(Malinin, 2015; Waber, Magnolfi, & Lindsay,
2014)

Cultural Model Influence #3:
Course directors observe executive
leadership within the institution
changing the culture of traditionalism
that maintains status quo and stifles
innovation for course directors.
(Culture and Leadership)
(Berger, 2014; McCrickerd, 2012; Schneider,
Brief, & Guzzo, 1996)

Conclusion
This study addressed the assumed knowledge, motivation, and organizational needs
(KMO) among Ibis Academy course directors that impact the organization’s effectiveness in
leading next generation medical education reforms that featuring student-centered learning
strategies. A general review of literature that summarized effective transformational leadership
strategies under the context of organizational change was presented. Assumed knowledge,
motivation, and organizational influences currently impacting the implementation of an
innovative medical education reform initiative was showcased and verified alongside theories
and corresponding literature. The assumed KMO influences include the following:
● Declarative, procedural, and metacognitive knowledge.
● Expectancy-value, self-efficacy, and attribution theories of motivation.
● Organizational leadership, vision, strategic plans, and accountability.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 60

● Organizational policies, procedures, and processes.
● Organizational commitment to creativity and innovation.
The procedures for validating these assumed influences appear in Chapter Three.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 61

CHAPTER THREE: METHODOLOGY
Purpose of the Project and Questions
The purpose of this study is to conduct a needs assessment to understand knowledge,
motivation, and organizational factors that are needed to help 100% of the preclinical course
directors achieve the stakeholder goal of implementing student-centered teaching strategies by
using Ibis Academy approaches for technology-enriched course designs. To date, two modules
within the two-year preclinical medical education curriculum have been redesigned and
successfully piloted. Thus, Ibis Academy has impacted two weeks of the entire preclinical
curriculum. The guiding questions for this study are the following:
1. What are the knowledge, motivation, and organizational needs for course
directors implementing Ibis Academy approaches during preclinical medical
education modules as represented in their critical behaviors?
2. What are the recommended knowledge, motivation, and organizational solutions
to those needs?
Site
The Urban School of Medicine is a medium-sized, private university located in the
southeastern United States (Ibis Academy, 2016). Faculty members, administrators, executive
leadership, and students are the primary stakeholders found within the medical school. The
medical education department provides academic services to preclinical (years one and two) and
clinical (years three and four) medical education students. The department is nested within the
school of medicine, which sets institutional-level priorities, vision statements, and strategic
goals. An institutional strategic goal aims to provide innovative (technologically-enhanced) and
efficient (cost-friendly) educational experiences for preclinical medical education students
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 62

(SUUCSOM, 2016). Thus, Ibis Academy serves as a resource to support such faculty-driven
curricular overhauls by providing assistance with generating technology-enriched learning
experiences using established educational best practices (Ibis Academy, 2016). Ibis Academy
personnel typically interact with faculty members who serve as course directors. These faculty
members oversee all logistics associated with the preclinical academic modules, manage the
lecturers who deliver academic content, and are responsible for student academic performance.
Conceptual and Methodological Approach
This study incorporated the Clark and Estes (2008) gap analysis framework, which is a
diagnostic process to identify root causes of gaps between stakeholder performance goals and
existing performance lags. Figure 2 describes the Clark and Estes (2008) gap analysis process.

Figure 2. Gap analysis process conceptual framework adapted from Clark and Estes (2008).
Conceptual frameworks graphically depict underlying notions and theories that direct a
research study (Maxwell, 2013). In other words, a conceptual framework is a provisional model
that informs research design (Maxwell, 2013). Merriam and Tisdell (2016) describe the
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 63

theoretical framework as the “scaffolding” that “informs a study” (p. 85). For this study,
assumed influences that limit course director participation and success in Ibis Academy
(pseudonym) initiatives were described independently. In reality, these assumed influences
coexist and interact in concert. The purpose of the interactive conceptual framework presented
here (see Figure 3) is to graphically describe the alignment between a relevant organizational
goal with the assumed needs and theories underlying the Knowledge-Motivation-Organizational
(KMO) gap analysis (Clark & Estes, 2008), while simultaneously depicting the nested
organizational context within which Ibis Academy support staff and course directors are
collaborating.
In sum, conceptual frameworks illustrate the underlying assumptions and theories that
scaffold research design (Maxwell, 2013; Merriam & Tisdell, 2016). In this case study,
organizational goals are impacted by the interaction of knowledge and motivation influences
within a nested organizational structure. In order for course directors and Ibis Academy to
achieve success, which in this case is exceeding thresholds for all internal metrics used to
measure medical education courses, underlying knowledge, motivation, and organizational
influences needed to be better understood. Furthermore, the interactions associated with these
influences and the situational contexts within which these interactions occur were important
considerations when analyzing current performance gaps. The conceptual model presented here
illustrates underlying assumptions and theories that guide the mixed methods approach used in
this study.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 64

Figure 3. Interactive conceptual framework that depicts the course directors’ needs analysis.
Assessment of Performance Influences
Next generation medical education features several components that course directors
need to understand and incorporate into effective course redesign projects. These components
include technology-enriched learning environments, analytics to drive interventions,
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 65

neuroscience and cognitive research, self-regulated learning strategies, competency-based
approaches, and blended learning instructional design (Green, 2016). However, knowledge gaps,
motivational issues, and organizational influences can interact to either facilitate or limit course
director adoption of nontraditional teaching strategies during this paradigm shift (Clark & Estes,
2008). For example, course directors need declarative knowledge of educational best practices
and student outcomes (Dailey-Hebert, Carbonell, & Gijselaers, 2013; Garrison & Vaughan,
2008; Garrison & Vaughan, 2013), procedural knowledge of how to design and develop content
(Anguera et al., 2013; Azevedo, Cromley, Moos, Greene, & Winters, 2011; Berman et al., 2008;
Homer et al., 2008; Mayer, 2011; Schraw & McCrudden, 2006), and metacognitive knowledge
that helps with reflection-in-practice (Ferry & Ross-Gordon, 1998; King & Boyatt, 2015; Mayer,
2011; Rodgers, 2002; Schraw and McCrudden, 2006; Wilson, 2008).
Next, course director motivation could potentially be explained by several motivational
theories, which include cost/benefit values, self-efficacy, emotions, and attribution (Bandura,
2000; Eccles, 2006; Jaskyte, Taylor, & Smariga, 2009; Johnson, Stewart, and Bachman, 2015;
Matusovich, Paretti, McNair, & Hixson, 2014; McCrickerd, 2012; Pajares, 2006; Pintrich, 2006;
Porter et al, 2016; Rogers, 2003; Schraw & Lehman, 2009; Yough & Anderman, 2006).
Lastly, organizational influences are important to help course directors align teaching
responsibilities with expected institutional objectives, while providing them opportunities and
resources to be creative and challenge traditionalism (Bolman and Deal, 1994; Eisenbach,
Watson, & Pillai, 1999; Hill, S., Kogler, T., & Keller, 2009; Lipton, 1996; McDonald, 2007;
Sawyer, 2012a; Sawyer, 2012b; Schein, 2004; Senge, 1990). Organizational leadership directly
influences the cultural models and cultural settings within which course directors are working
(Bender & Schuh, 2002; Bolman and Deal, 1994; Doerfel & Ruben, 2002; Dowd, 2005; Earl &
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 66

Fullan, 2003; Elmore, 2002; Immordino-Yang, Christodoulou, & Singh, 2012; Marsh, 2012;
Marsh & Farrell, 2015; McCrickerd, 2012; Pintrich, 2003; Sawyer, 2012a; Sawyer, 2012b;
Schein, 2004; Schneider, Brief, & Guzzo, 1996; Senge, 1990). Knowledge and motivation
influences interact within the situational context of a nested organizational structure to impact
course director performance and Ibis Academy’s ability to achieve organizational goals. This
study explored which of those assumed influences are already present (assets) and which are
needed (gaps) for the course designers to be successful. Table 5 provides a summary of the
assumed needs for knowledge, motivation, and organizational influences that limit course
director performance.
An explanatory sequential mixed methods approach was an appropriate experimental
design for this project (Creswell, 2014). First, quantitative data was collected from purposefully-
selected course directors via an online survey and analyzed. This analysis helped generate
appropriate questions for follow-up qualitative research. Face-to-face interviews with course
directors provided nuanced responses to help explain the survey data and assess any areas that
were not effectively addressed by the survey, such as some knowledge causes. The KMO needs
analysis will now be summarized so that solutions and recommendations can be made to the
organization’s executive leadership.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 67

Table 5
Summary of assumed needs for knowledge, motivation, and organizational influences
Assumed Needs
Sources Knowledge Motivation Organization

Learning,
Motivation, and
Organizational
Theory and Related
General Literature

• Course directors
need to know the
goal of Ibis
Academy and what
is expected of them
with respect to
course redesign.
(Factual)

• Course directors
need to know
educational best
practices for learner-
centered blended
learning design.
(Factual)

• Course directors
need to know
appropriate
educational
technologies that
support cognitive
process and effective
delivery. (Factual)

• Course directors
need to know the
relationship between
best practices and
student outcomes.
(Conceptual)

• Course directors
need to know the

• Course directors
need to value
redesigning courses
to reflect best
practices for
learner-centered
blended learning.
(Value)

• Course directors
need to value
developing courses
that use appropriate
educational
technologies that
support cognitive
process and
effective delivery.
(Value)

• Course directors
need to be
confident that they
can design courses
based on
educational best
practices for
learner-centered
blended learning
design. (Self-
Efficacy)

• Course directors
need to be
confident that they

• Course directors
need to have the
resources (time,
human and financial
support) to redesign
courses based on
educational best
practices for learner-
centered blended
learning design.
(Resources)

• Course directors
need to have the
resources (time,
human and financial
support) to develop
the course by using
appropriate
educational
technologies that
support cognitive
process and effective
delivery. (Resources)

• Course directors
need to have the
organizational
policies and
procedures aligned
with their efforts to
redesign courses
based on educational
best practices for
learner-centered
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 68

relationship between
appropriate
educational
technologies and
student outcomes.
(Conceptual)

• Course directors
need to know how to
redesign courses
based on educational
best practices for
learner-centered
blended learning
design. (Procedural)

• Course directors
need to know how to
develop the course
by using appropriate
educational
technologies that
support cognitive
process and effective
delivery.
(Procedural)

• Course directors
need to reflect on
their progress toward
redesigning courses
based on educational
best practices for
learner-centered
blended learning
design.
(Metacognitive)

• Course directors
need to reflect on
their progress toward
developing the
course by using
appropriate
educational
can develop
courses that use
appropriate
educational
technologies that
support cognitive
process and
effective delivery.
(Self-Efficacy)

• Course directors
need to feel
positive about
redesigning courses
based on
educational best
practices for
learner-centered
blended learning
design. (Emotions)

• Course directors
need to feel
positive about
developing courses
that use appropriate
educational
technologies that
support cognitive
process and
effective delivery.
(Emotions)

• Course Directors
need to believe that
improved student
outcomes are the
result of their
efforts in
redesigning courses
based on
educational best
practices for
learner-centered
blended learning
blended learning
design. (Policies)

• Course directors
need to have the
organizational
policies and
procedures aligned
with their efforts to
develop the course by
using appropriate
educational
technologies that
support cognitive
process and effective
delivery. (Policies)

• Course directors
need to believe that
they are part of an
organization that
supports their efforts
to redesign courses
based on educational
best practices for
learner-centered
blended learning
design. (Cultural
Model)

• Course directors
need to believe that
they are part of an
organization that
supports their efforts
to develop the course
by using appropriate
educational
technologies that
support cognitive
process and effective
delivery. (Cultural
Model)

• Course Directors
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 69

technologies that
support cognitive
process and effective
delivery.
(Metacognitive)
design.
(Attribution)

• Course directors
need to believe that
improved student
outcomes are the
result of their
efforts in
developing courses
that use appropriate
educational
technologies that
support cognitive
process and
effective delivery.
(Attribution)
need to believe that
they are part of a
team that works
together to redesign
courses based on
educational best
practices for learner-
centered blended
learning design.
(Cultural Setting)

• Course directors
need to believe that
they are part of a
team that works
together to develop
the course by using
appropriate
educational
technologies that
support cognitive
process and effective
delivery. (Cultural
Setting)

Knowledge Assessment
The literature revealed nine possible knowledge influences, as displayed in Table 6.
Three of these represent factual knowledge and were assessed through open-coding of interview
questions asking participants to describe their understandings of key terminology. Two of these
represent conceptual knowledge and were assessed through interview questions asking
participants to describe the types of instructional practices and educational technologies that
enrich courses and improve student outcomes. Two of these represent procedural knowledge and
were assessed through interview questions asking participants to describe how they would create
a technology-enriched learning environment. Two of these represent procedural knowledge and
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 70

were assessed through interview questions asking participants to describe how they reflect on
their teaching practices and self-assess their effectiveness with developing student-centered
learning environments.
Table 6

Summary of course directors’ assumed knowledge needs aligned with validation strategies

Assumed needs for reducing ambivalence

Validation strategies

Knowledge

Course directors need to know the goal of Ibis
Academy and what is expected of them with respect to
course redesign. (Factual)

• Open-coding of interview
transcripts
Course directors need to know educational best
practices for learner-centered blended learning design.
(Factual)
• When I say “blended
learning,” what does this
term mean to you?

Course directors need to know appropriate educational
technologies that support cognitive process and
effective delivery. (Factual)
• When I say “technology-
enriched learning
environment,” what does this
phrase mean to you?

Course directors need to know the relationship between
best practices and student outcomes. (Conceptual)
• In your opinion, what types
of instructional practices
improve student outcomes?

Course directors need to know the relationship between
appropriate educational technologies and student
outcomes. (Conceptual)
• If any, what types of
educational technologies
might you use to enrich your
current course?

Course directors need to know how to redesign courses
based on educational best practices for learner-centered
blended learning design. (Procedural)

Course directors need to know how to develop the
course by using appropriate educational technologies
that support cognitive process and effective delivery.
(Procedural)
• Non-lecture based courses
employ educational
technologies to deliver
content to students. Explain
to me how you would create
a computer-assisted learning
environment. Please walk
me through that process.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 71

Course directors need to reflect on their progress
toward redesigning courses based on educational best
practices for learner-centered blended learning design.
(Metacognitive)

• When designing learning
experiences, how do you
reflect on your progress?
Course directors need to reflect on their progress
toward developing the course by using appropriate
educational technologies that support cognitive process
and effective delivery. (Metacognitive)
• Please tell me how you
assess your effectiveness in
developing learning
environments.

Motivation Assessment
The literature revealed eight possible motivation influences, as displayed in Table 7.
Two of these can be described by the Expectancy-Value Theory with cost/benefit value construct
and were assessed through survey and interview questions asking about the value participants
have for redesigning and developing technology-enriched courses. Two of these can be
described by the Self-Efficacy Theory and were assessed through survey and interview questions
asking participants about their perceived effectiveness in creating and leading technology-
enriched learning environments. Two of these can be described by emotions and were assessed
through survey and interview questions asking participants about their emotional mindsets
toward redesigning and developing technology-enriched courses. Two of these can be described
by attribution theory and were assessed through survey and interview questions asking
participants to explain their beliefs about the relationships between efforts spent developing
technology-enriched courses and student outcomes.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 72

Table 7

Summary of course directors’ assumed motivation needs aligned with validation strategies

Assumed needs for reducing ambivalence

Validation strategies

Motivation

Course directors need to value redesigning courses to
reflect best practices for learner-centered blended
learning. (Value)
• How important do you feel it
is it for you to redesign
courses using non-lecture
based approaches?
• Survey: value items

Course directors need to value developing courses that
use appropriate educational technologies that support
cognitive process and effective delivery. (Value)
• How important do you feel it
is it for you to develop
courses using educational
technologies?
• Survey: value items

Course directors need to be confident that they can
design courses based on educational best practices for
learner-centered blended learning design. (Self-
Efficacy)
• To what degree do you feel
confident about your ability
to design a student-centered
learning environment?
• Survey: self-efficacy items

Course directors need to be confident that they can
develop courses that use appropriate educational
technologies that support cognitive process and
effective delivery. (Self-Efficacy)
• When developing a course,
to what degree do you feel
confident about your ability
to implement educational
technologies?
• Survey: self-efficacy items

Course directors need to feel positive about redesigning
courses based on educational best practices for learner-
centered blended learning design. (Emotions)

• How do you feel about
redesigning courses using
non-lecture based
approaches?
• Survey: emotions items

Course directors need to feel positive about developing
courses that use appropriate educational technologies
that support cognitive process and effective delivery.
(Emotions)
• How do you feel about
developing courses using
educational technologies?
• Survey: emotions items
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 73

Course Directors need to believe that improved student
outcomes are the result of their efforts in redesigning
courses based on educational best practices for learner-
centered blended learning design. (Attribution)
• To what extent do you
believe that your effort spent
on redesigning courses using
non lecture-based approaches
improves student learning?
• Survey: attribution items

Course directors need to believe that improved student
outcomes are the result of their efforts in developing
courses that use appropriate educational technologies
that support cognitive process and effective delivery.
(Attribution)
• To what extent do you
believe that your effort spent
on developing courses using
educational technologies
improves student learning?
• Survey: attribution items

Organization/Culture/Context Assessment
The literature revealed eight possible organization influences, as displayed in Table 8.
Two of these influences are described as resources influences and were assessed through survey
and interview questions asking participants about organizational resources that support
instructional creativity. Two of these influences are described as policies influences and were
assessed through survey and interview questions asking participants about the alignment of their
teaching activities with the institutional vision and strategic plan. Two of these influences are
described as cultural model influences and were assessed through survey and interview questions
asking participants about executive leadership’s value for pedagogical innovation and creativity.
Two of these influences are described as cultural setting influences and were assessed through
survey and interview questions asking participants about the extent to which they believed they
are part of a team that works together to design and develop student-centered technology-
enriched courses.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 74

Table 8

Summary of course directors’ assumed needs for organizational influences aligned with
validation strategies

Assumed needs for reducing ambivalence

Validation strategies

Organizational

Course directors need to have the resources (time,
human and financial support) to redesign courses based
on educational best practices for learner-centered
blended learning design. (Resources)

Course directors need to have the resources (time,
human and financial support) to develop the course by
using appropriate educational technologies that support
cognitive process and effective delivery. (Resources)

• Describe the organizational
resources that support your
creativity as an educator.
• Survey: Organizational
Influences Section I items

Course directors need to have the org policies and
procedures aligned with their efforts to redesign
courses based on educational best practices for learner-
centered blended learning design. (Policies)

Course directors need to have the org policies and
procedures aligned with their efforts to develop the
course by using appropriate educational technologies
that support cognitive process and effective delivery.
(Policies)

• What policies exist to help
you align your teaching
practices with the
institution’s strategic plan for
innovative medical
education?
• Survey: Organizational
Influences Section I items

Course directors need to believe that they are part of an
organization that supports their efforts to redesign
courses based on educational best practices for learner-
centered blended learning design. (Cultural Model)
• Imagine I am a new faculty
member here and you are
speaking to me about
teaching practices during my
first week on-the-job. Tell
me about the organizational
culture of undergraduate
medical education.

Course directors need to believe that they are part of an
organization that supports their efforts to develop the
course by using appropriate educational technologies
that support cognitive process and effective delivery.
(Cultural Model)
• Tell me about the executive
leadership team’s vision for
supporting your efforts with
developing innovative
teaching and learning
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 75

environments.
• Survey: Organizational
Influences Section I items

Course Directors need to believe that they are part of a
team that works together to redesign courses based on
educational best practices for learner-centered blended
learning design. (Cultural Setting)

• To what extent do you
believe that you are part of a
team that works together to
redesign courses using
nontraditional educational
practices?
• Survey: Organizational
Influences Section I items

Course directors need to believe that they are part of a
team that works together to develop the course by using
appropriate educational technologies that support
cognitive process and effective delivery. (Cultural
Setting)

• To what extent do you
believe that you are part of a
team that works together to
develop courses using
appropriate educational
technologies?
• Survey: Organizational
Influences Section I items

Participating Stakeholders
A comprehensive needs analysis would be all-inclusive of myriad stakeholders at the
Urban School of Medicine. However, to best investigate the interaction of organizational
influences with knowledge and motivation factors that drive performance, this project focuses on
course directors, as they are the faculty members most responsible for direct participation with
Ibis Academy initiatives. Course directors are faculty members who oversee the organizational
and logistical components of the various undergraduate medical education academic modules
that comprise the two-year curriculum. These responsibilities include overseeing the groups of
faculty members that lead lectures and teach preclinical medical students. Thus, course directors
ultimately decide how courses will be delivered, what content is to be included in the learning
experiences, and which teaching strategies will be featured.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 76

The 34 course directors who oversee the preclinical medical education curriculum at this
medical school were deliberately recruited for this study. For this mixed methods study,
particular criteria, described below, were used to identify the appropriate research participants to
sample (Creswell, 2014; Maxwell, 2013; Merriam & Tisdell, 2016).
Data Collection
This study used an explanatory sequential mixed methods design, where quantitative data
were collected and analyzed first (Creswell, 2014). Qualitative data collection and analysis
followed, which helped the researcher explain the quantitative data in greater depth (Creswell,
2014). First, quantitative data were collected via an online survey and analyzed. Then,
qualitative data were collected using follow-up face-to-face standardized open-ended interview
sessions with individual participants (Creswell, 2014; Patton, 2002). The sample size of 34
course directors is small for a quantitative study and the timeframe for investigation is short.
Thus, the qualitative component of the mixed methods approach was important and allowed for a
deeper exploration of perspectives. The qualitative component assisted with gaining further
insight and helped to explain the quantitative results that were previously obtained via online
survey. Therefore, although the quantitative data collected were useful, it will not be
generalizable to a larger population, though future studies could be conducted in a similar
manner at other medical schools and results could be compared across the institutions.
In this study, all research was conducted in a manner that is consistent with ethical
guidelines as outlined by the Institutional Review Board (Glesne & Peshkin, 2011). Information
sheets were shared with participants at the start of the study that outlined ethical practices and
rights. Likewise, consent for audio recording of the face-to-face interview sessions was obtained
(Glesne & Peshkin, 2011). Participants were reminded that their participation was completely
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 77

voluntary, they may withdraw at any time for any reason without penalty, identities would be
kept anonymous without identifiers, and data will be kept confidential (Glesne & Peshkin, 2011).
Survey
Non-probability, purposeful sampling was used in this study that employed an
explanatory sequential mixed methods approach (Creswell, 2014; Maxwell, 2013). Unique
course directors lead or co-lead each of the 25 academic modules within the preclinical medical
education curriculum. Therefore, sampling is limited to those 34 individuals who lead or co-lead
the academic modules. The course directors must be targeted, which meant that a random
sampling technique was not feasible for this study (Maxwell, 2013). These course directors are
nested within the larger organization, so it should be possible to identify how their knowledge
and motivation influences interact with the organization to shape their abilities to reach
performance goals.
Survey Sampling Criteria.
Criterion 1. Eligible research participants had to be faculty members at the Urban School
of Medicine. A more robust study could include faculty members from across the university.
However, as the research questions are focused on a narrower initiative (Ibis Academy), only
faculty members who have professional ties to the Ibis Academy initiative were included in this
study.
Criterion 2. Eligible research participants had to be faculty members who teach classes
within the two-year undergraduate medical education programs at the Urban School of Medicine.
Not all faculty members actually teach classes. Such faculty members were not applicable to the
gap analysis proposed for this study.
Criterion 3. Eligible research participants had to be course directors who oversee a
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 78

module(s) within the two-year undergraduate medical education programs at the Urban School of
Medicine. Ibis Academy personnel interact directly with course directors on course redesign
projects. Faculty members who teach but are not course directors do not necessarily have the
control over logistics and course design. Thus, course directors who oversee the modules that
comprise the preclinical medical education curriculum are the stakeholders who interact directly
with Ibis Academy. Consequently, course directors are also most responsible for organizational
change efforts associated with medical education reform. Likewise, they interact with many
other faculty members and can influence many members of the organizational community.
Therefore, understanding the KMO influences that limit their participation and/or negatively
influence their abilities to effectively create computer-assisted learning environments makes
course directors the appropriate choice as the focal participant group for this study.
Survey Instrumentation. Knowledge, motivation, and organization theory found during
the literature search was applied to the focal stakeholder group (course directors). Then,
assumed needs were generated and organized according to the knowledge, motivation, and
organizational influences. Each assumed need was aligned with an appropriate prompt, which
was then ingested into a secure survey tool called Qualtrics. The online survey used a
combination of Likert-style scale questions, interactive rating scales, and open-ended prompts to
gather information about course director perspectives on assumed knowledge, motivation, and
organizational influences that drive their participation in Ibis Academy initiatives (see Appendix
A).
Survey Data Collection. First, all 34 course directors were sent an email invitation with
a link to complete an online survey (see Appendix C). A secure, cloud-based survey tool
(Qualtrics) was used to field the survey and gather data. Course director email addresses were
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 79

obtained from the school of medicine’s curriculum office, which maintains a database of course
director contact information. An email reminder was sent seven days, 14 days, and 21 days after
the initial invitation to help increase response rate. The online survey was closed after 28 days.
Interview
The second data collection strategy incorporated face-to-face standardized open-ended
interview sessions (Patton, 2002). An interview protocol was generated based on analysis of
survey data so that each participant was asked the same question in exactly the same order
(Creswell, 2014). Open-ended questions adhered to best practices for interview question
construction as described by Patton (2002). While this approach limited flexibility during the
interview sessions, interviewer biases were minimized, efficiency was increased, and responses
were comparable across all respondents (Patton, 2002; Weiss, 1994). Given the researcher’s
working relationship with the research participants, minimizing the potential for conflicts-of-
interest was important in this study (Glesne & Peshkin, 2011). These interviews provided the
necessary venue to ask questions of the stakeholders who are best able to reveal deeper, complex
understanding of this study’s core research questions.
In qualitative research, purposeful sampling is useful so that those participants who can
best help provide insight into the primary research aims can be selected (Creswell, 2015). In this
study, course directors are the stakeholder most capable of contributing to the understanding of
factors that drive organizational successes and failures in terms of achieving performance goals.
Since this study is not a random sampling of all faculty members at the school of medicine and
course directors were targeted, non-probability sampling is appropriate. While this will not
necessarily lead to results that can be generalized to a larger population beyond the immediate
research setting, this pool of research participants should provide useful and nuanced insight into
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how knowledge and motivation influences interact with cultural settings and cultural models to
impact their capacity to achieve performance goals.
Interview Sampling Criteria.
Criterion 1. Eligible research participants had to be faculty members who teach classes
within the two-year undergraduate medical education programs at the Urban School of Medicine.
A more robust study could include additional stakeholders from inside the focal institution. For
example, all faculty members, administrators, and students could potentially provide meaningful
insight. However, such research is beyond the scope of the current study. The research
questions focused specifically on Ibis Academy, so only those faculty members who have direct
relationships to the Ibis Academy initiative were included in this study.
Criterion 2. Eligible research participants had to be course directors who oversee
module(s) within the two-year undergraduate medical education programs at the Urban School of
Medicine. The gap analysis used in this study is applicable specifically to those faculty members
who serve as course directors. These stakeholders have wide-ranging impact across the
organization and are most directly tied to the Ibis Academy initiative.
Criterion 3. Eligible research participants had to be course directors who oversee
module(s) within the two-year undergraduate medical education programs at the Urban School of
Medicine and they must have completed the online Qualtrics survey. For this mixed methods
approach, there were two data collection strategies. To be eligible to participate in the second
data collection phase of the study, eligible participants had to have already completed the online
survey.
Interview Instrumentation. Knowledge, motivation, and organization theory obtained
during literature searches was applied to the focal stakeholder group (course directors).
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Following analysis of the survey data, interview questions were developed to help identify
emergent themes and nuanced data around the assumed knowledge, motivation, and organization
needs. Each assumed need was aligned with at least one appropriate interview question. A copy
of the survey appears in Appendix 2.
Interview Data Collection. Follow-up face-to-face standardized open-ended interview
sessions were used to gather perspective data from each of the course directors who were
interested in participating (Patton, 2002). The goal was to conduct interviews with ten course
directors. Eleven interviews were actually conducted. A few course directors did not complete
the online survey and some declined participation in the interview phase.
During the face-to-face interview sessions and with permission of the research
participants, these discussions were audio-recorded for transcription and data analysis needs
(Glesne & Peshkin, 2011). The researcher led the interview sessions, followed the interview
protocol, and took field notes. Face-to-face interviews typically lasted about one hour, and were
composed of the interviewer and a single interviewee. Rich, nuanced discussions were observed
during these sessions as conversations evolved (Rubin & Rubin, 2012; Weiss, 1994). Data
collection via interviews ceased once a saturation point was observed and no new themes were
emerging (Creswell, 2015).
Data Analysis
This explanatory sequential mixed methods study required two different phases of data
analysis. First, quantitative survey data were analyzed. The results from this analysis helped
guide the development of the interview protocol. Then, qualitative data was collected via face-
to-face interviews and analyzed. Integration of the two datasets was used to determine if each of
the assumed needs was validated or not.
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Survey
The survey was administered online via Qualtrics software, and the response rate was
79.4% (27 of 34 course directors responded). Then, data were statistically analyzed. Descriptive
statistics analyses were used to summarize data from each of the survey prompts. To begin, data
was exported from Qualtrics into an Excel spreadsheet, where it was cleaned (Alkin, 2011;
Johnson & Christensen, 2015; Salkind, 2017). In the event that data was missing, a period was
to be placed within the appropriate cell to indicate there is no value. However, an initial review
of the data revealed that all surveys were fully completed. Once the entire dataset was cleaned
and missing or conflicting data was accounted for, then the descriptive statistical analysis
followed. When applicable, frequency of responses, means, modes, and standard deviations
were calculated for each of the survey items. The survey contained a variety of question types,
which determined the types of descriptors for central tendency and measures of variability
(Johnson & Christensen, 2015; Salkind, 2017). Nominal data was described with a mode, but no
measure of variability. Modes and medians alongside a range were reported for ordinal data.
For questions with interval or ratio scales of measurement, modes, medians, and means were
used to describe the central tendencies, and standard deviations were calculated to describe the
variability (Johnson & Christensen, 2015).
A descriptive statistical analysis was conducted for the self-efficacy responses, where
measures of central tendency and dispersion statistics were calculated. Values-based survey
questions used a Likert-type scale, so frequencies and modes were obtained. The organizational
barriers questions yielded information that informed the interview process. Following the survey
data analysis, preliminary emergent themes were identified, and these themes were used to guide
development of the interview protocol. The complete survey data analysis ultimately yielded
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information to compare against and validate assumed knowledge, motivation, and organizational
needs.
Interviews
Eleven face-to-face interviews were completed. Audio recordings were made during
each interview session, and notes were taken within a journal during each interview. Reflection
notes and research memos were written immediately following each interview by the researcher.
Following completion of each interview session, audio files were immediately transcribed. Each
audio file was listened to twice during the transcription process to ensure accuracy. Next, data
was analyzed and coded to identify emergent themes and to explore deeper, nuanced
meaning. Likewise, field notes were analyzed to enhance understanding of participant responses
and for any body language and other nonverbal forms of communication that may have been
observed during the live sessions.
Multiple coding phases were conducted that allowed for the analysis of qualitative data to
progress from open coding to axial coding (Harding, 2013; Merriam & Tisdell, 2016; Miles,
Huberman, & Saldaña, 2014). The coding scheme was based on the study’s guiding research
questions, which were aligned with the assumed knowledge, motivation, and organizational
needs. Thus, specific interview questions aligned with the individual assumed needs, which
yielded data that was used to validate this study’s underlying assumptions and theories.
These coding procedures led to pattern coding and identification of themes and findings
(Harding, 2013). To begin the coding process, each transcript was opened in Microsoft Word.
Passages were highlighted that contained some level of useful information. Then, using the
“Comments” function, each of these passages was paraphrased and assigned a category that was
related to the study’s conceptual framework. The annotated passages were then color-coded
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according to category. Each of the paraphrased comments was copied and pasted into the fourth
column of a four-column Microsoft Excel spreadsheet, which served as the codebook. Each
interview transcript had a unique worksheet within the codebook. Similar codes were grouped
and sorted, which yielded a sub-category (third column of the Excel spreadsheet). These sub-
categories formed the foundation of the axial, or analytic, coding process (Harding, 2013;
Merriam & Tisdell, 2016). The sub-categories were copied and pasted into the second column of
the Excel spreadsheet. These were each grouped according to the umbrella category in the first
column, which aligned with the study’s conceptual framework.
A frequency table was generated from all interviews, categories, and sub-categories.
These frequency tables helped with determinations of typicality across the entire dataset.
Emergent patterns were observed, and themes were documented via synthesis statements
(Merriam & Tisdell, 2016). As part of the member-checking process, several interview
participants were recruited to validate the findings (Merriam & Tisdell, 2016). The interview
data analysis produced additional and nuanced information to compare against and validate
assumed knowledge, motivation, and organizational needs.
Corbin and Strauss (2008) identify multiple strategies that help researchers interrogate
datasets, critically think about observations, and align findings with the study’s conceptual
framework. In this study, researcher bias and reactivity were potential validity threats, so it was
important to engage in multiple analytic strategies to ensure proper conclusions are made
(Maxwell, 2013). Constant questioning of the data, making comparisons, drawing upon personal
experience, and looking for negative cases were the four strategies I used to interrogate the data
(Corbin and Strauss; 2008). First, I employed the strategy constant questioning during the entire
data collection and analysis phases, which provided opportunities to investigate information from
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multiple perspectives in a probing manner (Corbin and Strauss; 2008). Second, I constantly
compared responses to identify similarities and dissimilarities, which helped elucidate both
patterns and divergent beliefs. Third, I share a workplace with the research participants, so
drawing upon my own personal experiences helped identify meaning, as I maintained bias-free
interpretations. Lastly, I looked for anomalies, or negative cases in datasets, which added
richness and depth to the analysis. Continual reflection during the data collection and analysis
phases led to a thoughtful and critical examination of the data (Corbin and Strauss; 2008).
Data Integration
Integration of the quantitative and qualitative datasets followed (Creswell, 2015). Glesne
(2011) describes the importance of combining datasets so that analysis does not become
compartmentalized. Findings and assertions were used to validate the study’s assumed needs,
which were then used to generate organizational recommendations. The mixed methods
approach using multiple data collection techniques helped with triangulation of data, identifying
complex perspectives, and illuminating the impact of cultural settings and cultural models on
course directors’ willingness to be creative, use nontraditional teaching strategies, and
incorporate computer-assisted learning opportunities.
Reliability and Validity
Reliability describes the consistency and temporal stability of a data collection
instrument, while validity describes the instrument’s accuracy with respect to intentions of
measurement (Creswell, 2014; Kurpuis & Stafford, 2006). Therefore, reliable instruments
consistently measure the same elements across time and repetition, and valid instruments
actually measure the intended elements (Fink, 2013). For this study, the researcher generated a
customized survey and interview protocol. To help ensure reliability and validity, both
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instruments were pilot-tested with other external faculty members who were not participants in
the actual study. Reliability concerns exist for quantitative data since the sample size is small.
Trustworthiness of Data
Four strategies were used to ensure that the data collected for this study are credible and
trustworthy. First, triangulation of different data sources was used to examine multiple inputs of
evidence (Merriam & Tisdell, 2016). Themes emerged from the converging pieces of contextual
information which increased this study’s validity (Creswell, 2014). Second, valid and reliable
instruments are those that consistently and accurately measure what is intended to be measured
across time (Creswell, 2014; Fink, 2013; Kurpuis & Stafford, 2006). This study employed data
collection instruments that were deemed to be valid and reliable. Third, anonymity and
confidentiality was emphasized throughout the data collection process with all participants. This
study was ethically-grounded to ensure accurate and honest participation was obtained from
research participants. Fourth, this study utilized a member checking process (Creswell, 2014).
Follow-up consultations with a subset of the interviewees was conducted. During these sessions,
emergent themes were described to participants and their input was requested to critique and
comment on the accuracy of the findings. Collectively, these four strategies reinforced the
credibility and trustworthiness of these data.
Role of Investigator
The principal investigator (PI) is an employee at the Urban School of Medicine, which is
where this needs analysis was conducted. Results from the mixed methods study will be used to
provide recommendations to improve organizational performance. Therefore, confusion could
be created where participants could view the PI as serving dual roles. Importantly, the PI always
clearly articulated that the role in this study was as an investigator, not as an employee.
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Although research participants are not subordinates, efforts were taken to minimize any potential
conflicts-of-interest, coercion, and/or professional performance concerns. For example,
anonymity and confidentiality safeguards were in place. Open and transparent conversations
were had to address any concerns.
Positionality and Biases
I am a white male employee who works directly with the participants in this study.
While I don’t have a leadership role and I don’t manage these course directors in any way, we do
collaborate on projects. So, my role as a researcher-colleague had to be clearly articulated
during data collection and analysis. The course directors are a male-dominated group, where
only 30% are females. While I haven’t noticed any sense of gender discrimination or
intimidation during my day-to-day in the workplace, this male-dominated ratio seems to be
inconsistent with modern workplaces. I have interviewed female participants and all of them
have been forthcoming, and I did not notice that gender was any kind of an issue that prevented
participation in the study. In terms of being a colleague, I have found that, generally speaking,
the course directors are speaking with a cooperative style and are quite happy to share their
stories with me. All interview questions were answered and nobody left an interview early.
Many of the course directors asked me at the end what I hope to do with my data. I took
these opportunities to remind them of the IRB information sheet and the purpose of the study.
Then, I reiterated that anonymity and confidentiality safeguards were incorporated. During these
conversations, a couple of course directors offered themselves for further questioning and
follow-up, if I needed it. Thus, member-checking was a useful strategy to help eliminate my
inherent biases and to maintain the integrity of participant’s information.
I spent a great deal of time reflecting on my role as a both a colleague and researcher, and
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what that might have meant for my own data interpretations. Although I don’t share the same
teaching role as the faculty members, we do all share the same executive leadership. Thus, some
of the frustrations and barriers that course directors mentioned are similar to items I encounter in
the workplace, too. It was crucial for the integrity of this study that I only let the data from the
course directors tell the story. It was imperative that my own personal feelings about leadership
be left out of the study altogether and not influence the lenses through which I interpreted data.
Additionally, I was concerned with reactivity, which describes how my presence potentially
influenced participant responses (Maxwell, 2013). Admittedly, I am a novice interviewer. But
during the interviews, I tried my best to gauge body language and responses. I hoped to pick-up
on any cues that might indicate a course director was telling me only what I wanted to hear.
While I did not encounter anything blatant, I do know there was potential for this to occur, so I
made immediate reflective notes about all interviews in my journal.
Maxwell (2013) describes a validity test checklist for qualitative studies that includes
various strategies for verifying conclusions. Field notes in a journal and reflective memos of the
experiences accompanied my verbatim interview transcripts. This strategy ensured that I told a
complete story. Next, I member-checked, and asked several participants to check my
interpretations of their responses. This strategy helped me minimize misinterpretations, and it
also helped me to minimize the introduction of personal biases. Another strategy I incorporated
was triangulation. I used multiple data sources (survey responses and interview transcripts).
Additionally, course directors ranged in age, experience, and gender. I tried to interview a pool
of course directors who were similar in these demographic variables to the entire population of
course directors at our medical school. Finally, my dissertation committee peer-reviewed this
study and helped me identify any flaws in my conclusions. It was important to recognize
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potential sources of bias and positionality so that the results from this study are deemed to be
trustworthy and I am found to be a credible researcher (Merriam & Tisdell, 2016).
Ethics
A combination of quantitative and qualitative approaches was used to answer the research
questions (Creswell, 2014). Therefore, when interacting with research participants, ethical
choices were imperative while overseeing this study because surveys, face-to-face interviews,
and focus groups necessitated the minimization of risk or potential harm (Glesne, 2011; Krueger
& Casey, 2009; Rubin & Rubin, 2012). Respect for research participants, minimization of harm,
and ethical practices guided this study’s research procedures (Glesne, 2011; Krueger & Casey,
2009; Rubin & Rubin, 2012). This study’s protocols were first submitted to the University of
Southern California Institutional Review Board (IRB). Although position of power was not a
factor in this study, the researcher works with the research participants, which could have created
the potential for unanticipated conflicts-of-interest. Therefore, identical protocols were also
submitted to the site institution’s Institutional Review Board (IRB) to minimize any coercion
concerns. All directives that guarantee participants’ rights, well-being, and protection from harm
were followed.
At the study’s onset, all participants were provided with information sheets (see
Appendix D). This was a communication safeguard that articulated to study participants that
their participation was voluntary, confidentiality and privacy concerns were addressed, data
security was ensured, and no penalties existed should they choose to withdraw at any point
(Glesne, 2011). Following participant agreement via the information sheets process, participants
were periodically reminded that participation in the study was completely voluntary, identities
were being kept confidential, data was securely stored, and they could withdraw without penalty
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 90

at any point should they become uncomfortable or no longer wished to participate. Via a
separate communication mechanism, participants were asked for their permission to audio record
interview sessions (Merriam & Tisdell, 2016). To minimize any potential coercion concerns or
conflicts-of-interest, it was conveyed to participants that they would not receive any incentives
for participating in this study (Rubin & Rubin, 2012). Collectively, the actions taken above
should have minimized exploitation, protected research participants, minimized harm, and
promoted ethical practices.

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CHAPTER FOUR: RESULTS AND FINDINGS
Introduction
Initially, two critical behaviors were identified for course directors to achieve their
performance goal. The first was that course directors should redesign their courses based on
educational best practices for learner-centered blended learning design. The second critical
behavior was that course directors should develop their courses by using appropriate educational
technologies that support cognitive process and effective delivery. Then, both of these critical
behaviors were aligned with assumed knowledge, motivation, and organizational needs. Factual,
conceptual, procedural, and metacognitive knowledge types were investigated. Motivation
investigations included value, self-efficacy, emotions, and attribution. Resources, policies,
cultural model, and cultural setting were the organizational needs explored within this study.
Multiple sources of quantitative and qualitative data were collected to validate the
assumed needs. Specifically, survey and interview data were collected to understand the
knowledge, motivation, and organizational barriers that course directors encounter, as
represented in their critical behaviors and performance goal. The results and findings will be
organized by the categories of assumed knowledge, motivation, and organizational needs.
Quantitative data were collected via online surveys that were delivered to the course
directors, first. These surveys focused only on assumed motivation and organizational needs.
Then, follow-up face-to-face interviews were conducted with a subset of the population to collect
qualitative data. Knowledge, motivation, and organizational needs were explored during these
interviews. Twenty-seven course directors completed the online survey (79.4% response rate)
and eleven course directors participated in the interview. Given the small sample size and
intimacy of the working environment, demographic information is not reported in an effort to
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 92

maintain anonymity. Instead, course directors were asked to describe their innovative identities,
which influences the degree to which they may function socially and creatively. Likewise,
gender-neutral pseudonyms replaced actual course director names.
Following an exploration of course directors’ social and creative identities, results and
findings will be presented together and organized by individual assumed knowledge, motivation,
and organizational needs. This order corresponds to survey construction and interview protocol.
Each assumed need will be classified as “validated” or “not validated” depending upon observed
knowledge, motivation, and organizational deficits. Validated assumed needs are those where
data indicated a gap exists. Specific criteria used for validation strategies will be explained
according to the knowledge, motivation, and organizational assumed needs. Lastly, validated
and prioritized knowledge, motivation, and organizational needs are summarized at the end of
the chapter.
Creativity, Innovation, and Stakeholder Social Identity
Creative medical educators are not isolated individuals, but instead operate within social
professional environments where interactions, discourses, and ideologies shape their social and
creative identities, and influence their innovative engagements (Glaveanu & Tanggaard, 2014).
By linking identity theory with creativity research, Glaveanu and Tanggaard (2014) described a
socio-cultural framework of creative identities, where they stated that creative individuals must
consider their individuality within a social context, spatio-temporal dynamism, plasticity and
situational contexts, their multiple social selves, and how their actions are mediated by social
interactions and discourse with peers and colleagues. Thus, creative medical educators
potentially face social identity challenges with how their creative endeavors might deviate from
group norms and what this might mean for their group relationships (Adarves-Yorno & Haslam,
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 93

2007). For example, when challenging the status quo, they may have to decide to yield to
conformity or display contrastive behaviors to cultural norms (Adarves-Yorno & Haslam, 2007).
Course directors can be classified according to shared social characteristics, which
correspond to their creative and social identities (Moore, 2002; Porter et al., 2016; Rogers,
2003). Five categories describe the degree to which educators adopt innovative practices (Porter
et al., 2016; Rogers, 2003). This continuum of categories includes innovators, early adopters,
early majority, late majority, and laggards (Rogers, 2003). Thus, course directors may approach
discussions about technology-enriched learning environments through a wide range of
perspectives. Their participation in conversations and perspectives on assumed needs will be
shaped largely by their creative and social identities.
To begin, course directors were asked to describe their typical reaction to new
educational technologies. Most course directors conveyed they must have compelling evidence
before choosing to innovate in their classrooms (Table 9). Thus, no course directors identified as
innovators, while 29.63% identified as early adopters, 40.74% identified as early majority,
29.63% identified as late majority, and no course directors identified as laggards (Figure 4).
Generally speaking and with respect to creative identity summaries from other situational
contexts, the focal population for this study appeared to be comparable to those summarized by
Moore (2002) and Rogers (2003), which may allow results and findings from this study to be
useful for other settings.
These creative identities are important to consider when trying to understand course
directors’ perspectives on innovative medical education initiatives, because they could be
approaching the conversation from very different places. A late majority course director, for
example, may face greater internal difficulties when wrestling with conforming to or rebelling
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against their organization’s cultural norms than would an early adopter course director (Adarves-
Yorno & Haslam, 2007). As a result, knowledge, motivation, and organizational needs are likely
to be impacted by course directors’ varying social and creative identities.
Table 9
Course director reactions to educational technologies (adapted from Porter et al. (2016)
Category Course director reaction # of course
directors
Innovators I am constantly adopting multiple new technologies. I adopt well
before anyone else, sometimes even before a new technology is
publicly available.

0
Early
adopters
I actively investigate new technologies and adopt the best ones. I am
generally one of the first to adopt a new technology, and my peers
adopt based on my recommendation / example.

8
Early
majority
I wait to adopt until I have compelling evidence of the technology’s
value and recommendations from my peers. I am not among the first
to adopt, but I am generally in the first half of those adopting a
technology.

11
Late
majority
I am not necessarily opposed to new technologies, but I am cautious
and will only adopt when it becomes necessary to do so.

8
Laggards I recognize that new technologies have value to my colleagues, but I
feel strongly about using traditional resources. I will continue using
my current resources, even when pressured to adopt a new
technology.
0

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Figure 4. Course directors’ creative identities aligned with terminology from Moore’s (2002)
innovation curve.
Findings for Assumed Knowledge Needs
Interview questions validated the four knowledge types, which were factual, conceptual,
procedural, and metacognitive (survey prompts were not used to validate the knowledge types).
Course directors were asked a total of seven knowledge-related questions during the interview
process. If course directors demonstrated an overall deficit in knowledge for a particular
assumed need, then that need was classified as validated. If no deficit in knowledge emerged,
then that assumed need was classified as not validated. The criteria used to define “deficits” in
knowledge and classify assumed knowledge needs as “not validated” are outlined in Table 10. A
synopsis of the emergent knowledge patterns and frequencies (organized by knowledge type and
by assumed knowledge need) is provided in Table 11.

0
29.63
40.74
29.63
0
0
15
30
45
%
Course Directors Compared to
Moore's Innovation Curve
Innovators Early Early Late Laggards
Adopters Majority Majority
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Table 10
Criteria used to classify assumed knowledge needs as “not validated”
Survey Interview
Factual N/A >75% adequately
described key
components of
terminology

Conceptual N/A >75% aligned best
practices with student
outcomes

Procedural N/A >75% described an
actual process for
learner-centered design
that aligned with
blended learning and
educational technologies

Metacognitive N/A >75% demonstrated
reflection practices
aligned with redesigning
and/or developing
courses

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Table 11

Knowledge patterns frequency table (n = 11 interviewees)

Knowledge patterns

Frequency

Factual

Ibis Academy goal and expectations
• Specifically mentioned the Office of Educational
Enhancement, which houses Ibis Academy
5
• Specifically mentioned Ibis Academy’s goal, mission, or
vision
0
• Aligned teaching practices with Ibis Academy’s strategic
plan for innovative medical education
0
• Described the Ibis Academy conceptual model for blended
learning courses
0
Blended learning design
• Defined multi-modal, and not blended learning 11
• Casually referenced technology 2
• Explained the “careful fusing” or “best elements”
components of the blended learning definition
0
• Mentioned best practices for blended learning instructional
design
0
• Related best practices for student-centered instructional
design to true definition of blended learning
0
Educational technologies
• Casually mentioned the passive addition of technology to
the teaching and learning environment
11
• Stated that technology can be used to “help teaching” and
to make real-time “adjustments of material based on what
students need at that moment”
2
• Stated a deliberate purpose or approach to developing a
technology-enriched learning environment
0
• Stated ways that students would benefit from such a
teaching and learning environment
0
• Mentioned cognitive process 0
• Aligned effective delivery with cognitive process with
appropriate educational technologies
0

Conceptual

Instructional best practices and student outcomes
• Described the importance of interactions within the
learning environment
4
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• Focused on self-directed learning 2
• Described the importance of active over passive learning 2
• Explained that students “learn differently” so many
teaching approaches are needed
2
• Aligned best practices with specific student outcomes 0
Educational technologies and student outcomes
• Described using the learning management system in a
basic manner (posting exam scores, repository, etc.)
4
• Expressed desire to use more educational technologies, but
were not there yet
4
• Described using educational technologies in a basic
manner (incorporating videos)
3
• Described using educational technologies in a basic
manner (incorporating PowerPoint slides)
3
• Described using the learning management system in a
slightly more advanced manner (online modules;
incorporated as part of flipped learning experiences, etc.)
2
• Aligned best practices with specific student outcomes
(formative assessment; self-directed learning)
2
• Stated that technology cannot provide the same
experiences for students
1

Procedural

• Demonstrated some degree of learner-centered design 9
• Admitted to not knowing how to do it at all 2
• Specifically aligned responses with blended learning 0
• Described an actual process of demonstrating how to
develop the course based on educational technologies that
support cognitive development and effective delivery
0

Metacognitive

Reflect on progress when designing learning experiences
• Response actually aligned with progress toward
redesigning courses
0
• Response actually aligned with blended learning design 0
• Specifically mentioned post-course reflection, with no
mention of real-time, formative, or in-practice reflection
7
• Specifically mentioned some degree of during-course
reflection
3
• Post-course exam scores are used to reflect 6
• Student engagement during class sessions is used as an
indicator for reflection
3
• Post-course student assessment of instruction surveys are
used for reflection
2
Reflect on effectiveness in developing learning environments
• Response actually aligned with assessing effectiveness in 0
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 99

developing learning environments
• Response actually aligned with appropriate educational
technologies
0
• Mentioned post-course reflection, with no mention of real-
time, formative, or in-practice reflection
11
• Mentioned some degree of during-course reflection 1
• Post-course exam scores are used to reflect 8
• Post-course student assessment of instruction surveys are
used for reflection
4
• Random or informal conversations with students are used
for reflection
3
• Student engagement during class sessions is used as an
indicator for reflection
1
• Peer benchmarking is used for reflection 1
• 360 degree feedback (students and faculty) is used for
reflection
1

Course directors need to know the goal of Ibis Academy and what is expected of them
with respect to course redesign (Factual). This assumed factual knowledge need was validated.
Open-coding of the interview transcripts revealed knowledge deficits in terms of Ibis Academy’s
goal, mission, vision, and expectations of faculty members during course redesign projects.
Kotter (2007) indicated that failed organizational change initiatives typically share common
characteristics in that they lack clear visions or stated goals, but have a plethora of plans or
programs. Course directors revealed that Ibis Academy could be an example of such a program
lacking a vision or goal. For example, when speaking about creativity as an educator, five
course directors highlighted the Office of Educational Enhancement, which houses the Ibis
Academy initiative. Robin stated:
Well, I think that the greatest resource that we have had the privilege of working with in
the medical education office, is being able to have resources like the medical education
fellow who will work on videos. People who do design of the courses. Because frankly,
as a physician, there's no way that I would be able to do that on my own because of
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technological deficiencies that I lack and also time. So having that as part of a medical
school resource is essential to being able to pull this off. Because I can't imagine other
physicians being able to do that unless they don't have to see patients.
While Robin mentioned human capital associated with Ibis Academy (the medical education
fellow and course designers), they also only provided vague descriptions of their role, critical
behaviors, and expectations (“pull this off”). Furthermore, they equated course redesign projects
as only “working on videos” and paid no attention to blended course design or appropriateness of
educational technology choices. While they indicated value for having such resources available
(“the greatest resource that we have”), they never directly referred to Ibis Academy’s goal or
expectations. Indeed, throughout the entire interview process, not a single course director
referred to Ibis Academy’s goal, mission, vision, or expectations of faculty members.
Furthermore, no course directors aligned their teaching practices with Ibis Academy’s strategic
plan for innovative medical education. Lastly, no course director specifically highlighted the
Ibis Academy conceptual model for blended learning courses.
These findings are consistent with Kotter’s (2007) recommendation that stakeholders
benefit from knowing goals and receiving clear messaging. This factual knowledge deficit
indicated that course directors appeared to be lacking basic knowledge about the purpose of Ibis
Academy and its role in supporting faculty members. This lack of knowledge could result in
performance gaps. Therefore, course directors are potentially not knowledgeable about what is
expected of them during course redesign projects, which limits achievement of performance
goals (Clark & Estes, 2008). This factual knowledge deficit likely serves as a barrier for course
directors because they may not know the goal of Ibis Academy nor what is expected of them.
Course directors need to know educational best practices for learner-centered blended
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learning design (Factual). This assumed factual knowledge need was validated. During the
interview process, interviewees were asked to explain what the term “blended learning” meant to
them. When compared with the definition used within this dissertation, all eleven responses
tended to define multi-modal instruction, and not blended learning (Garrison & Vaughan, 2008;
Garrison & Vaughan, 2013; VanDerLinden, 2014). For example, none of the responses
encouraged the “careful fusing” or “best elements” components of the blended learning
definition. Also, no responses made mention of educational best practices. Although several
responses mentioned student-centered, flipped learning, or active interactions, none of the course
directors specifically described best practices for these educational approaches. Furthermore,
none of the course directors specifically related these educational approaches to a true definition
of blended learning.
These findings are consistent with VanDerLinden’s (2014) recommendation that
achieving successes requires knowledge and skills of educational best practices for blended
learning. Furthermore, course directors appeared to lack the foundational knowledge about
blended learning practices upon which new knowledge can be built (Mayer, 2011; Schraw &
Lehman, 2009; Schraw & McCrudden, 2006). For example, when defining blended learning, Pat
stated:
I imagine more than lecture and exam, which could incorporate small group activities,
homework, maybe quizzes, along with major exams, may be independent gathering of
materials by students. Anything aside from the teacher giving students notes to prepare
for exam.
This explanation included non-lecture based components, like group activities and student-
centered exercises. However, there was no alignment of these activities with educational best
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practices. Furthermore, Pat never stated how these activities would have been carefully fused
with appropriate computer-assisted learning environments. Another course director, Kris, also
demonstrated deficits in factual knowledge when they stated:
I would think it's a variety of learning techniques. Video, in-class, individual, group
sessions, just the word "blended" I would imagine that it's a collage of different
techniques.
Kris expanded upon the instructional elements that could be used in blended learning
environments. For example, they described online content, like incorporating videos. But, when
they used the phrase “collage of different techniques,” they indicated a multimodal teaching and
learning environment, but not necessarily a blended learning environment. Again, there was no
alignment with educational best practices and no mention of how computer-assisted elements
would be carefully fused with face-to-face learning opportunities.
This knowledge deficit indicated that course directors appeared to be defining basic
principles differently from Ibis Academy personnel. This misalignment could result in
performance gaps. Therefore, when course directors try redesigning courses, they are potentially
not incorporating educational best practices, which limits achievement of performance goals
(Clark & Estes, 2008; VanDerLinden, 2014). This factual knowledge deficit could potentially
serve as a barrier for course directors because they seem not to know educational best practices
for learner-centered blended learning design.
Course directors need to know appropriate educational technologies that support
cognitive process and effective delivery (Factual). This assumed factual knowledge need was
validated. During the interview process, interviewees were asked to explain what the term
“technology-enriched learning environment” meant to them. When compared with the
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expectations of computer-assisted instruction and technology-enriched learning environments
within this dissertation, all eleven responses casually mentioned the passive addition of
technology to the teaching and learning environment (Kalet et al., 2012). In this sense, they were
more likely defining computer-assisted instruction and/or computer-assisted learning. Two of
the eleven responses took this a step further and stated that technology can be used to “help
teaching” and to make real-time “adjustments of material based on what students need at that
moment.” None of the course directors actually stated a deliberate purpose or approach to
developing a technology-enriched learning environment. Nor did any of them state ways that
students would benefit from such a teaching and learning environment. No course directors
specifically aligned effective delivery with cognitive process and with appropriate educational
technologies.
These findings are consistent with recommendations from Clark and Estes (2008), who
stated that stakeholder achievement improvements require foundational knowledge and skills.
Furthermore, course directors appeared to lack the foundational knowledge about technology-
enriched learning environments upon which new knowledge can be built upon (Mayer, 2011;
Schraw & Lehman, 2009; Schraw & McCrudden, 2006). For example, when explaining
technology-enriched learning environments, Morgan stated:
I guess using different types of, maybe, tech. It seems redundant. Using technology
basically to learn. So that could be using videos, software programs, audio recordings or
podcasts. That's what I think about.
This explanation listed several types of digital learning assets. However, there was no
association of these assets with cognitive process or with effective delivery. This response was
consistent with those of other course directors, like Cameron, who stated:
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I think it can mean several things. For one, it can mean that you enhance whatever you
are doing in the normal classroom, in addition to a PowerPoint with using other
technology resources such as recordings to incorporate, but it can also mean that you use
a variety of platforms to create modules, with varying technologies. It sounds kind of
vague and fluffy.
Again, Cameron listed several types of learning assets that could be created. Furthermore,
confusion with the term appeared when Cameron used phrases like “can mean several things”
and “sounds kind of vague and fluffy.” This confusion could be indicative of a knowledge
deficit or even unclear expectations of their role in creating technology-enriched learning
environments for their students. Additionally, they used the word “enhance” but it is difficult to
ascertain if this is a student-centric or instructor-centric qualifier. Again, there was no alignment
of using appropriate educational technologies with cognitive process or with effective delivery.
This knowledge deficit indicated that course directors appeared to demonstrate confusion
with foundational content, which could result in performance gaps. Therefore, when course
directors develop courses, they are potentially unsure of what types of educational technologies
could be used to supplement their teaching practices (Kalet et al., 2012). This factual knowledge
deficit likely serves as a barrier for course directors because they may not know appropriate
educational technologies that support cognitive process and effective delivery.
Course directors need to know the relationship between educational best practices for
learner-centered blended learning design and student outcomes (Conceptual). This assumed
conceptual knowledge need was validated. During the interview process, interviewees were
asked to describe the types of instructional practices that improve student outcomes. Four of the
eleven responses described the importance of interactions within the learning environment.
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Within their explanations, some course directors focused on self-directed learning, active over
passive learning, and many teaching approaches needed. But the term interaction can have
different meanings. For example, Morgan defined interaction as: “The ability for students to ask
questions or respond to questions or offer their opinion during a lecture.” This understanding is
inconsistent with the deep, rich type of student-centered interactions educators seek in blended
learning environments, like inquiry-based, team-based, or active-learning opportunities (Garrison
& Vaughan, 2008; Garrison & Vaughan, 2013; Green, 2016; Land, Hannafin, & Oliver, 2012).
Additionally, none of the course directors specifically aligned best practices with specific student
outcomes.
These findings indicated most course directors may be unable to explain the relationship
between student-centered learning environments and relevant student outcomes, as described by
White (2007), which were developing self-regulated learning skills, using higher order thinking
skills, and improving long-term retention of academic content. Furthermore, course directors
appeared to lack the conceptual knowledge about the associations of pedagogical design with
student outcomes (Mayer, 2011). For example, when explaining the relationship between their
teaching approaches and student outcomes, Pat stated, “Teaching the students how to answer the
questions on the exams of which the outcomes are based. Without a doubt, that ... yeah.” This
explanation indicated the importance of performance on exams in undergraduate medical
education. However, there was no description of educational best practices that could have
aligned these teaching activities with improved student outcomes. Furthermore, the students
were clustered into a homogenous group when Pat used the phrase “the students,” which is
inconsistent with student-centered, adaptive learning approaches. However, a couple of course
directors recommended using multiple teaching approaches to reach many students. For
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example, Casey explained:
I think that's one of the things that many times people don't look at, is that different
students learn differently. And there are different mechanisms that help them to learn and
therefore there's not one size that fits all. With that said, I then try to approach my
teaching to enable as many students as possible through different formats. You know,
you've heard of visual learners, auditory learners, kinesthetic learners, and I think it's
valuable to try to work in as many of those domains as possible because then you can
help different students learn better, through different domains. And that can be
problematic when we get technological. These technological advances tend to be auditory
or visual and it leaves the kinesthetic learner behind in many ways.
While Casey described a variety of ways in which they help students approach learning course
content, they never actually related this to examples of improved student outcomes in their
course. For example, when they stated that they “enable as many students as possible through
different formats,” it is difficult to know what the success measure, or outcome, is for the
students. Again, there was no alignment of teaching activities with improved student outcomes.
This knowledge deficit indicated that course directors appeared to be inconsistent with
explaining student-centered interactions and learning outcomes. This inconsistency in
educational expectations could result in performance gaps. Therefore, when course directors try
redesigning courses using blended learning designs, they are potentially not conceptualizing the
relationships of their teaching approaches with relevant student outcomes, which limits the
achievement of performance goals (Clark & Estes, 2008; White, 2007). This conceptual
knowledge deficit could potentially serve as a barrier for course directors because they may not
know the relationships between educational best practices for learner-centered blended learning
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design and increased student outcomes.
Course directors need to know the relationship between appropriate educational
technologies and student outcomes (Conceptual). This assumed conceptual knowledge need
was validated. During the interview process, interviewees were asked to describe the types of
educational technologies they might use to enrich their courses. In terms of incorporating
educational technologies into their preclinical modules, several course directors described using
the learning management system (LMS) in a basic manner (i.e. posting exam scores, repository
of information, etc.). Two of the eleven course directors described using the learning
management system (LMS) in a slightly more advanced manner (i.e. online modules,
incorporated as part of flipped learning experiences, etc.). Several course directors expressed
desire to use more educational technologies, but were not there yet. This stratified grouping that
course directors displayed under the context of adopting educational technologies is consistent
with the innovators-laggards classification continuum described by Moore (2002) and Rogers
(2003).
The most commonly mentioned educational technologies were videos, PowerPoint slides,
and the Blackboard learning management system. Yet, only two course directors attempted to
align educational best practices with specific student outcomes (formative assessment and self-
directed learning). One course director indicated a degree of traditionalism and explained that
technology cannot provide the same experiences for students (for example, in a dissection lab).
Finally, no course director described an actual process of demonstrating how to develop the
course based on educational technologies that support cognitive development and effective
delivery. Course directors, like Jordan, who could be characterized as late majority adopters
(Rogers, 2003) were unsure of how best to implement educational technologies:
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Well I have to admit that personally I don't have as many as I wish because basically
what I have available is just PowerPoints that I use. And in fact I know that there's videos
that students use, but I'm not so sure about other resources that would be available that
would be effective.
Some course directors, who could be characterized as early majority adopters (Rogers, 2003),
demonstrated more comfort with educational technologies and considered what a course redesign
could include by attempting to align with student outcomes. For example, Cameron highlighted
student-centered opportunities for learners to practice, self-assess, and reflect on their learning:
I would like to have more material that students can do up front, like as delivered like a
flipped learning classroom that also contains practice exercises in it. Or, just moments
where students can reflect. Whether it's an online module that contains practice exercises,
but where students can kind of see for themselves where they're at, and how they're
progressing.
A couple of course directors could be characterized as early adopters (Rogers, 2003) because
they were more advanced with their approaches than their colleagues, and had already
implemented some degree of educational technologies into their courses. For example, Jamie
mentioned using the university’s learning management systems to support their flipped
classroom design:
At the current moment, we use an online flipped classroom for our course in which
students have a curriculum that's designed through either Canvas or Blackboard, and
there's a lot of support through the university to upkeep these websites together and these
courses together, and blend that with in-class sessions that are taught by professors,
usually using a case-based approach.
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While Jamie described ways in which use educational technologies, they never actually related
this to examples of improved student outcomes in their module. This conceptual knowledge
deficit indicated that course directors appeared to be inconsistent with explaining the
relationships between appropriate educational technologies and student outcomes. These
inconsistencies in comfort levels with implementing educational expectations could result in
performance gaps. Therefore, when course directors try develop their courses using appropriate
educational technologies, they may not be conceptualizing the relationships of their technology
choices with relevant student outcomes, which limits the achievement of performance goals
(Clark & Estes, 2008). This conceptual knowledge deficit could potentially serve as a barrier for
course directors because they may not know the relationships between appropriate educational
technologies and increased student outcomes.
Course directors need to know how to create computer-assisted learning environments
(Procedural). There were two assumed procedural knowledge needs. First, course directors
need to know how to redesign courses based on educational best practices for learner-centered
blended learning design. Second, course directors need to know how to develop the course by
using appropriate educational technologies that support cognitive process and effective delivery.
Both of these assumed conceptual knowledge needs were validated. During the interview
process, interviewees were asked to explain the process they would use to create a computer-
assisted learning environment. None of the course directors described an actual process of
demonstrating how to develop the course based on educational technologies that support
cognitive development and effective delivery. Most course directors (nine of eleven)
communicated some degree of learner-centered design, but these responses did not align that
thinking with blended learning.
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A couple course directors admitted to not knowing how to create a computer-assisted
learning environment it at all, when they stated: “the truth is I have no idea” (Kris) and “there's
probably a lot of it that involves skillsets that I do not have” (Jamie). In the absence of
procedural knowledge, course directors lack the capability to use their skills and apply factual or
conceptual knowledge (Clark & Estes, 2008). When they did talk about creating computer-
assisted learning environments, the procedural knowledge tended to be vague. For example,
Morgan explained:
I think in my course one way to go about doing it is since we have labs that we could use
I would say different types of software programs that are available. Then also certain
types of very short, two minute, three minute instructional videos that cover areas that we
don't necessarily cover in class in depth. So things that can give students an overview,
preview maybe of what to expect. So that when they get to class, they're kind of better
prepared in a way. That's how I kind of think about it.
Morgan attempts to describe a technology-enriched learning environment. But, when they say
“different types of software programs” within their response, it is unclear what type of software
would be utilized and how it would be integrated within the course. They also mention that
students could use technology to be “better prepared” before coming to class. But, it is unclear
how Morgan would ensure this preparedness given there are no learning objectives or outcomes
explained. Additionally, Morgan fails to explain how the “instructional videos that cover areas
that we don't necessarily cover in class in depth” would be provided to learners.
Course directors appeared to be lacking with their capacities to create computer-assisted
learning environments. The vagueness with which procedures were explained reveals a lack of
depth in understanding, which could result in performance gaps. Therefore, when course
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directors try redesign and develop their technology-enriched courses, they may not have the
necessary procedural knowledge, which limits their achievement of performance goals (Clark &
Estes, 2008). This procedural knowledge deficit likely serves as a barrier for course directors
because they may not know how to redesign courses based on educational best practices for
learner-centered blended learning design or how to develop the course by using appropriate
educational technologies that support cognitive process and effective delivery.
Course directors need to reflect on their progress toward redesigning courses based on
educational best practices for learner-centered blended learning design (Metacognitive). This
assumed metacognitive knowledge need was validated. During the interview process,
interviewees were asked to explain how they reflect on their progress during designing learning
experiences. Clark and Estes (2008) explained that metacognitive knowledge stimulates
reflection-of-practice and self-regulation behaviors, which enhance performance. Although
seven course directors specifically highlighted some form of post-course reflection, there was no
mention of real-time, formative, or in-practice reflection. Furthermore, none of the course
directors actually aligned their responses with progress toward redesigning courses.
Additionally, no course director aligned a response with blended learning design. Three course
directors stated that student engagement during class sessions was used as an indicator for
reflection, but this was tied more to student satisfaction and less to educator progress toward
redesigning courses. Similarly, two course directors highlighted post-course student assessment
of instruction surveys are typically used for reflection. Six course directors mentioned post-
course exam scores are typically used to reflect. For example, when speaking about reflection
practices, Robin said:
Well, that's something that's in evolution for us. But I guess our progress, whether right
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or wrong, is based on how the students do on the test. And we compare that with how
they've done in other years on the test. But right now that's really the only way that we
know for sure how they're learning and what they write down on the cases.
When Robin stated that their progress “is based on how the students do on the test,” they were
referring more to how they are evaluated as faculty members and less on how they self-assess
their own progress with redesigning courses using blended learning approaches. They also
indicated an unfamiliarity with using analytics and formative feedback to guide real-time
interventions. This same lack of self-assessment was evident again when Pat stated:
I reflect on the progress by the outcome, the exam scores. I know my exams questions are
well constructed to assess the ability for someone to take a material and understand it in a
way that I can ask of regarding any given concept. If I ask a question from one angle or
the other angle, that they can answer a question no matter which angle it's asked from.
That's the overall outcome.
Pat specifically said that they “reflect on the progress by the outcome.” In this case, that
outcome is student performance on an exam, and not instructor self-evaluation of their own
progress toward redesigning courses using student-centered approaches. Thus, there was no
alignment of these reflective practices with progress toward redesigning courses or toward
blended learning design. Perhaps Alex exemplified this lack of alignment best when they simply
replied that reflection on their progress toward designing learning experiences “is a gut feeling.”
These findings seem to be consistent with Schraw and McCrudden’s (2006) recommendation
that self-reflecting on effectiveness is integral to developing mastery of new tasks. Furthermore,
course directors appeared to lack the metacognitive knowledge about reflecting-on-practice
(Barley, 2012).
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This knowledge deficit indicated that course directors appeared to not know to reflect on
their progress toward redesigning courses. This lack of reflection could result in performance
gaps. Therefore, when course directors redesign courses, they are potentially not incorporating
self-regulation skills, which limits their achievement of performance goals (Barley, 2012; Clark
& Estes, 2008; Schraw & McCrudden, 2006). This metacognitive knowledge deficit could
evolve into a barrier for course directors because they may not know to improve their learner-
centered courses based on their own reflection and self-evaluation.
Course Directors need to reflect on their progress toward developing the course by
using appropriate educational technologies that support cognitive process and effective
delivery (Metacognitive). This assumed conceptual knowledge need was validated. During the
interview process, interviewees were asked to describe how they assess their effectiveness in
developing learning environments. None of course directors actually aligned their responses
with effectiveness in developing learning environments. Similarly, none of the course directors
aligned their responses with appropriate educational technologies. All course directors
specifically mentioned post-course reflection, with no mention of real-time, formative, or in-
practice reflection. Of these, course directors mentioned post-course exam scores were used to
reflect and self-assess.
The course directors highlighted other indicators for reflection, which included student
engagement during class sessions, post-course student assessment of instruction survey, informal
conversations with students, peer benchmarking, and 360-degree feedback between students and
faculty. When speaking about self-assessing their effectiveness with developing learning
environments, Robin stated, “It's imperfect, in my opinion. We're only basing it on their test.”
Cameron expanded on this sentiment, when they stated:
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I can't say that I rigorously do this, but I look at the outcomes. I look and see ... Not only
that for the online learning environment, just in general. I look and see what the students
are doing well. Then I link that back, and I review whatever module or lecture. If there's
certain items that they're not doing well on, or there are less than whatever, a certain
percentage of students are getting, then obviously we're probably missing something in
the instructional environment. Then we have to go back and try to add back to the
instructional content that way. So it's sort of driven by the students outcomes. It kind of
tells us how we're doing.
Both Robin and Cameron mentioned that student outcomes, specifically performance on exam
content, was their primary method of self-assessing their effectiveness with developing learning
environments. They both indicated a lack of reflective practice during the self-assessment
process when they stated “it's imperfect, in my opinion” and “I can't say that I rigorously do
this.” These findings are inconsistent with suggestions that reflective practices in the
professional environment improve performance (Barley, 2012; Clark & Estes, 2008). Course
directors appeared to lack metacognitive knowledge related to reflecting-on-practice, when
assessing their effectiveness in developing learning environments (Barley, 2012).
This metacognitive knowledge deficit indicated that course directors appeared to not
know to reflect on their progress toward developing their courses by using appropriate
educational technologies that support cognitive process and effective delivery. This lack of self-
assessment could result in performance gaps. Therefore, when course directors develop courses,
they may not be using reflection skills, which could risk their achievement of performance goals
(Barley, 2012; Clark & Estes, 2008; Schraw & McCrudden, 2006). This metacognitive
knowledge deficit could translate into a barrier for course directors because they may not know
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to improve their technology-enriched learning environments based on their own reflection and
self-evaluation.
Synthesis of Findings for Knowledge Causes
Course directors demonstrated deficits in factual knowledge of Ibis Academy goals and
expectations, of best practices for learner-centered blended learning instructional design, and of
appropriate educational technologies that support cognitive process and effective delivery.
Course directors demonstrated needs for conceptual knowledge of the relationship between
educational best practices and student outcomes. Likewise, these stakeholders demonstrated a
need for conceptual knowledge of the relationship between appropriate educational technologies
and student outcomes. Course directors demonstrated deficits in procedural knowledge in terms
of how to redesign courses based on educational best practices for learner-centered blended
learning design. Likewise, they demonstrated deficits in procedural knowledge in terms of how
to develop courses by using appropriate educational technologies that support cognitive process
and effective delivery. Course directors demonstrated overall lack of metacognitive knowledge
needed to reflect on their progress toward redesigning courses based on educational best
practices for learner-centered blended learning design. Also, they demonstrated overall lack of
metacognitive knowledge needed to reflect on their progress toward developing their courses by
using appropriate educational technologies that support cognitive process and effective delivery.
Results and Findings for Assumed Motivation Needs
Survey and interview questions validated the four motivation constructs, which were
value, self-efficacy, emotions, and attribution. The survey contained 36 motivation-related items
and course directors were asked a total of eight motivation-related questions during the interview
process. Following integration of the two datasets, if course directors demonstrated an overall
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deficit in motivation for a particular assumed need, then that need was classified as validated. If
no deficit in motivation emerged, then that assumed need was classified as not validated. The
criteria used to define “deficits” in motivation and classify assumed motivation needs as “not
validated” are outlined in Table 12. A synopsis of the emergent motivation patterns with
frequencies and percentages (organized by motivation construct and by assumed motivation
need) is provided in Table 15.

Table 12
Criteria used to classify assumed motivation needs as “not validated”
Survey Interview
Self-Efficacy Majority in “high”
category (>50%)
and >25% felt very confident
in abilities

Value >50% positive and >25% stated was very
important

Emotion >50% positive and >50% demonstrated
positive emotions

Attribution >50% positive and >50% stated would
improve learning a great
deal

Survey Results
Self-efficacy items. Participants were asked about their confidence levels with their
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abilities to design and develop technology-enriched student-centered learning environments.
They used an interactive scale and recorded a value between zero (cannot do at all) and ten
(highly certain can do). Five categories were subdivided into 24 items. First, aggregate
descriptive statistics were summarized for each of the five categories. Aggregate mean values
were similar across all five categories (Table 13). Then, each individual item was analyzed
further. A complete summary of the items is provided in Table 14. Overall, course directors
indicated they were least efficacious with using scaffolds in their course designs to help students
connect new information to previous knowledge. Course directors indicated they were most
efficacious with measuring student competencies with formal assessments.
Each item was further scrutinized because variability was high. The 0-10 scale was sub-
categorized into low self-efficacy (0-3), medium self-efficacy (4-7), and high self-efficacy (8-
10). Then, the percentage values of responses for each sub-category were reported (Figure 5).
Table 13
Self-Efficacy aggregate mean values
Rate your degree of confidence in your ability to do each
of the following tasks as of today by recording a number
from 0 to 10.
Mean Standard deviation
(SD)
Using competency-based approaches in medical education

5.75 3.03
Building technology-enriched learning environments

5.41 2.38
Promoting self-regulated learning strategies with students

5.23 2.64
Using analytics to drive instructional interventions

5.13 2.63
Using neuroscience and cognitive psychology research to
drive teaching strategies
5.10 2.60

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Table 14

Self-Efficacy Results

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Figure 5. Percentage of course directors scoring in self-efficacy categories of low, medium, and
high.
When items asked about using competency-based approaches in medical school, course
directors were fairly evenly divided between low self-efficacy (30.86% of course director
responses), medium self-efficacy (34.57%), and high self-efficacy (34.57%; Figure 5a). When
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items asked about building technology-enriched learning environments, the majority of course
directors (47.41%) indicated medium self-efficacy (Figure 5b). When items asked about
promoting self-regulated learning strategies with students, 51.11% of the course directors
indicated medium self-efficacy (Figure 5c). When items asked about using analytics to drive
instructional interventions, 49.07% of the course directors indicated medium self-efficacy
(Figure 5d). Finally, when items asked about using neuroscience and cognitive psychology
research to drive teaching strategies, 50.37% of the course directors indicated medium self-
efficacy (Figure 5e).
Course directors’ value, emotion, and attribution. Participants were asked about the
extent to which they agreed with a series of prompts. They used a Likert-type scale and
recorded a value of strongly disagree (SD), Disagree (D), somewhat disagree (SWD), somewhat
agree (SWA), agree (A), or strongly agree (SA). Three categories were subdivided into four
items. The three categories were traditional lectures, learner-centered blending learning design,
and appropriate educational technologies. Since the majority of courses in preclinical medical
education are delivered via traditional lectures, this category was used as a baseline to compare
course directors’ value emotion, and attribution responses. Additionally, since most responses
fell within the positive range, the two scale metrics of “somewhat disagree” and “somewhat
agree” were treated as neutral for visualization purposes, so that the extreme responses on each
end of the continuum could be compared.
Course directors first shared their perspectives on traditional lectures. To begin,
74.08% of course directors either agreed or strongly agreed that they enjoyed delivering
traditional lectures (Figure 6a). Next, 48.15% of course directors either agreed or strongly
agreed that it was important for them to design courses that use traditional lectures even if it
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takes time away from other professional activities, while 7.41% of course directors strongly
disagreed with this statement (Figure 6b). Then, 59.26% of course directors either agreed or
strongly agreed that they felt positive when delivering traditional lectures, while 11.11% either
strongly disagreed or disagreed with this sentiment (Figure 6c). Finally, 40.74% of course
directors either agreed or strongly agreed that they believed improved student outcomes were the
result of their efforts in delivering traditional lectures, while 14.81% either strongly disagreed or
disagreed with this belief (Figure 6d).

Traditional lectures: To what extent do you agree with the following statements?

Figure 6. Course director perspectives on traditional lectures (value, emotion, and attribution)

Course directors then shared their perspectives on learner-centered blending learning
design. To begin, 59.26% of course directors either agreed or strongly agreed that they enjoyed
redesigning courses using learner-centered blended learning design (Figure 7a). Next, 48.15% of
course directors either agreed or strongly agreed that it was important for them to redesign
courses using learner-centered blended learning design even if it took time away from other
professional activities (Figure 7b). Then, 55.55% of course directors either agreed or strongly
0% 25% 50% 75% 100%
a. I enjoy delivering traditional lectures.
b. It is important for me to design courses that use traditional
lectures even if it takes time away from other professional
activities.
c. I feel positive when delivering traditional lectures.
d. I believe that improved student outcomes are the result of my
efforts in delivering traditional lectures.
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agreed that they felt positive about redesigning courses using learner-centered blended learning
design, while 3.70% disagreed with this sentiment (Figure 7c). Finally, 37.03% of course
directors either agreed or strongly agreed that they believed improved student outcomes were the
result of their efforts in redesigning courses using learner-centered blended learning design,
while 7.41% disagreed with this belief (Figure 7d).

Learner-centered blending learning design: To what extent do you agree
with the following statements?

Figure 7. Course director perspectives on learner-centered blending learning design
(value, emotion, and attribution)

Lastly, course directors shared their perspectives on appropriate educational technologies.
To begin, 70.37% of course directors either agreed or strongly agreed that they enjoyed
developing courses that use appropriate educational technologies (Figure 8a). Next, 66.67% of
course directors either agreed or strongly agreed that it was important for them to develop
courses that use appropriate educational technologies even if it took time away from other
professional activities (Figure 8b). Then, 70.37% of course directors either agreed or strongly
0% 25% 50% 75% 100%
a. I enjoy redesigning courses using learner-centered blended
learning design.
b. It is important for me to redesign courses using learner-centered
blended learning design even if it takes time away from other
professional activities.
c. I feel positive about redesigning courses using learner-centered
blended learning design.
d. I believe that improved student outcomes are the result of my
efforts in redesigning courses using learner-centered blended
learning design.
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agreed that they felt positive about developing courses that use appropriate educational
technologies (Figure 8c). Finally, 55.56% of course directors either agreed or strongly agreed
that they believed improved student outcomes were the result of their efforts in developing
courses that use appropriate educational technologies, while 3.70% disagreed with this belief
(Figure 8d).

Appropriate educational technologies: To what extent do you agree
with the following statements?

Figure 8. Course director perspectives on appropriate educational technologies (value, emotion,
and attribution)

0% 25% 50% 75% 100%
a. I enjoy developing courses that use appropriate educational
technologies.
b. It is important for me to develop courses that use appropriate
educational technologies even if it takes time away from other
professional activities.
c. I feel positive about developing courses that use appropriate
educational technologies.
d. I believe that improved student outcomes are the result of my
efforts developing courses that use appropriate educational
technologies.
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Interview Findings
Table 15

Motivation patterns frequency table (n = 11 interviewees)

Motivation patterns

Frequency

Value

Blended learning design
• Redesigning courses using non-lecture based approaches
was not important
4 (36.4%)
• Redesigning courses using non-lecture based approaches
was important
3 (27.3%)
• Redesigning courses using non-lecture based approaches
was very important
4 (36.4%)
• Important for improving student outcomes 6 (54.5%)
• Important for feeling successful as an educator 2 (18.2%)
• Important for adhering to national educational trends 2 (18.2%)
• There were limitations to ability and achievement 2 (18.2%)
• Delivering traditional lectures was more effective and
efficient
1 (9.1%)
Educational technologies
• Developing courses using educational technologies was
not important
2 (18.2%)
• Developing courses using educational technologies was
important
4 (36.4%)
• Developing courses using educational technologies was
very important
5 (45.5%)
• Important for satisfying students 3 (27.3%)
• Important for organizing academic content 2 (18.2%)
• Important for improving access to information 2 (18.2%)
• Important for improving student learning outcomes 1 (9.1%)
• Important for staying consistent with national trends 1 (9.1%)
• Important only when used in appropriate situations 1 (9.1%)
• Limitations to ability and achievement exist when
developing courses using educational technologies
1 (9.1%)

Self-Efficacy

Blended learning design
• Not confident with their abilities to design a student-
centered learning environment
5 (45.5%)
• Confident with their abilities to design a student-centered 4 (36.4%)
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learning environment
• Very confident with their abilities to design a student-
centered learning environment
2 (18.2%)
• Confidence increases with teamwork and support 3 (27.3%)
• Need to learn more and improve their own understanding
to increase confidence
2 (18.2%)
• Quality educators should be flexible and student-centric
with their teaching strategies
1 (9.1%)
• Confidence increased because of past experiences that
helped them learn more and improve their own
understanding
1 (9.1%)
Educational technologies
• Not confident with their abilities to implement educational
technologies when developing a course
5 (45.5%)
• Confident with their abilities to implement educational
technologies when developing a course
5 (45.5%)
• Very confident with their abilities to implement
educational technologies when developing a course
1 (9.1%)
• Confidence increases with teamwork and support 2 (18.2%)
• Confidence increased because of past experiences that
helped them learn more and improve their own
understanding
2 (18.2%)
• Confidence increases with feedback 1 (9.1%)
• Confidence decreases with increased complexity of
technology
1 (9.1%)
• Directly compared their own abilities to their perception of
their peers’ abilities
1 (9.1%)
• Need to learn more and improve their own understanding
to increase confidence
1 (9.1%)

Emotions

Blended learning design
• Demonstrated negative emotions toward redesigning
courses using non-lecture based approaches
1 (9.1%)
• Demonstrated neutral emotions toward redesigning
courses using non-lecture based approaches
3 (27.3%)
• Demonstrated positive emotions toward redesigning
courses using non-lecture based approaches
7 (63.6%)
• Felt positive about adapting to modern learners 3 (27.3%)
• Felt positive about being able to create better connections
and interactions with students
2 (18.2%)
• Positive emotions increase when teaching strategies are
aligned with learner goals
2 (18.2%)
• Felt positive about getting to increase skillset as an
educator and learn new things
1 (9.1%)
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• Felt positive about their past experiences that have helped 1 (9.1%)
• Felt strongly that student success is determined more from
their own behaviors, and less from the instructor’s teaching
approaches
1 (9.1%)
• Concerned more with preparing effective physicians than
ensuring they are good learners
1 (9.1%)
• Felt negative because it was too time-intensive 1 (9.1%)
• Felt negative because it changes their job description
without approval
1 (9.1%)
• Felt negative because they would lose control of the
educational setting, which would lead to uneven student
outcomes
1 (9.1%)
Educational technologies
• Demonstrated negative emotions toward developing
courses using educational technologies
1 (9.1%)
• Demonstrated neutral emotions toward developing courses
using educational technologies
2 (18.2%)
• Demonstrated positive emotions toward developing
courses using educational technologies
8 (72.7%)
• Felt positive because it improves their professional
satisfaction and self-worth
2 (18.2%)
• Felt positive because this is the best way to teach and
include the most recent evidence and resources
1 (9.1%)
• Felt positive because this improves course organization 1 (9.1%)
• Positive emotions increase when effective technologies are
aligned with improved student outcomes
3 (27.3%)
• Positive emotions increase when support is provided 1 (9.1%)
• Negative emotions increase with fear of failure 1 (9.1%)

Attribution

Blended learning design
• Indicated that their efforts spent on redesigning courses
using non-lecture based approaches would not improve
student learning at all
2 (18.2%)
• Indicated neutral beliefs that their efforts spent on
redesigning courses using non-lecture based approaches
would demonstrate improve student learning
1 (9.1%)
• Indicated that their efforts spent on redesigning courses
using non-lecture based approaches would somewhat
improve student learning
5 (45.5%)
• Indicated that their efforts spent on redesigning courses
using non-lecture based approaches would improve student
learning a great deal
3 (27.3%)
• Effort spent improves student learning outcomes 5 (45.5%)
• Effort spent improves course structure and organization 2 (18.2%)
• Would be a lag in performance indicators as improvements 1 (9.1%)
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are made when redesigning courses using non-lecture based
approaches would improve student learning
• Effort spent would help some students, but hurt
performance of others
1 (9.1%)
• Effort spent would demonstrate no impact on student
learning because current teaching approaches already work
well
1 (9.1%)
• Effort spent would demonstrate no impact on student
learning because it is too time-intensive
1 (9.1%)
• Effort spent would demonstrate no impact on student
learning because modifying and identifying appropriate
assessments is a challenge that limits successes
1 (9.1%)
Educational technologies
• Indicated that their efforts spent on developing courses
using educational technologies would not improve student
learning at all
1 (9.1%)
• Indicated neutral beliefs that their efforts spent on
developing courses using educational technologies would
demonstrate improved student learning
1 (9.1%)
• Indicated that their efforts spent on developing courses
using educational technologies would somewhat improve
student learning
7 (63.6%)
• Indicated that their efforts spent on developing courses
using educational technologies would improve student
learning a great deal
2 (18.2%)
• Improves various student learning outcomes 4 (36.4%)
• Facilitates student learning processes, like connecting to
prior knowledge
1 (9.1%)
• Improves course structure and organization 1 (9.1%)
• No impact on student learning because live-lecturing
already works well
1 (9.1%)
• Improves student learning only with proper instructional
design
3 (27.3%)

Course directors need to value redesigning courses to reflect best practices for learner-
centered blended learning (Value). This assumed motivation need was not validated, but given
the variability in responses, there is a high probability that some course directors value
redesigning courses to reflect best practices for learner-centered blended learning more than
others. During the interview process, interviewees were asked how important they felt it was for
them as individuals to redesign courses using non-lecture based approaches. Four course
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directors (36.4%) stated that redesigning courses using non-lecture based approaches was very
important. Three course directors (27.3%) stated that redesigning courses using non-lecture
based approaches was important. Four course directors (36.4%) stated that redesigning courses
using non-lecture based approaches was not important. Many course directors (54.5%)
mentioned that redesigning courses using non-lecture based approaches was important for
improving student outcomes.
Additionally, there were several reasons that contributed to value for redesigning courses
using non-lecture based approaches. For example two course directors (18.2%) mentioned that
redesigning courses using non-lecture based approaches was important for feeling successful as
an educator. Two (18.2%) mentioned that redesigning courses using non-lecture based
approaches was important for adhering to national educational trends. And, two course directors
(18.2%) mentioned that there were limitations to ability and achievement when redesigning
courses using non-lecture based approaches. One course director (9.1%) stated that delivering
traditional lectures was more effective and efficient than redesigning courses using non-lecture
based approaches.
Eccles (2009) suggests that when participants find personal value in a task, active choice
to initiate that task increases. Many of the course directors displayed personal value for
redesigning courses using learner-centered approaches. Yet, they have not yet made the active
choice to initiate these tasks, which indicated a potential motivational deficit (Clark & Estes,
2008). When reflecting on their teaching philosophies, some course directors, such as Sam,
addressed this motivational challenge through an instructor-centric lens:
For me, it's important, personally, to try to evolve in how I present the educational
material, so that I don't get bored and get into a rut and teach the same thing over and
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over and miss the possible opportunities. I want to make it, for me, as exciting as I hope it
is for the students.
This explanation included a personal evaluation of teaching behaviors. Sam explained that if
they keep teaching approaches fresh, they are better able to relay this passion to their students.
They identified learner-centered approaches as a mechanism that allows them to do this. Other
course directors, such as Alex, addressed this motivational challenge by addressing their own
opportunities for growth as educators:
It would be super nice for me, but obviously I have learned to deal without it. So, that
clearly means it can't be that important because otherwise I would not continue, but there
are limitations of what you can do and what you can achieve.
Alex revealed that while there is personal value, they recognized it is not very important to them
or they would have already made active choices to redesign their courses using student-centered
approaches. They addressed their motivational challenges by describing the limits of what they
can accomplish on their own.
The majority of course directors found some degree of value in non-lecture based
approaches to teaching and learning, so there did not appear to be a value-related deficit to
motivation. However, many of these same course directors had not yet actively chosen to
redesign their courses, which potentially contributed to performance gaps (Clark & Estes, 2008).
Therefore, course directors may not be motivated to redesign courses based only on intrinsic
value for such tasks. While this value-related motivation challenge could potentially serve as a
barrier for some course directors, there may be other motivation deficits actually limiting
performance.
Course directors need to value developing courses that use appropriate educational
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technologies that support cognitive process and effective delivery (Value). This assumed
motivation need was not validated, but, as with the last influence discussed, there is a high
probability that some course directors value developing courses that use appropriate educational
technologies that support cognitive process and effective delivery more than others. During the
interview process, interviewees were asked how important they felt it was for them as
individuals to develop courses using educational technologies. Five of the eleven course
directors (45.5%) stated that developing courses using educational technologies was very
important. Four course directors (36.4%) stated that developing courses using educational
technologies was important. And, two course directors (18.2%) stated that developing courses
using educational technologies was not important.
There were several reasons that contributed to value for developing courses using
educational technologies. These explanations included the ideas that using educational
technologies was important for satisfying students, organizing academic content, improving
access to information, and improving student learning outcomes. Another course director
indicated that developing courses using educational technologies was important for staying
consistent with national trends. Additionally, some explanations provided by the participants
may contribute to lack of value for developing courses using educational technologies. For
example, one course director (9.1%) stated that developing courses using educational
technologies was important only when used in appropriate situations, which limited their
personal value. And, a single course director (9.1%) specified that there were limitations to their
ability when developing courses using educational technologies, which limited their personal
value.
When stakeholders find utility value in projects, their motivation likely increases because
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the associated tasks align with their positive values (Eccles, 2006; Pintrich, 2003). Many of the
course directors displayed positive values for developing courses using educational technologies.
And, they identified several explanations that were consistent with finding utility value in these
types of course development projects. For example, Kris stated:
Yeah, I think it's very important. I think again, the new trend is towards new technologies
and this is a generation of technologies. We better provide them what they are familiar
with and at the pace that they have this flexibility with pace, where they can fast forward
lectures and all of that. They would have that option with the technology, yeah.
In this case, Kris equated utility of technology-enriched learning environments with providing
learners the “flexibility” and “pace” needed in today’s world. They also highlighted factors like
“national trends” and “generation of technologies” that influenced their value for adopting
educational technologies. Other course directors, like Casey, were more cautious with their
enthusiasm, but still referenced utility value:
I think technology has its place, and I think there is value, but we have to make sure that
we realize what the value is and not over emphasize the technology when we don't know
if there's truly value associated with it.
Casey made a clear distinction of not using technology solely for the sake of using technology
when they spoke about not “over emphasizing” it. Instead, they found higher importance with
identifying the association with why the technology is being used and for what purposes. To
Casey, utility value was influenced by the degree to which educational technologies were
properly used and aligned with improving the learning environment.
The majority of course directors found some degree of value in developing a course using
appropriate educational technologies, so there did not appear to be a value-related deficit in
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motivation. However, there were nuanced differences with respect to utility value, which
potentially contributed to performance gaps (Clark & Estes, 2008). Therefore, course directors
may not be motivated to develop courses using educational technologies based only on value for
such tasks. Understanding these value-related motivation challenges could be important, but
other motivation deficits might actually be limiting course director performance.
Course directors need to be confident that they can design courses based on
educational best practices for learner-centered blended learning design (Self-Efficacy). This
assumed motivation need was validated. During the interview process, interviewees were asked
about their confidence in their ability to design a student-centered learning environment. Nearly
half of the course directors (45.5%) stated they were not confident with their abilities to design a
student-centered learning environment. Four course directors (36.4%) stated they were confident
with their abilities, and two indicated they were very confident with their abilities to design a
student-centered learning environment.
Several elements contributed to increased course director confidence in their abilities to
design a student-centered learning environment. These factors that increased their confidence
included teamwork and support, learning more, improving their own understanding, and relating
to past experiences. Regardless of confidence levels, one course director (9.1%) mentioned that
quality educators should be flexible and student-centric with their teaching strategies.
Typically, high self-efficacy is positively correlated with increased motivation (Pajares,
2006). Additionally, early successes and encouragement improves confidence (VanDerLinden,
2014). In the absence of actively choosing to redesign a course using blended approaches,
however, early success might not be achieved. When describing confidence levels, some course
directors, like Cameron, specifically related their response to active choice:
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I'm gonna [sic] say moderate here. I think I have good ideas, but putting them into
practice is a little different. I think I have a fair understanding of how in an ideal sense to
do it, but then the reality sets in.
Cameron conveyed some confidence in their abilities, but also articulated they were unable to
translate this into active choice to initiate the tasks involved with redesigning courses. Lack of
self-efficacy could contribute toward this motivation barrier. For example, Robin conceded:
I think it's very difficult to do as an individual. It requires a team approach, support of the
medical school with specialized skilled staff members who can incorporate it and make it
go. It's very difficult if it's just the physician trying to do it. I would think it's impossible.
Robin clarified that, as an individual medical educator, it might be “impossible” to redesign
courses using non-lecture based approaches. They identified teamwork, support, and dedicated
experts as factors that would help them improve their confidence. Others, like Jamie, echoed this
sentiment about teamwork and support:
I really don't like to compliment myself too much or put myself in too much of the bright
lights, but I do feel that this process has given me a much better understanding of the
components required to put something like that together. I feel that with the correct
amount of support, time, and guidance, that I would have a reasonably shot to do a good
job.
Jamie displayed optimism and confidence in their abilities. But, they slightly tempered that
individuality and enthusiasm when they conveyed that “support, time, and guidance” were
needed. Thus, while confidence in abilities was apparent to some degree, adequate support and
teamwork were factors course directors identified they needed to feel efficacious.
Self-efficacy appeared to be a motivation deficit that limited course directors’ capacities
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to design courses based on educational best practices for learner-centered blended learning
design. This deficit likely results in performance gaps. When course directors attempt to initiate
new tasks involved with redesigning courses, they potentially lack the confidence in their
abilities, which minimizes opportunities for success (Clark & Estes, 2008; Pajares, 2006). This
self-efficacy deficit could potentially serve as a barrier for course directors because they may
doubt their individual abilities to be successful, which decreases motivation.
Course directors need to be confident that they can develop courses that use
appropriate educational technologies that support cognitive process and effective delivery
(Self-Efficacy). This assumed motivation need was validated. During the interview process,
interviewees were asked about their confidence in their ability to implement educational
technologies when developing courses. Nearly half of the course directors (45.5%) stated they
were not confident with their abilities to implement educational technologies when developing a
course. An equal percentage of course directors (45.5%) stated they were confident with their
abilities to implement educational technologies when developing a course. And a single course
director (9.1%) indicated they were very confident with their abilities to implement educational
technologies when developing a course.
Multiple factors contributed to increased course director confidence in their abilities to
implement educational technologies when developing a course. These factors included
teamwork and support, past experiences, feedback, and learning more about educational
technologies. Casey directly compared their own abilities to their perception of their peers’
abilities, when they stated “I’m probably the LXR expert here, sad to say. And, I’ve used
Blackboard as much as many of the faculty have.” And, Alex stated that their confidence with
their abilities to implement educational technologies when developing a course decreases with
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increased complexity of technology.
Authentic and prompt feedback during professional development opportunities stimulates
motivation, which increases self-efficacy and promotes persistence (Bandura, 1997; Clark &
Estes, 2008; Porter et al., 2016). But, in the absence of such opportunities, Jordan pointed out
that motivation could be decreased:
Yeah, it's because I think in order to say that you're confident in doing this you need to
know what it is that you're supposed to do in order to be able to implement those things.
And I don't think I have gotten the training, I don't have the opportunities to really
observe or be observed to see what it is that I should be doing in order to be effective in
that sense.
Jordan appeared to be longing for some level of authentic feedback when they described
“opportunities to really observe or be observed.” Without those opportunities, they could not
actively choose to develop courses using educational technologies because they did not feel
efficacious. Kris agreed: “With the team, I think it's doable. I need a lot of help and a lot of
feedback. I think I'm confident that with the team, I can succeed.” Indeed, with proper training
and past experiences, Jamie indicated higher degrees of self-efficacy:
Prior to this course, I would have said very little. But I think after having put this course
together, it's opened my eyes to the myriad of options that are available to really augment
and improve the course.
In this example, past experiences illuminated new educational possibilities that were previously
unknown to them. Jamie also related these past experiences to “augmenting and improving”
their educational experiences, which added to a tone of excitement. In this particular case, past
successes appeared to increase self-efficacy, which is consistent with suggestions from Bandura
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 136

(1997) and from Clark and Estes (2008).
Self-efficacy appeared to be a motivation deficit that limited course directors’ capacities
to develop courses that use appropriate educational technologies that support cognitive process
and effective delivery. This deficit likely results in performance gaps. When course directors
attempt to initiate new tasks involved with developing courses, they potentially lack the previous
experiences and feedback opportunities from which to build upon, which likely decreases
motivation (Bandura, 1997; Clark & Estes, 2008). These types of deficits could serve as a
barrier for course directors because they may lack confidence in their abilities, which decreases
motivation.
Course directors need to feel positive about redesigning courses based on educational
best practices for learner-centered blended learning design (Emotions). This assumed
motivation need was not validated. During the interview process, interviewees were asked how
they felt about redesigning courses using non-lecture based approaches. Most of the course
directors (63.6%) demonstrated positive emotions toward redesigning courses using non-lecture
based approaches. Several (27.3%) demonstrated neutral emotions, and one course director
(9.1%) demonstrated negative emotions.
Several factors that contributed to positive emotions from course directors toward
redesigning courses using non-lecture based approaches. These factors included adapting to
modern learners, being able to create better connections and interactions with students,
increasing skillset as an educator, and gaining from past experiences. Also, several factors
contributed to negative emotions from course directors toward redesigning courses using non-
lecture based approaches. Under these circumstance, course directors felt that redesigning
courses was too time-intensive, changed their job description without approval, and they would
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 137

lose control of the educational setting, which would lead to uneven student outcomes. Some
course directors shifted the focus to the student and mentioned that student success is determined
more from students’ own behaviors, and less from the instructor’s teaching approaches. For
example, Pat explained:
In the end, it's delivering content, so the lecture, however you want to describe it,
classroom lecture or a video made in an office, to me I don't think it makes any
difference. In the end, a good student will read the textbook and poor students tend to not
even read any resources and just learn what I'm telling them anyways.
Additionally, a couple of course directors indicated that preparing future physicians was their
primary goal so positive emotions increased when they ensured that teaching strategies were
aligned with learner goals. But to others, like Dane, there were other factors that contributed to
their emotional responses:
I feel like it's a lot of work, and it may not be worth the effort. I understand that it makes
sense to do it, but it doesn't work for all material all the time. And it radically changes
what the job description is. And the manpower involved and the preparation ahead of
time. I mean, traditionally you could have a lecture that you've given every year and you
tweak a few slides and you go in again. But now if you're gonna [sic] be doing a team-
based learning session or some kind of interactive discussion, then you have to spend
more time preparing those things.
Extra effort and time created anxiety when Dane could not reconcile the potential benefits of
non-lecture based approaches to teaching and learning. They addressed how issues like time,
preparation, and job duties negatively impacted their motivation. As a result Dane felt more
positive about delivering traditional lectures. However, other course directors demonstrated
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emotional responses that conflicted with this. For example, Sam responded:
I love doing it. I think it's fun. Again, for me it's exciting. I get to learn a new way to
teach, I relearn things when I do that, I connect with students in different ways, and that's
especially the good thing is the different ways to connect to students, as opposed to just a
traditional lecture.
Sam displayed a positive mindset when they highlighted the excitement behind personal growth
as an educator and interacting with students on deeper levels. They specifically mentioned this
was not what they encountered with “traditional lectures” and did not display anxiety. Indeed,
reducing anxiety increases motivation because successes are facilitated (Clark & Estes, 2008;
Lord & Kanfer, 2002). Additionally, positive mindsets usually increase motivation (Clark &
Estes, 2008).
Emotions did not appear to be a motivation deficit that limited course directors’
capacities to redesign courses based on educational best practices for learner-centered blended
learning design. It is likely that emotions do not result in performance gaps for most course
directors. Emotional responses were aligned with preparing students for their future professional
lives, which were articulated through positive mindsets. Such mindsets and positivity generally
increase motivation (Clark & Estes, 2008; Lord & Kanfer, 2002). Thus, emotions did not seem
to be a motivational deficit that could serve as a barrier for course directors when they redesign
courses using non-lecture based approaches.
Course directors need to feel positive about developing courses that use appropriate
educational technologies that support cognitive process and effective delivery (Emotions).
This assumed motivation need was not validated. During the interview process, interviewees
were asked how they felt about developing courses using educational technologies. Most of the
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course directors (72.7%) demonstrated positive emotions toward developing courses using
educational technologies. A couple (18.2%) demonstrated neutral emotions, and one course
director (9.1%) demonstrated negative emotions.
Several factors contributed to positive emotions from course directors toward developing
courses using educational technologies. These factors included improvement of their
professional satisfaction and self-worth, best way to teach and include the most recent evidence
and resources, and improved course organization. Additionally, some course directors indicated
that other factors could potentially increase positive emotions toward developing courses using
educational technologies. For example, aligning effective technologies with improved student
outcomes, and providing technical support with implementation increased positive emotional
responses. One factor contributed to negative emotions, which was the fear of failure. Fear of
the unknown and other apprehensions demotivate stakeholders (Mitchell, Parlamis, & Claiborne,
2015). When speaking about such fears, Dane said:
I think anytime you introduce technology you are at risk for making yourself look a little
silly or you don't know what you're doing, and I don't know how to solve all of the
problems, and so you're actually really more dependent on the supports. So I feel a little
nervous about introducing them.
Dane used words like “silly” and “nervous” to describe their emotions. Likewise, they
anticipated “problems” that would arise, rather than potential benefits. Negative mindsets, like
that displayed here, coupled with fears of failure decrease motivation (Clark & Estes, 2008;
Mitchell et al., 2015). But, not all course directors let such fears manifest into anxiety. For
example, Kris said:
Because it has been an old style, traditional way, I am excited about implementing the
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change and the technologies. It's a good opportunity, it's less boring, it makes me feel that
I did contribute to this course if I implement this technology.
In this case, Kris displayed a positive mindset and was motivated for the “exciting changes” that
left the “old style, traditional ways” behind. They used words like “excited” and “opportunity”
to describe their emotions. Course directors with positive mindsets are more likely to make an
active choice to develop technology-enriched courses (Clark & Estes, 2008). Likewise, fears and
apprehension will likely be replaced with increased motivation and persistence (Mitchell et al.,
2015).
Emotions did not appear to be a motivation deficit that limited course directors’
capacities to develop courses that use appropriate educational technologies that support cognitive
process and effective delivery. Therefore, it is likely that emotions do not result in performance
gaps for most course directors. Most course directors displayed positive mindsets and emotions,
which usually increases motivation (Clark & Estes, 2008; Lord & Kanfer, 2002). Thus,
emotions did not seem to be a motivational deficit that could serve as a barrier for course
directors when they develop technology-enriched learning environments.
Course directors need to believe that improved student outcomes are the result of their
efforts in redesigning courses based on educational best practices for learner-centered blended
learning design (Attribution). This assumed motivation need was validated. During the
interview process, interviewees were asked to what extent they believed their efforts spent on
redesigning courses using non-lecture based approaches would improve student learning. Nearly
one-third of the course directors (27.3%) indicated that their efforts spent on redesigning courses
using non-lecture based approaches would improve student learning a great deal. Almost half of
the course directors (45.5%) indicated their efforts would somewhat improve student learning.
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One course director (9.1%) indicated neutral beliefs, and two course directors (18.2%) indicated
this would not improve student learning at all.
Course directors described several factors that contributed to positive relationships
between efforts spent on redesigning courses using non-lecture based approaches and
improvements with student learning. Improved student learning outcomes and improved course
structure/organization were the primary reasons provided. Additionally, several factors
contributed to neutral relationships between efforts spent on redesigning courses using non-
lecture based approaches and improvements with student learning. Course directors described a
lag in performance indicators as improvements are made when redesigning courses and the fear
that course redesigns would help some students, but hurt performance of others. Finally, several
factors indicated there would be no impact yielded on improvements with student learning at all.
Course directors stated that current teaching approaches already work well, course redesigns
were too time-intensive, and identifying appropriate assessments were challenges that limited
potential successes.
Regardless of their teaching approaches, most course directors indicated they regularly
modify their courses to improve student outcomes. For example, Casey said:
It's a time to effort distribution, but we make changes in the course like this, on a yearly
basis. It's always, I would like to say always based, on the view that this is somehow
going to increase their knowledge retention, their learning, their ability to understand the
material. That's primarily the only reason we try to make changes.
Casey described that course modifications are made solely to “increase knowledge retention” and
to enhance “their ability to understand the material.” Thus, course directors seemed to naturally
attribute their efforts spent on improving student outcomes. However, the phrase “somehow
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going to” also indicated a lack of understanding about effective instructional practices that
promote improved learning outcomes (for example, knowledge retention). Direct faculty
involvement in course redesigns and recognizing that their efforts yielded improved student
outcomes generally increases faculty motivation (Fink, 2013; VanDerLinden, 2014). But, when
course directors related these attributions specifically to blended-learning course redesigns, there
were divergences in their responses. For example, when relating efforts spent to student
outcomes, Sam said:
The grades on the exams stay pretty stable all the way through, no matter what changes I
make. I think that there is a plateau at which you can't reach anymore students, and I
think changing what I do may reach a different subset of students, but then leave
somebody somewhere else.
Sam based student outcomes on exam performance, and did not include other potential outcomes
that could have been affected. Likewise, they did not specify the actual modifications they made
to their courses. They also used words like “stable” and “plateau” when attributing their efforts
spent to student outcomes. Similar to previous observations, Sam also indicated a lack of
understanding about the science of learning, when they described their perceived relationships
between instructional practices and student learning. On the other hand, some course directors,
like Jamie, felt quite differently:
I think that one of the things that I noticed is that the students were starting to ask a little
bit more challenging questions. I felt that they were getting a much stronger knowledge
base as a result of the exposure. It may be the result of the fact that this process not only
helps engage them, but it also helps revisit the curriculum, update the curriculum, modify
the curriculum, eliminate redundancies, and do a better job of establishing foundations of
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the principles of the field. In my opinion, the time spent putting all of those things
together was worth it.
Jamie related efforts to many types of student outcomes, which included the types of questions
students asked in class sessions and overall engagement in the learning process. They also
reflected on how the changes they made updated their curriculum and made it stronger. Jamie
used words like “stronger” and “better” when attributing their efforts spent to student outcomes.
Yet, Jamie also demonstrated a lack of understanding about using analytics and formative
feedback to guide their teaching interventions and reflection practices when they used the phrase
“I felt” to describe student responses to the learning environment.
Attribution appeared to be a deficit that impacted course directors’ motivation to design
courses based on educational best practices for learner-centered blended learning design. This
deficit likely results in performance gaps. When faculty members attribute their successes to
effort spent, as opposed to natural ability, then motivation usually increases (Anderman &
Anderman, 2009). This attribution deficit could potentially serve as a barrier for course directors
because they may choose to limit risk or avoid failure, which decreases motivation.
Course directors need to believe that improved student outcomes are the result of their
efforts in developing courses that use appropriate educational technologies that support
cognitive process and effective delivery (Attribution). This assumed motivation need was
validated. During the interview process, interviewees were asked to what extent they believed
their efforts spent on developing courses using educational technologies would improve student
learning. Two course directors (18.2%) indicated that their efforts spent on developing courses
using educational technologies would improve student learning a great deal. Nearly two-thirds
of the course directors (63.6%) indicated that their efforts would somewhat improve student
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 144

learning. One course director (9.1%) indicated neutral beliefs, and one course director (9.1%)
indicated this would not improve student learning at all.
Several factors contributed to positive relationships between efforts spent on developing
courses using educational technologies and improvements with student learning. For example,
course directors described improvements in various student outcomes, facilitating learning
processes, such as connecting to prior knowledge, and improvements in course
structure/organization. Three course directors (27.3%) specifically indicated that their efforts
spent on developing courses using educational technologies would improve student learning only
with proper instructional design. And, one course director stated no impact on student learning
would be observed because live lecturing already works well.
Attributing achievements to personal effort spent on tasks increases motivation
(Anderman & Anderman, 2009). Generally, course directors were cautiously optimistic, but they
provided student-centric responses rather than attributing successes to their own efforts in
developing the course. For example, Cameron stated:
I think technology is gonna [sic] help students learn, but it all depends on whether it's
correctly designed, because I can convert everything to technology. That doesn't mean it's
going to be meaningful, or they're gonna [sic] like it. If it's part of a well-designed
curriculum, using instructional design, using the appropriate technologies and tools, then
yes I think.
In this case, Cameron deflected away from their own efforts spent on redesigning courses.
Instead, they referred to the quality of the instructional design process. They deflected again to
student satisfaction metrics (“they’re gonna [sic] like it”) rather than relate to their own efforts
spent. Relating instructional efforts to increased student outcomes likely increases motivation
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because course directors are more self-aware (Anderman & Anderman, 2009; Self & Schraeder,
2008; Tagg, 2012). When reflecting on their instructional efforts, Casey said:
It's hard to say that it improves their learning, but it makes the learning that they need to
have, maybe more accessible, or more approachable. I think about that frequently, that
I'm trying to ... The courses that I teach, I'm trying to make the material that they need to
learn as easy, and as valuable for them, in their particular learning environment, whether
they be visual, auditory, kinesthetic. Whether they work better as a loner, or they work
better as a group, I want to provide as many avenues for them to learn that's gonna [sic]
work into their situation.
Although Casey did not specifically focus their response on educational technologies, they did
reflect on the efforts they spent on improving courses and related that to student outcomes. In
doing so, Casey attributed their own efforts to students’ achievements. During this reflection,
they used words like “valuable” and “provide” when relating their instructional efforts to student
outcomes. However, Casey also related their instructional strategies to student learning styles,
which is inconsistent with current neuroscience and cognitive psychology research. Jamie
provided specific examples of the items they included during a technology-enriched course
redesign project, and how those efforts improved student outcomes:
I think that it improved student learning significantly. I think that that in particular,
looking at real time questions that students were answering online with regards to pre-
test, mid-test, post-test, allowed to, for example, identify deficiencies in their knowledge
base that maybe was a result of concepts that were not made clear through the lectures,
and allowed for modification and clarification during in-class sessions. I found that that
was a very highly useful tool.
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Jamie used words like “clarification” and “useful” to describe the student outcomes. But, they
also pointed out specific components of the course they built that led to these student outcomes.
Jamie attributed their efforts spent to impactful student outcomes, which is likely increased
motivation (Anderman & Anderman, 2009).
For many course directors, attribution appeared to be a deficit that impacted course
directors’ motivation to develop courses that use appropriate educational technologies that
support cognitive process and effective delivery. This deficit likely results in performance gaps.
When faculty members attribute their successes to effort spent, as opposed to deflecting it to
other potential influences, then motivation typically increases (Anderman & Anderman, 2009).
This attribution deficit could serve as a barrier for course directors because they may focus too
heavily on natural capabilities or self-efficacy, which would likely decrease their motivation.
Synthesis of Results and Findings for Motivation Causes
Course directors demonstrated mixed responses for value toward redesigning courses to
reflect best practices for learner-centered blended learning and toward developing courses that
use appropriate educational technologies that support cognitive process and effective delivery.
Course directors demonstrated low self-efficacy in terms of their confidence with designing
courses based on educational best practices for learner-centered blended learning design and with
developing courses that use appropriate educational technologies that support cognitive process
and effective delivery. However, course directors demonstrated positive emotions toward
redesigning courses based on educational best practices for learner-centered blended learning
design and toward developing courses that use appropriate educational technologies that support
cognitive process and effective delivery. Lastly, course directors demonstrated a tepid belief that
improved student outcomes are the result of their efforts in redesigning courses based on
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educational best practices for learner-centered blended learning design. Likewise, course
directors demonstrated a tepid belief that improved student outcomes are the result of their
efforts in developing courses that use appropriate educational technologies that support cognitive
process and effective delivery. Finally, observations revealed a pattern of evidence that
suggested course directors may not understand the science behind how people learn, which
would likely influence the degrees to which they would be motivated to redesigning courses and
implementing technology-enriched learning environments.
Results and Findings for Assumed Organizational Needs
Survey and interview questions validated the four organizational constructs, which were
resources, policies, cultural models, and cultural settings. The survey contained 14 organization-
related items and they were asked a total of six motivation-related questions during the interview
process. Following integration of the two datasets, if course directors demonstrated an overall
organizational deficit for a particular assumed need, then that need was classified as validated. If
no organizational deficit emerged, then that assumed need was classified as not validated. The
criteria used to define organizational “deficits” and classify assumed organizational needs as “not
validated” are outlined in Table 16. A synopsis of the emergent organizational patterns with
frequencies and percentages (organized by organizational construct and by assumed organization
need) is provided in Table 19.

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Table 16
Criteria used to classify assumed organizational needs as “not validated”
Survey Interview
Resources Majority in “frequently”
and “always” category
(>50% combined)

and >50% aligned description
of resources with support
for educational creativity

Policies Majority in “frequently”
and “always” category
(>50% combined)

and >50% aligned response
with institution’s strategic
plan of innovative medical
education and teaching
practices

Cultural model Mean, Median, and
Mode >7
and >50% demonstrated
positive beliefs toward
organizational support

Cultural setting Mean, Median, and
Mode >7
and >50% aligned response
with learner-centered
environments and/or
educational technologies
with a detailed description
of collaborative teamwork

Survey Results
Resources items. Participants were asked about the extent to which they had time,
resources, and financial support to redesign and develop their courses. They used a Likert-type
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scale and recorded a value of Never, Rarely, Occasionally, Frequently, or Always. Prompts
aligned with the two critical behaviors. First, course directors reported their perspectives on
organizational resources that supported their abilities to redesign courses based on educational
best practices for learner-centered blended learning design. Then, they reported their
perspectives on organizational resources that supported their abilities to develop courses using
appropriate educational technologies that support cognitive process and effective delivery.
When redesigning courses using blended learning approaches, course directors reported
deficits in organizational resources. Most course directors indicated they did not have sufficient
time to redesign their courses using non-lecture based approaches. For example, 44.44% of
course directors reported they rarely had time, 40.74% reported they occasionally had time, and
none reported they always had time (Figure 9). Additionally, most course directors indicated
they did not have sufficient human capital to support their efforts with redesigning courses using
non-lecture based approaches. For example, 44.44% of course directors reported they rarely had
sufficient human capital, 29.63% reported they occasionally had sufficient human capital, and
none reported they always had sufficient human capital (Figure 9). Finally, most course
directors indicated they did not have the financial support they needed to redesign their courses
using non-lecture based approaches. For example, 33.33% of course directors reported they
never had financial support, 33.33% reported they rarely had financial support, and none
reported they always had financial support (Figure 9).
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Figure 9. Percentage of course directors describing their perceptions of organizational support
(time, human capital, and financial support) for redesigning learner-centered courses.

When developing courses using appropriate educational technologies, course directors
also reported deficits in organizational resources. Most course directors indicated they did not
have sufficient time to develop technology-enriched learning environments. For example,
40.74% of course directors reported they rarely had time, 37.04% reported they occasionally had
time, and none reported they always had time (Figure 10). Additionally, most course directors
indicated they did not have sufficient human capital to support their efforts with developing
technology-enriched learning environments. For example, 22.22% of course directors reported
they never had sufficient human capital, 33.33% reported they rarely had sufficient human
capital, and none reported they always had sufficient human capital (Figure 10). Finally, most
course directors indicated they did not have the financial support they needed to develop
technology-enriched learning environments. For example, 33.33% of course directors reported
they never had financial support, 44.44% reported they rarely had financial support, and none
reported they always had financial support (Figure 10).
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Figure 10. Percentage of course directors describing their perceptions of organizational support
(time, human capital, and financial support) for developing technology-enriched learning
environments.

Policies. Participants were asked about the extent to which they had policies and
procedures aligned with their efforts to redesign and develop their courses. They used a Likert-
type scale and recorded a value of Never, Rarely, Occasionally, Frequently, or Always. Prompts
aligned with the two critical behaviors. First, course directors reported their perspectives on
organizational policies and procedures that aligned with their efforts to redesign courses based
on educational best practices for learner-centered blended learning design. Then, they reported
their perspectives on organizational policies and procedures that aligned with their efforts to
develop courses using appropriate educational technologies that support cognitive process and
effective delivery.
Course directors reported deficits in organizational policies and procedures aligned with
their efforts to redesign their courses using non-lecture based approaches. For example, 33.33%
of course directors reported they occasionally had such organizational policies and procedures,
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40.74% reported they rarely had policies and procedures, and none reported they always had
policies and procedures (Figure 11) aligned with their efforts to redesign their courses using non-
lecture based approaches. Similarly, course directors reported deficits in organizational policies
and procedures aligned with their efforts to develop technology-enriched courses. For example,
33.33% of course directors reported they occasionally had such organizational policies and
procedures, 40.74% reported they rarely had policies and procedures, and none reported they
always had policies and procedures aligned with their efforts to redesign their courses using non-
lecture based approaches (Figure 11).

Figure 11. Percentage of course directors describing their perceptions of organizational support
(policies and procedures) for redesigning learner-centered courses and developing technology-
enriched learning environments.
Cultural model. Participants were asked a series of prompts about the extent to which
they believed they were supported by the organization and executive leadership to redesign and
develop their courses. They used an interactive scale and recorded a value between zero
(strongly do not believe) and ten (strongly believe). Prompts aligned with various characteristics
of their organization’s cultural model. First, course directors reported their perspectives on
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 153

organizational support for their efforts to redesign courses based on educational best practices for
learner-centered blended learning design. Then, they reported their perspectives on
organizational support for their efforts to develop courses using appropriate educational
technologies that support cognitive process and effective delivery. Next, they reported their
perspectives on encouragement they received from executive leadership to be creative with their
teaching practices. Finally, they reported their perspectives on the degree to which they
considered the educational environment they work in to be innovative.
Course directors reported they believed some degree of organizational support existed to
support their efforts when redesigning courses using blended learning approaches, but there was
high variability across the sample (Table 17a). The mean value was 6.41 (SD = 2.06) with a
mode of 8 and a median of 7. Next, course directors reported they believed there was a lesser
degree of organizational support for their efforts when developing courses using appropriate
educational technologies (Table 17b). The mean value was 6.33 (SD = 2.35) with a mode of 5
and a median of 7. Then course directors reported they believed they were moderately
encouraged by executive leadership to be creative with their teaching practices (Table 17c.). The
mean value was 6.37 (SD = 3.05) with a bimodal distribution (mode = 6, 10) and a median of 6.
Lastly, course directors reported they considered the educational environment they worked in in
to be marginally innovative (Table 17d). The mean value was 5.93 (SD = 2.77) with a mode of 6
and a median of 6.

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Table 17
Cultural model
Please rate the extent to which you believe the following as of
today by recording a number from 0 to 10 using the interactive
scale below:
Mean SD Mode Median
a. I am part of an organization that supports my efforts to
redesign courses based on educational best practices for learner-
centered blended learning design.

6.41

2.06

8 7
b. I am part of an organization that supports my efforts to
develop courses using appropriate educational technologies.

6.33

2.35

5 7
c. I am encouraged by executive leadership to be creative with
my teaching practices.

6.37

3.05

6, 10 6
d. I consider the educational environment I work in to be
innovative.
5.93 2.77 6 6

Cultural setting. Participants were asked a series of prompts about the extent to which
they believed they were part of a team that worked together to redesign and develop their
courses. They used an interactive scale and recorded a value between zero (strongly do not
believe) and ten (strongly believe). Prompts aligned characteristics of their organization’s
cultural setting with the two critical behaviors. First, course directors reported their perspectives
on the extent to which they felt part of a team that worked together to redesign courses based on
educational best practices for learner-centered blended learning design. Then, they reported their
perspectives on the extent to which they felt part of a team that worked together to develop
courses using appropriate educational technologies that support cognitive process and effective
delivery.
Course directors reported they believed they were somewhat part of a team that worked
together to redesign courses using blended learning approaches, but there was high variability
across the sample (Table 18a). The mean value was 6.22 (SD = 2.44) with a mode of 6 and a
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median of 6. Similarly, course directors reported they believed they were somewhat part of a
team that worked together to develop courses using appropriate educational technologies (Table
18b). The mean value was 6.19 (SD = 2.34) with a mode of 5 and a median of 6.

Table 18
Cultural setting
Please rate the extent to which you believe the following as of
today by recording a number from 0 to 10 using the interactive
scale below:
Mean SD Mode Median
a. I am part of a team that works together to redesign courses
based on educational best practices for learner-centered blended
learning design.

6.22

2.44

6 6
b. I am part of a team that works together to develop courses
using appropriate educational technologies.
6.19

2.34

6 6

Interview Findings
Table 19
Organization patterns frequency table (n = 11 interviewees)

Organization patterns

Frequency

Resources

Support creativity as an educator
• Actually aligned with description of resources 10 (90.9%)
• Provided only a vague description of resources 8 (72.7%)
• Actually aligned with educational creativity 3 (27.3%)
• Specifically said not a lot (or something very similar) 3 (27.3%)
• Specifically mentioned the Office of Educational
Enhancement
5 (45.5%)
• Specifically mentioned educational experts 3 (27.3%)
• Specifically mentioned incentives 2 (18.2%)
• Specifically mentioned the Academic Technologies
website
1 (9.1%)
• Specifically mentioned the medical education grand 1 (9.1%)
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 156

rounds series
• Specifically mentioned casual conversations with other
faculty members
1 (9.1%)

Policies

Aligning teaching practices with institution’s strategic plan of
innovative medical education

• Actually aligned with the institution's strategic plan of
innovative medical education
0 (0%)
• Actually aligned the institution's strategic plan with
teaching practices
0 (0%)
• Specifically said “I don’t know of any policies” (or
something very similar)
5 (45.5%)
• Specifically said no policies exist (or something very
similar)
4 (36.4%)
• Specifically mentioned the Institutional Educational
Objectives
2 (18.2%)
• Stated policies are not needed, but more time dedicated to
teaching activities is needed
1 (9.1%)
• Stated that innovation is for innovation sake and does not
increase student performance
1 (9.1%)
• Stated that there is no support or incentives from executive
leadership for teaching effort
1 (9.1%)

Cultural Model

Supportive of efforts for blended learning design
• Demonstrated negative beliefs toward organizational
support
7 (63.6%)
• Demonstrated positive beliefs toward organizational
support
4 (36.4%)
• Indicated there are two fragmented groups of educators
that diverge in their attitudes of innovative versus traditional
education
7 (63.6%)
• Indicated that there was a lack of effective communication
about organizational change from executive leadership
4 (36.4%)
• Indicated that they were in the midst of a transitional phase
with little expectations
3 (27.3%)
• Indicated they received mixed messages from executive
leadership in terms of innovative education
2 (18.2%)
• Indicated it was pleasant and respectful 2 (18.2%)
• Mentioned respect of student learning needs was important 1 (9.1%)
Supportive of efforts with educational technologies
• Demonstrated positive beliefs toward organizational
support
8 (72.7%)
• Demonstrated negative beliefs toward organizational
support
3 (27.3%)
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• Articulated a response consistent with the actual vision
from executive leadership
1 (9.1%)
• Importance of student outcomes and learning
environments
4 (18.2%)
• Committees and taskforces to reinvent the curriculum 3 (27.3%)
• Incentives program 2 (18.2%)
• Mixed messages from executive leadership on developing
innovative teaching and learning environments
2 (18.2%)
• Damaging impact on initiative, drive, and morale 1 (9.1%)

Cultural Setting

Collaborative team that redesigns courses
• Indicated that the course director feels part of a team 6 (54.5%)
• Indicated that the course director does not feel part of a
team
5 (45.5%)
• Failed to describe collaboration or working together in any
detail
10 (90.9%)
• Response aligned with using non-traditional educational
approaches
5 (45.5%)
• Response aligned primarily with administrative tasks
and/or hierarchical structure
5 (45.5%)
• Feel that potential exists for improved collaboration or
support
4 (36.4%)
• Feel intentionally excluded from decision-making
processes
1 (9.1%)
Collaborative team that develops courses using appropriate
educational technologies

• Indicated that the course director feels to be very much
part of a team
6 (54.5%)
• Indicated that the course director feels to be somewhat part
of a team
4 (36.4%)
• Indicated that the course director does not feel part of a
team
1 (9.1%)
• Failed to describe collaboration or working together in any
detail
9 (81.8%)
• Response aligned with using appropriate educational
technologies
4 (36.4%)
• Mentioned specific examples of educational technologies 4 (36.4%)
• Indicated unevenness in organizational priorities toward
commitment to developing courses using educational
technologies
6 (54.5%)

Course directors need organizational resources (time, human and financial support) to
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redesign and develop technology-enriched learning environments (Resources). There were
two assumed resources needs. First, course directors need to have the resources (time, human
and financial support) to redesign courses based on educational best practices for learner-
centered blended learning design. Second, course directors need to have the resources (time,
human and financial support) to develop the course by using appropriate educational
technologies that support cognitive process and effective delivery. Both of these assumed
organizational resources needs were validated.
Course directors frequently provided only vague descriptions of organizational resources,
and nearly 30% of the course directors said that not a lot was available to them. Although they
highlighted various types of resources, including the Office of Educational Enhancement or
educational experts, incentives, university websites, presentation seminars, and casual
conversations with other faculty members, most did not identify specific descriptions of how any
of these resources supported them to redesign and develop their courses (Table 19). These
findings are inconsistent with Waters, Marzano, and McNulty’s (2003) recommendation that
effective leaders enable organizational change by guaranteeing that stakeholders have sufficient
resources. Clark and Estes (2008) also stated that organizational goals should be aligned with
adequate resources. Under the context of organizational resources aligned with the institution’s
strategic goal of delivering innovative medical education initiatives, Sam said:
We don't have a lot. We have our med ed grand rounds, that's medical education grand
rounds, and that's pretty much it. The only other thing is on the fly, if I run into another
faculty or something like that who mentioned something, but that's it.
Sam indicated that executive leadership does not appear to be aligning adequate resources to
support course directors with generating technology-enriched learning environments. Their
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statements of “we don’t have a lot” and “that’s pretty much it” are not indicative of commitment
to organizational change by executive leadership. Sam mentioned that colleagues played a
supportive role, but they did not highlight a formal mechanism that could enhance these
relationships to enrich teaching practices. Dane confirmed that there was room for improvement
with the ways in which institutional resources were incorporated to support educators:
I would say that it still seems like the Office of Educational Enhancement is not as
integrated into faculty’s everyday lives as it could be. You're aware that it's a resource,
but you're not thinking on a daily basis of how they can help you.
Dane provided a potential explanation that illustrated how executive leadership was not
providing sufficient resources and aligning them with institutional goals. When Dane used the
phrase “you're not thinking on a daily basis of how they can help you,” they indicated that
executive leadership has not communicated effectively with them about how these resources can
support their creativity as an educator while simultaneously helping the institution realize its
strategic goals. According Dane, there is an opportunity to better integrate these institutional
resources into their workflow. This potentially leads to a situation where course directors
receive uneven messaging on institutional priorities and accountability processes (Hentshe &
Wohstetter, 2004).
Therefore, when course directors try to maximize educational creativity, they are
potentially not receiving adequate organizational resources aligned with the institution’s strategic
plan for innovative medical education (Clark & Estes, 2008; Waters et al., 2003). This perceived
deficit with organizational resources potentially impacts capacity to redesign and develop
courses using non-lecture based approaches, which could serve as barriers for innovative course
directors. They may not have the organizational resources (time, human and financial support)
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and support mechanisms they need to redesign and develop technology-enriched learning
environments.
Course directors need organizational policies and procedures to help align teaching
practices with the institution’s strategic plan for innovative medical education (Policies).
There were two assumed policies’ needs. First, course directors need to have the organizational
policies and procedures aligned with their efforts to redesign courses based on educational best
practices for learner-centered blended learning design. Second, course directors need to have the
org policies and procedures aligned with their efforts to develop the course by using appropriate
educational technologies that support cognitive process and effective delivery. Both of these
assumed organizational policies needs were validated.
Course directors were unable to align organizational policies with the institution's
strategic plan of innovative medical education or teaching practices (Table 19). Furthermore,
most of the course directors specifically stated they did not know of any such policies or that no
policies existed. For example, Alex succinctly stated: “Zero. Let me rephrase this. I am not
aware of such policies.” Although some course directors highlighted a couple types of policies,
including institutional-level medical education objectives and unwritten support for
nontraditional teaching approaches, they did not identify specific procedures of how these
policies helped them align their teaching practices with the institution’s strategic plan for
innovative medical education.
These findings indicated a perceived lack of guidance from executive leadership to
empower course directors to achieve success with the organizational change toward innovative
medical education (Clark & Estes, 2008; Kotter, 2009). Course directors conveyed there was a
lack of compelling messages and modeled behaviors from executive leadership that could
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promote organizational change (Denning, 2005; Lewis, 2011; Van den Akker, Heres, Lasthulzen
& Six, 2009). Under the context of unclear communication from executive leadership about
policies for helping course directors achieve the institution’s strategic goal of delivering
innovative medical education initiatives, Jamie said:
Policies that are in place to align those as it pertains to innovation? I'm not sure I'm
aware of those policies. I do know that we have institutional educational objectives
within our university and that we try to incorporate all those objective in all our courses;
however, as it pertains to technologic innovation, I'm not sure I'm aware of that.
Jamie conveyed that executive leadership does not appear to be communicating policies that
support course directors with aligning their teaching practices with the institution’s strategic
plan. Their statements of “I'm not sure I'm aware of those policies” and “I'm not sure I'm aware
of that” are indicative of ineffective communication processes. Jamie mentioned that
institutional-level objectives exist, but they highlighted they do not apply to technology-enriched
course development. Sam conveyed confusion with institutional policies:
There are none. Well, not that I know of. And if there are, they're not implemented
because there is nothing out there to help support you to be able to develop better
technology, to take the time to do that if you're a clinical educator.
In addition to stating they were unaware of policies, Sam potentially illuminated a deeper rift
between course directors and executive leadership. When Sam used the phrase “there is nothing
out there to help support you to be able to develop better technology, to take the time to do that if
you're a clinical educator,” they conveyed frustrations with their role at the university as a
clinical educator and provided a glimpse at their relationship with what they suggested is an
unsupportive executive leadership team. This potentially leads to a situation where course
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directors encounter a deficit in organizational policies coupled with untrustworthy relationships
with an executive leadership who may or may not be committed to organizational change (Clark
& Estes, 2008).
Therefore, when course directors try to align innovative teaching approaches with the
institution’s strategic plan, they are potentially not receiving adequate organizational policies and
commitment from executive leadership (Clark & Estes, 2008; Denning, 2005; Kotter, 2009;
Lewis, 2011; Van den Akker et al., 2009). This perceived deficit with organizational policies
potentially impacts their willingness to redesign and develop courses using non-lecture based
approaches, which could serve as barriers for innovative course directors. They may not have
the organizational policies and procedures they need to help align teaching practices with the
institution’s strategic plan for innovative medical education.
Course directors need to believe that they are part of an organization that supports
their efforts to redesign courses based on educational best practices for learner-centered
blended learning design (Cultural Model). Course directors frequently indicated the importance
of being able to observe how the institution’s executive leadership team changes the culture of
traditionalism. Yet, most course directors also suggested that the organizational culture they
experience is not supportive of their needs to innovate in the classroom. These findings are
contrary to Schneider, Brief, and Guzzo’s (1996) recommendation that successful and sustained
culture change implementations rely on robust messages from organizational leadership about
their values for innovative cultures. Berger (2014) also found that effective leaders model
expected behaviors to help shape cultural norms. In terms of replacing traditionalism with
innovative teaching practices, Dane said:
I would tell you that things have been pretty well established here. I mean, even as a
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message that I got when I took over a course was, "Don't make a lot of changes. Stick to
how we've been doing it. This has been working," with like a little peppering in of, "You
can be innovative if you want to, but still if it's not broke, don't fix it" kind of idea. So I
think that there's a lot of talk of innovation, but I think that truthfully the organization
doesn't really think that there's a major problem with the way that the curriculum has
been delivered.
Dane indicated that executive leadership seems to be content with the current organizational
culture. Their statements of “stick to how we’ve been doing it” and “if it’s not broke, don’t fix
it” are not the types of statements expected of visionary leadership during a culture change.
Dane further explained that although leadership implies curricular innovation is an
organizational goal, actions from executive leadership do not tend to align with their messages.
Cameron indicated that deans were “kind of far removed” from educators. They elaborated by
saying:
Far removed from the educational vision in a way, which seems kind of strange because
you're in an educational environment, and that it's always been about clinical research,
and then education has always been relegated, the same with the department chairs.
Cameron explained a potential reason why the leadership team may not align their
communicated messages for innovative medical education with their actions. When Cameron
used the phrase “far removed,” they indicated that the executive deans are disconnected from the
reality of educators within the classroom. According Cameron, these deans tend to be more
focused on “clinical research” and less on education. From their perspective, this potentially
leads to a situation where education is “relegated” to a lower tier of importance within the
organization.
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Therefore, when course directors try to minimize traditionalism, they are potentially not
receiving effective messages or modeled behaviors from the executive leadership team (Berger,
2014; Schneider et al., 1996). This organizational culture potentially impacts motivation and
capacity to redesign courses, which could serve as barriers for innovative course directors. They
may not believe that they are part of an organization that supports their efforts to redesign
courses based on educational best practices for learner-centered blended learning design.
Course directors need to believe that they are part of an organization that supports
their efforts to develop the course by using appropriate educational technologies that support
cognitive process and effective delivery (Cultural Model). A common occurrence was that all
course directors stated that they knew of no institutional vision for technology-enriched course
designs. This is inconsistent with Schein’s (2004) description of charismatic leadership, where
followers engage around a shared organizational vision. In this case, survey results indicated
that 85.19% of respondents felt that if the institution’s vision for promoting technology
integration aligned with their own, that this would be a moderate or significant level of influence
with helping them effectively implement technology-enriched courses. Furthermore,
inconsistent articulation of an organizational vision appears to negatively impact course director
motivation. For example, Alex admitted:
Initially, when I got more into medical school teaching, I was actually, I had a lot of
initiative and fire because what was voiced was really great, pretty much along the lines.
So, I would love to be able to teach and educate students. But, the longer I'm here, the
more I realized that there is a difference between what is said and what actually is done,
and there is a weird break on making progress possible.
Alex entered the institution with a passion for teaching. They were energized to work within this
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medical education program, which is evidenced when they stated that they “had a lot of initiative
and fire.” But, with years of experience, their enthusiasm diminished. Alex cited that over time,
they observed a mismatch in what leadership publicly stated about innovative medical education
and “what actually is done.” In terms of innovative teaching practices, this poorly articulated
vision lessened their enthusiasm, drained them of motivation, and created a barrier to progress.
Other course directors expressed similar frustrations with this lack of vision from executive
leadership. For example, Pat said:
The culture is that we seem to be in this thing and it is very difficult to do the
reorganization. Although there is a lot of talk and everybody knows that it must be done,
it's just a question of how to actually go about and do it. There might be some mystery
there that could be resolved from a higher level.
The lack of communication from the executive leadership team appears to create confusion for
course directors. This confusion during the organizational change was apparent when Pat stated,
“it's just a question of how to actually go about and do it” and also when they used words like
“mystery” and “difficult” to describe the situation. Pat expanded on that sentiment by indicating
that guidance from the executive leadership team could facilitate the culture change when they
stated “there might be some mystery there that could be resolved from a higher level.” When
asked what they meant by the phrase “higher level,” Pat specified by saying “executive
leadership.”
The lack of a clearly articulated vision statement is inconsistent with Schein’s (2004)
recommendation that followers respond positively during organizational change when they
receive clear communication and visionary leadership. Kotter (2007) also explained that
effective leaders place significant importance on effectively communicating a shared vision
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during organizational change. Thus, when course directors attempt to enrich their courses with
technology-enriched strategies, they may face significant and demotivating organizational
barriers that limit their abilities to succeed.
Course directors need to believe that they are part of a team that works together to
redesign courses based on educational best practices for learner-centered blended learning
design (Cultural Setting). Slightly more than half of the course directors (54.5%) indicated that
they felt part of a team, while 45.5% of them indicated they did not. Yet, ten of the 11 course
directors (90.9%) failed to describe collaboration or working together in any detail.
Furthermore, only five course directors aligned being part of a team with using non-traditional
educational approaches. Several indicated that potential existed for improved collaboration or
support (Table 19). Increased productivity likely results from shared experiences and teamwork
(Buckingham & Coffman, 1999; Harter, Schmidt, Killham & Asplund, 2006; Schein, 2004;
Schlossberg, 1989). For example, Schein (2010) described the importance of stakeholders
observing the behaviors and attitudes of peers to increase engagement. Under the context of
organizational settings and teams working together to redesign course using nontraditional
practices, Dane said:
I mean, I am officially a part of a team, but I personally feel like, at least as far as
Blackboard's concerned, I'm the only person on my team that knows anything about
Blackboard or that has done anything ... Not anything, but has explored other
possibilities. So I don't think everybody on my team is motivated, has the time,
understands exactly how to do that. So I'm on a team, but I'm not on a team that shares
that as a primary goal.
Dane indicated that there were within-group performance and motivation issues that interrupted
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progress. Their statements of “I don't think everybody on my team is motivated” and “I'm not on
a team that shares that as a primary goal” are indicative of a cultural setting where trusting
relationships might be lacking. Dane mentioned that they are “officially a part of a team,” but
they did not follow this positive sentiments or praises. However, other course directors, like
Kris, conveyed a much more positive outlook and spoke highly of the cultural setting:
Yeah, I believe that big time. I wouldn't be able to do this myself. If I didn't see that there
is a support system here and they've done this successfully, I wouldn't dare do this on my
own. I'm very busy and this is all extra work to me, so the fact that there is a team in
place and they will help me do this is encouraging, so I do believe there's good support.
While Kris did not describe the composition of the team they are part of, they did indicate that it
was a “support system” for course redesign projects. When Kris used the words “successfully”
and “encouraging,” they indicated that they encountered a positive setting, supportive of their
needs. According to Kris, the rest of the team enhanced project success because of their
demanding schedules and professional commitments. These mixed responses about teams and
cultural setting could lead to situational contexts where some course directors fail to encounter
shared learning experiences with trusted colleagues (Schein, 2010).
As a result, when course directors attempt to work together with team members, they are
potentially dependent upon their unique situation, which may or may not be beneficial to their
engagement in course redesign projects (Schein, 2010). This potential deficit could negatively
impact productivity, emotions, and value, which could serve as barriers for some course
directors. Within their cultural settings, some course directors may not believe that they are part
of a team that works together to redesign non-lecture based courses.
Course directors need to believe that they are part of a team that works together to
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develop the course by using appropriate educational technologies that support cognitive
process and effective delivery (Cultural Setting). More than half of the course directors
indicated that they feel very much part of a team. But, nine course directors (81.8%) failed to
describe collaboration or working together in any detail. Four course directors specifically
aligned teamwork with descriptive examples of educational technologies. However, more than
half of the course directors (54.5%) indicated unevenness in organizational priorities toward
commitment to developing courses using educational technologies. During organizational
changes, though, Fix and Sias (2006) recommended strengthening team members’
communication processes to enhance stakeholder capacity. Furthermore, unevenness in
organizational priorities and lack of commitment demonstrates unreliable leadership (Kotter,
2009; Schein, 2010). Dane highlighted lack of commitment when they stated: “I feel like I am
part of a team, but do I feel like the team is trying to work towards using more educational
technologies? Not as a priority.” Shifting organizational priorities make it difficult for
stakeholders to engage and build trustworthy relationships around shared experiences (Knowles,
1980; Schein, 2010). When asked whether they believed they were working as a team to develop
courses using appropriate educational technologies, this course director said:
Somewhat. I mean we do have meetings periodically where they talk about some of these
things we talked about some of these things we talked about. You know, right now
they're talking about Blackboard, and they're talking about, they talked before about the
Khan Academy, they talked with, but those are general meetings. But as far as being a
small focus group of people that sit together to really plan, you know, courses, to review
content and things like that, those are less of those things. And those presentations
occurred very intermittently from that perspective.
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They described their team interactions as passive meetings, but made it a point to explain they
weren’t actively working together in any sort of meaningful way to dissect and redesign their
courses. When they used the words “Somewhat” and “intermittently,” they indicated there was
an overall feeling of indifference or apathy. According to this course director, teams appeared to
meet for administrative purposes, but they were not enthusiastically engaged in working
together, building relationships, or sharing experiences. These dispirited attitudes about teams
and the cultural setting could decrease motivation for some course directors who fail build
meaningful bonds with team members (Schein, 2010).
Course directors did not seem to encounter meaningful interactions with their peers
through common team experiences, which might minimize their commitment to organizational
change efforts (Schein, 2010). This potential organizational deficit could negatively impact
stakeholder motivation, which could serve as barriers for some course directors. Within their
cultural settings, some course directors may not believe that they are part of a team that works
together to develop technology-enriched courses.
Analytic Memo
During the interview process, an unanticipated theme emerged, where it was discovered
that faculty members have self-organized into informal classifications, based primarily on their
reactions to executive leadership encouraging them to incorporate educational technologies into
their lecture-based courses. For example, one course director stated the following:
I do believe that there's a cadre of faculty, us traditionalists, we'll use it that way, who are
somewhat excluded from decision making processes about education.
This use of the descriptor “traditionalist” seemed to be a direct challenge to establishing a culture
of innovation. To date, medical education at this institution has been largely lecture-based.
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Indeed, many internal stakeholders refer to this system as traditional. Internally, novel
approaches to curricular overhauls in medical education are often called nontraditional
approaches. When reflecting on innovation in medical education, one course director had this to
say:
There's a lot of innovation that's just innovation for innovation purposes. And not
necessarily data to show that the students who engage in that education are any better
prepared, or perform better on exams, or are better physicians later on in life. The goal of
this innovation is sometimes difficult to see. And I wonder if we are perhaps wasting
time, effort, energy, resources, to pursue things that may not actually be beneficial.
There are two things to take note of from this quotation. First, this course director indicated that
communication messages are inadequate when explaining the institution’s vision for innovative
educational practices to key stakeholders. Second, this skepticism toward the benefits of
technology-enriched learning environments could actually be grounded in previous attempts by
executive leadership to overhaul the curriculum, rather than in the use of pedagogical innovation
itself. Some of these course directors appeared to hold deep-seeded mistrust of curricular
changes because of previous negative experiences:
In 2006, there was a huge curricular shift in which they used to have discipline based
curricula. You know anatomy, and then physiology, and then biochemistry, or whatever.
And then they went to systems based. And when they went to systems based, they did a
lot of curricular changes, of which I understand, and I don't know because I wasn't here,
but I understand there was a lot of pushback from the faculty. There were many faculty
that did not like the change. And I think that has set up a somewhat antagonistic view
between the faculty and the administration that even to this day still lingers. There's this
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mistrust, is maybe the best way to say that. Because they felt this old curriculum was
somewhat foisted on them, the faculty are now, especially the older faculty, are less
trustful of what's going to happen in the future.
Future studies could examine legacy and history effects on organizational cultural models and
norms. It would be interesting to identify whether or not these self-named “traditionalists” are
truly anti-innovation or is it they are anti-administration because of past mistreatments? This
level of mistrust has the potential to impact the organizational culture in unanticipated ways. For
example, several interviewees mentioned a “next generation taskforce” that is exploring ways to
overhaul the current curriculum. When a traditionalist spoke about this same taskforce, they had
this to say:
For instance, there's this next generation taskforce that you are probably well aware of.
The traditionalists among us are not on that taskforce. Yet we're some of the most
engaged in the teaching phenomenon, right? I teach more hours to medical students than
any other faculty member, by far. And I'm not on that committee. I wasn't even asked to
be on that committee. Now, I don't really care to be on that committee because again, it's
an issue. But in some ways they're putting all the people who have a like interest on that
committee to try to develop cool, new, next generational educational aspects.
This course director described a divide from administration by using words like “traditionalists”
and “they’re”. Furthermore, a comparison was made in which this faculty member self-
promoted their teaching abilities, engagement, and commitments when compared against other
faculty members. By discounting the taskforce itself and aligning against innovative approaches,
this self-named traditionalist faculty member articulated the rift that currently exists between
established faculty members and executive leadership.
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One of the participants assumed the course director role relatively recently, and their
perspective was quite different in that a sense of eagerness was expressed. For example, rather
than describe the traditional mindset of some colleagues, they observed a creative culture full of
opportunity when they said:
It's exciting! It's feeling you're part of a new culture, so there's a lot of room for
creativity.
This eager attitude was consistent with a couple of their colleagues. Thus, an interesting point
for further exploration will be to compare and contrast the responses of the more traditional
course directors with the eager course directors. In describing resistance to the Ibis Academy
initiative, there could very well be differences between course directors because of their previous
experiences with executive leadership. New course directors would never have observed
previous curricular overhauls and may not carry similar negative sentiments.
Cultural models help illustrate the norms that exist within an organization. An innovative
organization might reflect this through norms like challenging the status quo and rapid
prototyping of new ideas. However, participants in this study did not appear to be describing
such an organization. Instead, course directors seemed to describe an organization that prefers to
maintain the status quo:
I would tell you that things have been pretty well established here. I mean, even as a
message that I got when I took over a course was, ‘Don't make a lot of changes. Stick to
how we've been doing it. This has been working,’ with like a little peppering in of, ‘You
can be innovative if you want to, but still if it's not broke, don't fix it’ kind of idea. So I
think that there's a lot of talk of innovation, but I think that truthfully the organization
doesn't really think that there's a major problem with the way that the curriculum has
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been delivered.
The divide between traditional course directors and executive leadership was evident again under
this situational context of maintaining the status quo when a participant stated:
I know that there's older, more established faculty who feel very strongly that we've been
teaching medical education a certain way for a long time so, ‘Don't tell me now to come
use and bells and whistles when I know how I've been doing it for a long time.’ So there's
definitely that message that is still very loud and present here.
This course director validated the earlier characterization of the “traditionalists” group by using
the descriptor of “older, more established faculty.” In this case, however, the rift between
traditional course directors and medical education administration infiltrated the thought
processes of other course directors who might otherwise be willing to challenge the status quo.
For example, skepticism appeared within the statements of newer course directors:
I don't know how they're going to solve this. I don't know what coordination we're going
to get between the technology people, educational technology, the deans of education,
and logistics. But apparently everyone is working on that, so we'll see.
Thus, this rift between some course directors and executive leadership is a potential barrier worth
exploring. When investigating this organizational barrier, it will be helpful to understand the
leadership’s vision, policies, and communication efforts. However, in terms of an organizational
vision for innovative medical education, one course director succinctly stated: “I don't feel like a
vision is communicated.” Another simply stated, “Zero.” Furthermore, none of the eleven
interviewees stated that they know of any policies that help them align their teaching practices
with the institution’s strategic plan for innovative medical education. When summarizing
executive leadership’s vision, another course director characterized it as an empty promise:
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So then it's like the executive leadership talks the talk, but then when push comes to
shove, there's not a whole lot of vision or pressure or fostering of getting faculty to follow
that vision.
This notion of empty promises was reiterated in another interview, when a different course
director said:
The longer I'm here, the more I realized that there is a difference between what is said
and what actually is done, and there is a weird break on making progress possible.
Therefore, with future studies, it could be important to explore whether or not executive
leadership is failing to communicate policies and vision because of the previous events that
generated faculty mistrust, which ultimately led to the “traditionalists” rift.
Synthesis of Results and Findings for Organizational Needs
Course directors provided only vague descriptions of resources that were available to
them. Furthermore, most of the course directors did not actually align these resources with direct
support of their educational creativity. Also, course directors demonstrated that policies do not
exist that help them align teaching practices with the institution’s strategic plan for innovative
medical education. Most of the course directors indicated that no policies exist or that they are
unaware of any policies that exist that might help them align their efforts with redesigning
courses based on educational best practices for learner-centered blended learning design.
Furthermore, most of the course directors indicated that no policies exist or that they are unaware
of any policies that exist that might help them align their efforts with developing courses by
using appropriate educational technologies that support cognitive process and effective delivery.
In terms of describing their institution’s cultural model, course directors demonstrated
negative beliefs toward feeling part of an organization that supports their efforts to redesign
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courses based on educational best practices for learner-centered blended learning design. They
also indicated that there are two fragmented groups of educators that diverge in their attitudes of
innovative versus traditional education. On the other hand, course directors demonstrated
positive beliefs toward feeling part of an organization that supports their efforts to develop
courses by using appropriate educational technologies that support cognitive process and
effective delivery. However, most could not articulate an actual vision from executive
leadership, perhaps indicating ineffective communication from executive leadership.
Within the realm of describing the cultural setting, course directors demonstrated mixed
assessments about whether or not they are part of a team that works together to redesign courses
based on educational best practices for learner-centered blended learning design. They also
demonstrated a mixed belief that they are part of a team that works together to develop the
course by using appropriate educational technologies that support cognitive process and effective
delivery. Additionally, most failed to describe what collaborative relationships looked like in
any sort of detail. Finally, many course directors indicated unevenness in organizational
priorities toward commitment to developing courses using educational technologies.
Summary
Two critical behaviors required of course directors to achieve their performance goal
were aligned with assumed knowledge, motivation, and organizational needs. Data analysis
yielded nuanced insight and increased our understanding to help focus on the most pressing
assumed knowledge, motivation, and organizational needs. On the basis of the analysis of the
qualitative dataset, the researcher concluded that most assumed knowledge needs were validated.
Following integration of the quantitative and qualitative datasets, many of the assumed
motivation needs were validated. Likewise, the integrated data from the quantitative and
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qualitative datasets revealed that many of the assumed organizational needs were validated.
When recommending solutions in Chapter 5, the assumed needs focusing on learner-
centered blended learning design, which align with critical behavior #1, will be given highest
priority. During the evolution of a course design process, this is the arena in which course
directors can best lend their subject matter expertise and achieve early successes. Within these
prioritized needs, motivation gaps will be given highest priority for recommending solutions,
then organizational, and then knowledge (Clark & Estes, 2008). Upon demonstration of mastery
and successes with redesigning courses based on educational best practices for learner-centered
blended learning approaches (critical behavior #1), course directors can then focus their efforts
on developing their courses by using appropriate educational technologies that support cognitive
process and effective delivery (critical behavior #2). The validated needs that will be used to
present recommendations for solutions to these knowledge, motivation, and organizational
deficits are displayed in Table 20.

Table 20
Validated and prioritized needs that will be used to present recommendations for solutions
Validated Need Type /
Construct
Knowledge Course directors need to know educational best practices for
learner-centered blended learning design

Factual
Course directors need to know how to redesign courses based
on educational best practices for learner-centered blended
learning design

Procedural
Course directors need to reflect on their progress toward
redesigning courses based on educational best practices for
learner-centered blended learning design

Metacognitive
Motivation Course directors need to value redesigning courses to reflect Value
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best practices for learner-centered blended learning

Course directors need to be confident that they can design
courses based on educational best practices for learner-
centered blended learning design

Self-Efficacy
Course directors need to believe that improved student
outcomes are the result of their efforts in redesigning courses
based on educational best practices for learner-centered
blended learning design

Attribution
Organizational Course directors need to have the resources (time, human and
financial support) to redesign courses based on educational
best practices for learner-centered blended learning design

Resources
Course directors need to have the organizational policies and
procedures aligned with their efforts to redesign courses based
on educational best practices for learner-centered blended
learning design

Policies
Course directors need to believe that they are part of an
organization that supports their efforts to redesign courses
based on educational best practices for learner-centered
blended learning design

Cultural
Model
Course directors need to believe that they are part of a team
that works together to redesign courses based on educational
best practices for learner-centered blended learning design
Cultural
Setting

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CHAPTER FIVE: SOLUTIONS, IMPLEMENTATION AND EVALUATION
Recommendations for Practice to Address KMO Influences
Knowledge Recommendations
Introduction. Table 21 describes the assumed knowledge influences and whether or not
they were validated, based on frequency counts obtained during coding of the interview
transcripts with stakeholders, and literature reviews of educational best practices for student-
centered blended learning design and technology-enriched learning environments. Clark and
Estes (2008) recommended that factual or conceptual knowledge is needed for successful
implementation of change initiatives. Thus, declarative knowledge is important for course
directors who wish to redesign their medical education courses using nontraditional approaches
to teaching and learning. Therefore, Table 21 indicates that these assumed influences, which are
aligned with achieving the course directors’ performance goal, are validated. The context-
specific recommendations proposed in Table 21 are grounded in literature-based theory.
Table 21
Summary of Knowledge Influences and Recommendations
Assumed Knowledge
Influence*

Validated
Yes or No
(V, N)
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
Course Directors (CDs**)
need to know educational
best practices for learner-
centered blended learning
design. (F)
V Y Developing competencies
originates with learning
declarative knowledge
(factual and conceptual)
about domain-specific best
practices. (Clark & Estes,
2008).

Learning potentially
increases when personal
curiosity is generated and
built upon with meaningful
connections to prior
knowledge (Schraw &
Provide a job aid
containing concepts
and a glossary of key
terms that pertain to
educational best
practices for learner-
centered blended
learning design.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 179

Lehman, 2009; Schraw &
McCrudden, 2006).

Blended learning strategies
attempt to maximize student
performance by fusing the
best elements of face-to-
face and online learning, but
require that course directors
understand their new role
and have the needed
knowledge and skills to
succeed (VanDerLinden,
2014).

CDs need to know
appropriate educational
technologies that support
cognitive process and
effective delivery. (F)
V Y Helping learners identify
high-yield information
improves learning (Schraw
& McCrudden, 2006).

Learning increases when
information is organized in
ways that enhance transfer
to long-term memory
(Mayer, 2011).

Provide a job aid
containing concepts
and a glossary of key
terms that pertain to
appropriate
educational
technologies that
support cognitive
process and effective
delivery.

CDs need to know the
relationship between
educational best practices
for learner-centered blended
learning design and student
outcomes. (C)

V Y Cognitive load theory
suggests that minimizing
extraneous load facilitates
learning (Kirshner,
Kirshner, & Paas, 2006).

Compartmentalizing and
simplifying complex content
enables effective learning
(Kirshner, Kirshner, & Paas,
2006).

Provide a job aid that
includes a rubric
aligning educational
best practices for
learner-centered
blended learning
design with examples
of increased student
outcomes.

CDs need to know the
relationship between
appropriate educational
technologies and student
outcomes. (C)

V Y Worked examples enhance
learning (Mayer, 2011).

Guidance and scaffolded
instruction improve learning
(Mayer, 2011).
Provide a job aid that
includes a rubric
aligning appropriate
educational
technologies with
examples of increased
student outcomes.

CDs need to know how to
redesign courses based on
educational best practices
for learner-centered blended
learning design. (P)

V Y Increased procedural
knowledge provides the
capacity to strategically use
appropriate skills and
declarative knowledge
(Clark & Estes, 2008).

Modeling educational best
practices for learner-
Provide frequent
training with
scaffolded, authentic
opportunities to
redesign courses based
on educational best
practices for learner-
centered blended
learning design, where
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 180

centered blended learning
design potentially improves
learning, increases
performance, and
proliferates implementation,
as consistent with
recommendations by
Denler, Wolters, and
Benzon (2009).

participants will
encounter
demonstrations, rapid-
prototyping of ideas,
and receive feedback
from reviewers.

CDs need to know how to
develop the course by using
appropriate educational
technologies that support
cognitive process and
effective delivery. (P)

V N Learning and achievement
are increased when
procedures are modeled
(Denler, Wolters, &
Benzon, 2009).

Learning is facilitated with
demonstrations and modeled
behaviors (Denler et al.,
2009).

Provide frequent
training with
scaffolded, authentic
opportunities to
develop courses by
using appropriate
educational
technologies that
support cognitive
process and effective
delivery, where
participants will
encounter
demonstrations, rapid-
prototyping of ideas,
and receive feedback
from reviewers.

CDs need to reflect on their
progress toward redesigning
courses based on
educational best practices
for learner-centered blended
learning design. (M)

V N Metacognitive knowledge
promotes reflection-of-
practice and self-regulation
skills, which increases
overall performance (Clark
& Estes, 2008).

Developing mastery
requires time to acquire
knowledge and skills,
practice implementing
prototypes, and self-reflect
on effectiveness (Schraw &
McCrudden, 2006).

Metacognitive approaches
aid with the transfer of
information to long-term
memory (Baker 2006;
Mayer, 2011).

Provide education that
models metacognitive
strategies, prepares
participants to reflect
on their progress
toward redesigning
courses based on
educational best
practices for learner-
centered blended
learning design, and
uses feedback to
improve performance.

CDs need to reflect on their
progress toward developing
the course by using
appropriate educational
technologies that support
cognitive process and
V Y Authentic and timely
feedback improves
performance (Shute, 2008).

Self-regulated learning
strategies improve learning
Provide education that
models metacognitive
strategies, prepares
participants to reflect
on their progress
toward developing
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 181

effective delivery. (M)

(Dembo & Eaton, 2000).

Reflecting on prior
knowledge before learning
commences improves
metacognition (Mayer,
2011).

Self-assessment and self-
monitoring enhance
autonomous learning and
promote metacognitive
practices (Baker, 2006).

courses by using
appropriate
educational
technologies that
support cognitive
process and effective
delivery, and uses
feedback to improve
performance.

*Indicated knowledge type for each influence listed using these abbreviations: (F)actual;
(C)onceptual; (P)rocedural; (M)etacognitive
** Course Director abbreviated as CD
Declarative knowledge solutions, or description of needs or assets. Course directors
need to know educational best practices for learner-centered blended learning design (F). Clark
and Estes (2008) explained that developing competencies originates with gaining declarative
knowledge (factual and conceptual) about domain-specific best practices. Additionally, learning
potentially increases when personal curiosity is generated and built upon with meaningful
connections to prior knowledge (Schraw & Lehman, 2009; Schraw & McCrudden, 2006).
Furthermore, VanDerLinden (2014) suggests that blended learning strategies attempt to
maximize learner performance by fusing the best elements of face-to-face and online learning,
but require that course directors understand their new role and have the needed knowledge and
skills to succeed (VanDerLinden, 2014). Therefore, providing stakeholders with a job aid that
facilitates learning could help them develop competencies when implementing nontraditional
teaching and learning approaches based on educational best practices. The proposed
recommendation for course directors who wish to redesign their courses using nontraditional
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 182

approaches might be to provide them with a job aid containing concepts and a glossary of key
terms that pertain to educational best practices for learner-centered blended learning design.
McGee and Reis (2012) reviewed educational best practices for blended course
instructional design to determine how essential knowledge should be communicated with
educators. In all, these authors examined 67 artifacts and identified emergent themes. Their
qualitative meta-analysis revealed that course designers need factual knowledge about the
primary patterns that emerged, which were the instructional design process, pedagogical
approaches, classroom and online technology utilization, assessment strategies, and course
implementation procedures. They recommended that educators need to be briefed on particular
differences between blended learning course designs and other educational approaches. Thus,
this case study’s recommendation of providing a job aid that highlights key terminology and
concepts may assist course directors and contribute to learning foundational knowledge about
educational best practices for learner-centered blended learning design.
Procedural knowledge solutions, or description of needs or assets. Course directors
need to know how to redesign courses based on educational best practices for learner-centered
blended learning design (P). Clark and Estes (2008) suggested that increased procedural
knowledge provides the capacity for stakeholders to strategically use appropriate skills and
declarative knowledge. Additionally, modeling educational best practices for learner-centered
blended learning design potentially improves learning, increases performance, and proliferates
implementation, as consistent with recommendations by Denler, Wolters, and Benzon (2009).
Therefore, providing frequent training sessions with embedded scaffolded learning opportunities
and timely feedback could help course directors learn how to redesign courses using educational
best practices for learner-centered blended learning design. The proposed recommendation for
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 183

course directors who wish to redesign their courses using nontraditional approaches might be to
provide them with frequent training sessions that feature scaffolded, authentic opportunities to
redesign courses based on educational best practices for learner-centered blended learning
design, where participants will encounter demonstrations, rapid-prototyping of ideas, and receive
feedback from reviewers.
Duffy and Azevedo (2015) researched which types of “pedagogical agents”, or
educational reinforcements, positively influence learner processes and performance (p. 338).
Specifically, they investigated interactions between scaffolding and increased achievement of
learning outcomes in technology-enriched learning environments. In this empirical study with
83 participants, scaffolds and timely feedback stimulated advanced learning behaviors by
learners. In a mixed methods study where 214 faculty members completed a survey and 39 were
interviewed, Porter, Graham, Bodily, and Sandberg (2016) added to these recommendations by
stating that administrators can utilize early adopters to model effective practices during
professional development initiatives. Thus, this case study’s recommendation of providing
course directors with frequent training sessions that feature scaffolded, authentic learning
opportunities, demonstrations, and formative feedback may assist course directors and contribute
to learning how to redesign courses based on educational best practices for learner-centered
blended learning design.
Metacognitive knowledge solutions, or description of needs or assets. Course
directors need to reflect on their progress toward redesigning courses based on educational best
practices for learner-centered blended learning design (M). Metacognitive knowledge promotes
reflection-of-practice and self-regulation skills, which increases overall performance (Clark &
Estes, 2008). Also, Schraw and McCrudden (2006) stated that developing mastery requires time
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 184

to acquire knowledge and skills, practice implementing prototypes, and self-reflection of
effectiveness. Finally, metacognitive approaches aid with the transfer of information to long-
term memory (Baker 2006; Mayer, 2011). Consequently, providing education that promotes the
use of self-regulatory skills could help course directors with reflecting on their progress toward
course redesign projects. Therefore, the proposed recommendation for course directors who
wish to reflect on their progress toward redesigning courses might be to provide education that
models metacognitive strategies, prepares participants to reflect on their progress toward
redesigning courses based on educational best practices for learner-centered blended learning
design, and uses feedback to improve performance.
To advance the understanding of how to best cultivate reflective educators, Ferry and
Ross-Gordon (1998) studied the influences that reflecting-in-action have on problem-solving and
establishing competence. Using a qualitative approach featuring expressive interviews, the
authors compared problem-solving practices of eight beginner and ten veteran educators. In this
empirical study, they found that using reflective practices to solve problems was a more
significant indicator of successful capacity than professional experience alone. Moreover,
Barley (2012) stated in a perspective essay that reflective practices enhanced lifelong learning
and professional expertise. Thus, this case study’s recommendation of providing appropriate
formal and informal education opportunities might assist course directors and contribute to their
abilities to reflect on their progress toward redesigning courses based on educational best
practices for learner-centered blended learning design.
Motivation Recommendations
Introduction. Table 22 describes the assumed motivation influences and whether or not
they were validated, based on frequency counts obtained during coding of the interview
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 185

transcripts with stakeholders, and literature reviews of educational best practices for student-
centered blended learning design and technology-enriched learning environments. Clark and
Estes (2008), suggested that active choice, persistence, and mental effort are three key indicators
of motivation needed for successful implementation of change initiatives. Thus, motivation is
important for course directors who wish to redesign their medical education courses using
nontraditional approaches to teaching and learning. The assumed motivation influences
considered in this analysis are value, self-efficacy, emotions, and attribution. Therefore, Table
22 indicates that these assumed influences, which are aligned with achieving the course
directors’ performance goal, are validated. The context-specific recommendations proposed in
Table 22 are grounded in literature-based theory.
Table 22
Summary of Motivation Influences and Recommendations
Assumed Motivation
Influence*

Validated
Yes or No
(V, N)
Priority
Yes, No
(Y, N)
Principle and Citation Context-Specific
Recommendation
CDs need to value
redesigning courses to
reflect best practices for
learner-centered blended
learning. (Value)
V Y Active choice to initiate a
task increases when
participants find personal
value (Eccles, 2009).

Faculty members respond
positively to multi-modal
professional development
opportunities (Porter et al.,
2016).
Provide collaborative
opportunities where
team-based learning
activities are relevant
to real-world
scenarios, enthusiasm
is generated, and
values are modeled.

CDs need to value
developing courses that use
appropriate educational
technologies that support
cognitive process and
effective delivery. (Value)

V Y Promoting the utility value
of projects facilitates
development of positive
values and increases
motivation (Eccles, 2006;
Pintrich, 2003).

Demonstrating alternative
and better approaches to
Provide training
opportunities where
participants work
individually and in
small groupsto
analyze the importance
and utility value of
technology-enriched
learning environments.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 186

teaching and learning is a
first step toward increasing
value for change
(VanDerLinden, 2014).

CDs need to be confident
that they can design courses
based on educational best
practices for learner-
centered blended learning
design. (Self-Efficacy)

V Y High self-efficacy and
increased motivation are
positively correlated
(Pajares, 2006).

Prompt feedback during
professional development
opportunities increases
faculty satisfaction and
stimulates motivation
(Porter et al., 2016).

Encouragement from
colleagues helps faculty
members experiment and
achieve early successes
(VanDerLinden, 2014).

Provide course
directors with early
successes by
generating measurable
SMART goals that are
clear, challenging,
timely, and aligned
with authentic, real-
time feedback to
develop their self-
efficacy.

CDs need to be confident
that they can develop
courses that use appropriate
educational technologies
that support cognitive
process and effective
delivery. (Self-Efficacy)
V Y Repeated successes increase
self-efficacy, promotes
persistence, and boosts
mental effort (Bandura,
1997; Clark & Estes, 2008).

Individualized instruction
during professional
development opportunities
stimulates motivation
(Porter et al., 2016).
Provide relevant
models followed by
scaffolded practice
activities where
participants experience
frequent successes,
receive targeted
feedback, and
ultimately generate
authentic technology-
enriched course
redesign applications.

CDs need to feel positive
about redesigning courses
based on educational best
practices for learner-
centered blended learning
design. (Emotions)

V N Motivation typically
increases with positive
emotions and mindsets
(Clark & Estes, 2008).

Faculty motivation increases
when negative emotions are
released during group
learning opportunities, such
as role-play exercises
(Mitchell, Parlamis, &
Claiborne, 2015).

Provide a nurturing
training environment
where participants
encounter self-directed
learning experiences
with multiple
opportunities for
practice and targeted
feedback.

CDs need to feel positive
about developing courses
that use appropriate
educational technologies
that support cognitive
process and effective
V N Reducing anxiety facilitates
success and increases
motivation (Clark & Estes,
2008; Lord & Kanfer, 2002)

Self-identification and
Assist participants
with developing self-
regulated learning
skills to cope with
anxiety and diagnose
their learning needs.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 187

delivery. (Emotions)

expression of demotivators
(fear of the unknown and
other apprehensions) during
transitions to novel teaching
approaches may promote
positive emotions (Mitchell,
Parlamis, & Claiborne,
2015).

CDs need to believe that
improved student outcomes
are the result of their efforts
in redesigning courses based
on educational best practices
for learner-centered blended
learning design.
(Attribution)

V N Attributing achievements to
effort (instead of natural
capabilities) increases
motivation (Anderman &
Anderman, 2009).

Demonstrating that direct
faculty involvement with
designing blended learning
environments yields optimal
learning conditions
increases faculty motivation
(Fink, 2013; VanDerLinden,
2014).

When providing
feedback to
participants, ensure
that their successes
with redesigning
courses are aligned
with effort spent on
task (and not with
natural ability).

CDs need to believe that
improved student outcomes
are the result of their efforts
in developing courses that
use appropriate educational
technologies that support
cognitive process and
effective delivery.
(Attribution)

V N Self-awareness and control
of effort spent on tasks
increases motivation
(Anderman & Anderman,
2009).

Faculty members limit risk
when making choices, so
framing communication
efforts and clarifying the
importance of faculty effort
toward reaching student
outcomes increases
motivation (Self &
Schraeder, 2008; Tagg,
2012).

Provide feedback that
emphasizes the
importance of effort
spent on developing
technology-enriched
learning environments,
identifies opportunities
for growth, and
recommends remedial
interventions, when
necessary.

Value. Course directors need to value redesigning courses to reflect best practices for
learner-centered blended learning. Electing to initiate a task, or active choice, increases when
participants find personal value (Eccles, 2009). Furthermore, faculty members respond
positively to multi-modal professional development opportunities (Porter et al., 2016).
Consequently, providing collaborative, motivation-enriching learning activities could help course
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 188

directors with increasing their personal value for redesigning courses to reflect best practices for
learner-centered blended learning. Therefore, the proposed recommendation for course directors
who wish to redesign courses to reflect best practices for learner-centered blended learning might
be to provide collaborative opportunities where team-based learning activities are relevant to
real-world scenarios, enthusiasm is generated, and values are modeled.
Beaver, Johnson, and Sinkinson (2014) conducted a needs analysis to identify support
mechanisms for instructors using technology-enriched learning environments. Their goal was to
advance the understanding of how to best design professional development opportunities that
support educators and align with individual faculty member motivation constraints. Their mixed
methods approach incorporated a faculty needs assessment survey and a focus group (26
participants completed the survey; 6 participants participated in a focus group). They found that
a training timeline should include collaborative opportunities for faculty members, exemplar
courses used as models, authentic feedback of course design projects, and an integrated rewards
mechanism. Thus, this case study’s recommendation of providing collaborative opportunities
where team-based learning activities are relevant to real-world scenarios, enthusiasm is
generated, and values are modeled might assist course directors and increase their personal value
for redesigning courses to reflect best practices for learner-centered blended learning.
Self-Efficacy. Course directors need to be confident that they can design courses based
on educational best practices for learner-centered blended learning design. Pajares (2006)
suggests that high self-efficacy and increased motivation are positively correlated. Additionally,
when participants are immersed in professional development opportunities, prompt feedback
increases faculty satisfaction and stimulates motivation (Porter et al., 2016). Furthermore,
VanDerLinden (2014) indicates that encouragement from colleagues helps faculty members
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 189

experiment and achieve early successes. Consequently, providing opportunities where course
directors can achieve early successes could boost their confidence when designing courses based
on educational best practices for learner-centered blended learning design. Therefore, the
proposed recommendation for course directors who wish to design courses based on educational
best practices for learner-centered blended learning design might be to provide course directors
with early successes by generating measurable SMART goals that are clear, challenging, timely,
and aligned with authentic, real-time feedback to develop their self-efficacy. (SMART goals are
Specific, Measureable, Achievable, Results-focused, and timebound).
Graham, Woodfield, and Harrison (2013) investigated implementation strategies of
blended learning initiatives used by higher education institutions along an adoption timeline
continuum. Their primary aim was to identify key issues and differences in institutional
strategies, structure, and support. For this qualitative study, one representative from six different
institutions was selected to participate in a semi-structured telephone interview. They found that
mature initiatives featured rigorous course development processes that were methodically
promoted. For example, at one of the institutions, faculty members must complete a robust 80-
hour faculty development workshop, where they are paired with an instructional designer to
iteratively improve a course and acclimate to administrative expectations. Thus, this case
study’s recommendation of providing course directors with early successes by generating
measurable SMART goals that are clear, challenging, timely, and aligned with authentic, real-
time feedback might develop their self-efficacy with redesigning courses to reflect best practices
for learner-centered blended learning.
Attribution. Course directors need to believe that improved student outcomes are the
result of their efforts in redesigning courses based on educational best practices for learner-
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 190

centered blended learning design. Anderman and Anderman (2009) suggested that attributing
achievements to effort (instead of natural capabilities) increases motivation. Furthermore,
demonstrating to stakeholders that direct faculty involvement with designing blended learning
environments yields optimal learning conditions potentially increases faculty motivation (Fink,
2013; VanDerLinden, 2014). Consequently, providing opportunities where course directors
receive timely and targeted formative feedback during course redesign projects could increase
motivation. Therefore, the proposed recommendation for course directors who wish to design
courses based on educational best practices for learner-centered blended learning design might
be to provide course directors with authentic feedback that ensures their successes with
redesigning courses are aligned with effort spent on task (and not with natural ability).
King and Boyatt (2014) investigated drivers that influenced faculty adoption of
technology-enriched learning environments. Their goal was to identify emerging themes to help
prioritize institutional changes in higher education. During this qualitative study, 37 faculty
members participated in a series of seven focus groups and an additional 11 participants were
interviewed individually. One of the three themes that emerged related to educator attitude and
attributes of using technology, under the context of increased student achievement. In particular,
they stated that when implementing computer-assisted learning initiatives, faculty members need
to be supported and made aware of how appropriate technologies can promote positive student
outcomes. They recommended that this support should include demonstrations of effective
teaching approaches and individualized guidance. Thus, this case study’s recommendation of
providing course directors with feedback to ensure that their successes with redesigning courses
are aligned with effort spent on task (and not with natural ability) might help them recognize that
improved student outcomes are the result of their efforts in redesigning redesigning courses to
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 191

reflect best practices for learner-centered blended learning.
Organization Recommendations
Introduction. Table 23 describes the assumed organizational influences and whether or
not they were validated, based on frequency counts obtained during coding of the interview
transcripts with stakeholders, and literature reviews of educational best practices for student-
centered blended learning design and technology-enriched learning environments. Clark and
Estes (2008) suggested that even with adequate knowledge and motivation, deficits in
organizational support limit stakeholder achievement and performance. Thus, organizational
influences are important for course directors who wish to redesign their medical education
courses using nontraditional approaches to teaching and learning. The assumed organizational
influences considered in this analysis are resources, policies, cultural model, and cultural setting.
Therefore, Table 23 indicates that these assumed influences, which are aligned with achieving
the course directors’ performance goal, are validated. The context-specific recommendations
proposed in Table 23 are grounded in literature-based theory.
Table 23
Summary of Organization Influences and Recommendations
Assumed Organization
Influence*

Validated
Yes or No
(V, N)
Priority
Yes, No
(Y, N)
Principle and Citation

Context-Specific
Recommendation
CDs need to have the
resources (time, human and
financial support) to
redesign courses based on
educational best practices
for learner-centered blended
learning design. (Resources)

V Y Structures, processes, and
resources aligned with
organizational goals
increases stakeholder
performance (Clark & Estes,
2008).

Organizational change is
facilitated when leaders
ensure their followers have
adequate resources (Waters,
Marzano, & McNulty,
Clearly articulate how
time, human capital,
and fiscal resources
will be aligned with
course directors’
performance
expectations.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 192

2003).

CDs need to have the
resources (time, human and
financial support) to develop
the course by using
appropriate educational
technologies that support
cognitive process and
effective delivery.
(Resources)

V N Improved accountability
relationships necessitate the
alignment of resources with
organizational goals
(Hentshe & Wohstetter,
2004).

New systems and structures
should be implemented that
support the organizational
vision (Kotter, 2009).

Develop a shared
accountability system
between course
directors, Ibis
Academy staff, and
executive leadership.
CDs need to have the
organizational policies and
procedures aligned with
their efforts to redesign
courses based on
educational best practices
for learner-centered blended
learning design. (Policies)

V Y Compelling communication
processes promote effective
organizational change
(Denning, 2005; Lewis,
2011).

Performance increases when
policies and procedures
empower a guiding coalition
of change agents (Kotter,
2009).

Generate policies and
procedures that clearly
define expectations,
desired outcomes, and
performance metrics.
CDs need to have the
organizational policies and
procedures aligned with
their efforts to develop the
course by using appropriate
educational technologies
that support cognitive
process and effective
delivery. (Policies)

V N Leading by example is an
influential asset to promote
effective organizational
change (Van den
Akker, Heres, Lasthulzen &
Six, 2009).

Organizational performance
increases when followers
trust their leaders and
encounter continual
commitment from executive
leadership (Clark & Estes,
2008).

Demonstrate values
and model desired
behaviors to course
directors within all
communication
processes.
CDs need to believe that
they are part of an
organization that supports
their efforts to redesign
courses based on
educational best practices
for learner-centered blended
learning design. (Cultural
Model)

V N Organizational performance
increases when concrete and
measureable goals are
aligned with a clear
organizational vision (Clark
& Estes, 2008).

Commitment from
executive leadership
promotes successful
organizational change
Create an outreach
program that
effectively
communicates the
organization’s vision
and strategic plan for
innovative medical
education.

Generate an action
plan that outlines steps
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 193

(Clark & Estes, 2008).

for executive
leadership members to
stay actively involved
in communication
strategies and outreach
programs.

CDs need to believe that
they are part of an
organization that supports
their efforts to develop the
course by using appropriate
educational technologies
that support cognitive
process and effective
delivery. (Cultural Model)
V N Participation and motivation
increase when tasks are
aligned with a relevant
organizational vision
(Knowles, 1980).

Leaders direct change
efforts by using a shared
vision, which enhances
organizational capacity,
teamwork, and commitment
(Kotter, 2009).
Communicate the
organizational vision
for innovative medical
education at all public
speaking events.

Align all Ibis
Academy activities
with the institution’s
vision and strategic
plan for innovative
medical education.

CDs need to believe that
they are part of a team that
works together to redesign
courses based on
educational best practices
for learner-centered blended
learning design. (Cultural
Setting)

V N Shared learning experiences
enhance organizational
productivity and build
trusting relationships
(Buckingham and Coffman,
1999; Harter, Schmidt,
Killham & Asplund, 2006;
Schein, 2004;
Schlossberg, 1989).

Stakeholders who identify
with the behaviors and
attitudes of others are more
likely to increase
engagement (Schein, 2010).

Build relationships by
demonstrating
integrity,
trustworthiness, and
compassion.
CDs need to believe that
they are part of a team that
works together to develop
the course by using
appropriate educational
technologies that support
cognitive process and
effective delivery. (Cultural
Setting)

V N Strengthening
communication skills
among organizational
stakeholders augments
capacity for change (Fix &
Sias, 2006).

Communicating the specific
problem that is being
addressed rather than
labeling it as a culture
change enhances shared
commitment (Schein, 2010).

Communicate
effectively with
stakeholders to build
and sustain positive
relationships.

Resources. Course directors need to have the resources (time, human and financial
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 194

support) to redesign courses based on educational best practices for learner-centered blended
learning design. Clark and Estes (2008) suggested that structures, processes, and resources
aligned with organizational goals increases stakeholder performance. Furthermore,
organizational change is facilitated when leaders ensure their followers have adequate resources
(Waters et al., 2003). Consequently, enhancing public outreach and communication efforts from
executive leadership could improve organizational performance. Therefore, the proposed
recommendation for course directors who wish to design courses based on educational best
practices for learner-centered blended learning design might be to ensure that during townhall
sessions with faculty members, executive leadership clearly articulates how time, human capital,
and fiscal resources will be aligned with course directors’ performance expectations.
Porter, Graham, Bodily, and Sandberg (2016) investigated barriers to faculty
implementation of blended learning environments. Their primary goal was to characterize
institutional frameworks for adopting blended learning initiatives. During this mixed methods
study, 214 professors completed a survey and 39 faculty members participated in semi-structured
interviews. Three themes emerged, where both early-adopters and late-majority faculty
members agreed that technical support, pedagogical support, and incentives were important
factors that facilitated or impeded their abilities to innovate in their classrooms (Porter et al.,
2016). In relation to time, nearly two-thirds of the interviewees stated that course load
reductions would be a significant factor in their decision-making processes (Porter et al., 2016).
The authors recommended that institutional-level support mechanisms needed to be aligned with
individual faculty needs. Thus, this case study’s recommendation of articulating how time,
human capital, and fiscal resources will be aligned with course directors’ performance
expectations might help them overcome inhibitive barriers and gain the necessary resources
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(time, human and financial support) to redesign courses based on proven and evidence-based
educational best practices for learner-centered blended learning design.
Policies. Course directors need to have the organizational policies and procedures
aligned with their efforts to redesign courses based on educational best practices for learner-
centered blended learning design. Compelling communication processes promote effective
organizational change (Denning, 2005; Lewis, 2011). Furthermore, Kotter (2009) states that
performance increases when policies and procedures empower a guiding coalition of change
agents. Consequently, providing opportunities where executive leadership describes and
communicates policies and procedures for course redesign projects could improve stakeholder
and organizational performance. Therefore, the proposed recommendation for course directors
who wish to design courses based on educational best practices for learner-centered blended
learning design might be to generate policies and procedures that clearly define expectations,
desired outcomes, and performance metrics.
Carbonell, Dailey-Hebert, and Gijselaers (2013) explored elements that helped faculty
members implement blended learning initiatives. Their goal was to propose institutional-level
recommendations for scaling-up blended learning initiatives in higher education settings. During
this qualitative study, 19 stakeholders (administrators, student, and faculty members) participated
in semi-structured interviews. Interviewees revealed that existing policies created the primary
bottleneck during course redesign projects. Furthermore, they added that individual faculty
members had no capacity to change policies. They recommended that during organizational
changes from face-to-face instruction to blended learning delivery, administration must forge
collaborative relationships with faculty members to provide appropriate support and contextual
policies. Thus, this case study’s recommendation of generating policies and procedures that
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clearly define expectations, desired outcomes, and performance metrics might help course
directors overcome organizational barriers when redesigning courses that implement best
practices for learner-centered blended learning.
Cultural models. Course directors need to believe that they are part of an organization
that supports their efforts to redesign courses based on educational best practices for learner-
centered blended learning design. Clark and Estes (2008) advised that organizational
performance increases when concrete and measureable goals are aligned with a clear
organizational vision. Additionally, commitment from executive leadership promotes successful
organizational change (Clark & Estes, 2008). Consequently, active modeling of expected
behaviors and norms from executive leadership would likely improve organizational
performance. Therefore, there are two proposed recommendations for course directors who wish
to design courses based on educational best practices for learner-centered blended learning
design. The first might be to create an outreach program that effectively communicates the
organization’s vision and strategic plan for innovative medical education. The second might be
to generate an action plan that outlines steps for executive leadership members to stay actively
involved in communication strategies and outreach programs.
Macfadyen and Dawson (2012) investigated influential factors of culture changes during
institutional strategic-planning. Their goal was to use data analytics to describe the extent to
which these data appropriately informed strategic decisions during a change management case
study. During this qualitative study, the researchers used combinations of data analytics from a
learning management system, data visualization techniques, and participant observations. The
findings from Macfadyen and Dawson (2012) revealed an “institutional resistance” where the
culture of higher education conflicts with innovation because of the existing administration-
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faculty relationships (p. 160). Specifically, they identified the following cultural barriers: shared
governance, faculty jurisdiction of student learning outcomes, lack of strategically-aligned
resources allocations, and incorrect speculations about learner uniformity. They recommended
that institutional leadership should use compelling and contextual data-driven communication
strategies that increase positive stakeholder perceptions of organizational change initiatives.
Thus, this case study’s two recommendations of creating an outreach program that effectively
communicates the organization’s vision and strategic plan for innovative medical education, and
of generating an action plan that outlines steps for executive leadership members to stay actively
involved in communication strategies and outreach programs might help course directors believe
that they are part of an organization that supports their efforts to redesign courses based on
educational best practices for learner-centered blended learning design.
Cultural setting. Course directors need to believe that they are part of a team that works
together to redesign courses based on educational best practices for learner-centered blended
learning design. Shared learning experiences enhance organizational productivity and build
trusting relationships (Buckingham & Coffman, 1999; Harter, Schmidt, Killham & Asplund,
2006; Schein, 2004; Schlossberg, 1989). Moreover, Schein (2010) states that stakeholders who
identify with the behaviors and attitudes of others are more likely to increase engagement.
Consequently, integrating engaged stakeholders into teams by delivering mutual experiences and
trust could improve organizational performance. Therefore, the proposed recommendation for
course directors who wish to design courses based on educational best practices for learner-
centered blended learning design might be to increase camaraderie and relationship-building by
demonstrating integrity, trustworthiness, and compassion.
Van Rooij and Zirkle (2016) discussed emerging challenges and insights that resulted
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from a course redesign process. Their goal was to provide recommendations for fostering
conditions that yield sustainable and collaborative processes during course redesign efforts
utilizing nontraditional approaches to teaching and learning. During this case study, a faculty
advisory group and 19 undergraduate students collaborated via meetings, focus groups, and
phone interviews. An emergent theme related to the awareness of an institution’s capacity to
support the development process early in the course redesign process. In particular, they stated
that collaborative relationships between faculty members, instructional designers, and
multimedia personnel yield learning experiences that are grounded in educational best practices.
They recommended that leadership should nurture the appropriate setting that facilitates such
collaborative relationships. Thus, this case study’s recommendation of increasing camaraderie
and relationship-building by demonstrating integrity, trustworthiness, and compassion is
consistent with this recommendation and might help course directors achieve success believe that
they are part of a team that works together to redesign courses based on educational best
practices for learner-centered blended learning design.
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
The New World Kirkpatrick Model formed the framework for the integrated program
implementation and evaluation plan (Kirkpatrick & Kirkpatrick, 2016). Unlike traditional
models, this inverted evaluation plan begins with organizational goals and works backward.
Leading indicators align recommended solutions with organizational goals, which enhances the
potential for success. This inverted sequence triggers three important actions: a) first, generating
solution outcomes that emphasize the transfer of knowledge gains to work behaviors, b) second,
establishing indicators that demonstrate learning actually transpired during program
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implementation, and c) third, gauging the satisfaction and engagement of organizational
stakeholders with implementation approaches. Packaging the integrated program
implementation and evaluation plan ensures that precise solutions align with key organizational
goals to drive successful change initiatives (Kirkpatrick & Kirkpatrick, 2016).
Organizational Purpose, Need and Expectations
Ibis Academy aims to generate next generation educational solutions by implementing
student-centered learning strategies to train future physicians. Given the pending societal
challenges with physician shortages, efficient and effective physician training programs are
needed. This project examined the contextual interactions of medical educators’ knowledge,
motivation, and organizational needs that would help them design and develop technology-
enriched learning environments that exceed internal evaluation thresholds. The proposed
solutions, which include novel supports, resources, accountability policies, a collaborative
training program, and improved communication strategies, should yield the desired aspirational
outcome – 100% of course directors will implement student-centered teaching strategies by using
Ibis Academy approaches for technology-enriched course designs.
Level 4: Results and Leading Indicators
Table 24 shows the proposed Level 4: Results and Leading Indicators in the form of
outcomes, metrics and methods for both external and internal outcomes for technology-enriched
course designs at the Urban School of Medicine. If internal outcomes are achieved following the
novel training and organizational support mechanisms for preclinical course directors at the
Urban School of Medicine, then the external outcomes should also be reached.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 200

Table 24

Outcomes, Metrics, and Methods for External and Internal Outcomes

Outcome Metric(s) Method(s)
External Outcomes
1. Increased donors for
innovative medical education
programs and resources.

Donation dollars that support Ibis
Academy initiatives
Compare donation levels from
upcoming fiscal years against the five
previous fiscal years.
2. Improved test scores on
national USMLE exams.
Test scores on national exams Track test scores on national exams
and compare across time.
3. Improved public perception
of Urban School of Medicine’s
degree of innovative
educational practices.
3a. The number of peer-reviewed
journal articles resulting from Ibis
Academy course redesigns
3a. Track the number of peer-reviewed
journal articles resulting from Ibis
Academy course redesigns across time.

3b. The number of Ibis Academy
research presentations delivered at
national meetings

3b. Track the number of Ibis Academy
research presentations delivered at
national meetings across time.

3c. The number of times Ibis Academy
publications are cited by other authors
3c. Track the citation counts of Ibis
Academy publications.

3d. The national ranking of the medical
school

3d. Compare national rankings of the
medical school over time.
Internal Outcomes
4. Increased faculty
participation in Ibis Academy
initiatives.
Number of course directors who
collaborate on Ibis Academy course
redesign projects.
Track the number of course directors
who collaborate on Ibis Academy
course redesign projects over time.
5. Increased medical student
academic performance resulting
from Ibis Academy initiatives

Medical student exam scores across all
modules.
Compare medical student exam scores
across all modules across time.

6. Increased student satisfaction
with preclinical medical
education curriculum

6a. Student assessment-of-instruction
scores on post-module evaluations.
6a. Compare student assessment-of-
instruction scores on post-module
evaluations with previous academic
years with the Executive Faculty
Curriculum Steering Committee.

6b. Positive/negative feedback from
students.
6b. Interviews with outgoing medical
students at graduation timeframe.

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Level 3: Behavior
Critical behaviors. The stakeholders of focus are the preclinical medical education
course directors, who oversee course logistics and report student performance metrics to the
executive curricular committees. The first critical behavior is that course directors will redesign
their courses based on educational best practices for learner-centered blended learning design,
per the committee’s criteria. The second critical behavior is that they will develop their courses
by using appropriate educational technologies that support cognitive process and effective
delivery. The specific metrics, methods, and timing for each of these outcome behaviors appears
in Table 25.

Table 25

Critical Behaviors, Metrics, Methods, and Timing for New Reviewers
Critical Behavior Metric(s) Method(s) Timing
1. Course directors
redesign courses based on
educational best practices
for learner-centered
blended learning design
per the committee’s
criteria.

1a. Exceeds 80% for all
satisfaction metrics, as
defined by the Executive
Faculty Curriculum
Steering Committee, used
to evaluate preclinical
medical education
modules

1a. Course directors will
report course evaluation
summaries to the Executive
Faculty Curriculum Steering
Committee.
1a. Following
completion of each
course.
1b. Number of course
redesigns approved by the
Director of Educational
Technologies

1b. Director of Educational
Technologies reviews course
redesigns with a quality
control rubric that evaluates
educational best practices for
learner-centered blended
learning design.

1b. During first 90 days
of course redesign
project – weekly.

Thereafter – monthly, so
long as previously
successful.
2. Course directors
develop courses by using
appropriate educational
technologies that support
cognitive process and
effective delivery.
2a. Active engagement in
educational technologies
training sessions that
course directors attend.
2a. Director of Educational
Technologies shall track
course director attendance
and active participation in
educational technologies
training sessions.

2a. Ongoing - monthly.
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2b. Number of courses
developed using
appropriate educational
technologies that are
approved by the Director
of Educational
Technologies

2b. Director of Educational
Technologies reviews course
redesigns with a quality
control rubric that evaluates
course director effectiveness
with using appropriate
educational technologies that
support cognitive process and
effective delivery.

2b. During first 90 days
of course redesign
project – weekly.

Thereafter – monthly, so
long as previously
successful.

Required drivers. Course directors require collaborative relationships with Ibis
Academy personnel and organizational support to help them transfer their reinforced knowledge
gains into application by designing and developing technology-enriched learning environments
that exceed expectations. To enhance visible organizational support of successful course
directors, formal and informal recognition programs and rewards systems should be established
that showcase achievement of performance goals. Table 26 shows the recommended drivers to
support critical behaviors of course directors.

Table 26
Required Drivers to Support New Reviewers’ Critical Behaviors
Method(s) Timing Critical Behaviors Supported
Reinforcing
Job Aid containing concepts
and a glossary of key terms
that pertain to educational best
practices for learner-centered
blended learning design.

Ongoing 1
Job Aid containing concepts
and a glossary of key terms
that pertain to appropriate
educational technologies that
support cognitive process and
effective delivery.

Ongoing 2
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Team meetings with course
directors and Ibis Academy
personnel to establish
SMART goals and time
frames.

Weekly 1, 2
Provide a job aid that includes
a rubric aligning educational
best practices for learner-
centered blended learning
design with examples of
increased student outcomes.

Ongoing 1
Team meetings to
relationship-build and
generate collaborative spirit.

Weekly 1, 2
Encouraging
Collaboration, peer modeling,
and self-directed learning
experiences during training
sessions.

Monthly 1, 2
Feedback and coaching from
Director of Educational
Technologies.

Ongoing 1, 2
Rewarding
Performance incentive when
successful course redesigns
improve student academic
performance and student
satisfaction.

Project-based 1, 2
Targeted and authentic
feedback, with both private
and public real-time
recognition, to celebrate early
successes.

Ongoing 1, 2

Monitoring
Director of Educational
Technologies can create
venues where course directors
publicly share their successful
projects.
Annually 1, 2
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Director of Educational
Technologies can ask course
participants to self-monitor
their responses to knowledge,
motivation, and organizational
barriers during course
redesign projects via a
reflection portfolio.

Ongoing 1, 2
Director of Educational
Technologies can assess the
performance of the course
directors. Data dashboards can
be used to provide real-time
information that compares
expectations with results.

Ongoing 1, 2

Organizational support. Implementation of required drivers will drive anticipated
achievements and successes. To ensure this happens, the organization will take an active role in
supporting course directors by providing the following support. First, executive leadership will
clearly articulate how time, human capital, and fiscal resources will be aligned with course
directors’ performance expectations. Next, stakeholders will develop a shared accountability
system between course directors, Ibis Academy staff, and executive leadership. Then, policies
and procedures that clearly define expectations, desired outcomes, and performance metrics will
be generated. Importantly and within all communication processes, organizational values and
desired behaviors will be demonstrated to and modeled for course directors. To complement
this, an outreach program that effectively communicates the organization’s vision and strategic
plan for innovative medical education will be created. Simultaneously, an action plan that
outlines steps for executive leadership members to stay actively involved in communication
strategies and outreach programs will be generated. The organizational vision for innovative
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medical education will be clearly communicated at all public speaking events. Finally, all
internal and external relationships will be grounded in integrity, trustworthiness, and compassion
so that all stakeholders can sustain positive relationships.
Level 2: Learning
Learning goals. Following completion of the recommended solutions, particularly the
training exercises and collaborative prototyping sessions, course directors will be able to:
1. Recognize educational best practices for learner-centered educational activities,
(Factual)
2. Identify appropriate teaching strategies and educational technologies to support their
teaching activities, (Factual)
3. Describe relationships between educational best practices and student outcomes,
(Conceptual)
4. Correctly apply educational best practices to learner-centered blended course redesign
projects, (Procedural)
5. Plan, monitor, and reflect on their progress during course redesign projects,
(Procedural, Metacognitive)
6. Indicate confidence that they can design courses based on educational best practices
for learner-centered blended learning design, (Self-Efficacy)
7. Value direct involvement in course redesign projects and feel positive that their efforts
lead to improved student outcomes (Value, Emotions, Attribution)
8. Effectively collaborate on course redesign projects with team members, (Cultural
setting)
9. Receive authentic feedback and apply to blended course design improvements,
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 206

(Cultural setting)
10. Value the institutional commitment to designing and developing technology-enriched
courses, (Cultural model, Value)
11. Create a reflective teaching portfolio that describes their professional growth during
the course redesign project, (Metacognitive)
12. Design and develop a prototype for a learner-centered blended-learning experience
that is based on educational best practices for technology-enriched courses. (Procedural,
Metacognitive)

Program. The learning goals, listed in the previous section, will be achieved with a
faculty development initiative that explores in–depth educational best practices for student-
centered and technology-enriched learning environments. The learners, who are preclinical
medical education course directors, will be immersed in a high-impact experiential curriculum
focused on the design and development of courses that integrate blended learning strategies with
educational technologies. The blended program features ten online self-guided modules, a series
of six face-to-face collaborative workshops, a day-long bootcamp, and learner-centered
reflection strategies (Figure 12). The estimated total time for completion is 27 hours.
During the asynchronous self-guided learning modules, learners will be provided a job
aid of containing concepts and a glossary of key terms that pertain to educational best practices
for learner-centered blended learning design and technology-enriched learning environments, as
well as a rubric aligning appropriate educational technologies with examples of increased student
outcomes. Another job aid will contain an infographic that links frequent barriers course
directors encounter with institutional resources and solutions. These scenario-based job aids will
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be demonstrated digitally using authentic Ibis Academy applications, where key terms and
concepts will be defined with real-world examples. Knowledge check questions and formative
feedback will be embedded within the digital learning assets to enable learners multiple options
to self-gauge their understanding. Learners will then be provided scaffolded, authentic
opportunities to practice and apply their learning gains to mock course design projects. They
will encounter demonstrations, rapid-prototyping of ideas, and receive targeted feedback from
peers and the Director of Educational Technologies. The asynchronous content will prepare
participants for the face-to-face workshops.
During the synchronous face-to-face workshop sessions, course directors will apply their
knowledge gains from the asynchronous content to relevant Ibis Academy applications through
collaborative team-based activities, self-directed learning experiences, discussions,
demonstrations, and rapid-prototyping of ideas. Clear, challenging, and timely SMART goals
will be used to help course directors achieve early successes, build confidence, receive authentic
feedback, and develop self-regulated learning skills. Targeted feedback will be provided that
emphasizes the importance of effort spent on developing technology-enriched learning
environments, identifies opportunities for growth, and recommends remedial interventions, when
necessary. Modelled behaviors and practices will be demonstrated in a nurturing environment
where course directors will complete a reflective teaching portfolio that illustrates their
professional growth and documents their progress with course redesign projects. Digital badges
and certificates will be incorporated to generate motivation and provide recognition. A total of
five digital badges and two certificates will correspond to achievement levels that increase in
complexity and generate sustained motivation and persistence (Figure 12).
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 208

Figure 12. The faculty development initiative that explores in–depth educational best practices
for student-centered and technology-enriched learning environments features digital badges and
certificates to generate motivation and provide recognition.

Components of learning. Scaffolded training opportunities provide learners the
opportunities they need to demonstrate declarative knowledge, achieve early successes, and
increase motivation. Therefore, formative assessments of both declarative and procedural
knowledge during program evaluations is necessary. Additionally, value for training programs
increases learners’ motivation to learn new knowledge and skills that they will apply later.
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When applying knowledge gains, learners must also be confident with their abilities to succeed
so that they may commit to post-training behavioral modifications. Therefore, Table 27
describes the evaluation methods, activities, and timing of the faculty development program’s
learning components.

Table 27
Components of Learning for the Program.
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Knowledge checks using online quizzes in the
learning management system.
In the asynchronous portions of the course
during and after the self-guided online learning
modules.
Knowledge checks through discussions, “think,
pair, share” and other active-learning
approaches.
Periodically during the face-to-face workshop
sessions and documented via observation
notes.

Procedural Skills “I can do it right now.”
Scenario-based knowledge checks using online
quizzes in the learning management system.
In the asynchronous portions of the course
during and after the self-guided online learning
modules.

Demonstration of applying knowledge gains to
successfully perform the necessary skills for
course redesigns (individually and
collaboratively through role-play activities,
simulations, and other deliverables).

During each face-to-face workshop session.
Facilitator’s observation of participants’
quality of workmanship during the activities.
During each face-to-face workshop session.
Individual application and presentation of
prototype materials.

At the end of each face-to-face workshop
session.
Retrospective pre- and post-test assessment
survey asking course directors about their level
of proficiency before and after the training.

Following each face-to-face workshop session.
Attitude “I believe this is worthwhile.”
Facilitator’s observation of participants’ During each face-to-face workshop session.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 210

statements, emotions, and actions
demonstrating that they see the benefit of what
they are being asked to do during course
redesign projects.

Discussions of the value of what they are being
asked to do during course redesign projects.

During each face-to-face workshop session.
Reflection portfolio

Following each face-to-face workshop session.
Retrospective pre- and post-test assessment
item.

Two weeks after the program ends.
Confidence “I think I can do it on the job.”
Self-Efficacy survey using scaled items

Following each face-to-face workshop session.
Discussions following demonstrations, models,
practice, and feedback.

During each face-to-face workshop session.
Reflection portfolio

Following each face-to-face workshop session.
Retrospective pre- and post-test assessment
item.

Two weeks after the program ends.
Commitment “I will do it on the job.”
Group discussions following practice and
feedback.

During each face-to-face workshop session.
One-on-one check-in conversations between
course director and Director of Educational
Technologies.

Periodically throughout the program and on-
demand.
Create an individual action plan.

Following each face-to-face workshop session.
Retrospective pre- and post-test assessment
item.

Two weeks after the program ends.

Level 1: Reaction
New learners respond best to engaging, relevant, and satisfying training programs
(Kirkpatrick & Kirkpatrick, 2016). First, engaged learners are those who actively involve
themselves and contribute to the learning environment. Next, relevancy to real-world scenarios
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and problems improves the likelihood that learners will apply knowledge gains to their post-
training tasks. Finally, formative assessment of learner satisfaction yields opportunities where
just-in-time modifications can be made to training curricula to enhance learning. Therefore,
Table 28 describes the engagement strategies and timing of the faculty development program’s
components that formatively and summatively measure participants’ reactions.

Table 28
Components to Measure Reactions to the Program.
Method(s) or Tool(s) Timing
Engagement
Data analytics in the learning management
system (Blackboard)

Ongoing during asynchronous portion
of the course.
Completion of online self-guided learning
modules

Ongoing during asynchronous portion
of the course.
Observation by Director of Educational
Technologies (training facilitator)

During the face-to-face workshop
sessions
Attendance During the face-to-face workshop
sessions

Discussions During the face-to-face workshop
sessions

Reflection portfolio After every face-to-face workshop
session

Program evaluation Two weeks after the program ends

Relevance
Brief pulse-check with course directors via
survey (online) and discussion (ongoing)
After every online self-guided learning
module and during each face-to-face
workshop session

Action planning At the end of each face-to-face
workshop session

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Focus group Two weeks after the program ends

Program evaluation

Two weeks after the program ends
Customer Satisfaction
Brief pulse-check with course directors via
survey (online) and discussion (ongoing)
After every online self-guided learning
module and during each face-to-face
workshop session

Focus group

Two weeks after the program ends
Program evaluation

Two weeks after the program ends

Evaluation Tools
Immediately following the program implementation. During the asynchronous
portion of the faculty development program where participants engage online self-guided
learning modules, the learning management system (LMS) will collect data about the time spent
on tasks, performance on knowledge checks, and completion of the modules by course directors.
These analytics will yield insight into the engagement with the online content. Online surveys
will also be delivered via the LMS following each online learning module, where course
directors will report the relevance of the content to their teaching activities and their overall
satisfaction with the self-guided learning modules.
During the face-to-face workshop sessions, the Director of Educational Technologies will
conduct brief Level 1 pulse-checks by asking the participants about the relevance of the content
to their teaching activities and professional responsibilities. Level 2 will include declarative
knowledge checks and observations of procedural skills during the active-learning activities in
both individual and team settings. Additionally, evaluations of course directors’ prototype
lessons and reflection portfolios will complement post-session surveys. Such surveys will yield
insights into course directors’ attitude, confidence, and commitment to transferring knowledge
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 213

gains from the faculty development program to their teaching activities. See Appendix E for
example survey prompts and rubric usage for both Level 1 and Level 2 evaluation tools.
Delayed for a period after the program implementation. Every two weeks during the
implementation of the faculty development program, and then again at 12 weeks following the
completion of the program, the Director of Educational technologies will oversee a series of
Qualtrics surveys that are comprised of both open response and scaled items (Appendix F). The
Blended Evaluation approach will measure the following from participants’ perspectives
(Kirkpatrick & Kirkpatrick, 2016):
• course directors’ relevance of and satisfaction with the faculty development program
(Level 1);
• confidence in applying their knowledge gains to their teaching activities, value of
applying their training, and commitment to applying their knowledge gains to their own
teaching practices (Level 2);
• application of the faculty development program content to modify their own teaching
practices (Level 3);
• the extent to which their implementation of technology-enriched student-centered
learning environments has become efficient, effective, and supportive of the Urban
School of Medicine’s organizational strategic plan for innovative medical education
(Level 4).
Following analysis of the survey data, the Director of Educational Technologies will moderate a
focus group session with 5-7 course directors who completed the faculty development program.
Data Analysis and Reporting
Three external outcomes and three internal outcomes will be continuously tracked to
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analyze progress toward achieving the organizational goal of exceeding thresholds used to
evaluate technology-enriched preclinical medical education modules at the Urban School of
Medicine. The three external outcomes are: increased donation levels for innovative medical
education initiatives, improved student test scores on national exams, and improved public
perception of the Urban School of Medicine’s degree of innovative educational practices. These
outcomes will be tracked throughout the fiscal year, summarized at the end of that year, and
compared with previous fiscal years. The three internal outcomes are: increased faculty
participation in Ibis Academy initiatives, increased medical student academic performance
resulting from Ibis Academy initiatives, and increased student satisfaction with the preclinical
medical education curriculum. These outcomes will be tracked throughout the academic year,
summarized at the end of that year, and compared with previous academic years. The Director
of Educational Technologies will compile and report the outcomes data by using the “Ibis
Academy Organizational Outcomes Dashboard” (Figure 13) to report relevant metrics to
university stakeholders. The dashboard will be used as a monitoring and accountability tool that
tracks successes and highlights opportunities for growth.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 215

Figure 13. The proposed “Ibis Academy Organizational Outcomes Dashboard” is a monitoring
and accountability tool that reports relevant metrics to university stakeholders, by tracking
successes and highlighting opportunities for growth. The color-coded scheme identifies
shortcomings (red), areas of concern (yellow), and successes (green).

Summary
The integrated implementation and evaluation plan for this study utilized the New World
Kirkpatrick Model as a framework (Kirkpatrick & Kirkpatrick, 2016). The four levels of this
model ensure that preclinical medical education course directors have the knowledge,
motivation, and organizational support they need to effectively design and develop student-
centered technology-enriched learning environments that exceed institutional thresholds for
success. Consistent with the New World Kirkpatrick Model, the faculty development program
begins with describing external and internal outcomes aligned with the organizational goal,
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metrics to track these outcomes, and methods for measuring results. Next, stakeholders’ critical
behaviors are assessed to ensure course directors transfer their new knowledge to their teaching
activities. Required drivers are implemented, learning goals are described, and the organization
assumes an active role in supporting the course directors’ critical behaviors to help them achieve
successes. Then, blended evaluation methods were created to help determine participant
knowledge, satisfaction, and engagement with the faculty development program. Additionally,
evaluation tools were created for measuring participant confidence, value, and commitment to
applying what they learned to their teaching activities. Delayed evaluation tools were developed
to evaluate behavioral modifications and perceived organizational impacts.
To maximize positive impacts from the faculty development program, continual
evaluation and data collection approaches were integrated within the instructional design of the
program itself. This creates opportunities for real-time or just-in-time adjustments to the training
program itself to adapt to participant needs as they arise. For example, Kirkpatrick and
Kirkpatrick (2016) recommended three key questions to ask during data analysis and program
evaluation, which are: “Does … meet expectations? If not, why not? and If so, why?” (p. 126).
Thus, combinations of formative and summative feedback, gathered through direct observations
of participants, critiquing of prototypes, reviewing professional reflection portfolios, surveys,
and focus groups, were incorporated within the integrated implementation and evaluation plan
for this study. These data and metrics will be compiled regularly to track successes and
opportunities for growth. Outcomes will be reported via a data dashboard to inform
stakeholders, communicate results, monitor performance, and ensure accountability. Thus,
leadership will receive relevant and credible data-driven reports that describe the faculty
development program in a compelling manner, and relate the program’s outcomes to the
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 217

organization’s vision, strategic plan, and primary goals (Kirkpatrick & Kirkpatrick, 2016; Kotter,
2009).
Limitations and Delimitations
Limitations are items that potentially affect the credibility of a study and are usually
beyond the control of the researcher, but may represent methodological flaws (Creswell, 2014).
For the quantitative part of this study, the sample size was small, and this is a potential
methodological limitation. There were only 34 potential participants in the targeted pool of
course directors. This small sample size was likely problematic for identifying statistically
significant relationships. Given that this was an innovation study, the possibility of not
collecting the right data and/or failing to identify meaningful themes was a possibility. Although
procedures were taken to guard against conflicts-of-interest, the PI works with the research
participants, and this could have introduced researcher limitations.
Delimitations describe issues that are related to generalizability and external validity due
to experimental design choices (Creswell, 2014). Although the data collected will be useful for
understanding the problem-of-practice at the research site, this study will not be generalizable to
a larger population. Future studies could be conducted in a similar manner at other medical
schools and only then could results be compared across multiple institutions. Additionally, while
a robust research study would have included multiple stakeholders, this study only focused on
course directors. This means results may not be generalizable to other stakeholder groups. It
also means that interest in the findings might be relevant to only some groups at the institution.
Future Research
Several emergent themes arose during the study that the survey, interview protocol,
and/or literature search did not directly address. Thus, future research should focus on these
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 218

three key areas:
1) documenting historical occurrences and relationships between faculty members and
leadership that impact current resolve to respond to organizational change initiatives;
2) examining the relationships between stakeholders’ limited understanding of the
science of learning and how they approach teaching interventions;
3) scrutinizing incentives programs to understand alignment of behaviors with strategic
plans, accountability mechanisms, and performance-based budgeting processes.
Broader Implications
Although this was a case study whose results are likely contextually unique to the
research site, several broader implications resulted from this study. First, this study directly
contributed to the current discussions about medical education’s paradigm shift. Second, higher
education administrators involved with implementing educational technology initiatives, even
those unaffiliated with medical education, should benefit from knowing the results of this study.
Third, this study provided a blueprint for implementation and evaluation of future faculty
development programs that could be contextually applied. Fourth, this study was a direct
application of the Clark and Estes (2008) gap analysis and of the New World Kirkpatrick Model
for program evaluation (Kirkpatrick & Kirkpatrick, 2016). Lastly, this study contributed to the
organizational change literature. Based on the results and findings of this study, these broader
implications for practice, policy, and research could support university stakeholders who are
engaged in organizational change efforts that are aimed at implementing novel technology-
enriched educational initiatives.
Conclusions
This mixed methods study provided quantitative and qualitative data that revealed deeper
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 219

understanding of knowledge, motivation, and organizational barriers that prevent preclinical
medical education course directors from effectively implementing technology-enriched courses.
Twenty-five literature-based knowledge, motivation, and organizational influences were
investigated through the lens of two critical behaviors. Specifically, two critical behaviors were
explored that aligned with the medical school’s primary organizational goal and strategic plan
for delivering nontraditional educational opportunities. The critical behaviors included the
following:
1) Course directors should be able to redesign their courses based on educational best
practices for learner-centered blended learning design.
2) Course directors should be able to develop their courses by using appropriate
educational technologies that support cognitive process and effective delivery.
These critical behaviors also created the foundation for generating an integrated
implementation and evaluation plan. Within this evaluation plan, solution outcomes that
emphasized transfer of knowledge from a carefully designed faculty development program to
teaching-related behavioral modifications were generated. Then, indicators were established,
which were grounded in the knowledge, motivation, and organizational influences needs
analysis, to demonstrate learning actually occurred during the program. And, data-driven
communication strategies were incorporated to enhance open conversations with all
stakeholders. Thus, the solutions that emerged from this needs analysis were aligned with
critical organizational goals and critical behaviors to drive successful organizational change.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 220

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APPENDIX A
SURVEY

Motivation: Self-Efficacy Questions

(Note: these efficacy questions are interactive slides within Qualtrics.)

1. Efficacy in building technology-enriched learning environments

Rate your degree of confidence in your ability to do each of the following tasks as of today by
recording a number from 0 to 10 using the interactive scale given below:
______ Generate digital learning materials.
______ Use accepted educational best practices for instructional design.
______ Incorporate online elements that improve user experience.
______ Use appropriate interactions to create a personalized online learning experience.
______ Incorporate appropriate aesthetics, colors, and branding to enhance the learning
experience.

2. Efficacy in using analytics to drive instructional interventions

Rate your degree of confidence in your ability to do each of the following tasks as of today by
recording a number from 0 to 10 using the interactive scale below:
______ Use data to drive my teaching interventions with individual students.
______ Use data to modify my teaching activities during the course.
______ Create learning environments where students use data to self-assess their learning.
______ Make use of analytics to create self-guided learning environments.

3. Efficacy in using neuroscience and cognitive research to drive teaching strategies

Rate your degree of confidence in your ability to do each of the following tasks as of today by
recording a number from 0 to 10 using the interactive scale below:
______ Create learning environments that focus on the needs of an individual learner.
______ Use scaffolds in my course designs to help students connect new information to previous
knowledge.
______ Use instructional methods that break up complex ideas into manageable learning events.
______ Use instructional methods that foster learner engagement with the material.
______ Use instructional methods that minimize unnecessary details.
______ Use methods that help learners organize their knowledge.

4. Efficacy in promoting self-regulated learning strategies with students

Rate your degree of confidence in your ability to do each of the following tasks as of today by
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recording a number from 0 to 10 using the interactive scale below:
______ Help students set learning goals in the classes I lead.
______ Create instructional activities that promote the use of many different learning strategies.
______ Help students improve their time management skills in the classes I lead.
______ Provide students strategies to overcome learning barriers in physical spaces.
______ Create instructional activities that promote combinations of social interactions
(independent learning, peer interactions, and social learning).
______ Provide students opportunities to reflect on their academic performance throughout the
learning process.

5. Efficacy in using competency-based approaches in medical education

Rate your degree of confidence in your ability to do each of the following tasks as of today by
recording a number from 0 to 10 using the interactive scale below:
______ Align courses with national entrustable professional activities (EPAs).
______ Measure student competencies with formal assessments.
______ Modify traditional exams to incorporate competency-based assessments.

6. Efficacy in using blended learning instructional design

Rate your degree of confidence in your ability to do each of the following tasks as of today by
recording a number from 0 to 10 using the interactive scale below:
______ To design my learning activities, begin by writing measurable learning objectives.
______ Use computer-assisted learning environments that are aligned with face-to-face sessions.
______ Create face-to-face sessions that are not lecture-based.
______ When designing learning activities, carefully fuse the best elements of online learning
with the best elements of face-to-face instruction.

Motivation: Value, Emotions, and Attribution Questions

7. To what extent do you agree with the following statements?

7a. I enjoy redesigning courses using learner-centered blended learning design.
7b. I enjoy developing courses that use appropriate educational technologies.
7c. It is important for me to redesign courses using learner-centered blended learning design
even if it takes time away from other professional activities.
7d. It is important for me to develop courses that use appropriate educational technologies even
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if it takes time away from other professional activities.
7e. I feel positive about redesigning courses using learner-centered blended learning design.
7f. I feel positive about developing courses that use appropriate educational technologies.
7g. I believe that improved student outcomes are the result of my efforts in redesigning courses
using learner-centered blended learning design.
7h. I believe that improved student outcomes are the result of my efforts developing courses that
use appropriate educational technologies.
7i. I enjoy delivering traditional lectures.
7j. It is important for me to design courses that use traditional lectures even if it takes time away
from other professional activities.
7k. I feel positive when delivering traditional lectures.
7l. I believe that improved student outcomes are the result of my efforts in delivering traditional
lectures.

Organization Influence Questions I

8. Using the scale below, please rate the extent to which you have the following:

8a. Time to redesign courses based on educational best practices for learner-centered blended
learning design

8b. The human capital needed to redesign courses based on educational best practices for
learner-centered blended learning design

8c. Financial support to redesign courses based on educational best practices for learner-centered
blended learning design

8d. Time to develop courses using appropriate educational technologies

8e. The human capital needed to develop courses using appropriate educational technologies

8f. Financial support to develop courses using appropriate educational technologies

8g. Policies and procedures aligned with my efforts to redesign courses based on educational
best practices for learner-centered blended learning design

8h. Policies and procedures aligned with my efforts to develop courses using appropriate
educational technologies

9. Using the scale below, please rate the extent to which you believe the following:

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9a. I am part of an organization that supports my efforts to redesign courses based on educational
best practices for learner-centered blended learning design.

9b. I am part of an organization that supports my efforts to develop courses using appropriate
educational technologies.

9c. I am part of a team that works together to redesign courses based on educational best
practices for learner-centered blended learning design.

9d. I am part of a team that works together to develop courses using appropriate educational
technologies.

9e. I am encouraged by executive leadership to be creative with my teaching practices.

9f. I consider the educational environment I work in to be innovative.

Organization Influence Questions II

10. (adapted from Porter et al., 2016) Please indicate the level of influence each of the
following would have on impacting your ability to effectively implement technology-
enriched course designs (e.g., placing quizzes, exams, discussions, lectures, learning
resources online). Use this scale:

❏ Financial stipends
❏ Temporary course load reductions
❏ Valuing your teaching innovations during tenure/promotion
❏ Technical support
❏ Pedagogical support (e.g., the ongoing ability to consult with an instructional developer
regarding course design/delivery)
❏ One-on-one professional development/training
❏ Face-to-face group setting professional development/training
❏ Online professional development/training
❏ Evaluation data demonstrating effectiveness of technology-enriched courses
❏ Whether faculty, departments, or the institution make policy decisions regarding online
course materials (e.g., intellectual property rights)
❏ University-level policies and guidelines identified for technology-enriched courses (e.g.,
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administrators publish examples of different ways to appropriately combine face-to-face
and online instruction)
❏ Other faculty members’ success stories
❏ Encouragement from department leadership for technology-enriched courses
❏ Encouragement from institutional administrators for technology-enriched courses
❏ Whether the institution's vision for promoting technology integration aligns with your
own
❏ Physical workspaces that promote collaboration, innovation, and rapid-prototyping of
ideas
❏ Online faculty communities that promote collaboration, innovation, and rapid-
prototyping of ideas

Other Questions

11. Which of the following BEST describes your current status at the university?
❏ Full-time faculty
❏ Part-time / adjunct instructor
❏ Researcher only

12. Do you currently serve as a Course Director for an undergraduate medical education module?
❏ Yes
❏ No

13. What BEST describes your typical reaction to new educational technologies? (from Porter et
al., 2016)
❏ I am constantly adopting multiple new technologies. I adopt well before anyone else,
sometimes even before a new technology is publicly available.
❏ I actively investigate new technologies and adopt the best ones. I am generally one of the
first to adopt a new technology, and my peers adopt based on my recommendation /
example.
❏ I wait to adopt until I have compelling evidence of the technology's value and
recommendations from my peers. I am not among the first to adopt, but I am generally in
the first half of those adopting a technology.
❏ I am not necessarily opposed to new technologies, but I am cautious and will only adopt
when it becomes necessary to do so.
❏ I recognize that new technologies have value to my colleagues, but I feel strongly about
using traditional resources. I will continue using my current resources, even when
pressured to adopt a new technology.

Thank you for the time you spent completing this survey. Your thoughts and feedback are very
important.

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APPENDIX B
INTERVIEW PROTOCOL
Introduction:
1. Briefly build rapport and give sincere appreciation for the time they’ll spend and
willingness to participate.
2. Briefly describe the purpose of the study.
3. Remind participant that they can withdraw at any time.
4. Remind them of anonymity, confidentiality, and ethical safeguards.
5. Ask if you have permission to record audio of the interview session.
6. Start the audio recording.
7. Collect signed permission to audio-record form. Provide copies of both forms to
participant.

Knowledge

Factual

● Critical behavior 1: When I say “blended learning,” what does this term mean to you?
● Critical behavior 2: When I say “technology-enriched learning environment,” what does
this phrase mean to you?

Conceptual

● Critical behavior 1: In your opinion, what types of instructional practices improve student
outcomes?
● Critical behavior 2: If any, what types of educational technologies might you use to
enrich your current course?

Procedural

● Critical behaviors 1 & 2: Non-lecture based courses employ educational technologies to
deliver content to students. Explain to me how you would create a computer-assisted
learning environment. Please walk me through that process.

Metacognitive

● Critical behavior 1: When designing learning experiences, how do you reflect on your
progress?
● Critical behavior 2: Please tell me how you assess your effectiveness in developing
learning environments.

Motivation

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 244

Value

● Critical behavior 1: How important do you feel it is it for you to redesign courses using
non-lecture based approaches?
● Critical behavior 2: How important do you feel it is it for you to develop courses using
educational technologies?

Self-Efficacy

● Critical behavior 1: To what degree do you feel confident about your ability to design a
student-centered learning environment?
● Critical behavior 2: When developing a course, to what degree do you feel confident
about your ability to implement educational technologies?

Emotions

● Critical behavior 1: How do you feel about redesigning courses using non-lecture based
approaches?
● Critical behavior 2: How do you feel about developing courses using educational
technologies?

Attribution

● Critical behavior 1: To what extent do you believe that your effort spent on redesigning
courses using non lecture-based approaches improves student learning?
● Critical behavior 2: To what extent do you believe that your effort spent on developing
courses using educational technologies improves student learning?

Organization

Resources

● Critical behaviors 1 & 2: Describe the organizational resources that support your
creativity as an educator.
○ Probe 1: Explain how you use such resources.

Policies

● Critical behaviors 1 & 2: What policies exist to help you align your teaching practices
with the institution’s strategic plan for innovative medical education?

Cultural Model

● Critical behaviors 1 & 2: Imagine I am a new faculty member here and you are speaking
to me about teaching practices during my first week on-the-job. Tell me about the
organizational culture of undergraduate medical education.
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 245

● Critical behaviors 1 & 2: Tell me about the executive leadership team’s vision for
supporting your efforts with developing innovative teaching and learning environments.

Cultural Setting

● Critical behavior 1: To what extent do you believe that you are part of a team that works
together to redesign courses using nontraditional educational practices?
● Critical behavior 2: To what extent do you believe that you are part of a team that works
together to develop courses using appropriate educational technologies?

Other Questions

● What should I have asked you about that I didn't think to ask?
● Do you have any questions for me?

Conclusion:
1. Thank the participant and ensure they have all their materials.
2. End the audio recording.
3. Complete writing of field notes and summarize the experience as soon as possible.
4. Reflect on the interview and include this reflection in field notes.

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APPENDIX C
SURVEY RECRUITMENT SCRIPT
Dear [Course Director Name],
My name is David Green, and I am your Senior Instructional Designer for undergraduate
medical education at the University of Miami Miller School of Medicine within the Educational
Development Office (EDO). I am also a doctoral candidate in the Rossier School of Education
at the University of Southern California. I am conducting a research study that examines
knowledge, motivation, and organizational resources necessary for course directors to effectively
implement technology-enriched medical education courses that are based on accepted
educational best practices. As a course director, your feedback is important to me and will be
used to directly shape the future of the services, support, and resources you need to train our next
generation of physicians.
You are invited to participate in this research study conducted by David Green (Senior
Instructional Designer at the University of Miami Miller School of Medicine and Doctoral
Candidate at the University of Southern California), Principal Investigator, and Dr. Melora
Sundt, Faculty Advisor, from the University of Southern California. You have been selected as a
potential participant because you are a course director at the University of Miami Miller School
of Medicine. If you agree, you are invited to participate in this mixed methods study, which
incorporates a survey and a face-to-face interview. The survey is anticipated to take
approximately 20 minutes to complete and the interview is anticipated to take up to one hour.
Please take as much time as you need to read the information in the attached information
form. Also, please ask questions about anything you do not understand or about anything you
would like clarified. You will be provided a copy of this IRB-approved “Information/Facts
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 247

Sheet for Exempt Non-Medical Research” when the study commences. Please contact me at
davidpgr@usc.edu to receive information about completing the survey and to schedule the
follow-up interview.

Thank you for your participation.

David Green
University of Southern California
Rossier School of Education
Doctoral Candidate

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 248

APPENDIX D
INFORMATION SHEET FOR EXEMPT NON-MEDICAL RESEARCH
University of Southern California
Rossier School of Education
Organizational Change and Leadership
Waite Phillips Hall
3470 Trousdale Parkway
Los Angeles, CA 90089

INFORMATION/FACTS SHEET FOR EXEMPT NON-MEDICAL RESEARCH

A Gap Analysis of Course Directors’ Effective Implementation of
Technology-enriched Course Designs: An Innovation Study

You are invited to participate in a research study. Research studies include only people who
voluntarily choose to take part. This document explains information about this study. You should
ask questions about anything that is unclear to you.

PURPOSE OF THE STUDY
Efficient and effective student-centered instructional elements could potentially streamline
educational processes and still produce competent professionals. But successful implementation
of technology-enriched courses that exceed course design standards and meet learners’ needs is
limited by contextual interactions of the course designer’s knowledge, motivation, and
organizational influences. The purpose of this project is to conduct a needs analysis in the areas
of knowledge, motivation, and organizational resources necessary for course directors to
effectively implement technology-enriched medical education courses that are based on accepted
educational best practices.

The purpose of this project is to conduct a needs’ analysis in the areas of knowledge, motivation,
and organizational resources necessary for course directors to effectively design, develop, and
implement technology-enriched medical education courses that are based on accepted
educational best practices. The questions I want my study to answer are:
1) What are the knowledge, motivation, and organizational barriers to course directors
implementing Ibis Academy approaches during preclinical medical education modules as
represented in their critical behaviors and performance goal?
2) What are the recommended knowledge, motivation, and organizational solutions to
those barriers/needs?

PARTICIPANT INVOLVEMENT
This study is completely voluntary. If you agree to participate, you will be asked to complete an
online survey, which is estimated to take 20 minutes. Following the online survey, participants
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 249

will be asked to participate in a one-hour face-to-face interview. Again, participation is
voluntary and withdrawal at any point and for any reason is your right. With your consent, audio
recordings will be collected during the interview sessions. Upon request, surveys can be
completed via printed hard copies.

PAYMENT/COMPENSATION FOR PARTICIPATION
You will not be compensated for your participation in this study, but your input will help guide
future decision-making processes.

ALTERNATIVES TO PARTICIPATION
Your alternative is to not participate. Non-participation in this study will not affect your
relationship with your employer.

CONFIDENTIALITY
Any identifiable information obtained during this study will remain confidential. Your name and
address will not be collected. Your responses on the survey and during interview sessions will
be coded with a false name (pseudonym). Data and audio recordings will be stored on a
password-protected computer in the researcher’s office for approximately three years after the
conclusion of the study. Then data and audio recordings will be destroyed.

The members of the research team, and the University of Southern California’s Human Subjects
Protection Program (HSPP) may access the data. The HSPP reviews and monitors research
studies to protect the rights and welfare of research subjects.

When the results of the research are published or discussed in conferences, no identifiable
information will be used.

INVESTIGATOR CONTACT INFORMATION
Principal Investigator David Green via email at davidpgr@usc.edu or phone at (305) 243-7605
or Faculty Advisor Melora Sundt at sundt@usc.edu or phone at (213) 821-2520

IRB CONTACT INFORMATION
University Park Institutional Review Board (UPIRB), 3720 South Flower Street #301, Los
Angeles, CA 90089-0702, (213) 821-5272 or upirb@usc.edu

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 250

APPENDIX E
LEVEL 1 AND LEVEL 2 EVALUATION TOOLS
Level 1
Strongly Strongly
disagree agree

1 2 3 4 5 6 7 8 9 10

Engagement
1. My participation was encouraged by the Director of Educational Technologies.
2. The workshop series held my interest.
3. The faculty development series helped me to learn.
Relevance
1. What I learned from this workshop series will help my teaching activities.
2. I am clear about what is expected of me during blended course redesign projects.
3. I found the active-learning exercises relevant to my teaching activities.
Customer satisfaction
1. The self-guided online learning modules were helpful to my learning.
2. The workshop series helped me apply my knowledge gains to real-world scenarios.
3. I will recommend this faculty development program to other preclinical medical
educators.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 251

Level 2
Declarative knowledge
None or very Very high
low level level

1 2 3 4 5

1. My knowledge of writing measurable learning objectives.
2. My knowledge of the science of learning.
3. My knowledge of creating a course blueprint.
Procedural skills
1. Evaluation of course redesign prototypes during the workshop series and bootcamp.
(evaluation rubric)
2. Observations of individual and collaborative active-learning activities during the
workshop series. (observation rubric)
Attitude
Strongly Strongly
disagree agree

1 2 3 4 5 6 7 8 9 10

1. I believe it will be worthwhile for me to apply what I learned to my teaching activities.
2. I believe completing the reflection portfolio was a worthwhile use of my time.
Confidence
Strongly Strongly
disagree agree

1 2 3 4 5 6 7 8 9 10

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 252

1. I feel confident that I can apply what I learned to my teaching activities.
2. I feel confident that I can design a technology-enriched learning environment.
Commitment
Strongly Strongly
disagree agree

1 2 3 4 5 6 7 8 9 10

1. I am committed to applying what I learned to my teaching activities.
2. I am committed to designing a technology-enriched learning environment.

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 253

APPENDIX F
DELAYED BLENDED EVALUATION TOOLS
Level 1
Relevance
Strongly Strongly
disagree agree

1 2 3 4 5

1. I have had occasion in my teaching activities to use what I learned during the faculty
development program.
2. The information provided during the faculty development program is applicable to my
teaching activities.
3. (Open response) What information should be added to this faculty development
program to make it more relevant to your teaching activities?
Customer satisfaction
Strongly Strongly
disagree agree

1 2 3 4 5

3. Looking back, the faculty development program was helpful to my learning.
4. Looking back, the faculty development program was a good use of my time.
5. I will recommend this faculty development program to other preclinical medical
educators.
6. (Open response) Looking back, what would you change about the faculty
development program?
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 254

Level 2
Confidence
Strongly Strongly
disagree agree

1 2 3 4 5 6 7 8 9 10

1. At this time, I feel confident in my abilities to effectively apply what I learned during
the faculty development program to my teaching activities.
2. At this time, I feel confident in my abilities to effectively design a technology-enriched
learning environment.
Attitude
Strongly Strongly
disagree agree

1 2 3 4 5 6 7 8 9 10

1. At this time, I believe it was worthwhile for me to apply what I learned during the
faculty development program to my teaching activities.
2. At this time, I believe that completing the reflection portfolio was a worthwhile use of
my time.
Commitment
Strongly Strongly
disagree agree

1 2 3 4 5 6 7 8 9 10

1. I am committed to applying what I learned to my teaching activities.
2. I am committed to designing a technology-enriched learning environment.
3. (Open response) How are you currently applying what you learned during the faculty
TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 255

development program to your teaching activities?
4. (Open response) Please describe any challenges you are experiencing that limit your
commitment.

Level 3
Behavior
Strongly Strongly
disagree agree

1 2 3 4 5 6 7 8 9 10

1. I have successfully applied what I learned during the faculty development program to
my teaching activities.
2. I have been modified my teaching activities in response to what I learned during the
faculty development program.
3. (Open response) How have you used what you learned during the faculty development
program?
4. (Open response) What else do you need to successfully apply your knowledge gains
from the faculty development program?
5. (Open response) If you are not applying what you learned during the faculty
development program to your teaching activities, what are the reasons?

Level 4
Desired results
Strongly Strongly
disagree agree

TECHNOLOGY-ENRICHED COURSE IMPLEMENTATION 256

1 2 3 4 5 6 7 8 9 10

1. This program has helped me align my teaching activities with the Urban School of
Medicine’s strategic plan for innovative medical education.
2. My efforts have contributed to the Urban School of Medicine’s mission.
3. This program has positively impacted my students.
4. (Open response) Please provide one example of a positive outcome you have
experienced since completing the faculty development program.
5. (Open response) Please describe any early signs of success you have observed,
following your participation in the faculty development program.
6. (Open response) How has your participation in this faculty development program
benefited the Urban School of Medicine?

Abstract (if available)

Abstract Efficient and effective student-centered instructional elements could potentially streamline educational processes and still produce competent professionals. However, successful implementation of technology-enriched courses that exceed course design standards and meet learners’ needs is limited by contextual interactions of the course designer’s knowledge, motivation, and organizational influences. The purpose of this project was to conduct a needs’ analysis in the areas of knowledge, motivation, and organizational resources necessary for preclinical medical education course directors to perform two critical behaviors related to redesigning courses using learner-centered approaches and developing technology-enriched learning environments. This study answered two research questions. First, what are the knowledge, motivation, and organizational barriers to course directors implementing technology-enriched approaches during preclinical medical education modules as represented in their critical behaviors and performance goal? Second, what are the recommended knowledge, motivation, and organizational solutions to those barriers/needs? For this study, the Clark and Estes (2008) gap analysis was adapted for a needs analysis as the conceptual framework, and an explanatory sequential mixed methods approach was used for the methodological framework. Twenty-seven preclinical medical education course directors, from a private, east-coast medical school, completed the online survey, and eleven voluntarily participated in the follow-up face-to-face interview. Twenty-five literature-based assumed knowledge, motivation, and organizational influences were investigated through the lenses of the two critical behaviors. Using the New World Kirkpatrick model as a guide, an integrated implementation and evaluation plan of a novel faculty development program was proposed as a solution to help course directors achieve their performance goals and facilitate organizational change. Data-driven communication strategies were incorporated into the integrated plan to enhance communication amongst key stakeholders and improve accountability relationships. This study contributes to the organizational change literature, and the broader implications of this research are applicable to the current medical education paradigm shift, higher education and educational technology initiatives, evaluation of novel faculty development programs, and gap analysis application research.

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Asset Metadata

Creator Green, David Patrick James (author)

Core Title A gap analysis of course directors’ effective implementation of technology-enriched course designs: An innovation study

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 01/19/2018

Defense Date 11/30/2017

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag active learning,blended learning,needs analysis,OAI-PMH Harvest,program evaluation,technology-enriched learning environments

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Sundt, Melora (committee chair), Datta, Monique (committee member), Yates, Ken (committee member)

Creator Email davidpgr@usc.edu,dgprovideo@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c40-462270

Unique identifier UC11266804

Identifier etd-GreenDavid-5962.pdf (filename),usctheses-c40-462270 (legacy record id)

Legacy Identifier etd-GreenDavid-5962.pdf

Dmrecord 462270

Document Type Dissertation

Rights Green, David Patrick James

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA