Issues

Digital Literary Pedagogy: Teaching Technologies of Reading the Nineteenth-Century

Roger Whitson, Washington State University

Digital Literary Pedagogy: An Experiment in Process-Oriented Publishing

 

Digital pedagogy is at a crossroads. Many humanist scholars have begun experimenting with digital technology and reporting those experiments on Twitter, in blogs, and in journals like The Journal of Interactive Technology and Pedagogy. At the same time, our more traditional disciplinary structures limit the amount of critical reflection or pragmatic application those experiments have. Scholars in the field of Computers and Writing, Cheryl Ball for example, have criticized the digital humanities as being “uncritical of its teaching practices,” something she calls “paradoxical,” since DH is “mostly comprised of literary-critical scholars.” Yet these critics are unaware that their “discovery of teaching with technology is relatively new” (Ball 2013). Ball’s Spring 2013 “Logging On” column in Kairos calls most pedagogical sessions at the MLA, THATCamp, and HASTAC “boring,” especially since, unlike scholarly-article length pieces that situate themselves in a field, most digital humanities pieces on pedagogy have a “Here’s What I did in my Classroom” approach (Ball 2013). While I empathize with Ball’s argument that the digital humanities needs more critical reflections on technological pedagogy, I also think that her criticism is symptomatic of an academic institution that has not yet conceptualized the scholarly place for faster-paced conversations like those on blogs and Twitter.[1] Reports of classroom activities certainly have their place in the larger conversation about pedagogy, even if these conversations are not citing articles that have bearing on their understanding of digital practice. This article will show how a scholarly reflection based in actual classroom practice can provide an effective way of bridging Ball’s concerns with the experiences of actual students in my classroom, while doing so from the disciplinary standpoint of literary studies. My fundamental question: what can literary studies contribute to the interdisciplinary pedagogical issues surrounding digital media and online publication?

I decided to collaborate with JITP editors Kimon Keramidas and Amanda Licastro because I wanted to use the academic journal to drive questions of student publication and online participation in a literary studies course. Many DH-pedagogies emphasize the publication of student work. On his course websites, Brian Croxall regularly includes a section to his students titled “Why Blog?” and answers the question by arguing that “f we draw attention from the outside world, it will help us remember that college is not simply preparation for ‘the real world’ but that it is in fact a vital part of the ‘real’ world” (Croxall 2012). I agree with Croxall about the importance that students work have resonances beyond the classroom and the need for student work to make a difference. However much we publish student work online, the vast majority of that work is obscured by everything else that competes with it for reader attention. Most content produced on class websites goes unnoticed unless it is actively promoted by teachers or students, both of whom are often overworked or may not know the complexities of online communication. Posting a blog doesn’t have the same resonance as publishing a book did in the nineteenth century, and for this reason, we needed to explore in our course how editorial oversight might help to make work more noticeable.

I realized that The Journal of Interactive Technology and Pedagogy was a perfect choice for finding editors that were invested in the idea of a professional writing environment, but who also understood that the meaning of “professional” was changing rapidly as social media forces journals to rethink their mission and purpose. The need to have an academic “weight” to the material produced by my students and, at the same time, my desire to embrace new forms of scholarly communication in the student’s projects drove my idea that student publication might require a new role for the editor. In many cases, editors are seen outside of the pedagogical process or part of teaching students to become better peer-reviewers.[2] If students published at all, they either created blogs (that might or might not be visited and commented upon by outside readers) or wrote essays that were never intended to have an outside audience. I wanted my students to have an audience and carefully craft their work to be received, retweeted, and reposted by that audience. What if, I thought, I could bring editors in on the process from the beginning? What if editors could help me co-teach the course?

The introduction of digital content, especially guided by a journal dedicated to digital teaching, can contextualize and revitalize the teaching of literary reading. I call this complementary approach digital literary pedagogy: using digital technology to extend what we do in a literary survey class. While this approach can work in other humanities disciplines, particularly courses that examine textuality from a historical viewpoint, I emphasize how literary studies is particularly suited for a pragmatic approach to editorially-guided instruction combined with historical perspectives on editorial apparatuses. My course interweaves the concerns of composition with literary studies: by using technology and cultural research, I argue, we can historicize the emergence of new practices associated with digital media. I’m focusing specifically on literary studies in this article for two reasons. First, literary studies courses are filled with students who have no idea why books from centuries past have any relation to their lived experience. Second, a social media ecology is emerging in front of us that begs critical reflection, and our students do not yet have the tools to know what they are doing when they sign up for a Facebook account or post a blog. A course reflecting on the kinds of “publics” emerging now is urgently needed, and literary studies can use the anxieties over writing and reading in the past as a touchstone to explore how anxieties over social media can be addressed today.

The design of my fall 2012 course at Washington State University, ENGL 366: “The British Novel to 1900,” focused on providing a set of comparisons between two media revolutions: the expansion of middle-class reading and printing in the nineteenth century and the discourse surrounding digital media today.  As William St. Clair recounts in The Reading Nation in the Romantic Period, novel-writing and reading during the nineteenth century were associated with a newly-literate middle class. The phenomenon of middle-class readers transformed the literary marketplace, since poetry and novels had different funding models.  Whereas poetry was “supply pushed by authors and patrons,” “[n]ovels were demand-led by book purchasers, by commercial borrowers, and by readers” (St. Clair 2004, 176). The emergence of middle-class reading interfaces with a remarkable number of cultural issues defined by the period: the change in attitudes surrounding the literary merit of novels by different classes, the role of the novel in defining specific forms of subjectivity, and the rise of professional writing and editing. For me, the historical question of writing as a profession is particularly important for defining a literary studies whose historical content can help illuminate technology since, as Paul Fyfe has observed, “the entire production-reception complex of popular literature seemed unprecedented, unpredictable, and immense” in a similar way as digital content overwhelms contemporary users (2009, 2).

I found that it was helpful for students to understand, for example, that authors like Jane Austen and Edmund Burke incorporated anxieties about novel reading with much the same tone as Nicholas Carr uses when he asks “Is Google Making Us Stupid?”[3] Austen’s Northanger Abbey is famous for an ambivalent approach to novels and novel-reading. On the one hand, it was clear to my students that the heroine Catherine Morland’s obsession with Ann Radcliffe’s The Mysteries of Udolpho keeps her from reading Shakespeare and Milton, and thus memorizing lines that could be used to prove she is cultured and more able to attract rich suitors. My student Tyler Andrews noticed Austen’s criticism “that life can be the same as fiction, with danger around every corner” by emphasizing Catherine’s narration of her quite commonplace life. “Catherine,” Andrews observes, “mention[s] a robbery-free ride to Bath, and […] assume[s] the best in everyone” (Andrews 2012). On the other hand, my students found Austen’s famous rant against the literary critics of her day very compelling. In the section, Austen sees “almost a general wish of decrying the capacity and undervaluing the labor of the novelist, and of slighting the performances which have only genius, wit, and taste to recommend them. ‘I am no novel reader;’ ‘I seldom look into novels;’ ‘Do not imagine that I often read novels;’ ‘it is really very well for a novel,’ such is the common cant” (Austen 1903, 35-6). The students grew to understand how a social-realist approach to writing in the nineteenth century emerged out of Austen’s and other authors’ ambivalence toward novel-reading.[4] The relationship between this ambivalence and the development of the novel is made in the work of Richard Altick and Patrick Brantlinger, who formed the intellectual core of my course.[5]

Reading the Nineteenth Century Aloud

It was useful for me to complicate my students’ notions of reading with those from the critics and authors of the nineteenth century. Many critics have noted the period’s communal reading practices, including the public readings Dickens gave at the end of his life and the common practice of reading aloud to one’s family.[6] Charles Kent attended the readings and wrote about the audience’s breathlessness upon hearing Dickens’s voice “– the words he was about to speak being so thorough well remembered by the majority before their utterance that, often, the rippling of a smile over a thousand faces simultaneously anticipated the laughter which an instant afterwards greeted the words themselves when they were articulated” (Kent 1872, 20). We read Kent’s book Charles Dickens as a Reader along with Edward Cox’s 1878 guide to public reading, The Arts of Writing, Reading, and Speaking in Letters to a Law Student. Cox gives powerful and specific advice about topics as various as overcoming shyness when reading in front of an audience, affecting different voices and practicing different lines before a performance, and reading aloud when preparing for public speaking. He also examines acoustics, advising his readers to practice in the performance room before their event to make sure audiences can hear them. “If they [the audience] fail to do so,” Cox argues, “not only are the distant deprived of whatever pleasure you can give them, but there is sure to be restlessness among those who cannot hear which will disturb those of the audience within earshot and annoy you not a little” (Cox 1878, 183). The nineteenth-century readings by Kent and Cox inspired me to construct a project that asked my students to record oral reading performances of Jane Austen’s Northanger Abbey on Soundcloud and write about the experience.[7] Soundcloud is like many online audio distribution applications, except that it makes collaboration between different members extremely easy. The application also assigns each sound a specific URL and has a variety of different widgets that can be used to embed the file into websites. I wanted to have the students thinking about the presence of sound and its resonance both in the nineteenth-century and as an emergent mode of composition within our own digital media space, particularly in the rise of commercial services like Audible and open source community projects like Librivox. Jeff Rice, in “The Making of ka-knowledge: Digital Aurality,” uses both Marshall McLuhan and The Beastie Boys to show how aural modes of composition are central in digital media. These aural modalities, for Rice, depend less on a literate notion of topos for organization and more on aural conventions like rhyme, tonality, rhythm, and voice (Rice 2006).[8] I knew that the knowledge my students would gain from performing the novels in question would be very different from the knowledge gained in an argumentative paper. As such, the book by Brian Cox provided both a historical source and a theoretical guide for our new practice. My students were asked to demonstrate their interpretation of each character in the tonality they used to perform them. Each student picked an individual chapter of the novel, and were encouraged to distinguish the narrator from each of the characters, possibly add music, then edit the recording. They translated the topos often encapsulated in a thesis statement and supporting arguments into the speed in which they read the lines, the surprise or sarcasm in their voice when they performed a character, and the music they used to imply the overall feeling of a scene.

Devin Truchard was particularly good at dramatizing the different voices of the novel, powerfully affecting the naïve enthusiasm of Catherine, the gruff arrogance of John Thorpe, and the anxious loneliness of Mrs. Tilney. The voice he used for the narrator was low, and seemed a little more appropriate for an action movie than an Austen story. It worked well to highlight the darker tones of the novel, as well as Austen’s mocking attitude toward the Gothic. In his written reflection, Truchard writes revealingly about his struggle to differentiate characters with tonality: “Being able to swap to multiple female voices is something I have never tried before.” Truchard continues, “Being able to get at least one feminine voice was trouble enough, but applying a second voice was almost the death of me. I eventually decided to differentiate the two voices by how much strain I put in them” (Truchard 2012). It was quite interesting to see how using an audio project forced my students to write essays about the novel in ways that were unusual to them. Many of the written responses read more like Cox’s how-to manual, rather than the simple response they were accustomed to producing in most literature classes. They needed to know motivation, character, and plot in order to reproduce the characters in a compelling way, but they could not talk about these elements of the novel without mentioning how they impacted the aural elements of the character’s voices in the recording.

Jenna Walter, by contrast, did little to distinguish the voices of the characters, but she added extremely effective music and was clearly quite enthusiastic about the process. She also did a wonderful job syncing the tone of her narrator’s voice with the accompanying music. The connection between her voice and the music is particularly acute when she gets to Catherine’s “desponding tone,” upon noticing that the day might bring rain in Chapter 11 (Walter 2012). The full strings Walter added in the beginning are quickly replaced by a simple piano playing softly, underscoring the delicacy of the “few specks of rain” Catherine sees and the slight depression she feels when she thinks that no one will visit the pump room that day: the center of social activity at the beginning of Northanger Abbey. Walter’s voice betrays a more sincere approach to the novel than Truchard, and perhaps delineates a gender distinction in my class’s reception of its topic. Whereas the men in the course tended to see the conflicts of the novel as inconsequential and somewhat satirical, the women often either empathized with Catherine’s plight or were extremely harsh in their reactions. Walter compares Catherine’s despondence in the novel in which she “may not sleep well […] from all her crying” to “the Twilight series when Edward leaves Bella and she spends half the book in a fetal position, in a majorly depressed state of silence, or a seriously suicidal state.” Given that Walter describes Bella and Catherine as “overreact[ing] to their boy problems,” you can see that she takes the novel much more personally than Truchard seems to with his pseudo-mocking tone (Walter 2012).

The discussions emerging out of this project were often more interesting than the projects themselves. Students connected the physical experience of reproducing voices to gender issues and imagined their own subjectivity in relation to the male and female characters in the novel. Inasmuch as Truchard distinguished different female voices by using different amounts of “strain,” Emeri-Erin Callahan over-emphasized the arrogant masculinity of Mr. Thorpe as a way of articulating his difference from the female characters. Callahan describes “lower[ing] my voice, and [speaking] in a very short and direct manner. I wanted it to feel like he was aggressively asserting himself with every sentence he spoke” (Callahan 2012). She recounts in detail the way she varied the rapidity of her reading to create this effect. “I noticed that he [Thorpe] drove his attention away for a moment onto Mrs. Allen,” Callahan recounts, “asking how she was, and then voiced an additional question about the ball the night before, but before she could even respond he had already turned his focus onto Catherine telling her to hurry up” (Callahan 2012). The darker side of Mr. Thorpe’s dominance is much more pronounced in Callahan’s recording than the mock masculine tone used in Truchard or the sincere yet ultimately judgmental approach by Walter. Callahan “convey[ed] this act [Thorpe’s domination] by making the portion addressed to Mrs. Allen rushed and quiet before I immediately leapt back into talking to Catherine, as though my speech to Mrs. Allen never happened” (Callahan 2012). Callahan made it clear that she understood how speech could be used as a weapon, and she inserts this awareness into the texture of her recording.

The Soundcloud assignment was effective in my course because it highlighted a practice that was common in the nineteenth century, yet used digital technology to bring that practice into the present. Most of the students understood that reading for a computer recorder was quite different than reading for a live audience, but they also learned the importance of going back to old nineteenth century texts for advice. It showed them how critical interpretation could make a tangible difference in how a text is performed. Mark Sample has argued that having students read aloud in class allows them to “become voices in the classroom, authorities in the classroom, empowered to speak both during the reading, and even more critically, after the reading” (Sample 2011). I agree, but I also wanted to show my students how the practice of reading silently emerged only relatively recently. It is important to engage multiple modes of student engagement when dealing with a subject often seen by them as distant and dry. Asking them to incorporate their interpretations directly into a vocal reading practice empowers students to see how criticism can have a practical application in performance.

Editing the Nineteenth Century

I designed the Soundcloud assignment and the blog posts to get students creating as much multimodal content as possible that engaged with the readings of the course. We would then collaborate with Amanda and Kimon to promote the best content, design it as effectively for online users as possible, and create a final site that effectively presented the work of the semester. The readings of the semester shifted from issues of writing and reading to economic and editorial concerns. I found this portion of the course an opportune time to introduce students to the editorial and design practices of bookmakers during the nineteenth century.[9] We investigated Alexis Weedon’s argument about how print runs were initially based upon tokens of 250 that were used to mark the hourly rate owed to the two men who set up the press and ran the copies. “The print run was calculated as the number of such ‘tokens’ rather than by estimating sales,” Wheedon argues, “a practice that was wasteful and clearly untenable in the more competitive 1830s when steam printing challenged the old system” (Wheedon 2003, 12). Of course, such methods were also tied to the economic triumph of the novel as the literary form of the bourgeoisie, as we noted earlier with the work of William St. Clair and Patrick Ballinger. How might we reconsider design choices today if we understood that such choices are shaped by technological and historical affordances? I agree with Kristin Arola when she says that teachers “must (re)engage ourselves and our students with the rhetoric of the interface and thus the rhetoric of design” (Arola 2010, 7). This means, for me, that we should not only have students rhetorically analyze the assumptions of content management sites like WordPress and Drupal, but they also need to know how these assumptions work in a larger historical and cultural frame.[10] My final project would be framed around students editing the content produced during the semester and collaborating with real editors from JITP to make the work publishable. I wrote Sarah Ruth Jacobs of JITP in April 2012 to see if the journal would be interested in rethinking the role of student publication in the class, as well as reconceptualizing the role of the editor in teaching. In my email, I said that:

I’d like to incorporate editors from the journal into the final project. This may mean a session or two where editors Skype in and talk about scholarly editing, what it means, and how to make a “website” publishable. It may mean that we all (myself, editors, and the students) brainstorm during one of those sessions about what it means to publish a website. I’d like to use the project to reimagine the role of the scholarly publication in digital pedagogy – to see editors as part of a collaborative teaching experience. This in itself could be something we could both write about in a separate article, linked perhaps to the website, about having students publish and the role of the peer-reviewed journal in that process. I wanted to see if JITP would be interested in seeing this process as an opportunity for a different type of collaboration and work through what that may mean for my role as a teacher and your role as a publisher. (Whitson 2012)

The response from Sarah, Kimon, and Amanda was positive. Amanda responded that she wanted my perspective as a teacher to be a major part of what was finally produced.

[A]s we are focused on pedagogy, we would like this project to be framed by a narrative in order to reveal the process that led to the final product. We are envisioning a more “meta” submission that would include reflections from both you and your students and perhaps Kimon and me [Amanda]. The reason we are so interested in this proposal is because of its experimental nature, therefore we want to remain true to that goal throughout the creation and in the final deliverable. (Licastro 2012)

We met subsequently on Google Hangout and decided to have the editors virtually attend the class twice. The first meeting would introduce the journal and talk about some larger issues regarding editing and online publication. The final meeting would have students present their blog posts and projects and get pointed critiques by the editors, as well as give the students a chance to reflect on their experiences throughout the semester.

The first hangout meeting went quite well. Students were introduced to the ways Twitter, Facebook, and other social media are changing the methods scholars use to communicate to one another. We discussed how JITP occupied a middle-space between traditional scholarly publications and blogs. They also previewed their thoughts about the final project, where I asked them to curate blog posts produced throughout the semester, picking four of them for the final website. I asked the students to create at least one post per week, based upon a modified version of Mark Sample’s blogging assignment from his Spring 2011 graphic novel class (Sample 2013). That assignment divided students into four groups, and each group had a different stated purpose to their blogging. First Readers would post questions to the week’s reading by Monday night; Responders would respond to questions from the first readers and post their own by Wednesday night; Searchers would find some interesting resource on the web that related to class and discuss its relevance; finally, the Weekly Roundup group would bring the week to a close by reflecting on discussions happening in class and online. We had been producing posts since the first week of class, so by the later weeks we had quite a pool to choose from. Instead of grading them myself, I wanted the students to start practicing their own editorial skills, think about what makes online content successful, and pick out the best examples that fit those criteria from our class.

I tasked three students to survey the rest of the class about editorial criteria. The results of their survey found that clarity, content, evidence, and credentials were what most (55%) of the students saw as important criteria. Leech, Champion, and Martin excerpted some of the written responses to the survey in their presentation.

One group noted, “essays must be clear in order for readers to understand, otherwise they will lose interest and have no additional motive to finish reading the piece. If an author does not use evidence to support his/her claims, they lose credibility.” Another group came to a similar conclusion, arguing that “clarity and evidence work to organize the content into a readable form and support the validity of the essay. Credentials further support the author of the essay, which allow the audience to take the author seriously” (“JITP Form” 2012). The students did not choose the same criteria I would, but I feel the exercise gave them the opportunity to see how their thoughts about good work could be put into practice when choosing content to display on the site.

Students then chose the five submissions that best exemplified the determined criteria, and wrote short answers discussing how the submission fit. One student discussing Anne Boothman’s post noted that her piece was “fresh,” that it left “readers thinking and questioning their own feelings about the book’s ending,” and that it cited research to “support her claim” and “her academic opinion.” Another post by Bryant Goetz “demonstrated going beyond the given text and discussing sources that were used in Mary Shelley’s Frankenstein.” The author of Goetz’s review “thought it was pretty interesting how he linked to Wikipedia right in his article, demonstrating how online writing can reference other sources in different ways than essay writing.” In addition to Goetz and Boothman’s posts, the students picked Colleen Stuckey’s “The Modern Sherlock,” Deven Tokuno’s “Gossip Girl Jane Austen Style,” and Jenna Walter’s “Mary Braddon Drew Inspiration from Her Own Life?” I found that the posts were picked for very different reasons. Deven Tokuno’s analyzed the parallels between Jane Austen’s Northanger Abbey and the television program Gossip Girl, which fascinated several of the students who followed the show. Anne Boothman’s was favored because it included a good bit of research into the history of madness in the nineteenth century. Students appreciated the contemporary tone of Tokuno’s, while enjoying the applied research of historical documents in Boothman’s.

Surprisingly, the students seemed more interested in the written blog posts than any of the SoundCloud projects completed during the semester. None of the SoundCloud projects were promoted to the final website. In my mind, despite the large amount of time we spent in class discussing the historical differences between written, aural, visual, and non-verbal modalities, many of the students were uncomfortable articulating specific reasons for picking one non-textual artifact over another. The student reaction may be related to the relative lack of educational infrastructure at WSU devoted to analyzing and producing multimodal content in an academic or professional setting. Individual programs highlight multimodal writing, like the 355 course in our Digital Technology and Culture major titled “Multimodal Authoring: Exploring New Rhetorics,” but there are few resources for scholars or students outside of these courses who want to explore multimodality.[11] WSU has a University-wide “Junior Writing Program” that acts as “a mid-career diagnostic to determine if your writing abilities are ready to handle the challenges of your Writing-In-The-Major (M) courses and other upper division courses that assign writing” (“Junior Writing Portfolio” 2013). The program has been remarkably successful in encouraging writing across different majors, but is only now starting to conceptualize how multimodal and digital forms of writing might fit into its requirements. This has effects on many teachers who might otherwise assign multimodal projects, because such projects would not count in the current portfolio guidelines. The effects of student unease in my course underscores the fact that students in different regions of the country have very different needs when it comes to multimodal literacy, and simply giving them the chance to produce multimodal content in one course may not be enough if other courses and programs on campus continue to be dominated by print assumptions about communication. We spent some time reflecting on how this unexpected consequence put into relief our own historical context, that this same course might look very different five or ten years in the future.

The final part of the project asked students to create their own WordPress website designed to display the best blog posts, summarize the themes of the course, and discuss the major assignments. Students were divided into groups that worked on editing the chosen blog posts, writing an overview of the course, composing a piece on the themes and projects covered in the course, and designing the site itself. Students had to be able to articulate just how historical knowledge can impact current ideas and decisions, and they needed to be able to also present the case for learning about reading controversies in the nineteenth century. For example, the novel Frankenstein clearly associates a literary education with bestowing a certain amount of power on the titular scientist Victor Frankenstein. Students wondered whether literature would play such a central part if Frankenstein were written today. Of course, you only have to look at the reception of the character in film and television for the past hundred years to see that the association between the novel’s veneration of literary tradition and its attitude toward scientific innovation has been largely removed from the story.

The last  meeting with the JITP editors allowed my students to connect several of these questions to the larger issues in scholarly communication that concern the journal. Kimon and Amanda asked the design group why they didn’t incorporate more multimodal content. While the site design had a clean interface and visual cues that recalled my own site for the course, it relied largely on the written content that we produced over the semester. The designers did not create video or audio interviews with the authors chosen by the class, nor did they really spend much time considering what kinds of visual images could enhance the content in the posts. The editors also asked the students how collaborative forms of writing were integrated into the process of constructing the site. Much of the site content not devoted to posts or projects was collaboratively written in groups. The students found that the variation between individual and collaborative writing to reflect the writing situations they expected to encounter after graduating from college and getting a job. In all, the suggestions by Kimon and Amanda reflected what might occur in a multimodal composition course: design elements, writing processes, and rhetorical strategies informed much of the early conversation.

The final discussion between the editors and Anne Boothman, however, added a new dimension that was more clearly associated with the literary content of the course. As I mentioned earlier, Boothman had written a piece on the history of madness in the nineteenth century, with special attention paid to Mary Elizabeth Braddon’s Lady Audley’s Secret. The editors were pleased that her writing led to research in WSU’s library surrounding the questions her reflections had provoked. Was madness always understood in the same way? Amanda’s questions regarding the visual representation of madness were particularly useful for the student and caused her to think more closely about the performance of madness in Braddon’s novel. For me, this conversation showed just how questions of communication and composition can quickly turn into fascinating reflections on culture and subjectivity. If, for example, Lady Audley had acted mad in accordance with the cultural understanding of insanity during Braddon’s lifetime, does this performance allow her to get away with murder? Audley’s performance of madness quickly opens questions regarding gender, the criminal system, even the history of sanity itself.

The Literary in Digital Literary Studies

Boothman’s contribution to the final talk with the JITP editors illustrates just how much digital pedagogy can learn from literary studies. Despite the new methodologies for analyzing texts that the digital humanities have developed, like distant reading and topic modeling, DH itself has little to say about the role of technology in shaping the lives of people throughout history. Students still need to understand how technologies like the novel impacted women, how the rise of women as professional writers challenged what people thought the novel could do, and how novels written by women inspired wider social movements that forever changed the world. And many of the historical issues encountered in a course like the one I designed have analogues in cultural situations students encounter today. For instance, Digital Book World reported on September 6, 2012 that Amazon Publishing Group is looking to market a new set of serialized novels. According to Jason Ashlock, these novels would be “like the serials of publishing generations past, readers can encounter a work of fiction in installments. In classic Dickensian fashion, the long story is fragmented and sold in episodes. A consumer pays one price one time, and each installment is delivered upon its release” (Ashlock 2012). The reference to Dickens is a powerful one, especially if read by students who just finished a twelve-week project reading Oliver Twist from the version of Bentley’s Miscellany found online (Bentley’s Miscellany 1837). Literary studies can show students how history, technology, and marketing collide to bring about a new narrative experience (that may not be so new).

My students also learned quite a bit about the process of writing, editing, and publishing, yet they did so from a perspective that made them aware of the cultural and technological changes which brought about many of the practices used in publishing today. Historicizing reading is important because it shows just how contingent many of our practices can be, while always also illustrating why they were used in the first place. Most importantly to me, however, the emphasis in my course on both the digital and the literary gave my students a sense of historicity that subverted the digital utopianism and apocalypticism so prevalent in our culture today. Students who are used to seeing their teachers lament the rise of Facebook are often shocked to see that something as seemingly innocent as the novel once inspired a similar amount of vitriol. As digital pedagogy can be used to introduce students to new modalities of communication and new skills that are transferrable to different kinds of career opportunities, so can literary studies give students in digital classrooms the ability to critically and historically analyze the culture emerging around them. For all of these reasons, and many others, we need more teachers in literary studies who are willing to experiment with new methodologies, embrace different forms of technology, and write critically reflective articles sharing their teaching with the rest of the discipline.

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Callahan, Emeri-Erin. 2012. “Audacity Reading and Blog.” 19th Century British Novel: Technologies of Reading. 15 September. Accessed September 30, 2013: http://www.rogerwhitson.net/britnovel2012/2012/09/15/audacity-reading-and-blog/

Carr, Nicholas. 2008. “Is Google Making Us Stupid?” The Atlantic. 01 July. Accessed September 30, 2013: http://www.theatlantic.com/magazine/archive/2008/07/is-google-making-us-stupid/306868/

Cook, Susan. 2013. “The Reading Project.” Journal of Victorian Culture Online. 25 June. Accessed September 30, 2013: http://myblogs.informa.com/jvc/2013/06/25/the-reading-project/

Cox, Edward W. 1863. The Arts of Writing, Reading and Speaking in Letters to a Law Student. London: J. Crockford. OCLC: 60718779.

Croxall, Brian. 2012. “Why Blog?” briancroxall.net. Accessed September 30, 2013: http://www.briancroxall.net/dh/why-blog/

Details for DTC 355 Fall 2013, WSU Online. 2013. Pullman: Washington State University. Accessed September 30, 2013. http://schedules.wsu.edu/List/DDP/20133/DTC/355/01

Fister, Barbara. 2012. “Serial Scholarship: Blogging as Traditional Academic Practice.” Inside Higher Ed. 12 July. Accessed September 30, 2013: http://www.insidehighered.com/blogs/library-babel-fish/serial-scholarship-blogging-traditional-academic-practice

Fitzpatrick, Kathleen. 2013. “Blogs as Serial Scholarship.” Planned Obsolescence. 12 July. Accessed September 30, 2013: http://www.plannedobsolescence.net/blog/blogs-as-serialized-scholarship/

Fitzpatrick, Kathleen. 2013.  “The Unpopular.” Planned Obsolescence. 07 July. Accessed September 30, 2013: http://www.plannedobsolescence.net/blog/the-unpopular/

Fitzpatrick. Kathleen. 2013. “Unpopular Seriality.” Planned Obsolescence. 17 June. Accessed September 30, 2013: http://www.plannedobsolescence.net/blog/unpopular-seriality/

Fyfe, Paul. 2011. “Digital Pedagogy Unplugged.” Digital Humanities Quarterly 5.3. Accessed September 30, 2013: http://digitalhumanities.org/dhq/vol/5/3/000106/000106.html

Fyfe, Paul. 2009. “2008 Van Arsdel Prize Graduate Student Essay: The Random Selection of Victorian New Media.” Victorian Periodicals Review 42.1. OCLC: 428457485.

Goetz, Bryant. 2012. “Are We All a Modern Prometheus?” The 19th Century British Novel. 5 December. Accessed September 30, 2013: http://www.rogerwhitson.net/19thcenturyreading/are-we-all-a-modern-prometheus/

“JITP Form Results.” 2012. Email to Roger Whitson. 30 December.

“Junior Writing Portfolio.” 2013. Washington State University. Accessed September 30, 2013: http://universitycollege.wsu.edu/units/writingprogram/units/writingassessment/juniorwritingportfolio/guidelines/index.html

Kent, Charles. 1872. Charles Dickens as a Reader. Philadelphia: J.B. Lippincott. OCLC: 4820273.

Lane, Maggie. 1995. Jane Austen and Food. London: Hambledon. OCLC: 32087496.

Licastro, Amanda. 2012. “Re: Question about Possible Publication Idea.” E-mail to Roger Whitson. 14 May.

McCormack, Emily. 2012. “To Read or Not To Read?” 19th Century Novel: Technologies of Reading. 29 August. Accessed September 30, 2013: http://www.rogerwhitson.net/britnovel2012/2012/08/29/to-read-or-not-to-read/

Morrison, Robert and Daniel S. Roberts. 2013. Romanticism and Blackwood’s Magazine. London, Palgrave. OCLC: 811729078.

Rice, Jeff. 2006. “The Making of ka-knowledge: Digital Aurality.” Computers and Composition 23: 266-279. OCLC: 442994478.

Rubery, Matthew. 2009. “Victorian Literature Out Loud: Digital Audio Resources for the Classroom.” Journal of Victorian Culture 14.1: 134-9. OCLC: 378506896.

Sample, Mark. 2013. “Guidelines.” ENGL 300 The Graphic Novel. Accessed September 30, 2013: http://samplereality.com/gmu/engl300/guidelines-2

Sample, Mark. 2011. “On Reading Aloud in the Classroom.” Samplereality. 14 Sept. Accessed September 30, 2013: http://www.samplereality.com/2011/09/14/on-reading-aloud-in-the-classroom/

Sample, Mark. 2012. “Serial Concentration is Deep Concentration.” Samplereality. 12 February. Accessed September 30, 2013: http://www.samplereality.com/2012/02/12/serial-concentration/

St. Clair, William. 2004. The Reading Nation in the Romantic Period. Cambridge, U.K.: Cambridge UP. OCLC: 53886917.

Stuckey, Colleen. 2012. “Modern Sherlock.” The 19th Century British Novel. 5 December. Accessed September 30, 2013: http://www.rogerwhitson.net/19thcenturyreading/modern-sherlock/

Tokuno, Deven. 2012. “Gossip Girl, Jane Austen Style.” The 19th Century British Novel. 5 December. Accessed September 30, 2013: http://www.rogerwhitson.net/19thcenturyreading/gossip-girl-jane-austen-style/

Truchard, Devin. 2012. “Project 1: Reading Aloud, Chapter 14.” 19th Century British Novel: Technologies of Reading. 15 September. http://www.rogerwhitson.net/britnovel2012/2012/09/15/project-1-reading-aloud-chapter-14/

Walter, Jenna. 2012. “Mary Elizabeth Braddon Drew Inspiration From Her Own Life?” The 19th Century British Novel. 5 December. Accessed September 30, 2013:  http://www.rogerwhitson.net/19thcenturyreading/mary-braddon-drew-inspiration-from-her-own-life/

Walter, Jenna. 2012. “Project 1: Chapter 11 – Northanger Abbey Recording.” 19th Century British Novel: Technologies of Reading. 15 September. Accessed September 30, 2013: http://www.rogerwhitson.net/britnovel2012/2012/09/15/project-1-chapter-11-northanger-abbey-recording/

Wheedon, Alexis. 2013. Victorian Publishing: The Economies of Book Production for a Mass Market. Burlington: Ashgate. OCLC: 51022630.

Whitson, Roger. 2012. “Question about Possible Publication Idea.” E-mail to Sarah Ruth Jacobs.


[1] Hybrid Pedagogy, a publication that exists between a traditional journal and a social media ecosystem, offers a pretty powerful model. Further, Mark Sample, Katherine Fitzpatrick, and Barbara Fister’s discussion of “serial scholarship” is yet another. In a post about “Blogs as Serialized Scholarship,” Fitzpatrick discusses how the academic journal emerged during the Enlightenment as a formalized version of the letters scholars wrote to one another, often without the formal conclusion that exist in so many journal articles. “[W]hen a scholar with a blog writes a bit about some ideas-in-process,” Fitzpatrick notes, “receives some feedback in response, returns with further ideas, reiterates, and so on, we can glimpse again the seriality that has always been at the heart of scholarly production” (2013).
[2] I took a few ideas for the editorial portion of my own class from Cheryl Ball’s editorial approach to pedagogy. Her serialized article “Editorial Pedagogy” illustrates how she emphasizes editing and publishing throughout her scholarly identity. In her first entry in the series, she details how she “teach[es] apprentices to analyze genre ecologies, practice those genres with those contexts in mind, and set up multiple levels of revision feedback specific to the situations in which those genres would be received or evaluated” (Ball 2012). While her set up is useful for someone who also acts as the editor of a well-regarded composition journal (Kairos), I felt that inviting editors from JITP worked better in my specific situation.
[3] Paul Fyfe and Pamela Gilbert guided me through potential readings for the course and suggested some paths I could take in understanding reading practices during the Victorian period.
[4] Emily McCormack noted how “in Austen’s time, reading was not something to be praised. I mean women reading was almost scandalous, especially the types of novels that Catherine would read. But in today’s society, it seems as if the world would be overjoyed if more students picked up something as ridiculous as a Twilight novel. I like the contrast between these two worlds” (McCormack 2012).
[5] Of particular note is Patrick Brantlinger’s argument that novels grew more bourgeois from the period between 1800 and 1840. “That change,” Brantlinger suggests, “has less to do with new readers or the sheer increase of literacy than with, on the one hand, evangelical and utilitarian stress on reforming public morality and, on the other, the industrial and commercial restructuring of the ‘literary field,’ including printers, publishers, reviewers, booksellers, readers, and of course authors” (Brantlinger 1998, 12). See also Richard Altick’s foundational work The English Common Reader: A Social History of the Mass-Reading Public for further information about the history of book-reading in the nineteenth century.
[6] Maggie Lane has noted that novel reading for families was a common pasttime after dinner. “Most people,” Lane observes, “took it for granted that they must amuse one another during those last hours of the day. In Jane Austen’s own family there was often reading aloud” (Lane 1995, 50).
[7] Matthew Rubery briefly discusses his own reading aloud project in “Victorian Literature Out Loud: Digital Audio Resources for the Classroom.” Rubery writes that “[t]he use of podcasts […] can instill awareness of the ways in which media influence our understanding of literary texts while at the same time providing students with a free audiobook at the end of the semester” (Rubery 2009, 139). Similary, Susan Cook shares the success of her own oral reading project in which she “expurgated A Christmas Carol into a version that could be read in an hour, divided up the text into ‘roles’ – without transforming the text into a script – and arranged for the students to perform a reading for the Southern New Hampshire University community at the end of the semester” (Cook 2013).

[8] Rice sees the dislocation of topos in aural composition as its contribution to digital pedagogy:

What makes ka-knowledge valuable to any type of writing pedagogy concerned with technology and communication, is how it moves attention away from the dominant topos-themes of knowledge acquisition in terms of power (either empowerment or resistance to power structures) or the still prevalent topos concept of literacy. Ka-knowledge is the digital rhetorical practice of assemblage. Whether it is used for empowering the subject or forging a political or cultural position or acquiring financial stability and professional success is not relevant (though any one of these points may occur). What is important is the recognition of a different method of forming ideas and presenting such ideas. (Rice 2006, 277-8)

[9] Unfortunately, time and the reading demands of the course made it difficult to incorporate such readings into the schedule. If I teach the course again, I will be more direct about the importance of design and editing to the history of reading in the period. The letters of the second John Murray, Byron’s editor, would form an important aspect of the course, as would essays from Robert Morrison and Daniel S. Roberts’s collection Romanticism and Blackwood’s Magazine. Blackwood’s Magazine published original work from many of the authors in the nineteenth century including Coleridge, Percy Shelley, Thomas de Quincey, George Eliot, and Elizabeth Clementine Stedman.
[10] One example is the fact that WordPress sites are designed around the blog as an organizational device. It’s one thing to criticize the decision to design a management system around the blog; it’s another to see that choice within the larger cultural history of the blog as a means for disseminating information quickly, or, as I mentioned earlier, the blog as repeating the Enlightenment practice of exchanging letters between scholars. The much more open design of Drupal, organized as it is around endless and sometimes incompatible modules, offers another possibility. Historically, it would be useful to make an analogy between WordPress and Drupal on the one hand, and commercial printers and DIY-printmakers like William Blake on the other. While WordPress offers some design choices, users ultimately have to sacrifice control for ease of use like authors did with commercial printers in the nineteenth century. Drupal offers much more control, but to make a Drupal site you need to become skilled at hacking their modules. Blake, as the inventor of a technique called relief etching, where etchings were produced as a negative of the desired image, had much more control over his prints. Yet these prints were never adopted by the larger printing industry since they were difficult to reproduce quickly, nor was Blake’s work ever really commercially-viable as a mass produced product. See the work of Michael Phillips, Joseph Viscomi, Robert Essick, and Mei-Ying Sung for more information about Blake’s printing methods.
[11] The 2011 WSU course description for DTC 355 says that it investigates “[w]riting for new computer-based media; multimedia authoring project; examination of new rhetorics of information technology” (Details for DTC 355 Fall 2013, WSU Online 2013).

Digital Literary Pedagogy: An Experiment in Process-oriented Publishing

Roger Whitson, Kimon Keramidas, and Amanda Licastro

 

Digital Literary Pedagogy: An Experiment in Process-Oriented Publishing

What classroom roles do journal editors have in the digital age? Roger Whitson invited JITP editors Amanda Licastro and Kimon Keramidas into his class on “The Nineteenth-Century Novel” to explore how editors can supplement traditional classroom instruction and investigate the purpose of design and digital publishing in literary period courses. The course involved a history of reading and book-design in the nineteenth century, along with assignments that encouraged students to experience reading and writing in different modalities. Over the course of twenty months this project has resulted in a wide variety of content, both formal and informal. To display that process and those materials, the authors have designed this project in the form of the interactive timeline below, which gives the scope of the project as a whole. Included in the timeline are date markers of specific milestones and events that took place during the process but don’t link to any specific product, links to documents and multimedia elements created in the evolution of that process, and links to the final formal articles published in the journal.

 

 

In the timeline, the authors have presented the website Whitson made for his class; the site designed by the students for the final project; a final reflective Google Hangout between the JITP editors, Whitson, and his class; drafts of the authors’ work in progress on Google Docs; and links to the final written pieces for the journal. The two articles by Whitson, Keramidas and Licastro reflect on the process and products of this collaboration. Whitson’s “Digital Literary Pedagogy: Teaching Technologies of Reading the Nineteenth Century” explores the unique way literary studies can contribute to digital pedagogy by highlighting the historical and cultural contexts of editorial and publication practices in the nineteenth century and comparing them to similar media shifts occurring today on podcasts, in blogs, and on streaming video. Keramidas and Licastro’s “Practicing Collaboration in Process and Product: A Response to ‘Digital Literary Pedagogy’” frames the class from the perspective of journal editors who contributed to the teaching of the course and illustrates the complications of teaching students to combine audience awareness, multimedia design, and period-specific literary content. Together these separate elements reflect different stages and manifestations of the process of instruction, reflection and production that occur as teachers and students consider and execute the role of technology in pedagogy and publication.

 

About the Authors

Roger Whitson is Assistant Professor of English and Digital Technology and Culture at Washington State University. Most recently, he is the author (with Jason Whittaker) of William Blake and the Digital Humanities: Collaboration, Participation, and Social Media (Routledge 2012). He has written “How to Survive a Graduate Career,” published by Workplace: A Journal of Academic Labor; and “Altac and the Tenure-Track” for The Chronicle of Higher Education, as well as a number of pieces about Blake and the genre of steampunk. He is currently working on a special issue of Romantic Circles devoted to “Blake & Pedagogy” and a book theorizing steampunk within emergent practices of critical making, digital humanities, and alt-history.

Kimon Keramidas is Assistant Professor and Director of the Digital Media Lab at the Bard Graduate Center, where he is responsible for the development and implementation of digital media practices across academic programs and for the Focus Gallery project. Kimon also serves on the Editorial Collective of The Journal of Interactive Technology and Pedagogy and is Director of Digital Initiatives for the Martin E. Segal Theatre Center where he leads new initiatives in the integration of digital media in support of the center’s programs. Kimon’s academic research centers on two areas of study: the role of intellectual property in contemporary theatrical production and the sociocultural impact of interface design in personal computing. Kimon has had articles published in the journals Journal of Interactive Technology and Pedagogy and Currents in Electronic Literacy, in the collections Objects of Exchange (co-authored with Aaron Glass), Theater und Medien: Theatre and the Media, and Studying the Event Film: The Lord of the Rings (co-authored with Henry Bial and Ryan Reynolds), and on the sites Profhacker and Mediacommons’s The New Everyday.

Amanda Licastro is a doctoral candidate in the English Program at the Graduate Center, CUNY and is an Instructional Technology Fellow at Macaulay Honors College. She is currently working on her dissertation, which focuses on student writing in online open spaces, and recently completed her certificate in Interactive Technology and Pedagogy through an independent study involving her work on the Writing Studies Tree. Amanda is also a co-director of the CUNY Digital Humanities Initiative and serves on the Editorial Collective of The Journal of Interactive Technology and Pedagogy.

Table of Contents: Issue Three

Introduction
Luke Waltzer and Mikhail Gershovich

Establishing a New Paradigm: the Call to Reform the Tenure and Promotion Standards for Digital Media Faculty
James Richardson

Special Feature: Behind the Seams with James Richardson
Sarah Ruth Jacobs, Luke Waltzer, and Steve Brier

Teaching Communication to Medical Students in a Virtual World
Susan Lowes, Gillian Hamilton, Vicki Hochstetler, and SeungOh Paek

Digital Close Reading: TEI for Teaching Poetic Vocabularies
Kate Singer

Incorporating the Virtual into the Physical Classroom: Online Mastery Quizzes as a Blended Assessment Strategy
Kyle Beidler and Lauren Panton

 

Issue Three Masthead

Issue Editors
Mikhail Gershovich
Lucas Waltzer

Managing Editor
Sarah Ruth Jacobs

Copyeditors
Steve Brier
Carlos Hernandez
Kimon Keramidas
Benjamin Miller
Leila Walker

Web Layout
Sarah Ruth Jacobs

Teaching Communication Skills to Medical Students in a Virtual World

Susan Lowes, Teachers College/Columbia University
Gillian Hamilton, University of Arizona College of Medicine and Hospice of the Valley
Vicki Hochstetler, Hospice of the Valley
SeungOh Paek, University of Hawaii at Manoa

Lowes1

Fig. 1. Second Life screenshot.

Abstract

The ability to communicate is a core competency for medical practitioners and role-playing is an increasingly common tool for teaching communication skills in medical schools around the world. While there is general agreement that the outcomes are better when these skills are practiced, not just preached (Lane and Rollnick 2007; Rosenbaum, Ferguson, and Lobas 2004; Andrade et al. 2010; Cahan et al. 2010; Orgel, McCarter, and Jacob 2010), in-person role-plays are time consuming and resource intensive. As a result, in recent years a number of medical schools have experimented with using virtual environments as sites for role-plays (for examples see Lane and Rollnick 2007; Hulsman, Harmsen, and Fabriek 2009; Andrade et al., 2010; Mantovani et al. 2003; Alverson et al. 2005). A recent meta-analysis of controlled studies using virtual patients found that in general there was a positive effect, although the type and extent of the effect depended on the outcomes being considered (Consorti et al. 2012). Only four of the studies examined addressed communication skills, and the findings were less clear in this area.
 

 

This article describes a design-based research intervention that used virtual role-plays, conducted in Second Life, to train medical students to communicate with patients and family members about end-of-life care decisions. The intervention was designed at Hospice of the Valley (HOV), the largest free-standing hospice in the country, located in Phoenix, Arizona, while the research was conducted by the Institute for Learning Technologies at Teachers College, Columbia University. The goal of design-based research projects is to use each iteration to inform the next, a process that has been characterized as “research through mistakes” (Anderson and Shattuck 2012). Thus, the program was adjusted over the course of eight months, evolving from role-plays in face-to-face sessions to role-plays conducted in Second Life, from role-plays with two HOV staff members playing the roles of mentor and patient to role-plays with one staff member playing both roles, and from role-plays taking place in an off-the-shelf Second Life-room to role-plays taking place in a more hospice-like virtual setting. The hope was that the anonymity of the virtual environment, with students and mentors communicating through avatars, would reduce the anxiety that students reported with face-to-face role-plays, allowing them to focus on their interactions with the virtual patients.

In this article, we first look at the evolution of the project and then analyze the data that was collected at each stage.

Background

In 2006, Hospice of the Valley (HOV) received funding from the Virginia G. Piper Charitable Trust to develop a short program in its facilities to provide residents and hospitalists in the Phoenix area with an introduction to the principles of good palliative care. The program was tailored to the resident/hospitalist specialty and included a half-day group orientation focusing on hospice services, pain management, and advance directives, followed by a series of half-day visits: to an in-patient unit with the unit’s medical director; to a patient’s home with a nurse, social worker, or chaplain; and to a dementia unit. The orientation session included role-plays, using three scenarios common in palliative care: two involve discussing end-of-life decisions with patients and the third involves talking with a patient’s family. For each scenario, a resident or hospitalist would play the role of doctor, an actor would play the role of patient, and the doctor who was facilitating the session would interrupt to point to mistakes as they happened, while the rest of the group watched. The goal was to provide a toolkit of techniques that practitioners could use in different situations.

The program received very high ratings from the 150 residents and hospitalists who took part and in late 2008 the University of Arizona College of Medicine asked HOV to develop a similar program for third-year medical students. This program, which began in January 2009, replicated the hospitalist/resident program with four half-day sessions spread over three months, but without the role-plays in the orientation. Then, in December 2010, the orientation was expanded to include the role-plays, using the same scenarios that had been used with the residents and hospitalists, again in a group setting.

The medical students proved a far more challenging group, however: in their post-program evaluations, they wanted more “hard science” and expressed a dislike of instruction on “soft” skills. As for the role-plays, not only did these students do poorly, but in their evaluations they indicated that they disliked them, did not think them effective, and in general would have preferred that they never happen. This is a not uncommon reaction to in-person role-plays (for discussions of in-person role-plays, see Lane and Rollnick 2007; Rosenbaum, Ferguson, and Lobas 2004; Arnold and Koczwara 2006).

The main reason the medical students disliked the role-plays was that they felt uncomfortable: uncomfortable acting in public and uncomfortable having their weaknesses pointed out in front of their peers. Here are three sample comments from their evaluations:

  • “The improv sessions were my least favorite of all the activities. They are stressful and embarrassing for those of us called upon to go up to the front of the classroom and act out scenarios with fake patients and they really are not very helpful at all.”
  • “I do not like ‘interactive’ learning where people are put on the spot. I think it’s enough to have case-based lectures.”
  • “Having to sit through the ‘interviews’ in lecture. They were not helpful or productive and students were more worried about being chosen to speak than interested in the material… I think the hospice experience would have been MUCH better without having to speak involuntarily on the microphone when a lecture would have been more productive.”

The students were also unhappy because these were group sessions and not everyone was equally involved. Here are three responses from students who listed the role-plays as the worst or most difficult experiences of the entire program:

  • “I don’t think the role-playing as an entire class is very good. It doesn’t engage everybody and would be more appropriate for a doctoring session.”
  • “The skits in the large group. Large groups work well for lectures. It is not effective to have discussions in large group settings. People lose interest and it is not beneficial to try to force them to pay attention.”
  • “I really don’t care for the ‘acting out’ ‘fake patient’ scenarios in the lecture. The ‘pretending’ is hard to stomach as a grown adult, it seems more like an opportunity for people to display their class clown abilities, as opposed to learning appropriate approaches to hospice care.”

It was also not clear that the students felt that the experience had prepared them well for the two key aspects of communication—discussing end-of-life decisions with patients and talking with patients about death and dying—with 20 percent or less reporting in the evaluation that they felt the HOV experience had prepared them “very well” to do either of these and between 25 percent and 30 percent saying they did not feel they had prepared them well at all:

Table 1

How well do you feel the HOV experience prepared you for:

Discussing end of life decisions with patients
(n=68)

Very well

21%

Moderately well

54%

Not very well

13%

Not well at all

12%

Talking with a patient about death and dying
(n=68)

Very well

18%

Moderately well

51%

Not very well

22%

Not well at all

9%

 

As a result of the large number of negative evaluations, in July 2011 the program was modified to move the role-plays into Second Life, where a student’s avatar would interact with the avatar of a patient or family member (depending on the scenario) in a simulated patient’s room in a hospice palliative care unit, with the student sitting at a computer in one HOV office and the facilitator in another. It was hoped that the novelty of a virtual environment would not only be attractive to the students, but that it would have a number of affordances. It would remove the anxiety of the in-person role-plays, the distraction of an audience, and the added burden of having to fully act out a part, not only verbally but also physically, with appropriate body language and facial expressions. In addition, the setting would be a (simulated) hospice room rather than a conference room that was totally disconnected from the situation in the role-play. Thus, although the Second Life role-plays would be less directly embodied than face-to-face role-plays, the sense of place (the simulated in-patient unit) was potentially greater and the use of avatars made for surrogate or partial embodiment (Black et al. 2012). Perhaps equally important, the students would not be watching other members of a group and occasionally participating but would be doing this work on their own (thus allowing them more focused time with each scenario) and would be somewhat anonymous to the facilitators.

Fig. 2. Screenshot of palliative care unit room in Second Life.

Fig. 2. Screenshot of palliative care unit room in Second Life.

However, it was also recognized that there were potential pitfalls. First, experiments with Second Life at Teachers College had found that there were technical challenges with avatar movement and with the audio, as well as a steep learning curve for new users. Because of logistics and time constraints, it was not possible to train the students in navigating within the environment, so interactions would have to focus on voice rather than movement. Second, Barney Dalgarno and Mark Lee, after a detailed review of the research on the potential benefits of 3-D virtual environments such as Second Life, proposed that for these environments to provide successful learning experiences, they must have both representational fidelity and learner interaction (Dalgarno and Lee 2010, 15). In particular, the user must be able to construct an identity, create a sense of presence by interacting with the environment, and create a sense of co-presence by interacting with others in that environment. The first two would be missing and the third would be limited. It therefore seemed possible that the students would not experience the degree of “psychological immersion” that Dalgarno and Lee believed to be necessary engagement and learning (Dalgarno and Lee 2010, 14). It was also possible that the one-on-one coaching approach might not be as effective as the group discussion that had taken place during the in-person group role-plays (for a discussion of the advantages and disadvantages of individual and group role-plays, see Rosenbaum, Ferguson, and Lobas 2004)—although given the students’ comments on the group experience, this seemed unlikely.

Although the total number of hours HOV staff spent with students would increase compared to the group in-person role-plays, it was hoped that the individual role-plays would be more efficient and easier for all those involved because they could be scheduled back-to-back on the same day. In addition, the logistics would be more easily managed because mentors and students did not have to be in the same building.

In the first round (July), there were three avatars in Second Life: one each for the patient/family member, the student, and a practitioner-mentor who made comments and suggestions. Having three participants proved difficult to manage logistically as well as demanding in terms of personnel time, so beginning in August, mentors acted as patients/family members and also gave feedback to the student throughout the role-play. Although we were concerned that having the roles of patient and mentor played by the same person would be disconcerting to the students, allowing the students to focus on their avatars seemed to make interruptions less intrusive. Recordings of sessions show the students simply stopping, discussing the moment with the mentor, and then going back into the role. Students might stop and say, “I don’t know what to say next!” or “Oh, help! I’m stuck! I went down the wrong path!” The combined roles unexpectedly allowed the mentor to guide the scenario as it unfolded, stopping the student, pointing out what was wrong, and proposing a different approach.

These two video clips give a glimpse of this process at work. In the first clip, medical student Josh is talking to a patient. In the second clip, medical student Maggie is talking to a patient’s caregiver. Both are very common scenarios in end of care settings.

Josh

Maggie

We were concerned that Second Life would act as a barrier rather than a facilitator, since research has shown that facility with computer use is a significant determinant of perceived usefulness and ease of use among healthcare professionals (Chow et al. 2012). Although this seemed unlikely to be an issue with the younger and more technically adept medical students, it could have been a problem with HOV staff. Further, in terms of technology, there was also concern as to whether Second Life would prove viable as a virtual environment. In fact, in the first few months it was full of glitches—the audio was unpredictable, screens froze, and sometimes users got kicked out of the system. When this happened, the image of the Second Life room remained on the screen but mentors and students moved the audio to the telephone. Audio problems were resolved by using Skype for all the audio. In addition, the students complained that the room in Second Life (a stock room) was distracting because it was so unrealistic (see Chen et al. 2011 for an interesting discussion of the relationship between feelings of presence and levels of abstraction in a virtual environment). HOV therefore decided to build its own campus in Second Life, which involved hiring an outside designer. The HOV palliative care unit is in a converted house and the contractor was sent pictures of the unit, including the common living room and a patient room, so that the overall feeling is as much as possible similar to the unit the medical students had visited in person. This production work took some time and was not completed until October.

Fig. 3. Screenshot of palliative care unit’s common living area in Second Life.

Fig. 3. Screenshot of palliative care unit’s common living area in Second Life.

Research Design

Our research into the use of Second Life at Hospice of the Valley had begun in Spring 2011 with a small project (jointly funded by the Mayo Clinic and HOV) led by Lisa Thompson, a Fellow in Hospice and Palliative Care. A mix of fifteen students and residents were given a scenario and then assigned to one of three pathways: an in-person didactic session (a PowerPoint presentation followed by a discussion with a doctor/mentor); an interactive session in Second Life with an actor playing the role of simulated patient and a doctor/mentor giving in-person advice as the scenario evolved; and no training. This was followed by a repeat of the scenario, live, with an actor playing the patient. A doctor and two experienced nurses acted as an expert panel and ranked each student’s performance in eight key communication skills before and after the intervention. The results showed that although all the students improved, those who used Second Life improved the most overall, and in all areas being assessed (Thompson and Prommer 2012). As a result, in July 2011 all HOV role-plays were moved into Second Life.

The research discussed below addresses the following questions:

  • Did the students feel they learned the basic principles of communicating with patients or their family members better when doing the role-plays in Second Life than they had when they had done them in-person?
  • Were the students more satisfied with the role-plays done in Second Life than they were with the role-plays done in-person?
  • Did the students learn the basic principles of communicating with patients and family members when they did the role-plays in Second Life?
  • Can using Second Life be an efficient and cost-effective way to teach this type of communication?

Procedure

Students came to the HOV office, were given a few minutes to read over a printed version of a scenario, and then played it out over the next fifteen or twenty minutes. There were three scenarios that dealt with three very common end-of-life care situations: obtaining code status; the placement of a feeding tube in an Alzheimer’s patient (a discussion with the patient’s wife); and a discussion of whether to admit a patient to hospice. The facilitators/mentors evaluated the students’ performances in each scenario using a simple rubric based on three basic principles of communication for physicians:

  • Did the trainee begin by finding out what the patient/family knew?
  • Did the trainee listen at least 50 percent of the time?
  • Did the trainee explain in understandable language with no medical jargon?

Students were also evaluated on the specific content or questions required in each scenario (for example, whether advance directives had ever been discussed, what happens when feedings tubes are used with advanced Alzheimer’s patients, etc.).

Each item was rated from 1 to 3. The highest possible score for each scenario was 12, and the highest total score was 36. The scoring was done immediately following each scenario, but the results were not revealed to the student.

In addition to the mentors’ evaluations, the students completed a post-program evaluation that asked about the entire HOV experience and included a specific question about Second Life.

Data Sets

Because the experience in July 2011 was substantially different from the subsequent role-plays (when the mentor also played the role of patient), the July data were dropped from the analysis and only the August 2011 – February 2012 data were considered. Forty-two students participated: 23 did all the scenarios in Second Life, 13 did a mix of Second Life and telephone (because Second Life broke down during the course of the first or second scenario), and 6 did scenarios only on the telephone (because Second Life would not work at all). All 42 students were scored, while the online survey that was given to the students at the end of the program was completed by 41 of the 42 participants.

Results

In response to an open-ended question that asked whether they had liked or not liked the virtual role-play experience and what they had liked/not liked about it, 83 percent of the 36 students who responded to the question said they had liked it. A higher percentage of those who had used Second Life had liked it (76 percent) compared to of those who used a Second Life/phone combination or phone alone (69 percent). There were some who were positive about the experience but had reservations, but only six students were entirely negative. All six said they would prefer role-plays that were one-on-one and in person.

The students who liked the virtual role-plays, in any mode, liked them for two main reasons: they felt they were immediately applicable and they appreciated immediate feedback.

Students who thought the role-playing experience was immediately applicable offered the following types of comments:

  • “The role-playing session was the most readily applicable to our everyday duties.”
  • “I really enjoyed the clinical interviewing because it felt it started to build a foundation of skills I will need as I move forward in my career.”
  • “I liked the clinical interviewing best. The activity was quick, succinct, to the point, and best prepared me for conversations I may have to have as a physician in the future.”

Those who liked getting immediate feedback offered these types of comments:

  • “The interviewing seemed as real as it could get and the insight was helpful when I got caught up at an awkward moment where I wasn’t sure where to go.”
  • “Second Life allowed me to practice talking with a patient about tough decisions and ways to say things that convey a message and are gentle to the patient.”
  • “It was interactive and I got feedback immediately. It is also something we can apply to many different clinical situations.”

Those who had reservations liked having the interview training but were not enamored with Second Life:

  • “Practicing these skills was useful and I’m glad this is a part of the rotation. However, I don’t feel the computer program aided the experience.”
  • “While I thought the experience was good, it would be much better to have a real person sitting in front of you with eye contact, expressions, and without the delay in speaking-to-hearing.”

The hypothesis that building in distance by having the student and mentor communicate through Second Life would reduce anxiety while doing the role-plays one-on-one would allow the students to focus on the scenario seemed to be true for a large majority of the students. There were many comments such as the following:

  • “I really like the Second Life and telephone to teach clinical interviewing rather than in-person role-plays because it allows you to relax a little more and work through the conversation. I like that you can still get feedback and commentary as you go, but it is a much more relaxed and I think productive environment.”
  • “I found it to be a much more comfortable learning environment given I was in the room by myself without any pressure. Probably the best way to learn something so personal and important.”
  • “I liked that it doesn’t provoke as much anxiety as live role-playing and I was able to learn a great deal.”
  • “I liked seeing the illustration of a face-to-face encounter, as it made me feel that I was really in this situation but without the added anxiety of a ‘real’ person in front of me…. I also liked the role-playing situation, but liked being able to ‘break character’ if necessary to ask questions and get help immediately, rather than waiting until the end of the encounter for advice and feedback.”

Student Self-Assessment of Preparation

The post-program evaluation repeated one of the questions asked on the prior evaluation about whether the students felt they were better prepared to discuss end-of-life decisions with patients as a result of the HOV experience.1 The difference between the ratings for those who had done the role-plays in person and those who had done them virtually was striking:

Table 2

Percent reporting that they felt “very well” prepared to discuss end-of-life care decisions
with a patient as a result of the HOV experience

In-person

(n=68)

Virtual

(n=41)

Very well

21%

54%

Moderately well

54%

44%

Not very well

13%

2%

Not well at all

12%

0%

100%

100%

 

We next looked to see if there was a difference in the students’ evaluation of their own learning among the three modes. We focused on those who said that the program has prepared them “very well” (the highest choice) to “discuss end-of-life-care decisions with a patient” and to “discuss difficult subjects with patients.”

If we look at the results for the entire August 2011-February 2012 period, we see that those who used a mix of Second Life and phone felt that they learned more than those who used Second Life alone, with those who used only the phone reporting that they learned the least:

Table 3
Percent reporting that they felt “very well” prepared to do the following

Second Life
(n=22)

Mixed

(n=13)

Phone

(n=6)

Discuss end-of-life care decisions with a patient

45%

85%

17%

Discuss difficult subjects with patients

64%

69%

33%

 

Since the audio problems were entirely in the August-November period, when almost 60 percent of the participants had to go over from Second Life to the telephone or used only the phone (none did so in the December-February period) and since the Second Life room was not a realistic representation of the hospice room until November, it seemed possible that the scores for Second Life alone might differ for the two time periods. The number of participants is small, but when we compare the students’ evaluations of their own learning in Second Life, we see that there were indeed differences:

Table 4
Percent reporting that the program prepared them “very well” to do the following
Students who used only Second Life

August-November

(n=9)

December-February
(n=13)

Discuss end-of-life care decisions with a patient

22%

62%

Discuss difficult subjects with patients

56%

69%

 

Perhaps the most surprising result—at least to the HOV staff—was that the clinical interviewing experience was the second highest rated item (after a visit to a palliative care unit with a doctor) in the ratings of all the program activities, with 60 percent saying they had gained “a great deal” (the highest rating) from the experience. In this case also, the ratings from those who used only Second Life were lower overall than the ratings from the group that used both, but were much higher for the second period compared to the first:

Table 5
Percent reporting that they gained “a great deal” from the clinical interviewing experience
All students, all time periods

Second Life
(n=22)

Mixed

(n=13)

Phone

(n=6)

50%

77%

50%

Table 6
Percent reporting that they gained “a great deal” from the clinical interviewing experience
Second Life only

August-November

(n=9)

December-February
(n=13)

33%

62%

 

In addition, 8 of the 41 students listed the virtual role-play as the best experience they had had in the entire program, a striking difference from the in-person students, many of whom had considered it the worst experience of the program.

But Did They Learn?

Student satisfaction was important, but only if the students also showed evidence of learning. The chart below not only shows the improvement from scenario to scenario (S1 to S2 to S3) but that the range scores narrowed (i.e., the boxes became smaller and the line inside the box that represents the mean score for each scenario increased). A majority (67%) had perfect scores of 12 on the third scenario:

Fig. 4. Change in scores by scenario.

Fig. 4. Change in scores by scenario.

Unlike the students’ self-assessments of learning, with the formal assessments there was no statistically significant difference in the combined mean scores for all three scenarios whether the student did the scenarios on the phone, in Second Life, or in a mixed mode (p > .05):

Table 7

Mean scores for all scenarios combined

N

Mean

Std. Deviation

Phone

6

30.6667

2.06559

Second Life

23

28.3913

3.82265

Mixed

13

28.3077

5.85071

Total

42

28.6905

4.36442

 

There was also no significant difference between the modalities when the scores on the first scenario were controlled for (p > .05).

And even if we look only at those who used Second Life and compare the August-November and December-February groups, we find no significant difference in the mean scores between the two time periods (p > .05):

Table 8
Mean scenario scores, Second Life only, by time period

N

Mean

Std. Deviation

August-November

10

29.0000

4.71405

December-February

13

27.9231

3.09466

 

However, although there were no significant differences in the mean scores between the three modes, there were differences in how much students in each mode gained from Scenario 1 to Scenario 2 and from Scenario 2 to Scenario 3 (hereafter S1, S2, S3). (Those who did the scenarios entirely on the phone are dropped from the analysis here, since there were only six, three in the first time period and three in the second.) The overall mean gain was greater for the Second Life group than for the Mixed group:

Table 9
Mean gain from scenario to scenario, by group

S1 to S2

S2 to S3

Total gain

All

1.42

1.78

3.19

Second Life

1.39

2.13

3.52

Mixed

1.46

1.15

2.62

 

The gains from S1 to S2 and from S2 to S3 were statistically significant for those who used Second Life alone (p < .01), but only the gain from S1 to S2 was significant for the Mixed group (p < .05). In addition, the gain from S2 to S3 was considerably greater in the later time period, with the result that the overall gain for this later group was much greater than the overall gain for the Mixed group (which only existed in the earlier time period):

Table 10
Mean gain from scenario to scenario, by group and time period

S1 to S2

S2 to S3

Total gain

Second Life August-November

1.00

1.80

2.80

Second Life December-February

1.69

2.38

4.08

Mixed August-November

1.46

1.15

2.62

 

Together, these results suggest that once the technical difficulties were resolved, Second Life was the more effective mode. It also suggests that at least three scenarios are needed if the role-plays are to be effective in this mode.

We were also interested in seeing if the students had difficulty with one particular item in the scoring rubric. The differences in the scores among items were not statistically significant, but they suggested that the students had the most difficulty listening and the least difficulty not using medical jargon. There was no difference between those who did the role-plays in Second Life compared to those who used the phone or mixed. The highest score for each scenario is 3:

Table 11
Mean scores by item, all students

Began by finding out what the patient/family knew

2.32

Listened at least 50 percent of the time

2.29

Used understandable language with no medical jargon

2.50

Overall for specific content

2.46

Efficiency and Cost Effectiveness

The final research question was whether using Second Life could be an efficient and cost-effective approach to teaching communication skills. Although HOV did not keep detailed cost and time estimates, it is clear that using Second Life was more demanding of staff time than the original iterations, when all the students met together for an orientation session that integrated the role-play. The face-to-face role-plays took about one hour out of a three-hour session and required an actor to play the role of patient and a practitioner to be the mentor. Once the role-plays moved to a virtual environment and the role of mentor and patient were combined, there was no need for an actor. Since each student now spent about an hour doing the role-plays, the student time was approximately the same but the mentor time increased by the number of students enrolled.

While at first the mentor/patient role was played by a doctor, in the final two months covered in this study, two nurses played this role. This reduced the cost in terms of salaried time, but not in terms of person-hours. Although the nurses reported that they were enjoying the process and the medical students appeared as receptive to the nurses as they were to the physician mentors—if indeed they knew the difference, since they did not see them in person—there was a possibility that this would not be sustainable, even though the mentors could complete their work from home or from another site, and could eat or drink during the process. On the other hand, as staff became more familiar with Second Life and the audio problems were resolved, the amount of technical support needed decreased dramatically. The net result has been that HOV decided the virtual role-plays in Second Life are so much more effective than the in-person version that the added expense is worthwhile.

Conclusion and Next Steps

With design-based research projects that evolve as rapidly as this one, the goal is not to come up with definitive results but to use the findings to inform the next iteration of the implementation. The results presented here show that the effectiveness of the Second Life role-plays increased over time, both in term of the students’ assessment of their own learning and from the point of view of their improved ability to demonstrate best practices from scenario to scenario. The HOV staff much prefers the use of Second Life to the in-person role-plays, with the expense of time compensated for by the flexibility of being able to work from their own desks when playing out the scenarios in the virtual environment. One of the next steps has been to train additional mentors in order to reduce the burden on what was originally a small group. However, this decision raised the issue of inter-rater reliability in the scenario scoring—with more mentors, it became important that all were scoring according to the same standards. HOV addressed this through a series of formal mentor training sessions, conducted by an outside facilitator. These sessions have had the unintended consequence of being very effective and very popular staff development exercises. In addition, the mobility of the patient/mentors in the Second Life environment has been improved so that they are less static and able to act, and react, more realistically. The goal has been to enhance the interaction between avatars and thereby further deepen the psychological immersion necessary for engagement and learning, as well to make the Second Life experience satisfying for even the most technologically sophisticated medical students.

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Thompson, Lisa, and Eric Prommer. Poster presented at the Annual Assembly of the American Academy of Hospice and Palliative Medicine, Denver, CO, March 7-9, 2012.

 

About the Authors

Susan Lowes is Director of Research and Evaluation at the Institute for Learning Technologies at Teachers College, Columbia University. She has directed evaluations of multi-year projects at the K-12, university, and post-secondary level funded by the U.S. Dept. of Education, the National Science Foundation, the National Institutes of Health, the Environmental Protection Agency, state and local departments of education, and private foundations, and has served on U.S. Dept. of Education and NSF Advisory and Review panels. Dr. Lowes has a Ph.D. in Anthropology from Columbia University and is also Adjunct Professor in the Program in Communication, Computing, and Technology in Education at Teachers College, where she teaches courses on research methods and on online schools and online schooling. She has been the evaluator on several recent initiatives at Hospice of the Valley funded by the Virginia G. Piper Charitable Trust, including this one. She can be reached at lowes@tc.edu.

Gillian Hamilton, M.D., is Vice-President of Education and Innovation at Hospice of the Valley. She is board-certified in hospice and palliative medicine, geriatrics, and internal medicine and holds a PhD in physiological and clinical psychology. At the time of this project, she was responsible for oversight of all education programs at Hospice of the Valley, including those to train residents, hospitalists, nurses, social workers, and chaplains in the principles of palliative care. This program was her brainchild.

Vicki Hochstetler is Director of Education at Hospice of the Valley. She has an M.Ed. in Instructional Technology from Arizona State University. She was the manager of this project.

SeungOh Paek is an Assistant Professor at the University of Hawaii-Manoa and has an Ed.D. from Teachers College, Columbia University. At the time of this study, she was a Research Associate at the Institute for Learning Technologies at Teachers College and did the statistical analysis.

  1. The phrasing of the second item was different on this survey compared to the previous survey (which asked about “Talking with a patient about death and dying”), so the two modes can only be compared on the one item.

Behind the Seams

About Behind the Seams

In Behind the Seams, the editors and authors reflect on the oft-hidden path from initial submission to published piece. This feature centers on a recorded audio conversation—not an interview, but an open-ended discussion—built around observations and recollections of what stands out in the process of developing, editing, and publishing an article with JITP.

Issue Editor Lucas Waltzer, Reviewer Steve Brier, and Managing Editor Sarah Jacobs in conversation with Issue 3 author James Richardson. Camera setup, audio setup, and technical support by Tom Harbison. Video editing by Sarah Ruth Jacobs.

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