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Descriptive study of the mobile instructional resource centre project : August 1973 to March 1974 1977

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A DESCRIPTIVE STUDY OF THE MOBILE INSTRUCTIONAL RESOURCE CENTRE PROJECT: AUGUST 1973 TO MARCH 1974 by ROBERT CHARLES GOBERT B.A., University of Manitoba, 1964 B.Ed., University of Manitoba, 1968 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN THE FACULTY OF GRADUATE STUDIES (Adult Education) We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1977 Cf-) Robert Charles Gobert, 1977 In presenting t h i s thes is in p a r t i a l f u l f i l m e n t o f the requirements for an advanced degree at the Univers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree l y ava i lab le for reference and study. I fur ther agree that permission for extensive copying of this thesis for scho lar ly purposes may be granted by the Head of my Department or by his representat ives . It is understood that copying or publication of th is thes is fo r f i n a n c i a l gain sha l l not be allowed without my wri t ten permission. Department of Adult Education The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 D a t e August 2 0 t h , 1 9 7 7 ABSTRACT The P.A. Woodward Mobile Instructional Resource Centre Project (MIRC) was a motorized educational delivery system used by the Division of Continuing Education i n the Health Sciences at the University of B r i t i s h Columbia to provide learning opportuni- t i e s for health professionals i n th e i r home communities. This study describes the project and analyzes i t s role i n continuing education i n the health f i e l d for those resident i n the r u r a l areas served by the project. The MIRC was a highway bus converted into a mobile con- tinuing education f a c i l i t y containing three audio v i s u a l learning stations and over 1300 audio v i s u a l learning programs. Operated by a graduate adult education student, the MIRC v i s i t e d 17 r u r a l B r i t i s h Columbia communities between August 1, 1973 and March 31, 1974. During t h i s period, data were obtained from 521 p a r t i c i - pants i n 11 health professions and from 136 non-participants i n seven health professions. P a r t i c i p a t i o n rates i n the MIRC project were higher than those in other programs provided by the Div i s i o n of Continuing Edu- cation i n the Health Sciences during the same period whether exa- mined by community or by professional category. MIRC p a r t i c i p a t i o n rates were s i g n i f i c a n t l y higher among those professions for whom the Div i s i o n provided other programs than they were among those for whom i t did not. P a r t i c i p a t i o n rates were not related to distance from Vancouver but were higher for communities with smaller l o c a l hospitals. The MIRC project appears to have served a d i f f e r e n t set of individuals than did other D i v i s i o n programs. Direct costs were approximately four times as high but the expenses borne by participants and t h e i r employers were not considered. Participants and non-participants d i f f e r e d s i g n i f i c a n t l y with respect to sex, profession, location of employment, and num- ber of professional books read. Reactions to the project, measured on a five-point scale, were favorable o v e r - a l l . S i g n i f i c a n t differences among the pro- fessional groups were observed on two items and among various com- munities on a l l items. Reaction scores were not s i g n i f i c a n t l y re- lated to p a r t i c i p a t i o n rates or to the size of communities, but were higher i n communities nearer Vancouver. By assigning ranks to eight a l t e r n a t i v e educational de- l i v e r y systems, the respondents as a whole indicated that they preferred an audio-visual learning station i n a hospital or i n the MIRC project. Participants whose rankings were not related to those of non-participants preferred these same two systems. Non- participants preferred using a hospital l i b r a r y or attending courses outside t h e i r communities. Among the reasons given for not p a r t i c i p a t i n g , most did not suggest ways in which the project could be altered to improve p a r t i c i p a t i o n . i v I t was concluded that the and e f f e c t i v e system for d e l i v e r i n g t u n i t i e s to health professionals i n MIRC project i s an acceptable continuing education oppor- r u r a l B r i t i s h Columbia. V TABLE OF CONTENTS Page ABSTRACT i i LIST OF TABLES v i i i LIST OF FIGURES X ACKNOWLEDGEMENTS x i CHAPTER I INTRODUCTION 1 PURPOSE OF THE STUDY 3 PROCEDURE 3 DATA COLLECTION 3 DATA ANALYSIS 4 DEFINITION OF TERMS : .. . 4 REVIEW OF THE LITERATURE 5 HOME STUDY 6 OFF-CAMPUS COURSES 9 MEDIA 12 Mass Media 12 Instructional Media 19 COMMUNITY-INITIATED SYSTEMS 23 Discussion Groups 24 Community-Initiated Courses 26 II THE MIRC PROJECT 28 ORIGINS OF THE PROJECT 28 DESCRIPTION OF THE MIRC 29 v i CHAPTER Page ADMINISTRATION 30 OPERATION 31 ROLE OF THE FIELD SUPERVISOR 36 SUMMARY 38 III PARTICIPATION AND COMPARISON WITH OTHER CONCURRENT PROGRAMS 39 PARTICIPATION 39 PARTICIPATION BY PROFESSION 40 PARTICIPATION BY LOCATION 4 3 PARTICIPATION BY HOSPITAL SIZE 44 PARTICIPATION BY COMMUNITY DISTANCE . . . . 47 COMPARISON OF PARTICIPATION IN THE MIRC WITH OTHER PROGRAMS 49 PARTICIPATION BY PROFESSION 51 PARTICIPATION BY LOCATION 54 COMPARISON OF CLIENTELE . . . . . 57 COMPARATIVE COSTS 6 0 SUMMARY . . . . . . 64 IV CHARACTERISTICS OF PARTICIPANTS 66 CHARACTERISTICS OF THE POPULATION 66 DEMOGRAPHIC CHARACTERISTICS 67 EMPLOYMENT CHARACTERISTICS 67 CONTINUING EDUCATION ACTIVITIES 68 COMPARISON OF PARTICIPANTS AND NON-PARTICIPANTS 69 DEMOGRAPHIC CHARACTERISTICS 6 9 v i i CHAPTER Page EMPLOYMENT CHARACTERISTICS 71 CONTINUING EDUCATION ACTIVITIES 74 REACTIONS OF PARTICIPANTS 7 8 REACTIONS BY PROFESSION 7 8 REACTIONS BY LOCATION 80 RANKINGS OF ALTERNATIVE DELIVERY SYSTEMS . . . 85 REASONS FOR NOT PARTICIPATING 88 SUMMARY 90 V SUMMARY, CONCLUSIONS AND IMPLICATIONS 9 3 SUMMARY 93 CONCLUSIONS 98 IMPLICATIONS FOR CONTINUING EDUCATION 99 IMPLICATIONS FOR THE MIRC PROJECT 102 IMPLICATIONS FOR FURTHER STUDY 104 BIBLIOGRAPHY . 107 APPENDICES 114 A QUESTIONNAIRES 114 B SPECIFICATIONS FOR VEHICLE AND EQUIPMENT 131 C ITINERARY 133 D SCHEDULE OF OPERATION 135 v i i i LIST OF TABLES TABLE Page I Percentage D i s t r i b u t i o n Of Materials In The MIRC By Profession And Type of Program: August 1973 . . 33 II Percentage D i s t r i b u t i o n And P a r t i c i p a t i o n Rates For Eleven Health Professional Categories 41 III Comparison Of Communities By P a r t i c i p a t i o n Rates, Population, And Number of Local Hospital Beds . . . 45 IV Comparison of Communities By P a r t i c i p a t i o n Rates And Distances From Vancouver 48 V Percentage D i s t r i b u t i o n of Enrollment In Courses And Workshops By Profession And By Residence: August 1, 1973 to March 31, 1974 50 VI Comparison Of P a r t i c i p a t i o n Rates In The MIRC Project And Other Di v i s i o n Programs Between August 1, 1973 and March 31, 1974 52 VII Comparison Of P a r t i c i p a t i o n Rates In The MIRC Project And In Other Divi s i o n Programs By Health Professionals From Communities V i s i t e d By The MIRC By Profession 55 VIII Comparison Of P a r t i c i p a t i o n Rates In The MIRC Project And Other Divi s i o n Programs By Health Professionals From Communities V i s i t e d By The MIRC By Location 56 IX Comparison Of Individuals P a r t i c i p a t i n g In The MIRC Project And Other Di v i s i o n Programs By Participants' Home Communities . 58 X Costs Of Operating The MIRC Project Between August 1, 1973 And March 31, 1974 61 XI Comparison Of Costs Of The MIRC Project And Other Divi s i o n Programs Between August 1, 197 3 And March 31, 19 74 ~ 63 XII Comparison Of Participants And Non-Participants On Demographic Characteristics VO XIII Percentage D i s t r i b u t i o n Of Participants And Non-Participants By Profession 72 ix TABLE Page XIV Percentage Distribution Of Participants And Non-Participants By Employment Characteristics ... 73 XV Percentage Distribution Of Participants And Non-Participants By Continuing Education Activities 76 XVI Percentage Distribution Of Participants And Non-Participants By Use Of Media 77 XVII Participant Reaction To The MIRC Project By Profession 79 XVIII Participant Reaction To The MIRC Project By Location 81 XIX Correlations Between Participants1 Reactions And Community Size, And Distance From Vancouver . . 83 XX Participants' And Non-Participants' Rankings Of Alternative Delivery Systems 86 XXI Percentage Distribution Of Reasons For Not Participating In The MIRC Project 89 X LIST OF FIGURES FIGURE Page 1 Layout And Arrangement Of The Mobile Instructional Resource Centre 32 2 Map Of Communities Included In The MIRC Itinerary: August 1, 1973 To March 31, 1974 . . . 35 3 P a r t i c i p a t i o n Rates By Hospital Size 46 x i ACKNOWLEDGEMENTS The author would l i k e to express his sincere apprecia- t i o n to a number of people whose invaluable assistance made t h i s study possible. In adult education: Dr. Coolie Verner, whose outstand- ing contributions to the d i s c i p l i n e brought me to t h i s u niversity, who introduced me to the health sciences, and whose gentle persua- sion encouraged me to "get the damn thing done"; and Dr. John C o l l i n s , who i s able to inspire and demand more than seems possible but provides the support to make i t happen. In the health sciences: Mr. Ralph Barnard, whose gra- ciousness and u n f a i l i n g support i n the face of more than occasional adversity were a mainstay during the MIRC project; Dr. H.O. Murphy, whose energy and imagination helped to develop the project; Mrs. M.S. Neylan, who helped to make i t go; Dr. M.F. Williamson and other members of the Divis i o n Committee, whose encouragement and support during the preparation of t h i s manuscript were greatly appreciated; and Dr. John F. McCreary, whose leadership and v i s i o n w i l l be a continuing i n s p i r a t i o n to us a l l . Special thanks to Vinay Kanetar for his assistance with computer problems and to M i l l i Penner and Elaine Liau who somehow made my notes look l i k e a thes i s . 1 CHAPTER I INTRODUCTION In the modern world, the pervasive influence of constant and rapid change is having an impact on virtually every aspect of human endeavour. Technological advances resulting in a prolifera- tion of new skills and knowledge make it virtually impossible for highly trained individuals to keep abreast of developments in their fields. This problem is compounded by the fact that knowledge and skills which are not in consistent use deteriorate unless they are reinforced in some other way. The several professions are becoming increasingly aware that unless their members take steps to keep abreast of changes and developments, and to offset the deteriora- tion of present knowledge and skills, the inevitable result will be professional obsolescence (12,15,17,24,30,75). The implications of this possibility are serious for all professional groups, but they are serious in the extreme for the health professions, where the consequences of obsolescence can be measured not only in eco- nomic terms but also in terms of the intensity of human suffering and the length of human life; therefore, increasing pressure is being exerted by governments, professional associations, and the general public on members of the health professions to demonstrate continuing competence (21,22,47,56,68,75). The solution most often proposed to the problem of ensur- 2 ing and maintaining competence i s continuing professional educa- t i o n . Indeed, four of the professions: dentistry, medicine, nursing and pharmacy have begun to specify that the r i g h t to prac- t i c e i s conditional on p a r t i c i p a t i o n i n continuing education (11, 56,68,75). This increasing emphasis on continuing education i s appropriate i n an i d e a l sense because of i t s p o t e n t i a l a b i l i t y to provide the necessary opportunities for l i f e l o n g professional de- velopment and growth, but there are a number of p r a c t i c a l problems that must be resolved before the id e a l can be achieved. For those responsible for providing continuing education, a major problem i s i t s marginal status i n the eyes of governments as well as sponsoring agencies and i n s t i t u t i o n s . The p r i n c i p a l consequences of t h i s perceived marginality are a lack of funds and a shortage of appropriately trained health education manpower. The geographical remoteness of many pr a c t i c i n g health professionals makes these even more s i g n i f i c a n t . This i s borne out by profes- sionals who c i t e an i n a b i l i t y to leave t h e i r work s i t u a t i o n , costs, the time required and the distance to be t r a v e l l e d to attend courses as reasons for non-participation (53). I t i s clear that i f continuing education i s to provide an ef f e c t i v e means of preventing professional obsolescence, p a r t i c u - l a r l y for those p r a c t i c i n g i n remote areas, delivery systems must be developed that can replace the t r a d i t i o n a l approaches to i n - :. structi o n . Such systems must minimize costs, make economical use of health education manpower, reduce time l o s t i n t r a v e l and 3 stimulate i n t e r e s t i n non-traditional forms of learning. PURPOSE OF THE STUDY This study describes the P.A. Woodward Mobile Instruc- t i o n a l Resource Centre (MIRC) Project, which was developed to respond to the learning needs of r u r a l health p r a c t i t i o n e r s , and analyzes i t s role i n continuing education i n the health professions. PROCEDURE Data were obtained from members of 11 health professions in 17 communities i n B r i t i s h Columbia between August 1, 1973 and March 31, 1974. The health professions were: dentistry, medicine, nursing, n u t r i t i o n and d i e t e t i c s , pharmacy, r e h a b i l i t a t i o n medi- cine, s o c i a l work, licensed p r a c t i c a l nursing, medical records l i b r a r i a n s h i p , medical laboratory technology and radiologic tech- nology. Data from non-participants were obtained from the f i r s t seven groups. DATA COLLECTION Participants were asked to complete a data form during t h e i r f i r s t v i s i t to the MIRC, and a t o t a l of 521 were completed. Non-participants were i d e n t i f i e d from a l i s t of a l l health pro- fessionals i n each community v i s i t e d , and a random sample, to a maximum of 20 i n each community, was selected. Each person selected was mailed a questionnaire during the week following the MIRC's v i s i t to t h e i r community. Of the 333 forms mailed, 136 4 were returned for a return rate of 40.8 percent (Appendix A, page 115). Data on p a r t i c i p a t i o n rates i n the MIRC project were ob- tained from records maintained during the v i s i t to each community while data on p a r t i c i p a t i o n i n other educational a c t i v i t i e s were obtained from records maintained by the University of B r i t i s h Columbia. DATA ANALYSIS Frequency d i s t r i b u t i o n s were calculated and means and standard deviations obtained. Chi square tests were conducted to measure discrepancies between expected and obtained frequencies, and F tests performed to t e s t for s i g n i f i c a n t differences among subgroup means. Pearsonian correlations were calculated where appropriate to measure the degree of association between variables. DEFINITION OF TERMS Adult Education - "... any planned and organized a c t i v i t y provided by an i n d i v i d u a l , an i n s t i t u t i o n , or any other s o c i a l i n - strumentality that i s intended s p e c i f i c a l l y to a s s i s t an adult to learn and which i s under the immediate and continuing supervision of an i n s t r u c t i o n a l agent who manages the conditions for learning i n such a way as to f a c i l i t a t e the successful achievement of the learning objectives" (82) . Continuing Education i n the Health Sciences - "systematic learning a c t i v i t i e s designed to modify attitudes and/or update or 5 enlarge the knowledge and s k i l l s of health professionals so that t h e i r competence i s maintained for the purpose of improving health care services" (50). Distance Education - educational a c t i v i t i e s designed for learners who are geographically separated from the i n s t i t u t i o n , organization or agency providing the a c t i v i t i e s . Delivery System - a means of making learning opportuni- t i e s accessible to potential learners. The term implies a pur- poseful a c t i v i t y on the part of a learning agent intended to create opportunities for learning and to provide a means of making those opportunities accessible. REVIEW OF THE LITERATURE In order to provide a background for the examination of the MIRC Project, t h i s section w i l l review the continuing educa- tion l i t e r a t u r e related to distance education for health p r a c t i - tioners. The problem of providing for the needs of adult learners who are geographically remote from centres of learning i s not unique to the health sciences. It has been a concern of adult educators for centuries. Indeed, continuing education i n the health sciences as a whole has emerged only recently as a recog- nizable movement within the f i e l d of adult education, so that most of the approaches taken to providing learning opportunities for health professionals i n remote communities have t h e i r o r i g i n s i n the general development of the f i e l d . Because most of the important delivery systems currently used i n the health sciences 6 have originated i n North. America, only l i t e r a t u r e from the United States and Canada has been included. This review of l i t e r a t u r e i n the health sciences draws heavily on the extensive review of North American l i t e r a t u r e i n continuing education i n dentistry, medicine, nursing and pharmacy published by Nakamoto and Verner i n 1973. I t extends t h e i r review as i t pertains to distance education i n those professions to Decem- ber 1976. Literature from six other professions: occupational therapy, physiotherapy/.-.nutrition and d i e t i t i c s , medical records l i b r a r i a n s h i p , medical laboratory technology and radio l o g i c tech- nology covering the period from January 19 60 to December 19 76 was reviewed and i s included because representatives of these groups also participated i n the MIRC project. This review w i l l focus on delivery systems designed to meet the needs of potential learners who are geographically d i s - tant from major educational centres. It w i l l include both those systems developed for distant learners by learning agents i n the major educational centres and those developed by distant learners to meet t h e i r own needs. Definitions of the various systems w i l l be presented where appropriate when they are described. The cate- gories of delivery systems used i n t h i s review are: home study systems, off-campus and t r a v e l l i n g courses, media, and community- i n i t i a t e d systems. HOME STUDY One of the e a r l i e s t and most important means of providing 7 learning opportunities to the general population of adult learners who are at a distance from teaching centres i s correspondence study, but formal correspondence courses have played a r e l a t i v e l y small part i n the distance education of health p r a c t i t i o n e r s . Other forms of home study, most notably programmed i n s t r u c t i o n , have been used to a greater extent. Mackenzie (1971) defined correspondence i n s t r u c t i o n as "... i n s t r u c t i o n offered through correspondence which requires int e r a c t i o n between the student and the in s t r u c t i n g i n s t i t i o n . " In i t s t r a d i t i o n a l form, correspondence study consists of a series of printed lessons with assignments which the student completes and returns to the instr u c t o r for marking and suggestions. This has been supplemented by a variety of media: audio-tapes, films and s l i d e s , open or c l o s e d - c i r c u i t t e l e v i s i o n , videotape, pro- grammed in s t r u c t i o n , computer assisted i n s t r u c t i o n , telephone (telelecture and consultations) and radio (49). Home study i s not a s i g n i f i c a n t factor i n continuing education i n any of the health professions. Medicine, the only profession which summarizes continuing education courses by type on an annual basis, reported a t o t a l of 12 home study courses in 1969-70 which was 0.59 percent of a l l courses offered (53). In 1975-76, 67 home study courses were 1.2 percent of the t o t a l num- ber (68). Correspondence and programmed in s t r u c t i o n are the p r i n - c i p a l home-study delivery systems, other than journals, used by other professions as well; however, no descriptive studies on either have appeared i n the l i t e r a t u r e . 8 No important developments i n the use of correspondence have appeared i n the health sciences l i t e r a t u r e since 1970. As was reported by Nakamoto and Verner (1973), i t i s used f a i r l y ex- tensively i n continuing pharmaceutical education. The United States Dental Corps, which has been o f f e r i n g continuing education through correspondence since 1957 (53), i s s t i l l the p r i n c i p a l user of t h i s delivery system i n Dentistry. Correspondence i s s e l - dom used i n continuing nursing education. Programmed in s t r u c t i o n has been defined as "... a s e l f - i n s t r u c t i o n a l approach to learning i n which information i s pre- sented i n a co-ordinated sequence of question-and-answer steps or frames" (10). As Nakamoto and Verner (1973) pointed out, i t i s used most extensively in continuing education i n pharmacy. The Journal of the American Pharmaceutical Association l i s t e d 31 sources of programmed in s t r u c t i o n courses for pharmacists i n August 1973 (10). The appropriateness of programmed i n s t r u c t i o n for continuing pharmaceutical education was examined by Mrtek and Mrtek (1971) who concluded that i t was most e f f e c t i v e as a remedial t o o l . Hodapp and Kanun (19 70) compared programmed in s t r u c t i o n and closed c i r c u i t t e l e v i s i o n and found them equally e f f e c t i v e i n terms of cognitive gains. The only study reporting the use of programmed instruc- t i o n i n continuing dental education since 19 7 0 i s a study by Mel- rose (197 6) conducted by the Department of Pathology of the School of Dentistry at the University of Southern C a l i f o r n i a . Approxi- 9 mately 3,100 dentists completed an o r a l cancer course which i n - cluded a pre- and post test. The results based on tes t scores, pa r t i c i p a n t responses, number of r e f e r r a l s and other measures were p o s i t i v e . Programmed i n s t r u c t i o n courses on a wide variety of subjects are available through the Div i s i o n of Dental Health of the United States Public Health Service. Programmed materials for general p r a c t i t i o n e r s have been developed by the Di v i s i o n of Periodontology of the University of C a l i f o r n i a School of Dentistry as well (53). The use of programmed i n s t r u c t i o n i n medicine and nursing has not changed s i g n i f i c a n t l y since 1970. Nakamoto and Verner (19 73) pointed out that although programmed materials on a variety of topics are available to doctors from a number of sources, they receive greatest use i n continuing medical education as a supple- mentary device i n conjunction with other forms of i n s t r u c t i o n . Their use i n nursing has not been extensive. Adams (1971) de- scribed a number of guided independent study packages on a variety of topics available to nurses through the Department of Nursing at the University of Wisconsin. The American Journal of Nursing i s publishing a series of programmed in s t r u c t i o n supplements on assessment techniques (62). OFF-CAMPUS COURSES An early approach to distance education was the t r a v e l - l i n g lecture which has become one of the p r i n c i p a l delivery systems 10 both i n general adult education and i n continuing education i n the health sciences. Off-campus and t r a v e l l i n g courses are a t r a d i - t i o n a l way of d e l i v e r i n g continuing education to r u r a l health pro- fessionals and they are mentioned i n the l i t e r a t u r e of most of the professions where they are c a l l e d "community" or " c i r c u i t " courses. A c i r c u i t course usually has a regularly i t i n e r a r y which includes a number of communities, whereas a community course i s offered i n a single location; however, the terms are frequently used interchangeably i n the l i t e r a t u r e . C i r c u i t courses have been defined as "... those presented at r e l a t i v e l y i s o l a t e d com- munities by touring faculty groups" (68) and t h i s d e f i n i t i o n i s s u f f i c i e n t l y broad to include a l l types of community courses. Nakamoto and Verner (19 73) reported that c i r c u i t courses were receiving increasingly less emphasis i n the la t e 1960's as a way of delivery continuing medical education. Since then, t h i s trend seems to have been reversed. In 19 69-7 0, only 14 c i r c u i t courses were reported i n the United States and they accounted for 0.69 percent of a l l courses. In 1975-76, however, 136 were re- ported, accounting for 3.25 percent of the t o t a l (68). This i s consistent with the " . . . ( v i r t u a l ) t i d a l wave of i n t e r e s t i n learning by community physicians" noted by Strauch (1975). Braucher (1971) provides a summary of programs offerings 'in continuing pharmacy education. In a four-year comparison of pro- grams sponsored by pharmacy schools alone and co-sponsored with professional associations (19 66-69), he reports that the number of off-campus courses was greater than the number offered on campus 11 each year. The number and proportion of off-campus courses actually declined during the period, from 158 (62%) i n 1966 to 121 (54%) i n 1969, whereas the number and proportion of on-campus courses re- mained f a i r l y constant. The difference i s accounted for by "com- bination" courses offered both on campus and o f f using e l e c t r o n i c media. They were f i r s t reported i n 19 67 and accounted for seven percent of the t o t a l i n that year. No general summary of course offerings by type or loca- tion has been published by the other professions; therefore, i t i s not possible to determine the extent to which community or c i r c u i t courses are used. A v a r i a t i o n of the off-campus course i s a delivery system that employs a specially-equipped motor vehi c l e . Such vehicles are used extensively for d e l i v e r i n g primary health care services i n r u r a l areas (6,18,20,42,48) and i n providing consumer education (6,13,42). They have been used by r e h a b i l i t a t i o n medicine (48) and dentistry (20) i n B r i t i s h Columbia. T s e i t l i n (1973) reported descriptions and s p e c i f i c a t i o n s of vehicles that could be used for these purposes. Limited use has been made of such vehicles for continuing education for health professionals. Spicer (1975) de- scribed a project i n Arizona which comprised a small van staffed by a registered nurse who led learning experiences i n r u r a l com- munities using audio v i s u a l equipment and materials stored i n the van. The learning experiences were conducted i n l o c a l f a c i l i t i e s and not i n the van i t s e l f . No other similar projects have been described. 12 MEDIA Ely (1963) defined major categories of media: mass media, i n s t r u c t i o n a l media and i n s t r u c t i o n a l aids. The f i r s t two are useful for c l a s s i f y i n g mediated delivery systems. Because instruc- t i o n a l aids were defined as "supplementary" i n the teaching- learning process and "not self-supporting 1 1, they cannot comprise the e s s e n t i a l component of a delivery system and while they w i l l be mentioned i n descriptions of other delivery systems, they w i l l not be described separately. Media has played an important role i n the development of distance education delivery systems both for the general adult population and for health p r a c t i t i o n e r s . Mass media i s used ex- tensively i n general adult education while i t s use i n continuing education i n the health sciences i s less extensive i n some re- spects, but with certain mass-media delivery systems used mainly in the health sciences. The use of i n s t r u c t i o n a l media has not been nearly as extensive i n general adult education as i t has i n continuing education i n the health sciences. Mass Media Mass Media has been defined as "the instruments of com- munication that reach large numbers of people with a common mes- sage" (28) . Knowles (1962) -has said that the progress made- by the p r i n c i p a l mass media i n developing programs organized s p e c i f i c a l l y for educational purposes i s one of the more s i g n i f i c a n t adult 13 educational achievments of the modern era. The forms of mass media used most frequently in general adult education are: p r i n t media (newspapers, books, magazines), motion pictures, radio and t e l e v i - sion. In continuing education i n the health sciences, journals are the only form of p r i n t media used extensively; motion pictures are used primarily as i n s t r u c t i o n a l media or i n s t r u c t i o n a l aids; t e l e v i s i o n i s used extensively and radio to a lesser degree. Tele- phone delivery systems, which are less often used i n general adult education, are beginning to play an important role i n continuing health education. The p r i n c i p a l form of p r i n t media used i n continuing edu- cation i n the health sciences i s the professional journal. Each profession has at l e a s t one. Most have several and some deal exclusively with matters r e l a t i n g to education. Many professional journals o f f e r self-assessment systems to t h e i r subscribers. The t y p i c a l system involves an anonymous multiple-choice t e s t which i s mailed to a testing agency. The r e s u l t s , a reading l i s t , and i n some cases a discussion of incorrect responses i s returned, usually within two weeks. The primary purpose i s to stimulate i n - dependent study among members of the professions and to d i r e c t that study i n areas where d e f i c i e n c i e s have been shown to e x i s t . Self-assessment systems are used most extensively i n medicine and dentistry (14,39,66,67,68). Although the motion picture has played a f a i r l y important role i n providing distance education opportunities for the general 14 population of adult learners, the l i t e r a t u r e i n the health sciences makes no reference to i t s use for de l i v e r i n g continuing education to health p r a c t i t i o n e r s . Broadcast radio played a prominent role i n adult educa- tion between 1920 and 19 60 but i t has been less prominent i n con- tinuing education i n the health sciences; however, two-way radio has been used to some extent. Nakamoto and Verner (1973) reported that two-way radio had been used i n continuing medical education and i n continuing education i n nursing during the 1960's. Griswold (1972) reported that i t was being used i n continuing pharmaceutical education i n Albany, New York. Denne (1972) described a study conducted by the Inter-Mountain Regional Medical Program involving several health professions i n 48 hospitals i n six states. The study found that more participants were from r u r a l than from urban areas, and that the majority of the physician-participants i n r u r a l areas did not attend courses away from home. Problems i n scheduling, reception and content were reported and the two-way f a c i l i t y was seldom used. The study concluded that audio record- ings and/or audiotape-slide programs could serve the same purpose at a lower cost and a high l e v e l of s a t i s f a c t i o n for the p a r t i c i - pants. There are two p r i n c i p a l types of t e l e v i s i o n delivery systems: broadcast or open-circuit, and c l o s e d - c i r c u i t systems. Broadcast or open-circuit systems are those through which "... programs are radiated for reception by any l i s t e n e r or viewer: with- 15 in range of the station" while a c l o s e d - c i r c u i t system " . . . l i m i t s d i s t r i b u t i o n of an image to those receivers which are d i r e c t l y connected to the o r i g i n a t i o n point by coaxial cable or microwave l i n k " (28) . General adult education has used broadcast systems more extensively than c l o s e d - c i r c u i t while both types of systems have been used i n continuing education i n the health sciences. As Nakamoto and Verner (1973) pointed out, open-circuit t e l e v i s i o n i s used most extensively i n continuing medical educa- tion but i t s use appears to have decreased since 1970. In 1969-70, 12 "TV-Radio" courses were reported i n the Journal of the American Medical Association (53) and i n 1976-77, the number had decreased to six (68). A study conducted by the Inter-Mountain Regional Medical Program, which had been providing open-circuit t e l e v i s i o n programs for general p r a c t i t i o n e r s over a period of 11 yeras, con- cluded that active learner-involvement, an element e s s e n t i a l for adequate motivation, has not been provided for i n open-circuit t e l e v i s i o n to date and that "the re s u l t s ... cast doubt on whether open-circuit t e l e v i s i o n has enough po t e n t i a l to compete with other means of continuing medical education and leisure-time programming on commercial t e l e v i s i o n stations" (19). A survey conducted by the Faculty of Medicine at the University of Western Ontario con- cluded that "Medical educational t e l e v i s i o n i s seen as being com- plementary to other forms of continuing education rather than com- pl e t e l y s a t i s f y i n g the need for such education by i t s e l f " (41). Open-circuit t e l e v i s i o n was scarcely used i n continuing 16 dental education before 19.7Q .(531. Since that time, it has been used extensively in New England and the North Central United States (38,84,85,86). In New England, an attempt to provide for active learner participation through the use of a telephone question-and- answer system was abandoned after three years because of a low rate of utilization. However further use of open-circuit tele- vision systems was encouraged (38). In the "MIND" region (Minne- sota, Iowa, Nebraska, and the Dakotas), an extensive educational television system supplemented by portable equipment and tapes for areas outside the broadcast area and by satellite clinics was operated with the assistance of federal government funds for two years, but attempts to continue the system through subscription fees were unsuccessful (84,85,86). Open-circuit television has not been extensively used in continuing nursing education. Nakamoto and Verner (1973) cited a California study designed to determine whether nurses gain more from television broadcasts viewed at home or with groups of col- leagues in a hospital conference room. Home viewing was found to be superior to group viewing as measured by learning achievement. Hensely (1975) reported a project at Chapel Hill in which nurses were trained to act as group leaders for their colleagues in tele- vision-centred classes conducted in their local work settings. Like the other professions, pharmacy used open-circuit television more extensively as a delivery system for continuing education during the late 1960's than it does at the present time. 17 Nothing has been published on i t s use since 1970. Clo s e d - c i r c u i t t e l e v i s i o n has been used as a delivery system for continuing education i n dentistry, medicine, nursing, pharmacy and i n d i e t e t i c s . Like broadcast t e l e v i s i o n , i t has been used mostiiextehsively i n medicine. Hufhines (1972) studied physician and h o s p i t a l charac- t e r i s t i c s associated with the use of medical t e l e v i s i o n i n Southern C a l i f o r n i a . He reported that the programs were being viewed "... by those physicians who are i n greatest need of continuing medical education; that i s , non-specialists with the least t r a i n i n g , who, on the average graduated from medical school about 20 years ago and who admit more patients to ho s p i t a l than do non-viewing physi- cians." He also found that the viewers tended to be associated with smaller hospitals and concluded that the t e l e v i s i o n network was an important delivery system for continuing education i n those hospitals because other educational opportunities were li m i t e d . Caldwell (1974), reviewing nine years of c l o s e d - c i r c u i t programming by the University of C a l i f o r n i a , noted a s i g n i f i c a n t decrease i n service when federal funds were withdrawn i n 1971. He concluded that t e l e v i s i o n appears to have no more inherent magnetism than any other form of continuing education and that motivation to en- gage i n learning appears to hinge on whether or not a p a r t i c u l a r program f i l l s a need at the time i t i s presented. The telephone has not been used to any great extent as a distance education delivery system i n general adult education. I t has achieved some prominence, however, i n the l a s t few years i n 1 8 continuing education i n the health sciences. Telephone systems have become increasingly popular as a means of d e l i v e r i n g continu- ing education to r u r a l health p r a c t i t i o n e r s . The terms most commonly used to describe this approach are "t e l e l e c t u r e s " and "teleconferences". Telelectures are frequently supplemented by electronic chalkboards or by s l i d e s . Nakamoto and Verner (197 3) reported the use of telelectures i n continuing education i n medi- cine, nursing, and pharmacy. Since 19 70 t h e i r use appears to have increased. Silverston and Hansen (1973) described a telephone con- ference system developed at the University of Wisconsin which grew from an 18 hospital network i n 1965 to 75 hospitals i n 1972. In that year, approximately one-third of a t o t a l of 50,000 hours of ins t r u c t i o n provided for p r a c t i s i n g physicians was delivered through telephone conferences. An evaluation study found that participants showed cognitive gains and demonstrated retention a f t e r a six-month i n t e r v a l . I t concluded that telephone con-;::': ferences were meeting the goals set for them. The University of Texas Health Sciences Centre at San Antonio has been operating a teleconference system for physicians for seven years l i n k i n g over 100 hospitals i n f i v e states with the San Antonio Centre (77). Dyment (1971A) described a telephone lecture-systems for nurses and a l l i e d health professionals developed by the Regional Medical Pro- gram in Western New York involving 51 hospitals. Donaldson (19 68) described a t e l e l e c t u r e system for d i e t i t i a n s operated by the 19 University of Wisconsin. Spears (1973) reported a study comparing res u l t s of a two-day workshop and a series of telelectures on the same topic. The study found no s i g n i f i c a n t differences between the means of post-test scores and concluded that the te l e l e c t u r e s were as e f f e c t i v e as the workshop. Instructional Media The term i n s t r u c t i o n a l media has been defined as "devices which present a complete body of information, and are largely s e l f - supporting rather than supplementary i n the teaching-learning pro- cess" (28). Unlike mass media, i n s t r u c t i o n a l media i n i t s e l f i s not a system of d e l i v e r i n g educational experiences to potential p a r t i c i p a n t s . Being largely self-supporting, i t provides the necessary i n s t r u c t i o n a l component, but learner access must be accomplished by adding a delivery component. Several- instruc- t i o n a l media delivery systems are being used i n continuing educa- ti o n i n the health sciences. P r i n c i p a l among these are audiotape and video tape subscription services, telephone dial-access ser- vices and computer-assisted i n s t r u c t i o n . Learning resources cen- tres, which have been developed i n a number of areas, provide an additional system for d i s t r i b u t i n g i n s t r u c t i o n a l media and other learning resources. Although learning resources centres have been developed to serve the needs of the general population of adult learners as well, the development of the other i n s t r u c t i o n a l media delivery systems described has been most extensive i n the health sciences. 20 A number of systems which d e l i v e r audiotapes and video tapes to health professionals on a regular basis through a sub- s c r i p t i o n are i n operation at the present time. As reported by Nakamoto and Verner (197 3) , the most extensive audiotape subscrip- tion services have been developed for continuing medical education. The largest of these i s operated by the Audio-Video Digest Founda- tion which d i s t r i b u t e s two to four tapes per month i n each of 12 subject areas to subscribers i n several countries. Oakley (1972) estimated that p a r t i c i p a t i o n rates i n Audio-Video Digest subscrip- tions i n the United States ranged from 18 percent of a l l family p r a c t i t i o n e r s to 41 percent of board-certified anaesthesiologists. The mean rate for a l l 12 groups was approximately 30 percent. The Philadelphia College of Pharmacists provides an audiotape sub- s c r i p t i o n service c a l l e d "Pharmatapes" designed p a r t i c u l a r l y for r u r a l pharmacists (32). The American Society of Hospital Phar- macists provides a s i m i l a r service (55) . Canadian dentists may subscribe to a cassette service provided by the Canadian Dental Association (11). The American D i e t e t i c Association o f f e r s a cassette-a-month subscription plan (70) and Thompson (1966) refers to an audiotape correspondence system for physiotherapists. No p a r t i c i p a t i o n figures for these services have appeared i n the l i t e r a t u r e . Video tape subscription services are less developed than those for audiotapes, p r i n c i p a l l y because of the higher costs i n - volved. The Canadian Dental Association has decided to postpone 21 entry into the f i e l d for t h i s reason (11). It i s seen by some, however, as an important future prospect. Services operating at present are intended primarily for continuing medical education. As of May 1974, the Los Angeles Ear Research I n s t i t u t e had over 1,500 monthly subscribers (83) and The Network for Continuing Medical Education has provided a bi-weekly video tape service to more than 800 i n s t i t u t i o n s i n the New England States for the past ten years (54). Pearson (1974) defined a d i a l access system as an i n f o r - mation service that provides telephone access to b r i e f recorded summaries, with a t y p i c a l message between four and eight minutes in length. This system appears to be unique to the health sciences. Nakamoto and Verner (1973) pointed out that d i a l access systems were being used most extensively i n continuing medical education and that they had been introduced i n Canada as well as in the United States. The only other profession to i n i t i a t e a service p r i o r to 1970 was nursing. The s i t u a t i o n appears to be largely unchanged, although the scope of the services may have grown. Pearson (1974) reported 13 d i a l access systems i n the United States and Canada serving 20 states and provinces. Although no objective data has been published, two studies indicate that the use of a d i a l access l i b r a r y may r e s u l t i n im- proved patient care. Silverston and Hansen (1973) described a study conducted at the University of Wisconsin which found that 22 nearly one-third of the c a l l s resulted i n a reported change i n behaviour by the physician. Pearson (1974) reported a more com- prehensive study involving a l l d i a l access services i n operation at the time and found that nurses and physicians were the heaviest users of the services, with approximately twice as many c a l l s be- ing made by nurses as by physicians. Some c a l l s were made by dentists and pharmacists even though i t was not intended for those professions. Proportionally more c a l l e r s were from r u r a l than from urban areas. The Users indicated that they had changed one or more aspects of t h e i r practice based on what they had heard and that they had gained confidence i n managing patient problems; however, they also indicated that they would not pay a nominal amount (even t o l l charges) for the use of the service. E r t e l (1972) defined computer-assisted i n s t r u c t i o n (CAI) as "an approach to education i n which the i n s t r u c t i o n a l program and some educational materials are stored i n a computer and u t i - l i z e d to teach an i n d i v i d u a l a pre-determined body of knowledge." Computerized delivery systems seem more appropriate for the pre- paratory t r a i n i n g of students or for courses i n major centres than for distance education. The s i t u a t i o n i n the health sciences may be changing to some extent. Hoffer (1975) described a small-scale study of the use of computer-assisted i n s t r u c t i o n i n f i v e community hospitals i n Michigan, Massachusetts, C a l i f o r n i a and Ohio. A t e r - minal connected to the computer at Boston Massachusetts General Hospital was placed i n the emergency department of each h o s p i t a l . 23 A number of physicians, nurses and para-medical personnel were receptive to CAI and considered i t a valuable resource, and the study concluded that CAI "... appears to have a p o s i t i v e impact on physician behaviour." Learning resources centres capable of d i s t r i b u t i n g and, i n some cases, producing a wide variety of learning resources have been developed i n Canada and the United States, some for general adult education and other exclusively for the health sciences. Nakamoto and Verner (19 73) reported that several were being de- veloped for physicians and other health professionals through the Regional Medical Programs i n the United States and that a number of others were being operated by u n i v e r s i t i e s , professional asso- ciations and federal government agencies. These centres, which d i s t r i b u t e materials on a loan or re n t a l basis, provide a valuable support system for adult learners i n r u r a l areas by supplying materials to individuals for independent study and aids to support in s t r u c t i o n i n programs i n i t i a t e d by communities. COMMUNITY-INITIATED SYSTEMS A fundamental p r i n c i p l e of adult education i s that i f maximum learning i s to occur, appropriate learning opportunities must be available when the need to learn a r i s e s . A l l too f r e - quently, t h i s i s not the case i n distance education. Content for learning experiences and schedules are often determined without adequate consultation with the prospective learners. Consequently, 24 distance education delivery systems do not always provide the kinds of learning opportunities that are most appropriate at the time they are required. To compensate for these d e f i c i e n c i e s , adult learners have tended to turn to informal types of learning opportunities such as consultations with l o c a l authorities and to relevant l i t e r a t u r e . When more comprehensive investigations of a topic have been required, they have formed primary learning groups to examine and discuss matters of mutual i n t e r e s t , and they have arranged formal courses and workshops. The two p r i n c i p a l forms of organized learning a c t i v i t i e s i n i t i a t e d within l o c a l com- munities have been discussion groups and short courses. Discussion groups have been used both by the general population of adult learners and by health professionals. Community-initiated courses for the general adult population tend to be organized by l o c a l educational authorities rather than by the learners themselves. This i s not the case i n the health sciences. Discussion Groups A discussion group i s "...a learning s i t u a t i o n which con- forms to the c h a r a c t e r i s t i c s and s o c i e t a l processes of a group so that learning i s achieved by the group as a unit as well as by i t s i n d i v i d u a l members; and i n which the r e s p o n s i b i l i t y for learning i s shared equally by the group members and the i n s t r u c t i o n a l agent" (81). The use of discussion groups i s referred to frequently i n the distance education l i t e r a t u r e using a variety of terms such as 25 study clubs, reading c i r c l e s , l i s t e n i n g groups, and others, but the nature of the a c t i v i t y i s the same. Discussion groups have been used i n general adult education and i n continuing education in the health sciences, both by agencies as a means to provide learning opportunities for adults i n t h e i r communities and by adult learners themselves to s a t i s f y t h e i r own learning needs. Nakamoto and Verner (1973) reported that the f i r s t health profession to use discussion groups extensively was den- t i s t r y . They pointed out that these groups, c a l l e d study clubs, have two c h a r a c t e r i s t i c s that make them p a r t i c u l a r l y e f f e c t i v e : 1) the members are involved i n planning t h e i r own education, and 2) as small informal primary groups, they provide for member i n - teraction and f a c i l i t a t e the use of i n s t r u c t i o n a l techniques with high learner p a r t i c i p a t i o n . In dentistry, approaches taken by study clubs vary, with members accepting r e s p o n s i b i l i t y for d i r e c t i n g the group on a rotating basis, or through the use of outside resource personnel. In most cases, the primary emphasis i s on c l i n i c a l s k i l l s . As of December 1976, seven states and two provinces accepted p a r t i c i p a - tion i n dental study club a c t i v i t i e s for c r e d i t toward mandatory continuing education requirements. Since 1970, study clubs have been reported i n medicine (16,7 7), pharmacy (55), and d i e t e t i c s (70). Johnson (1966) reported t h e i r use i n physiotherapy during the 1960's. In almost a l l cases, members of the group are respon- s i b l e for the planning and organization. Because costs are usually limited and arrangements r e l a t i v e l y easy to make, study clubs are 26 p a r t i c u l a r l y valuable to health p r a c t i t i o n e r s i n smaller r u r a l communities. Community-Initiated Courses Courses developed by adult learners i n t h e i r communities to meet t h e i r own learning needs seem to be more prevalent i n con- tinuing education i n the health sciences than i n general adult edu- cation. Nakamoto and Verner (1973) noted a trend toward courses and other learning experiences developed i n community hospitals. The trend appears to be continuing. Hiss (197 6) described two types of approaches commonly used i n continuing medical education: 1) formal programscorgahized by a l o c a l co-ordinator or a planning committee, and 2) s t a f f con- ferences, which may consist of presentations by l o c a l or v i s i t i n g a u t h o r i t i e s , discussions of record audits, x-ray conferences and other similar a c t i v i t i e s . Both Hiss (1976) and Brock (1975) men- tioned an aspect of the trend toward community-initiated learning experiences that i s emerging i n other professions as well: the appointment of l o c a l co-ordinators. These co-ordinators are l o c a l health professionals selected by t h e i r colleagues or by a central agency to i n i t i a t e and sometimes d i r e c t learning experiences i n th e i r communities. An extensive system of co-ordinators was estab- lished by the D i v i s i o n of Continuing Education i n Pharmacy at the University of B r i t i s h Columbia i n 1976 (5). The Canadian Dental Association Task Force on Continuing Education recommended in February 1976 that a national network of regional co-ordinators 27 be established. The co-ordinators would be located i n communities remote from teaching centres and, supported by materials and funds from the Canadian Dental Association, would be responsible for continuing education i n t h e i r regions (11). The appointment of these l o c a l and regional co-ordinators appears to an acknowledge- ment of two important p r i n c i p l e s : 1) i f continuing education i s to be delivered i n a way that i s l i k e l y to meet community needs, at l e a s t a portion of the r e s p o n s i b i l i t y must rest with l o c a l health p r a c t i t i o n e r s , and 2) l o c a l p r a c t i t i o n e r s are capable of and interested i n accepting t h i s r e s p o n s i b i l i t y . 28 CHAPTER II THE MIRC PROJECT In t h i s chapter, the history and orig i n s of the P. A. Woodward Mobile Instructional Resource Centre (MIRC) pro- j e c t , i t s purposes, and the manner i n which i t was operated and administered w i l l be described. ORIGINS OF THE PROJECT The Div i s i o n of Continuing Education i n the Health Sciences at the University of B r i t i s h Columbia was established on A p r i l 1, 1968 (31). At that time, i t was made up of repre- sentatives from four professions: medicine, nursing, pharmacy and dentistry. By August 1973, i t had expanded to include human n u t r i t i o n and d i e t e t i c s and r e h a b i l i t a t i o n medicine as well (4). One of the concerns of the Divis i o n has been that "con- tinuing education should be available where a (health professional) practices" (78). To achieve t h i s , the Division of Continuing Education i n Medicine offered "Community Hospital" courses i n several locations each year. In 1969-70 and 1970-71, i t co- • ordinated a t e l e v i s i o n series which consisted of 24 programs broad- cast at weekly inter v a l s over seven private stations and t h e i r 6 7 s a t e l l i t e s (3). During the 1970-71 and 1971-72 program years, the Division of Continuing Nursing Education conducted a Coronary and 29 Intensive Care Project which attracted 1517 registrants i n 21 locations (2,3). The Division of Continuing Education i n Pharmacy maintained a lending l i b r a r y of audiotapes that had 60 subscribers in 1972-73 of whom 48 were in communities outside Greater Vancouver. Although such special projects enjoyed considerable success, t h e i r impact on the o v e r - a l l problem of providing adequate continuing education opportunities for r u r a l health professionals was l i m i t e d because of t h e i r limited duration and scope. In September 1969 the idea of a mobile resources centre that would take continuing education opportunities into i s o l a t e d areas of the province was introduced and e n t h u s i a s t i c a l l y sup- ported and encouraged (27). To achieve t h i s objective, a vehicle was purchased i n January 1970 and by August 1973, with the neces- sary preparations completed, the P. A. Woodward Mobile Instruc- t i o n a l Resource Centre (MIRC) Project began. DESCRIPTION OF THE MIRC The t o t a l number of health personnel i n small r u r a l com- munities in B r i t i s h Columbia i s such that i t would be impossible for the MIRC to provide the volume and scope of continuing educa- ti o n opportunities required to meet t h e i r needs; therefore, i t was intended that the MIRC should act as a stimulus and a supplement rather than a substitute for other continuing education a c t i v i t i e s . S p e c i f i c a l l y , i t s purposes were: 30 1. to stimulate the inte r e s t of r u r a l health professionals in continuing education 2. to make r u r a l health professionals aware of modes of i n - dependent learning u t i l i z i n g audio v i s u a l media and to stimulate t h e i r i n t e r e s t in those p a r t i c u l a r modes, and 3. to supplement the continuing education a c t i v i t i e s of the Divis i o n (59). ADMINISTRATION The project was administered by a working committee made up of the directors of continuing education i n dentistry, human n u t r i t i o n , medicine, nursing, pharmacy, and r e h a b i l i t a t i o n medi- cine, along with representatives from s o c i a l work, adult education, biomedical communications, and the Bio-Medical Library. This com- mittee was chaired by the Executive Director of the D i v i s i o n . During the development phase, the committee was respon-* s i b l e for establishing the purposes, obtaining the necessary f i n - a n cial support, acquiring the vehicle, designing the physical lay- out for the learning environment, making arrangements for i t s reno- vation, selecting the equipment and materials, determining the i t i n e r a r y , and approving the design for the evaluation of the pro- j e c t . During the operational phase i t up-dated the materials, selected additional communities to be included i n the i t i n e r a r y , and made modifications and changes i n the purpose and operation of the project as required. 31 OPERATION The MIRC was a former highway bus"*" converted into a mobile continuing education f a c i l i t y by students at the B r i t i s h Columbia Vocational School (Figure 1). It contained three learn- ing stations, each of which could accommodate two people. Each station was equipped with a cassette tape recorder, a carousel s l i d e projector and a rear screen projection unit. The stations were also wired to accommodate a t e l e v i s i o n monitor for receiving c l o s e d - c i r c u i t video tape programmes played on a ha l f - i n c h black- and-white video tape recorder. One station contined an Autotutor (a programmed i n s t r u c t i o n a l device which uses s p e c i a l l y designed 2 35 mm film) and another had a cartridge movie projector. The programs were self-contained treatments of a p a r t i c u l a r topic ranging i n length from a few minutes to more than an hour and many of them were supported by supplementary printed material. Most of the programs were intended for physicians with very few for d i e t i - t i ans, and none at a l l s p e c i f i c a l l y for physiotherapists, occupa- t i o n a l therapists, licensed p r a c t i c a l nurses, medical records l i b r a r i a n s , medical laboratory technologists or radiologic tech- nologists (TABLE I ) . Specifications for the mechanical aspects of the vehicle are presented i n Appendix B, page 131. Specifications for the audio v i s u a l equipment are presented i n Appendix B, page 131. FIGURE 1 LAYOUT AND ARRANGEMENT OF THE MOBILE INSTRUCTIONAL RESOURCE CENTRE Sleeping Area for Driver STORAGE for Slide Tape Film Cartridge TV Cassettes Counter and Supplies VIDEOTAPE RECORDER for playback to Carrels STORAGE for TV below LEARNING CARRELS for Audio Cassettes Slide-Tape Film TV STORAGE for Audiotape Cassettes Learning Side Storage Side FILE CARD INDEX ORIENTATION and NOTICE BOARD TAKE-OUT PRINTED MATERIAL P. A. Woodward Mobile nstructional Resource Centre TABLE I PERCENTAGE DISTRIBUTION OF MATERIALS IN THE MIRC BY PROFESSION AND TYPE OF PROGRAM: AUGUST 197 3 PROFESSION TYPE Audio Tapes No. % Slide Tapes No. % OF Video Tapes No. PROGRAM Autotutor Films No. % Movie Cartridge No. % TOTAL! No. Dentistry 18 94.7 1 5.3 19 1.4 Di e t e t i c s 1 33.3 2 66.6 0.2 Medicine 973. 86.5 103 9.2 20 1.8 14 1.2 15 1.3 1125 84.2 Nursing 129 96.9 4 3.1 133 9.9 Pharmacy Social Work 38 100.0 9 45.0 11 55.0 38 2.8 20 ' 1.5 TOTAL 1168 87.3 106 7.9 35 2.7 14 1.0 15 1.1 1338 100.0 34 During the period from August 1, 1973 (the beginning of the operational phase) to March 31, 1974 (the end of the f i r s t pro- ject year), the MIRC v i s i t e d 17 r u r a l communities (Figure 2 ) \ The c r i t e r i a applied i n selecting communities for the i t i n e r a r y were: 1. expression of i n t e r e s t by l o c a l health professionals i n a v i s i t by the MIRC 2. size of the l o c a l h o spital as indicated by the number of beds with preference being given to communities with smaller hospitals 3. remoteness from major continuing education centres with preference being given to more remote communities, and 4. nearness to a route between other locations included i n the i t i n e r a r y . A standard procedure was applied i n each community v i s i t e d . Preliminary advertising describing the nature and purpose of the project and an appropriate news release were forwarded to the com- munity p r i o r to the v i s i t . An index l i s t i n g a portion of the material available and the hours of operation were included i n t h i s advance mailing to enable potential participants to plan t h e i r schedule for using the MIRC, and to help them determine the type of learning a c t i v i t y they wished to use. When the MIRC arrived The-itinerary is-presented i n Appendix C> page-133. ~-~ FIGURE 2 COMMUNITIES INCLUDED IN THE MIRC ITINERARY AUGUST 1, 1973 TO MARCH 31, 1974 36 in the community, additional p u b l i c i t y was undertaken by the f i e l d s t a f f to ensure that a l l l o c a l health professionals were aware that i t was at the l o c a l h o s p i t a l , where i t remained for a week. The hours of operation - a minimum of sixty per week - were designed to afford maximum opportunity for participation.''" No fee was charged. Appointments were necessary only i n the larger locations at times of peak demand. After a period of orientation, p a r t i c i - pants were assisted i n sel e c t i n g a program suited to t h e i r needs or interests and then taught how to operate the appropriate equip- ment along with some suggestions to f a c i l i t a t e t h e i r learning. Afte r using materials, they were asked to evaluate them. Before the end of the f i r s t v i s i t , each participant was asked to complete a questionnaire to gather data about demographic and employment c h a r a c t e r i s t i c s , continuing education a c t i v i t i e s , and reactions to the project. No l i m i t s were imposed on the length of time a participant could remain i n the MIRC or on the number of v i s i t s that could be made during the schedule of operation. ROLE OF THE FIELD SUPERVISOR During the operation phase, the f i e l d supervisors had three areas of r e s p o n s i b i l i t y : education, data c o l l e c t i o n , mis- cellaneous duties related to p u b l i c i t y , the operation and main- Various schedules were tested. They are presented i n Appendix D, page 135. 37 tenance of the vehicle and i t s equipment, and administrative de- t a i l s . When the operation phase began, two f i e l d supervisors who were graduate students i n the Department of Adult Education were assigned to the project. One of these withdrew a f t e r only a few communities had been v i s i t e d ; so the other continued alone. The basic nature of the role was not affected by t h i s change, although i t did have an impact on the amount of time that could be devoted to i n t e r a c t i o n with the p a r t i c i p a n t s . The educational role played by the f i e l d supervisor be- gan with an attempt to stimulate i n t e r e s t through v i s i t s to doc- tors, dentists, pharmacists, health care agencies, and the hospital to acquaint health care personnel with the nature and purpose of the project and to encourage them to p a r t i c i p a t e . Within the MIRC, the function of f a c i l i t a t i n g learning was added to and com- bined with stimulating and maintaining i n t e r e s t . The f i e l d s t a f f provided orientation for participants by stressing the unique aspects of the various types of materials and assisted them i n selecting programs appropriate to t h e i r i n t e r e s t s , t h e i r chosen media, and the time they had available. This was followed by i n - struction i n the operation of the appropriate equipment and sug- gestions as to how i t could be used most e f f e c t i v e l y for learning. Where two or more participants were using a program simultaneously, they were encouraged to engage i n discussion i n order to reinforce t h e i r learning. The f i e l d supervisor made no attempt to answer questions 38 about content. When such questions arose, the participants were asked to consult an authoritative source or others in the community who had used the program. At the request of participants, the field supervisor developed lists of programs on particular topics for more comprehensive study during subsequent visits. SUMMARY The Mobile Instructional Resource Centre project was one of a number of attempts by the Division of Continuing Education in the Health Sciences at the University of British Columbia to pro- vide learning opportunities for rural health professionals in their home communities. The core of the project was a highway bus that had been converted into.a mobile continuing education facility containing three learning stations, each with a variety of audio visual equip- ment, and over 1,300 programs, the majority of which were intended for doctors and nurses. The 17 communities included in the itin- erary between August 1, 1973 and March 31, 1974 were selected on the basis of their interest in the project, their size, and re- moteness. The MIRC spent a sixty-hour week at the hospital in each community. Appointments were seldom necessary and no fee was charged. Participants were given an orientation to the learning environment, helped to select a program, taught how to use the equipment, and asked to evaluate the program. Before leaving, they were asked to react to the project and provide information about their demographic and employment characteristics and continuing education activities. 39 CHAPTER III PARTICIPATION AND COMPARISON WITH OTHER PROGRAMS CONDUCTED BY THE DIVISION OF CONTINUING EDUCATION IN THE HEALTH SCIENCES DURING THE SAME PERIOD In th i s chapter, p a r t i c i p a t i o n i n the MIRC project w i l l be analyzed and compared with p a r t i c i p a t i o n i n other a c t i v i t i e s conducted by the Division during the same period. The c l i e n t e l e served by the MIRC project and other D i v i s i o n a c t i v i t i e s w i l l be examined to determine whether the same individuals were being served by both, and costs of operation w i l l be compared. PARTICIPATION Members of 11 health professions from 17 B r i t i s h Columbia communities participated i n the MIRC project between August 1, 1973 and March 31, 1974. The p a r t i c i p a t i n g professions comprised the major categories of health workers del i v e r i n g d i r e c t patient care i n communities outside the Lower Mainland at that time. The communities v i s i t e d ranged i n size from approximately 300 to over 13,000 inhabitants, and were' located i n the southern portion of the province and along the east coast of Vancouver Island, between 40 and 500 miles from Vancouver. A detailed analysis of p a r t i c i p a - t i o n based on professional categories and c h a r a c t e r i s t i c s of com- munities i s presented below. 40 PARTICIPATION BY PROFESSION A t o t a l of 521 health p r a c t i t i o n e r s i n 11 professional categories pa rticipated i n the MIRC project during the period con- cerned although some of the professions were not represented i n the smaller communities. Only four professions: medicine, nursing, licensed p r a c t i c a l nursing and x-ray technology were included i n the group of potential participants i n every location. The only profession to par t i c i p a t e i n a l l 17 communities was nursing. In addition to representatives of the 11 major professional categories, 92 other health-related personnel participated i n the project. In- cluded i n t h i s group were nurses' aides, ambulance attendants, housekeeping and maintenance personnel, i n d u s t r i a l f i r s t aid workers and others. Because the numbers i n each of these categories were small, they were not included i n the analysis of p a r t i c i p a t i o n . The 521 health professional who par t i c i p a t e d i n the pro- ject represented approximately 41 percent of the potential p a r t i - cipants (TABLE I I ) . The highest rates of p a r t i c i p a t i o n were re- corded by physiotherapists (62.5%) and medical laboratory tech- nologists (58.5%). This i s surprising since the MIRC contained no materials designed s p e c i f i c a l l y for th e i r use (see TABLE I, p.33). The lowest rates were recorded by medical records l i b r a r i a n s (23.1%) and dentists (24.4%). This might have been predicted because the MIRC contained no materials for medical records l i b r a r i a n s , and being located at the hospital i n each community, i t was not as accessible to dentists as i t was to members of other professions. 41 TABLE II PERCENTAGE DISTRIBUTION AND PARTICIPATION RATES FOR ELEVEN HEALTH PROFESSIONAL CATEGORIES POTENTIAL PARTICIPATION PROFESSION PARTICIPANTS PARTICIPANTS RATES NO. % No. % M e d T l c L o l c g y a t 0 r Y 3 1 5 - 9 5 " 4 - 1 9 D i e t e t i c s 5 0.96 9 0.71 55.56 Medicine 60 11.52 147 11.62 40.82 Nursing 278 53.36 632 50.00 40.82 Pharmacy 24 4.61 59 4.66 40.68 X-Ray Technology 12 2.30 32 2.53 37.50 Social Work 15 2.88 43 3.40 34.88 Licensed.Practical c 6 , T i. ... , T J . .. 68 13.05 211 16.69 32.33 Nursing Dentistry 10 1.92 41 3.24 24.39 ^ i i b r a r r 0 ^ 5 3 °' 5 7 1 3 1 ' ° 2 2 3 '° 8 TOTALS 521 100.0 1264 100.00 x = 41.22* * Weighted mean X 2 = 28.29 d.f. = 10 p^.01 42 In order to determine whether the differences i n p a r t i c i - pation rates among the various professional groups were s t a t i s - t i c a l l y s i g n i f i c a n t , a Chi square test was performed and was found to be s i g n i f i c a n t at the p<.01 l e v e l ( x 2 = 28.29, d.f. = 10). In view of t h i s , three further questions were investigated. Did the fact that the MIRC contained no learning materials s p e c i f i c a l l y intended for certain professions deter members of those professions from pa r t i c i p a t i n g ? The professions were grouped accord- to whether or not learning materials were provided for th e i r use and a Chi square test was performed on the proportions of p a r t i c i - pants to non-participants."'" Because the test was not signigicant (X 2 = 1.01, d.f. = 1 ) , i t was concluded that the a v a i l a b i l i t y of profession-specific learning materials was not a factor that affected p a r t i c i p a t i o n . Did the fact that the MIRC was located at the hospital in each community act as a deterrent to p a r t i c i p a t i o n for members of those professions not employed at the hospital? Dentistry, pharmacy and s o c i a l work were the professions whose employment did not normally relate d i r e c t l y to the h o s p i t a l . The r e s u l t of a Chi square te s t performed on the proportions of participants to poten- t i a l participants i n these three professions ( c o l l e c t i v e l y ) and in the remaining professions taken as a group tended toward s i g n i - ficance ( x 2 = 2.90, d.f. = 1, p<.10), indicating that location The professions for whom no learning materials were s p e c i f i c a l l y intended was l i s t e d i n Chapter II. 4 3 of employment may have been a factor that influenced participation to some extent. Were participation rates among these professions for whom the Division provided other forms of learning opportunities higher than among those for whom it did not? The regular programming of the Division during the term of the project did not include pro- grams for licensed practical nurses, medical laboratory technolo- gists, medical records librarians and social workers. A Chi square test performed on the proportions of participants to potential participants in these professions (collectively) and the remaining professions (also taken as a group) was significant at the p<.05 level ( x 2 = 3.95, d.f. = 1). The mean participation rate for the professions for whom the Division did provide other programs was 44.1 percent, whereas the mean rate for the other groups was 37.3 percent. This would appear to indicate that those groups for whom the Division provided other forms of learning opportunities were somewhat more likely to participate in the MIRC project than those for whom it did not. PARTICIPATION BY LOCATION The 17 communities visited by the MIRC were located in southern British Columbia and along the east coast of Vancouver Island (see Figure 2, p. 35 )• The total number of health pro- fessionals in the 11 categories discussed in the previous section ranged from 18 in one community to 211 in another, with an average 44 per community of 80. P a r t i c i p a t i o n rates i n the various communi- t i e s ranged from 76.2 percent i n Chemainus to 24.0 percent i n Powell River. The mean p a r t i c i p a t i o n rate was 41.2 percent. The largest community was Powell River with 13,726 inhabitants, which also had the largest h o s p i t a l : 150 beds. The smallest community was Ganges with 329 inhabitants and a 25 bed h o s p i t a l ; and the smallest hospital (17 beds) was located i n Armstrong, whose popu- l a t i o n was 1,648. The mean community si z e was 3,750, and the mean hospital size 54 beds (TABLE I I I ) . To test the relationship between community size and p a r t i c i p a t i o n rates, Pearsonian correlations.were calculated and found to be s i g n i f i c a n t at the p<.05 l e v e l (r - -.492, d.f. = 17). Therefore, i t appears that smaller communities tended to have higher p a r t i c i p a t i o n rates than larger communities. PARTICIPATION BY HOSPITAL SIZE A further test determined that p a r t i c i p a t i o n rates were also negatively related to the size of the l o c a l hospital as measured by the number of beds (r= -.503, d.f. = 17, p<.05). P l o t - ting the data revealed that, with three exceptions, p a r t i c i p a t i o n rates i n communities having hospitals 40 beds or smaller were higher than those i n communities with hospitals larger than 40 beds (Figure 3). A Chi square test revealed that the rates were s i g n i - f i c a n t l y higher i n communities with smaller hospitals (40 beds or fewer) than i n those i n larger hospitals ( x 2 = 45.051, d.f. = 1, p< .005) . 45 TABLE III COMPARISON OF COMMUNITIES BY PARTICIPATION RATES, POPULATION AND NUMBER". OF LOCAL HOSPITAL BEDS " • COMMUNITY NUMBER OF PARTICI- PANTS NUMBER OF POTENTIAL PARTICI- PANTS PARTICI- POPULA- NUMBER PATION TION OF OF BEDS RATES TOWNSHIP Chemainus 32 Al e r t Bay 29 Ganges 25 Enderby 24 Golden 27 Armstrong 16 Squamish 22 Campbell River 65 Ladysmith 2 7 Comox 81 Revelstoke 21 L i l l o o e t 12 Sechelt 36 Lytton 6 Salmon Arm 41 Ashcroft 13 Powell River 44 43 40 37 36 45 28 45 143 67 211: 59 34 107 18 125 44 183 76.19 72.50 67.57 66.67 60.00 57.14 48. 89 45.45 40.29 38. 39 35.29 35.29 33.64 33.33 32. 80 29.55 24.04 2170 760 329 1158 3000 1648 6121 10,000 3664 3980 4897 1514 590 494 7793 1916 13,726 37 40 25 23 40 17 24 96 49 120 50 30 70 25 93 32 150 TOTALS 521 1264 x=41.22* x=3,750.58 x=54 * Weighted mean 46' FIGURE 3 PARTICIPATION RATES BY HOSPITAL SIZE P A R T I C I P A T I 0 N R A T E S 100- 90< 80^ 70 60 50 I N 40 P E R C E N T 30 20 10 C f t K l C A L H O S P I T A L £IZ£ i i i i 1 i i i i • • i • i i 10 20 30 40 50 60 70 80 90 100 HO 120 130 140 150 NUMBER OF HOSPITAL BEDS 47 If an objective of the MIRC project i s to achieve maximum rates of p a r t i c i p a t i o n in each community v i s i t e d , the results of these tests appear to suggest that t h i s i s most l i k e l y to be achieved i n smaller communities with hospitals of 40 beds or less. Therefore, i f the length of the v i s i t s i s uniform and fixed, the policy of giving preference to smaller communities appears to be sound. However, because the same period of time (one week) was spent i n a l l communities, and because the actual number of p a r t i c i - pants i n most communities with a hospital larger than 4 0 beds was greater than the number i n communities with smaller hospitals, i t might be appropriate to relate the length of the v i s i t to the size of the hospital and to test the relationship again when t h i s ad- justment has been made. PARTICIPATION BY COMMUNITY DISTANCE The distance of., the communities from Vancouver ranged from 40 to 490 miles. The mean distance was 194.9 miles. Because ferry t r a v e l was required to reach several of the communities, th e i r distance was calculated i n terms of hours of t r a v e l time by automobile as well. The most distant community i n terms of t r a - v e l l i n g time was 10.89 hours from Vancouver; the nearest was 0.91 hours away, and the mean time distance was 5.08 hours (TABLE IV). To test the rela t i o n s h i p between p a r t i c i p a t i o n rates and the distance of communities from Vancouver, two Pearsonian corre- lations were calculated. The correlations were .10 with mileage 48 TABLE IV COMPARISON OF COMMUNITIES BY PARTICIPATION RATES" AND DISTANCE'FROM VANCOUVER PARTICIPATION DISTANCE DISTANCE LOCATION RATE MILES HOURS Chemainus 76.19 65 2. 70 Al e r t Bay- 72.50 245 9.61 Ganges 67.57 58 2.98 Enderby 66.67 329 7.31 Golden 60.00 490 10. 89 Armstrong 57.14 319 7.09 Squamish 48.89 41 .91 Campbell River 45.45 140 4. 32 Ladysmith 40.29 58 2.54 Comox 38.39 115 3.83 Revelstoke 35.59 398 8.84 L i l l o o e t 35.29 201 4.47 Sechelt 33.64 40 1.57 Lytton 33.33 161 3.58 Salmon Arm 32.80 337 7.49 Ashcroft 29.55 208 4.62 Powell River 24.04 108 3.70 MEANS 41.22* 194.88 5.08 * Weighted by frequency 49 distance (d.f. = 17), and .05 with travelling time (d.f. = 17). Neither was statistically significant. It appears that neither distance nor travel time to Vancouver was related to participation rates in communities included in the itinerary during the period concerned. COMPARISON OF PARTICIPATION IN : • THE MIRC -WITH OTHER PROGRAMS Between September 1, 1973 and March 31, 1974, the Divi- sion of Continuing Education in the Health Sciences conducted 75 short courses and workshops in 15 locations throughout the pro- vince, providing learning opportunities for 2,880 participants from 96 British Columbia communities as well as from other pro- vinces and the United States. Approximately half of the partici- pants in these programs were from the greater Vancouver area, with approximately 35 percent living in rural British Columbia com- munities (TABLE V). Slightly less than half (48.7%) were doctors, 22 percent were nurses, and 10 percent were dentists. None of the other professions accounted for more than six percent of the total. The majority of participants in all professional groups except medicine and pharmacy were drawn from greater Vancouver. Approximately 40 percent of doctors were from rural British Columbia and 40 percent from Vancouver. Forty percent of pharmacists were from rural British Columbia, 36 percent from Victoria and 24 percent from Vancouver. In order to calculate participation rates in Division TABLE V PERCENTAGE DISTRIBUTION OF ENROLLMENT IN COURSES AND WORKSHOPS BY PROFESSION AND BY RESIDENCE: AUGUST 1, 1973 TO MARCH 31,.-1974 PLACE OF RESIDENCE PROFESSION Gre a t e r Vancouver V i c t o r i a R ural B r i t i s h Columbia Outside B r i t i s h Columbia TOTAL No. a "5 No. a "O No. Q. "o No. o. "o No. Q. "o D e n t i s t r y 169 57.68 21 7.17 70 23. 89 33 11.26 293 10. 17 D i e t e t i c s 67 93.05 2 2.28 2 2.78 1 1.39 72 2. 50 Medicine 584 41.63 60 4.28 590 42.04 169. 12.05 1403 48. 72 Nursing 330 50.69 34 5.22 261 40.10 26 3.99 651 22. 60 Pharmacy 28 24.14 42 36.21 46 39.65 0 0.00 116 4. 03 R e h a b i l i t a t i o n Medicine 135 78.95 9 5.26 26 15.20 1 0.59 171 5. 94 S o c i a l Work 9 81. 82 0 0.00. 2 18..18 0 0. 00 11 0. 3 8 Others 122 74.85 6 3.68 29 17.79 6 3.68 163 5. 66 1444 50.14 174 6.04 1026 35.63 236 8.19 2880 100.00 51 a c t i v i t i e s other than the MIRC project, r e g i s t r a t i o n s between September 1, 1973 and March 31, 1974 were tabulated with duplica- tions (more than one r e g i s t r a t i o n by any individual) and re g i s - trations by health professionals from outside the province elimin- ated. Proportions were calculated using data for the number of potent i a l participants i n each profession (63). P a r t i c i p a t i o n rates in Divis i o n programs were compared with rates i n the MIRC project for those professions for whom learning opportunities were regularly provided i n the normal programming of the Di v i s i o n : dentistry, d i e t e t i c s , medicine, nursing, pharmacy and r e h a b i l i t a - t i o n medicine. PARTICIPATION BY PROFESSION A t o t a l of 2,474 B r i t i s h Columbia health professionals from the six professions served by the Div i s i o n participated i n programs during the period concerned, compared to 392 p a r t i c i - pants from the same professions i n the MIRC project (TABLE VI). The o v e r - a l l p a r t i c i p a t i o n rate i n the MIRC project (42.9%) was s i g n i f i c a n t l y higher than the o v e r - a l l rate (15.1%) for a l l other Divi s i o n programs ( x 2 = 438. 302 , .d.f. = l,p<.005). Comparing the rates for the in d i v i d u a l professional groups revealed no s t a t i s t i c a l l y s i g n i f i c a n t differences between the Divis i o n and the MIRC project for dentistry ( x 2 = 0.011, d.f. = 1), d i e t e t i c s ( x 2 = 2.482, d.f. .= 1), and medicine ( x 2 = 0.751, d.f. = 1 ) . In the other three professions, the rates for the MIRC project were TABLE VI COMPARISON OF PARTICIPATION RATES IN THE MIRC PROJECT AND OTHER DIVISION PROGRAMS BETWEEN AUGUST 1, 1973 AND MARCH 31, 1974 DIVISION PROGRAMS MIRC PROJECT PROFESSION Number Number of P a r t i c i - Number Number of P a r t i c i - of P a r t i - Potential pation of P a r t i - Potential pation cipants Participants Rates cipants Participants Rates Rehabilitation Medicine 170 Diet e t i c s 71 Medicine 1234 Nursing 625 Pharmacy 116 Dentistry 260 805 272 4310 11,182 .1534 1194 21.24 26.10 36.93 5.55 7.56 21.78 15 5 60 278 24 10 24 9 147 632 59 41 62. 50 55.60 40.82 40.82 40. 68 62.50 TOTALS 2474 16,375 x=15.11* 392 912 x=42.98* * Weighted Means 53 s i g n i f i c a n t l y higher than were those for the D i v i s i o n : nursing - 4 0 . 8 percent compared to 5 . 6 percent ( x 2 = 1 2 4 3 . 9 5 7 , d.f. = 1 , p < . 0 0 5 ) ; pharmacy - 4 0 . 7 percent compared to 7 . 6 percent ( x 2 = 7 3 . 6 5 0 , d.f. = 1 , p < . 0 0 5 ) ; and r e h a b i l i t a t i o n medicine - 6 2 . 5 per- cent compared to 2 1 . 2 percent ( x 2 = 2 0 . 6 9 5 , d.f. = 1 , p < . 0 0 5 ) . The r e l a t i v e l y high p a r t i c i p a t i o n rate for doctors i n Divi s i o n programs may have been accounted for i n part by the com- munity hospitals program operated by the Div i s i o n of Continuing Medical Education which offered courses i n several r u r a l locations during the period concerned. Moreover, both doctors and dentists were largely self-employed, and therefore may have found i t r e l a - t i v e l y easy to leave t h e i r communities to p a r t i c i p a t e i n learning experiences elsewhere. The comparison for d i e t e t i c s may be suspect because of the r e l a t i v e l y small number of cases involved. To focus the comparison on only those professional groups i n communities v i s i t e d by the MIRC, registrants i n D i v i s i o n a c t i - v i t i e s were sorted according to t h e i r home addresses to determine the number of actual participants from each community. P a r t i c i p a - t i o n rates were calculated using the same figures for the number of potential participants and once again, only those professions regu- l a r l y served by the normal programming of the Div i s i o n were i n - cluded i n the comparisons. It was found that p a r t i c i p a t i o n rates i n Div i s i o n pro- grams ranged from zero in r e h a b i l i t a t i o n medicine and d i e t e t i c s to 3 4 . 7 percent i n medicine, compared with a range from 2 4 . 4 percent i n dentistry to 6 2 . 5 percent i n r e h a b i l i t a t i o n medicine for the 54 MIRC project (TABLE VII), and that the pattern of participation described with respect to Division activities as a whole appeared to apply to participation in the communities visited by the MIRC as well. Participation rates in the MIRC project were signifi-:.. cantly higher than rates in other Division activities for dietetics (X 2 =4.43, d.f. = 1, p<.05), nursing ( x 2 = 240.566, d.f. = 1, p<.005), pharmacy ( x 2 = 9.647, d.f. = 1, p<.005) and rehabilitation medicine ( x 2 = 12.707, d.f. = 1, p<.05). There was no significant difference for dentistry ( x 2 =0.20, d.f. = 1) or medicine ( x 2 = 0.925, d.f. = 1). PARTICIPATION BY LOCATION Comparing participation in each community visited by the MIRC, it was found that the total number of participants from these communities in Division activities was 101 compared to 392 in the MIRC project (TABLE VIII); consequently the over-all participation rate in the MIRC project was significantly higher: 42.98 percent compared to 12.17 percent ( x 2 " = 233.73, d.f. = 1, p<.005). The number of participants in Division activities from most of the com- munities was quite small. There were none at all from Alert Bay, Lillooet, Lytton and Ashcroft, and fewer than five in eight other communities. There were 2 0 or more, however, from Campbell River, Salmon Arm and Powell River. These communities accounted for 60 percent of the participants for the Division but only 30 percent for the MIRC project. Only four locations provided fewer than 15 TABLE VII COMPARISON OF PARTICIPATION RATES IN THE MIRC PROJECT AND IN OTHER DIVISION PROGRAMS BY HEALTH PROFESSIONALS FROM COMMUNITIES VISITED BY THE MIRC BY PROFESSION Profession Number of Potential Participants Number of P a r t i c i - pants i n MIRC Project Number of Participants i n Division A c t i v i t i e s P a r t i c i - pation Rate: MIRC P a r t i c i - pation Rate: Di v i s i o n Rehabilitation Medicine 24 15 0 62.50 : 0.0 Dietetics 9 5 0 55.56 0.0 Medicine 147 60 51 40.82 34.69 Nursing 632 278 34 40.82 5.38 Pharmacy 59 24 8 40.68 13.56 Dentistry 41 10 8 24.39 19.51 TOTALS 912 392 101 x=42.98* x=12.17* * Weighted Means 56 TABLE VIII COMPARISON OF PARTICIPATION RATES IN THE MIRC PROJECT AND OTHER DIVISION PROGRAMS BY HEALTH PROFESSIONALS . FROM COMMUNITIES VISITED BY THE MIRC BY LOCATION Number of Number of Partici- Partici-Number of Pa'E'ticie.- Partici- pation pation LOCATION Potential pants•in pants in Rate: Rate: Partici- MIRC Pro-Division MIRC Division pants ject Activities Project Activities Chemainus 33 27 3 81. 82 9 .09 Alert Bay 21 16 0 76.19 0.0 Ganges 29 18 1 62.07 3.45 Enderby 19 16 3 84.21 15.79 Golden 29 21 3 72.41 10.34 Armstrong 18 11 1 61.11 5.56 Squamish 35 18 2 51.42 5.71 Campbell River 110 52 20 47.27 18.18 Ladysmith 45 20 3 44.44 6.67 Comox 145 55 12 37.93 8.28 Revelstoke 44 19 8 43.18 17.78 Lillooet 22 8 •0 36.36 0.0 Sechelt 82 32 4 39 .02 4.88 Lytton 13 4 0 30.77 0.0 Salmon Arm 88 30 20 34.09 22.73 Ashcroft 30 8 0 26.67 0.0 Powell River 149 37 21 24.83 1.4. 0.9 TOTALS 912 392 101 x=42.98* x=12.17* * Weighted Means 57 MIRC participants. P a r t i c i p a t i o n rates i n Divis i o n a c t i v i t i e s ranged from zero percent for the communities mentioned to 22.7 percent for Salmon Arm. P a r t i c i p a t i o n rates i n the MIRC project ranged from 2 4.8 percent i n Powell River to 81.8 percent i n Chemainus and were s i g n i f i c a n t l y higher for a l l communities (p<.005) except Salmon Arm for which the difference was not s t a t i s - t i c a l l y s i g n i f i c a n t ( x 2 = 2.262, d.f. = 1). With the exception of A l e r t Bay, which i s a very remote community and might therfore have been expected to send very few participants to outside a c t i v i t i e s , p a r t i c i p a t i o n rates i n the com- munities which provided no participants in Divis i o n a c t i v i t i e s were low i n the MIRC project as well. L i l l o o e t , Lytton and Ashcroft were a l l below the group mean, even though t h e i r hospitals had fewer than 40 beds and they therefore might have been expected to record higher rates. COMPARISON OF CLIENTELE In order to determine whether the same individuals were being served by the MIRC project and other Div i s i o n a c t i v i t i e s , the l i s t s of par t i c i p a n t s ' names from each community were compared. It was found that of a t o t a l of 433 parti c i p a n t s , 342 (77.2%) p a r t i - cipated i n the MIRC project but not i n any other Div i s i o n a c t i v i t y ; 50 (11.3%) participated i n the MIRC project and at least one other Divi s i o n a c t i v i t y and 51 . (llv.5%). p articipated i n at least one D i v i - sion a c t i v i t y but did not par t i c i p a t e in the MIRC project (TABLE IX). 58 TABLE IX COMPARISON OF INDIVIDUALS PARTICIPATING IN MIRC PROJECT AND OTHER DIVISION PROGRAMS BY PARTICIPANTS' HOME COMMUNITIES PARTICIPATION Division MIRC Project "MIRC COMMUNITIES Activities and Division "'Project Only Activities 'Only No. % No. % No. g. No. C Q, "o Chemainus 2 6. 89 1 3'i 45. 26 89 . 66 29 100. 00 Alert Bay 0 0. 0 0 0. 0 16 100 . 00 16 100. 00 Ganges 0 0. 0 1 5. 56 17 94. 44 18 10 o u 00 Enderby 2 11. 11 1 5. 56 15 83. 33 18 100. 00 Golden 2 8. 70 1 4 . 34 20 86. 96 23 100. 00 Armstrong 0 0. 0 1 9 . 10 10 90. .90 11 100. 00 Squamish 1 5. ,27 1 5. ,27 17 89 . ,46 19 100. 00 Campbell 54 100. 00 River 2 3. ,71 18 33. ,33 34 62. ,96 Ladysmith 2 4. 55 1 9. 09 19 86. 36 22 100. 00 Comox 8 12. 70 4 6. 35 51 80, .95 63 100. 00 Revelstoke 5 20. 83 3 13, .50 16 66, .67 24 100. 00 Lillooet 0 0. 0 0 0, .0 8 100, .00 8 100. 00 Sechelt 2 5. 88 2 5. 88 30 88 .24 34 100. .00 Lytton 0 0 .0 0 0 .0 4 100 .00 4 100. ,00 Salmon Arm 11 26 .82 9 21 .95 21 51 .23 41 100. .00 Ashcroft 0 0 .0 0 0 .0 8 100 .00 8 100. ,00 Powell .00 River 14 27 .45 7 13 .73 30 58 .82 51 100, TOTALS 51 11.51 50 11.29 342 77.20 443 100.00 59 Looking at the various communities, i t was found that i n each of seven of the 13 locations from which Di v i s i o n participants were drawn, only one in d i v i d u a l participated both i n the MIRC pro- je c t and i n other Div i s i o n a c t i v i t i e s . In each of three other locations, there were four or fewer common part i c i p a n t s . In these 10 communities, which provided a t o t a l of 16 common par t i c i p a n t s , 133 individuals participated i n the MIRC project or i n Di v i s i o n a c t i v i t i e s only. In only three locations did a f a i r l y large num- ber of individuals p a r t i c i p a t e i n both - Campbell River: 18 i n d i v i - duals (33 percent of the participants from that community); Salmon Arm: 9 individuals (21.95%); and Powell River: 7 ind i v i d u a l s (13.7%). However, as the percentage figures demonstrate, even i n these locations, the t o t a l number of individuals p a r t i c i p a t i n g i n the MIRC project or i n Div i s i o n a c t i v i t i e s only, greatly exceeded the number of common part i c i p a n t s . Therefore, i t seems that, on the whole, within the six professions included i n the regular programming of the Di v i s i o n , the MIRC project served a d i f f e r e n t set of in d i v i d u a l s . Moreover, the MIRC project served several professional groups not included to any appreciable extent i n other Division a c t i v i t i e s : licensed p r a c t i c a l nurses, medical laboratory technologists, medical records l i b r a r i a n s , x-ray technologists, and s o c i a l workers, thus r e i n - forcing the conclusion that separate sets of individ u a l s were served. 60 - .- COMPARATIVE COSTS The t o t a l c o s t s o f o p e r a t i n g the MIRC p r o j e c t between September 1, 1973 and March 31, 1974 were $42,500.28 (TABLE X). More than h a l f of t h i s amount ($25,296 . 46) was made, up of s t a r t i n g c a p i t a l c o s t s , i n c l u d i n g the s a l a r y o f a p r o j e c t d i r e c t o r h i r e d to do e a r l y developmental work. Approximately 35 percent ($15,445.27) was o p e r a t i n g c o s t s , and the remainder ($1,758.55) was spent on e v a l u a t i o n . In order t o determine the c o s t of the p r o j e c t d u r i n g the p e r i o d concerned, the s t a r t i n g c a p i t a l c o s t s were amortized over three years - the intended l i f e of the p r o j e c t . The amortized s t a r t i n g c a p i t a l c o s t s f o r the f i r s t year were found to be $8,432.15. The o p e r a t i n g and e v a l u a t i o n c o s t s brought the t o t a l c o s t s f o r the f i r s t year to $25,635.97. During the same p e r i o d , the D i v i s i o n r e c e i v e d $108,546.00 i n t u i t i o n fee revenue. Because i t s budget was c a l c u l a t e d on a c o s t - r e c o v e r y b a s i s , t h i s amount i s c o n s i d e r e d t o be i t s c o s t of o p e r a t i o n , e x c l u d i n g s a l a r i e s c o n t r i b u t e d by f a c u l t i e s , s c h ools and p r o f e s s i o n a l a s s o c i a t i o n s which amounted to $50,972.64. There- f o r e , the t o t a l c o s t of o p e r a t i n g the D i v i s i o n d u r i n g t h i s p e r i o d was $159,518.64. In order t o compare the c o s t of p r o v i d i n g the two types of s e r v i c e s , a common u n i t was d e r i v e d : the p a r t i c i p a n t - h o u r - o f - i n s t r u c t i o n or one hour of i n s t r u c t i o n p r o v i d e d to an i n d i v i d u a l p a r t i c i p a n t . Because the D i v i s i o n ' s programs are p r o v i d e d f o r groups of p a r t i c i p a n t s , the number of p a r t i c i p a n t - h o u r s - o f - 61 TABLE X COSTS OF OPERATING THE MIRC PROJECT BETWEEN AUGUST 1, 1973 AND MARCH 31, 1974 AMOUNT FOR ITEM AMOUNT FIRST YEAR Starting C a p i t a l Costs Vehicle $ 1,423.00 Renovations 6,14 3.19 A-V Equipment 4,67 4.3 0 A-V Materials 9,227.91 Project Director 3,828.06 $25,296.46 Amortized Starting Costs $ 8,432.15 ($25,296 .46 -f 3) F i r s t Year Operating Costs . , " ; Salaries $ 9,987.96 Vehicle 3,800.85 P u b l i c i t y 435.00 Supplies 312.00 A-V Repairs 3 64.00 T o l l Fees 19 5.00 Miscellaneous 349.40 $15,445.27 $15,445.27 Evaluation Costs Salaries $ 900.00 Supplies & Duplicating 518.55 Computing Time 100.00 C l e r i c a l Typing 240.00 $ 1,758.55 $ 1,758.55 Total Costs to March 31, 1974 $42,500.28 Total Annual Costs $25,635.97 62 in s t r u c t i o n provided had to be calculated by multiplying the num- ber of registrants i n each program by the length of the program in hours. The sum of the products for the 75 programs offered during the period produced the t o t a l number of participant-hours- o f - i n s t r u c t i o n . Because i n s t r u c t i o n i n the MIRC project was i n - div i d u a l i z e d , the comparable t o t a l was the sum of a l l of the hours of i n s t r u c t i o n provided. The costs per-participant-hour-of- i n s t r u c t i o n were calculated by di v i d i n g the t o t a l operating costs by the t o t a l number of participant-hours-of-instruction. The MIRC project served 521 participants during the period concerned at a t o t a l cost of $25,635.97, making the average cost per pa r t i c i p a n t $49.21 (TABLE XI). The t o t a l cost to the Division of serving i t s 2,880 participants was $159,518.64, making i t s cost per participant s l i g h t l y higher: $55.38. The average cost of the MIRC's 977 hours of i n s t r u c t i o n (the t o t a l number of hours i t was open and available for use) was $26.23 per hour com- pared to a per hour average of $192.65 for the Division's 828 hours. Making the comparison on the basis of the common unit, the cost of operating the MIRC project was found to be $16.44, approxi- mately four times as much as the cost for the D i v i s i o n : $3.89. I 63 TABLE XI COMPARISON OF COSTS OF THE MIRC PROJECT AND OTHER -DIVISION"PROGRAMS .BETWEEN' AUGUST 11,.' 1973 .AND MARCH'31, : 1974 ITEM DIVISION MIRC Operating Costs $159,518.64 $25 ,635. 97 Number of Participants 2880 521 Number of Hours of Instruction 828 977 Number of Participant-Hours of Instruction 41,005 1559. 3 Cost per Participant $55.38 $49. 21 Cost per Hour of Instruction $192.65 $26. 23 Cost per Participant-Hour of Instruction $3. 89 $16. 44 These figures seem to indicate that the cost to the Division of using group methods to deliver instruction were lower than individualized learning experiences delivered in the home com- munities through the MIRC project. These calculations, however, do not include costs to the participants and their employers. In the MIRC project, there were none. In order to attend many of the 64 Division's regular programs, participants (or t h e i r employers) had to pay for t r a v e l and accommodation as well as salary replacement and t u i t i o n fees. These factors would l i k e l y raise the t o t a l costs of the Division's other a c t i v i t i e s to a l e v e l at least equal to the cost of the MIRC project. Moreover, the MIRC project reached 291 participants not involved i n other Div i s i o n a c t i v i t i e s , and i t did so using less than one-quarter of the professional manpower. There- fore, i t would seem appropriate to make the comparison again at some future time, taking these other factors into consideration. SUMMARY A t o t a l of 521 health p r a c t i t i o n e r s i n 11 professional categories participated i n the MIRC project i n the 17 communities v i s i t e d . They represented approximately 41 percent of the poten- t i a l p a r t i c i p a n t s . P a r t i c i p a t i o n rates were found to be s i g n i f i - cantly higher among those professions for whom the Div i s i o n pro- vided other forms of learning opportunities than among those for whom i t did not, and higher to a degree that tended toward s i g n i - ficance among professions based outside a hos p i t a l than among hos- pital-based professions. P a r t i c i p a t i o n rates were not s i g n i f i c a n t l y related to the distance of communities from Vancouver, but were s i g n i f i c a n t l y higher i n communities with hospitals having 40 beds or fewer than i n those with larger hospitals. During the same period, a t o t a l of 2,880 health pro- fessionals drawn largely from six professional categories p a r t i c i - 65 pated i n 75 short courses and workshops conducted by the Di v i s i o n . Of these, 2,4 74 were from B r i t i s h Columbia and were members of those professions included i n the Divis i o n Committee. They repre- sented approximately 15 percent of the potential participants from those professions i n B r i t i s h Columbia. The o v e r - a l l p a r t i c i p a t i o n rate i n the MIRC project was found to be s i g n i f i c a n t l y higher than the rate i n other D i v i s i o n programs, as were the rates for nursing, pharmacy and r e h a b i l i t a - tion medicine. The rates for the three other professional groups did not d i f f e r to a degree that was s t a t i s t i c a l l y s i g n i f i c a n t . The same was found to be true when only those professionals from com- munities v i s i t e d by the MIRC were included i n the comparison, ex- cept that, i n t h i s case, a s i g n i f i c a n t l y higher proportion of d i e t i - tians participated i n the MIRC project. In most communities v i s i t e d by the MIRC, p a r t i c i p a t i o n rates among health professionals from those communities were found to be s i g n i f i c a n t l y higher i n the MIRC project than i n other D i v i s i o n programs. The only exception was Salmon Arm, where the difference i n rates was not s t a t i s t i c a l l y s i g n i f i c a n t . On the whole, the MIRC project appears to have served a d i f f e r e n t set of individuals than were served by other D i v i s i o n programs. When the two were compared on the basis of cost per- participant-hour-of-instruction, the MIRC project was found to have cost the Divis i o n approximately four times as much as i t s other programs. Costs to participants other than t u i t i o n fees were not included i n the comparison. 66 CHAPTER IV CHARACTERISTICS OF PARTICIPANTS In this chapter, the demographic and employment charac- t e r i s t i c s as well as the continuing education a c t i v i t i e s of par- t i c i p a n t s of the MIRC w i l l be described. A comparison of p a r t i - cipants and non-participants, the reactions of participants to the project, the r e l a t i v e preferences of both groups f o r various de- l i v e r y systems for continuing education, and the reasons given by non-participants for not p a r t i c i p a t i n g w i l l also be described. Differences among participants and non-participants w i l l be tested for s i g nificance, as w i l l t h e i r ranking of alte r n a t i v e delivery systems. Par t i c i p a n t s ' reactions w i l l be tested to determine whether they are s i g n i f i c a n t l y related to the size of t h e i r communities or thei r distance from Vancouver. CHARACTERISTICS OF THE POPULATION In order to establish a base-line description of the health professionals i n the communities v i s i t e d by the MIRC, data were obtained'on demographic and employment c h a r a c t e r i s t i c s and on continuing education a c t i v i t i e s from a l l participants and from a random sample of non-participants. Thus, the data presented below were obtained from 521 participants in 11 professional categories and from 136 non-participants i n seven professional categories i n a l l 17 communities included i n the i t i n e r a r y . 67 The demographic c h a r a c t e r i s t i c s described are sex, age, marital status and location of most recent professional education. The employment c h a r a c t e r i s t i c s are profession, f i e l d of employment, employment status, number of years of practice since graduation, and continuity of practice since graduation. The continuing educa- tion a c t i v i t i e s include the number of short courses and workshops attended, the number of professional books and issues of profes- sional journals read and the use of media during the year p r i o r to the v i s i t of the MIRC. DEMOGRAPHIC CHARACTERISTICS The majority (76.7%) of the 657 respondents were female. Their mean age was 3 7.8 years, with 50 percent between 2 8 and 47 (Q = 9.15) and approximately 70 percent between 26 and 49 (S.D. = 11.57). Almost 70 percent were married, and only 18.6 were single. The largest proportion (40.8%) obtained t h e i r most recent profes- sional education i n B r i t i s h Columbia, with other Canadian provinces accounting for 37.1 percent and the United States 10.4 percent. EMPLOYMENT CHARACTERISTICS More than half of the respondents (54.5%).were nurses, with the next largest groups, doctors and licensed p r a c t i c a l nurses, accounting for only 12.3 percent and 8.7 percent respec-r. t i v e l y . None of the other professions accounted for more than f i v e percent of the t o t a l . S ixty-six percent were employed i n a 68 ho s p i t a l , 18.4 percent i n private practice, and 5.2 percent i n a public health agency. The remainder (10.3%) were employed else- where such as i n a s o c i a l service agency or else did not respond. Sixty-eight percent were employed on a f u l l - t i m e basis; 22.8 per- cent part time, and approximately six percent were not employed. Their mean length of time i n practice was 10.9 years (S.D. = 8.3) and s l i g h t l y more than h a l f (54.6%) had practiced continuously since graduation. CONTINUING EDUCATION ACTIVITIES The respondents had attended an average of approximately two short courses or workshops during the year just p r i o r to the MIRC's v i s i t (x = 1.7, S.D. = 2.8), but almost 40 percent did not respond to this item. They had read an average of six professional books (x = 6.3, S.D. = 21.6) and 17 issues of professional journals (x = 16.9, S.D. = 19.1) during the same period. Thirty-two percent and 16 percent, respectively, f a i l e d to respond to these items. They had made r e l a t i v e l y l i t t l e use of media during the previous year, with 38 percent having used a tape recorder, 20 percent a tape-slide system, 16 percent video tape and 15 percent eight millimetre f i l m . Over 40 percent (41.1%) reported that they had used programmed i n s t r u c t i o n . None of the respondents indicated that they had attended no workshops or had read no books nor journals. However, as was noted, the "no response" rate on these items was high. I t may be 69 that included in the "no response" category were some responses that should have been recorded as zero. Because the questionnaires were not anonymous, it may be that respondents who were not using these basic approaches to continue their education were reluctant to state this and sign their names. The relatively extensive use of programmed instruction reported (41.1%) may be misleading. Comments by some of the parti- cipants after the questionnaires were completed indicated that they did not understand the term. Some understood it to mean instruction provided in a formal program (course). COMPARISON OF PARTICIPANTS AND NON-PARTICIPANTS DEMOGRAPHIC CHARACTERISTICS Participants and non-participants were compared on the basis of sex, age, marital status and location of their most re- cent professional education. Slightly over 80 percent of participants compared to only 61.8 percent of non-participants were female; whereas 32 per- cent of non-participants compared to 19.4 percent of participants were male (TABLE XII). The difference between the two groups on the basis of the proportions of male and female respondents in each was found to be statistically significant at the p<.005 level (X 2 = 12.45, d.f. = 1). 70 TABLE XII COMPARISON OF PARTICIPANTS AND NON-PARTICIPANTS ON DEMOGRAPHIC CHARACTERISTICS ...... "' CHARACTERISTICS PARTICIPANTS NON-PARTICIPANTS NO. % No. % SEX* Male 101 19 .38 44 32.35 Female 420 80.62 84 61.76 AGE Mean Standard 37. 55 38. 97 Deviation 11. 56 11. 58 MARITAL STATUS Single 104 20.08 18 13.24 Married 361 69.29 97 71.32 Other 55 10.56 13 9 .56 LOCATION OF B.C. 213 40.88 55 40.44 MOST RECENT PROFESSIONAL EDUCATION Elsewhere i n Canada Other 200 95 38.39 18.23 43 26 31.62 19 .12 * x 2 = 12.45 d.f. = 1 p<£.005 No s t a t i s t i c a l l y s i g n i f i c a n t differences were observed on the other c h a r a c t e r i s t i c s examined. The mean age of participants was 3 7.6 and non-participants 38.9 ( x 2 = 5.30 5, d.f. = 4). Approxi- mately 70 percent of both groups were married ( x 2 = 2.528, d.f. = 2); about 40 percent had obtained t h e i r most recent professional educa- tion i n B r i t i s h Columbia, and 38 percent of participants compared to 32 percent of non-participants had been trained elsewhere.in Canada ( x 2 = 0.98, d.f. = 2). EMPLOYMENT CHARACTERISTICS The participants were drawn from 11 professions, whereas the non-participants represented only seven. When a l l respondents from both groups were included i n a comparison on the basis of pro- fession, a difference s t a t i s t i c a l l y s i g n i f i c a n t at the p<.005 l e v e l ( x 2 = 47.16, d.f. = 10) was observed (TABLE XIII). When the groups were compared on the basis of equivalent professional categories, the l e v e l of significance f e l l to p<.01 ( x 2 = 11.47, d.f. = 6). The majority, and approximately the same proportions, of both groups were nurses. However, a higher proportion of non- participants were dentists, doctors, s o c i a l workers and physio- therapists, whereas a higher proportion of participants were phar- macists. Removing the l a s t four professions from the group of participants reduced the magnitude of the differences, but d i f - ferences s t i l l remained. Approximately 70 percent of participants compared to only 4 8.5 percent of non-participants were employed i n a ho s p i t a l , whereas 27 percent of non-participants compared to 17 percent of participants were i n private practice (TABLE XIV). The differences between the two groups on the basis of the proportions of respon- dents i n the various types of employment situations were found to be s t a t i s t i c a l l y s i g n i f i c a n t at the p<.01 l e v e l ( x 2 = 14.66, d.f. = 4). 72 T7ABLE XIII PERCENTAGE DISTRIBUTION OF PARTICIPANTS AND NON-PARTICIPANTS BY PROFESSION PROFESSION PARTICIPANTS NON-PARTICIPANTS No. % NO. % Dentistry 10 1.92 9 6.62 Diet e t i c s 5 0.96 1 0.74 Medicine 60 11.52 21 15.44 Nursing 278 53.35 77 56.62 Pharmacy 24 4.61 4 2.94 Rehabilitation Medicine 15 2.88 8 5.88 Social Work 15 2.88 8 5.88 Licensed P r a c t i c a l Nursing 68 13.05 0 0.0 X-Ray Technology 12 2.30 0 0.0 Medical Laboratory Technology 31 5.95 0, 0.0 Medical Records Librarianship 3 0.58 0 0.0.' No Response 0 0.0 8 5.88 TOTALS 521 100.00 136 100.00 EQUIVALENT GROUPS ( F i r s t 7 Professions) x 2 = 11.47 73 TABLE XIV PERCENTAGE DISTRIBUTION OF PARTICIPANTS AND NON-PARTICIPANTS BY EMPLOYMENT CHARACTERISTICS CHARACTERISTICS PARTICIPANTS NON-PARTICIPANTS NO. % No. % FIELD OF Hospital 368 70. 63 66 48. 53 EMPLOYMENT* Private Practice 88 16. 89 37 27. 21 Public Health Agency 25 4. 79 9 6. 62 Social Services Agency 13 2. 50 4 2. 94 Other 7 1. 34 2 1. 47 EMPLOYMENT Full Time 367 70. 44 83 61. 03 STATUS (ns) Part Time 119 22. 84 31 22. 79 Not At Present 28 5. 37 9 6. 62 YEARS OF Mean 10. 8 11. 7 PRACTICE SINCE GRADUATION (ns) Standard Deviation 8. 2 8. 6 CONTINUITY OF Yes 286 54. 89 73 53. 68 PRACTICE SINCE GRADUATION (ns) No 222 42. 61 54 39. .71 * X 2 = 14.66 d.f. = 4 p<.01 No statistically significant differences were observed on the other employment characteristics examined. The majority of both groups (70% of participants and 61% of non-participants) were employed full time ( x 2 = 0.99, d.f. = 2), with the mean length of practice for both between and 10.5 and 12 years (x 2= 7.43, d.f. = 4). Approximately 54 percent of both groups had practiced continuously since graduation (x 2 = 0.02, d.f. = 1). The comparison of participants and non-participants on the basis of demographic and employment c h a r a c t e r i s t i c s i d e n t i f i e d s i g n i f i c a n t differences on three variable: sex, profession and location of employment. S i g n i f i c a n t l y more non-participants than participants were doctors, dentists, physiotherapists and s o c i a l workers, whereas more participants were pharmacists. A greater proportion of non-participants were employed outside a h o s p i t a l . These differences are related. Location of employment probably emerged as a s i g n i f i c a n t variable because the MIRC was located at the h o s p i t a l i n each community. Those whose p r i n c i p a l place of employment was not i n a hospital may have found i t less convenient to p a r t i c i p a t e . The differences on the basis of pro- fession are accounted for i n part by the fact that a s i g n i f i c a n t l y higher proportion of non-participants than participants were mem- bers of professions employed outside a h o s p i t a l . Furthermore, the professions based outside a h o s p i t a l tended to be male-dominated, whereas those based at a hospital tended to be female-dominated. This may help to explain differences noted on the basis of sex. CONTINUING EDUCATION ACTIVITIES Participants and non-participants d i f f e r e d s i g n i f i c a n t l y only on the basis of the number of professional books read. Be- cause the "no response" rate on a l l items was f a i r l y high, s t a t i s - t i c a l calculations were based only on actual responses. The two groups did not d i f f e r s i g n i f i c a n t l y on the basis of the number of short courses or workshops they had attended ( X 2 = 2.701, d.f. = 2) with both means f a l l i n g between 1.5 and 1.8. Approximately 40 percent did not respond (TABLE XV). Non- participants had read a s i g n i f i c a n t l y greater number of professional books than participants ( x 2 = 25.5, d.f. = 3, p<.005), with a mean of 5.8 for participants and 8.0 f o r non-participants, but over 30 percent of both groups f a i l e d to respond. Participants had read an average of 16.9 issues of professional journals and non- participants 17.2, but the difference was not s t a t i s t i c a l l y s i g n i - f i c a n t ( x 2 = 7.75, d.f. = 4). Approximately 16 percent of p a r t i - cipants and 19 percent :of non-participants did not respond. Generally speaking, participants were more f a m i l i a r with the types of media included i n the comparison, except programmed ins t r u c t i o n and f i l m , with which both groups were approximately equally f a m i l i a r . Although a s i g n i f i c a n t l y higher proportion of non-participants f a i l e d to respond to these items, when the two groups were compared and those who f a i l e d to respond were excluded from the comparisons, no s t a t i s t i c a l l y s i g n i f i c a n t differences were observed (TABLE XVI). 76 TABLE XV PERCENTAGE DISTRIBUTION OF PARTICIPANTS AND NON-PARTICIPANTS BY CONTINUING EDUCATION ACTIVITIES ACTIVITIES PARTICIPANTS NON-PARTICIPANTS Standard Standard Mean Deviation Mean Deviation NO. OF WORKSHOPS ATTENDED (ns) 1.75 3.05 1.55 1.75 NO. OF PROFESSIONAL BOOKS READ* 5/85 23.29 7.99 12.42 NO. OF ISSUES OF PROFESSIONAL JOURNALS READ (ns) 16.89 19.54 17.24 18.03 * X 2 = 25.50 d.f. = 3 p<.005 The type of media with which the respondents were most familiar was programmed instruction, which had been ttsed by approximately 41 percent of both groups during the previous year. However, this figure may be inappropriately high, because comments from some of the participants indicated that they misunderstood the term, and the same may have been true of some non-participants. Approximately 41 percent of participants compared to only 25 per- cent of non-participants had used a tape recorder, but the dif- ference was not statistically significant (x 2 = 0.40, d.f. = 1). Less than 2 5 percent of both groups had used tape-slide programs, 77 TABLE XVI PERCENTAGE DISTRIBUTION OF PARTICIPANTS AND NON-PARTICIPANTS BY USE OF MEDIA TYPE OF MEDIA PARTICIPANTS NON-PARTICIPANTS No. o, "O No. % TAPE-RECORDER Yes 215 41.27 34 25. 00 No 277 53.17 26 26. 47 No Response 29 5.56 66 49. 53 x 2 = 0.401 d. f . = 1 n, . s. TAPE-SLIDE Yes 113 21.69 19 13. 97 PROGRAM No 369 70.83 45 33. 09 No Response 39 7.48 72 52. 94 x 2 = 0.878 d. f. = 1 n . s. VIDEO TAPE Yes 97 18.62 12 8. 82 No 382 73.32 43 31. 62 No Response 42 8.06 81 59. 56 x 2 = 0.00 d. f. = 1 n . s. 8mm FILM Yes 80 15 . 36 20 14. 71 No 400 76.78 68 50. 00 No Response 41 7.87 48 35. 29 x 2 = 1.48 d. f . = 1 n . s. PROGRAMMED Yes 214 41.07 56 41. 18 INSTRUCTION No 269 51.63 49 36. 03 No Response 38 7.29 31 22. 79 x 2 = 2.48 d. ,f . = 1 n . s. 78 video tape, and eight millimetre f i l m . The lower "no response" rate among participants may have been due i n part to the fact that they were supervised while they completed the questionnaire, where- as the non-participants were not. The comparison of participants and non-participants on the basis of t h e i r continuing education a c t i v i t i e s during the pre- vious year i d e n t i f i e d s i g n i f i c a n t differences between the two groups only on one variable when the "no response" category was eliminated: non-particants had read more professional books. REACTIONS OF PARTICIPANTS In order to obtain t h e i r reactions to the MIRC project, participants were asked to respond to seven items r e l a t i n g to the nature of the project, the learning environment, the learning materials, the schedule of operation and the location of the MIRC in their community. Response categories and assigned weights were: strongly agree 5, agree 4, undecided 3, disagree 2, and strongly disagree 1. The responses were analyzed on the basis of professions and the communities, i n which they l i v e d . REACTIONS BY PROFESSION The grand mean responses of the participants on a l l items ranged between 4.1 and 4.4 i n d i c a t i n g that they agreed (but not strongly) with the statements (TABLE XVII). Since a l l items were worded p o s i t i v e l y , t h i s was interpreted as a favorable re- T A B L E X V I I P A R T I C I P A N T R E A C T I O N T O T H E M I R C P R O J E C T B Y P R O F E S S I O N I T E M S M E A N R E S P O N S E S * X CO « u EH M en En W n Z W U H — Q „ _ — D X S . D . X S . D . w z a - a ! x E S . D . o z H CO « D 5" ^ S . D . X u u z • CJ ! H a u o o s Q < Cd U O M H Z Z r> H H U M cj 5 « H cd a x " S . D . H £ O S H K D _ ffu CO _ J p. Z x ^ S . D . . . x S . D . x S . D x S . D . o O a s I D . x o M X i s . D . CO Z I u S a z o • J CO < S . L . P r o b . F T h e M I R C p r o - 4 . 2 1 . 5 0 . 5 4 . 4 4 . 4 1 . 0 4 . 5 0 . 7 4 . 4 1 . 1 4 . 6 0 . 5 4 . 4 0 . 5 4 . 4 1 . 1 4 . 3 0 . 8 4 . 2 0 . 8 4 . 7 0 . 6 4 . 4 0 . 8 N . S . ? v i d e s a w o r t h - w h i l e o p p o r - t u n i t y f o r m e t o c o n t i n u e m y p r o f e s s i o n a l e d u c a t i o n T h e a u d i o v i s u a l d e - v i c e s i n t h e • M I R C f a c i l i - t a t e e f f e c - t i v e l e a r n i n g e x p e r i e n c e s 4 . 0 1 . 5 4 . 3 0 . 8 4 . 5 0 . 8 4 . 5 0 . 6 4 . 5 1 . 1 4 . 5 0 . 5 4 . 3 0 . 5 4 . 2 1 . 1 4 . 7 0 . 5 4 . 3 0 . 5 4 . 7 0 . 6 4 . 4 0 . 8 N . S . T n e M I R C p r o - 3 . 9 1 . 5 3 . 8 0 . 4 4 . 2 0 . 8 4 . 2 0 . 7 4 . 0 1 . 1 3 . 7 1 . 0 4 . 2 0 . 6 4 . 4 . 1 . 1 3 . 8 1 . 1 3 . 6 0 . 8 2 . 0 0 . 0 4 . 1 0 . 8 . 0 0 0 0 1 v i d e s m a t e r i a l s p e r t i n e n t t o m y n e e d s E n v i r o n m e n t 4 . 0 1 . 9 4 . 3 0 . 4 4 . 2 0 . 8 4 . 2 0 . 6 4 . 2 1 . 0 4 . 3 0 . 6 4 . 1 0 . 7 4 . 1 1 . 1 4 . 3 0 . 9 4 . 2 0 . 7 4 . 7 0 . 6 4 . 2 0 . 9 N . S . f a c i l i t a t e s c o n c e n t r a t i o n L a y o u t i s e f f i c i e n t . 3 1 . 6 4 . 8 0 . 4 4 . 2 0 . 8 4 . 3 0 . 7 4 . 3 1 . 0 4 . 0 0 . 5 3 . 9 0 . 5 3 . 9 1 . 1 4 . 2 0 . 5 4 . 4 0 . 6 4 . 7 0 . 6 4 . 3 0 . 8 N . S . H o u r s o f o p e r a - 4 . 3 1 . 6 4 . 8 0 . 4 4 . 1 0 . 9 4 . 3 0 . 7 4 . 1 1 . 1 4 . 0 0 . 7 4 . 1 0 . 5 4 . 0 1 . 2 4 . 4 0 . 5 4 . 4 0 . 5 4 . 7 0 . 6 4 . 3 0 . 9 « . S . t i o n w e r e c o n - v e n i e n t L o c a t i o n w a s 4 . 3 1 . 6 4 . 8 0 . 4 4 . 4 0 . 8 4 . 5 0 . 6 4 . 1 1 . 2 4 . 3 0 . 5 4 . 0 0 . 9 4 . 3 1 . 1 4 . 5 0 . 5 4 . 6 0 . 5 4 . 7 0 . 6 4 . 4 Q 0 . 8 . 0 , c o n v e n i e n t * R e s p o n s e W e i g h t s : S t r o n g l y A g r e e = 5 A g r e e = 4 U n d e c i d e d = 3 D i s a g r e e = 2 S t r o n g l y D i s a g r e e = 1 80 action to those aspects of the project referred to i n the state- ments . The items with the highest grand means (4.4), and on which there were no s i g n i f i c a n t differences among the professional groups, were: "The MIRC provides a worthwhile opportunity for me to continue my professional education," and "The audio v i s u a l de- vices i n the MIRC f a c i l i t a t e e f f e c t i v e learning experiences." This suggests that a l l of the groups tended to react favorably to the e s s e n t i a l nature of the project. A t h i r d item, "The location (of the MIRC) was convenient." which also had a grand mean of 4.4, did show s i g n i f i c a n t differences among the various professions (p<.04). This r e s u l t appears to be related to differences among the professions on the basis of location of employment, discussed e a r l i e r . The item with the lowest grand mean (4.1), on which s i g n i f i c a n t differences among the professions were also observed (p<.001), was "The MIRC provides materials pertinent to my needs." The low ra t i n g and the differences between the professional groups i s undoubtedly due to the fact that the MIRC contained no materials s p e c i f i c a l l y intended for certa i n participants. REACTIONS BY LOCATION The grand means for each item ranged between 4.1 and 4.4, as described above; however, an F test determined that there were s i g n i f i c a n t differences among the mean rating of the various communities on a l l of the items (TABLE XVIII). To determine whether T A B L E X V I I I P A R T I C I P A N T R E A C T I O N T O T H E M I R C P R O J E C T B Y L O C A T I O N M E A N R E S P O N S E S * U m § * ° H S " ft £ g ITEMS | g - s - a • 8 • 8 l § i I ' a« gg g £ i 1 I I as » * s § s Is I I I § < w c5 2 wrt J J rt to w 0 , 0 ; u r n - , p x S . D . x S . D . x S . D . x S . D . x S . D . X S . D . x S . D . X S . D . x S . D . x S . D . x S . D . x S . D . x S . D . x S . D . x S . D . X S . D . x S . D . P r o b . CO u 1 0 !x M 3 rt EH z H o M z < EH g 2 a. H a 33 •a Hi O U rt rt cj T h e MIRC 3 . 4 2 . 1 4 . 4 1 . 1 4 . 2 1 . 3 4 . 2 1 . 5 4 . 4 0 . 7 4 . 3 0 . 5 4 . 0 0 . 8 4 . 0 0 . 9 4 . 7 0 . 5 4 . 7 0 . 5 4 . 4 0 . 5 4 . 5 0 . 5 4 . 4 0 . 5 4 . 5 0 . 7 4 . 3 0 . 6 4 . 7 0 . 5 4 . 4 0 . 8 . 0 0 0 2 p r o v i d e s a w o r t h w h i l e o p p o r t u n i t y f c r me t o c o n t i n u e my p r o f e s s i o n a l e d u c a t i o n T h e a u d i o 3 . 3 2 . 0 4 . 4 1 . 1 4 . 2 1 . 3 4 . 4 . 1 . 1 4 . 3 0 . 5 4 . 7 0 . 7 4 . 3 0 . 6 4 . 6 0 . 5 4 . 5 0 . 5 4 . 5 0 . 6 4 . 4 0 . 5 4 . 6 0 . 6 4 . 5 0 . 5 4 . 5 0 . 6 4 . 5 0 . 5 4 . 6 0 . 6 4 . 4 0 . 8 . 0 0 0 1 v i s u a l d e v i c e s f a c i l i t a t e e f f e c t i v e l e a r n i n g ' e x p e r i e n c e s T h e MIRC 2 . 9 1 . 9 4 . 2 0 . 8 3 . 8 1 . 3 3 . 7 1 . 1 4 . 3 0 . 6 4 . 3 0 . 9 4 . 0 0 . 4 4 . 3 0 . 6 4 . 0 0 . 6 4 . 1 0 . 7 4 . 2 0 . 7 4 . 2 0 . 7 4 . 1 0 . 7 3 . 9 0 . 7 4 . 2 0 . 7 4 . 3 0 . 7 4 . 1 0 . 8 . 0 0 0 1 p r o v i d e s m a t e r i a l s p e r t i n e n t t o my n e e d s E n v i r o n m e n t 3 . 1 2 . 0 4 . 4 1 . 0 4 . 0 1 . 3 4 . 3 1 . 1 4 . 3 0 . 7 4 . 6 0 . 5 4 . 7 0 . 5 4 . 3 0 . 6 4 . 4 0 . 6 4 . 1 0 . 7 4 . 1 0 . 9 4 . 1 0 . 9 4 . 2 0 . 6 4 . 1 1 . 0 4 . 2 0 . 4 4 . 2 0 . 9 4 . 2 0 . 9 . 0 0 4 f a c i l i t a t e s c o n c e n t r a - t i o n L a y o u t i s 3 . 3 2 . 0 4 . 3 1 . 1 4 . 0 1 . 3 4 . 1 1 . 1 4 . 5 0 . 5 4 . 3 0 . 5 4 . 3 0 . 8 4 . 4 0 . 7 4 . 5 0 . 6 4 . 3 0 . 6 4 . 4 0 . 6 4 . 3 0 . 6 4 . 2 0 . 6 4 . 3 0 . 8 4 . 3 0 . 6 4 . 4 0 . 6 4 . 3 0 . 8 . 0 0 0 5 e f f i c i e n t H o u r s o f 3 . 3 2 . 0 4 . 6 0 . 5 4 . 0 1 . 3 3 . 9 1 . 5 4 . 4 0 . 6 4 . 6 0 . 5 4 . 3 0 . 5 4 . 7 0 . 5 4 . 5 0 . 7 4 . 7 0 . 6 4 . 2 0 . 8 4 . 4 0 . 5 4 . 1 0 . 5 4 . 4 0 . 5 4 . 3 0 . 6 4 . 3 0 . 8 4 . 3 0 . 9 . 0 0 0 1 o p e r a t i o n w e r e c o n v e n i e n t • • ' L o c a t i o n 3 . 3 2 . 0 4 . 8 0 . 4 4 . 2 1 . 3 4 . 1 1 . 2 4 . 5 0 . 5 4 . 6 0 . 5 4 . 5 0 . 5 4 . 7 0 . 5 4 . 7 0 . 5 4 . 5 0 . 5 4 . 5 0 . 5 4 . 5 0 . 5 4 . 4 0 . 5 4 . 4 0 . 8 4 . 5 0 . 5 4 . 4 0 . 7 , 4 . 4 0 . 8 . 0 0 0 1 v a s c o n v e n i e n t • R e s p o n s e W e i g h t s : S t r o n g l y A g r e e = 5 A g r e e = 4 U n d e c i d e d = 3 D i s a g r e e = 2 S t r o n g l y D i s a g r e e = 1 82 these differences were related to the size of the communities or t h e i r distance from Vancouver, Pearsonian correlations were c a l - culated between ratings on each item and 1) the population of each community, and 2) t h e i r distance i n miles from Vancouver. None of the correlations between pa r t i c i p a n t s ' responses and the population of communities was s t a t i s t i c a l l y s i g n i f i c a n t (TABLE XIX). Therefore, i t appears that community s i z e was not a factor that accounted for differences i n the mean ratings. A l l of the correlations between responses and distance from Vancouver were negative, with three s i g n i f i c a n t at the p<.05 l e v e l or less, and three tending toward s i g n i f i c a n c e . This suggests that remoteness from Vancouver may have been a factor which accounted for a portion of the difference i n the mean r a t - ings, with those nearer Vancouver tending to react more favorably than those farther away. This negative rel a t i o n s h i p may be due in part to the fact that 19 of the 36 item means that f e l l below the grand means were recorded i n the f i r s t four communities v i s i t e d , which were also the farthest from Vancouver. The low ratings i n these communities may have been due i n part to the inexperience of the f i e l d supervisors who were learning how to act as f a c i l i t a t o r s as the project proceeded. If t h i s was a factor, i t may account for the very low ratings i n Armstrong, the f i r s t community v i s i t e d . The mean responses to each of the items were tested and inspected i n an attempt to account further for the differences noted i n the mean reactions of the various communities. Possible 83 TABLE XIX CORRELATIONS BETWEEN PARTICIPANTS' REACTIONS AND COMMUNITY SIZE, AND DISTANCE FROM VANCOUVER REACTION ITEMS POPULATION Corre- lation" Level of S i g r i i f i - carice • DISTANCE FROM VANCOUVER Level of Corfe- S i g n i f i - c a t i o n carice The MIRC provides a worthwhile opportunity for me to continue my professional education r = 0.14 n.s. r = -0.52 p<.02 The audio v i s u a l devices i n the MIRC f a c i l i t a t e e f f e c t i v e learning experiences r = 0.05 n.s r = -0.44 p<.04 The MIRC provides materials pertinent to my needs r = 0.07 n.s. r = -0.37 p<.07 Environment f a c i l i t a t e s concentration r = -0.08 n.s, r--= -0.25 n.s Layout i s e f f i c i e n t Hours of operation were convenient r = 0.16 n.s, r = -0.005 n.s, r = -0.46 p<:63 r = -0 .38 p<.07 Location was convenient r - 0.07 n.s. r = -0.38 p<.07 84 explanations were found only for four, which are discussed below. No s t a t i s t i c a l l y s i g n i f i c a n t relationships were found to e x i s t be- tween the reaction scores and p a r t i c i p a t i o n rates. The low means recorded i n the f i r s t four communities w i l l be noted, but not d i s - cussed . For the f i r s t item: "The MIRC provides a worthwile opportunity for me to continue my professional education", three of the seven means below the grand mean (4.4) were recorded i n the f i r s t four communities. Three others were recorded i n Lytton (4.0), L i l l o o e t (4.3), and Ashcroft (4.3), whose participants rates in the MIRC project were lower than rates i n other communities with hospitals of similar s i z e , and which provided no participants i n other Division a c t i v i t i e s . There may have been a general lack of i n t e r e s t i n continuing education in these communities,during t h i s period. For the t h i r d item: "The MIRC provides materials per- tinent to my needs", communities (other than the f i r s t four) whose reaction scores were below the grand mean (4.1) tended to have a higher proportion of participants drawn from those professions for whom no s p e c i f i c materials were provided than did communities re- cording higher means. On the f i f t h item: "The environment f a c i l i t a t e s concen- t r a t i o n " , communities with the largest numbers of participants re- corded the lowest means. Because space i n the MIRC was l i m i t e d , movement' and conversation i n the learning area were d i s t r a c t i n g . 85 The r e l a t i v e l y low grand mean (4.2) indicates that this was a con- cern where the largest numbers part i c i p a t e d . However, t h i s rating indicates that, on the whole, participants f e l t that the environ- ment d i d i n fact f a c i l i t a t e concentration. For the l a s t item: "The location of the MIRC was con- venient", communities recording the highest means: Ashcroft (4.7), Squamish (4.7) and L i l l o o e t (4.6) were those i n which the MIRC was c l e a r l y v i s i b l e to anyone approaching the hospital and was only a few yards from a major entrance or e x i t . The only means below the grand mean (4.4) were recorded i n the f i r s t four communities. RANKINGS OF ALTERNATIVE DELIVERY SYSTEMS In order to determine the respondents' preferences for continuing education delivery systems, both participants and non- participants were asked to rank eight d i f f e r e n t systems. A forced choice rank ordering was used. The approach that was f i r s t i n the rank ordering by the group of respondents as a whole was an audio v i s u a l learning sta- tion located i n the hospital (TABLE XX). Continued v i s i t s by the MIRC were second, and lectures, seminars, etc. given by q u a l i f i e d people from outside the l o c a l health care community were t h i r d . Least preferred was a loan system for books, journals, etc. Participants included the same three approaches as the entire group of respondents i n their most preferred choices; how- ever, continued v i s i t s by the MIRC received a s l i g h t l y lower mean 86 rank than did a learning station i n the h o s p i t a l , and were there- fore the par t i c i p a n t s ' preferred approach by a s l i g h t margin. Least preferred were lectures, seminars, etc. given by members of the l o c a l health community and a loan system for books, journals and other p r i n t materials. TABLE XX PARTICIPANTS' AND NON-PARTICIPANTS' RANKINGS OF ALTERNATIVE DELIVERY SYSTEMS ALL NON- DELIVERY SYSTEMS RESPONDENTS PARTICIPANTS PARTICIPANTS Mean Rank Mean Rank Mean Rank Rank Order Rank Order Rank Order Audio Vi s u a l Learning Station i n the Hospital 2.81 1 ... \3>22 2 .'4.59 5 Continued V i s i t s by the MIRC 3.69 2 3.19 1 5.43 8 Lectures, Seminars, etc. Given by Outside Leaders 4.08 3 3.95 3 5.07 7 Hospital Library 4.14 4 4.45 4 2.46 1 Lectures, Seminars, etc. Given by Local Leaders 4.45 5 5.09 7.5 4.28 4 Loan System f o r ; •• • . Audio Vi s u a l ' Materials 4.85 6 4.88 5 3.97 3 Conferences, Workshops, etc. i n Larger Centres 5.04 7 4.95 6 3.32 2 Loan System for P r i n t Materials 5.98 8 5.09 7.5 4.88 6 87 A Spearman rank cor r e l a t i o n c o e f f i c i e n t calculated to test the relationship between the rank ordering assigned to the means was not s t a t i s t i c a l l y s i g n i f i c a n t (r = -0.398, d.f. = 8); nor was a Pearsonian c o r r e l a t i o n calculated between the mean ranks assigned to each item (r = -Q.,449,d.f. = 8, n.s.). This indicates that the two groups were d i s s i m i l a r i n th e i r preferences for edu- cational delivery systems. Indeed, comparing i n d i v i d u a l items re- vealed important differences. Understandably, continued v i s i t s by the MIRC was the approach most preferred by participants and lea s t preferred by non- participants, probably because participants, having made the de- c i s i o n to p a r t i c i p a t e and having invested time i n doing so, tended to be biased i n i t s favor; whereas non-participants had no basis on which to form an opinion. The second preference of p a r t i c i - pants (an audio-visual learning station i n the hospital) was the f i f t h choice of non-participants. This may be due i n part to the fact that a s i g n i f i c a n t l y greater proportion of non-participants were employed outside a hos p i t a l and therefore would not f i n d i t convenient to use a learning station located there. However, the t h i r d preference of non-participants was a loan system for audio-visual materials, i n d i c a t i n g some in t e r e s t i n using media for learning. The f i r s t choice of non-participants (a hos- p i t a l l i b rary) was fourth preference of participants, a r e s u l t consistent with the finding reported e a r l i e r that non-participants tended to read a greater number of books. The second preference 88 of non-participants (conferences and workshops in larger centres) was the sixth choice of participants. Because a greater propor- tion of participants were women working in hospitals, family and employment demands may have made it more difficult for them to get away. REASONS FOR NOT PARTICIPATING Non-participants were asked to indicate why they did not participate in the MIRC project by selecting one of nine reasons from a list or by writing in a reason not listed. Over 90 percent indicated in a previous item that they had been aware that the MIRC was in their community; so ignorance of its availability was discarded as a reason. Approximately 60 percent indicated that a demanding work schedule, family responsibilities, or holidays pre- vented them from participating (TABLE XXI). Practical problems related to the nature and operation of the project accounted for the reasons of only three percent. Other reasons such as illness accounted for approximately 7 percent, and 27 percent did not re- spond. Therefore, although more effective publicity might have some effect, the majority of the reasons cited do not suggest ways in which the project could be altered to improve participation. TABLE XXI PERCENTAGE DISTRIBUTION OF REASONS FOR NOT PARTICIPATING IN THE MIRC PROJECT 89 REASONS ALL RESPONDENTS No. My work schedule was too demanding 33 24.26 Family r e s p o n s i b i l i t i e s took up too much of my lei s u r e time 25 18.38 I was away on holidays 22 16.18 Community r e s p o n s i b i l i t i e s took up too much of my lei s u r e time 3.68 The MIRC was not at a convenient location 1.47 The hours of MIRC operation were not convenient 1.47 Other reasons 10 7.35 No response 37 27.21 TOTALS 136 100.00 90 SUMMARY The majority of the respondents were married females be- tween the ages of 26 and 49, who were employed on a f u l l - t i m e basis as nurses i n a h o s p i t a l . They had practiced continuously since graduation for an average of 10.8 years, had attended two workshops during the year p r i o r to the MIRC's v i s i t , and had read an average of six professional books and 17 issues of professional journals during the same period. They had made r e l a t i v e l y l i t t l e use of audio v i s u a l media for learning. There were no s i g n i f i c a n t differences between p a r t i c i - pants and non-participants on the basis of age, marital status, and location of most recent professional education; but a s i g n i f i - cantly greater proportion of participants were female and of non- participants male. Both groups had read approximately the same number of issues of professional journals and had used media for learning to approximately the same extent. However, non- participants had read s i g n i f i c a n t l y more books. The two groups did not d i f f e r s i g n i f i c a n t l y on the basis of employment status, number of years of practice since graduation and continuity of practice since graduation. However, a s i g n i f i c a n t l y high propor- ti o n of participants were pharmacists, and of non-participants were dentists, doctors, physiotherapists and s o c i a l workers. A s i g n i f i c a n t l y higher proportion of participants were employed i n a hospital, and non-participants i n private p r a c t i c e . 91 On the whole , participants 1 reactions to the MIRC pro- ject appear to have been favorable, although there were differences among the professions and the communities on individual items. Professions employed at a hospital tended to react more favorably to the location of the MIRC than those based outside, and groups for whom specific materials were provided tended to react more favorably than those who had to "borrow" materials from other pro- fessions. Differences among the mean reactions of the various com- munities could not be explained by differences in community size or participation rates, which were not significantly related to reaction scores; but were accounted for in part by distance from Vancouver which was negatively related to mean reactions on several items. This negative relationship may have been partly due to the relative inexperience of the field supervisors in the first four communities, whose ratings were among the lowest and which were the most distant. Other factors which may have accounted for some of the differences were: a possible lack of interest in continuing education in some communities; the lack of profession-specific materials for some groups; the difficulty of coping with large numbers of learners at one time; and the location of the MIRC in terms of its visibility'.and"accessibility. Respondents' rankings of alternative delivery systems for continuing education indicated that an audio visual learning station in a hospital was preferred, that continued visits by the MIRC was second, and that a loan system for print materials was least 92 preferred. The rank orderings assigned by participants and non- participants were not s i g n i f i c a n t l y related. Participants preferred the same three approaches as the group of respondents as a whole, although continued v i s i t s by the MIRC was t h e i r f i r s t choice. Lectures, seminars, etc. by l o c a l leaders and a loan system for p r i n t materials were least preferred. Non-participants, however, preferred using a hospital l i b r a r y or attending conferences or workshops i n larger centres. Continued v i s i t s by the MIRC was th e i r least preferred approach. The majority of non-participants c i t e d a demanding work schedule, family r e s p o n s i b i l i t i e s , or holidays as reasons for not p a r t i c i p a t i n g . Very few gave reasons that suggested ways in which the project could be altered to improve p a r t i c i p a t i o n . 93 CHAPTER V SUMMARY, CONCLUSIONS AND IMPLICATIONS SUMMARY The purpose of thi s study was to describe the P.A. Wood- ward Mobile Instructional Resource Centre Project and to analyze i t s r o le i n continuing professional education i n the health f i e l d for those resident i n iso l a t e d r u r a l areas i n B r i t i s h Columbia. Data were obtained on the demographic and employment c h a r a c t e r i s t i c s , continuing education a c t i v i t i e s , and reactions to the project of 521 participants i n 11 professional categories, resident i n 17 communities v i s i t e d by the MIRC between August 1, 1973 and March 31, 1974. Data were obtained on the c h a r a c t e r i s t i c s , continuing education a c t i v i t i e s , and the reasons for non- pa r t i c i p a t i o n of 136 (40.8%) of 333 non-participants i n seven professional categories. The P.A. Woodward Mobile Instructional Resource Centre Project was one of a number of delivery systems used by the D i v i - sion of Continuing Education i n the Health Sciences at the Uni- v e r s i t y of B r i t i s h Columbia to provide learning opportunities for r u r a l health professionals in the i r home communities during the early 1970's. The central feature of the project was a highway bus that had been converted into a mobile continuing education f a c i l i t y containing three audio v i s u a l learning stations and over 1300 audio v i s u a l programs. The MIRC spent a sixty-hour week at the hos p i t a l i n each community v i s i t e d . The project was supervised by an i n t e r - professional committee i n the Div i s i o n of Continuing Education i n the Health Sciences and was operated by a f i e l d supervisor who was a graduate student i n adult education. A t o t a l of 521 health p r a c t i t i o n e r s i n 11 professional categories, representing approximately 41 percent of the potential participants, took part i n the MIRC project during the period con- cerned. P a r t i c i p a t i o n rates were s i g n i f i c a n t l y higher among pro- fessions for whom the D i v i s i o n regularly provided other forms of learning opportunities than among those for whom i t did not, and higher to a degree that tended toward si g n i f i c a n c e among profes- sions employed outside a hos p i t a l than among hospital-based pro- fessions. P a r t i c i p a t i o n rates were not s i g n i f i c a n t l y related to the distance of communities from Vancouver eith e r i n terms of miles or t r a v e l time, but were negatively related to the size of the lo c a l hospitals. Rates i n communities with hospitals having 40 beds or fewer were s i g n i f i c a n t l y higher than i n those with larger hospitals. During the same period, a t o t a l of 2474 B r i t i s h Columbia health professionals from six professions, representing approxi- mately 15 percent of the po t e n t i a l p a r t i c i p a n t s , took part i n 7 5 short courses and workshops conducted by the D i v i s i o n . For the six professions normally served by the regular programming of the Div i s i o n , the o v e r - a l l p a r t i c i p a t i o n rate i n 95 the MIRC project was. s i g n i f i c a n t l y higher than the o v e r - a l l rate for other Di v i s i o n a c t i v i t i e s , as were the rates for nursing, pharmacy, and r e h a b i l i t a t i o n medicine. The differences i n rates for the other three professions were not s t a t i s t i c a l l y s i g n i f i c a n t . Limiting the comparison to health professional from those communities served by the MIRC project, 101 of whom p a r t i c i - pated i n other D i v i s i o n a c t i v i t i e s and 392 i n the MIRC project, i t was found that the o v e r - a l l rate for D i v i s i o n a c t i v i t i e s of other types was s i g n i f i c a n t l y lower than the rate for the MIRC project and that the same was true for four professional groups: d i e t e t i c s , nursing, pharmacy and r e h a b i l i t a t i o n medicine. There was no s i g n i - f i c a n t difference for dentistry and medicine. Making the comparison on the basis of in d i v i d u a l communi- t i e s , i t was found that p a r t i c i p a t i o n rates i n the MIRC project were s i g n i f i c a n t l y higher than rates i n other D i v i s i o n programs for a l l but one of the communities v i s i t e d by the MIRC. On the whole, i t appears that the MIRC project served a di f f e r e n t set of individuals than did other D i v i s i o n programs. Of a combined t o t a l of 443 participants from communitiescvisited by the MIRC, only 50 (11.3%) participated both i n the MIRC project and at least one other Div i s i o n a c t i v i t y . The number of common p a r t i - cipants i n most locations was less than 10 percent of the t o t a l number from that location. Moreover, the MIRC project served a number of professions for whom the Div i s i o n did not o r d i n a r i l y provide learning opportunities. 96 The cost of operating the MIRC project during the period concerned was $42,500.28 compared to $159,518.64 for other D i v i - sion programs. On the basis of the cost-per-participant-hour-of- i n s t r u c t i o n , the cost of the MIRC project ($16.44) was approxi- mately four times as high as the equivalent cost for other D i v i - sion a c t i v i t i e s ($3.89). Costs to participants and t h e i r employers were not available and therefore were not included i n the calcu- lations . The majority of the 657 respondents from whom data were obtained i n the MIRC project were married females between the ages of 26 and 49 who were employed on a f u l l - t i m e basis as nurses in a h o s p i t a l . They had obtained t h e i r most recent professional education i n B r i t i s h Columbia or another Canadian province and had practiced continuously for a period of 15 years or less since graduation. During the year p r i o r to the MIRC's v i s i t , they had attended an average of two workshops, and had read an average of six professional books and 17 issues of professional journals. When participants and non-participants were compared on the basis of demographic and employment c h a r a c t e r i s t i c s and con- tinuing education a c t i v i t i e s , a number of s t a t i s t i c a l l y s i g n i f i c a n t differences were i d e n t i f i e d . A s i g n i f i c a n t l y greater proportion of participants were female while more non-participants were male. A s i g n i f i c a n t l y : h i g h e r .proportion of - participants were pharmacists while more non-participants were dentists, doctors, physiotherapists, and s o c i a l workers. A s i g n i f i c a n t l y higher proportion of p a r t i c i - 97 pants were employed i n a ho s p i t a l , and non-participants i n private p r a c t i c e . Non-participants had read s i g n i f i c a n t l y more books. The two groups did not d i f f e r s i g n i f i c a n t l y on the other variables examined. On the whole, p a r t i c i p a n t s 1 reactions to .the project appear to have been favorable as measured by a f i v e point reaction scale on which the mean reaction score for a l l items was between 4.1 and 4.4. S i g n i f i c a n t differences encountered among the various professional groups appear to be attributed to the location of employment and the lack of professi o n - s p e c i f i c materials for some groups. S i g n i f i c a n t differences were also encountered among the various communities on a l l items. Distance from Vancouver was negatively related to reaction scores on three items, in d i c a t i n g that respondents i n communities nearer Vancouver l i k e d those as- pects of the project better than did those l i v i n g farther away. This r e s u l t may have been due i n part to e f f e c t s of the inexperience of the f i e l d supervisors i n the f i r s t few communities, which were the most remote. Other factors which may have accounted for d i f - ferences on some of the items are: a possible lack of i n t e r e s t i n continuing education i n some communities; the lack of profession- s p e c i f i c materials for certa i n groups; the d i f f i c u l t y of coping with large numbers of learners i n the learning environment at one time; and the location of the MIRC i n terms of i t s v i s i b i l i t y and a c c e s s i b i l i t y . 98 Respondents' rankings of eight alternative delivery systems for continuing education indicated that an audio-visual learning station i n a hospital was preferred, that continued v i s i t s by the MIRC was second, and that a l o a n system f o r p r i n t materials was l e a s t preferred. The rank orderings as- signed by participants and non-participants were not s i g n i f i c a n t l y related. Participants' f i r s t choice was continued v i s i t s by the MIRC, which were lea s t preferred by non-participants, whose f i r s t choice was using a hospital l i b r a r y . P a r t i c i p a n t s ' second choice was an audio-visual learning s t a t i o n i n a h o s p i t a l , whereas ..the second choice of non-participants was conferences and workshops i n larger centres. Neither group favored a loan system for p r i n t materials. The majority of non-participants c i t e d p r a c t i c a l pro- blems such as demanding work schedules, family r e s p o n s i b i l i t i e s and absence due to holidays as reasons for not p a r t i c i p a t i n g . Very few gave reasons that suggested ways i n which the project could be altered to improve p a r t i c i p a t i o n . CONCLUSIONS The Mobile Instructional Resource Centre appears to be an e f f e c t i v e system for d e l i v e r i n g continuing education to r u r a l health professionals because p a r t i c i p a t i o n rates for most profes- sional groups and in most communities were higher than rates i n other programs provided during the same period, and because i t 99 reached a substantial number of professionals not reached by the other programs. It also appears to be a system that is acceptable to the people it is intended to serve because the reactions of most of the participants to the project were favorable. Although it is more expensive than other delivery systems when only costs to the provider are considered, this may change when costs to participants and employers are included. Therefore, it appears that the MIRC Project is an acceptable, effective, and potentially economical system to deliver continuing education in the health sciences to rural areas. IMPLICATIONS FOR CONTINUING EDUCATION- On the basis of this study's findings, an audio-visual learning station located in a hospital is an attractive continuing education delivery system to rural health workers. Therefore, carrels such as those in the MIRC should be set up on a trial basis in a number of hospitals and a study made of their utiliza- tion. To be effective, however, this approach must be supported by a centralized loan system for audio-visual materials and by properly-trained technicians,to service the equipment and materials as necessary. Since non-participants expressed a preference for using a hospital library, it is important to ensure that all hospitals have libraries equipped with properly catalogued reference materials and appropriate periodicals. Learning stations should be located in or near the libraries and be supplemented by articles and other 100 relevant reference material. . In order to provide the necessary support systems for the l i b r a r i e s and learning stations i n the l o c a l hospitals, a learning resources network i s necessary to l i n k the regional hos- p i t a l s or the community colleges with a major central resource centre, possibly the Bio-Medical Library at the University of B r i t i s h Columbia. Non-participants expressed an in t e r e s t i n a loan system for audio v i s u a l materials to be used outside the l o c a l h o s p i t a l . Such a system could be operated from the hos p i t a l l i b r a r y or through the learning resources network. Before t h i s i s encouraged, c r i t e r i a should be established to ensure that formats for audio visualnmaterials are standardized and compatible with e a s i l y accessible and inexpensive playback equipment. Topical materials for hospital l i b r a r i e s , learning sta- tions and learning resources network could be determined i n a num- of ways: 1) analysis of the topics of programs used i n the MIRC; 2) analysis of epidemiological data; 3) analysis by region of the results of self-assessment tests conducted by professional jour- nals; 4) written simulations and self-assessment tests developed by the Di v i s i o n of Continuing Education i n the Health Sciences at the University of B r i t i s h Columbia. Because the participants i n the MIRC and other programs in this study represented less than 50 percent of the poten t i a l c l i e n t e l e , other distance education systems should be investigated. The f i r s t step should be to fin d out who the poten t i a l participants 101 are Cprofession, specialty, e t c . ) , where they are located, what types of continuing education a c t i v i t i e s they p a r t i c i p a t e i n at present, which they prefer, why they did not appear i n any of the facets of t h i s study, and other relevant information. This i n f o r - mation w i l l form a basis for selecting other approaches. The MIRC project suggests that learning opportunities offered i n the l o c a l communities are l i k e l y to a t t r a c t a larger proportion of the potential participants than those offered else- where. Examples with strong pot e n t i a l for B r i t i s h Columbia are: 1. Educational experiences planned and organized by appropriately trained l o c a l co-ordinators such as the network of co-ordinators associated with the D i v i s i o n of Continuing Pharmacy Education at the University of B r i t i s h Columbia. Members of the network plan and conduct programs for th e i r colleagues. 2. Off-campus courses and workshops planned by major education i n s t i t u t i o n s . 3. Two-way audio and video t e l e v i s i o n l i n k s connecting r u r a l communities with major centres. Because of the mountainous t e r r a i n , satellite.:transmission would be more appropriate than micro-wave transmission i n B r i t i s h Columbia. The present Hermes s a t e l l i t e i s suitable for t h i s purpose on a short-term basis. 4. Telephone d i a l access systems and telephone consul- tation services to provide assistance with s p e c i f i c patient manage- ment problems. However, while these services have been well- received elsewhere, the p r i n c i p l e users: nurses, doctors, dentists 102 and pharmacists, have not always been w i l l i n g to support the costs of operation. 5. Telephone conference systems. However, locations in which these have been successful have not been as mountainous as B r i t i s h Columbia and therefore higher costs of establishing s u i t - able telephone linkages may make them less f e a s i b l e i n this province. IMPLICATIONS FOR THE MIRC PROJECT Because of the high p a r t i c i p a t i o n rates and the favor- able reactions of participants, i t seems appropriate to continue the project. The present vehicle, which has serious mechanical pro- blems, should be replaced with a t r a c t o r - t r a i l e r combination. This would allow the f i e l d supervisor to t r a v e l independent of the t r a i l e r unit when required. Because of the problems of providing educational a c t i - v i t i e s for distant learners, the p r i n c i p a l objectives of the pro- ject should be 1) to stimulate i n t e r e s t i n the use of i n s t r u c t i o n a l media for independent learning, and 2) to a s s i s t with the develop- ment of l o c a l continuing education resources. The MIRC should be staffed by two f i e l d supervisors trained i n adult education and other matters related to the pro- j e c t . This would 1) permit maximizing the hours of operation with- out increasing the load on a single f i e l d supervisor; and 2) allow the f i e l d supervisors to lead and develop l o c a l discussion groups, 103 and work with, l o c a l educators (.co-ordinators of Continuing Phar- macy Education, in-service educators, chairmen of medical education committees, etc.) on matters pertinent to t h e i r i n t e r e s t s . The present p o l i c y of giving preference to smaller hos- p i t a l s should be continued. However, to afford maximum opportunity for p a r t i c i p a t i o n , the length of v i s i t s should be related to the size of the hospita l , with no less than f i v e days being spent i n any location and a maximum of 10 days i n locations with hospitals up to 100 beds i n s i z e . Because of space l i m i t a t i o n s i n the MIRC, no community with a hospital larger than 100 beds should be i n - cluded i n the i t i n e r a r y . The audio v i s u a l holdings should be expanded to include materials for a l l professions the project i s intended to serve. At present, the majority of the programs are intended for doctors, nurses, dentists and pharmacists. Because personnel i n small hos- p i t a l s form close-knit communities, i t seems appropriate to pro- vide materials for a l l workers d e l i v e r i n g d i r e c t patient care. This means that programs for d i e t i t i a n s , medical laboratory tech- nologists, medical records l i b r a r i a n s , occupational therapists, physiotherapists, X-ray technicians and ambulance attendants should be added. Space limi t a t i o n s i n the vehicle may make i t inappro- priate to try to include i n s t i t u t i o n a l support personnel?;-.(house- keeping, maintenance, laundry, e t c . ) . Group sessions i n the hos- p i t a l could be planned for them. A lending l i b r a r y of p r i n t materials should augment the 104 holdings to provide opportunity for i n depth study of selected topics. The second phase of the project should involve a change i n focus with comprehensive treatments of spe c i a l i z e d areas re- placing the present general introduction to i n s t r u c t i o n a l media. Topics i n demand at the present time are cardio-pulmonary resus- c i t a t i o n and the management of pain. One f i e l d supervisor should be a content expert who could conduct learning experiences for health professionals and the public while audio v i s u a l treatments of the topic were available i n the MIRC. If the MIRC project cannot continue i n i t s present form, the c a r r e l s , equipment and materials should be used to establish a p i l o t project with learning stations located i n three hospitals. Possible locations are A l e r t Bay, Enderby and L i l l o o e t , which are t y p i c a l of hospitals the project was intended to serve because of thei r small size and remoteness from Vancouver. If thi s i s not feas i b l e , the materials should become part of a loan system oper- ated out of the Divis i o n of Biomedical Communications or the Wood- ward Bio-Medical Library. IMPLICATIONS FOR FURTHER STUDY The following aspects of the project appear to warrant further study: 1. The a b i l i t y of the project to stimulate i n t e r e s t i n continuing education and i n the use of media for independent learn- 105 ing should be studied by gathering data on the continuing educa- tion habits and preferences of participants p r i o r to and at an appropriate i n t e r v a l following t h e i r p a r t i c i p a t i o n i n the project. This would help determine whether p a r t i c i p a t i n g i n the MIRC pro- ject contributed to any change. 2. A more complete study of the costs of the project including costs to participants and employers, and the u t i l i z a t i o n of professional manpower, compared with similar costs for other delivery systems would be valuable. 3. The impact of p a r t i c i p a t i n g i n the project on the participants' practice should be studied. 4. A study should be conducted to determine the accept- a b i l i t y , effectiveness and economic f e a s i b i l i t y of learning sta- tions i n l o c a l hospitals referred to i n the previous sections. 5. The degree of association between p a r t i c i p a t i o n rates and the size of communities should be tested again when the length of v i s i t s has been adjusted to relate to the size of the l o c a l h o s p i t a l . 6. The degree of association between p a r t i c i p a t i o n rates and the distance of communities from major continuing education centres should be tested again when a larger number of communities over a wider geographic area have been v i s i t e d and when a procedure has been derived for including other continuing education centres in addition to Vancouver i n the c a l c u l a t i o n . 7. 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"Extending Educational Opportunities for D i e t i t i a n s . " Journal of the American D i e t e t i c Association. 53:329-33 (Oct. 1968). Dubin, S.S. "Obsolescence or L i f e l o n g Education: A Choice for the Professional." American Psychologist. 486-98° (May 1972). Dyment, R. "Education by Telephone." Bedside Nurse. 4:18-21 (Mar. 1971). Dyment, R. "Mobile I n s t i t u t e s . " Bedside Nurse. 4:20-5 (May 1971). 109 Eighth Annual Report On Continuing Medical Education 1968- 1969. Div i s i o n of Continuing Medical Education, Faculty of Medicine, Health Sciences Centre, University of B r i t i s h Columbia (Sept. 1969) . Ely, D.P. "The Changing Role of the Audiovisual Process i n Education: A D e f i n i t i o n and a Glossary of Related Terms. Audio Visual Communication Review: suppl. 6 (Jan. - Feb. 1963). E r t e l , P.Y. "Learning From the Computer: What Every Health Care Administrator Should Know." Modern Hospital. 119:103-6 (Nov. 1972). F a r r e l l , G.M. "Diagnosis: Professional Obsolescence Treat- ment - Continuing Education." Canadian Journal of Hospital Pharmacy. 103-5 (May - June 1970). F i r s t Annual Report Continuing Education i n the Health Sciences 1968-69. Divi s i o n of Continuing Education i n the Health Sciences, Health Sciences Centre, University of B r i t i s h Columbia (Oct. 20, 1969). Goldstein, F.J. "Continuing Education Via Cassette Tape: Pharmatapes." American Journal of Pharmacy. 144:105-9 (July - Aug. 1972). Griswold, K.S. "Two-Way Radio Conferences Are Catalysts to Continuing Pharmacy Education." Pharmacy Times. 38:52-5 (Jan. 1972). Hensely, B.K. et a l . "The Mountain Goes to Muhammed: Broadcast Television for Continuing Education i n Nursing." Journal of Biocommunications. 2:2-9 (Mar. 1975). Hiss, R.G. "Establishing a Continuing Medical Education Program i n the Community Hospital." Michigan Medicine. 75:66-70 (Feb. 1976) . Hodapp, W.J. and C. Kanun. "Measurement and Relative Effectiveness of Programmed Instruction and Closed C i r c u i t Television as Adult Education Tools." American Journal of Pharmaceutical Education. 34:241-248 (1970). Hoffer, E.P. "Computer-Aided Instruction i n Community Hos- p i t a l Emergency Departments: A P i l o t Project." Journal of Medical Education. 50:84-6 (Jan. 1975). 110 38. Hozid, J. et a l . "New England Dental Reports: Continuing Dental'Education on Television." Journal of the American Dental Association. 85:645-8 (Sept. 1972). 39. Hubbard, J.P. "Self-Education and Self-Assessment as a New Method for Continuing Medical Education." Archives of Surgery. 103:422-4 (Sept. 1971). 40. Hufhines, D.M. "Physician and Hospital Charac t e r i s t i c s Associated With The Use Of Medical Television." Journal of Medical Education. 47:139-41 (Feb. 1972). 41. Hunter, J. et a l . "Medical Educational Television Survey." Journal of Medical Education. 47:57-63 (Jan. 1972). 42. Hunter, W.S. "CNIB Mobile Medical Eye Care Units In Canada: Ontario Mobile Eye Care Unit." Canadian Journal of Ophthalmology. 10:342-3 (July 1975). 43. Johnson, G.R. "Continuing Education Through Chapter A c t i v i t i e s . " Physical Therapy. 46:46-9 (Jan. 1966). 44. Jones, W.A. "The Study Club as a Means of Continuing Education." Journal of the Canadian Dental Association. 42:589-90 (Dec. 1976) . 45. Knowles, M.S. The Adult Education Movement i n the United States. Holt, Rinehart and Winston, Inc. (New York 1962). 46. La Fontan, L.J. "An Approach to ICU Nurse Education i n a Small Rural Community Hospital." Journal of Continuing Education i n Nursing. 2:32-7 (Sept. - Oct. 1971). 47. Lloyd, J.S. "State Regulation of Health Professionals." Hospital Progress. 51:70-4 (Mar. 1970). 48. MacBain, P. "OT's on Wheels." Canadian Journal of Occupa- t i o n a l Therapy. 37:63-8 (Summer 1970). 49. Mackenzie, 0. "Status and Trends of Correspondence Instruc- ti o n i n the United States." i n The Changing World of Correspondence Study., edited by 0. Mackenzie and E. Christensen. The Pennsylvania State University Press (University Park and London, 1971) p.p. 356-74. 50. Manual of Continuing Education i n the Health Sciences. Division of Continuing Education i n the Health Sciences, Health Sciences Centre, University of B r i t i s h Columbia (revised Apr. 1977). I l l 51. Melrose, R.J. e t a l . "Experience With a S e l f - I n s t r u c t i o n a l O r a l Cancer Course i n C o n t i n u i n g Education." J o u r n a l of Dental E d u c a t i o n . 40:150-3 (Mar. 1976). 52. Mrtek, M.B. and R.G. Mrtek. "The P o t e n t i a l of Programmed Review M a t e r i a l s i n C o n t i n u i n g Education." American J o u r n a l of Pharmaceutical E d u c a t i o n . 35:211-15 (1971). 53. Nakamoto, J . and C. Verner. C o n t i n u i n g Education i n the Health P r o f e s s i o n s - A Review of the L i t e r a t u r e P e r t i n e n t to North America: 1960-1970. E r i c C l e a r i n g - house on A d u l t E d u c a t i o n (Syracuse 1973). 54. Neu, H.C. " S e l f Assessment and L e a r n i n g V i a Videotape." New England J o u r n a l of Medicine. 293:1291-5 (Dec. 18, 1975) . 55. "A New Approach to C o n t i n u i n g E d u c a t i o n . " American J o u r n a l of H o s p i t a l Pharmacy. 28:597 (Aug. 1971). 56. Neylan, M. M a i n t a i n i n g the Competence of Health P r o f e s s i o n a l s - L i t e r a t u r e Review: 1970-1973. D i v i s i o n of C o n t i n u i n g Education i n the H e a l t h S c i e n c e s , U n i v e r s i t y of B r i t i s h Columbia (1974). 57. Neylan, M. e t a l . "An I n t e r p r o f e s s i o n a l Approach to Con- t i n u i n g Education i n the Health S c i e n c e s . " The J o u r n a l of C o n t i n u i n g Education i n Nursing. 2:21-8 (July - Aug. 1971). 58. Oakley, C.L. "The F i r s t Twenty Years of Audio-Digest." C a l i f o r n i a Medicine. 116:81-8 (June 1972). 59. P.A. Woodward Health Sciences Information S e r v i c e . D i v i s i o n of C o n t i n u i n g Education i n the H e a l t h S c i e n c e s , Health Sciences Centre, U n i v e r s i t y of B r i t i s h Columbia, (no d a t e ) . 60. "P.A. Woodward Mobile I n s t r u c t i o n a l Resource Centre." N a t i o n a l H e a l t h Grant Submission of P r o j e c t . D i v i s i o n of C o n t i n u i n g E d u c a t i o n i n the H e a l t h S c i e n c e s , Health Sciences Centre, U n i v e r s i t y of B r i t i s h Columbia, (Dec. 7, 1971) . 61. Pearson, K.M. J r . " D i a l Access L i b r a r i e s : T h e i r Use and U t i l i t y . " J o u r n a l of M e d i c a l E d u c a t i o n . 49:882-96 (Sept. 1974) . "Programmed Instruction: Patient Assessment: Examination of of the Ear." American Journal of Nursing. 3:Suppl. (Mar. 1975). R o l l c a l l ; A Status Report of Health Personnel i n the Province of B r i t i s h Columbia. Of f i c e of the Co-ordinator, Health Sciences Centre, University of B r i t i s h Columbia, Vancouver (19 74). Rosser, W.W. "A National Self-Evaluation Program for Canadian Family Doctors." Canadian Medical Association Journal. 112:982-6 (Apr. 19, 1975). Second Annual Report Continuing Education i n the Health Sciences 1969-70. Divi s i o n of Continuing Education i n the Health Sciences, Health Sciences Centre, University of B r i t i s h Columbia (Oct. 1970). "The Self-Assessment and Continuing Education Program. Some Comments by Participants." Journal of the American College of Dentists. 40:207 (Oct. 1973). "Self-Evaluation Program." Canadian Family Physician. 22:71-75 (Nov. 1976) . "75th Annual Report on Medical Education i n the United States: 1975-76." Journal of the American Medical Association. 236 (Dec. 27, 1976). Silve r s t o n , S.E. and R.H. Hansen. "The Role of Technology i n an Evolving Continuing Education Program for Health Professionals." Medical Progress Technology. 1:187-95 (Feb. 1973). Sinnema, M.J. "Cassettes and Abstracts Form Agenda of Monthly Club." Journal of the American D i e t e t i c Association. 63:277-8 (Sept. 1973). Spears, M.C. et a l . "Telelectures vs Workshops i n Continuing Education." Journal of the American D i e t e t i c Association. 63:239-47 (Sept. 1973). Spicer, M.R. "Travelling Teacher." Journal of Continuing Education i n Nursing. 6:17-21 (Nov. - Dec. 1975). STATISTICS CANADA. Population: Census Divisions and Sub- div i s i o n s (Western Provinces). Vol. 1, Part 1:1-7 (Ottawa, Oct. 1972). Strauch, G.O. "Surgical Learning In Community Hospitals - 1975." ConnecticutMedicine. 39:543 (Sept. 1975). 113 75. Stuart, C.T. "Mandatory Continuing Education for Relicensure in Nursing and the Implications for Higher Education." Journal of Continuing Education  in Nursing. 6:25-29 (Sept. - Oct. 1975). 76. Summary of Activities: September 1st, 1973 - August 31st, 19 74. Division of Continuing Education in the Health Sciences, Health - Sciences Centre, University of British Columbia, (Fall 1974) . 77. "Teleconferences: A New Idea in Continuing Education." Texas Medicine. 71:104-6 (Sept. 1976). 78. Third Annual Report 1962-63. Department of Continuing Medical Education, Faculty of Medicine, Health Sciences Centre, University of British Columbia (Aug. 15, 1963). 79. Thompson, B.E. "Continuing Education Through Staff Activities." Physical Therapy. 46:34-7 (Jan. 1966). 80. Tseitlin, M.A. "Specialized Medical Vehicles." Biomedical Engineering. 7:380-1 (Sept. 73). 81. Verner, C. A Conceptual Scheme For The Identification and Classification Of Processes For Adult Education. Adult Education Association of the U.S.A. (Washington, D.C. 1962). 82. Verner, C. "Fundamental Concepts in Adult Education." in Internationales Jahrbuch.der-Erwachsenbidung (International Yearbook of Adult Education), edited by J.H. Kroll (Berlin 1974) . 83. "Video Cassette Education Program." Eye, Ear, Nose and Throat Monthly. 53:118-23 (May 1974). 84. Watkins, F.H. et al. "South Dakota Continuing Dental Education Using Open Circuit Television: A Two Year Report." Journal of the American Dental Association. 86:988-94 (May 1973). 85. Watkins, F.H. et al. "MIND Regional Continuing Dental Education Courses Via Portable Videotape Coverage." North West Dentistry. 52:370-1 (Nov. - Dec. 1973). 86. Watkins, F.H. "MIND - A Five State Regional Approach to Continuing Dental Education." Journal of Dental Education. 39:522-9 (Aug. 1975). APPENDIX A Questionnaire For Participants Covering Letter To Non-Participants Questionnaire For Non-Participants Mobile Instructional Resource Centre Questionnaire for Participants Name Mailing Address Phone 4̂  Sex (1) male (2) female _ What i s your age? What i s your marital status? (1) single (3) widowed, divorced, or (2) married separated (a) In what country did you obtain your professional education? (b) If i n Canada, what province? What i s your current health, profession or occupation? (1) Dentistry (7) Social Work (2) D i e t e t i c s (8) LPN (3) Medicine • (9) X-Ray _ _ _ _ _ _ (4) Nursing (RN) (10) Med. Lab. _ _ _ _ _ _ (5) Rehab. Med. (11) Med. Library (6) Pharmacy (12) Other ' ' 1 (Specify) 116 9. What i s your f i e l d of employment? (check one) a. (1) hospital (5) c h i l d welfare (2) public health _ (6) mental health agency (7) corrections (3) private practice (8) Other (4) public welfare (Specify) b. If you are employed by a ho s p i t a l , how many beds does i t have? 10. Are you employed? (1) f u l l time (2) part time (3) not at present 11. In what year did you graduate from the course that gave you your professional q u a l i f i c a t i o n s ? 12. How many years have you practiced since graduation? ' 13. Have you practiced each year since graduation? (1) yes (.2) no 14. How many years have you practiced i n B r i t i s h Columbia? 15. What are your employment plans? Do you intend to: (1) continue working u n t i l retirement (2) stop working when you marry (3) stop working when you have a family 117 (4) stop working for an i n t e r v a l of time for . personal reasons but plan to return to f u l l or part time employment l a t e r (5) undecided 16. Approximately how many professional workshops, short courses, and conferences have you attended i n the past year? (number) 17. Approximately how many professional books (including reference books) have-you read i n the past year? (number) 18. Approximately how many issues of professionals journals have you read i n the past year? (number) 19. Which of the following aids to learning have you used i n the past year? (check each item) (i) tape recorder: (1) yes (2) no ( i i ) tape-slide programme: (1) yes (2) no ( i i i ) video tape: (t e l e v i s i o n film) (iv) 8 mm films or f i l m loops: (1) yes (2) no (v) 16 mm fil m s : (1) yes (2) no (vi) programmed i n s t r u c t i o n : (1) yes (.2) no 20. How did you f i r s t hear about the M.I.R.C? (check one) (1) l e t t e r from the hospital (.2) telephone c a l l from hospital 118 (3 (4 (5 (6 (7 (8 (9 (10 (11 (12 (13 (14 (15 informed i n person by someone i n authority at the hospital l e t t e r from Social Work contact person telephone c a l l from Social Work contact person informed i n person by Social Work contact person informed at a meeting saw introductory tape-slide presentation saw notice on hos p i t a l b u l l e t i n board to l d by someone who had used i t saw M.I.R.C. beside ho s p i t a l read a r t i c l e i n l o c a l newspaper received information from U.B.C. heard about i t on the radio other (specify) 21. How many weeks ago did you f i r s t hear about the M.I.R.C? STOP HERE. PLEASE COMPLETE THE REST OF THE QUESTIONS AT THE END OF YOUR FIRST VISIT TO THE M.I.R.C. 119 Wow> that you have, complztud qoix.fi lin&t v l & l t to the. M . I . R . C . ple.at>e. Indicate, youn. ie.e.llnQ& about It by chzcklng the. appn.opn.late. n.e.6pon6e.t> : strongly agree undee- disagree strongly agree cided disagree 22. M.I.R.C. provides a worthwhile op- portunity for me to continue my professional edu- cation 23. The audio v i s u a l devices i n the M.I.R.C. f a c i l i - tate e f f e c t i v e learning experi- ences 24. M.I.R.C. provides materials p e r t i n - ent, to my needs 25. Catalogue system :(indexes) was ade- quate to enable me to i d e n t i f y mate- r i e l s pertinent to my needs 26. M.I.R.C. environ- ment f a c i l i t a t e s concentration 27. M.I.R.C. i s e f f i c i e n t l y l a i d out 28. Hours of M.I.R.C. operation were convenient 120 strongly agree unde- disagee. strongly agree cided disagree 29. M.I.R.C. was at a convenient location 30. Length of M.I.R.C. v i s i t (1 week) was adequate 31. At present, the M.I.R.C. v i s i t s approximately 40 communities on a one-week per location basis. Do you f e e l that: (check one) (1) one week per year i s sa t i s f a c t o r y (2) v i s i t s should be one week i n length but more frequent (3) v i s i t s should continue to be once per year, but longer than one week (4) v i s i t s should be longer and more frequent 32. In order to f a c i l i t a t e planning of continuing education ex- experiences on a long-term basis, we would l i k e to determine what.your preferences are. Please rank the following methods of continuing education i n order of your preference by placing the numeral "1" beside the method that you f e e l best suits your needs, "2" beside the one '.: that seems second best and so on up to "8". Please rank each item. RANKING (1) A hospital l i b r a r y equipped with books, jour- '.. nals, brochures, etc. suitable for and a v a i l - able to a l l members of the health care team. (2) A learning station i n the hospital equipped with a tape recorder, s l i d e projector, video tape hookup and with appropriate audio v i s u a l materials for these devices. (3) Lectures, seminars, group discussions, etc. given or led by members of the l o c a l health care community. (4) Lectures, seminars, group discussions, etc. given or led by q u a l i f i e d people from out- side the l o c a l health care community. (5) Conferences, workshops and short courses held i n larger centres. (6) A correspondence system that would make available by mail on a short term loan tapes, s l i d e s , video tapes and films for use by ^..individuals or groups. (7) A correspondence system that would make available on a short term loan basis pertinent books, journals, brochures, etc. (8) Continued v i s i t s by the P.A. Woodward Mobile Instructional Resource Centre. COMMENTS T H E UNIVERSITY OF BRITISH C O L U M B I A H E A L T H SCIENCES C E N T R E ±2 i 2075 WESBROOK PLACE VANCOUVER, B.C., CANADA V6T 1W5 CONTINUING EDUCATION IN THE H E A L T H SCIENCES P.A. WOODWARD INSTRUCTIONAL RESOURCES CENTRE Phone: Dear The P.A. Woodward Mobile Instructional Resource Centre (M.I.R.C. was recently located i n your community. For a description of th Resource Centre, please refer to the pamphlet enclosed with t h i s l e t t e r . As part of an evaluation of the educational effectiveness of the M.I.R.C. we would l i k e to obtain information from health profes- sionals who did not use i t . We would appreciate your a s s i s t i n g us i n making t h i s evaluation by f i l l i n g out the enclosed ques- tionnaire. Within one week of receipt of t h i s l e t t e r please return your completed questionnaire to us i n the stamped, s e l f - addressed envelope provided. A l l r e p l i e s are s t r i c t l y c o n f i - d ential . Thank you for your help. Yours t r u l y , F i e l d Supervisor, M.I.R.C. 123 Mobile Instructional Resource Centre Questionnaire for Non-Participants 1. Name 2. Mailing Address 3. Phone 4. Had you heard about the M.I.R.C. p r i o r to reading the l e t t e r attached to th i s questionnaire? (1) yes (2) no IF YOUR ANSWER TO QUESTION 4 WAS "NO" PLEASE GO DIRECTLY TO QUESTION 9. 5. How did you f i r s t hear about the M.I.R.C? (check one) (1) l e t t e r from the hospital (2) telephone c a l l from hospital (3) informed i n person by someone i n authority at the hospital (4) l e t t e r from Social Work contact person (5) telephone c a l l from Social Work contact person (6) informed i n person by Social Work contact person (7) informed at a meeting (8) saw introductory tape-slide presentation (9) saw notice on hospital b u l l e t i n board 12 4 (10) told by someone who had used it (11) saw M.I.R.C. beside hospital (12) read article in local newspaper (13) received information from U.B.C. (14) heard about it on the radio (15) Other (specify) 6. How many weeks ago did you first hear about the M.I.R.C? 7. Did you know that the M.I.R.C. was in your community last week? (1) yes (2) no IF YOUR ANSWER TO QUESTION 7 WAS "NO" PLEASE SKIP QUESTION 8. 8. Please indicate why you did not use the M.I.R.C. by checking one of the following alternatives. (1) My work schedule was too demanding (2) I was away on holidays (3) I was unable to find a babysitter (4) Family responsibilities took up too much of my leisure time (5) Community responsibilities took up too much of my leisure time (6) The M.I.R.C. was not at a convenient location (7) The hours of M.I.R.C operation were not convenient 125 (8) Negative reports from M.I.R.C. users led me to believe that p a r t i c i p a t i o n i n the M.I.R.C. would not be worthwhile (9) I was i l l (10) Other (specify) 9. Please help us to understand your feelings about the M.I.R.C. project by checking the responses that best indicate your reactions to the following statements. (Answer a l l items). strongly agree undecided disagree strongly agree disagree (1) I f e e l that I do not require further pro- fessional edu- cation (2) I prefer to learn as a member of a group (3) I prefer to learn on my own (eg. read- ing, journals) (4) I f e e l that audio v i s u a l devices do not f a c i l i t a t e ef- fective' learn 1-, ing experiences (5) I would l i k e to have made use of the M.I.R.C. this week 126 10. COMMENTS 11. SEX: (1) male (2) female 12. What i s your age? 13. What i s your marital status? (1) single (3) widowed, divorced or (2) married separated 14. a. In what country did you obtain your professional education? b. If Canada, i n what Province? 15. What i s your current health profession or occupation? (1) Dentistry (7) S o c i a l Work (2) D i e t e t i c s (8) LPN (3) Medicine (9) X-Ray (4) Nursing (RN) (10) Med. Lab. (5) Pharmacy ( I D Med. Library (6) Rehab. Med. (12) Other (specify) 127 16. What is your field of employment? (check one) a. (1) hospital (5) child welfare (2) public health (6) mental health agency (3) private practice (4) public welfare (7) corrections (8) Other (specify) b. If you are employed by a hospital, how many beds does it have? 17. Are you employed? (1) full time (3) not.at present (2) part time 18. In what year did you graduate from the course that gave you your professional qualifications? 19. How many years have you practiced since graduating? 20. Have you practiced each year since graduation? (1) yes (2) no 21. : .How. many years-.have. you. practiced.'-in British Columbia?_ 22. What are your employment plans? Do you intend to: (check one) (1) continue working until retirement (2) stop working when you marry 128 (3) stop working when you have a family (4) stop working for an i n t e r v a l of time for personal reasons but plan to return to f u l l or part time employment l a t e r (5) undecided 23. Approximately how many professional workshops, short courses and conferences have you attended i n the past year? (number) 24. Approximately how many books (including reference books) have you read i n the past year? (number) 25. Approximately how many issues of professionals journals have you read i n the past year? (number) 26. Which of the following aids to learning have you used i n the past year? (check each item) (i) tape recorder: (1) yes (2) no (i i ) tape-slide programme: (1) yes (2) no ( i i i ) video tape: (1) yes (2) no (tel e v i s i o n film) (iv) 8 mm films or f i l m loops: (1) yes (2) no (home movie size) (v) 16 mm films: (1) yes (2) no ( f u l l length movie size) (vi) programmed i n s t r u c t i o n : (1) yes (2) no 129 27. At present, the M.I.R.C. v i s i t s approximately 40 communities on a one-week per location basis. Do you f e e l that (check one) (1) one week per year i s s a t i s f a c t o r y (2) v i s i t s should be one week i n length but more frequent (3) v i s i t s should continue to once per year, but longer than one week (4) v i s i t s should be longer and more frequent 28. In order to f a c i l i t a t e planning of continuing education experiences on a long-term basis, we would l i k e to deter- mine what your preferences are. Please rank the following methods of continuing education in order of your preference by placing the numeral "1" beside the method that you f e e l best suits your needs, "2" beside the one that seems second best and so on up to "8". Please rank each item. RANKING (1) A hospital l i b r a r y equipped with books, jour- nals, brochures, etc. suitable for and a v a i l - able to a l l members of the health care team. (2) A learning station i n the hospital equipped with a tape recorder, s l i d e projector, video tape hookup and with appropriate audio v i s u a l materials for these devices. (3) Lectures, seminars, group discussions, etc. given or led by members of the l o c a l health care community. (4) Lectures, seminars, group discussions, etc. given or led by q u a l i f i e d people from out- side the l o c a l health care community. (5) Conferences, workshops and short courses held i n larger centres. A correspondence system that would make available by mail on a short term loan basis tapes, s l i d e s , video tapes and films for use by individuals or groups. A correspondence system that would make available by mail on a short term loan basis pertinent books, journals, brochures etc. Continued v i s i t s by the P.A. Woodward Mobile Instructional Resource Centre. APPENDIX B S p e c i f i c a t i o n s For The V e h i c l e , I t s Major Mechanical Equipment, And For The Audio V i s u a l Equipment C a r r i e d By The MIRC 132 SPECIFICATIONS FOR THE VEHICLE AND MAJOR EQUIPMENT BUS - Model IC3741 B r i l l Bus manufactured by Canadian Car and Foundry Limited i n Fort William, Ontario i n 1947. I t i s powered by a 210 H a l l Scott pancake gasoline engine. (See accompanying schematic, page 32). GENERATOR - Onan model 10.0 CCKB - # CR 10 KW, 42 120/240 v o l t , single phase, 6 0 cycle gasoline powered generator unit. AIR CONDITIONER - 24,000 BTU, 230/1/60, 17.9 amps, e l e c t r i c a l comfort a i r conditioner. HEATER - 8 KW, 240 v o l t e l e c t r i c heater. FAN - Model A 1232 LECO fan with 120 v o l t , 1/6 horse power motor. SPECIFICATIONS.FOR AUDIO-VISUAL EQUIPMENT VIDEOTAPE RECORDER - 1 Sony AV 3600 half inch videocorder. TELEVISION MONITORS - 2 Sony CVM 1100 Monitor/Receivers (Black and White). TAPE RECORDERS - 3 Wpllensak 2550 A/V tape recorders. SLIDE PROJECTORS - 3 Kodak Model "Ektagraphic" AV-343 s l i d e projectors with 3" lens. FILM PROJECTOR - 1 F a i r c h i l d "Seventy-31" super 8 mm f i l m projector. AUTOTUTOR - 1 Sargent Welch S c i e n t i f i c Mark III Autotutor. APPENDIX C Communities Included In The Itinerary Of The MIRC Proje Between August 1, 1973 and March 31, 1974 COMMUNITIES INCLUDED IN THE ITINERARY OF THE MIRC PROJECT BETWEEN AUGUST 1, 1973 AND MARCH 31, 19 74 Armstrong August .13 to August 1 .18 Enderby August 20 to August 25 Golden August 27 to September 1 Revelstoke September 4 to September 8 Salmon Arm September 10 to September 15 Lillooet October 1 to October 6 Lytton October 9 to October 13 Ashcroft October 15 to October 20 Squamish October 29 to November 3 Sechelt November 5 to November 10 Powell River November 12 to November 17 Break for Christmas holiday, preparation of an interim November 19 to January 11 report, and repairs to vehicle and equipment Campbell River January 14 to January 20 Comox January 22 to January 27 Ladysmith January 29 to February 3 Chemainus February 5 to February 10 Ganges February 12 to February 17 Alert Bay March 5 to March 10 135 APPENDIX D Schedules of Operation 136 SCHEDULES OF OPERATION SCHEDULE I ARMSTRONG AND ENDERBY DAY OF THE WEEK TIMES OF DAY NUMBER DISTRIBUTION OF HOURS OF VISITS Monday Noon to 9:00 p.m. 3 Tuesday to Friday 9:00 a.m. to 9:00 p.m. 48 Saturday TOTALS 9:00 a.m. to Noon 54 8.42% 84.21% 7. 37% 100.00% SCHEDULE II GOLDEN TO POWELL RIVER DAY OF THE WEEK TIMES OF DAY NUMBER DISTRIBUTION OF HOURS OF VISITS Tuesday to Friday Noon to 10 Saturday 10:00 a.m. Sunday 9:00 a.m. :00 p.m. 40 66.97% to 10:00 p.m. 12 18.05% to Noon 3 14.98% TOTALS 55 100.00% 137 SCHEDULE III CAMPBELL RIVER TO ALERT BAY DAY OF THE WEEK TIMES OF DAY NUMBER DISTRIBUTION OF HOURS OF VISITS Tuesday to Friday Noon to 10:00 p.m. 40 66.97% Saturday 9:00 a.m. to 9:00 p.m. 12 18.05% Sunday 12:00 Noon to 10:00 p.m. 10 14.98% TOTALS 62 100.00%

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